Questions and Answers

Additional Information

Question Number Question Answer
1 Is there a period of time that you will be accepting Fee for Service claims and PPS claims at the same time? For dates of service May 1, 2012 and subsequent, FFS claims will be accepted only for patients under age 18. Claims for dates of service before May 1, 2012 will be accepted after May 1 for patients age 18 and older.
2 Will there be any comparisons between agencies pertaining to Clinical Outcomes? Are you moving forward to a PFP model based on outcomes? The Department is currently working on various approaches to assess clinical outcomes and performance. These approaches may be implemented in the future, but at this time it is not anticipated they will be implemented prior to the May 1, 2012 effective date of the episodic payment system.
3 Provide details on the testing phase:
  • Who can test, how, and when can testing start?
  • Can Test Data be sent Hard Copy or in the electronic format?
The Provider Test Environment (PTE) only accommodates electronic transactions. Anyone billing electronic 8371 claims can begin testing in the PTE as of January 4, 2012. Hard copy test data is not allowed. Testing will accommodate dates of service beginning Nov. 1, 2011. Information about the PTE can be obtained at the following location:
4 Will vendors be allowed/required to test the episodic billing? If so, will ´real data´ be required? And if so, will our customers inherited our approval if and when we pass testing? Testing in the Provider Test Environment (PTE) is allowed but is optional. ´Real data´ will be required. DOH does not impose any formal approval process.
5 What are you doing to make sure all the billing software vendors will be ready for April 1, 2012? Informational materials regarding the Episodic Payment System have been distributed to vendors as well as providers, and the Department has been in direct contact with vendors to assist them with preparations for the changes in payment methodology.
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