CoreMMIS stabilization: Day 12 Update

CoreMMIS stabilization: Day 12 Update

The Indiana Health Coverage Programs (IHCP) is completing 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 12 of the rollout:

  • Provider Healthcare Portal:
    • Issue: 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 has been working to remediate the remaining long-running transactions and to improve response times. Changes were implemented on February 23, 2017, to improve process time, and additional changes are planned for the near future.
      • When searching for RA information in the Search Payment History panel, providers with a large number of claims should avoid clicking the "Payment ID" hyperlink and instead select the "RA Copy" icon to look for detailed payment information. Clicking the Payment ID hyperlink could result in a long response time or a possible time-out.
  • 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 Monday, 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:
      • Waiver and transportation providers received error messages when attempting to file claims using their Provider IDs (rather than a National Provider Identifier).
      • 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.
      • There were account receivable (AR) transactions that were not recouped during the February 21, 2017, financial cycle.
    • Actions taken:
      • A system update was made to allow waiver and transportation providers to successfully submit claims using their Provider IDs; claim submissions can resume as normal for these provider types.
      • Claims that were suspended in IndianaAIM began processing this week and will be included in the February 28, 2017, financial cycle. If providers continue to have concerns about other claims that were submitted but not processed, they should forward the details via email to incoremmis2015im@hpe.com.
      • The February 28, 2017, financial cycle is expected to run as normal. Claims processed through 5 p.m. February 24 will be included.
      • Residual ARs will be recouped in this week's financial cycle.
  • Prior authorization:
    • Issues:
      • There has been a delay in mailing prior authorization (PA) notification letters for PA requests processed through Cooperative Managed Care Services (CMCS) since the implementation of CoreMMIS on February 13, 2017.
      • 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. Providers see different terminology than they did in Web interChange.
      • There are a number of PA functionality issues being researched.
    • Resolutions:
      • PA notification letters will be produced over the weekend and are expected to be mailed by Monday, February 27, 2017.
      • 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.)
      • Watch for information related to PA response terminology and other issues in upcoming IHCP provider publications.

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.