Confirming Client Eligibility

1
Confirming Client Eligibility

• Making the Transition To ProviderOne
• Spring 2008

2
Welcome and Introductions

• Meet your Workshop Hosts
• Melodie Olsen
• Roger Long
• Grant Stromsdorfer
• Barb Hansen
• Cindy Lee
• Workshop Format
• ProviderOne Preview
• Panel Q A
• Materials Available
• Thank you for partnering with us!

3
Providers Serve Critical Role

• Care for Nearly 1 Million Vulnerable Citizens
• 2/3 of these are children
• 1 in 3 Washington Children
• Children receiving foster care
• Children of working parents
  without health care
• Disabled children living at home
• Other Vulnerable Citizens Served include
• Working disabled adults
• Elderly citizens who can live at home with
  assistance
• Elderly low-income seniors living in nursing
  homes
• Individuals with Mental Illness or Emotional
  Disorders

4
What You Will Hear About Today

• New Client Services Card replacing MAID
• Plans to distribute Services Cards to clients
• What DSHS is doing to educate our clients
• New ProviderOne Client ID replacing PIC
• How to access ProviderOne Client ID
• Confirming Client Has Coverage
• Tools available now to prepare for smooth
  transition
• Confirming client has coverage in ProviderOne
• Whats Ahead - ProviderOne Update
• Schedule and upcoming readiness activities

5
Agenda and Format

• WELCOME AND INTRODUCTIONS
• Module 1 - Client Services Card
• Module 2 - ProviderOne Client ID
• BREAK
• Module 3 - Methods to Confirm Eligibility Today
• Module 4 - Confirming Eligibility in The Future
• BREAK
• Module 5 - ProviderOne Update Whats Ahead
• PANEL Q A

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Module 1 New Client Services Card

• Client Services Card Features
• Whats Changing What Remains the Same
• Strategy for Phasing out MAID
• Timing and Plans for Card Distribution
• What DSHS is Doing to Educate our Clients

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Client Services Card Features

• Services Card is plastic
• More durable and fits in wallet like EBT Card
• Resembles other insurance cards
• Industry Standard
• More permanent issued one time
• Clients will retain cards, even if temporarily
  ineligible
• Protects client privacy
• Can be quickly replaced if lost no personal data
• Includes magnetic strip
• Gives providers the option to use magnetic card
  readers to access eligibility data

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ProviderOne Client Services Card

• Front of Card
• Client name
• ProviderOne Client ID
• Date card is issued (date does not guarantee
  eligibility)
• Back of Card
• Magnetic strip
• Customer service
• Instructs clients to keep and present card
• Instructs providers to verify eligibility

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What Do These Changes Mean?

• Services Card replaces monthly paper MAID
• Medical Assistance ID Card retires
• Services Card will not display eligibility
  details
• Card is permanent and eligibility can change
• ID Card no longer tied to eligibility
• Eligibility was displayed on the MAID
• Eligibility determined by accessing ProviderOne
• Confirm eligibility each time you deliver
  services
• Services Card helpful - but not necessary
• One of many ways to access eligibility information

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What Remains the Same?

• Providers continue to confirm eligibility using
  any of the following combinations of data
• ProviderOne Client ID number (Services Card)
• Client full name and date of birth (DOB)
• Client full name and Social Security Number (SSN)
• SSN and DOB
• DSHS eligibility rules are not changing
• Clients enrolled in Managed Care will continue to
  receive separate card from their plan
• Award letters issued for nursing homes

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Phasing Out the MAID

• Initial distribution to all current clients
• Staggered mailing - by Region - 1 month prior to
  ProviderOne
• Small window of time with no MAID or Services
  Card
• MAID issued by request for new clients with
  emergent medical needs
• No MAID issued for early December - Providers
  look up ProviderOne Client ID

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All Eligible Clients Get Services Card

• Initial Distribution
• All eligible clients will get Services Card
• Every eligible family member gets their own card
• Services Cards issued centrally, not locally
• After go live
• New clients will receive cards 7-10 days after
  approval for medical assistance
• Services Cards issued centrally, not locally

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Robust Plan For Educating Clients

• Educational materials being developed
• Fact sheets and letters
• Informational Stuffers inserted with MAID
  Mailings
• Services Card video for DSHS offices and
  providers
• On-hold telephone messages for DSHS offices and
  call centers
• Public service announcements
• Materials will be available to providers who want
  to assist in the education effort such as
• Flyers
• Pictures of Services Card
• Posters

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Goals of the Client Education Plan

