Portal Handout

Novitasphere Portal Overview

What is Novitasphere?

What is Novitasphere? o Novitasphere Portal is a free internet-based

program that offers Providers and Billing Offices access to Medicare claim related data.

o The following slides will detail the various features of the portal, to include Eligibility, Claims Inquiry, Claim Submission and Reopenings.

NOVITAS SOLUTIONS, INC. CONFIDENTIAL AND PROPRIETARY INFORMATION. Disclosure is prohibited by the Trade Secrets Act, 18 U.S.C. 1905, FOIA, 5 U.S.C 552(B), and/or 48 C.F.R. Subpart 9.5.

Benefits & Eligibility Look-up (HETS) Get Benefits and Eligibility information instantly from HETS instead

of using the IVR

Benefits and Eligibility information that will be returned: o Effective Dates o Deductible o Date of Death o Therapy Limits o Medicare Advantage Plan Information o Medicare Secondary Payer (MSP) Information o Home Health o Hospice o Preventive Services o Hospital and SNF Days o Psych Dates


Claim Summary

Provides a summary from the Multi-Carrier System (MCS)

The same information is provided on the Interactive Voice Response Unit (IVR)

Unassigned claims are not included in volume and dollar figures presented


Claim Status Page

Claim Status includes a provider summary as well as detailed information to include: o Status of the Claim o Billed and Allowed Amounts o Paid Amount o Check Number, Status of Check, Deductible and Coinsurance o Patient Paid Amount o Medigap and Crossover Information o MSP Information o Diagnosis Codes o Procedures and Modifiers o Reduction Indicators o ANSI Reason Code Narratives o LCD and NCD Information


Claim Correction

Take control of your Claim Adjustments/Reopenings o Correct any of your claims that are eligible to be adjusted online. o Visibly see that your corrections are keyed correctly. o Make desired modifications to header level or line level claim data. o If invalid data is entered into any of the modifiable fields, an error will be generated for

immediate correction.

Save time o No phone calls. o No need to complete a written reopening request. o Corrections can be made online 24 hours a day, 7 days a week.

Confirmation

o Receive an Claim Correction Confirmation the day the reopening was initiated. o A Claim Correction Confirmation will be published to the Users Mailbox detailing the

original and corrected information after the Claim Correction is submitted. o Within 48 hours of submission, you will be able to see the status of the reopening

request by performing a Claim Status inquiry on the portal. NOVITAS SOLUTIONS, INC. CONFIDENTIAL AND PROPRIETARY INFORMATION.

Disclosure is prohibited by the Trade Secrets Act, 18 U.S.C. 1905, FOIA, 5 U.S.C 552(B), and/or 48 C.F.R. Subpart 9.5.

Remittance Advices

The Requested Remittance Advice Option will return a list of available remittances

View the Remittance Advice instantly if it is less than 45 days old (i.e., from claim finalization date) in a PDF format.

The Remittance Advice will be published to the Users Mailbox the next day if greater than 45 days old in a PDF format

Choose delete if the remittance is no longer needed NOVITAS SOLUTIONS, INC. CONFIDENTIAL AND PROPRIETARY INFORMATION. Disclosure is prohibited by the Trade Secrets Act, 18 U.S.C. 1905, FOIA, 5 U.S.C 552(B), and/or 48 C.F.R. Subpart 9.5.

Claim Submission/ERA for Existing EDI Customers

The Novitasphere Portal has an option that allows a user to upload and download files using high speed internet o Allows the upload/submission of an 837 file

o Allows the download/retrieval of the TRNACK,

999, 277CA, and 835 ERA files


Claim Submission (Direct Data Entry) The Novitasphere Portal allows a user to key a claim directly into the

MCS o Save Patients information for future use

o Save Providers information for future use

o Modify and submit existing claims

o Notified via online reports if claims are accepted or rejected within 24

hours of submission

o Shorter processing times: the claim will be treated as an EDI claim instead of a paper claim, and therefore, will be processed in 14 days verses the 29 days to process a paper claim.


Frequently Asked Questions (FAQs) Question

o When will Novitasphere be available? When can we enroll? Answer

o Novitasphere is currently available to Part B JL providers only. At this time, Novitasphere is not enrolling billing services or clearinghouses. We will begin roll out to the Part B JH community in early summer.

o For information about Novitasphere, as well as instructions and forms

for enrolling, please: http://www.novitas-solutions.com/webcenter/spaces/MedicareJL/page/pagebyid?contentId=00024648

Frequently Asked Questions (FAQs)

Question o How long does it take to enroll?

Answer o Our normal form processing time is 5-10 business days. Once your

enrollment form has been processed, an email will be sent to the contact person listed, and a letter will be sent to the address on the form. Once the email/letter has been received, you may continue with the steps to have the Security Official register in IACS. IACS requests are currently being processed on average within 48 business hours.


