Patient & Claim Information Manual - Blue Cross and Blue Shield of
Contents
1. Sm vice M Welcome to ProviderAccess your secure sign in for o Summary Plan Description clinic ID and password all Blue Cross and Blue Shield of Alabama e o H Patient Medical Information vor Practice Management and InfoSolutions Sign in transactions Use this single secure sign in page e Claim Information 51 099999 for access to Claim Payment Information and Claim Entry WebClaims Patient Account Information Primary Care o New Audit Trail Password Physicians will also use this sign in for access to o Audit Trail ke RK ERK Primary Care Network transactions o Audit Trail Error Descriptions o Claim Status o Upload NSF Claim File SOURIS or Register Now e Payment Information Institutional Online Remittance Report Institutional Refund Balance Activity Report Professional Online Remittance Report Professional Refund Balance Activity Report Pharmacy Online Remittance Report Customers Employers Healthcare Providers Products amp Services About Us Contact Us Blue Cross and Blue Shield of Alabama Payment History Refund Billing Invoices Download NSF Remittance File Institutional Activity Summary Report This site and all contents are Copyright 2003 by Blue Cross and Blue Shield of Alabama an Independent Licensee of the Blue Cross and Blue Shield Association ooo 00000 TIP You may bypass steps I and 2 by adding the above page to your list of favorites Based on the browser2. o Eligibility and Benefits o B Patient Medical Information e Claim Information o Claim Entry vVebClaims Audit Trail Audit Trail Error Descriptions Claim Status Upload WSF Claim File ooo 0 e Payment Information Oo Blue Cross Institutional Online Remittance Report o Professional Online Remittance Report o Pharmacy Online Remittance Report O Payment History OPN Fee Schedule Chiropractor Fee Schedule NOTE The Fee Schedule link will only be displayed DME Fee Schedule to PMD providers or Participating Dental providers Home Health Fee Schedule Hospice Fee Schedule Preferred CAT Fee Schedule Freferred MEI Fee Schedule Freferred PET Fee Schedule Fee Schedule Individual Code Refund Billing Invoices Download NSF Remittance File Institutional Activity Summary Report Poo oqgao0o0o0o ago a0 Guidelines and Policies O Fragmented Coding Edits Oo Medical Policies ProviderAccess Patient amp Claim Information 10 13 2003 Page 17 of 18 Enter the Type of Service and Procedure Code then click the Submit button Type of Service Codes Surgical Assistant Surgery Maternity Anesthesia X ray Diagnostic Total Fee Medical Care Dental Care Clinical Laboratory or Pathology Total Fee Consultation Emergency Medical Care Concurrent Care Psychiatric Care Physical Therapy Medicine including Speech Therapy X ray Therapeutic Ambulance Service Physical Accessories Purchase Durable Medica
3. of Alabama CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS ProviderAccess Menu Sign Out Contact Us Professional Payment History PRODUCTS amp SERVICES The Caring Company ABOUT Us Contact Us You are signed in as 51099999 1 Enter the date of payment for claims The date must be entered in MMDDYYYY format Provider payments are made weekly usually on Thursdays Payment history is available for approximately six months prior to the current date Payment Date 05152003 Reset Submit button Enter the date of payment for claims and click the VIEW NEW DATE Payroll Date May 15 2003 Provider TEST PROVIDER1 MD 51099999 Payee PROVIDER CLINIC 123 ANYWHERE STREET ANYWHERE AL 35298 Check Number 123456789 Total Submitted Charges 14 988 00 Payroll Date Payment 4 175 66 Number of Claims 37 ProviderAccess Patient amp Claim Information 10 13 2003 Customers Employers Healthcare Providers Products amp Services About Us Contact Us Blue Cross and Blue Shield of Alabama Page 14 of 18 Fee Schedule Use this option to view or download a complete fee schedule Click an available Fee Schedule link from the ProviderAccess menu BlueCrossBlueShield of Alabama The Caring Company CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES AgouTulls Contact Us Return to Providers ProviderAccess User Manuals Sign Out Help Welcome to Prov
