Provider Healthcare Portal Overview Indiana Health Coverage Programs DXC Technology October 2017
Session Objectives Provider Enrollment transactions Home Page Member Eligibility Prior Authorization Claims Member Focused Viewing Search Payment History Helpful Tools Q&A 2
3 Provider Enrollment Transactions
Access Home the application Page Click Provider Enrollment on the left side of the Provider Healthcare Portal home page 4 A user account is NOT needed to submit an online provider enrollment application
Check the Status To check the status of an application, click Enrollment Status on the left side of the Provider Enrollment page. 5
Other Enrollment Transactions Once enrolled and a Provider account is established choose from links on left side of the MY Home page to perform other enrollment transactions 6
7 Home Page
8 Home page
9 Verify Member Eligibility
Verify Member Eligibility To access the Eligibility Verification Request function, log in to the Provider Healthcare Portal and click Eligibility on the menu bar. 10
Verify Member Eligibility To perform a search, the Effective From date is required, in addition to one of the following: Member ID Social Security number (SSN) and birth date Last name, first name, and birth date 11
Verify Member Eligibility The Effective From field is always required. If a date is not entered, the Portal defaults this field to the current date This field accepts only current and previous dates The Effective To field is optional. The date entered must be on or after the Effective From date and must be within the same calendar month as the Effective From date If a date is not entered, the Portal will default to the Effective From date 12
Verify Member Eligibility When an eligibility search returns no results, qualified providers (QPs) will see an additional option below the message to complete a Presumptive Eligibility for Pregnant Women (PEPW) or Presumptive Eligibility (PE) application for the patient. 13
Verify Member Eligibility Viewing coverage details From the Eligibility Verification Information panel, click the coverage link for additional details. Note: Some searches may have more than one coverage type listed. 14
15 Verify Member Eligibility
Verify Member Eligibility Important! The provider s enrollment period affects the results of a search. The Portal allows a provider to search for member eligibility information only for date ranges that fall within the provider s enrollment period. For example, if a provider is enrolled starting on 04/01/2016 and attempts an eligibility verification search with an Effective From date of 01/03/2016 (before the provider s enrollment period), the Portal will not display eligibility information for that member. 16
17 Prior Authorization Fee-For-Service
Is a prior authorization needed? BEFORE logging into the Provider Healthcare Portal to create a request, save time and avoid submitting codes that do not require a prior authorization by looking up the codes on the Fee Schedule. For your convenience, there is a Search Fee Schedule link located on the Portal Home page. 18
Prior Authorization Access the prior authorization function from the Care Management drop-down menu. 19
Prior Authorization Complete the required information and submit the request by clicking on Confirm 20
Viewing Prior Authorization Status The authorization request is assigned an Authorization Tracking Number (ATN) Results list the first 20 authorizations with beginning service dates of today or greater Results list only authorizations where the viewing provider was on the request as the Requesting provider 21 Click to view the authorization Member name and ID will be displayed Requesting provider will be listed
22 Claims
Search Claims Two ways to access claim search function OR 23
Search Claims When searching for claims, you have the option to choose which type of claim to search and a date range Or Search by Claim ID, Member ID, or Service Dates and click 24
25 Claim Search Results
26 Claim Service Line Details
27 Claim Information
28 Member Focused Viewing
Member Focused Viewing Quick access to: Member details Coverage details Claims search and submission Prior authorization search and submission 29
Member Focused Viewing Member Focused Viewing search 30
31 Member Focused Viewing
32 Search Payment History
33 Search Payment History
Search Payment History Auto populates last 12 weeks, or Search by 12 week span 34
35 Search Payment History
36 Helpful Tools
Helpful Tools IHCP website at indianamedicaid.com IHCP Provider Reference Modules Medical Policy Manual Customer Assistance 1-800-457-4584 IHCP Provider Relations Field Consultants indianamedicaid.com > Provider Home page > Contact Us Written Correspondence DXC Technology Provider Written Correspondence P.O. Box 7263 Indianapolis, In 46207-7263 Secure correspondence via the Provider Healthcare Portal 37
38 Questions