DCH-i [July 2015]

July 2015

Attention Providers!
Please be advised that the Georgia Medicaid Management Information System (GAMMIS) website (www.MMIS.georgia.gov) is currently experiencing technical difficulties. The Georgia Department of Community Health (DCH) is aware of this and is working with its vendor HP to resolve the issue immediately.
Reminder: DCH to Launch Medicaid Provider Enrollment
and CMO Collaborative Credentialing Process

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Effective August 1, 2015, DCH will implement a NCQA certified Centralized Credentialing Verification Process utilizing a Credentialing Verification Organization (CVO). The new functionality will be added to the Georgia Medicaid Management Information System (GAMMIS) website (www.MMIS.georgia.gov) and will streamline the time it takes a provider to be fully credentialed.
Credentialing and recredentialing services will be provided for Medicaid providers enrolled in Georgia Families and/or the Georgia Families 360 program.
This new streamlined process will result in administrative simplification thereby preventing inconsistencies, as well as the need for a provider to be credentialed or recredentialed multiple times.
The CVO's one-source application process will:
Save time Increase efficiency Eliminate duplication of data needed for multiple CMOs Shorten the time period for providers to receive credentialing and recredentialing decisions
Click here to read more...
Update on the DCH Voluntary LTC Background Check Program
In August 2012, the Department of Community Health (DCH) received a grant from the Centers for Medicare & Medicaid Services (CMS) to:
Help Georgia protect vulnerable populations in long-term care settings; Identify efficient, effective and economical procedures for Georgia to conduct State and federal background checks; and Establish a framework for a standardized nationwide program for Georgia to conduct fingerprint-based background checks on all prospective direct patient access employees of long-term care facilities and providers.
On June 1, 2015, DCH implemented a pilot program for home health agencies and employees of private home care providers. Effective, August 1, 2015, DCH will expand the voluntary program to include employment employees and job applicants for hospice, acute care hospitals and nursing homes. Providers will be required to sign a Participation Agreement.
As mandated by Georgia law, DCH currently conducts state and national fingerprint checks of owners and directors of personal care homes and assisted living communities, as well as the owners of private home care providers and community living arrangements.
Click here to read more...
Reminder: Suspension of Providers Who Have Not
Revalidated August 1
The Affordable Care Act mandates that states revalidate the enrollment of all providers every five (5) years. Beginning in April 2014 and monthly thereafter, DCH and Hewlett-Packard Enterprise Services (HPES) sent letters to providers requiring that they revalidate their enrollment within 60 days of the date on the letter. A significant number of the letters mailed these providers were returned to HPES. It is critical that providers ensure their mail-to-address is correct in the Georgia Medicaid Management Information System (GAMMIS). Providers can review or update their mail-to address information by logging into GAMMIS and clicking on Demographic Maintenance.
Click here to read more...

Through effective planning, purchasing and oversight, the
Department of Community Health (DCH) provides access
to affordable, quality health care to millions of Georgians, including some of the state's
most vulnerable and underserved populations.
DCH is responsible for Medicaid and PeachCare for Kids, the State Health Benefit
Plan, Healthcare Facility Regulation and Health Information Technology in
Georgia. Clyde L. Reese III, Esq. is Commissioner of the Georgia Department of Community
Health. We are dedicated to A Healthy Georgia. www.dch.georgia.gov
DCH Mission We will provide Georgians with
access to affordable quality health care through effective
planning, purchasing and oversight.
We are dedicated to A Healthy Georgia.
About DCH-i DCH-i is the bi-monthly newsletter from the Georgia Department of Community Health for all matters DCH. It provides timely and important
information to you as physicians, dentists, hospitals, third-party payers, vendors and
health care advocates.
Send us your questions at DCH-i@dch.ga.gov

Upgrade of 2013 InterQual Criteria to 2015 Version
On July 1, 2015, Alliant/Georgia Medical Care Foundation (GMCF) 2013 InterQual criteria was upgraded to the 2015 InterQual criteria. This upgrade encourages clinical reviews to be based on current and scientifically valid evidence. The 2015 criteria will apply to reviews conducted on hospital and outpatient care, imaging studies, invasive procedures and Durable Medical Equipment.
InterQual helps assess the appropriateness of patient services across the continuum of care. The 2015 criteria continues to require a strong link between diagnosis, previous treatments, study results, and the requested services. Documentation must clearly indicate this connection. Specifically, patient specific information of previous treatments, related study results, and comorbidities need to be included in each individual provider request. To document less than these requirements will impact the approval process of the provider's request.
Thank you for your continued participation in the Georgia Medicaid program.

Nominations sought for FY '16 RAC Provider Relations Committee
The DCH Office of Inspector General (OIG) and the Recovery Audit Contractor (RAC) are soliciting nominations to serve on the RAC Provider Relations Committee for State Fiscal Year 2016. This committee gives the provider community the opportunity to discuss and give feedback regarding RAC audit procedures. More information, including how to apply for committee membership, can be found at the following: http://GeorgiaMedicaidRAC.mslc.com.
The deadline for submitting applications is July 31, 2015.