NYSIF.com Online Account Medical Providers.V4. April 26, 2018

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1 NYSIF.com Online Account Medical Providers.V4 April 26, 2018 Contents About this Guide... 1 Create an Account... 2 PIN Validation... 2 Enhanced Security Enrollment... 3 Enhanced Security Prompts... 4 Update Enhanced Security Questions, Phone/ Online Account Administration... 6 Account Management... 6 Change Password... 6 User Management (add/delete an authorized user)... 7 Recertifying Authorized Users... 9 Add (or remove) a Third-Party Biller Medical Provider Claim Search...13 Option 1 - Search Payments by Claim Number...14 Option 2 - Search Payments by Check Number Option 3 Find a Claim Number (Associated) Option 4 Find a Claim Number (Not Associated) Medical Provider Portal Terms & Conditions About this Guide To safeguard the privileged information of both you and the claimant, obtaining explanation of benefits (EOB) and bill payment information requires a secure login and two-step authentication procedure. This will allow authorized medical providers and/or their authorized representatives, access to bill status and payment information related to their submitted bills. April 26,

2 Create an Account Visit nysif.com, choose Login at the top and click Create an Account from the dropdown menu. You will need a recent check received from NYSIF (within the last 12 months) and will be asked to enter the following: check number, check date, check amount and zip code from your mailing address on the check. PIN Validation Once your registration is complete, you will receive an validating the address you provided. When you receive this , click on the link provided. You will see a message stating that your address has been validated and a PIN (personal identification number) will be sent to further verify your account. NYSIF will mail to you (via U.S. mail) a letter containing your unique PIN. Please note that in order to meet information security standards, the PIN must be sent to the address NYSIF mails bill payments. This is part of our verification procedure. Please be aware that if your NYSIF checks are mailed to a lockbox, your PIN will also go to that lockbox. Once this PIN letter is received the user must login to their NYSIF online account and enter the PIN. Your PIN will expire after 30 days. Note that only one master account can be created per medical provider Tax ID, but providers will be able to grant access to additional users once the account has been verified. Please see Page 13. April 26,

3 Enhanced Security Enrollment NYSIF takes your privacy seriously. To protect the personal information of its customers, including health records, NYSIF has implemented an enhanced security feature (also known as multi-factor authentication) for all NYSIF online account holders. Enhanced security allows NYSIF to identify you as the true owner of your online account by adding a layer of protection against unauthorized access. We do this by asking for information only you know or possess, in addition to your username and password. The first time you log into your online account following implementation of Enhanced Security, you will be prompted to answer three security questions and specify a phone number and address to receive verification alerts. The security questions, phone number and are not optional. 1. Select and answer three security questions. Each prompt includes a dropdown choice of questions. 2. Enter a phone number and check the Valid for SMS box, if applicable. Checking this box will enable a text message to be received. (Please enter numbers only.) 3. Enter an address. You must provide a phone number and address. 4. If using a trusted computer, you may check the Remember this computer box. 5. Click Go. April 26,

4 Enhanced Security Prompts When you log into nysif.com, NYSIF s systems will perform a risk assessment of your login details. If the assessment identifies a probability of fraud, you will be asked to select an authentication method: security questions, phone or . If you choose phone or , a one-time authentication code will be sent to your SMS-enabled phone or address. If the phone number you provided does not accept text messages, you will only be given a choice between security question and . Examples of information that might trigger an enhanced security login include: Frequent password changes Different user location or time zone Different user IP address Different browser or version Different or new device/computer Transaction history changes New mobile login If you choose a security question, you will be directed to this page where one of your security questions will be randomly populated. Answer the question and click Go. If you choose a text message you will first need to confirm the phone number you d like the text sent to, and check the box for Request One-Time password via SMS. Click Go. First, confirm the phone number you provided for text message one-time authentication by clicking the button next to the number. Then, check the box to Request One-Time Password. You will enter the password on the next page. April 26,

