TRIALLIANCE

06/02/2011

Chase Hall Bolds, M.Ed

Babies Can't Wait Program Manager

Office of Children and Youth with Special Needs

Maternal and Child Health Program

Division of Public Health

Georgia Department of Community Health

2 Peachtree Street, N.W. Suite 11-222

Atlanta, Georgia 30303-13422

RE: Questions regarding the Babies Can’t Wait Programs new centralized billing and information system, (BIBS).

Dear Ms. Bolds,

As The Trialliance, representatives of the Physical Therapy Association of Georgia, the Georgia Occupational Therapy Association and the Georgia Speech and Hearing Association, we look forward to the opportunity to meet with Eileen Kaiser next week and assist the BCW program in communications to our respective associations' membership. Our current understanding of the new BIBS program is that it is intended to provide up-to-date real-time information, gather data and ensure payer of last resort by the BCW program. It also appears to offer a number of administrative efficiencies - reducing provider responsibilities that could free up more time to focus on direct patient services.

However, there are a number of questions that providers have regarding the new system. In order for the Tri-Alliance to provide our members with accurate information so that they may be fully informed, we are enclosing the following questions which have already been raised. While we realize this is a lengthy list, the Trialliancerespectfully believes these are key concerns, which need to be addressed prior to implementation of the BIBS program.

Billing Questions:

  1. Will BCW be applying for new Medicaid provider numbers foreach therapist?
  2. Will BCW be getting their own contracts with private insurance companies (i.e., Blue Cross Blue Shield,Cigna, etc)?
  3. Under whose Tax ID number will claims be billed?
  4. If BCW will beusing providers’ current numbers to bill, how will BCW receive thepayment since they are not the payee?
  5. How will billing by the provider work? Will providers be creating their own charges/“claims” to ensure accurate coding of treatment sessions?
  6. How frequently will providers be paid? You mentioned payment within 2 weeks from each claim, will each claim be paid separately or bundled together and paid within two weeks?
  7. If therapists are charging electronically after visits, will there be any need for additional invoices to BCW by the provider?
  8. There was some language indicating that providers will have to enter claims into the system within 7 days from the date of service. Is this accurate?

Documentation Requirements & Processes:

  1. It is our understanding that the TPA will be requestingPrivate Insurance, Medicaid & CMO prior authorizations, is this accurate information?
  2. It is also our understanding that the TPA will be appealing authorization decisions. Will the therapist be able to see the patient during these appeals processes?
  3. When there are billing errors that need adjustments made will providers be notified what these adjustments will be?
  4. Who will be requesting prescriptions and signatures on POCs?
  5. Will the BIBS system be available to providers on PDAs, iPads, lap tops, etc.?
  6. Who will be responsible for providing hard copies of documentation to families?
  7. Will vouchers continue to be required in counties thatcurrently require them?

Policy Questions:

  1. How will BCW assure therapists and families that all licensing, Medicaid and CMO compliance issues will be satisfied?
  2. If a provider or family object to billing, what will be the process to address these objections?
  3. How will families be notified of their rights to obtain services other than those provided by BCW?
  4. Who will hold the providers contract, the state or local agencies?

The Tri-Alliance looks forward to the answers to these questions so that we might move forward with collaborating with the Babies Can’t Wait program on informing the association members of the ensuing changes to take place with the implementation of the BIBS system.

Respectfully Submitted,

Amie LoCicero PT, DPT

Tri-Alliance Representative

404-580-1528