eServices Manual Final - Beacon Health Strategies
Contents
1. Beacon Health Strategies eSewices Provider Manual Revised February 2 2009 Beacon Health Strategies eServices Provider Manual Table of Contents INTRODUCTION aara a senate aceon San os semen ch cots teens ake aAa eet 3 BEACON HEALTH STRATEGIES ee ee 3 BEACON ESERVIGES eege eege Eege 3 ELECTRONIC DATA INTERCHANGE 02 lt cs0nscccecensntecrssseeeceeeesnscuereetsnnesenseuseseceesanneereezens 4 EDI AND ESERVICES USER ACCESS TO PROTECTED HEALTH INFORMATION ss20seeeeeees 4 BEACON ESERANIE Eeer EES 5 REGISTER TO OPEN AN ESERVICES ACCOUNT esseeccceeeeeeeeeeeeeneeeeseeeeeeeesseeeeeeeeeneneeeeeees 5 Registration Step 1 Practice Organization Identification cccccccceeceeeeeeeeeseeeees 5 Registration Step 2 Terms and Conditions ANEN 6 Registration Step 3 User Name amp Password 6 Registration Step 4 User and Provider Information 7 Registration Step 5 Submit and Complete Registration ccccceeeeeeeeeeeseeeees 7 LOGON TO BEACON ESERVICES ss sccic sesscsessssesseuecestecsenctesececeteenaed odeczsc sees enveectennceececnseeoed 8 ACCOUNT ADMINISTRATOR geess EEN 8 How the Account Administrator is Assigne 8 Change the Account Administrator Au 9 Role of the Account Administrator 9 Provider Alert Important Guidelines for the Account Administrator 9 AGtivat a new User ore a a a E EEE EEE A O E AE e 9 Set User Permission Leer 2ee0eCekEoasgustaeeteieiekEer Sea eaveatiarace 10 Reset U2. Before using eServices the first time you must open an account by registering with Beacon This mechanism is designed to protect the extensive member information that is accessible through eServices To begin go to the Beacon website www beaconhealthstrategies com and click the PROVIDER ESERVICES quicklink on the home page This will take you to the main eServices page where you will click REGISTER LOGIN REGISTER Eligibility Benefits Or Welcome to eServices Beacon s web tool for providers All eServices functions are provided free to Beacon contracted Authorization providers and are aimed at enabling easy and secure access to a host of clinical administrative and patient Claims information as well as all provider business transactions with Beacon eServices allows providers to Search History Verify member eligibility quickly and easily Request authorizations eAuthorizations receive priority review Confirm the status of authorizations and print all authorization details including the number of units utilized Submit claims including reconsiderations Check the status of claims View and print explanation of benefit EOB information View and print claims performance information View update and print provider demographic and directory information View print and download provider documentations such as manuals forms bulletins mailings etc Provider Information Provider Reports Provider Materials Alerts
3. Contact Us Help Ifyou are not registered for eServices simply click the Register link on this page to start EDI Gateway Registration Step 1 Practice Organization Identification To ensure that only authorized individuals open accounts you will need two very important pieces of information to register e National Provider Identifier NPI number for your practice or organization e Tax Identification Number TIN for your practice or organization Enter these two numbers and click SUBMIT Please do not enter a personal NPI or TIN at registration unless you are a solo unincorporated practitioner Beacon Health Strategies eServices User Manual 2 2 09 5 LOGIN REGISTER Register Welcome to Beacon s Provider eServices registration Provider eServices enables Beacon s network providers to perform mosttransactions electronically including claims submission authorization requests and eligibility checks Ifyou have been directed by your eServices Account Administrator to sign up please fill in the fields below Ifyou are NOA provider click here to register Provider Information Organization NPI 2 Tax ID Registration Step 2 Terms and Conditions Review the eServices Terms amp Conditions carefully including User s Responsibilities and Obligations Changes Updates Governing Law Termination Unauthorized Use Misuse Accept the terms and conditions Click NEXT to continue Registr
4. Provider Information n User Information Provider Reports First Name BeaconDemo Manage Users Last Name BeaconDemo Provider Materials E mail helpdesk beaconhs com Alerts 0 Phone 781 994 7559 Contact Us Title BeaconDemo Help z Department eServices EDI Gateway Change Password Old Password New Password Confirm Password Change Security Question Answer Password Security Question Place of work Security Answer Save Cancel View and Edit Account Information Account Administrators and all other users can view their own account set up by clicking the My Account button at the top of most eServices screens Here you can edit your user name and other information change your secret question or password and find the Account Administrator for your practice Note Beacon eServices user names and passwords are unique to each user and are not to be shared Beacon will disable any account that is not accessed for more than two months or any account that is being used by a person other than the intended user Beacon Health Strategies eServices User Manual 2 2 09 13 Find a Member Most transactions available in eServices are member specific There are 2 ways to search for members Quick Search Click SEARCH HIsToRY on the blue menu bar to find all members for whom you have searched in the last 10 days Select th
5. 1955 Sex F Search History Provider Information Authorization Information Provider Reports Provider Name Jewish Board of Family amp Child Service Manage Users Mail To Address Jewish Board of Family amp Child Svc Downtown Clinic 125 Main Street New York NY Provider Materials Requested Procedure OPVISITS Outpatient Visits Alerts 0 Request Units 5 Contact Us Request From 6 26 2007 Help Request To 71112007 EDI Gateway Authorized Procedure OPVISITS Outpatient Visits Authorized Units 5 Authorized From 6 26 2007 Authorized To 74112007 PA Number 1306006 Decision Approved Used Units Note To prevent unauthorized employees from viewing confidential member information displayed on your screen each working session on eServices will expire 30 minutes after you logged on You will be prompted when 5 minutes are left and directed to the logon screen After entering your user name and password you will automatically be returned to the screen you were using before your time expired Claims Submit Claims Providers can submit outpatient and inpatient claims directly via Beacon s website The process is fast and easy and saves time and resources for providers The eClaim includes critical fields from the CMS 1500 form for outpatient services and from the UB 04 for inpatient services However since much of the required provider and member information is already in Beacon s database you fill out fewer fields in eServices t
6. Practice Contact Us More 07 25 1997 04 30 1998 Medicaid DrJohn Doe ABC Physician Practice Help EDI Gateway Click MORE next to the time period under Eligible to see the following additional information about the selected member Coverage for Outpatient Mental Health and Substance Abuse benefits Coverage Inpatient Mental Health and Substance Abuse benefits Copayment amount if any Number of medically necessary initial visits not requiring authorization that have been paid to all behavioral health providers for the member in the current year or period Note that this number does not reflect initial visits attended by the member but not yet billed Note Due to restrictions set forth by the Centers for Medicare and Medicaid Services information about individual Medicare members is not accessible via eServices To view general Medicare benefit information select See Benefits by Health Plan below Beacon Health Strategies eServices User Manual 2 2 09 17 Benefits Authorization Claims Search History Provider Information Provider Reports Manage Users Provider Materials Alerts 0 Contact Us ED Gateway Check up to date member eligibility benefit levels and copayments Member Information Member MEMBER DEMO BEST ID MA1849952839 City State Salem MA 12345 DOB 12 20 1955 Sex F BenefitLevel Medicaid MentalHealth IP Unlimited medically necessary services Men
7. information about a new outpatient clinician joining your provider organization Follow the instructions below under EDIT CLINICIAN to complete all fields Note that the ADD CLINICIAN option will appear only for licensed hospitals health centers clinics and other facilities Due to credentialing requirements private practices should contact provider relations beaconhs com to add clinicians Beacon Health Strategies eServices User Manual 2 2 09 32 EDIT CLINICIAN to edit update an array of important information about clinicians and to notify Beacon when a clinician leaves the practice Current information about the clinician is displayed at the top of the screen Scroll down to edit the following fields CLINICIAN DETAILS including prefix Mr Ms Dr name gender dob ethnicity and whether s he is accepting new referrals Recheck for accuracy and initial caps only Click UPDATE CLINICIAN INFORMATION Or click TERMINATE CLINICIAN if he or she leaves the practice The screen will refresh and you will see a message that your request for updates is pending Beacon s Provider Relations staff may contact you with questions and or you will be notified by email after they verify the new information Note Clinicians who leave the practice must be terminated from eServices to prevent unauthorized access to PHI and to alert Beacon that the clinician s languages and specialties are no longer available LANGUAGE DETAILS to specify la
8. record appears click CHECK AUTHORIZATION and search for the request by reference number if you have it You can also search by month or by year to view all previous authorization requests for the selected time period with date ranges authorization reference numbers and status For additional detail including denial reason s click MORE next to any request Eligibility Benefits Authorizations Authorization Manage Pending Reviews Member Information Member MEMBER DEMO BEST Recht MA1849952839 City State Salem MA 12345 Submit Authorization Request DOB 12 20 1955 Sex F Claims Search History M Select the month and year that the service was requested Provider Information Month and Year Service Requested January 2008 Provider Reports C earch by Year C erch by Month Manage Users Search for Authorizations Provider Materials Status Requested Requested Requested Requested Approved PA Decision Alerts 0 From To Procedure Units Units Contact Us More Accepted 09 03 2008 11 03 2008 OP ISITS 8 8 1365671 Approved Lol Mare Accepted 10 10 2008 12 31 2008 OPVISITS 10 10 1365671 Approved Help EDI Gateway Beacon Health Strategies eServices User Manual 2 2 09 22 Eligibility Benefits Authorizations Authorization Manage Pending Reviews Member Information i Member MEMBER DEMO BEST ReciD MA1849952839 Submit Authorization Request City State Salem MA 12345 Claims DOB 12 20
9. screen This action will save and close the request enabling providers to complete the request later and or pend it for supervisory review before or after submission Beacon Health Strategies eServices User Manual 2 2 09 21 Return to a Saved Authorization Request If you saved an authorization request you can go back to review edit and submit it at any time If you are the Account Administrator or if the Account Administrator activated your eServices account with permission to review authorization requests e g because you are a Supervisor you can also look at pended authorizations Choose AUTHORIZATION MANAGE PENDING REVIEWS from the blue menu bar and click MANAGE next to the authorization you wish to review edit and or submit Check Authorization Status When Beacon staff has made a determination on your authorization request you will receive an email notification containing the reference number and the medical necessity decision Consistent with HIPAA requirements no patient identifying information is included in the email message Instead it contains a link to eServices where you can log on and use the reference number to search for detailed information You can also check authorization status at any time regardless of whether your request was submitted through eServices or by fax Select AUTHORIZATION CHECK AUTHORIZATION REQUEST from the blue menu bar and enter the member information in the next screen When the members
10. within the group or facility terminating accounts when staff leaves the practice and determining which features are available to each user Provider Alert Important Guidelines for the Account Administrator To ensure protection of member confidentiality as required by HIPAA set each user s permission level in accordance with their legitimate need to know for Treatment Payment and or health care Operations TPO and your organization s internal criteria Each user including you should use only his her own username and password Do not create new accounts for users who forget their passwords Users can reset their own passwords at the log in screen There is no limit to the number of accounts that can be created at your organization and Remember to deactivate accounts when employees leave the practice or no longer need to access eServices Activate a new user When a new user registers for eServices see Registration below the name of the designated Account Administrator at his her practice is automatically emailed to the new user At the same time the Account Administrator receives an email indicating that the new user has registered with a link to the eServices logon page The Account Administrator selects MANAGE USERS MANAGE ACCOUNTS The new registrant s name will be visible but locked to indicate that it is not activated Click on EDIT next to the person s name Unclick the locked box click
