Post on 25-Mar-2019
transcript
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Provider Workshop
Training 2017
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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
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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
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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
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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/
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• When is the new system effective?
• Who do I contact for questions?
• Will my provider ID be changing?
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Provider Portal
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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
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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/
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INTRODUCTION CLAIMS PORTAL EFT
GETTING STARTED Main Functions
• Verify member eligibility and benefits • Referrals submission and inquiries • Claims status • Reports
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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
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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
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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 providerinquiries@passporthealthplan.com
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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.
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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 providerinquiries@passporthealthplan.com
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BASIC NAVIGATION – HOME PAGE
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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
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BASIC NAVIGATION – MEMBER LOCK
• Member Lock – New Feature – Located above the top navigation menu bar
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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
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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
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CLAIMS STATUS – REMITTANCE ADVICE SEARCH
Remittance Advice Search
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REFERRAL SUBMISSION Submitting an electronic referral:
1. Select the Patient drop-down from your menu bar 2. Select the Online Referral Submission option.
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REFERRAL SUBMISSION
3. Select Show Full Roster check mark box and complete appropriate member information
4. Click the Search button
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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
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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.
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REFERRAL INQUIRY
Searching previously submitted referrals:
1. Select the Patient drop-down from your menu bar
2. Select the Referral List option
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REFERRAL INQUIRY RESULTS
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REFERRAL CROSSOVER
• Referral crossover in new claims system – Yes
• Referral crossover in new portal – Dual access with Navinet
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MEMBER ELIGIBILITY AND BENEFITS Verifying member eligibility and benefits:
1. Select the Patient drop-down from menu bar, and choose member eligibility search link.
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MEMBER ELIGIBILITY AND BENEFITS Verifying member eligibility and benefits: 2. Select the Member name link
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MEMBER ELIGIBILITY AND BENEFITS
Verifying member eligibility and benefits: 3. Member Eligibility and Benefits can be validated from the Member Detail page
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REPORTS What reports are available?
– Panel Listing Reports 1. Select the Patient drop-down from your menu bar 2. Select the Panel Roster option
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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
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• 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
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Claims System
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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
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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
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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
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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
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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.
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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
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ELECTRONIC
REMITTANCE ADVICE &
ELECTRONIC FUNDS TRANSFER
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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
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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
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ERA/EFT
The Electronic Remittance Advice will look different
Activity Summary
Pending Funding
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ERA/EFT
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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)
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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
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• 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?
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WHAT’S NEXT? • Action Steps:
– Change Payer ID – Sign up with the new provider portal – Sign up for EFT/ERA
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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!