CoreMMIS stabilization: Day 19 Update

CoreMMIS stabilization: Day 19 Update

The Indiana Health Coverage Programs (IHCP) is ending 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 19 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.
  • Response clarification: Temporary changes have been made to several pages in the Portal. Providers will find that pages now respond faster but that a few functions have been somewhat limited.
    • Search Claims pages - Providers will temporarily be unable to see the Remittance Advice (RA) icon or view RAs from the Search Claims pages. Providers can continue to access RAs through the Search Payment History page and are encouraged to use the "RA Copy" icon to see detailed payment information.
    • View Authorization Response page - Providers will temporarily be unable to see attachment information associated with a specific prior authorization (PA).
    • Right Choices Program Search page - Providers will temporarily be unable to see or retrieve Right Choices Program (RCP) attachments.

    Note: Contrary to earlier information, providers can continue to upload attachments to PA and RCP transactions. HPE continues to work on a permanent solution to improve Portal response times. Watch for upcoming publications.

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, so that they are up-to-date with current eligibility information, as well as primary medical provider (PMP) assignments and MCE delivery system information. Watch for updates daily.

Claims transactions

  • Issue: Home health providers can bill Current Procedural Terminology (CPT) code 99600 - Home visit nonspecific with modifier TE if a licensed practical nurse (LPN) delivers the service or with modifier TD if a registered nurse (RN) delivers the service. Home health claims for CPT code 99600 are denying in CoreMMIS when the claim includes either the TD modifier or the TE modifier BUT the prior authorization (PA) indicates both the TD and TE modifiers.
  • Response: A possible solution to resolve this issue has been identified. Testing will be conducted, and if successful, the IHCP plans to deploy this fix early the week of March 6, 2017, so providers can resubmit denied claims. Additional information to be published on March 6.
  • Issue: Claims billed by small intermediate care facilities for individuals with intellectual disability (ICFs/IID) that included a "type of bill" in the 67X series are denying for explanation of benefits (EOB) 274 - The type of bill is invalid. Type of bill range 67X is not a Health Insurance Portability and Accountability Act (HIPAA)-compliant code.
  • Response: The system has been modified to temporarily allow use of the 67X series until replacements are identified and notice published to providers. Providers should resubmit claims impacted by this issue for reprocessing. Future changes to billing guidelines will be communicated in upcoming IHCP publications.
  • Issue: Claims billed with a National Provider Identifier (NPI) that crosswalks to more than one service location are denying for explanation of benefits (EOB) - The billing NPI is report to multiple service locations. Resubmit the claim with the billing provider service location ZIP Code + 4 and/or taxonomy code. This is occurring because the IHCP cannot identify a unique Provider ID to associate with the claim.
  • Response: If the provider's NPI is associated with more than one service location, the provider should indicate the billing provider's service location ZIP Code + 4 and taxonomy code on the claim and resubmit it.
  • Issue: Some electronic claim files are rejecting with an error code 025 on the TA-1 transaction - Duplicate Interchange Control Number.
  • Response: Error code 025 means that the interchange control number submitted in the ISA13 is a duplicate of a previously submitted interchange control number. In compliance with HIPAA, trading partners must be sure that the ISA control number (ISA 13) is unique for each transaction. Any files received with duplicate ISA control numbers will be rejected and reported on the TA-1.
  • Issue: Institutional long-term care crossover claims are denying for EOB 4276 - A present on admission (POA) code must be entered. A POA of 1 or blank is not acceptable.
  • Response: Providers are reminded that a POA of 1 or blank is not acceptable. Acceptable codes include the following. Providers should correct and resubmit affected claims.
    • Y (for yes) - Present at the time of inpatient admission
    • N (for no) - Not present at the time of inpatient admission
    • U (for unknown) - The documentation is insufficient to determine if the condition was present at the time of inpatient admission.
    • W (for clinically undetermined) - The provider is unable to clinically determine whether the condition was present at the time of inpatient admission.

Prior authorization

  • Issue: Mental health providers attempting to retrieve certain Medicaid Rehabilitation Option (MRO) prior authorization (PA) files from the file exchange are unable to do so. The missing files are for February 9, February 13, February 14, February 23, and February 27, 2017.
  • Response: The files will be available for providers to retrieve on Monday, March 6, 2017. The file names will include the original file date for ease of locating them. Providers are encouraged to use the Provider Healthcare Portal as an available workaround to view prior authorizations for members. For further information on how to use the MRO provider functions on the new Portal, please see IHCP provider bulletin BT201703, dated January 12, 2017.
  • Issue: Certain MRO prior authorization requests were denying. MRO prior authorization files received from the Department of Mental Health and Addiction that have been processed in CoreMMIS for eligible MRO members may have resulted in an inappropriate denial of prior authorization of services based on the members' level of need (LON).
  • Response: The members affected by this issue are being identified and the authorization files will be reprocessed to correctly create the necessary prior authorizations to support appropriate claim adjudication. Please monitor future publications for a date when this issue will be corrected.
  • Issue: Cooperative Managed Care Services (CMCS) has received and rejected numerous prior authorization (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.)

Call center

  • Issue: Extended evening and Saturday call center hours have generated low call volumes.
  • Response: Effective March 6, 2017, the extended evening and Saturday call center hours will be eliminated. The call center will resume regular hours from 8 a.m. to 6 p.m., Monday through Friday. Resources currently allocated to extended hours will be reallocated to better address member and provider inquiries during regular business hours.

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