CoreMMIS stabilization: Day 11 Update

CoreMMIS stabilization: Day 11 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 11 of the rollout:

  • Provider Healthcare Portal:
    • Issues: There have been reports of slow response times and timing out on the Portal for a number of transactions, including the Search Payment History panel where providers access their Remittance Advice (RA) information.
    • Actions taken:
      • HPE is actively working to improve functionality and response times.
      • For claims submitted by electronic batch, providers can refer to the 835 transmittal report for claim payment information.
  • Eligibility verification
    • Issues:
      • When verifying eligibility in the Portal, providers are unclear what is meant when "Medical Review Team" displays under "Coverage."
      • 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.
    • Resolutions:
      • To clarify, "Medical Review Team" coverage means that the member is being evaluated for IHCP eligibility. The description provided in the Portal (Step Two of the verification process) indicates "Medical Review Team Procedure Codes Only." Entities enrolled as Medical Review Team (MRT) providers can bill only MRT procedure codes for this individual. The member is not eligible for other services.
      • 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:
      • Providers expressed concerns that claims expected to be included in the February 21, 2017, financial cycle were not included - this may encompass claims suspended in IndianaAIM during the transition period.
      • Release of provider electronic funds transfer (EFT) payments from the February 21, 2017, financial cycle were delayed by one day to Thursday, February 23, 2017.
      • 835 transactions (RAs) for the February 21, 2017, financial cycle were delayed but are now available.
      • There were account receivable (AR) transactions that were not recouped during the February 21, 2017, financial cycle.
    • Actions taken:
      • Claims that were suspended in IndianaAIM began processing this week and will be included in the February 28, 2017, financial cycle.
      • Residual ARs will be recouped in this week's financial cycle.
    • Resolutions:
      • EFT payments from the February 21, 2017, financial cycle have been released.
      • 835 transactions for the February 21, 2017, financial cycle have been sent.
  • Prior authorization:
    • Issues:
      • Cooperative Managed Care Services (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 the member's benefits and whether the member is assigned to an MCE. If assigned, PA requests for that member must be sent to the MCE, rather than to CMCS. (Note: When the Portal displays "Full Medicaid" as a member's coverage, it does not mean the member is necessarily in the fee-for-service delivery system. Some members with "Full Medicaid" coverage may be enrolled in Hoosier Care Connect, and therefore, assigned to an MCE.)

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.