Change Healthcare Provider Portal

Transcription

1 MED3000, a wholly owned subsidiary of Change Healthcare Change Healthcare Provider Portal Overview The provider portal provides secure, web-enabled, role-based access. You will be able to perform the following functions: Verify a member s eligibility View a member s benefits, including copay information View a member s pre-authorization information Submit a pre-authorization request Status professional and facility claims *Please note: Information supplied by the Provider Portal is only available to authorized users. The product uses web protocols to ensure secure access to protected health information (PHI). An authorized physician s practice will only have access to view authorizations and claim status for their practice/offices. Inspiring a Better Healthcare System 1

2 Contents Overview... 1 Contents... 2 Logging In... 3 Security and Privacy Recommendations... 3 Provider Home Page... 4 Manage Patient... 8 Patient Search... 8 Glossary of Medical and Dental Product Titles in CWS Submit Outpatient Pre-Authorization Submit Inpatient Pre-Authorization Claims Search Find Outpatient Services Find Inpatient Stays Provider Search Upload attachments to authorization Revision History CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 2

3 Logging In Each time you start the application, you will be required to enter a Username and Password. Enter your personal Username, press the Tab key and enter your personal Password. Press Enter or Click Login. Security and Privacy Recommendations The Change Healthcare Provider Portal establishes and maintains procedures for creating, changing and safeguarding passwords. All users of the system are required to follow our password management procedures and safeguard their passwords. Each user accessing the portal must be assigned a unique Username and Password, they cannot be shared. Create a strong password. Use a minimum of 8 characters and three of the four kinds of characters: upper case, lower case, numbers and special characters. Users should be required to change their password every 90 days CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 3

4 Provider Home Page When you login, you will see arrows pointing to Search, Manage Account and Log Out. If you do not wish to see this each time you login, you can select Do Not Show This Again in the bottom right of the screen. The Provider Portal opens to the Provider Home page. This page lists the provider name, as well as additional provider information in the Provider Snapshot in the center of the page. From this page you can View Member List. This list is only available to Primary Care physicians. This list is available to view/print from 7am to 7pm daily. If there are any Associated Providers linked to the practice, you can view those by selecting the Associated Providers link CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 4

5 Top Navigation Menu Options: Manage Account Use this to change your password or track authorization requests you have submitted. Contact Us This menu option shows how to contact Customer Service at Change Healthcare by , by mail or by phone. Click the arrow beside each one to expand the pane. Help By clicking this menu option, a pop up will appear. The CWS Provider Portal Manual is here, along with the Provider UM Handbook Cover Letter and the CMS Utilization Management Provider Handbook CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 5

6 (Continued) Log Out Logs you out of the Provider Portal Right Navigation Menu Options: Listed on the right side of the screen is the Information Center. ICD-10 Announcement By clicking the title or the arrow to the right, an announcement about the implementation of ICD-10 will appear 2017 CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 6

7 Notice of Accreditation Survey This section provides information regarding the accreditation survey conducted by AAAHC of Children s Medical Services Managed Care Plan. Managed Medical Assistance This section contains a brief description of the MMA program and lists Emdeon and Availity payer IDs as well as the mailing address for claims. You can also find a link to the Authorization Requirements for CMS (Pedicare and CCP). Also on the Provider Snapshot page is the option to view recent claims and inpatient authorizations. Click the arrow to the right to expand the section, or click on the title CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 7

8 Manage Patient Under the Manage Patient menu is the option to search for a patient. This contains the member s eligibility information. Patient Search There are several options to search by, including Last Name, First Name, Patient ID or Subscriber ID. Once you have entered your criteria, select the Search button. The members matching the specified criteria will be listed on the screen. If there is more than one result for a child and you are unsure which record is current, click on each one CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 8

9 The information found on the Patient Information screen allows users to confirm member eligibility along with general insurance and personal information. This information includes but is not limited to: Insurance Plan, Primary Care Physician, Claims, Authorizations and Subscriber/Policy Details. By clicking on the Plan Name you can view benefit information. This includes copay and coinsurance CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 9

