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Provider Portal A How-To Guide for Using Your Online Resources AINPEC-0858-16 August 2016
Provider Portal
A How-To Guide for Using Your Online Resources
AINPEC-0858-16 August 2016
TABLE OF CONTENTS Select a link below to view the instructions
Register 4 …………………………………………………………………………………….….. Logging In 5 ……………………………………………………………………………………………………………… .…..
Resetting Your Password 6 ………………………….……………………………………………………….… …….
About DentaQuest 7 ……….………………………………………………………………………………………..….
Home 8 ……………………………………………………………………………………………. My Account 9 ……………………………………………………………………………………………..…………….…..
Message Center 10…………………………………………………………………………………………..……………...
Send a Message 11………………………………………………………………………………………………..
Provider Administration 12 …………………………………………………………….…. Manage Users 12………………………………………………………………………………………………………….….
Search Users 12 …………………………………………………………………………………………………….
Edit Users 13…………………………………………………………………………………………………………
Add Users 14…………………………………………………………………………………………………………
Billed Amount List 15………………………………………………………………………………………………………..
Amount List Associations 16………………………………………………………………………………..………….
Electronic Funds Transfer 18……………………………………………………………………………………………
Fee Schedule 19 ………………………………………………………………………………………………………………
Dental Information 20 …………………………………………………………………………
Patient Management 21………………………………………………………………….... Member Eligibility 21 ……………………………………………………………………………………………………….
Member Detail 23 ……………………………………………………………………………………………………………
POWER Account 25……………………………………………………………………………. Debit Submission 25 ……………………………………………………………………………………………………….
Debit Search 29 ……………………………………………………………………………………………………………….
Claims/Preauthorization 30 ………………………………………………………….…… Submit Claims and Pre-Authorizations 30 …………………………………………………………………………
Search Claims and Pre-Authorizations 32 ………………………………………………………………………….
Claims Confirmation Report 33………………………………………………………………………………………..
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TABLE OF CONTENTS Select a link below to view the instructions
Referrals 34 …..…………………………………………………………………………………... Manage Referrals 34 ..………………………………………………………………………………….…………………..
Search Referrals 35 ..…………………………………………………………………………………………………………
Referral Confirmation Report 36..……………………………………………………………………………………..
Explanation of Benefits 37 ………………………………………………………………….
Document List 38 ……………………………………………………………….………………
Find a Dentist 39 ..………………………………………………………………………………
Contact Us 40 ……………………………………………………………………………………..
Event Calendar 41………………………………………………………………………………
Health News 42 ………………………………………………………………………………….
FAQ 43 ………………………………………………………………………………………..……..
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HOW TO Register for the Portal
STEP 1 In your browser, go to https://provider.dentaquest.com and click on the Register button. The only way to self-register for the Portal is as a Super User. In order to do this, you will need to have information both about the business office and specific details on at least one of the Providers at that office. Complete all of the required information on the registration page and click REGISTER. If all of the information is correct, you will receive a “Registration Successful” notification. You will then have Tier 1 or Super User access, which can be used to add all further users in the system.
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HOW TO Login to the Portal
STEP 1
In your browser, go to https://provider.dentaquest.com and click on the SIGN IN button.
STEP 2
Enter the email address used to register, or that was used by your Administrator to create your login. Enter your password and click Login.
Insert screenshot
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HOW TO Reset a Password
STEP 1
If you’ve forgotten your password, click on the “Forgot password?” link right above the SIGN IN button. Enter the email used to register for the Portal.
STEP 2Go to your email inbox, click on the link, and update your password as directed.
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HOW TO Learn more About DentaQuest
STEP 1
Click on “About DentaQuest” on the login page. This will direct you to our corporate website, where you can read more about DentaQuest.
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HOW TO Navigate the Home Screen
Home ScreenYour primary menu is down
the left hand side bar. Click Home to return to this screen at any time.
See page 19 for information
on checking what information we have on
file for your business and staff.
