Provider Workshop Training -...
Transcript of Provider Workshop Training -...
1
Provider Workshop
Training 2017
2
INTRODUCTION CLAIMS PORTAL EFT
TODAY’S AGENDA
• Passport Provider Portal (New!) • Claims System (NEW PAYER ID)! • ERA/EFT InstaMed (NEW!) • Packet Information
– Title VI – Fraud, Waste and Abuse – FAQs – Quick Reference – Checkpoint Questions – 2017 FACT SHEET
3
INTRODUCTION CLAIMS PORTAL EFT
MIGRATION TO A NEW MEDICAL INFORMATION MANAGEMENT SYSTEM
• Continuous improvement toward value-based delivery of Medicaid Managed Care
• Operational changes to enhance provider experience with stronger Service Level Agreements
4
INTRODUCTION CLAIMS PORTAL EFT
WHAT’S CHANGING? • New Payer ID 61325 • New Provider Portal • New EFT/ERA: InstaMed • Passport Provider ID’s – new NPI based system • PCP Assignments
– Group level
• PCP Panel Status and Limitations – Group level
• WHEN? 10.1.17
5
INTRODUCTION CLAIMS PORTAL EFT
EDUCATIONAL OPPORTUNITIES eNews and Direct Mail
•New Claims System •New Provider ID •New Portal •New EFT Vendor
Online Information
•Self-registration for Portal Account Set-up
•eNews posted •PowerPoint Presentation
Lunch and Learn
Workshops
• 11 Statewide Workshops per Region (invitations sent to each office and online registration)
• 2 Webinars
Personal Presentations
•Personal Outreach with Provider Relations Specialists
OCTOBER 1
• CLAIMS SYSTEM GO LIVE DATE
Provider Services (800) 578-0775 Available Monday through Friday, between 8 a.m. and 6 p.m. (EDT)
Provider Relations Specialists http://passporthealthplan.com/providers/contact-providers-and-services/
6
INTRODUCTION CLAIMS PORTAL EFT
• When is the new system effective?
• Who do I contact for questions?
• Will my provider ID be changing?
7
INTRODUCTION CLAIMS PORTAL EFT
Provider Portal
8
INTRODUCTION CLAIMS PORTAL EFT
NEW PASSPORT PROVIDER PORTAL
• Getting Started • Portal Improvements • Administrator vs. User • Basic Navigation • Claims Status • Referrals Submission and
Inquiry • Member Eligibility and
Benefits • Reports Available
9
INTRODUCTION CLAIMS PORTAL EFT
GETTING STARTED
• New portal name – Passport Provider Portal
• Accessing the new portal – Passport website:
http://passporthealthplan.com/providers/provider-portal/ – Direct URL: https://phkyportal.valence.care/
10
INTRODUCTION CLAIMS PORTAL EFT
GETTING STARTED Main Functions
• Verify member eligibility and benefits • Referrals submission and inquiries • Claims status • Reports
11
INTRODUCTION CLAIMS PORTAL EFT
PORTAL IMPROVEMENTS
What are some improved features of the new portal? • Panel roster reports • Verify member eligibility for multiple members at a time • Historical member eligibility & PCP assignments available • Referrals limitations • Address indicators from the DMS file will be present • Diagnosis List – search ICD codes • Procedure List – search procedure codes
12
INTRODUCTION CLAIMS PORTAL EFT
OFFICE ADMINISTRATOR ROLE • What is an Office
Administrator? • How do I choose one for my
office? • Responsibilities of an Office
Administrator o Create user accounts o Grant access to user
accounts o Modify user accounts o Delete user accounts o Unlock user accounts
13
INTRODUCTION CLAIMS PORTAL EFT
OFFICE ADMINISTRATOR SET-UP
Passport can assist you in setting up your Office Administrator account.
Step 1: Go to http://passporthealthplan.com/providers/new-claims-system/ Step 2: Complete the fillable form, check Office Administrator box. Step 3: Email the form to [email protected]
14
INTRODUCTION CLAIMS PORTAL EFT
OFFICE USER ROLE
• What is an Office User?
• Multiple user accounts allowed within one practice.
• User accounts can view information within the portal
• Passport can assist you in setting up your Office Administrator account.
15
INTRODUCTION CLAIMS PORTAL EFT
OFFICE USER SET-UP
• Passport can assist you in setting up your Office User accounts.
