NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by

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1 NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden to download the files unless you read, agree to, and abide by the provisions of the copyright statement. Read the copyright statement now and you will be linked back to here.

2 MACtoberfest

3 Disclaimer The information provided in this presentation was current as of November 7, Any changes or new information superseding the information in this presentation are provided in articles with publication dates after November 7, 2018 posted on our website at: CPT only copyright 2017 American Medical Association. All rights reserved. The Code on Dental Procedures and Nomenclature is published in Current Dental Terminology (CDT), Copyright 2017 American Dental Association (ADA). All rights reserved. 2

4 MACtoberfest Why Every Palmetto GBA Provider Should Use eservices Presented by: Yoshiko White Senior Provider Relations Representative Provider Outreach and Education

5 Agenda What is eservices? Registering for eservices eservices Functions 4

6 What is eservices? Palmetto GBA s eservices is a secure Internet based, provider self service application Palmetto GBA s goal is to give the provider secure and fast access to their Medicare information seamlessly via our website through the eservices application There is no cost to the provider for registering and using eservices 5

7 What can eservices do for you? The eservices application provides information access over the Web for the following online services: Eligibility Claims Status Remittances Online Financial Information payment floor and last three checks paid Financial Forms eoffset requests, echeck payments and CMS 838 Credit Balance form Secure Forms Appeals, Medical Review ADR Response Form, and General Inquiry form edelivery ereview MBI Lookup 6

8 How do Providers Register for eservices? Providers can participate in eservices if there is a signed Electronic Data Interchange (EDI) Enrollment Agreement on file with Palmetto GBA The individual that registers the provider is considered the administrator of the account Only one person is allowed to register a provider The provider administrator then grants access to the different features of the application to their associates, who are provider users The provider administrator has the ability to, and should, assign additional provider administrators by selecting the Admin permission for key users All users must contact the provider administrator for to request access to the system eservices Registration Video 7

9 How do Providers Register for eservices? The following information must be entered to register: Provider name Contact name (The person assigned to this user ID) address Phone number Extension Provider, billing service or clearinghouse indicator PTAN NPI Tax ID Most recent Medicare payment amount received If several payments have been received in one day, use the amount related to the highest check number Line of business: choose from drop down selections Billing service/clearinghouse information, if required 8

10 How can I find my Last Payments Received? Call the IVR to verify your last payment received 9

11 Validation The individual that registers will receive an at the address entered on the registration page The individual must access the and select on the validation link Please make sure the address is correct on the profile before calling Palmetto GBA for assistance 10

12 eservices Registration Form 11

13 How do I Choose my Password? Once registered, a user ID will automatically be assigned in a format defined by CMS The user is allowed to choose the password. The password is case sensitive 12

14 How do I Choose my Password? Password requirements are as follows: Must be at least eight characters long Must contain an uppercase letter Must contain a lowercase letter Must have at least one of these special characters (@, #, or $) Must contain numbers (0 9) and letters (A Z, a z) Must start with a letter No leading portion of first or last names may occur Must contain at least four changed characters from the previous password Must be changed every 60 days Cannot contain spaces Cannot use same password as the previous 12 passwords 13

15 eservices System Security Updates 14

16 Someone From My Office Has Already Registered. How Do I Get Access? All users must contact the provider administrator to request access to the system If the provider administrator is unknown, communicate internally to determine if someone has registered the provider number The person that registered, is the provider administrator The provider administrator has access to view all designated users under the Admin tab 15

17 I Have Multiple NPIs And PTANs. Do I Need To Register Each One? Separate registration is required for each PTAN/NPI combination For multiple NPIs associated with a PTAN, each PTAN/NPI combination must be registered separately Each combination will have a unique user ID Once all accounts are registered, they can be linked (account linking information to follow) 16

18 Administration Provider administrators have access to the Admin tab Through this function, provider administrator grants access for additional users to access, view and print from eservices the information related to registered provider Provider administrator responsibilities include the following: Creating the provider user Assigning a temporary password to the provider user Assigning application permissions to the provider user Creating additional provider administrators Modifying the provider user profile Terminating provider users or additional provider administrators 17