See page 12 for information
on adding and managing users of this Portal.
See page 32 for information on searching Claims and Pre-
Authorizations.
To access the Message Center click here or here.
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HOW TO Update My Account
STEP 1
Click on “My Account”
STEP 2 Type the updated email and/or name, then click “UPDATE INFORMATION.” Click on the “UPDATE PASSWORD” or “UPDATE USER PROFILE” to update either of those items.
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HOW TO Access the Message Center
STEP 1
Click on “Go to Message Center” or on the envelope icon in the top right corner.
STEP 2 Any messages from DentaQuest or other Providers will show who they are from, the message itself, and the date it was created.
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HOW TO Send a New Message
STEP 1
Click on the SEND NEW MESSAGE button.
STEP 2
Communicate directly with other providers by sending them a message. A message can be sent to any Provider that is registered with the DentaQuest Provider Portal. You are also able to attach documents or files to be sent securely with your message. In order to send a message, you will need to know the other provider’s Individual NPI number.
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HOW TO Manage Users
STEP 1
Clicking on the Manage Users button on the home screen will take you to the same page as clicking on Provider Administration > Manage Users. Only Tier 1 users (super users) will be able to Manage Users. To search for a specific user, enter their information in the search fields.
Alternatively, leave the fields blank and hit SEARCH. This will return a search result list displaying all users.
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HOW TO Edit Users
STEP 1
After searching for a user, click on their name.
STEP 2
This will bring up the Edit User screen, where you can change permission levels, email address, location, or lock or disable the account.
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HOW TO Add a New User
STEP 1
Anyone with an Administrator, or ‘Super User’, User Role for your organization will be able to manage and add additional users to your Portal. To add a new user, click on ADD NEW USER.
STEP 2
Fill in the name, email address,and level of access desired.
User Role: this specifies if a user has Read Only or View All access. Tier: Tier 1 means the user will be able to interact with information from all office locations, users, and providers under your business. Tier 2 users can interact with all information, users, and providers for a specific office location. Tier 3 (Provider) allows a provider to interact with all information pertinent to themselves at any office location they are registered with. Permissions: Select the permissions this user should have, such as Manage Users, View Claims, and View EOB. A Tier 1 user defaults to having all of the permissions enabled. Once added successfully, you will receive a ‘Success!’ message before being automatically sent to the Manage Users screen.
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HOW TO Create a Billed Amount List
STEP 1
Provider offices have the ability to store billed amounts by procedure codes. This will result in faster and easier online claim submission. To created a new Billed Amount List, click on the ADD button.
STEP 2
First, name the new Billed Amount List. Next, click on the Billed Amount List Name to open the Billed Amount Detail page. To associate this Billed Amount List to a service office or provider, choose ADD BILLED AMOUNT ASSOCIATION. To add procedure codes and amounts, choose ADD BILLED AMOUNT DETAIL.
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HOW TO Add Associations and Details
STEP 1 – Billed Amount List Association
Connect this Billed Amount List to a specific Service Office and Provider combination by choosing an available facility from the dropdown list, then searching for a Provider associated to that location.
STEP 2 – Billed Amount List Detail
Add a Procedure Code and the Billed Amount for this Procedure. A description of the Procedure will auto-populate in the description field. Click ADD.
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HOW TO Assign Billed Amount Lists
STEP 1
Assign Billed Amount Lists to an office or office / dentist combination.
Click on ADD BILLED AMOUNT ASSOCIATION. Choose a list, Service Office, and/or Provider combination. Click ADD.
STEP 2
By leaving all fields blank and hitting SEARCH from the Amount List Associations page, you will be able to see a list of all Billed Amount List Associations that have been created.
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HOW TO Manage Electronic Funds Transfer
STEP 1
From this page, you can enroll in Electronic Funds Transfer (EFT), change your existing enrollment, or cancel your enrollment. Fill out all of the required fields (indicated with a red asterisk*). Once all fields have been completed, click REVIEW. Check for accuracy, then click CONFIRM.