11. A 28 Claim Approvals and Denial Report 29 PRACTICE DEMOGRAPHICS AND CAPABILITIES 0s0sssseseeeeeeeececessseeneeeeeceeneseensneeneeseeneasans 29 Add and Update Practice Information cccccceceseeeececeeeeeeeeeeeseeneeeeeeseeeeseeeneeeees 29 Provider Alert Required Information ccccecceseeeeeeeeceeeeeeeeeeeneeeeeeeeeeeeeeneeaes 30 EDITSIT GE 32 ADD GONTACTS tices caaecten atest atte EE 32 KI SE 32 DERETE rsiets sheer 6 tube othe cine Sie as tae eas eee Bie aS 22 tee hon eile Md Ae Ce 32 EDIT SCHEDULE T si e 32 EDIT SERVICES ee E Eeer EE T EN 32 ERKENNEN 33 PROVIDER MATERIALS 0 ccsssseseecssseseecneseueuseenseeueneneueuseaseeeeeoseeeaenuseeuaeoasseusonaeseesooases 34 ESER VICES H E P ear dadd Nee Dee E NEG EE EC Zeg 34 ELECTRONIC DATA INTERCHANGE ED eeeEeEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE KEEN 35 B BUR ee ee wee oe Bia cee Pace See aden dae sua cca awe teeta 35 Beacon Health Strategies eServices User Manual 2 2 09 2 Introduction Beacon Health Strategies Beacon Health Strategies Beacon is a behavioral health management organization specializing in the development and management of behavioral health services for health insurance plans Beacon integrates managed care operations and information technology to improve the quality effectiveness and efficiency of health and human services Through deployment of the principles and techniques of total quality management at all le
12. AGE ACCOUNTS from the blue menu bar Click EDIT next to the name of the user whose permission levels you wish to change Check additional roles or uncheck roles no longer appropriate for the user Option 2 Reset Permissions by Role Select MANAGE USERS MANAGE ROLES from the blue menu bar Select a ROLE from the drop down menu at the top of the screen The left hand box lists users who are not authorized for the selected role unassigned and the right hand box shows users who are assigned i e have permission to perform the selected role Highlight a name in either box and click the gt gt or lt lt arrows to move it to the other box Beacon Health Strategies eServices User Manual 2 2 09 11 Terminate or deactivate a user To protect member confidentiality it is very important to lock the accounts of users who leave the practice To do so go to Manage Users Manage Roles and click edit next to the user s name Click to remove the checkmark in active and to place the checkmark in locked It is also important to notify Beacon that the clinician has left the practice See Edit Provider Information Edit Site Terminate Clinician Note To prevent unauthorized employees from viewing confidential member information displayed on your screen each working session on eServices is set to expire 30 minutes after you logged on You will be prompted when 5 minutes are left and directed to the logon screen A
13. ATION OF BENEFITS from the blue menu bar Select a month and year and a list of claims submitted in that time period will appear Click PRINT next to any Beacon Health Strategies eServices User Manual 2 2 09 28 claim to display a screen view of the EOB Click the printer icon at the top of the page to print a hardcopy Eligibility Benefits k Authorization Eu Explanation Of Benefits Report Search History Provider Information ba Select month and year of service 08 2007 v Provider Reports H lanati enefits Check Number Check Date Check Amount Pian Name Payee Name Approval Rate with Denial report Print 104 08 07 2007 30 00 BEST Jewish Board of Family amp Child Service Manage Users z Provider Materials H Claim Approvals and Denial Report Authorized users can view aggregate claims information for their entire practice or organization by month Select PROVIDER REPORTS CLAIMS APPROVAL WITH DENIAL REPORT from the blue menu bar The report displays a table and pie charts showing the number and percent of claims approved and of claims denied for various reasons These calculations are provided both by member and by all claims since any single member may have multiple claims Move your mouse over denial codes in the table to see a full description Similarly move your mouse over any segment of the pie charts to see its title If your practice is contracted with Beacon to serve more than one heal
14. SUBMIT EDIT SITE to update site name site address site phone and fax numbers and site email address ADD CONTACTS to identify key personnel in your organization Fill in the person s complete name title address es telephone fax and email Beacon currently maintains contacts for the following categories in order to distribute information appropriately e Administrator Practice Manager Claims Billing Manager CMO Medical Director Executive Director Intake Managed Care Contracting PA Fax Mail Email Person to receive authorization notices EDIT next to an existing contact to edit the person s name title address es telephone fax email Email address will soon be a required field as Beacon is transitioning to all electronic communication with providers Click UPDATE CONTACT INFORMATION DELETE next to an existing contact name when the person changes positions or leaves the organization Click UPDATE CONTACT INFORMATION EDIT SCHEDULE to enter update the site s hours of operation by day of the week Recheck for accuracy Click UPDATE SITE SCHEDULE EDIT SERVICES to specify whether you provide inpatient mental health inpatient substance abuse outpatient mental health outpatient substance abuse accessibility features and additional services Your current practice information will be displayed edit by checking or unchecking boxes below Click each Save button as segments are completed ADD CLINICIAN to provide
15. a particular health plan Check Member Specific Eligibility and Benefits On the blue menu bar choose ELIGIBILITY BENEFITS CHECK ELIGIBILITY which will take you to the MEMBER SEARCH screen Select the member whose eligibility and benefits information is needed as described above The member s record indicates whether the member is currently eligible for benefits as a Yes or No under ELIGIBLE Note that you can also proceed to request or check an authorization submit a claim or view claims status from this screen Beacon Health Strategies eServices User Manual 2 2 09 15 CS e Services Y l i i ou are logged in as eServicesDemo01 MY ACCOUNT LOGOUT Eligibility Benefits Member Search o SES Benefits Step 1 At least one field is required Authorization Member ID 2 MA1849952839 tan ne Or Date Of Birth 5 Search History Step 2 At least one field is required Provider Information First Name Dermo Provider Reports Or Last Name Manage Users Provider Materials Alerts 0 0 1 Member s Found in your Search Contact Us Help DEMO 12 20 1955 BEST Yes Request Auth Check Authorization Submit Claims EDI Gateway MEMBER eClaim Status Note Due to restrictions set forth by the federal Centers for Medicare and Medicaid Services information about individual Medicare members is not accessible via eServices To view general Medicare be
