December Blue Cross Blue Shield Provider Resource Center Reference Guide

Transcription

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

2 Table of Contents Reference Guides Section 1: User Registration Section 2. System Administration Viewing Users Section 3. System Administration Editing User Information Section 4. System Administration Adding a New User Section 5: System Administration Removing Users Section 6: Member Eligibility, Benefits and Accumulators for BCBSVT Members Section 7: Realtime Benefits, Eligibility and Accumulators Section 8: Claims Inquiries BCBSVT Members Section 9: Realtime Claims Inquiries Section 10: Remittance Advices, Vouchers and Capitation Vouchers Section 11: Nation Drug Code (NDC) Tool Section 12: Clear Claim Connect (C3) Section 13: Need Help? 2

3 Section 1 User Registration

4 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

5 3. Only one person per office needs to complete these steps. Confirm you are the appropriate person for the Local Administrator role. 3. 5

6 4. Enter all required information. The confirmation will be sent to the address entered. Be sure to make note of your user name and password. 4. 6

7 5. Enter your office information and select Next. Note Do NOT enter hyphens in the tax ID field 5. 7

8 6. Review your registration summary. Verify office contact and user information. Select Edit if necessary. Once completed, select Finish. 6. 8

9 7. Make a note of your username and password. You WILL NOT be able to return to this page once you select Next. 7. 9

10 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 the registration. Please allow 3 business days for your account to be processed

11 System Administrator Viewing Users Section 2

12 Only the Local Administrator can view all users. 1. Select System Administrator 2. User Maintenance will appear. This lists all users associated with your Access List

13 System Administrator Editing User Information Section 3

14 Only the Local Administrator can edit users 1. Select System Administrator 2. User Maintenance will appear. This lists all users associated with your Access List Click on the user s name from the User Maintenance File Make appropriate changes 5. Click Submit

15 System Administrator Adding a New User Section 4

16 Only the Local Administrator can add users. 1. Select System Administrator 2. Select Add User Enter all required information 4. Select Add

17 5. Select a user role from the drop-down Note: the user will not be added if a role is not assigned. 6. Select Select Role

18 BCBSVT PROVIDER RESOURCE CENTER ROLES AND FUNCTIONALITY DESCRIPTIONS Roles: Office Manager (also called Local Administrator): General Content Eligibility/Benefits Claims Inquiry System Administrator Remittance Advices, Vouchers, Capitation Vouchers Acuity Connect (on-line prior approval) Office Manager w/o Demographics: General Contract Eligibility/Benefits Claims Inquiry System Administrator Remittance Advices, Vouchers, Capitation Vouchers Acuity Connect General Staff: General Content Eligibility/Benefits Claims Inquiry Remittance Advices, Vouchers, Capitation Vouchers Acuity Connect Functions: General Content: Resource Center Page Provider Search Tools and Resources Reports Eligibility and Benefits: Eligibility and Benefit inquires and Responses Accumulators (Benefit Usage) Claims Inquiries: Claim Status Inquiries and Responses, including Real Time Clear Claims Connect (C3) Authorizations Remittance Advices, Vouchers, Capitation Vouchers System/Local Administrator: User Maintenance and Role Assignment Admitting Staff: General Content Eligibility/Benefits Provider: General Content Eligibility/Benefits Claims Inquiry Remittance Advises, Vouchers, Capitation Vouchers Acuity Connect 18

19 System Administrator Removing Users Section 5

20 Only the Local Administrator can remove users. 1. Select System Administrator 2. Select User 3. Check role box Select Remove

21 5. Indicate reason for removing 6. Select Yes

22 Member Eligibility, Benefits and Accumulators for BCBSVT Members Section 6

23 1. Select Search Patients under Patient Management 2. Search by patient s last and first name format or by member ID number. 3. Select Search

24 4. Select Select to view the patient s summary screen and continue on to current benefits and accumulator information. Member name will display in Current Patient box. (See next page for further instructions.) 5. Select patient s name to view the member s benefit summary and benefits prior to 01/01/2019. To check eligibility: Prior to 01/01/2019, select the patient records that has the ID starting with 8 01/01/2019 and beyond, select the patient record that has the ID starting with V Test Member 2 09/01/2013 Smith Street, VT Test Member 2 09/01/2013 Smith Street, VT V Test Member 3 07/1/1968 Beach Lane, VT V

25 1. Once you have selected Select from the previous page 2. Select Eligibility under Patient Management 1. Test Member 2 Sandy Hill, VT 09/01/2013 Test Member 2 V

26 3. Search Requesting Provider using last name, first name format or by billing provider NPI; then select Search The patient name searched for pre-populates in the subscriber name field and may not be the subscriber of the policy. If the member ID number ends with anything other then 001, this is NOT the subscriber. 05/01/2013 Test Member 1 V

27 4. Select Provider by selecting Select 5. Select Service Type from the drop-down, then select Search 4. Spence, Test Test Group V Spencer, Test

28 6. Review Eligibility Details 7. Review Benefit

29 8. Select the appropriate accumulator 8 29

30 Realtime Benefit, Eligibility and Accumulators Section 7

31 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 1. Select Eligibility/ Benefits under Office Management 2. Select click here to conduct a Realtime Benefit Search

32 3. Complete all mandatory fields: Subscriber full name Subscriber date of birth 4. If patient is not the subscriber, complete mandatory fields: Patient full name Patient date of birth Patient ID, including alpha-prefix and member number (example R ) Requesting provider Service type for all benefits, select General Benefits Select Search

33 6. The Member s Eligibility/Benefit information details, including costsharing details, will appear

34 7. Select the appropriate accumulator 7. 34

35 Claim Inquiries BCBSVT Members Section 8

36 1. Under Office Management, select Claim Status Inquiry 2. Search by either claim number, member name, ID, or account number as well as date of service (or you may enter a date span) 3. Choose the billing provider from the drop-down. 4. Select Search Jo Smith, MD

37 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 2 37

38 Realtime Claims Inquiries Section 9

39 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 1. Under Office Management, select Claims Status Inquiry 2. Select Click here to conduct a Realtime Claims Search

40 3. Complete all required information (identified by red asterisk [*]) Optional Total Claim Charges Select Search 4. 40

41 5. Review results 5. Doe, Jane BCBS

42 Remittance Advices, Vouchers and Capitation Vouchers Section 10

43 1. Select Remittance Advice 2. Select Continue 3. Select practice NPI from dropdown 4. Enter start and end dates 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 5. Select Search

44 National Drug Code (NDC) Tool Section 11

45 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 1. Select National Drug Code (NDC) Tool 2. Select the version to match the date of service you are billing Use Ctrl-F to open the Find dialogue box, enter the 11-digit HNC code (no dashes) and click 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 on a periodic basis, with notification to providers of changes at least 60 days prior to effective date

46 Clear Claim Connect (C3) Section 12

47 C3 Tool Determines claims editing (Claim Check) in advance of 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 1. Select Clear Claims Connect (C3) 2. Enter the following information Gender Date of birth Procedure code(s) Date of service(s) Modifier(s) Select Review Claim Audit Results

48 Help Section 13

49 Need Help? For assistance, contact Provider Relations at Blue Cross and Blue Shield of Vermont at the following: By By phone: