10-19-18
Cost Effective Health Insurance (CEHI) Billing-
Our CEHI workers are determining eligibility, the fiscal
team approves payment, and we have someone
that bills. With the new CEHI policies we are running into a problems
when we are billing.
Every time there is a circumstance change in the case (some
examples include: MA ended/started, new
baby, premium change, number of people covered by insurance changes). Per the instructions,
we
need
to make re-determinations of the CEHI eligibility. Typically this change will
change the amount approved
for reimbursement and date range in the TPCO screen in MMIS (this is where we
get the obligation
number for billing). Our CEHI workers are updating the TPCO screen every time
they re-determine
eligibility or end eligibility. Our clients, once approved for the
program, will need to send in paystubs
along with a claim form. The TPCO is ready for billing once the payment is
processed. We also make a
detailed case note when the eligibility is determined in MAXIS/METS on approved
amount, OB number,
who is covered, insurance amount deducted per check.
Our clients are not very timely about turning in claims
forms and paystubs. This is where the issue
comes in.
- The claim comes directly
to the Fiscal team to issue payments. In the meantime the case had
to
be re-determined 1,2 or even 3 times. Per the instructions for the CEHI
eligibility worker they
are to update the TPCO screen payment amount and date but the OB number is
staying the
same. We are running into problems when billing because the worker
is making changes on the
obligation number before we bill the state for the payments we made. Right
now we bill
monthly but are looking at possibly billing weekly after each payment.
- In the example below
we were unable to bill 2017 because in March 2018 it was determined
they
were eligible back to July 2017- 2 different amounts approved. We approved
one payment to
the client from July 2017-Feb 2018 but because we never billed the for
2017. The Obligation ID
was reused.
MMIS-TPCO will not give you a new obligation number unless
a payment has been billed.
This is the last correspondence with the state:
The system isn’t capable of
having more than one obligation open on a policy at a time so that is not an
option. I think your temporary solution of making
the dollar amount high enough works except that it goes against our updated
policies and procedures in
regards to tracking purposes. In other words, if we were to audit
you, what you have listed on the
TPCO screen would possibly not match the dollar amount from the 3767D.
The correct way to proceed
would be to bill the state before you update the obligation #, which requires
you to be diligent in your
tracking and record keeping. And I realize this is why it has been
brought to my attention. I will discuss
this internally next week and let you know what, if anything, we can figure
out. Thank you!
Health
Insurance Recovery Unit
Is anyone else running into this problem? Or have any
ideas?
Thank you for your help!
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Kate Dahl • Fiscal Supervisor
WRIGHT COUNTY, MINNESOTA: Health & Human Services
direct: (763) 684-8457 • fax: (763) 682-7701
Human Services Center, 1004 Commercial Drive, Buffalo, MN 55313
www.co.wright.mn.us
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