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Basic Billing 2013

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Title: Basic Billing 2013


1
Basic Billing 2013 Ohio Medicaid Home Care Aides
2
Ombudsman
  • Kathy Frye
  • Laura Gipson
  • Dwayne Knowles
  • Kenneth Morgan
  • Jamie Speakes
  • Meagan Lyle, Manager
  • Office of Ohio Health Plans
  • External Business Relations

3
External Business Relations
  • Investigate and resolve billing issues
  • Identify system and policy issues
  • Speak at seminars for provider associations
  • Conduct individual consultations with providers
  • Conduct basic billing trainings

4
Agenda
  • Medicaid Overview
  • Policy Overview
  • MITS
  • Websites

5
Medicaid Overview
6
Ohio Department of Medicaid(ODM)
  • Covered Families and Children
  • (Healthy Start and Healthy Families)
  • Aged, Blind or People with Disabilities
  • Home and Community Based Waivers
  • Medicare Premium Assistance
  • Hospital Care Assurance Program
  • Medicaid Managed Care

7
Ohio Department of Medicaid(ODM)
  • Covered Families and Children
  • (Healthy Start and Healthy Families)
  • Aged, Blind or People with Disabilities
  • Home and Community Based Waivers
  • Medicare Premium Assistance
  • Hospital Care Assurance Program
  • Medicaid Managed Care

8
Ohio Medicaid Benefits
  • Home Health Services
  • Transportation services
  • Physician Services
  • Inpatient/ Outpatient Services
  • Nursing Facility
  • Dental services
  • Durable medical equipment
  • Hospice Services
  • Behavioral Health
  • Pharmacy Services
  • Vision

9
Medical Necessity
The fundamental conceptunderlying the Medicaid
Program.
All services must meet accepted standards of
medical practice
10
Interactive Voice Response System
(IVR)1-800-686-1516
  • All calls are directed through the IVR prior to
    accessing the customer call center staff
  • Providers are responsible for granting and
    maintaining IVR access for their billing entities
    or trading partners
  • Provider Assistance staff are available weekdays
    from 800 am to 430 pm
  • Because of HIPAA laws you must authenticate with
    your Provider Identification Number (PIN) to
    access Protected Health Information (PHI)

11
Ohio Medicaid
  • Card for individuals not on a specific program
    under Medicaid
  • Issued monthly

12
SPENDDOWN VS. PATIENT LIABILITY
13
When a consumers
Medicaids
EXCEEDS
Monthly Income
Need Standard
There is a SPENDDOWN!
14
Medicaid Spenddown51011-39-10
  • If a non-waiver consumer has an income that
    exceeds the Medicaid need standard, the consumer
    must incur medical expenses that will reduce
    his/her income to the Medicaid need standard.
  • The department defines incurred expenses as
    expenses that the client is obligated to pay.
  • When the spenddown amount is incurred, the
    consumer must contact his/her caseworker at his
    or her local CDJFS to be eligible for Medicaid.

15
Medicaid Spenddown(Continued)
  • Three ways spenddown can be met
  • ONGOING Routinely occurring medical expenses, of
    the same type and amount each month, that are not
    covered by Medicaid
  • PAY-IN The spenddown amount is paid to the CDJFS
  • DELAYED Medical expenses vary from month to
    month, must verify the incurred amount with the
    CDJFS

16
Medicaid Spenddown Example
When a Medicaid consumers monthly income exceeds
the need standard there is a Spenddown.
Consumers Monthly Income 500.00
Medicaid Need Standard 400.00
Spenddown 100.00
_

17
PATIENT LIABILITY
  • A consumer on a waiver program may have a patient
    liability instead of a spenddown.
  • The department defines patient liability expenses
    as expenses that the client is obligated to pay.
  • Refer to the consumers All Services Plan for the
    liability amount and the provider(s) who receives
    the liability payment.

