Secure Provider Website
Contents
1. Account Details Y Update Account Add a TIN ne M User Name Email p Tax ID Password 123456789 Telephone Nothing on file Number NPI Number 123456789 Fax Number Nothing on file Secret Question What is your favorite pet s name Zip Code Secret Question What city were you born in 42345 Secret Question What is your father s middle name Your TINs PRIMARY PROFILE NAME Current Default ST LUKES HOSPITAL Operational Training 8 12 12 2012 3 To update your account click the Update Account button You are able to update the details of your account and your security information 4 Under Your TINs you see the Primary Current Default TIN for the account and can select another TIN to Mark As Default or Remove a TIN Operational Training 9 12 12 2012 User Management To manage users of your account 1 Log in to the secure website 2 Select the drop down arrow next to your name in the upper right corner Select User Management If you do not have a User Management option it means you are not set up to manage the account q E v oa Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Viewing For er ST LUKES HOSPITAL Support Users Invite a User Email Address Kyle Campbell disable name domain com User Permissions User Mi Send Invitation 3 Using this feature you can disable users and manage permissions for your2. Previous Submit Authorization 24 In the Review and Submit section review your information and make any corrections that are necessary 25 Click Submit Authorization E q w Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Viewing Authorizations For N ST LUKES HOSPITAL Authorizations for M vou Progress gt gt gt 2 2 4 THIS SECTION Congratu lations Your authorization has been submitted Thanks for submitting your authorization Please check back in 24 hours for a response Authorization for Member for Medical Your confirmation number is 349 26 The confirmation number for your Authorization submittal appears Please check back for response to your authorization within 24 hours Operational Training 33 12 12 2012 Claims To view the most recent submitted claims Viewing Dashboard For Ser ST LUKES HOSPITAL Quick Eligibility Check Member ID or Last Name Birthdate 123456789 or Smith mmiddiyyyy Recent Claims STATUS RECEIPT DATE Eligibility v Claims Messaging Ryan Lindbeck Welcome Add a TIN to My Account Recent Activity Date Activity 1 Log in to the secure website On the Dashboard you see the 5 most Recent Claims displayed 2 To view additional claims click Claims at the top of the screen Operational Training 34 12 12 2012 To view all claims submitted 1 Click Claims
3. 11 In the Providers section populate the information for the Referring Provider Rendering Provider Billing Provider and Service Facility Location Use the blue Search button after entering a Tax ID or NPI for assistance with your search Required fields are dependent on the type of claim submitted Professional or Institutional 12 Click Attachments Operational Training 57 12 12 2012 ga q e Ryan Lindbeck Eligibility Patients Authorizations Claims AN TOO STLUKES HOSPITAL Professional Claim for Your Progress ree gt THIS SECTION Attachments au any attachments to the claim 5mb limit Attachments There are no attached files Provider Details Review and Submit gt 13 In the Attachments section you can Browse and Attach any documents to the claim as desired If you have no attachments none are required 14 Click Review and Submit HE q w Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging MEA EA E ST LUKES HOSPITAL fi Upload EDI Professional Claim for Your Progress fy Ss ss ee THIS SECTION Review Please review your claim and submit Almost done You can go back to review your claim or submit now Attachments Submit gt 15 In the Review section you can review the claim once again before clicking Submit Operational Training 58 12 12 2012 Y 4 Ryan Lindbeck Eligibility Patients Authorizations Claims
4. 04 16 2012 04 16 2012 04 16 2012 04 16 2012 Ambulance Lan Emergency Room Hospita Emergency Room Hospita Ambulance Lan Emergency Room Hospita Emergency Room Hospita City Of Jacksonville Fire Rescue Baptist Medical Center South Mayer Suman City Of Jacksonville Fire Rescue Baptist Medical Center South Deflorio Robert h Inside the patient record select Health Record on the left The Health Record tab allows you to view a record of visits or medications for the patient 3 Click on Visits to view any visit information i e Office Visits ER visits etc for the patient 4 Click on Medications to view any medication information i e Medications prescribed to a Member for the patient M Visits and Medications appearing in the Patient Record are based on the last 18 months of claims data DS Wisits Medications Overview Coordination of Benefits Fill Date Drug Name Dose Quantity Dispensing Pharmacy 04 30 2012 Betamethasone Dipropionate Cream 0 05 0 45 WALGREEN DRUG Assessments STORE Health Record 11 09 2012 Amoxicillin amp K Clavulanate For Susp 600 42 9 WA 125 PUBLIX PHARMACY MG 5ML Care Plan 10 11 2012 Azithromycin For Susp 100 MG SML 100 MG 5ML 15 PUBLIX PHARMACY Authorizations 05 09 2012 Cefprozil For Susp 250 MG 5ML 250 MG SML 100 PUBLIX PHARMACY 10 06 2012 Azithromycin For Susp 100 MELMIL 100 MG ML 15 PUBLIX PHARMACY Claims 08152012 O
5. 2 The Authorizations tab of the patient record allows you to view current authorizations and create new authorizations for the patient If there are current authorizations for this patient they display on this tab 3 To create a new authorization click the Create a New Authorization button Please reference the Authorizations section of this manual for additional information on how to create a new authorization on the website Authorizations To view an authorization 1 Log in to the secure website 2 Select Authorizations at the top of your screen Viewing Authorizations For Oo g HOPE FAMILY CARE CENTER Authorizations Errors Authorization Number PEND APPROVE APPROVE APPROVE APPROVE APPROVE APPROVE Operational Training 1P0034701067 OP0032270437 1P0032947606 IP0033735816 OP0031109725 OP0031097217 OP0031393488 Eligibility 25 i A Patients Authorizations Claims Surgical Office Visit Surgical Vaginal Delivery Outpatient Services Observation Observation 4 Messaging Kyle Bailey Create Authonzation 12 12 2012 3 To view an authorization that has been processed enter the Authorization Number in the field and click Search E ft v zrs Kyle Bailey Eligibility Patients Authorizations Claims Messaging PCE dias OS HOPE FAMILY CARE CENTER APPROVE OP0032270437 Office Visit 4 The Authorization Status Auth ID Member N
6. secme Claim No M Ref Acct No ME Receipt Date 07 17 2012 Medicaid ID 2222000 Billed Amount 2 142 20 Member Name 0 Payment Amount 362 09 Servicing Provider ST LUKES HOSPITAL Payment Date 07 20 2012 DOS Range 07 10 2012 07 10 2012 Status PAID JAYMENT 07 10 2012 19 60 0 00 07 20 2012 DENY THIS SERVICE IS NOT COVERED 07 10 2012 156 00 13 60 07 20 2012 PAID IN FULL 07 10 2012 155 00 11 29 07 20 2012 PAID IN FULL 07 10 2012 104 40 10 74 07 20 2012 PAID IN FULL 07 10 2012 270 00 24 65 07 20 2012 PAID IN FULL 07 10 2012 1 158 90 243 37 07 20 2012 PAID IN FULL 07 10 2012 48 00 10 08 07 20 2012 PAID IN FULL 07 10 2012 230 30 48 36 07 20 2012 PAID IN FULL 4 The Claim Details appear allowing you to see which services were covered and which were denied You can view the payment amount and payment date along with check number 5 To return to the list of claims click the Back to Claims button Operational Training 36 12 12 2012 Correct Claim To correct a claim wat Eligibility EA O DIXON FAMILY PRACTICE AN a 2 Patients Authorizations Claims Messaging Jerome Mullner E Upload EDI CLAIM HO MEMBER NAME SERVICE DATE S 08 03 2012 08 03 2012 08 03 2012 08 03 2012 08 01 2012 08 01 2012 08 01 2012 08 01 2012 07 27 2012 07 27 2012 07 27 2012 07 27 2012 07 27 2012 07 27 2012 07 26 2012 07 26 2012 07 24 2012 07 24 2012 1 Clic
