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Provider - Connecticut Medical Assistance Program

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1. 61 Web Claim Inquiry Dental Claim base information Panel label and contents are subject to change based on claim type dental institutional professional Provides important basic information about the claim provider and client identification reimbursement CM 2011150050007 Emergency Provider ID 1234567890 NPI Accident AVRS ID 111111114 Facility Type Code 11 Search Client ID 001223334 imi Last Name SMITH Total Charges First Name MI JOHN B Total Billed Amount 500 00 Date of Birth 09 15 1988 TPL Amount 50 00 Patient Account MLIA Total Paid Amount 182 00 837 Version 5010 CT interChange MMIS 62 Web Claim Inquiry Detail Provides a detailed account of the billed services procedures Available required fields are subject to change based on claim type Clicking on a detail line will populate the relevant information into the fields below Item DOS Procedure Units Billed Tooth Number Quadrant Charges Status Allowed Amount 1 06 05 2011 D4211 900 00 PAID Type changes below Item 1 DOS 06 05 2011 Procedure D4211 Search Units Billed 1 00 Modifiers Search Search Charges 500 00 Search Search Allowed Amount 182 00 Tooth Number Rendering Provider 1234567890 NPI Search Quadrant 10 Search Status PAID Surfaces Buccal Distal Facial Incisal Lingual T Mesial T Occlusal I CT interChange MMIS 63 W
2. Nursing Facilities Long Term Care State Institution ICF MRs Personal Care Services Acquired Brain Injury Fiduciary Regional Family Service Coordination Center RFSCC Birth to Three Billing and Performing Providers DMH and DDS Performing Providers Employment and Day Support Waiver Performing Providers School Corporations Private Non Medical Institution Billing and Performing Providers Connecticut Home Care CHC Personal Care Assistant PCA Fiduciary Connecticut Home Care CHC Program Access Agency Performing Providers Managed Care Organizations CT interChange MMIS 81 d Re enrollment Five Year Re enrollment Period Most provider types who complete their re enrollment on or after January 1 2012 will be required to re enroll every tive years Providers will receive a reminder letter when they are due for re enrollment 30 days prior to the end of their previous contract Re enrollment via the Enrollment Re enrollment Wizard on the CMAP Web site www ctdssmap com is required The following providers are excluded and are required to re enroll every two years Home Health Agencies Clinics DME Dentists Dentist Groups Pharmacies State Institutions Drug and Alcohol Abuse Centers e Long Term Care providers will still be required to re enroll every 15 months CT interChange MMIS amp 4 Re enrollment To check th
3. Denied claims allow you to Resubmit the claim with or without making changes EN Cancel any alterations you have made EN Create a new claim from scratch Suspended claims allow you to EEE Create a new claim from scratch CT interChange MMIS 66 Web Claim Submission e New Claim Submission Perform the following steps to easily submit a new claim Select the appropriate claim type Professional Institutional Dental A blank claim will appear At a minimum enter data into all required fields identified by an asterisk after the field name Dental Claim ICN Emergency Provider ID 1234567890 NPI Accident AVRS ID 111111114 gt Facility Type Code 11 Search gt Client ID 001223334 To enter additional diagnosis codes claim details additional NDC s or a TPL record click the add button within the panel Click the su bm it button at the bottom of the claim page The claim will process immediately and return a status of Paid Denied or Suspended CT interChange MMIS 1 67 d Web Claim Submission Void a Claim Perform the following steps to void or completely recoup a paid claim Select Claim Inquiry Enter the paid claim ICN found on your RA in the ICN field Click the search button Once the claim is retrieved click the void button at the bottom of the claim page The void will process immediately and return a message that the claim has
4. Base Information e Ownership Service Location e County Organization Code Service Language e Language Effective Date End Date CT interChange MMIS 16 Demographic Maintenance The Location Name Address panel allows you to specify different mailing payment and service locations Location Name Address Usage Name Address 1 City State Zip Zip 4 Phone Ext Access Mail to DOE JOHN 15 MAIN STREET WILLIMANTI CT 06614 4008 39555 5555 5555 Pay to DOE JOHN 250 OAK AVENUE WILLIMANTI CT O66i4 0001 203 555 5555 5555 Y Service Location DOE JOHN 15 MAIN STREET WILLIMANTI CT 06614 4008 203 555 5555 5555 Y Type changes below select from list Apply Changes To fs Sve Loc Mame DOE JOHN z Pay To Title DDS Iv M Mail To Country UNITED STATES Address 1 15 MAIN STREET Phone 203 555 5555 5555 Address 2 SUITE 2A Fax 203 555 5550 city WILLIMANTIC ves State Handicap Accessible Zip 06614 4008 EMail john_doe_dds doedental com a m IE Name Type Business Name Personal Name CT interChange MMIS SII 17 Demographic Maintenance To alter address information simply select the applicable row trom the provided list Mail to Pay to or Service Location then click maintain address Select till in the appropriate information address phone number etc click save The following messages were generated Message Description Panel Field Save was Succe
5. CT interChange MMIS 1 1 35 s Eligibility Verification Benefit Plan e Provides the benefit plan s with which the client was as active member on the date s of service requested Service Information Benefit Month Effective Date Effective Date End Date Husky C For Behavioral Health Services call BHP at 877 552 8247 01 01 2012 01 11 2012 01 22 2012 Service Type Codes HP Services e A list of services for which the client was eligible that would be submitted tor payment to HP Enterprise Services Service Type Codes HP Services Service Type Service Type Information 1 Medical Care 33 Chiropractic 35 Dental Care 4 Diagnostic X Ray 42 Home Health Care 45 Hospice 4 Hospital 5 Diagnostic Lab 54 Long Term Care 56 Medically Related Trans 123 Next gt CT interChange MMIS 1 36 Eligibility Verification Service Type Codes MCO Services e A list of services covered for the client that should be submitted for payment to the Managed Care Organization MCO with which they were enrolled e Clients on the HUSKY and Charter Oak plans were enrolled with an MCO tor dates of service prior to 1 1 2012 Benefit Plan Service Information Benefit Month Effective Date Effective Date End Date HUSKY B For Behavioral Health Services call BHP at 877 552 8247 08 01 2011 08 11 2011 08 21 2011 Service Type Codes HP Services Service Type Code Service Type Information 35
6. Claims can potentially deny when a discrepancy in TPL data exists on the client s state profile e A Third Party Liability Information Form should be sent to Health Management Systems HMS This form is available on the Information gt Publications page of ctdssmap com e HMS will contact the insurance carrier and notify DSS of any discrepancy e DSS will update client eligibility CT interChange MMIS VI 47 E Claim Processing Submission Information Third Party Liability Information TPL claims submitted to HP with other insurance payment or denial must include e Carrier s unique three digit carrier code Available through eligibility verification Web phone X12N 270 271 Eligibility Benefit Inquiry Response Transaction and in Chapter 5 of the CMAP Provider Manual e The Amount Paid on a paid claim or 0 00 for a TPL denial e The date of payment or denial from the TPL Explanation of Benefits EOB he physical TPL EOB should not be submitted with paper claims the provider must retain this for audit purposes CT interChange MMIS 48 Claim Processing Submission Information Timely Filing Guidelines Claims tor CMAP client must be submitted within one year of the actual date of service EOB 512 Claim exceeds timely filing limit is bypassed it e Original claim with no TPL ICN Julian date is within 366 days of the detail through date of service e Client eligibility tile update
7. Client eligibility has been added or updated where the ICN Julian date is within 366 days of the change and the claim date of service is between the effective dates of the change Other Insurance denial Providers have one year from the date the primary insurance denied the claim as long as the provider received a response from the private carrier within a year lf multiple carriers exist and if any one does not meet the above criteria the claim will deny with EOB 512 CT interChange MMIS 49 E Claim Processing Submission Information Timely Filing Guidelines EOB 512 Claim exceeds timely filing limit is bypassed if e Medicare and or Other Insurance Payment TPL or Medicare paid amount is greater than 0 00 and the paid date is within 366 days of the ICN Julian date of the claim olf multiple carriers exist and if any one does not meet the above criteria the claim will deny with EOB 512 Medicare denial lt the Medicare carrier code MPA or MPB denial date on the claim is within 549 days of the from date of service on the claim and within 366 days of the ICN Julian date e Prior claim history s When a claim in history with the same Client Provider Billed Amount detail From and Through dates of service and Revenue Center Code RCC or RCC Procedure code where the ICN Julian date on the current claim is less than or equal to 366 days from the previous claim s Remittance Advice date an
8. ist Answer Smith 2nd Secret Question Name of first pet 2nd Answer Buster Security Agreement Provider agrees to meet all applicable state and federal laws and regulations pertaining to confidentiality privacy and security and to maintain and safeguard in accordance with all state and federal laws and regulations the confidentiality of all information concerning DSS clients including but not limited to personal J financial and medical information Provider agrees that this agreement is an v ELT Em Before clicking submit be sure to write down the chosen User ID Password and secret question Answer s and keep them in a secure location CT interChange MMIS 11 Web Account Set Up e You have successfully set up your CTDSSMAP com Secure Site account Home Information Provider Trading Partner ConnPACE Pharmacy Information Claims Eligibility Prior Authorization Trade Files MAPIR Messages home Eea M a account maintenance account setup change password clerk maintenance demographic maintenance reset password log out Your password expires in 60 day s on 2 21 2012 at 12 00 AM Change Password Claim Status Inqui Client Eligibility Verification Prior Authorization Inquiry Download Remittance Advices Welcome JOHN_DOE_DENTAL oO Provider ID 1234567890 NPI Provider AVRS ID 123456 Zip Code 06000 1111 Your R A s or 835 transactions are being sent to Your download page in the Trade Files menu o
