Welcome to the Blue Cross ilinkblue Training

Transcription

1 Welcome to the Blue Cross ilinkblue Training For the listening benefit of webinar attendees, we have muted all lines and will be starting our presentation shortly This helps prevent background noise (e.g. unmuted phones or phones put on hold) during the webinar This also means we are unable to hear you during the webinar Please submit your questions directly through the webinar platform only How to submit questions: Open the chat feature at the top of your screen to type your question related to today s training webinar In the Send to field, select Webinar Host Once your question is typed in, hit the Send button to send it to the presenter We will address submitted questions at the end of the webinar 1

2 Blue Cross ilinkblue Training Webinar August 23, 2016 Presented by Kelly Smith Provider Relations Department Blue Cross and Blue Shield of Louisiana Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross and Blue Shield Association and incorporated as Louisiana Health Service & Indemnity Company. 2

3 ilinkblue Introduction The ilinkblue Provider Suite is a secure web portal available at no cost for healthcare providers and their approved associates. ilinkblue is designed to help you quickly complete important functions such as eligibility and coverage verification, claims filing and review, and payment queries and transactions. Information is available for all Blue Cross and Blue Shield of Louisiana, BCBS Outof-Area/State and Federal Employee Program (FEP) and Blue Advantage members. The system is available 24 hours a day 7 days a week with occasional maintenance times. 3

4 Initial Enrollment To gain access to ilinkblue, provider locations must, complete and return the appropriate ilinkblue agreement packet. These agreements are available online at >Electronic Services >ilinkblue. This packet includes: ilinkblue Provider Agreement Blue Cross and Blue Shield of Louisiana Addendum to Agreement with Business Associate Guide to Completing the EFT Enrollment Form EFT Enrollment Form These agreements only need to be completed once for a location. Once set up, new users must refer to the New User/Registration instructions located in the ilinkblue System User Guide to gain access. 4

5 ilinkblue Message Board The ilinkblue Message Board is a feature that appears when you first log in. It contains up-to-the-minute posts for upcoming events, new features, system outages, holiday notices and other important bulletins. 5

6 ilinkblue Message Board You receive an alert message when there are open BlueCard (out-of-area) medical record requests for your patients. You can access current and worked requests by clicking on the link in the alert message or from the Medical Record Requests option on the ilinkblue menu. 6

7 Contract # Search Blue Cross uses unique identifiers called member identification (ID) numbers. If you do not have the member ID number, you may search for a member s ID number using the Social Security number in the Contract # Search function. How to: Choose the Contract # Search option from the ilinkblue menu. Click on the SSN radio button Enter the member s Social Security number. Click the Submit button. 7

8 Coverage Information For Blue Cross and Federal Employee Program (FEP) members, eligibility, copays, deductible and detailed contract information is available from the applications listed on the Coverage Information menu item. Coverage Summary - lists members on the contract, active and terminated, and allows you to view the member s Coverage Report (a detailed health benefit coverage summary that includes deductible and out-of-pocket amounts that have been met) and COB (coordination of benefits) information when the member also has coverage with another carrier. Eligibility - provides information on who is covered on the Blue Cross policy number entered, including the effective date and the status of the contract (active, pended, cancelled). 8

9 Coverage Information Contract Benefits - includes a search function to research and view specific member benefits information based on key words such as wellness, diagnostic, etc. FEP Benefits and Eligibility - shows copay, coinsurance, deductible, out-of-pocket, accumulation, contract status, effective/termination dates and other contract-related information for FEP members only. APTC Grace Period provides a printable PDF guide on Affordable Care Act Advanced Premium Tax Credit (APTC) grace period status information for APTC members. 9

10 Claims Entry The Claims Entry option allows for the direct data entry of certain UB-04 and CMS-1500 claims. Dental claims cannot be submitted through ilinkblue. UB04 & requires separate security access. Applicable providers may use these screens to directly file claims to Blue Cross. Contract Prefix Validation - verifies where you should directly file a member s claim based on the member ID alpha prefix. You must enter the member s alpha prefix, claim type (inpatient, outpatient or professional) and beginning date of service. Place of Service File- allows you to enter the place of service(s) once prior to filing claims in ilinkblue. Then, while filing claims in ilinkblue, your pre-entered place of service information can be auto-inserted on each claim using a drop down box in the place of service file. 10

