Managed Health Services (MHS) Candace V. Ervin Market Manager, Indiana Provider Relations Candace.Ervin@Envolvehealth.com October 18, 2017 1
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
MHS Card ID Samples
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
MHS Card ID Samples Hoosier Healthwise The Hoosier Healthwise program is a health care program for pregnant women, children and former foster children. 5
MHS Card ID Samples Healthy Indiana Plan The Healthy Indiana Plan (HIP) covers adults age 19-64 6
MHS Card ID Samples HIP Maternity 7
Scheduling Provider Visits and Training
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 email to Candace.Ervin@Envolvehealth.com 9
D1110 D3230 D3430 Anesthesia Billing Space Maintainers Timely Filing Reconsiderations
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
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: www.envolvedental.com Provider Web Portal: https://pwp.envolvedental.com 12
Anesthesia Code Updates effective for DOS on or after July 20, 2017
MHS Envolve Bulletins and Updates MHS Envolve contracted providers can enroll to receive faxed Bulletins and updated information. Please send an email to Provider Services and update your profile. Include the Providers name, Tax identification number and your fax number. The Provider Services email address is: providerrelations@envolvehealth.com or you can contact Provider Services directly at 1-855-609-5157. 2017 Envolve Dental, Inc. 14
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 1-855-609-5157 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. 2017 Envolve Dental, Inc. 15
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 20847 Tampa, FL 33622-0847 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 1-855-609-5157 or Providerrelations@envolvehealth.com 16
Contracting and Credentialing
Contracting and Credentialing Contracting Paperless Go to our secure website at Provider Web Portal: https://pwp.envolvedental.com Enter code [IN] Enter information in each electronic document Provider must be contracted with IHCP Credentialing Paperless dentalcredentialing@envolvehealth.com 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
Out of Network Providers
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 20847 Tampa, FL 33622-0847 Please confirm through CoreMMIS the patient is an MHS member and has the benefits in question For more details, please call 1-855-609-5157 20
MHS Envolve Dental Provider Web Portal
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
Resource Resource Page Contact Member Inquiries (MHS) 1-877-647-4848 Provider Web Portal Provider Email Provider Relations Phone & Fax MHS Envolve Provider Manual Requests MHS Envolve Bulletin Enrollment https://pwp.envolvedental.com providerrelations@envolvehealth.com Phone: 1-855-609-5157 Fax: 1-844-815-4448 Credentialing Fax 1-844-847-9807 EDI Payor ID 46278 Paper Claims Address Envolve Dental IN Claims PO Box 20847 Tampa, FL 33622-0847 Authorization Address Provider Dental Appeals/Corrected Claims Candy Ervin Provider Relations and Market Manager Envolve Dental IN Authorizations PO Box 20847 Tampa, FL 33622-0847 Envolve Dental IN Appeals/Corrected Claims PO Box 20847 Tampa, FL 33622-0847 1-317-684-9478 x 20187 Candace.Ervin@Envolvehealth.com 23
Thank You!