Medicaid Operations Conversion Update – Workshop Questions & Answers

7/2/2015 4:17:53 PM

Medicaid conversion workshops are winding down, and we’ve answered most of the questions that have been asked in the various workshops. We will continue to share answers to some of the frequently asked conversion questions with weekly updates on our “Latest Notices and Updates” page on our website at CommunitySolutions.PacificSource.com/Providers.

Please be sure to check the website every Friday afternoon for the most up-to-date information.

Go-Live: August 1, 2015

 

Question: Will PacificSource require red/white CMS1500 form for paper Medicaid claims? Currently, PH Tech and the State require this.

Answer: They are preferred, but not required.

Question: Will the member ID cards have the -00 suffix?

Answer: No. The suffix will not be required for verifying eligibility or claim submission.

Question: Will all of the group IDs be the same for Medicaid or will they vary by CCO?

Answer: All Medicaid members will have the same group ID. The group ID will not be displayed on the member ID card and will not be required for claim submission.

Question: What is the maximum number of diagnosis codes that can be added when submitting a referral/preapproval request through the InTouch portal?

Answer: Still be researched.

Question: In the preapproval section of InTouch, can PacificSource reword "Place of Service" to “Service Location” or something similar? This may cause confusion with POS codes, such as 11, 22, etc.

Answer: This is not something that can be changed immediately. This is under internal review.

Question: Will both the State issued ID and the PacificSource ID print on the explanation of payments (EOPs) and be included in the 835 files?

Answer: The PacificSource ID will be included. We are in the testing phase of including the State assigned Medicaid ID and will communicate once we have additional information.

Question: Will there be future ability to email claims or referral/preapproval questions via InTouch?

Answer: This functionality is not available in the claims area of the InTouch portal at this time. It will, however, be available in the authorizations area of InTouch. We are looking at options of offering this functionality in the claims area in the future.

Question: Will InTouch show coordination of benefit (COB) information?

Answer: Yes. Currently, InTouch has this capability for our Medicare Advantage/Commercial lines of business. We are testing Medicaid now, but we expect the functionality to be available for Medicaid.

Question: Will InTouch show historical primary care provider (PCP) information?

Answer: Yes.

Question: Can pediatric offices continue to email newborn PCP assignment changes in addition to calling Customer Service?

Answer: Yes, as long as they are sent securely.

Question: In the Pharmacy PA section of InTouch, is PacificSource planning on adding spaces for additional diagnosis codes?

Answer: This is currently on our InTouch wish list.

Question: Are there browser limitations for InTouch?

Answer: InTouch is supported by Internet Explorer 9 (8 may work at times).

Question: Recently, InTouch has looked “squished”, has something changed?

Answer: This is likely a browser issue. PacificSource is investigating further.

Question: Will PCPs be able to view chart notes if they are attached to a specialist submitted referral request in InTouch?

Answer: Yes. This will be available if they are included in the request submitted by the specialist.

Question: Will InTouch show future termination date information?

Answer: If the member is termed, InTouch will provide termination information. It will not show future termination information.

Question: Will there be in indicator code on the PacificSource Medicare EOP for dual members to indicating a crossover claim?

Answer: Still being researched.

Question: What are Customer Service Department hours for Medicaid?

Answer: Customer Service Department hours will continue to be Monday through Friday, 8:00 a.m. to 5:00 p.m.

Question: Will the FFS column be on the EOP?

Answer: No.

Question: Is a provider required to use a clearinghouse?

Answer: In order to submit a claim electronically, providers do need to partner with one of our affiliated clearinghouses. PacificSource does partner with Office Ally who offers some free services. It’s important to note, this option is not available until July 10, 2015.

Providers can also submit directly to PacificSource via InTouch. This option should not be used prior to August 1, 2015. Submissions via the InTouch portal prior to August 1 will result in a denial.

Question: Will there be an indicator in InTouch to identify if a member is an ICCS member?

Answer: If the member is an ICCS member, their plan will indicate “No referral required”. PacificSource is looking into the possibility of adding a flag indicator in addition to this language, however it may not be available at go-live.

Question: How is PacificSource going to report to PCPs the day-to-day PCP assignment changes?

Answer: The monthly capitation report will show these changes. Providers can also check InTouch for the most up-to-date PCP assignment information.

Question: How long before InTouch will time out when entering a request?

Answer: Four hours.

If you have a question that is not included above, please feel free to email us at ORProviderService@pacificsource.com. We’ll include your question and answer in a future weekly update. (Some questions require additional research. We will communicate answers as soon as we have information.)

If you have any questions regarding this notice, contact your PacificSource Provider Service Representative.


Back