icare s Provider Portal Guide

Transcription

1 icare s Provider Portal Guide

2 2 CONTENTS New Provider Registration... 4 New Registration...5 Login Page 9 Sign In 9 Forget Your Password...10 Provider Home Page 12 Track Request 12 Contact Us.. 14 Provider Snapshot..15 Claims.. 18 Authorizations. 19 Manage Member 24 Member Search 24 Submit Claim (New Feature) 26 Search 30 Claims. 32 Find Authorization. 36 Search icare Provider Network.. 40 Office Management (New Feature) 42 Manage Office Locations. 42

3 3 INTRODUCTION icare s Provider Portal allows you to bill your LTC Professional claims, view service authorizations and view claim information for the icare members you serve using your personal computer, cell phone or tablet. SYSTEM REQUIREMENTS To run the CWS Provider Portal application, you need a computer with the following specifications: Internet Explorer (IE) 11.0 or higher or the latest version of Google Chrome, Firefox and Safari.

4 4 New Provider Registration The New Provider Registration will be used by the Provider to gain access to the Provider Portal and provide health care services to subscribers and or members. In order to complete the registration process, the provider will receive a PIN Letter containing your unique PIN number provided by icare. If you have not received your PIN Letter please contact icare at NetDev@icare-wi.org to obtain your unique PIN number. Provider name, Tax ID, and PIN must match exactly with what is on file with icare to complete a successful registration. In addition, Providers can create multiple user ID s utilizing the same PIN number. To begin the New Provider Registration process, please type the following URL into your browser and click Enter: If you have problems registering please contact icare s Provider Outreach at ProviderOutreach@icare-wi.org for assistance. Provider Information NEW PROVIDER REGISTRATION To begin the registration process, click on Create New Account.

5 5 NEW REGISTRATION Step1 Click on Provider. PHYSICIAN & BILLING INFORMATION Step2 Enter information to verify user in the claim system. Full Name of Provider/Facility: Name of the Provider Registering. Federal ID: Tax identification number. Provider ID: PIN number supplied by icare. NPI: National Provider Identifier number. Confirm information then click on Verify.

6 6 ACCOUNT INFORMATION Step 3 Enter information to verify user in the claim system. Street: Mailing address of facility. City, State, Zip Code: Demographics information for Provider Mailing address. Phone Number: Phone number for Provider. Address: Provider address. Step 3 Continued USER ID & PASSWORD User ID: This unique user ID will be set up by the provider and will be used each time the provider user accesses the application. User ID should contain at least one and the following _ -). An address can be used as a User ID. Password: Password must be a minimum of eight upper and lowercase letters and contain at least one special number. Security Questions: Select pre-set security question from the drop down menu for Security Questions. The answer you provide will be used for password recovery. During the password recovery process, the application will randomly display one of the security questions. The answer entered will be compared to the previously entered answers to validate the user. Security Question #1: Select the appropriate security question from the drop down menu and enter the answer. Security Question #2: Select the appropriate security question from the drop down menu and enter the answer. Security Question #3: Select the appropriate security question from the drop down menu and enter the answer.

7 7 Security Question #4: This security question is determined and entered by the registering provider group. Multiple Users: Multiple users ID s can be created for each Provider Registration. Log in to application Click on Create New account Enter Provider & Billing Information Enter Contact Information Enter User ID and Password information Select and enter Password Recovery Security questions and responses Click the Register button

8 8 CONFIRMATION Step 4 Registration Complete To access the provider portal from this page click on Log in.

9 9 LOGIN PAGE SIGN IN User ID: Unique user ID set by the Physician or Provider when completing Create New Account process. Password: Unique password set by the Physician or Provider when completing Create New Account process. To login into the provider portal click on Login. Access Provider Information User will receive the message; Welcome, your experience is loading if your user id and password are authenticated. Initial Landing Screen will display. If you do not want this initial landing to display, click on Don t Show Me This Again at the bottom of the screen. Provider Home Page will display.

