CoreMMIS stabilization:
Day 22 Update
The Indiana Health Coverage Programs (IHCP) is in week four 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 22 of the
rollout:
Eligibility verification
- Issue: When verifying eligibility in the
Portal, providers are unclear what is meant when "Medical Review
Team" (MRT), "PASRR Mental Illness (PASMI)", or "PASRR Individuals
with Intellectual Disabilities (PASMR)" displays under
"Coverage."
- Response: To clarify, the MRT, PASMI, and
PASMR coverage categories are used to indicate that the individual
is being evaluated for IHCP eligibility or for a diagnosis of
service needs. The description provided in the Portal - step two of
the verification process - provides a brief explanation of the
services associated with this coverage category. Entities enrolled
to conduct assessments and evaluations can bill only specific
procedure codes related to the assessment process for these
individuals. The member is not eligible for other services under
that coverage category.
- 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. Hoosier Healthwise and Hoosier
Care Connect eligibility information is up-to-date. Plans are
working to bring Healthy Indiana Plan (HIP) eligibility information
current. 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: In CoreMMIS, the PA request
must match the service delivered and billed. In this instance, for
example, if the claim indicates modifier TD, and the PA indicates
both TD and TE, the claim will deny. As an interim solution,
effective March 6, 2017, a mass update has been made to remove the
TE modifier from all PA requests to Cooperative Managed Care
Services (CMCS) for CPT code 99600 that included both modifiers.
Beginning March 7, 2017, providers may resubmit affected claims for
reprocessing. Moving forward, providers should include only the TD
modifier on all PA requests for CPT code 99600. If modifier TD is
on the PA, claims with either the TD or the TE modifier will be
able to adjudicate properly. This is not a change in existing PA
guidance; see the Home Health
Services provider reference module. Watch for an IHCP
publication clarifying this guidance.
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 are available for
providers to retrieve. The file names 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: 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.)
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.