2. 1

3. 2  New 10 digit Provider ID -Provider ID/Service Location 123456789A  Fewer User ID Numbers Today: IDs for MMIS, PCSS, APAS, REVS Tomorrow: NewMMIS: 1 User ID and 1 Password Key Concepts - Provider

4. 3  Industry Standards Claim Level Processing - NewMMIS Adjudicate Multi-line Claims as a Single Claim with Multiple Lines: Consistent With Other Major Payers Real-Time Processing of DDE Claims NewMMIS Will Utilize the Standard UB-04 and CMS-1500 Claim Forms Key Concepts - Provider

5. 4  Industry Standards Ability to “Copy” a Claim Will Be Preserved NewMMIS Replaces 12-digit TCN with 13-digit ICN (Interchange Control Number) ICN Format: RR YY JJJ BBB SSS Julian DayBatch Sequence RegionYear Key Concepts - Provider

6. 5  Electronic Attachments NewMMIS Replaces Claims Attachment Form (CAF) Providers can Submit Electronic Attachments with DDE Submissions for PA, PAS, Referrals, Claims, Provider Enrollment, MMQ, SCO/PACE enrollments etc. Key Concepts - Provider

7. 6  Service Authorization Numbers Service Authorizations Will Now Be Identified by a 10-character Number: S 07124 0014 1st Character: ‘R’ for Referral, ‘P’ for Prior Authorization ‘S’ for Pre-Admission Screening 1st CharacterJulian Date Unique Sequential Number Key Concepts

8. 7 2.0 Access Provider On-Line Service Center Five Steps in the Provider Scenario 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

9. 8 8 A Provider’s Scenario How a Provider, Harriet Potter, gets enrolled in MassHealth, submits request for services and submits claims for payment How Dr. Potter will access a variety of functions through the NewMMIS Provider on-Line Service Center 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

10. 9 Start an Enrollment Application 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

11. 10 Continue an Enrollment Application Certification Provider Relationships Hospital Affiliation Billing Intermediary Trading Partner Agreement Background Info Attachments Summary Confirmation 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered The Provider Continues To Complete the Application: Service Locations Address Type Identification Info Medicare Info Personal Info Specialty Info License Info 5.0 Receive Payment for Services Rendered

12. 11 Provider Application Workflow NewMMIS Provider Applications Provider Submits DDE App As the Provider begins an Enrollment Application, NewMMIS will present specific panels depending upon the Provider Type Legal Entity, Managed Care or Group details. An Application Tracking Number (ATN) is generated to the provider to log onto the Web Portal and save or submit an existing application. 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

13. 12 Provider Application Workflow NewMMIS Provider Applications Workflow Provider Submits DDE App Revie w App CST Enters Application Provider Submits Paper App Approve Application & Generate ID Notify Providers 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

14. 13 “Search for Active Therapists (192) in Boston?” ………… no problem! Search by Provider ID or Legacy ID or NPI Search by Provider Type Address Type Remittance Information DBA Billing Check Mailing

15. 14 Provider Information Panel 1 3 2 Section 1: Details don’t change with a Multi-Location Provider Sections 2 & 3 Service Location etc. when a Different Service Location is Chosen From the Drop Down Menu A - Warren A. Thomas B- Michael B. Thomas C- Michael C. Douglas

16. 15 Provider Maintenance 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

17. 16 Provider Maintenance 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

18. 17 Provider Preferences Check Mailing 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

19. 18 Provider – Check Mailing Address 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

20. 19 Key Concepts – Provider Enter data directly and modify individual transactions (i.e. claims submission, eligibility verification, MMQ, Prior Authorization, Pre-Admission Screening, and Referrals). View your notifications, contracts, reports, metrics, and financial data. Download most MassHealth forms and publications. The Provider Online Service Center gives you the tools to effectively manage your business with MassHealth electronically. Use these services to enroll as a MassHealth provider. Manage your profile information and submit and retrieve transactions. 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

21. 20 Verify Member Eligibility POTTER, HARRIET MD 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

22. 21 Verify Eligibility – Member Info Bailey, Mary 011 11 1111 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

23. 22 Verify Member - Eligibility Panel 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

24. 23 Verify Member – Eligibility Restrictions 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

25. 24 Submit A Pre-Admission Screening Dr. Potter Submits a PAS for George Bailey 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

26. 25 Submit A Pre-Admission Screening Drop Down to Select PAS Assignment Dropdown to Select Dr. Potter’s Choices Potter Harriet MD Search Button to Find Facility or Attending Physician Bedford Falls Rehab Hospital 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

