Provider Workshop Training 2017 1 INTRODUCTION PORTAL CLAIMS - - PowerPoint PPT Presentation

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Provider Workshop Training 2017 1 INTRODUCTION PORTAL CLAIMS - - PowerPoint PPT Presentation

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Provider Workshop Training 2017 1 INTRODUCTION PORTAL CLAIMS EFT TODAYS AGENDA Passport Provider Portal (New!) Claims System (NEW PAYER ID)! ERA/EFT InstaMed (NEW!) Packet Information Title VI Fraud, Waste and

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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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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/

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INTRODUCTION CLAIMS PORTAL EFT

  • When is the new system effective?
  • Who do I contact for questions?
  • Will my provider ID be changing?
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INTRODUCTION CLAIMS PORTAL EFT

Provider Portal

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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
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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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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
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INTRODUCTION CLAIMS PORTAL EFT

OFFICE ADMINISTRATOR ROLE

  • What is an Office

Administrator?

  • How do I choose one for my
  • ffice?
  • Responsibilities of an Office

Administrator

  • Create user accounts
  • Grant access to user

accounts

  • Modify user accounts
  • Delete user accounts
  • 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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INTRODUCTION CLAIMS PORTAL EFT

BASIC NAVIGATION – HOME PAGE

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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
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INTRODUCTION CLAIMS PORTAL EFT

BASIC NAVIGATION – MEMBER LOCK

  • Member Lock

– New Feature – Located above the top navigation menu bar

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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

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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
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INTRODUCTION CLAIMS PORTAL EFT

CLAIMS STATUS – REMITTANCE ADVICE SEARCH

Remittance Advice Search

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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.

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INTRODUCTION CLAIMS PORTAL EFT

REFERRAL SUBMISSION

  • 3. Select Show Full Roster check mark box and

complete appropriate member information

  • 4. Click the Search button
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INTRODUCTION CLAIMS PORTAL EFT

REFERRAL SUBMISSION

5. Click the Select link to the left

  • f 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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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.

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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

  • ption
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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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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.

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INTRODUCTION CLAIMS PORTAL EFT

MEMBER ELIGIBILITY AND BENEFITS

Verifying member eligibility and benefits:

  • 2. Select the Member name link
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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

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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

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INTRODUCTION CLAIMS PORTAL EFT

NAVINET vs NEW PASSPORT PROVIDER PORTAL

  • Access to Navinet post 10/1/17
  • Historical Information
  • Navinet
  • Limited access until 3/31/18
  • New Passport Provider Portal
  • Full access beginning 10/1/17
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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

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INTRODUCTION CLAIMS PORTAL EFT

Claims System

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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:
  • Practice Payment Administrators
  • Internal EDI (electronic data interchange)
  • HIS (Hospital Information System) such as Epic
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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

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INTRODUCTION CLAIMS PORTAL EFT

CLAIMS SYSTEM

  • You will still call the same

phone number for claims questions

  • 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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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

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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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INTRODUCTION CLAIMS PORTAL EFT

ELECTRONIC REMITTANCE ADVICE & ELECTRONIC FUNDS TRANSFER

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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

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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:
  • 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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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
  • r provider’s clearinghouse of choice)
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INTRODUCTION CLAIMS PORTAL EFT

Outbound Communication Channels

  • You may receive a number of communications from InstaMed

to assist you:

  • Direct Mail
  • Phone Calls
  • Emails
  • Fax
  • Website
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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?

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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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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!