ProviderConnect Claims March 2017
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
ProviderConnect Advantages 3
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
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
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
Claims Process Improvement Program 7
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
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
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
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
How to Access ProviderConnect 12
How to Access ProviderConnect 13
How to Access ProviderConnect Go to www.beaconhealthoptions.com, 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
Direct Claim Submission 15
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
Direct Claim Submission 17
Direct Claim Submission 18
Direct Claim Submission 19
Direct Claim Submission 20
Direct Claim Submission - COB 21
Direct Claim Submission 22
Direct Claim Submission 23
Summary Page 24
Batch Claim Submission 25
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
Batch Claim Submission 27
Batch Claim Submission 28
Batch Claim Submission 29
Batch Claim Submission 30
Batch Claim Submission 31
Batch Claim Submission 32
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
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
Claim Search 35
Review a Claim 36
Search Claims 37
Searching a Specific Member 38
Searching a Specific Member 39
Viewing Member Claims 40
Claim Search Results 41
Claims Summary 42
Service Line Detail 43
Correcting a Claim 44
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
Change/Reprocess Claim 46
Disclaimer 47
Type of Adjustment 48
Select Service Address 49
Member Search 50
Coordination of Benefits 51
Service Line Entry 52
Attaching an EOB 53
Summary Page 54
EAP Case Activity Form Submission 55
EAP Case Activity Form Submission 56
Authorization Search 57
Enter EAP CAF 58
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
Summary Page 60
Viewing Provider Summary Vouchers 61
Provider Summary Vouchers 62
Search by Provider 63
Search by Check 64
Provider Summary Voucher Results 65
PaySpan Health: Electronic Funds Transfer (EFT) A tool that enables you to: Receive payments automatically Receive email notifications immediately upon payment View your remittance advice online Download an 835 file to use for auto-posting purposes 66
Payment Stub Example Giving Value Back to the Provider 2015 67
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 www.payspanhealth.com or call 877-331-7154 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? Email: corporatefinance@beaconhealthoptions.com Reply will be received within three (3) business days 68
Additional Training Options 69
Helpful Resources On the provider homepage choose ProviderConnect Scroll down to find: Guides Forms Compliance Resources EDI Resources 70
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
Important Tools 72
How-To Video Tutorials Short Video Tutorials: 73
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
Contact Information Website and EDI Provider Relations Beacon Health Strategies eservices 866-206-6120 eservices@beaconhealthoptions.com Electronic Data Interchange 888-204-5581 EDI.Operations@beaconhealthoptions.com Provider Relations 781-994-7556 Provider.Relations@beaconhealthoptions.com Beacon Health Options (formerly ValueOptions) EDI Helpdesk Monday through Friday, 8 a.m. - 6 p.m. ET Phone: 888-247-9311 e-supportservices@beaconhealthoptions.com Provider Service Line Monday through Friday, 8 a.m. 8 p.m. ET Phone: 800-397-1630 Regional Provider Relations Team 75