ProviderConnect Claims March 2018
Agenda ProviderConnect Advantages Claims Process Improvement How to Access ProviderConnect Direct Claim Submission Batch Claim Submission Claim Search Correcting a Claim EAP Case Activity Form Submission Viewing Provider Summary Vouchers 2
ProviderConnect Advantages 3
Services Verify member benefits and eligibility View and print forms Request and view authorizations Download and print authorization letters Submit claims and view status Access Provider Summary Vouchers (PSV) Request payment for EAP services Submit EAP case activity forms (CAF) Submit updates to provider demographic information Submit credentialing applications Submit customer service inquiries Access ProviderConnect message center 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
Benefits Free and secure online application, available 24/7 Reduces the need to call for routine information Integrates with practice management software Decreases labor expenses, paper files, and postage Efficient processing allows for quicker payment Less risk of human error or mishandling Mobile device friendly Mac and Windows compatible INCREASED CONVENIENCE, DECREASED ADMINISTRATIVE PROCESSES 5
Claims Process Improvement Program 6
Claims Process Improvement (CPI) Project Mailroom Project: Transition to a centralized shared-service process to improve paper claims intake Mailing addresses changed in 2017 Incomplete or incorrect claims will be rejected EDI/Data Exchange: Implement a single gateway for front-end claims intake for all Beacon submitters to improve intake and processing of electronically submitted batch claims New companion guides will be released for 837 and 277CA files Payment Integrity and Claims Analysis: Analyze claims to identify payment errors Documentation requests to verify submissions and payment accuracy Claim adjustments will occur if overpayment is identified 7
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 credentialing applications Updating of provider information Electronic fund transfer through PaySpan Health 8
How to Access ProviderConnect 9
How to Access ProviderConnect 10
How to Access ProviderConnect Click on ProviderConnect on the right side of the screen and choose the appropriate portal. 11
Tips for Claim Submission Success When submitting any claim, be sure to complete all required fields Providers: Tips for completing the CMS-1500 or UB04 located under Administrative Forms EAP: Be mindful of case opening questions for each submission and case closing questions at final billing Direct claim submission: Required fields designated with an asterisk (*) Batch claim submission: Follow the Implementation and Companion Guides located on the ProviderConnect resource page 12
Direct Claim Submission 13
Direct Claim Submission 14
Direct Claim Submission 15
Direct Claim Submission 16
Direct Claim Submission 17
Direct Claim Submission - COB 18
Direct Claim Submission 19
Direct Claim Submission 20
Summary Page 21
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 22
Batch Claim Submission 23
Batch Claim Submission 24
Batch Claim Submission 25
Batch Claim Submission 26
Batch Claim Submission 27
Batch Claim Submission 28
Batch Claim Submission 29
Batch Claim Submission Allows you to upload HIPAA 5010 compliant files directly to Beacon Expedites processing of the claim and payment Available for all levels of care Recommended for facilities and providers submitting a higher volume of claims Payer ID FHC &Affiliates Clearinghouses may provide their own five digit payer ID for Beacon Health Options Contact your clearinghouse to see what payer ID is needed 30
EDI Claims Link for Windows (ECLW) Free Beacon Health Options software that submits HIPAA 5010 compliant files Used only for claims submitted directly to Beacon Health Options Available for download under ECLW on our ProviderConnect page Only available for Windows platform 31
Claim Search 32
Review a Claim 33
Search Claims 34
Search Claims by Member 35
Search Claims by Member 36
Search Claims by Member 37
View Member Claims 38
Claims Summary 39
Service Line Detail 40
Correcting a Claim 41
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 42
Change/Reprocess Claim 43
Disclaimer 44
Type of Adjustment 45
Select Service Address 46
Member Search 47
Coordination of Benefits 48
Service Line Entry 49
Attaching an EOB 50
Summary Page 51
EAP Case Activity Form Submission 52
EAP Case Activity Form Submission 53
Authorization Search 54
Enter EAP CAF 55
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 56
Summary Page 57
Viewing Provider Summary Vouchers 58
Provider Summary Vouchers 59
Search by Provider 60
Search by Check 61
Provider Summary Voucher Results 62
PaySpan Health: Electronic Funds Transfer (EFT) Multiple registration options: Through PaySpan s website by clicking the link in ProviderConnect or visiting PaySpanHealth.com Call PaySpan at 877-331-7154 Have registration code and PIN from the payment stub of a paper check handy Note: EFT is location specific, so if you update or add an address, you will have to contact PaySpan to add it to your file Until successful registration with PaySpan is complete, physical checks will continue be generated 63
Additional Training Options 64
Helpful Resources On the provider homepage choose ProviderConnect Scroll down to find: ProviderConnect Demo Guides Forms Compliance Resources EDI Resources How-to video tutorials Webinars and archives 65
Contact Information Website and EDI PaySpan Provider Relations Beacon Health Strategies eservices Phone: 866-206-6120 eservices@beaconhealthoptions.com Electronic Data Interchange Phone: 888-204-5581 EDI.Operations@beaconhealthoptions.com PaySpan Registration Provider Support Monday through Friday, 8 a.m. 8 p.m. ET Phone: 877-331-7154 providersupport@payspanhealth.com Provider Relations Phone: 781-994-7556 Provider.Relations@beaconhealthoptions.com Beacon Health Options (formerly ValueOptions) EDI Helpdesk Monday through Friday, 8 a.m.-6 p.m. ET Phone: 888-247-9311 e-supportservices@beaconhealthoptions.com Unable to locate your registration code? Email: corporatefinance@beaconhealthoptions.com Reply will be received within three business days National Provider Services Line Monday through Friday, 8 a.m.-8 p.m. ET Phone: 800-397-1630 Regional Provider Relations Team 66
Thank you 67