The CMS decisions in December to delay the start of the Managed Care in Iowa, has provided us a bit more time to prepare for the start of the initiative. To that end, Therap continues to move forward with the Billing System preparation.
Iowa Providers that utilize Therap’s Billing Plus functionality (the ability to submit claims directly from the platform), please find below our current progress.
Therap Billing Specialist, Heather Thornton, has provided the following update…
The electronic links to submit claims from Therap to the 4 MCO’s via Emdeon were completed on 12/18/15. As luck would have it, the news regarding Wellcare’s contract being terminated was released the same day.
On 12/22/15, we saw that Wellcare was/is appealing the termination decision. Therefore, we are keeping that link available in the event Wellcare wins the appeal.
Therap will be working with an Iowa agency to complete the link testing process this month. We anticipate this testing to be complete by the end of January.
As shared in December, “…once (it is established) that these links are fully functional, we will make them available as funding sources in Therap.
In turn, providers can then begin working on Service Authorizations for the Managed Care Organizations. Providers will need to create new Service Authorizations in order to apply these new funding sources.”
When this process can advance, providers will expire existing service authorizations for 3/1/16.
AGAIN – please wait to expire your current service authorizations until further notice.
Please note, this is all predicated on whether or not CMS approves the Managed Care initiative for Iowa and the new 3/1/16 start date. From the available information, CMS is forecast to return to Iowa in mid-February to make that determination.
Please feel free to contact Heather (firstname.lastname@example.org) if you have any questions specific these changes in the Billing Plus module. We will keep you updated on the progress as we want this to be an easy transition.