7. 4 On the Batch Claims Upload screen select the File Type of either 8371 or 837P For an Institutional Claims batch upload select 8371 for a Professional Claims batch upload select 837P 5 Browse and Attach your batch claims file to upload Be sure to check your codes before you click Submit Note On the batch claims upload screen companion guides and a list of FAQs are provided as resources An EDI Support telephone line and email address is provided for additional support with EDI files S M Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging MON PUTOS ST LUKES HOSPITAL f Batch Claims Results File successfully uploaded You will be able to check the status of your submission on the status tab within 24 hours A 997 functional acknowledgement will be provided reflecting HIPAA edit pass fail status Web Reference 50000043 Date Time Received Fri Aug 03 13 22 55 CDT 2012 Submit Another Batch Claim 6 When a file is successfully uploaded the Web Reference ID is generated for your records 7 Click Submit Another Batch Claim to submit additional batch claims Operational Training 46 12 12 2012 To view submitted batch claims 1 Click Claims at the top of the screen 2 Click Batch to view batch claims submitted in a 3 month period 2 Y S v Eligibility Patients Authorizations Claims Ryan Lindbeck Messaging MO A MS ST LUKES HOSPITAL Claims individual di Save
8. Click Claims at the top of your screen 2 Select Payment History to view the claims payment history Kyle Bailey Create Claim 3 Click the Filter button to enter search criteria such as Check Trace Date Amount Range and or Check Trace number 4 Click Search For best results enter the date range to include 2 days before and 2 days after the targeted date 5 The claims payment results appear To view the explanation of payment details click the check date Operational Training 48 12 12 2012 Viewing Claims For MS HOPE FAMILY CARE CENTER Explanation of Payment Details Check Trace Number 0000010332 Check Date 08 09 2012 Insured Name Patient Name Control Numbe Service Provider ll PROC DIAG DAY SCNT DRUG PROCZ MOD QTY CHARGED 10 07 25 2012 78031 99213 JN 0 1 115 00 Sub 115 00 36 38 Total Insured Patient Name DAYSICNT DATE DRUG PROC2 MOD QTY 07 18 2012 6929 99213 JN 0 1 115 00 115 00 36 38 ALLOVVED 36 38 CHARGED ALLOWED 36 38 Eligibility 0 00 0 00 0 00 0 00 0 00 S NS Authorizations Claims Messaging Kyle Bailey Patients Upload EDI Back to Payments List Download Excel Format E Print Group HOPE FAMILY CARE CENTER 1D Account NPI DEDUCT DISCOUNT ALLOW ANSI COPAY COINSUR IN MEDPAID TPP DENIED CODES PAYMENT 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 92 36 38 0 00 0 00 0 00 0 00 0 00
9. Next to the disable user s name click Enable User Es BLE An v a i Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Viewing For ST LUKES HOSPITAL Support Users Invite a User Success User enabled Email Address name domain com NAME Kyle Campbell Ryan Lindbeck 4 You receive a Success message and the user is enabled immediately Operational Training 13 12 12 2012 Manage TINs To manage Tax Identification Numbers for your account 1 Log in to the secure website E 2 lt v Hi Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Viewing Dashboard For E ST LUKES HOSPITAL Quick Eligibility Check Welcome Member ID or Last Name Birthdate 123456789 or Smith mmiddiyyyy Sheck Eligibilit Add a TIN to My Account Recent Claims Recent Activity STATUS RECEIPT DATE Date Activity 07 30 2012 You submitted an assessment 2 Manage TINs by selecting the drop down arrow next to the Viewing Dashboard For or selecting Add a TIN to My Account 2 lt Ryan Lindbeck Eligibility Patients Authorizations Claims Go to Dashboard For i ST LUKES HOSPITAL Account Details _ Update Account Add a TIN Name User Name Email Tax ID Password 5 123456789 Telephone Nothing on file NPI Number Number 123456789 Fax Number Nothing on file Secret Question What city were you born in Zip Co
10. account To manage permissions click Permissions next to the user name pl E v Et Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Viewing For ST LUKES HOSPITAL Modify __ Campbell s Permissions for TIN Can Access Assessments Health Record WClaims Manage Account Authorizations Cancel Save Permissions 4 Onthe Modify Permissions screen you can view all permissions granted to a user It is the responsibility of the Account Administrator to manage the account It is recommended for only 1 2 staff members to have permission to Manage Account at each entity Operational Training 10 12 12 2012 5 Uncheck the box next to Manage Account and click Save Permissions 6 Instantly the identified user will not be able to manage account 2 x ce Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Viewing For E ST LUKES HOSPITAL Support Users Invite a User Email Address Kyle Campbell name domain com Mi Send Invitation Ryan Lindbeck 7 After clicking save permissions you return to the Support Users screen to manage additional users if necessary 8 To invite a user to join your account enter their Email Address in the email address field and click Send Invitation Operational Training 11 12 12 2012 Disable a User To disable a user from an account 1 Log in to the secure website 2 Select the drop down arrow next to y
11. lt Previous Next gt 9 Enter the Service Start Date and End Date 10 Enter the Total Units Visits Days for the service 11 Enter the Primary Diagnosis and Additional Diagnosis by typing the code or description in the field and clicking Find 12 After the diagnosis is found it appears to the right of the field 13 To Add Additional Additional Diagnosis click the button 14 Select the Place of Service from the drop down options 15 Click Next Operational Training 30 12 12 2012 w Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Viewing Authorizations For lt Create Authorization Authorizations for Your Progress ED a gt SECTIC THIS SECTION Sel ct Providers These are provider selections Requesting Provider Information Provider NPI Find Provider Provider First Name Provider Last Name Find Provider Provider TIN Provider Phone Provider Fax Servicing Provider Information Provider NPI Find Provider Provider First Name Provider Last Name Find Provider Provider TIN Provider Phone Provider Fax Previous 16 Enter the Requesting Provider Information using either the Provider NPI or Provider Last Name to Find the Provider Enter either the Provider NPI or Provider Last Name and click Find Provider to initiate your search Once the Provider Name is found and selected the remaining fields will populate 17 Select yo
12. 0 00 0 00 0 00 0 00 36 38 Group HOPE FAMILY CARE CENTER 1D Account B DISCOUNT ALLOW ANSI COINSUR INTEREST MED PAID TPP PAYMENT DENIED CODES 0 00 0 00 0 00 0 00 0 00 0 00 92 36 38 0 00 0 00 0 00 0 00 0 00 0 00 0 00 36 38 6 The explanation of payment details displays the check number and date with all of the payments made on the check Operational Training 49 12 12 2012 Claims Audit Tool 1 Log in to the secure website 2 Click Claims at the top of the screen 3 Select the Claims Audit Tool Code Editing Assistant Home State Health Plan has partnered with McKesson Information Solutions McKesson to provide you with a web based code auditing reference tool designed to mirror how Home State Health Plan s code auditing products evaluate code combinations during the auditing of claims Home State Health Plan can now share with our providers the claim auditing rules and clinical rationale we use to pay claims This tool offers many benefits Prospectively access the appropriate coding and supporting clinical edit clarifications for services before claims are submitted Proactively determine the appropriate code code combination representing the service for accurate billing purposes Retrospectively access the clinical edit clarifications on a denied claim for billed services after an Explanation of Payment EOP has been received The tool will review what was entered an
13. A health risk assessment will help us determine how we can help you get healthier Fill Out Now Fill Out Now You have nottold us about anything yet Please fill out a form Notification of Pregnancy Please let us know if you are pregnant so we can help keep you and your baby healthy 1 Inside the patient record select Assessments on the left 2 The Assessments tab of the patient record allows you to fill out a Notification of Pregnancy Assessment WO Click the Fill Out Now 4 Aconfirmation appears confirming the submittal stating the assessment information displays within 24 hours Operational Training 22 12 12 2012 ako Overview VES Medications Coordination of Benefits Primary Diagnosis Date Visit Type Facility Provider Other Convulsions 11 19 2012 11 19 2012 Outpatient Hospita Baptist Medical Center South Assessments Other Convulsions 11 19 2012 11 19 2012 Outpatient Hospita Hammond David N Health Record Other Convulsions 05 06 2012 05 06 2012 Ambulance Lan Board Co Comm Clay Co Rescue Care Plan syncope And Collapse 05 06 2012 05 06 2012 Emergency Room Hospita Delacruz Rick Authorizations Claims Other Convulsions Anxiety State Unspecified Anxiety State Unspecified Injury Oth amp Uns Oth Spec Site W Mx Head Injury Unspecified Unspecified Chest Pain 04 18 2012 04 18 2012 04 18 2012 04 18 2012 04 18 2012 04 18 2012 04 16 2012 04 16 2012
14. Details Eirg Provider 7 Inthe Provider Details section enter the billing and other provider information in the appropriate fields 8 Click Service Lines to proceed Operational Training 62 12 12 2012 A ES iesivuonal Claim tor Sample Member Your Progress S gt o me me ge Service Lines Add New Service Line ae Pair Da 9 In the Service Lines section enter the information about the services provided You can enter up to 99 service lines 10 Click Save Update and to add a new service line click the New Service Line button on the left 11 When all necessary service lines have been entered and saved click the Insurance button to proceed Operational Training 63 12 12 2012 nn Clan er ani ee mm DID DDD Additional Insurance You may skip this section if there i no additional insurance ES Primary insurance lira La Dar ee 12 In the Additional Insurance section enter any additional insurance details as needed If there is no additional insurance you may skip this section 13 Click Codes to proceed Operational Training 64 12 12 2012 Diagnosis Codes dr a en Dikri Coders 10 740 Pte Wiebe Er la Eimi Ci IP Cee EET Eripe Para Coe Cosas Coden Gi A Ce bod A A 14 In the Diagnosis Codes section enter all relevant diagnosis information 15 Click Attachments to proceed Operational Training 65 12 12 2012 Attachments Citadel Fa ap tig coe ee Mara a Ea Pods ta
15. Operational Training 15 12 12 2012 To check additional patients eligibility status continue to add the DOS Member ID Last Name and DOB for each additional patient 5 To print the eligibility information click Print 6 To open the Patient Record click on the blue Patient Name Operational Training 16 12 12 2012 Patient List To view and download a patient list 1 Click Patients at the top of your screen 2 Click the drop down arrow next to Viewing Patients For and select the desired TIN a Eligibility Patients Authorizations Claims Viewing Patients For HOPE FAMILY CARE CENTER X Kyle Bailey Find Patient pr ELIGIBLE MEMBER NAME MEDICAID DATE OF BIRTH PHONE NUMBER sde de rfp fe lo ds sde ide dde CARE GAPS None On File None On File None On File None On File None On File None On File None On File None On File None On File No chlamydia test in past 12 months in patient 16 25 years No office visit for preventive care 3 The Patient List appears displaying Eligibility Status Member Name Medicaid DOB Phone Number and Care Gaps 4 To download the patient list to Excel click Download This allows for you to manage your patient information as desired in Excel Downloading the patient list to Excel allows you to see all patients for that TIN including the Physician s Name Operational Training 17 12 12 2012 5 T
16. Registration is complete and an email verification link is emailed to the address provided during registration Operational Training 5 12 12 2012 N 9 Registration Verification noreply test provider ME Tue 7 24 2012 10 13 AM Tammy Holen Tammy Holen Thank you for registering with MO i Plan Please use the link below to login and verify your email address wa http test provider_homestatehealth_com careconnect verification verificationCode f63c539b 6cc8 4189 9fd7 89bc7538a254 If the link above does not appear as a link in your email please copy and paste the entire link that starts with http in a new browser window This link will take you back to the login page Please login using your email address and the password you created when you signed up Thank you BE Health Plan Click the link in the email to finish setting up your account If you cannot find the email please be sure to check your spam junk folder Login using the email address and password you created when you signed up Click Login Finish setting up your account by selecting 3 security questions and answers and a telephone and fax number Click Submit 10 Validate your registration by entering your NPI and billing zip code 11 Click Validate Registration Note If the message We could not match what you entered into our system please check and try again is received Click Skip Validation A Health Plan employee must validate your accou
17. claims submittal 1f the Recommendation Status states Disallow or Review click the status for more clinical edit information Operational Training 52 12 12 2012 Professional Claims To create a Professional Claim 1 Click Claims at the top of your screen Y Eligibility Patients AE MS ST LUKES HOSPITAL MEMBER NAME CLAIM NO 07 13 2012 07 13 2012 07 13 2012 07 13 2012 07 11 2012 07 12 2012 07 10 2012 07 10 2012 S N Eligibility Patients MAN OO ST LUKES HOSPITAL Authorizations Authorizations Claims v Claims Messaging Ryan Lindbeck BILLED PAID 187 50 39 38 187 50 39 38 1 609 39 226 08 2 142 20 362 09 E 4 Messaging Ryan Lindbeck E Upload EDI Choose Claim for e Choose a Claim Type CMS 1500 Professional Claim gt CMS UB 04 institutional Claim gt Need to correct a claim Please be patient this online feature is coming soon 3 Select Professional Claim by clicking the green button Operational Training 53 12 12 2012 ER 2 E m Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Professional Claim for VautProgious gt os SS gt oS gt THIS SECTION Patient Info providers on tnis ciaim Patients Account Number Patient s Status I Employed Education Full Time Student Part Time Student Marital Status Married Single Other Is the patient s condition related
18. 00635 7 You receive a success message confirming your submittal Operational Training 39 12 12 2012 Copy Claim To copy an existing claim pl w Eligibility Patients Authorizations Claims Messaging Viewing Claims For M DIXON FAMILY PRACTICE AN E Upload EDI Create Claim Jerome Mullner Back to Claims Correct Claim Copy Claim laim No Ss Ref Acct No 7 Receipt Date 07 26 2012 Medicaid ID P Billed Amount 95 00 Member Name Payment Amount 0 00 Servicing Provider Oy Payment Date 08 02 2012 DOS Range 07 24 2012 07 24 2012 Status PAID 4 07 24 2012 99213 38200 95 00 0 00 08 02 2012 0000000000 PAID GLOBAL FEE 1 Select Claims at the top of the screen 2 Click on an Individual claim to open the details 3 Click Copy Claim to copy the information in the existing claim into a new claim Operational Training 40 12 12 2012 pl S v ii Jerome Mullner Eligibility Patients Authorizations Claims Messaging ES DIXON FAMILY PRACTICE AN Upload EDI Professional Claim for Your Progress HD O gt THIS SECTION Patient Info Providers on this claim Patients Account HEN Number Patients Status TF Employed Education Full Time Student Part Time Student Neither Marital Status Married Single Other Is the patient s condition related to Employment Auto Accident Other Accident 4 The copied claim information appears Proceed through t
19. E DATE S BILLED PAID STATUS CHECK NO 07 18 2012 07 18 2012 187 50 39 38 07 18 2012 07 18 2012 66 00 60 00 07 18 2012 07 18 2012 312 00 81 00 AAA 07 18 2012 07 18 2012 396 00 85 00 EA 07 18 2012 07 18 2012 195 00 81 00 3 To upload a batch of claims click the Upload EDI button Eligibility Patients Authorizations Viewing Claims For a ST LUKES HOSPITAL v Ryan Lindbeck Claims Messaging E Upload EDI Batch Claims Upload File Type 8371 837P Please choose a file format of dat edi or bt no larger than 5MB Upload File File name should not contain any of the following special characters 45 amp PAT The Submitter ID for the ISA06 must be WebBatch The receiver ID for ISA08 must be 421406317 The Application Senders Code for GS02 must be WebBatch The Application Receivers code for GS03 should match the value used in the ISA08 Check your codes Resources Operational Training 45 Please note that we currently accept formatted 837 claims files only We apply HIPAA level 4 edits If you are not familiar with generating or submitting an 837 file please use a clearinghouse or our single claims submission module We are continually developing new claims submission tools to allow you other formats by which to submit claims to use directly both individually and in bulk Companion Guides Batch Claims FAQs 12 12 2012
20. Messaging Viewing Claims For E ST LUKES HOSPITAL THIS SECTION S uccess Congratulations Your claim has been submitted Your confirmation ID is 500000570 Submit another 16 In the Success section a confirmation ID displays for your records 17 Click Submit another to submit another claim Operational Training 59 12 12 2012 Institutional Claims To create an Institutional Claim 1 Click Claims at the top of your screen 2 Click Create Claim 3 Enter the Member ID Last Name and Birthdate for the member Click Find E Y A 4 Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Viewing Claims For Ss ST LUKES HOSPITAL Upload EDI Choose Claim for o O Choose a Claim Type CMS 1500 CMS UB 04 Professional Claim gt Institutional Claim gt Need to correct a claim Please be patient this online feature is coming soon 4 Select CMS UB 04 Institutional Claim Operational Training 60 12 12 2012 ria Clara f or ieee inversion Claim fr Same Mercer You Proven DP gt General 5 In the General section populate the admission and condition code information The fields displayed here reflect those on a UB 04 form Hover over the Claim Field Tabs to the right of the screen to help determine what field on the UB 04 form from which to obtain the information 6 Click Provider Details to proceed Operational Training 61 12 12 2012 Provider
21. Secure Provider Website Instructional Guide Operational Training 2 12 12 2012 us Be AA A E A A A E IRA 4 ROW TtO0 Use ne Mana enntvs E Menai Odeds endo an mots eens nae 4 A tae ate ch erpaa a gn haan a laeatcee led a a a 5 LOG ate ACCOUNT see tA Sh onic heen eat oA ah aot Aetna oat otk tava has 8 A mm ent ete erent eee eer ee erent ee 10 BEA RA o PA 12 al Fo 0 oars I A A A E E E TE 13 Manage UNS A A O A A ds 14 Checking Patent Egib iba 15 P Wan ES o y a O 17 A ON 20 Coordination of Benefits oooooconoconcnoncnonoonnnononanonnonanononononnnnnnonononononnnnonononononnnconnnnnononanccnnnnnono 21 ASSOSSMESt ad 22 Heathi RECO A A O 23 A A ncatquanieadoecaths tan asee aes 24 AMO Sd e ee eee 25 AMO OS gS ed a eter enc eens EPS Toa 2 ease nC eee ene 20 ed eC ea Re Sn 25 Greate AUTO zan as 28 A A ee ee eee ee ere ae 34 Omer 37 o e O tana tial 40 rev lo 1 67 fea q eee ee een 0 a O A A e o En 42 FAIA VOOM tds 43 Fal Gere A A A te ee eR ea te me S 44 Ba MIA died 45 A O 48 CAINS RUG TOO lassie secs oO On o A A 50 Prolessional Callis erritarra ec eta a ea lena lao 53 GEN ce elt cpees Sette Eatse let hoth cen Atsnens ENN 60 Secure Mess AGING SS A es E 67 Operational Training 3 12 12 2012 The Secure Provider Web is a secure website developed to allow Providers across Centene health plans to perform a variety of functions from their office By registering and creating an account a Provider can easily check patien
22. To fix a rejected claim 1 Select Claims at the top of the screen 2 Click Errors to see the rejected and pended claims Viewing Claims For STATUS DATE SUBMITTED 08 15 2012 08 15 2012 08 15 2012 08 14 2012 08 14 2012 08 14 2012 08 14 2012 08 14 2012 08 10 2012 BIREFH d WE LAIM NUMBER 500000633 500000631 500000630 500000623 500000611 500000607 500000606 500000605 500000597 Eligibility E DIXON FAMILY PRACTICE AN E a Patients Authorizations Jerome Mullner Create Ciaim CMS 1500 CMS 1500 CMS 1500 CMS 1500 CMS 1500 CMS 1500 CMS 1500 CMS 1500 Institutional MEDICAID ID ORIGINAL CLAIM TOTAL CHARGES 95 00 EEE 95 00 95 00 95 00 95 00 95 00 A 435 37 95 00 343 37 3 The list of claims appears and in the Status column you see a Caution icon indicating a Rejected Claim 4 Inthe far right column you see a Fix link Click the Fix link 5 Proceed through the screens fixing any errors or reasons the claim may have been rejected 6 Review and Submit the claim again Operational Training 44 12 12 2012 Batch Claims To upload batch claims 1 Log in to the secure website 2 Click Claims at the top of the screen EE A Eligibility Patients Authorizations Viewing Claims For PE ST LUKES HOSPITAL 8 w Ryan Lindbeck Claims Messaging CLAIM NO MEMBER NAME SERVIC
23. You cain go back do review your daim or abril nina Claimid Mamber Record Number HS Mernber Claim Amount Paid Member Socount Humber E Patient Info Education Neither Member Relabonsh p Status Mone Employment Related false falo Acciden Related fale Stale of Aulo Accident Related Ciner Accident Related false General Info Gabe of qunent Wess Fest Syama Gr Injury denli of Pregnancy LMP Date of similar illness give first date Dates Unable To Work From Dates Unable To Wowk Po Hos petalized Erorn Hospitalized Tec Outside Las false Dutside Lab Amount Prior Authorisston Hunvber Diageosis Codes 4077 ESSENTIAL HIPERTENSI N BENIGN Primary Insurance Camar Type Police Number Service Lines Line From To Place Emergency Proc Diageesis Amount Daysinits 1 A e lr E 11 no 28213 401 595 00 1 Providers family Plan EFSDT WDC Supp emental into falsa Provider Type Medicaid Taxonomy Address Retemapg rmaider Renderingrrodger BillingFrod dar Serer Fiii Lorian ANa menis Terms amp Conditions Privacy Policy Copyright 2012 Centeri Corporation 6 Review the claim information you have corrected before clicking Submit Operational Training 38 12 12 2012 q 4 Jerome Mullner Eligibility Patients Authorizations Claims MT AAN DIXON FAMILY PRACTICE AN THIS SECTION S uccess Congratulations Your claim has been submitted Your confirmation ID is 5000
