1. Monday, 2 May 2016 5:30 pm – 7:30 pm 1329 SW 16th Street, Room 4150
Provider Meeting
UF North Central Early Steps
FY Contract Period Review
SHARON
Monday, 2 May 2016
5:30 pm – 7:30 pm
1329 SW 16th Street, Room 4150

2. Agenda Welcome State and Contract Updates MOA FY 16-17 Fiscal Updates
NCES Fiscal Team
Claims Filing Process
FY Close Out
Service Code Updates
Q & A and Comments
SHARON

3. DOH – CMS EARLY STEPS UPDATES
Florida House Bill 7053
Requires DOH to create clearinghouse
Establish performance standards
Expands eligibility
NICU Level II and III DEI
SHARON

4. Fiscal Year 2016-2017 MOA Changes
SHARON

5. FY16-17 MOA Changes Section __: Section __ :
In Relation to Billing Requirements & Provider Enrollment, Service Provider Agrees:
Section __: Section __ :
SHARON Covering Policy – Carla to Cover Procedures
Section ___: Page __ –
Remember to: remind them to complete each form fully prior to handing in (e.g. progress note must have SC, Date range of authorization and they have to sign at the bottom)
BDI-2 forms – are not on a 30 day cycle and must be turned in when completed

6. NCES FISCAL TEAM TRANSITION SLIDE FROM SHARON TO CARLA
Introduction of NCES Fiscal Team
Emily Hurlston, Clinical Coder I
Meayki Batie, Program Assistant
Adilene Hernandez, Program Assistant

7. JUNE 15 Fiscal Year 2016-2017 Close Out
TRANSITION SLIDE FROM SHARON TO CARLA
Reminder: Time is of the essence…
June 15th claims must be received then entered into workflow by June 17th
UF Accounting Deadline is June 22nd to Approve invoices already in workflow
Next claims / billing / accounts payables period will occur in the new fiscal year

8. FY 16-17 Close Out Processes
Time is of the essence… P
PROVIDER CLAIMS FILING Submit within 30 days or less from DOS A
ANY EOB DENIALS rec’d, send to NCES Fiscal Team via fax or Move It (NOT REGULAR !!!) I
INCLUDE Claim Form and EOB Denial for request for payment via CONT D
DENIALS eligible for payment will be paid via UF Accounts Payable (AP) system
CARLA

9. P A I D FY 16-17 Close Out Timeline JUNE 30 - FYE
Time is of the essence…
JUNE 30 - FYE P
JULY 15 - CONT CLAIMS for May 1 - June 30 should be received no later than July 15
(60 day claim filing period per FY contract) A
JULY 15 - CONT DENIALS eligible for payment for DOS up to June 30th should be submitted no later than July 15 I
JULY 30 - EOB DENIALS eligible for payment should be submitted D
CARLA
Expedite claims submissions per FY15-16 contract
For both CONT and EOB Denial requests to pay via CONT
Only back 60 days with few exceptions
Example: Today, we would be honoring claims payments from March 1st to May 1st

10. Section VI. 1h: Vendor application with UF (PAGE 7)
Forms (Exhibits N1, N2, N3, O, and P)
Vendor Application
UF Tax Information Form
Electronic Payment Authorization AND Voided Check
IRS Form W9
MMA Enrollment Summary Form***
Deadline
May 31st
CARLA
All forms may be found on the Early Steps Website under “Resources for Providers”

11. New Claims Process Overview
CARLA

12. Claims Process Overview
Reference SOPs
Provider Manual, Fourth Edition
Billing, Contracted Therapy Providers
Billing, EI & ITDS
Reference Rates
Billing Legend (See Exhibit G, First Tab)
CARLA

13. Claims Process Overview
PROVIDER
Verify Coverage
Obtain Auths (Including on IFSP)
Provide Service
Submit Claim
Reference IFSP
SOPs
Billing Legend
Provider Manual
NESF & Claims Sheet Template
CARLA -

14. Claims Process Overview
PROVIDER
Verify Coverage
IMPORTANT: You should be a credentialed provider with MMA or TPI
Verify Coverage – Beginning of each month for:
Medicaid Coverage and MMA Plans
TPI (Third Party Insurance)
NOTE: TPI EOBs for Denials, Due Once Per Calendar Year
(So long as coverage remains unchanged)
CARLA -

15. Claims Process Overview
PROVIDER
Obtain Authorizations
Obtain Authorizations From:
IFSP
Health Insurance Plan
CARLA
If uncertain about specific codes and/or dates authorized on IFSP, contact the Service Coordinator responsible for the case

16. Claims Process Overview
PROVIDER
Provide Service
Submit Claim
Provide Service
Submit Claim by 15th of month following month DOS took place
Ex: DOS , Claim Deadline or
If EOB Denial, by
Process Defers for:
CONT Claims (Services Covered Under Contract)
Denials with EOBs (Explanation of Benefit)
AT (Assistive Technologies)
CARLA
-Actual Claims Process Overview for CONT, EOB Denials, and AT up next

17. Claims Process Exercise
Hands On and Step-By-Step
Complete Form
Service & Natural Environment Support Fee
Invoice Prep
INV A - CONT
INV B – EOBs
INV C – AT
Submit Claims
CARLA
Training Exercise, Reference and Download Exhibit G from the website at:
Carla Now to Open Exhibit G for Walk Through with Providers
*NOTE: PROCESS FOR AGENCIES MAY DIFFER AND MAY BE DISCUSSED

