_experience the commitment TM
CGI Ohio RAC Medicaid Update
June 2012
Agenda
• Similarities
to the ODJFS Medicare RAC Program
• Differences to the ODJFS Medicare RAC Program
• Medicaid RAC Operations
• Provider Assistance and Online Tools
•
Customer Service
• Ohio RAC Website
• Credit
Balance Reviews
• Open Question and Answer
2
Confidential
Similarities to the Medicare RAC Program
•
Execute an Education and Outreach program
• Provide Customer service via a toll-free telephone
number
• Compile and maintain provider-approved addresses and
points of contact
• Mandatory acceptance of provider submissions of
electronic medical records on CD/DVD or via facsimile
• Notification to providers of overpayment findings within
60 calendar days
• A five-year review period for provider claims
• A 45-day timeline to submit medical records to the RAC
3
Confidential
Differences to the Medicare RAC Program
• CGI
Federal will be responsible for the first two
levels of the appeals on overpayments with the CGI
Medical Director responsible for the second level of
appeal.
• Postage and copy fees are not paid by ODJFS or
CGI.
4
Confidential
Medicaid RAC Operations
Types of Reviews
•
ODJFS will approve CGI Federal-selected areas of review. CGI Federal will review for:
• Coverage Determinations
•
•
Be included as a covered service, as described in Ohio Administrative Code 5101:3
Be medically necessary, as defined in OAC 5101:3-1
•
Coding Determinations
• CGI Federal will perform both Automated and Complex reviews.
• Project scope is being modified to include Credit Balance Reviews.
Medical Record Submission
•
Medical Record submission standards will be posted on CGI’s Ohio Medicaid RAC Web
Portal.
Letters
•
CGI Federal will issue the following letters according to the program timelines:
• Medical Record Request Letter
• Review Results
• Demands
5
Confidential
Provider Assistance and Online Tools:
Customer Service
•
CGI’s existing Call Center Team will be servicing ODJFS
Medicaid RAC provider calls. Benefits of this approach
include:
•
Familiarity with the Ohio Provider community
• Existing knowledge of systems and processes
• Expedited training program
•
The CGI Ohio Medicaid Call Center hours of operation are
from 8:00 a.m. to 4:30 p.m.
6
Confidential
Provider Assistance and Online Tools:
Ohio RAC Website
•
CGI Federal has implemented a website for Providers,
similar to the CGI Medicare RAC Region B Web Portal.
• Providers can use the website to accomplish the following:
•
•
•
•
•
View audit findings
View audit status
Update contact information
View Medical Record Submission and Contact Information
View general program information
7
Confidential
Provider Assistance and Online Tools:
Ohio RAC Website (cont’d.)
•
The Ohio RAC website: http://odjfs.cgicleve.com
•
Providers authenticate by clicking on the Providers link and
entering their Provider Number, NPI or other information listed.
8
Confidential
Provider Assistance and Online Tools:
Ohio RAC Website (cont’d.)
•
A Bulletin Board is available for communicating important
updates to the Provider community.
•
Once authenticated to the website, click on the Home link to
view the Bulletin Board. Important information is located in the
What’s New box.
9
Confidential
Overview and Update: RAC B Website
Claim Status
•
Providers can view the status of their RAC cases from the
Claim Status link.
10
Confidential
Overview and Update: RAC B Website
Claim Status Details
•
Detailed information on cases is available from the Claim
Audit Details link.
11
Confidential
Overview and Update: RAC B Website
Address Maintenance
•
Providers can update their contact information.
•
Providers can only update contact information for addresses
entered for the logon identity.
• Click on the link in the ‘Provider Number’ column to open the
Address Maintenance.
12
Confidential
Credit Balance Reviews
•
Approval has been received by ODJFS to increase the scope
to include Credit Balance Reviews.
• CGI is currently working to get the necessary subcontractor
agreement in place to start this scope of work.
13
Confidential
Contact Information
Call Center for CGI Medicaid RAC
Ohio
Toll Free: 1-855-210-3438, Option 1
E-mail: rac.medicaid@cgifederal.com
Website: http://odjfs.cgicleve.com/
14
Confidential
Questions
15
Confidential