• Raise awareness of new Services Cards
• Anticipate delivery of Services Card
• Recognize the Services Card when it arrives
• Understand who will receive a Services Card
• Clients understand how to use the Services Card
• Keep the card - even if temporarily ineligible
  for services
• Have card handy when making appointments
• Understand importance of carrying and keeping
  card
• Know what to do if card is lost or stolen
• Know how to access care without Services Card
• Remind clients to be good consumers of health
  care services

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How to Help Ease The Transition

• Services Cards are a big departure from how
  things are done today for both staff and clients
• You can help prepare staff by
• Exploring options now for confirming a clients
  eligibility with or without a MAID or Services
  Card
• Select and try methods that will work for you in
  advance of ProviderOne
• You can help educate clients by
• Talking about Services Card as we approach
  distribution
• Making DSHS materials available in your office

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Module 2 New ProviderOne Client ID

• New ProviderOne Client ID
• Access to new Client ID Numbers

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ProviderOne Client ID Number

• The Client ID is Changing.
• ProviderOne will assign a
• unique ProviderOne Client ID
• number for each client
• ProviderOne Client ID numbers will be assigned to
  all clients eligible for service over the last 4
  years
• The ProviderOne Client ID will replace the
  Personal Identification Code (PIC)
• Providers will use the ProviderOne Client ID
  number to check client eligibility and bill claims

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What Do These Changes Mean?

• ProviderOne cannot recognize the PIC
• To receive payment, claims in ProviderOne must be
  billed using the new ProviderOne Client ID
• Retro claims originally billed using the PIC will
  be submitted using the ProviderOne Client ID
• DSHS is developing Crosswalk to map a clients
  former PIC to the new ProviderOne Client ID

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Enter your 7-digit provider number and Tax ID.
20
Click here to view ProviderOne crosswalk data
connected to your Tax ID.
21
Data Clients Seen Last 12 Months
A-010199PLOMNA
A-010199PLOMNA
A-010199PLOMNA
A-010199PLOMNA
A-010199PLOMNA
A-010199PLOMNA
A-010199PLOMNA
A-010199PLOMNA
A-010199PLOMNA
A-010199PLOMNA
A-010199PLOMNA
A-010199PLOMNA
A-010199PLOMNA
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Not All Providers Need the Crosswalk

• You may need a crosswalk if
• Your billing system or clearinghouse will submit
  batch claims on day one, or
• You are involved in testing with DSHS
• The crosswalk will ready after we move client
  data to the new system and client ID numbers are
  assigned
• 30 days before testing and updated 30 days before
  go live
• You can access ProviderOne Client ID at Go Live
• ProviderOne Services Card
• Single or batch eligibility inquiry in
  ProviderOne (270/271)
• Enrollment Roster (834)

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Questions?

• Break

24
Module 3Current Methods to Confirm Client Has
Coverage

• Current Methods to Confirm Eligibility
• WAMedWeb Helps Staff Transition to ProviderOne

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DSHS Supports Several Options

• Several no or low cost options available now and
  in the future
• Regardless of method source of information the
  same

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Web Inquiry Using WAMedWeb

• Providers have been using WAMedWeb to conduct
• Eligibility Inquiries (270/271 transaction)
• Claim Status Inquiries (276/277 transaction)
• Submit individual and Batch Claims (837
  transaction)
• 837P Professional
• 837I Institutional
• 837D Dental
• Download and View Remittance Status Reports
• Why Sign Up for WAMedWeb Now?
• Gain experience using on line eligibility
  inquiries before ProviderOne
• Free!
• No Software Required

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WAMedWeb Eligibility Inquiry
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Entering Client Data
info needed

• WAMedWeb eligibility information dates back three
  years

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WAMedWeb Eligibility Response
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Want More Information?

• See Demo
• Pick up Enrollment Packet
• Easy step by step instructions to get started
• How to sign up on line
• Trading Partner Agreement
• See Full Training Tutorial
• https//wamedweb.acs-inc.com/wa/general/home.do
• Technical Assistance
• ACS 1-800-833-2051

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Telephone Options Available Today

• Interactive Voice Response (IVR) 1-800-562-3022
• Telephone technology where a computer responds to
  a callers voice or touch tones
• Use IVR to get what you need without waiting in
  phone queues for a customer service
  representative
• Use (IVR) today to query
• Client Eligibility
• Warrant Status
• Warrant Amount
• Customer Service Representative 1-800-562-3022
• Call wait times could increase at first as we go
  live and stabilize

