Encounter Submission Guide Page 1 of 6 Independence Blue Cross offers products directly, through its subsidiaries Keystone Health Plan East and QCC Insurance Company, and with Highmark Blue Shield independent licensees of the Blue Cross and Blue Shield Association.
In response to Health Care Reform requirements, the Encounter Submission transaction has been modified. As a result, when submitting encounter data through the NaviNet web portal, participating primary care physicians are now required to report additional information related to the member's visit. This transaction allows you submit the information in a HIPAA-compliant format. Submitting an encounter The following are steps to submit an encounter: 1. Select Encounters and Referrals from the Plan Transactions menu, and then select Encounter Submission. 2. On the Encounter Submission Patient Search screen, select one of the following Search Types and enter the information accordingly: Member ID Number Member ID Number/Patient Name For Date of Service, the system uses today's date as the default. However, you can enter a prior date of service up to one year from the current date. You cannot enter a future date. 3. Select Search. 4. If a search results summary screen appears, click on the desired patient to access the Encounter Submission Header screen. Otherwise, skip to the next step. Page 2 of 6
5. Enter all the required fields (as indicated by the *) on the Encounter Submission Header screen, and select Continue. 6. Optional: Under Servicing Facility, to search for a servicing facility's provider ID, type the provider ID in the Provider ID field and select Optional Search. In the results that appear, select the servicing facility. The servicing facility will then appear on the Encounter Submission Header and Encounter Submission Detail screens. 7. Enter all the required fields on the Encounter Detail screen: Diagnosis Codes: You must enter at least one diagnosis code. You may enter a diagnosis code directly or select Search. Click on the appropriate row to have the code appear in the Encounter Submission Detail screen. Select Add More to insert up to 12 additional diagnosis codes. DX Pointers: At the service line level, a diagnosis pointer is required. Enter up to 4 pointers per line from the codes in the Diagnosis Information section. CPT /HCPCS: You must enter at least one CPT/HCPCS code. You may enter a CPT/HCPCS code directly or select Search. Click on the appropriate row to have the code appear in the Encounter Submission Detail screen. Modifiers: Enter up to four modifiers per service line (one per box). Page 3 of 6
Add More: Select Add More to add additional service lines to the Encounter Submission Detail screen. Add Details: Select Add Details to report drug or ambulance data, or to report additional comments for Not Otherwise Classified (NOC) procedures. Note: Date of service and place of service is entered at the header and cannot be changed at the service line level. 8. Confirm that the data on the Encounter Verification screen is correct and select Continue. To edit the encounter before submission, click Header or Detail in the breadcrumbs to return to the appropriate data entry screen. Page 4 of 6
9. The Encounter Submission Submission Result screen appears, indicating the status of your submission. Searching the claim log The following are the steps to search the claim log: 1. To review your encounters submitted through NaviNet, select Office Central and then select Claim Log. The Claim Log will appear. 2. On the Claim Log screen, you can search for the desired encounters. You may search for an encounter using any of the following options: Status Type (i.e., Encounter) Member Number Patient Name Submitted To Patient DOB Billing Provider Date of Service Submitted Date Page 5 of 6
3. Select Search. The search results summary screen will appear: There are four possible encounter statuses: Tips: Accepted: An encounter that was submitted and accepted by the plan. To review the encounter, select View Form. Rejected: An encounter returned by the plan because of editing errors. To review, correct, and resubmit the encounter, select Edit Form to be taken back to the encounter. Sent: An encounter that will be submitted to your plan via the batch process. Once submitted successfully, the encounter's status will be updated. To review the encounter, select View Form. Incomplete: An encounter that you have started and saved. To return to the encounter, select Edit Form and complete the remainder of the form. When searching by member ID number, enter the member's complete ID number as indicated on the member's current ID card. You can search for a patient using a prior date of service up to one year from the current date. Once you select a member from the patient search, enter the required data on the Encounter Submission Header screen and select Continue. The encounter is saved with an incomplete status within NaviNet. You can leave this submission and revisit it from the Claim Log at any time. Select Clear to delete all the data in the search fields at once. This is useful if you want to eliminate previously entered search criteria and start a new search. CPT copyright 2012 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. NaviNet is a registered trademark of NaviNet, Inc., an independent company. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Page 6 of 6