Tellus EVV Claims Portal TRAINING REFERENCE GUIDE

Transcription

1 Tellus EVV Claims Portal TRAINING REFERENCE GUIDE REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA

2 Table of Contents Overview Claims Home Page Claims Review Authorizations Visits Completed Claim Reconciliation Quick Finder Claim Entry Claim Entry Header Claim Entry by Status Claim Entry by Claim No New Claim Header Help Documents REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page ii

3 5.0 CLAIMS PORTAL This section allows for the review of visits and electronically distinguishes which are eligible for claim submission, matched claims and those that have to be re-submitted. 5.1 Overview The Tellus Claims Portal includes relevant query fields to track the submission process, claim-related documents, help documents, and the ability to communicate easily with your claims representative and the Florida Medicaid payment system (FMMIS). The Portal is effective for all claims filed with Florida Medicaid after January 15, This No-Fee Claims Portal ensures that you remain compliant with any changes in rules, policy and regulations. Getting quality real-time data into the Medicaid system is vital for payment processing. It is a secure, individual and claim-specific web site where you can access, review and retain specific information. Information about Claims There is some terminology that is commonly used in the Portal, which is explained here. 1. All claims will be assigned unique identifiers, which are referred to as the Authorization number, service code, and diagnosis qualifier. 2. As the claim progresses, the claim will go through a number of phases, which changes the status. 3. Process- the steps that a claim is progressed through. There is one process for claims review and one for claims entry. REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 3

4 5.2 Claims Home Page This page is the initial entry point of the claims portal. It allows access to the menu options which enables users to search, select, and view claims and authorizations. These options are posted to the left as buttons for searching and reviewing designated claims and authorizations. The Helpdesk information in the left corner, is designed for technical queries relating to the portal. All questions should be directed to customer support 1 (800)-AHCAEVV ( ). Figure 1: Claims Home Page Table 1: Home Page Menu Summary # Item Description Claims Review Review of authorizations and claims status. Claims Entry Help Documents Logout Review of claims entered into system. Upload guides, reports, FAQs etc. Exits the system. REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 4

5 Accessing the Claims Portal Home Page 1. Select <Claims> on the Menu Bar of the Dashboard. Figure 2: Claims Home Page 2. Claims Portal opens and brings you to the <Claims Home Page> in Figure 2. REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 5

6 5.3 Claims Review The claims review section of the portal is broken into two main components which are combined to begin the review process. In both components you can review claims by Recipient, Service Code and/or Status. Table 2: Claims Authorizations Menu Summary # Item Description Authorizations By Recipient By Service Code By Status Visits Completed By Recipient By Service Code By Status Quick Finder Allows user to view authorizations by recipient. Allows user to view authorizations by service code. Allows user to view authorizations by status-approved, Modified, Used or Cancelled. Allows user to view visits completed by recipient. Allows user to view visits completed by a service code. Allows user to view visits completed by status. Search tool used to look-up recipients Authorizations View authorization by recipient, service code, and status. View authorization by specific recipient services. Accessing Claims Review Authorizations 1. Select <Claims Review> from the menu. 2. A drop down list appears, select <Authorizations>. 3. Next select desired view: a. By Recipient b. By Service Code c. By Status REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 6

7 Claims Review: Authorizations by Recipient The view sorts the authorization by the recipient shown in Figure 3. Figure 3: Authorizations by Recipient Accessing Authorizations by Recipient 1. Select <Claims Review> from the Menu Options. Figure 4: Claims Review Tab 2. Click <By Recipient>. 3. The screen in Figure 5 will open. Figure 5: Authorizations by Recipient Selection REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 7

8 4. <Authorizations by Recipient> screen opens, as in Figure 6. Figure 6: Authorizations by Recipient View 5. Select a claim based on the recipient. Select recipient <Andy Cann>. Figure 7: Recipient Selection 6. Select drilled down record shown in Figure The link will redirect you to the view the recipient s <Authorization > screen. Figure 8: Recipient s Authorization Record REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 8