24. aluate the results of claims activity from Home State Health Plan only as related to Provider s practice management Provider shall protect the confidentiality of the information contained in and provided by the Software and that it has access to in this web site by using at least the degree of care and security it uses to protect its own confidential information Provider acknowledges and agrees that any unauthorized disclosure or distribution of the confidential information may result in irreparable injury to Home State Health Plan or licensor s entitling the injured entity to obtain immediate injunctive relief in addition to any other legal remedies available Provider shall not modify translate decompile disclose create nor attempt to create any derivative work of the Software Provider acknowledges that the Software is in no way intended to prescribe designate or limit wa dinal anea ta dan menridad ae mena dwar ta ha nan Dens dae nannmte enni an cthilite Faw man A ACCEPT REJECT 4 The Code Editing Assistant screen appears with terms and conditions to Accept or Reject 5 Click Accept Operational Training 50 12 12 2012 Clear Claim Connection McKesson Edit Development Glossary About Help Logoff Claim Entry Gender C Male Female Date of Birth po mm dd yyyy Click grid to enter information For quick entry use your Down Arrow key after you enter a Procedure Code Date of Service will default to toda
25. ame Type of Service and Mentioned As details display 2 Eligibility Patients Authorizations Claims Viewing Authorizations For BELOIT MEMORIAL HOSPITAL INC Authorization Number Prasad Balla STATUS AUTH ID PEND 1P0038 Medical APPROVE 1P0038 C Section Delivery PEND IP0038 Medical APPROVE IP0038 C Section Delivery PEND 1P0038 Medical PEND 1P0038 Premature False Labor PEND OP003 DME 5 To view Processed Authorizations select Processed You see a list of authorizations that have been processed along with the Status Auth ID Member Name and Service provided Operational Training 26 12 12 2012 En pis NA Prasad Balla Eligibility Patients Authorizations Claims Messaging Viewing Authorizations For BELOIT MEMORIAL HOSPITAL INC Authorizations Errors Medical Admitting Provider Medical Admitting Provider 6 To view Authorizations which have errors select Errors You see a list of authorizations that have a Status of Error along with the Auth ID Member Name Service provided and Mentioned As information Operational Training 27 12 12 2012 Create Authorizations To create an authorization 1 Log in to the secure website 2 Select Authorizations at the top of the screen E 2 v Eligibility Patients Authorizations Claims Messaging Viewing Authorizations For a ST LUKES HOSPITAL Authorization Number There are no authorizations to show Q Click Creat
26. at the top of the screen and select Individual pa M Ryan Lindbeck Eligibility Patients Authorizations Claims A A O ST LUKES HOSPITAL Claims B Errors Batch Claims Audit Tool LAIN HO MEMBER NAME SERVICE DATE S BILLED PAID STATUS CHECK NO 07 13 2012 07 13 2012 187 50 39 38 07 13 2012 07 13 2012 187 50 39 38 07 11 2012 07 12 2012 1 609 39 226 08 07 10 2012 07 10 2012 2 142 20 362 09 07 09 2012 07 09 2012 137 00 36 38 07 09 2012 07 09 2012 187 50 39 38 07 09 2012 07 09 2012 2 105 24 306 34 07 09 2012 07 09 2012 260 00 91 50 07 09 2012 07 09 2012 66 00 60 00 07 06 2012 07 06 2012 187 50 39 38 07 05 2012 07 05 2012 137 00 36 38 07 05 2012 07 05 2012 147 00 36 38 07 05 2012 07 05 2012 1 060 95 184 87 07 03 2012 07 03 2012 187 50 39 38 07 03 2012 07 03 2012 187 50 39 38 amp amp eokh e B amp OC fF F amp F OC OO 2 The list of individual claims appears displaying the Claim Number Member Name service Date Amounts Billed Paid Status and Check Number Hover your mouse over the Status column and a Paid or Pending status displays 3 To view the details of the Individual claim click the blue Claim Number to open the claim Operational Training 35 12 12 2012 q E v Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Viewing Claims For SS ST LUKES HOSPITAL gt A Upload EDI Create Claim
27. d A nor GE PaymentHistory Claims Audit Tool Start Date End Date 08 02 2012 08 09 2012 Date span limited to a 3 month period Web Reference Batch Claim Status 3 Enter the information to filter your results by Start Date End Date Web Reference and Batch Claim Status Click Search E3 BLE e v uml Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging TT Per ae ea OS ST LUKES HOSPITAL Upload EDI Claims Ez Ad Saved A Errors MEA Claims Audit Tool 08 03 2012 837P 50000043 UI_SUBMITTED 08 03 2012 8371 50000041 UI_SUBMITTED 08 03 2012 837P 50000042 UI_SUBMITTED 4 The submitted batch claims display showing Submitted Date Type Web Reference File Name and Status Note Only the last 18 months of batch claims submission history is available online You will receive an explanation of payment EOP or 835 for your claims submission depending on your contract arrangement Operational Training 47 12 12 2012 Payment History To view claims payment history Ee Oot Eligibility Patients Authorizations E HOPE FAMILY CARE CENTER T 1 Claims individual di Saved Errors Batch MAA Claims Audit Tool 1 1 Transactions All activity posted to your account between 05 16 2012 and 08 16 2012 Instructions To view transaction details click the check date 08 09 2012 72 76 08 02 2012 30 00 07 26 2012 125 00 07 20 2012 343 98 1
28. d will determine if the code or code combinations are correct based on the age sex location and modifier if applicable or other code s entered DISCLAIMER This tool is used to apply coding logic ONLY It will not take into account individual fee schedule reimbursement authorization requirements or other coverage considerations Whether a code is reimbursable or covered is separate and outside of the intended use of this tool PASS THROUGH TERMS AND CONDITIONS Home State Health Plan Home State Health Plan licenses a code auditing reference tool on the Web the Software that enables Home State Health Plan to disclose its code auditing rules and associated clinical rationale to Providers Home State Health Plan provides access to such Software to its Providers subject to the terms and conditions contained in this agreement Agreement which may be updated from time to time at Home State Health Plan or its licensors sole discretion without notice Provider s night to access and use the Software is non transferable nonexclusive and for the sole purpose of internal use within the United States Provider will limit access to the Software to 1 only employees and agents of Provider and ii only to the extent necessary to request the outcome of specific code combinations that Provider proposes to submit to Home State Health Plan regarding billing activity and or 111 request information about submitted code combinations to ev
29. de Secret Question What is your father s middle name 12345 Secret Question What is your favorite pet s name Your TINs PRIMARY ST LUKES HOSPITAL 3 To add a TIN enter the Tax ID NPI and Zip Code in the fields provided 4 Click Add TIN Operational Training 14 12 12 2012 5 Note If the message We could not match what you entered into our system please check and try again is received only add TIN and Click Add TIN A Health Plan employee must validate your account before it can be used Checking Patient Eligibility To verify patient eligibility HE q an w Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Viewing Eligibility For MA ST LUKES HOSPITAL Eligibility Check Date of Service Member ID Last Name 07 25 2012 123456789 or Smith Check Eligibility 1 Select Eligibility at the top of your screen 2 Enter the Date of Service DOS Member ID Last Name and DOB of your patient 3 Click Check Eligibility Y e a NA Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Viewing Eligibility For Ss ST LUKES HOSPITAL Eligibility Check Date of Service Member ID Last Name DOB 07 25 2012 Check Eligibility SCE En erre rf Eligible 07 25 2012 7 25 2012 4 The eligibility information appears below the fields The view contains eligibility status date of service patient name and the date checked