18
Provider Agreement51013-1-17.2
  • The provider agreement is a legal contract
    between the state and the provider. In that
    contract, you agreed to
  • Accept the allowable reimbursements as
    payment-in-full and will not seek reimbursement
    for that service from the patient, any member of
    the family, or any other person
  • Maintain records for 6 years

19
Provider Agreement(Continued)
  • You also agreed to
  • Render medically necessary services in the amount
    required
  • Recoup any third party resources available
  • Inform us of any changes to your provider profile
    within 30 days
  • Abide by the regulations and policies of the state

20
Provider Reimbursement51013-1-02 51013-1-60
  • The departments payment constitutes
    payment-in-full for any of our covered services
  • Providers are expected to bill the department
    their usual and customary charges (UCC)
  • The department reimburses the provider at the
    Medicaid rate (established fee schedule) or the
    UCC, whichever is the lesser of the two.

21
Coordination of Benefits51013-1-08
  • Medicaid is the payer of last resort.
    Therefore, providers must obtain a payment or
    denial from other payers prior to billing
    Medicaid.
  • Providers who have gone through reasonable
    measures to obtain all third party payments, but
    who have not received a payment (or received a
    partial payment) from other payers, may submit a
    claim to Medicaid requesting reimbursement for
    the rendered service(s) in accordance to OAC rule
    51013-1-08.

22
Recipient Liability51013-1-13.1
  • A Medicaid consumer cannot be billed
  • When a Medicaid claim has been denied
  • Unacceptable claim submission
  • Failure to request a prior authorization
  • Retroactive Peer Review determination of lack of
    medical necessity

23
Medicaid Subrogation Rights51013-1-08
  • Section 5101.58 of the Ohio Revised Code requires
    that a Medicaid consumer provide notice to the
    department prior to initiating any action against
    a liable third party
  • The department will take steps to protect its
    subrogation rights if that notice is not provided
  • For questions, contact the Coordination of
    Benefits Section (614-752-5768)

24
Electronic Funds Transfer (EFT)
  • ODJFS suggests electronic funds transfer (EFT)
    for
  • payment instead of paper warrants. Benefits of
    direct
  • deposit include
  • Receipt of payment quicker Funds are transferred
    directly to your account on the day paper
    warrants are normally mailed
  • No more worry about lost or stolen checks or
    postal holidays delaying receipt of your warrant
  • If you move your payment will still be deposited
    into your banking account
  • For additional information and to begin receiving
    funds
  • electronically, you will find the Direct
    Deposit/EFT form at
  • http//jfs.ohio.gov/OHP/provider.stm

25
Policy Overview
26
OAC Ruleshttp//emanuals.odjfs.state.oh.us/emanua
ls/
  • Based on your provider agreement, you are
    obligated to abide by the regulations and
    policies of the state. Therefore, you must read
    and understand all Ohio Administrative Code (OAC)
    rules that pertain to your provider type. To
    start, please refer to the OAC rules noted below
  • 51013-45-01, Definitions
  • 51013-45-10, Conditions of Participation
  • 51013-46-04, Covered Services, Requirements,
    Specifications
  • 51013-46-06, Reimbursement Rates and Billing

27
Policy Updates
  • Policy updates from Ohio Medicaid announce the
    changes to Ohio Administrative Code that may
    affect providers. There are two types of letters
  • Community Services Transmittal Letters (CSTL)
  • Medical Assistance Letters (MAL)

28
STATE PLAN SERVICES VS. WAIVER SERVICES
29
What are State Plan Services?
  • STATE PLAN SERVICES are services that all
    Medicaid recipients can receive if they are
    medically necessary and Ohio Administrative Code
    (OAC) rules allow those recipients to receive the
    services.
  • ODJFS submits a State Plan to the federal
    government that describes how the Medicaid
    program is administered.
  • Medicaid is an entitlement program. Therefore,
    all Medicaid recipients are entitled to receive
    State Plan services if they are medically
    necessary and allowable based on OAC rules.

