Provider Workshop Training

Transcription

1 Provider Workshop Training

2 TODAY S AGENDA Passport Provider Portal (New!) Claims System (NEW PAYER ID)! ERA/ InstaMed (NEW!) Packet Information Title VI Fraud, Waste and Abuse FAQs Quick Reference Checkpoint Questions 2017 FACT SHEET 2

3 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 3

4 WHAT S CHANGING? New Payer ID New Provider Portal New /ERA: InstaMed Passport Provider ID s new NPI based system PCP Assignments Group level PCP Panel Status and Limitations Group level WHEN?

5 EDUCATIONAL OPPORTUNITIES enews and Direct Mail Online Information Lunch and Learn Workshops Personal Presentations OCTOBER 1 New Claims System New Provider ID New Portal New Vendor Self-registration for Portal Account Set-up enews posted PowerPoint Presentation 11 Statewide Workshops per Region (invitations sent to each office and online registration) 2 Webinars Personal Outreach with Provider Relations Specialists SYSTEM GO LIVE DATE Provider Relations Specialists Provider Services (800) Available Monday through Friday, between 8 a.m. and 6 p.m. (EDT) 5

6 When is the new system effective? Who do I contact for questions? Will my provider ID be changing? 6

7 Provider Portal 7

8 NEW PASSPORT PROVIDER Getting Started Portal Improvements Administrator vs. User Basic Navigation Claims Status Referrals Submission and Inquiry Member Eligibility and Benefits Reports Available 8

9 GETTING STARTED New portal name Passport Provider Portal Accessing the new portal Passport website: Direct URL: 9

10 GETTING STARTED Main Functions Verify member eligibility and benefits Referrals submission and inquiries Claims status Reports 10

11 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 11

12 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 12

13 OFFICE ADMINISTRATOR SET-UP Passport can assist you in setting up your Office Administrator account. Step 1: Go to Step 2: Complete the fillable form, check Office Administrator box. Step 3: the form to 13

14 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. 14

15 OFFICE USER SET-UP Passport can assist you in setting up your Office User accounts. Step 1: Go to Step 2: Complete the fillable form, check Office User box. Step 3: the form to 15

16 BASIC NAVIGATION HOME PAGE 16

17 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 17

18 BASIC NAVIGATION MEMBER LOCK Member Lock New Feature Located above the top navigation menu bar 18

19 STATUS STATUS LIST PAGE Searching previously submitted claims: 1. Select the Claims dropdown from your menu bar 2. Select the Claim Status List option Input search criteria to populate values in the Results section 19

20 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 20

21 STATUS REMITTANCE ADVICE SEARCH Remittance Advice Search 21

22 REFERRAL SUBMISSION Submitting an electronic referral: 1. Select the Patient drop-down from your menu bar 2. Select the Online Referral Submission option. 22

23 REFERRAL SUBMISSION 3. Select Show Full Roster check mark box and complete appropriate member information 4. Click the Search button 23

24 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 24

25 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. 25

26 REFERRAL INQUIRY Searching previously submitted referrals: 1. Select the Patient dropdown from your menu bar 2. Select the Referral List option 26

27 REFERRAL INQUIRY RESULTS 27

28 REFERRAL CROSSOVER Referral crossover in new claims system Yes Referral crossover in new portal Dual access with Navinet 28

29 MEMBER ELIGIBILITY AND BENEFITS Verifying member eligibility and benefits: 1. Select the Patient drop-down from menu bar, and choose member eligibility search link. 29

30 MEMBER ELIGIBILITY AND BENEFITS Verifying member eligibility and benefits: 2. Select the Member name link 30

31 MEMBER ELIGIBILITY AND BENEFITS Verifying member eligibility and benefits: 3. Member Eligibility and Benefits can be validated from the Member Detail page 31

32 REPORTS What reports are available? Panel Listing Reports 1. Select the Patient drop-down from your menu bar 2. Select the Panel Roster option 32

33 NAVINET vs NEW PASSPORT PROVIDER 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 33

34 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 ed to you after

35 Claims System 35

36 SYSTEM PAYER ID Passport Health Plan s new Payer ID is 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 36

37 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 DOS on or after 10/1/17 Use Payer ID

38 SYSTEM You will still call the same phone number for claims questions o Provider Claims Service Unit at (800) This claims system change will not impact behavioral health, dental, vision, pharmacy claims, or Passport Advantage 38

39 SYSTEM PAPER Where will I submit paper claims and appeals? Claims: Passport Health Plan PO Box 7114 London, KY For Appeals, you may also fax to: (502)

40 SYSTEM CORRECTED 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. 40

41 SYSTEM ELECTRONIC Who do I contact if I have issues with electronic claims? Please call Change Healthcare/Emdeon at (877) 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 41

42 ELECTRONIC REMITTANCE ADVICE & ELECTRONIC FUNDS TRANSFER 42

43 ERA/ Will ERA/ change? Claims will still be submitted to Change Healthcare (formerly Emdeon) through your clearinghouse, however InstaMed will be responsible for payment transactions. Action Required- Contact practice management, EDI and/or HIS to set up new Payer ID Will I need to set-up a new account with InstaMed? Yes 43

44 ERA/ How do I set up a new 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 44

45 ERA/ The Electronic Remittance Advice will look different Activity Summary Pending Funding 45

46 ERA/ 46

47 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 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) 47

48 Outbound Communication Channels You may receive a number of communications from InstaMed to assist you: o Direct Mail o Phone Calls o s o Fax o Website 48

49 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/ vendor? Will there be a new address to submit paper claims and appeals? 49

50 WHAT S NEXT? Action Steps: Change Payer ID Sign up with the new provider portal Sign up for /ERA 50

51 THANK YOU! For questions, please contact our Provider Services Department at (800) You may also contact your Provider Relations Representative for training and assistance! 51