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MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PR

MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSING October 18 th , 2011. REGISTRATION. MCO CARD OR LETTER . BACK OF CARD. Identified with #6 Log on to www.directprovider.com

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MEDICAID MANAGED CARE ORGANIZATION (MCO) TRAINING CONDUCTED BY : THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PR

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  1. MEDICAIDMANAGED CARE ORGANIZATION(MCO) TRAININGCONDUCTED BY :THE DEPARTMENT FOR PUBLIC HEALTH & CUSTOM DATA PROCESSINGOctober 18th, 2011

  2. REGISTRATION MCO CARD OR LETTER

  3. BACK OF CARD

  4. Identified with #6 Log on to www.directprovider.com Call CoventryCares IVR line @ 1-855-300-5528 http://chcmedicaid-kentucky.coventryhealthcare.com/

  5. Identified with #7 Log on to www.KentuckySpiritHealth.com Search by date of service and Medicaid ID # or KY Spirit ID # Call automated system(IVR) at 1-866-643-3153 from a touch tone phone Call Ky Spirit Health Plan Provider Services @ 1-866-643-3153

  6. Identified with #8 Log on to www.kentucky.wellcare.com Call WellCare’s IVR @ 1-877-389-9457 Call WellCare’s Customer Service @ 1-877-389-9457

  7. VERIFY PATIENT ELIGIBILITY • Verify Medicaid # and MCO member #. • Print both initially and place in patient chart. • This will provide proof for billing/inquiries in case there are any problems. • If no card or letter use KY Health Net & call the MCO listed there. • Key into Registration.

  8. Registration Process

  9. Medicaid Eligibility & Number

  10. Managed Care fields • Medicaid MCO – drop down of available MCO’s. Previously shown as: “Managed Care Region” • MCO Member # - up to 20 characters available Previously shown as: “Managed Care Member #”

  11. Managed Care Fields

  12. Medicaid MCO Drop Down

  13. MCO Member #

  14. Label changes • PEF label will show MCO/REGN# • Registration label will show MCO Member #

  15. PEF Label – REGN# will be MCO

  16. PEF Label – REGN# will be MCO MCO COV

  17. 2nd Registration Label – PART# will be MCOMember # 1234567890 MCO

  18. SERVICES • CODING IS THE SAME AT THIS TIME • Anything currently covered by Preventive.

  19. CHECK OUT PROCEDURES ENTER PEF

  20. CHECK OUT VERIFY Appropriate Medicaid status is in MDCD Field on Encounter Entry Screen Put Y in bill screen field On Bill Screen a). If not payor code 2, re-verify system information b). If not working properly call LHO Help Desk at 502-564-6663, option 5. Localhealth.helpdesk@ky.gov

  21. Encounter Entry ScreenCheck MCD field for Medicaid

  22. Fill out the encounter. It is recommended to request the bill screen when you start entering encounters.

  23. Bill Screen – Check the payor codes

  24. BILLING CDP is working with each MCO to program their specific requirements. IE: VFC modifiers. New E-reports must be created. Testing of billing files-live during first week.

  25. QUESTIONS?

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