16. ation Step 3 User Name amp Password Create a unique user name and password that you will use to access the Beacon eServices website The user name you choose is for your use only Other staff members must create their own unique user names and passwords You will also be required to select a secret question and corresponding answer Choose a question and answer that you will remember as these will be needed to reset your password in the event that it is lost or forgotten in the future Please keep your password written in a secure place as Beacon does not store user passwords in any form Users can reset their own passwords at any time See Forgot Password Reset Password Note User name password secret question and secret answer fields are all case sensitive Beacon Health Strategies eServices User Manual 2 2 09 6 Registration Step 4 User and Provider Information Enter all user and provider information accurately Review all entries carefully and correct any typographical or other errors Registration Step 5 Submit and Complete Registration Click SUBMIT to complete your online registration for eServices If you are the first person in your practice to register for eServices the confirmation email will designate you as the Account Administrator You will be asked to print sign and fax the eServices Terms of use to Beacon Upon receipt and verification we will activate your account and send an email confirming your eSe
17. e member you need Standard Member Search For all other members click ELIGIBILITY AUTHORIZATIONS or CLAIMS on the blue menu bar and choose any member specific function e g submit authorization submit claim check eligibility etc This will take you to the member look up screen You will need two identifying data elements unique to the member e Enter the Membere Beacon identification number or Date of Birth And e Enter the member s first or last name Click SEARCH Records for all members who match the search criteria will appear Select the member you are treating Note Due to restrictions set forth by the federal Centers for Medicare and Medicaid Services CMS information about individual Medicare members is not accessible via eServices Please call Beacon at the applicable phone number below Fallon Community Health Plan 888 421 8861 Beacon Health Strategies eServices User Manual 2 2 09 14 BEACON eServices Step 1 At least one field is required Authorization Member ID 2 Claims Or Date Of Birth Fe Search History Step 2 At least one field is required Provider Information First Name Provider Reports Or Last Name Manage Users Search for Mernber Provider Materials ELIGIBILITY and BENEFITS Eligibility and benefit information can be retrieved for a specific member or for each benefit category Medicaid Commercial etc within
18. e menu bar All sites and locations previously provided to Beacon will appear in a drop down menu Select the site to review and edit Eligibility Benefits Provider Information Authorization Claims Search History Site Information Provider Information Site Information Provider Reports Jewish Board of Family amp Child Sve Downtown Clinic Manage Users 123 Main Street Suites 10 15 New York New York 10024 781 631 4455 Provider Materials Alerts 0 Contact Us Site Contacts Add Contacts Help Contact Address Phone Fax EDI Gateway Managed Care Contract 123 Main Street 781 631 4455 781 631 4400 Site Hours Edit Schedule Day Hours Monday By Appointment Site Services Edit Services Inpatient Services MH Adolescent MH Adults MH Children SA Adolescent SA Adults SA Children Outpatient Services MH Adolescent MH Adults MH Children SA Adolescent SA Adults SA Children Accessiblity Handicap Accessible Public Transportation Additional Services Ambulance Clinicians Edit Clinicians Add New Clinician Theodore Abercrombie Patricia Flanagan Tania Povolitis Test Test Beacon Health Strategies eServices User Manual 2 2 09 31 A summary of information currently in Beacon s database is displayed Note that many additional data elements are available to edit Choose the area s to be updated Please recheck your entries for accuracy and capitalization initial caps only before clicking
19. e selected a member click the REQUEST AUTHORIZATION link in the member s record summary Next select the type of authorization On the following page choose the start and end dates for the authorization by clicking on the calendar or type the dates using MM DD YY format Select the site where you will provide treatment and enter the number of visits or units you are seeking To continue with the authorization request click NEXT at the bottom of each screen or SAVE to complete the request at a later date time or to pend it for supervisory review See Save an Authorization Request Eligibility Benefits Authorization Claims Outpatient Authorization Search History Member Information Provider Information e Member MEMBER DEMO BEST ID MA1849952839 Provider Reports City State Salem MA 12345 Manage Users DOB 42 20 1955 Provider Materials Date of Service Requested Alerts 0 Contact Us From Date Help To Date EDI Gateway Site of Service Total of Visits Requested Beacon Health Strategies eServices User Manual 2 2 09 19 Pre Load Information from Previous to New Authorization Request After entering the number of visits requested users have the opportunity to copy information from a previous request into a new request for the same member eliminating re entry of unchanged data Click the down arrow in the box under Existing Reviews and select the previous requ
20. elcome to the EDI Gateway This secure application is for a health care provider business associate or vendor who established a trading partner relationship with Beacon to conduct electronic data interchange EDI transactions Utilizing the Forgot Password EDI Gateway you will be able to e Upload EDI files Create a Login ID e Check the status of your file e Download responses and reports Terms of Use EDI Help Technical and business related questions regarding EDI should be directed to edi operations beaconhs com Beacon Health Strategies eServices User Manual 2 2 09 35
21. est you wish to use Click SHOW to see the request then PRELOAD to copy information into the new authorization Diagnostic and other fields will auto populate Edit the pre loaded data as needed and continue with the Request an Authorization process Eligibility Benefits Authorization Claims Outpatient Authorization Search History Existing Reviews Provider Information eSericesDemo01 11 07 200 Show Provider Reports Manage Users CURRENT PSYCHOTROPIC MEDICATIONS Are psychotropic medications being precribed Provider Materials Alerts 0 Contact Us Help EDI Gateway y DSM V DIAGHOSIS Axish e Enter all required clinical information as identified by asterisks on the subsequent screens You may also wish to complete the non required fields to help Beacon make a determination on your request Be sure to include accurate and complete information in all required fields Note that the Goals and Modality fields require free text while the Progress Update fields have drop down menus At least 2 goals are required If you fail to input required information the fields will be highlighted in yellow as an indication that you are missing information When done click SAVE if you or your supervisor want to complete or review the request later or click SUBMIT Beacon Health Strategies eServices User Manual 2 2 09 20 You will immediately rece
