TODAY S PRESENTERS AND CONTACT INFORMATION

Transcription

1 DECEMBER 9, 2011

2 TODAY S PRESENTERS AND CONTACT INFORMATION Connie Winkley, Education Coordinator, Institutional Provider Relations, Blue Cross and Blue Shield of Kansas Connie.winkley@bcbsks.com, Cindy Garrison, CPC Provider Consultant, Institutional Provider Relations, Blue Cross and Blue Shield of KS Hospitals in Northern Kansas Cindy.Garrison@bcbsks.com, Denny Cassel Hartman, CPC Provider Consultant, Institutional Provider Relations, Blue Cross and Blue Shield of KS Hospitals in Southern Kansas Denny.Hartman@bcbsks.com, Marie Burdiek, EDI Account Representative, EDI Operations, Blue Cross and Blue Shield of Kansas Marie.burdiek@bcbsks.com,

3 BCBSKS AGENDA Blue Cross and Blue Shield of Kansas Availity ICD-10 CPT Code Changes for 2012 EDI - Electronic Data Interchange HIPAA 5010 TRICARE/TriWest

4 AVAILITY: BCBSKS Future Secure Web site Access for Member s Eligibility and Claim Status effective in 2012 What is Availity? Availity offers a multi-payer portal at that gives physicians, hospitals and other health care providers secure access to multiple payers information through a single sign-on. Availity offers a variety of business and clinical solutions to help providers reduce administrative costs by eliminating paperwork and phone calls. Availity is one of the nation s largest electronic health information networks, processing more than a billion transactions each year. Why is Blue Cross Blue Shield of Kansas teaming with Availity? Our relationship with Availity will help remove costs from the system by streamlining transactions and processes. This will help reduce the amount of paperwork for medical practices, allowing physicians to spend more time with patients. What are the advantages of using Availity? No Charge Health plan transactions are available at no charge to providers. Accessibility Availity functions are available 24 hours a day from any computer with Internet access. Standard responses Availity returns responses from multiple payers in the same format and screen layout, providing users with a consistent look and feel. Commercial and Government Payers Access to data from BCBSKS, Medicare, Medicaid and other commercial insurers. A full list of participating payers for each state by participation type is available at > Info for Providers > View Availity Health Plan Partners. The link to View Availity Health Plan Partners can be found on the right hand side of the Info for Providers page. Compliance Availity is compliant with the Health Insurance Portability and Accountability Act (HIPAA) regulations. Availity s statement of compliance is available at Select Info for Providers and then Regulatory Compliance. The link to Regulatory Compliance can be found on the right hand side of the Info for Providers page. Training Availity offers free live and pre-recorded Web-based training seminars (webinars). Providers simply log into the Availity portal and register to attend the webinars of their choice. Demonstrations, frequently asked questions and comprehensive help topics are available online as well.

5 What services are available through Availity? Providers can use the portal for the following BCBSKS member transactions: Eligibility and Benefits Claim Status Additional services and functions may be available from other payers. Who should providers call if they have questions about Availity? Contact Availity Client Services toll free at 800-Availity ( ) or questions to Availity Client Services is available Monday through Friday 8 a.m. to 7 p.m. ET (excludes holidays). For other assistance: Availity Help In Availity, click Help at the top of the page. Browse the books and topics as necessary Show Me Demos For a demonstration of many tasks available on Availity, go to on the Home page under Availity Training and Resources, click Show Me Demos. Click any of the categories to expand them. Click a blue triangle to launch a demo. Live and Pre-recorded Webinar Training Availity offers live training conducted by phone and teleconferencing tools. To see the schedule and enroll: In Availity, click Free Training on any page. Click Live Webinar Schedule. To enroll, click a webinar title and follow the instructions on the page that displays. If I already have access to BCBSKS s web site, will I need to register to use the Availity Health Information Network? Yes. The Availity Health Information Network requires that you register and obtain a user ID and password. Once logged in to Availity s network, you have the ability to transact with multiple health plans, eliminating the need to visit multiple sites and remember multiple passwords. What are the technical requirements? All a provider needs to access Availity.com is: A computer with internet access. High speed is recommended for best results Microsoft Internet Explorer 6.0 or greater, which supports 128-bit encryption. A 1024 x 768 or greater pixel display for best results.

