1. HP Provider Relations October 2011 Dental Billing Guidelines

2. Dental Billing GuidelinesOctober 20112 Agenda –Objectives –Provider Classifications –Web interChange Overview –Billing –Third Party Liability –Dental Policy –Prior Authorization –Claim Returns and Denials –Electronic Health Records (EHR) –ANSI 5010 Conversion –Helpful Tools –Questions

3. Dental Billing GuidelinesOctober 20113 Session Objectives At the end of this session, providers will understand the following: –Difference between group, billing, dual, and rendering providers –How to find out if a service is covered –EHR program –Implementation of the ANSI 5010 conversion –How to avoid claim denials

4. Dental Billing GuidelinesOctober 20114 Provider Classifications –Billing Provider – A practitioner or facility operating under a unique taxpayer identification number (TIN). The TIN may be the dentist’s Social Security number or a federal employer identification number. –Group Provider – Any practice with one or more dental practitioners sharing a common TIN. The group must have members linked to the business, and these members are identified as “rendering providers.” –Rendering Provider – A practitioner employed by a group provider. The rendering provider actually performs the service. The IHCP makes payment to the group. –Dual Provider – A provider that is both a billing and a rendering provider.

5. Learn Web interChange Demo

6. Dental Billing GuidelinesOctober 20116 Web interChange –Allows for claim submission directly to HP –Allows access to claim and member information –Provides for secure data transmission –Available 24 hours a day, seven days a week –Free!

7. Dental Billing GuidelinesOctober 20117 Web interChange Functions –Member eligibility verification –Claim submission including voids and replacement and electronic attachments –Claim status inquiry –Check/RA inquiry –Provider profile inquiry, including access to enrollment documents –Web administrator –PA submission and inquiry

8. Dental Billing GuidelinesOctober 20118 –Insert screen print here

9. Dental Billing GuidelinesOctober 20119 Web interChange Member eligibility –On the home page, click Eligibility Inquiry –Enter the member ID –Enter the desired date of service Name and demographics Spend-down, level of care, Medicare TPL information Managed care information Restricted information  Prescriptions must be filled at the restricted pharmacy Amount of dental cap paid Dental benefit limitations

10. Dental Billing GuidelinesOctober 201110 Required information

11. Dental Billing GuidelinesOctober 201111 Required information

12. Dental Billing GuidelinesOctober 201112 Web interChange Claim submission –Submit dental claims with as many as 50 details –Add, copy, or delete details –Rework denied claims –Mail attachments separately Claims that require attachments suspend for 45 days waiting for the attachments to arrive –Claim notes to reduce paper attachments 90-Day Provision Retroactive eligibility

13. Dental Billing GuidelinesOctober 201113 Claim Notes Window No attachment needed!

14. Dental Billing GuidelinesOctober 201114 Claim Submission Claim notes for 90-Day Provision –Use claim notes instead of a separate attachment when submitting claims for the 90-Day Provision using Web interChange –Document in the claim note segment: The phrase 90-Day Provision The member identification number (RID) Name of the Third Party Liability billed Dates of filing attempts

15. Dental Billing GuidelinesOctober 201115 Required Information

16. Dental Billing GuidelinesOctober 201116 Claim Submission Coordination of Benefits –Coordination of Benefits (COB) information is required for TPL payments –Click Benefit Information to open the COB window Report the primary insurance information that applies to the entire claim –Access a TPL help guide on the Web interChange help page

17. Dental Billing GuidelinesOctober 201117 Web interChange Claim inquiry –Inquire about previously submitted claims – even before they appear on an RA –View the claim status within two hours of submitting the claim using the internal control number (ICN) that displayed when the claim was submitted –Search by date range, member ID, or ICN –When the claim displays, click on the ICN to retrieve the detailed information for the claim

18. Dental Billing GuidelinesOctober 201118 Web interChange Voids and replacements –Access the Claim Inquiry function to void or replace claims –A void is the cancellation of an entire claim, whether same day, same week, or post-financial –A replacement is a change to an original claim, whether same day, same week, or post-financial

