Provider Healthcare Portal Demonstration:

Transcription

1 Provider Healthcare Portal Demonstration: Claim Denials Professional Claims (CMS-1500) HPE October 2016

2 Agenda Getting started Searching claims Copying and correcting claims Most common denials; how to avoid Helpful Tools Q&A 2

3 Getting started

4 Researching and correcting claims The Provider Healthcare Portal allows providers to: Search for claims in the system Locate paid and denied claims Determine the reason for full claim or line item denials Correct denials and resubmit claims 4

5 5

6 Menu bar shows provider or delegate s authorized functions 6

7 Searching claims

8 hover on Claims and click Search Claims or click Claims and click Search Claims

9 Search for claims by Claim ID, Member Information, or Service Information If not searching by Claim ID, enter paid date, or service from/to dates When searching by DOS, you can search up to 60- day range 9

10 A list of claims meeting search criteria is displayed Click + to see service line detail Click Claim ID to retrieve actual claim

11 Click + to display service line detail. Click - to collapse information

12 Displaying claim information Claim data can be copied, edited, voided, previewed, and printed Data display can be expanded and collapsed Diagnosis codes Service details Claim EOB information Insurance details Attachment information Notes Adjustment reason codes (ARCs) Adjudication errors 12

13 Full claim display shows provider, patient, and claim information Expand All to display more information Denied claims have Copy feature Paid claims have Edit, Copy, and Void features

14 Paid claims can be edited, which is similar to REPLACE on Web interchange Paid claims can be voided. Entire payment is recouped from future claim payments 14

15 Provider and patient information displayed 15

16 Claim information displayed 16

17 All PAY and DENY codes will post for each service line EOB codes are displayed for each service line pay dispostion code example 2043 deny dispostion code example 17

18 Copying and correcting claims

19 Correcting claims If a denied claim has a correctable error it can be copied and resubmitted Correctable error examples: Transposing numbers on a procedure code Incorrect billed charge amount Misspelling member s name Error code 2043-THE MEMBER IS ENROLLED IN HIP, is not a correctable error. Claim needs to be billed to the correct MCE 19

20 Choose the information you want to copy 20

21 Correcting claim errors If a claim denies for error code 2505-RECIPIENT COVERED BY PRIVATE INSURANCE or 2502-RECIPENT COVERED BY MEDICARE, the insurance information can be added Diagnosis codes can be added or removed Service line information can be corrected Attachments can be added and uploaded to submit electronically Claim notes can be added 21

22 Other insurance information can be added when Medicaid is the secondary payer 22

23 Coordination of Benefit (COB) information for other insurance 23

24 Drop-down arrows display Relationship to Patient and Claim Filing Code 24

25 Invalid or missing data will generate pop-up responses in red 25

26 Click on claim line # to display service Cline data. Make corrections, as necessary 26

27 Click + to add service lines 27

28 Diagnosis codes can be edited, added, or removed 28

29 Search diagnosis codes by key words or numbers 29

30 Attachments can be submitted by file transfer (jpeg, tif, pdf); or by mail Total size of attachments is limited to five megabytes 30

31 Attachments sent by mail require a control # and attachment type code 31

32 Drop-down arrow displays attachment types 32

33 Claim notes can be added 33

34 Drop-down arrow displays Note Reference Code 34

35 After submitting claim, Claim ID displays 35

36 Most common denials How to avoid

37 Most common denials EOB code Description #(000 s) 0593 Medicare denied detail Procedure code vs. program indicator Coinsurance and deductible missing Billed amount missing Exact duplicate HIP or HCC member not eligible for service Recipient covered by Medicare Rendering NPI not reported Billing provider not enrolled at service location for DOS Recipient covered by private insurance Claim data is for physician provider type-january to July 2016

38 Best way to prevent claim denials is to stay informed! Subscribe to automatic notification of Banner pages and bulletins Use Provider Reference Modules 38

39 Claims and Billing Procedures modules 39

40 Helpful Tools

41 Helpful Tools IHCP website at indianamedicaid.com IHCP Provider Reference Modules Medical Policy Manual Customer Service Provider Relations Field Consultants indianamedicaid.com > Provider Home page > Contact Us Written Correspondence HPE Provider Written Correspondence P.O. Box 7263 Indianapolis, In

42 Q&A