9 8. When done reviewing you can click <Close> or <Print>. Claims Review: Authorizations by Service Code The view sorts the authorization by service code. Figure 9: Authorizations by Service Accessing Authorizations by Service Code 1. Select <Claims Review> from the Menu Options, Figure Click <By Service Code>. 3. On a single click the screen appears. Figure 10: Authorizations by Service Code Selection REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 9

10 4. <Authorizations by Recipient> screen opens, as in Figure 11. Figure 11: Authorizations by Service Code View 5. Select a claim based on the service code. Select service code <S5130>. Figure 12: Service Code Selection 6. Select drilled down record shown in Figure 12. Figure 13: Drill-Down Record 7. This link will redirect you to the <Authorizations> screen shown in Figure 8, which allows the user to review the authorization. REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 10

11 Claims Review: Authorizations by Status The status is divided into four categories: 1. Approved a prior authorization that has been approved and imported into the portal. 2. Modified a prior authorization that has been modified by addition or subtraction of units from the authorization. 3. Cancelled a prior authorization that has been cancelled. 4. Used a prior authorization of which all the units have been used, so there are no units remaining. This view sorts authorizations by claims status. Figure 14: Authorizations by Status Accessing Authorizations by Status 1. Select <Claims Review> from the Menu Options, as in Figure Click <By Status>. 3. On a single click the screen appears. 4. <Authorizations by Status> screen opens, as in Figure 15. Figure 15: Authorizations by Status REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 11

12 5. Partial View: Select <Partial>, <Authorizations by Status> screen opens, as in Figure 16. Figure 16: Authorizations by Status View 6. Select a claim based on the status see Figure 16. Select <Partial> or <Unused>. 7. Select <Partial> <AHCA> <Jane Doe> <Select Date> <Service Code>. Figure 17: Drill-Down Service Codes 8. Select record <12345>. Figure 18: Record Drill Down REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 12

13 9. The link selected will redirect you to the <Authorization> screen highlighting the status, the authorized, and remaining units. Figure 19: Authorizations by Status Partial View Note: Status of the claim. Number of units used and the number of units remaining. 10. Unused View: From the menu, select <Unused> <Authorizations by Status> screen opens as in Figure 20. Figure 20: Authorizations by Status- Unused Units View 11. Select a claim based on the status seen in Figure 20. Select <Partial> or <Unused>. REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 13

14 12. Select <Unused> <AHCA> <Andy Cann> <Select Date> <Service Code>. Figure 21: Authorizations by Status Screens 13. Select record <123456>. Figure 22: Authorization by Status Drill Down 14. The link will redirect you to the <Authorization> screen highlighting the status, the authorized, and remaining units. Figure 23: Authorizations by Status Unused View Note: Status of the claim. Number of units available. 15. When done reviewing you can click <Close> or <Print>. REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 14

15 5.3.2 Visits Completed View recipient visits that have been completed. Accessing Visits Completed 1. Select <Claims Review> from the main menu. 2. Drop down list appears, select <Visits Completed>. 3. Next select desired view: a. By Recipient b. By Service Code c. By Status Visits Completed: Claims by Recipient This view sorts completed visits by recipient. Figure 24: Visits Completed by Recipient Accessing Visits Completed by Recipient 1. Select <Claims Review> from the main menu. 2. Drop down list appears, select <Visits Completed>. REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 15

16 3. Select <By Recipient>. Figure 25: Visits Completed by Recipient Selection Figure 26: Visits Completed by Recipient View 4. Select <Recipient>, in this case <Andy Cann>. Figure 27: Recipient Selection Screen REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 16

17 5. Record link appears, select it to be redirected to the <Visits Completed> record screen. Figure 28: Visits Completed Record Access Link 6. On a single click, the <Visit Completed> screen opens. Figure 29: Visit Completed Screen View 7. When done reviewing you can click <Close> or <Print>. Visits Completed: Claims by Service Code This view sorts visits completed by service code. Figure 30: Claims by Service REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 17

