1. Finance Successfully Reading Your RA Financial HP Provider Relations Febuary 2012

2. Agenda • Session Objectives • Remittance Advice (RA) – General Information • Financial Transactions • Summary RA Page • Stale-Dated and Reissued Checks • Helpful Tools • Questions

3. Objectives Following this session, providers will be able to: Understand the purposes of the RA Learn how to read and understand the weekly RA Summary Page Understand financial transactions; refunds, A/R, claim-specific and nonclaim-specific transactions Understand the benefits of the electronic funds transfer (EFT)

4. Define Remittance Advice

5. Remittance Advice General Information The most significant tool an Indiana Health Coverage Programs (IHCP) provider has to monitor participation in the program is the weekly RA. The RA provides information about claims processing and financial activity. Web interChange Claim Inquiry/Show More Claim Information functions provide similar information for individual claims. The Health Insurance Portability and Accountability Act (HIPAA) 835-Health Care Claim Payment Advice is the electronic version of the RA.

6. Remittance Advice General Information Lists all claims processed during a particular week Is the main claim and payment tracking device for providers Is available each Monday via Web interChange After four weeks, the RA is no longer available via Web interChange Providers should reconcile claim transactions as soon as possible after receiving the RA Sorts claims by status: paid, denied, suspended, or adjusted Identifies claims still in process (not finalized): suspended claims and claims in the adjustment cycle • Suspended claims appear on the RA for the week in which they first suspend and the last RA each month only

7. Remittance Advice General Information RAs provide information about adjudicated claims that are paid, denied and adjusted. The RA outlines claim information at the “header” level (claim level) and the “detail” level (service line level). Each section of the RA, such as Claims Paid or Claims Denied, totals the information at the end of that section. Each managed care entity (MCE) establishes and communicates its own financial processes.

8. Click here to download the RA

9. The most recent weeks’ RAs are displayed for four weeks

10. Learn Financial Transactions

11. Financial Transactions • The financial transaction section of the RA provides information about claim-specific and non-claim-specific transactions: • Payouts • Refunds • A/R

12. Payouts • Claims in a paid status, including claims paid at zero dollars, such as crossover claims, claims that include third party liability (TPL), and claims impacted by spend-down. • An example of a zero-paid claim is a claim for a member with other insurance when the other insurance paid an amount equal to or greater than the IHCP allowable amount.

13. Provider Initiated Refunds • Refund made to the IHCP by the provider that exceeds the claim paid amount or the amount owed. • A provider may send a refund check to the HP Finance Department to offset this amount.

14. Accounts Receivable (A/R) • An A/R is money determined by the State or one of its contractors to be payable to the IHCP from an enrolled provider. • An A/R may also occur when a provider has adjusted a claim or requested a claim adjustment.

15. Accounts Receivable (A/R) • IndianaAIM automatically establishes an individual A/R for an adjustment in which the net reimbursement of the adjustment is less than the original payment. • A/R control numbers identify these system-generated A/Rs on the RA.

16. Accounts Receivable (A/R) • System-generated A/Rs can be identified on the Remittance Advice (RA) as A/Rs with control numbers that begin with the number 5 • 50 – Provider Initiated Non-Check Related Adjustments • 51 – Provider Initiated Check Related Adjustments • 54 – Void Transaction • 55 – Mass Adjustment – Nursing Facility Retroactive Rate • 56 – Mass Adjustment • 59 – Point of Service (POS) Reversal Adjustment

17. Accounts Receivable (A/R) • If an A/R has not been recovered after 15 days, HP will mail a letter requesting repayment of the amount due . • If the A/R remains unpaid 15 days after the letter is mailed, HP will call the provider requesting repayment of the amount due. • HP Finance Unit will send request for a referral to the Attorney General’s Office (may be sent to the Office of Medicaid Policy and Planning (OMPP) .

18. Nonclaim-Specific Financial Transactions • Nonclaim-specific financial transactions are transactions unrelated to a particular claim that affect a provider’s payment • Nonclaim-specific refunds - Refunds made by a provider to the IHCP that cannot be directly tied to a specific claim • Nonclaim-specific payouts – Payments made to a provider that are not specific to a member or date of service

19. Understand Summary Page of The RA

20. Summary RA Page • Data from the entire RA is included on the summary page. • The summary page summarizes all claim and financial activity for each weekly cycle and reports year-to-date totals.

21. RA Account Receivable

22. RA Summary

23. Clarify EFT Features

24. How to Request Reissue of a Check • To request the reissuance of a payment check, providers may call the HP Customer Assistance Unit at (317) 655-3240 in the Indianapolis local area or toll free at 1-800-577-1278. • Finance will not reissue a check if a provider’s “pay to” address is out of date. We will only mail checks to the current “pay to” address.

25. Stale Dated Checks • If a check is not presented for payment within 180 days after the date of issuance, the check is “stale dated” and will not be honored for payment. • When a check is voided because it is stale dated, or for any other reason, HP voids the check and any associated claims from IndianaAIM.

26. How to Avoid Reissued and Stale Dated Checks • Providers are strongly encouraged to consider EFT, which automatically deposits payments into their bank accounts each week. • EFT payments have several advantages: • Significantly decrease the provider’s administrative processing that is required by paper checks • Safe and allows the deposit of funds into only a designated account • Eliminate lost, misplaced, voided, and stale-dated checks

27. Find Help Resources Available

28. Helpful Tools • IHCP Web site at indianamedicaid.com • IHCP Provider Manual (Web, CD-ROM, or paper) • IHCP Fee Schedule • Customer Assistance • 1-800-577-1278, or (317) 655-3240 in the Indianapolis local area • Written Correspondence • P.O. Box 7263Indianapolis, IN 46207-7263 • Provider field consultant • provider.indianamedicaid.com/contact-us/provider-relations-field-consultants.aspx

29. Q&A