30. e 16 In the Attachments section Choose File and Attach any relevant file to the claim 17 Click Review and Submit Operational Training 66 12 12 2012 Secure Messaging To send a secure message Y v Eligibility Patients Authorizations Claims Messaging Viewing Messages For n ST LUKES HOSPITAL gt Secure Messaging Inbox Sent Trash No Message to display 1 Click Messaging at the top of the screen 2 The Secure Messaging Inbox appears displaying any messages you have 3 Click Create Message to create a secure message New Message Ryan Lindbeck Create Message To Subject Your Message Home State Health Plan Benefit Inquiry Benefit Limits Copay Y Benefit Inquiry Benefit Limits Copay Benefit Inquiry Transportation Eligibility Inquiry Claim Payment Claim Status Claim Adjustment Contract Clarification Contract Request Provider Material Provider Relations Visit Request Appeal Provider Demographic Correction Update Member Connections Request Member Patie Provider Panel Question Member Patient Problem Other 4 Inthe New Message screen the To field populates and you are able to select a Subject from the drop down menu 5 Inthe Your Message field you can free text type the message to the Health Plan staff 6 Click Send when complete 7 A confirmation message appears that your message successfully sent Operational Training 67 12 12 2012 To
31. e Authorization Enter the patient s Member ID Last Name and DOB Click Find Ryan Lindbeck Create Authorization 5 Populate the 6 sections of the Authorizations with the appropriate information starting with the Service Type section Operational Training 28 12 12 2012 m Y v Eligibility Patients Authorizations Claims Messaging Viewing Authorizations For MAA A ST LUKES HOSPITAL Authorizations for Your Progress NIDO THIS SECTION Service Ty pe Please select a service type Service Type Service Type Medical Contact Information Please list the individual to contact for questions related to this Authorization Name Ryan Lindbeck Phone 314 225 4654 Fax 314 225 1515 6 Select a Service Type from the drop down list Authorization being requested 8 Click Next Operational Training 29 Enter the Contact Information of an individual to contact for questions related to the 12 12 2012 Authorizations for A THIS SECTIC Y 4 Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Viewing Authorizations For D ST LUKES HOSPITAL Create Authorization General these are general me Service Dates Start Date End Date Total Units Visits Days Diagnosis Primary Diagnosis Additional Diagnosis Place Of Service Find DIABETES MELLITUS Code or Description Add Additional Additional Diagnosis Place Of Service i Office
32. e On File SUPERVISION NORMAL FIRST PREGNANCY Three Most Recent Inpatient Admissions Recent Pharmacy Activity None On File Amoxicillin Trihydrate Cap 500 MG Three Most Recent Office Visits Metronidazole Tab 500 MG a eee Ondansetron Orally Disintegrating Tab 4 MG ROUTINE 03 29 2012 CARDENAS POSTPARTUM JOSE FOLLOW UP ROUTINE 03 12 2012 CARDENAS ROUTINE 03 12 2012 CARDENAS POSTPARTUM JOSE FOLLOW UP PROLONG PG DELIV 02 15 2012 CARDENAS ANTPRTM COND COMP JOSE Instruction Manual PDF Terms amp Conditions Privacy Policy Copyright 2012 Centene Corporation Operational Training 19 12 12 2012 8 The Patient Record opens the Overview appears providing detailed information for the patient Patient Member Record Components Overview 1 From the Eligibility Check or Patient List select the blue Patient Name to open the Patient Record EF 2 Eligibility Patients Authorizations Viewing Patients For aa ST LUKES HOSPITAL E v Ryan Lindbeck Claims Messaging Tosco JIM Coordination of Benefits Assessments Health Record Claims Authorizations Operational Training a This patient is eligible as of today Jul 30 2012 Patient Information Name MO Gender M Birthdate MM Age MN Medicaid iD MES PCP Information Name Address Practice Type Phone Number MS Three Most Recent ER Visits None On File Three Most Recent Inpatient Admissions None On Fi
33. floxacin Ophth Soln 0 3 Oo 3 5 PUBLIX PHARMACY 0815 2012 Cefprozil For Susp 250 MGe 5ML 250 MG SML 100 PUBLIX PHARMACY 1013 2012 Amoxicillin amp K Clavulanate For Susp 600 42 9 PA 125 PUBLIX PHARMACY MGISML Operational Training 23 12 12 2012 Claims 2 v Eligibility Patients Authorizations Claims Messaging Viewing Patients For BAPTIST MEDICAL CENTER Find Patient Overview s qe Ref Acct Mem Recei rvici led P p chet CO jan Osha mo ee A A i No Name Date Provider Amount Amount Date BAPTIST oli 11 26 2012 663 80 309 96 PENDING 11 15 2012 CENTER SOUTH BAPTIST 11 14 2012 MEDICAL 41 14 2012 11 21 2012 CENTER 1 875 60 636 17 11 29 2012 PAID SOUTH Coordination of Benefits L331FLE03034 814324083 Assessments L326FLE05688 814318523 MN Care Plan Create a New Claim Authorizations 1 Inside the patient record select Claims on the left 2 The Claims tab of the patient record allows you to view any recent claims for the patient and also create a new claim If the patient has any recent claims they display on this tab 3 To create a new claim click the Create a New Claim button Health Record Please reference the Claims section of this manual for additional information on how to create a new claim through the website Operational Training 24 12 12 2012 Authorizations 1 Inside the patient record select Authorizations on the left
34. he claims screens updating any information that may differ 5 Click Next to move through the screens Review your claim and click Submit 7 Asuccess message appears confirming your submittal Operational Training 41 12 12 2012 Saved Claims To view saved claims E pl A v 23 Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Viewing Claims For E ST LUKES HOSPITAL Upload EDI Claims d Saved Batch PaymentHistory Claims Audit Tool Claims listed below have missing information or contain errors Click Edit to view a cisim then fix sny emors or complete it before submitting DATE CREATED CLAIM TYPE MEMBER NAME MEDICAIDID ORIGINAL CLAIM TOTAL CHARGES 08 08 2012 CMS 1500 0 00 08 08 2012 CMS 1500 100 00 07 27 2012 CMS 1500 100 00 07 26 2012 CMS 1500 75 00 1 Click Claims at the top of the screen 2 Select Saved Saved claims are those that have missing information or contain errors 3 Click Edit to view a claim then fix any errors or complete it before submitting ce Ns HH Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging A E MOS ST LUKES HOSPITAL isted below have missing information or contain Message from webpage eng CLAIM TYPE CLAIM 1D O Are you sure you want to delete claim with ID gt 08 08 2012 CMS 1500 0 00 08 08 2012 CMS 1500 100 00 07 27 2012 CMS 1500 100 00 07 26 2012 CMS 1500 75 00 4 Click Delete
