| Site
Map Search |
|
Provider Update Newsletter
April 2005, Volume 150
All Providers
Filing Limit Reminder
Scanning
Technology to Make Claim Processing More Efficient
2005 Provider Representative Assignments
2004 Provider Satisfaction Survey Results
Community Psychiatric Support Services Providers
Billing Clarification
Dental Providers
Important Change in Limitations for Dental X-Rays
Filing Limit Reminder
EDS and the Department of Human Services (DHS) enforce
a claim submission restriction of 12 months from the last date of
service provided to Medical Assistance recipients. A claim for services
provided to a Medical Assistance recipient with no other health
insurance must be received by EDS within 12 months in order to be
processed for adjudication. Any claim with a date greater than 12 months
will be denied for timely filing.
Claims that involve a third party payer must be submitted within 12
months of the date of payment by the other payer. This will be verified
by the other insurance Explanation of Benefits (EOB). Any claim received
with a date greater than the 12 months from payment of the other third
party will be denied for timely filing.
In the situation of claims related to an accident, the claim must also
be received within a 12-month period. If an accident claim suspends and
its resolution exceeds the 12-month limitation, DHS will still allow
payment, if appropriate. However, if the claim is not submitted until
after resolution of the accident and it is greater than 12 months, the
claim will be denied for timely filing.
Adjustments to a paid claim will be accepted up to 12 months from the
remittance advice date on which the original claim payment was posted.
Scanning Technology to Make Claim
Processing More Efficient
As of February 15, 2005, UB92 claims billed on paper
are being scanned through an electronic imaging system created by
Recognition Research, Inc. This technology, which has been used to
process paper HCFA claims for some time, eliminates the need for the
claims to be manually keyed. As a result, after the initial preparation
of these claims to ensure that all required fields are completed, they
are rapidly processed within 24 to 48 hours. To assist us in this effort
to expedite claim payment, please be sure that the following
requirements are met when submitting a HCFA or UB92 on paper:
-
Claim information is legible
-
Required data is contained within the designated
blocks
-
Claim information is not crossed out
-
Print is sufficiently dark to be read by the
scanner
-
Red ink is not used to print claim
information
-
Claims include an original, inked signature
-
An EOB is attached is the recipient has other
insurance
-
Staples, paperclips and /or tape are not used
on the claim or EOB
-
Highlighting is not on the claim or EOB
-
There are no marks of any kind on the EOB
The EDS Claims Department is committed to processing
your claims in an efficient and timely manner. For this reason, we
request your attention to these guidelines to avoid the unnecessary
rejection of claims by the scanner and consequent delays in payment.
2005 Provider Representative
Assignments
The EDS Claims Department is committed to
processing your claims in an efficient and timely manner. For this
reason, we request your attention to these guidelines to avoid the
unnecessary rejection of claims by the scanner and consequent delays
in payment.
Our current Provider Representative assignments are shown on the
following chart. You will notice four changes:
Dawn Durocher has moved to our Quality Production Support (QPS)
team, an internal team focusing on the refinement of system
processes for a continuous increase in overall quality. Dawn's
knowledge of the MMIS, claims processing, and provider services will
be valuable in her new role.
New to the Provider Representative team, Ashley Cunningham has
assumed Dawn's responsibilities as the Representative for Dental and
Physician providers. Ashley has extensive customer service and
communication experience, including customer service support for
RIte Care/RIte Share families participating in premium collection
and the RIte Care enrollment of children with special health care
needs. This new responsibility will capitalize on Ashley's prior
experience in management, marketing, and various customer service
positions.
Kelly Leighton, a Provider Representative since 2003, has added
Ambulance providers to her area of support and Ingelcia Simas, our
Pharmacy Representative who has been with EDS for 11 years, is
assuming customer service for the Independent Labs.
We are excited about these changes, leveraging the experience and
background of our staff, to provide knowledgeable and effective
support for the Rhode Island Medical Assistance Program and the
Rhode Island providers. Ashley, Kelly, and Ingelcia look forward to
meeting their new providers.
