CoreMMIS stabilization: Day 15 Update

CoreMMIS stabilization: Day 15 Update

The Indiana Health Coverage Programs (IHCP) is beginning week three 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 some performance issues continue. 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 15 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.
    • Responses:
      • HPE has been working to remediate the remaining long-running transactions and to improve response times.
      • 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
    • Issue: When verifying eligibility in the Portal, providers are unclear what is meant when "Medical Review Team" displays under "Coverage."
    • Response: 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.
    • 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.
    • Response: The plans continue to update their portals, and the portals should be fully updated with current eligibility information, as well as primary medical provider (PMP) assignments and MCE delivery system information, within the next couple of days. Watch for updates daily.
  • Claims transactions
    • Issue: Due to a system error, institutional crossover claims with Medicare-paid amounts equal to zero but deductible amounts greater than zero are being denied incorrectly for explanation of benefits (EOB) 0346 - Medicare is indicated as a prior payer, but no prior payment amount is indicated. Please verify and resubmit.
    • Response: Because the denials were due to a system error, providers should not resubmit these claims. Once the system is corrected, affected claims will be reprocessed. IHCP will issue publications regarding processing dates.
    • Issue: The February 28, 2017, financial cycle ran as normal. This included claims that were suspended in IndianaAIM. Residual accounts receivable from the previous financial cycles were also included in this financial cycle. RAs for the February 28, 2017, financial cycle should be available for review in the Portal on Wednesday, March 1, 2017.
    • Response: If providers have concerns about claims that were submitted but not processed, they should forward the details via email to incoremmis2015im@hpe.com.
  • Prior authorization
    • Issue: There was 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.
    • Response: PA notification letters were produced over the weekend and were mailed on Monday, February 27, 2017.
    • Issue: CMCS has received and rejected numerous PA requests for members enrolled with an MCE.
    • Response: 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.)
    • Issue: 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
    • Response: 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.