© Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. HP – BreastCare and the Arkansas Department of Health, serving Arkansas since

© Copyright 2013 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Agenda The BreastCare Program The Medicaid Provider Portal Eligibility & Claims Procedure Code Updates WebRA ADH Online System BreastCare Rejections Passwords

3 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. a program of the Arkansas Department of Health. BreastCare is… BreastCare offers screening and diagnostic services to qualifying women at no cost. BreastCare offers public and professional education related to breast and cervical cancer diagnosis screening at no cost. MISSION: BreastCare’s mission is to increase the rate of early detection of breast and cervical cancer and reduce the morbidity and mortality rates among women in Arkansas by lowering barriers to screening that result from lack of information, financial means, or access to quality services.

4 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Increase breast and cervical screening services BreastCare’s goals… Plan and deliver evidence-based actions that increase breast and cervical cancer screening. Offer breast and cervical cancer screenings and follow-up services to clients at no cost to them. Monitor and ensure quality breast and cervical cancer activities. Improve provider education for BreastCare providers and partners. Maintain data for all screening, diagnostic and treatment for BreastCare clients. Track and measure all program activities to determine effectiveness and best practices.

5 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Screening and diagnostic breast and cervical services including: - CBEs - PAP tests, - Mammograms - Biopsies - Other related services BreastCare provides… BreastCare is a program for uninsured women ages 40 to 64 who are at or below 250% of the Federal Poverty Level (FPL). Client enrollment through contracted BreastCare providers Policy and decision making These services are administered by the Arkansas Department of Health

6 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Who does what? The BreastCare program partners include… Arkansas Department of Health sets policy and rules. Arkansas Department of Health – Regional Care Coordinators are nurses employed by the program to assist patients seeking screening/diagnostics services and ensuring continuum of care throughout treatment. Enrolling Providers determine eligibility, enroll and provide services to patients and enter medical information including procedures and results in the BreastCare Online System. HP Billing Analysts assist clients and providers with reimbursement issues. HP Provider Representative assists providers with billing, reimbursement, provider enrollment, provider training, and program updates. HP Systems Analysts coordinate policy with computerized billing and eligibility to ensure timely information that is accurate and prompt payment for services.

7 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Regional Care Coordinators provide: Case Management for abnormal tests and cancer diagnosis Assist with non-compliant patients Answer programmatic questions Provides programmatic technical assistance ADH BreastCare Regional Care Coordinators…

8 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Regional Care Coordinators by Region: Polly Lockett-Fox (Central Region) Debby Harris (Northwest Region) Lisa Martin (Northeast Region) Verna Ferry (Southeast/Southwest Regions) ADH BreastCare Regional Care Coordinators

9 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. The ADH Online System

10 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Patient Enrollment Enrolling BreastCare Providers assess patient eligibility and enroll women into the program using the ADH BreastCare Online System. Women can find enrolling providers at

© Copyright 2011 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. HP BreastCare offers BreastCare Providers and billers quality claims and billing support, personal training, and Virtual training opportunities. Call and speak to one of our analysts at

12 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. HP provides… HP has served the Arkansas Department of Health BreastCare program since HP also provides client eligibility, billing, provider outreach and other services for clients. This makes HP an integral player for both healthcare providers as well as patients.

13 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. HP services in Arkansas Healthcare Billing, eligibility, reporting, and provider services. Breast and cervical cancer screening and diagnostic services for eligible women years of age

14 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. HP provides ADH BreastCare with the following provider outreach services… In service visits by experienced billing professionals Recruitment at statewide HCP events Virtual training services for billers and providers Statewide provider billing workshops Guest speaker services for associations state-wide Billing specific courses for new and established providers Assists providers with escalated billing issues Training for the ADH BreastCare Online System Conducts provider visits in person or virtually Conducts billing workshops for changes, enhancements and updates Recruits new providers

15 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. HP BreastCare team members Karen Young – Provider Representative Karyette Simmons – Billing Analyst or Terrie Withers – Billing Analyst or

16 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. BreastCare Program Contacts Arkansas Department of Health Policy and Standards Patient Enrollment Questions 1(501) Provider Enrollment https//:health.arkansas.gov/adhinternetapps 1 (800) 462 – (501) 661 – 2836 HP BreastCare Provider Services Claims and Eligibility Processing Provider Visits for Billing Issues (on- site or virtual) Virtual Training Provider Billing Assistance 1 (855) 661 – (501) 372 – 0225

© Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. BreastCare Providers and the Medicaid Provider Portal

18 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.

19 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Provider Portal

© Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Client Eligibility

21 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Plan Descriptions for Billing Eligible clients are placed into a plan. For billing purposes, the plans are combined into two categories. Plan A – aid category 53 – women 40 to 49 Plan C – aid category 55 – women 50 to 64

22 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Checking Eligibility Providers are strongly encouraged to check eligibility status of a client before providing services. 1.A provider rendering services without verifying eligibility for BreastCare does so at the risk of not being reimbursed for the services. 2.An accepted eligibility verification ensures that claims will not deny due to client ineligibility. 3.Each client has an ID card with initial dates of eligibility listed, but these may change over time.

