PROVIDER WEBSITE SITE ADMINISTRATOR GUIDE » PATIENT INQUIRY» CLAIM CENTER» FIND A DOCTOR» CLAIMS EDITING SYSTEM (CES)

Transcription

1 PROVIDER WEBSITE SITE ADMINISTRATOR GUIDE» PATIENT INQUIRY» CLAIM CENTER» FIND A DOCTOR» CLAIMS EDITING SYSTEM (CES) 2018 WPS Health Plan, Inc. 1 All rights reserved. JO

2 ADMINISTRATIVE USER GUIDE INDEX Introduction... 3 Registering as the Provider Administrator... 3 Administrator Invitation... 3 Administrator Registration... 4 Registration Message... 4 Accessing the Website... 5 My Account... 5 Logging In... 5 Site Administrator Responsibilities... 6 Invite Sub Users... 6 Invite Individual Sub Users... 6 Schedule Invites to Individual Sub Users... 6 Invite Multiple Sub Users... 7 Schedule Invites to Multiple Sub Users... 7 Manage Users... 8 User Management... 8 General Information Tab... 9 Invite Status Tab... 9 Admin Status Tab Delete User Tab Arise Health Plan Provider Website Features Patient Inquiry Patient Information Claim Center Claim Editing Claim Editing System (CES) Navigating CES Submit Claims and WPS Community Manager Find a Doctor System Notes

3 INTRODUCTION Welcome to the Arise Health Plan Provider website. The enhanced website allows providers access to benefits, patient information, claims, subscriber and policy details, and other insurance information through the Patient Inquiry tab. The Claim Center tab allows providers to search for claims, check claims for errors or omissions prior to submission, and submit claims. You can also view the providers within a patient s current network and look for providers within selected networks. Arise encourages large facilities to use the electronic 270/271 Health Care Eligibility/Benefit Inquiry and Information Response transaction and the electronic 276/277 Health Care Claim Status Request and Response transaction. REGISTERING AS A PROVIDER ADMINISTRATOR Administrator Invitation We encourage providers with multiple locations to take advantage of our electronic 276/277 transactions. Contact Arise EDI at , option 1 to learn more. To register, send an to register@wpsic.com with the following information: Administrator name, address, tax ID, practice name, and a list of all clinic locations (including addresses). You will receive an invitation to register. Click on Begin Registration within the body of the . The first administrator invited for that tax ID will need to complete the registration in order for any other administrators to register. The first administrator will have to approve additional administrators that register. Invitation to register for your account When you click the Begin Registration link, it will open a web page to initiate the registration process. Click on Begin My Registration to start. Read and agree to the Terms, Conditions, and Disclaimers by checking the I Agree box and clicking Continue. 3

4 Administrator Registration Complete the Provider Registration form and click Register. Registration Message You will receive the following message. If you are not the first administrator to be invited to register for this location, you will have to be approved by the original administrator. 4

5 ACCESSING THE WEBSITE My Account Access the website at arisehealthplan.com. Logging In Log in with the User ID and Password you created. 5

6 SITE ADMINISTRATOR RESPONSIBILITIES The Site Administrator has the capability to invite additional users within the office that will need to access this system. These accounts are called Sub User accounts. The Sub User accounts will only be active for the location specified by the Site Administrator. The Sub Users will have the same access as the Site Administrator for these locations, except for creating accounts. In addition to adding new Sub User accounts, the Site Administrator has the ability to edit, delete, and update the profiles for the Sub User accounts as needed. Please contact the Arise EDI Department at , option 1 for assistance regarding functions of the website and password issues for either the Site Administrator or Sub Users. Invite Sub Users Create user accounts for other staff, if required. Invite Individual Sub Users To invite each user for this location separately, complete the Enter Individual Invitees fields shown below and click Add to List. Schedule Invites to Individual Sub Users Confirm information transferred to Step 2 and click Schedule Invitations. 6

7 Invite Multiple Sub Users To invite multiple users at once, choose Upload a list of Invitees. Click on CSV file to open a spreadsheet. Row 1 is filled in with questions. Enter the answers to the questions into rows 2 101, Columns A E for each user. Column A: Is this User an Administrator? (Y or N) Column B: Invitee First Name (25 characters or less) Column C: Invitee Last Name (25 characters or less) Column D: Invitee Address (40 characters or less) Column E: Delivery Date (Current or a future date MM/DD/YYYY) The spreadsheet will look like this: Save the spreadsheet on your computer. Click on Browse from the Upload a list of Invitees tab and select the spreadsheet you saved. Verify name in upload section is correct. Click Upload file. Schedule Invitations to Multiple Sub Users Confirm information transferred to Step 2 and click Schedule Invitations. 7

8 MANAGE USERS User Management This section lists all registered and pending Sub Users that have been assigned by Administrators. Each user has the following information displayed: Name, Address, Role, Invitation Date, Status, Approve Registration, and Delete User. Approve users that have registered and are pending an Administrator Approval. Delete users that may have been invited incorrectly. View detailed information on the user by clicking the user Name. The Name link opens four new tabs: General Invite Status Admin Status Delete User 8

9 General Information Tab The General tab contains the invitation information and the registration status of all users. Invite Status Tab Invite Status tab allows you to resend the invitation when necessary. 9

10 Admin Status Tab The Admin Status tab allows the Administrator to change administrative access for all users. Delete User Tab The Delete User tab allows you to delete users. 10

11 ARISE HEALTH PLAN PROVIDER WEBSITE FEATURES The Arise Provider website offers the following: Patient Inquiry: Search benefits, patient s network, insurance entity name, patient information, subscriber and policy details, and other insurance information Claim Center: Search for claims, check claims for errors or omissions prior to submission, and link to electronic claim submissions Find a Doctor: View the current providers within a patient s network and look for doctors within selected networks CES: Providers can enter procedure codes, modifiers, diagnosis codes, date(s) of service, patient gender, date of birth, and place of service parameters in order to review results specific to the procedure codes being queried Patient Inquiry To access patient information, click on Patient Inquiry. You may search by Patient ID and Birthdate or by First and Last Name and Birthdate. YOU CAN SEARCH BY EITHER 11

12 Click on the Patient name for more patient details. If the search does not yield any results, the following error will be produced. Users will be directed to refine their search or call Customer Service at Information in regard to the 270/271 Transaction as an alternative option for claim eligibility can be located in the EDI section of the WPS Health Insurance website at wpsic.com/edi/companion-guide.shtml. Patient Information This screen displays information regarding effective and term dates, other insurance, primary care providers, and more. 12

13 Claim Center The Claim Center allows providers to search for claims by patient or claim ID, check claims for errors or omissions prior to submission, submit electronic claims using the Submit Claims button, or use the WPS Community Manager to self-register for EDI, access lines of business and transactions, and retrieve and submit agreements. Information regarding the Transaction as an alternate option to the Claim Center can be found in the EDI section of the WPS Health Insurance website at wpsic.com/edi/companion-guide.shtml. You may search for claims by the member name or claim ID. In the Advanced Search, you can search by Type (Medical or Hospital) and the service dates (cannot exceed 60 days), Member, and Provider. Clicking on the magnifying glass icon by the Member field takes you to the Patient Inquiry Screen. Once you have located the patient, click on the name and this will populate the Member field on the Advanced Search. YOU CAN SEARCH BY EITHER 13

14 When the search is complete, you will see the Claim ID, Service Dates, Patient (ID), Service Provider s National Provider Identifier (NPI), and Status for the claim(s) you requested. For additional information, such as ANSI codes, click on the Claim ID number. If no claims are found matching the search criteria, you will be directed to the appropriate claims processing area. If the claim was submitted electronically, you will be directed to contact EDI at , option 1 to verify receipt of the claims and status of your file. If the claim was submitted on paper, then you will be directed to contact Customer Service at Claim Editing 14

15 Claims Editing System (CES) In the interest of payer transparency, Arise has developed an interactive portal within the Arise Provider website at arisehealthplan.com. Providers can proactively determine how a particular code combination will process. Providers can enter procedure codes, modifiers, diagnosis codes, dates of service, patient gender, date of birth, and place of service parameters in order to review results specific to the procedure codes being queried. The results and rationale are displayed and can be downloaded as a PDF. This allows greater transparency of the code combination edits being used at Arise. Upon entering the CES, this is the first screen you see. Navigating CES 1. Professional Claim Entry Enter all applicable fields and then click Submit. Note: Begin Date of Service, End Date of Service, and patient Date of Birth are each a drop-down calendar; select the mm/dd/yyyy Patient Gender is a drop-down selection Claim type defaults to Commercial 15

16 2. Results The results will display on this page. 3. Export to PDF Clicking this button creates a PDF file for the provider to print the results. Submit Claims and WPS Community Manager Submit Claims This button directs you to WPS Gateway Express, where you can log in and submit your claims electronically. Direct Submitters are required to have a WPS Submitter ID in order to log in and submit claims. WPS Community Manager WPS Community Manager is a full self-service tool and allows your office to self-register for EDI as well as self-manage your account details. This includes the external users ability to create their own accounts, register for lines of business and transactions, and retrieve and submit agreements. For more information on submitting claims or WPS Community Manager, please contact our EDI Help Desk at , option 1. 16

17 Find a Doctor This tab allows you to locate an in-network provider by name, specialty, or location. Select Visitors general provider panel listing and enter your search criteria. System Notes After 30 minutes of inactivity, you will receive the following pop-up warning that you are about to time out. To continue your session, you can click on the Continue Session button to return to your activity or Log Out to quit. If you actually time out, the system will return you to the login screen. 17