Hospital Presumptive Eligibility Web interChange Training HP Provider Relations/March 2014.

Hospital Presumptive Eligibility Web interChange Training HP Provider Relations/March 2014

Hospital Presumptive Eligibility 2 December 2013

Agenda

• Overview• Hospital Presumptive Eligibility Qualified Provider • How to become a HPE Qualified Provider• How Hospital Presumptive Eligibility Works• Questions

Hospital Presumptive Eligibility- An Overview

HP Provider Relations/March 2014


Hospital Presumptive Eligibility (HPE) – What is it?

Overview

•What is Hospital presumptive eligibility?− Effective January 1, 2014, qualified acute care hospitals, as qualified providers (QP),

have the ability to enroll qualifying individuals in certain aid categories to receive temporary coverage until eligibility for the Indiana Health Coverage Programs (IHCP) is officially determined by the Indiana Family and Social Services Administration (FSSA).

− Hospital PE will be identified on the EVS systems as the AID category that the member qualifies for.

− All services that are covered by IHCP within the designated HPE aid category are covered during the presumptive eligibility period.


Non-HPE Benefit Packages

Overview

• Package A – Standard Plan• Package B – Pregnancy Coverage• Package C – Children’s Health Plan• Package E – Emergency Services Only• HIP – Healthy Indiana Plan• Package P – Presumptive Eligibility for

Pregnant Women• Family Planning

HPE Benefit Packages

• Package A – HPE Infants• Package A - HPE Children• Package A HPE - Parent /Caretaker• Package A – HPE Former Foster kids• Package P – HPE Pregnant Women• Family Planning – HPE Family Planning

Benefit Package


Hospital Presumptive Eligibility – Who Is eligible?

Overview

Hospital Presumptive Eligibility is based on the following criteria:

1.Be a U.S. citizen or a qualified noncitizenThe applicant must be a citizen of the United States or a qualifying immigrant with one of the following immigration statuses:

• Lawful permanent resident immigrant living lawfully in U.S. for five years or longer

• Refugee• Individual granted asylum by immigration office• Deportation withheld by order from an immigration judge• Amerasian from Vietnam• Veteran of U.S. Armed Forces with honorable discharged• Other qualified alien


Hospital Presumptive Eligibility – Who Is eligible?

Overview

Hospital Presumptive Eligibility (HPE) is based on the following criteria:

2. Be an Indiana resident•An Indiana address must be provided on the application.

3. Not be a current Indiana Health Coverage Programs (IHCP) member, including Healthy Indiana Plan (HIP)

4. Not be enrolled in the presumptive eligibility program (HPE or Presumptive Eligibility for Pregnant Women [PEPW])

5. Not be currently incarcerated

6. Must meet the income level requirements specific to certain aid categories, as outlined in table 7.1


Presumptive Eligibility – Income Standards

Overview

Table 7.1 –

Aid Category Description FPL Limit HPE Infants 213% HPE Children (Ages 1 to 18) 163% HPE Parents/Caretakers Converted AFDC limits HPE Former Foster Care Children No FPL Requirement HPE Pregnant Women 213% HPE Family Planning 146%

NOTE: These percentages include a 5 percent income disregard. When completing a full application, the 5% income disregard will only be applied if an individual is otherwise ineligible for IHCP.

Weekly income

should be multiplied

by 4.3 to determine

monthly income

Biweekly income

should be multiplied

by 2.15 to determine

monthly income


• HPE allows uninsured or under insured individuals and their families to obtain healthcare while the Indiana Application for Health Coverage is being processed.

• Allows providers to be reimbursed for services provided immediately after HPE approval

• During the presumptive eligibility period, the individual will be able to receive treatment from other IHCP providers after he or she leaves the hospital.

Hospital Presumptive Eligibility (HPE) – Why Is It important?

Overview

Hospital Qualified Providers


Who Can Be a Hospital Qualified Provider (QP)?

• Only acute care hospitals will be considered to be a qualified provider (QP) for Hospital Presumptive Eligibility (HPE).


Who Can Be a Hospital Qualified Provider?

