ProviderConnect Claims. March 2017
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- Delilah Hardy
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1 ProviderConnect Claims March 2017
2 Agenda ProviderConnect Advantages Claims Process Improvement How to Access ProviderConnect Direct Claim Submission Batch Claim Submission Claim Search Reprocessing a Claim EAP Case Activity Form Submission Viewing Provider Summary Vouchers 2
3 ProviderConnect Advantages 3
4 Services Verify member benefits and eligibility View and print forms Request and view authorizations Download and print authorization letters Submit claims and view status Access Provider Summary Vouchers (PSV) Request payment for EAP services Submit EAP case activity forms (CAF) Submit updates to provider demographic information Submit credentialing applications Submit customer service inquiries Access ProviderConnect message center Disclaimer: Please note that ProviderConnect may look different and have different functionalities based on individual contract needs, therefore some functions may not be available or may look different for your specific contract. 4
5 Benefits Free and secure online application, available 24/7 Reduces paper files Reduces the need to call for routine information Quicker Payment Mobile device friendly Mac and Windows compatible INCREASED CONVENIENCE, DECREASED ADMINISTRATIVE PROCESSES 5
6 Electronic Claim Submission: Advantages Better, faster, and cheaper Reduces paper files Reduces labor and postage expenses Reduces potential of error or mishandling Faster claims processing improves cash flow Accepts claim files from any Practice Management System outputting HIPAA formatted 837p or 837i batch files and from EDI claims submission vendors 6
7 Claims Process Improvement Program 7
8 Claims Process Improvement Program Beacon continues to strengthen claims submission processes in order to maintain industry standards and ensure timely, efficient claims adjudication by implementing improved datadriven management techniques: Front-end Claims (Mailroom): Improving paper claims intake through transition to a centralized shared-service process. Claims mailing addresses will be changing in 2017 Paper claims will be held to the same standards as electronic claims Incomplete or incorrect claims will be rejected 8
9 Claims Process Improvement Program EDI/Data Exchange: Improving the intake and processing of electronically submitted batch claims, through the implementation of a single gateway for front-end claims intake for all Beacon submitters: New companion guides will be released for 837 and 277CA files Payment Integrity and Claims Analysis: Analyzing claims to identify payment errors: May request documentation to verify claims submissions and payment accuracy Claim adjustments will occur if overpayment is identified 9
10 Reminders When submitting any claim, be sure to complete all required fields Providers: Tips for completing the CMS-1500 or UB04 located under Administrative Forms Direct claim submission: Required fields designated with an asterisk (*) Batch claim submission: Follow the Companion Guide 10
11 E-Commerce Providers in the Beacon Health Options network are expected to electronically conduct all routine transactions, including: Submission of claims Submission of authorization requests Verification of eligibility inquiries Submission of credentialing applications Updating of provider information Electronic fund transfer 11
12 How to Access ProviderConnect 12
13 How to Access ProviderConnect 13
14 How to Access ProviderConnect Go to choose Providers and Beacon Health Options (formerly ValueOptions) Providers Click on ProviderConnect on the right side of the screen and choose the appropriate portal. 14
15 Direct Claim Submission 15
16 Direct Claim Submission Provides ability to enter a claim directly into ProviderConnect portal without using special software Expedites processing of the claim and payment Available for professional services only, not higher levels of care Recommended for providers submitting a lower volume of outpatient claims 16
17 Direct Claim Submission 17
18 Direct Claim Submission 18
19 Direct Claim Submission 19
20 Direct Claim Submission 20
21 Direct Claim Submission - COB 21
22 Direct Claim Submission 22
23 Direct Claim Submission 23
24 Summary Page 24
25 Batch Claim Submission 25