18 Accessing Visits Completed by Service Code 1. Select <Claims Review> from the main menu. 2. Drop down list appears, select <Visits Completed>. 3. Select <By Service Code>. Figure 31: Claims by Service Code View 4. Select <Service Code> to be filtered. Figure 32: Service Code 5. Select <John Doe>. Figure 33: Service Code (S5130) List REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 18

19 6. On a single click, the <Claims by Service Code> screen opens. Figure 34: Claims by Service View highlighting Service Code 7. When done reviewing you can click <Close> or <Print>. Visits Completed: Claims by Status This view sorts visits completed by status. Figure 35: Visits Completed by Status View REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 19

20 Accessing Visits Completed by Status 1. Select <Claims Review> from main menu. 2. Drop down list appears, select <Visits Completed>. 3. Select <By Status>. Figure 36: Visits Completed by Status Selection 4. On a single click select desired option in under <Select>, in this case select <SUBMITTED> and <UNMATCHED ON HOLD>. Figure 37: Visits Completed by Status Records REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 20

21 5. Select <Andy Cann> from the list. Figure 38: Visit Completed Record Selection 6. This will direct you to the <Visit Completed> screen as shown in Figure 39. Figure 39: Visit Completed by Status Authorizations Page 7. When done reviewing you can click <Close> or <Print>. REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 21

22 5.3.3 Claim Reconciliation As the status of the claim is not sent from FMMIS back to the EVV Claims, the status of the claim has to be reconciled manually. This information is send directly from FMMIS to the Healthcare Provider through the 835 report. Reconciling Claims 1. Click <Claim Reconciliation>. 2. The <Claims For Reconciliation> list will display. Figure 40: Claims Reconciliation List 3. Select the items your wish to reconcile as in Figure 41. Figure 41: Claims Selection for Reconciliation 4. Click the <Reconcile Claims> button. 5. The Reconciliation Information window will open. Figure 42: Reconciliation Status Selection REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 22

23 6. Select the Reconcile Status from the selection list. Figure 43: Reconcile Status Selection 7. If you select <PAID>, the following selection will open. Figure 44: Paid Selection Reference Id 8. The Claims Electronic Visit Verification will allow the entry of the reference number from the 835 report. 9. If the Reconciliation Status selection is <DENIED>, the system will request the Denial Code. Figure 45: Denial Code Selection 10. Select the desired code from the drop-down list. Figure 46: Denial Code List REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 23

24 11. When the appropriate code is selected, click <OK>. Figure 47: Denial Code Selected. Press <OK>. 12. A Confirmation Message widow will advise that the claims will be set to DENIED status. Figure 48: Confirmation Message. 13. The claims will no longer appear on the list. REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 24

25 5.3.4 Quick Finder This is a tool used to find authorizations or claims for recipients by: o Name o ID Figure 49: Quick Finder Accessing Quick Finder 1. Select <Claims Review>. 2. Click <Quick Finder>. Figure 50: Quick Finder REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 25

26 3. Set your filter: o Authorizations by Recipient Name. o Authorizations by Recipient ID. o Claims Review by Recipient Name. o Claims by Recipient ID. Figure 51: List of Filters Accessing Authorizations by Recipient Name 1. Select <Authorizations by Recipient Name>. Figure 52: Quick Finder Recipient ID 2. Enter <Recipient s ID>. 3. Click <Find>, a list of recipients meeting the selection criteria appears. REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 26

27 4. Select <Recipient Name and ID> from the list. Figure 53: Recipient Name List 5. Select record Figure 54: Recipient Drill-Down Record 6. You will be directed to the authorization screen. Figure 55: Authorizations Screen View 7. When done reviewing you can click <Close> or <Print>. Follow the same steps to find claims for either Authorizations for Claims by Recipient Name or ID. REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 27

