iCare’s Provider Portal Guide

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CONTENTS

New Provider Registration……………………………………………………………………………4

New Registration………………………………………………………………………………..5

Login Page………………………………………………………………………………………………………9

Forget Your Password………………………………………………………………….…...10

Provider Home Page………………………………………………….…………………………………12

Track Request……………………………………………………………..…………………… 12

Contact Us……………………………………………………………………………………….. 14

Provider Snapshot……………………………………………..……………………………..15

Claims……………………………………………………………………………………….…….. 18

Authorizations………………………………………………………………….…………. 19

Manage Member………………………………………………………………..………………24

Member Search……………………………………………………………………….24

Submit Claim …………………………………………………………………………..26 Search………………………………………………………………………………………………..32

Claims……………………………………………………………………………………..32

Find Authorization…………………………………………………………………..36

Search iCare Provider Network………………………………………………. 40

Office Management …………………………………………………………………….……42

Manage Office Locations………………………………………………………….42 Manage Office Admin………………………………………………………………43

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INTRODUCTION

iCare’s Provider Portal allows you to bill your LTC Professional claims, view prior authorizations and service requests, view claim information and view eligibility for the iCare members you serve. You can also obtain your Explanation of Payments (EOP)

SYSTEM REQUIREMENTS To run the CWS Provider Portal application, you need a computer with the following specifications:

• Internet Explorer (IE) 11.0 or higher or the latest version of Google Chrome, Firefox and Safari.

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New Provider Registration

The New Provider Registration will be used by the Provider to gain access to the Provider Portal.

To complete the registration process, the provider will receive a Provider Identification Number (PIN) letter containing your unique PIN. If you have not received your PIN letter, please contact iCare at NetDev@iCarehealthplan.org to obtain your unique PIN.

To begin the New Provider Registration process, please copy the following URL into your browser: https://ichcwsregion3.tzghosting.net/tzg/cws/registration/registrationLogin.jsp

If you have problems registering please contact iCare’s Provider Outreach at ProviderOutreach@iCarehealthplan.org for assistance.

Provider Information

NEW PROVIDER REGISTRATION

• To begin the registration process, click on Create New Account.

5 NEW REGISTRATION

Step1 Click on “Provider”.

PHYSICIAN & BILLING INFORMATION

Step 2

• Full Name of Provider/Facility: Name of the Provider Registering. • Federal ID: Tax identification number. • Provider ID: PIN number supplied by iCare. • NPI: National Provider Identifier number. • Confirm information then click on Verify.

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ACCOUNT INFORMATION Step 3 Enter information to verify user in the claim system.

• Street: Mailing address of facility. • City, State, Zip Code: Demographics information for Provider Mailing address. • Phone Number: Phone number for Provider. • E-Mail Address: Provider e-mail address.

Step 3 Continued USER ID & PASSWORD

• User ID: The User ID is created by the provider and will be used each time

the provider logs into the Provider Portal. User ID should contain at least one of the following (space. @ _ -). An email address can be used as a User ID.

• Password: Password must be a minimum of eight upper and lowercase letters and contain at least one number or special character.

• Security Questions: Select pre-set security question from the drop-down menu for Security Questions. The answer you provide will be used for password recovery. During the password recovery process, the application will randomly display one of the security questions. The answer entered will be compared to the previously entered answers to validate the user.

Security Question #1: Select the appropriate security question from the drop-down menu and enter the answer.

Security Question #2: Select the appropriate security question from the drop-down menu and enter the answer.

7 Security Question #3: Select the appropriate security

question from the drop-down menu and enter the answer. Security Question #4: This security question is determined

and entered by the registering provider group.

• Multiple Users: Multiple User ID’s can be created under the

PIN, simply follow the registrations steps to create additional users.

• Log in to application • Click on Create New account • Enter Provider & Billing Information • Enter Contact Information • Enter User ID and Password information • Select and enter Password Recovery Security questions

and responses • Click the Register button

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CONFIRMATION Step 4 Registration Complete

• To access the Provider Portal from this page, click on Log in.

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LOGIN PAGE

SIGN IN

• User ID: Enter the User ID you created.

• Password: Enter the password you created. Password is case and

character sensitive. • Click Login.

Access Provider Information

• A message will appear; Welcome, your experience is loading if your User ID

and password are authenticated. • Initial Landing Screen will display. If you do not want this initial landing to

display, click on “Don’t Show Me This Again” at the bottom of the screen. • Provider Home Page will display.

