Cancer Services Program Direct Provider Payment webinar for CSP - PowerPoint PPT Presentation

Direct Provider Payment in the Cancer Services Program Direct Provider Payment webinar for CSP August 2018 1

Agenda/Topics To Be Covered ● Introduction to Direct Provider Payment (DPP) ● DPP Process for: o State-funded clinical services o Federally-funded (HRI) clinical services ● Provider payment inquiries ● Responsibilities of: o NYS Department of Health (“Department”) o contractors o providers Direct Provider Payment webinar for CSP August 2018 2

Direct Provider Payment Direct Provider Payment webinar for CSP August 2018 3

Beginning 10/1/18, services provided to eligible clients by CSP participating providers will be reimbursed directly by the State and HRI Depending on service(s) provided, CSP-participating providers may receive two separate payments (State and HRI) each month • The Department and HRI will use the Monthly Billing Report (MBR) for October 2018, and all future MBRs, to reimburse providers directly. o Services that occurred before, but are not reported until after, October 1, 2018 will be reimbursed via the Direct Pay Process (DPP). • Regardless of funding source (State or Federal), the DPP will reimburse the global (professional and technical) payment directly to the one site code reported. Direct Provider Payment webinar for CSP August 2018 4

5 The mechanism, and therefore the process, for providers to be reimbursed for State- and HRI-funded services via the DPP is different. State: HRI: reimbursement via the State reimburses providers Financial System (SFS) - NYS via check government’s accounting and financial management system Direct Provider Payment webinar for CSP August 2018 5

6 Important DPP Definitions • SFS Vendor ID #: 10-digit identifier issued by • Program Pay To Contact : point person at NYS to vendors (provider practice/facility) provider site (may be different from SFS registered in the Vendor File (associated with Contact) including email, address and Federal Employee ID #) telephone. • SFS Payee Name : vendor name shown on o responsible for all CSP billing issues its charter or other legal documents o receives monthly CSP Patient Service • Vendor Address : default address in SFS Summaries Vendor Portal, corresponds with SFS Vendor o receives HRI checks ID # o works with SFS contact (if different) to • SFS Contact : designated by vendor as ensure proper identification of CSP primary contact; has ability to add/update payments and assists with client account information such as contacts, addresses, and reconciliation bank account for direct deposit; can view status of invoices and pending payments via vendor self-service portal Direct Provider Payment webinar for CSP August 2018 6

Process to Reimburse State- funded Services Direct Provider Payment webinar for CSP August 2018 7

8 1: CSP contractors collect all information (via annual credentialing process) needed to set up DPP with each participating provider All site codes for each provider site need an SFS Vendor ID # to receive reimbursement for State-funded services 1. Department reviews current credentialing 4. provider completes Substitute W9 workbooks to identify current provider site codes 5. provider returns completed Substitute W9 to with existing SFS Vendor ID# contractor 2. Department staff pre-fills credentialing workbooks 6. contractor submits completed Substitute W9 form with SFS Vendor ID and SFS Vendor Address if to CSPcredentialing@health.ny.gov available 7. CSP Credentialing facilitates submission of 3. Department staff sends contractor Substitute W9 to SFS to obtain Vendor ID * a) list of providers who have no SFS Vendor ID and other discrepancies *NOTE: only DOH programs can submit Vendor ID requests b) link to Substitute Form W9 (including instructions) to request SFS Vendor ID# Direct Provider Payment webinar for CSP August 2018 8

9 2: CSP contractors obtain new provider agreements required for contract period 10/1/18 – 9/30/23 • Department staff provides contractor with required Provider Agreement o contractor obtains signatures from each CSP-participating provider and contracting agency ▪ contractor submits Agreements to CSPcredentialing@health.ny.gov o Department staff documents receipt of Agreement and obtains Department authorized signature • Division Fiscal staff returns copy of completed & signed Agreement to contractor • contractor provides copy of Agreement to appropriate CSP-participating providers Direct Provider Payment webinar for CSP August 2018 9