18. Natural Environment Support Fee
CARLA
Reference Exhibit G, Tab labeled “Service and NESF Log”

19. NCES Claims Sheet
CARLA

20. Claims Process Workflow INV A - CONT
Claims Form Received by NCES via Move It ©
AND
Entered into ESDS*
Invoice Created & Reviewed by NCES Fiscal Team via Claims Export from ESDS
Invoice Reviewed, Sent to, and Approved via Corcentric for Payment**
Invoice Paid via EFT (Near Due Date)
CARLA
If there is an issue with the claims, NCES will contact you regarding correction and will only process payment for eligible claims—check your invoice notes for issues
Claims will be audited on a regular basis as part of the Quality Assurance (QA) process
Payment date Example: Invoice dated , Provider with Net 30 showing due date of will be made on or before
If setup for EFT, these typically are deposited on Wednesdays and Fridays
If setup for checks, these typically are distributed on Tuesdays—please get setup for EFT!!! This allows you to track your payments.
* Claims issues will be either returned or entered to ESDS as a denial
**Provider must have NCES fully executed contract, UF Vendor Setup, and PO

21. Claims Process Workflow INV B – EOB Denials
Claims Form Received by NCES via Move It ©
AND
Entered into ESDS*
Invoice Created & Reviewed by NCES Fiscal Team via Claims Export from ESDS
Invoice Reviewed, Sent to, and Approved via Corcentric for Payment**
Invoice Paid via EFT (Near Due Date)
CARLA
As long as we receive EOB, claim will be entered to ESDS
EOB may be sent to us at any time and does not need to accompany the actual invoice— once appropriate EOB received, we will update in ESDS to CONT
All CONT and EOB claims entered to ESDS will show on same invoice during invoice export
*Invoices without EOB copy for the year either on file or accompanying claims form will be either returned or short paid for eligible claims only
*EOB should be for procedure code(s) invoiced to be accepted

22. New Claims Process Workflow INV C – AT Equipment
Approval via Service Coord;
Provider supplies AT items to child & obtains signed Parent Receipt
Approved Claim form Entered to ESDS, then Invoice Exported and Routed to Dept, then Division*
Invoice Reviewed and Approved for Payment*
Invoice Paid via EFT (Near Due Date)
CARLA
*Invoices without EOB copy for the year either on file or accompanying claims form will be either returned or processed and paid for eligible claims only

23. How to Reconcile Your Claims
Send claims forms with appropriate naming convention (Ex. STPH-MAY1, STPH-MAY2, STPH-JUN1, STPH-JUN2, etc.)
Claims are entered using the line item # associated with invoice number (Ex. STPH-MAY1.01, STPH-MAY1.02, etc.)
Invoices sent to UF Corcentric by the Fiscal Team are named using naming convention STPH-MAY-A, STPH-MAY-B, etc.) and provider is copied via ; totals and denials both show unless we were unable to enter into ESDS for some reason
All UF vendors who receive payments via EFT may track invoices and payments at: disbursement-services/vouchers-expenditures-and-payment- processes/
CARLA
If you do not see claims on the invoice sent to Corcentric that you know were submitted, please contact the NCES Fiscal Team immediately to inquire and back- track

24. How to Reconcile Your Claims
5. Open the appropriate Excel document at: services/vouchers-expenditures-and-payment-processes/
Filter the document by your UF vendor number (Highlight the row, select “Data” and “Filter” then from drop down menu under Vendor #, select arrow and unselect all, then select only your #)
Filter the document by invoice number (STPH-MAY-A, etc.) (From the drop down menu under invoice #, select the arrow and unselect all, then select only your invoice number(s))
Look for the payment date, payment amount, and voucher #
Next, take this payment info and apply to all the claims shown on the invoice sent to UF Corcentric that you were cc’d on
CARLA

25. Where to Route Documents
EOBs
When: As soon as received, no later than when claim filed
Where: USPS or Fax
Claims Forms
When: 15th each month (Bulletin 11)
Where: Move It©
Progress Notes
When: 15th and 30th of each month (Bulletin 9)
Where: USPS or Fax (DO NOT SEND VIA MOVE IT©)
CARLA

26. Fiscal 2016-2017 MOA Timeline CARLA
FY MOA due by COB June 15, 2016
Statement of Understanding of Part C Procedural Safeguard
Must be signed by each individual provider
Ex. If more than one Early Steps Provider, such as with an agency, each individual provider must sign
Professional Liability Insurance Copy
Exhibit P – Form, MMA Plan Enrollment Summary

27. Reminder: When Your Info Changes
CARLA
Often providers may notify a SC, but forget to notify NCES Fiscal and Administration
Please ensure to notify the NCES Fiscal Team when any of the following info changes:
Name
Address
Phone Number
Fax Number
Address
Bank Info for EFTs
Changes To:

28. SHARON AND CARLA

29. SHARON AND CARLA
and-thank-you-cards-as-a-gift-for-their-teacher.html

30. For More Information
Sharon Hennessy, NCES Program Director Emily Hurlston, Clinical Coder I Tamelia Malcolm, Service Coordinator Supervisor
Contact Info Available at: