Georgia Medicaid Fair 5/6/15 and other updates

I attended the Medicaid fair in Gwinnett today and thought I would pass along some of the news I heard...

Once again, as of May 1st, no paper claims, applications, additional location information should be mailed to Medicaid. Any such documents will be returned. If you ever have any questions about the application process or additional location process, feel free to contact me. If you have trouble uploading any enrollment documents to the web site, you can fax them to: 866‐483‐1045 if necessary. Medicaid is quoting a 3 week turnaround for any applications submitted currently. I have seen this to be true for most applications. As of 7/1/15, DCH will process all applications for not only new enrollment for Medicaid, but all CMOs as well. They will review documentation, approve your enrollment, but the CMO itself will have to approve your participation still (from my understanding). This will improve the process time greatly for new enrollment into the CMOs, which now takes 6‐8 months. For those of you looking into a CMO to be able to become a BCW provider, my experience lately has been Peachstate is the quickest to process applications.

Re-validation will be required every 5 years. If you did not re‐validate with Medicaid online, please do so asap before your provider ID is termed.

It is projected that on 6/1/15, requests for CMO prior authorizations for Children's Intervention Services will be submitted through Medicaid's web site instead of sending directly to the patient's CMO. Since many Medicaid members change their eligibility at different times of the month, it had been requested several times to submit auth requests directly to DCH instead to avoid confusion. A banner message will be sent out in the next few weeks to let providers know when this change should take place. The CMOs will still be reviewing and rendering decisions for whether a prior authorization is allowed. Checking the status of that request can be obtained online at mmis.georgia.gov. This gives a

centralized location to submit, check and obtain status of any PA. Any denials will have up to 3 days to submit a reconsideration request.

TPLs (third party liability claims), or secondary medicaid claims as we sometimes refer to them, must be entered in correctly to avoid issues with future audits due to Medicaid becoming paperless now. Please feel free to email me on how to enter these claims for more information. Traditionally what use to be the proper way to submit those claims has changed now, so make sure you understand how to do them.

I have received rejections lately for prior authorization requests to Medicaid due to Plan of Care's date range is prior to Dr's signature. Please make sure you do not have any dates listed other than what is beside your signature, the date of the evaluation, and the space to allow the Dr to sign and date.

As a side note, if you have not updated your CAQH in the past couple of months, please make sure you do so no later than this month. Many applications and issues are happening due to CAQH not being updated. CAQH should show your current employment, current liability and license. The web site has made it easier to work with by allowing you to upload documents directly to their site. They also have added a few new questions that will need to be answered. Their new site is: https://proview.caqh.org Enter your old username and password, then follow the prompts to change that information on the next page. If you have questions about your log in, you can contact CAQH 7am‐7pm at 888‐599‐1771.