Managed Health Services (MHS) Candace V. Ervin Market Manager, Indiana Provider Relations October 18, 2017

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1 Managed Health Services (MHS) Candace V. Ervin Market Manager, Indiana Provider Relations October 18,

2 Today s Agenda MHS ID Card Samples Provider Visits D1110 (Prophylaxis Adult): Frequency Changes Anesthesia Code Updates Space Maintainers MHS Envolve Dental Timely Filing Reconsiderations MHS Envolve Dental Contracting and Credentialing Out of Network Providers MHS Envolve Dental Provider Portal Key Advantages Resource Page

3 MHS Card ID Samples

4 MHS Card ID Samples Hoosier Care Connect Hoosier Care Connect is a health care program for individuals who are aged 65 years and older, blind, or disabled and who are also not eligible for Medicare. 4

5 MHS Card ID Samples Hoosier Healthwise The Hoosier Healthwise program is a health care program for pregnant women, children and former foster children. 5

6 MHS Card ID Samples Healthy Indiana Plan The Healthy Indiana Plan (HIP) covers adults age

7 MHS Card ID Samples HIP Maternity 7

8 Scheduling Provider Visits and Training

9 Scheduling Provider Visits and Training MHS Envolve Dental Provider Trainings include the following topics: Claims Submission Process Current Claim Issues Provider and Member Appeals Authorization Process MHS Envolve Dental Provider Web Portal Fraud, Waste and Abuse Send your request via to 9

10 D1110 D3230 D3430 Anesthesia Billing Space Maintainers Timely Filing Reconsiderations

11 D1110 (Prophylaxis-adult) Frequency changes Frequency changed to 1 per six months for HIP Plus members only. Per Indiana Health Coverage Programs (IHCP) guidelines, frequency remains 1 per 12 months for: Hoosier Care Connect Hoosier Healthwise HIP State Plan Basic and HIP State Plan Plus members ages 21 and older 11

12 Endodontics D3230 D3430 (Endodontics): For Hoosier Care Connect members over the age of 21, these codes are not covered benefits for 2017 per IHCP guidelines. This information can be found in the 2017 MHS Envolve Provider Manual. The 2017 MHS Envolve Provider Manual can be found on the Document Tab on the MHS Envolve Provider Portal. You can enroll at: Website: Provider Web Portal: 12

13 Anesthesia Code Updates effective for DOS on or after July 20, 2017

14 MHS Envolve Bulletins and Updates MHS Envolve contracted providers can enroll to receive faxed Bulletins and updated information. Please send an to Provider Services and update your profile. Include the Providers name, Tax identification number and your fax number. The Provider Services address is: or you can contact Provider Services directly at Envolve Dental, Inc. 14

15 Space Maintainers PROVIDER BULLETIN: Clarification to Space Maintainer Authorization Requests Envolve Dental, Inc. has updated its space maintainer review procedures based on guidance from the Indiana Health Coverage Programs (IHCP). Space maintenance in children age 20 and younger is a covered Envolve Dental benefit. Per IHCP guidelines, prior authorization is required only for children under 3 years of age or if permanent teeth are missing. For all space maintainers, providers must indicate the tooth number for the tooth to which the device or appliance is cemented (the abutment tooth) on the ADA claim form or its electronic equivalent. This does not replace the need for arch designation for bilateral space maintainers D1515 and D1525. Please continue to also indicate that information in the appropriate field. If you have any questions, please contact MHS Envolve Dental Provider Services at or providerrelations@envolvehealth.com. Thank you for being our partner in care. MHS Envolve Provider Services Hours of Operation: Monday Friday 8 a.m. 8 p.m. EST Envolve Dental, Inc. 15

16 MHS Envolve Dental Timely Filing Reconsiderations The timely filing requirement for MHS Envolve is 90 calendar days from the date of service. Informal claim disputes and objections must be submitted in writing to Envolve Dental. Upon receipt, Envolve Dental will review the claim and notify the provider within 30 days of the result when the denial is upheld, or via EOB if the denial is overturned. If a provider disagrees with the informal claim dispute resolution, the provider may file a formal claim dispute. For timely filing reconsiderations, please submit by mail to the address below: Envolve Dental Timely Filing Reconsiderations PO Box Tampa, FL Please include: Copy of denied claims and include the Encounter # found on the EOB Proof of timely filing submission for each claim If you have any questions please contact Provider Services or Providerrelations@envolvehealth.com 16

17 Contracting and Credentialing

18 Contracting and Credentialing Contracting Paperless Go to our secure website at Provider Web Portal: Enter code [IN] Enter information in each electronic document Provider must be contracted with IHCP Credentialing Paperless Complete the credentialing application If you have an CAQH identification number you can provide your identification for credentialing purposes Entire process typically is completed within 45 days 18

19 Out of Network Providers

20 Out of Network Providers Currently, Out of Network providers can still see MHS members for services The provider must have a valid Medicaid identification number from IHCP to perform services Providers must submit claims by paper with a W-9 for claim processing until the contracting and credentialing process is complete to: Envolve Dental Claims: IN PO Box Tampa, FL Please confirm through CoreMMIS the patient is an MHS member and has the benefits in question For more details, please call

21 MHS Envolve Dental Provider Web Portal

22 MHS Envolve Dental Provider Web Portal Fast, Efficient, Time Saving! Key advantages Member eligibility CoreMMIS is the source of truth for eligibility View member history Scheduling assistant Paperless authorizations Electronic claims submissions Fast payments - EFT Updated MHS Envolve Dental information Medicaid reimbursement fee schedules Important notices 22

23 Resource Resource Page Contact Member Inquiries (MHS) Provider Web Portal Provider Provider Relations Phone & Fax MHS Envolve Provider Manual Requests MHS Envolve Bulletin Enrollment Phone: Fax: Credentialing Fax EDI Payor ID Paper Claims Address Envolve Dental IN Claims PO Box Tampa, FL Authorization Address Provider Dental Appeals/Corrected Claims Candy Ervin Provider Relations and Market Manager Envolve Dental IN Authorizations PO Box Tampa, FL Envolve Dental IN Appeals/Corrected Claims PO Box Tampa, FL x Candace.Ervin@Envolvehealth.com 23

24 Thank You!