23 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. How Do You Verify Eligibility? What Are Your Options? 1.DDE – most popular option 2.PES 3.Voice Response (in-state toll-free) (local or out-of-state) 4.HP Billing Department (toll-free)

24 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Verify Eligibility Using the Portal (DDE)

25 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Enter NPI. Verify Eligibility Using the Portal (DDE)

26 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Verify Eligibility Using the Portal (DDE)

27 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Note: If client is seen on the same day of enrollment, eligibility will not update until the next day. Verify Eligibility Using the Portal (DDE)

28 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Eligibility Verification Response

© Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Submitting Claims

30 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Provider Electronic Solutions (PES) Software Provider Electronic Solutions software is HP’s free eligibility and claims submission software. It is available for download from the Arkansas Medicaid website.

31 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. BreastCare’s Claim Form

32 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Using the Portal (DDE) to submit claims

33 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Using the Portal (DDE) to submit claims

34 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Using the Portal (DDE) to submit claims

35 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Reporting NPI for BreastCare Both paper and electronic claims require NPI in the following fields: Billing provider Performing provider. Referring provider Two methods for reporting or changing NPI Internet reporting tool –BreastCare providers use the NPI reporting tool at –Facilities/Groups need to report their individuals. Paper form sent to BreastCare enrollment

36 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Taxonomy Code Taxonomy code is a unique, 10-character, alphanumeric code that allows a provider to identify a specialty category. Used to match an NPI to a legacy Arkansas Medicaid provider ID. Providers applying to NPPES for an NPI are required to submit their Taxonomy codes. Providers may have one or more Taxonomy codes associated to them. If a provider is required to report a Taxonomy code when using the Web-based NPI reporting crosswalk tool, only one Taxonomy can be chosen regardless of how many taxonomies were reported to NPPES. NOT EVERYONE has or needs to use a Taxonomy Code! Providers that are required to report their Taxonomy code in the NPI reporting crosswalk tool are also required to report their Taxonomy code on claims.

© Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. WebRA

38 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Remittance Advices Remittance advices are distributed in PDF format Providers must register to have access to their RAs Providers may share access to their RAs WebRAs are mandatory for hospitals WebRAs are available for 35 days before they are dropped from the website After an RA is dropped, there is a charge for retrieving the RA Providers who have extenuating circumstances, such as limited or no internet access, may opt out of WebRA by completing a hardship waiver and faxing it to ADH Provider Enrollment.

39 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. The ADH Online System

40 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. BreastCare Online Provider Enrollment Enrollment Process for New Providers Simple process with step by step instructions Complete in about 15 minutes Valid for two years Renew existing agreements online 1 (501)

41 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. BreastCare Online Provider Enrollment Provider Types 1. Enrolling Provider –Primary Care Physician (PCP) – enrolls patients into the BreastCare program and enters procedures and results in BreastCare Online System 2. Referring Provider –You can also opt to be a Specialty Provider for referrals only

42 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Automatic Denial of Office Visits with no Results All Enrolling Provider claims submitted for a BreastCare patient office visit will be denied unless: Claim data matches the office visit procedure and results entered in the BreastCare Online System: Provider NPI Client ID (BreastCare Number) Procedure code Date of service

43 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Automatic Denial of Office Visits with no Results

44 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. What do I do if this happens to me? Automatic Denial of Office Visits with no Results If your claim is denied, enter the patient visit, procedures and all results into the ADH BreastCare Online System and then re-file your claim. What about Mammograms? It is BreastCare policy that providers enter Mammogram appointment date and results after the procedure also. If the visit and results are in the BreastCare Online System, contact HP Billing at

45 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Cancer Treatment

46 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Cancer Treatment Referrals Contact your Regional Care Coordinator to refer a patient who is diagnosed with breast or cervical cancer, CIN II, or CIN III and requires treatment. You may also contact the BreastCare Cancer Treatment Case Manager or Patient Navigator at

47 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. BreastCare Rejections

48 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Top Rejections Error codeDescriptionCorrection 2940/2950Valid result code is required (breast/cervical) Add appropriate codes and resubmit. See section 530, BC Billing Manual 3350Recipient ineligible for serviceVerify client’s plan to see approved services 3740Diagnosis invalid for procedureVerify diagnosis is valid for procedure billed in the BC billing manual 1610System derived TOSProcedure requires the appropriate modifier, correct and resubmit 2500Recipient not on fileVerify client’s ID and resubmit

© Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Passwords

50 © Copyright 2015 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Passwords Provider Portal Password: Provider Portal passwords do not expire. WebRA Password: We encourage all providers to register for and receive your remittance through the Provider Portal to reduce paper use and lower costs for the program. Remittances are downloaded through the Portal and you can share your remittance with business partners. ADH Application Password: If you forget your password, please click forgot password link to reset it. ADH cannot reset the password for you.

Your passwords are your responsibility. Keep them safe. Log them in a password protected application for easy access! © Copyright 2013 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.

Forgotten Passwords If you need assistance with any of these passwords please contact HP’s EDI helpdesk at: 1 (800) 457 – 4454 Ext 300, option 1 or (501) 376 – 2211 Ext 300, option 1.

Questions? © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.