22. fter entering your user name and password you will automatically be returned to the screen you were using before your time expired Forgot Password Reset Password eServices allows an immediate password reset option should you lose or forget your password Note that Beacon does not store user passwords in any form If you lose your password create a new password according to the instructions below DO NOT re register as a new user On the eServices login page simply scroll to the lower half of the page and click the FORGOT PASSWORD link You will be asked to enter your user name and then to answer the secret question you selected when you registered Below your answer fill in a new password Identity Confirmation Answer the following question to change your password User Name eServicesDemo01 Question Place of work Answer New Password A message will appear verifying that you have successfully reset your password and a confirmation will automatically be sent to you by email You can also change your password at any time by clicking on the My ACCOUNT button at the top of the screen See View and Edit Account Information Beacon Health Strategies eServices User Manual 2 2 09 12 Eligibility Benefits Authorization Claims You are logged in as eServicesDemo01 Your account is linked to Provider 212810 Jewish Board of Family amp Child Service Search History
23. gd d gd sg Total Charges SSS aa When done click SUBMIT ECLAIM A confirmation screen will immediately appear with the claim reference number for future inquiries All claims information remains available to you in eServices and the confirmation screen can be printed for your records as well Beacon Health Strategies eServices User Manual 2 2 09 24 Eligibility Benefits Authorization Claims Your eClaim has been successfully submitted The Reference Number for this transaction is 252978 Check Claims By Member Check Claims By Provider You can check the status of this claim on our web site Please allow 3 to 4 hours for the claim to be posted in our system Ifyou have any other questions regarding this claim please contact the Claims Hotline at 1 988 249 0478 piosa esiaims amp Print this page Check Claims Status Any user can view the status of claims that he or she has submitted Additionally users who have been authorized by their Account Administrator to review claims can view the status of all claims submitted by the practice or organization Claims status is available on eServices regardless of how the claim was submitted In most cases the status of a claim is posted on eServices within the following timeframes Method of Claim Status Posted Within Submission eServices 1 hour EDI 1 hour EMDEON 1 hour after receipt from EMDEON usually 24 hours after provider sends
24. han on the paper forms To submit a claim choose CLAIMS SUBMIT ECLAIM from the blue menu bar Search for the member then click SUBMIT CLAIM in the member record summary The member s name and health plan identification number city state and date of birth will automatically populate on the eClaim Complete all required fields a primary diagnostic code is required secondary and tertiary diagnostic codes are optional For outpatient claims only one service date not a date range will be Beacon Health Strategies eServices User Manual 2 2 09 23 accepted for each line Additional dates of service claim lines can be added by clicking ADD SERVICE LINE in the final box Eligibility Benefits Claims Authorization Claims Submit eClaim Outpatient Professional CMS 1500 Check Claims By Member Check Claims By Provider Member Information Member MEMBER DEMO BEST ID MA1849952839 Upload eClaims City State Salem MA 12345 Search History DOB 12 20 1955 Provider Information Claim Information Provider Reports Manage Users Is this claim a resubmission adjustment of an original Claim Mo IC ke Patient Acc No Dx Code 1 Box 26 2 Dx Code 2 Dx Code 3 Service Site i B Provider Materials Alerts 0 Contact Us Help Clinician EDI Gateway Service Line Information Add Service Line Sve From Svc To POS Procedure Mod1 Mod2 Units Charges Clinician NPI Ber TS Sal
25. ive a printable confirmation reference number and copy of the electronic authorization request CG e Services Yi rel i d ou are logged in as eServicesDemo01 MY ACCOUNT LOGOUT Eligibility Benefits Authorizations Authorization Claims Your Outpatient Authorization has been successfully submitted Search History The Reference Number for this transaction is 83015 Provider Information Provider Reports Click Here to go back to member search Manage Uses amp printthis page Provider Reports eOREGubmitted Authorization Result Manage Users See Provider Materials Reference Number 84241 Alerts 0 Submitted By BeaconDemo BeaconDemo ABC Behavirol Health Phone 781 994 Contact Us mone Submission Date And Time 2008 11 07 11 58 06 Request EDI Gateway Member DEMO MEMBER MA1849952839 Site Jewish Board of Family amp Child Svc Downtown Clinic 1777 Date From 1110 2008 Date To 1141 7 2008 Requested Procedure Outpatient Visits OPVISITS Requested Visits 5 Diagnosis Axis I 292 89 OTH DRUG INDUCD MENTAL DISORDERS Current GAF 5 Highest GAF in last year 15 Have you communicated with member s Yes PCP and or with prescriber Yes Risk Assessment Suicidality Not Present Yes Risk Assessment Homicidality Not Present Yes Risk of Psychiatric Hospitalization 2 medium low Yes Risk Factors Save an Authorization Request You can save the authorization request at any point by clicking SAVE at the bottom of the
26. larly current and archived news and bulletins can be found by clicking the ALERTS button We encourage users to check ALERTS frequently Additional forms bulletins tools and links are available in the public area of Beacon s website www beaconhealthstrategies com under Providers and Providers Tools eServices Help For questions or comments about eServices please visit the Provider section on https provider beaconhs com email eServices beaconhs com If you are having trouble finding a member submitting a claim or submitting an authorization please make sure that all of the required information fields have been filled in Beacon Health Strategies eServices User Manual 2 2 09 34 ELECTRONIC DATA INTERCHANGE EDI Beacon accepts standard HIPAA 837 Professional and Institutional health care claims transactions as well as provides 835 transactions through EDI Download Beacon s 837 and 835 companion guides from http www beaconhealthstrategies com Resources Hipaa for information regarding testing and setup for EDI transactions with Beacon Electronic Data Interchange or EDI can be accessed at the Beacon eServices site To access EDI select EDI GATEWAY from the blue menu bar The EDI Gateway will open allowing you to upload EDI files check the status of files and download responses and reports Beacon Health Strategies EDI Gateway HEALTH STRATEGIES Login ml Welcome To Beacon EDI Password Log In W
27. nefit information select See Benefits by Health Plan below For individual information about a Medicare member please call Beacon at the applicable phone number below Affinity Health Plan 800 974 6831 Fallon Community Health Plan 888 421 8861 Neighborhood Health Plan of New York 866 969 2661 Click the YEs or No entry and the members basic demographic information will appear including name city and state of residence and date of birth Below that you ll find a history of the membere health plan eligibility along with his or her Health Plan benefit type e g Medicaid Commercial PCP name and PCP practice name Beacon Health Strategies eServices User Manual 2 2 09 16 You are logged in as eServicesDemo01 Pa Us E Eligibility and Benefits Check up to date member eligibility benefit levels and copayments Authorization Member Information Member MEMBER DEMO BEST ID MA1849952939 Claims City State Salem MA 12345 OEMS CIs DOB 12 20 1955 Sex F Provider Information Begin Date EndDate Benefit Name PCP Name PCPSite Name Provider Reports More 08 01 2005 OPEN Medicaid Dr Jane Doe XYZ Physician Practice Manage Users More 08 01 2000 07 31 2005 Commercial ProductA DrJane Doe XYZ Physician Practice Provider Materials ore 03 15 1999 07 31 2000 Medicaid DrJohn Doe ABC Physician Practice Alerts 0 ore 08 18 1998 02 21 1999 Medicaid DrJohn Doe ABC Physician