9. 1 500 842 8440 toll free in state CT interChange MMIS 8 Web Account Set Up Information Required for Account Set Up As a new Provider or Trading Partner you should receive your logon IDs via your enrollment confirmation Web and AVRS PINs will arrive under separate cover New Providers e AVRS Initial Web User ID e Web PIN e AVRS PIN New Trading Partners e Initial Web User ID e Web PIN You will need to have the Web ID and Web PIN on hand when you first access the secure site CT interChange MMIS 1 9 Web Account Set Up Enter the provided Initial Web User ID and PIN in the appropriate fields click sefup account Account Setup Initial Web User ID 001111111 Personal Identification AB12C3de4 Number Please note User ID and Personal Identification Number are case sensitive Click here to find answers to the most frequently asked questions FAQs regarding Web account set up CT interChange MMIS 10 Web Account Set Up You will be brought to the Account Setup screen Fill in the fields with the appropriate information Required fields are are indicated with an asterisk 73 User ID JOHN _DOE_DENTAL Password gt eeeeee6 Contact Last Name Doe Confirm Password eeesees Contact First Name Jonathan EMail john_doe_dds doedental cam Phone Number 800 555 5555 5555 Confirm EMail john doe dds doedental com ist Secret Question Mother s maiden name
10. Codes affected by CMS National Correct Coding Initiative NCCI 06 01 2011 PB11 39 New Prior Authorization Override Process for Non referred Mental Health Related 05 23 2011 PB11 39 New Pharmacy Edit for Diabetic Supplies Effective June 1 2011 05 23 2011 CT interChange MMIS 88 Information Provider Manual The Provider Manual is available to assist providers in understanding how to receive prompt reimbursement through complete and accurate claim submission t is the primary source of information for submitting CTMAP claims prior authorizations and other related transactions This manual contains detailed instructions regarding the Program and should be your first source of information pertaining to policy and procedural questions The Provider Manual is divided into twelve 12 chapters e Click on the chapter title to open the document disable pop up blockers e Chapters 7 and 8 are provider specific select your provider type from the drop down menu and click View Chapfer to access the chapter e Chapter 11 is claim type specific CT interChange MMIS 89 f Information Chapter 1 Introduction e Provides information on the CT Medical Assistance Program the Department of Social Services and HewlettPackards responsibilities and re sources as well as information about the organization of the Provider Manual Chapter 2 Provider Participation Regulations e Details the C
11. IEEE Personal Identification Number Number This is the personal identification number PIN assigned to the provider trading partner Please note User ID and Pers CT interChange MMIS 14 Demographic Maintenance The Demographic Maintenance section of the secure site allows you to alter and maintain demographic information Mail to Pay to and Service Location addresses Service Languages EFT Electronic Funds Transfer Account e Bank account that will receive all CTMAP related reimbursements Access this section by selecting demographic maintenance trom either the Account submenu or the Account drop down menu Authorization Trade Files MAPIR Messages Account eS eo ite reset password Account Home a 4 lt lt ount maintenance Account Setup Change Password Clerk Maintenance Reset Password Log Out CT interChange MMIS 15 Demographic Maintenance The Demographic Maintenance page displays the provider information panel as well as a submenu Provider Information Provider ID 1234567890 Address 15 Main Street Organization Sole Proprietor Suite 2A Usage Service Location city Willimantic Provider Type 27 Dentist County Fairfield Ownership Yes State 7ip CT 06614 4008 Phone 203 555 5555 Base Information Service Location Location Name Address gt EFT Account gt Service Language e Clicking the submenu options will open a panel with related information
12. been successfully adjusted voided with a new ICN CT interChange MMIS 68 Web Claim Submission Claim Adjustment Perform the following steps to easily adjust a paid claim Select Claim Inquiry Enter the paid claim ICN found on your RA in the ICN field Click the search button Once the claim is retrieved make any necessary changes to the claim Click the adjust button at the bottom of the claim page The adjustment will process immediately and return a status of Paid Denied or Suspended CT interChange MMIS 69 Web Claim Submission Claim Copying Paid claims may be copied and submitted as a new claim This feature is helpful for reoccurring services Perform the following steps to easily copy a paid claim for submission as a new claim Select Claim Inquiry Enter the paid claim ICN found on your RA in the ICN field Click the search button Once the claim is retrieved click the copy button at the bottom of the claim page Make the necessary changes to the claim Click the su bm if button at the bottom of the claim page The new claim will process immediately and return a status of Paid Denied or Suspended CT interChange MMIS 1 70 Web Claim Submission Claim Resubmission Perform the following steps to easily resubmit a denied claim Select Claim Inquiry Enter the denied claim ICN found on your RA in the ICN field Click the search button On
13. of a paid claim e ls the current claim for an inpatient hospital stay with the same date of service as a paid long term care room and board claim Does the billed procedure code require prior authorization PA CT interChange MMIS SII 45 d Claim Processing Submission Information Claims submitted to HP are each assigned a unique 13 digit Internal Control Number ICN that is used for tracking and research 120 12 032 123 456 1 2 3 4 5 1 Claim Region Identities the manner in which the claim was submitted 20 Electronic Claims with No Attachments 2 Year of Receipt Indicates the year in which the claim was received by HP 12 2012 3 Julian Date of Receipt The Julian calendar date of receipt 032 the thirty second day of the year February 1 4 Batch Number An internal number assigned by HP to uniquely identity a batch 123 5 Claim Number A sequential number assigned by HP to uniquely identity a claim within a batch 456 CT interChange MMIS 1 46 Claim Processing Submission Information Third Party Liability TPL Information Commercial private insurance coverage other than Medicare or Medicaid under which the client may be covered Connecticut Medical Assistance Program is the payer of last resort Because of this providers must investigate the possibility of clients having other insurance coverage and pursue payment prior to submitting their claim to HP
14. of topics Provider Newsletters Provider Newsletter nicum Claims Processing Information Guides and FAQs to assist with billing claims processing Claims Processing Information Dental Other Insurance Billina Guide Institutional Other Insurance Medicare Billing Guide Professional OI Medicare Billing Guide Hospice Procedure Code Exception List Drug Rebate 1 SS on Professional Claims B l CT interChange MMIS f f 101 Information The Links page accessible by selecting Links trom either the Information box on the left hand side of the home page or from the Information drop down menu provides Web links to various relevant sites and resources Information Provider Trading Partner ConnPACE Pharmacy Information hon Publications 7 HIPAA State Government Sites m State of Connecticut Department of Social Services m HUSKY Health Healthcare for Uninsured Kids and Youth m ConnPACE Connecticut Pharmaceutical Assistance Contract for the Elderly and Disabled Federal Government Sites m Centers for Medicare and Medicaid Services m Department of Health and Human Services m National Institute of Health Health Care Provider Organizations m American Dental Association m American Academy of Pediatrics m American Medical Association HIPAA Information m Centers for Medicare and Medicaid Services HIPAA page a Washington Publishing Company the manuals and imp
15. 016 O0xxxxxxx RebeccaD Smith 01 04 2011 01 04 2011 Dental Claims Adj Voided 04 10 2011 500 00 54 6 2011098050015 0O0xxxxxxx Johnny Q Appleseed 01 12 2011 01 12 2011 Dental Claims Denied 04 10 2011 500 00 0 00 5311104001038 O00xxxxxxx Johnny Q Appleseed 01 02 2011 01 02 2011 Dental Claims Paid o 500 00 182 00 2011098050009 O0xxxxxxx Johnny Q Appleseed 01 02 2011 01 02 2011 Dental Claims Adj Voided O 500 00 54 6 CT interChange MMIS 59 Web Claim Inquiry Exclude Adjusted Claims Removed claims that have been altered since their initial submission Results in a more accurate representation of your total reimbursement Claim Search 1234567890 NPI ICN Client ID TCN FDOS 01 01 2011 TDOS Prescription Mo Pharmacy Only Search Results ICH 2211172050004 2011143050007 2011143050008 2011105050003 2011105050001 9311104001039 2011098050015 5311104001038 03 28 2011 Client ID QOO xxxxxxx 0xXXXXXxxx 0xXxxxxx xXXXxxxx D xxxxxxx DO0xxxxxxx O0xxxxxxx O0xxxxxxx Claim Type Status FDate Paid TDate Paid Pending Claims Client Name Johnny Q Appleseed Johnny Q Appleseed Samantha Johnson Samantha Johnson Rebecca D South Johnny Q Appleseed Johnny Q Appleseed Johnny Q Appleseed Prescription Ho FDOS 03 01 2011 01 02 2011 03 20 2011 03 02 2011 03 02 2011 01 04 2011 01 12 2011 01 02 2011 Records TDOS 03 01 2011 01 02 2011 03 20 2011 03 02 20
16. 11 03 02 2011 01 04 2011 01 12 2011 01 02 2011 CT interChange MMIS ttf Claim Type Dental Claims Dental Claims Dental Claims Dental Claims Dental Claims Dental Claims Dental Claims Dental Claims 60 Status Denied Denied Paid Paid Paid Paid Denied Paid Date Paid 06 24 2011 05 25 2011 05 25 2011 04 20 2011 04 20 2011 04 16 2011 04 10 2011 0 Amount Billed Amount Paid 1 200 00 500 00 500 00 500 00 500 00 500 00 500 00 500 00 0 00 0 00 182 00 182 00 182 00 182 00 0 00 182 00 Web Claim Inquiry Pending Claims Claims submitted since the last Remittance Advice RA was issued ICN Client ID Claim Type TCN Status FDOS FDate Paid TDOS Prescription No Pharmacy Only Exclude Adjusted Claims l search Search Results ICN Client ID Client Name Prescription No FDOS TDOS Claim Type Status Date Paid gt Amount Billed Amount Paid 2011098050009 QO0xxxxxxx Samantha Johnson 01 02 2011 01 02 2011 Dental Claims Adj vaided 0 500 00 54 6 5311104001038 Q0xxxxxxx Samantha Johnson 01 02 2011 01 02 2011 Dental Claims Paid Q 500 00 182 00 2211167600009 Ofooononex Rebecca D Smith 04 01 2011 05 01 2011 Professional Claims Suspended oO 350 00 0 00 Convenient way to see all claims that will impact your reimbursement tor the current cycle Click on any line in the Search Results panel in order to view alter the corresponding claim CT interChange MMIS
