October 2009 Web interChange Advanced Functions Presented by the EDS Provider Field Consultants.

October 2009

Web interChange Advanced FunctionsPresented by theEDS Provider Field Consultants

2 October 2009Web interChange Advanced Functions

Agenda

• Session Objectives• Administrator Request Form• Administrator Functions• Provider Profile Updates• Paperless Remittance Advice• User List Functions• Void and Replacement Features• Claim Attachments• Prior Authorization Submission and Inquiry• TPL Updates• Crossover Claim Billing• Helpful Tools - Avenues of Resolution • Questions

Welcome and Announcements

Session Objectives

Following this session, providers will:•Understand how to obtain Web interChange

administrator access•Understand Web interChange administrator functions•Know how to view and print your provider profile•Know what can be updated in the provider profile, and

how to update the information•Know how to view/print/save Paperless Remittance

Advice•Know how to develop user lists•Understand void and replacement functions•Understand how to add claim attachments•Understand prior authorization inquiry and submission•Understand how to update TPL information•Understand crossover claim billing

Web interChange Accesshttps://interchange.indianamedicaid.com

Logon Screen

Administrator Request Form

•Complete and mail the Administrator Request Form to:

Electronic Solutions Help Desk950 N. Meridian StreetSuite 1150Indianapolis, IN 46204-4288

•Request Form and letter may be faxed to (317) 488-5185

•Submit a letter of acknowledgement on your company’s letterhead from the organization’s owner, indicating you are approved as an administrator for your organization

•Each provider should assign an administrator to oversee the daily functions of the individual practice or group

Web interChange Administrator MenuWeb interChange Home Page

Administrator Functions

•User Administration– Create User

– Update User

– Reset Password

– Reactivate User

•Group Administration– Administer Groups

• Group Maintenance• Group Member Maintenance• View Group Report

» Review the Group Report every 90 days

» Compliance is tracked by OMPP and EDS

Administrator FunctionsCreate a User

Administrator FunctionsGroup Administration

Administrator FunctionsGroup Member Maintenance

Administrator FunctionsReports

•Create user

•Establish groups and security levels

•Add users to group

•View group report

Group Administration

Password Resets

•Necessary when user has not logged on for more than 90 days

•Administrator may reactivate an inactive user

•Administrator gets e-mail from the EDI Solutions Help Desk when user is reactivated

•An inactive administrator must be reactivated by the EDI Solutions Help Desk

Reactivate User

Password ResetsBy User

Administrator FunctionsProvider Profile

Select “View” or “Edit”

Must respond

to ‘CHOW’ question

Change of Ownership?

Update Provider Address

Update Provider Specialty

Begin or Update Electronic Funds Transfer

Click “Edit”

Update Rendering Provider Information

Profile Maintenance

•Using Web interChange, providers can also make the following profile updates:

– Ownership information

– Changes in members of a Board of Directors

– Name of office manager or other management personnel

– Ownership in subcontractor entities

•Group providers may not remove rendering provider linkages via Web interChange

– Complete the IHCP Provider Termination Form

Note: EFT deposits occur 18 days after submitting an enrollment via Web interChange

Other Types of Updates

Paperless Remittance Advice

Accessing Paperless RAs Through Web interChange *Three Easy Steps

Step 1 – From the Web interChange Home page, select Check/RA Inquiry. On the Check/RA Inquiry page, enter the desired search criteria and click Submit. A list of checks and RAs (most recent first) displays.

