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NewMMIS PilotNewMMIS Pilot

Provider Orientation Provider Orientation

August 21 & 22, 2008August 21 & 22, 2008

NewMMISNewMMIS

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AgendaAgenda9:00 – 9:05 AM Sign/Registration

9:05 – 9:55 AM Presentation Welcome NewMMIS Overview & Update Purpose of Pilot Pilot Timeline Pilot Activities Pilot Functionality Paper Claims Submission Pilot Data Parameters & Constraints Test Scenarios Pilot Participant Readiness Provider Communications Help Desk Support Pilot Coordinators Pilot Provider Access Contact/Available Resources E-Learning Debriefing Next Steps

9:55 - 10:00 AM Questions & Answers

WELCOME!WELCOME!Pilot Phase IIPilot Phase II

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NewMMIS NewMMIS Overview/UpdateOverview/Update NewMMIS Timeline/Activities:

User Acceptance Testing (UAT)

Pilot

Trading Partner Testing (TPT)

Implementation

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Purpose of PilotPurpose of Pilot Primary objective : TEST, TEST,

TEST

Pilot Responsibilities Test transactions Review responses Identify defects Based upon feedback CW may identify

additional training needs

What you can expect Claims may not pay accurately Claims may deny Responses may not be accurate Reporting may not be 100%

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Purpose of PilotPurpose of Pilot Validate Infrastructure

Environment is stable Interfaces are working Security is working Helpdesk ticketing system is functioning

appropriately

Prepare for Implementation Identify provider type specific defects Identify additional training needs Identify additional communication needs Identify additional helpdesk & infrastructure

needs

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EDS Readiness report – 8/8/08

Commonwealth (CW) Testing/Validation 8/11 – 8/22

Pilot Start Date: 8/25/08

Pilot End Date: 9/12/08

Debriefing Assess Provider experience Assess User experience Assess system performance

Pilot TimelinePilot Timeline

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Pilot ActivitiesPilot Activities Complete Trading Partner Testing

Complete test scenarios & provide feedback based on day-to-day business

Follow Pilot data parameters for transaction submission

Participate in debriefing

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Pilot FunctionalityPilot Functionality HIPAA Batch Transactions

270/271 276/277 837P 837I 997 835

Direct Data Entry (DDE)Eligibility Verification Professional Health Care Claim Institutional Health Care Claim Claim Status Inquiry

Paper Claims

Cross-Over Claims / COB

View Metrics / Reports Remittance Advice (RA) Claims Metrics

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Paper Claims Paper Claims SubmissionSubmission For Pilot Providers submitting paper and

TPL/COB claims, forward all paper claim forms to the following address:

MassHealth

Attn: Pilot

PO Box 9118

Hingham, MA 02043

Note "Pilot" on the claim form 

Submit TPL paper claims

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Pilot Data Parameters Pilot Data Parameters Conversion claims data through 4/23/08

Member & Provider PA/PAS/Referrals Procedure/Revenue Codes TPL

Use claim and member data through 4/23/08 to submit pilot transactions

Timely filing edits will apply

Converted claims cannot be modified

NewMMIS initiated claims can be modified and resubmitted

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Pilot Data Pilot Data Parameters Parameters

Batch cycles that will be run during Pilot: Claims Financial—Thursday Eligibility Verification System (EVS) System Wide

HIPAA Batch Cycles Tracking number will display immediately 997 will display estimated 15 – 30 minutes HIPAA related response estimated 45 minutes to 1 hour

Batch Cycles are supported between 8:00AM – 5:00 PM

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Pilot Data ParametersPilot Data Parameters Use NewMMIS Provider ID/Service Location

(PID/SL) on all claims (obtain number after Pilot training)

Use NewMMIS Member ID on DDE to obtain member number through REVS or NewMMIS EVS functionality

HIPAA 837 batch claims will accept current MassHealth Member ID, however, NewMMIS ID is preferred

Input 2 leading Zeros when using existing referral numbers on claim submission

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ConstraintsConstraints Dupe “S” procedures – Some legacy service

codes are flagged/bypassed (small number of denials for services performed on the same day/same member)

Impact: Primarily DME Approach: Work around constraint

Professional claims with PA pricing – PA end dates may effect pricing

Impact: DME Approach: Do not submit claims with PA

Pricing procedure codes

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ConstraintsConstraints Max unit override – In some instances current

MMIS allows more units than on current procedure file. Some NewMMIS claims may be “cut back”