19 Administration Any access granted and maintained by the provider administrator is the sole responsibility of that provider administrator It is recommended providers have more than one administrator Palmetto GBA has no responsibility for maintaining provider user access and permission to the data assigned to them by the provider administrator 18

20 Administration Tab, List of Provider Users 19

21 Administration Tab, Creating a New User 20

22 Administration Tab, Modifying a User 21

23 User ID For the provider administrator, the user ID is assigned when the registration was completed A provider user is granted access by the provider administrator who will give each individual their User ID and a temporary password User will then be prompted to create a new password The user must enter the password exactly as it was entered when chosen If the user forgets his/her password, select the Forgot or Change Your Password? link from the returning user box of the eservices introduction screen 22

24 Profile Verification and Recertification Palmetto GBA and CMS are dedicated to ensuring that access to Medicare data is secure To do this, CMS requires that all users regularly verify and/or update the information on their eservices profile This includes validating the user's address listed on their profile This must occur for Palmetto GBA to continue to offer eservices Users must verify their profile for each user ID at least once every 90 days to avoid an interruption in access and/or deactivation 23

25 FAQ I left the system without logging out, and now I cannot get back in. What should I do? A log out link is located in the upper right of each screen, once you have logged in The user must log out to end the session If user does not log out, the user ID will be locked for 15 minutes If user continues to be locked out, and: Is a provider user, contact the provider administrator to verify the user s identity and regain access Is the provider administrator, contact Palmetto GBA to verify identity and regain access 24

26 User ID Palmetto GBA will disable any user ID that has not been used in 30 days per CMS security requirements Provider users ID if either they or the administrator has no logged in within 30 days If provider administrators ID is disabled, all provider users will also be disabled 25

27 Session Timeout eservices session will timeout after 15 minutes of inactivity A notification box will display when are approaching inactivity limit 26

28 Multi-Factor Authentication CMS requires the use of multi factor authentication (MFA) in eservices After successfully entering user name and password, the system directs the user to the MFA verification screen where the MFA verification code is required to complete the login process Once on this screen the user is prompted to select a method to receive your MFA code Elect to either receive a text (if the mobile phone number was entered on the My Account tab) or an message All users will have the option to receive their code via by default 27

29 Multi-Factor Authentication 28

30 Verification Code The verification code can be reused repeatedly for up to eight hours from the time the code was requested If reusing the verification code, enter the code in the box on the How do you want to be verified screen User may still request a new MFA code at any time Select the Didn t get the code link to begin the request Once a new MFA code is generated, the previously generated MFA code cannot be used 29

31 Medicare Beneficiary Identifier (MBI) Look-up Tool The Medicare Beneficiary Identifier (MBI) Look up tool allows providers to use Palmetto GBA s secure eservices online portal to obtain the new MBI number when patients do not present their Medicare card The MBI Look up tool will only return an MBI if the new Medicare card has been mailed 30

32 MBI Look-up Once logged into eservices, select the MBI LOOKUP tab located in the header of the portal Complete the required* fields: Beneficiary s Last Name First Name Date of birth and Social security number. NOTE: The social security number must be in the XXX XX XXXX format The user must select the I M NOT A ROBOT checkbox Select SUBMIT INQUIRY 31

33 MBI Look-up Tool 32

34 Look-Up Tool Status Results If the inquiry successfully returns an MBI, the screen will refresh with the data at the bottom 33

35 Look-Up Tool Status Results In the event that the MBI lookup request does not result in a successful response, eservices will display error messages to assist you. If any required fields are left blank or are not in a proper format, a message will appear advising you which fields to correct 34

36 Claims Status To access claim status, select on the Claims tab The claims status screen will appear In addition to the other required fields, user must enter a Medicare ID and the date range of date of service for the claims you seek The claims status date range will default to 45 days from the beginning date User can choose a smaller date range, but cannot choose a date range larger than 45 days 35