4. of the Blue Cross and Blue Shield Association ITS Onter Plan Teleprocessing System Eligibility and Benefits Inquirg All rights reserved Please see our Legal Disclaimer and Privacy Statement For Your Health Customers Employers Healthcare Providers Products amp Semices About Us Alabama Doctor Finder National Doctor Finder Pharmacy Finder Career Opportunities Emergency Patient Information Preferred Long Term Care Community Relations InfoSolutions Electronic Data Interchange Search 3 Enter your Sign In and Password then click the Submit button A Select the desired ProviderAccess application by clicking the associated link BlueCrossBlueShield CLICK HERE of Alabama The Caring Company BlueCrossBlueShield D Y TO CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES ABOUT Us Contact Us of Alabama The Caring Company 5 pany DOWNLOAD Return to Providers ProuderAccess User Manuals Sign Out Help CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES Asout Us Contact Us ProviderAccess User Manuals Help USER elcome to ProviderAccess You are signed in as 51099999 MANUALS Please select the e Practice Management application you would like to perform from the list below To provideraccess perform additional transactions please return to this page to select your next function your secure link to Blue Cross o Paian nioni Eligibility and Benefits
5. 002 a arta mit eit oa Based on the Fee Schedule link clicked on the previous page the PMD Fee Schedule associated Fee Schedule will be Effective April 1 displayed 2003 CPT five digit codes nomenclagffe and other data are copyright 2002 American Medical Association All Rights Reserved No fee g hedules basic units relative values or listings are included in CPT The As of Ap ril l 2003 assumes no liability for the data contained herein Be sure to check e Practice Management for the moet current fee ly 2002 American Medical Association All Rights Reserved NOTE Click the desired Series Alinna series link in the table of contents on the left The appropriate Series will then be displayed in the screen on the right Anesthesia Series Category ill Code To download a text document con taining the entire fee schedule click the Download 2003 PMD Fee x a 8 i Schedule link Mm the top right comer Q Some files can harm your computer If the file information below looks of the page e PR or you do not fully trust the source do not open or save this ile Filename PMDFeeSchedDownload exe a i Filetype Application Click the Open button on the File Download screen Sie SO amp S This type of file could harm your computer if it contains malicious code Would you like to open the file or save it to your computer E o Sae Cancel Mo re
6. Blue Cross and Blue Shield of Alabama This site and all contents are Copyright 2003 by Blue Cross and Blue Shield of Alabama an Independent Licensee of the Blue Cross and Blue Shield Association ProviderAccess Patient amp Claim Information 10 13 2003 Page 6 of 18 The second way to access the Summary Plan Description 2 From the main ProviderAccess Menu select Summary Plan Description under the option for Eligibility and Benefits BlueCrossBlueShield of Alabama The Caring Company mY CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES Agour Us Contact Us Return to Providers ProviderAccess User Manuals Sign Out Help Welcome to ProviderAccess You are signed in as 51099999 Please select the e Practice Management application you would like to perform from the list below To perform additional transactions please return to this page to select your next function Patient Information o Eligibility and Benefits gt o summary Plan Description o RA Patient Medical Information Claim Information o Claim Entr ebClaims Audit Trail Audit Trail Error Descriptions Claim status Upload NSF Claim File oo Oo Payment Information Institutional Online Remittance Report o Institutional Refund Balance Activity Report o Professional Online Remittance Report o Professional Refund Balance Activity Report o Pharmacy Online Remittance Report O G G C co Payment History Refund Bil
7. DUCTS amp SERVICES Agour Us CONTACT Us Return to Providers ProviderAccess User Manuals Sign Out Help Welcome to ProviderAccess You are signed in as 51099999 Please select the e Practice Management application you would like to perform fram the list below To perform additional transactions please return to this page to select your next function Patient Information O O Eligibility and Benefits H Patient Medical Information Claim Information oO oo oO 0 Claim Entr Audit Trail Audit Trail Error Descriptions Claim Status Upload NSF Claim File VvebClaims e Payment Information D Oo ooo oe eoceaoeao8o Blue Cross Institutional Online Remittance Report Professional Online Remittance Report Pharmacy Online Remittance Report Payment History PMD Fee Schedule Chiropractor Fee schedule DME Fee Schedule Home Health Fee Schedule Hospice Fee Schedule Preferred CAT Fee Schedule Preferred MRI Fee Schedule Preferred PET Fee Schedule Fee Schedule Individual Code Refund Billing Invoices Download WSF Remittance File Institutional Activity Summary Report Guidelines and Policies BlueCrossBlueShield of Alabama CUSTOMERS EMPLOYERS ProviderAccess Menu Sign Out Professional Payment History HEALTHCARE PROVIDERS PRODUCTS amp SERVICES O D The Caring Company ABOUT Us You are signed in as 51099999 Fragmented Coding Edits Medical Policies BlueCrossBlueShield j