35. k Claims at the top of the screen 2 Select an individual paid claim to see the details Eligibility AE DIXON FAMILY PRACTICE AN lt Patients Authorization Back to Claims Correct Claim Copy Claim Claim No 7 L208 e RefiAcct No T Medicaid ID PE Member Name Servicing Provider M DOS Range 07 24 2012 07 24 2012 PLACE OF BILLED LINE DOS PROC DX MODIFIERS SERVICE AMOUNT 07 24 2012 99213 4011 LC11 95 00 3 The claim displays for you to correct as needed Receipt Date 07 26 2012 Billed Amount 95 00 Payment Amount 0 00 Payment Date 08 02 2012 Status PAID BILLED PAID 95 00 0 00 140 00 0 00 95 00 0 00 95 00 0 00 95 00 0 00 95 00 0 00 95 00 0 00 100 00 0 00 95 00 0 00 Is Claims PAYMENT PAYMENT AMOUNT DATE 0 00 08 02 2012 Operational Training 37 CHECK NO l D wn CHECK NO 10 0 0 0 0 0 0 0 Jerome Mullner Create Claim STATUS STATUS DESCRIPTION 0000000000 PAID GLOBAL FEE PAID Click Correct Claim 12 12 2012 4 Proceed through the claims screens correcting the information that you may have omitted when the claim was originally submitted 5 Continue clicking Next to move through the screens required to resubmit me tel eal ARO FAMILY PRACTICE AN d Jove Messaging HA upoan Em Professional Chim for You Popes TT Review riase reves Almost done
36. le Three Most Recent Office Visits None On File 20 Eligibility History Start Date End Date Jul 1 2012 Ongoing Care Gaps None On File Top 5 Most Occurring Diagnosis None On File Recent Pharmacy Activity None On File 12 12 2012 2 The Patient Record opens to the Overview tab displaying the Patient Information PCP Information Eligibility History and the most recent Medical Activity Overview Effectve Date Term Date Policy Number Group Number Carrier Name Coverage 01 01 2010 12 06 2011 23752568 GEHA4H GOVERNMENT EMPLOYEES HOSP ASSOC MEDICAL AND HOSPITAL Coordination of Benefits 01 01 2010 12 06 2011 23752568 GEHA4SH GOVERNMENT EMPLOYEES HOSP ASSOC MEDICAL AND HOSPITAL Assessments Health Record Claims Authorizations 1 Inside the Patient Record select Coordination of Benefits on the left 2 The Coordination of Benefits COB tab of the patient record displays the other insurance information for the patient If the patient has no other insurance the web indicates it does not have any COB information Operational Training 21 12 12 2012 Assessments q Patients Claims Authorizations wv Messaging Eligibility MEA MOS ST LUKES HOSPITAL Ryan Lindbeck Find Patient soe A Overview Coordination of Benefits Health Record Claims Authorizations Ways you can let us know about your health Previous Assessments Health Risk Screening
37. ne New Service Line Dates of Service From 07 21 2012 Place of Service 11 PROVIDER S OFFICE Emergency Procedure Code Modifiers Diagnosis Code s 7 250 DIABETES MELLITUS Charges Days Units Family Planning Yes EPSDT Select Supplemental Supplemental Information Information 24h y NDC y General Info Provider Details gt 8 In the Service Lines section add your service line information You can enter up to 99 service lines Note When entering charges for the service billed include the decimal point to ensure the data is populated accurately For example 99 00 converts to 99 00 9 To add additional service lines click the Save Update button and then click the New Service Line button 10 When you are ready to proceed click Provider Details Operational Training 56 12 12 2012 Engi bility Patients Alita DOS Dee ee TL STLUKES HOSPITAL Professional Claim for Your Prope III O Providers providers on ins claim Referring Provider MFI Tax ID Medicaid Provider Last Hame Fira Mame a EERE EEEE LastName Tanonary A Rendering Provider MFI Tax ID Medicaid Provider A Last Mame First Mame 1340251543 INN COO Ea ker Tamera ry Billing Provider HPI Tar ID Medicaid Preader Last Name Firs Hame a OK Last Name First Marne Taxonomy Y aelected Frowicer Service Facility Location MFI Tan anonamy Medicaid Frovader A Address City Senie Lines
38. nt before it can be used Operational Training 6 12 12 2012 q 4 Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Viewing Dashboard For MA ST LUKES HOSPITAL Quick Eligibility Check Welcome Member ID or Last Name Birthdate 123456789 or Smith mmiddiyyyy Add a TIN to My Account Recent Claims Recent Activity RECEIPT DATE Date Activity 12 Once logged in from your Dashboard you can access various tools to do the following e Verify patient eligibility e View and print your patient list e Submit and view authorizations e Submit and view claims e Send secure messaging Operational Training 7 12 12 2012 Update Account To make updates to your account 1 Log in to the secure website Eligibility Patients Authorizations Claims Messaging METIDA MS ST LUKES HOSPITAL Account Details User Management v Ryan Lindbeck Quick Eligibility Check Welcome ERES Member ID or Last Name Birthdate E 123456789 or Smith mmiddiyyyy Add a TIN to My Account Recent Claims Recent Activity STATUS RECEIPT DATE MEMBER NAME Date Activity 07 26 2012 07 25 2012 07 25 2012 LO LO a 07 25 2012 ra rl 07 25 2012 2 Select the drop down arrow next to your name in the upper right corner and click Account Details g q E w Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Go to Dashboard For E ST LUKES HOSPITAL
39. o filter the patient list click Filter You can filter by NPI and Provider Medicaid Filtering the patient list allows you to view the patients per NPI or Provider Medicaid that belong to a single TIN 6 To search for a specific patient click Find Patient Enter the Medicaid ID Last Name and DOB of the patient and click Find 7 To open the patient record click the blue member name Operational Training 18 12 12 2012 A LA E i Prasad Balla Eligibility Patients Authorizations Claims MT ELA AA 4751093698 PHILLIP L POTT E Find Patient Ea Coordination of Benefits m ia This patient is eligible as of today Dec 7 2012 Assessments Patient Information Eligibility History Health Record Name AAN Start Date End Date Product Name Care Plan Gender F Dec 1 2011 Ongoing TANF Non Reform i Birthdate Dec 2 1991 Mar 14 2011 Sep30 2011 TANF Non Reform Authorizations Age 21 years old Feb 1 2011 Mar 13 2011 TANF Non Reform Claims Medicaid MMMM Dec1 2010 Dec31 2010 TANF Non Reform Address MIMANDARIN DR ORLANDO FL 328198464 Care Gaps PCP Information Due for annual adult physical Name REYNALDO DACO Address 60 W KALEY ST ORLANDO FL 32806 Practice Type GENERAL PRACTICE Phone Number 407 MI Top 5 Most Occurring Diagnosis SUPERVISION OTHER NORMAL PREGNANCY OTH DISEASES RESPIRATORY SYSTEM NEC dia ROUTINE POSTPARTUM FOLLOW UP Three Most Recent ER Visits NORMAL DELIVERY Non
40. our name in the upper right corner Select User Management E O S H Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Viewing For ST LUKES HOSPITAL Invite a User Support Users NAMI Email Address Kyle Campbell name domain com Ryan Lindbeck 3 Select Disable User next to the user name that you wish to disable access i S v E Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Viewing For ST LUKES HOSPITAL Support Users Invite a User Success User disabled NAME E MAIL ADDRESS ACTIONS Email Address name domain com Kyle Campbell Ryan Lindbeck 4 After a user is disabled you receive a Success message Under the Actions column you have an Enable User function if necessary Once a user is disabled their login and password are disabled immediately and the user is unable to access the account Operational Training 12 12 12 2012 Enable a User To enable a user previously disabled ES q e an v Eligibility Patients Authorizations Claims Ryan Lindbeck Messaging a T ST LUKES HOSPITAL Support Users Invite a User Success User disabled Email Address name domain com NAME E MAIL ADDRESS ACTIONS Kyle Campbell es ES Ryan Lindbeck 1 Log in to the secure website 2 Select the drop down arrow next to your name in the upper right corner Select User Management 3