For a complete listing of Provider
Representatives and their current Assignments, please click
here.
2004 Provider Satisfaction Survey
Thank you to the providers who recently responded to
the EDS 2004 Provider Satisfaction Survey. The tenth annual Survey was
conducted in December 2004 to gather feedback on our performance as the
Fiscal Agent for the Rhode Island Medical Assistance Program. The
surveys were mailed to 549 providers, including all Hospitals and all
Nursing Homes plus a random sampling of other providers; 23% of the
providers responded, including Hospitals, Physicians, Nursing Homes,
Behavioral Health providers, Dentists, Pharmacies, and other service
providers. Providers were asked to rate 23 service measures using a
scale of Superior, Good, Satisfactory, Fair, or Poor.
The 2004 results are very positive. 98% of the respondents rated the
overall performance of EDS as Satisfactory, Good, or Superior. In fact,
provider satisfaction increased in 17 of the 23 measures, compared to
the 2003 survey, with the "Superior" rating increasing by more than 10%
in 14 of the 23 measures. The largest increases recognized the areas of
provider enrollment, the consistency of information provided by the
Provider Representatives and the telephone representatives and the
quality of billing assistance obtained from the provider
representatives.
We also learned through the 2004 Survey that 81% of the respondents have
access to the Internet and 63% utilize the Department of Human Services
(DHS) website. In 2004, the information available to providers on the
DHS website was significantly enhanced allowing access 24/7 to printable
information including client eligibility, claim status, prior
authorization status, and scheduled financial payments for the Medical
Assistance Program. Recently, the website information was further
upgraded to provide service limits for dental and vision procedures as
well as long term care authorizations. Please visit the
DHS website and access “MMIS Web
Transactions” to take advantage of these useful features.
Provider Services
-
98% of the respondents rated the accessibility of the Customer
Service Help Desk (CSHD) as satisfactory or better and 99% scored
the professionalism of the CSHD similarly. Our team answered
108,073 calls in 2004. 85% of the calls were answered in 10
seconds, 92% of the calls in 30 seconds and 95% of the calls in 60
seconds. EDS exceeds the industry standard by answering 98% of
incoming calls. The highest volumes of calls were for the status of
hospital and physician claims and dental limits.
-
The
quality of our service is equally important to the efficiency. 92%
of the respondents are satisfied with the accuracy, consistency, and
clarity of information given by the telephone representatives.
Through training, we continually strive to deepen our knowledge. Our
Customer Service Help Desk has frequent trainings to keep them
informed on topics like Provider Electronic Solutions billing,
Hospital pricing, Department of Elderly Affairs Copay billing, as
well as Homemaker and Personal Care training. Other program training
included a CEDARR Program overview and multiple sessions on Pharmacy
Q&A.
-
100% of
the respondents are satisfied with the quality and relevancy of
information contained in the Provider Update. Please know that we
welcome suggestions from you on topics or information that would be
helpful to you for future updates.
-
Over
92% of responding providers are satisfied with the timeliness of
response from our Provider Representatives with 43% of the
respondents rating this service as "Superior". 95% of the
respondents are satisfied with the effectiveness of our provider
workshops, and satisfaction in the frequency of provider workshops
increased by 6% to 91% in 2004. The Provider Representatives
continue to provide workshops for Medical Assistance Billing 101,
Web Enhancement training, and individualized provider type awareness
sessions. Overall for 2004, 36 workshops were provided.