30
What are Waivers?
  • The term waiver refers to an exception to
    federal law that waives certain Ohio Medicaid
    eligibility requirements and allows eligible
    Medicaid recipients to cost effectively live in
    their communities instead of nursing homes or
    hospitals.
  • Since waiver programs are not entitlement
    programs, only recipients enrolled on a waiver
    program can receive waiver services from that
    waiver program.

31
Waiver Programs Administered By ODJFS
  • The Ohio Home Care Waiver
  • This waiver program serves recipients who are
    under the age of 60 and are not mentally retarded
    or developmentally delayed.
  • The Transitions DD Waiver
  • This is wavier is currently administered by the
    Ohio Department of Developmental Disabilities
    (DODD).
  • The Transitions Carve-Out Waiver
  • This is a waiver program for 60 year old (or
    older) recipients who were on the Ohio Home Care
    waiver.

32
Waiver Programs Administered By ODJFS(Procedure
codes)
  • Waiver Personal Care Services
  • T1019 Personal Care/Aide Services

When an RN or LPN is providing a waiver service,
the appropriate procedure code and modifier must
be used.
33
Waiver Programs Administered By ODJFS(Procedure
codes)
  • Waiver Services, continued
  • H0045 - Out-of-Home Respite Care Services
  • S0215 - Non-Emergency Transportation Services
  • S5101 - Day Care Services, Adult Half Day
  • S5102 - Day Care Services, Adult Full Day
  • S5160 - Emergency Response ServicesInstallation
  • S5161 - Emergency Response ServicesMonthly Fee
  • S5165 - Minor Home Modifications
  • S5170 - Home Delivered Meals
  • T2029 - Specialized Medical Equipment

34
Waiver Programs Administered By ODJFS(Modifiers)
  • U1 is for infusion therapy, RNs only
  • U2 is for the 2nd visit on the same day
  • U3 is for 3rd (or more) visit on same day
  • U4 is for a visit over 12 hours up to 16 hours
  • HQ is the group modifier

35
Services At a Glance
  • The Services-at-a-Glance chart has been developed
    as a way to quickly see the major components of
    State Plan and of Waiver Services.

36
Fix The Problem Before It Becomes A Problem That
Cant Be Fixed.
37
Problems That Must Be Fixed Prior To Submitting
Claims
  • Follow the All Services Plan.
  • Understand the terminology (e.g., state plan,
    waiver).
  • Read and understand the OAC rules.
  • Make sure your billing staff or billing company
    have all the information they need to submit
    claims for you (e.g., correct dates of service,
    procedure codes, modifiers).

38
BILL ALL WAIVER SERVICES ACCORDING TO THE ALL
SERVICES PLAN
39
Waiver Services
  • You or your agency must provide waiver services
    according to the All Services Plan. Contact your
    case manager for details.

40
When billing for waiver services for recipients
on other waiver programs (e.g., PASSPORT),
contact the appropriate state or county agency
for billing instructions.
Waiver Programs Administered By Other State
Agencies
41
Key Points
  • Follow the billing instructions.
  • Bill all services in chronological order.
  • Each line on a claim represents a visit or a
    service.
  • Most services are billed in multiple units.
  • Bill for services using the appropriate procedure
    code and modifier.
  • Some services may require multiple modifiers.
  • Only bill for the services noted on the All
    Services Plan.