10 10 Forgot Your Password Users who forgot their passwords can click the Forgot your password for help in getting their password reset. Step 1 User ID Verification: Enter user name click Next. Step 2 User Answer Verification: Enter the answer to the selected security question and click Next.

11 11 Step 3 Change Password: Enter new password and confirm new password. Step 4 Password reset: Complete. Login: click to bring you back to the Login Page of the portal.

12 12 PROVIDER HOME PAGE Track Request Users can track any transactions submitted through the provider portal in this section. Full Search Status: select from the drop down box; Any Status, Errored, Complete, or Submitted. Submitted From: End date To: Enter date Search by Transaction Reference Number Reference#: Enter number assigned to claim at time of submission.

13 13

14 14 Contact Us Users will have access to icare s address, Customer Service phone number and as well as Provider Outreach address. Users will click on the drop down arrow to obtain information. Address: icare s corporate office address. Customer Service: Milwaukee and Other (out of state) phone numbers with fax number. Customer Service is limited to three claim inquires per phone call. The Provider Services is an alternative for providers to submit more than three claim status request. Provider Outreach: Users can for questions on various EDI inquires, provider or portal education questions, as well as Long Term Care claims submissions.

15 15 HOME PROVIDER SNAPSHOT Please review your Provider Snapshot; if any information has changed or is incorrect; please contact icare Network Development at Provider Snapshot Provider: Provider name on file with icare. ID: Provider ID number. NPI: National Provider Identifier. Type: Type of Provider. Specialty: Provider Specialty. Languages: Language provided by provider. Primary Address: Provider address.

16 16 Users can click on the Associated Providers to view provider details and primary location along with driving directions and hyperlink navigation. Provider Details ID: Provider ID number. NPI: National Provider Identifier. Type: Type of Provider. Specialties: Provider Specialty. Languages: Language provided by provider. Primary Location Address: Physical address of the provider. Phone: Office phone number. Fax: Office fax number.

17 17 Associated Providers This page will show a list of providers that have a direct affiliation to the logged in provider. Providers can click on the dropdown arrow and see other list of associated providers that provider is associated to-i.e. other provider that do business with the logged in provider. Example: Provider group logged in and sees list of other hospitals and provider he/she does business with.

18 18 Claims User can obtain a list of claims. Click on the drop-down arrow to view the claim list. Explanation of payment-click on EOP (view remittance statement) Claim ID: System generated number assigned to the claim. Service Dates: Date(s) the service was performed. Patient: Name of icare enrolled member. Service Provider (NPI): National Provider Identifier. Status: Reflects current claim status.

19 19 To view claim details, click on the Claim ID To view Explanation of Payment, click on to view EOP

20 20 Authorizations User can obtain a list of authorizations Click on the drop down arrow to view authorization list. Authorization Number: Number identifying your approved/denied service. Admission Dates: Effective dates of authorization. Admitting Provider: Not Applicable. Referred To: Provider Name. Diagnosis: Code (s) used to decribe routine/illness or injery condition.

21 21 Authorization Details To the right click on the drop down arrow to view in detail each category. Authorization Reference ID: System generated authorization number. Status: Approved or denied authorization. Patient: Member Name. Member ID: Member s Medicaid or Medicare Number. Admitted: Date member admitted. Discharged: Date member discharged. Requested LOS: Requested length of stay. Actual LOS: Actual length of stay. Service Level: Level of service. Place of Service: Place service was obtained. Onset Date: Not applicable.

22 22 Eligibility Eligibility of the member. Service Detail Service Level: Level of service. Place of Service: Location where service was performed. Services by: Name of provider performing the service. Diagnosis: Code (s) used to decribe routine/illness or injery condition.

23 23 Requested Service Requested/Authorized Units: Requested numberof units by the provider. Used Units: Number of units used by the provider. Codes: Code to describe services rendered. Type: Not applicable. Service Description: Definiation of the requested HCPS code. From: Start date of the authorization. To: End date of the authorization. Physcians Admitting Physician: Provider: Not applicable. NPI: Not applicable. Address: Not applicable.

