ProviderConnect Claims. May 2016

Transcription

1 ProviderConnect Claims May 2016

2 Agenda Services and Benefits Direct Claim Submission Batch Claim Submission Claim Search Reprocessing a Claim EAP Case Activity Form Submission Viewing Provider Summary Vouchers 2

3 Services Verify member benefits and eligibility Request and view authorizations Submit claims and view status Request payment for EAP services Submit updates to provider demographic information Submit customer service inquiries View and print forms Download and print authorization letters Access Provider Summary Vouchers (PSV) Submit EAP case activity forms (CAF) Submit recredentialing applications Access ProviderConnect message center 3

4 Benefits Free and secure online application, available 24 / 7 Mobile Device friendly Quicker Payment Reduces paper files Reduces the need to call for routine information Mac and Windows compatible INCREASED CONVENIENCE, DECREASED ADMINISTRATIVE PROCESSES Disclaimer: Please note that ProviderConnect may look different and have different functionalities based on individual contract needs, therefore some functions may not be available or may look different for your specific contract. 4

5 E-Commerce Providers in the Beacon Health Options network are expected to electronically conduct all routine transactions, including: Submission of claims Submission of authorization requests Verification of eligibility inquiries Submission of recredentialing applications Updating of provider information Electronic fund transfer 5

6 ProviderConnect s New Look ProviderConnect new look Current functionality remains the same 6

7 ProviderConnect Stats Nine out of ten providers are satisfied with the functions they use in ProviderConnect 95% of providers submitting claims electronically are satisfied with the process ProviderConnect website is one of the best insurance based websites that I have ever utilized. Everything a provider needs or may want is available on the one web site. Impressive! -Provider Testimonial 7

8 How to Access ProviderConnect Go to choose Providers Click on Login under ProviderConnect on the right side of the screen. Unregistered providers can self register using a provider ID number and clicking Register on the login screen. Multiple logons from same provider ID number available Contact Information: EDI Helpdesk Monday through Friday, 8:00 a.m. 6:00 p.m. ET Phone: e-supportservices@beaconhealthoptions.com 8

9 Electronic Claim Submission: Advantages Better, faster, and cheaper Reduces paper files Reduces labor and postage expenses Reduces potential of error or mishandling Faster claims processing improves cash flow Accepts claim files from any Practice Management System outputting HIPAA formatted 837p or 837i batch files and from EDI claims submission vendors 9

10 Direct Claim Submission 10

11 Direct Claim Submission Provides ability to enter a claim directly into ProviderConnect portal without using special software Expedites processing of the claim and payment Available for professional services only, not higher levels of care Recommended for providers submitting a lower volume of outpatient claims 11

12 Direct Claim Submission 12

13 Direct Claim Submission 13

14 Direct Claim Submission 14

15 Direct Claim Submission 15

16 Direct Claim Submission - COB 16

17 Direct Claim Submission 17

18 Direct Claim Submission 18

19 Summary Page 19

20 Batch Claim Submission 20

21 Batch Claim Submission Allows you to upload HIPAA 5010 compliant files directly to Beacon Health Options Expedites processing of the claim and payment Available for all levels of care Recommended for facilities and providers submitting a higher volume of claims 21

22 Batch Claim Submission 22

23 Batch Claim Submission 23

24 Batch Claim Submission 24

25 Batch Claim Submission 25

26 Batch Claim Submission 26

27 Batch Claim Submission 27

28 EDI Claims Link Free Beacon Health Options software that submits HIPAA 5010 compliant files Used only for claims submitted directly to Beacon Health Options Available for download in our Compliance Information section of our Education Center Only available for Windows platform 28

29 Additional EDI Information Beacon Health Options Companion Guide Located on the Compliance Information page Shows Beacon s specific batch file requirements Reprocess and Voids Beacon accepts frequency indicators of original (1), replacement (7), and void (8) Corrected claims can be completed as a replacement claim Replacement and Voided claims require original claim number Payer ID FHC &Affiliates Clearinghouses may provide their own 5 digit payer ID for Beacon Health Options Contact your clearinghouse to see what payer ID is needed 29

