Behavioral Health Provider Training: Claims Tutorial

Transcription

1 Behavioral Health Provider Training: Claims Tutorial 1

2 Claims Submissions Claims can be submitted in 3 ways: 1. Paper Claims mailed to: - Passport Health Plan Attn: Claims P.O. Box 1866 Hicksville, NY Out of network providers must submit paper claims 2. Electronic Data Interchange 3. 2

3 Electronic Data Interchange (EDI) EDI is the preferred method for receiving claims. We accept the standard HIPAA 837 format and provide 835 transactions. Beacon also uses 270/271 transactions for eligibility purposes. Beacon does allow EDI claims to be submitted from a Clearing House or Billing Agency. EDI claims may also be submitted to Beacon via Change Healthcare. Beacon s Change Healthcare payer ID is Passport Health Plan s ID is: 028 All EDI claims submitted via Change Healthcare must include the member s Passport Plan ID and Beacon s Change Healthcare payer ID. Using just one or the other will cause claims to reject. To initiate the process to submit via EDI, contact the EDI Helpdesk to request a testing account. They can be reached at from 8 a.m. 6 p.m. ET or via at claimsmigration@beaconhealthoptions.com. If you currently submit via EDI, please outreach the EDI Helpdesk with any issues. 3

4 This is a free service for all contracted and in-network Passport providers. The goal of is to make clinical, administrative, and claims transactions easy to do. By using you will be able to: Submit requests for authorization Submit claims Verify member eligibility for Passport Health Plan Confirm authorization status Check claim status 4

5 To register for : Go to registration site (listed below) and click the Click Here to Register Link member eligibility for Passport Health Plan Complete the terms of use form and follow instructions for returning form to Beacon Health. You will be set up with an username within 3-5 business days. Screen shots from the website appear on the following slides. 5

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7 is simple to log into and use. You create your own username and password 7

8 Once the account is activated, there are a host of clinical functions available. Beacon prefers that authorization requests be sent via. 8

9 Click Here à 9

10 Click here à Simply use the Member Search to find the member for which you are wanting an Authorization. We now require three unique member identifiers for a Member Search. You will need: Passport Member ID or Medicaid (Alternative) ID, Member Date of Birth and Member Last Name 10

11 Choose the type of service from the drop down menu. 11

12 Once you have entered all of the required fields, you may submit your request. 12

13 After you have successfully submitted your request, you will receive a reference number for your records 13

14 Once you have an authorization in place, you may submit a claim via. Inpatient and outpatient claims can be submitted via. 14

15 Click here à Submitting a claim electronically takes less time and is more efficient than a paper claim. Once the fields are entered just hit submit! 15

16 Enter the Billing NPI and Taxonomy à Select rendering clinician à ß Referring/Ordering NPI and Taxonomy is only required for certain Provider Types. Please follow ORP billing guidelines. ß Add additional Service Lines ß Please note that the rendering clinician NPI and Taxonomy must be manually entered for ALL Service Lines to avoid denials. 16

17 Note the transaction number à Now that your claim has been submitted, you will receive a transaction number. You may also print the page for your records. 17

18 Click here for additional details on your submission à *When checking on the status of a submitted claim, please note that a claim may show a Decision of Denied if the claim has not fully processed* 18

19 Claim Approval/Denial narrative will be reflected here once claim is in a Processed status à By selecting More you will be brought to this screen to see additional details regarding your processed claim, including Decision codes and payment information. 19

20 à Claim reconsiderations may be done online, for claims that were submitted and denied and require an in depth review. 20

21 Use the free text box to enter your explanation à Once you have entered your claim info and explanation you can submit a reconsideration request 21

22 Click here à Claims that may have denied for an incorrect procedure code or diagnosis code may also be re-submitted electronically. 22

23 ß Click here Once the claim has been chosen, click on the resubmit link. 23

24 After you have clicked on re-submit, the information will automatically fill-in from the previous submission. Not ALL information is automatically filled in. For example, tax ID, ICD code drop down and taxonomy are NOT filled in when resubmitting a claim. You can then make corrections and re-submit. Re-submissions must be made within the timely filing limit of 2 years. 24

25 Important Claim Reminders All claims must be received within Passport s timely filing limit of 180 days. All clean claim submissions (meaning no missing or incorrect numbers or information) will be processed and paid within 30 days. The top denial reasons for behavioral health claims submitted are : Timely filing (claim denied as it was not received within 180 days). Missing or incorrect NPI number. (All claims must list the rendering clinicians individual NPI number, along with the site NPI number. If either of these numbers are missing or entered incorrectly, the claim will deny.) No authorization. (If the member has no authorization to see the provider, or the authorization has expired the claim will deny. It is important to make sure the member has an authorization in place, or has initial benefit visits remaining, before seeing them.) 25

26 Additional Info: Waivers, Reconsiderations, Resubmissions All claim resubmissions must include the Rec ID from the original claim to prevent unnecessary timely filing denials. Waiver requests (for timely filing) may be submitted within 180 days from the qualifying event and must be accompanied by a claim form (available on Qualifying events include: retroactive member eligibility; retroactive authorization and retroactive provider eligibility. If your request is not for one of these reasons, it will be denied and you must follow the procedure for reconsiderations. Once you have exhausted all other avenues, you can submit a request for reconsideration of the 180 day timely filing limit. Reconsiderations must include: Copy of claim form with a cover letter explaining why claims were not filed in a timely manner, along with supporting documentation. Screen prints of billing ledgers certified mail receipts or documentation that claims were sent to a clearing house are not considered proof of timely filing. 26

27 Contact Numbers Passport s Behavioral Health Access Line: (855) Main fax number: (781) TTY Number (for hearing impaired): (781) or (866) Claims Hotline: (888) Helpline: (866) IVR: (888) PCP Consult Line: (866) All departments may be reached via the Passport Behavioral Health Access Line at (855)

28 Contact Us For behavioral health questions, please contact the Behavioral Health Mailbox, Jay Soto (Western and Southern Kentucky Regions): (502) Teri Hardman, Provider Relations (CMHC, Louisville area): (502) Michelle Stepp, Provider Relations (Eastern and Northern Kentucky Regions): (502) Micah Cain, Behavioral Health Manager: (502) Passport Health Plan s mission is to improve the health and quality of life of our members. 28

29 Thank you! Thank you for helping us with our mission of improving the health and quality of life of our members. 29