26 Batch Claim Submission Allows you to upload HIPAA 5010 compliant files directly to Beacon Expedites processing of the claim and payment Available for all levels of care Recommended for facilities and providers submitting a higher volume of claims Payer ID is FHC &Affiliates Note: Some clearinghouses may assign a separate payer ID 26
27 Batch Claim Submission 27
28 Batch Claim Submission 28
29 Batch Claim Submission 29
30 Batch Claim Submission 30
31 Batch Claim Submission 31
32 Batch Claim Submission 32
33 EDI Claims Link Free Beacon Health Options software that submits HIPAA 5010 compliant files Used only for claims submitted directly to Beacon Health Options Available for download under ECLW on our ProviderConnect page Only available for Windows platform 33
34 Additional EDI Information Beacon Health Options Companion Guide Located under Guides on the ProviderConnect page Shows Beacon s specific batch file requirements Reprocess and Voids Beacon accepts frequency indicators of original (1), replacement (7), and void (8) Corrected claims can be completed as a replacement claim Replacement and Voided claims require original claim number Payer ID FHC &Affiliates Clearinghouses may provide their own 5 digit payer ID for Beacon Health Options Contact your clearinghouse to see what payer ID is needed 34
35 Claim Search 35
36 Review a Claim 36
37 Search Claims 37
38 Searching a Specific Member 38
39 Searching a Specific Member 39
40 Viewing Member Claims 40
41 Claim Search Results 41
42 Claims Summary 42
43 Service Line Detail 43
44 Correcting a Claim 44
45 Reasons to Correct a Claim Change Claim Data Incorrect diagnosis code, service date, etc. Incorrect service address Voiding one line of the claim Resubmit Previously Denied Charge Member eligibility was updated Authorization was updated Void Entire Claim Claim was entered for incorrect member Entire claim was incorrect and a new claim is needed or requested 45
46 Change/Reprocess Claim 46
47 Disclaimer 47
48 Type of Adjustment 48
49 Select Service Address 49
50 Member Search 50
51 Coordination of Benefits 51
52 Service Line Entry 52
53 Attaching an EOB 53
54 Summary Page 54
55 EAP Case Activity Form Submission 55
56 EAP Case Activity Form Submission 56
57 Authorization Search 57
58 Enter EAP CAF 58
59 Online CAF Key Points Select a Billing Type Complete all case opening questions for both interim and final billing type If Final was selected for billing type, complete all case closing questions 59
60 Summary Page 60
61 Viewing Provider Summary Vouchers 61
62 Provider Summary Vouchers 62
63 Search by Provider 63
64 Search by Check 64
65 Provider Summary Voucher Results 65
66 PaySpan Health: Electronic Funds Transfer (EFT) A tool that enables you to: Receive payments automatically Receive notifications immediately upon payment View your remittance advice online Download an 835 file to use for auto-posting purposes 66
67 Payment Stub Example Giving Value Back to the Provider
68 PaySpan Registration To register online for Electronic Funds Transfer (EFT), either Click the PaySpan link in ProviderConnect, or Visit the PaySpan Health website directly at or call Have registration code and PIN from the payment stub of a paper check handy Until successful registration with PaySpan is complete, physical checks will continue be generated Unable to locate your registration code? corporatefinance@beaconhealthoptions.com Reply will be received within three (3) business days 68
69 Additional Training Options 69
70 Helpful Resources On the provider homepage choose ProviderConnect Scroll down to find: Guides Forms Compliance Resources EDI Resources 70
71 Scheduled monthly Training Webinars Topics include: An Overview of ProviderConnect, Authorizations, and Tips and Tricks Next scheduled webinar: ProviderConnect Tips and Tricks: Thurs., 3/30/2017 at 1 p.m. ET Registration available through links in the Provider Newsletter on our Webinars page 71
72 Important Tools 72
73 How-To Video Tutorials Short Video Tutorials: 73
74 Customized Training Scheduled at your convenience Available to just one employee or your entire office Training topics are customized based on your needs, timeframes, etc. 74
75 Contact Information Website and EDI Provider Relations Beacon Health Strategies eservices Electronic Data Interchange Provider Relations Beacon Health Options (formerly ValueOptions) EDI Helpdesk Monday through Friday, 8 a.m. - 6 p.m. ET Phone: e-supportservices@beaconhealthoptions.com Provider Service Line Monday through Friday, 8 a.m. 8 p.m. ET Phone: Regional Provider Relations Team 75
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