1

Provider Workshop

Training 2017

2

INTRODUCTION CLAIMS PORTAL EFT

TODAY’S AGENDA

• Passport Provider Portal (New!) • Claims System (NEW PAYER ID)! • ERA/EFT InstaMed (NEW!) • Packet Information

– Title VI – Fraud, Waste and Abuse – FAQs – Quick Reference – Checkpoint Questions – 2017 FACT SHEET

3

INTRODUCTION CLAIMS PORTAL EFT

MIGRATION TO A NEW MEDICAL INFORMATION MANAGEMENT SYSTEM

• Continuous improvement toward value-based delivery of Medicaid Managed Care

• Operational changes to enhance provider experience with stronger Service Level Agreements

4

INTRODUCTION CLAIMS PORTAL EFT

WHAT’S CHANGING? • New Payer ID 61325 • New Provider Portal • New EFT/ERA: InstaMed • Passport Provider ID’s – new NPI based system • PCP Assignments

– Group level

• PCP Panel Status and Limitations – Group level

• WHEN? 10.1.17

5

INTRODUCTION CLAIMS PORTAL EFT

EDUCATIONAL OPPORTUNITIES eNews and Direct Mail

•New Claims System •New Provider ID •New Portal •New EFT Vendor

Online Information

•Self-registration for Portal Account Set-up

•eNews posted •PowerPoint Presentation

Lunch and Learn

Workshops

• 11 Statewide Workshops per Region (invitations sent to each office and online registration)

• 2 Webinars

Personal Presentations

•Personal Outreach with Provider Relations Specialists

OCTOBER 1

• CLAIMS SYSTEM GO LIVE DATE

Provider Services (800) 578-0775 Available Monday through Friday, between 8 a.m. and 6 p.m. (EDT)

Provider Relations Specialists http://passporthealthplan.com/providers/contact-providers-and-services/

6

INTRODUCTION CLAIMS PORTAL EFT

• When is the new system effective?

• Who do I contact for questions?

• Will my provider ID be changing?

7

INTRODUCTION CLAIMS PORTAL EFT

Provider Portal

8

INTRODUCTION CLAIMS PORTAL EFT

NEW PASSPORT PROVIDER PORTAL

• Getting Started • Portal Improvements • Administrator vs. User • Basic Navigation • Claims Status • Referrals Submission and

Inquiry • Member Eligibility and

Benefits • Reports Available

9

INTRODUCTION CLAIMS PORTAL EFT

GETTING STARTED

• New portal name – Passport Provider Portal

• Accessing the new portal – Passport website:

http://passporthealthplan.com/providers/provider-portal/ – Direct URL: https://phkyportal.valence.care/

10

INTRODUCTION CLAIMS PORTAL EFT

GETTING STARTED Main Functions

• Verify member eligibility and benefits • Referrals submission and inquiries • Claims status • Reports

11

INTRODUCTION CLAIMS PORTAL EFT

PORTAL IMPROVEMENTS

What are some improved features of the new portal? • Panel roster reports • Verify member eligibility for multiple members at a time • Historical member eligibility & PCP assignments available • Referrals limitations • Address indicators from the DMS file will be present • Diagnosis List – search ICD codes • Procedure List – search procedure codes

12

INTRODUCTION CLAIMS PORTAL EFT

OFFICE ADMINISTRATOR ROLE • What is an Office

Administrator? • How do I choose one for my

office? • Responsibilities of an Office

Administrator o Create user accounts o Grant access to user

accounts o Modify user accounts o Delete user accounts o Unlock user accounts

13

INTRODUCTION CLAIMS PORTAL EFT

OFFICE ADMINISTRATOR SET-UP

Passport can assist you in setting up your Office Administrator account.

Step 1: Go to http://passporthealthplan.com/providers/new-claims-system/ Step 2: Complete the fillable form, check Office Administrator box. Step 3: Email the form to providerinquiries@passporthealthplan.com

14

INTRODUCTION CLAIMS PORTAL EFT

OFFICE USER ROLE

• What is an Office User?

• Multiple user accounts allowed within one practice.

• User accounts can view information within the portal

• Passport can assist you in setting up your Office Administrator account.

15

INTRODUCTION CLAIMS PORTAL EFT

OFFICE USER SET-UP

• Passport can assist you in setting up your Office User accounts.

Step 1: Go to http://passporthealthplan.com/providers/new-claims-system/

Step 2: Complete the fillable form, check Office User box.