8. Info M Always ask before opening this type offile 60 of PMHDFeeSchedDownload exe Completed l l 7 7 x After the file download is complete click the Browse button to E E E hoepeated us F Openin folder press the Unzip button we choose the location of where the file will be unzipped PMDFe m Unzip to folder 11m C WINDOWS Desktop Close Sadie V Overwrite files without prompting ownlo Sunes TIP The desktop is a convenient vere Hop Help place to store the document It can M Clos then be moved to a different location if desired After the file is unzipped successfully go to the location where you specified in the previous step Double click on the text document to open the file 1 file s unzipped successfully ProviderAccess Patient amp Claim Information 10 13 2003 Page 16 of 18 Click the Fee Schedule Individual Code link from the ProviderAccess menu BlueCrossBlueShield of Alabama The Caring Company CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES Agourt Us Contact Us Return ta Providers Provider4ccess User Manuals Sign Out Help Welcome to ProviderAccess You are signed in as 51099999 Flease select the e Practice Management application you would like to perform from the list below To perform additional transactions please return to this page to select your next function Patient Information
9. PProviderAccess www bcbsal com User Manual for Professional Dental amp Institutional Providers Patient Information Eligibility and Benefits Summary Plan Description Claim Information Claim Status BlueCrossBlueShield Of Alabama An Independent Licensee of the Blue Cross and Blue Shield Association ProviderAccess Patient amp Claim Information 10 13 2003 Page 1 of 18 CONTACT NAMES AND NUMBERS For connectivity or communication problems call all or e mail the Corporate Support Center at 205 220 6134 6 00 a m 5 30 p m CST SupportCenter bcbsal org For other questions or problems e Check System Status on the Hot Topics page under the Providers section of the Blue Cross and Blue Shield of Alabama web page at http www bcbsal com e Contact your Network Data Operations Representative at 205 220 2533 HARDWARE REQUIREMENTS Minimum Browser Requirements Netscape or Internet Explorer 4 0 or higher Adobe Acrobat Reader Version 4 0 or later Minimum Hardware Requirements for best results Screen resolution 640 x 480 Internet connection with at least 28 800 bps HELPFUL HINTS If you leave the PC for a long period of time the application will time out You will need to close and restart your browser or if you have previously bookmarked your Provider Access Sign In page you may use your Favorites or Bookmark to access the Sign In page directly If you were k
10. RECRUIT ETE and click the Submit button Professional Eligibility and Benefits You are signed in as 51099999 Required fields are denoted with an asterisk TIP When the name submitted 1S not an exact Enter the patient s information whose history you wish to review Contract Number match to the name on the Blue Cross system an First Name attempt will be made to match using a portion of PON the name along with the date of birth LastName Date of Birth MMDDYYYY Gender gt Enter the date a provider needs to verify a patient s eligibility and benefits If no date is entered today s date will be defaulted Service Date MMDDYYYY Disclaimer The information provided is only general benefit information and is not a guarantee of payment Benefits are always subject to the terms and limitations of the plan and no employee of Blue Cross and Blue Shield of Alabama has authority to enlarge or expand the terms of the plan The availability of benefits is always conditioned upon the patients coverage and the existence of a contract for plan benefits as of the date of service A loss of coverage as well as contract termination can occur automatically under certain circumstances There will be no benefits available if such circumstances occur Submit Reset TIP If no date is entered in the Service Date field today s date will be defaulted TIP Click ProviderAcces
