CoreMMIS stabilization: Day 10 Update

CoreMMIS stabilization: Day 10 Update

The Indiana Health Coverage Programs (IHCP) is in week two of implementation of the CoreMMIS and the Provider Healthcare Portal (Portal). The Indiana Family and Social Services Administration (FSSA) and Hewlett Packard Enterprise (HPE) have made progress in stabilizing the new system but are aware some performance issues still exist. It is our intention to resolve issues as quickly as possible. We also intend to keep the provider community aware of problems that have been identified and the progress being made to resolve them.

Please see the following synopsis for Day 10 of the rollout:

  • Provider Healthcare Portal:
    • Issues:
      • There have been reports of slow response times on the Portal for claim void transactions, Notification of Pregnancy (NOP) transactions, and Right Choices Program (RCP) utilization requests.
      • Historical information on dental services rendered was previously not visible in the Portal.
    • Actions taken:
      • HPE continues to monitor and work to remediate the few remaining long-running transactions and to improve response times.
      • Historical dental services information is now visible in the Portal for determining dental benefit limits.
  • Eligibility verification
    • Issue: IHCP eligibility information is up-to-date in CoreMMIS. Eligibility verification through the Portal and the interactive voice response (IVR) provides current eligibility information. Eligibility information in the managed care entity (MCE) portals may not yet match eligibility information in CoreMMIS.
    • Action taken: By the end of the week, the MCE portals should be fully updated with current eligibility information, as well as primary medical provider (PMP) assignments and MCE delivery system information.
  • Claims transactions:
    • Issues:
      • 835 transactions (RAs) for the February 21, 2017, financial cycle were delayed.
      • Provider EFT payments from the February 21, 2017, financial cycle were delayed by one day. Check payments were not affected by this delay.
      • There were account receivable (AR) transactions that were not recouped during the February 21, 2017, financial cycle.
    • Actions taken:
      • Remittance Advices (RAs) for all claims processed during the February 21, 2017, financial cycle can be viewed on the Portal through the Search Payment History page.
      • 835 transactions are being reviewed and providers will be notified when they are available.
      • Electronic funds transfer payments from the February 21, 2017, financial cycle will be released to post to provider accounts on Thursday, February 23, 2017, rather than on Wednesday, February 22, 2017, as originally announced. The issue causing the delay has been corrected and mitigating controls implemented to prevent future occurrences.
      • Residual ARs will be recouped in this week's financial cycle.
  • Presumptive Eligibility:
    • Issue: Income field rejects $0 entry.
    • Action taken: During Portal maintenance a system fix was made to correct this issue.
    • Resolution: Qualified providers can now successfully enter an income of $0 when a member reports no income.
  • Prior authorization:
    • Issues
      • CMCS has received and rejected numerous PA requests for members enrolled with an MCE.
      • Some providers have expressed confusion about the meaning of prior authorization (PA) responses on the Portal.
    • Action taken: A review of the PA responses in the Portal is underway and related guidance being developed.
    • Resolution - Providers must complete a two-step process when verifying eligibility. The first eligibility screen identifies the programs for which the member is eligible; clicking on a program link will identify if the member is assigned to an MCE. If assigned, PA requests for that member must be sent to the MCE rather than to CMCS.

The FSSA and HPE continue to monitor the system to stabilize its performance. We appreciate the patience and help of the provider community in making that happen. Please continue to contact us at 1-800-457-4584 or by email at incoremmis2015im@hpe.com. Watch for broadcast messages about progress posted to the Portal and interactive voice response, as well as regular new alerts posted to indianamedicaid.com.