5 Enter the password you received on the next screen. The password may be a series of numbers, letters or combination of both. Click the box for remember this computer if you trust this device. Click Go. If you choose , confirm the address and click Go. Please confirm the address you provided for one-time authentication by clicking the button next to the address. Enter the password you received on the next screen. The password may be a series of numbers, letters or combination of both. Click the box for remember this computer if you trust this device. Click Go. Update Enhanced Security Questions, Phone/ To update your security questions, address or phone number: On the password page, enter your password and check the box for Edit Enrollment Information. Click LOGIN, and you will be directed to your Enhanced Security Enrollment page. April 26,

6 Online Account Administration Account Management To manage your online account, select Account Management from the dropdown menu under your user name at the top right of the page. Choosing Account Management will bring you to your Administration Console Home page, where you can update your profile or password and add authorized users. Change Password From your Administration Console, choose Update Profile. Change your password and submit. April 26,

7 User Management (add/delete an authorized user) Select Manage User Access under User Management to add, edit or delete an authorized user account. These authorized users inherit the permissions of the master account and will be able to see all of the billing and payment information for that provider. This feature may be useful in cases where multiple people are associated with the same provider, such as the management, accounting, or clerical staff from a particular office. Each employee should have his or her own account to access the portal. The first account to register for a provider will be the master account; subsequent accounts will be authorized user accounts. Choose Add New User to add a new user account. Complete all required fields these begin with an asterisk (*). For edits to an existing user, make any changes and click Submit. When adding a new user, in addition to contact information, you will be asked to choose a username and password for this individual. This person will receive a notification from NYSIF advising him/her to obtain the username and password from you. The user will be prompted to change the password upon first login, and must enroll in our enhanced security protocol and accept NYSIF s Terms & Conditions before gaining access to the online account. April 26,

8 The master account holder will also receive a confirmation Please note that any authorized user added to this online customer account will inherit nearly all* permissions of the master manager account. This may include access to policy and claims information for NYSIF workers compensation clients. Please ensure that all authorized users understand the legal obligation to handle this sensitive and confidential information appropriately. *Authorized user account holders cannot create other authorized user accounts, edit/delete user accounts or enroll the provider in direct deposit. April 26,

9 Recertifying Authorized Users NYSIF has established a recertification process for authorized user accounts. The master account holder will be required annually to recertify each authorized user account. Master Account Holder If a master account holder has accounts that must be recertified, the user will encounter this pop-up window upon login. The link will take the user directly to the Account Management page. The master account holder will receive an notification of upcoming recertifications 30 days from expiration, 15 days from expiration and the day of expiration. Following the directions from the , the master account holder will: 1. Go to nysif.com and log in to the online master account. 2. At the top right of your landing page, select Account Management from the drop-down menu under your user name. 3. Under "User Management, select "Manage User Access." 4. Click Extend Access on the authorized user whose access is scheduled to expire (or whose access has already expired) to recertify the user. PLEASE NOTE: The master account holder can recertify any user at any time. For example, if the master account logs in to recertify Child1 because that user s access will be expiring first, the user can also recertify Child2 and Child3 at the same time. This is an added convenience for the user. April 26,

10 Once the user recertifies, the access expiration date will be updated to one year in the future. (There is no confirmation screen.) For example, the master account holder in the previous screen shot recertified Child1. The page now reflects: If a user s access expires before recertification, the User Management page will reflect: The master account holder can choose Extend Access to certify the expired user. Authorized User Account Holder The authorized user will receive an notification of upcoming recertification 30 days from expiration, 15 days from expiration and one day from expiration. If the authorized user s access expires, the user will be presented with the following message upon login. Please note that only the master account holder can recertify an authorized user; NYSIF cannot provide this authorization. April 26,

11 Add (or remove) a Third-Party Biller This option allows a medical provider to grant access to payment/billing information, for that provider s own payments, to a third-party billing service. In order for this permission of access to occur, the following prerequisites must be in place: The billing service must have registered for a NYSIF online account. The billing service must have shared its unique ID with the provider. The provider must acknowledge and accept responsibility for the release of information to the biller. To begin, the third-party biller must complete registration for a NYSIF online account. Once verified, NYSIF will send the vendor biller a unique identifier code that they must share with the provider. The provider should then log back into his/her NYSIF account and add the biller by entering the unique ID code in the textbox on the landing page. By clicking submit, the medical provider acknowledges and accepts responsibility for the release of information to the billing service. The user will be presented with a dialog box indicating the name and address of the billing service. If this is correct, and the Provider accepts the conditions detailed in the dialog box, click the I Agree button, or click Cancel. April 26,