11 Claims Research The Claims Research menu offers the following topics: Claims Status- provides information on paid, rejected and pended claims. Providers can view claims detail pages that display the amounts applied toward the deductible, ineligible amounts or coinsurance amount for a specific claim. When you choose to view pended claims, an additional menu will prompt you to select a line of business (All, Federal, ITS BlueCard, Reg BC, Supplemental) category. When All: is selected, you will be able to view all pended claims on file. On each claim, providers have the option to submit an Action Request when they have questions or concerns about the claim. 11

12 Claims Research ITS Out of Area Claims- provides the same claims information as the Claims Status page, but for BlueCard (out-of-area) members only. Out-of-Area results are transmitted usually within less than a minute of the request so there isn t a long wait for a response. Action Request Inquiry - allows you to view Action Requests submitted on any pended, processed or rejected claims. You may only view Action Requests submitted for your provider. 12

13 Claims Research Check Information displays the specifics of the payment information once the payment is issued. 13

14 Medical Record Requests (Out of Area) You are able to view BlueCard medical records requests for your BlueCard patients by clicking on the link on the message board or directly from the ilinkblue menu under Medical Record Request. Once on the Outstanding Requests page, second requests and reopened requests will be highlighted in red and will appear at the top of your outstanding requests list. You may also research the status of your medical records on the Requests Completed By Provider and Requests Received by BCBSLA screens. 14

15 Allowable Charges (Professional and Dental Services) With ilinkblue, you can look up your professional allowable charges by network, date of service and individual or multiple codes. Click on the Allowable Charges option on the ilinkblue menu. You will be prompted to enter a date of service. (This is important because providers can search current, past or future, when available, allowables.) Click the Continue button. You must then enter the appropriate network and code. Click the Submit button to obtain the allowable charge for the desired date of service and code. 15

16 Authorizations and Medical Policy The authorization process ensures that members receive the highest level of benefits to which they are entitled and that the most appropriate setting and level of care for a given medical condition are provided. Authorization requirements may vary slightly by product. Providers should initiate the authorization process at least 48 hours prior to the service being rendered. You can research, view and even submit some authorization requests from ilinkblue using the Authorizations and Medical Policy menu option. 16

17 Authorizations and Medical Policy Authorization/Medical Policy Guidelines provides information regarding the services which require authorization. From this application you will be able to view Blue Cross and Blue Shield of Louisiana and Out of Area/State Blue Cross member contracts/policies authorization guidelines. Authorizations Portal - allows you to enter automated, self-service authorization requests for all services except Pharmacy Services, which require a different authorization process. In addition, High Tech Diagnostic Imaging requires accessing the AIM Specialty Health portal. You must have a designated administrative representative to use the Authorizations Portal. 17

18 Authorizations and Medical Policy AIM Specialty Health allows you to submit and receive pre-authorizations over the web on a real-time basis eliminating the need to call AIM for the following outpatient high-tech diagnostic services: Computerized Tomography Scans (CT) Computerized Tomographic Angiography (CTA) Magnetic Resonance Imaging (MRI) Magnetic Resonance Angiography (MRA) Nuclear Cardiology Procedures Positron Emission Tomography (PET) Scans Inpatient and Outpatient Auth/Cert Inquiry - allows you to view most authorizations on file with BCBSLA. 18

19 Authorizations and Medical Policy Training Tutorials provides instructional guides and computer-based training to increase your understanding and assist in familiarizing you with the authorization applications. 19

20 Authorizations Portal Blue Cross offers our network providers the resources to request authorizations electronically through ilinkblue ( Authorization applications that are available: BCBSLA Authorizations Pre-Service Review Behavioral Health Authorizations (NEW) As part of this access, Blue Cross requires providers to designate an administrative representative to manage and delegate that access. Beginning early 2017, all providers will need to designate an administrative representative to delegate ilinkblue access. 20