17. 1111 52111 52111 s00 dd 0 0d 6023165 PL SEEV PROC CD TOOTH SURFACE QUAD DATE SVC EILLED PERF AMOUNT DETAIL EOS 11 B a0 ODL O62111 200 00 ea OB Cod iption EOB Code Description REPORT CR A BANN E interchange MMIS Date 7 12 2011 Rig 25533855 PAGE 121 MEDICAID MANAGEMENT INFORMATION SYSTEM CS eo BF Zahn arr EOB CODE DESCRIPTIONS JOHN DOE DENTAL 100 MAIN STREET SUITE 24 NEW HAVEN CT 06106 EOB CODE EOB CODE DESCRIPTION O261 Tooth number is missing 0513 Client s name and number disagree 2102 CLIENT ELIGIBILITY SYSTEM I5 NOT CURRENTLY AVAILABLE ee IL IL Tooth number is non cowered for the procedure code Billed SS ie PRICING ADJUSTMENT MAX FEE PRICING APPLIED CT interChange MMIS VI 77 PAYEE ID ISSUE DATE TAXONOMY P AVES ID NPI 1234567850 07 12 2011 1223GO0001X 001111111 Remittance Advice Examples Summary NHEW DAY CLAIMS POSITIVE ADJIUSTMENTS Medicaid HUSKY B 3 3 HUSKY B 1 and 2 aul CADAP ul D ConnPACE In E E SAGA 0 Charter Oak a Fate MLIA 310 YEAR TO DATE YEAR TO DATE NUMBER AMOUNT SEL 8 L 4 2600 250 56 re ee 03 2 S o eas c ATA ces CLAIMS DENIED BIS CLAIMS IN PROCESS T PAYMENTS CLAIMS PAYMENTS c EI El PAYOUTS 0 00 ACCOUNTS RECEIVABLE CLAIM SPECIFIC CURRENT CYCLE r30 s OUTSTANDING FROM PREVIOUS CYCLES Meus SI NON CLAIM SPECIFIC O 00 HET PAYMENT REFUNDS 4 259 862 70 CLAIM SPECIFIC ADJUSTMENT
18. 4 Forms Physician s Certification for Abortion Title XIX Form W 484 5 15 Forms Consent to Sterilization Form W 6 12 5 16 Forms Notification of Newborn Form W 416 5 17 e Prescribing 5 18 Co pays Cost Shares CT interChange MMIS 96 Provider Manual Table of Contents Chapter 7 Specific Policy Regulation Chapter 8 Provider Specific Claim Sub This chapter has a number of provider specific This chapter has a number of provider specitic versions Content will not be the same from versions Content will not be the same from one one version to another Below is an example of version to another Below is an example of the the information contained in the Dental information contained in the Physician version version of chapter 7 of chapter 8 7 1 Medical Services Policy 8 1 Overview Requirements for Payment of Dental Services 8 2 Prior Authorization NBN 8 3 EPSDT Information Clinics 8 4 Behavioral Health Claim Submission 8 5 Professional Service Claim Submission Instructions lor CMS 1500 Claim Form Dental Clinics Requirements for Payment of Public Health Dental Hygienist Services Regulations of State Agencies Scope 8 6 Medical Transportation Modifier List Definitions 8 7 Fee Schedule Provider Participation Eligibility Services Covered and Limitations Services Not Covered Payment Rate and Billing Procedure Documentation CT interChange MMIS 97 Provide
19. 790 f Benefit Plan Service Information Benefit Month Effective Date Effective Date End Date Husky C For Behavioral Health Services call BHP at 877 552 8247 01 01 2012 01 11 2012 01 22 2012 Service Type Codes HP Services Service Type Code Service Type Information 1 Medical Care 33 Chiropractic 35 Dental Care 4 Diagnostic X Ray 42 Home Health Care 45 Hospice ay Hospital 5 Diagnostic Lab 54 Long Term Care 56 Medically Related Trans 123 Next gt Service Type Codes MCO Services No rows found TPL Managed Care Provider 7 No rows found Lockin Mo rows found Medicare Coverage Medicare A Eligibility Veritication e What does all this information mean Eligibility Verification Response e Provides a verification number that should be kept on record in case the client s coverage is retroactively changed at a later date e Reports client s eligibility status for the requested date s of service Eligibility Verification Response Verification Number 1120900015 i ient TE i e R far tn Benef Plan for specifi ao PEST Response Text Client is eligible Refer to Benefit Plan for specific program coverage Client Information e Provides important client information Client Information Client ID 009999999 Last Name THOMAS S9N 111 99 9999 First Name MI THOMAS Birth Date 01 20 1997 Street 1 MAIN ST Gender M City State Zip TORRINGTON CT 06790
20. Connecticut Department of Social Services Making a Difference Connecticut Medical Assistance Program New Provider Workshop Presented by The Department of Social Services amp HP Enterprise Services III a Training Topics www CTDSSMAP com Web Portal Overview Web Account e Set Up Capabilities e Demographic Maintenance Clerk Maintenance e Adding Deleting Clerks Assigning Roles Eligibility Verification e Eligibility Searches Interpreting Results e Service Codes e Benefit Plans Claim Processing Submission Information Web Claim Inquiry Submission e Claim Inquiry e Search Results e Submission e Void Adjustment e Copy e Resubmission e Prior Authorization Inquiry Remittance Advice Re enrollment CT interChange MMIS 1 2 Training Topics Available Resources Information Important Messages Banner Page Announcements e Publications Provider Bulletins Provider Manual Forms Newsletters Etc e Links e HIPAA e Fee Schedule Wrap Up What s New in 2012 EHR Incentive Program Contacts Questions amp Comments CT interChange MMIS 1 3 CIDSSMAP com Web Portal Overview Section 1 1 WEB ACCOUNT CT interChange MMIS SI 4 Web Account Welcome Page at www CTDSSMAP com CONNECTICUT DEPARTMENT or SociAL SERVICES Caring far Canncclical Home Information Provider Trading Partner ConnPACE Pharmacy Information Inf
21. DS Prosthetic Orthotic CSV Mental Health Waiver CSV Natureopath PDF Optician CSV Personal Care Assistant CSV Physical Therapy CSV Physician Anesthesia CSV Physician Office and Outpt Services CSV Physician Radiology CSV Physician Surgical CSV Psychologist PDF Special Services CSV Travel Agent CSV Information Example of the Physician Office and Outpatient Services tee schedule TAROT Office and Outpatient Services p Hate Type to PED pediatric services or OBS obstetrical services or Lab Lab services billed by a Physician indicates a unique rate for services for qualied c clients and claim data You may disregard any other rate type Trae ective Era DYNAMIC SURFACE ELECTROMYOGRAPHY DURING per 4233 inoa 120 439299 DYNAMIC FINE WIRE ELECTROMYOGRAPHY DURI DEF 4147 1 2008 12033722909 PHYSICIAN REVIEW AND INTERPRETATION OF C DEF 8700 1 1 2008 12 31 2299 NEUROFUNCTIONAL TESTING SELECTION AND AD 3 DEF MP 1H 2008 12 31 2299 6020 MEN NEUROFUNCTIONAL TESTING SELECTION AND AD 26 DEF MP 8182010 12 31 2299 O MATTE ee 1712008 1205902250 ER 96101 PSYCHO TESTING BY PSYCH PHYS DEF 7843 1 0 2008 12 31 2299 Y 36102 PSYCHOLOGICAL TESTING INCLUDES PSYCHODI DEF 3088 112008 1212006 96103 PSYCHOLOGICAL TESTING INCLUDES PSYCHODI DEF 2330 1 1 2008 12 31 2299 ASSESSMENT OF APHASIA INCLUDES ASSESS
22. Dental Care 88 Pharmacy MH Mental Health RT Residential Psych Treatment Service Type Codes MCO Services Service Type Service Type Information 1 Medical Care 33 Chiropractic 4 Diagnostic X Ray 42 Home Health Care 45 Hospice ay Hospital 5 Diagnostic Lab 54 Long Term Care 56 Medically Related Trans 75 Prosthetic Device 1 2 Next gt CT interChange MMIS If 37 Eligibility Veritication TPL Third Party Liability e Private insurance plan s listed in the client s CTMAP profile TPL Carrier Code Carrier Name 060 BC BS OF CONNECTICUT Due to HIPAA 5010 restrictions CTMAP is unable to disclose the eligibility status or covered services with the private insurance plan s via the web portal The Automated Voice Response System AVRS will continue to return TPL information in the client eligibility verification response Providers can access the AVRS by dialing 1 800 842 8440 Press 1 for Self Service Options enter your AVRS ID and PIN Press 1 for Eligibility Verification Otherwise providers are required to initiate a separate request to the other payer or plan to determine the client s level of coverage CT interChange MMIS 1 38 Eligibility Veritication Managed Care Provider e Identities the MCO with which the client was enrolled on the date s of service requested if prior to 1 1 2012 Provider Name Provider Phone Effective Date End Date BLUE CARE FAMILY P
23. E DATE TAXONOMY P AVES ID Date 07 12 2011 PAGE 1 NPI 1234567850 07 12 2011 1223GO0001X 001111111 Claim Information Paid Dental REPORT CRA DNPD E interchange MMIS Rig 25533855 MEDICAID MANAGEMENT INFORMATION SYSTEM P BI DB PR BB i DENTAL CLAIMS PAID JOHN DOE DENTAL 100 MAIN STREET SUITE 24 NEW HAVEN CT 06106 CLIENT NAME JENNIFER SMITH CLIENT NO 001234567 1 2011178000555 NPI 1234567890 O625311 O623511 240 00 160 b023 176 PL SERV PROC CD TOOTH SURFACE QUAD DATE SVC EILLED ALLOWED PERF AMOUNT AMOUNT DETAIL EOB 11 ias 14 52311 60 00 40 00 NEN 1i S alk 30 O6e2311 60 00 40 00 NEN 11 oa 19 52311 60 00 40 00 gu 11 Pus oll 3 52311 60 00 40 00 eae 1 CT interChange MMIS f 76 00 PAYEE ID ISSUE DATE TAXONOMY P AVES ID Date 07 12 2011 PAGE 3 NPI 1234567850 07 12 2011 1223GO0001X 001111111 ab BIS EIE Remittance Advice Examples Claim Information Denied Dental REPORT CR A BANN E interchange MMIS Rig 5553305 MEDICAID MANAGEMENT INFORMATION SYSTEM 555 i Ts Dr DENTAL CLAIMS DENIED JOHN DOE DENTAL 100 MAIN STREET SUITE 2A NEW HAVEN CT 06106 ee ru RENDERING SERVICE DATES BILLED TPL PATIENT NUM PROVIDER FROM THRU AMOUNT AMOUNT CLIENT NAME JENNIFER SMITH 1 2011178000555 NPI 1234567890 CLIENT NO 001234567 PAYEE ID ISSUE DATE TAXONOMY P AVES ID Date 07 12 2011 PAGE l NPI 1234567850 07 12 2011 1223GO0001X 00111
24. LAN 800 554 1707 08 11 2011 08 21 2011 Lockin e Some clients are locked into receiving certain health care services only from specific providers or pharmacies those providers or pharmacies will be listed here Lockin Lockin Type Effective Date End Date Provider Hame Provider Phone Hospice 08 05 2011 08 05 2011 HOSPICE AGENCY 860 555 1234 Medicare e Types of Medicare coverage active for the client on the date s of service requested Medicare Coverage Medicare A Medicare B CT interChange MMIS 1 39 Eligibility Verification Service Codes Medical 54 Long Term Care AD Occupational Therapy 4 Diagnostic X Ray 56 Medical Related AF Speech Therapy Transportation 5 Diagnostic Lab 75 Prosthetic Device AL Vision Optometry 33 Chiropractic 82 Family Planning DM Durable Medical Equipment 35 Dental 86 Emergency Services MH Mental Health 42 Home Health Care 88 Pharmacy PT Physical Therapy 45 Hospice 93 Podiatry RT Residential Physical Treatment 47 Hospital 98 Professional Physician UC Urgent Care Office Visit CT interChange MMIS f 40 Eligibility Veritication Benefit Plans HUSKY A and HUSKY A Primary Care Provider Prior to 1 1 2012 HUSKY A clients had an MCO that handled all medical services Federally Qualified Health Center FQHC behavioral health dental and pharmacy ser
