interChange aka MMIS Update Parrish Steinbrecher: Deputy Office - PowerPoint PPT Presentation

interChange aka MMIS Update Parrish Steinbrecher: Deputy Office Director, Health Information Office Scott Lindblom: Division Director, Health Information Office 1

We are 51 days in, but why a new system? • States are required by CMS to re-procure their MMIS system every ten years. • The new MMIS is modular and interfaces with other systems, modern, and flexible to make changes • It is an Affordable Care Act requirement to revalidate Medicaid providers every 3-5 years depending on provider type. 2

How did the Department Communicate the change? • Began in September of 2014 with stakeholder engagement • External communication began in May of 2015  Provider Bulletins, At-A-Glance articles, Stakeholder meetings, email assistance  Emails Blasts to providers  Association and stakeholder meetings  Letters to revalidate sent in five “waves”  Facebook  Daily Webinars  And more…. 3

System Testing • 3190 test cases completed  Testing claim scenarios and provider types  The delay in go-live allowed for additional tests re- tests  System testing  End-to-End • Soft go live on 2/27/17  Identify any claims issues  Hospital, clearinghouse, providers 4

Enrollment • 44,709 providers enrolled currently • Since go live on March 1, DXC is processing 50% more enrollments than the monthly enrollment average before March 1 • Enrollment related questions account for 60% of the escalated items DXC and the Department receive 5

Claims Processing • We have processed 6,459,374 claims to date  On par with average weekly payments in legacy Xerox system • The interChange has paid $1.08 billion in claims to date  This is on par with our payments issues when Xerox was the Department’s fiscal agent. • Two additional weekly financial cycles were run in March to ensure providers received payments timely • The number of paid claims processed has increased from 40-60% weekly 6

Claims Processing • Most recent financial cycle: $120,556,000 • The first financial cycle happened three days after go-live 7

Weekly Claims Adjudication Averages 70.0% 59.7% 60.0% 58.4% 58.4% 55.9% 53.8% 49.6% 48.6% 50.0% 42.7% 45.6% 44.7% 40.0% 41.0% 40.8% 38.1% 37.6% 37.6% 36.6% 30.0% 19.7% 20.0% 10.0% 5.8% 5.6% 5.2% 5.0% 3.5% 3.2% 2.6% 0.0% 3-Mar 10-Mar 17-Mar 24-Mar 31-Mar 7-Apr 14-Apr 21-Apr Paid Denied Suspended 8

DXC call center • Call volume to HPE is 25-50% higher on average than the call volume Xerox experienced  We are seeing a decline in the number of calls each week • ASA is 26:51 for all queues.  Claims queue average speed of answer is 86 minutes  Member eligibility is 3 seconds  Prior authorization inquiry is 1 second  Provider Enrollment is 12 seconds  EDI is 52 minutes  Provider Services (all others) is 19 seconds 9

Current Call Center Stats 10

DXC Call Center • What are we doing about the high hold times? • DXC call center: 18 agents on March 1  26 agents by the end of March  45 agents in early April  51 agents currently  Xerox had 12 call agents for comparison • Opening an hour early 3 days a week  Monday, Tuesday, and Thursday open at 7:00 instead of 8:00 11

DXC Call Center • Call center opens Wednesday and Friday at 10:00 to allow time to call back providers • Priority Queuing:  Callers no longer have to wait at the back of queue if the wrong queue is selected, DXC will priority transfer the call to the front of the correct queue • Initially there were two issues contributing to hold times and “dropped calls”  Cut phone line in Florida  Telephone software problem causing calls to drop when holding for extended periods  Problem resolved in less than 10 business days for large volume of dropped calls  Monitoring the issue 12

Department Operations • We are working with providers through our established escalation channels  Top 3 escalated issues are 1) enrollment  2) Provider Portal  3) Claims   The Department and DXC have an escalation process and teams for urgent provider needs • Department Command Center began 2/23 and will continue as needed  8:00-5:00 daily:  8:30 Escalated Issues  9:00 claims  10:00 Defects/Issues  11:00 HCPF Program, Policy, and System open issues  12:00 – 5:00: Escalation teams 13

Department Operations • HCPF HCBS SME’s Outreach to HCBS clients • Outreach to providers with high claims denial % from denied claims report • Review incoming call report: identify high call numbers and outreach caller • Transitioned staff To assist PAR entry • To assist outreach to providers • Escalated issue management • 14

Updates • Staffing: 81 new staff  Including 8 Provider Field Representatives to assist with claims and enrollment issues and training • Timely filing change from 120-240 days • RA’s available on weekend • Option on IVR for Provider to select if experiencing Financial Hardship. 15

Issues/Fixes • Known Issues Web Page: https://www.colorado.gov/hcpf/known-issues • EOB 1504 (Rendering Provider Number Not Found) / EOB 0952 (Multiple Provider Locations)  In Production 4/27/17  Claims Will be resubmitted • Timely Filing  120 to 240 days through October.  In production 5/11/17 • EOB Codes  Provider Portal – MO and UAT 5/11/17  RA – TBD  Revisions being made to make descriptions more accurate - Ongoing  Update field length in the Provider Portal - TBD 16

Issues/Fixes • Vision Codes  Provider contract updated for 101 procedure codes. 4,366 claims resubmitted • Backdate – No contract  600,000 claims impacted. Reprocessing date TBD • CLIA  End dates open ended. Claims reprocessing this weekend  Providers with no CLIA on file need to add it 17

Resources • The Department and DXC have developed resources that can help providers with these frequent questions about using the new system. Overview of Online Resources for interChange •  Revalidation and Enrollment and Online Provider Enrollment Tool  Training Page  Cheat Sheets  FAQs  Frequent Updates on Provider Resources page  Go-Live Transition Special Bulletin  And many more... The Provider Portal and Provider Resources pages are updated as soon as new materials are • available, providers can sign up for our e-newsletter to receive updates, along with accessing billing manuals and provider bulletins. Visit these pages on colorado.gov/hcpf/our-providers often for updates. Providers should also be sure that they are signed up to receive Department publications and that their contact email in the Provider Portal is correct. 18