19. Dental Billing GuidelinesOctober 201119 Web interChange Voids –Submit void requests electronically using the 837D electronic transaction or Web interChange –Submit void requests for a previously paid claim submitted either electronically or via paper –A void cancels the original claim –The original claim being voided cannot be in a denied status –There is no filing limit for void requests

20. Dental Billing GuidelinesOctober 201120 Web interChange Replacements –A replacement claim can be submitted using the electronic 837D transaction or Web interChange –A replacement also can be submitted on paper (also known as an adjustment) –Check-related replacements must be submitted on paper –There is a one-year filing limit for replacement requests –If the date of service is over the one-year filing limit, utilize the paper Adjustment Request Form to correct the claim Note: When the Replace This Claim feature is used more than one year after the date of service, a full recoupment may be applied to the claim

21. Dental Billing GuidelinesOctober 201121 Web interChange Replacements –A replacement takes the place of the original claim –When the IHCP receives a replacement claim, the replacement becomes a new claim (including attachments and claim notes)

22. Dental Billing GuidelinesOctober 201122 Check for Remittance Advice every week!

23. Dental Billing GuidelinesOctober 201123 Web interChange Check/RA inquiry –Inquire about previously received payments –Find a check or electronic funds transfer (EFT) by searching within a date range or by searching for a specific check number –When the basic check information displays, click on that line to see all the paid claims associated with that check

24. Dental Billing GuidelinesOctober 201124 Web interChange Provider profile –Allows IHCP providers to view and edit profile information –Includes the basic profile, service location information, and rendering provider information –Update capabilities directly to provider files – Service location, Pay To, Mail To addresses – EFT, add, delete or change – Add specialties (group and rendering) – Board of Directors – Office manager

25. Dental Billing GuidelinesOctober 201125 Web interChange Web administrator –This function allows one person within the provider group to determine which users have access to specific functions of Web interChange –The Web administrator can create, maintain, and delete user groups, reset passwords, and modify user information –When a provider has a Web administrator, each user’s assigned logon ID and password are unique Logon ID is not a provider number

26. Dental Billing GuidelinesOctober 201126 Web interChange Prior authorization inquiry and submission –A requesting provider may inquire about all nonpharmacy prior authorization (PA) using the Web The PA request may have been submitted on paper, by telephone or fax, or through the Web The requesting provider and the named service provider may view a PA without the PA number All other providers must have the PA number to view the PA

27. Dental Billing GuidelinesOctober 201127 Requesting and Service providers can use member ID to check status. All other providers must have the PA number to see authorization status

28. Dental Billing GuidelinesOctober 201128 Web interChange Prior authorization inquiry and submission –This function allows providers to submit PA requests via the Web in a HIPAA- compliant format –ADVANTAGE Health Solutions processes all PA requests for traditional Medicaid –Dental services are self-referral for Care Select members

29. Bill Dental Services

30. Dental Billing GuidelinesOctober 201130 2006 ADA Dental Claim Form –Report billing and rendering NPIs on the dental claim form: Billing provider NPI field 49 Rendering provider NPI field 54 –Rendering providers must be associated with the billing provider’s group and linked to that group in the provider profile –The Remittance Advice (RA) identifies the rendering provider NPI on the detail line –Chapter 8, Section 5 of the IHCP Provider Manual details the requirements for the ADA 2006 claim form

31. Dental Billing GuidelinesOctober 201131 Managed Care Entities (MCEs) –Dental services are carved-out of the risk-based managed care (RBMC) delivery system –Dental providers who bill Current Procedural Terminology (CPT ® ) codes must submit claims using the electronic 837P transaction or the paper CMS-1500 claim form These claims must be submitted to the MCE after obtaining authorization Members with Traditional Medicaid or Care Select, including spend-down, and Level Of Care, are not enrolled in an MCE CPT copyright 2010 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