42
CALCULATION FOR AIDE SERVICES
(Total Units 4) x Unit Rate Base Rate
Medicaid Maximum
  • EXAMPLE
  • Noted below is the Medicaid maximum calculation
    for a 12-hour independent aide visit.
  • 12 (hours) x 4 48 (convert hours to units)
  • 48 - 4 44
  • 44 x 3.00 132.00
  • 132.00 18.61 150.61 (Medicaid Maximum)

43
Medicaid Information Technology System (MITS)
44
MITS General Information
  • Medicaid Information Technology System
  • MITS is the new Web-based, Medicaid management
    system
  • MITS design is based upon the Medicaid
    Information Technology Architecture (MITA)
  • MITS is a .NET environment able to process
    transactions in real time

45
MITS General Information
  • Provider Contracts
  • In MITS, a provider will have a provider contract
    that determines the Medicaid population the
    provider is contracted to provide services to and
    receive reimbursement.
  • If a provider provides aide services to ODJFS
    waiver clients, the provider will receive an
    ODJFS Waiver Personal Care contract.
  • If a provider provides aides services to clients
    on the Individual Options waiver, the provider
    will receive an Individual Options contract.
  • If providers have questions regarding their
    contract, they should contact Provider Enrollment
    (1-800-686-1516).

46
MITS General Information
  • Internal Control Number (ICN)
  • The ICN replaced the Transaction Control Number
    (TCN)
  • All claims will be assigned an ICN
  • 2010170357321

20 10 170 357 321
Region Code Calendar Year Julian Day Claim Type/Batch Number Number of Claim in Batch
47
MITS General Information
  • Internal Control Number (ICN)
  • Primary region codes new claim submission
  • 10 Paper Claim without attachment
  • 11 Paper Claim with attachment
  • 20 Electronic 837 without attachment
  • 21 Electronic 837 with attachment
  • 22 Web Portal without attachment
  • 23 Web Portal with attachment

48
MITS General Information
  • Primary Region Codes, continued
  • 50 Adjustment Non-check Related
  • 51 Adjustment Check Related
  • 52 Mass Adjustment Non-Check Related
  • 53 Mass Adjustment Check Related
  • 54 Mass Adjustment Void Transaction
  • 55 Mass Adjustment Provider Retro Rates
  • 56 Adjustment Void Non-Check Related
  • 57 Adjustment Void Check Related
  • 58 Adjustment Internet claims

49
MITS General Information
  • Converted Claims
  • Claims in MMIS were converted for historical
    purposes and are denoted by the ICN region code
    40
  • Claims converted from MMIS to MITS can only be
    voided

50
System Requirements
  • Technical Requirements
  • Internet Access (high speed works best)
  • Internet Explorer version 8.0 and above or
    Firefox 1.5 3.5
  • MAC Users-download Internet Explorer for MAC
  • Turn off pop-up blocker functionality
  • How do I Access the MITS Portal?
  • Go to http//jfs.ohio.gov
  • The ODJFS Welcome Page displays
  • Select the Medicaid Information Technology System
    (MITS) link

51
System Requirements
52
Navigation
  • MITS Web Portal Navigation
  • Copy, Paste, and Print features will work
    in the MITS Portal
  • Back feature will not work in the MITS Portal
  • MITS Web Portal access will time-out after 15
    minutes of inactivity

53
Navigation
  • Panel Help
  • The ? button in the upper right corner of a
    panel may be selected to reveal panel information

54
Navigation
  • Field Help
  • Clicking a field title will open a box containing
    field information

55
Registration
  • Ohio Medicaid Providers must create a MITS web
    portal account to access the system. Setting up
    the account can be a three step process.
  • The Administrator Account Setup
  • Agent Account Setup
  • Assigning Agent Roles

56
Registration
  • Administrator Account Setup
  • One account per billing NPI
  • Only one person may set-up an Administrator
    Account
  • Access to all secure information
  • Responsible for assigning roles to agents
  • Unlimited Agents
  • Responsible for maintaining the providers MITS
    Portal account including demographic information

57
Registration
58
Registration
59
Registration
  • Agent Account Setup
  • Each Agent needs only one account
  • Agents set up own accounts
  • Administrator Account holder sets up Agent roles
  • Each Agent account is role based
  • Accounts setup by Pay to NPI
  • Agent User ID remains the same
  • Access to different NPIs can be granted
  • Agents access may be revoked by role and NPI