24 24 Referred To: Provider: Name of provider. NPI: Provider s National Provider Identifier number. Address: Provider s address. Referred By: Provider: Name of provider. NPI: Provider s National Provider Identifier number. Address: Provider s address. Notes Non-Clinical Notes: Represents the provider s negotiated rate. Clinical Notes: Details of approved hours and units for a specified period or time.

25 25 MANAGE MEMBER Member Search This function requires the user to enter the member s Last Name, First Name and Birth Date OR Health Plan ID. Required for Search Search by Last name, First name and Birth Date Last Name: Last Name of the member. First Name: First Name of the member. Birth Date: Birth Date of the member listed MM/DD/YYYY. Search by Health Plan ID Health Plan ID: Unique Identifiers for Health Plan (Medicare or Medicaid number). For dual eligibility members, icare Medicare number or Forward Health Medicaid number may be used. Example: User entered Healthplan ID. Click on Search.

26 26 Member s Name, Date of Birth, Address and Phone number will be displayed. Click on the Member s Name to view additional details. Member Information Member Name, Member ID, Effective Date, Birth Date, Gender, Address, Country and Phone Number. Click on the drop down arrows to view the following links. Authorizations: List of members authorizations. Claims: List of status for claims. Benefit Details: Member s current benefits. Deductibles and Limits: Member s deductible for individual and family. Other Insurance: Member s other Insurance.

27 27 Submit Claim Providers submitting long term care professional claims for Medicaid Family Care Family Partnership members now have the ability to submit claims through the portal. This function requires the user to enter the member s Last Name, First Name and Birth Date OR Health Plan ID. Required for Search Search by Last name, First name and Birth Date Last Name: Last Name of the member. First Name: First Name of the member. Birth Date: Birth Date of the member listed MM/DD/YYYY. Search by Health Plan ID Health Plan ID: Unique Identifiers for Health Plan (Medicare or Medicaid number). For dual eligibility members, icare Medicare number or Forward Health Medicaid number may be used.

28 28 Example: User entered Healthplan ID. Click on Search. Member s name, Date of Birth, Address and Phone number will be displayed. Click on the Member s Name to begin Step1 of submitting a claim.

29 29 Step1 Click on the drop down arrow to view each link. Member Information: Name of member, member s Coverage, Healthplan ID, Birthdate, Address, Phone number. Servicing Provider: Name of provider performing the services. Pay to Provider: Name of the provider who will receive payment. Servicing Facility: None applicable. Referring Provider: None applicable. Authorization: None applicable. Claim Information: None applicable. Coordination of Benefits: None applicable. Claim Diagnosis Codes: Code (s) used to decribe routine/illness or injery condition. Claim Lines: Requested services for payment.

30 30 Step1 Continued Claim Diagnosis Codes User will enter the diagnosis code. Code: Enter in the diagnosis code in the Code box. Find Diagnosis Codes: If you don t know the diagnosis codes, click on the magnifying glass to search for the diagnosis code. Description: Details of the diagnosis code. Action: Function allows adding or deleting additional diagnosis lines.

31 31 Step1 Continued Claim Lines User will enter DOS From, DOS to, POS, CPT/HCPCS, Charge, and Units. DOS From: Enter beginning date of service. DOS To: Enter end date of service. POS: Select Place of Service.

32 32 CPT/HCPCS: Enter code. Click on the magnifying glass to search for a CPT/HCPCS code. Find Procedure Codes (CPT/HCPCS): If you don t know the procedure codes, click on the magnifying glass to search for the code. Charge: Enter charge for services. Units: Enter number of units for services. Action: Function allows adding or deleting claim lines. Total Charges: Charges will auto generate. Total Units: Units will auto generate. Cancel: Claim will be deleted for user to begin again. Submit: Click to submit your claim. Step2 Claim Submission Confirmation Users will receive a confirmation once your claim has been submitted. Claim ID: System generated claim number that identifies your submitted claim. Submit New Claim: By clicking on this option, you will be taken back to the Member Search Screen to enter the next member for submission of claim.