37 Claims Status If claims are found for the date range entered, a list of claims will be displayed Each claim line will have a link to the claims details Retrieving claims information older than six months may take additional time Offline claims will not be displayed Many claims are offline after three years, sometimes earlier 36

38 Claims Status 37

39 Claims Status 38

40 Claims Status 39

41 Claims Status 40

42 Claims Status (Part A Only) 41

43 Remittances From the remittance tab: Choose to view remittances for the last 30 days or for a specific date range The remittance selection screen defaults to the last 30 days The remittance date range will default to 45 days from the beginning date A shorter date range can be selected, but no longer than 45 days Additional search parameters, such as Check Number and Paid Date, can also be entered to narrow down your query results These values will also be displayed in the results screen to help identify the remittance the user is looking for 42

44 Remittances 43

45 Remittances 44

46 Remittances Remittances are readily available for approximately one year Remittances are listed in eservices by the remittance upload date and not the deposit date Search a few days earlier or later in the remit list to find the specific remittance To view the remittance, select the PDF link in the remittance list Sort the list of remittances by selecting on the date column header Once your remittance is displayed, save or print from the menu as needed 45

47 Eligibility eservices eligibility functions are based on CMS HIPAA Eligibility Transaction System (HETS) When Eligibility tab is selected, a new set of tabs is displayed with information related to the inquiry as follows: Inquiry Eligibility Deductibles/Caps Preventive Plan Coverage MSP Hospice/Home Health Inpatient QMB 46

48 Eligibility 47

49 Eligibility The first step is to perform the inquiry Select the Eligibility tab The user will be directed to the Inquiry sub tab first Use the Inquiry sub tab to enter beneficiary information and submit a Medicare beneficiary eligibility request The user should enter a beneficiary s information in the required fields A date range must also be entered Users can view eligibility information up to 4 years prior to and 4 months in the future of the current date A maximum of a 12 month range can be entered 48

50 Eligibility 49

51 MSP Tab 50

52 Hospice/Home Health Tab The Hospice/Home Health tab only displays active Hospice and/or Home Health data and will not be accessible when there have been no claims To see all of the information, enter a date range in the inquiry screen HETS 270/271 system allows date requests up to 12 months in the past In cases of claim appeals or other scenarios which may involve the need for eligibility information older than 12 months, please contact Palmetto GBA Home health and hospice providers may use the HIQA or HIQH screens in DDE 51

53 Hospice/Home Health Tab 52

54 Eligibility The Hospice section provides eligibility information when the hospice benefit is effective and when it terminates in addition to the total hospice occurrence count for the listed beneficiary If the patient has any gap in their episode of care or changes providers at any time, or if their hospice provider has sent the final claim revoking hospice care, more than a single effective date will be returned Once the final claim has been submitted, the hospice termination (or revocation) date is returned along with the revocation code If the patient is still in hospice care, but has changed providers, the start and termination date with each provider will be returned If no termination date is returned, it is to be assumed that the patient is still under hospice 53

55 Home Health Information Field HHEH Start Date HHEH End Date HHEH DOEBA Start Date HHEH DOLBA End Date Provider Number Provider Number Type Contractor Number Cert Date Recert Date Description The date the 60 day home health episode period started The date that the home health episode terminated The date of earliest billing activity for spell of illness The date of latest billing activity for spell of illness The NPI or Legacy Provider Number of the home health facility A display of Legacy or NPI depending on the source of the provider number A display of the contractor number The date the beneficiary was certified to receive home health care services The date the beneficiary was recertified to receive home health care services 54