10 3 : Provider authorization of payments Pay To Contact: Department: • • uses Monthly Billing Report (MBR) to reviews PSS to confirm listed services were provided & are accurate prepare monthly Patient Services Summary (PSS) • replies to email with confirmation of services, o e.g.: PSS provides client-level detail for all State-funded services: “We confirm that we have provided the o ▪ rendered by that provider; and services on the attached listing and request reimbursement for reported services” ▪ entered or modified on Data System for that month NOTE: providers cannot receive reimbursement for State-funded services without this • emails password-protected PSS (via confirmation. CSPfiscal@health.ny.gov) to designated Pay To contact each month Upon receipt of confirmation, Department staff creates SFS invoice to initiate payment Direct Provider Payment webinar for CSP August 2018 10

11 Provider authorization of payments (continued) What if provider does not respond to Patient Services Summary (PSS) communication? • Department staff makes three (3) bi-weekly attempts to obtain payment authorization on 3 rd attempt, CSP Coordinator and Regional Manager will be copied to assist with o follow-up • CSP Coordinator contacts provider to ensure they received email & confirm whether Pay To contact has changed o changes in Pay To contact require Credentialing Workbook update ▪ contractor must submit name and email address of new Pay To contact to CSPcredentialing@health.ny.gov Direct Provider Payment webinar for CSP August 2018 11

12 4: Receipt of payment via SFS • Provider receives payment per SFS-designated method o Checks are mailed to address designated in SFS o electronic payments deposited to bank account designated in SFS o SFS contact will be able to view payments in the SFS via the Vendor portal. o Beginning October 2018 will appear as Site Code – MBR Month – CSPDPP. Example 730014 OCT18 CSPDPP • Pay To contact works with SFS contact and other provider billing staff as applicable to reconcile payment to PSS for that month Direct Provider Payment webinar for CSP August 2018 12

13 Direct Provider Payment webinar for CSP August 2018 13

Provider Inquiries on Payment of State- funded Services Direct Provider Payment webinar for CSP August 2018 14

15 Department FMU staff will respond to questions Department FMU staff generally cannot respond posed by the Pay To contact about payment to questions from anyone other than SFS contact details, including: except for inquires about: • • confirmation the Department has/has payment amount not successfully communicated with • date of payment the Pay To contact • • the specific “Subject Line” included on payment method (ACH or check) the PSS emails sent (to help locate the • invoice number associated with email communication) payment • how to contact SFS help desk Department FMU staff will not provide the password for PSS communication or client-level information (name, DOB, ID, service date, procedure, or rate) over the phone. All questions related to clients who do/do not appear on PSS, data reporting, and direct client care will be directed to the CSP Coordinator. Direct Provider Payment webinar for CSP August 2018 15

Process to Reimburse Federally- funded (HRI) services Direct Provider Payment webinar for CSP August 2018 16

17 • HRI will reimburse providers directly for all federally-funded services rendered by CSP-participating providers and entered or modified on the data system each month. o HRI does not require PSS sign-off from Pay To contact to process reimbursement of Federally-funded services. • HRI sends check to Pay To contact for site code (collected during credentialing process). • Checks include PSS, which provides client-level detail for all federally-funded services reported on the data system that month. Direct Provider Payment webinar for CSP August 2018 17

Provider Inquiries on Payment of Federally- funded (HRI) Services Direct Provider Payment webinar for CSP August 2018 18

19 All HRI checks are stamped with: "Please deposit within 30 Days, for Questions: cspfiscal@health.ny.gov ” Department staff will respond to questions related to: • check and invoice numbers • payment amount • date of payment All other questions (e.g. data reporting (clients who do/do not appear on PSS), direct client care) will be referred to the CSP Coordinator Direct Provider Payment webinar for CSP August 2018 19

Contractor Responsibilities related to Direct Provider Payment Direct Provider Payment webinar for CSP August 2018 20