Many of the requirements for qualified providers (QP) are mandated by federal Medicaid regulations:

1. Hospitals must participate as a provider under the Indiana Health Coverage Programs (IHCP) State plan or a demonstration under Section 1115 of the Social Security Act;

2. Must Notify the IHCP of its intention to make hospital presumptive eligibility (HPE) determinations, and

3. Agree to make hospital presumptive eligibility determinations consistent with state policies and procedures.

The State requires that an HPE QP must:1. Assist individuals in the process of completing and submitting a full Indiana Application for Health

Coverage; 2. Complete and submit HPE QP eligibility attestations through the HPE QP enrollment process on

Web interChange;3. Participate in HPE Web interChange training; and4. Participate in HPE training.

How to Become a QP for HPE


How to Become a QP

Acute care hospitals must attest to the following:

•Affirm that this organization understands and will abide by any published guidance regarding the performance of HPE activities.

•Affirm that this organization will not knowingly or intentionally misrepresent client information in order to inappropriately gain presumptive eligibility.

•Affirm understanding that all HPE QP enrollment activities undertaken in this hospital must be performed by a hospital employee or hospital designee.


How to Become a QPWith access to Web interChange, the hospital can complete the HPE QP enrollment application by following these instructions:

1.Click Provider Profile and then

2.Click View/Edit a Profile

3.Choose the appropriate NPI

Step #1

Step #2


How to Become a QP

4.Answer the question, “Does your organization have a change of ownership (CHOW)?”

•If the answer is “No”, select the correct radio button to answer the question and then click the Presumptive Eligibility tab.

•If the answer is “Yes”, select the correct radio button to answer the question and then complete and submit the Change of Ownership to HP Provider Enrollment.


How to Become a QP

5. Answer the following questions on the Hospital Presumptive Eligibility Information page:


How to Become a QP

6. The individual responding to the questions must provide his or her name and email address in the appropriate fields.

7. Click the Review Summary to Submit tab to verify the responses entered, and then click Submit to complete the prequalification process.

• The hospital immediately receives an automated email notification with new HPE QP status. The HP Provider Relations representative will contact the prequalified HPE QP within 10 days to schedule Web interChange training session.

• The Provider Relations Representative will also provide the acute care hospital with a printed copy and electronic link of the HPE Process Training. After completing the Web interChange training session, HP activates the certified QP in IndianaAIM. The HPE QP may then provide services under the HPE program.


How to Locate a QP

•IHCP Web site

– www.indianamedicaid.com

– Select Provider Services > Provider Search

– Click the “Yes” radio button beside “Show only Presumptive Eligibility Qualified Providers?”

•HP Customer Assistance

– (317) 655-3240 or 1-800-577-1278

http://www.indianamedicaid.com/

Hospital Presumptive Eligibility – How it Works


How the HPE Process WorksFollowing is a step-by-step process for the Hospital Presumptive Eligibility (HPE) applicant enrollment process is outlined below, as well as in the HPE Training.

1.The HPE qualified provider (QP) uses the Eligibility Inquiry feature in Web interChange to verify that the individual is not already an Indiana Health Coverage Programs (IHCP) member.

2.As long as the member does not have any coverage, click the HPE Application button

3.Eligibility can be verified using the three EVS options – Automated Voice Response, Omni, and Web interChange however the HPE application can only be completed using web interChange


How the PE Process WorksMay search by Name/DOB, SSN, or Medicare ID. Users with Web interChange access to multiple office locations must be sure to select the actual location that is an enrolled as a QP. Perform eligibility inquiry to verify the applicant is not already eligible for Medicaid.

Click here to complete the

HPE Member Application


Completing the HPE ApplicationIf the individual is not currently presumptively eligible under Presumptive Eligibility for Pregnant Women (PEPW) or HPE, or enrolled in IHCP, the HPE QP completes the HPE application via Web interChange. The hospital staff or it’s designee, completes the application with the information provided by the individuals applying for HPE. The following questions are asked on the application:

• First Name

• Middle Initial

• Last Name

• Suffix

• Social Security Number (SSN)

• Date of Birth (DOB)

• Home Address

• Mailing Address

• Phone number

• Race

• Ethnicity

• Gender

• Marital Status

NOTE: If using a third party vendor to complete the HPE application, the hospital as the registered QP, is responsible for adherence to the guidelines set for the by the state of Indiana.


Completing the HPE Application

• Is the applicant an Indiana Resident?

• Is the applicant incarcerated?