32. Dental Billing GuidelinesOctober 201132 Billing a Member if Dental Cap Exhausted –Dental Cap amount is $1,000 Applies each calendar year to members age 21 and above Does not apply to services rendered in a hospital setting After the member exhausts the $1,000 annual cap, the provider can bill member the usual and customary fees  Providers are encouraged to obtain a signed waiver once the $1,000 cap is showing exhausted on the eligibility verification PA will not override the dental cap of $1,000 –Example: On the date of service, the full $1,000 cap amount has been exhausted The provider renders services and the usual and customary charge equals $300 The provider can bill the member for $300

33. Dental Billing GuidelinesOctober 201133 Billing a Member if Dental Cap Exhausted –When a claim is partially paid because of the dental cap limit, the provider can bill the member only for the difference between the IHCP rate and the amount actually paid –Example: On the date of service, $800 of the cap amount has been exhausted ($200 of the cap amount remains) The provider renders services and the total IHCP rate is equal to $300 The provider can bill the member for $100

34. Dental Billing GuidelinesOctober 201134 Spend-down –The spend-down amount is deducted from the first claim processed by IndianaAIM –ARC 178 appears on the Remittance Advice when spend- down is credited on claims –Providers may bill the member for the amount listed beside ARC 178 –Members are responsible to pay upon receipt of the Spend-down Summary Notice

35. Bill Third Party Liability

36. Dental Billing GuidelinesOctober 201136 Third Party Liability Billing tips –If a third-party insurer makes a payment, do not include an explanation of benefits (EOB) with the claim Enter third-party liability (TPL) paid amount on the claim in field 35, or its electronic equivalent –Include the EOB with the claim only when: The primary insurer denies a service, or The primary insurer allows the charges but pays zero dollars

37. Dental Billing GuidelinesOctober 201137 Third Party Liability Billing tips –Always verify TPL information prior to providing services The Eligibility Verification System (EVS) identifies active TPL for eligible members Assignment of benefits should be on file for each member with TPL –Providers may update TPL through Web interChange or by contacting the HP TPL Unit – Local (317) 488-5046 – Toll free 1-800-457-4510

38. Dental Billing GuidelinesOctober 201138 Third Party Liability Billing tips –IHCP makes payment on TPL claims only when the total Medicaid rate for the entire claim exceeds the amount paid by the primary insurer for the entire claim –IHCP reimbursement includes the lesser of the: Difference between the IHCP rate and the TPL paid amount for the entire claim OR Amount billed on the claim

39. Dental Billing GuidelinesOctober 201139 Third Party Liability Blanket denials –What is a blanket denial? When a healthcare service is not a covered benefit for the insured, the IHCP accepts an EOB from the other insurer showing that the service is not covered –What must the blanket denial EOB include? Name of primary insurance carrier Information sufficient to identify the member Description of healthcare service Statement of noncoverage of the service –Blanket denial EOBs can be used until the end of the calendar year of the date of service and must contain the same procedure code(s) that are billed on the claim

40. Dental Billing GuidelinesOctober 201140 Third Party Liability 90-Day Provision –What is the 90-Day Provision? –How to submit claims under the 90- Day Provision: – Write 90-Day Provision on the top of the claim – Boldly make a note on the attachment: Date of the filing attempt The words no response after 90 days Member identification number (RID) Provider’s National Provider Identifier (NPI) TPL billed Name of Insurance company billed –IHCP Provider Manual, Chapter 5, contains billing instructions

41. Dental Billing GuidelinesOctober 201141 Third Party Liability Insurance carrier reimburses IHCP member –Contact the TPL Unit to advise that payment was made to the member in error –If unable to recover payment from a member or TPL, the provider should submit the claim under the 90-Day Provision –Have the member sign an assignment of benefits authorization form prior to receiving services

42. Dental Billing GuidelinesOctober 201142 Third Party Liability Insurance carrier reimburses IHCP member –QMB members are eligible for Medicare and Medicaid The State pays the premium for Medicare Part B –Two Types: QMB-Only – The IHCP pays “only” the Medicare coinsurance and deductible  QMB-Only members do not have dental coverage as Medicare does not cover dental services QMB-Also – The IHCP pays “also” for Medicare noncovered services in addition to the coinsurance and deductible  Services must be covered by Medicaid to be reimbursed

