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MDCH HIPAA Transactions Provider Outreach David McLaury Director of Project Development and Implementation mclauryd@michigan.gov

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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

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3 Michigan Medicaid Information 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

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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.

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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).

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6 MDCH Assistance for Health Plans and 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.

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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.

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8 HIPAA Outreach Program MDCH Web Site & HIPAA Page

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9 HIPAA Outreach Program 2003 Provider Brochure

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10 HIPAA Outreach Program 2003 Testing Brochure

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11 HIPAA Outreach Program HIPAA Tool Kit

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12 HIPAA Outreach Program Testing Instructions Flyer

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13 MDCH HIPAA Transaction Compliance Plan Schedule October 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.

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14 Transactions Currently Operational HIPAA Transaction No. and DescriptionMDCH Transaction Type 837 X096 Claim (Institutional)Inbound 837 X097 Claim (Dental)Inbound 837 X098 Claim (Professional)Inbound 837 Encounter (096, 097, 098)Inbound

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15 Transactions Scheduled for B2B Testing in April HIPAA Transaction No. and DescriptionMDCH Transaction Type 835 Payment AdviceOutbound 277 Unsolicited ResponseOutbound 820 Capitated PaymentOutbound 276 Claim Status RequestInbound 277 Claim Status ResponseOutbound 270 Eligibility InquiryInbound 271 Eligibility ResponseOutbound Transactions are scheduled for production by October 2003

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16 Transactions Scheduled for B2B Testing in May HIPAA Transaction No. and DescriptionMDCH Transaction Type 834 Plan EnrollmentOutbound 278 Prior Authorization RequestInbound 278 Prior Authorization ResponseOutbound Transactions are scheduled for production by October 2003

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Slide Presentation Last Updated March 14, 2003