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Forgot Your Password

• It is suggested to log into the Provider Portal regularly to keep your account and password active.

• Users who forgot their passwords can click the Forgot your password for

help in getting their password reset.

Step 1

• User ID Verification: Enter user name click “Next”.

11 Step 2

• User Answer Verification: Enter the answer to the selected security

question and click “Next”.

Step 3

• Change Password: Enter new password and confirm new password.

Step 4 Password reset: Complete. Login: click to bring you back to the Login Page of the portal.

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PROVIDER HOME PAGE

Track Request

• Users can track any transactions submitted through the provider portal in this section.

Full Search

• Status: select from the drop-down box; Any Status, Errored,

Complete, or Submitted. • Submitted From: End date • To: Enter date

Search by Transaction Reference Number

• Reference#: Enter number assigned to claim at time of submission.

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Contact Us

• Users will have access to iCare’s address, Customer Service phone numberand email as well as Provider Outreach email address.

• Users will click on the drop-down arrow to obtain information.

Address: iCare’s corporate office address. Customer Service: Milwaukee and Other (out of state) phone numbers with fax number. Customer Service is limited to three claim inquires per phone call. The Provider Services email is an alternative for providers to submit more than three claim status requests. Provider Outreach: Users can email for questions on various EDI inquires, provider or portal education questions, as well as Long Term Care claims submissions.

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HOME

PROVIDER SNAPSHOT

• Please review your Provider Snapshot; if any information has changedor is incorrect; please contact iCare Network Development atnetdev@iCarehealthplan.org.

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• Users can click on the Associated Providers tab to view providerdetails and primary location along with driving directions andhyperlink navigation.

Provider Details

• ID: Provider ID number.

• NPI: National Provider Identifier.

• Type: Type of Provider.

• Specialties: Provider Specialty.

• Languages: Language provided by Provider

Primary Location

• Address: Physical address of the provider.

• Phone: Office phone number.

• Fax: Office fax number.

17 Associated Providers

• This page will show a list of providers that have a direct affiliation to the

logged in provider. • Providers can click on the dropdown arrow and see the list of associated

providers i.e., other providers that do business with the logged in provider. Example: Provider group logged in and sees list of other hospitals and provider he/she does business with.

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Claims

• User can obtain a list of claims. • Click on the drop-down arrow to view the claim list.

• Claim ID: System generated number assigned to the claim. • Service Dates: Date(s) the service was performed. • Patient: Name of iCare enrolled member. • Service Provider (NPI): National Provider Identifier. • Status: Reflects current claim status. To view claim details, click on the Claim

ID.

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Authorizations

• User can obtain a list of authorizations• Click on the drop-down arrow to view authorization list by PIN.

• Authorization Number: Number identifying your approved/denied service.• Admission Dates: Effective dates of authorization.• Admitting Provider: Not Applicable.• Referred To: Provider Name.• Diagnosis: Code (s) used to describe routine/illness or injury condition.

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Authorization Details

Authorization

• Reference ID: System generated authorization number. • Status: Approved or denied authorization. • Patient: Member Name. • Member ID: Member’s Medicaid or Medicare Number. • Admitted: Date member admitted. • Discharged: Date member discharged. • Requested LOS: Requested length of stay. • Actual LOS: Actual length of stay. • Service Level: Level of service. • Place of Service: Place service was obtained. • Onset Date: Not applicable.

• To the right click on the drop-down arrow to view in detail each category.

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Eligibility

• Eligibility of the member.

Service Detail

• Service Level: Level of service.• Place of Service: Location where service was performed.• Services by: Name of provider performing the service.• Diagnosis: Code (s) used to describe routine/illness or injury condition.

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Requested Service

• Requested/Authorized Units: Requested number of units by the provider. • Used Units: Number of units used by the provider. • Codes: Code to describe services rendered. • Type: Not applicable. • Service Description: Definition of the requested HCPS code. • From: Start date of the authorization. • To: End date of the authorization.

Physicians Admitting Physician:

• Provider: Not applicable. • NPI: Not applicable. • Address: Not applicable.

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Referred To:

• Provider: Name of provider.• NPI: Provider’s National Provider Identifier number.• Address: Provider’s address.

Referred By:

• Provider: Name of provider.• NPI: Provider’s National Provider Identifier number.• Address: Provider’s address.

Notes

• Non-Clinical Notes: Represents the provider’s negotiated rate.• Clinical Notes: Details of approved hours and units for a specified

period or time, including required modifiers.

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MANAGE MEMBER

Member Search

• This function requires the user to enter the member’s Last Name, First Nameand Birth Date OR Healthplan ID.

