AmeriHealth Caritas Iowa

Transcription

1 AmeriHealth Caritas Iowa Chronic Condition Health Home (CCHH) & Integrated Health Home (IHH) Providers Roster Claims Submission Training SourceHOV s

2 Training Agenda About SourceHOV s Reminders about CCHH and IHH enrollment Roster Claims Microsoft Excel Spreadsheet Registration Process for Uploading Roster Claims File Upload Reports AmeriHealth Caritas Iowa - Proprietary & Confidential 2

3 About Source HOV s Free & secure online solution for CCHH and IHH providers. Convenience tool. Not mandatory you can still submit claims electronically or use the CMS 1500 paper claim submission process. processes healthcare payment transactions, giving you the ability to submit roster claims. You will use a Microsoft Excel spreadsheet to populate pertinent information. Each month, you can upload the Microsoft Excel spreadsheet into to get roster claims processed. AmeriHealth Caritas Iowa - Proprietary & Confidential 3

4 CCHH and IHH Enrollment Updates and Reminders Always notify AmeriHealth Caritas Iowa to report a member s: Enrollment Transfer to another health home and/or managed care organization (MCO) Change in tier Disenrollment Complete notification form and fax to AmeriHealth Caritas Iowa at New form coming soon. Contact your Provider Network Account Executive or call Provider Services at AmeriHealth Caritas Iowa - Proprietary & Confidential 4

5 Roster Claims Microsoft Excel Spreadsheet All fields must be completed and remain constant. Once you populate fields, you must follow a particular naming convention. Column A (Provider Number)_file submission date_file version_rosterbilling Example: _021616_versi on1_rosterbilling Microsoft Excel Spreadsheet review. AmeriHealth Caritas Iowa - Proprietary & Confidential 5

6 Other Things to Know About Roster Claims Submission Modifiers U1, U2, TF and TG will remain the same whether you submit roster claims electronically, via CMS 1500 or through. The roster claims Microsoft Excel spreadsheet can be used to: Submit multiple claims for multiple members. Submit roster claims monthly. AmeriHealth Caritas Iowa - Proprietary & Confidential 6

7 SourceHOV s Registration 7

8 Link AmeriHealth Caritas Iowa - Proprietary & Confidential 8

9 SourceHOV AmeriHealth Caritas Iowa - Registration 9

10 Self-Registration Home Page

11 Self-Registration

12 Self-Registration User Name

13 Self Registration NPI Verification 13

14 Self Registration NPI Verification 14

15 Self-Registration Contact Us 15

16 Self-Registration Process Notification 1: User Name & Security Info 16

17 Self-Registration Process Notification 2: Reset Password 17

18 Self-Registration Password Setting 18

19 Self-Registration Login 19

20 Self-Registration My Profile 20

21 Self-Registration Dashboard Page 21

22 SourceHOV AmeriHealth Caritas Iowa - Roster Claim Upload 22

23 Link AmeriHealth Caritas Iowa - Proprietary & Confidential 23

24 Login 24

25 File Upload 25

26 File Upload Success 26

27 Microsoft Excel Spreadsheet Validation Ensure roster claim Microsoft Excel spreadsheet has 22 columns. SourceHOV Proprietary & Confidential Column names must match-up to the system. 1) Provider ID 2) NPI Provider Number 3) Tax I.D. # 4) Taxonomy Code 5) Provider Name 6) Provider Street Address 7) Provider City 8) Provider State 9) Zip Code 10) Member ID 11) Member Last Name 12) Member First Name 13) Member Birth Date 14) Member Gender 15) First Date of Service 16) Last Date of Service 17) Place of Service 18) Diagnosis 19) Procedure Code 20) Modifier 21) Units 22) Billed Amount 27

28 Microsoft Excel Spreadsheet Validation Data level mandatory checking 1) NPI Provider Number 2) Tax I.D. # 3) Taxonomy Code 4) Place of Service - default 99 5) Diagnosis - Default R69 19) ProcedureCode - S0280/ ) Modifier - U1/U2/TF/TG If the NPI is numeric: Perform LUHN check; If valid pass the NPI. NPI logic check If NPI is invalid, reject the claim with rejection code 43 NPI is invalid. If the NPI begins with an X: Do not validate. Date validation (MM/dd/yyyy or MM-dd-yyyy) 13) Member Birth Date 15) First Date of Service 16) Last Date of Service Member eligibility check As per the Standard AMH Setup. 28

29 File Level Rejection 29

30 File Level Rejection 30

31 File Level Rejection 31

32 File Upload Reports 32

33 File Upload Transaction Report

34 File Upload Summary Report 34

35 File Upload Summary Report Detail 35

36 Questions 36

37 Questions Contact your Provider Account Executive or call Provider Services at AmeriHealth Caritas Iowa Proprietary & Confidential 37

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