October 2006 Who, What, Where, and When Presentation Presented by EDS Provider Field Consultants Who, What, Where, and When Presentation October 2006 page 2 Agenda IHCP Information Eligibility Verification Systems Division of Family Resources Health Care Excel Pharmacy Services Third Party Liability Managed Care EDS Member and Provider Relations Questions Welcome and Announcements Who, What, Where, and When Presentation October 2006 page 3 IHCP Information The main sources for information about the Indiana Health Coverage Programs (IHCP) is available in the following locations: IHCP Web site atIHCP Provider Manual IHCP provider monthly newsletters IHCP provider bulletins IHCP provider banner pages Note: These reference tools apply to fee-for- service/Traditional Medicaid, not the risk based managed care delivery system Who, What, Where, and When Presentation October 2006 page 4 IHCP Information Member-focused information about specific IHCP Programs: Hoosier Healthwise www.healthcareforhoosiers.com Medicaid Select www.medicaidselect.com Who, What, Where, and When Presentation October 2006 page 5 Web InterChange Functions Web interChange provides access to the following: Member eligibility Benefit limits Claim status Check inquiry Claim submission Prior authorization Prior authorization inquiry Provider profile update Third party liability update Web interChange Who, What, Where, and When Presentation October 2006 page 6 Access Web interChange to verify member eligibility using: Member ID number Social Security Number Name and date of birth Medicare ID number Eligibility Verification Systems Web interChange Who, What, Where, and When Presentation October 2006 page 7 Eligibility Verification Systems The automated voice-response (AVR) provides access to the following: Member eligibility verification Benefit limits Prior authorization Claim status Check write Available 24 hours, seven days a week at (317) in the Indianapolis local area or Automated Voice-Response Who, What, Where, and When Presentation October 2006 page 8 Eligibility Verification Systems The OMNI 380 terminal is a swipe card system. Support is available by dialing: or (317) To purchase new equipment contact: MedData a Division of AGDATA, Inc Hurley Way, Suite 180 Sacramento, CA (916) OMNI Who, What, Where, and When Presentation October 2006 page 9 Division of Family Resources Consists of 92 county offices Uses the Indiana Client Eligibility System (ICES) Determines member eligibility Determines spend-down monthly obligations Determines Qualified Medicare Beneficiary (QMB) eligibility Who, What, Where, and When Presentation October 2006 page 10 Contact the HCE Prior Authorization Department to make PA requests By telephone at (317) in the Indianapolis local area or By mail at: HCE Prior Authorization Department P.O. Box Indianapolis, IN Health Care Excel Prior Authorization Who, What, Where, and When Presentation October 2006 page 11 Contact the Provider and Member Concern Line to report fraud and abuse Call (317) in the Indianapolis local area or Report member misuse of medical benefits Report provider misconduct Health Care Excel Fraud and Abuse Who, What, Where, and When Presentation October 2006 page 12 Contact the HCE Medical Policy Department: By telephone at (317) By mail at: HCE Medical Policy Department P.O. Box Indianapolis, IN Health Care Excel Medical Policy Who, What, Where, and When Presentation October 2006 page 13 Pharmacy Services Contact the EDS Pharmacy/POS Helpdesk By telephone at (317) in the Indianapolis local area or On the Web atObtain pharmacy prior authorizations from ACS By telephone at By fax at Who, What, Where, and When Presentation October 2006 page 14 Third Party Liability Report and correct third party liability (TPL): By telephone at (317) or By fax at (317) Online through Web interChange TPL updates may include the following: TPL no longer effective for member TPL not on file for member Who, What, Where, and When Presentation October 2006 page 15 Managed Care Contact AmeriChoice for PMP enrollment and education: Medicaid Select or Who, What, Where, and When Presentation October 2006 page 16 Managed Care The following are the five Managed Care Organizations (MCOs) in risk-based managed care (RBMC) through December 31, 2006: CareSource orHarmony orMDwise orManaged Health Services orMolina orManaged Care Organizations Who, What, Where, and When Presentation October 2006 page 17 Contact Customer Assistance for answers to general program questions: Call (317) in the Indianapolis local area or Telephone lines are open from 8 a.m. to noon and 1 p.m. to 5 p.m., Monday through Friday Analysts are cross-trained on all facets of the program Analysts do not provide eligibility information. EDS Member and Provider Relations Customer Assistance Who, What, Where, and When Presentation October 2006 page 18 Contact Provider Enrollment for answers to questions about enrollments and provider file information Call Telephone lines are open from 8 a.m. to noon and 1 p.m. to 5 p.m. Monday through Friday EDS Member and Provider Relations Provider Enrollment Who, What, Where, and When Presentation October 2006 page 19 Send issues requiring extensive research to the Written Correspondence Unit at the following address: EDS Written Correspondence P.O. Box 7263 Indianapolis, IN EDS Member and Provider Relations Written Correspondence Who, What, Where, and When Presentation October 2006 page 20 Provider field consultants perform the following tasks: Educate providers Serve as provider association liaisons Manage projects EDS Member and Provider Relations Provider Field Consultants Who, What, Where, and When Presentation October 2006 page 21 Questions October 2006 page 22 EDS 950 N. Meridian St., Suite 1150 Indianapolis, IN Presentation by EDS Provider Field Representatives EDS and the EDS logo are registered trademarks of Electronic Data Systems Corporation. EDS is an equal opportunity employer and values the diversity of its people. 2005 Electronic Data Systems Corporation. All rights reserved.