43. Dental Billing GuidelinesOctober 201143 Third Party Liability Impact of QMB members –Dental providers must have QMB-Only members sign a waiver prior to furnishing services –The IHCP can pay for dental services for QMB-Also members for Medicaid-covered services

44. Dental Billing GuidelinesOctober 201144 What is covered under the IHCP Program? –Refer to the IHCP Fee Schedule IHCP Provider Manual, Chapter 8, Section 5 to determine which Current Dental Terminology (CDT) codes are covered

45. Dental Billing GuidelinesOctober 201145 Live demo –The IHCP Fee Schedule is available on the IHCP Web site at indianamedicaid.com indianamedicaid.com –Included on the fee schedule: Pricing for procedure codes Code descriptions Code start and end date Prior authorization requirements for codes Fee Schedule

46. Understand Dental Policy

47. Dental Billing GuidelinesOctober 201147 Dental Policy Evaluation codes Use the following codes to bill for evaluations: –D0120 – Periodic Oral Evaluation One visit per member every six months, irrespective of age –D0150 – Comprehensive Oral Evaluation – new or established patient or D0160 Extensive Oral Exam Limited to one per lifetime, per member, per provider with an annual limit of two per member –D0140 – Emergency Oral Exam Enter the word Emergency in field 2 of the ADA 2006 dental claim form - Required for package E

48. Dental Billing GuidelinesOctober 201148 Dental Policy Fluoride –For fluoride services: D1203 – Topical application of fluoride – child (ages 1 through age 12) D1204 – Topical application of fluoride – adult (ages 13-20) –Topical application of fluoride is not covered for members age 21 and above

49. Dental Billing GuidelinesOctober 201149 Dental Policy Prophylaxis –Use the following codes to bill for prophylaxis: D1120 – Prophylaxis - child (ages 1-11) D1110 – Prophylaxis - adult (ages 12 and older) –The IHCP covers one cleaning every six months for members 20 years old and younger, and one cleaning every 12 months for members 21 years and older –If the member is institutionalized, he or she is eligible for one cleaning every six months

50. Dental Billing GuidelinesOctober 201150 Dental Policy Periodontal scaling and root planing D4341 is limited to: –Four units every two years for members aged 3-20 –Four units per lifetime for members aged 21 and older –Four units every two years for institutionalized members

51. Dental Billing GuidelinesOctober 201151 Dental Policy Periodontal scaling and root planing –Claims submitted for procedure code D4341 must have required documentation to support the procedure –Do not include quadrants on the detail lines –Quadrant limitation verification is available on the EVS and is noted only after the fourth quadrant is paid EVS does not indicate the benefit limit until AFTER the full benefit is met (four units) –Providers may also send an inquiry to Written Correspondence requesting paid claim history

52. Dental Billing GuidelinesOctober 201152 Dental Policy Sealants –The IHCP only covers procedure code D1351 – Sealants, for permanent molars and premolars –Reimbursement is limited to members younger than 21 years old, one sealant per tooth, per lifetime –EVS provides tooth number detail for paid sealants

53. Dental Billing GuidelinesOctober 201153 Dental Policy Multiple restoration reimbursement –The IHCP reimburses for only one restoration code per tooth using the same material when performed for the same member on the same date by the same dentist –For example, the IHCP reimburses for only one of the appropriate procedure codes (D2140, D2150, D2160, D2161) for an amalgam restoration of primary tooth letter –When a dentist performs multiple restorations on the same tooth, on the same day, and uses different materials on the same surface (without a second surface), the IHCP reimburses for a single surface restoration for each material The IHCP reviews these claims for medical necessity