30 Billing Updates General Billing Updates Beacon Health Options must be the name on the claim Should also be listed on the claims mailing address Note: Some entities are not changing See list on upcoming slides ICD-10 diagnosis codes are required Billing by Batch or Clearinghouse Payer ID does not change 30

31 Entities Not Changing Name to Beacon Health Options At this time, there is no change to the following ValueOptions subsidiary entities: ValueOptions Federal Services, Inc. (Military OneSource and TRICARE ) Value Behavioral Health of Pennsylvania, Inc. ValueOptions of Texas, Inc. (NorthSTAR) ValueOptions of Kansas, Inc. ValueOptions of New Jersey, Inc. (Horizon Behavioral Health) ValueOptions of California, Inc. Billing and all correspondence should continue business as usual 31

32 Entities Not impacted by Beacon Name Change The following partnership-owned companies and joint ventures are not impacted by the name change: Massachusetts Behavioral Health Partnership Colorado Health Partnership, Inc. Foothills Behavioral Health Partnership, Inc. Integrated Community Health Partnership, Inc. Northeast Behavioral Health Partnership, Inc. Billing and all correspondence should continue business as usual 32

33 Claim Search 33

34 Review a Claim 34

35 Search Claims 35

36 Searching a Specific Member 36

37 Searching a Specific Member 37

38 Viewing Member Claims 38

39 Claim Search Results 39

40 Claims Summary 40

41 Service Line Detail 41

42 Correcting a Claim 42

43 Reasons to Correct a Claim Change Claim Data Incorrect diagnosis code, service date, etc. Incorrect service address Voiding one line of the claim Resubmit Previously Denied Charge Member eligibility was updated Authorization was updated Void Entire Claim Claim was entered for incorrect member Entire claim was incorrect and a new claim is needed or requested 43

44 Change/Reprocess Claim 44

45 Disclaimer 45

46 Type of Adjustment 46

47 Select Service Address 47

48 Member Search 48

49 Coordination of Benefits 49

50 Service Line Entry 50

51 Attaching an EOB 51

52 Summary Page 52

53 EAP Case Activity Form Submission 53

54 EAP Case Activity Form Submission 54

55 Authorization Search 55

56 Enter EAP CAF 56

57 Online CAF Key Points Select a Billing Type Complete all case opening questions for both interim and final billing type If Final was selected for billing type, complete all case closing questions 57

58 Summary Page 58

59 Viewing Provider Summary Vouchers 59

60 Provider Summary Vouchers 60

61 Search by Provider 61

62 Search by Check 62

63 Provider Summary Voucher Results 63

64 PaySpan Health: Electronic Funds Transfer (EFT) A tool that enables you to: Receive payments automatically Receive notifications immediately upon payment View your remittance advice online Download an 835 file to use for auto-posting purposes 64

65 Payment Stub Example Giving Value Back to the Provider

66 PaySpan Registration To register online for Electronic Funds Transfer (EFT), either Click the PaySpan link in ProviderConnect, or Visit the PaySpan Health website directly at or call Have registration code and PIN from the payment stub of a paper check handy Until successful registration with PaySpan is complete, physical checks will continue be generated Unable to locate your registration code? corporatefinance@beaconhealthoptions.com Reply will be received within three (3) business days 66

67 Additional Training Options 67

68 Helpful Resources On Valueoptions.com choose Providers Click on Helpful Resources under ProviderConnect on the right 68

69 Training Webinars Scheduled monthly Topics include: High level overview, authorizations, enhancements, etc. Registration available by clicking Education Center from the provider homepage Upcoming webinars schedule: An Overview of ProviderConnect Wednesday, 6/15/16 at 11:00 a.m. ET 69

70 Customized Training Scheduled at your convenience Available to just one employee or your entire office Training topics are customized based on your needs, timeframes, etc. 70

71 How-To Video Tutorials Short Video Tutorials: Viewing Member s Eligibility Viewing and Submitting Authorizations Direct Claim Submission Process Batch Claim Submission Process Re-credentialing 71

72 Contact Information EDI Helpdesk (ProviderConnect Technical Questions) Monday through Friday, 8:00 a.m. - 6:00 p.m. ET Phone: e-supportservices@beaconhealthoptions.com Provider Service Line (Training Requests) Monday through Friday, 8:00 a.m. 8:00 p.m. ET Phone: