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October 2016
In this issue:
Health System Transformation
- Behavioral Health Integration Resource Library now available
- Medicaid Electronic Health Records (EHR) Incentive Program
Other provider updates
- Changes for provider customer service numbers scheduled for Wednesday, Oct. 26
- Provider revalidation letters planned for November 2016
- Medicaid Program Integrity resources from CMS
- Reminder: Please use EDMS Coversheet on all prior authorization and provider enrollment requests
- Reminder: Monthly payment recovery for Oregon Health Plan newborn claims
Behavioral Health Integration Resource Library now available
The Patient-Centered Primary Care Institute is excited to announce the new Behavioral Health Integration Resource Library, developed in partnership with the Oregon Health Authority's Transformation Center. The library features:
Please visit the library at http://www.pcpci.org/BHRL, share this information with your colleagues and network, and check back as more resources and videos are added.
If you need further information, or if you have questions on any of the content of the library, please email the institute at info@pcpci.org. You can also give feedback and make resource suggestions about the library through their online survey.
To find other helpful resources and updates, visit the institute’s website.
Medicaid Electronic Health Records (EHR) Incentive Program
Program Year 2016 updates for eligible professionals
Eligible professionals can submit their 2016 adopt, implement or upgrade (AIU) and meaningful use (MU) first year attestations until March 31, 2017. Please include the following documents as part of your attestation:
- Copy of meaningful use summary report;
- Security risk assessment (SRA). HealthIT.gov offers an SRA tool to help providers complete this assessment;
- Inventory list;
- Deficiencies noted and the corrective action plan(s), including target dates for implementation; and
- Documentation of who completed the SRA.
This is the last year to begin the program (coming in under AIU or MU payment year one).
- Eligible professionals can receive an incentive payment for adopting, implementing or upgrading certified electronic health record technology (CEHRT) in their first year of participation.
- Eligible professionals must choose to participate in either the Medicare or Medicaid EHR Incentive Program.
For more information
Changes for provider customer service numbers scheduled for Wednesday, October 26
The following customer service phone lines will be moving to a new call management system October 26:
- Benefit RN Hotline, 1-800-393-9855
- Prior Authorization Line, 1-800-642-8635
- Provider Enrollment, 1-800-422-5047
- Provider Services, 1-800-336-6016
There will also be changes to the greetings and menu options you hear when calling these numbers. There may also be phone and fax interruptions that day.
Provider revalidation letters planned for November
According to federal regulations at 42 CFR §455.414, “The State Medicaid agency must revalidate the enrollment of all providers regardless of provider type at least every 5 years.” Provider revalidation is how we make sure that all enrolled providers continue to meet Medicaid rules and regulations.
To this end, the Oregon Health Authority will be begin mailing requests for providers to revalidate their Oregon Medicaid enrollment. If your office gets a letter asking you to complete a revalidation form (OHP 3140) or and ownership disclosure form (OHA 3974), please complete and return the forms as soon as possible.
Medicaid Program Integrity resources from CMS
The Medicaid Program Integrity Education (MPIE) website now features the Personal Care Services Toolkit to provide medical professionals with resources to avoid improper payments when patients receive care in their home.
What is MPIE?
The CMS Center for Program Integrity provides a variety of educational resources to promote best practices and awareness of Medicaid fraud, waste and abuse, such as:
Reminder: Please use EDMS Coversheet on all prior authorization and provider enrollment requests
Please help us process your requests faster by including the EDMS Coversheet (MSC 3970) as a fax cover sheet for each prior authorization (PA) and provider enrollment (PE) request you submit to OHA.
- We do not see the faxes sent to our central PA and PE numbers until they are scanned into our system.
- Unfortunately, only requests sent under the EDMS Coversheet get into the system.
- Requests missing this coversheet are destroyed and not returned.
To make sure your faxes are processed and reviewed by OHA, please read our EDMS Coversheet tips to learn more.
Reminder: Monthly payment recovery for OHP newborn claims
Every month OHA recovers a small number of payments made in the preceding month for services to newborns who are now enrolled in a CCO.
- Once the birth is reported, we enroll children born to CCO members in the mother’s plan.
- Depending on when the birth is reported to us, this process may take three or more weeks to complete.
To avoid future recoveries for newborn services:
What you will see on the paper remittance advice (RA), electronic remittance advice (ERA) or Provider Web Portal (PWP):
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On the paper RA: Adjusted claims will have an Internal Claim Number (ICN) beginning with “52.” The “Detail EOBs” for these ICNs will list Explanation of Benefits (EOB) code EOB 0090 – Service is covered by a managed care plan. Claim must be billed to the appropriate managed care plan.
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On the ERA or PWP: The ERA should list these adjustments as overpayment recoveries. PWP will show the adjustment ICN as a denied claim. In both ERA and PWP, the reason for recovery will be Adjustment Reason Code 24 - Charges are covered under a capitation agreement/managed care plan.
To learn more about recovery of overpayments or appeals, please see Oregon Administrative Rules 410-120-1397(7), 410-120-1560 and 410-120-1580 in the General Rules guidelines. |