6 ICD-10 Mapping - General Equivalence Mapping (GEM) Look-up Tool Log into BlueAccess and click on ICD-10 Mapping WELCOME INSTITUTIONAL PROVIDER 1. Single Diagnosis Code Retrieval

7 2. Diagnosis Code Range Retrieval (Choose by code and page number to retrieve GEM) 3. Description Look-Up (Choose by code and page number to retrieve GEM)

8 4. Single ICD-10 Diagnosis Code 5. Single ICD-10 Procedure Code

9 TriWest Provider Services Webinars, eseminars Available TriWest Healthcare Alliance (TriWest) has developed various webinars and eseminars to help you learn about TRICARE and TriWest. Webinars are training sessions from your own computer with a live instructor in which you can ask questions and also hear questions asked by other providers attending the training. eseminars allow you to learn about TRICARE and TriWest in the comfort of your own office, home or any location with Internet access. Here is a list of webinars that are currently available on the following topics: Title Behavioral Health TRICARE 101 TRICARE 101 Ambulatory Surgery Autism Electronic Data Interchange (EDI) PT/OT/ST Secure Website-Claims Description This webinar is for behavioral health professionals and facilities and gives a comprehensive review of TRICARE programs, TRICARE/TriWest administrative requirements, and provider resources. This webinar is for medical/surgical professionals, facility, and ancillary providers and gives a comprehensive review of TRICARE programs, TRICARE/TriWest administrative requirements, and provider resources. This webinar is for outpatient surgery providers subject to ASC grouper reimbursement. Information about authorizations, claims submission and reimbursement, and provider resources relevant to outpatient surgery providers is provided. This webinar is for autism providers who will learn about the Autism benefit, the two options for providing Autism services to TRICARE beneficiaries, authorization requirements, submitting claims, and reimbursement for Autism services. This webinar discusses the benefits, advantages and the workflow for your online claims process. You will learn about the following topics: EDI transmission options, guidelines for other health insurance and secondary claims, electronic remittance advices, electronic funds transfer, and how to access and use the claims status report. You will also learn about 5010 and ICD-10 and provider resources. This informative Physical Therapy/Speech Therapy/ Occupational Therapy webinar covers TRICARE s physical therapy, speech therapy, and occupational therapy benefits in an outpatient setting, authorization requirements, and claims submission. Want to save time with your claims submission and Accounts Receivable? The Secure Website-Claims webinar will show you how to streamline your work relating to online claims submission for your TRICARE West Region patients and other time saving tools, including claims status and online claims correspondence/webmail. TriWest Healthcare Alliance provides access to quality health care for 2.9 million members of America's military family in the 21- state TRICARE West Region. HO /30/2011

10 TriWest Provider Services Title Secure Website-Referrals and Authorizations TriWest Online Care Behavioral Health Webinar Vision Coverage Description Want to save time submitting your referral and authorization requests and get an almost immediate response in most cases? The Secure Website-Referrals and Authorizations webinar will show you how to streamline your work relating to referrals and authorizations for your TRICARE West Region patients. This webinar is designed for providers interested in participating in Tele-Behavioral Health Care as originating sites or distant providers. The vision coverage webinar was developed for vision providers and gives a comprehensive review of the TRICARE vision coverage. Here is a list of eseminars that are currently available on the following topics: Title Behavioral Health TRICARE 101 TRICARE 101 Ambulatory Surgery Autism Electronic Data Interchange (EDI) Extended Health Care Option (ECHO) Home Health Agency Prospective Payment System Description This eseminar is for behavioral health professionals and facilities and gives a comprehensive review of TRICARE programs, TRICARE/TriWest administrative requirements, and provider resources. This eseminar is for medical/surgical professionals, facility, and ancillary providers and gives a comprehensive review of TRICARE programs, TRICARE/TriWest administrative requirements, and provider resources. This eseminar is for outpatient surgery providers subject to ASC grouper reimbursement. Information about authorizations, claims submission and reimbursement, and provider resources relevant to outpatient surgery providers is provided. This eseminar is for autism providers who will learn about the Autism benefit, the two options for providing Autism services to TRICARE beneficiaries, authorization requirements, submitting claims, and reimbursement for Autism services. This Electronic Data Interchange (EDI) eseminar discusses the benefits, advantages and the workflow for your online claims process. You will learn about the following topics: EDI transmission options, guidelines for other health insurance and secondary claims, electronic remittance advices, electronic funds transfer, and how to access and use the claims status report. You will also learn about HIPAA 5010, and ICD-10 and provider resources. This eseminar is for Extended Care Health Option (ECHO) providers. ECHO supplements the basic TRICARE benefit for active duty family members with special needs. This eseminar provides important information to understand the ECHO benefit and provider responsibilities and administrative requirements. This eseminar is for home health providers and gives an overview of the home health benefit and related administrative requirements. TriWest Healthcare Alliance provides access to quality health care for 2.9 million members of America's military family in the 21- state TRICARE West Region. HO /30/2011

