MDCH HIPAA Transactions

Provider Outreach

David McLauryDirector of Project Development

and Implementation

mclauryd@michigan.gov

2

MDCH Medicaid Overview• 1.2 Million Beneficiaries

• 800,000 Beneficiaries in Managed Care Plans

• 20 Managed Care Plans

• Capitated Dental Program for Children

• 18 Prepaid Health Plans for Mental Health Services

• 16 Prepaid Plans for Substance Abuse

• 30,000 Medicaid Providers

• 33,000,000 Claims Annually

3

Michigan MedicaidInformation System (MMIS)• The Michigan Department of Community Health (MDCH) is the single

state agency for Medicaid

• MDCH operates its own management information system and makes continual updates to its MMIS

• Converting the MMIS to HIPAA compliance.has been a large multi-year project

• MDCH works with outside consultants to ensure MMIS is HIPAA compliant

• MDCH works with outside consultants to educate providers through outreach efforts

4

Collaborative Activities with BCBSM and Other Large Payers• Established a strong collaborative effort with Blue Cross Blue Shield of

Michigan (BCBSM) and Medicare Part A & B to strongly encourage electronic claims and remittance.

• Stayed in sync with the implementation plans of BCBSM and Medicare Part A & B.

• HIPAA Validator (Integrity Testing) made available to all Medicaid providers free of charge.

5

Collaborative Activities with BCBSM and Other Large Payers (cont.)

• Regularly scheduled meetings to coordinate provider outreach activities (e.g., brochures and other outreach materials).

• Joint provider seminars and training sessions. Ten sessions were held June 2002. 5000 providers, billers and software vendors attended.

• Joint HIPAA technical seminars exclusively for software vendors (February, 2003).

• More sessions scheduled for providers and e-Billers (June, 2003).

6

MDCH Assistance for Health Plansand other Capitated Plans• Several informative sessions for health plans.

• Monthly meetings to discuss encounter data clarifications and QI reporting.

• HIPAA brochure for Mental Health and Substance Abuse capitated plans.

• Training and educational seminars for all capitated health plans. Additional training sessions in the near future.

7

Assistance for Medicaid Providers• Several informative sessions for provider associations and members.

• Outreach team has presented at several provider association meetings.

• Collateral materials (provider brochures, e-newsletters, flyers, postcards).

• Informative materials for inclusion in provider association monthly mailings, bulletins and newsletters.

• Provider training for Medicaid billing.

• Online interactive learning sessions at Michigan Virtual University (MiVU) for Medicaid HCFA 1500 and UB-92 (Uniform Billing Project).

• HIPAA Primer course featuring transactions and code sets hosted at MiVU.

8

HIPAA Outreach Program – MDCH Web Site & HIPAA Page

9

HIPAA Outreach Program – 2003 Provider Brochure

10

HIPAA Outreach Program – 2003 Testing Brochure

11

HIPAA Outreach Program – HIPAA Tool Kit

12

HIPAA Outreach Program – Testing Instructions Flyer

13

MDCH HIPAA Transaction Compliance Plan ScheduleOctober 1, 2002: Began accepting 837 v. 4010 Dental, Professional and

Institutional claims.

January 1, 2003: Began accepting 837 v. 4010 encounters from Medicaid Health Plans.

Began accepting 837 v. 4010 Nursing Facility claims.

835 Claims Remittance advice currently in internal testing.

April 16, 2003: Begin testing 835 claim remittance advice & all other HIPAA transactions.

October 16, 2003: Only HIPAA compliant transactions accepted.

14

Transactions Currently OperationalHIPAA Transaction No. and Description MDCH Transaction Type

837 X096 Claim (Institutional) Inbound

837 X097 Claim (Dental) Inbound

837 X098 Claim (Professional) Inbound

837 Encounter (096, 097, 098) Inbound

15

Transactions Scheduled for B2B Testing in AprilHIPAA Transaction No. and Description MDCH Transaction Type

835 Payment Advice Outbound

277 Unsolicited Response Outbound

820 Capitated Payment Outbound

276 Claim Status Request Inbound

277 Claim Status Response Outbound

270 Eligibility Inquiry Inbound

271 Eligibility Response Outbound

Transactions are scheduled for production by October 2003

16

Transactions Scheduled for B2B Testing in MayHIPAA Transaction No. and Description MDCH Transaction Type

834 Plan Enrollment Outbound

278 Prior Authorization Request Inbound

278 Prior Authorization Response Outbound

Transactions are scheduled for production by October 2003

Slide Presentation Last Updated March 14, 2003