Required for Search

Search by Last name, First name and Birth Date

• Last Name: Last Name of the member.• First Name: First Name of the member.• Birth Date: Enter Birth Date of the member listed as MM/DD/YYYY.

Search by Healthplan ID

• Healthplan ID: Unique Identifiers for Health Plan (Medicare or Medicaidnumber). For dual eligibility members, iCare Medicare number or ForwardHealth Medicaid number may be used.

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• Example: User entered Healthplan ID.• Click on Search

Member’s Name, Date of Birth, Address and Phone number will be displayed. • Click on the Member’s Name to view additional details.

Member Information

• Member Name, Member ID (internal ID, not Medicare/MedicaidHealthplan ID), Effective Date, Birth Date, Gender, Address, Country andPhone Number

• Click on the drop-down arrows to view the following links.• Referrals and Authorizations: List of members

authorizations.• Claims: List of status for claims.• Benefit Details: Member’s current benefits.

** Benefit History• Deductibles and Limits: Member’s deductible

for individual and family.

• Other Insurance: Member’s other Insurance.

26 Submit Claim

• Providers submitting long term care professional claims only for Medicaid Family Care

Family Partnership members have the ability to submit claims through the portal.

• This function requires the user to enter the member’s Last Name, First Name and Birth

Date OR Healthplan ID.

Required for Search Search by Last name, First name and Birth Date

• Last Name: Last Name of the member. • First Name: First Name of the member. • Birth Date: Birth Date of the member listed as MM/DD/YYYY. Search by Hea l thp lan

ID • Healthplan ID: Unique Identifiers for Health Plan (Medicare or Medicaid number). For

dual eligibility members, iCare Medicare number or Forward Health Medicaid number may be used.

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• Example: User entered Healthplan ID. • Click on Search.

• Member’s name, Date of Birth, Address and Phone number will be displayed. • Click on the Member’s Name to begin Step1 of submitting a claim.

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Step1

• User may click on the drop-down arrow to view each field for review.

• Member Information: Name of member, member’s Coverage,Healthplan ID, Birthdate, Address, Phone number.

• Servicing Provider: Name of provider performing the services.• Pay to Provider: Name of the provider who will receive payment.• Servicing Facility: None applicable.• Referring Provider: None applicable.• Authorization: None applicable.• Claim Information: None applicable.• Coordination of Benefits: None applicable.• Claim Diagnosis Codes: Code (s) used to describe routine/illness or

injury condition.• Claim Lines: Requested services for payment.

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Step1 Continued Claim Diagnosis Codes

• Prepopulated with default diagnosis code. • To add a secondary diagnosis, click the Plus Button

• Code: Prepopulated diagnosis code in the “Code” box. • Find Diagnosis Codes: If you don’t know the diagnosis codes, click on

the magnifying glass to search for the diagnosis code. • Description: Details of the diagnosis code. • Action: Function allows adding or deleting additional diagnosis lines.

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Step1 Continued Claim Lines

• User will enter DOS From, DOS To, POS, CPT/HCPCS, Modifier, Diagnosis # (not code),

Charge and Units.

• DOS From: Enter beginning date of service. • DOS To: Enter end date of service. • POS: Select Place of Service from drop down.

• 11 – Office • 12 – Home • 99 - Other

• CPT/HCPCS: Enter code per Service Request. If unknown, click on the magnifying glass to search for a CPT/HCPCS code.

• Find Procedure Codes (CPT/HCPCS): If you don’t know the procedure codes, click on the magnifying glass to search for the code.

• Charge: Enter total charge per line (not unit/rate). • Units: Enter number of units for services. (Units do not multiply charge) • Action (+): Function allows adding or deleting claim lines. • Total Charges: Charges will auto generate all lines entered. • Total Units: Units will auto generate all units entered. • Cancel: Claim will be deleted for user to begin again. • Submit: Click to submit your claim.

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Step2

Claim Submission Confirmation

• Users will receive a confirmation once your claim has been submitted.

• Claim ID: System generated claim number that identifies yoursubmitted claim.

• Submit New Claim: By clicking on this option, you will be taken back tothe Member Search Screen to enter the next member for submission ofclaim.

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SEARCH

Claims

• Users will be able to search claim(s) by using Full Search or Search by claim ID.

Full Claim Search

• From: Enter date (i.e.,03/01/2019) and tab or select the date of the claim from the calendar link.

• To: Enter date (i.e.,03/31/2019) and tab or select the date of the claim from the calendar link.

