CGI Ohio RAC Medicaid Update

Report
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CGI Ohio RAC Medicaid Update
June 2012
Agenda
• Similarities
to the ODJFS Medicare RAC Program
• Differences to the ODJFS Medicare RAC Program
• Medicaid RAC Operations
• Provider Assistance and Online Tools
•
Customer Service
• Ohio RAC Website
• Credit
Balance Reviews
• Open Question and Answer
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Similarities to the Medicare RAC Program
•
Execute an Education and Outreach program
• Provide Customer service via a toll-free telephone
number
• Compile and maintain provider-approved addresses and
points of contact
• Mandatory acceptance of provider submissions of
electronic medical records on CD/DVD or via facsimile
• Notification to providers of overpayment findings within
60 calendar days
• A five-year review period for provider claims
• A 45-day timeline to submit medical records to the RAC
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Differences to the Medicare RAC Program
• CGI
Federal will be responsible for the first two
levels of the appeals on overpayments with the CGI
Medical Director responsible for the second level of
appeal.
• Postage and copy fees are not paid by ODJFS or
CGI.
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Medicaid RAC Operations
Types of Reviews
•
ODJFS will approve CGI Federal-selected areas of review. CGI Federal will review for:
• Coverage Determinations
•
•
Be included as a covered service, as described in Ohio Administrative Code 5101:3
Be medically necessary, as defined in OAC 5101:3-1
•
Coding Determinations
• CGI Federal will perform both Automated and Complex reviews.
• Project scope is being modified to include Credit Balance Reviews.
Medical Record Submission
•
Medical Record submission standards will be posted on CGI’s Ohio Medicaid RAC Web
Portal.
Letters
•
CGI Federal will issue the following letters according to the program timelines:
• Medical Record Request Letter
• Review Results
• Demands
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Provider Assistance and Online Tools:
Customer Service
•
CGI’s existing Call Center Team will be servicing ODJFS
Medicaid RAC provider calls. Benefits of this approach
include:
•
Familiarity with the Ohio Provider community
• Existing knowledge of systems and processes
• Expedited training program
•
The CGI Ohio Medicaid Call Center hours of operation are
from 8:00 a.m. to 4:30 p.m.
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Provider Assistance and Online Tools:
Ohio RAC Website
•
CGI Federal has implemented a website for Providers,
similar to the CGI Medicare RAC Region B Web Portal.
• Providers can use the website to accomplish the following:
•
•
•
•
•
View audit findings
View audit status
Update contact information
View Medical Record Submission and Contact Information
View general program information
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Provider Assistance and Online Tools:
Ohio RAC Website (cont’d.)
•
The Ohio RAC website: http://odjfs.cgicleve.com
•
Providers authenticate by clicking on the Providers link and
entering their Provider Number, NPI or other information listed.
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Provider Assistance and Online Tools:
Ohio RAC Website (cont’d.)
•
A Bulletin Board is available for communicating important
updates to the Provider community.
•
Once authenticated to the website, click on the Home link to
view the Bulletin Board. Important information is located in the
What’s New box.
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Overview and Update: RAC B Website
Claim Status
•
Providers can view the status of their RAC cases from the
Claim Status link.
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Overview and Update: RAC B Website
Claim Status Details
•
Detailed information on cases is available from the Claim
Audit Details link.
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Overview and Update: RAC B Website
Address Maintenance
•
Providers can update their contact information.
•
Providers can only update contact information for addresses
entered for the logon identity.
• Click on the link in the ‘Provider Number’ column to open the
Address Maintenance.
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Credit Balance Reviews
•
Approval has been received by ODJFS to increase the scope
to include Credit Balance Reviews.
• CGI is currently working to get the necessary subcontractor
agreement in place to start this scope of work.
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Contact Information
Call Center for CGI Medicaid RAC
Ohio
Toll Free: 1-855-210-3438, Option 1
E-mail: [email protected]
Website: http://odjfs.cgicleve.com/
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Questions
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