WV Bureau for Medical Services, KEPRO, & Molina Medicaid Solutions

Transcription

1 WV Bureau for Medical Services, KEPRO, & Molina Medicaid Solutions 1

2 The West Virginia Medicaid and West Virginia Children s Health Insurance Program web portal for Members and Providers provides significant functionality for the WV Medicaid provider community. Provides the latest notices and announcements to members, providers, trading partners, and the public. Permits real-time completion of healthcare transactions over the internet. Contains many useful website links BMS, WVCHIP, NCCI, etc. and many useful documents - Billing Instructions, User Guides, Companion Guides, and Forms. Learning Management System (LMS) web based training documents and elearning videos. 2

3 Web Portal Functions Fully automated Trading Partner registration and administration Submit DDE Claims View, Submit, Edit, Adjudicate, Void, and Reverse a Claim Add Attachments Create a Claim Template Verify Member Eligibility Create a Patient Roster View Medical Authorizations associated with the Provider Upload X12 Files and Review Responses Access payment information and Remittance Advices Access and maintain Provider Enrollment Application (PEA) 3

4 In the Health PAS-Online banner, click the Register hyperlink. Information Tax ID or SSN NPI or API Name and address PIN (to obtain contact the EDI Helpdesk) Options Select Provider-Already Enrolled if actively enrolled with WV Medicaid or WVCHIP. Select Provider Not Yet Enrolled if needing to access PEA to become an enrolled provider. 4

5 In the Health PAS-Online banner click the Sign In hyperlink. Enter the trading partner: User Name Password Read the Attention HIPAA PHI statement and select the check box. Click Sign In If an incorrect password is entered five times, the account will be locked out. 5

6 Health PAS-OnLine Sign In If your account becomes locked, the Account Self Unlock and Reset Password Click here link will assist with unlocking your account or you may contact the EDI Helpdesk, (888) Option 9. 6

7 Checking Member Eligibility It is a best practice to verify eligibility for all Medicaid participants before a service is rendered by a provider. This ensures the provider that the participant is eligible on the date the services will be rendered. 7

8 Eligibility continued Always make certain that the correct Billing Provider is selected. This is important for TPA accounts that manage multiple billing providers. Find Member: Enter two of the following criteria: Member Identification (ID) Name (Last and First Name) Date of Birth Social Security Number After the search criteria has been submitted, the Eligibility Verification screen appears. 8

9 Eligibility continued After the search criteria have been submitted, the Eligibility Inquiry section verifies whether a member was eligible for a Medicaid program on the date(s) of service submitted in the request. This information does not guarantee eligibility or payment for the service rendered. 9

10 Eligibility continued According to the selected coverage code, the details of the coverage code are listed. If further clarification is needed, call Provider Services between 7:00a.m. to 7:00p.m. Link to the WV User Guide for Eligibility Verification: 20Trading%20Partner%20Account%20-%20Eligibility%20Verification%20User%20Guide.pdf 10

11 Health PAS-OnLine Claim Submission Functionality (Direct Data Entry) Professional Claim, CMS 1500 The CMS 1500 is used for noninstitutional providers (generally group or individual provider practices) or suppliers. 11

12 Health PAS-OnLine Claim Submission Functionality (Direct Data Entry) There are four sections to the Claim Submission - Professional screen: Claim Information Diagnosis Services Additional Information 12

13 Health PAS-OnLine Claim Submission Functionality continued A confirmation page will display allowing the user to adjudicate a claim, edit a claim, add an attachment, or create a new claim. Link to the WV User Guides for Claim Submission: %20Partner%20Agreement%20-%20Claim%20Submission%20User%20Guide.pdf 13

14 Health PAS-OnLine Claim Reversal Functionality 1. Only Paid and Denied claims can be reversed 2. Select Reverse The Claim and Create A New Claim to modify a claim without creating a whole new claim. 3. Select Reverse This Claim Only to reverse a claim without creating an adjustment. 4. A message will popup validating action completed. 14

15 Saving a Claim Template 1. Claim templates provide a method of saving partial claim data for reuse in the future 2. It saves data entry time and reduces errors. 3. Select the claim radio button then click SAVE AS TEMPLATE 4. Under Claim Status, select New Claim 5. Select the option Use Template then click the desired template. 15

16 The Patient Roster is a list of members customized to each individual billing provider. The list is created and customized by the trading partner. The list is sorted by the first letter of the member s last name. Submit claims directly from the roster. Verify a member s eligibility. 16

17 Contact Information Our website provides valuable contact information as well as office hours and office closures. Phone Support: Local and toll-free phone numbers (304) or (888) Secure Messaging: Send a secure Call Back: Request a call back from a call rep who can review the issue ahead of time Web Chat: Chat real time via the internet with a call rep during business hours Grievance & Appeals: Submit online, by mail, or fax 17

18 Provider Field Representative Map 18