11 TriWest Provider Services Title Outpatient Prospective Payment System (OPPS) TRICARE s Hospice Benefit TriWest Online Care Program Vision Coverage Description This eseminar is for hospitals and other facilities subject to OPPS reimbursement and provides an overview of the reimbursement methodology. This eseminar is for hospice providers and gives an overview of the hospice benefit and related administrative requirements. This eseminar provides information for Originating Site and Distant Site Providers participating in the TriWest Online Care program (tele-behavioral health). The vision coverage eseminar was developed for vision providers and gives a comprehensive review of the TRICARE vision coverage. Additional webinars and eseminars will be added for your convenience, as needed. TriWest Healthcare Alliance provides access to quality health care for 2.9 million members of America's military family in the 21- state TRICARE West Region. HO /30/2011

12 TriWest Provider Services Website Demonstrations To view website demonstrations, go to TriWest.com/provider, then click the blue button Website Demonstrations. Links to Topics Account Administration Eligibility West Region Benefit Lookup Tool Online Referral/Authorization Submission Practice It! Online Referral/Authorization Status Online Claims Submission Online Claims Status Online Claims Correspondence/Webmail Descriptions Learn how to manage your online account Learn how to check eligibility online Learn to research covered benefits and check referral/authorization and medical review requirements for specific codes Choose from three website demonstrations on online referral/authorization submission: Medical/Surgical, Inpatient Notification, and Behavioral Health. Take the online referral/authorization submission demonstration and then spend some time interactively practicing with the application. Learn how to check the status of a referral or authorization online Choose from two website demonstrations on submitting claims online: UB-04 and CMS-1500, or access a tip sheet on submitting corrected, replacement, and void/cancelled claims Learn how to check the status of your claims online Learn how to correspond with TriWest online regarding claims issues/inquiries and your secure account at TriWest.com/Provider TriWest is continually improving the functionality on our secure website to better serve providers. The secure website applications described in these demonstrations may change before these demonstrations are updated. TriWest Healthcare Alliance provides access to quality health care for 2.9 million members of America's military family in the 21-state TRICARE West Region. HO /30/2011

13 Cut the Cord and Go Online! TriWest Healthcare Alliance s self-service tools for providers and their office staff can make daily office work more convenient, immediate, faster and easier. Convenient Using the tools offered on TriWest s secure provider website allows you to conveniently check your patients eligibility, submit and check status of referrals and authorizations, as well as submit and check status of claims, and much more! Immediate Did you know that most referrals and authorizations properly submitted through TriWest s secure provider website are processed automatically within minutes? Now, your patients can get the care they need faster and you can move on to the next task at hand. Faster No one likes to wait to get paid and with electronic claims submissions, you won t wait long! On average, 90% of clean claims submitted online are processed in less than five days more than 10 days faster than submitting paper claims. Easier Stay up-to-date with TRICARE! After registering online, you will automatically receive exclusive access to the West Region Benefit Lookup Tool at TriWest.com/Provider>Eligibility an easier way to check benefits and eligibility. Plus, you ll receive TRICARE enews with resources and TRICARE updates, including billing, reimbursement, and benefit changes and more all direct to your account! Not registered? Register today by clicking the orange Register Now button in the top right-hand corner of TriWest/com/Provider. To make the registration process as easy as possible, make sure you have the following information available before you register: Your Tax ID number License number, Medicare number or NPI (National Provider Identifier) One of the following: o Two claim numbers (from TRICARE West-Region Claim remittance advices) o Two authorization reference numbers o One claim number and one reference number In addition, you will need the date of birth of the beneficiary or beneficiaries from the internal control number (ICN) or reference number. Need help registering? If you don t have the information needed to register for the secure website, you can click on the Contact Us link at the bottom of TriWest.com or call WPS EDI at (800) for assistance. Already registered? Start taking advantage of the convenient online tools available now at TriWest.com/Provider.