25. ME po DEF 7843 1 1 2008 12 31 2299 96110 DEVELOPMENTALTESTLIM DEF 1800 1 1 2008 12 31 2299 RE OEVELOPMENTAL TEST EXTEND pg 1 DEF ENEEEE 10 2008 12 31 2299 NEUROBEHAVIORAL STATUS EXAM CLINICAL AS DEF 60566 1 1 2008 1231 2299 96118 NEUROPSYCH TST BYPSYCHIPHYS DEF 7347 ini2008 1251 2288 Y OH INEUROPSYCH TESTING BY TEC ner aama 12008 126512298 NEUROPSYCHOLOGICAL TESTING EG WISCONSI DEF 3735 1008 12 31 72299 96125 COGNITIVE TEST BY HC PRO X DEF 5699 1 1 2008 12 31 2299 Posteo ASSESS HLTHBERAVE RIT ee MAS rans 2812288 SGI52 INTERVENE FLTHIBEHAVE INBIV oErF 3338 irio0s 128512288 96153 INTERVENE HLTHIBEHAVE GROUP DEF 325 1 4 2008 12 31 2299 96154 INTERV HLTHIBEHAV FAMW PT X DEF 13207 1 1 2008 12 31 2299 FAMILY WITHOUT THE PATIENT PRESENT HEA DEF 12 1 1 12008 12 31 2299 HYDRATION IV INFUSION INIT DEF 3ryr 1 2009 12 31 2299 CT interChange MMIS 107 Wrap Up Section 3 1 WHAT S NEW IN 2012 CT interChange MMIS 108 What s New in 2012 Medicaid EHR Incentive Payment Program The Electronic Health Records EHR incentive program was established by the Health Information Technology for Economic and Clinical Hea
26. REFUNDS Le 00 NON CLAIM SPECIFIC REFUNDS elo 00 OTHER FINANCIAL MANUAL PAYOUTS 0 0d CHECK VOIDS i0 00 NET EARNINGS CT interChange MMIS 78 4 259 862 70 CIDSSMAP com Web Portal Overview Section 1 7 RE ENROLLMENT CT interChange MMIS 79 Re enrollment e CTDSSMAP com allows a majority of providers to complete the re enrollment process online via the Web portal A majority of the required information is automatically populated based on the provider s previous contract information Online re enrollment cannot be initialized until an Application Tracking Number ATN is received from the HP Provider Enrollment Unit To begin the re enrollment process select Provider Enrollment trom either the Provider box on the lett hand side of the home page or the Provider drop down MENU Information Provider Trading Partner ConnPACE m Publications Provider Enrollment m Links s Important Information Provider Enrollment Tracking m RA Banner Announcements HIPAA Provider Matrix E Provider Services Provider Search Provider Drug Search Provider Services Provider Fee Schedule Download mg Cro wider search A EHR Incentive Program i 1 J I g Secure Site Secure Site CT interChange MMIS 80 Re enrollment Online enrollment re enrollment is available to all provider groups and provider taxonomies types specialties with the exception of the following
27. Schedule Download EHR Incentive Program If you have forgotten vour password please click the rese CT interChange MMIS S I 7 Web Account Set Up e Setting Up your Secure Site Account Alternately click on the Provider icon trom the main page then click Logging in for the first time trom the Quick Login panel on the right side of the screen Quick Login User ID Password ELCOME m Logging in for the first time TO THE Connecticut MEDICAL Assistance PROGRAM ea WELCOME TO THE CONNECTICUT MEDICAL ASSISTANCE PROGRAM WEB SITE PROVIDED BY HP ON BEHALF OF THE CONNECTICUT DEPARTMENT OF SOCIAL Services THIS SITE PROVIDES IMPORTANT INFORMATION TO HEALTH CARE PROVIDERS ABOUT THE CONNECTICUT MEDICAL ASSISTANCE PROGRAM THIS SITE CONTAINS A WEALTH OF RESOURCES FOR PROVIDERS INCLUDING ENROLLMENT BILLING MANUALS BULLETINS PROGRAM REGULATIONS PLUS INFORMATION ON ELECTRONIC DATA INTERCHANGE Provider Enrollment AND THE AUTOMATED ELIGIBILITY VERIFICATION SYSTEM THE SITE ALSO PROVIDES MEDICAL ASSISTANCE PROGRAM CLIENTS Eligibility Response THE ABILITY TO SEARCH FOR ENROLLED HEALTHCARE PROVIDERS IN THEIR AREA CONNPACE CLIENTS CAN ACCESS ENROLLMENT Reference Guide AND REENROLLMENT INFORMATION AT THIS SITE ALSO Fl Rx Conn ACT f Information Provider Trading Partner ConnPACE Pharmacy m 1 866 604 3470 alternate TTY TDD line Provider Services Provider Search Provider Assistance Center m
28. T interChange MMIS 87 Information e Provider Bulletins Publications mailed to relevant provider types specialties documenting changes or updates to the CT Medical Assistance Program Bulletin Search allows you to search for specific bulletins by year number or title as well as for all bulletins relevant to your provider type The online database of bulletins goes back to the year 2000 Bulletin Search Number Title Search Results Bulletin Humber Title Published Date PB11 67 Important NCPDP D 0 and HIPAA 5010 Cutover Date Schedule 07 27 2011 PB11 62 July 1 2011 Changes to the Connecticut Medicaid Preferred Drug List PDL 06 28 2011 PB11 52 Reminder About the 5 day Emergency Supply 06 28 2011 PB11 62 Billing Clarification for Brand Name Medications on the Preferred Drug List PDL 06 28 2011 PB11 61 Changes to the Dental Fee Schedule and Program Limitations 06 28 2011 PB11 60 HIPAA 5010 Implementation of Provider Electronic Solutions Software 06 23 2011 PB11 57 Presumptive Eligibility Certification and Guarantee of Payment Form W 538 06 16 7011 PB11 55 Electronic Claims Submission Web Remittance Advice Check EFT and 835 Schedule 06 14 2011 PB11 45 Inmate Inpatient Hospital Coverage Delayed 06 13 2011 PB11 45 Termination of Medicaid Eligibility for Certain Non Citizens 06 30 2011 PBi11 42 Clarification on the requirements for pre screening client s eligibility for ort 05 23 2011 PB11 41 Updated Procedure
29. TMAP regulations for provider participation Chapter 3 Provider Enrollment e Provides information on provider eligibility in regards to provider enrollment and re enrollment as well as specific program enrollment information for the various state offered health care programs Chapter 4 Client Eligibility e Provides information regarding client eligibility in the Medical Assistance Program client eligibility verification and client third party liability CT interChange MMIS 1 90 E Information Chapter 5 Claim Submission Information e Provides information on general claims processing and billing requirements Chapter EDI Options e Provides information on electronic claim submission and electronic RAs Chapter 7 Regulations Program Policy e This section contains the Medical Services Policy sections that pertain to the chosen provider type Chapter 8 Billing Instructions e Provides information on provider specific billing requirements and instructions Chapter 9 Prior Authorization e Provides information on how to obtain Prior Authorization for designated services CT interChange MMIS 91 4 Information Chapter 10 Web Portal Automated Voice Response System AVRS e Provides information on the self service features available to the provider from both the AVRS and the Web Portal functions of interChange This serves as a standalone self service manua
30. action ASC X12N 270 271 Eligibility Benefit Inquiry Response Transaction ASC X12N 276 277 Claim Inquiry Response Transaction ASC X12N 278 Healthcare Services Review Requested for Review and Response ASC X12N 997 Functional Acknowledgement CT interChange MMIS 104 Information Frequently Asked Questions HP and DSS have compiled a list of common HIPAA related questions and answers y Asked Questions Q Ive submitted my transactions but have not received a 997 functional acknowledgement A This can in the following situations wm The correct trading partner ID is not included on the ISA or GS records a You have submitted transactions for which you are not authorized based on your trading partner agreement The website is slow due to the high volume of transactions being submitted Q Why is the date on my 835 Remittance Advice RA different than my paper RA What date should I use if I have questions or concerns A The paper RA displays the date the check was issued The electronic RA displays the date the file was created Providers should use the date indicated on the paper RA Q How do I print the report before transmitting A Choose Form Status and click on Ready For an individual client claim go into provider type highlight the client click For a detailed claim go to Reports Detail Forms Q Can providers assign more than one account number per client A The account number can be change
31. add additional clerks reset an existing clerk s password or to alter clerks Assigned Roles CT interChange MMIS SII 24 s Clerk Maintenance When a new clerk logs into the secure site for the first time they will be required to change their password from the one created by the account administrator e Fill in the fields with the appropriate information Change Password UserID JUANMARTINE4 Current Password eeeeeses New Password eeeeeeeees Confirm Password s eeeeeeeees New EMail juan_martinez doedental com Confirm New EMail juan_martinez doedental com pepe p Please correct the following errors We are sorry but your password has expired Please change your password e Click change password The clerk is now ready to perform the job duties allowed under the Assigned Roles chosen by the account administrator CT interChange MMIS 1 25 s Clerk Maintenance Once a clerk is signed in they can update their information by selecting account maintenance trom either the Account submenu or the Account drop down menu Fill in the appropriate information Account Maintenance User Profile User ID Contact First Name Contact Last Name Phone Number EMail Confirm EMail ist Secret Question 1st Answer 2nd Secret Question 2nd Answer AVR ID e Click Save JUAMMARTIMEZ Juan Martinez 800 555 5555 1234 juan_martinez doedental com juan_martinez doedent
32. al com Highschool mascot Knight Favorite pro sports team Cardinals 111111113 CT interChange MMIS 1 26 Clerk Maintenance e f multiple providers create clerk accounts using an identical clerk User ID the clerk in question will have the ability to switch back and forth between submitting online transactions for those providers To switch between providers select switch provider trom either the Account submenu or the Account drop down menu Switch Provider Default Provider Trading Partner Provider ID Provider AVRS ID Provider Type Address City State Zip Zip 4 Trading Partner 15 MAIN STREET WILLIMANTIC CT 06226 1948 iv 47 CRESCENT STREET WILLIMANTIC CT 06226 3606 Select row above to update Current Provider Trading Partner 1234567890 NPI Provider Trading Partner ID 1234567890 MPI 1234567890 NPI 123456 Dentist 1122334450 NPI 111222 Clinic Address 15 MAIN STREET Provider AVRS ID 123456 City WILLIMANTIC Provider Type Dentist State CT Default Provider Trading Partner M Zip 06226 1948 Select the line of the provider you wish to switch to click switch to A window will appear asking you to verity the switch click OK CT interChange MMIS 27 Clerk Maintenance To delete a clerk account select that account from the list of existing clerks and click on rem ove clerk A window will appear asking to you verity that you want to mark that clerk account for deletion Clic
33. am Attention Providers Subset of HIPAA 837 Institutional Version 5010 Production Claims Not Crossing Over Hospital interchange Issues Updated as of 7 15 2011 Pharmacy Information Revised Provider Manual Chapters Updated 6 30 2011 Connecticut Behavioral Health Provider CT BHP Rate Increase Package Interim Payment Adjustment r Pharmacy Home CT gov Home SiteMap AboutUs Feedback CT interChange MMIS 1 5 Web Account Set Up Secure Your Web Access to www CTDSSMAP com Ensure access to the Web portal to utilize the self service features of interChange f your office company has security measures blocking your access you will need to contact the individual responsible for your firewall and internet permissions and request access to the Connecticut Medical Assistance Program CTMAP Web site CT interChange MMIS 1 6 Web Account Set Up e Setting Up your Secure Site Account Select Secure Site trom either the Provider panel on the left or the Provider drop down menu Click setup account Home Information Provider Trading Partner ConnPACE If you have received your Personal Identification Number click on the setup account button Information Provider Enrollment Provider Enrollment Tracking m Publications m Links Provider Matrix O om Provider Services a anne An User ID a Provider Search m Regional Offic Password Drug Search EF login Provider Provider Fee
34. ation e Claims for certain services and procedures require that a Prior Authorization PA be obtained betore the service is rendered in order for the provider to receive reimbursement Prior authorization forms are located on the CTDSSMAP com Web site Go to Information gt Publications gt Authorization Certification Forms e PA forms are currently submitted to HP for scanning and submission for clinical review by Community Health Network of Connecticut CHNCT n the future authorization requests will be submitted directly to CHNCT for processing Providers will be notified in advance when the required destination of PA requests will change e The HP fax number for PA submission depends upon the type of authorization being requested refer to the form for the correct fax number Services that require authorization are identified as such on the Provider Fee Schedule Go to Provider gt Provider Fee Schedule Download CT interChange MMIS 1 1 55 E CIDSSMAP com Web Portal Overview Section 1 5 WEB CLAIM INQUIRY SUBMISSION CT interChange MMIS 1 56 Web Claim Inquiry To search or submit claims to HP using the CTDSSMAP com secure site click on the Claims tab on the main menu Home Information Provider Trading Partner ConnPACE Pharmacy Information Claims Eligibility Prior Authorization Trade Files MAPIR Messages Account Enter enough information to satisfy at least one of the following criter
35. ccount click add clerk e Fill in the fields with the appropriate information Clerk Maintenance User ID Contact First Name Contact Last Name MARCUSWILLIAMS JENNIFERSMITH Jennifer Smith JUANMARTIMEZ Juan Martinez TOMJOHNSON Tommy Johnson Type data below for new record User ID MARCUSWILLIAMS Contact First Name Marcus Contact Last Name Wiliams Phone Number 860 555 5555 1234 Password eeseese Confirm Password eeesees AVR ID 111111114 AVR Pin eese Confirm AVR Pin eees Assigned Roles Available Roles Claim Inquiry Submission Adjustment Clerk Roles Internet Only PA Inquiry Submission Client Eligibility Verification Trade Files e Click subm if CT interChange MMIS 23 Clerk Maintenance e The new clerk account has been added The following messages were generated Message Description Panel Clerk Maintenance Save was Successful Clerk Maintenance Clerk Maintenance User ID Contact First Name Contact Last Name JANESMITH Jane smith JUANMARTINEZ Juan Martinez MARCUSWILLIAMS Marcus Williams TOMJOHNSON Tommy Johnson Type changes below Preset password User ID MARCUSWILLIAMS Contact First Name Marcus Contact Last Name Williams Phone Number 800 555 5555 Assigned Roles Available Roles Claim Inquiry Submission Adjustment Clerk Roles Internet Only PA Inquiry Submission Client Eligibility Verification Trade Files Return to the Clerk Maintenance menu to
36. ce advice Some banner announcements are provider specific and therefore are only sent to the relevant provider types specialties Often published in regards to reprocessed claims explaining the reasons behind the reprocessing as well as the claim types affected RA Banner Announcement Banner Effective Banner Page Announcement Date Attention Connecticut Home Care CHC Access Agencies REPROCESSED THIS CYCLE HP previously identified a Atea subset of Connecticut Home Care claims that paid S WE _ between March 1 2008 and January 30 2009 but did not 07 22 2011 Sil siiis Jeh mass adjust as the rate increases had not been entered 07 29 2011 Care CHC Access The rates have since been updated and the claims have been reprocessed and will appear on the July 26 2011 Agencies Remittance Advice RA with an Internal Control Number ICN beginning with a region 55 CT interChange MMIS 86 Information A majority of the information available on the CTDSSMAP com Web site is located on the Publications page Access the Publications page by selecting Publications trom either the Information box on the lett hand side of the home page or from the Information drop down menu Information Home Information Provider Trading Partner ConnPACE Pharmacy Information honi Publications u Important Information Info Links m RA Banner Announcements HIPAA 8 m Regional Office Locations C
37. ce the claim is retrieved make any necessary changes to the claim Click the re su bm it button at the bottom of the claim page The claim will process immediately and return a status of Paid Denied or Suspended CT interChange MMIS 71 CTDSSMAP com Web Portal Overview Section 1 6 REMITTANCE ADVICE CT interChange MMIS VI 72 Remittance Advice All claims processed by HP are reported to the provider on a bi monthly Remittance Advice RA RAs provide comprehensive information about claims that are paid denied in process and adjusted and are produced based on a provider s claim activity Providers receive RAs electronically via the secure Provider Web site at www CIDSSMAP com Available in either the ASC X12N 835 Payment Advice standard transaction format or in the Portable Document Format PDF which provides the paper version of the RA Only the last 10 RAs are maintained on the HP Web site it is highly recommended that providers save a copy of their RAs to their local computer system for future access Quick Link e Click Download Remittance Advice trom the m Quick Link box on account home screen LE emn CT interChange MMIS If 73 Remittance Advice The PDF version of the RA is also available and can be accessed by selecting Download trom the Trade Files drop down menu Authorization Trade Files MAPIR Messages teed demographic it e Select Re
38. d for each claim but only one account number can be entered per claim Glossary Of Terms CT interChange MMIS ff 105 Information e CTMAP fee schedules are available for download from the Web site Select Provider Fee Schedule Download trom the Provider drop down menu Provider Trading Partner ConnPACE Provider Enrollment Provider Enrollment Tracking Provider Matrix Provider Services Drug Search Provider Fee Schedule Download You must read and accept the End User License Agreement prior to downloading the fee schedule click Accept Provider Fee Schedules are listed by provider type and in some cases specialty Click the corresponding link to download the appropriate fee schedule CT interChange MMIS 106 Provider Fee Schedule Download Acquired Brain Injury CSV Air Ambulance CSV Alcohol Treatment CSV Audiology CSV Basic Advanced Transportation CSV Behavioral Health Partnership PDF Chiropractor CSV Clinic Ambulatory Surgical Center CSV Clinic Dialysis CSV Clinic Family Planning Abortion CSV Clinic Medical CSV Clinic Mental Health CSV Clinic Rehabilitation CSV Clinic Substance Abuse CSV Critical Helicopter CSV CT Home Care CSV Dental PDF CSV Home Health PDF Hospice CSV Independent Radiology CSV Lab CSV MEDS DME CSV MEDS Hearing Aid Prosthetic Eye CSV MEDS Medical Surgical Supplies CSV MEDS MISC PDF MEDS Parenteral Enteral CSV ME
39. d the previous claim did not deny for timely filing CT interChange MMIS 1 50 E Claim Processing Submission Information Timely Filing Guidelines Claims through CT Behavioral Health Partnership CTBHP must be submitted within 120 days of the actual date of service EOB 555 Claim is past behavioral health timely filing guidelines is bypassed if e Original claim Detail through date s of service on the claim is within 120 days prior to the ICN Julian date e Claim History Adjudicated claim for same Client Provider Billed Amount detail From and Through dates of service and RCC or RCC Procedure code where the ICN Julian date on the current claim is less than or equal to 120 days from the previous claim s Remittance Advice date and the previous claim did not deny for timely filing Nursing home providers have one year from the Pay Start date it authorization was added after the through date of service CT interChange MMIS 51 d Claim Processing Submission Information Medicare Coinsurance and or Deductible Claim Submission Claims for clients covered under Medicare must first be billed to Medicare Crossover claims are claims that Medicare has considered and made payment on Only claims paid by Medicare will be electronically submitted to Medicaid Crossover claims trom Medicare will be denied if TPL information is on the client s eligibility file Claims that do not cro
40. e discussed in the Guide chapter 1 1 0226 Referring Provider Name Number is Missing 11 1 Introduction 0512 Claim Exceeds Timely Filing Limit 11 2 Determining Other Coverage 0513 Client s Name and Number Disagree 0550 Electronic Adjustment is Invalid 0570 Header Total Days Less Than Covered Days 0572 Quantity Disagrees with Days Elapsed ADA Dental Claim Form 0813 Claim Denied After Medical Policy Review Provider Electronic Solutions PES Software 11 3 Private Insurance as Primary 11 4 Billing Instructions Other Ins Payment 0818 Invalid Processor Control Number Web Claim 0861 NDC is Missing ASC X12N 837 D Health Care Claim 1927 Billing Providers NPI is Missing or Invalid 11 5 Billing Instructions Other Ins Denial 2002 Client Ineligible for Dates of Service 11 6 Billing Instructions Multiple Other Ins 2504 Bill Private Carrier First 11 7 Timely Filing Rules 2509 Bill Medicare First 2516 Claim Adjustment Reason Code is Invalid 3004 Inpatient Claim Requires Prior Authorization CT interChange MMIS 1 99 A Information e Forms Authorization Certification Claim and Adjustment Hospice Provider Enrollment Maintenance Provider Workshop Invitation Third Party Liability Well Care Exam EPSDT Other Forms Auth palaces bey cation Forms 4 CT interChange MMIS 100 Information Provider Newsletters Quarterly publications to providers on a wide range
41. e providers interested in the CT Medicaid EHR Incentive Program Connecticut began accepting registrations in July of 2011 For further information please go to www ctdssmap com under Provider gt EHR Incentive Program You may also contact us via a toll tree Provider Assistance line or email address with any questions e 1 855 313 6638 e ctmedicaid ehr hp com CT interChange MMIS L 1 110 Available Resources Section 3 2 CONTACTS CT interChange MMIS 111 Contacts HP Provider Assistance Center PAC Monday through Friday 8 00 AM 5 00 PM EST excluding holidays 1 800 842 8440 toll tree HP Pharmacy Prior Authorization Assistance Center PPAAC n the office Monday through Friday 7 00 AM 9 00 PM EST and Saturday 9 00 AM 4 00 PM EST on call service available outside of office hours 1 866 409 8386 toll free HP Electronic Data Interchange EDI Help Desk Monday through Friday 8 a m to 5 p m EST excluding holidays 1 800 688 0503 toll free CHNCT Provider Relations prior authorizations Monday through Friday 9 a m to 7 p m EST 1 800 440 5071 toll free e www CTDSSMAP com e CTDSSMAP ProviderEmail hp com CT interChange MMIS ff 112 Wrap Up Section 3 3 QUESTIONS amp COMMENTS 1 113 Questions Q Comments Thank You For Attending the CT interChange MMIS New Provider Workshop Training All questions and comments regarding
42. e secure site click on the Eligibility tab on the main menu Home Information Provider Trading Partner ConnPACE Pharmacy Information Claims Eligibility Prior Authorization Trade Files MAPIR Messages Account Enter enough client data to satisty at least one of the valid search combinations and then click search Valid Search Combinations m Client ID S5N m Client ID Birth Date m Birth Date SSN m Full Name SSW m Full Name Birth Date Eligibility Response Quick Reference Guide Eligibility Verification Request Client ID last name DOE From DOS 09 01 2010 SSN 666 55 4444 First Name MI JOHN To DOS 09 30 2010 Birth Date BUM NEAN e When entering a client s full name as part of your search criteria a middle initial is required if one is present in their CTMAP profile CT interChange MMIS 31 s Eligibility Veritication The Eligibility Verification Response window appears with the results of your search Eligibility Verification Response Verification Number 1120900005 Cannot validate eligibility for dates older than 1 yea tert PT ce Cannot validate eligibility for dates older than 1 year n this specific case the client s eligibility cannot be verified for the requested dates Sept 1 30 2010 Eligibility verification can only look as far back as one year Changing the dates of the eligibility request to within the allowable one year window nets a different result I
43. e status of an enrollment re enrollment application select Enrollment Tracking Search trom either the Provider submenu or the Provider Trading Partner ConnPACE Provider dropdown menu Home Information Trading Partner ConnPACE Pharmacy Information Provider Enrollment home provider enrollment Bug ilies ie provider matrix id Enter your ATN and Business OR Last Name and click search ATM 305929 Business OR Last Name SMITH n this example HP is reviewing the application that was submitted by Jonathan Q Smith on January 23 2012 Search Results Date ATH Name Received Status 01 23 2012 HP Reviewing Submitted Applctn 3059298 SMITH JONATHAN Q CT interChange MMIS 83 Available Resources Section 2 INFORMATION CT interChange MMIS 84 Information www CTDSSMAP com contains a wealth of information for providers m portant Messages Available on the home page Also available on the Information page Contains urgent messages that require immediate communication to the provider community as well as links to important information regarding recent upcoming system changes CT interChange MMIS 85 Information RA Banner Announcements Available by selecting the nformation tab or clicking on RA Banner Announcements in the Information box on the left hand side of the home page Messages originally published for providers on the first page of their remittan
44. eb Claim Inquiry Diagnosis Lists diagnosis codes submitted on the claim Diag Sea Dia i Descrinti Other 4 01003 PRIM TB COMPLEX MICRO DX Other 5 0088 INTESTINAL INF DUE OTH ORGANISM NEC Other 6 Other 7 Code Set ICD 9 Principal Search Other 1 Search Other 2 Search Other 3 Search e Claim Status Information Provides important claim status and reimbursement information Claim Status Information Claim Status PAID Claim ICN 2011150050007 Paid Date 06 06 2011 Paid Amount 5182 00 CT interChange MMIS 1 64 Web Claim Inquiry FOB Explanation of Benefits Codes posted to claims to provide a brief explanation of the reason why claims were either suspended or denied The EOB codes are also used to explain any discrepancies between amounts billed and amounts paid on paid claims EOB Information Detail Humber Code 1802 0619 1912 0621 9996 H O O O G CT interChange MMIS 65 Description TYPE OF BILL IS INVALID FOR THE PROVIDER ZIP CODE I5 NOT A VALID 9 DIGIT ZIP CODE BILLING PROVIDER S TAXONOMY IS MISSING BILLING PROV ENTITY TYPE QUALIFIER TO PROV TYPE SPECIALTY MISMATCH REFER TO HEADER EOB Web Claim Inquiry What can I do with these claims Paid claims allow you to Cancel any alterations you have made Adjust the claim void Void the claim Copy the claim and use it as a template to create a new claim Create a new claim from scratch
45. eed pleseed pleseed pleseed pleseed Samantha Johnson Samantha Johnson Rebecca D 5 Johnny Q Ap Johnny Q Ap Johnny Q Ap Johnny Q Ap Rebecca D 5 mith pleseed pleseed pleseed pleseed mith Samantha Johnson Samantha Johnson Rebecca D 5 mith Prescription No FOOS 03 01 2011 05 01 2011 06 01 2011 06 01 2011 06 01 2011 06 01 2011 06 01 2011 05 02 2011 04 01 2011 04 01 2011 05 01 2011 06 01 2011 04 01 2011 06 01 2011 05 02 2011 03 20 2011 03 02 2011 03 02 2011 04 01 2011 TDOS 03 01 2011 05 01 2011 06 01 2011 06 01 2011 06 01 2011 06 01 2011 06 01 2011 05 02 2011 04 01 2011 04 01 2011 05 01 2011 06 01 2011 05 01 2011 06 01 2011 05 02 2011 03 20 2011 03 02 2011 03 02 2011 05 01 2011 Claim Type Dental Claims Dental Claims Dental Claims Dental Claims Dental Claims Dental Claims Dental Claims Dental Claims Dental Claims Dental Claims Dental Claims Dental Claims Dental Claims Dental Claims Dental Claims Dental Claims Dental Claims Dental Claims Status Denied Paid Paid Paid Denied Denied Denied Denied Denied Denied Denied Paid Paid Paid Paid Paid Paid Paid Date Paid 06 24 2011 06 24 2011 06 24 2011 06 24 2011 06 24 2011 06 24 2011 06 24 2011 06 24 2011 06 24 2011 06 24 2011 06 24 2011 06 24 2011 06 18 2011 06 08 2011 05 25 2011 05 25 2011 04 20 2011 04 20 2011 Professional Claims Suspended 0 CT interChange MMIS 58 A
46. han the Medicare paid amount Waiver e Provides coverage for non medical services Eligibility requirements vary by waiver CT interChange MMIS Vf 42 E CIDSSMAP com Web Portal Overview Section 1 4 CLAIM PROCESSING SUBMISSION INFORMATION ap Claim Processing Submission Information Claims for services rendered to CMAP clients may be submitted in a variety of ways Internet Web site at www ctdssmap com Software utilizing the following HIPAA ASC X12N transactions e 837D Health Care Claim Dental e 8371 Health Care Claim Institutional e 837P Health Care Claim Professional Point of Sale POS Paper UB 04 Claim Form ADA 2006 Dental Claim Form CMS 1500 Claim Form NCPDP Universal Pharmacy Claim Form e The HP mailing address for claims submission depends upon claim type e Appropriate addresses are in Chapter 1 of the CMAP Provider Manual CT interChange MMIS SII 44 A Claim Processing Submission Information When a claim processes through the Connecticut interChange system it is subject to a series of edits that check the validity of claim data such as The submitted Provider must be actively enrolled on the date of service Client must be eligible on date of service Procedure Code submitted must be valid for the Provider Type Each claim then passes through a series of audits The claim is compared to previously paid claims e Is the current claim a duplicate
47. ia Enter the ICN the TCN the From and Through Dates of Service the From and Through Dates of Payment Prescription No or check the Pending Claims box Claim Search 1234567890NPI ICN Client ID Claim Type TCN Status FDOS FDate Paid TDOS TDate Paid Prescription Mo Pharmacy Only Pending Claims Exclude Adjusted Claims Records 0 e Click search CT interChange MMIS 57 Web Claim Inquiry e Search Results When more than one claim matches the claim inquiry search criteria a list of claims will appear in the Search Results panel Search results may be sorted by clicking on the column headings Click anywhere on a given row to select the claim to view Search Results ICH 22111 2050004 2211173050028 2211172050018 2211172050016 2211172050023 2211172050017 2211172050014 2211172050025 2211172050002 2211172050010 2211173050027 2211172050019 2211167050001 2011157050004 2011143050004 2011143050008 2011105050003 2011105050001 2211167600009 Client ID OXXXXXxx 0XXxxxxx 0xxxxxxx DXxxxxxxx Xxxxxxxx xXXXXxxxx XXXXxxx XXXXXXX XXXXXXX xxxxxxx 0Xxxxxxxx O 0XXxxxxx 0Xxxxxxxx 0xxxxxxx 0xxxxxxx XXXXXXx XXXXXXxx XXXXXXXx XxXXXxxx Client Name Johnny Q Ap Johnny Q Ap Johnny Q Ap Johnny Q Ap Johnny Q Ap Johnny Q Ap Johnny Q Ap Johnny Q Ap pleseed pleseed pleseed ples
48. k OK Windows Internet Explorer 1 J Are you sure this is the row you want marked for deletion Clerk Maintenance User ID Contact First Name Contact Last Name D JANESMITH Jane Smith JUANMARTINEZ Juan Martinez MARCUSWILLIAMS Marcus Williams TOMIQHNSON Tommy Johnson e Click Subm if to finalize the clerk account removal The following messages were generated Message Description Clerk Maintenance Save was Successful Clerk Maintenance User ID Contact First Name Contact Last Name JUANMARTINE Juan MARCUSWILLLAMS Marcus Williams Panel Field Row Clerk Maintenance TOMIOHNSON Tommy Johnson l CT interChange MMIS 28 CIDSSMAP com Web Portal Overview Section 1 3 ELIGIBILITY VERIFICATION CT interChange MMIS 29 Eligibility Veritication e DSS recommends that providers verity a client s eligibility on the date of service prior to performing said service Eligibility can change at any time Eligibility verification can be performed in the following ways Internet Web site at www ctdssmap com Automated Voice Response System AVRS Point of Sale POS Device Vendor software utilizing the ASC X12N 270 271 Health Care Eligibility Benefit Inquiry and Information Response transaction Via e Prescribing using Surescripts and the ASC X12N 270 271 transaction CT interChange MMIS 1 30 Eligibility Veritication e To verity a CTMAP client s eligibility through th