12 (Language shown above in acknowledgement of adding a third-party biller) By agreeing to this selection, you as the Medical or Healthcare Provider ('Provider') are affirming that the above named third party biller ('Vendor') is authorized to access your billing information and claimant s personal, private and protected health information ('Portal Data') on NYSIF's Medical Payee Portal ('Portal'); that the Provider and Vendor have entered into a Business Associate Agreement consistent with federal law and the Portal Terms & Conditions applicable to this account; and that Provider is responsible for Vendor's compliance with the Portal Terms and Conditions. It is the sole responsibility of the Provider to promptly remove access to the Portal when the Vendor is no longer authorized to access Provider s Portal Data. After agreement, the Medical Provider landing page will include those billers who currently have permissions to view the provider s billing and payment information. Please note again that this unique ID must be provided by the biller to the provider through direct communication. NYSIF cannot provide this information, nor play an active role in granting these permissions. Please note that only the master account for the medical provider can add/authorize a third-party biller. Authorized user child accounts set up by the provider do not have permission to grant authorization. This biller can now, and until such time as access is revoked, view all billing and payment information associated with this provider. Some additional notes: A single provider can grant access to more than one billing service. A single billing service can view bills for more than one provider but only for one at a time. A billing service cannot grant or obtain permission to view a provider s information, nor can NYSIF personnel issue such grants. These permissions must come from the provider. A provider can revoke permissions from any billing service at any time. To revoke permissions from a billing service, click the Delete link corresponding to the service in question. A confirmation dialog will display. Click the OK button, and this biller will no longer have access to information about this provider. The service will disappear from the list. April 26,

13 Medical Provider Claim Search From here, you can click on one of the following options from the menu: Search Payments by Claim Number Search Payments by Check Number (Direct deposit participants should use this function using the draft number provided in the payment notification .) Find a Claim Number Add or delete a Third-Party Biller Enroll in direct deposit April 26,

14 Option 1 - Search Payments by Claim Number From your landing page, select Search Payments by Claim Number. Note on this page that the user s (NYSIF-generated, internal) Payee ID and business name are displayed. For any searches performed by these applications, only information specifically associated with payments to a single provider, over a specific time period, will be displayed. Enter the claim number. You may search by claim number for any date of service in the last five years. Drag the date range fields to reposition the slider or narrow the range. The maximum range for a single search is 180 days. TIP: Place your cursor on the blue slider and reposition the date range in six-month increments. TIP: Drag the right or left end-point to narrow your date range. Click Submit. The system will return information about the claim specifically the claimant last name, date of birth, and accident date. The NYSIF case manager s name and address are also available. April 26,

15 Click the plus sign to expand details about the payment. Click Bill Details for further information. In the table there will be a record for each bill stored for this claimant, for services billed by this provider, during the service date range submitted. For each record, the following fields, if applicable, are displayed: NYSIF Bill Number Billed Amount Last Date of Service Paid Amount (for this specific bill) Check Number (if payment was issued) Check Amount (can and will often differ from billed amount/paid amount, due to repricing and the combination of multiple bills on a single check) Check Date Bill Status Message Document Link (Documents related to Objections and Repricing on the bill) Service Dates covered by the payment Codes, charges and paid amount for each service date. The text in the Document Link field describes the type of each available document: OBJ (Objection Letter), Repricing EOR (Explanation of Review from repricing service), or C-8-4 (NYSIF generated C-8.4 document). Clicking on one of these document links will open a new web page that displays the requested document. Note: All documents available for display are images of documents already sent to the Provider. Note: If there are no bills associated with the submitted claim/service date range and this Provider, no information will be returned. If more than one payment was made during the search period, the search will return all payments. April 26,

