Georgia preparing for EDS/HP Medicaid system conversion

Editor’s Note: In 2008, EDS won a seven-year, $391 million contract to design, develop and implement a new Medicaid Management Information System (MMIS) for the state of Georgia. The EDS “Georgia interchange” system will provide the state’s 45,000 Medicaid providers with fiscal agent and enrollment broker services. It will also establish electronic health records (EHR) for Medicaid recipients in Georgia. The Georgia Department of Community Health (DCH) is consequently converting its Medicaid system from ACS, its current fiscal agent, to EDS – which was recently purchased by HP Enterprise Services (HP).

Date of Conversion
Originally scheduled to occur on July 1, 2010, DCH recently announced that the conversion will take place on November 1, 2010. HP will schedule implementation workshops in the state during the August-October timeframe. HP will also conduct ongoing workshops as part of its contract with DCH. Go to
http://providerinfo.mmis.georgia.gov/providerprereadiness/home.aspx for additional conversion readiness information.

Provider Representatives
HP’s territories will mirror those of ACS. There will be one HP representative for hospitals in the state – so physician representatives will be expected to help resolve hospital issues. HP’s Provider Representative Supervisor is Billé Frazier, who will supervise 11 regional provider representatives. Frazier says that each regional representative will be expected to conduct at least six pre-scheduled provider visits per week. E-mail Frazier at bille.frazier@hp.com.

Patient ID Cards
Every Medicaid beneficiary in the state will receive a new member ID card one
month before the switch goes live. Medicaid numbers will not change, but the contact information for claims submissions will be different.

Medicaid MMIS Web Portal
• The Web portal is expected to change its address and look – but it will essentially function the same way. Group logins will no longer be allowed – so each individual accessing the Web portal will be required to establish a personal login
• Letters containing new PIN numbers will be mailed to providers about two months before the transition
• The Web portal will include a number of features, including a claims submission function, claim status checks, eligibility verification, provider enrollment, remittance advice (RA) forms, manuals, workshop schedules, and details on patient liability. It will also eventually offer a “live support chat” feature.
• HP says that “server volume” issues are not expected to be a problem based on the extensive server load testing that has taken place.

EDI Transmission Software
HP will provide free EDI transmission software and will no longer accept the current ACS software – WINASAP2003. Providers will have to purchase their own EDI software or download a free copy of HP’s Provider Electronic Solutions (PES) software before the transition takes place.

Call Center
The call center will be staffed by three supervisors and 59 representatives. Phone support will be offered Monday through Friday from 7 a.m. to 7 p.m. HP is supposed to address issues within 72 business hours.

Billing Manuals
HP will publish three provider billing manuals – institutional, dental, and professional – which will be updated quarterly.

Prior Authorizations
Prior authorizations will be conducted directly with GMCF as opposed to an intermediary, which represents a change from current ACS procedures.

Provider Enrollment
Existing providers will not be required to re-enroll.

Other Issues
• HP has expressed some concern about adjudicating crossover claims
• HP says it will address systemic claims payment issues using banner messages on the Web portal
• HIPAA 5010 standards – which go into effect on January 1, 2012 – will likely effect change within the claims submission/status checking process, and are expected to pose hurdles early in the conversion process. Go to https://www.claredi.com/public/Final%20Rule.5010.pdf to access the Federal Register for additional information on the HIPAA 5010 standards

Thomas O’Brien, JD, MBA, is a partner with Feiler & Associates, a law practice dedicated to Medicaid eligibility, Social Security, and medical reimbursement. He can be reached at Thomas@feilerandassociates.com.