Impact: Physician, CHC, MH Centers, State agencies, OPD

Approach: Submit claims but be aware of constraint (less than 10 codes)

Home Health Claims – X-walk issue with Type of Bill

Impact: Home Health

Approach: Do not submit Home Health Claims/expect accurate processing/payment; explore claims DDE & remits; submit EVS; view metrics reports

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ConstraintsConstraints Holiday/weekend rates – Claims may not reflect

special rates Impact: Home Health

Approach: Do not submit Home Health Claims/expect accurate processing/payment; explore claims DDE & remits; submit EVS; view metrics reports

Restrictive Messages – Under CW review; less than 20 may result in incorrect messages being issued to providers

Impact: All

Approach: Work around constraint

Do not submit codes with modifiers

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ConstraintsConstraints Payment based on provider specialty - claims may not

pay accurately (25 estimated procedure codes impacted)

Impact: State Agencies

Approach: Work around constraints

Procedures codes paid on both a class rate and provider specific rates - Claims may pay incorrectly - (primarily when Community Health Centers (CHC) bill certain clinic visits codes e.g. codes 9993xx)

Impact: CHCs Approach: Do not submit certain procedure codes

Remittance Advice – currently prints portrait, which may be difficult to read

Impact: All

Approach: View remit on screen and use discretion when printing

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Test ScenariosTest Scenarios Review list of test scenarios and select those that

are pertinent to your day to day activities/ identified in your survey response

Perform up to 10 test case scenarios - examples: Check Member Eligibility Submit a Claim Download RA or 835

Complete the test scenario, including feedback section and email to your Pilot Coordinator

Follow-up outreach activities may occur

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List of Pilot Test List of Pilot Test Scenarios Scenarios POSC-LOG Provider logs in to Provider Online Service Center

EVS-DDE Provider submits DDE member eligibility

PHYS-DDE Provider submits Physician DDE claim

INST-DDE Provider submits Institutional DDE claim

STATUS-DDE Provider submits DDE claim status

CLAIM-837P Provider submits 837P

CLAIM-837I Provider submits 837I

EVS-270 Provider submits 270

STATUS-276 Provider submits 276

CLAIM-997 Provider views 997

EVS-271 Provider views 271

STATUS-277 Provider views 277

CLAIM-RA Provider views RAs

CLAIM-835 Provider views 835

CLAIM-REP Provider views metric reports

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Eligibility Test Eligibility Test ScenarioScenario

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Pilot Participants Pilot Participants ReadinessReadiness Continue preparing for the transition

Complete Trading Partner Testing (as applicable) Review EDI submission instructions Provide member numbers Use your NPI – it is required Obtain your User ID/Password (to access CST web page)

Complete System Readiness activities: Billing intermediary Practice management Software vendors

Review Pilot Materials: Companion guides Billing instructions Review E-Learning Participate in Pilot overview

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Pilot Participants Pilot Participants Readiness Readiness Identify for Pilot:

Provider numbers

Member identification numbers

Billing Intermediaries/Vendors

Identify claims you will use during testing

Identify PA/PAS & referral numbers you will use during testing using the data parameters date (4/23/08)

Coordinate resources within your organization

Determine daily testing timeframes

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Pilot Participant Pilot Participant ReadinessReadiness NewMMIS PID/SL will be provided to all

Pilot participants

Billing Intermediaries/Large Organizations: Identify the name and Legacy provider numbers of

the providers you will submit claims on behalf of during Pilot

CW will validate the existing relationship

Once the NewMMIS PID/SL is validated, it will be provided to you. This number is not to be shared with anyone and must only be used for testing purposes

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Provider Provider CommunicationsCommunications Help Desk

Pilot Coordinators

Pilot Provider Primary Contact

Weekly Status Meetings

Email

Debriefing

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Help DeskHelp Desk

Trading Partner Testing (TPT)

Testing must be completed for HIPAA Transactions before providers can submit “production” transactions in the Pilot environment

Help Desk at @ 1-888-824-3484

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Help Desk SupportHelp Desk Support

Mirror implementation

Enhancements to existing customer service center environment

Monitoring tools in place to track caller, types of calls, response time results

Anticipated response time for critical impact is immediate < or = to 3 hours

Email option: pilotsupport@mahealth.net

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The help desk is the first line of support for providers with questions on their use of the NewMMIS

Support hours of operation: Phone: 1-888-824-3484 Monday - Friday 8AM - 5PM No after hours or weekend support will be available

