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New York Department of Health Bureau of Early Intervention State Fiscal Agent

New York Department of Health Bureau of Early Intervention State Fiscal Agent. NY EI SFA Steering Committee September 23, 2013. www.publicconsultinggroup.com. Agenda. Introductions Purpose of the Steering Committee PCG SFA Go-Live Customer Service Call Center Enhanced Web Site

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New York Department of Health Bureau of Early Intervention State Fiscal Agent

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  1. New York Department of HealthBureau of Early InterventionState Fiscal Agent NY EI SFA Steering Committee September 23, 2013 www.publicconsultinggroup.com

  2. Agenda Introductions Purpose of the Steering Committee PCG SFA Go-Live Customer Service Call Center Enhanced Web Site New Training Current Challenges, and Remedial Action Plans Other Business Next Meeting NY EI SFA Steering Committee - September 23, 2013

  3. PCG • Public Consulting Group (PCG) is a management consulting firm headquartered in Boston, MA • PCG specializes in consulting services to governmental agencies on federal, state and county-based levels. The map to the right illustrates our national experience NY EI SFA Steering Committee - September 23, 2013

  4. PCG’s Experience • PCG is a national leader in providing SFA services processing over $1.2B annually for 50 programs on behalf of clients in 22 states • PCG assists more than 20 states with call center operations, supporting 650,000 health care consumers and 300,000 providers • PCG leverages the research and practices of the Project Management Institute’s Project Management Body of Knowledge (PMBOK) as a guidepost to all of our projects and will do so here NY EI SFA Steering Committee - September 23, 2013

  5. PCG SFA Go-Live NY EI SFA Steering Committee - September 23, 2013

  6. Purpose of the Steering Committee • Comprises stakeholders including providers, municipalities, parents, Department of Health and Financial Services representatives, and insurance industry representatives • Avenue for stakeholder engagement and involvement • Two-way channel for information sharing throughout the SFA transition and operation NY EI SFA Steering Committee - September 23, 2013

  7. PCG Staffing • The SFA will deploy 53 staff members to support implementation and on-going operations NY EI SFA Steering Committee - September 23, 2013

  8. Customer Service Call Center • Beginning on October 1, 2013 • Staff have been trained on NY-specific claiming processes • Help users with: • EI billing process • forms management • Medicaid documentation • walkthroughs of the claiming process and systems • other items related to the Fiscal Agent • Available from 7 a.m. to 7 p.m. ET Monday through Friday, toll-free number • Current inquiry and knowledge base is being transferred to PCG NY EI SFA Steering Committee - September 23, 2013

  9. Enhanced Website • Keep the same EI Billing web address and name • Same login and password • Same functionality • Same knowledge and system information • Enhance the website based on initial user feedback, reorganized to offer better accessibility to information users need to: • Find data • Input information • Complete billing • PCG will send specific communication to website users on changes as they are rolled out • The site will continue to be updated as PCG reviews user feedback, enhances processes, and addresses issues raised during the interim process NY EI SFA Steering Committee - September 23, 2013

  10. EIBilling: New Home Page Mockup NY EI SFA Steering Committee - September 23, 2013

  11. EIBilling: New Training Page Mockup NY EI SFA Steering Committee - September 23, 2013

  12. EIBilling: New Contact Page Mockup NY EI SFA Steering Committee - September 23, 2013

  13. New Training • Increase the availability of training for providers and service coordinators regarding billing and claiming • PCG training staff will be available to meet with groups to help them better understand and use the system • NYS-based Regional trainers • New calendar of training webinars for municipalities, providers, and service coordinators • Participants will be able to access these webinars live or view a recording from the training section of the EIBilling site • A link to register for these training webinars with sign-up instructions are being emailed to stakeholders now NY EI SFA Steering Committee - September 23, 2013

  14. Training Schedule • Phase 1 of training has begun: Provider introductions to the SFA webinars begin September 23, 2013 and continue until October 8, 2013 • Training is being recorded and so available at any time • Training Goals and Objectives: • Implement an efficient and effective administrative process for the payment of early intervention claims through a State Fiscal Agent (SFA) • Ensure all stakeholders understand the purpose for, and implications of, the introduction of a State Fiscal Agent • Ensure that each individual stakeholder understands how the SFA impacts them individually as well as the system as a whole • Ensure stakeholders understand and, where required, execute new responsibilities, processes and procedures. • Ensure stakeholders know what to do, who to call, and how to get help NY EISFA Steering Committee - September 23, 2013

  15. Training Topics • Some of the Provider training topics that will be covered after the initial introductory webinars are as follows: • Insurance 101 • 835 & 277 Denials • Health Savings/Spending Account (HSA) Billed in Error • Guidance for Parent’s Receiving Checks for EI Services • Explanation of Benefits (EOB) and Subrogation • Regulated and Non-Regulated Insurance • Prior Authorizations PCG looks for user feedback when designing training NY EI SFA Steering Committee - September 23, 2013

