MARTIN S POINT HEALTH CARE PROVIDER PORTAL GUIDE

Transcription

1 MARTIN S POINT HEALTH CARE PROVIDER PORTAL GUIDE The Martin s Point Provider Portal allows registered users to check the status of claims, pre-authorization requests and benefits/eligibility for US Family Health Plan and Generations Advantage health plan members. The following guidelines explain how to register for and use this time-saving tool. REGISTRATION To access the Martin s Point Provider Portal, you must first create a username and password for our system. To begin the registration process, please visit the portal log in page: Choose Sign In or Register button in top right Select Provider as the account type, then click Next Complete the required fields on the following pages to complete your registration. Do not enter dashes in the Federal (Tax) ID field. Do not use spaces in the User ID field. During the registration process, you will need to call us at to obtain your Martin s Point Provider/Facility ID number.

2 Required field are marked with an asterisk. Please mark the I am NOT the provider box if you are a representative of the provider (i.e. office staff). After you have completed the registration process you will be able to sign in and use the tool once your security settings have been assigned.

3 SIGN IN To access the portal, navigate to: Once you re on this page, click the Benefits and Eligibility link as shown below or Sign in or Register If you have used Sign in or Register, you will still need to sign into the module click the Check Member Eligibility or Claims tab as shown below

4 Click to sign-in to the portal as shown.

5 Key in your username and password to enter the Provider Portal. If you experience difficulty with the login process or have been locked-out of your account due to multiple username/password entry attempts, please call for assistance. This is what your Provider Home page will look like. You have the ability to not show this over screen again by simply checking the do not show me this again box To update any of the information on this screen, please visit: and download the appropriate change form.

6 PATIENT SEARCH Click Manage Member to search for a member. You must enter either the member s health plan ID # or their social security # (SSN), you do not need both, in addition to the member s last name. It is best to search by health plan ID # as our system does not contain the SSN for all members. The health plan ID # is 11 digits long. You must include all zeroes.

7 If you have difficulty finding a member, this could be due to a spelling or hyphenation discrepancy. Try a search with only two letters of the member s last name. You will notice that on each result page, you can filter by any of the columns If there are no details in the Benefit Details (0) then you should look in Benefit History. This indicates that member is not currently eligible but was, at some point in time. It will give you the effective and term dates as well as the Plan Name.

8 If any information on this page needs to be updated, please have the member call us at (US Family Health Plan members) or (Generations Advantage members). We cannot change member information without a request from the member.

9 VIEW CLAIMS You can view claims in two ways. 1. Right from your home screen 2.Via the Search drop down You Can do a FULL Search (auto defaults to 6 months )

10 or click the tab and search by claim id Use the Type drop down menu to show professional (CMS-1500) or institutional (UB-04) claims. You will only be able to see claims that were submitted using your provider ID number. Change the date range to search for claims submitted within a certain time frame. Or, search by claim status (Paid, Denied, In Process) if you prefer. The search results will display as shown below.

11 Click the claim number to view additional claim details. Use the View Payment Details to find out check number and location of what check went and when it was paid

12 VIEW AUTHORIZATIONS Use the Authorization Inquiry link on top of your screen to search for authorizations. As with claims, you can narrow down your search results by entering a specific date range or search by authorization id To look at the details of the authorization simply click the authorization id link

13 Please note that although the status may say approved, if the member is accessing a non par provider, out of network benefits may apply. If you are an out of network provider to determine if benefits will be paid out of network, please call provider inquiry to veriy. Please note that when viewing authorizations, the onset date and discharge date may show as 1/1/1980 or 1/1/1753. We are working with our system vendor to rectify this issue. Though it is not always the case, you are most likely to experience this temporary glitch when search for authorizations that date prior to the year 2012 Questions? Please call our Provider Inquiry team at

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