• Is the applicant pregnant?

• Number of people in applicant’s family

• Is the applicant a U.S. citizen?

• Family income amount multiply weekly income by 4.3 to determine the monthly income

multiply biweekly income by 2.15 to determine the monthly income (biweekly is every two weeks)

• Does the applicant have health insurance coverage?

• Does the applicant have Medicare coverage?

• Does the applicant have a pending Indiana Application for Health Coverage on file?

• Was the applicant in foster care in Indiana on his or her 18th birthday, under the responsibility of the State of Indiana and was the applicant enrolled in an IHCP program on his or her 18th birthday?

• Is the applicant the parent or legal guardian living in the same household of at least one child under 18 years of age and is the primary caretaker?

NOTE – Each individual who is seeking health care must complete his or her own application to be considered for HPE.


How the PE Process Works

The HPE Application will be opened in a new window

Enter responses on the

PE Member application

Move your pointer over eachfield for convenient HELP text,or click on the question markwhere available


How the PE Process Works

Move your pointer over eachfield for convenient HELP text,or click on the question markwhere available


Complete PE Member Application

A disclaimer statement ends the application.

Place a check mark in the Disclaimer check box and click the Submit Application button.


Hospital Presumptive Eligibility Approval Determination

Once the application is submitted, you will receive an immediate determination.

600000000000


Hospital Presumptive Eligibility Approval Letter


Hospital Presumptive Eligibility Denial Determination

Once the application is submitted, you will receive an immediate determination.

600000000000

XXXXX XXXX


Hospital Presumptive Eligibility Denial Letter


Completing the HPE Application Process

The HPE QP should inform the member of his or her coverage, including limitations of HPE Family Planning or Pregnant Women eligibility, the coverage period, and provide guidance on how the hospital will assist the member in completing the full Indiana Application for Health Coverage.

HPE QPs should inform the individual of the coverage period and conditions. If the individual has filed an Indiana Application for Health Coverage, his or her presumptive eligibility period lasts until a final eligibility determination from FSSA has been made. Otherwise coverage ends the last day of the following month that the HPE application is completed.

During the presumptive eligibility period, the eligible individual will also be able to receive treatment from other IHCP providers after he or she leaves the hospital. It is imperative that the hospital employee informs the individual that he or she needs to complete the full application before their temporary eligibility period ends, and provide information on how he or she can do so. As explained in the acceptance letter, the individual may complete the Indiana Application for Health Coverage in one of the following ways:• At the hospital where the individual was determined presumptively eligible.• Online from the DFR Benefits page at in.gov (link to www.dfrbenefits.in.gov).• Over the telephone at 1-800-403-0864.• At an FSSA, Division of Family Resources (DFR) local office.



PE Considerations

– PE coverage begins the same day a QP determines a HPE member to be presumptively eligible

– PE eligibility is terminated the last day of the following month of eligibility if no Indiana Application for Health Coverage is pending with the DFR

• Example: HPE member is determined presumptively eligible on July 14 and does not submit a Indiana Application for Health Coverage - the HPE coverage will end on August 31

– Failure of the member to cooperate with DFR to complete the enrollment process will result in termination of HPE eligibility

– PE eligibility is terminated on the day after IHCP benefits are open



• DFR makes its eligibility determination for Hoosier Healthwise

– Applicants must comply with the IHCP application process (for example, documentation submission)

– If the Indiana Application for Health Coverage is received by the DFR before the last day of the month after PE was applied, the individual’s PE will not end until the IHCP determination is completed

• This ensures there is no gap in coverage

– IndianaAIM receives eligibility determinations from DFR on a daily basis


Eligibility Verification Systems and HPE• The eligibility verification systems (EVS) will communicate information

about HPE members the day following the determination by the QP.

– Web interChange• https://interchange.indianamedicaid.com/Administrative/logon.aspx

– Omni machine

– Automated Voice Response (AVR)• (317) 692-0819 or 1-800-738-6770

• Only Web interChange can be used to submit a member application for HPE.

https://interchange.indianamedicaid.com/

Questions

Hospital Presumptive Eligibility Web interChange Training HP Provider Relations/March 2014.

Documents

Transcript of Hospital Presumptive Eligibility Web interChange Training HP Provider Relations/March 2014.