• Type: Select All, Institutional or Professional claims from the drop-down menu. Selecting Institutional from the drop-down menu will only return Institutional claims. Selecting Professional from the drop-down menu will only return Professional claims.

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• Status: Select the status of the claim. • Member: Enter Member’s Last Name, SSN, or Health Plan ID. • Provider NPI: *not required* Provider National Identifier Number. • Click on Search to obtain claim detail.

Search by Claim ID

• Claim ID: Enter claim number of the claim submitted.

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Example: Search by claim ID

Results of Claim Search

• Claim ID: Claim number of the claim submitted

• Service Dates: Date service was provided.

• Patient: Member name.• Service Provider (NPI): Provider performing the service.

• Total Claim Amount: Amount of charges submitted

• Status: Status of the claim.

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Claim ID

• Click on “Claim ID” to view claim in detail.

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FIND AUTHORIZATIONS

• Users will be able to search authorization(s) by using Full Search or Search by ID.

Full Search

• From: Enter date (i.e.,03/01/2019) and tab or select the date of the claim from the calendar link.

• To: Enter date (i.e.,03/31/2019) and tab or select the date of the claim from the calendar link.

• Provider NPI: *not required* Provider National Identifier Number. • Member: Enter Member’s Last Name, SSN, or Health Plan ID.

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Search by ID

• Reference ID Search: Enter authorization number.

Example: Authorization Search by Reference ID

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Results of Authorization Search

• User will receive information on the authorization.

• Authorization Number: Authorization number of services requested.• Admission Dates: Dates of authorization.• Admitting Provider: Name of Admitting Provider.• Referred To: Service Provider name are displayed in alphabetical order.• Diagnosis: Diagnosis Code

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Authorization Number

• Click on “Authorization Number” to view Authorization details.

• Click on the drop-down arrow to view each section.

• Eligibility: Member’s eligibility. • Service Details: Provider who is providing services. • Approved Service: Services requested by provider. • Physicians: Indicates Admitting, Referred to and Referred by Providers • Notes: Record of hours/units, rate per code and modifiers as needed.

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Search iCare Provider Network • This page allows the user to search for participating providers who are

providing healthcare services or supplies to iCare members.• Click on Search iCare Provider Network to begin your search.

Provider Search • Plan: Family Care Partnership, Medicare or Medicaid SSI, BadgerCare Plus,

Aurora CompleteCare• Provider Name: Enter specific provider• Specialty: Select the specialty.• Language Spoken: Select the language.• Service Location Name: Name of location where service to be rendered.

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• Service Location City: City of service location. • Service Location Zip: Zip code of service location. • Servicing County: Select serving County of provider.

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OFFICE MANAGEMENT

Manage Office Locations

• Click on Manage Office Locations to view details.

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Manage Office Admin

The first person to login in Provider Portal is the Account Manager and is the initial user. The initial user can add additional Office Admin User ID. Any Office Admin can create additional Office User ID.

The Account Manager should set up initial user as the main entity under the provider naming convention. i.e., Happy Home Health Inc. could be HappyHHInc

User Hierarchy: Account Manager is initial user

• Account Manager creates Admino Admin creates User and assigns roles

Roles Are• Provider Clerk• Claim Admin• UM Admin• Super Admin

Office Admin can create additional Admin • Click New• Create ‘Unique’ User ID: i.e., Msmith• First Name: i.e., Mary• Last Name: i.e., Smith• Password• Confirm

The Pencil icon under Action, allows the Office Admin to change User ID name.

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The Key icon under Action allows the Office Admin to Reset password. • When checked the Force Change box, will force the User to change password to their own,

upon login • If not checked Office Admin can set password for User

Office User can create additional users and assign Role • Click New• Create User ID:• First Name• Last Name• Password• Confirm

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• Provider Clerk: Has access under Manage Member: Patient Search, Patient Roster and Submit Claim. Under Search: Provider Search.

• Claim Admin: Has access under Manage Member: Member Search, Submit Claim. Under Search: Claims and Provider Search.

• UM Admin: Has access under Manage Member: Member Search, Submit Referral/Authorization and Submit Inpatient Pre-Authorization. Under Search: Find Outpatient Services, Find Inpatient Stays and Provider Search.

• Super Admin: Has access under Manage Member: Patient Search, Patient Roster, Submit Referral/Authorization, Submit Inpatient Pre-Authorization and Submit Claim. Under Search: Claims, Find Outpatient Services, Find Inpatient Stays and Provider Search.