Greetings Iowa Therap User Community!
As we wait for CMS to rule as to whether or not the Iowa Medicaid Modernization initiative is a “GO” for March 1st, Heather Thornton, Therap Billing Specialist, has asked that I share the following regarding agency preparation…
In order to process claims via Therap for the Iowa MCO’s, clearinghouse enrollment is required. Therefore, if Iowa providers using Therap’s Billing Plus module want to send me their NPI, EIN and address information for enrollment into the clearinghouse, I can enter that information now. Please send ALL of your NPI numbers.
Send this information to firstname.lastname@example.org .
Upon receipt and after I enter this information on your behalf, the agency will have the capability to submit claims to the Iowa MCO’s via Therap.
In order to obtain your ERA (Electronic Remittance Advice) for AmeriHealth, there is a pre-enrollment form that must be completed by the agency. If not done so already, please request this form when you send your NPI, EIN information for Amerihealth to me. I will then send you the form that needs to be completed. In turn, you must complete the form and send it to the listed address for Amerihealth.
As you are aware, IME has stated that they will be paying all Iowa Magellan claims for the service dates starting on and after 1/1/16. To make sure you are able to bill within Therap during this transition time, your funding source listed on the Magellan Service Authorizations will need to be changed to IME.
If you have already generated Iowa Magellan claims, you will need to create a new Service Authorizations for the Iowa Magellan claims and replace the funding source with IME in order for them to be processed.
AGAIN – please wait to expire current service authorizations until further notice.
As stated in previous communications, this is all predicated on whether or not CMS approves the Managed Care initiative for Iowa and the new 3/1/16 start date.
THERAP IOWA PROVIDER BILLING WEBINAR BEING PLANNED.
Once we have definitive information on the start date for the Iowa Medicaid Modernization initiative, I plan to hold an instructional webinar for Iowa Providers using the Billing Plus module and explain how to move your current Service Authorizations to the new MCO funding sources and other preparation tasks. More information regarding this webinar will be shared when available.
As always, please feel free to contact me (email@example.com) 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.
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.
Iowa is quickly moving towards Managed Care. While there are still several issues yet to be resolved by the governing parties involved, Therap, like you, is preparing for the January 1st start date. We anticipate no insurmountable issues with this change. Therap is very comfortable in an MCO environment.
Heather Thornton, our Billing Specialist who is deeply engaged with this Iowa change reports the following…
“Therap is in the process of establishing the electronic links for the Iowa MCO’s with the clearinghouse, Emdeon. We expect to have this completed towards the end of the December.
When these links are established, Therap will then proceed with testing of claims submission through each of the MCO’s, to make sure everything is ready to “Go Live”.
Once Therap establishes 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 12/31/15.
Please wait to expire your current service authorizations until further notice.”
This is all predicated on the responsiveness of the MCO’s and whether or not CMS approves the Managed Care initiative for Iowa and the 1/1/16 start date.