Medicaid Revalidation: Frequently Asked Questions
MCO/BHO Provider Enrollment/Revalidation FAQ
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Learn the answers to frequently asked questions about MedicaidnnImportant Notes:nnRevalidation is required for all currently enrolled Medicaid providers (those with a Medicaid ID). MCO/BHO providers that are enrolled in Medicaid as well as credentialed into a plan network must complete the revalidation process.nnMCO/BHO and CHP+ network providers who are currently not enrolled in Medicaid must complete enrollment no later than October 31, 2016. Although the Centers for Medicare and Medicaid (CMS) has extended its deadline for provider revalidation to September 24, 2016, it is critical that Colorado providers complete revalidation and/or enrollment as soon as possible. The Department is launching its new enrollment and claims management system, the Colorado interChange, on November 1, 2016. Starting on that date, claims and encounters submitted by providers who have not enrolled and/or revalidated will be denied. Questions regarding provider revalidation and enrollment should be addressed to Provider.Questions@state.co.us. Please be patient, as response time may run 10-14 days.nnFrequently Asked Questionsnn[vc_toggle title=”1. What is the purpose of this initiative?” size=”sm” el_id=””]New federal regulations established by the Centers for Medicare and Medicaid Services (CMS) require enhanced screening and revalidation of all Medicare, Medicaid, and CHP+ providers. Beginning Sept. 15, 2015, all Colorado providers who want to continue, or begin, providing services to Medicaid and CHP+ members after March 31, 2016, will be required to enroll and revalidate their licensure and business information under new federal enrollment screening criteria. The Department of Health Care Policy and Financing (HCPF) has posted more information on the provider screening rule on their website; click on the Federal Provider Screening Regulations link.[/vc_toggle]nn[vc_toggle title=”2. With revalidation, we understand the providers will keep their existing Medicaid IDs, but may be assigned additional IDs depending on how they’re currently set up. How will the providers and Plans be notified if the existing Medicaid ID changes?” size=”sm” el_id=””]With revalidation, we understand the providers will keep their existing Medicaid IDs, but may be assigned additional IDs depending on how they’re currently set up. How will the providers and Plans be notified if the existing Medicaid ID changes? Current providers will continue to use their Medicaid ID numbers through October 31, 2016. Starting on November 1, all Medicaid and CHP+ providers will be identified in the interChange system either by their NPI or by a system-assigned ID number (for providers not eligible for an NPI). Providers identified by a system-assigned number will be notified shortly before full implementation, hopefully by mid-October. Current/existing Medicaid ID numbers will remain in the system as legacy identifiers but will not be used to pay claims with a DOS of 11/1/16 or later.[/vc_toggle]nnn[vc_toggle title=”3. Plans have to put a process in place to identify providers that have either not revalidated or are up for revalidation (every 3-5 years). In this process, there needs to be a way the MCOs/BHOs can verify the revalidation. How will the MCO/BHO know which providers have been revalidated?” size=”sm” el_id=””]Plans have to put a process in place to identify providers that have either not revalidated or are up for revalidation (every 3-5 years). In this process, there needs to be a way the MCOs/BHOs can verify the revalidation. How will the MCO/BHO know which providers have been revalidated?” The Department is still working on an outreach plan for providers who have not revalidated within established time frames. A spreadsheet was distributed to MCOs/BHOs in mid-January 2016 that listed providers, by county, who had not started revalidation by 12/31/15. MCOs/BHOs should compare this list to their list of network providers that are currently enrolled in Medicaid. An updated list will be provided by the end of February 2016. These providers should be outreach targets. Providers will be notified by the interChange system several months prior to their next revalidation period, which will be either 3 years or 5 years, depending on provider type.[/vc_toggle]nnn[vc_toggle title=”4. Will there be a lookup on the State’s portal (or other mechanisms) similar to verifying eligibility for members, where plans can verify revalidation for providers?” size=”sm” el_id=””]Will there be a lookup on the State’s portal (or other mechanisms) similar to verifying eligibility for members, where plans can verify revalidation for providers?” Not at this time. Providers will be notified of their next required validation.[/vc_toggle]nnn[vc_toggle title=”5. Will there be a list of validated providers available to the plans?” size=”sm” el_id=””]The Department is able to pull a list of providers who have revalidated by NPI number, but cannot pull a list of providers by health plan.[/vc_toggle]nnn[vc_toggle title=”6. We understand providers will get a confirmation letter when they’re revalidated. Can the plans get a copy of this letter template?” size=”sm” el_id=””]The current letter is being revised and a new letter with additional information will be published in the near future. We will provide a copy of both letters. The date for distribution of the new letter is still pending.[/vc_toggle]nnn[vc_toggle title=”7. Can the Plans be a cc on the letter to the providers?” size=”sm” el_id=””]No. Letters are sent directly to the email address submitted by the provider in its revalidation application. A costly systems change would be required to include a cc for health plans in these letters.[/vc_toggle]n