Claims
Processing
In 2004 EDS processed 6,795,613 claims;
During 2004, 98% of claims were processed
within 30 days
For 2005
we are committed to providing you with responsive, excellent service,
from the correct, efficient processing of claims to quality information
and support obtained through the Department of Human Services (DHS)
Website and the EDS Customer Service Help Desk and
Provider Representatives. Feedback from you helps us focus on your
needs. At anytime, you can reach us by email by clicking
here.
|
Survey Topic |
Total % |
5 |
4 |
3 |
2 |
1 |
|
|
5, 4, 3 |
Superior |
Good |
Satisfied |
Fair |
Poor |
|
Accessibility of Customer Service Help Desk |
98% |
37% |
50% |
10% |
2% |
1% |
|
Accuracy and Clarity of Customer Service Help Desk |
92% |
33% |
50% |
9% |
7% |
2% |
|
Courtesy and Professionalism of Customer Service Help Desk |
99% |
51% |
41% |
7% |
1% |
0% |
|
Timeliness of Claims Research Inquiries |
95% |
27% |
46% |
21% |
3% |
2% |
|
Timeliness of Provider Enrollment Process |
95% |
25% |
52% |
18% |
3% |
2% |
|
Customer Service Compared to Other Insurers |
97% |
43% |
44% |
10% |
2% |
1% |
|
Accuracy and Clarity of Provider Representatives |
96% |
42% |
44% |
10% |
2% |
2% |
|
Provider Representatives Give Consistent Information |
96% |
41% |
42% |
14% |
3% |
1% |
|
Courtesy and Professionalism of Provider Representatives |
98% |
55% |
38% |
6% |
1% |
1% |
|
Accessibility of Provider Representatives |
93% |
34% |
50% |
9% |
6% |
1% |
|
Timeliness of Response from Provider Representatives |
92% |
41% |
39% |
12% |
6% |
2% |
|
Effectiveness of Provider Relations Workshops |
95% |
33% |
43% |
20% |
1% |
3% |
|
Frequency of Provider Relations Workshops |
91% |
11% |
52% |
28% |
6% |
4% |
|
Quality and Relevancy of Information contained in the Provider
Update |
100% |
21% |
59% |
20% |
0% |
0% |
|
Quality of Billing Assistance Obtained from Provider
Representatives |
95% |
42% |
42% |
11% |
4% |
1% |
|
Timeliness and Accuracy of Paper Claims |
82% |
17% |
36% |
28% |
14% |
4% |
|
Timeliness and Accuracy of Electronic Claims |
97% |
42% |
41% |
15% |
3% |
0% |
|
Clarity and Value of Explanation of Benefits on the Remittance
Advice |
91% |
21% |
44% |
25% |
8% |
2% |
|
Timeliness of Claim Resolution |
85% |
20% |
39% |
25% |
10% |
5% |
|
Claims Processing Performance Compares to Other Insurers |
90% |
29% |
43% |
17% |
6% |
5% |
|
EDS Performance As Fiscal Agent for the RI Medical Assistance
Program |
98% |
32% |
51% |
15% |
2% |
1% |
|
Clarity of Reference Manuals |
96% |
25% |
54% |
17% |
3% |
2% |
|
Clarity and accuracy of Website information |
97% |
21% |
59% |
17% |
3% |
0% |
|
Total % |
94% |
32% |
46% |
16% |
4% |
2% |
Billing Clarification
When documenting services that are being billed in
units, please be sure that each client contact includes the client name,
the name and title of the professional who is rendering the service, the
place of visit, the type of visit, the service provided and the date,
time and duration of service. The duration of service must include the
beginning time of service and finish time of service.
When records are requested for review by the Department of Human
Services (DHS) or the Surveillance Utilization Review (SUR) team, any
documentation to justify the units of service billed should include all
information listed above. These points are taken from Medical
Documentation Guidelines.
Important Change on Limitations for Dental
X-Rays
Effective April 1, 2005 the following dental
procedures will be reimbursed once every four years:
D0210: INTRAORAL-COMPLETE SERIES (FMX) (including bitewings)
D0330: PANORAMIC FILM (PANO)
Should you have any questions or comments please feel free to call your
provider representative Ashley Cunningham at 401-784-3832 or email
Ashley by clicking here.
Please note, these changes currently display on the dental/vision limit
screen on the Department of Human
Services (DHS) website under MMIS Web Transactions.
|
