MDCH HIPAA Transactions Provider Outreach David McLaury
Director of Project Development and Implementation
[email protected]
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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