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IVR Available 24 Hours/Day

• IVR will help you confirm client eligibility
  when
• A client does not bring a Services Card
• You need a no-cost option for inquiring about
  client eligibility
• You need client eligibility information 24 hours
  per day
• You do not have access to the internet
• You dont want to wait in a phone queue
• When you call the IVR system today, you will
  need
• Your Provider ID and a single date of service,
  AND
• ProviderOne Client ID number and Date of Birth
  (DOB), or
• The clients Social Security Number and DOB

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Module 4Confirming Client Has Coverage in the
Future

• Enhanced IVR
• Magnetic Card Readers
• Client Eligibility Inquiry in ProviderOne

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Enhanced IVR with ProviderOne

• Eligibility Information Available
• Medicaid
• Medicare
• Managed Care
• Hospice
• Children with special needs
• Developmentally disabled
• New Eligibility Information
• Third Party Liability (TPL)
• Restrictions to provider or facility
• Long Term Care
• New Features
• Prior Authorization Inquiry
• Claim Status Inquiry
• Can drill down for more detail

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New Magnetic Card Reader Option1

• The option to use a magnetic card reader to
  access client eligibility information will be
  available using the new Client Services Card
• Using a magnetic card reader is optional readers
  will not be provided or sold by DSHS
• While swipe card technology give providers an
  easy and immediate way to check eligibility,
  there are the other low or no-cost inquiry methods

1DSHS does not favor, endorse, or recommend
Magnetic Card Readers over any other inquiry
method, and does not favor, endorse, or recommend
any Magnetic Card Reader model or vendor over any
other model or vendor. DSHS and its employees
have neither a financial interest, nor any other
type of interest, in which inquiry method you
choose.
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What are Magnetic Card Readers?

• Mini Magnetic Card Readers attach to PC Screen
  and UB Connection
• Provider swipes Services Card
• Eligibility information is displayed on the PC
  screen
• Providers can print the screen
• Desktop Magnetic Card Readers connect directly to
  Internet
• Provider swipes Services Card
• Eligibility information is printed line by line
  similar to a cash register tape

1DSHS does not favor, endorse, or recommend
Magnetic Card Readers over any other inquiry
method, and does not favor, endorse, or recommend
any Magnetic Card Reader model or vendor over any
other model or vendor. DSHS and its employees
have neither a financial interest, nor any other
type of interest, in which inquiry method you
choose.
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Choosing a Magnetic Card Reader1

• Most commercial readers should be able to read
  the ProviderOne Services Card
• Your existing reader may read Services Card
• Some models may need reconfiguration
• Providers can have their magnetic card reader
  vendor work with the States vendor, Client
  Network Services, Inc. (CNSI), or designee
• Together, they can determine if the reader can be
  configured to read the Services Card
• Contact information provided 90 days before go
  live

1DSHS does not favor, endorse, or recommend
Magnetic Card Readers over any other inquiry
method, and does not favor, endorse, or recommend
any Magnetic Card Reader model or vendor over any
other model or vendor. DSHS and its employees
have neither a financial interest, nor any other
type of interest, in which inquiry method you
choose.
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Third Party Vendors Offer Card Readers1

• Equipment and costs for readers may vary by
  vendor
• To ensure providers have at least one option for
  equipment capable of reading the Services Card,
  under the System vendor contract, CNSI is
  required to make readers available for purchase
  by providers who request them
• The models under the contract range from 100 to
  300 for the reader plus a 15/month fee for
  unlimited transactions
• A link to CNSIs, or its designees, Website for
  specific ordering information will be made
  available 90 days before go live
• Providers who choose to purchase readers are
  encouraged to shop for the model and vendor that
  best meets their business needs

1DSHS does not favor, endorse, or recommend
Magnetic Card Readers over any other inquiry
method, and does not favor, endorse, or recommend
any Magnetic Card Reader model or vendor over any
other model or vendor. DSHS and its employees
have neither a financial interest, nor any other
type of interest, in which inquiry method you
choose.
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ProviderOne Preview

• Client Eligibility

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Web Inquiry Using ProviderOne
Click Benefit Inquiry to begin.
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Client Eligibility Inquiry
Required client benefit inquiry critera sets
explained here. . .
New ProviderOne Client ID
. . .and entered here
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Selection Criteria Entered
Scroll through information returned or print page
43
Client Demographic Information
Client language
Foster care billing information
44
Client Eligibility Spans
Heading name change same information
Previous information provided on MAID
Benefit Service Package description is hyperlink
to list of covered programs.
Previous information on MAID
45
Spenddown Information
When a client is pending Spenddown, details on
base-period and balances are returned immediately
following the clients eligibility spans.
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Managed Care Information
Managed care program and plan (i.e., CHPW
Healthy Options)
PCP clinic name provided for RHCs, FQHCs, and
PCCMs when available
47
Medicare Eligibility Information
48
Coordination of Benefits Information
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New Individual Sections
New section previously included in restricted
client information section
50
New Individual Sections
New section previously included in restricted
client information section
New section previously included in restricted
client information section
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Info Source Receiver Data
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Questions?