Step 3: Email the form to providerinquiries@passporthealthplan.com

16

INTRODUCTION CLAIMS PORTAL EFT

BASIC NAVIGATION – HOME PAGE

17

INTRODUCTION CLAIMS PORTAL EFT

BASIC NAVIGATION – TOP NAVIGATION MENU BAR

• Home • Claims

• Claims Status List • Remittance Advice Search

• Patient • Online Referral Submission • Referral List • Member Eligibility Search • Panel Roster

• Tools & Resources • Inbox • Diagnosis List • Procedure List • Provider List

• Office Administration • User Profile • Access Other Offices

18

INTRODUCTION CLAIMS PORTAL EFT

BASIC NAVIGATION – MEMBER LOCK

• Member Lock – New Feature – Located above the top navigation menu bar

19

INTRODUCTION CLAIMS PORTAL EFT

CLAIMS STATUS – CLAIMS STATUS LIST PAGE

Searching previously submitted claims:

1. Select the Claims drop-down from your menu bar

2. Select the Claim Status List option

• Input search criteria to populate values in the Results section

20

INTRODUCTION CLAIMS PORTAL EFT

CLAIMS STATUS – RESULTS PAGE

3. Select the Claim number link to view the Claim Detail page 4. Select the View EOB link to view the Explanation of Benefits

21

INTRODUCTION CLAIMS PORTAL EFT

CLAIMS STATUS – REMITTANCE ADVICE SEARCH

Remittance Advice Search

22

INTRODUCTION CLAIMS PORTAL EFT

REFERRAL SUBMISSION Submitting an electronic referral:

1. Select the Patient drop-down from your menu bar 2. Select the Online Referral Submission option.

23

INTRODUCTION CLAIMS PORTAL EFT

REFERRAL SUBMISSION

3. Select Show Full Roster check mark box and complete appropriate member information

4. Click the Search button

24

INTRODUCTION CLAIMS PORTAL EFT

REFERRAL SUBMISSION 5. Click the Select link to the left

of the appropriate members name

6. Select the appropriate provider record from the Provider Last Name drop-down in the Referring Provider Information section

7. Search (and select) the appropriate provider from the Refer to Provider Information section

25

INTRODUCTION CLAIMS PORTAL EFT

REFERRAL SUBMISSION 8. Enter any other necessary information

9. Select the Review button

10. Confirm information is accurate and select the Submit button to complete your request and receive a system generated Referral number.

26

INTRODUCTION CLAIMS PORTAL EFT

REFERRAL INQUIRY

Searching previously submitted referrals:

1. Select the Patient drop-down from your menu bar

2. Select the Referral List option

27

INTRODUCTION CLAIMS PORTAL EFT

REFERRAL INQUIRY RESULTS

28

INTRODUCTION CLAIMS PORTAL EFT

REFERRAL CROSSOVER

• Referral crossover in new claims system – Yes

• Referral crossover in new portal – Dual access with Navinet

29

INTRODUCTION CLAIMS PORTAL EFT

MEMBER ELIGIBILITY AND BENEFITS Verifying member eligibility and benefits:

1. Select the Patient drop-down from menu bar, and choose member eligibility search link.

30

INTRODUCTION CLAIMS PORTAL EFT

MEMBER ELIGIBILITY AND BENEFITS Verifying member eligibility and benefits: 2. Select the Member name link

31

INTRODUCTION CLAIMS PORTAL EFT

MEMBER ELIGIBILITY AND BENEFITS

Verifying member eligibility and benefits: 3. Member Eligibility and Benefits can be validated from the Member Detail page

32

INTRODUCTION CLAIMS PORTAL EFT

REPORTS What reports are available?

– Panel Listing Reports 1. Select the Patient drop-down from your menu bar 2. Select the Panel Roster option

33

INTRODUCTION CLAIMS PORTAL EFT

NAVINET vs NEW PASSPORT PROVIDER PORTAL

• Access to Navinet post 10/1/17

• Historical Information o Navinet

o Limited access until 3/31/18

o New Passport Provider Portal o Full access beginning 10/1/17

34

INTRODUCTION CLAIMS PORTAL EFT

• What is an Office Administrator for the provider portal? • Can we set-up multiple users on the new provider portal? • Will Passport set-up an account for me in the new portal prior

to 10/01/17? User Name and Password will be emailed to you after 9.15.17

35

INTRODUCTION CLAIMS PORTAL EFT

Claims System

36

INTRODUCTION CLAIMS PORTAL EFT

CLAIMS SYSTEM – PAYER ID Passport Health Plan’s new Payer ID is 61325. • Please let your internal systems know of this change:

o Practice Payment Administrators o Internal EDI (electronic data interchange) o HIS (Hospital Information System) such as Epic

