Blue Cross Blue Shield Provider Resource Center Reference Guide. March 2018

Transcription

1 Blue Cross Blue Shield Provider Resource Center Reference Guide March 2018

2 Table of Contents Reference Guides Section 1: Provider Registration Section 2. System Administration Viewing users Section 3. System Administration Editing a Users Information Section 4. System Administration- Editing a Users Role Section 5: System Administration- Adding New Users Section 6: Removing Users Section 7: Member Eligibility and Benefits Section 8: Realtime Member Eligibility and Benefits Section 9: Accumulators Section 10: Realtime Accumulators Section 11: Claim Status Section 12: Realtime Claim Status Section 13: Reviewing Remittance Advices and Vouchers Section 14: National Drug Code (NDC) Tool Section 15: Clear Claims Connect (C3) Section 16: Need Help? Table of Contents 2

3 PROVIDER REGISTRATION 1. Note: Background pictures may change To start the registration process go to 1. Hover over and select Provider option to access the Provider Resource Center. 2. Select Register Now to continue the Provider registration process. It is recommended that the practice/office manager be the first to register as the Local Administrator role is automatically assigned to the first user. 2. Section 1, page 31

4 3. Only one person per office needs to complete these steps. Confirm you are the appropriate person for the Local Administrator role Section 1, page 2

5 Enter your office information and select Next. Note- Do not enter hyphens in the Tax identification number 4. Enter all required information. (The address entered is where the registration confirmation will be sent). Make note of your username and password and select Next Review your registration summary. Verify office contact and user information. Select Edit if necessary. Once completed select Finish. Section 1, page 53

6 7. Note your username and password. You WILL NOT be able to return to this page once you select Next. 8. Congratulations! You have completed your registration. Once your account is processed for approval/denial, you will be notified at the address you provided during registration. Allow 3 business days for your account to be confirmed Section 1, page 4

7 SYSTEM ADMINISTRATION- VIEWING USERS Sally Jones user Provider Sjon1 05/11/2018 confirmed M. Smith user Provider Msmi1 03/01/2018 confirmed 1358 John Smith user Provider Jsmi5 04/28/2018 confirmed 1258 Only the Local Administrator can view all users. 1. Select System Administrator 2. User Maintenance will appear which list all users associated with your Access List Section 2, page 1

8 SYSTEM ADMINISTRATION- EDITING USERS INFORMATON Only the Local Administrator can edit users 1. Select System Administrator 2. User Maintenance will appear which list all users associated with your Access List 3. Click on user Name from the User Maintenance File 4. Make appropriate changes 5. Click on Submit 4. John W. Smith American/New York Office Manager Section 3, page 1

9 SYSTEM ADMINISTRATION- EDITING USER ROLE Only the Local Administrator can edit users 1. Select System Administrator 2. User Maintenance will appear which list all users associated with your Access List 3. Click on user Name from the User Maintenance File 4. John W. Smith American/New York Office Manager Section 4, page 1

10 5. Review User Role Maintenance 6. Click on Add Choose Role from the drop down 8. Click on Select Role 9. Return to Previous Page 10. Click back onto the user from the User Maintenance List 11. Click on the Role to Remove Click Remove Section 4, page 2

11 SYSTEM ADMINISTRATION ADD USER Only the Local Administrator can add users. 1.Select System Administrator 2. Select Add User 3. Enter all required information 4. Select Add 5. Select a user role from the drop down menu ** (the user will not be added if a role is not assigned). 6. Select Submit Section 5, page 11 1

12 ADDING A LOCAL ADMINISTRASTION Only the Local Administer can add a role to an existing user. 1. Select System Administrator 2. Select User Check Local Administrator Box 4. Complete mandatory fields 5. Select Submit 12 Section 5, page 2