56 Hospice Information Field Total Occurrence Count Effective Date Termination Date Provider Number Provider Number Type Revocation Code Description Total number of hospice occurrences on file for the beneficiary, including those listed for the date range requested The start date of a beneficiary s elected period of hospice coverage The termination date of a beneficiary s elected hospice coverage. No date in this field means the beneficiary s elected period of hospice coverage has not terminated The NPI or Legacy provider number of the Hospice Facility A display of Legacy or NPI depending on the source of the provider number The code indicating the revocation status for the spell listed Medicare Beneficiary in Hospice Care 0 Not revoked, open spell Medicare Beneficiary with Hospice Care Revoked 1 Revoked by notice of revocation 2 Revoked by notice of revocation with a non payment code of N and an occurrence code of 42 3 Revoked by a hospice claim with an occurrence code of 23 55

57 Financial Tools Select the Financial Tools tab to inquire about payment floor status and last three checks paid No information will be displayed Select the Submit button to retrieve the information 56

58 Financial Tools Tab 57

59 echeck The echeck function allows payments to be sent electronically to Palmetto GBA Only check payments are accepted through this form echeck utilizes ACH to complete the transaction Submitting the form through eservices automatically enters your information into Palmetto GBA's workflow management system, iflow, for processing according to current Medicare guidelines There is no transaction fee for submitting an echeck payment 58

60 echeck Form 59

61 echeck Payment Confirmation 60

62 eoffset The eoffset function allows offset information to be sent electronically to Palmetto GBA Users have the option to request an immediate offset when they receive a demanded overpayment or make a permanent request for all future demanded overpayments More information regarding this is located on the form page 61

63 eoffset Select the Financial Tools tab Select the Financial Forms sub tab located Once on the financial forms landing page, select the option for eoffset from the PaymentType drop down menu Select the eoffset form link The form will pre populate the Contract/Region, Provider Number (PTAN) and National Provider Identifier (NPI) fields with the data associated with the user ID that is logged in 62

64 eoffset Requests Voluntary refunds via immediate offset are not allowed by the Centers for Medicare & Medicaid Services (CMS) and are not available through the eoffset feature in eservices Providers may only submit an eoffset request once you have received a demand letter or invoice for the overpayment Providers that wish to submit a voluntary refund may utilize our echeck feature to conveniently resolve the overpayment via a secure electronic payment transaction When submitting the payment, simply indicate on the echeck form that the payment is not associated with a demand letter and upload a copy of the voluntary refund form and documentation eservices ereview: eutilization and eaudit Video 63

65 eoffset Form 64

66 eoffset Signature Confirmation 65

67 Secure Messaging and Forms In addition to the financial forms, eservices users have the ability to submit appeals forms, General Inquiry, and Medical Review ADR Response form along with attachments, through eservices Once a form has been submitted, the user will receive a message either advising how to correct the form for resubmission or that the form was received by Palmetto GBA Once the form has been accepted into our processing system, the received date will be assigned and an additional message will be generated with the Document Control Number (DCN) If a form is submitted over the weekend, the DCN may not be assigned until the next business day 66

68 How Do I Access Secure Forms? If the secure forms function is available to the user, a Forms tab will be displayed as part of the menu once successfully log in For users that do not have permission to this tab, it will appear grayed out Select the Forms tab to access the secure forms page Use the 'Select a Topic and Select a type' drop down boxes to access the available forms The available forms will appear as links at the bottom of the page Select the link to access the desired secure form 67

69 Secure Forms Screen 68

70 How Do I Submit A Form? The form is pre populated with the information from the provider registration record This will saves several steps Complete all of the required information Add any attachments Users may submit attachments up to 40 megabytes (MB) in size, but no more than a total of 150 MB combined 69

71 Appeals Form 70

72 Upload Attachments All attachments must be PDF documents unless otherwise noted Most scanners have the ability to save documents in the PDF format If an error is encountered when uploading the file, the form will refresh with the error listed at the top of the page, and the PDF will no longer be attached Errors can occur if the PDF is corrupt or if it was not created using PDF software For example, the file extension cannot be changed to PDF as it will not be in the correct PDF format and cannot be uploaded If the file is over 40 MB, break it down into smaller files in order to attach it to your form This can be done through the PDF software or by changing the original files and creating the PDFs again 71