41. t eligibility and view their patient list Providers can view and submit both authorizations and claims through the website A secure messaging feature allows a Provider to communicate with the health plan without having to pick up the telephone This manual is intended to be a quick reference for using a tool or function offered on the website when a Provider or staff member needs assistance The manual also explains many ways to use the site in order to get the most out of the resource Access the secure provider website using Internet Explorer 7 0 or higher Firefox and or Google Chrome Each browser should be updated to the most recent version available optimal performance Operational Training 4 12 12 2012 Registration To create an account The Tools You Need Now Our site has been designed to help you get your job done Check Eligibility Find out if a member is eligible for service Authorize Services See if the service you provide is reimbursable Need To Create An Account Registration is fast and simple give it a try Manage Claims Submit or track your claims and get paid fast 1 Click the Create An Account button 2 Start your registration by entering your Tax ID number First Name Last Name Email and Password Passwords must be at least 6 characters in length with at least one uppercase and lowercase letter and at least 1 number or symbol amp gt Click Register 4
42. to Employment Yes Auto Accident Yes Other Accident Yes 4 Inthe Patient Info section populate the Patient s Account Number and other information related to the patient s condition by clicking the appropriate button 5 Click Next Operational Training 54 12 12 2012 ES e w Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging A AA MS ST LUKES HOSPITAL Upload EDI Professional Claim for IE Your Progress os SS SS gt THIS SECTION General Info intormation about the dates of the claim Date of current illness First Symptoms Or 07 21 2012 Injury Accident or Pregnancy LMP Date of similar illness give first date 07 21 2012 Dates Unable To Work From MM DD YYYY To MM DDIVYYY Hospitalization From MM DDIYYYY To MM DDIYYYY Outside Lab Prior Authorization Number Diagnosis Codes XXXX e g 1409 250 DIABETES MELLITUS Add Coordination of Benefits Patient Info 6 In the General Info section populate the claim information and dates You can Add Coordination of Benefits by selecting the button 7 Click Service Lines Operational Training 90 12 12 2012 q w Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging E OS ST LUKES HOSPITAL E Upload EDI Create Clain Professional Claim for MI Your Progress eS SS THIS SECTION Service Lines enter up to 99 service lines Total 0 00 Add New Service Li
43. to delete a saved claim that is no longer necessary Click OK to confirm the deletion Operational Training 42 12 12 2012 Claim Errors 1 Log in to the secure website 2 Select Claims at the top of the screen 2 4 Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging WCU Teli eal MOS STLUKES HOSPITAL Upload EDI Claims Individual A saved Se Batch Claims Audit Tool O 07 27 2012 500000570 cms 1500 M 3 jy 100 00 3 Click on Errors to see any claims submitted that may have encountered errors in processing 4 If you receive multiple results filter the list by clicking the Filter button q 4 Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Viewing Claims For ST LUKES HOSPITAL Claims individual A Saved Batch Claims Audit Tool Date Range From 07 01 2012 To 08 01 2012 Web Ref Status Select El Go ch citeria The Submission 07 27 2012 500000570 cms 1500 MS A 100 00 5 To filter the list of claim errors enter either one or more of the following search criteria Date Range Web Ref and or Status 6 Click Go Note The Submission Date range you provide is limited to a three month span Only the last 18 months of claims data is available online 7 The filtered list appears allowing you to click on the Claim Number to open the claim to identify the errors Operational Training 43 12 12 2012 Fix a Claim
44. ur Provider from the list of results 18 Enter the Servicing Provider Information using NPI or First Name Last Name to Find the Provider Operational Training 31 12 12 2012 19 Click Next Ryan Lindbeck Eligibility Patients Authorizations Claims MEA MS ST LUKES HOSPITAL Authorizations for MMMM Your Progress gt gt gt gt D gt gt THIS SECTION Question naire These are questions specific to Medical Medical Previous 20 Enter Additional Information in the Questionnaire section 21 Click Next 4 Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging OVE Uc te MS ST LUKES HOSPITAL Authorizations for Your Progress EROS gt THIS SECTION Attachments Upload any relevant attachments 5Mb limit Attachments Previous 22 Browse and Attach any relevant documents i e Medical Records for this authorization 23 Click Next Operational Training 32 12 12 2012 En q 4 Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Viewing Authorizations For y ST LUKES HOSPITAL Authorizations for MIMI Your Progress I gt gt gt gt gt gt THIS SECTION Review and Su bm it Please review all the information below If any corrections need to be made make them and then come back here and hit submit You are about to submit an authorization If you need to review your information please do so now
45. view Sent messages q v dia Ryan Lindbeck Eligibility Patients Authorizations Claims Messaging Viewing Messages For Ma ST LUKES HOSPITAL Secure Messaging Inbox Sent Trash E Health Plan To Health Plan 7 30 2012 Benefit Inquiry Benefit Inquiry Benefit Limits Copay Benefit Limits Copay 730 2012 at 9 08 AM testing 1 Tosee the sent messages click Messaging at the top of the screen 2 Click Sent and your sent messages appear 3 To send to trash click the Send to trash button Operational Training 68 12 12 2012 To view messages sent to Trash 2 lt 8 v Eligibility Patients Authorizations Claims Messaging ME A A OS ST LUKES HOSPITAL Create Message Ryan Lindbeck Secure Messaging Inbox Sent Trash z To Health Plan Benefit Inquiry Benefit Benefit Inquiry Benefit Limits Copay Limits Copay 730 2012 at 9 08 AM testing 1 To view the messages sent to Trash click Messaging at the top of the screen 2 Click Trash and the messages sent to Trash appear The messages sent to Trash will be deleted after 30 days 3 Ifa message is not trash but is found under the Trash tab you can reverse it by clicking the not trash button Operational Training 69 12 12 2012
46. y s date and Place of Service will default to 11 Office Tabbing through Date of Service and Place of Service will give you the same defaults Line Procedure Quantity Mod 1 mos 2 pate of service Place of Service Diagnosis A eh Co METEO O OIC oe ee Review Claim Audit Results 6 The Clear Claim Connection screen appears allowing you to enter the Procedure Code Quantity Modifiers Date and Place of Service and Diagnosis for a claim proactively before you submit or retroactively after you submit Date of Service defaults to today s date and Place of Service defaults to 11 Office if not populated otherwise Use the Tab key to move through the fields easily If you have more than 5 procedure codes click the Add More Procedures link 7 Click the Review Claim Audit Results button Clear Claim Connection McKesson Edit Development Glossary About Help Logoff Claim Audit Results Gender Date of Birth Click on recommendation of Disallow or Review to obtain clinical edit clarification Quantity Mod 1 mod 2 Date of Service Place of Service ee ee 23 Leon arsson a rman om Buen Jo aoe The results displayed do not guarantee how the claim will be processed Operational Training 51 12 12 2012 8 The results of the claim audit display the Recommendation Status of Allow Disallow or Review The results displayed do not guarantee how the claim will be processed but assist in
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