Therap in Iowa – MCO’s & Billing Functionality Update 1.2016

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, Medicaid-Managed-Care-SquareTherap 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 (heather.thornton@therapservices.net) 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.

To learn more about Therap’s Billing Plus Module, click here.

Therap in Iowa – MCO’s & Billing Functionality Update

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.

To learn more about Therap’s Billing Plus Module, click here.

 

By |2016-11-03T09:56:37+00:00December 17th, 2015|Categories: Central Region, Heather Thornton, Iowa, Jeff Mau, Uncategorized|Tags: , , , |0 Comments