Step 1: Go to http://passporthealthplan.com/providers/new-claims-system/
Step 2: Complete the fillable form, check Office User box.
Step 3: Email the form to [email protected]
16
INTRODUCTION CLAIMS PORTAL EFT
BASIC NAVIGATION – HOME PAGE
17
INTRODUCTION CLAIMS PORTAL EFT
BASIC NAVIGATION – TOP NAVIGATION MENU BAR
• Home • Claims
• Claims Status List • Remittance Advice Search
• Patient • Online Referral Submission • Referral List • Member Eligibility Search • Panel Roster
• Tools & Resources • Inbox • Diagnosis List • Procedure List • Provider List
• Office Administration • User Profile • Access Other Offices
18
INTRODUCTION CLAIMS PORTAL EFT
BASIC NAVIGATION – MEMBER LOCK
• Member Lock – New Feature – Located above the top navigation menu bar
19
INTRODUCTION CLAIMS PORTAL EFT
CLAIMS STATUS – CLAIMS STATUS LIST PAGE
Searching previously submitted claims:
1. Select the Claims drop-down from your menu bar
2. Select the Claim Status List option
• Input search criteria to populate values in the Results section
20
INTRODUCTION CLAIMS PORTAL EFT
CLAIMS STATUS – RESULTS PAGE
3. Select the Claim number link to view the Claim Detail page 4. Select the View EOB link to view the Explanation of Benefits
21
INTRODUCTION CLAIMS PORTAL EFT
CLAIMS STATUS – REMITTANCE ADVICE SEARCH
Remittance Advice Search
22
INTRODUCTION CLAIMS PORTAL EFT
REFERRAL SUBMISSION Submitting an electronic referral:
1. Select the Patient drop-down from your menu bar 2. Select the Online Referral Submission option.
23
INTRODUCTION CLAIMS PORTAL EFT
REFERRAL SUBMISSION
3. Select Show Full Roster check mark box and complete appropriate member information
4. Click the Search button
24
INTRODUCTION CLAIMS PORTAL EFT
REFERRAL SUBMISSION 5. Click the Select link to the left
of the appropriate members name
6. Select the appropriate provider record from the Provider Last Name drop-down in the Referring Provider Information section
7. Search (and select) the appropriate provider from the Refer to Provider Information section
25
INTRODUCTION CLAIMS PORTAL EFT
REFERRAL SUBMISSION 8. Enter any other necessary information
9. Select the Review button
10. Confirm information is accurate and select the Submit button to complete your request and receive a system generated Referral number.
26
INTRODUCTION CLAIMS PORTAL EFT
REFERRAL INQUIRY
Searching previously submitted referrals:
1. Select the Patient drop-down from your menu bar
2. Select the Referral List option
27
INTRODUCTION CLAIMS PORTAL EFT
REFERRAL INQUIRY RESULTS
28
INTRODUCTION CLAIMS PORTAL EFT
REFERRAL CROSSOVER
• Referral crossover in new claims system – Yes
• Referral crossover in new portal – Dual access with Navinet
29
INTRODUCTION CLAIMS PORTAL EFT
MEMBER ELIGIBILITY AND BENEFITS Verifying member eligibility and benefits:
1. Select the Patient drop-down from menu bar, and choose member eligibility search link.
30
INTRODUCTION CLAIMS PORTAL EFT
MEMBER ELIGIBILITY AND BENEFITS Verifying member eligibility and benefits: 2. Select the Member name link
31
INTRODUCTION CLAIMS PORTAL EFT
MEMBER ELIGIBILITY AND BENEFITS
Verifying member eligibility and benefits: 3. Member Eligibility and Benefits can be validated from the Member Detail page
32
INTRODUCTION CLAIMS PORTAL EFT
REPORTS What reports are available?