nnMedical liability reforms are likely to be advanced and challenged in 2016, according to a report published by the American Medical Association. nnTo address existing and developing issues in medical liability, the AMA is pursuing legislative solutions at the federal and state levels. To expedite the resolution of meritorious claims, provide more consistent damage awards, and reduce defensive medicine, 3 states recently passed new bills to create early disclosure system. Other states are likely to design systems to engage in early discussion with patients following adverse health care incidents. States will also work to establish and protect existing medical liability reforms, with implementation of caps on noneconomic and total damages.nnThe report also addresses new movements underway to adopt a no-fault patient compensation system for medical liability in which patients would be compensated automatically; many, including the Physician Insurers Association of America, are not in favor of the no-fault system. Legislation that the AMA will be advocating for in 2016 includes the Sports Medicine Licensure Clarity Act, which would protect sport medicine professionals when they travel with teams across state lines, and the Good Samaritan Health Professionals Act, which will protect health care professionals who volunteer during a federally declared disaster. Lastly, physicians are also supporting medical liability reforms in the midst of legal challenges, including cases that threaten physician-patient confidentiality and cases questioning the admissibility of expert evidence and testimony.n
S01.02XA — Laceration with foreign body of scalp, initial encounternnW61.33XA — Pecked by chicken, initial encounternnY92.72 — Chicken coop as the place of occurrence of the external cause
nnIf you think it’s tough to create a comprehensive patient payment plan among the staff members of your own practice, imagine doing it with 115 physicians and staff spread across six locations in Utah, who process more than 1,000 claims per day. nnGranger Medical Clinic (GMC), the largest independent multi-specialty medical clinic group in Utah’s Salt Lake Valley. GMC was facing the same issues as smaller practices: an increasing number of patients responsible for a higher financial burden of their healthcare through high deductibles and copays. What’s more, they were losing money once those patients walked out the door, mostly because of a soft or absent payment policy and training for staff.nn“We had opportunities to collect missed and it forced things to the back end when a lot could have been resolved on the front end (of operations),” said Tim Ledbetter, former director of revenue cycle operations for GMC. Ledbetter discussed GMC’s collections transformation at a session during this year’s Health Information and Management Systems Society (HIMSS) conference in Las Vegas. Ledbetter noted that across healthcare today, out-of-pocket spending for patients is on the rise, not only among plans affiliated with the Affordable Care Act, but also those sponsored by employers. Add to that rising medical debt among patients and practices are facing a tough situation with those who actually show up for treatment.nnA 2014 Bankrate survey indicated that 55 percent of patients worry they won’t have enough savings to pay their medical bills. “You have more than half of patients walking into a clinic not just worried about their care and services, but also paying that bill.” Ledbetter continued, “That’s a lot of stress walking in the door.” To collect more on the front end of patient visits, GMC gathered its internal stakeholders (physicians, front-desk staff, etc.), as well as its health IT vendors to not only come up with a standardized policy for its six locations, but a technology process to both manage and streamline it.n
S73.015A — Posterior dislocation of left hip, subsequent encounternnS62.162A — Displaced fracture of pisiform, left wrist, initial encounter for closed fracturennW00.1XXA — Fall from stairs and steps due to ice and snow, initial encounternnX37.2XXA — Blizzard (snow)(ice), initial encounter
The Centers for Medicare & Medicaid Services (CMS) is beginning Cycle 2 of the provider and supplier revalidation process as required under the Affordable Care Act. Providers and suppliers will receive a revalidation notice 2-3 months prior to the revalidation date, either by mail or email. Failure to revalidate on time will result in deactivation of your billing privileges and your payments will come to a screeching halt!nnIf you need assistance with the revalidation process (we have done thousands!),