Medicaid Webinar Ppt. 10-5-2010

Kathy Whitmire
HomeTown Health, LLC
From: Argartha Russell
Sent: Monday, August 08, 2011 3:29 PM
To: 'Kathy Whitmire'
Cc: Edwinlyn Heyward
Subject: Legacy Outlier Edit
Below is a banner notice that was posted today by HP on behalf of DCH. There have
been concerns raised by hospitals that they still have not gotten paid for
processed and paid inpatient claims that posted the ACS Outlier edit 4807. These
paid claims were not sent to GMCF after the HP transition in November 2010, for
the Outlier request.
Please share this notice with your hospital members (to get this message out quickly)
to send their old legacy inpatient claims to DCH. Thanks.
Argartha Russell, Director
GA Medicaid Division
Medical Policy Unit
(404) 657-9093
[email protected]
If your UB-04 paid claims had not been processed by
ACS as an outlier according to the procedures
outlined in Appendix L of the Hospital Services Policy
and Procedures Manual, please submit the following
documents to the Department for review:
◦ A written letter requesting an outlier review with a list of
each Transaction Control Number (TCN) that paid in the
legacy system but had never received the outlier payment;
◦ A copy of the ACS’ Remittance Advice (RA) attached to your
request that lists Edit 4807 for each TCN for outlier review;
◦ Supporting documentation that demonstrates that you had
requested an outlier review through ACS, e.g.,
correspondence tracking number, a cover letter addressed
to Georgia Medical Care Foundation (GMCF).
Send your written request letter and the above supporting
documents to the following address:
Customer Service & Resolution Unit
Department of Community Health
Division of Medicaid
2 Peachtree Street, N.W., 37th Floor
Atlanta, GA 30303-3159
DEPARTMENT OR TO HP at this time for these legacy paid
inpatient claims.
Upon receipt of the above documents a review will be conducted
to determine if your request is valid. You will be notified in
writing of the Department’s determination within 30 days.
CAH Specific
Claims denying for 3 day window
Error Code 5159
From: Edwinlyn Heyward [mailto:[email protected]]
Sent: Monday, September 12, 2011 6:18 PM
To: Kathy Whitmire
Subject: 72 Hour Rule Policy
My staff and I figured out the issue relating to CAH’s being exempt from the 72º rule. Medicare
requires all CAH to bill these claims on separate UBs. Section 906G in the hospital manual informs
the provider to combine these charges; there are no exceptions to this policy. When these claims
cross over, they are denying as possible dupe of a previously paid crossover claim. Possibly in
ACS because of the way we were paying cross over claims at that time, there is a strong possibility
that these claims paid. I’m not sure about that because I can’t find any old claims from ACS to
validate this. We have opened an issue for this so that HP can do their research and my staff and I
are pulling data to look at the budgetary impact if we allowed these claim when originally crossed
over to pay.
I hope this information sheds some light to the situation.
Edwinlyn R. Heyward
Customer Service & Resolution
Department of Community Health
Medicaid Division
2 Peachtree Street, N.W. 37th Floor
Atlanta, Georgia 30303-3159
404.657.5464 (Telephone)
Edit 3044 and 3003 - Provider Number does
not match prior authorization
Physical Therapy Issue to move to production
of final testing on Sept 15th – Edit 3044 and
3003 modification and then they will apply to
the universe.
Edit 3044 Mass Processing – Provider notice
will be posted to inform providers about mass
From: Kerry Elledge [mailto:[email protected]]
Sent: Wednesday, October 05, 2011 7:24 AM
To: Kathy Whitmire
Cc: Blair Elledge; Jimmy Lewis
Subject: RE: Quadax/HP meetinge
I am going to be sending an update out to HTH re: Medicaid progress by end
of week.
We are moving along, and based upon our
recommendations/discoveries/discussions, HP is working to reformat/map
ANSI codes appropriately and pull across data in a meaningful way for
posting capabilities. We have our third meeting with them next week and
continue to test things with them on behalf of our clients!
Kerry Elledge
Executive, Account Management
Quadax, Inc.
440.777.6305 ext. 2210 (office)
678.827.0670 (fax)
[email protected]
Begins November 9th with training and
checklists to ensure that all hospitals are
◦ Discuss Example of changes
 12 month ICD-10 Readiness Program will be
led by Sherry Milton, Coding & Documentation
Expert will begin in January
Medicaid & CHIP Redesign
The Georgia Department of Community Health (DCH) issued a
Request for Proposal for a comprehensive assessment and
recommended redesign of Georgia's Medicaid Program and
Children's Health Insurance Program (CHIP/PeachCare for
The redesign initiative will focus on solution planning,
innovation and strategic options for managing the care and
financing of Georgia's Medicaid and CHIP populations. On July
26, 2011, DCH awarded the consulting contract to Navigant
Consulting, Inc.
SAVANNAH – Oct 12th – First Meeting
 New Members – Elbert Memorial & Chatuge Regional
 New Partners – VendorMate and Data Rx – 340B for hospitals
 New DCH Commissioner Davis Cook confirms keynote at Fall
 Oct 12th – Medicare Monthly Webinar
 Oct 12th – Medicaid Redesign First Meeting – SAVANNAH
 Oct 13th – CNO – Case Mgr Workshop
 Oct 18th - Physicians’ Lunch and Learn – MU Series – Session 2
 Oct 19th – Interqual Cerme User Group Webinar
 Nov 9th, 30th, Dec 7th, 14th – Countdown to HIPAA 5010
 Nov 16th -18th – HTH Fall Conference
 Dec 12th -13th – HIPAA Compliance Officer Training
 Jan 19th – 20th – GA Rural HIT Conference - Macon
November 16 - 18 – Callaway Gardens
KEY NOTE SPEAKER: David Cook, Commissioner of the Dept of Community Health
DCH Medicaid – HP - CMO – Navigant Discussion
PANEL: Dr Jerry Dubberly, Medicaid Director and Cheryll Collier, HP
Georgia Redistricting Update - David Tatum, CHOA
A New Day in the Future of Health Care
SPEAKER: Kirk McGhee, Vice President and Regional Counsel for Kaiser Permanente
GA Health Information Exchange – GA-HITREC – Dr Denise Hines
Value Based Purchasing / ACO Discussion – Led by Michelle Madison, Attorney
Health Insurance Exchange – What Hospitals Need to do to Prepare - Ryan Teague
4 Requirements for Survival in 2012 and Beyond –
PANEL: Change -Sue Spivey, Technology- Brenda Jarrett, Leadership – Jeff Dunn,
Revenue Mgmt – Lynn Byrd

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