21 What is an Administrative Representative? A person designated to serve as the key person for delegating access to appropriate users for the provider. A person who agrees to adhere to Blue Cross guidelines. A person who will only grant access to those employees who legitimately must have access in order to fulfill their job responsibilities as well as promptly terminate employee access at such time as an employee changes roles or terminates employment. 21

22 How to Setup an Administrative Representative Administrative representatives must use the Security Setup Tool in order to delegate security access to their employees for using the applications currently found on our Authorizations Portal, available on ilinkblue ( under the Authorizations and Medical Policy section. Once a provider has selected the appropriate individual(s) for the administrative representative role, send an to ProviderIdentMgmt@bcbsla.com. The Provider Identity Management team will you an initial packet that includes: Administrative Representative Acknowledgment Form Administrative Representative Profile Setup Instructions Administrative Representative Profile Setup spreadsheet Complete the form and spreadsheet then return to ProviderIdentMgmt@bcbsla.com 22

23 Confirmation Reports Under the Confirmation Reports menu option on ilinkblue, you can access daily reports that we generate to confirm claims that were accepted or not accepted by the Blue Cross editing system. Reports are available for up to 120 days. The Accepted/Warning/Not Accepted Claims Report is provided to reflect all claims that passed HIPAA validation and were subjected to our Blue Cross Business Rules. Claims listed on the Accepted Report have moved into the Blue Cross claims processing system and require no further action. Claims listed on the Not Accepted Report contain errors and require correction and resubmission. 23

24 EFT Notifications Electronic Funds Transfer (EFT) is a free service where Blue Cross deposits your payment directly into your checking account. By clicking on EFT Notifications, you can access your latest EFT statements showing your most recent as well as past weekly payment transactions. A maximum of two years of EFT notifications is available in ilinkblue. EFT notifications for the current week will automatically appear at the bottom of the screen. All lines of business (Blue Cross, HMO, OGB and FEP) will display and you may see EFT notifications for more than one NPI, depending on how many NPIs you have access to. Click the EFT Payment Message link to preview an EFT notification or Print & Download to create a printable PDF. 24

25 Remittance Advice The Remittance Advice option allows providers to view remittance advices (commonly called payment registers). Reports for the current week will appear at the bottom of your remittance listing (separate reports for each applicable line of business; Blue Cross, HMO Louisiana, OGB and FEP). Providers may view remittances for more than one NPI, depending on how many NPIs you have access to. You may view or print remittances. Remittance Advice Total - a tool that allows you to query and view the total payment from all of your remittances (Blue Cross, HMO Louisiana, OGB and/or FEP, as applicable) for a given week. 25

26 BlueCard Out of Area ilinkblue includes the option to request eligibility and benefit inquiries for both out-of-area Blue Plan and National members. It is located in the ilinkblue menu under BlueCard - Out of Area. Coverage Information Request and Response - submits an electronic request to the member s Blue plan then waits for an electronic response to be delivered. Though not immediate, out-of-area results are transmitted usually within less than a minute. Click on Coverage Information Request, then enter the member s three letter alpha prefix, contract number and required patient information fields then press submit. You will receive a message stating transmission submitted successfully. To view response, click on Coverage Information Response, then choose the Review New button to view new responses. Locate the member s contract number to view and print requested information. Claims Research Request and Response - allows you to request out-of-area claims information in the same manner as when requesting coverage information. You will need the member s alpha prefix and the contract number. 26

27 Manuals When you click on the Manuals option on the ilinkblue menu, you will find much more than manuals. ilb System User s Guide provides a step-by-step on the many functions of ilinkblue. BlueCard - gives you access to The BlueCard Program Office Manual, which is designed to provide information to aid you in servicing members of a Blue Plan other than Blue Cross and Blue Shield of Louisiana. The BlueCard (Out-of-Area) Tool User Manual provides step-by-step instructions on using the BlueCard - Out of Area function highlighted at the top of this page. The ITS Overpayments Notification form is a printable PDF form that providers should complete when they feel an overpayment has been made to a BlueCard member s claim. 27

