1. HSN Claims Migration to MMIS April 2012 2. Agenda • Migration Schedule • Rolling Schedule • DHCFP Payment • MMIS Payment • Training Resources / Claims Support • Key Points • Conclusion 3. Migration Schedule • HSN 837I (Institutional) & 837P (Professional) claims migrating to MMIS on 7/1/2012 • 4010 837I & 837P claim processing by DHCFP (the Division) ends 4/30/2012 > Required due to conversion of historical paid claims data in June • Dental claims will continue to be processed at the Division • Dental claims must be submitted in the 5010 837D claim format beginning 5/1/2012 4. Rolling Schedule • Allows transition to MMIS claims processing on 7/1, 8/1, 9/1 or 10/1/2012 • All providers must transition no later than 10/1/2012 • Provides ample opportunity for providers to test 837I & 837P HSN claim submissions to MMIS • Testing should occur for all potential HSN claim scenarios (i.e., Prime, Second, Partial, Bad Debt, Medical Hardship, Confidential) 5. DHCFP Payment Interim payment methodology to be used for base months of May & June (July & August processed payments, resp.) Interim payments to be determined based on historical claims / payment data for the period that providers are unable to submit HSN claims to MMIS Interim payment methodology will also be used during rolling transition period: – Ex.: a provider transitioning on 9/1/2012 would be paid based on interim payments for months of July & August (September & October payments) Payment recovery schedule TBD DHCFP will – provide updates in the near future regarding interim payments & recovery schedules – will continue to generate remittance advices (RAs) detailing HSN payments to be made. RAs will remain in current format and be downloaded directly from INET. 6. MMIS Payment • MMIS claims adjudication will include generation of an 835 and a Remittance Advice (RA) that will note MMIS priced payment • MMIS priced payment is not reflective of HSN payment that will occur based on repricing and payment of claim at DHCFP • Providers should use MMIS 835 for posting of claim disposition and to correct claim errors • Providers should not use MMIS 835 and RA for payment posting 7. Training Resources / Claims Support 837I & 837P Billing Guides > Illustrate HSN specific segments & data required for claims processing > Unless noted in billing guide, claims processing & adjudication to occur in accordance with MassHealth 5010 specifications, companion guide & billing requirements Providers should contact MassHealth Customer Service Center at (800) 841-2900 for all HSN claim inquiries except: > Eligibility, Payment & Policy inquiries should be forwarded to the Division’s claims customer support center at (866) 697-6080 or HSNHelpLine@PublicSectorPartners.com 8. Key Points • Providers will be issued an HSN Provider ID / Service Location in May, 2012 that will be used in HSN claims processing • Claims must be submitted with correct billing NPI as reported by providers • Claims and RAs from MassHealth will not be combined with HSN claims and RAs/835s as the Provider ID/SL will be different • Direct Data Entry not available for HSN claims processing on 7/1/2012 Frequency codes (xx1 = Admit thru Discharge; xx7 = Replacement; xx8 = Void) will remain the same Dummy member identification numbers (i.e., 000000001, 000000000001) are not allowed; if unknown, leave field blank • Billing deadline waivers will be allowed during conversion / migration period; waiver period to be determined 9. Thank You!