73 Secure Messaging Inbox 72

74 How Do I Check The Status Of A Submitted Form? Use the DCN that is assigned to the form to look up form processing status and view submitted forms Open the confirmation that has the DCN and select the DCN in the message to look up the status of the form In addition, the form and list of attachments submitted can be viewed by selecting the View Documents button When logged into eservices, access the status look up tool by selecting the 'Get Status' button on the Messaging/Forms tab Enter the DCN to view the status through this screen 73

75 ereview Palmetto GBA uses Comparative Billing Reports (CBRs) as an educational tool for providers to use in order to provide insight into your billing patterns and utilization of services in comparison to your peers Providers can use this information to conduct a selfaudit to ensure they are in compliance with the Medicare regulations and prevent improper claims submission in order to avoid possible pre or post pay medical review 74

76 75

77 76

78 eutilization eutilization is located under the ereview tab Rendering, ordering and referring providers will be able to access on Demand their personal utilization data. This data can be reviewed to assure you are aware of when and by whom your NPI for billing Medicare services and when you are notated on a Medicare claim as the ordering referring physician. This will provide you with the ability to identify misuse of your NPI Ordering and Referring This function will enable an individual ordering and referring to see all billing NPIs which are associated and billing under their NPI. The report will also allow you to click and see a summary by the type of code for the services billed Rendering This will allow an individual provider who is part of a group practice or multiple groups to pull a data report for their NPI which will enable them to view their usage as compared to the total usage of the group for a particular time period. eservices ereview: eutilization and eaudit Video 77

79 eutilization 78

80 eutilization 79

81 eaudit eaudit is located under the ereview tab Allows providers the ability to access personal reports of audit results for claims which have been chosen for Complex Medical Review by various Medicare review contractors Gives providers the opportunity to see what claims may be pending Complex Medical Review currently and the results of any recent review decisions Information can be used for self assessment of provider performance on Medicare audits utilizing a dashboard which contains the most common denial reasons Currently features CERT data by error code category eservices ereview: eutilization and eaudit Video 80

82 eaudit 81

83 eaudit MAC Medical Review 82

84 eaudit MAC Medical Review 83

85 eaudit MAC Medical Review 84

86 eaudit CERT Review 85

87 eaudit CERT Review 86

88 edelivery Providers can opt to receive their letters via edelivery For providers enrolled in edelivery, a secure inbox message will be sent with a link to the letter There is an notification option that allows the user to receive an when new eletters are available 87

89 edelivery 88

90 edelivery Part A Overpayment Demand Letters Appeal Acknowledgement Letters Revalidation Letters ADRs (coming in November) Pre Claim Review (Coming in December) Part B Overpayment Demand Letters Appeal Acknowledgement Letters Revalidation Letters ADRs (coming in November) Prior Authorization Ambulance Decision Letters General Inquiry Response Letters Decision Letter: Medicare Redetermination Notice An article will be posted to Palmetto GBA s website as new eletters are implemented 89

91 edelivery Once an eletter is posted, it can be accessed by Locating the message/alert applet from the homepage Selecting the numbered hyperlink to retrieve unread messages 90

92 Account Linking Users have the ability to link their previously assigned eservices user IDs under one default ID Any additional PTAN/NPI combinations for which an account is not set up, a provider administrator must create the account before it can be linked Once linked, users will not need a separate login for each PTAN/NPI combination 91

93 Account Linking Getting started is simple Log into eservices with the user ID that you wish to designate as the default login ID This is the user ID that will be used to access the linked accounts Once successfully logged into eservices, select the My Account tab and then access the Account Linking sub tab Enter the IDs of the accounts you wish to link Each ID has to be entered separately 92

94 Account Linking 93

95 Account Linking Once user accounts are linked the user will Select a drop down menu that lists all linked PTAN/NPI combinations attached to the user ID Select the desired account to view information Providers are only able to link active eservices accounts Accounts that are already linked to a default user ID cannot be linked to another account Accounts that are inactive/terminated cannot be linked 94

96 Account Linking 95

97 MACtoberfest Questions?