13 BCBSVT PROVIDER RESOURCE CENTER ROLES AND FUNCTIONALITY DESCRIPTIONS **Roles **Functions Office Manger (also Local Administrator) General Content Eligibility/Benefit Claims Inquiry System Administrator Demographic Updates AcuExchange (on-line prior approval tool) Office Manager w/o demographic updates: General Content Eligibility/Benefits Claims Inquiry System Administrator General Staff: General Content Eligibility/Benefits Claims Inquiry AcuExchange Admitting Staff: General Content Eligibility/Benefits Provider: General Content Eligibility/Benefits Claims Inquiry General Content: Resource Center Page Provider search and updates Tools and Resources Prior Authorizations Reports Eligibility and Benefits: Eligibility and Benefits Inquires Responses, including Real Time Accumulators (benefit usage) Claims Inquiries: Claim Status Inquiries and Responses, including Real Time Clear Claims Connect (C3) Authorizations System/Local Administrator: User Maintenance and Role Assignment Demographic Updates: Demographic Updates (currently not available) 13 Section 5, page 3

14 Removing Users Only the Local Administrator can remove users. 1. Select System Administrator 2. Select User 3. Check Role Box 4. Select Remove Section 6, page 14 1

15 5. Indicate Reason for Removing 6. Select Yes Section 6, page 152

16 MEMBER ELIGIBILITY AND BENEFITS For FEP, Blue Card (out of state Blue Cross Blue Shield) and the most up -to -date information for Blue Cross Blue Shield of Vermont members, see Section 6 Real Time Eligibility Search Select Eligibility/Benefits under Office Management 2. Search by patient s last and first name or Member ID Select Search Section 7, page 161

17 4. Doe, Jane Jo Smith MD Doe, Jane 145 Circle Hill Jo Smith MD 4. Select, Select to review patient effective date 5. Review Patient Information Section 7, page 17 2

18 6. Doe, Jane Joe Smith, MD 6. Select Member s Name to review detailed information 7. View the Member s Eligibility information and Benefit details, including cost-sharing details. Doe, Jane Circle Street 7. Joe Smith MD Section 7, page 183

19 8. 8. To review specific Benefit Plan information, at the bottom of the Patient information screen you will find Benefit Plan information. Joe s Small Repair H Select Health Plan Contracts for full descriptions of member s benefits. 9. Section 7, page 194

20 REALTIME BENEFIT AND ELIGIBILITY REFERENCE GUIDE Realtime Eligibility and Benefits Search: Federal Employees Program (FEP) members eligibility and benefits Blue Card Members (out of state Blue Cross Blue Shield members) eligibility and benefits The most up- to- date eligibility and benefit information for Blue Cross Blue Shield of Vermont members Select Eligibility/ Benefits under Office Management 2. Select click here to conduct a Realtime Benefit Search Section 8, page 20 1

21 3. 3. Complete all mandatory fields: Subscriber Full Name Subscriber Date of Birth 4. John Smith MD D Physician Wellness Office Visit 4. If Patient is not Subscriber complete mandatory fields: Patient Full Name Patients Date of Birth Patient ID, including Alpha-Prefix and Member Number (example R ) Requesting Provider Service Type for all benefits select General Benefits 5. Select Search 5. Section 8 page, 21 2

22 6. The Member s Eligibility/Benefit information details including costsharing details will appear 1 6. Section 8, page 223

23 ACCUMULATORS REFERENCE GUIDE For FEP, Blue Card (out of state Blue Cross Blue Shield) and the most up -to -date information for Blue Cross Blue Shield of Vermont members, see Section 8 Real Eligibility Search Select Eligibility/Benefits under Office Management 2. Search by patient s last and first name or Member ID 4. Doe, Jane Jo Smith MD 3. Select Search 4. Select, Select. 5. Patient s name should now be displayed under Patient Management as current patient. 5. Doe, Jane Section 9, page 1

24 Doe, Jane Doe, Jane Select Accumulators/Benefits 7. View Benefits and Limit Summary The benefit usage displayed on this page provides benefit limitations, deductibles and outof-pocket information which is updated every Tuesday. Note: Member accumulators will change on the first day of the group benefit effective month listed on the Benefit and Plan Limit Summary. 24 Section 9, page 2