16 Option 2 - Search Payments by Check Number Clicking the Search Payments by Check Number link on the landing page will bring up a check-specific search. Enter a check number, and click the Submit button. If the check number entered does not match that of a check issued to the Provider being queried, no information will be returned. If you are enrolled in direct deposit, please use the draft number provided to you in the payment notification to "Search Payments by Check Number." Hover over the claim number for case manager information. Hover over the claimant name for accident date and date of birth. The document links in the far right column function in the same way as described for Option 1 Search by Claim. April 26,

17 Option 3 Find a Claim Number (Associated) In some cases, the user may not know the claim number that is required for a billing/payment search. Find a Claim Number requires certain claimant information and returns a claim number meeting the submitted criteria. If the provider has previously submitted a bill to NYSIF for this claimant, choose Yes and complete the fields required. The provider must provide the claimant s exact date of birth, an accident date that falls within three days of the date stored by NYSIF, and the first two letters of the claimant s last name. As with the Search Payments by Claim Number function, use the slider to select and narrow the service date range. The search will return the claim number and full last name of the claimant. If there are no bills associated with the submitted claim/service date range and this provider, no information will be returned. Other conditions resulting in No records would include a mismatch on last name, an accident date out of range, or no billing information for this provider during the range submitted. Only claimants that fit the provided identification information AND were provided billed services by this provider, during the specific service date range in question, will be returned. April 26,

18 Option 4 Find a Claim Number (Not Associated) In some cases, the provider may have recently treated a claimant, but not yet submitted a bill to NYSIF. Because the claimant and the provider are not associated yet, NYSIF requires more information to perform a search for a claim number. The provider must have the exact name and birthdate, and the accident date within three days. A successful search will return the claim number. If there are no bills associated with the submitted claim/service date range and this provider, no information will be returned. Other conditions resulting in No records would include an incorrectly spelled first or last name, an accident date out of range, or incorrect date of birth. Only claimants that fit the provided identification information will be returned. April 26,

19 Medical Provider Portal Terms & Conditions (I) Introduction In addition to the Terms and Conditions of Use, the Medical Provider Portal Terms and Conditions ( Terms and Conditions ) govern the use of the New York State Insurance Fund ( NYSIF ) Medical Provider Portal (the Portal ). The Portal User shall mean any individual or entity entering the Portal, including but not limited to a medical provider or health care provider and their employees ( Provider ) and a third-party billing vendor ( Vendor ) and their employees who provides billing and payment services to a Provider. The Portal is an internet web portal designed to provide a point of access to billing and payment information for the needs of Providers and Vendors. The Portal is a private, secure network available only to authorized Portal Users. For the purposes of the Terms and Conditions, the Portal includes Portal data, website, and all relevant parts and components thereof. NYSIF may make improvements and/or changes in the products and/or programs described in these Terms and Conditions at any time without notice. The Terms and Conditions govern the use of the Portal. Unless a Provider or a Vendor accepts the Terms and Conditions, as set forth below, in full, and so indicates acceptance by clicking that they agree, they will not be allowed to access and use the Portal. (II) Terms and Conditions By assenting to the Terms and Conditions: 1. Any Provider who has authorized a Vendor to utilize the Portal on behalf of the Provider is affirming to NYSIF that the Provider has entered into a Business Associate Agreement, as described below, with that Vendor; and 2. Any Vendor is affirming to NYSIF that it has entered into a Business Associate Agreement as described below, with the Provider who has authorized the Vendor access to the Portal on its Provider s behalf. A Business Associate is a person or entity, other than a member of the workforce of the Provider, who performs functions or activities on behalf of, or provides certain services to, the Provider that involves access by the Business Associate to protected health information ( PHI ). A Business Associate also is a subcontractor that creates, receives, maintains, or transmits protected health information on behalf of another Business Associate. Federal regulations require that Providers and the Business Associate enter into a Business Associate Agreement to ensure that the Business Associates will appropriately safeguard protected health information. A Business Associate Agreement is an agreement between a Provider and Business Associate that requires the inclusion of several provisions that must state the following, including but not limited to: establish the permitted and required uses and disclosures of PHI; provide that there will be no further disclosure of the protected health information other than as permitted or required by the agreement or as required by law; require implementation of appropriate safeguards to prevent unauthorized use or disclosure of the protected health information; require reporting to the Provider any use or disclosure of the information not provided for by its agreement, including incidents that constitute breaches of unsecured protected health information; at termination of the agreement, if feasible, require the return or destroying of all protected health information received from, or created or received by the Business Associate on behalf of, the Provider; require the Business Associate to ensure that any subcontractors it may engage on its behalf that will have access to protected health information agree to the same restrictions and conditions that apply to the Business Associate with respect to such information; and; authorize termination of the agreement by the Provider that if the Business Associate violates a material term of the agreement. April 26,