28. nguages spoken by the clinician The left box contains a list of all available languages and the right box lists the languages spoken assigned to this clinician Add or remove assigned languages by clicking the arrows between the boxes Hold the shift key to highlight two or more adjacent listings or hold the Control key to highlight multiple languages that are not adjacent within a box Click on SAVE when done the screen will refresh and you will see a message that your request for updates is pending Beacon s Provider Relations staff may contact you with questions and or you will be notified by email after they verify the new information DEGREE DETAILS to identify the clinicians professional training Highlight a degree in the left hand box and assign it to the clinician by using the gt gt key Or highlight an incorrect degree from the right hand box and use the lt lt button to remove it Hold the shift key to highlight two or more adjacent listings or hold the Control key to highlight multiple languages that are not adjacent within a box Click on SAVE when done the screen will refresh and you will see a message that your request for updates is pending Beacon s Provider Relations staff may contact you with questions and or you will be notified by email after they verify the new information SPECIALTY DETAILS to specify up to 10 clinical specialties in which the clinician has appropriate experience and expertise H
29. old the shift key to highlight two or more adjacent listings or hold the Control key to highlight multiple languages that are not adjacent within a box Click on SAVE when done the screen will refresh and you will see a message that your request for updates is pending Beacon s Provider Relations staff may contact you Beacon Health Strategies eServices User Manual 2 2 09 33 with questions and or you will be notified by email after they verify the new information ID DETAILS to provide NPI and other state specific and health plan specific identification numbers An individual NPI number is required for each clinician and should be included for the rendering provider on all claims The items that begin with NYS and the Medicare number need only be completed for clinicians serving New York members The IDX number is only required for providers in Beacon s Fallon Community Health Plan network Click on SAVE when done the screen will refresh and you will see a message that your request for updates is pending Beacon s Provider Relations staff may contact you with questions and or you will be notified by email after they verify the new information Provider Materials Beacon s Provider Manuals and Level of Care Criteria are available to contracted providers Select PROVIDER MATERIALS from the blue menu bar then choose PROVIDER MANUALS or LEVEL OF CARE CRITERIA Additional options will be added in the future Simi
30. onicov Employee Woburn MA bemployee bhs com E F Beacon Beacon Health Beacon Health D eServices Man Aog m WG 9 32 AM Set User Permission Levels When activating a new user the Account Administrator will see a list of transactions that can be accomplished through eServices Simply click the box next to each transactions that the user is authorized to perform or click again to remove assigned permissions In compliance with HIPAA confidentiality requirements please grant access to individual users on a need to know basis only Beacon Health Strategies eServices User Manual 2 2 09 10 Eligibility Benefits Authorization Claims User Name eServicesDemo01 Search History First Name BeaconDemo Provider Information Last Name BeaconDemao Provider Reports Email helpdesk beaconhs com Manage Users Locked PS Active M Provider Materials Roles Manage Authorizations Vv Ea Check Authorizations M Contact Us Submit Authorizations M Help Check Claims Vv MEDI Gateway 7 Submit Claims M Eligibility v Reports Vv Edit Provider Information M Reset User Permission Levels The Account Administrator can modify permission levels for users within his or her organization at any time There are two ways to access this ability Option 1 Reset Permissions by User Select MANAGE USERS MAN
31. prevent unauthorized employees from viewing confidential member information displayed on your screen each working session on eServices will expire 30 minutes after you logged on You will be prompted when 5 minutes are left and directed to the logon screen After entering your user name and password you will automatically be returned to the screen you were using before your time expired Account Administrator How the Account Administrator is Assigned The Account Administrator for each provider is automatically assigned by Beacon At group practices and provider organizations who were using eServices prior to September 2008 the individual who appeared to be the highest level user or the only active user was designated as Account Administrator For providers who are new to eServices during and after September 2008 the first user to register will be designated as the Account Administrator Solo practitioners are the Account Administrators for their own accounts but will have limited use for these functions Beacon Health Strategies eServices User Manual 2 2 09 8 Change the Account Administrator To change the Account Administrator at your practice at any time email provider relations beaconhs com Role of the Account Administrator The Account Administrator controls all user accounts within his her practice or organization and as such plays a critically important role The Account Administrator is responsible for activating new users
32. rvices registration The Account Administrator is automatically registered with permission to use all eServices features If you are not the first user the name of the Account Administrator for your organization will be included in the confirmation message and also visible at My ACCOUNT The Account Administrator will receive an email notification that you have registered and can activate your account As soon as your account is activated by Beacon for the first user or by the Account Administrator for subsequent users in your practice you will be able to log on and begin using the many great features available through Beacon s Provider eServices Note that each user will see only the menu options for which he or she has been given permission Beacon Health Strategies eServices User Manual 2 2 09 7 Log on to Beacon eServices Go to the Beacon homepage at www beaconhealthstrategies com and choose the eServices quicklink at the top right This will take you to the Login screen WK e Services LOGIN REGISTER Eligibility Benefits eServices Login e Authorization Claims User Name Search History Password Provider Information Not Registered Forgot Password Provider Reports Provider Materials Alerts Enter your user name and password and click LOGIN You will be directed to the eServices welcome page from which you can select any option on the blue menu bar Note To