• Break

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Module 5ProviderOne Update

• ProviderOne Update
• Upcoming Readiness Activities

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ProviderOne Projected Schedule

• Phased Approach
• Phase 1 - Transition medical transactions
  currently paid through Medicaid Management
  Information System and RSN payments
• Phase 2 - Transition remaining medical and social
  services payments
• Projected implementation date for Phase 1 is
  December 2008.
• DSHS may re-examine its schedule after internal
  system testing.

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ProviderOne System Testing

• Testing Status
• System developers completed first round of
  testing
• Each individual part of ProviderOne working
  properly
• Individual subsystems working with other
  subsystems
• Claims successfully processed from beginning to
  end
• DSHS Project staff reviewing results
• Next Steps
• DSHS staff run critical processes beginning to
  end through ProviderOne
• 600 700 key processes
• Nearly 2,000 claim variations
• Provider pre-production testing

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Provider Pre-Production Testing

• Electronic Data Interchange (EDI) Testing to
  ensure providers can send and receive electronic
  transactions
• Stage One testing to ensure files formatted
  correctly
• All providers who submit batch transactions
  required to participate
• Stage Two Full adjudication cycle
• Claim submission through generation of remittance
  advice (no check)
• Providers verify the test results
• Pre-Production Pilot test to compare claims
  processed through both the old and new system
• Cross-section of provider types submit claims
  into both legacy and ProviderOne
• Occurs the same time as Stage Two EDI testing
• State staff compare results
• Email your request to volunteer for Pilot at
  ProviderOne_at_dshs.wa.gov
• MMIS ID number
• Name of clearinghouse or billing agent used (if
  applicable)

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Register in ProviderOne

• Registration Process
• Access ProviderOne
• Validate data transferred from current system
• Report NPI and complete your file set up
• Submit to DSHS for approval
• Billing method chosen determines if you need to
• Participate in EDI testing
• Complete new Trading Partner Agreement
• Registration projected to begin July 2008
• Training Available to support Registration
  Process
• How to sign on and navigate in ProviderOne system
• How to update your file
• Access and sign on instructions distributed in
  advance

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Go Green During Registration
You Can Eliminate Paper Remittance Advice!

• Faster delivery
• Manual collation can take up to three days
• Can be delivered electronically (835) or PDF
• More efficient storage
• 3 year document retention
• Store on CDs or computer
• Can import 835 into your accounts receivable
  system
• Reduced taxpayer costs
• 4,300 envelopes each week
• Some RAs mailed in boxes
• Postage envelopes costly

59
DSHS Developing System Training

• Large audience format training (cooking show
  style)
• System and operational updates delivered around
  the state
• Attendees watch system demonstrations and
  instructional activities, driven by an instructor
  and/or speaker
• Approximately 2 month period right before go live
• Online Tutorials (Computer Based Training)
• Computer-based training aids that provide
  self-paced instruction on the most common types
  of ProviderOne tasks
• Tutorials can be run via the internet or
  downloaded and copied to a local PC that may not
  have internet access
• Can stand alone or follow cooking show sessions
• Can be repeated as needed

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Training Topics

• Anticipated Training Content
• How to Navigate in ProviderOne
• Set up and Maintain User Access
• How to register in ProviderOne
• How to confirm patient has coverage and who they
  can see
• Determining what a patient can get
• Obtaining and Adjusting Prior Authorization
• Submitting FFS claims and backup documents in
  ProviderOne
• Submitting and retrieving HIPAA Transactions
• Viewing enrollment and Managed Care Capitation
  Payments
• Access and Reconcile Remittance Advice
• Step By Step Instructions
• ProviderOne Billing Guide
• Replaces General Information Booklet
• On Line User Manuals
• For System tasks

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Provider Readiness Checklist

• Checklist outlines steps to
• Stay Informed
• Remain Enrolled/Payable
• Confirm Client Eligibility
• Ensure Services Are Covered
• Bill DSHS Correctly
• Reconcile Payments

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Questions?

• Email our ProviderOne Response Team at
• ProviderOne_at_DSHS.wa.gov
• Visit the ProviderOne Internet and sign-up for
  email distribution list to receive updates
• http//maa.dshs.wa.gov/providerone