MPAA Updates 10/31/14

AgendaNew look of CHAMPSMSA 14-34Proposed Policy 1442New look of TPL webpageL-Letter 14-28Top RejectionsAdditional Updates

New look of CHAMPS

CHAMPS new look and feel as of 9/29/14, same functionality

Defects in the new look of CHAMPSPrint member summary hyperlink does not print all

that is displayed on the screenPrint function in blue ribbonScreen capture tool on your computerChange print setting to landscape

Internet Explorer version 9 users have encountered problems accessing Archived Documents, Adobe setting instructions

When accessing DDE from the favorites function, the billing NPI does not pre-populateUntil corrected, access DDE without using the favorites

feature

MSA 14-34

Inpatient Hospital Claim Requirements for Newborns

MSA 14-34• Inpatient hospital newborn claims dates of discharge on or after

October 1,2014• Admission type

• Newborn Admission type of 4• Origin code of 5 or 6

• Value code 54 reported with birth weight in grams as a whole number• Further clarification being issued to clarify that cesarean and

induction information should be reported on the mother’s claim not on the newborn’s claim

• Condition Code "81": C-sections or inductions performed at less than 39 weeks gestation for medical necessity

• Condition Code "82": C-sections or inductions performed at less than 39 weeks gestation electively

• Condition Code "83": C-sections or inductions performed at 39 weeks gestation or greater

Proposed Policy Project 1442

Diagnosis Related Group (DRG) Grouper Update, DRG Rate Update, Rehabilitation Per Diem Rate Update, Birth Weight Reporting, Prospective Capital, All Patient Refined DRG (APR-DRG) Notification

Proposed Policy 1442Comments on this policy due by November 14, 2014 Effective January 1, 2015, claims for inpatient hospital

discharges using the DRG methodology will be processed using Medicare DRG Grouper Version 32.0

Claims for discharges on or after January 1, 2015 that fail to report the newborn priority (type of) admission or visit and newborn birth weight will be denied Reporting of cesarean sections or inductions related to

gestational age will continue to result in informational editing only

New look of TPL web page

DCH-0078 electronic webpage

New look of TPL webpage• Save this link to your favorites

www.michigan.gov/reportTPL• MDCH is now receiving monthly files from BCBS

and BCN• Currently files are handled manually, loaded by the

15th of each month• TPL is no longer making many changes to the TPL

coverage file related to BCBS or BCN• If a change, start or term date, has happened within

the last 30-60 days to the BCBS or BCN coverage, MDCH will receive the update in the next monthly file, no need to submit the DCH-0078 form

L-Letter 14-28

Fee-for-Service Healthy Michigan Plan Beneficiaries with Retroactive Health Plan Enrollment Dates

L-Letter 14-28L-Letter was only mailed to affected providersInpatient Hospital claim recoveries total $1,753,817.70Outpatient Hospital claim recoveries total

$1,287,146.45Credited claims appeared on Remittance Advice

October 16,2014Providers should bill claims to health plans within 60

days of the MDCH take-backThe health plan must process these claims for all in-

network and out-of-network providers without prior authorization, even if prior authorization is normally required for the service

Top Denials

Top CARC’s and RARC’s for Inpatient and Outpatient Hospitals

Top Denials IPH

CARC 24: Beneficiary enrolled in a managed care planPayer at the time of admission is responsible for the claim

CARC 251/RARC N205: Predictive modeling has reviewed the documentation submittedIPH claims admission/discharge reports are missing

CARC 133/RARC N47: Fifteen day re-admissionAlways check against your own facility prior to contacting provider

supportCARC 16/RARC N253: Attending NPI not active on date of service

Attending NPI must be active and enrolled on the claim header from date of service

Provider verification tool can be used to verify enrollmentCARC 109/RARC N193: Substance abuse

Check diagnosis information on claim

Top Denials OPHCARC A8: Ungroupable DRG/APC

One or more lines on the claim has denied which causes the claim not to be able to be priced by the APC software

CARC 251/RARC N205: Predictive modeling has reviewed the documentation submittedOPH claims missing orders/results

CARC 16/RARC M51: Missing procedure codeCARC 22/RARC N598-: Other insurance is primary

Review eligibility for other payer information prior to submitting claim

Additional Updates

Additional UpdatesEffective September 26,2014 MDCH is now processing

OPH claims using the July APC softwareEffective September 26,2014 the attending NPI reported

has to be effective on the Header date of serviceEffective December 12,2014 EZ link will no longer be an

available option to submit claim documentation such as:Consent formsMedical DocumentationPredictive Modeling

After December 12,2014 providers will need to use Document Management Portal (DMP) tips and tutorial to submit claim documentation

Resources

Provider Resources• Medicaid Provider Training

• One on One trainings requests• Association requests• Current trainings available

• Provider Support• www.michigan.gov/medicaidproviders • 1-800-292-2550• ProviderSupport@michigan.gov

• Evaluation Form