Foster Care Agency Follow-up Webinar: Managed Care Readiness Funds. February 23, am-10am
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1 Foster Care Agency Follow-up Webinar: Managed Care Readiness Funds February 23, am-10am
2 AGENDA Introductions Overview of 1/20 webinar- Q&As posted to VFCA Technical Assistance webpage Part 1:Directed to agencies who have already applied or are in the process of applying for an MMIS and/or NPI number and have limited to no experience billing Medicaid Part 2:Directed to agencies that already have an MMIS and an NPI number and currently bill Medicaid 1
3 2 Introductions New York State Department of Health Anna Dean Julie Harris CSRA Rita Guido, emedny Outreach Supervisor
4 3 Overview of 1/20 Webinar All payments for the Managed Care Readiness funds will be processed through the emedny system As a rate add on for agencies with existing MMIS/NPI number As a new rate for agencies obtaining a new MMIS/NPI number or reactivating their MMIS number This rate will be in effect for the service period covering 11/1/15 to 3/31/16 Once rate is approved by Department of Budget (DOB), all agencies will be notified by DOH. Billing can NOT occur until this happens. Rate = VFCA s approved contract amount/estimated care days over the period 11/1/13 to 3/31/14 Each agency s allocation amount has not changed All allocations must be spent by June 15, 2016 Final Readiness Fund Report due 8/15/16 The Department will provide agencies with a report template
5 4 PART 1 This portion of the webinar will provide a high level overview of the billing process and applies to the following agencies who need to either apply for a new MMIS/NPI number or reactivate their existing MMIS number: AWIXA Buffalo Urban League Catholic Charities of Saratoga Washington and Warren Counties Compass House Homespace Corporation Native American Community Services Sarah Minnie Badger Foster Care Harmony Heights School Martin De Porres School Pathways Inc. KidsPeace
6 5 Part 1: MMIS and NPI applications Each of your agencies was contacted by DOH or OCFS regarding the need to apply for MMIS and/or NPI numbers Your agency should have already applied for, or be in the process of applying for, an MMIS and/or NPI number. Information on these processes can be found at: NPI Application and Information MMIS Application and Information Please notify DOH by sending an to When you submit your MMIS application and When your agency has received your NPI and MMIS numbers
7 6 Part 1: What are emedny and epaces? emedny is the electronic Medicaid system of New York developed and implemented by Computer Sciences Corporation (CSC) for Medicaid claims and billing epaces (Electronic Provider Assisted Claim Entry System) This is web-based program that allows enrolled New York Medicaid providers to submit and receive responses for HIPAA-compliant claims, eligibility requests, prior approval requests and claim status requests electronically
8 7 Part 1: Resources emedny Call Center Provides assistance with questions regarding: -claims -billing -electronic and paper remittance - new enrollment into the New York State Medicaid program - requests for training from Regional Representatives emedny Website -epaces enrollment -Electronic Funds Transfer (EFT) -ETIN applications -provider maintenance forms -Explanation of eligibility responses For example - Information, Provider Manuals, Edit/Error Knowledge Base, Listserv
9 Part 1: Provider Enrollment 8
10 9
11 Part 1: emedny Website Home Page 10
12 Part 1: emedny Website Self Help page 11 Refer to epaces Institutional Claim Reference Guide prior to billing using epaces
13 Part 1: epaces Home Screen 12 Web-based application Role-based security Submit claims Check claim status Verify eligibility
14 13 Part 1: Billing Methods Billing Methods Paper Claim Form UB-04 Electronically 837 Institutional format (rate-based) HIPAA Compliant Software to create and send claims via: emedny exchange, FTP (File Transfer Protocol), SOAP (Simple Object Access Protocol) epaces (electronic Provider Assisted Claim Entry System) If you choose to bill electronically, you will need to enroll in epaces
15 14 Part 1: Billing Methods-Electronically For agencies who choose to bill electronically, you will also need to obtain the following: Electronic Transmitter Identification Number - ETIN Certification Statement for New Enrollments - form # Need Electronic Funds Transfer (EFT) Authorization - form # (Follow instructions for additional forms/information that may be required) ERA/PDF Remit application (epaces enrollment required for ERA/PDF delivered to emedny exchange)
16 epaces Institutional Claim Screen 15
17 16 PART 2 This portion of the webinar applies to all agencies who have obtained their MMIS and NPI number including the following agencies that currently bill Medicaid: Behavioral Health Services North Equinox Inc. Family of Woodstock Inc. Family Services of Westchester HONORehg Inc. Liberty Resources Inc. Mental Health Association Ulster New Alternatives for Children
18 17 Part 2: Billing Medicaid for the Managed Care Readiness Funds You will need to bill using the Institutional Claim Form On your claim: You must use rate code 1210 Your agency location, identified by your 9 digit zip code, must match your agency location and zip code that was submitted on your provider enrollment form to emedny Each claim will need to include each child and their number of care days per month Please ensure that claim forms are accurate and complete. If they are not completed properly, this will delay the processing of your payment CSRA will provide individual training and technical assistance on completing and submitting claims form Please see CSRA contact information on last slide Link to emedny Foster Care Provider Billing Manual
19 18 Part 2: Billing Medicaid for the Managed Care Readiness Funds (continued) Once the Institutional Claim Form is properly completed, submitted and processed, the claim will initially be denied Your agency will receive a Remittance Statement outlining the denial Send this Remittance Statement ASAP upon receipt to VFCAManagedCareTrans@health.ny.gov DOH and CSRA will review and override the denial Your agency will receive another Remittance Statement from emedny indicating that your claim is in Pending status Upon notice of this status, notify DOH through the above DOH and CSRA will process the denial so that the claim can get paid Your agency will then receive another Remittance Statement indicating that your claim is in Paid status
20 19 Next Steps Once DOB approves the Foster Care rate package and you are notified by DOH, agencies will be able to submit 1 claim for the care days provided from November 2015-March 2016 Complete application to obtain NPI number Enroll in emedny to obtain MMIS number Contact CSRA for individual agency training and technical assistance from your Regional Representatives on Medicaid Billing and Claiming
21 20 CSRA emedny Provider Outreach emedny Provider Outreach Regional Representatives located in 8 regions Capital District, North Country/Mohawk Valley, South/Central NY, Finger Lakes, Western NY, Hudson Valley, NYC and Long Island CSRA Regional Representatives are available to offer provider billing training on a variety of topics through numerous methods including: Individual meetings with providers to train and troubleshoot issues Group training seminars and webinars To request a meeting with a Regional Representative call emedny Call Center at Other Training Register to attend a seminar or webinar on the emedny website Training page at ww.emedny.org
22 Please send questions to
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