IHCP Announcement: Update on CoreMMIS Stabilization - Day 16

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 Service 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 their intention to resolve issues as quickly as possible. They 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 16 of the roll out:

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.

Response: To help speed response times in the Provider Healthcare Portal, Hewlett Packard Enterprise (HPE) is making temporary changes to several pages in the Portal. As HPE continues to fine-tune these pages' processing time, providers will find that several pages respond faster but have somewhat limited functions. This change will occur at 7 p.m. on Tuesday, February 28, 2017. In the interim, we ask that providers follow these instructions: 
    - 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 upload prior authorization attachment information.
       Providers must mail or fax attachments, because the attachment file  
       names will not display. 
    - Right Choices Program Search page - Providers will temporarily be
       unable to view or upload Right Choice Program (RCP) attachments.
       Providers must mail or fax attachments, because attachment file
       names will not display or be retrievable.

HPE continues to work on a permanent solution to Portal response time. 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, 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: Institutional long-term care crossover claims are denying for explanation of benefits (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: 
    - 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.

Providers should correct and resubmit the affected claims.

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 [email protected].

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.)


The FSSA and HPE continue to monitor the system to stabilize its performance. They 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 [email protected]. Watch for broadcast messages about progress posted to the Portal and interactive voice response (IVR), as well as regular new alerts posted to indianamedicaid.com.

To view the announcement, click here.
 
INARF has learned that it is helpful to the HPE support team if providers include as much specific information and examples when communicating with the team about issues. HPE encourages you to send screenshots or excerpts from RAs to demonstrate the issue.

We request that members send information concerning any issues you are experiencing to Sarah Chestnut. We will continue to compile information regarding issues members are experiencing and work with the State to find solutions.