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December 2011 |
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A report on events affecting Oklahoma providers |
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December 1–31 Safe Toys and Gifts Month More information December 4-10 National Hand Washing Awareness Week More Information December 8-9 ODMHSAS SOC Wrap Training OKC More Information December 8-11 22nd Annual Meeting & Symposium American Academy of Addiction Psychiatry Scottsdale, AZ More Information December 13-14 ODMHSAS Case Management Training OKC More Information December 20 SOC Family Support Provider Training OKC More Information December 24 Christmas Eve December 25 Christmas Day December 31 New Year’s Eve observed January 1 New Years Day |
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Practice Management Insight |
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Since the roll out of OptumHealth on October 1, 2011, it has been one issue after another for the providers of Mental Health & Substance Abuse centers in Oklahoma. Many have still not been paid by Oklahoma Health Care Authority, several centers have incurred difficulties trying to upload transactions, getting PA’s approved or being partially paid. Checks have been lost and OptumHealth has denied some claims, which never have been denied before. OptumHealth also changed all of the codes, which led to sporadic acceptance of claims. After numerous complaints to the State of Oklahoma & them conducting their own investigation, they finally came to the conclusion that it was time to fire OptumHealth. As of November 30th, 2011, OHCA announced its 30-day intent to terminate their contract with OptumHealth. As of now, there is still no definite plan of how, when or who will replace OptumHealth, but rest assured, at the end of December, OptumHealth will no longer be the liaison between the Mental Health & Substance Abuse centers of the State of Oklahoma & the Oklahoma Health Care Authority. For related stories, please refer the following links… 2 Enid mental health facilities report not getting money from Oklahoma Health Care Authority How did the state miss problems with Optum? OHCA’s letter of intent to terminate with OptumHealth OrionNet Systems Facebook link |
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- Thank you so much Clyde for your response. I appreciate your dedication, especially over the past few weeks. I am hoping that things are down hill for now and should you need any further assistance from us, please don’t hesitate to ask. ~ Steve - Did anyone call New York and warn them about the MESS they were getting ready to go through???? Clyde, we want you to know we really appreciate you and all of your team. You all make our lives so much easier!!!! Thanks so much, ~ Dixie - I have thanked God many times for you and your team for getting us through this horrible ordeal. I truly don't think I could have survived this mess if I had not had you guys doing the talking and work behind the scenes for me. I shudder to think of the mess I'd be in right now. Anyway, thank you from me, my therapists, and my staff. You ARE truly appreciated!!! Sincerely, ~Debbie |
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Clyde Wafford, President of OrionNet Systems, and his team have worked hard to prepare for the up coming changes with the state and Oklahoma Department of Mental Health & Substance Abuse Services (ODMSAS). He & his team have prepared themselves & our software, in order to stay in compliance with the up come changes for January 1, 2012. It has been brought to our attention that some providers may have utilized APS in the past and most recently, Optum, as an online record system to meet portions of the documentation requirements for certification, accreditation &/or contract monitoring review. Please be aware those forms of electronic documentation are unavailable and perhaps will never be retrievable. If you’re a ThinkHealth member with OrionNet Systems, you can rest assured that you are in Full Compliance!! Our Practice Management Software has all of the documentation integrated into the software so there is no confusion when its time for review. If you are having trouble and/or know a center that is having trouble with certification, accreditation and/or contract monitoring review of documentation Treatment Plan, CDCs/Paperwork, Authorizations issues and need a reliable Practice Management Software please give contact OrionNet Systems. We will be happy to answer any questions you may have at any time. 405-286-1674 |
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Physicians and other healthcare providers who have yet to adopt or implement newer health information technology (health IT), may be in danger of missing electronic payments from Medicare and private insurers. The deadline for compliance with the Health Insurance Portability and Accountability Act’s (HIPAA) Version 5010 is January 1, 2012. The updated standards, aim to promote more widespread use of electronic healthcare transactions and include front matter, technical, structural and data content improvements. According to the Department of Health and Human Services (HHS), Version 5010 will reduce ambiguities by requiring more specific data to be collected and transmitted in a transaction. The new version also accommodates ICD-10 code sets, which providers must comply with by October 1, 2013. Yet, in spite of the risk of not being reimbursed by insurance providers, many physicians have not started to check to verufy it they are compliant with Version 5010, the American Medical Association (AMA) reports. A March survey by the Medical Group Management Association found that 56% of practices have yet to schedule internal testing for 5010. Additionally, 61% haven’t scheduled any testing with their major payers, according to the AMA. AMA President Dr. Cecil Wilson said in a statement that although the transition may seem overwhelming, “it is important and not too late to get started in order to avoid significant disruptions to patient care and claims payments.” Carefully and thoughtfully planning an ICD-10 and HIPAA implementation strategy will give practices a better chance of catching and addressing possible problems before the government deadlines, according to the American Health Information Management Association (AHIMA). For more information click here. |
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OKMMIS will be down from Saturday December 31, 2011 at 6:00pm until Sunday, January 1, 2012 at 5:00 am. Effective Saturday, December 31, 2011 at 6:00 all claims submission must be in ASCX12 5010 format. |
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To implement system changes into the Oklahoma Medicaid Management Information System (OKMMIS), necessary to accommodate the federal mandate to be HIPAA compliant with ASC X12 5010 transactions beginning Sunday, January 1, 2012, the OHCA is providing advanced notice to all providers that there will be an extended maintenance period that will exceed the normal four hour maintenance period between 1:00 a.m. and 5:00 a.m. CST. The extended maintenance period will begin at 6:00 p.m. CST on Saturday, December 31, 2011 and continue until 5:00 a.m. CST on Sunday, January 1, 2012. During this extended maintenance period, the secure provider portal will not allow uploads of EDI files in the ASC X12 4010 or 5010 formats. This cutoff for uploads will allow the OHCA to process all remaining ASC X12 4010 transactions prior to receipt of any of the new ASC X12 5010 transaction formats. Maintaining this separation between the different formats is critical since the OKMMIS |
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will not have the ability to dual process both formats once the new ASC X12 5010 format system changes have been implemented. IMPORTANT! For providers submitting ASC X12 transactions, please note that any ASC X12 transaction you wish to have processed under the 4010 format MUST BE submitted PRIOR to the Saturday, December 31, 2011 6:00 p.m. CST of the extended maintenance period. All ASC X12 transactions submitted AFTER the 6:00 p.m. CST MUST BE in the ASC X12 5010 format or the transaction will be rejected as non-compliant. Even if the date of service occurred on Saturday, December 31, 2011, but after 6:00 p.m. CST of the extended maintenance period, submitting a 4010 transaction once the extended maintenance period expires on Sunday, January 1, 2012 will still result in the ASC X12 4010 transaction being rejected as non-compliant. |