60
Registration
61
Registration
62
Registration
63
Registration
  • Each agent is assigned one or more of the
    following roles
  • Eligibility
  • Prior Auth Search
  • Prior Auth Submit
  • Claim Search
  • Claim Submission
  • 1099 Information
  • (includes remittance advices)

64
Registration
  • Agent Maintenance Panel

65
Registration
MITS Web Portal Access Flowchart
1
Provider Account Setup
2
Agent Account Setup
3
Provider Assigns Role(s)
66
Registration
67
Registration
Switch Provider Panel
68
Registration
  • Reminder
  • MITS Portal is Web based and as long as access is
    still active, agents will be able to log into
    your account(s) so remove their access as soon as
    they leave the office.

69
Registration
  • Updating Provider Demographics
  • Perform updates via the MITS Web Portal by
    selecting Providers and then Demographic
    Maintenance from the main menu
  • Reminder Per Ohio State Law, Providers must
    notify the State within 30 days of any change to
    demographics

70
Re-enrollment
  • Processes and Features
  • All new providers or current providers who are
    re-enrolling must use the MITS Web Portal
  • Check the status of re-enrollments via the MITS
    Web Portal

71
Re-enrollment
72
Re-enrollment
73
Re-enrollment
  • Application Tracking Number (ATN)
  • The 6 digit ATN will be assigned at the beginning
    of the enrollment process
  • Up to 3 days to complete the application
  • Check status of applications once completed

74
Re-enrollment
75
Eligibility Verification
  • Providers can use the MITS Web Portal to search
    and verify recipients eligibility for benefit
    programs
  • Eligibility information is found on the
    Eligibility Verification Request Panel

76
Eligibility Verification
  • Verification of the following
  • Medicare Managed Care
  • Benefit Plan Long Term Care
  • Third Party

77
Eligibility Verification
78
Eligibility Verification
79
Claim Submission
  • Methods of Claim Submission
  • Electronic Data Interchange (EDI)
  • MITS Web Portal
  • Paper claims
  • Paper claims will not be accepted after 1/1/2013
  • If you currently submit paper, plan for the
    transition now to either EDI or MITS portal

80
Claim Submission
Comparison of EDI and Portal
  • EDI
  • Need to contract with a trading partner or
    create/or purchase own software.
  • Fees for claims submitted
  • Claims received electronically via the trading
    partner by 1200 am Wednesday will be processed
    for adjudication over the weekend.
  • No limit to number of claims you can submit each
    day.
  • Portal
  • Free submissions
  • Providers need access to the internet.
  • Claims received by 500 pm Friday will be
    processed for adjudication over the weekend.
  • Limit of 50 claims per day, and this may change
    to unlimited claims in the near future. When the
    change occurs, providers will be notified.

81
Claim SubmissionElectronic Data Interchange
  • Information for Trading Partners
  • jfs.ohio.gov/OHP/tradingpartners/info.stm
  • Companion Guides
  • 837 Health Care Claim Professional
  • EDI Information Guide
  • Technical Questions/EDI Support Unit
  • 614-387-1212
  • MMIS-EDI-Support_at_odjfs.state.oh.us

82
Claim Submission
  • Claims Entry Format are divided into different
    sections called panels
  • Each Panel will have an asterisk () for a portal
    required field. There are some fields that are
    situational for claims adjudication that do not
    have an asterisk, but are required for
    adjudication.
  • Add/Delete/Copy
  • Search
  • Description
  • Numeric

83
Claim Submission
  • Billing instructions for submitting claims via
    the MITS Web Portal are accessible via eManuals,
    and these instructions will provide information
    that includes (but isnt limited to)
  • Field level information
  • A brief explanation of options in drop down menus
    (e.g., Medicare Assignment, Release of
    Information)
  • Provider specific information (e.g., which
    providers must enter diagnosis codes).