28 Manuals Clear Claims Connection Manual - provides step-by-step details on the many functions of the Clear Claims Connection tool. Dental - gives you access to The Dental Network Office Manual and Dental Network Speed Guide, as well as printable PDFs of the FEP Standard Option Dental Allowables Listing and FEP Basic Option Dental Allowable Listing. Hospital - accessible by facility providers only. This is the only location that our Member Provider Policies & Procedures Manual is available. 28

29 Manuals Professional - gives you access to the HMO Louisiana Provider Manual and Professional Provider Office Manual. These manuals are extensions of your Blue Cross and HMO Louisiana network agreements. Also available is the 1500 Claims Entry Manual, which can be used in conjunction with filing claims in ilinkblue. Allowable Charges - houses printable PDF listings for the two most recent Drug Allowable Charge updates, including pricing for standard, durable medical equipment (DME), home infusion, Oncology Management Program and administration drug codes. Also available on this page are the HCPCS allowable charge listings for DME. 29

30 Manuals APTC Grace Period Info provides a guide on understanding the APTC Grace Periods. Authorizations Portal Guides these guides offer you detailed instructions on how to use our Authorizations Portal. 30

31 Medical Code Editing The Medical Code Editing menu option is home to the Clear Claim Connection (C3) tool. C3 is an easy-to-use web-based code-auditing reference tool designed to audit and evaluate professional code combinations. C3 is a self-service inquiry tool to help reduce manual inquiries and time-consuming appeals. C3 also indicates whether or not a CPT, Modifier and/or CPT/Modifier combination is valid for the date of service entered on the inquiry. 31

32 Estimated Treatment Cost One of the tools available to our Preferred Care PPO members is the Estimated Treatment Cost Tool. With this tool, members can view information about the value you bring to the healthcare community and are enabled to be more active in managing their own healthcare choices. The tool features the costs and volumes associated with 1682 elective/planned procedures. View Reports - allows you to view the most recent report that contains the cost ranges calculated for your facility or practicing location, as well as an overview of the methodology used to develop these cost ranges. Reconsideration Form - only available to providers during the reconsideration period prior to each cost data submission. During times outside this window, the link to the form will be inactive. Prior to submitting the interactive electronic form, you will have the option to print a copy for your records. All required fields must be completed in order to submit the form electronically. Faxed or mailed forms will not be accepted. Cost Data Methodology provides an overview to define the methods in which the data was collected and generated. FAQs - a printable PDF listing of frequently asked questions about the Estimated Treatment Cost tool and data to help our providers better understand the cost data process and the member tool. Treatment Codes Listing - a printable PDF listing of all the procedures included in the Estimated Treatment Cost tool. This listing is updated as we add new procedures and is available to view and print at any time. 32

33 Blue Advantage The Blue Advantage Provider Portal offers resources such as office manuals, guides, forms and more. The portal also provides access to secure information such as eligibility, claims and authorization inquiries, and the Accountable Delivery Services Platform (ADSP) for primary care physicians (PCPs) only. In order to use these functions, you must have a separate sign-on and password in addition to your current ilinkblue sign-on and password. It is important to understand that, although you log into ilinkblue, you will not actually use the ilinkblue resources for Blue Advantage information. You will simply use ilinkblue to access the Blue Advantage Provider Portal. 33

34 Coming Soon In early 2017, ilinkblue will be updated to have a new look and feel. It will become more user-friendly, but not lose the informative functions it currently has to offer. Be on the look out for training in early 2017 about the new features. Because of the wealth of information ilinkblue gives providers access to, it will become a mandatory tool for all Blue Cross providers to use. In addition to the new ilinkblue, it will also become mandatory for providers to have an administrative representative setup at their location. This administrative representative will delegate ilinkblue access to staff members. If you currently do not have an administrative representative we encourage you to set one up today to prevent loss of access to ilinkblue in the future. 34

35 Support Questions about ilinkblue or EFT: Phone: BLUE ( ) Provider support for the administrative representative: 35

36 ADDRESSING YOUR At this time, we will address the questions you submitted electronically through the webinar platform. 36