Provider Healthcare Portal Overview - IN.gov · Provider Healthcare Portal Overview October 2017. 2...
Transcript of Provider Healthcare Portal Overview - IN.gov · Provider Healthcare Portal Overview October 2017. 2...
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Indiana Health Coverage Programs
DXC Technology
Provider Healthcare Portal
Overview
October 2017
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Session Objectives• Provider Enrollment transactions
• Home Page
• Member Eligibility
• Prior Authorization
• Claims
• Member Focused Viewing
• Search Payment History
• Helpful Tools
• Q&A
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Provider Enrollment Transactions
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Click Provider
Enrollment on
the left side of
the Provider
Healthcare
Portal home
page
A user account is
NOT needed to
submit an online
provider
enrollment
application
Access the application Home Page
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To check the status of an application, click Enrollment
Status on the left side of the Provider Enrollment page.
Check the Status
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Once enrolled and a Provider
account is established choose from
links on left side of the MY Home
page to perform other enrollment
transactions
Other Enrollment Transactions
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Home Page
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Home page
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Verify Member Eligibility
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Verify Member Eligibility
• To access the Eligibility Verification Request function,
log in to the Provider Healthcare Portal and click
Eligibility on the menu bar.
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Verify Member Eligibility
To perform a search, the Effective From date is required, in addition to
one of the following:
• Member ID
• Social Security number (SSN) and birth date
• Last name, first name, and birth date
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Verify Member Eligibility
The Effective From field is
always required.
– If a date is not entered, the
Portal defaults this field to the
current date
– This field accepts only current
and previous dates
The Effective To field is optional.
– The date entered must be on or
after the Effective From date and
must be within the same calendar
month as the Effective From date
– If a date is not entered, the Portal
will default to the Effective From
date
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Verify Member Eligibility
When an eligibility search returns no results, qualified providers
(QPs) will see an additional option below the message to complete
a Presumptive Eligibility for Pregnant Women (PEPW) or
Presumptive Eligibility (PE) application for the patient.
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Verify Member Eligibility
Viewing coverage details
• From the Eligibility Verification Information panel, click the coverage link for additional details.
• Note: Some searches may have more than one coverage type listed.
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Verify Member Eligibility
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Verify Member Eligibility
Important!The provider’s enrollment period affects the results of a search. The Portal
allows a provider to search for member eligibility information only for date
ranges that fall within the provider’s enrollment period.
For example, if a provider is enrolled starting on 04/01/2016 and attempts an
eligibility verification search with an Effective From date of 01/03/2016 (before
the provider’s enrollment period), the Portal will not display eligibility
information for that member.
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Prior AuthorizationFee-For-Service
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Is a prior authorization needed?BEFORE logging into
the Provider
Healthcare Portal to
create a request, save
time and avoid
submitting codes that
do not require a prior
authorization by
looking up the codes
on the Fee Schedule.
For your convenience,
there is a Search Fee
Schedule link located
on the Portal Home
page.
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Access the prior authorization function from the Care Management
drop-down menu.
Prior Authorization
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Prior Authorization
Complete the
required
information and
submit the
request by
clicking on
Confirm
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Viewing Prior Authorization Status
– The authorization request is assigned an Authorization Tracking Number
(ATN)
– Results list the first 20 authorizations with beginning service dates of
today or greater
– Results list only authorizations where the viewing provider was on the
request as the Requesting provider
Click to view the
authorization
Member name and
ID will be displayed
Requesting provider
will be listed
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Claims
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Search Claims
Two ways to access claim search function
OR
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Search Claims
When searching for claims,
you have the option to
choose which type of claim
to search and a date range
Or…
Search by Claim ID,
Member ID, or Service
Dates and click
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Claim Search Results
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Claim Service Line Details
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Claim Information
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Member Focused Viewing
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Member Focused
Viewing
Quick access to:
– Member details
– Coverage
details
– Claims search
and
submission
– Prior
authorization
search and
submission
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Member Focused Viewing
Member Focused Viewing search
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Member Focused Viewing
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Search Payment History
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Search Payment History
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Search Payment History
Auto populates last 12 weeks, or
Search by 12 week span
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Search Payment History
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Helpful Tools
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Helpful Tools
• IHCP website at indianamedicaid.com
– IHCP Provider Reference Modules
– Medical Policy Manual
• Customer Assistance
– 1-800-457-4584
• IHCP Provider Relations Field Consultants
– indianamedicaid.com > Provider Home
page > Contact Us
• Written Correspondence
– DXC Technology Provider Written
Correspondence
P.O. Box 7263
Indianapolis, In 46207-7263
• Secure correspondence via the Provider Healthcare Portal
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Questions