33. ser Permission Levels ccccccccccecccecccecccececeeeececeeeeeeeeceneeeeseeneeeeeeneess 11 Terminate or e EE EE 12 FORGOT PASSWORD RESET PASSWORD ssseecceseseeeeeeeeeneeeeeeeeeeeeeneeeeeeeeseeseeeeneneeeeeess 12 VIEW AND EDIT ACCOUNT INFORMATION sccccseeeeeeeeeeeeeeeeeeeeeeeeeeeseneeeeeeeeneeeeeeeeeeeeeneeenes 13 FIND A MEMBER ege Eegeregie 14 EWE SS ATC E 14 Standard Member Search ccccseesscccceecceeeeessccnaaeeeeeeeeesseeseceeeeeeeeeessesesseneeeeeeees 14 ELIGIBILITY AND BENEFITS E 15 Check Member Specific Eligibility and Benefits A 15 View Benefits by Health Plan 2 Z ertebgeegedusgkebegk egeerg Ee de CERS SCENE EE 18 AUTHORIZ nde 19 Request an Authorization EE 19 Pre Load Information from Previous to New Authorization Heouest 20 Save an Authorization REQUEST 2 riieccccesdecsesteeecisteessylets nies ENEE ENEE 21 Return to a Saved Authorization Heouest EE 22 Check Authorization Ee ode ege egen DEE 22 Beacon Health Strategies eServices User Manual 2 2 09 1 CLAUS geed e Akt e e EE ENEE de dated ant EE e Deed EES E Sane Seat ac Deeg 23 ell eil GE lan EE EE 23 Check E a E EE 25 Check Claims Status by Member 25 Check Claims Status for Practice or Organization 26 Resubmit a Denied Cam 26 tele RE TEE 26 Request Reconsideration of a timely filing dente 26 Check Number of Visits Initial Encounters Used ssssseneeesennesserrnnerernerssrerrrsee 27 SI e CR 28 Explanation of Benefits
34. t you can only adjust a claim that has paid Request Reconsideration of a timely filing denial When a claim falls outside of all timely filing for resubmission a provider may submit a request for a reconsideration of the timely filing rules To submit a request for reconsideration of timely filing denial first find the member through SEARCH HISTORY on the blue menu bar Select your member and then under action select SUBMIT RECONSIDERATION Select the type of claim and enter all required claims field Please explain why you are requesting a waiver of timely filing in the EXPLANATION free text field Please note that filing such a request is not a guarantee of payment The request will be reviewed and a determination will be posted on a future Explanation of Benefit statement Beacon Health Strategies eServices User Manual 2 2 09 26 Check Number of Visits Initial Encounters Used Each member has an allowance of outpatient visits that can be used without authorization called Initial Encounters or IEs The number of IEs varies by health plan and benefit type For most health plans the IE allowance is counted per calendar year but for some health plans it is a lifetime allowance Click here for plan specific benefit information Link to Eligibility and Benefits section above There are two ways to determine how many IEs have been billed by and paid to all treaters on behalf of a member Users can follow instructions to Check Claim S
35. talHealth OP Psych Testing covered in full SubstanceAbuselP Unlimited medically necessary services SubstanceAbuseOP 1 Methadone dose day and up to 4 methadone counceling sessions per week Other This is the notes field for Medicaid 1 benefit Copay Type Copa Value Copay Range Medically Necessary Initial Visits Last Visit Billed SA OP 0 Dollars Per Visit During Current Calendar Year 3 09 01 2008 View Benefits by Health Plan To view benefits levels within a particular health plan click BENEFITS ELIGIBILITY then BENEFITS from the blue menu bar Choose the health plan and benefit type that you wish to view You are logged in as eServicesDemo01 Eligibility Benefits Check Eligibility Authorization Benefits Plans Benefits Medicaid 7 A summary of inpatient and outpatient mental health and substance abuse benefits will appear Beacon Health Strategies eServices User Manual 2 2 09 18 Authorizations Request an Authorization eServices users can request authorization for outpatient services day treatment and methadone services where applicable Requests submitted through eServices get priority over requests submitted by fax or mail To create and submit an authorization request choose AUTHORIZATIONS SUBMIT AUTHORIZATION from the blue tool bar This will take you to the member search function to find the member you are treating See Find a Member Once you hav
36. tatus for a Member or to Check Member Specific Eligibility and Benefits Note that the information provided by Beacon reflects only paid claims the member may have used additional visits that have not been billed as of the day you check Beacon Health Strategies eServices User Manual 2 2 09 27 Eligibility Benefits Authorization Claims Member Information Member MEMBER DEMO BEST ReciD MA1849952839 Check Claims By Provider City State Salem MA 12345 DOB 12 20 1955 Sex F Medically Necessary Initial Visits Used Last Visit During Current Calendar Year Submit eClaim Upload eClaims Search History Provider Information 3 09 01 2008 Provider Reports Manage Users Provider Materials Select the month and year of the service Alerts 0 Month of Service October DI 2008 D Contact Us C search by Year earch by Month Help Search for Claims EDI Gateway Decision Invoice Record ID From To Procedure Paid Status Resubmit More Process C2972001242 7859911 10 20 08 10 20 08 90806 AJ In Process Resubmit More Process C2972001242 7859912 10 21 08 10 21 08 90806 AJ In Process Resubmit More Process C3012001099 7869783 10 27 08 10 27 08 90806 AJ In Process Resubmit Reports eServices enables users to view and print Explanation of Benefits EOB and Claims Approval Denial reports Explanation of Benefits To print an Explanation of Benefits EOB form select PROVIDER REPORTS EXPLAN
37. th plan results for each health plan are displayed separately Press CONTROL P or click the printer icon to print this report Practice Demographics and Capabilities Add and Update Practice Information Providers are contractually required to notify Beacon of material practice changes including the addition or departure of outpatient clinicians To make this as easy as possible providers can now add and maintain their detailed practice information online thus avoiding calls to Beacon and completion of detailed paper forms Beacon Health Strategies eServices User Manual 2 2 09 29 Provider Alert Required Information It is imperative that Beacon have current information about providers Our live provider database is used constantly as follows Published in health plan provider directories Reported to state agencies Available to the public online at www beaconhealthstrategies com Shared with members to direct referrals appropriately and Source of email and mail addresses for important notices to providers Beacon is phasing out paper communication All important notices are posted at our main website www beaconhealthstrategies com and in eServices See Provider Materials Alerts and or sent by electronic mail Beacon Health Strategies eServices User Manual 2 2 09 30 Choose from the blue menu bar To update provider demographic information select PROVIDER INFORMATION EDIT SITE INFORMATION from the blu