10 To view recent Claims or Outpatient/Inpatient Stays for the member, click on Claims, Referrals and Authorizations, then select what you wish to view. To return to the previous page, click Back to Member Information in the upper right portion of the screen CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 10

11 Glossary of Medical and Dental Product Titles in CWS Pedicare XXI Title XXI Medical Plan Pedicare Title XXI Dental Plan Pedicare CCP XXI Title XXI Medical Plan CCP Title XXI Dental Plan CCP MMA Title 19 MMA CMS Specialty Medical Plan Pedicare MMA CMS Specialty Dental Plan Pedicare MMA CMS Specialty Medical Plan CCP MMA CMS Specialty Dental Plan CCP 2017 CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 11

12 Submit Outpatient Pre-Authorization This is located in the Manage Patient menu option. Your first step will be searching for the member. You have the option to search by Name, Patient ID or Subscriber ID. Enter the criteria and select Search. The Requesting Provider will auto populate with your provider. If you wish to choose another Requesting Provider, select the pencil icon. This will allow you to search by Last Name, Type and Specialty. You can also select the NPI/ID Search tab CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 12

13 The next step is to fill out the Servicing Provider information. Use the same search methods as above. You have the option to use the Advanced Search. This allows you to enter a City, State, Zip, Gender, Handicap Access and Status. Next, you can add a Servicing Facility if applicable. Use the same search methods used when searing for a Requesting or Servicing Provider CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 13

14 The Notes section collects your Name, Phone and Fax Number. These are important fields and it is recommended that you complete this section for each pre-authorization you enter. The last section is the Medical Services portion. Any field with a blue asterisk is required. First, select a Type of Care. Elective, Emergency or Urgent. Then, select the Place of Service CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 14

15 Enter Service Date From and Service Date To. You can type it the date or select the calendar icon beside the date field. Next, enter the ICD code (diagnosis), CPT/HCPCS code or Service Group ID, number of units. You can search for the diagnosis or CPT/HCPCS code by entering search criteria and clicking the magnifying glass beside the box CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 15

16 Once the codes have been entered, a description will display in the Code Descriptions box. If you need to add additional service lines to the pre-authorization, click the plus (+) sign to the right. When all fields have been completed, select the Submit button at the bottom of the screen. You will then receive a submission confirmation. Take note of the Transaction Reference Number CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 16

17 To view a summary of your submission, click Download PDF. A new window will open with your pre-authorization. You can use the Transaction Reference ID you receive on your Submission Confirmation to track requests. Go to Manage Account at the upper navigation menu and select Track Requests. Select Searcy by Transaction Number and enter the Reference # CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 17

18 Submit Inpatient Pre-Authorization From Manage Patient at the top of the screen, select Submit Inpatient Pre-authorization. Enter your search criteria, Name, Patient ID or Subscriber ID. Then select Search. Select your member from the search results by clicking the row. By default, the Requesting Provider will be your information. To change, click the arrow beside the field to expand the section, then click the pencil icon to choose a new Requesting Provider CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 18

19 Next, select a Servicing Provider. This will be the facility to which the child was admitted. You can search by name, Type, Specialty or NPI. Select an Admitting Provider by using the same search method. Now, select a Servicing Facility associated with the inpatient service CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 19

20 The next section captures Confinement Information. This includes Place of Service, Admission Date, Type of Care, Requested LOS (Length of Stay), Treatment Type and Date of Onset, the ICD code, and a CPT/HCPC code. In the Notes section, include your name and contact information along with any pertinent notes to the inpatient admission 2017 CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 20

21 Lastly, in the Medical Services section, enter Type of Care, Place of Service, Service Date From, Service Date To, ICD code and any CPT/HCPC or Service Group IDs, and the Units. Then select Submit. After submitting your inpatient pre-authorization, you will receive a submission confirmation screen. Select Download PDF to view a summary of your entry, or New Inpatient Pre- Authorization if you have additional submissions CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 21

