Home Health Agency and Hospice Facility Workshops
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1 Home Health Agency and Hospice Facility Workshops October 2015 Presented by Blue Cross and Blue Shield of Kansas
2 Agenda Communicating with our providers BCBSKS Website Availity Web Portal Provider Manual Member ID Card Billing Instructions Home Health Agencies Hospice Agencies Case Management Electronic Data Interchange (EDI) Question and Answers (Q&A)
3 Institutional Provider Relations Department Functions of the Institutional Provider Relations Dept: Liaison between the provider and BCBSKS Manage facility contracts Provide Training and Education Communication Provider Inquiries
4 Institutional Provider Relations Department Functions of the Institutional Provider Relations Dept: Provider Types: Ambulatory Surgery Centers (ASCs) Birthing Centers Dialysis Centers Home Health Agencies Hospice Facilities Hospitals (Acute, Rehab, Psych, Military and VA) Substance Abuse
5 Institutional Provider Relations Department Institutional Provider Relations Department Staff Director Angie Strecker Manager Teresa Van Becelaere Provider Consultants: Janne Denton Topeka Ancillary Provider Cindy Garrison Topeka Northern KS Hospitals Sally Stevens Wichita Southern KS Hospitals Education and Communication Coordinator Connie Winkley Provider Program Specialist Brent Matile
6 Institutional Provider Relations Department Institutional Provider Relations Department Staff: Claims Research Analyst Katie Dennison Support Staff: Administrative Coordinator Topeka Dona Hewes Administrative Assistant Topeka - Melanie Moriarty Administrative Assistant Wichita Kristi Donelan
7 Communicating with our Providers How we communicate with our providers.. Website tools and resources One-on-one provider consultant visits Inquiries by: Mail Phone
8 BCBSKS Website, and the BlueAccess and Availity Web Portals BCBSKS Public Website Includes information for providers that which does not require secure access. enews Primary means of communication for institutional providers. Sign up so that you are not left behind!
9 Glossary Glossary As you view the BCBSKS Website, you may come across an unfamiliar word or term. We've developed a glossary that we hope will help you.
10 BCBSKS Website, and the BlueAccess and Availity Web Portals BlueAccess BCBSKS Secure Website Accessible only by logging onto the Availity Web Portal Some of the secure information found on BlueAccess include: Remittance Advice Institutional Provider Manual Patient ID (BCBSKS Member) Search Pre-Service Review Institutional Providers General Polices and Procedures
11 BCBSKS Website, and the BlueAccess and Availity Web Portals Availity Web Portal - Secure Website BCBSKS moved secure information to Availity in August 2013 Information found on the Availity Web Portal include : BCBSKS Member Eligibility and Benefits BCBSKS Member Claims Status Requires secure log in and access is granted from the facility's Availity Primary Access Administrator (PAA) Several payers use Availity, including CMS/Medicare
12 BCBSKS Membership BCBSKS ID Card: Provides important information that healthcare providers need to know to submit a claim. Front of card contains information on the type of coverage and a brief description of the out-of-pocket amounts. Back of the card contains information on plan contact numbers and mailing address and the plan's website. Are for identification purposes only; they do not guarantee eligibility or payment of claims. Providers should always verify patient eligibility for BCBSKS members on the Availity web portal. BCBSKS Members receive an updated ID card whenever their benefits change or BCBSKS information on the card changes.