11. al Claim Status Listing Contract Number 4A1234567869 View New Patient Service From Date 09 02 2003 Service Thru Date 09 02 2003 Acknowledgement Not Found The claim encounter can not be found in the adjudication system qfhttI Provider ID 51099999 BlueCrossBlueShield of Alabama The Caring Company CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES Agout Us CONTACT Us Prowideraccess Menu Sign Out Professional Claim Status You are signed in as 51099999 Required fields are denoted with an asterisk 1 Enter the patient s information whose history you wish to review Contract Numbers AAT 23456789 First Name John Middle Initial Last Name Brown Date of Birth fio161970 MMOD YY Gender os Enter the claim informatgn you wish to review Claim Numb Se aya BlueCross BlueShield of Alabama The Caring Company CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES ABOUT Ls CONTACT Us Claim Status Please wait while we process your request The Caring Company NOTE If you receive the message AgourUs CONTACT Us Acknowledgement Not Found The claim encounter can not be found in You are signed in as 51099999 ef the adjudication system and feel this is being returned to you in error check that you are signed in as the appropriate provider number REMEMBER you must be signed in Customers Employers Healthcare Providers Products amp Semic
12. ch benefit period with a maximum of BlueCrossBlueShield of Alabama CUSTOMERS The Caring Company EMPLOYERS PRODUCTS amp SERVICES AgourT Us CONTACT Us HEALTHCARE PROVIDERS Providensccess hlenu Sign Out Professional Summary Plan Description You are signed in as 51099999 Group Number 12345 View Mew Group Group Division ABC Service Date 09 19 2003 Select one Get Summary Plan Description by Category SUMMARY PLAN DESCRIPTION ATTENTION PLEASE REVIEVY ALL DATA TO IDENTIFY APPLICABLE BENEFITS END OF FILE IS NOTED BY lt END OF FILE lt Exception Procedure Processing This group and division has Bluecard PPO benefits This allows members to access PPO networks available in each state that participates There are two levels of benefits available In Network and Qut ot Network lt Exclusion gt see specific categories for exclusions Coordination of Benefits NOAG O B Non Duplication spousal carveouti calculate primary l ee PLR ee be PT me I A ee ee be ee am aak Page 9 of 18 Patient Information Claim Status Click the Claim Status link from the ProviderAccess menu mY BlueCrossBlueShield of Alabama The Caring Company CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES Agourt Us CONTACT Us Return to Providers ProviderSccess User Manuals Sign Out Help Welcome to ProviderAccess You are signed in as 51099999 Flease select the e Practice Manag
13. claim header or the expand or collapse E buttons processing of the claim Service Claim Pat Date of Submitted Paid Payroll Status Status Date Number Init Sex Birth Charges Amount Date Catgy Code 10 06 2003 5510000003 JS M 10 16 1970 48 00 0 00 00000000 Line Serice service Proc ane Proc Rey of Submitted Paid Status status Payroll tem From To Code oe Mod Code Units Charges Amt Catgy Code Date 001 10 06 2003 10 06 2003 99213 AC 00g 45 00 0 00 Pe 4 OO O0 000 Service Claim Pat Date of Submitted Paid Payroll Status Status Date Number Init Sex Binh Charges Amount Date Catgy Code 09 16 2003 6510000004 JS M 10 16 1970 133 00 84 60 10 16 2003 Line Service service Proc ae Proc Rey of Submitted Paid Status status Payroll Item From To Code neta Mod Code Units Charges Amt Catgy Code Date 001 09 16 2003 09 16 2003 99213 AC O000 45 00 20 00 F1 b5 10 16 20 002 09 16 2003 09 16 2003 72050 HC 000g po5 00 64 60 F1 ps5 10 1620 ProviderAccess Patient amp Claim Information 10 13 2003 Page 12 of 18 The Status Catgy Category codes indicate the general category of the status accepted rejected addi tional information requested etc which is then further detailed in the Status Codes Claim status codes communicate information about the status of a claim The Claim Status transaction returns standard codes which communicate information about the status of a claim A comp