20 (III) Protected Health Information Protected Health Information refers to information as defined in the Health Insurance Portability and Accountability Act of 1996, or any successor federal statute, and the rules and regulations thereunder, all as may be amended or supplemented from time to time. In the event the Portal User creates, receives, maintains, or otherwise is exposed to PHI, personally identifiable aggregate patient or other medical information, Portal User shall: Not use or further disclose the PHI, except as permitted by federal or state law; Not use or further disclose HIV related PHI in violation of New York State Public Health Law 2782(5)a. PHL 2782(5)a prevents further disclosure of HIV related information without the specific written consent of the person to who it pertains, or as otherwise permitted by law. Any authorized further disclosure in violation of state law may result in a fine or jail sentence or both. A general authorization for the release of medical or other information is NOT sufficient authorization for further disclosure of HIV related PHI. Not use or further disclose, the PHI in a manner that violates New York State Workers' Compensation Law 110-a Confidentially of Workers Compensation Records or any other state or federal law. Use appropriate safeguards (including implementing administrative, physical, and technical safeguards for electronic PHI) to protect the confidentiality, integrity, and availability of and to prevent the use or disclosure of the PHI other than as provided for by the Terms and Conditions; Report immediately to NYSIF any security incident or other use or disclosure of PHI not permissible under the Terms and Conditions of which Portal User becomes aware; Ensure that any subcontractors or agents who receive or are exposed to PHI (whether in electronic or other format) are provided the Terms and Conditions and agree to the same restrictions and conditions; Make its internal practices, books, and records that relate to the use and disclosure of PHI available to NYSIF for purposes of determining compliance with the Terms and Conditions. (IV) Information Security Breach In the event of a Breach of Security as defined in NY CLS Gen Bus 899-aa and NY CLS State Technology Law 208, or otherwise, involving NYSIF-supplied Personal Information or Private Information from systems owned, operated, sub-contracted or otherwise routed through Providers or Vendors systems or networks, the Provider or Vendor shall notify NYSIF immediately, without unreasonable delay. Breach of Security shall mean the unauthorized acquisition or acquisition without valid authorization of computerized data that compromises the security, confidentiality, or integrity of personal information maintained by a business. Personal Information shall mean any information concerning a person which, because of name, number, mark or other identifier, can be used to identify such person. Private Information shall mean personal information in combination with any one or more of the following data elements, when either the personal information or the data information or the data element is not encrypted or encrypted with an encryption key that has also been acquired: a. social security number; b. driver s license number or non-driver identification cards number; or c. account number, credit or debit card number, in combination with any required security code, access code, or password which would permit access to an individual s financial account. April 26,