28 5.4 Claim Entry This section of the Claims Portal, allows the user to manually enter and or add new claims. Authorizations cannot be added and are not editable. Table 3: Claim Entry Menu Summary # Item Description Claim Entry By Status By Claim No. New Claim Header Allows user to view claims based on the status of the claim. Allows user to view claims based on the claim number. Allows user to manually enter re-submitted and corrected claims into the portal. CAUTION: Authorization MUST be valid. Claim MUST match the authorization on record. Claim MUST include a valid service or procedure code. Caregiver visit times MUST match the schedule. There MUST be a valid claim number, claim type, number of claim lines. Above the valid service diagnosis code there MUST be a valid recipient Medicaid ID and a service date. REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 28

29 5.4.1 Claim Entry Header Figure 56: Claim Entry Screen View Table 4: Claim Entry Screen Fields # Item Description Billing Provider ( ) Provider Name, NPI Number, and ID Number Insurance ( ) Insurance Provider and ID Number (600- Florida Medicaid) Date Received Date the service were rendered. Unique Identifier ( ) Unique Identifier ID for the service Claim Number Number assigned to the claim Claim Amount Total amount for the claim Date Submitted Date the claim was submitted Status ( ) Status of claim (New, Approved, Rejected) Claim Type Type of claim (Original, Resubmission) Claim Lines Number of lines in the invoice Recipient ID The ID for the recipient receiving the service (Medicaid ID) Provider ID (+) Provider ID and should match the ID In Insurance ID ( ) This will match the insurance ID in Service Code The procedure code for the service provided Service Date The date the service was provided Amt. Billed The amount billed for the service Units Number of units used for the service Current Attachments Any documentation required for the invoice can be attached Claim Details Totals Documents detailing claim Totals for claims, quantity and billed * Mandatory Fields Defaulted Fields REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 29

30 5.4.2 Claim Entry by Status This view sorts a new claim by status. Figure 57: Claim Entry by Status Accessing Claim Entry by Status 1. Select <Claim Entry>, then select <By Status> claim entry is identified by the status of the claim. Figure 58: Claim Header by Status View REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 30

31 2. Expand <New> to access claims. Figure 59: Link to Claims Record 3. A list of batch claims appears as in 4. Figure 60 below. Figure 60: Batch Claims List 5. Select <Claim>. Figure 61: Individual Claim REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 31

32 6. <Claim Entry Header> appears. Figure 62: Status Claim Entry Screen 7. When done reviewing you can click <Close> or <Print> Claim Entry by Claim No. This view sorts a new claim by the claim number associated with that record. Figure 63: Claim Entry by Claim No. REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 32

33 Accessing Claim Entry by Claim No. 1. Select <Claim Entry>, then select <By Claim Number> claim entry is identified by the claim number. Figure 64: Claim Header by Claim No. View 2. Click the claim number to access claims. Figure 65: Link to Claims REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 33

34 3. A list of batch claims appears as in Figure 66 below. Figure 66: Batch Claims 4. Select the claim number and date for the claim to review. Figure 67: Individual Claim REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 34

35 5. <Claim Entry Header> appears. This yields an identical screen to Figure 62. Figure 68: Status Claim Entry Screen REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 35

36 6. When done reviewing you can click <Close> or <Print>. Tip: You are able to export Claim Header by Claim No. into Excel! REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 36

37 5.4.4 New Claim Header This section allows the user to manually re-submit a claim. When adding a new claim all required fields must be filled to proceed. Figure 69: New Claim Entry Screen REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 37

38 Accessing New Claim Header 1. Select <Claim Entry>, then select <New Claim Header>. Figure 70: New Claim Header 2. New <Claim Entry Header> screen opens and appears as in Figure Enter all required fields, no required field can be left blank. 6. When all fields are completed, select <Save>, <Send for Review>, or <Close>. CAUTION: Authorization MUST be valid. Claim MUST match the authorization on record. Claim MUST include a valid service or procedure code. Caregiver visit times MUST match the schedule. There MUST be a valid claim number, claim number, claim type, number of claim lines. Above the valid service diagnosis code there MUST be a valid recipient Medicaid ID and a service date. Always save the claim header before adding claim details. 5.7 Help Documents This connects to the reference documents at: REV: 11/17 Sponsored by Centric Consulting, LLC, and the State of Florida, AHCA Page 38