MCE Technical MeetingMinutes

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Meeting Details
Meeting Name: / MCE Technical Meeting
Leader/Facilitator: / Jeanne Lewer
Location, Date and Time: / HP Conference Room 1102
April 20,2012 2:00-4:00pm
Call in number (866) 409-2889 Access Code: 231-339-2439#
HP Virtual Rooms event link:
Virtual room participant code:EPY7ABN2B2
Scribe: / MCU (RH)
Invitees

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Jeanne Lewer, HPErica Smith, HPMarcia Shively, MDwise

Becky King, HPDiann Brown, ACSDebbie Tinsley, MDwise

Linda Stahl, HPCristy Douglas, AnthemTracy Silvers, MDwise

Maria Hernandez, HPMichele Turner, AnthemCindy Fulper, MDwise

Julie Sloma, HPMinga Williams, AnthemGary Phillips, MDwise

Beth Linginfelter, HPCindy Embry, AnthemManju Nair, MHS

Rebecca Siewert, HPMaureen Griffin, AnthemJeff Dill, MHS

Raeann Hewitt, HPCory Hadley-Hurt, AnthemPenny Brocksmith, MHS

Jenni Albers, HPTammy Chadd, MDwiseNatalie Smith, Maximus

Brian DiPiro, OMPP

Agenda Items
Item / Topic / Facilitator / Notes (conclusions, discussions, decisions, and next steps)
1 / ICD-10 / HP / Updates/Status given by Jenni Albers. ICD-10 Implementation date for HP will still be 10/1/2013 although the effective date will be moved to 10/1/2014.
-A new CMS 1500 will be introduced in June 2014. It has not been approved yet.
-DSM5 coming in May
-Next survey for vendor readiness is May 7th and for provider readiness is May 8th.
-New DRG to come out also
Updated presentation posted to MCO Q&A web site.
2 / Project Status Updates / HP / 2011- 834 Modifications - Reporting PMP’s across regions-Implemented
2009-2010 – HIP Modifications - Postponed release to September. Joe Poisson is new PM.. Planning in 2 weeks to have projects reviewed and approved MCEs will be invited to a meeting to review.
2027- Hospital Assessment Fee - On track but CMS has not yet approved the SPA, contingency plan in place if needed. If approval is received after cap cycle runs next month, HP may issue manual checks. Once the system changes are in place, MCEs will receive electronic payments. Vendor testing next week, will have update on Monday. HP will change the description of the 0483-ESP High Risk Member Payment expenditure to 0483-Miscellaneous MCE Payment.
A few questions were raised by the plans…What loop will the PLB elements for the expenditure payments be sent on the 835 file? The PLB segment does not have a loop designation. This is because it is included in the summary section of the transaction along with the transaction set trailer.
Will plans continue to receive payments for these items as they do today? Will the references to Stop Loss and ESP be removed from CO 2027? There are no changes to reimbursement for HIP plan payments with CO 2027. HAFonly applies to risk-based managed care. Only HHW supplemental program payment changesapply to HAF. The updated BD was sent to the plans this week.
2032-2033-2034 – HIP –change orders will be implemented in September.
2015 - HOLD status-possible December release. HP must send monthly pay.no pay file to ICES by 7pm. Therefore, it is critical for plans to submit their files by the agreed upon deadline. If an MCE receives an email stating there is an error, the plan must use the email box to respond to HP that it will be resubmitting the file. This must be done before the time specified in the email.
AI: Plans are to respond to Beth Linginfelter and Gretchen Atkins by May 4th if they are interested in moving the pick-up time to earlier in the day on the monthly pay/no pay files. If there is consensus, HP and OMPP will investigate the feasibility of changing the schedule and determine whether a change order is needed to facilitate the change.
Project Status Updates Continued / 2023 – NPI File Sequence LOC End Date - HOLD with possible December release
2006 - Provider Eligibility file-Implemented
1970 - ACA-September release-Fee for Service claims
2030 - Present on Admission-excluded specific diagnosis codes for peds and ob
-to be implemented on 7/1/12
-Provider Preventable Conditions – new rules and edits
4 / HIP 834 B9/P3 Updates / HP / See MCO Q&A Web site for presentation/recap of the HIP cumulative claims transaction and how it’s reported on the 834s.
5 / 835 Issues / HP / Recreating the 835 supplemental files from January and February needs a change request-not able to work under prior issues process.
Linda: Crosswalk to First Steps LPI would not create 835. EDI put in a Service Manager ticket to research issues on 835 dual providers and other.
AI: HPwill present examples in next technical meeting
6 / Patient Status Code / HP / Patient status code is not being reported on outpatient encounters. 1/1/12 implementation date was updated in the IHCP provider manual so that providers are aware that claims will deny with no status code.
7 / Top Ten Denials / HP / The top 10 encounter denials were reviewed. Documentation can be found on the MCE Q & A Website.
8 / Encounter claim denials / HP / Review of edits affecting MCE encounter claims
  • 591
  • 4028
Copies can be found on the MCE Q&A Website.
9 / Recap past month’s activities / HP /
  • Posted new version of MCE Policy and Procedures Manual to MCO Q&A website
  • Right Choices Program Policy and Procedures Manual posted to MCO Q&A Website
  • NCCI Edits questions from plans were addressed. There are no optional parts of the NCCI edits. HP implemented edits4181, 4182, and 4183. HP added code auditing rules which are 4186-4196. HP excluded 100 code pairs for the ante-partum care policies listed in chapter 8 pgs 8-331 of the provider manual. Please request the job aid or the excluded code pairs from

10 / Action item review / HP / Review open and new action items
Materials and Handouts
Item / Owner / Description/Location
1 / HP / CARE PROGRAMS CO Summary listing
2 / HP / ICD-10 April Update
Details for Next Meeting
Meeting Name: / MCE Technical Meeting
Leader/Facilitator: / Jeanne Lewer
Location, Date and Time: / HP Conference Room 1102
May 18, 2012
2:00-4:00 pm
Scribe: / MCU(MH)

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