21 The Provider and/or Vendor additionally undertakes to, solely at its own cost and expense, provide any requisite notices that either the Provider and/or Vendor or NYSIF would have to provide pursuant to NY CLS Gen Bus 899-aa and NY CLS State Technology Law 208, or any other applicable statute, both on behalf of the Provider and/or Vendor on behalf of NYSIF. The Provider and/or Vendor s notification shall include but not be limited to a description of the categories of information that were, or are reasonably believed, to have been acquired by a person without valid authorization, including specification of which of the elements of personal information and private information were, or are reasonably believed to have been, so acquired, or as otherwise provided for by applicable law. In addition to the above stated requirements, and to the extent permitted by law, the Provider and/or Vendor shall indemnify and hold harmless NYSIF for any Breach of Security by the Provider and/or Vendor, its sub-contractors, or its employees or agents. (V) Provider Termination of Vendor When a Provider no longer authorizes a Vendor to access its Portal data, it is the sole responsibility of the Provider to promptly remove Vendor s access by deleting the Vendor as their authorized third party biller from the Provider s Portal account. (VI) Termination Upon Breach of Provisions The Portal is provided by NYSIF solely as a courtesy and convenience to you, and we assume no obligation to continue to make the Portal available or to grant access to any person who we determine fails to comply with these Terms and Conditions. NYSIF reserves the right, in its sole discretion, to terminate, modify or discontinue (temporarily or permanently) your online account and access to the Portal and any application or web site accessed via this account, at any time, with or without notice. Notwithstanding any other provision of the Terms and Conditions, NYSIF may immediately, terminate, modify or limit Portal User s online account and Portal User s portal access if it determines that Portal User has breached any provision of the Terms and Conditions. Alternatively, NYSIF may provide written notice to Portal User in the event of a breach and give five (5) business days to cure such breach. (VII) Return or Destruction of PHI by Vendor Once Vendor is notified by Provider, in any manner, that Provider will no longer utilize Vendor s services, unless otherwise directed by NYSIF, Vendor shall either return or destroy all PHI received from NYSIF, or created or received by Vendor from the Portal which Vendor maintains in any form. Vendor shall not retain any copies of such PHI. Notwithstanding the foregoing, in the event that Vendor determines that returning or destroying the PHI is infeasible upon rescinding of Portal access, Vendor shall provide to NYSIF notification of the condition that makes return or destruction infeasible. To the extent that it is not feasible for Vendor to return or destroy such PHI, Portal User shall (1) retain only that PHI which is necessary to carry out the legal responsibilities of the Portal Users subject to the Terms and Conditions and (2) continue to use appropriate safeguards and comply with federal and state laws with respect to PHI to prevent use or disclosure of the PHI, for as long as Portal User retains the PHI. The Terms and Conditions shall survive Provider s rescission of Vendor s access. (VIII) Amendment NYSIF may amend the Terms and Conditions to the extent necessary to allow compliance with the relevant state or federal laws or regulations created or amended to protect the privacy of patient information. All such amendments shall be made in writing. (IX) Interpretation Any ambiguity in the Terms and Conditions shall be resolved in favor of a meaning that permits NYSIF to comply with the most applicable federal and state laws and regulations. April 26,

22 (X) Survival The obligations imposed by the Terms and Conditions shall survive the Portal User s access to the Portal and PHI. (XI) No Waiver Failure or delay of the part of NYSIF to exercise any right, power, privilege or remedy hereunder shall not constitute a waiver thereof. No provision of the Terms and Conditions may be waived by NYSIF except in writing. (XII) Severability The provisions of the Terms and Conditions shall be severable, and if any provision of the Terms and Conditions shall be held or declared to be illegal, invalid or unenforceable, the remainder of the Terms and Conditions shall continue in full force and effect as though such illegal, invalid or unenforceable provision had not been contained herein. (XIII) Knowledge of Governing Law Portal User agrees to review, understand, and comply with all applicable federal and all state laws. (XIV) Rights of Proprietary Information NYSIF retains any and all rights to the proprietary information released to any Portal User. (XV) Choice of Law The Terms and Conditions and the rights and the obligations of the Portal Users hereunder shall be governed by and construed under the laws of the State of New York, without regard to applicable conflict of laws principles. (XVI) Indemnification Portal User shall be fully liable for the actions of its agents, employees, partners or sub-contractors and shall fully indemnify and save harmless NYSIF, whether or not involving a third-party claim, from suits, actions, damages and costs of every name and description relating to injury and damage caused by any intentional act or negligence of Portal User, its agents, employees, partners or sub-contractors, without limitation New York State Insurance Fund. All rights reserved. Last Updated: June 1, April 26,