Question o How do I access Novitasphere?

Answer o You must visit https://www.novitasphere.com. The HTTPS is a

requirement due to the PHI claim related data.


o Is portal compatible with Google Chrome and browsers other than Internet Explorer?

Answer o Yes, you must be running Internet Explorer Version 8 (or newer), Google

Chrome, Apple Safari, or Mozilla Firefox

Question o Can we enroll for Novitasphere if we currently submit through a billing

service/clearinghouse? Answer

o While we are not enrolling billing services or clearinghouses for Novitasphere at this time, providers who use a billing service or clearinghouse for EDI submissions can still enroll to utilize the features of portal! Your existing submitter setup will not be removed, and you will be asked to designate where your Electronic Remittance Advice (ERA) should go. However, you will have the opportunity to use the claim submission and ERA features of Novitasphere should you choose to.


o Can we continue our current method of file submission?

Answer o Your existing submitter setup will not be removed, and you will be asked to

designate where your Electronic Remittance Advice (ERA) should go. Ensure that you use the correct submitter ID for the method of transmittal. This information will be saved in your software.

Question

o How do we use Novitasphere with PC-ACE Pro32? Answer

o You may continue to use, or sign up to use, PC-ACE Pro32 in conjunction with Novitasphere. For information, please see our PC-ACE User Quick Steps on our website: http://www.novitas-solutions.com/webcenter/spaces/MedicareJL/page/pagebyid?contentId=00027493


o Can we still submit claims through our current setup? Are we required to use Novitasphere for claim submission and ERA if we enroll?

Answer o When enrolling, your existing submitter setup will not be affected, and

you will be asked to designate where your Electronic Remittance Advice (ERA) should go.

o Your existing non-portal submitter ID will remain set-up should you need

to use it to submit claims, or if you choose to return to dial-up or SFTP submission.

o Customers who continue to utilize Novitasphere as their main source for

claim submission will only remain linked to their non-portal submitter as long as it is considered active.


o How is Electronic Remittance Advice handled when enrolling for Novitasphere? Answer

o All Novitasphere Portal users will be set up to receive Electronic Remittance Advice through one of the following options: Provider Direct Portal Submitter ID Maintain existing ERA receiver ID setupif you are currently receiving paper

remittance, your ERA will be sent to the providers direct portal submitter ID. Also, a copy of the paper remittance can be obtained and printed through the Request Remittance Advice function in Novitasphere.

o If choosing to receive ERA through the Portal direct submitter ID, you have two

options to obtain this information: The Request Remittance Advice feature will provide users with a copy of

the Standard Paper Remittance. The Claim Submission/ERA will allow users to download the 835 file of

their Electronic Remittance Advice (ERA) for translation through their electronic software of choice.


Question o Are our ERAs available in Novitasphere if the claims were

submitted from a billing service/clearinghouse? Answer

o If you designate your ERA files to be sent to your Novitasphere direct submitter ID when enrolling, all ERAs for your organization will be available through the portal.

Question

o What is HIC number or HICN? Answer

o HIC is the patients Health Insurance Claim number


Question o What are the advantages of using Direct Data Entry (DDE) vs

uploading an 837 file? Answer

o The DDE option has some built in edits to assist in getting our claims submitted without errors. However, you can only submit one claim at a time, versus the 837 format which allows you to send multiple claims at one time.

Question o When will DDE be available?

Answer o DDE should be available with the April 28, 2014 release.


Question o Can we send Medicare secondary claims?

Answer o At this time, you cannot send Medicare secondary claims

through DDE.

Question o When will claim correction be available?

Answer o We anticipate that this feature will be available with the April 28,

2014 release.

Thank You

If interested in enrolling to take advantage of this online functionality, please contact the dedicated Novitasphere Portal Help Desk!

1-855-880-8424


Novitasphere Portal OverviewWhat is Novitasphere?Benefits & EligibilityLook-up (HETS)Claim SummaryClaim Status PageClaim CorrectionRemittance AdvicesClaim Submission/ERA for Existing EDI CustomersClaim Submission (Direct Data Entry)Frequently Asked Questions (FAQs)Frequently Asked Questions (FAQs) 1Frequently Asked Questions (FAQs) 2Frequently Asked Questions (FAQs) 3Frequently Asked Questions (FAQs) 4Frequently Asked Questions (FAQs) 5Frequently Asked Questions (FAQs) 6Frequently Asked Questions (FAQs) 7Frequently Asked Questions (FAQs) 8Frequently Asked Questions (FAQs) 9Frequently Asked Questions (FAQs) 10Thank You

Portal Handout

Documents

Transcript of Portal Handout