An Overview of ProviderConnect. May 2016

Transcription

1 An Overview of ProviderConnect May 2016

2 Key Topics Services and Benefits Registering Benefits and Eligibility Search Authorizations and Claims Search Provider Summary Vouchers Recredentialing and Demographic Update 2

3 Services Verify member benefits and eligibility Request and view authorizations Submit claims and view status Request payment for EAP services Submit updates to provider demographic information Submit customer service inquiries View and print forms Download and print authorization letters Access Provider Summary Vouchers (PSV) Submit EAP case activity forms (CAF) Submit recredentialing applications Access ProviderConnect message center 3

4 Benefits Free and secure online application, available 24 / 7 Mobile Device friendly Quicker Payment Reduces paper files Reduces the need to call for routine information Mac and Windows compatible INCREASED CONVENIENCE, DECREASED ADMINISTRATIVE PROCESSES 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

5 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 recredentialing applications Updating of provider information Electronic fund transfer 5

6 ProviderConnect s New Look ProviderConnect new look Current functionality remains the same 6

7 Ready to take your office to the next level? Having the remittance advice online is a real timesaver as well as being able to check claim status and benefits. I would recommend them to other providers. Everything a provider needs or may want is available on one website. Impressive! 7

8 How to Access ProviderConnect 8

9 Registering Option 1: Online Go to choose Providers On the right side select Getting Started, then Register Complete Registration page **Note: The online registration process now includes e-signature for claims access 9

10 Registering Option 1: Online 10

11 Registering Option 2: Account Request Form Go to choose Providers Choose Forms under Overview on the right side of the screen, then click Administrative Forms Under ProviderConnect Forms choose Online Services Account Request Form Complete the form and fax to the fax number indicated on the form 11

12 Registering Option 2: Account Request Form 12

13 Logging into ProviderConnect Go to choose Providers Click on Login under ProviderConnect on the right side of the screen Contact Information: EDI Helpdesk Monday through Friday, 8:00 a.m. 6:00 p.m. ET Phone:

14 Logging into ProviderConnect 14

15 Member Eligibility and Benefits 15

16 Verifying Member Eligibility 16

17 Member Eligibility 17

18 Member Demographics 18

19 Member Enrollment History 19

20 Member Benefits 20

21 Authorizations 21

22 Enter an Authorization Request 22

23 Disclaimer 23

24 Search a Member 24

25 Member Information 25

26 Service Address 26

27 Requested Services Header 27

28 Review an Authorization 28

29 Search Authorizations 29

30 Authorization Search Results 30

31 Claims 31

32 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 claims files from any Practice Management System outputting HIPAA formatted 837P or 837I batch files, and from EDI claims submission vendors 32

33 Direct Claim Submission Ability to enter a claim directly into the 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 33

34 Direct Claim Submission 34

35 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 35

36 Batch Claim Submission 36

37 Batch Claim Submission 37

38 Billing Updates General Billing Updates Beacon Health Options must be the name on the claim Should also be listed on the claims mailing address Note: Some entities are not changing See list on upcoming slides ICD-10 diagnosis codes are required Billing by Batch or Clearinghouse Payer ID does not change 38

39 Entities Not Changing Name to Beacon Health Options At this time, there is no change to the following ValueOptions subsidiary entities: ValueOptions Federal Services, Inc. (Military OneSource and TRICARE ) Value Behavioral Health of Pennsylvania, Inc. ValueOptions of Texas, Inc. (NorthSTAR) ValueOptions of Kansas, Inc. ValueOptions of New Jersey, Inc. (Horizon Behavioral Health) ValueOptions of California, Inc. Billing and all correspondence should continue business as usual 39

40 Entities Not impacted by Beacon Name Change The following partnership-owned companies and joint ventures are not impacted by the name change: Massachusetts Behavioral Health Partnership Colorado Health Partnership, Inc. Foothills Behavioral Health Partnership, Inc. Integrated Community Health Partnership, Inc. Northeast Behavioral Health Partnership, Inc. Billing and all correspondence should continue business as usual 40

41 PaySpan Health: Electronic Funds Transfer (EFT) A tool that enables you to: Receive payments automatically Receive notifications immediately upon payment View your remittance advice online Download an 835 file to use for auto-posting purposes 41

42 Payment Stub Example 42

43 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 or call 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? corporatefinance@beaconhealthoptions.com Reply will be received within three (3) business days 43

44 Viewing Provider Summary Vouchers 44

45 Provider Summary Vouchers 45

46 Provider Summary Voucher Search 46

47 Recredentialing 47

48 Recredentialing on ProviderConnect Reduces need for paper recredentialing forms Eliminates phone call for recredentialing application and CAQH number Available in all states except for: Colorado Maryland Tennessee Texas Pennsylvania (Medicaid Only) 48

49 Recredentialing on ProviderConnect 49

50 Recredentialing on ProviderConnect 50

51 Demographic Updates 51

52 Demographic Updates Demographic information should be reviewed on a regular basis Make updates through ProviderConnect and CAQH for consistency Paper Change of Address forms no longer available online For assistance if unable to use the website, reach out to your Regional Provider Relations team or our National Provider Service Line 52

53 Demographic Update Features Ability to update through ProviderConnect Phone number Fax number Mailing address address Office hours Ability to add and expire service and billing locations Personal training available For assistance, contact the EDI Helpdesk for more information 53

54 Demographic Update Features 54

55 Demographic Update Features 55

56 Additional Training Options 56

57 Helpful Resources On Valueoptions.com choose Providers Click on Helpful Resources under ProviderConnect on the right 57

58 Training Webinars Scheduled monthly Topics include: Authorizations, Claim Submission, Role-based security, Re-credentialing, Viewing Patient Info, etc. Next webinar is scheduled for Wednesday, 5/11/2016 at 11:00 a.m. ET and will be titled ProviderConnect Claims Registration available through links in the Provider Newsletter or online 58

59 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. 59

60 How-To Video Tutorials Short Video Tutorials: Viewing Member s Eligibility Viewing and Submitting Authorizations Direct Claim Submission Process Batch Claim Submission Process Re-credentialing 60

61 Contact Information EDI Helpdesk (ProviderConnect Technical Questions) Monday through Friday, 8:00 a.m. - 6:00 p.m. ET Phone: e-supportservices@beaconhealthoptions.com National Provider Service Line (Training Requests) Monday through Friday, 8:00 a.m. 8:00 p.m. ET Phone: