Nursing Homes
MEDS® users know that for any applications or conversions submitted to EDITS, we make sure that the coverage gets put up correctly and the NAMI is correct so that you can bill. Now, RES Systems has added Electronic Data Interchange (EDI) capability with eMedNY to check your residents against the state database in a single batch to manage ongoing Medicaid eligibility.
The nursing home will have capability to run a full census ePACES look up multiple times per month, as well as for other lists such as all cases approved during the month. Clients who also have MEDS can run any custom report on that system through the interface with the push of a button. For example, you can check pending cases every day in order to identify if any were approved offline. We have also added a feature that provides inquiry for residents where you can enter a from and to date, and eligibility will be automatically checked for every month in the range for up to two years.
The Batch Eligibility Inquiry System can also assist our clients who have shared with us their frustration with the number of residents who lose Medicaid eligibility because the Managed Care plan does not submit the renewal package to the Home Care Program. The homes are sometimes not notified until months later when the plan takes back payments retroactively. With the Batch Eigibility Inquiry System, you will be able to identify the Plan, the renewal due date, to what address it was mailed, and obtain a copy of the form if not available to the facility. The nursing home will be able to load their census report onto MEDS which will run all the residents on ePACES. A report of the eligibility responses will be produced that includes every field currently viewable on the ePACES screen. This will identify closed cases, provider file problems, changes in managed care providers, and recertification due dates, as well as any other info the nursing home would check for on ePACES. RES will identify the appropriate managed care company and the recertification due date to ensure that the renewal package is located. The nursing home will have control over the managed care renewal process, as well as the added benefit of ePACES eligibility responses for all residents in one report, instead of case by case manual inquiry.
However, the greatest benefit is that you receive the same dedicated service that we offer all of our clients. We will track problems identified from the ePACES results and work with you to resolve them. For example, we can help to get the "N" R/E code up on ePACES so the managed care plan doesn't take back payments. And we can help you if you didn't receive the recertification package on a resident if you should have, based on the recert date in the results. After all, the point of finding problems is to correct them, ensuring ongoing eligibility and receiving payments more timely.
MLTC and Community Health Plans
With the implementation of Mandated Managed Care for nursing home residents, having a tool to check eligibility on all of your members is becoming a necessity. In one step, you will be able to verify proper coverage and plan assignment, track eligibility changes, R/E code changes, and cases that lose coverage, and obtain eligibility history on problem cases, as well as the added benefit of having ePACES eligibility responses for all members in one report - no more case by case manual inquiry. The plan will have capability to run the full member list ePACES look up multiple times per month and upload other case lists, such as members who lost eligibility, at any time for inquiry.