37

INTRODUCTION CLAIMS PORTAL EFT

CLAIMS SYSTEM - TRANSITION

• The transition to a new claims payment system is intended to better serve you: – Quicker turnaround times – Quicker system changes – Local support

• DOS prior to 10/1/17 – Use Payer ID 61129

• DOS on or after 10/1/17 – Use Payer ID 61325

38

INTRODUCTION CLAIMS PORTAL EFT

CLAIMS SYSTEM

• You will still call the same phone number for claims questions o Provider Claims Service

Unit at (800) 578-0775 • This claims system change

will not impact behavioral health, dental, vision, pharmacy claims, or Passport Advantage

39

INTRODUCTION CLAIMS PORTAL EFT

CLAIMS SYSTEM – PAPER CLAIMS

• Where will I submit paper claims and appeals?

– Claims: Passport Health Plan PO Box 7114 London, KY 40742

– For Appeals, you may also fax to: (502) 585-8339

40

INTRODUCTION CLAIMS PORTAL EFT

CLAIMS SYSTEM – CORRECTED CLAIMS

• For DOS on or before 9/30/17 corrected claims must be submitted within two years of the last process date of the original claim.

41

INTRODUCTION CLAIMS PORTAL EFT

CLAIMS SYSTEM – ELECTRONIC CLAIMS

• Who do I contact if I have issues with electronic claims? – Please call Change Healthcare/Emdeon at (877) 234-4275

• Will Passport’s EDI department information change? – No

• There will be no more Passport unique provider ID’s – The new system will be NPI based

• Inpatient claims with DOS spanning before and after 10/1 – Claims should be submitted using the new payer ID

42

INTRODUCTION CLAIMS PORTAL EFT

ELECTRONIC

REMITTANCE ADVICE &

ELECTRONIC FUNDS TRANSFER

43

INTRODUCTION CLAIMS PORTAL EFT

Will ERA/EFT change? • Claims will still be submitted to Change Healthcare (formerly

Emdeon) through your clearinghouse, however InstaMed will be responsible for EFT payment transactions.

• Action Required- Contact practice management, EDI and/or HIS to set up new Payer ID 61325.

Will I need to set-up a new EFT account with InstaMed? • Yes

ERA/EFT

44

INTRODUCTION CLAIMS PORTAL EFT

ERA/EFT

How do I set up a new EFT with InstaMed?

• You will get a letter and/or phone call from InstaMed about how to set up an account.

• You can self-register now: o www.instamed.com/eraeft

45

INTRODUCTION CLAIMS PORTAL EFT

ERA/EFT

The Electronic Remittance Advice will look different

Activity Summary

Pending Funding

46

INTRODUCTION CLAIMS PORTAL EFT

ERA/EFT

47

INTRODUCTION CLAIMS PORTAL EFT

What are the benefits to InstaMed?

• New, free solution to accelerate payments

• Easy to enroll, easy to use, free training

• No high costs and manual processes

• Direct deposit with ERA re-association

• Email notification of payment

• Access secure portal to view all remittance and transaction detail

• Auto post 835 to PMS/EHR via sFTP delivery (through InstaMed or provider’s clearinghouse of choice)

48

INTRODUCTION CLAIMS PORTAL EFT

Outbound Communication Channels

• You may receive a number of communications from InstaMed to assist you:

o Direct Mail

o Phone Calls

o Emails

o Fax

o Website

49

INTRODUCTION CLAIMS PORTAL EFT

• Do I have to change my Payer ID? • What is Passport’s new electronic Payer ID? • What is the name of Passport’s new ERA/EFT vendor? • Will there be a new address to submit paper claims and

appeals?

50

INTRODUCTION CLAIMS PORTAL EFT

WHAT’S NEXT? • Action Steps:

– Change Payer ID – Sign up with the new provider portal – Sign up for EFT/ERA

51

INTRODUCTION CLAIMS PORTAL EFT

THANK YOU!

• For questions, please contact our Provider Services Department at (800) 578-0775.

• You may also contact your Provider Relations

Representative for training and assistance!