54. Dental Billing GuidelinesOctober 201154 Dental Policy Extractions –The IHCP reimburses 100 percent of the maximum allowed amount or the billed amount, whichever is less, for the initial extraction –For multiple extractions within the same quadrant on the same date of service, the IHCP reimburses 90 percent of the maximum allowed amount for procedure code D7140 or the billed amount, whichever is less –Bill only one tooth number per detail line

55. Dental Billing GuidelinesOctober 201155 Claim Submission Supernumerary tooth extraction –Effective January 1, 2010, the IHCP adopted the ADA tooth designations for supernumerary tooth extractions –Eliminates the necessity to bill D7999

56. Dental Billing GuidelinesOctober 201156 Claim Submission Claim notes for supernumerary tooth extraction Permanent dentition – Supernumerary teeth are identified by the numbers 51 through 82, beginning with the area of the upper right third molar, following around the upper arch and continuing on the lower arch to the area of the lower right third molar Tooth #12345678910111213141516 “Super”#51525354555657585960616263646566 Tooth #32313029282726252423222120191817 “Super”#82818079787776757473727170696867

57. Dental Billing GuidelinesOctober 201157 Claim Submission Claim notes for supernumerary tooth extraction Primary dentition – Supernumerary teeth are identified by the placement of the letter “S” following the letter identifying the adjacent primary tooth (supernumerary “AS” is adjacent to “A”) Tooth #ABCDEFGHIJ “Super”#ASBSCSDSESFSGSHSISJS Tooth #TSRQPONMLK “Super” #TSSSRSQSPSOSNSMSLSKS

58. Dental Billing GuidelinesOctober 201158 Dental Policy Dentures –The delivery date is the date of service for each service –Providers may charge the member for dentures if the member is ineligible upon delivery A waiver is not required –Providers must verify member eligibility prior to rendering services

59. Dental Billing GuidelinesOctober 201159 Dental Policy PA requirements for dentures –Denture replacement requires PA –Requests for relines or repairs may be approved if they will extend the useful life of a prosthesis –Members 20 years old and younger do not require PA for dentures

60. Dental Billing GuidelinesOctober 201160 Dental Policy Orthodontia –All orthodontic procedures require PA –The IHCP only approves orthodontic procedures in cases of craniofacial deformity or cleft palate –The patient must be diagnosed by a member of the American Cleft Palate – Craniofacial Association

61. Dental Billing GuidelinesOctober 201161 Dental Policy Orthodontia –The diagnosis must include descriptive information of facial and soft tissue, skeletal, dental/occlusal, functionality, and applicable medical or other conditions –The treatment plan must accompany the request for authorization The plan must show the phase and length of treatment –The IHCP authorizes PA on a case-by- case basis

62. Dental Billing GuidelinesOctober 201162 Dental Policy General anesthesia D9220 and D9221 (General Anesthesia) is reimbursable –Per 405 IAC 5-14-15, Medicaid reimbursement is available for general anesthesia –Per 405 IAC 5-3-13, dental services rendered in an inpatient setting require prior authorization

63. Dental Billing GuidelinesOctober 201163 Dental Policy General anesthesia –General anesthesia for members 21 years of age and older may only be provided in a hospital (inpatient or outpatient) or ambulatory surgical center and must include documentation of the following in the patient’s record to be eligible for reimbursement: Specific reasons why such services are needed, including specific justification if such services are to be provided on an outpatient basis Documentation that the member cannot receive necessary dental services unless general anesthesia is administered  Example: A member may be unable to cooperate with the dentist due to physical or mental disability

64. Dental Billing GuidelinesOctober 201164 Dental Policy IV sedation –Bill D9241 and D9242 for intravenous conscious sedation and analgesia –The IHCP reimburses these codes in conjunction with services provided for oral surgery procedures only –Maintain documentation in the patient’s file to support the service provided

65. Dental Billing GuidelinesOctober 201165 Dental Policy Posting payments and refiling claims –Check all detail lines when posting IHCP payments to ensure all procedures are reimbursed –Only resubmit denied details to avoid duplicate payments –Resubmit using Web interChange –Send paper claims to: Dental Claims P.O. Box 7268 Indianapolis, IN 46207-7271

