PROVIDER PORTAL. NEW USER/REFRESHER LEARNING PROVIDER PORTAL OVERVIEW Module

Transcription

1 PROVIDER PORTAL NEW USER/REFRESHER LEARNING PROVIDER PORTAL OVERVIEW Module

2 WELCOME TO THE PROVIDER PORTAL Dean Health Plan recognizes the importance for our Providers to simplify everyday tasks, promote efficiency in business and streamline electronic transactions. The Provider Portal allows functionality to check realtime HIPAA compliant transactions along with Internetbased and self-service functionalities. 1

3 HOW DO I GET ACCESS? Self-Enrollment The first step is for your organization to complete the Provider Portal Self-Enrollment process. User Access The person within your organization who initially registers through the Self-Enrollment process becomes the primary Provider Portal Super User aka Site Administrator. A Portal Super User has the ability to add new users and assign the applicable access level. 2

4 ACCESSING THE PROVIDER PORTAL There are two ways to access the Provider Portal. Go directly to deancare.com/providerportal Go to Provider s Home page on deancare.com and select the Provider Portal hyper link located under the Provider Resources section. 3

5 LOGIN PAGE Enter your Username Enter your Password Click the Login button HIPAA guidelines prohibit users from sharing login information. 4

6 Forgot My Password If you forgot your password, you can re-set your password by entering your Username and selecting Forgot My Password located at the bottom right corner of the login page. 5

7 I Forgot My Password Form After selecting Forgot My Password, the I Forgot My Password Form will be displayed. The form consists of two security questions, tax ID and ZIP code. A valid address is required to reset your password. If you cannot answer these questions or have difficulty, contact your assigned Provider Portal Super User (Site Administrator) for assistance. *Information regarding where to locate your Provider Portal Super User (Site Administrator) can be found on slide 18 under the My Account sub-category of the SETUP feature. 6

8 Dean Health Plan Home Page The Dean Health Plan Home Page is the first screen displayed after logging in. 7

9 The Dean Health Plan Home page is designated with a house icon located on the left side of the navigation bar. The house icon will appear in white color when you are on the Dean Health Plan Home page. 8

10 The Dean Health Plan Home page has the following features. MESSAGE CENTER FLASH MESSAGES DEAN HEALTH LIBRARY CUSTOMER SUPPORT 9

11 Message Center The Message Center provides access to secure messaging. Example: An acknowledgement letter confirming receipt of a claim appeal along with a determination letter regarding the claim appeal decision. Flash Messages The Flash Messages feature consists of alerts, important updates about upcoming enhancements or changes and announcements. Example: There will be system maintenance performed on June 16, 2016, starting at 5:15 pm. 10

12 Dean Health Library The Dean Health Library section consists of helpful documents and links that are also available at deancare.com on the Provider s Home page. Example: Provider Manuals and Brochures and the Medical Management page. Customer Support This section provides online support, tutorials and webbased training, customer support and other information as it pertains to Emdeon now known as Change Healthcare. 11

13 MAIN MENU-NAVIGATION BAR The main menu/navigation bar) is located in the upper gray area and is used to navigate throughout each of the features and their functions. The features may vary depending on the user s access level. Therefore, some that appear above may not be visible to all users. 12

14 Main Menu Features & Functions ELIGIBILITY AUTHORIZATIONS CLAIMS PAYMENT MEDICAL CODES SETUP HELP PRINT LOGOUT 13

15 ELIGIBILITY This feature provides human readable real time EDI (Electronic Data Interchange) 270/271 transactions. Checking eligibility can be done with four simple steps. The information would include detail regarding Dean Health Plan eligibility & benefit plan coverage, copayments & deductibles. It also provides the member s primary health insurance carriers name, if applicable. 14

16 AUTHORIZATIONS This feature contains two sub-categories, Submit Authorizations and View Authorizations. Submit Authorizations: Allows the submission of new authorizations. View Authorizations: Allows the viewing of authorizations that may have been started, saved or submitted. Please note: This feature should not be used for the following types of authorizations as they should be submitted to the applicable external vendor. Rehabilitative and Habilitative outpatient Physical & Occupational Therapy Behavioral Health Services High-End Radiology Services 15

17 CLAIMS This feature contains two subcategories: Claim Status and Claim Appeals. Claim Status: Provides human readable real time EDI (Electronic Data Interchange) 276/277 transactions. Claim Appeals: Processed claims with a finalized status (paid-denied) can be appealed directly through the Provider Portal. 16

18 PAYMENT -(Payment Remit) The Payment feature allows Dean Health Plan to deliver ERAs (Electronic Remittance Advice) or remits to providers online. The ERA will show payment information for a specific claim or by batch. 17

19 MEDICAL CODES This feature allows the functionality to search for Procedure, Diagnosis and NDC Codes. For Procedure & Diagnosis codes, the search criteria allows the code types of CPT/HCPCS, ICD9 & ICD10. 18

20 SETUP This feature contains two sub-categories: Manage User-User Management My Account-User Account Information 19

21 Manage Users-(User Management) This is a subcategory of the Set-up feature and is available to Provider Portal Super Users (Site Administrators) only. Provider Portal Super Users have the ability to manage locations and user data. 20

22 My Account (User Account Information) This is a subcategory of the Setup feature and is available to all users. It allows users to modify or make certain changes to their existing user information. The name of the Provider Portal Super User (Site Administrator) can be found at the bottom of the User Account Information screen. 21

23 OTHER FEATURES icon=help The Help function is situational as the information displayed depends on the window that is currently active. icon=print The Print function prints the content that appears in the screen below the navigation bar. icon=logout The Logout function is located on the right hand side of the navigation bar. This will log the user out of the session. 22

24 THANK YOU. If you have any suggestions on how we can improve this PowerPoint slide, please send them to 23