14. d of Alabama The Caring Company Benefits are returned for a CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS Peopucts amp Services AgouTUs ContactUs patient at the bottom of ProvidernSiccess hlenu Sign Out the paom you ean select Professional Benefits You are signed in as 51012345 the option to retrieve the Contract Number XAA123456789 Summary Plan Date of Service 09 19 2003 Description SPD based Patient Name JOHN Q TEST BA view New Patient Birthday OCTOBER 16 1970 on the group number and Contes Ae division associated with the current requested DEDUCTIBLE contract MAJOR MEDICAL THIS PATIENTS DEDUCTIBLE TAKEN FOR THIS CALENDAR YEAR IS 0 00 CO PAYMENT PROFESSIONAL PHYSICIAN VISIT OFFICE ACTIVE COVERAGE HEALTH BENEFIT PLAN COVERAGE PATIENT IS PRIMARY ON CONTRACT PROFESSIONAL PHYSICIAN MAJOR MEDICAL MANAGED CARE COORDINATOR HEALTH BENEFIT PLAN COYWERAGE PATIENT IS COVERED UNDER MANAGED CARE ALL DISEASES COVERED BY DISEASE MANAGEMENT COVERAGE BASIS PLAN WAITING PERIOD PATIENT HAS COMPLETED WAITING PERIOD PHARMACY STANDARD PRESCRIPTION CONTRACEPTIVE COVERAGE AVAILABLE OCCUPATIONAL THERAPY HAND THERAPY BENEFITS THAT ARE MEDICALLY NECESSARY ARE COVERED WHEN PERFORMED BY A MEMBER OF THE PREFERRED OCCUPATIONAL THERAPY NETWORK PSYCHIATRIC PATIENT COVERED BY EPS BENEFITS e Get Summary Plan Description Customer Employers Healthcare Providers Products amp Senices About Us Contact Us
15. e In Network and Qut otNetwork lt Exclusion gt see specific categories for exclusions Coordination of Benefits gt NOBIC 0 6 Non Duplicatian spousal careout calculate primary benefits hold ta UCR or PMD payment subtract OIC payment Any claim submitted for secondary payment in which the primary insurance issued a denial due to non compliance with the primary insurer guidelines will be paid on a carve out basis That is Blue Cross will pay 20 of the covered charge cPre avistina wating rerio gt Sn BlueCrossBlueShield CI of Alabama The Caring Company CUSTOMERS EMPLOVERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES Agour Us Contact Us ProviderAccess hlenu Sign Out Professional Summary Plan Description You are signed in as 51099999 Group Number 12345 BY View Mew Patient Group Division ABC Service Date 09 19 2003 Selectone Get Summary Plan Description by Category IDENTIFY APPLICABLE BENEFITS fits This allows members e that participates There nd Out of Network COORDINATION OF BENEFITS TA DA CO NSURANCE X NOBIC 0 6 Non Duplication spousal carveout calculate primary benefits hold ta UCR or PMD payment subtract OIC payment Any claim submitted for secondary payment in which the primary insurance issued a denial due to non compliance with the primary insurer guidelines will be paid on a carve out basis That is Blue Crass will pay 20 of the covered charge lt Pre ex
16. e and all contents are Copyright 2003 by Blue Cross and Blue Shield of Alabama an Independent Licensee of the Blue Cross and Blue Shield Association ProviderAccess Patient amp Claim Information 10 13 2003 Page 7 of 18 The Professional Summary Plan Description will display the Group Number Group Division and the Service Date requested TIP Select additional plan coverage information by category grouping by clicking on the drop down arrow and selecting one of the categories listed Then click the option Get Summary Plan Description by Category TIP Click on drop down arrow to obtain list ProviderAccess Patient amp Claim Information 10 13 2003 BlueCrossBlueShield of Alabama The Caring Company CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES Agout Us CONTACT Us ProviderAccess Menu Sign Out Professional Summary Plan Description You are signed in as 51099999 Group Number 12345 View Mew Patient Group Division ABC Service Date 09 19 2003 Soelectone _ Get Summary Plan Description by Category SUMMARY PLAN DESCRIPTION ATTENTION PLEASE REVIEW ALL DATA TO IDENTIFY APPLICABLE BENEFITS END OF FILE Is NOTED BY lt END OF FILE Exception Procedure Processing This group and division has Bluecard PPO benefits This allows members to access PPO networks available in each state that participates There are two levels of benefits availabl
17. ement application you would like to perform from the list below To perform additional transactions please return to this page to select your next function Patient Information O Eligibility and Benefits D A Patient Medical Information Claim Information D ooog Claim Entry vVebClaims Audit Trail Audit Trail Error Descriptions Claim Status Upload NSF Claim File e Payment Information D Ooo oe ge0g goo oc ego ego G Blue Cross lrastitutonall Online Remittance Report Frofessional Online Remittance Report Pharmacy Online Remittance Report Payment History FMD Fee Schedule Chiropractor Fee schedule DME Fee Schedule Home Health Fee Schedule Hospice Fee Schedule Freferred CAT Fee Schedule Freferred MR Fee Schedule Freferred PET Fee Schedule Fee schedule Individual Code Refund Billing Invoices Download NSF Remittance File Institutional Activity summary Report Guidelines and Policies O O Fragmented Coding Edits Medical Policies ProviderAccess Patient amp Claim Information 10 13 2003 Page 10 of 18 Enter the appropriate information 1n the fields and click the Submit button If you need to clear all fields click the Reset button Once you click the Submit button then the following message will be displayed BlueCrossBlueShield j of Alabama CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES ProviderAccess Menu Sign Out Profession
18. es About Us Contact Us under the provider number that the Blue Cross and Blue Shield of Alabama claim was originally submitted under in This site and all contents are Copyright 2003 by Blue Cross and Blue Shield of Alabama order to view claim Status an Independent Licensee of the Blue Cross and Blue Shield Association ProviderAccess Patient amp Claim Information 10 13 2003 Page 11 of 18 Claims Listing When retrieving claim status by Date of BlueCrossBlueShield l of Alabama The Caring Company Service a list of summarized claims will be displayed in Date of Service order The most recent date of service will be CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES AgoutT Us Contact Us ProviderAccess Menu Sign Out Professional Claim Status Listing You are signed in as 51099999 first Each summary line is the total of all the individual claim lines Contract Number XAA123456789 BJ View New Patient Service From Date 09 01 2003 Provider ID 51099999 Service Thru Date 10 10 2003 These are the claims found for the information you entered sorted by date of service To view the details for a Status If you wish to see the Claims Detail Category or Status Code place your mouse pointer over the code you wish to view To view the line items details for a information click the claim header claim click the claim header or the expand or collapse E buttons 9 anywhere in t
19. eying a claim any information not previously saved will be lost Use the Tab key not the Enter key when navigating through a screen however don t forget to select the Continue button to save your data prior to leaving the screen Be patient when selecting link and navigation buttons Do not double click or click a link several times Remember throughout ProviderAccess you must always use the Continue and Finish buttons to save your data prior to leaving the screen To select a field using a mouse Move the mouse pointer to the information to be selected Depress or click the left mouse button once The item is selected if the information you choose is highlighted by color shading To select a field without using a mouse Use the Tab key to move the cursor to the item you would like to select The item is selected if the information you choose is highlighted by color shading To select a button choose one of the following Move the mouse pointer to the button and depress the left mouse button once or Press the Tab key until a dotted line appears around the word and then press the Enter button ProviderAccess Patient amp Claim Information 10 13 2003 Page 2 of 18 Easy Steps to Provider Access www bcbsal com Click Healthcare Providers on the Click the ProviderAccess link 1 Blue Cross and Blue Shield of Alabama 2 home page B
20. he claim header including Service Claim Pat Date of Submitted Paid Payroll Status Status Date Number Init Sex Birth Charges Amount Date Catgy Code the columns for Service Date Claim 10 06 2003 5510000003 Number Pat Init Sex Date of Birth etc or click the expand m or collapse E buttons Service Claim Pat Date of Submitted Paid Payroll Status Status Date Number Init Sex Birth Charges Amount Date Catgy Code n6203 ssi0900001 ss m ionenso 1930 seaeojioneamoa Pi S Customers Employers Healthcare Providers Products amp Services About Us Contact Us Blue Cross and Blue Shield of Alabama This site and all contents are Copyright 2003 by Blue Cross and Blue Shield of Alabama an Independent Licensee of the Blue Cross and Blue Shield Association Claims Detail When retrieving claim status by Claim Number OR when clicking any of the claim header from the Claims Listing screen the detail of individual claim lines will be displayed Each line displays Contract Number XAA123456789 View New Patient Serice From Date 09 01 2005 the procedure code Provider ID 51099999 Service Thru Date 10710 2003 and the charges These are the claims found for the information you entered sorted by date of service To view the details for a Status associated with Category or Status Code place your mouse pointer over the code you wish to view To view the line tems details for a claim click the
