I am constantly being asked, what do you do for work? Well, that is a short question with a long answer. I work as one of the billing implementation specialists at MediSked with a focus on claims that come through our MediSked Coordinate – Care Management Platform. The behind the scenes actions of a care manager performing a service with an individual to then the agency seeing payment on an 835 remittance is a very intricate process. Thankfully, I have the best team of engineers, integration architects, and project managers to make this process possible and smooth!
On July 1st 2018, New York State began the change of the state’s system of services for people with intellectual and/or developmental disabilities with the start of seven new Care Coordination Organizations. Of course, one asks, why? Transitioning individuals with I/DD to CCO’s provides inclusive Health Home Care Management, transitions case management through State Plan Medicaid Service Coordination and Plan of Care Support Services in a justly person-centered approach. Here at MediSked, we were very excited to be a part of this transition!
Since going live on July 1st, the MediSked Coordinate – Care Management platform has billed well over $200 million, with the numbers climbing each week by $10 million. The weekly cycle of submitting claims is like clock work for us. On Monday and Tuesday evenings our billing automation pulls the 837 claim files to make the Wednesday cutoff for New York State Medicaid. On Thursday, we can access early check amounts to provide utilization reports for each CCO. On Monday morning, our 835 remittance files flow into the system automatically for the agencies to view – then we start the process all over again. The formatting and submission of claim files is not something that is new to MediSked – it is something we have perfected.
You may have read our Billing 101 blog post by my colleague Jason Nicholas, which details the lifecycle of a claim in our agency management platform, MediSked Connect. The process in how Coordinate bills claims vs our MediSked Connect platform in New York State is virtually the same. Our automation engineer submits the 837 files to eMedNY, the access method used to submit HIPAA-compliant transactions to New York’s Medicaid department, and we immediately get a 999 response stating that the file is accepted. Proceeding that, we receive a 277 file that will contain any rejections and preadjudication information that we can also check in ePaces (Electronic Provider Assisted Claim Entry System). On Monday morning the 835 remittance files are automatically ingested into MediSked Coordinate to reconcile the claims that have been submitted on each Care Coordination Organization site.
My name is Kristy Love and I am the Billing Implementation Specialist here at MediSked. I work closely with the EDI team, support and engineering to ensure that file submissions and editing is complete and compliant for all agencies. I enjoy that each day there is something new to tackle. The MediSked team effort and work ethic is contagious!