84
Claim Submission
  • Multiple Visits in One Day
  • If a provider is providing multiple visits in one
    day, all of the visits must be noted on a single
    claim.

85
Claim Submission
86
Claim Submission(Billing/Service Information
Panel)
Complete all of the appropriate fields. Fields
marked with an asterisk () must be completed. If
providers received patient liability payments
from clients, denote the payment in the Patient
Amount Paid field.
87
Claim Submission(Diagnosis Panel)
A diagnosis is optional on claims with any of the
following procedure codes G0151, G0152, G0153,
G0154, G0156, H0045, S0215, S5101, S5102, S5125,
S5160, S5161, S5165, S5170, T1000, T1002, T1003,
T1019, T2029. However, if one or more diagnoses
are specified, then each claim line in the
'Detail' panel must point to (be associated with)
at least one diagnosis.
88
Claim Submission(Other Payer Panel)
  • Considering Medicaid is the payer of last
    resort, providers must receive a payment or
    denial from other payers (i.e., payers other than
    Medicaid) prior to submitting claims to Medicaid,
    and these claims must reflect the other payers
    payment and/or denial information.
  • Submitting claims with Other Payer information
    will be discussed in a separate section of this
    presentation.

89
Claim Submission(Detail Panel)
Complete all of the appropriate fields. Fields
marked with an asterisk () must be completed.
90
Claim Submission(Attachment Panel)
In most situations, home care aides will not
include an attachment with claims.
91
Claim Submission(Delayed Submission/Resubmission
Panel)
If a claim was initially received within 365 days
from the 1st date of service on the claim, but
the claim was adjusted or resubmitted within 180
days after the initial claim was paid or denied,
denote the ICN of the initial claim. This
process establishes timely filing for
adjusted/resubmitted claims.
92
Claim Submission(Claim Status Panel)
  • This panel denotes the status of claims. If the
    claim was submitted and the status is Not
    Submitted Yet refer to the top of the claim for
    error messages.
  • Correct the errors (as noted in the error
    messages) and resubmit the claim. When the claim
    is appropriately submitted, the status of the
    claim will be
  • Paid,
  • Denied, or
  • Suspended

93
TPL Submission
  • Other Payer Information
  • Third-Party Liability (TPL) claims must be
    submitted EDI or via web portal
  • HIPAA compliant adjustment reason codes and
    amounts are required
  • Other payer information can be reported at the
    claim level (header) or at the line level
    (detail). This includes primary other payer
    payments or denials
  • Allowed amount is required for other payer TPL.
    MITS will automatically calculate the allowed
    amount.

94
SUBMITTING COMMERCIAL PAYER DENIAL INFORMATION
AT THE CLAIM LEVEL
Click the Other Payer Amount and Adjustment
Reason Code link to denote the appropriate CAS
Group Code, ARC Amount, and ARC.
94
95
SUBMITTING COMMERCIAL PAYER PAYMENT INFORMATION
AT THE CLAIM LEVEL
Click the Other Payer Amount and Adjustment
Reason Code link to denote the appropriate CAS
Group Code, ARC Amount, and ARC.
95
96
Adjusting, Voiding, Copying Claims
  • Paid claims can be
  • Adjusted
  • Voided
  • Copied

97
Adjusting, Voiding, Copying Claims
  • Adjusting paid claims
  • Select the claim to adjust
  • Change the necessary information within the
    header and detail, as applicable
  • Click the adjust button

98
Adjusting, Voiding, Copying Claims
  • Adjusting paid claims
  • Once you click the adjust button
  • A new claim is created and assigned its own
    adjustment ICN
  • Refer to the information in the Claim Status
    Information and EOB Information areas at the
    bottom of the page to see how your new claim
    processed.