66. Authorize Prior authorization

67. Dental Billing GuidelinesOctober 201167 Prior Authorization –Mail PA requests for traditional Medicaid to: ADVANTAGE Health Solutions-FFS P.O. Box 40789 Indianapolis, IN 46240 –Or call 1-800-269-5720 –Fax is the preferred method for submitting PA requests Fax ADVANTAGE at 1-800-689-2759

68. Dental Billing GuidelinesOctober 201168 Prior Authorization – Care Select –Fax is the preferred method for submitting PA requests –Mail PA requests for Care Select Medicaid to: ADVANTAGE Health Solutions P.O. Box 80068 Indianapolis, IN 46280 Phone 1-800-269-5720 Fax request 1-800-689-2759 OR MDwise P.O. Box 44214 Indianapolis, IN 46244-0214 Phone 1-866-440-2449 Fax request 1-877-822-7186

69. Deny Common Returned Claims and Denial Reasons

70. Dental Billing GuidelinesOctober 201170 Return to Provider (RTP) Claims –If you receive claims back with a cover letter, your claims have not been entered into the claims processing system –The following are examples of the top reasons claims are returned to providers Invalid NPI –Verify that all paper claim submissions contain the correct NPI in the following fields of the ADA 2006 claim form Field 49, Enter the NPI of the Group or Billing Provider Field 54, Enter the NPI of the Rendering provider

71. Dental Billing GuidelinesOctober 201171 RTP Claims Illegible handwriting –HP will accept claims that are handwritten If submitting handwritten paper claims, be sure the writing is clearly legible and all information is inside the field line –Do not use red ink RID number missing –Verify that all paper claim submissions contain the RID in field 15 of the ADA 2006 dental claim form –Claim field instructions are found in Chapter 8, Section 5 of the IHCP Provider Manual for the ADA 2006 claim form

72. Dental Billing GuidelinesOctober 201172 Exact Duplicate –Cause When the claim being processed is an exact duplicate of a claim(s) on the history file in a paid status –Resolution Review claims submitted to identify claim in paid status  Review Claims Inquiry inquire on Web interChange  Review past-dated Remittance Advices Edit 5001

73. Dental Billing GuidelinesOctober 201173 Procedure code vs. age restriction –Cause Procedure code listed is designated for a particular age range that does not coincide with the age of the member on the claim  For example, if a member is 10 years old and a D1110 is billed, this edit will cause the claim line to deny –Resolution Research the age and benefit limitations detailed in the IHCP Provider Manual in Chapter 8, Section 5 Edit 4034

74. Dental Billing GuidelinesOctober 201174 Dates of service not on PA master file –Cause The procedure code listed requires PA, and no PA is on file in the IndianaAIM claims processing system –Resolution Contact the PA vendor (ADVANTAGE Health Solutions or MDwise Care Select) and request PA Edit 3001

75. Dental Billing GuidelinesOctober 201175 Recipient name and number disagree –Cause The member number and the member name on the claim do not match what is listed on the recipient eligibility –Resolution Check the Eligibility Inquiry on Web interChange and verify all information on the claim matches the eligibility information exactly Edit 0513

76. Dental Billing GuidelinesOctober 201176 Recipient covered by private insurance –Cause The claim does not contain either (1) indication of the primary insurance payment or (2) a copy of the primary insurance EOB form –Resolution Verify eligibility using Web interChange to determine what primary insurance should be billed; after obtaining payment or denial from the primary carrier, rebill for adjudication through the IHCP Providers can either file the claim:  Using Web interChange when a payment has been made (no attachment needed)  Refiling the claim on the Web interChange with a paper attachment using the attachment process  Refiling the claim on a paper claim form including the primary EOB behind the claim form When primary insurance denies or pays zero on a claim, providers will need to include the primary insurance EOB with their claim Edit 2504