22 Claims Search In the top navigation menu is the Search option. You can locate claims for your provider(s) here. Select Claims from the drop-down menu. Select a Type: Dental, Hospital or Medical. Enter a date range and a Status. Best practice recommendation is to leave the Status at Any Status. If your office has more than one provider, you can utilize the Provider NPI criteria as well. You can also select a member to view only one member s claims. Your search results will appear on the screen with Claim ID, Service Dates, Patient, Service Provider and Status. Click on the claim you wish to view CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 22

23 The top section of the screen will show the Patient, Subscriber, Policy, Group, Service Dates, Date Claim was Received, Status, Payments and the Diagnosis. The bottom section shows the service dates, CPT code, charge amount, allowed amount, plan paid amount. By clicking on View Payment Details, you can see the check information, including the address to which it was mailed CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 23

24 Find Outpatient Services Click on Find Outpatient Services from the top navigation menu to search for any outpatient pre-authorizations on file. Enter search criteria, including Type (Select Authorizations), From and To Date and a Provider ID if you have more than one provider in your practice. You can also search by Member. To search by Member, click the arrow beside the Member search box. Enter the last name, first name of the member in the boxes, then click Search Member CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 24

25 The member s name will show in the Member box, grayed out. Click Search to locate outpatient pre-authorizations for this member. Results will show at the bottom of the screen. Columns will show pre-authorization ID, Units, Description of service, Referred By, Referred To, Start date and Status. To view a submission, click on that line. The pre-authorization details will show CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 25

26 To return to the list, select Back to outpatient services in the upper right corner. Find Inpatient Stays Also under the Search menu in the upper navigation pane is the ability to Find Inpatient Stays. You can search for all members narrowed down by date range, search by Provider ID or Member. Once you click Search, your results will appear. You will see the Reference ID (preauthorization number), Admission Dates, Admitting Provider, Referred To (Facility) and the Diagnosis CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 26

27 To view details of the pre-authorization, click on the line. From this screen, you will see a summary at the top of the screen as well as Eligibility, Service Details, Requested Service, Facility and Physicians. Click the arrow beside each section to expand. To return to the list of Inpatient Stays, click the link in the upper right corner of the screen CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 27

28 Provider Search The last option in the Search menu is the Provider Search. This can be used to locate a provider by Name, Specialty, City, State, Zip, and Gender. You can also click on the ID/NPI Search to search by NPI or Facets provider ID number CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 28

29 Your results will show the Name of the provider, ID, NPI and Address. Click on the selection to view additional details. The Facets Provider ID is listed on the details page, along with the provider specialty, languages spoken, addresses and a map of the office location. There is also a link for driving directions to the address listed on this page. Upload attachments to authorization The first step is to locate the authorization submission for which you are uploading documentation. From the provider home page, select Find Outpatient Services under the Search tab CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 29

30 You will have the option to search using the Type of Submission, Date Rage, Patient ID or Patient Date of Birth, or by using the Search by ID tab, utilizing the preauthorization Reference ID number: 2017 CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 30

31 Enter the search criteria and select Search. Submissions meeting the criteria specified will be displayed. Select the appropriate pre-authorization from the search results by clicking the row. A page displaying the authorization overview will open. The Upload Attachments section of the overview allows for documentation to be attached to your submission CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 31

32 Select Choose File to browse for documents and click submit. After uploading your documents, you will receive a submission confirmation at the bottom of the screen CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 32

33 Revision History Date Version Description Author 11/03/ Branding and format updated 12/15/ Upload attachment instructions added Heather Jones, Business Systems Analyst, MED3000 Erica Leslie, Sr. Training Instructor, MED CHANGE HEALTHCARE OPERATIONS, LLC. ALL RIGHTS RESERVED. 33