14 TriWest Provider Services Don t Wait Update! Check Your Information Today Have you moved into a new office recently? Changed your telephone number? Have more missed appointments or patients arriving late for appointments? If you answered yes to any of these questions, you need to take a minute to check your information on the TriWest Provider Directory to update your contact information. To verify your information, go to TriWest.com and click on Find a Provider at the top of the page. If a change is necessary, go to TriWest.com/UpdateNow to find your Local TRICARE Representative. It is important to provide your Local TRICARE Representative with demographic updates like changes in physical location, tax identification number, telephone number, claims payment address, addresses for staff working with TRICARE, etc. We thank you for taking the time to verify your information and for the service you provide to TRICARE beneficiaries. TriWest Healthcare Alliance provides access to quality health care for 2.9 million members of America's military family in the 21-state TRICARE West Region. HO /28/2011

15 TriWest Provider Services Why Share Your Address With TriWest? Our Goals Communicate the right information to the right person at the right time o Inform you about TRICARE program changes and TriWest processes to ensure that you have the information you need to receive reimbursement quickly and efficiently o Provide resources to help you care for TRICARE beneficiaries, including those active duty service members in your community who may have recent combat experience o Notify you of educational opportunities or events in your community, including live continuing education conferences, live provider education seminars, and open houses hosted by Military Treatment Facilities o Quick alerts, which when you opt-in, will notify you when your online transactions have been completed or for important updates regarding the secure website Our Method Targeted, timely communications based on your: o Geography o Provider specialty or facility type Our Commitment to You We will not sell or distribute your address to other companies, with the exception of your local TRICARE representative. We will not send spam s; all communications will be for TRICARE/TriWest-related information only. We will not overload your account; we generally send an enewsletter every 2-3 weeks. Our Next Steps Continue to gather provider addresses and the information needed to get the right message to the right person Your Next Steps Share your address in one of the following ways: Register for secure website access at TriWest.com/provider Sign up for the TRICARE enews at TriWest.com/provider Give your address to your local TRICARE representative When you receive an online request to complete your profile for purposes of communications, please respond. Make sure you add noreply@triwest.com to your safe sender list to ensure our enewsletters reach you. TriWest Healthcare Alliance provides access to quality health care for 2.9 million members of America's military family in the 21-state TRICARE West Region. FL /3/2011

16 TriWest Provider Services Register Today for the Secure Provider Portal TriWest Healthcare Alliance (TriWest) has a variety of online resources available on the secure provider portal at TriWest.com/provider for network and non-network TRICARE providers. This password protected website is intended to help enhance your experience in administratively caring for TRICARE West Region beneficiaries. Registered users can: Verify patient eligibility Research covered benefits and checking referral/authorization and medical review requirements for specific codes Submit referrals/authorizations online and check their status regardless of how the request was submitted Submit claims online and check claim status regardless of how the claim was submitted Download remittance advices Download claims status reports Submit corrected claims Claims correspondence/webmail To make the registration process as easy as possible, make sure you have the following information available before you register: Your tax ID number One of the following: o License number o Medicare number o NPI One of the following: o Two claim numbers (from TRICARE West-Region Claim remittance advices) o Two authorization reference numbers o One claim number and one reference number You also need the date of birth of the beneficiary or beneficiaries from the internal claim number (ICN) or reference number (You can use the same beneficiary for both or have two different beneficiaries.) The first person to register for the secure website is automatically the administrator. Administrators can give access to additional users in their office. If you don t have the information needed to register for the secure website, you can call WPS EDI at (800) for assistance. TriWest Healthcare Alliance provides access to quality health care for 2.9 million members of America's military family in the 21-state TRICARE West Region. HO /3/2011