27. 26 10000555555 Search Button to Find Diagnosis Code Length of Stay in Days 7871 = Heartburn Submit A Pre-Admission Screening S08000000B Request has been saved with this PAS# S08000000B Save & System Returns PAS # After Edits 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

28. 27 Adding a Line Item: Requested Level of Care & Admission Type to PAS PAS 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

29. 28 PAS Confirmation  Bedford Falls Rehab 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

30. 29 Update a Pre-Admission Screening S08000000B S08000000B 100023924251 Bailey, George 01/30/08 Entering PAS Number Produces Link to PAS Base Information 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

31. 30 Update a Pre-Admission Screening 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

32. 31 Update Pre-Admission Screening Bedford Falls Rehab George Bailey Harriet Potter, MD Modify Reopens the Modify Reopens the PAS Base Information Panel for Changes 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

33. 32 PAS Flow NewMMIS Transaction Assignment Submits PAS Workflow MassPRO PAS Unit Approved Denied Modified Approved Denied Modified Notification 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

34. 33 Submit Prior Authorization 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

35. 34 PA – Enter Base Information 100023924251 POTTER, HARRIET MD 7871 DIAGON ALLEY CLINIC AND EMPORIUMTEST 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

36. 35 PA – Enter Line Items 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

37. 36 PA – Line Items – Basic Medical Details 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

38. 37 PA – Submit for Confirmation Request has been saved with this Tracking# 103,401,225 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

39. 38 Enter PA Request - Confirmation Request has been saved with this Tracking# 103,401,225 You are about to submit a Prior Authorization request for Member 1234443212 for the following procedures. Please verify the data and the click “Submit”. 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

40. 39 PA Flow NewMMIS Transaction Assignment Submits PA’s Workflow PA Unit Approved, Denied, Modified Notification Workflow PA Unit Workflow 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

41. 40 Submit A Referral for George Bailey 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

42. 41 Submit A Referral for Harry Bailey POTTER, HARRIET MD BEDFORD FALLS PSYCHIATRY 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

43. 42 Referral Confirmation George Bailey 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

44. 43 Inquire About a Referral – 3 Ways 1. Inquire by the Referral Number: e.g. R08035001F 2. Search for Referrals Submitted to Bedford Falls Psychiatry 3. Search for Referrals Submitted by Bedford Falls Psychiatry to Another Provider 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

45. 44 Referral Information – Update Potter, Harriet Bedford Falls Psychiatry Bailey George Male 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

46. 45 Submit A Claim – Billing & Services 011000001111 – Bedford Falls Psychiatry Dropdown of Billing Provider ID Numbers Member Member Info Info COBAttachmentsProcedureConfirmationBilling and Service 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

47. 46 ServiceInformation Diagnosis Codes Submit A Claim – Billing & Services Place of Service Total Charges Billing and Service 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

48. 47 Submit A Claim – Billing & Services Extended Service Information Service Facility Provider List of Claim Notes Ambulance Transport and Certification Home Healthcare Plan Coordination of Benefits 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

49. 48 Submit Claim – Coordination of Benefits Coordination of Benefits (COB) Detail 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

50. 49 Submit Claim – Procedure Procedure Professional Service Detail 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

51. 50 Submit Claim – Procedure (cont’d) Durable Medical Equipment Service Ambulance Service Home Oxygen Therapy Information 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

52. 51 Inquire A Claim Status 011000001111 – Bedford Falls Psychiatry Enter Member ID Procedure Code etc. to Narrow Search Inquire By ICN 2208036600010 Bailey, George Inquire by Date of Service Range 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

53. 52 Questions & Answers

54. 53 Inquire A Claim Status George Bailey 01/20/1946 Male 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

55. 54 TPL Claims – Key ConceptsRecovery Cost Avoidance Matching with Multiple CMS/SSA Files and Third Party Carriers Automated TPL Verification Process User Maintained Other Insurance Plans Replacing TPL Matrix Retro-active, Pay & Chase & User Defined Recovery Enhance Up-front Cost Avoidance Capabilities Comprehensive Tracking and A/R System Re-pricing Methodologies Integration of MA21/MMIS TPL Data Table Driven Re-pricing Methodologies 2.0 Access Provider On-Line Service Center 1.0 Enroll a Provider & Maintain Profile 3.0 Submit Requests for Service Authorization 4.0 Submit a Claim for Services Rendered 5.0 Receive Payment for Services Rendered

56. 55 Getting ReadySeptember2007 September 2007 thru Go Live http://newmmis-communication-center/ Communications Center: http://newmmis-communication-center/ 4-6 Weeks Before Go-Live