The Indiana Health Coverage Programs (IHCP) is in 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 17 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 clarification: To help speed response times in the Provider Healthcare Portal, Hewlett Packard Enterprise (HPE) made temporary changes to several pages in the Portal. As HPE continues to fine-tune processing times, providers will find that several pages respond faster but that a few functions have been somewhat limited. In the interim, providers should 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 see attachment information associated with a specific authorization.
- Right Choices Program Search page - Providers will temporarily be unable to see or view Right Choices Program (RCP) attachments.
HPE continues to work on a permanent solution to improve Portal response times. Watch for upcoming publications.
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.
Issue: Some electronic claim files are rejecting with an error code 025 on the TA-1 transaction - Duplicate Interchange Control Number.
Resolution: 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 the Health Insurance Portability and Accountability Act, 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 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@example.com.
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.)
To view the announcement, click here.
For Waiver providers: The State is advising waiver providers to use your individual LPIs when possible. They advised providers to use individual rendering numbers when using group LPIs. When submitting EDI, they asked providers to continue to use your NPI, your five-digit code plus the four additional digits for your geographic area, and your taxonomy number so that the system can identify your unique organization.
Concerning Remittance Advice (RA), the State is working to make changes to their formatting. They advised that PDFs look different depending on which browser providers use to download it. In the interim, providers whose downloaded PDFs do not align correctly should try using different browsers. They did inform us that claims now have more EOBS and denial reasons, so they will continue to be longer than they were previously.
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.