June 19, 2009 — NC Medicaid to Require Electronic Claims and Payments

Like all of our clients who bill NC Medicaid, Horizon is watching closely the North Carolina legislature’s debate over potential cuts to the state budget in the health services sector. Now more than ever, it is critical to collect every possible penny of reimbursement (in a timely fashion) and to not exceed authorized service limits. It’s a scary time, and the providers who are smart enough to adapt quickly and cheaply will be the ones who weather the storm.

NC DMA announced in the June 2009 Medicaid bulletin that as a cost-cutting measure, soon all Medicaid claims and payments must be handled electronically. If you are currently receiving paper checks from Medicaid, you will need to sign up for “Electronic Funds Transfer”, also known as “Automatic Deposit”. Instructions are included here in the online Medicaid bulletin.

It’s not clear whether the electronic payment requirement also means paper remittance advices (RAs) will be stopped. In case it does turn out that electronic RAs are required, please be aware that Horizon Healthware has a cost-effective software module to handle the download, translation, and printing of electronic remittance files. In light of the Medicaid cuts, even if paper RAs do continue, this may be a smart time to consider switching to electronic RAs. With potential cuts in reimbursement affecting cash flow, it will be more important than ever to shorten the collection cycle and find out about denials as quickly as possible. Getting RAs electronically puts the denial information in the agency’s hands several days faster.

On the claim side, many providers are already using the free NCECS “web tool” that lets you type in claims to EDS over an internet connection, a good solution for a low-volume Medicaid agency. For a higher-volume situation, another option is Horizon’s Medicaid Electronic Claims system. Our Medicaid module also has the additional feature of Eligibility Verification, which lets you check Medicaid eligibility for all clients at once rather than using the manual phone call verification. This can be used either stand-alone as a replacement for NCECS, or as an add-on to our full billing and management system (PROMISE).

Our PROMISE agency management system provides a full range of tools to track authorizations/certifications, generate claims, track staff time and units, report non-Medicaid services to mental health LMEs, print the Medicaid cost report, manage collections, and much more. Used in combination with the electronic RA module, the system can also save time by actually posting the payments to your client accounts so you don’t have to key in payments manually. This frees up valuable staff time for doing follow-up on unpaid claims.

Please be sure to review the June Medicaid bulletin and keep an eye out for the more detailed information that should be in the July edition on the NC DMA site. And if you would like to discuss any of the software tools mentioned here, feel free to call or email us.

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