A Three tier support system to address provider technical & non technical issues

Tier 1 = CST Tier 2 = NewMMIS Technical Team Tier 3 = NewMMIS SMEs and BAs

Help Desk Support Help Desk Support

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Help Desk Support - Help Desk Support - PriorityPriority

Priority/Severity

Impact Description Response Time

Resolution Time

Level 1 Critical

No work around

High: Large number of Providers

affected Affects online processing Major component not available

for use Loss of functionality Problem cannot be bypassed

3 hours

6 hours

Level 2 Serious

Work around available

Moderate: Large number of Providers affected Potentially affects online commitment Serious slow response times & functionality

6 hours

12 hours

Level 3 Moderate to Low

Non-critical problem

Low: No direct impact on Provider Few functions impaired Problem can be by passed & acceptable to the Provider

12 hours

5 days

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Pilot Coordinator Pilot Coordinator ActivitiesActivities Pilot Coordinators:

This team is comprised of NewMMIS Functional Coordinators

(FCs). They will function as liaison to Pilot Providers.

Pilot Coordinators Role: Serve as a liaison to Pilot Providers Conduct welcome call – initial contact Check in with providers Collect test scenarios feedback from Providers Review monitoring reports & confer with Providers

regarding status of activities & support needs Research issues, identify defects and solutions Conduct debriefing with Providers Report debriefing results to Project Leadership

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Pilot ProviderPilot Provider Role of Pilot Provider Primary contact:

Coordinate activities within your organization

Work directly with the NewMMIS Pilot Coordinator to communicate issues and resolve Pilot process concerns from your organization

Validate the number of pilot participants/users from your organization

Confirm your organization is prepared for Pilot by validating that participants/users have conducted the following activities:

Completed TPT Reviewed the E-learning Identified the member and claims data that will be used for Pilot Participants/users have helpdesk number and email Etc.

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AccessAccess Provide Access To Pilot Environment

The Commonwealth will issue User ID & Passwords to all participants

Provide security data collection information required to initiate a request for a User ID & password

Contact Pilot Support to provide security data

Environment available on 8/25/08

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AccessAccess User ID & Passwords:

User ID and password to access the Pilot environment will be sent to you via email shortly after you attend the Pilot training

The email will be auto-generated to the email address you supplied to us (security data collection information)

The password is temporary and will be revoked once Pilot is completed

Once you receive the User ID and Password, you must log-in to Virtual Gateway, change your password, and set up a series of security questions.

This User ID and password can then be used to access the NewMMIS Pilot Environment on 8/25/08.

URL: www.mass.gov/masshealth/newmmispilot

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Contact Contact InformationInformation

CST Phone Number: 1-888-824-3484

Email for MassHealth Customer Service:

Email Address @ pilotsupport@mahealth.net

Paper Claims Mailing Address:MassHealth

Attn: Pilot

PO Box 9118

Hingham, MA 02043

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Available ResourcesAvailable Resources Check our web site often for the most up-to-

date information: www.mass.gov/masshealth/newmmis

Masshealth provider bulletins & transmittal letters

MassHealth trainings

E-Learning: http://masshealthnewmmisprovidertraining.ehs.state.ma.us/

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Available Available ResourcesResources Accessing E-learning Tips

If you have not yet registered, go to Don’t have a user name click here

Allow pop ups…. Go to tools on your menu bar, Select Pop Up Blocker, then select Turn off Pop up blocker

Complete all fields, regardless of * (don’t forget county) User name must be different from password Password must be a minimum of 6 characters Select one provider type if you have many. If you have multiple

provider types, have different staff select different provider numbers and types.

Select Register Select Continue Select Course Catalog Select appropriate courses, beginning with A Provider Information

and Navigation course Select course from center of screen Select Enroll Select Launch Select Launch again

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E-Learning/Help E-Learning/Help OverviewOverview E-Learning overview

Navigation

Panel help & field level help

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DebriefingDebriefing At the end of Pilot, a debriefing

session will be held to obtain feedback on the NewMMIS and the overall Pilot experience:

Assess Provider experience

Assess User experience

Assess System performance

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Next StepsNext Steps Issue User IDs & Passwords

Identify provider numbers to test

Review E-learning

Define testing data & testing timeframes

Submit HIPAA Batch Tests (TPT)

Open Pilot Environment

Test, Test, Test!!!

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Q & AQ & A

Questions & Answers