DCH-i [Vol. 3, no. 3 (Apr.-May 2014)]

April/May 2014 Volume 3, Issue 3

Ordering, Prescribing, and Referring Denials Begin June 1, 2014
As of June 1, 2014, physicians or other eligible practitioners who order, prescribe or refer items or services for Medicaid beneficiaries will be required to enroll in the Georgia Medicaid Program, even if they do not submit claims to Medicaid. These providers are known as "OPR providers."
Additionally these OPR providers' individual -- not the organizational -- NPI numbers must be included on claims filed by rendering providers and practitioners or these claims will be denied. This is a requirement of the Patient Protection and Affordable Care Act.
OPR Providers should access the Georgia Medicaid Management Information System (GAMMIS) website at www.mmis.georgia.gov to enroll. During the enrollment process, individual practitioner applicants have the option to list both their Individual and/or Organizational NPI numbers on the enrollment application; however, it is critical that the OPR provider's Individual NPI be entered when providers file claims.
It is important to note that enrollment as an OPR Provider:
Does not obligate you to see Medicaid patients. Does not mean you will be listed as a Medicaid provider for patient assignment and referral. Does not require annual renewal. Allows you to continue seeing Medicaid patients if you choose without billing Medicaid directly. Helps ensure that your orders, prescriptions, and referrals are accepted and processed appropriately for Medicaid patients.
For further information, please read the Frequently Asked Questions on the DCH website. For questions, please contact Medicaid's fiscal agent Hewlett Packard Enterprise Services (HPES) at 800-766-4456, press option 0. For questions or additional information, email OPREnrollment@dch.ga.gov.

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In This Issue OPR Claims Denials Begin Revalidation System Automated ICD-10 Implementation Delay DCH, HP Begin Online-only Enrollment EHR Incentives April and May Board Actions

Automated Provider Revalidation, Application Fee System Saves Time
On April 1, 2014, the Department of Community Health (DCH) launched its fully automated Medicaid enrollment revalidation and application fee system. As mandated by the Affordable Care Act (ACA), the revalidation initiative requires all providers and suppliers currently enrolled in Medicaid to revalidate their enrollment information under new enrollment screening criteria. The ACA also requires that application fees be paid at initial enrollment and at revalidation every five years (affecting only certain facility types, not individual practitioners).
Considering the amount of paperwork already imposed upon providers, DCH developed an electronic system to ensure the process is as streamlined as possible. Rather than having to mail in the required documentation and wait for the information to be manually entered by the department, providers can verify their contact information, upload documents, pay fees, and apply for hardship waivers online.
The revalidation process is designed to require minimal data input. Providers will be required to verify their name, date of birth, Social Security Number, NPI, Tax ID number and license numbers.
In preparation of the process, providers are encouraged to immediately verify and update their contact information in the Georgia Medicaid Management Information System (GAMMIS, www.mmis.georgia.gov). Providers will then receive a letter from Hewlett Packard (HP) notifying them when it is time to revalidate their information.
The process started with providers who enrolled in Georgia Medicaid before December 31, 2012. Providers should not begin revalidation until they receive correspondence from HP instructing them to do so. Providers will have 60 days from the date of their revalidation letter from HP to complete the process.
For additional questions, please refer to the Frequently Asked Questions posted on the DCH website under Provider News. Questions may also be referred to ApplicationFeeEnrollment2@dch.ga.gov regarding the application fees, or to RevalidationEnrollment2@dch.ga.gov regarding the revalidation initiative.

About DCH-i
DCH-i is the regular 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, health care advocates, consumers and legislators. Our
goal is to help create A Healthy Georgia -- together.
Write us at DCH-i@dch.ga.gov.
Do you have a question or a comment? Tell us what's on your mind at DCH-i@dch.ga.gov.
About DCH

ICD-10 Implementation Delay: No Sooner than October 1, 2015
The implementation of the transition to ICD-10 Code Sets has been delayed by federal law (HR 4302) until at least October 1, 2015.
The U.S. Department of Health and Human Services expects to release an interim final rule soon that will include a new compliance date of October 1, 2015. The rule is expected to also require HIPAA-covered entities to continue to use ICD-9-CM through September 30, 2015.
While the Georgia Department of Community Health (DCH) will comply with this federal law, the department will continue its initiative for system remediation, internal and external testing, provider awareness and provider education as scheduled.
DCH urges you to continue with your transition plans within your practices and businesses. ICD-10 information is just a click away. Visit www.dch.georgia.gov/icd-10 for more information and resources, as well as the most recent webinar schedule. The website also includes links to previous webinars.
Join the mailing list to receive updates to ICD-10 news, webinars and events by emailing AskDCH@dch.ga.gov.
Online-only Institutional Enrollment Begins September 1, 2014
Effective September 1, 2014, the Georgia Department of Community Health (DCH) and Hewlett Packard (HP) will no longer accept paper enrollment applications from institutional providers. All paper applications will be removed from the Georgia Medicaid Management Information System (GAMMIS www.mmis.georgia.gov). Paper applications received on or after September 1, 2014, will be returned to the applicant with instructions to submit the application online through GAMMIS.
DCH is implementing this process to increase efficiency and effectiveness, reduce the administrative burden for the provider community, and expedite the enrollment process, which will reduce the time it takes enroll providers into Georgia Medicaid.
On January 1, 2015, DCH will implement this same process for all individual practitioners. Paper applications received on or after January 1, 2015, will be returned to the applicant with instructions to submit the applications online through GAMMIS. Read more.
More than $217 Million Has Been Paid in EHR Incentives Since 2011
Georgia's Medicaid Electronic Health Record (EHR) Incentive Program has issued more than $217 million in payments of federal funds to eligible providers through May 12, 2014. The program was launched on September 5, 2011.

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 is the DCH Commissioner.
We are dedicated to A Healthy Georgia. www.dch.georgia.gov
Editor-in-Chief Pamela A. Keene
Additional Contributors Kallarin Richards David Leblang
Director of Communications and Legislative Affairs Lisa Marie Shekell

DCH Mission
We will provide Georgians with access to affordable quality health care through effective planning, purchasing and oversight.

Board of Community Health Actions in April and May 2014
The Board of Community Health took the following actions at its Thursday, April 10, meeting:
RESOLUTION -- SHBP Teachers Plan Employer Contribution Rates for Fiscal Year 2015 RESOLUTION -- SHBP State Employees Plan Employer Contribution Rates for Fiscal Year 2015 PUBLIC NOTICE -- Air Ambulance for Medicaid Adults approved for final adoption

We are dedicated to A Healthy Georgia.

The Board of Community Health took the following actions at a special called meeting on Tuesday, April 29:
PUBLIC NOTICE -- Amend the Rules and Regulations for Hospitals, Chapter 111-840 approved for final adoption

The Board of Community Health took the following actions at its Thursday, May 8, meeting:
PUBLIC NOTICE -- Nursing Home Services Rate Increase Public Notice, Initial Adoption
The next regular meeting of the Board of Community Health is scheduled for Thursday, June 12, in the 5th Floor Board Room at 2 Peachtree Street, Atlanta.