Working with Aetna Electronically Tennessee Healthcare Financial Management Association Payer summit

Transcription

1 Quality health plans & benefits Healthier living Financial well being Intelligent solutions Working with Aetna Electronically Tennessee Healthcare Financial Management Association Payer summit Nancy Yates Contract Negotiator Sara MacLeod Arena Provider e.solutions Project Manager March 27 & 28, 2017

2 Aetna Provider esolutions Responsible for Aetna's suite of electronic transactions for providers Manage and support a variety of online solutions to offer providers multiple ways of easily conducting business with Aetna Financial Ensure electronic transactions are compliant according to HIPAA and the Affordable Care Act (ACA) Provider esolutions Implement transaction enhancements and new tools Admin Clinical Promote and train users on transactions and tools 2

3 Agenda 1. Accessing Aetna Tools and Resources > Health Care Professionals Navinet Topics of discussion 3. Claims Submission, Status, Reports Tips and reminders for claims submission Claims Status Inquiry Reports Online EOB Claim Reconsideration Code Editing Tool Policy information 2. Eligibility, Precertification, and Payment Estimator Eligibility Digital Member ID Card Precertification Payment Estimator 4. Where to go for help Contact Aetna Online Navinet User Guides Free Monthly Webinars 3

4 Aetna s Health Care Professionals website

5 Aetna s secure provider website Contact:

6 Eligibility and Benefits Inquiry On the Patient Search screen: 1. Enter the Servicing Provider or Facility 2. Enter the Member ID 3. Enter the Service date 4. Click Search Click Quick Tips for assistance. For more help click Help for this screen On the Patient Search screen: 1. Enter the Servicing Provider or Facility 2. Enter the Member ID 3. Enter the Service date 4. Click Search Some ID formats (e.g , W, or badge IDs) will require additional search criteria to return result. If your Member ID search does not return results, try one of the following search criteria combinations: Last Name, First Name, and Date of Birth Member ID and Date of Birth Member ID, Last Name, and First Name

7 Eligibility Details Select next transaction Click to access digital ID card Choose benefit type Benefit information

8 Accessing online member ID cards TEST12345 TEST MEMBER TEST DEPENDENT 8

9 Precertification

10 Precertification Information

11 Payment estimating tools Determine patient responsibility Professional, outpatient and some inpatient services Commercial medical benefits plans only (not Medicare) Your fee schedule + patient s benefits plan = Aetna s estimated payment amount Patient s estimated out of pocket expense Printable information helps you initiate financial discussions with your patients. Available on: NaviNet Payment Estimator Availity CareCost Estimator 11

12 Claims

13 Claims submission reminders Get paid faster by submitting all your claims electronically. Participating and nonparticipating providers Secondary claims Corrected and voided claims Submit your claims in one of three ways: 1. Secure provider website (NaviNet) 2. Vendor 3. PNTdata (formerly Post N Track) 13

14 Claims submission reminders Coordination of benefits (COB) secondary claims Aetna secondary claims can be sent electronically. Aetna accepts Medicare Part A and Part B claims electronically. If the Medicare electronic remittance advice (ERA) or Explanation of Payment (EOP) contains an MA18 or N89 remark code, the Medicare carrier has automatically sent us the claim. For more information refer to: 14

15 Coordination of Benefits (COB) patient form Use our COB patient form to print and share with your patients. Collect and send COB data to us. Form is available on our COB page. 15

16 Claim Status Inquiry Single patient Real time response Use up to a 90 day date span Search back up to 27 months

17 Claim Status Inquiry; line level detail

18 Claim Status Report Multiple patients Use up to a 90 day date span Search back up to 27 months Semi real time Available next business day Downloadable for 5 days

19 Claims Status Report Result Claim level detail Line level detail Sort by claim status (finalized, denied, in process)

20 Claim EOB Tool available New EOBs

21 Electronic Explanation of Benefits

22 Electronic Explanation of Benefits

23 Account Management Tool Claim History Report

24 Account Management Tool Multiple Claim Reconsideration This section is prepopulated with your registration information stored on file. Aetna uses this address and contact person to correspond regarding this request.

25 Account Management Tool Multiple Claim Reconsideration

26 Fee Schedule

27 Claim Policy and Code Editing Tools

28 Code Editing Tool

29 Code Editing Tool

30 Medical Clinical Policy Bulletins Medical Clinical Policy Bulletins (CPBs) detail the services and procedures we consider medically necessary cosmetic experimental and unproven

31 Medical Clinical Policy Bulletins View an alphabetical list of claim payment and coding policies ranging from anesthesia, modifiers, surgery, eligibility of an assistant surgeon, and various code specific logic.

32 Contact us through

33 Aetna user guides

34 Self service tools and transactions Use our secure online tools and transactions to save time and money. Review our available tools at: Account management tools Claims status Claims submission Eligibility and benefits EFT and ERA enrollment Online EOBs Payment Estimator Precertification Referrals 34

35 Free Monthly Webinars Working with Aetna on NaviNet how to contact us identify our products tools and transactions registration role of the security officer Claims management tools claims status claims reports online Explanation of Benefits (EOB) statements single and multiple claims reconsiderations claim EOB Tool and ERA/EFT Precertification Precertification Code Search Tool inpatient, outpatient and behavioral health precertification precertification inquiry precertification status update 35

36 Thank you NaviNet Customer Support