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HOW TO View a Fee Schedule
STEP 1 Select the Date of Service, Fee Schedule Type, and Network for which you would like to see a fee schedule. Click SEARCH.
STEP 2
The search results will show you the details of all procedures and associated information.
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HOW TO Use the Search Dentist List
STEP 1
The Dental Information tool is for checking the credentialing and contact information for locations and dentists specific to this login, based on Tax ID number.
To search for a specific location or dentist, enter as much information as possible in the search fields. To search for all associated locations and dentists, leave the search fields blank and click on SEARCH. If any information needs to be updated, use the Contact Us form to submit updated details.
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HOW TO Check Member Eligibility
STEP 1 Enter the Member’s Service Date (date on which they received treatment), their Date of Birth, and either Member ID or Member Last Name.
STEP 2 Repeat the above step on this same screen to search eligibility for multiple Members at the same time. If more search lines are needed, click “+ ADD ADDITIONAL SEARCH LINES”. When all Members are entered, click on the SEARCH button. You can search for up to 30 members at a time.
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HOW TO Check Member Eligibility
STEP 3 Search results will return in three sections: Active, Inactive, and Not Found.
If a member is not found based on your search information, this could mean that they are not in the system, or that there was more than one member found with matching information (such as matching Service Date, Date of Birth, and Last Name). You can SEARCH AGAIN and add more information, such as first name or member Number.
STEP 4 It is possible to save the search list for later use, as in the case of searching for all appointments scheduled for tomorrow. Simply click on SAVE SEARCH. Saved searches will display at the bottom of the Member Eligibility page. Click LOAD SEARCH to re-populate the search fields with all previously entered data. You will need to re-select the Location and Provider field manually.
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TIP: The Benefit Effective Date for members will display in the eligibility Search Results.
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HOW TO Check the Member Detail Screen
STEP 1 From the Member Eligibility Search Results screen, click on the Member Number.
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STEP 2 Clicking on the Member Number will open Member Detail screen. This provides information regarding the member, including contact information, claims and service history. Clicking on the Power Account button here will auto-fill all of this member’s information on the POWER Account Debit Submission page.
TIP: The Benefit Effective Date for members will display in the Member Detail screen.
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HOW TO Check the Member Detail Screen
STEP 3 Additional information regarding the member can be found further down the page.
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HOW TO Make a Debit Submission
STEP 1 For Anthem Blue Cross and Blue Shield (Anthem) members only, use the POWER Account feature to quickly and easily submit a debit transaction. From the Member Detail page, click on the POWER Account button to auto-complete the Debit Submission page. Alternatively, navigate to the Debit Submission page using the left hand menu. Begin filling out all of the required information, denoted by an asterisk.
STEP 2 Enter information for the provider. Users only have access to enter providers under their security model. As each section is completed with correct information, the header will change to green.
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STEP 3
Date of Birth, Group ID, and either Member Number or First and Last Name are required to search. However, adding more data points will ensure better results.
HOW TO Make a Debit Submission
STEP 4
Choose the member’s network; if only one network exists, it will be automatically selected. The member’s current balance will also display in this area.
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STEP 5
Add Procedure Codes to get the estimated cost. If tooth location is required to get the proper fee schedule, the user will be required to enter that information.
STEP 6 The user can then generate a cost estimation letter and/or submit a debit transaction. The debit transaction will send a message to the Anthem API and add a record in the DentaQuest system for reconciliation.
HOW TO Make a Debit Submission
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HOW TO Generate an Estimate Letter
STEP 1 Click on the Generate Letter button. The letter will be automatically downloaded to the computer as a .PDF file.
An example of an Estimate Letter:
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HOW TO Conduct a Debit Search
STEP 1 Enter at least one search criteria, such as Service Office, in order to search for previously submitted POWER Account Debit Transactions. The more data points that are entered in the search fields, the more specific the Search Results will be.