– Panel Listing Reports 1. Select the Patient drop-down from your menu bar 2. Select the Panel Roster option
33
INTRODUCTION CLAIMS PORTAL EFT
NAVINET vs NEW PASSPORT PROVIDER PORTAL
• Access to Navinet post 10/1/17
• Historical Information o Navinet
o Limited access until 3/31/18
o New Passport Provider Portal o Full access beginning 10/1/17
34
INTRODUCTION CLAIMS PORTAL EFT
• What is an Office Administrator for the provider portal? • Can we set-up multiple users on the new provider portal? • Will Passport set-up an account for me in the new portal prior
to 10/01/17? User Name and Password will be emailed to you after 9.15.17
35
INTRODUCTION CLAIMS PORTAL EFT
Claims System
36
INTRODUCTION CLAIMS PORTAL EFT
CLAIMS SYSTEM – PAYER ID Passport Health Plan’s new Payer ID is 61325. • Please let your internal systems know of this change:
o Practice Payment Administrators o Internal EDI (electronic data interchange) o HIS (Hospital Information System) such as Epic
37
INTRODUCTION CLAIMS PORTAL EFT
CLAIMS SYSTEM - TRANSITION
• The transition to a new claims payment system is intended to better serve you: – Quicker turnaround times – Quicker system changes – Local support
• DOS prior to 10/1/17 – Use Payer ID 61129
• DOS on or after 10/1/17 – Use Payer ID 61325
38
INTRODUCTION CLAIMS PORTAL EFT
CLAIMS SYSTEM
• You will still call the same phone number for claims questions o Provider Claims Service
Unit at (800) 578-0775 • This claims system change
will not impact behavioral health, dental, vision, pharmacy claims, or Passport Advantage
39
INTRODUCTION CLAIMS PORTAL EFT
CLAIMS SYSTEM – PAPER CLAIMS
• Where will I submit paper claims and appeals?
– Claims: Passport Health Plan PO Box 7114 London, KY 40742
– For Appeals, you may also fax to: (502) 585-8339
40
INTRODUCTION CLAIMS PORTAL EFT
CLAIMS SYSTEM – CORRECTED CLAIMS
• For DOS on or before 9/30/17 corrected claims must be submitted within two years of the last process date of the original claim.
41
INTRODUCTION CLAIMS PORTAL EFT
CLAIMS SYSTEM – ELECTRONIC CLAIMS
• Who do I contact if I have issues with electronic claims? – Please call Change Healthcare/Emdeon at (877) 234-4275
• Will Passport’s EDI department information change? – No
• There will be no more Passport unique provider ID’s – The new system will be NPI based
• Inpatient claims with DOS spanning before and after 10/1 – Claims should be submitted using the new payer ID
42
INTRODUCTION CLAIMS PORTAL EFT
ELECTRONIC
REMITTANCE ADVICE &
ELECTRONIC FUNDS TRANSFER
43
INTRODUCTION CLAIMS PORTAL EFT
Will ERA/EFT change? • Claims will still be submitted to Change Healthcare (formerly
Emdeon) through your clearinghouse, however InstaMed will be responsible for EFT payment transactions.
• Action Required- Contact practice management, EDI and/or HIS to set up new Payer ID 61325.
Will I need to set-up a new EFT account with InstaMed? • Yes
ERA/EFT
44
INTRODUCTION CLAIMS PORTAL EFT
ERA/EFT
How do I set up a new EFT with InstaMed?
• You will get a letter and/or phone call from InstaMed about how to set up an account.
• You can self-register now: o www.instamed.com/eraeft
45
INTRODUCTION CLAIMS PORTAL EFT
ERA/EFT
The Electronic Remittance Advice will look different
Activity Summary
Pending Funding
46
INTRODUCTION CLAIMS PORTAL EFT
ERA/EFT
47
INTRODUCTION CLAIMS PORTAL EFT
What are the benefits to InstaMed?
• New, free solution to accelerate payments
• Easy to enroll, easy to use, free training
• No high costs and manual processes
• Direct deposit with ERA re-association
• Email notification of payment
• Access secure portal to view all remittance and transaction detail
• Auto post 835 to PMS/EHR via sFTP delivery (through InstaMed or provider’s clearinghouse of choice)
48
INTRODUCTION CLAIMS PORTAL EFT
Outbound Communication Channels
• You may receive a number of communications from InstaMed to assist you:
o Direct Mail
o Phone Calls
o Emails
o Fax
o Website
49
INTRODUCTION CLAIMS PORTAL EFT
• Do I have to change my Payer ID? • What is Passport’s new electronic Payer ID? • What is the name of Passport’s new ERA/EFT vendor? • Will there be a new address to submit paper claims and
appeals?
50
INTRODUCTION CLAIMS PORTAL EFT
WHAT’S NEXT? • Action Steps:
– Change Payer ID – Sign up with the new provider portal – Sign up for EFT/ERA
51
INTRODUCTION CLAIMS PORTAL EFT
THANK YOU!
• For questions, please contact our Provider Services Department at (800) 578-0775.
• You may also contact your Provider Relations
Representative for training and assistance!