17 Streamline Your Work: Use TriWest s Secure Website TriWest Provider Services TriWest Healthcare Alliance (TriWest) offers the following online features on the secure provider portal at TriWest.com/provider. To register and get instant access to your secure account, go to the Register Now section of Triwest.com/provider. TriWest has created several website demonstrations, which can be accessed in the Videos section of Triwest.com/provider, demonstrating how to use the secure website to streamline your work. Registered User Options Verifying Patient Eligibility Research Benefits, Check Referral/Authorization and Medical Review Requirements Online Referral/Authorization Submission and Status Submit Claims and View Claims Status Online Download Remittance Advices Download Provider Claims Status Reports Claims Correspondence/Webmail Details From the Eligibility & Benefits area, view the patient s TRICARE status, Primary Care Manager history (if applicable), and details on eligibility, other health insurance and out of pocket. In the West Region Benefit Lookup Tool, users enter the CPT or HCPCS code and information about the patient. The tool will display benefit exceptions, if applicable, based on search criteria. From the Referral and Authorization area, you will get an almost immediate response to your online referral and authorization requests in most cases. You can view the real-time status of your request online. You also can view, download or print the requests from the referring provider and the letters from TriWest. Under the Claims Center area, submit TRICARE West Region claims (including secondary and corrected claims) online and receive an immediate processing response. Most clean claims are processed within 24 hours. Use View Claim status to determine a claim s status, regardless of the submission method. Electronic Remittance Advice (ERA) is an electronic version of the provider s Remittance Advice and gives detailed financial information regarding processed claims. This report provides financial information for all claims processed over a four-week period. It can be printed, downloaded to an Excel spreadsheet or viewed online. Registered users can use online claims correspondence for appeals, claim check and claim reviews. Webmail allows users to submit inquiries regarding their user profile that don t necessarily require an immediate resolution. TriWest Healthcare Alliance provides access to quality health care for 2.9 million members of America's military family in the 21-state TRICARE West Region. HO /3/2011

18 TRICARE Programs Overview TriWest Provider Services TRICARE Program TRICARE Prime TRICARE Prime Remote (TPR), TRICARE Prime Remote for Active Duty Family Members (TPRADFM) TRICARE Standard TRICARE Extra TRICARE Reserve Select (TRS) TRICARE Retired Reserve (TRR) TRICARE Young Adult Description Managed care option defined by TRICARE Prime service areas Fewer out-of-pocket costs than other TRICARE options Enrollment necessary Beneficiaries have TRICARE enrollment card and Military ID card No copays for active duty Service members and active duty family members unless using pharmacy or Point of Service benefit Copays for retirees and their families Eligibility determined by military branch Enrollment necessary Beneficiaries have TRICARE ID enrollment card and Military ID card No copays unless using pharmacy or Point of Service benefit TPR ZIP Code Look-Up Tool Fee-for-service option No enrollment required Military ID cards used for eligibility determination Deductible, cost-shares, catastrophic cap based on fiscal year Beneficiaries may seek care from any TRICAREcertified/authorized provider Preferred provider option No enrollment required TRICARE Standard beneficiaries can choose a doctor, hospital, or other medical provider within the TriWest provider network Deductible, reduced cost-share TRICARE health plan similar to TRICARE Standard Health care coverage for National Guard/Reserve members who meet specific eligibility requirements TRICARE health plan similar to TRICARE Reserve Select Qualified Members of the Retired Reserve may purchase TRICARE Standard Coverage. TRICARE health plan similar to TRICARE Standard/Extra (Prime coming late 2011) Covers eligible dependent of sponsor who is TRICARE-eligible up to age 26 Need to meet specific criteria to be eligible Monthly premiums Handbook Reference pgs Section 6, pgs pgs ; Section 6, pg. 60 pg. 28; Section 6, pg. 62 pg. 28; Section 6, pg. 62 pgs ; Section 6, pg. 62 pgs ; Section 6, pg. 62 Not in West Region Handbook; see TriWest Healthcare Alliance provides access to quality health care for 2.9 million members of America's military family in the 21-state TRICARE West Region. HO /3/2011