77. Describe EHR Incentive Program

78. Dental Billing GuidelinesOctober 201178 –The American Recovery and Reinvestment Act (Recovery Act) of 2009 provides for incentive payments for eligible professionals (EPs), and eligible hospitals (EHs) who are meaningful users of certified electronic health record technology –EHR Incentive Program runs from 2011-2021 –EPs register for the incentive program through a two-step process: 1.Providers must register at the CMS Registration and Attestation system and select Indiana as their state 2.Register their EHR system using the Provider Profile feature of Web interChange –Ensure your National Plan and Provider Enumeration System (NPPES) and Provider Enrollment, Chain, and Ownership System (PECOS) records are updated and accurate EHR Incentive Program Eligibility information

79. Dental Billing GuidelinesOctober 201179 –Per federal rule, EPs must register for EHR incentive payments no later than calendar year (CY) 2016 –EPs must meet patient volume criteria as follows: Minimum 30 percent patient volume attributable to Medicaid-funded services OR Practice predominantly in a federally qualified health center (FQHC) or rural health clinic (RHC) and have a minimum 30 percent patient volume attributable to needy individuals EHR Incentive Program Eligible professional (EP)

80. Dental Billing GuidelinesOctober 201180 EHR Incentive Program –The maximum incentive payment to an EP is $63,750, over a six-year period –EPs must begin receiving payment no later than CY 2016 –The last year an EP can receive payments is 2021 ProviderEPEP-Pediatrician Patient Volume30%20-29% Year 1$21,250$14,167 Year 28,5005,667 Year 38,5005,667 Year 48,5005,667 Year 58,5005,667 Year 68,5005,667 Total Incentive Payment $63,750$42,500

81. Prepare ANSI version 5010

82. Dental Billing GuidelinesOctober 201182 HIPAA 5010 –The mandatory compliance date for ANSI version 5010 for all covered entities is January 1, 2012 –If submitting claims to the IHCP, you need to prepare for these upgrades to prevent delay in payment –Indiana Health Coverage Programs (IHCP) 5010 Companion Guides and Upcoming Changes document are available at provider.indianamedicaid.com provider.indianamedicaid.com Upcoming Changes document contains only segments that are updated, added, or deleted

83. Dental Billing GuidelinesOctober 201183 HIPAA 5010 Transactions affected that may impact you: –Dental claims (837D) –Eligibility verifications (270/271) –Claim status inquiry (276/277) –Electronic Remittance Advices (835) –Prior authorizations (278)

84. Dental Billing GuidelinesOctober 201184 Testing Information –All trading partners currently approved to submit 4010A1 will be required to be approved for 5010 –All software products used to submit 4010 must be tested and approved for 5010 –Testing began January 2011 and includes: Clearinghouses, billing services, software vendors, individual providers, and provider groups –Providers that exchange data with the IHCP using an IHCP- approved software vendor will not need to test –Each trading partner is required to submit a new Trading Partner Agreement

85. Dental Billing GuidelinesOctober 201185 What You Need To Do –If you bill IHCP directly: Begin the process to upgrade to the ANSI 5010 –If you are using a billing service or clearinghouse: Find out if they are preparing for the HIPAA upgrades to ANSI version 5010 IHCP Companion Guides will be available during the fourth quarter of 2010 –Questions should be directed to INXIXTradingPartner@hp.com OR –Call the EDI Solutions Service Desk 1-877-877-5182 or (317) 488-5160 –Watch for additional information on the testing process, revised IHCP Companion Guides, and the schedule for transaction testing on this mandated initiative in bulletins, banner pages, and newsletters at indianamedicaid.comindianamedicaid.com

86. Find Help Resources Available

87. Dental Billing GuidelinesOctober 201187 Helpful Tools Avenues of resolution –IHCP Web site at indianamedicaid.comindianamedicaid.com –IHCP Provider Manual –IHCP Fee Schedule –Customer Assistance 1-800-577-1278, or (317) 655-3240 in the Indianapolis local area –Written Correspondence P.O. Box 7263 Indianapolis, IN 46207-7263 –Provider field consultant

88. Q&A