99
Adjusting, Voiding, Copying Claims
  • Adjustment Terminology
  • Original or active claim referred to as Mother
    Claim
  • New adjusted or voided claim is referred to as
    the Daughter Claim
  • Credit Balance If a claim adjusts for more than
    the original amount, the provider will receive an
    additional payment
  • Account Receivable - If funds are due back to the
    state

100
Adjusting, Voiding, Copying Claims
Adjustment Example
2010220234001 Originally paid 45.00
5010274127250 Now paid 50.00
Credit Balance 5.00

2010220234001 Originally paid 50.00
5010274127250 Now paid 45.00
Account Receivable (5.00)
The providers additional payment.
Money due to State.
101
Adjusting, Voiding, Copying Claims
  • Voiding paid claims
  • Select the claim you wish to Void
  • Click the void button at the bottom of the page
  • The status of the original claim does not change
    however, the claim is flagged as non-adjustable
    in MITS
  • An adjustment claim is automatically created and
    given a status of Denied

102
Adjusting, Voiding, Copying Claims
Void Example
2010220234001 Originally paid 45.00
5610274127250 Reversal Void
Account Receivable (45.00) Account Receivable (45.00)
103
Adjusting, Voiding, Copying Claims
  • Copying Paid Claims
  • Search and open the claim you want to copy
  • At the bottom of the claim, select Copy claim
  • Make your changes to the fields
  • The submit and cancel buttons display at the
    bottom of the new page
  • Select Submit when changes are made
  • Claim is assigned a new ICN

104
Remittance Advice
  • Remittance Advices for claims processed are
    available on the MITS Web Portal

105
Remittance Advice
  • Pages are titled by claim type and outcome
  • CMS 1500, Inpatient, Outpatient, Long Term Care,
    and Dental
  • Medicare Crossovers A, B and C
  • Paid, Denied, and Adjustments
  • Adjustment Page
  • Identifies the original claim header information
    and the new adjusted claim

106
Remittance Advice
  • Financial Transactions
  • Non-claim specific payouts
  • Claim and non-claim refunds
  • Accounts receivable tracking
  • Summary Page
  • Provides current payment information
  • Per month information
  • Year to date information

107
Remittance Advice
  • Informational pages
  • Banner Messages
  • Provides messaging to the provider community
  • EOB Code Descriptions
  • Provides a comparison of the codes to the
    description that appeared on claims on the paid,
    denied and adjustment pages
  • TPL Information
  • If a claim was not paid due to the recipient
    having another payer source (Third Party
    Liability) this section provides other insurance
    information

108
MMIS Remittance Advices
  • Historical Remittance Advices (RA) created prior
    to MITS will continue to be available on the old
    Medicaid Provider Portal.
  • Only the RA function will be active on the
    previous web portal, and it will continue to be
    available 18 months from August 2, 2011.

109
Websites
110
ODJFS Websites
  • ODJFS Main Website
  • http//jfs.ohio.gov
  • ODJFS Consumer Website
  • http//jfs.ohio.gov/ohp/consumer.stm
  • ODJFS Provider Website
  • http//jfs.ohio.gov/ohp/provider.stm
  • MITS Website
  • http//jfs.ohio.gov/mits/index.stm
  • MITS eTutorial Website
  • http//www.odjfs.state.oh.us/tutorials/MITS-Extern
    al-Training
  • eManuals
  • http//emanuals.odjfs.state.oh.us/emanuals

111
CareStar Website
  • http//www.myohiohcp.org
  • Access the CareStar website for the following
    information
  • All Services Plans
  • Training opportunities
  • Basic information regarding background checks
  • Finding new clients/cases

112
Washington Publishing Website
  • http//www.wpc-edi.com/reference/
  • The Washington Publishing website provides
    adjustment reason codes (ARCs) that must be noted
    on claims that involve other payers.
  • The common ARCs are noted below
  • 1 (Deductible)
  • 2 (Coinsurance)
  • 3 (Copayment)
  • 45 (Contractual Obligation/Write-Off)
  • 96 (Non-Covered Services)

113
Questions
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