49. l that describes the comprehensive features available to the provider such as claims inquiry submission prior authorization inquiry Web enrollment and re enrollment etc Chapter 11 Other Insurance Medicare Billing Guides e Provides claim type specific information on other insurance and Medicare billing Chapter 12 Claim Resolution Guide e Provides descriptions of the most common claim errors and if applicable information to resolve the error conditions ap CT interChange MMIS 92 Provider Manual Table of Contents Chapter 1 Introduction Chapter 2 Provider Participation Policy 1 1 Overview 2 1 Overview 1 2 Organization of Manual 2 2 Requirements for Provider Enrollment About the Provider Manual 1 3 CTMAP Overview Connecticut Medical Assistance Program Responsibilities 1 4 HP Directory HP Telephone Numbers HP Mailing Addresses 1 5 DSS Directory DSS Addresses DSS Phone Numbers 1 6 CTMAP Provider Research Request Scope Definitions Provider Participation Termination or Suspension of Agreement General Provider Requirements Needs for Goods or Services Prior Authorization Billing Procedures Payment Rates Payment Limitations Payment for Out of State Goods or Services Paid in excess of the authorized schedules of payment or for other reasons of ineligibility for payment CT interChange MMIS 93 Provider Manual Table of Contents Chapter 3 Enrollment Re enro
50. lementation guides for new transaction sets CT interChange MMIS ff 102 Information Information regarding the recent implementation of HIPAA 5010 Transaction and Code Sets is located on the CTDSSMAP com Web site on the HIPAA page Access the HIPAA page by selecting H PAA trom either the Information box on the left hand side of the home page or from the Information drop down menu Information T Home Information Provider Trading Partner ConnPACE Pharmacy Information u Publications m Links l hon Publications m Important Information ini nnouncements Info Links CT interChange MMIS ff 103 Information HIPAA Mandated Transactions Lists the HIPAA transaction types utilized by DSS and HP Provides links to documents that explain the updates mandated by the implementation of version 5010 HIPAA Mandated Transactions New HIPAA 5010 Version Updates m ASC X12M 270 271 Eligibility Benefit Ingui Response Transaction m NCPDP D O Transaction HIPAA transactions that DSS and HP utilize for the Connecticut Medical Assistance Program are the ASC X12N 837 Health Care Claim Institutional Transaction for inpatient outpatient home health Part A crossover and Part B of A crossover claims ASC X12M 837 Health Care Claim Professional for professional and Part B crossover claims ASC X12N 837 Health Care Claim Dental ASC X12N 835 Health Care Claim Payment Advice for all claim types NCPDP 5 1 Trans
51. llment 3 1 Overview Enrollment Re enrollment Responsibilities 3 2 Taxonomies Provider Type Specialties 3 3 In State Enrollment Re enrollment Program Information 3 4 Re enrollment Periods 3 5 Out of State Enrollment Program Information Out of State Enrollment Process 3 6 Provider File Maintenance 3 7 Specific Program Enrollment Information ConnPACE Chapter 4 Client Eligibility 4 1 Overview 4 2 CONNECT Charter Oak ConnPACE Cards 4 3 Automated Eligibility Verification System Eligibility Dispute Resolution Manuals and Additional Information 4 4 Internet Web Portal Eligibility Client Eligibility Verification Secure Provider Web Site Portal 4 5 AVRS Eligibility Verification Global Message Special Function Keys General Instructions Voice Response AVRS Telephone 4 6 Availability of AEVS and Pharmacy Point of Sale POS System 4 7 Client TPL Update Procedures Instructions on Completing the TPL Information Form CT interChange MMIS 94 Provider Manual Table of Contents Chapter 5 continued 5 9 Provider RA and Electronic Funds Transfer Chapter 5 Claim Sub Information 5 1 Overview 5 2 Paid Claim Adjustment Request 5 3 Instructions and Form for TPL Legal Notice of Subrogation Request for Assistance in Obtaining Payments Under 38a 472 of the CT General Statues 5 4 Client TPL Update Procedures 5 5 Return to Provider Letter 5 6 Timely Filing Guidelines Claim Requirements E
52. lth HITECH Act of the American Recovery amp Reinvestment Act of 2009 This program aims to transform the nation s health care system and improve the quality safety and efficiency of patient health care through the use of electronic health records EHR Incentive Program Eligibility The following eligible professionals and hospitals may participate in the EHR incentive program Eligible Professionals Physicians Nurse practitioners Certified nurse midwives e Dentists Physician assistants who are working in a Federally Qualified Health Center FQHC or Rural Health Clinic RHC that is led by a physician assistant Eligible Hospitals Acute care hospitals including critical access hospitals and cancer hospitals Children s hospitals CT interChange MMIS ce evecare a 109 4 What s New in 2012 Incentive Payments Eligible Professionals Maximum incentives are 63 750 over six years First year payment is 21 250 if a provider adopts implements or upgrades certified EHR technology Incentive payments are the same regardless of the starting year Must begin by 2016 to receive incentive payments Incentive Payments Eligible Hospitals Hospital incentive payments are based on a formula provided in the statute that can be reviewed on the EHR Incentive Programs Hospitals page and the Medicaid Hospital Incentive Payment Calculations document on the CMS Web site www cms hhs gov For thos
53. mit Advice RA PDF trom the Transaction Type menu click Search File Download Search Transaction Tvpe Billing Reversal Claim Payment Advice Claim Status Response Providers and Tr Drug Rebate File Transfer the ASC X12N 83 S MM TA1 Eligibility J Eligibility Response Premium Paymer Enrollment Maintenance retained on the Functional Ack longer be avallal Interchange Ack REMINDER DO at all available download files including Remittance Advices RA in PDF format Advice Functional Acknowledgements 997 Interchange Acknowledgement esponse 277 Prior Authorization Response 278 Benefit Enrollment 834 ary format files excluding Drug Rebate files available for download will be ir a period of five 5 months at which time they will be removed and will no will be available to authorized users for a period of twelve 12 months at which time they PA Revers Ing Reg Only jer be available It is recommended all electronic files be downloaded when they become avapccM Reports vider or Trading Partner in an electronic format for easy storage and search access by such PDP MAPD Reports ation of Benefits EOB Codes Premium Payments Prior Authorization To receive summas NALE E S n submit a request to have them mailed to your current address You will need Transportation PA Files our computer to view and or download the request form CT interChange MMIS 74 All file retention e Cha
54. mount Billed 1 200 00 201 00 1 300 00 1 300 00 1 200 00 1 300 00 1 200 00 1 200 00 1 200 00 1 200 00 201 00 1 200 00 1 400 00 500 00 500 00 500 00 500 00 500 00 350 00 Amount Paid 0 00 104 00 511 52 711 52 0 00 0 00 0 00 0 00 0 00 0 00 0 00 611 52 10 00 162 00 182 00 182 00 182 00 182 00 0 00 Web Claim Inquiry Results searching by FDOS and TDOS no greater range than 93 days Claim Search 1234567890 NPI ICM Client ID Claim Type TCN Status FDOS 01 01 2011 FDate Paid TDOS 03 28 2011 TDate Paid ae OW Pending Claims Exclude Adjusted Claims D search Records 20 Search Results ICH Client ID Client Name Prescription No FDOS TDOS Claim Type Status Date Paid Amount Billed Amount Paid 2211172050004 QO0xxxxxxx Johnny Q Appleseed 03 01 2011 03 01 2011 Dental Claims Denied 06 24 2011 1 200 00 0 00 2011143050007 QO0xxxxxxx Johnny Q Appleseed 01 02 2011 01 02 2011 Dental Claims Denied 05 25 2011 500 00 0 00 2011143050008 O0xxxxxxx Johnny Q Appleseed 03 20 2011 03 20 2011 Dental Claims Paid 05 25 2011 500 00 182 00 2011105050003 O0xxxxxxx Johnny Q Appleseed 03 02 2011 03 02 2011 Dental Claims Paid 04 20 2011 500 00 182 00 2011105050001 dO0xxxxxxx Samantha Johnson 03 02 2011 03 02 2011 Dental Claims Paid 04 20 2011 500 00 182 00 5311104001039 O0xxxxxxx SamanthaJohnson 01 04 2011 01 04 2011 Dental Claims Paid 04 16 2011 500 00 182 00 2011098050
55. n this case the client was not eligible Eligibility Verification Request Client ID last name DOE From DOS 09 01 2011 55M 666 55 4444 First Name MI JOHN To DOS 09 01 2011 Birth Date Eligibility Verification Response gt Verification Number 1200500005 lt Client 000087958 Client is not eligible Response Text CT interChange MMIS a Eligibility Veritication Eligibility searches cannot span multiple months 11 1 2011 11 30 2011 is valid 11 30 2011 12 2 2011 is not Submitting a request that spans multiple months will result in the following error message Eligibility Verification Request Client ID last name DOE From DOS 11 30 2011 SS5M 666 55 4444 First Name MI JOHN To DOS 12 02 2011 Please correct the following errors verification requests must not span iple months Positive eligibility responses provide greater detail Eligibility Verification Request Client ID 009999999 last name SSN 111 929 9599 First Name MI Birth Date From DOS 01 11 2012 To DOS 01 22 2012 CT interChange MMIS IIs 33 Eligibility Verification Response Verification Number 1120900015 ERIT ITIGIUM Client is eligible Refer to Benefit Plan for specific program coverage A Client Information Client ID 009999999 Last Name THOMAS SSM 1111 99 9999 First Name MI THOMAS Birth Date 01 20 1997 Street 1 MAIN ST Gender M City State Zip TORRINGTON CT 06
56. nges to file retention schedules will be posted on this paae Remittance Advice e RAs consist of the following 7 sections Banner Page Important messages from DSS or HP Claims Information Paid Denied and Adjustments e Sorted by claim type and status reports up to 20 EOB codes per claim TPL Information e The primary insurance that is on file for clients whose services appear on the RA Financial Transactions Processed e Payouts Refunds Accounts Receivable RA Summary e Month to day and year to day summaries of financial activities accounts receivable EOB Code Descriptions e Descriptions of the EOB codes that affected claims on the RA Claims in Process e Lists claims that are in suspense CT interChange MMIS 75 Remittance Advice Examples Banner Page REPORT CR BANN E interchange MMIS Rig 5553305 MEDICAID MANAGEMENT INFORMATION SYSTEM 555 E E OLE E L NL ian PROVIDER BANNER MESSAGES JOHN DOE DENTAL 100 MAIN STREET SUITE 24 NEW HAVEN CT 06106 Attention ll Frowiders Tee URE IED NONE TERS TEES RERO ICI es ee Ie E E lel ec a E E E igvele were EE lalate clictelale gnele aces ertsem IW sic lee ate hes Seem jetcgieiejetel ine slide aee fet providers The purpose of this bulletin is to prowide information related to the celle telets BOE deum echt iobebealizs eeitie eeaL Lew wos DSS MeECLEAL sists ieinelaicl2 MEDEE SiS ENEE Weme Limra erret Dima dhad Ie AILI a PAYEE ID ISSU
