Home Health Agency and Hospice Facility Workshops October 2015 - - PowerPoint PPT Presentation
Home Health Agency and Hospice Facility Workshops October 2015 Presented by Blue Cross and Blue Shield of Kansas Agenda Communicating with our providers BCBSKS Website Availity Web Portal Provider Manual Member ID Card
BCBSKS Website Availity Web Portal Provider Manual Member ID Card
Home Health Agencies Hospice Agencies
Liaison between the provider and BCBSKS Manage facility contracts Provide Training and Education Communication Provider Inquiries
Provider Types:
Ambulatory Surgery Centers (ASCs) Birthing Centers Dialysis Centers Home Health Agencies Hospice Facilities Hospitals (Acute, Rehab, Psych, Military and VA) Substance Abuse
Director – Angie Strecker Manager – Teresa Van Becelaere Provider Consultants:
Janne Denton – Topeka – Ancillary Provider Cindy Garrison – Topeka – Northern KS Hospitals Sally Stevens – Wichita – Southern KS Hospitals
Education and Communication Coordinator – Connie Winkley Provider Program Specialist – Brent Matile
Claims Research Analyst – Katie Dennison Support Staff:
Administrative Coordinator – Topeka – Dona Hewes Administrative Assistant – Topeka - Melanie Moriarty Administrative Assistant – Wichita – Kristi Donelan
Website tools and resources One-on-one provider consultant visits Inquiries by:
Mail Email Phone
Includes information for providers that which
eNews – Primary means of communication for
Accessible only by logging onto the Availity Web Portal Some of the secure information found on BlueAccess include:
Remittance Advice Institutional Provider Manual Patient ID (BCBSKS Member) Search Pre-Service Review Institutional Providers General Polices and
BCBSKS moved secure information to Availity in August 2013 Information found on the Availity Web Portal include :
BCBSKS Member Eligibility and Benefits BCBSKS Member Claims Status
Requires secure log in and access is granted from the
Several payers use Availity, including CMS/Medicare
Provides important information that healthcare providers need to
know to submit a claim.
Front of card contains information on the type of coverage and a
brief description of the out-of-pocket amounts.
Back of the card contains information on plan contact numbers and
mailing address and the plan's website.
Are for identification purposes only; they do not guarantee eligibility
eligibility for BCBSKS members on the Availity web portal.
BCBSKS Members receive an updated ID card whenever their benefits
change or BCBSKS information on the card changes.
Includes a 3-character alpha prefix, plus a 9-digit
Current On and Off Exchange BCBSKS member alpha-prefix and description
Alpha Prefix Network and Product Description XSA BCBSKS CAP XSB Blue Choice Small Group Off Market XSC Individual Exchange Solutions XSD BlueCap – SHOP (On Exchange) Select XSE Blue CAP – Individual On Exchange XSF Blue Choice Select Individual Off Exchange XSG SHOP Exchange Solutions XSH Blue Choice Select Small Group Off Exchange XSI Bleu Choice Individual Off Exchange XSJ BlueCap – SHOP (On Exchange) XSK BlueCap – MultiState Individual On Exchange XSL BlueCap – Individual On Exchange Select
Includes a 3-character alpha prefix, plus a 9-digit
Current On and Off Exchange BCBSKS member alpha-prefix and description
Alpha Prefix Network and Product Description
XSM Plan 65 XSQ Individual Solutions Off Exchange XSR Small Group Solutions Off XSV Value Blue ARX AirXcel HEH Harris Enterprises IPH and PHF Pizza Hut KGS OneOK KSE State of Kansas LSR Del Frisco's Restaurant Group SPA Spirit AeroSystems TOE City of Topeka
A new BCBSKS subsidiary Effective January 1, 2015 Limited network – BCBSKS' 103-county service area only!
Excludes Johnson & Wyandotte Counties in KS
Represented by an empty suitcase Sold to individuals on and off the exchange and small
group (SHOP) markets
Claims for Solutions members will have its own remittance
advice (RA)
Blue Solutions is not a traditional HMO:
Members will NOT choose a Primary Care Provider (PCP) No referral is needed for visiting a specialty provider Members have open access through the BCBSKS Blue
Providers reimbursed using Blue Choice payment rates
http://www.bcbsks.com/CustomerService/Providers/Public
http://www.bcbsks.com/CustomerService/Providers/Public
I.D. CARD NO. PATIENT NAME BCBS CLAIM NO. PROVIDER PATIENT ACCOUNT NUMBER SERVICE DATE STANDARD CODE SET O T L R D A Y S PROVIDER TOTAL CHARGE AMOUNT ALLOWED PROVIDER'S CONTRACTUAL OBLIGATION OTHER ADJUSTMT PAYER INITIATED
PATIENT RESPONSIBILITY
TOTAL AMT PAID C N T R ADJUST REASON CODE R E M A R K S TOTAL AMT NOT COVERED DEDUCTIBLE
CO-PAY AMT PATIENT OWES XSP123456789 Claim, Ima 255556300299 0000006998 0000006998 SUBTOTAL 121514 121514 92002 92015 92002 0000 0000 54.00 10.00 64.00 64.00 0.00 64.00 0.00 0.00 0.00
10.00 0.00 0.00 0.00 0.00 15.00 0.00 0.00 0.00 15.00 0.00 0.00 0.00 15.00 0.00 15.00 49.00 0.00 0.42 49.42 BC CH BC CH 1 94 97 M15 DAYS TOTAL CHARGES AMOUNT ALLOWED CONTRACTUAL OBLIGATION ADJUSTMT AMOUNT NOT COVERED DEDUCTIBLE & CO-INSUR CO-PAY PATIENT OWES AMT PAID TOTALS 64.00 64.00 0.00 0.00 0.00 15.00 15.00 49.42 CHECK NO. PAY DAY PROV. NO. 5555650035 03/06/14 555555
Claim Control Number
LLYYJJJNNNNZ-S
LL - Internal Number YY - Year JJJ - Julian Date NNNNZ - Sequential Number S - Suffix (optional)
20 – Paper claim 15 – It was received in 2015 005- It was received on January 5th 00001 – It was the first claim in the sequence
I.D. CARD NO. PATIENT NAME BCBS CLAIM NO. PROVIDER PATIENT ACCOUNT NUMBER SERVICE DATE STANDARD CODE SET O T L R D A Y S PROVIDER TOTAL CHARGE AMOUNT ALLOWED PROVIDER'S CONTRACTUAL OBLIGATION OTHER ADJUSTMT PAYER INITIATED
PATIENT RESPONSIBILITY
TOTAL AMT PAID C N T R ADJUST REASON CODE R E M A R K S TOTAL AMT NOT COVERED DEDUCTIBLE
CO-PAY AMT PATIENT OWES XSP123456789 Claim, Ima 255556300299 0000101555 00134555-0005555 0000101555 00134555-0005555 0000101555 00134555-0005555 SUBTOTAL 010314 010314 010314 80053 83036 36415 0000 0000 0000 40.00 40.00 12.00 92.00 12.39 25.18 7.60 45.17 27.61 14.82 4.40 46.83 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.39 25.18 7.60 45.17 BC BC BC 45 45 45 DAYS TOTAL CHARGES AMOUNT ALLOWED CONTRACTUAL OBLIGATION ADJUSTMT AMOUNT NOT COVERED DEDUCTIBLE & CO-INSUR CO-PAY PATIENT OWES AMT PAID TOTALS 92.00 45.17 46.83 0.00 0.00 0.00 0.00 0.00 45.17 CHECK NO. PAY DAY PROV. NO. 5555650035 03/06/14 555555 45
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