EZ-NET Tips & Tricks

Presented By:Ken HopperQA Manager

Co-Presenter:Bhaskar ReddyTechnical Manager, Clinical Care Products

Course Outline

New User Registration

Password Reset

Communications between Providers & EZ-CAP Client

Claim Appeals

Provider Update Demographics

Referrals in EZ-NET

2

Course Outline

Duplicate Auth Warning Message

Submit Auth with Same Info. As Previous

Modify Submitted Auth

Print Auth Fax Cover Sheet

3

Course Outline

HP Auth# in Auth Search

Pend Record based on Primary COB

Member Search Screen: Address / Last Name / DOB

Warning Message for Termed Members

Favorites

Memos & Notes Submission

4

Course Outline

View Multiple Adjustment Codes

12 Diagnosis Codes Submission

Auth# in Claim Search

File Attachment Submission

View EZ-Alerts

EZ-NET Access to Files in Document Management

5

What is EZ-NET?

6

• EZ-CAP’s secured web-based portal

• Share clinical and administrative info

• Expedite clinical flow

• Enhanced data accuracy

New User Registration

7

New User Registration

8

New User Registration

9

• User is created in EZ-CAP User table

New User Registration

10

Password Reset

11

Password Reset

• Valid e-mail address is required

• E-mail is sent to the user to verify account

12

Password Reset

• Username

• Valid e-mail

13

• E-mail is sent to user

• Click link to reset password

Forgot Username

• Last Name

• E-mail address

• Hint Question & Answer

14

Password Reset

• Password is reset by the User

• No need to call EZ-CAP Admin

15

Communications between Providers

& EZ-CAP Client

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Compose E-mail

• Providers can send e-mail to Specialists or Other Providers

17

•E-mails automatically create an Incident ticket

EZ-NET Chat

18

• Chat widget • EZ-NET user initiates chat• Provider to Provider Chat• Provider to Customer Service Chat• Separate chat window

Customer Support Chat

19

• EZ-CAP user signs into new Customer Support table• Available to accept calls• Chat history is stored in back-end table

Claim Appeals

• Submit Claim Appeals

• Incident created in EZ-CAP

• Efficient route

• Better communication between plan & Provider

• Saves time

• Provide better documentation for audits

20

Claim Appeal Setup

21

• Configured in EZ-NET Company table• Setup default values for Incident ticket

Access Claim Appeal

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• Search for a submitted appeal• Submit an appeal for an existing claim

Claim Appeal Submission

23

• Company ID• Claim #

• Appeal Reason• Provider’s Last Name

Claim Appeal Submission

Confirmation

24

• Appeal# is the Customer Incident#

Submitted Claim Appeal as an

Incident Record

25

Customer Action Entry

26

• Notes added as action item

Customer Action Entry

27

• File attachment is noted in the action item

Claim Appeal Inquiry

28

• View existing appeals• Enter date range

Appeal Submission in EZ-NET

Claim Screen

29

Provider Update Demographics

30

• Allow Providers to submit an address change

• Request will be sent to EZ-CAP client via Incident record

Incident Record in EZ-CAP

31

Incident Action Item

32

• Address change information

Referrals

33

• Now available in EZ-NET & EZ-CAP

• Separate Auths from Referrals

• Referrals – used as an approval to be referred to a specialist

• Auths – is to Authorize a procedure

Referrals

34

• Referrals added to the Authorization table• Differentiated by Request Type

Referrals

• Added Request Type in Auth Table

• “A” for Authorization

• “R” for Referral

35

Referrals

• Auto Adjudication rules can be built for Referrals

36

Referrals

37

• Configure Duplicate Logic for Referrals• Auth/Referral = current logic without regard to request type• Auth to Auth Referral to Referral = perform logic based on request type

Referrals

38

• Limit referral request to Provider Group• Not allow Auth Submission without existing Referral

Duplicate Auth Warning Message

39

Submit Auth with Same Info.

as Previous

40

• Improve efficiency• Lessen keystrokes

Modify Submitted Auths

41

• Providers can edit their submitted Auths

• Configure time limit to Modify Auths

Print Auth. Fax Cover Sheet

42

Print Auth. Fax Cover Sheet

43

HP Auth# in Auth Search

44

• Enhanced Auth Searches by adding HP Authorization#

Pend Auth based on Primary COB

45

• EZ-NET Auth submission pends based on COB• Enhanced both EZ-CAP & EZ-NET• New Pend Code is OPC (Member has active primary COB)

Member Search Screen

• Easily Search Members by defined criteria:

46

Warning Msg. for Termed Members

47

Favorites

• Access frequently used codes in Favorites :

48

Memos & Notes

• View and Submit Memos & Notes

• Available for Claims, Auths, Referrals and Members

49

View Multiple Adjustments

50

• Only first adjustment code was viewable in previous version• Now you can see ALL adjustment codes

Submit up to 12 Dx for Claims &

Auths

51

Auth# in Claim Search

52

• Search claims easily by Authorization #

File Attachment Submission

53

• Send files during Claim, Auth & Referral submission• File is retrievable in EZ-CAP

View Member EZ-Alerts

54

Document Management files

accessed in EZ-NET

55

• Configure file as EZ-NET Viewable• Documents can be retrieved in EZ-NET

Recap

New User Registration

Password Reset

Communications between Providers & EZ-CAP Client

Claim Appeals

Provider Update Demographics

Referrals in EZ-NET

Duplicate Auth Warning Message

Submit Auth with Same Info. As Previous

Modify Submitted Auth

Print Auth Fax Cover Sheet

HP Auth# in Auth Search

Pend Record based on Primary COB

Member Search Screen: Address / Last Name / DOB

Warning Message for Termed Members

Favorites

Memos & Notes Submission

View Multiple Adjustment Codes

12 Diagnosis Codes Submission

Auth# in Claim Search

File Attachment Submission

View EZ-Alerts

EZ-NET Access to Files in Document Management

56

Thank you!

Questions &

Answer Session

57

©2014 Orange/MZI Healthcare