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HOW TO Submit Claims/Pre-Authorizations
STEP 1
To submit a Claim or Pre-Authorization, enter the relevant information and click SEARCH. This will confirm the Member’s eligibility.
STEP 2
The Optional Information section mirrors standard language on the ADA claim form. These fields are not required, but are present for those providers that want to include the additional detail.
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HOW TO Submit Claims/Pre-Authorizations
STEP 3 After entering all basic information about the claim and determining Member eligibility, add individual line items to your claim. This is done by entering Procedure Codes that were created as Billed Amount Lists, as well additional information about the tooth or teeth serviced. You can also attach supporting documents directly to the Claim.
STEP 4 Once the Claim is submitted, you will receive a confirmation and the Claim Number.
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HOW TO Search Claims/Pre-Authorizations
STEP 1
Clicking on the Claims and Referrals button from the Home screen will bring you to the Search Claims and Pre-Authorizations page. Enter the relevant information and click Search. Alternatively, simply choose either Dental Claim or Pre-Authorization and hit SEARCH to see all results for either category.
Search results will display information about the Claim or Pre-Authorization, including the date received and the amount paid.
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HOW TO View a Claims Confirmation Report
STEP 1 As an administrative function, some Providers like to print out copies of submitted claims to place in patients’ files. To get a Dental Claim Confirmation Report, select the Service Office, Treating Dentist, and what type of submission was made. The report can be sorted either by Member ID or Member Last Name.
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HOW TO Manage Referrals
STEP 1
Verify the Member’s eligibility prior to submitting a referral to another Provider.
STEP 2
Select the specialty of the Provider you are referring the Member to, the type of referral (Standard, Urgent, Emergency), provide any additional information in the text field, and attach any documentation that would be beneficial for the next Provider.
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HOW TO Search Referrals
STEP 1 In order to search past referrals, fill in as much information as possible to locate a specific Referral, or leave most fields blank to see a list of all Referrals made. As a minimum, choose at least one data point to search for, such as Referring Service Office or Referring Dentist.
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HOW TO View a Referral Confirmation Report
STEP 1 In order to see a Dental Referral Confirmation Report, fill in information to narrow the scope of the report, or fill in only the Service Office to see a full report for that location.
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HOW TO Search Explanation of Benefits
STEP 1 You are able to look up past payments using the check or deposit number, Payer Name, Payee Name, or you can opt to see all payments for a given date range. The last eighteen months’ worth of records will be available.
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HOW TO View your Document List
STEP 1 Your Document List contains items that DentaQuest has attached for your reference.
Leave all fields blank and click SEARCH to see a list of all documents.
Alternatively, add more information to the search fields to narrow your results, such as searching by category of document.
STEP 2
Search results display the title of the document, the date it was uploaded, category of document, and a brief description. Click “DOWNLOAD” to download the document and read it.
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HOW TO Find a Dentist
STEP 1 Begin the search for a Dentist by choosing to search either by Plan or by Member.
STEP 2
Enter further search criteria, including Zip Code and search radius. Additional search details to narrow the results are optional.
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HOW TO Contact DentaQuest
STEP 1 To Contact DentaQuest, fill out the Contact Form, including attaching any relevant documents that would enable us to assist you more quickly. These messages are auto-assigned to the appropriate internal teams, based on the Message Type, that can best respond.
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HOW TO Use your Event Calendar
STEP 1 The Event Calendar shows all of the events that DentaQuest has shared with your organization. Click on the numbers of a given date (i.e., on the digits themselves) to see more information about the day.
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HOW TO Find articles on recent Health News
STEP 1 The Health News section contains articles and news stories that DentaQuest has found helpful and educational.
STEP 2 Click on the title to pull up the full article or news story.
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HOW TO Use the FAQ section
STEP 1 For a list of Frequently Asked Questions (FAQs), as well as their answers, click on the FAQ menu.
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