  16. Further Training • Service Coordinator trainings will also be initiated in October • Introduction of the New York Early Intervention State Fiscal Agent • Outline the EI Service Coordinator’s role/responsibilities regarding the billing/claiming procedures • Increase understanding of the new claiming process • Training will be ongoing for stakeholders, including municipalities, providers, parents, insurance companies, advocates, others NY EI SFA Steering Committee - September 23, 2013

  17. Current Challenges NY EI SFA Steering Committee - September 23, 2013

  18. Challenge Action Plan #1 • Challenge: Payment delays to providers due to commercial third party payment processing policies (includes resolving return of 835 and Remittance information to State Fiscal Agent) • Action Plan • Lead Actions: • Conduct Provider Contracting and Credentialing with Payers • Pursue industry assisted processing change for EI claims for non-participating Providers • Industry-wide effort processing of EI claims for non-participating Providers • Support Actions • Conduct training and support for Providers and Service Coordinators • Conduct communications to Providers, Service Coordinators and Payers NY EI SFA Steering Committee - September 23, 2013

  19. Changes to Insurance Companies Payment Processes • Prioritize Commercial Insurance companies with high volumes of EI claims and work with them to find and implement solutions • Success Story: Excellus Health Plan • Changed information system to allow remittance advices to be sent to the SFA and payments to providers • Adhering to subrogation requirements to ensure payments are directed to providers and not families • Sending a letter to all members / EI parents who received misdirected payments owed to providers • Providing a report to the SFA on all EI claims processed since April 1 with remittance advice information • Letter from DOH and Excellus to providers with instructions • Success Story: Health Now Plan • Plan on contracting with billing providers NY EI SFA Steering Committee - September 23, 2013

  20. Challenge Action Plan #2 • Challenge: Define a best practice for service coordinators and providers, leading to their greater confidence, data accuracy, and claim correction • Action Plan • Lead Action: Review collection issues; conduct root cause analysis • Support Actions • Interview Providers & Service Coordinators • Conduct As-Is analysis of family and provider enrollment and cases management practices • Develop troubleshooting guidance & business process change plans as needed • Conduct communication, training and support to Providers and Service Coordinators NY EI SFA Steering Committee - September 23, 2013

  21. Challenge Action Plan #3 • Challenge: Define claim rejection and denial reasons to tailor proper follow-up responses and training and education programs for service coordinators and providers • Action Plan • Lead Action: Analyze Insurance Claiming Results • Support Actions • Enhance processes for directing claims to Providers or Service Coordinators for correction, aided by SFA claiming and customer service teams • Conduct training and support to Providers and Service Coordinators • Conduct communications to Providers and Service Coordinators NY EI SFA Steering Committee - September 23, 2013

  22. Challenge Action Plan #4 • Challenge: Greater understanding of the impact of current system of payment policies on third party claiming • Action Plan • Lead Action: Review program rules and administrative requirements to enhance business practices • Support Actions • Design acceptable enhanced business practices • Conduct training and support to Providers and Service Coordinators • Conduct communications to Providers and Service Coordinators • Assess potential NYEIS changes NY EI SFA Steering Committee - September 23, 2013

  23. Assistive Technology Devices • Assistive technology devices authorized in children’s IFSPs • Assistive technology devices will continue to be accessed through loan programs (e.g., TRAID, municipal loan closets), if available and appropriate for the child • The PCG Assistive Technology Coordinator will collaborate with the municipalities/counties to facilitate the purchases through ATD vendors • Payment for the purchased devices will primarily originate from commercial and public insurance, with the municipalities/counties being responsible for the residual • A pricing methodology will be implemented to ensure cost-effective procurement of ATDs NY EI SFA Steering Committee - September 23, 2013

  24. Other Business NY EI SFA Steering Committee - September 23, 2013

  25. Contact Sheet Rick Dwyer Jamie Kilpatrick PCG Deputy Project Manager jkilpatrick@pcgus.com (615) 983-5318 Joe Baile Nathan Grossman Tina Chen-Xu Rob Lillpopp Stephen Greene PCG Project Manager rdwyer@pcgus.com (617) 717-1250 PMO Manager jbaile@pcgus.com (617) 717-1241 Business Process Redesign Manager ngrossman@pcgus.com (617) 717-1189 Billing and Claiming Manager sgreene@pcgus.com Consultant tchenxu@pcgus.com Communications Lead rlillpopp@pcgus.com NY EI SFA Steering Committee - September 23, 2013

  26. Public Consulting Group, Inc. 148 State Street, Tenth Floor, Boston, Massachusetts 02109 (617) 426-2026, www.publicconsultinggroup.com

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