Maryland Medicaid ProviderConnect Claims...
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Maryland Medicaid ProviderConnect Claims 1915i April 2016 ValueOptions, Inc. is a Beacon Health Options company.
Transcript of Maryland Medicaid ProviderConnect Claims...
Maryland Medicaid ProviderConnectClaims 1915iApril 2016
ValueOptions, Inc. is a Beacon Health Options company.
Agenda
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Maryland Specific Site
Direct Claim Submission
Batch Claim Submission
Claim Search
Reprocessing a Claim
Viewing Provider Summary Vouchers and Payspan registration
Maryland specific
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To access the Maryland specific site please go to:
http://maryland.valueoptions.com/index.html
Choose Behavioral Health Providers
Maryland specific
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Choose Behavioral Health Providers Menu
Maryland specific
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Choose Provider Information from the left hand task bar
Key Components
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Key Components within Provider Information section:
• Claims/Finance
1915i Fee Schedule
• Clinical/Utilization Management
DHMH 1915(i) Program Summary
PBHS Diagnosis Codes
Claims/Finance
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Clinical/Utilization Management
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Provider Alerts
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Coordination of Benefits (COB) Provider Alerts:
January 13, 2011 – Commercial/Medicaid Coverage
• http://maryland.valueoptions.com/provider/alerts/2011/011311-Commercial-Medicaid_Coverage.pdf
(applicable to mental health only)
January 28, 2011 – Coordination of Benefits (COB) Update
• http://maryland.valueoptions.com/provider/alerts/2011/072811_Provider_Alert_COB_Update.pdf
August 15, 2011 – Provider/Consumer Eligibility Verification
http://maryland.valueoptions.com/provider/alerts/2011/081511-Consumer_Eligibility_Verification.pdf
(Copy and paste these links to your browser)
All Provider Alerts can be found at: http://maryland.valueoptions.com/provider/prv_alerts.html
How to Access ProviderConnect
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Unregistered providers can self register using a provider ID number and
clicking “Register” on the login screen.
Multiple logons available for the same assigned provider ID
Contact Information:
Beacon Health Options EDI Helpdesk
Monday through Friday, 8:00 a.m. – 6:00 p.m. ET
Phone: 888.247.9311
Email: [email protected]
Direct Claim
Submission
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ValueOptions, Inc. is a Beacon Health Options company.
Direct Claim Submission
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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
Direct Claim Submission
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Direct Claim Submission
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Direct Claim Submission
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Direct Claim Submission
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Direct Claim Submission
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Direct Claim Submission
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Summary Page
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Batch Claim
Submission
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ValueOptions, Inc. is a Beacon Health Options company.
Batch Claim Submission
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Allows you to upload HIPAA 5010 compliant files directly to Beacon
Health Options
Expedites processing of the claim and payment
Available for all levels of care
Recommended for facilities and providers submitting a higher
volume of claims
Batch Claim Submission
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Batch Claim Submission
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Batch Claim Submission
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Batch Claim Submission
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Batch Claim Submission
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Batch Claim Submission
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EDI Claims Link
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Free Beacon Health Options software that submits HIPAA 5010
compliant files
Used only for claims submitted directly to Beacon Health Options
Available for download in our “Compliance Information” section of
our Education Center
Only available for Windows platform
Additional EDI Information
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Beacon Health Options Companion Guide
• Located on the Compliance Information page
• Shows ValueOptions’ specific batch file requirements
Reprocess and Voids
• Beacon Health Options Accepts frequency indicators of Original (1), Replacement
(7), and Void (8)
Corrected claims can be completed as a replacement claim
Replacement and Voided claims require original claim number
Payer ID
• FHC &Affiliates
• Clearinghouses may provide their own 5 digit payer ID for Beacon Health Options
Contact your clearinghouse to see what payer ID is needed
Claim
Search
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ValueOptions, Inc. is a Beacon Health Options company.
Review a Claim
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Search Claims
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Searching a Specific Member
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Searching a Specific Member
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Viewing Member Claims
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Claim Search Results
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Claims Summary
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Service Line Detail
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Correcting a
Claim
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ValueOptions, Inc. is a Beacon Health Options company.
Reasons to Correct a Claim
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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
Change/Reprocess Claim
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Disclaimer
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Type of Adjustment
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Select Service Address
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Member Search
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Coordination of Benefits
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Service Line Entry
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Attaching an EOB
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Summary Page
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Viewing Provider
Summary
Vouchers
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ValueOptions, Inc. is a Beacon Health Options company.
Provider Summary Vouchers
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Search by Provider
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Search by Check
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Provider Summary Voucher Results
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Provider Summary Voucher Sample
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Electronic Funds Transfer
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The Maryland Public Behavioral Health System is requiring all
providers to receive their payments electronically. please visit
www.payspanhealth.com to complete registration
Additional
Training Options
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ValueOptions, Inc. is a Beacon Health Options company.
Helpful Resources
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On Valueoptions.com choose “Providers”
Click on “Helpful Resources” under
ProviderConnect on the right
Contact Information
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Beacon Health Options EDI Helpdesk
(ProviderConnect Technical Questions)
Monday through Friday, 8:00 a.m. - 6:00 p.m. ET
Phone: 888.247.9311
Email: [email protected]
Claims Customer Service Line
Monday through Friday, 8:00 a.m. – 6:00 p.m. ET
Phone: 800.888.1965
Provider Relations
Email: [email protected]
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Questions?
