New York Department of Health Bureau of Early Intervention State Fiscal Agent NY EI SFA Steering Committee September 23, 2013

New York Department of HealthBureau of Early InterventionState Fiscal AgentNY EI SFA Steering Committee

September 23, 2013

www.publicconsultinggroup.com

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Agenda1. Introductions

2. Purpose of the Steering Committee

3. PCG SFA Go-Live

4. Customer Service Call Center

5. Enhanced Web Site

6. New Training

7. Current Challenges, and Remedial Action Plans

8. Other Business

9. Next Meeting

NY EI SFA Steering Committee - September 23, 2013

3NY EI SFA Steering Committee - September 23, 2013

PCG

Public Consulting Group (PCG) is a management consulting firm headquartered in Boston, MA

PCG specializes in consulting services to governmental agencies on federal, state and county-based levels. The map to the right illustrates our national experience


PCG’s Experience

• PCG is a national leader in providing SFA services processing over $1.2B annually for 50 programs on behalf of clients in 22 states

• PCG assists more than 20 states with call center operations, supporting 650,000 health care consumers and 300,000 providers

• PCG leverages the research and practices of the Project Management Institute’s Project Management Body of Knowledge (PMBOK) as a guidepost to all of our projects and will do so here


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PCG SFA Go-Liveproject area current state October next phase

Provider Support

Communications Plan Approved Implement Communications

Training Plan Approved Implement Training

Call Center Planning and Preparation Online 10/1/2013 Ongoing

Mail Room Planning and Preparation Online 10/1/2013 Ongoing

Business Process Redesign

As-Is Modeled Correction of Urgent Problems

Continuous Quality Improvement

Billing and Claiming

Standard Operations McGuinness with support from PCG

PCG

Backlog McGuinness works the backlog PCG works the backlog No backlog

Payers MedicaidClearinghouses (Emdeon, Post-N-Track)

MedicaidClearinghouses (e.g. Emdeon, Post-N-Track)Direct to Payers (e.g. Excellus)

MedicaidClearinghouses (e.g. Emdeon, Post-N-Track, additional)Direct to Payers (e.g. Excellus, additional)

SFA System McGuinness McGuinness, with enhanced UI and Reporting, if required

PCG SFA System

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Purpose of the Steering Committee

• Comprises stakeholders including providers, municipalities, parents, Department of Health and Financial Services representatives, and insurance industry representatives

• Avenue for stakeholder engagement and involvement

• Two-way channel for information sharing throughout the SFA transition and operation



PCG Staffing

• The SFA will deploy 53 staff members to support implementation and on-going operations

Position or Area of Responsibility Manager FTE Count

Manager Rick Dwyer 1.0

Enterprise Management Office Joe Baile 1.0

Deputy Project Manager Jamie Kilpatrick 1.0

Technical Advisor Maureen Greer 0.8

Business Process Review Nathan Grossman 3.0

Information Technology Department Michael Dieter 9.0

Accounting, Billing and Claims

Operations

Stephen Greene 18.0

Customer Service Pam Fuqua 19.0

Total FTE Count 52.8


Customer Service Call Center

• Beginning on October 1, 2013

• Staff have been trained on NY-specific claiming processes

• Help users with:• EI billing process• forms management• Medicaid documentation• walkthroughs of the claiming process and systems• other items related to the Fiscal Agent

• Available from 7 a.m. to 7 p.m. ET Monday through Friday, toll-free number

• Current inquiry and knowledge base is being transferred to PCG


Enhanced Website• Keep the same EI Billing web address and name

• Same login and password• Same functionality• Same knowledge and system information

• Enhance the website based on initial user feedback, reorganized to offer better accessibility to information users need to:

• Find data• Input information• Complete billing

• PCG will send specific communication to website users on changes as they are rolled out

• The site will continue to be updated as PCG reviews user feedback, enhances processes, and addresses issues raised during the interim process

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EIBilling: New Home Page Mockup


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EIBilling: New Training Page Mockup


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EIBilling: New Contact Page Mockup



New Training• Increase the availability of training for providers and service coordinators

regarding billing and claiming

• PCG training staff will be available to meet with groups to help them better understand and use the system

• NYS-based Regional trainers

• New calendar of training webinars for municipalities, providers, and service coordinators

• Participants will be able to access these webinars live or view a recording from the training section of the EIBilling site

• A link to register for these training webinars with sign-up instructions are being emailed to stakeholders now

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Training Schedule

• Phase 1 of training has begun: Provider introductions to the SFA webinars begin September 23, 2013 and continue until October 8, 2013

• Training is being recorded and so available at any time

• Training Goals and Objectives:• Implement an efficient and effective administrative process for the payment of

early intervention claims through a State Fiscal Agent (SFA)• Ensure all stakeholders understand the purpose for, and implications of, the

introduction of a State Fiscal Agent• Ensure that each individual stakeholder understands how the SFA impacts them

individually as well as the system as a whole• Ensure stakeholders understand and, where required, execute new

responsibilities, processes and procedures.• Ensure stakeholders know what to do, who to call, and how to get help