57. ormation m Publications m Links m Important Information COME m RA Banner Announcements m HIPAA m Regional Office Locations TO THE Connecticut MEDICAL Assistance PRoGRAM Provider WELCOME TO THE CONNECTICUT MEDICAL ASSISTANCE PROGRAM WEB SITE PROVIDED BY HP ON BEHALF OF THE CONNECTICUT DEPARTMENT OF SOCIAL SERVICES THIS SITE PROVIDES IMPORTANT INFORMATION TO m Provider Services HEALTH CARE PROVIDERS ABOUT THE CONNECTICUT MEDICAL ASSISTANCE PROGRAM THIS SITE CONTAINS A WEALTH OF RESOURCES FOR PROVIDERS INCLUDING ENROLLMENT BILLING MANUALS BULLETINS PROGRAM a Provider Search REGULATIONS PLUS INFORMATION ON ELECTRONIC DATA INTERCHANGE AND THE AUTOMATED ELIGIBILITY VERIFICATION SYSTEM THE SITE ALSO PROVIDES MEDICAL ASSISTANCE PROGRAM CLIENTS THE ABILITY TO Provider Enrollment SEARCH FOR ENROLLED HEALTHCARE PROVIDERS IN THEIR AREA CONNPACE CLIENTS CAN ACCESS ENROLLMENT AND REENROLLMENT INFORMATION AT THIS SITE ALSO wm EHR Incentive Program m Secure Site ee t 5 q x E p gt Rx Trading Partner z g ConnpaCl a Trading Partner Enrollment Trading Partner Documents Information Provider Trading Partner ConnPACE Pharmacy m Provider Electronic Solutions Billing Instructions Important Messages r ConnPACE Welcome to the HIPAA 5010 Implementation Information Page Updated 8 3 2011 m ConnPACE Information a ConnPACE Enrollment Electronic Health Record EHR News Updated 8 3 2011 m CHOICES Progr
58. ppropriate spoken language from the drop down menu Enter an Effective and End Date f more than one language is spoken at your service address click add to select additional languages Service Language Language Effective Date End Date A HUNGARIAN 01 01 2010 12 31 2299 A ENGLISH 01 01 1900 12 31 2299 Type data below for new record Language ENGLISH I Effective Date 01 01 2010 End Date 12 31 2299 e Click save CT interChange MMIS 20 CTDSSMAP com Web Portal Overview Section 1 2 CLERK MAINTENANCE CT interChange MMIS 21 Clerk Maintenance e Clerk accounts grant Web access to staff members allowing them to pertorm functions based on their job responsibilities The local administrator is responsible for maintaining clerk accounts within their organization This includes adding clerks changing the role s for clerks removing clerks and resetting passwords Access the Clerk Maintenance section of the secure site by selecting clerk maintenance trom either the Account submenu or the Account drop down menu ims Eligibility Prior Authorization Trade Files MAPIR Messages Account fe during demographic maintenance reset password Account Home Account Setup Select row above to update or click Add button below Change Password Demographic Maintenance Reset Password Log Qut CT interChange MMIS 22 Clerk Maintenance To create a new clerk a
59. ption Global Messages Category Subject Message Date Date Date Notification Web Claim Submission is Here Web claim submission ts now 12 22 2009 12 22 2009 12 31 2299 Secure Mailbox No rows found CT interChange MMIS 12 Web Account Capabilities Accessing your secure site provider account allows you to Set Up clerk accounts to allow multiple users access to specified roles Check client eligibility via the Web Perform claim and prior authorization PA inquiries Create Submit Resubmit Adjust Void and Copy claims e Even those claims submitted through other means paper electronic Professional Dial e HIPAA 5010 compliant since March 201 1 Institutional Obtain your Remittance Advice RA Re enroll with the CT Medical Assistance Program Update your demographic information addresses bank accounts Retrieve E Messages sent by HP CT interChange MMIS 13 Web Account Capabilities e The CTDSSMAP com Web site features Online Field Help to assist providers with accessing and submitting information Placing your mouse cursor over a data field name will create a small question mark beside the cursor Initial Web User ID Personal Identification Number Ej Click the left mouse button when the question mark is displayed to open the Online Field Help window relevant to the selected field Online Field Help Windows Int t ise Initial Web User ID
60. r Manual Table of Contents Chapter 9 Prior Authorization Chapter 10 Web Portal AVRS 9 1 Overview 10 1 Overview 10 2 PAC Call Flow Chart 10 3 PAC Call Flow Manual 10 4 PPAAC Call Flow Manual 9 2 Professional and Miscellaneous 9 3 Hospital Inpatient Services 9 4 Chronic Disease Hospital Services 10 5 Web Portal Features 9 5 CT Behavioral Health Partnership TOt Poblicaionsand Services 9 6 Transportation Services 10 7 Provider Enrollment Re enrollment 9 7 CT Dental Health Partnership 10 8 Trading Partner Enrollment 10 9 Web Security Administration 10 10 Claims Submit Resubmit Adjust and Inquiry 10 11 Client Eligibility Verification 10 12 Prior Authorization 10 13 Trade Files 10 14 Provider Electronic Mail 10 15 Provider Demographic Maintenance 10 16 Pharmaceutical and Therapeutics P amp T Committee 10 17 Provider Search 10 18 Drug Search 10 19 Provider Fee Schedule Download 10 20 Provider Services 10 21 22 Help Troubleshooting CT interChange MMIS 98 9 8 Pharmacy Provider Manual Table of Contents Chapter 11 Other Insurance and Chapter 12 Claim Resolution Guide Medicare Billing Guides 12 1 Overview This chapter has three claim specific versions 12 2 Explanation of Benefit Codes Content will not be the same from one version to another Below is an example of the This is just a sample of the complete list of information contained in the Dental version of EOB codes that ar
61. ss over from Medicare or are denied by Medicare can be submitted by the provider to HP Claims submitted on paper do not need the EOMB Explanation of Medicare Benefits voucher attached if Medicare denied the service CT interChange MMIS Wtf 22 Claim Processing Submission Information e Medicare HMO Claims Providers are responsible for identitying Medicare HMO enrolled clients Providers must indicate Medicare HMO in the Insurance Plan field of the claim form Medicare HMO claims must be sent to HP P O Box 2911 Hartford CT 06104 Medicare HMO claims must include a valid Medicare HMO attachment unless Medicare HMO denied the services CT interChange MMIS 1 53 A Claim Processing Submission Information e Medicare Coinsurance and or Deductible Reimbursement Method of Medicaid reimbursement when Medicare is the primary payer e Medicaid will pay up to the Medicaid Allowed Amount minus any Medicare or private insurance payment e Medicaid will not pay if the Medicare payment is equal to or exceeds the Medicaid Allowed Amount A provider may not balance bill the client financially responsible relative or representative of the client Explanation of Medicare Benefits EOMB is required for Medicare and Medicare HMO paid claims and must include Provider Name Client Name Date of Service Billing Amount CT interChange MMIS 54 Claim Processing Submission Inform
62. ssful To have the fields automatically filled in with the information from an address already on file click se ect from list and then click on the address you would like to use Select Address For Change 4 Address 1 Address 2 City State Zip Zip 4 Phone Ext Fax MAIN STREET SUME 2A WILLIMANTI 06614 4008 203 555 5555 5555 203 555 5550 ETIN EHE CT interChange MMIS 1 18 Demographic Maintenance The EFT Account panel allows you to add and maintain bank accounts into which reimbursements from CTMAP will be electronically deposited Click add enter the appropriate information and click save This action will place the provider in a pre notitication status and the provider will once again receive a paper check until a successful pre notification EFT has been confirmed EFT Account X ABA Number Account Number Account Type EFT Status Effective Date End Date Last Change Date A 001111100 5555 123 45 777 Savings Active 08 01 2011 12 31 2299 08 05 2011 Type data below for new record ABA Number 001111100 Account Number 5555 123 45 777 Effective Date 08 01 2011 Account Type End Date 12 31 2299 EFT Status Active m Last Change Date 08 05 2011 Financial Institution Street 1 Street 2 City State Zip CT interChange MMIS 19 Demographic Maintenance The Language Spoken panel allows you to select the language s spoken at your service locations e Click add select the a
63. this training are welcome Please fill out the supplied workshop survey Your feedback helps us to improve future workshops
64. vices were submitted to HP As of 1 1 2012 claims for all services are billed to HP e HUSKY A Primary Care Provider clients have enrolled with a Primary Care Case Manager PCCM rather than an MCO eligible for all Medicaid services plus behavioral and support services through HP HUSKY B e Medical services obtained through MCO prior to 1 1 2012 Behavioral health dental FQHC and pharmacy claims were submitted to HP As of 1 1 2012 claims for all services are billed to HP HUSKY C previously referred to as Medicaid HUSKY D previously referred to as Medicaid for Low Income Adults MLIA CT interChange MMIS 41 E Eligibility Veritication Limited Behavioral Health Services e Intensive in home child and adolescent psychiatric services only Charter Oak e Medical services obtained through MCO prior to 1 1 2012 behavioral health services and pharmacy services submitted to HP As of 1 1 2012 claims for all services are billed to HP Connecticut AIDS Drug Assistance Program CADAP e Pharmacy benefits for FDA approved HIV AIDS medications and medications approved to prevent complications associated with HIV AIDS Drug coverage only under the ConnPACE Program e Pharmacy assistance for the Medicare ineligible elderly and disabled Medicare Covered Services Benefits are limited to the payment of Medicare coinsurance and deductible amounts if the Medicaid allowed amount is greater t
65. xceptions to the Timely Filing Limit 5 7 Medicare Coinsurance and or Deductible Claim Submission 5 8 Behavioral Health Services Claim Sub State Administered General Assistance Behavioral Health Services Connecticut Behavioral Health Partnership CT BHP Charter Oak Behavioral Health Services RA Layout Header and Banner Messages RA Inpatient Claims RA Home Health Claims RA CMS 1500 Claims RA Dental Claims RA Long Term Care Claims RA Drug Claims RA Medicare Crossover Part A Claims Financial Transactions Explanation of Benefit Code Descriptions TPL Information RA Summary RA Claims in Process Electronic Funds Transfer ETF 5 10 Carrier Code List 5 11 EPSDT Information EPSDT Billing Chart Immunization Tracking Codes CT interChange MMIS 95 Provider Manual Table of Contents Chapter 5 continued Chapter 6 EDI Options Periodicity Schedule 6 1 Overview Immunization Schedule 6 2 EDI Eligibility Verification Options F Anticipat i D M Well Care Exam Forms amp Anticipatory Guidance 6 3 Electronic Transmission Submission Options Recommendations for Anticipatory Guidance Broeaduras cmd Forms 5 12 Forms Examination Request for Medical Eligibility Determination Form W 513 W 300 W 300A W 538 6 9 EDI Unit Services 5 13 Forms Hysterectomy EDI Unit Form W 613 and W 613A EDI Trading Partner Agreement Form 6 4 Electronic Remittance Advice 5 1

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