Administrative System Enhancement FAQs

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Why is ODS making this change?

The enhanced system is more flexible than our existing administrative system and will help ODS better serve our customers.

When will ODS transition clients to the enhanced system?

In order to ensure a smooth transition for our customers and minimize customer impact, the system enhancement will be done in multiple phases. Phase I is expected to begin in December 2006. The timing of subsequent phases has not yet been finalized.

Can you give me an example of how the enhanced administrative system will benefit me?

A good example of how the enhanced administrative system will benefit you relates to claims payment. We know how important prompt and accurate claims payment is to our providers. While our claims turnaround time and accuracy rates are excellent, some benefit structures require manual intervention using our current administrative system. The enhanced system has the flexibility to handle a much wider variety of benefit structures on an automated basis.

Will the Payment Disbursement Register (PDR) that I receive from ODS look different?

The PDR generated from the enhanced system will look very similar to the PDR you currently receive from ODS. While business is being transitioned from our old system to our new system, differences between an EOB or PDR produced from the two systems will be limited to differences in explanation codes and network identifier codes on the PDR. No changes will be made to the appearance of checks during this transition period.

Will this enhancement to the administrative systems change how frequently we receive payments from ODS?

On the current administrative system, ODS releases payments to providers twice a month with an occasional supplemental payment at the end of the month. Payments of claims processed on the enhanced system will be released on a weekly basis. This payment schedule will increase the frequency of your claims payment by ODS and decrease the lag time between the date a claim is processed by ODS and the date you receive payment for that claim.

I understand ODS is transitioning ODS members to the enhanced system in phases. During that transition, will I receive payments from both the current and the enhanced administrative systems?

Claims payments for your ODS covered patients who have transitioned to the new administrative system, will be paid from the enhanced system claims payment calendar. Claims payments for your ODS covered patients who have not yet transitioned to the enhanced system will be paid from our current administrative system according to the existing claims payment calendar.

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Will my patients’ ODS group numbers or subscriber ID numbers change as a result of this system enhancement? Will I need to bill with the new numbers in order to have claims paid correctly?

Group numbers will change as ODS members transition to the enhanced administrative system. However, because the group number is not a necessary piece of information for processing claims, ODS will not be reissuing ID cards to members as a result of a change in group numbers. Providers can continue to bill ODS using a member’s “old” group number without any problems. The key identifier for our claims system is a member’s subscriber ID number and that number is not changing as a result of the system enhancement. Any new ID cards (for new members, replacement cards, added dependents, etc.) issued after a group’s transition to the enhanced system will include the “new” group number.

I like having the ability to use the ODS website to view our patient’s eligibility, claims and benefit information online. Will I still be able to use Benefit Tracker after our account transitions to the enhanced administrative system?

We understand Benefit Tracker is an important tool for many of our providers and this service will continue to be available to you during and after the transition to the enhanced system. The URL for Benefit Tracker will be changing soon. Before the URL changes, we will send you information about the change including the new URL.

Will myODS and any of the value-added services currently available to our ODS patients and their families change because of the new system?

We know myODS and the services ODS members access through the ODS website help make healthcare easier and add significant value to their health plans. These tools will not be affected by the enhancement to our current administrative system and will continue to be available for their use during and after their transition to the enhanced system.

Will there be delays in answering customer service calls?

Speed to answer is a critical service measure for ODS. Throughout the implementation to the enhanced systems, ODS will remain committed to answering customers’ calls with friendly, highly trained customer service professionals as quickly as possible. Because ODS will be administering two systems simultaneously throughout the transition, occasions may arise when calls need to be transferred to best serve the customer. When a transfer is necessary, it will be handled as quickly as possible. Provider disbursement registers (PDRs) for members who have been transitioned to the enhanced system will show a new telephone number which will allow providers direct access to a customer service representative who can assist you with any questions.

Will there be any interruptions in service levels during the transition to the enhanced system?

We are working hard to ensure service levels are not interrupted during the transition to the enhanced system.

I send my claims electronically, will that continue?

The electronic process for claims, eligibility benefits, electronic remittance and others are very important to our customers and will not be disrupted.

I have more questions about the planned system enhancement. How can I find out more information?

We encourage you to call an ODS customer service representative if you have additional questions about your transition to the enhanced administrative system. In addition, our professional relations staff are available to assist you and help you better understand how this system enhancement will affect you.