25 REALTIME ACCUMULATORS REFERENCE GUIDE Realtime Eligibility and Benefits Search: Federal Employees Program (FEP) Blue Card Members (out of state Blue Cross Blue Shield members) Blue Cross Blue Shield of Vermont members Select Eligibility/Benefits under Office Management 2. Select click here to conduct a Realtime Benefit Search 2. Section 10, page 251

26 3. 3.Complete all mandatory fields: Subscriber Full Name Subscriber Date of Birth If Patient is not subscriber complete mandatory fields: Patient Full Name Patients Date of Birth Patient ID, including Alpha-Prefix and Member Number (example R ) Requesting Provider Service Type John Smith MD D 5. Select Search Physician Wellness Office Visit 5. Section 10, page 262

27 5. Scroll past Eligibility/Benefits to view details. Click on + to expand field to view details. 5. Section 10, page 27 3

28 CLAIMS INQUIRY REFERENCE GUIDE For FEP, Blue Card (out of State Blue Cross Blue Shield) and the most up-to-date for Blue Cross Blue Shield of Vermont members, see Section 10 Realtime Claims Search Under Office Management, select Claim Status Inquiry 2. Search by either claim number, or member name, ID, or account number as well as date of service or enter a date span 3. Choose the billing provider from the drop down. Jo Smith, MD Select Search Section 11, page 281

29 Doe, Jane 0000BCBS Jo Smith, MD 5. Review results. If there are multiple claims, you can click on the header to sort column. 6. Select View to review the Remittance Advice. Select the hyperlinks in each column for additional information regarding the processing of this claim. Any claims reflecting a pending status, could change and may not reflect the final claim processing. Section 11, page 29 2

30 REALTIME CLAIMS INQUIRY REFERENCE GUIDE Realtime Claim Inquiry: Federal Employees Program (FEP) members Blue Card Members (out of state Blue Cross Blue Shield members) Blue Cross Blue Shield of Vermont members Under Office Management, select Claims Status Inquiry Select click her to conduct a Realtime Claim Search Section 12, page 30 1

31 3. 3. Complete all required information (identified by red *) Optional Total Claim Charges 4. Select Search 4. Section 12, page 31 2

32 5. 5. Review Results Doe, Jane BCBS Section 12, page 32 3

33 REVIEWING REMITTANCE ADVICES AND VOUCHERS 1. WEB BROWSER REQUIREMENT- This service supports most modern browsers. Compatible with: Internet Explorer Version 8.0, 9.0, 10.0 and 11.0 Chrome Safari 1. Select Remittance Advice 2. Select Continue Select Practice NPI from drop down Select Start and End Date 5. Select Search 33 Section 13, page 1

34 NATIONAL DRUG CODE (NDC) TOOL NDC Tool is intended to assist practices in determining the unit of measure that needs to be reported to Blue Cross and Blue Shield of Vermont. The Tool provides the following information associated with any given NDC code: Drug Name Dosage Form Manufacturer Name Billed Unit of Measure Select National Drug Code (NDC) Tool 2. Select the version to match the date of service your are billing NDC use Ctrl=F to open the Find dialogue box, enter in the 11-digist HNC code (no dashes) and press enter For that NDC you will see drug name, dosage form, manufacturer name and the billed unit of measure. *Note, the Billed Unit of Measure field indicates the appropriate unit of measure (UN, GR, ML, ME or F2) for billing. If an NDC is not on file, then the NDC number may be inactive or newly added. This tool is updated semiannually; February and August Section 14, page 34 1

35 CLEAR CLAIMS CONNECT (C3) C3 Tool Determines claims editing (Claim Check) in advance or after claim submission to explain the logic Not tied to benefits or Medical Policies, will only provide claims editing logic Looks back up to 99 lines regardless of rendering provider Select Clear Claims Connect 2. (C3) 2. Enter the following information Gender Date of birth Procedure code(s) Date of service(s) Modifier(s) 3. Select Review Claim Audit Results 3. Section 15 page 351

36 Need Help? For Assistance Contact Provider Relations at Blue Cross and Blue Shield of Vermont at the following: By By phone: Section 16