To: All Medical Assistance Program Providers
Re: Third Notice: New HFS Provider Resolution Process and Portal effective 02/28/2020
This notice is third in a series of notices regarding the implementation of the new provider MCO resolution portal. As of 02/28/2020, all providers are submitting unresolved complaints with an MCO via the new secure web-based Provider Resolution portal. The new link to the Resolution Portal may be found on HFS’ Care Coordination Webpage, or may be accessed directly from the HFS Managed Care Provider Resolution Webpage
Requirement Reminders and Timeline for Submitting Provider Disputes
As provided under the new provider resolution process, providers must first work with the MCOs regarding any issues or complaints. All disputes must be submitted to the MCOs internal dispute process before submitting a ticket in the portal. Providers are responsible for working with MCOs to understand their internal MCO dispute process and to follow-up with the MCO on the status of a dispute prior to submitting a ticket in the portal. If it is determined that a complaint was submitted in the portal, sooner than 30 days or later than 60 days after submitting the dispute to the MCO’s internal process, the complaint will be immediately closed.
A list of the new Provider Portal Resolution Requirements can be found in the first Provider Portal Notice. As outlined in the new requirements, providers must use the new standard Complaints/Claim-Issue template which can be found here when submitting two (2) or more smilar complaints with the same MCO.
Additionally, all MCOs are required to assign the provider a tracking number for each dispute submitted. If providers did not receive a tracking number from their MCO for disputes submitted to the MCOs internal dispute process, the respective MCO now has the capability to provide tracking numbers for the original dispute filed. Providers must contact the MCO to obtain a tracking number for original disputes submitted.
The following resources are being provided to assist providers in learning more about the new resolution portal.
· Individual and Multiple Provider/Facility Portal Registration Information: Providers or their representatives must first register as a user in the Portal before complaint tickets can be submitted. The link to the Portal Registration process can be found here. The multiple Provider/Facility Registration Template can also be found here.
· Provider Resolution Portal Tutorial: A tutorial on the use of and navigation of the portal. The link to the Portal Tutorial can be found here. A recorded demonstration on how to navigate the web-based portal and submit a provider complaint ticket will be provided a later date.
· Provider Resolution Portal Overview PowerPoint: Provides a one-stop overview of the resolution portal. The link to the Resolution Portal PowerPoint can be found here.
Deputy Administrator, Care Coordination