33 33 SEARCH Claims Users will be able to search claim(s) by using Full Search or Search by claim ID. Full Claim Search From: Enter the date or select the correct date from the claim from the calendar link. To: Enter the date or select the correct date for the claim from the calendar link. Type: Select Institutional or Professional claims from the drop down menu. Selecting Institutional from the drop down menu will only return Institutional claims. Selecting Professional from the drop down menu will only return Professional claims.

34 34 Status: Select the correct status of the claim. Member: Enter Member s Last Name, SSN, or Health Plan ID. Provider NPI: Provider National Identifier Number. Click on Search to obtain claim detail. Search by claim ID Claim ID: System generated claim number that identifies your submitted claim.

35 35 Example: Search by claim ID Claim ID: Enter system generated claim number. Click on Search. Search Results User will receive information on the submitted claim. Claim ID: System generated claim number that identifies your submitted claim. Service Dates: Date service was given. Patient: Member name. Service Provider (NPI): Provider performing the service. Status: Status of the claim.

36 36 Claim ID Click on Claim ID to view claim in detail. To view Explanation of Payment, click on to view EOP

37 37 FIND AUTHORIZATIONS Users will be able to search authorization (s) by using Full Search or Search by ID. Full Search From: Enter the date or select the correct date for the claim from the calendar link. To: Enter the date or select the correct date for the claim from the calendar link. Provider NPI: Provider National Identifier Number. Member: Enter Member s Last Name, SSN, or Health Plan ID.

38 38 Search by ID Reference ID Search: Enter system generated authorization number.

39 39 Example: Authorization Search by Reference ID ID: Enter system generated authorization number. Click on Search. Search Results User will receive information on the authorization. Authorization Number: Number assigned for a specific service. Admission Dates: Dates of authorization. Admitting Provider: Name of Admitting Provider. Referred To: Service Provider name are displayed in alphabetical order. Diagnosis: Diagnosis

40 40 Authorization Number Click on Authorization Number to view claim in details. Click on the drop down arrow to view each link. Eligibility: Member s eligibility. Service Detail: Provider who is providing services. Requested Service: Detailed services requested by provider. Physicians: Provider address who is providing services. Notes: Record of hours and units per code.

41 41 Search icare Provider Network This page allows the user to search for participating providers who are providing healthcare services or supplies to icare members. Click on Search icare Provider Network to begin your search. Provider Search Plan: Family Care Partnership, Medicare or Medicaid. Provider Name: Enter specific provider. Specialty: Select the specific specialty. Language Spoken: Select specific language. Service Location Name: Name of location where provider is performing service.

42 42 Service Location City: City of service location. Service Location Zip: Zip code of service location. Servicing County: Select serving County of provider.

43 43 OFFICE MANAGEMENT Manage Office Locations Click on Manage Office Locations to view details.

44 44 Office Admin has the ability to assign access levels per the roles listed. Provider Clerk: Has access under Manage Member: Patient Search, Patient Roster and Submit Claim. Under Search: Provider Search. Claim Admin: Has access under Manage Member: Member Search, Submit Claim. Under Search: Claims and Provider Search. UM Admin: Has access under Manage Member: Member Search, Submit Referral/Authorization and Submit Inpatient Pre-Authorization. Under Search: Find Outpatient Services, Find Inpatient Stays and Provider Search. Super Admin: Has access under Manage Member: Patient Search, Patient Roster, Submit Referral/Authorization, Submit Inpatient Pre-Authorization and Submit Claim. Under Search: Claims, Find Outpatient Services, Find Inpatient Stays and Provider Search.

45 45 The Office Admin has the ability to terminate access or change the password for these roles.

46 46