– The link to download the RA displays regardless of check availability

– If no check was issued in conjunction with the RA, the check number displays as “000000000”

– The Provider/National Provider Identifier (NPI) fields populate based on the user’s security

•Step 2 – Click on the PDF icon to the right of the check number (in the “Download RA” column)

– A PDF of the RA opens in a new window

– Downloaded RAs have a Family and Social Services Administration (FSSA) watermark

– If users wish to save copies of RAs for their records, they can use the “Save a Copy” feature of Adobe Acrobat Reader

• RAs can also be printed from Adobe Acrobat Reader

•Step 3 – If the desired RA is not displayed, change the search criteria at the top of the Check/RA Inquiry page

– RAs are available in Web interChange for four weeks

User List Functions

•Features of a User List:

– May create user lists to alleviate keying information manually in specific claim submission fields

– Allows information to be added or deleted as needs change

– Can only be created for fields listed with a drop-down arrow in the claim submission screen

Void and Replacement Features Void

Void and Replacement Features

•Void requests can be submitted electronically using the 837 transaction or Web interChange

•Void requests submitted electronically can be for a previously submitted electronic claim or paper claim

•Voids cannot be performed on a claim in a denied status

•Void is a HIPAA term for adjustment

•Void is the cancellation of an entire claim whether same day, same week, or post financial

•A void can be performed on claims in a paid or suspended status

• If the void of a claim occurs the same day or week that the original claim was submitted, a new ICN is not created

– The same ICN assigned to the claim applies to the void

– The original claim denies with edit 0120 – Claim denied due to an electronic void request

• If the original claim being voided is a historical claim, a new claim with a new ICN is created

– The new ICN starts with 63

•Check-related voids (adjustments) continue to be submitted on paper

Pre-Financial Post-Financial

2009010000002 – Paid

User voids the claim

Voided claim denies EOB 0120

2009242001001 – Paid

Today’s date: 10/10/09

6300252001000 – Denied with EOB 0120

RA/835 shows:

Claim shows on the denied page only – same ICN

RA/835 shows:

Mother Claim: 2009242001001 and Daughter Claim: 6309252001000

Both appear on the adjustment page

Void and Replacement Features Replacement

•Replacement is a change to an original claim, whether same day, same week, or post financial

– Original claim indicates the most recent ICN assigned to that claim

•An electronically submitted replacement claim can be for a previously submitted electronic or paper claim

•Only noncheck-related replacements are accepted electronically

•Check-related replacements continue to be submitted on paper

Replacement

• If the IHCP receives a replacement claim for an original claim that has been through a financial process (has appeared on an RA), the replacement claim ICN starts with one of the following:

―61 – Provider initiated replacement containing attachments and/or claim notes

―62 – Provider initiated replacement with no attachments and/or claim notes

Replacement

No filing limit for void requests

One-year filing limit for replacement requests

•Web interChange will not display a Replace This Claim button on claims that are past the filing limit

– These replacements must be submitted on paper

•The system compares the last date of claim activity and the date of the current activity to make sure that a year has not passed

– If the date of service of the claim is greater than one year, proof of timely filing is required to avoid a payment take back on the paid claim

•The filing limit does not apply to crossover claims

Filing Limits for Voids and Replacements

Claim Attachment Feature

Claim Attachments

•Unique number assigned by provider

•Claim and document specific

•Each ACN may only be used one time

•Write “ACN #” and the assigned ACN on each page of documentation corresponding to that number

Attachment Control Number (ACN)

Claim Attachments

•Select the appropriate Report Type

– Report Type describes the document being sent

•Transmission Code defaults to “BM” – by mail

– Electronic and e-mailed attachments are not accepted

•Text Box

– Applies to institutional claims only

Report Type and Transmission Code

Claim AttachmentsAttachment Control Cover Sheet

Claim Attachments

•Available on IHCP home page, under Forms

•Complete cover sheet for each claim

• Include provider information

•Provide member ID

•List each ACN pertaining to specific attachment

• Indicate the number of pages of documentation submitted per attachment (not including the cover sheet)

•Mail cover sheet and supporting documentation to the appropriate P.O. Box (P.O. Box 7259)

Attachment Control Cover Sheet

Prior Authorization Inquiry and Submission278 Prior Authorization Inquiry

Prior Authorization Inquiry and Submission

•Allows the requesting provider to inquire about all non-pharmacy prior authorizations via the Web

