DHS Systems and IT Updates SSIS resources SSIS Fiscal Fiscal Advisory Group

Background Information Regarding Survey:

After the July 2012 FAC meeting, SSIS sent a survey for FAC members to send the counties they represent to find out more about how many claims are being submitted to the MCOs, the dollar amount and time to create the claims. We stressed to the FAC the importance of every county's response to the survey and indicated a lack of response to the survey would be considered a vote to not pursue automating the MCO billing.

Survey Summary:

The average amount per claim is $185 and takes six minutes on average to create. Fifty-one counties responded to the survey. Many counties are using clearinghouses and have found various ways to streamline the process. Following is a summary of the counties' ratings of the importance to automate MCO billing:

Rank	Votes
Very Important	14
Important	18
Nice to Have	16
No Opinion	1
Prefer to spend resources elsewhere	1
County agencies that did not respond, which we said was a vote not to pursue	31
Total	81*
*Notes: The tribes do not use SSIS for Healthcare Claiming and were not surveyed Dakota does not use SSIS for Healthcare Claiming and did not respond Redwood responded but is joining SWHHS so did not rate the importance 81 is the total number of agencies, counting each region as 1 and excluding the tribes, Dakota, and Redwood

MCO Billing Cost Estimates and Issues:

The estimate for the MCO Billing project is $3,000,000 total. The main reason for the high cost is the lack of standard billing requirements. For example:

• Some MCOs require a prior authorization, which is not required to claim to MMIS. We would need to include a way to import the prior authorization or have the county enter that information
• Some MCOs use tiered rates, which includes activities other than "Client Contact," billing to MMIS is done only for "Client Contact" and is billed as one monthly unit
• MCOs have their own client IDs, which would need to be imported or entered
• Not all MCOs accept the UMPI (Unique MN Provider ID) assigned by MMIS
• We would need to create some type of interface with the MCOs or with a clearing house and multiple interface settings

Related SSIS Enhancements:

SSIS has completed the following to help counties with MCO billing:

• MA Eligibility Expansion project, which includes additional PPHP information
• Enhancements to claiming reports

The following projects are slated for the near future, which will help MCO billing

• Marking proofing records as claimed in another system
• Enhancements to the Do Not Claim screen to add MCO related information
• Additional report enhancements

Status of AUC Request and Alternatives

A few counties submitted a request to the AUC (Administrative Uniformity Committee), whose focus is to standardize, streamline, and simplify health care administrative processes. We are planning to discuss this further with the AUC, but at this point they have said this is a DHS issue. SSIS has also discussed the issue with Chandra Breen, the MCO contract manager at DHS. Counties may want to talk to Chandra or the MH policy area to pursue standardized billing requirements for mental health, such as the rates and HCPCS/Modifiers used, and not requiring a prior authorization. Even if SSIS does not proceed with this project, common billing requirements may reduce the time counties spend on these claims.

Detailed Survey Results

The following tables show the results of the survey by MCO, by claim category and by county.

Summary of Survey Results by MCO
MCO	Claims per Month	Monthly Claim Amount	Hours per Month to Claim	Average Claim Amount	Average # of Minutes per Claim
Blue Cross/Blue Shield	2260	$324,996	222	$144	6
Blue Plus	491	$90,185	59	$184	7
Bridgeview	304	$70,870	30	$233	6
Health Partners	195	$27,173	15	$139	5
Itasca Medical Care	550	$35,000	28	$64	3
Mixed	86	$39,000	7	$453	5
Medica	526	$132,998	84	$253	10
Prime West	1304	$269,703	118	$207	5
South Country Health Alliance	215	$77,158	19	$359	5
UCare	392	$104,670	65	$267	10
Total for all MCOs	6323	$1,171,753	647	$185	6

Summary of Survey Results by Claim Category
Claim Category	Claims per Month	Monthly Claim Amount	Hours per Month to Claim	Average Claim Amount	Average # of Minutes per Claim
MH	1130	$442,546	171	$392	9
Mix	3566	$499,911	352	$140	6
Waiver	1602	$227,796	120	$142	4
MSHO	25	$1,500	4	$60	10

Note: Some counties reported information for CD Assess, ACT, ARMHS, and MA Transportation, which cannot be billed in SSIS. Those amounts are included in the "Summary of Survey Results by County" on the next page; they have been removed from the "Summary of Survey Results by MCO" and "Summary of Survey Results by Claim Category".

Summary of Survey Results by County
County	Claims per Month	Monthly Claim Amount	Hours per Month	Avg. Claim Amount	Avg. Minutes per Claim
Anoka	985	$93,000	27	$94	2
Beltrami	392	$51,820	20	$132	3
Big Stone	89	$18,636	13	$209	9
Blue Earth	70	$0	4	$0	3
Brown	86	$39,000	7	$453	5
Cass	31	$3,773	6	$122	11
Clearwater	162	$25,000	29	$154	11
Cottonwood	64	$11,400	14	$178	13
Crow Wing	243	$63,230	42	$260	10
Freeborn	0	$0	0	$0	0
Goodhue	77	$35,000	5	$455	4
Houston	141	$35,735	15	$253	7
Hubbard	103	$25,200	11	$245	7
Itasca	550	$35,000	28	$64	3
Jackson	78	$7,200	14	$92	11
Kandiyohi	170	$37,000	65	$218	23
Kittson	67	$4,850	6	$72	5
Koochiching	21	$7,490	3	$357	8
Lac qui Parle	39	$11,500	4	$295	6
Lake of the Woods	30	$6,317	3	$211	5
McLeod	243	$62,083	12	$255	3
Mahnomen	60	$15,200	3	$253	3
Marshall	125	$33,200	8	$266	4
Meeker	189	$47,800	12	$253	4
Morrison	82	$13,100	8	$160	5
Nicollet	34	$10,200	3	$300	4
Norman	114	$17,550	30	$154	16
Olmsted	347	$64,099	9	$185	1
Otter Tail	437	$38,750	11	$89	1
Pennington	40	$6,000	5	$150	8
Pipestone	65	$13,000	12	$200	11
Polk	315	$93,000	11	$295	2
Pope	54	$22,000	12	$407	13
Red Lake	30	$9,248	2	$308	5
Redwood	60	$1,780	20	$30	20
Rice	50	$15,500	48	$310	58
Roseau	55	$15,500	3	$282	3
St. Louis	70	$31,500	6	$450	5
Scott	115	$8,101	7	$70	4
Sibley	39	$14,100	5	$362	8
Swift	90	$20,000	16	$222	11
Todd	41	$12,326	6	$301	8
Traverse	0	$0	0	$0	0
Wabasha	35	$11,505	3	$329	5
Wadena	168	$35,800	14	$213	5
Waseca	7	$333	1	$48	5
Washington	229	$52,518	44	$229	12
Wilkin	15	$6,000	1	$400	4
SWHHS	156	$26,500	36	$170	14
Faribault/Martin	41	$12,668	3	$309	4
County not specified	40	$3,500	8	$88	12
TOTALS	6,744	$1,224,011	670	$182	6