38. the active box and set the user s permission levels Beacon Health Strategies eServices User Manual 2 2 09 9 Beacon Health Strategies LLC Windows Internet Explorer provided by Beacon Health Strategies Go v https provider beaconhs com Private Admin ManageAccounts aspx v Ei EI EI File Edit View Favorites Tools Help Ka D ei Be Be Beacon Health strategies Lic l EN teh page Gp Tools You are logged in as eServicesDemo01 MY ACCOUNT LOGOUT Eligibility Benefits Manage Users Authorization Claims Name City State Email Account Account S ES Locked Active earc isto A Edit AnupV1 Ventner Marblehead MA aventner abc org E F Provider Information User Man e Edit bcassell Castle Woburn MA jcastle abc org o F Provider Reports E Justin Manage Users Edit Green Green Woburn MA Courtney Gorzkowicz beaconhs com JE E 4 ser Cathy q Edit jeskin Jetson butler MA _ jjetson abc com E E Manage Roles ser Judy Provider Materials Edit equinn Jones Woburne MA bjones abc com F Ir ser Beverly Alerts 0 i S SSS Edit eSenicesDemo01 Robins Marblehead MA Irobins clinic org E F Contact Us User Linda Help Edit jdoe01 Doe John NewYork NY jdoe abc com E E ser EDI Gateway Edit jdoe02 Doe John NewYork NY jdoe abc com E RS Ser Edit Peters Peters Lily Woburn MA Ipeters bhs com E E ser mk
39. tinues onto other pages Move from page to page by clicking the arrows Check Claims Status for Practice or Organization Select CLAIMS CHECK CLAIMS BY PROVIDER on the blue menu bar Enter the month and year you wish to search and a list of claims submitted within that timeframe will appear below Check the bottom of the screen to see if the list of claims continues onto other pages Move from page to page by clicking the arrows Resubmit a Denied Claim If a claim is denied by Beacon because it contained invalid or incorrect information you may resubmit the claim following timely filing guidelines Follow the instructions for checking claim status then click RESUBMIT at the end of that service line to be resubmitted All information submitted on the original claim will display Correct the data element s that caused the claim to deny and click Submit You then have an option to review claim if additional edits are needed click edit claim if not additional edits are needed click submit claim Submit a Claim Adjustment If you were overpaid or underpaid for a claim you can submit a claims adjustment via eServices Follow the instructions for submitting a claim Under the Claim Information section Answer yes to Is this claim a resubmission adjustment of an original Claim This will open the REC ID entry field under Service Line Information Section Enter the REC ID of the claim you wish to adjust Itis important to remember tha
40. to EMDEON Paper 21 days Check Claims Status by Member On the blue menu bar choose CLAIMS CHECK CLAIMS BY MEMBER Enter required information to find the member and CLAIMS STATUS on the member s summary record At the next screen choose whether you wish to search by year or by month If searching by month enter the month and year of your search If searching for a full year enter any month and the year you wish to search The member s identifying information will appear along with a count of claims that have been submitted and paid on behalf of the member this information helps providers to determine how many of the membere initial authorization free visits have been used by all treating providers combined Note that the number shown does not reflect visits that have not been billed and paid Scroll down to see a list of all claims submitted for the member in the selected time period Each summary claim line includes the provider s invoice number Beacon s record number dates of service procedure code adjudication Beacon Health Strategies eServices User Manual 2 2 09 25 decision and payment status Note that you can sort the list by clicking on any column heading To resubmit a claim that denied click on RESUBMIT at the far right of that claim line Click More at the beginning of any claim line to see additional detail including the reason for denial Check the bottom of the screen to see if the list of claims con
41. transmission problems mail delays and most errors are eliminated and as a result rework by provider administrative staff is nearly eliminated Beacon Health Strategies eServices User Manual 2 2 09 3 Electronic Data Interchange Electronic Data Interchange EDI is a secure application accessed through the internet Health care providers business associates and vendors who have established trading partner relationships with Beacon can use EDI as an effective and efficient tool for large volume claim submissions Authorized representatives of health care providers who render behavioral health treatment to members of the health plans served by Beacon are eligible to use EDI EDI enables users to e Upload EDI files e Check the status submitted files e Download responses and reports EDI functions are accessible through eServices EDI and eServices User Access to Protected Health Information EDI and eServices users may be allowed access to certain confidential or individually identifiable Protected Health Information PHI of health plan members In exchange users must agree to take certain precautions comply with certain practices and implement certain procedures required by applicable law and Beacon for the purposes of guarding data integrity and safeguarding the confidentiality of Protected Health Information Beacon Health Strategies eServices User Manual 2 2 09 4 Beacon eServices Register to Open an eServices Account
42. vels of operations Beacon has been able to successfully administer programs that yield both cost savings and improved satisfaction from members and providers Beacon provides customers with a number of comprehensive services including managed behavioral health program design development and implementation provider network development and management clinical protocol development service authorization and utilization management claims processing provider contracting and credentialing and managed care readiness accreditation services Beacon eSeuices Beacon eServices is a web based suite of tools that allow Beacon contracted providers to do business at their convenience This free service is aimed at improving business processes for providers by allowing secure access to a host of clinical and administrative functions as well as a multitude of helpful resources eServices allows you to complete all of the following transactions online Submit claims Check real time claim status Print Explanation of Benefit EOB information Check member eligibility Check initial encounters used Request authorizations Check the status of authorizations including units used Update practice and clinician information View or print provider documents such as manuals forms or bulletins and Generate and print reports eServices transactions take less time to complete than paper submissions enabling providers to improve productivity Fax
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