– It does not matter if the PA was submitted via paper, telephone, fax, or Web

•The requesting provider and the named service provider may view a PA without the PA number

•All other providers must have the PA number to view a PA

278 Prior Authorization Inquiry

Prior Authorization Inquiry and Submission278 Prior Authorization Submission

•The following provider types can submit PA requests via Web interChange:– Chiropractor

– Dentist

– Doctor of Medicine

– Doctor of Osteopathy

– Home Health Agency (authorized agent)

– Hospice

– Hospitals

– Optometrist

– Podiatrist

– Psychologist endorsed as a Health Service Practitioner in Psychology (HSPP)

– Transportation providers

•Must be given access to submit PAs by the administrator

•Web interChange PA attachments follow the same guidelines as the Web interChange claim attachment process

•Assign a unique Attachment Control Number (ACN) for each attachment

•Enter assigned number into attachment screen in Web interChange

•Documentation must be submitted within 30 calendars days of the request

278 Prior Authorization Submission

Decision letters:

•The system sends a decision letter for PAs submitted via Web interChange, the same way it does for all PA requests

278 Prior Authorization Submission

Prior Authorization

•ADVANTAGE Health Solutions-FFSPrior Authorization DepartmentP.O. Box 40789Indianapolis, IN 462401-800-269-5720 Fax: 1-800-689-2759

•ADVANTAGE Health Solutions-Care SelectPrior Authorization DepartmentP.O. Box 80068Indianapolis, IN 462801-800-784-3981 Fax: 1-800-689-2759

•MDwise-Care SelectPrior Authorization DepartmentP.O. Box 44214Indianapolis, IN 46244-02141-866-440-2449 Fax: 1-877-822-7186

Prior Authorization by Telephone, Fax, or Mail

TPL Updates

•Submit an electronic request to the EDS TPL Unit to update a member’s insurance information

•The TPL Unit receives the request, researches, confirms the information, and updates the eligibility screen with corrected information

– Updates are usually made within 20 days

•Confirm that eligibility has been updated by reviewing the Eligibility Inquiry feature

Crossover Claim Billing

•Submit Medicare crossover claims electronically using Web interChange

•The following header information is required for the claim to process:

– Payer ID and Payer Name

– TPL/Medicare Paid Amount

– Subscriber Name, Primary ID, Relationship Code, Gender, DOB, and Claim Filing Code

– If the Payer ID is a Medicare payer and the Claim Filing Code is MA or MB, the claim is considered to have crossover information

Note: Obtain COB information, including Payer IDs from the HELP tab, Reference Materials on Web interChange

Header Information

•The following detail level elements are requirements for the claim to process:

– Payer ID

– TPL/Medicare Paid Amount

– Group Code, Reason Code, and Amount

Note: Obtain COB information from the HELP tab on Web interChange

Detail Information

Helpful Tools

• IHCP Web site at www.indianamedicaid.com

• IHCP Provider Manual (Web, CD-ROM, or paper)

•Customer Assistance

– 1-800-577-1278, or

– (317) 655-3240 in the Indianapolis local area

•Written Correspondence

– P.O. Box 7263Indianapolis, IN 46207-7263

•Provider Relations field consultant

– View a current territory map and contact information online at www.indianamedicaid.com

Avenues of Resolution

October 2009

Questions

October 2009

EDS and the EDS logo are registered trademarks of Hewlett-Packard Development Company, LP. HP is an equal opportunity employer and values the diversity of its people. ©2009 Hewlett-Packard Development Company, LP.

Office of Medicaid Policy and Planning (OMPP)

402 W. Washington St, Room W374

Indianapolis, IN 46204

EDS, an HP Company

950 N. Meridian St., Suite 1150

Indianapolis, IN 46204

October 2009 Web interChange Advanced Functions Presented by the EDS Provider Field Consultants.

Documents

Transcript of October 2009 Web interChange Advanced Functions Presented by the EDS Provider Field Consultants.

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