19 TRICARE Program TRICARE For Life Extended Care Health Option (ECHO) Autism Demonstration Project Transitional Assistance Management Program (TAMP) Transitional Care for Service- Related Conditions Continued Health Care Benefit Program (CHCBP) Dental Program Retiree Dental Program Description Serves as Medicare wraparound coverage for TRICARE beneficiaries who are entitled to Medicare Part A and who have Medicare Part B coverage Administered by Wisconsin Physicians Service Insurance Corp. (WPS), not TriWest TFL pays after Medicare for covered health care services Provides additional healthcare coverage benefits to active duty family members with special needs Beneficiaries must qualify; based on specific mental or physical disabilities Offers integrated set of services and supplies beyond the basic TRICARE programs Enhances TRICARE Extended Care Health Option (ECHO) program Benefits available to children of active duty Service members Allows tutors and tutors-in-training supervised by an applied behavior analysis (ABA) therapist to deliver EIA services to eligible beneficiaries Allows certain uniformed services members separated from active duty service and their family members transitional health care benefits Eligibility determined by Department of Defense (DoD) TRICARE coverage is available for 180 days Sponsors separating from active duty and family members enrolled in TRICARE Prime have to re-enroll to continue their enrollment upon the sponsor s separation from active duty Extends TRICARE coverage for qualified former active duty Service members who are diagnosed with service-related conditions during their 180-day Transitional Assistance Management Program (TAMP) period Covers care only for the specific service-related condition; preventive and health maintenance care are not covered No copayments or cost-shares Provides transitional benefits for a specified period of time (18 36 months) to former service members and their families, some unremarried former spouses, and emancipated children (living on their own) Administered by Humana Military Healthcare Services, Inc. Voluntary dental insurance program Available to eligible active duty family members (ADFMs), Selected Reserve and Individual Ready Reserve (IRR) members, and their eligible family members Premium required for coverage Voluntary dental insurance program Dental coverage for uniformed services retirees and their eligible family members, certain surviving family members of deceased active duty sponsors, and Medal of Honor TriWest Provider Services Handbook Reference pgs pgs pg. 39 pgs Pg. 42 pg. 41 pg. 33; Section 5, pgs pg. 33 TriWest Healthcare Alliance provides access to quality health care for 2.9 million members of America's military family in the 21-state TRICARE West Region. HO /3/2011

20 TRICARE Program Pharmacy Program TRICARE Plus US Family Health Plan (USFHP) Military OneSource (Not a TRICARE program) Supplemental Health Care Program (SHCP) (Not a TRICARE program) Description recipients and their immediate family members and survivors Premium required for coverage Includes Medicare-eligible beneficiaries age 65 and over who can have a written prescription filled using any of these pharmacy options: MTF pharmacies TRICARE Retail Network Pharmacy TRICARE Pharmacy Home Delivery Non-network pharmacies Note: Filling prescriptions in non-network pharmacies is the most expensive option Home delivery and retail network pharmacy services administered by Express Scripts Inc. (ESI) Allows beneficiaries who normally are only able to get care at an MTF on a space-available basis to enroll and receive primary care appointments within same access standards as TRICARE Prime beneficiaries Only available at certain MTFs Not a health plan, just a way to access primary care at an MTF A TRICARE Prime option Offered in six geographic regions in the United States Separately funded program, different from TRICARE Provides information ranging from every day concerns to deployment/reintegration issues for active duty, Reserve, and National Guard military members and their families, and deployed DoD civilians and their families 24-7, toll free information and referral telephone service available worldwide; from the U.S.: Online services available at No cost for Military OneSource services Different payment source for active duty Service members (except those enrolled in TPR) and non-active duty individuals under certain conditions when referred to civilian providers for service related to injuries or treatments Enrollment not required Administered by MTF Command Submit claims same as for West Region TriWest Provider Services Handbook Reference pgs Not in West Region Handbook; see Section 8, Pg Not in West Region Handbook; see MilitaryOneSource.com pgs TriWest Healthcare Alliance provides access to quality health care for 2.9 million members of America's military family in the 21-state TRICARE West Region. HO /3/2011