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Provider Update Newsletter

March 2003, Volume 125
 

All Providers

HIPAA Happenings
2002 Provider Satisfaction Survey Results
Provider Search Engine
New Billing Specialists

Assisted Living Providers

Electronic Billing of Claims

Home Health Providers

Need Help Resolving Claims?

HIPAA Happenings

Security Rule
The White House Office of Management & Budget, Office of Information and Regulatory
Affairs (OMB/OIRA) received the Final Rules on the HIPAA Security Standards on
January 13 for review. Final clearance typically takes between two weeks and 90 days, 
at which point, the final version of the regulations will be placed on display at the 
Government Printing Office (GPO) in Washington, DC, and then published in the Federal Register.

Transactions and Code Sets
DHS and EDS continue to push toward compliance with the Transaction and Code Sets Rule. 
You may not be aware but DHS has joined with sister agencies in the states of VT, NH, and 
CT to leverage the implementation of the Transactions and Codes Sets Rule. These four states 
are working cooperatively to share resources and information to reduce the cost and length of 
the implementation. To date the states have implemented a shared translator solution platform to
translate HIPAA compliant transactions to formats compatible with the internal processing 
requirements of the individual states. 

HIPAA Timeframes
Following are the planned testing and production time frames for each of the transactions being
implemented by DHS. Additional information regarding testing procedures and dates will be 
communicated as it is available.

Transaction	Testing	Production
837 Claim (Inbound)	2 Qtr	October 03
837 Claim (COB)	2 Qtr	October 03
835 Remittance	2 Qtr	October 03
270/271 Eligibility Inquiry/Response	3 Qtr	October 03
276/277 Claims Status Inquiry/Response	3 Qtr	October 03
820 Premium Payment	3 Qtr	October 03
278 Referral/Authorization	TBD	TBD

Privacy Workshop

What: You are invited to a workshop: HIPAA Privacy Regulations Awareness Training

Why: HHS Secretary Tommy G. Thompson recently issued the first – ever comprehensive 
federal regulation that gives patients sweeping protections over the privacy of their medical 
records. The final regulation, which takes effect April 14, 2003, will ensure strong privacy
protection without interfering with American’s access to quality healthcare. The workshop 
will help with identifying your needs. Has your organization appointed a Privacy Officer? 
Are your procedures developed for new policy needs required by HIPAA?

When: Friday, March 21, 2003, 9:00 AM – 12:00 PM

Where: Community College of Rhode Island, (CCRI) Knight Campus
400 East Avenue, Warwick, RI 
Presentation Room

How do I sign up: Contact Dorothy Pizzarelli, 
EDS Provider Services, at 401-784-3849

2002 Provider Satisfaction Survey Results

Thank you to the providers who recently responded to the EDS 2002 Provider Satisfaction
Survey. This eighth annual Survey was conducted in November 2002 to gather feedback on 
our performance as the Fiscal Agent for the Rhode Island Medical Assistance Program. The 
surveys were mailed to a random sampling of 529 providers; 22% of the providers responded, 
including physicians, nursing homes, Behavioral Health providers, dentists, hospitals, pharmacies, 
and other service providers.

The results are positive; 94% of the respondents are satisfied with EDS performance as fiscal 
agent for the Rhode Island Medical Assistance Program. We are glad for the positive responses, 
which validate our continued focus on timely, accurate processing of claims and effective customer 
service support. The surveys also show us areas for improvement and provide suggestions for our 
service to you. The comments are helpful and range from “… electronic filing has been the best 
update” to questions on the Remittance Advice and suggestions for website publications. The 
2002 Survey results are shown on the next page. Some highlights are discussed below:

Provider Services

Customer Service Help Desk (CSHD) and Provider Representatives
· Over 95% of the respondents are satisfied with the accessibility of the CSHD and 99% are satisfied 
with the professionalism of the CSHD. In fact, the CSHD answered 105,914 incoming provider calls 
in 2002, answering 85% of the calls in 10 seconds, 91% of the calls in 30 seconds and 95% of the 
calls in 60 seconds. The highest volumes of calls were for the status of hospital and physician claims 
and dental limits. 
· Over 95% of the responding providers are satisfied with the timeliness of response from our Provider 
Representatives, which is a 3% improvement over the 2001 responses. Satisfaction with the effectiveness 
of the Provider Relations Workshops also increased 4% to 93% in 2002 reflecting the focus on provider 
workshops. Throughout 2002, EDS Provider Representatives provided 19 Medicaid Billing 101 workshops, 
which included the basics of billing a claim and understanding the Remittance Advice (RA). Fourteen other 
workshops were provided to target new programs or to specialize in specific provider billing areas. 
· 97% of the respondents are satisfied with the quality and relevancy of information contained 
in the provider update

Claims Processing

In 2002 EDS processed 5,785,891 claims:
· 97% of the respondents were satisfied with the timeliness and accuracy of electronic claims 
· There was a 5% increase in satisfaction from 2001 in the timeliness and accuracy of paper claims
During 2002, 98% of claims were processed within 30 days. 
In 2003 we are committed to provide you responsive, excellent service from the correct, efficient 
processing of claims to quality information and support obtained through the Department of Human 
Services Website and our Customer Service Help Desk and Provider Representatives. Feedback 
from you helps us focus on your needs. At anytime, you can reach us by email 

	Total % Satisfied or Better	5	4	3	2	1
2002		Superior	Good	Satisfied	Fair	Poor
Accessibility of Customer Service Help Desk	95%	34%	45%	16%	4%	1%
Accuracy and Clarity of Customer Service Help Desk	94%	22%	58%	15%	5%	1%
Courtesy and Professionalism of Customer Service Help Desk	99%	45%	47%	8%	1%	0%
Timeliness of Claims Research Inquiries	89%	21%	44%	24%	7%	4%
Timeliness of Provider Enrollment Process	84%	16%	37%	32%	11%	4%
Customer Service Compared to Other Insurers	95%	35%	47%	14%	5%	0%
Accuracy and Clarity of Provider Representatives	94%	23%	54%	18%	6%	0%
Provider Representatives Give Consistent Information	95%	23%	51%	22%	3%	2%
Courtesy and Professionalism of Provider Representatives	98%	43%	45%	10%	2%	0%
Accessibility of Provider Representatives	88%	26%	45%	17%	9%	3%
Timeliness of Response from Provider Representatives	95%	18%	46%	31%	3%	2%
Effectiveness of Provider Relations Workshops	94%	11%	58%	24%	5%	2%
Frequency of Provider Relations Workshops	85%	10%	34%	41%	8%	7%
Quality and Relevancy of Information contained in the Provider Update	97%	22%	52%	23%	3%	0%
Quality of Billing Assistance Obtained from Provider Representatives	92%	25%	51%	16%	7%	1%
Timeliness and Accuracy of Paper Claims	82%	9%	37%	36%	14%	5%
Timeliness and Accuracy of Electronic Claims	96%	40%	35%	20%	2%	2%
Clarity and Value of Explanation of Benefits on the Remittance Advice	87%	16%	41%	30%	9%	4%
Timeliness of Claim Resolution	78%	8%	29%	42%	16%	6%
Claims Processing Performance Compares to Other Insurers	83%	19%