Training Topics

• Some of the Provider training topics that will be covered after the initial introductory webinars are as follows:

• Insurance 101• 835 & 277 Denials• Health Savings/Spending Account (HSA) Billed in Error• Guidance for Parent’s Receiving Checks for EI Services• Explanation of Benefits (EOB) and Subrogation• Regulated and Non-Regulated Insurance • Prior Authorizations

PCG looks for user feedback when designing training


Further Training

• Service Coordinator trainings will also be initiated in October

• Introduction of the New York Early Intervention State Fiscal Agent• Outline the EI Service Coordinator’s role/responsibilities regarding the

billing/claiming procedures • Increase understanding of the new claiming process

• Training will be ongoing for stakeholders, including municipalities, providers, parents, insurance companies, advocates, others


Current Challenges

# Challenge Being Addressed

1 Payment delays to providers due to delays in commercial third party payment processing (inc. resolve return of 835 and Remittance information to State Fiscal Agent)

2 Define a best practice for service coordinators and providers, leading to their greater confidence, data accuracy, and claim correction

3 Define claim rejection and denial reasons to tailor proper follow-up responses and training and education programs for service coordinators and providers

4 Greater understanding of the impact of current system of payment policies on third party claiming


Challenge Action Plan #1

• Challenge: Payment delays to providers due to commercial third party payment processing policies (includes resolving return of 835 and Remittance information to State Fiscal Agent)

• Action Plan• Lead Actions:

• Conduct Provider Contracting and Credentialing with Payers• Pursue industry assisted processing change for EI claims for non-

participating Providers

• Industry-wide effort processing of EI claims for non-participating Providers

• Support Actions• Conduct training and support for Providers and Service

Coordinators• Conduct communications to Providers, Service Coordinators and

Payers


Changes to Insurance Companies Payment Processes

• Prioritize Commercial Insurance companies with high volumes of EI claims and work with them to find and implement solutions

• Success Story: Excellus Health Plan• Changed information system to allow remittance advices to be sent to the SFA and

payments to providers• Adhering to subrogation requirements to ensure payments are directed to providers

and not families• Sending a letter to all members / EI parents who received misdirected payments owed

to providers• Providing a report to the SFA on all EI claims processed since April 1 with remittance

advice information• Letter from DOH and Excellus to providers with instructions

• Success Story: Health Now Plan• Plan on contracting with billing providers



• Challenge: Define a best practice for service coordinators and providers, leading to their greater confidence, data accuracy, and claim correction

• Action Plan• Lead Action: Review collection issues; conduct root cause analysis

• Support Actions• Interview Providers & Service Coordinators• Conduct As-Is analysis of family and provider enrollment and cases

management practices• Develop troubleshooting guidance & business process change

plans as needed• Conduct communication, training and support to Providers and

Service Coordinators



• Challenge: Define claim rejection and denial reasons to tailor proper follow-up responses and training and education programs for service coordinators and providers

• Action Plan• Lead Action: Analyze Insurance Claiming Results

• Support Actions• Enhance processes for directing claims to Providers or Service

Coordinators for correction, aided by SFA claiming and customer service teams

• Conduct training and support to Providers and Service Coordinators

• Conduct communications to Providers and Service Coordinators



• Challenge: Greater understanding of the impact of current system of payment policies on third party claiming

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• Action Plan• Lead Action: Review program rules and administrative requirements to

enhance business practices

• Support Actions• Design acceptable enhanced business practices• Conduct training and support to Providers and Service

Coordinators• Conduct communications to Providers and Service Coordinators• Assess potential NYEIS changes


Assistive Technology Devices• Assistive technology devices authorized in children’s IFSPs • Assistive technology devices will continue to be accessed through loan

programs (e.g., TRAID, municipal loan closets), if available and appropriate for the child

• The PCG Assistive Technology Coordinator will collaborate with the municipalities/counties to facilitate the purchases through ATD vendors

• Payment for the purchased devices will primarily originate from commercial and public insurance, with the municipalities/counties being responsible for the residual

• A pricing methodology will be implemented to ensure cost-effective procurement of ATDs

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Other Business


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Contact Sheet

Rick DwyerPCG Project Manager

[email protected]

(617) 717-1250

Jamie KilpatrickPCG Deputy Project Manager

[email protected]

(615) 983-5318

Joe BailePMO Manager

[email protected]

(617) 717-1241

Nathan GrossmanBusiness Process Redesign Manager

[email protected]

(617) 717-1189

• NY EI SFA Steering Committee - September 23, 2013

Tina Chen-Xu

Rob LillpoppBilling and Claiming Manager

[email protected]

Consultant

[email protected]

Stephen GreeneCommunications Lead

[email protected]

mailto:[email protected]







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Public Consulting Group, Inc.148 State Street, Tenth Floor, Boston, Massachusetts 02109

(617) 426-2026, www.publicconsultinggroup.com

Documents

New York Department of Health Bureau of Early Intervention State Fiscal Agent NY EI SFA Steering Committee September 23, 2013