CoreMMIS stabilization: Day 25 Update

CoreMMIS stabilization: Day 25 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.

Note: Friday, March 10, will be the last day the IHCP will publish a daily update about CoreMMIS stabilization. After Friday, the IHCP will issue topic-specific news announcements regarding emergent issues as needed and will cover other issues in regular IHCP publications.

Please see the following synopsis for Day 25 of the rollout:

Eligibility verification

  • Issue: Members with a Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiary (SLMB) benefit plan are incorrectly loading as "No Coverage" in OptumRx's system.
  • Response: HPE and OptumRx are working to correct the issue and hope to have a correction in place soon. Watch tomorrow's update for more information.
  • Issue: Waiver eligibility for certain members was ended in the system in error; thus, their eligibility for waiver services is not displaying accurately on the Portal.
  • Response: HPE is manually restoring accurate eligibility information for these waiver members and is working to develop a permanent system modification to automatically open the member's waiver eligibility (or dependent plans) when the member's Medicaid eligibility is re-opened (extended). Although HPE is doing everything to ensure that waiver eligibility information is re-opened for these members correctly, it is possible some inaccuracies may continue to exist, as information can change daily. Watch provider alerts for updates on a permanent solution.
  • Issue: Benefit limits are not displaying as expected when providers check eligibility. One example is the benefit limit for 6114 - DME limited to $5,000 per member per lifetime for Package C members. This benefit limit is displaying for members who are not current or have not been in Package C.
  • Response: HPE has corrected the problem. Member benefit limits are now reporting correctly.
  • Issue: When verifying eligibility in the Portal, providers are unclear what is meant when "Medical Review Team" (MRT), "PASRR Mental Illness," or "PASRR Individuals with Intellectual Disabilities" displays under "Coverage."
  • Response: To clarify, the MRT and PASRR 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 but may be eligible for services under additional coverage categories, if other categories are indicated for the member.

Claims transactions

  • Issue: Some claim adjustments were inappropriately denying as duplicate claims.
  • Response: HPE corrected an issue that was causing claim adjustments in certain situations to inappropriately fail as duplicates. This fix also addressed certain situations in which limit audits set inappropriately.
  • 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, if the claim indicates either modifier TE or TD, but 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 existing PAs through Cooperative Managed Care Services (CMCS) for CPT code 99600. 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 skilled nursing care will be provided. 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: Certain Medicaid Rehabilitation Option (MRO) PA files received from the Department of Mental Health and Addiction (DMHA) for eligible MRO members that were processed in CoreMMIS may have resulted in inappropriate denials based on the members' level of need (LON).
  • Response: The members affected by this issue are being identified and the authorization files reprocessed to correctly create the necessary PAs 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 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 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.