13 BCBSKS Membership BCBSKS ID Card: Includes a 3-character alpha prefix, plus a 9-digit randomly selected number. Current On and Off Exchange BCBSKS member alpha-prefix and description Alpha Prefix XSA XSB XSC XSD XSE XSF XSG XSH XSI XSJ XSK XSL Network and Product Description BCBSKS CAP Blue Choice Small Group Off Market Individual Exchange Solutions BlueCap SHOP (On Exchange) Select Blue CAP Individual On Exchange Blue Choice Select Individual Off Exchange SHOP Exchange Solutions Blue Choice Select Small Group Off Exchange Bleu Choice Individual Off Exchange BlueCap SHOP (On Exchange) BlueCap MultiState Individual On Exchange BlueCap Individual On Exchange Select
14 BCBSKS Membership BCBSKS ID Card: Includes a 3-character alpha prefix, plus a 9-digit randomly selected number. Current On and Off Exchange BCBSKS member alpha-prefix and description Alpha Prefix XSM Plan 65 Network and Product Description XSQ XSR XSV ARX HEH IPH and PHF KGS KSE LSR SPA TOE Individual Solutions Off Exchange Small Group Solutions Off Value Blue AirXcel Harris Enterprises Pizza Hut OneOK State of Kansas Del Frisco's Restaurant Group Spirit AeroSystems City of Topeka
15 BCBSKS Membership
16 BCBSKS Membership Kansas Solutions Membership: A new BCBSKS subsidiary Effective January 1, 2015 Limited network BCBSKS' 103-county service area only! Excludes Johnson & Wyandotte Counties in KS Represented by an empty suitcase Sold to individuals on and off the exchange and small group (SHOP) markets Claims for Solutions members will have its own remittance advice (RA)
17 BCBSKS Membership Kansas Solutions Membership: Blue Solutions is not a traditional HMO: Members will NOT choose a Primary Care Provider (PCP) No referral is needed for visiting a specialty provider Members have open access through the BCBSKS Blue Choice network Providers reimbursed using Blue Choice payment rates
18 BCBSKS Membership Providers can learn more about the BlueCross and/or Blue Shield member ID cards by using the following resources available on our website. ations/institutional/manuals/pdf/quick-guide-to-bcbs- Member-ID-Cards.pdf ations/institutional/manuals/pdf/inst_exchange-bluecardand-kansas-provider-networks.pdf
19 Remittance Advice (RA) PATIENT RESPONSIBILITY I.D. CARD NO. PATIENT NAME BCBS CLAIM NO. PROVIDER PATIENT ACCOUNT NUMBER SERVICE DATE STANDARD CODE SET O T L R D A Y S PROVIDER TOTAL CHARGE AMOUNT ALLOWED PROVIDER'S CONTRACTUAL OBLIGATION OTHER ADJUSTMT PAYER INITIATED TOTAL AMT NOT COVERED DEDUCTIBLE CO-INSUR CO-PAY AMT PATIENT OWES TOTAL AMT PAID C N T R ADJUST REASON CODE R E M A R K S XSP Claim, Ima BC CH BC CH M SUBTOTAL Claim Control Number DAYS TOTAL CHARGES AMOUNT ALLOWED CONTRACTUAL OBLIGATION ADJUSTMT AMOUNT NOT COVERED DEDUCTIBLE & CO-INSUR TOTALS CO-PAY PATIENT OWES AMT PAID CHECK NO. PAY DAY PROV. NO /06/
20 Claim Control Number Claim Control Number Format LLYYJJJNNNNZ-S LL - Internal Number YY - Year JJJ - Julian Date NNNNZ - Sequential Number S - Suffix (optional)
21 Claim Control Number Examples Claim Number Paper claim 15 It was received in It was received on January 5 th It was the first claim in the sequence
22 Clean Claim Processed PATIENT RESPONSIBILITY I.D. CARD NO. PATIENT NAME BCBS CLAIM NO. PROVIDER PATIENT ACCOUNT NUMBER SERVICE DATE STANDARD CODE SET O T L R D A Y S PROVIDER TOTAL CHARGE AMOUNT ALLOWED PROVIDER'S CONTRACTUAL OBLIGATION OTHER ADJUSTMT PAYER INITIATED TOTAL AMT NOT COVERED DEDUCTIBLE CO-INSUR CO-PAY AMT PATIENT OWES TOTAL AMT PAID C N T R ADJUST REASON CODE R E M A R K S XSP Claim, Ima BC BC BC SUBTOTAL DAYS TOTAL CHARGES AMOUNT ALLOWED CONTRACTUAL OBLIGATION ADJUSTMT AMOUNT NOT COVERED DEDUCTIBLE & CO-INSUR CO-PAY PATIENT OWES AMT PAID TOTALS CHECK NO. PAY DAY PROV. NO /06/
23 Remittance Advice Resource A list of Remittance Advice codes can be found at the Washington Publishing Company
24 Exchange Individual Grace Period Individual has paid at least one month's premium The payer is only obligated to pay claims during the first month During the grace period, the payer may pend claims during the second and third months The provider can not bill the patient during the grace period
25 Medicare Advantage What is it? Claims Submission Appeals HIPPS codes
26 Home Health Billing General Guidelines Prior Authorization Primary Diagnosis codes for ICD 10 Type of Bill 032X 033X (DISCONTINUED EFF 10/1/13) 034X
27 Hospice Billing Home hospice Inpatient hospice Total Parenteral Nutrition (TPN)
28 CMS Changes for 2016 Two tiered home care rate based on length of stay Service Intensity Add-on
29 QUESTIONS? An Independent Licensee of the Blue Cross and Blue Shield Association.
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