21. iderAccess You are signed in as 51099999 Please select the e Practice Management application you would like to perform from the list below To perform additional transactions please return to this page to select your next function Patient Information o Eligibility and Benefits o B Fatient Medical Information Claim Information o Claim Entry VVebClaims Audit Trail Audit Trail Error Descriptions Claim Status Upload NSF Claim File oOo o08 e Payment Information Blue Crass Institutional Online Remittance Report Frofessional Online Remittance Report Pharmacy Online Remittance Report Payment History FMD Fee Schedule Chiropractor Fee Schedule O DNIE Eee Scheddie NOTE Only Fee Schedule links associated with the Home Health Fee Schedule provider s specialty will be displayed The provider must Hospice Fee schedule be PMD or in a participating network Preferred CAT Fee Schedule Freferred MRI Fee Schedule Freferred PET Fee Schedule Fee schedule Individual Code Refund Billing Invoices Download WSF Remittance File Institutional Activity Summary Report ooo of oococoocopeo n Guidelines and Policies o Fragmented Coding Edits Oo Medical Policies ProviderAccess Patient amp Claim Information 10 13 2003 Page 15 of 18 2003 PMID Fee Schedule Effective April 1 2003 Download 2003 PMD Fee Schedule A gt Deubkie chek on the downloaded tall 2002 PMD Fee Schedule Effective October 1 2
22. isting waiting periad gt This group complies with HIPAA Page 8 of 18 Sample Deductible Copays selected and returned below TIP If you selected to view the Summary Plan Description after obtaining plan coverage information for a specific contract number then you will have the option to view a New Patient Click on View New Patient TIP If you selected to view the Summary Plan Description from the ProviderAccess main menu then you can choose to View a New Group Click on View New Group ProviderAccess Patient amp Claim Information 10 13 2003 BlueCrossBlueShield CUSTOMERS The Caring Company EMPLOYERS PRODUCTS amp SERVICES Agour Us CONTACT Us HEALTHCARE PROVIDERS ProviderAccess hlenu Sign Out Professional Summary Plan Description You are signed in as 91099999 Group Number 12345 Group Division ABC 09 19 2003 View Mew Patient Service Date Get Summary Plan Description by Category DEDUCTIBLE COPAYS CATEGORY GROUPING ATTENTION PLEASE REVIEW ALL DATA TO IDENTIFY APPLICABLE BENEFITS END OF FILE Is NOTED BY END OF FILE lt Deductible gt In Metwork 750 00 inpatient hospital deductible per admission Benefits are provided at 100 of the allowed amount after the deductible Qut ofNetwork 150 00 inpatient hospital deductible per admission Benefits are provided at 80 of the allowed amount after the deductible 200 00 Maior Medical deductible ea
23. l Equipment Medical Surgical Supplies Optical Accessories Orthopedic Accessories Prosthetic Devices H Physical Accessories Rental Durable Medical Equipment Medical Surgical Supplies Optical Accessories Orthopedic Accessories Prosthetic Devices I Dental Surgery J Home Care Program Services K Technical Component L Visiting Nurse Service M Vision Care N P JAW LOLENDURUUNO Gi Om Emergency Accident Care Radiology and Pathology Professional Component Q Chemotherapy Antineoplastics R Donor Surgery and Related Services T Radioimmunoassay RIA or Competitive Protein Binding Analysis Supplemental Accident Hearing Care Second Opinion Alcohol Rehabilitation Portable X ray Technical Hospice Care Prescription Drugs Outpatient Hospital Cardiac Rehab Private Duty Nursing Home Private Room Allowance Hospital Deductible eOrEENKXE lt C Professional Fee Schedule Type of Service 6 ProviderAccess Patient amp Claim Information 10 13 2003 BlueCrossBlueShield of Alabama lhe Caring Company CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES AsouTUs ContactUs ProviderAccess Menu Sign Out Professional Fee Schedule You are signed in as 51099999 1 Enter the type of service code to 2 The five digit procedure code that display current fee schedule This indicates the procedure that has iS a one digit code been performed For example 4 Anesthesia Procedure Code 99213 Re
24. lete list of these standard codes can be found on the Washington Publishing Company web site for your reference http www wpc edi com codes Codes asp Service Claim Detail Payroll Status Status Date Number oan aaa i Date Catgy Code 5510000003 Finalized Payment The claim line has been Line Serice Semice Proc RE Proc Rey of Submitted Paid Status status Payrall Item From To Code a Mod Code Unts Charges Amt Catgy Code Date 001 09 76 2003 09 16 2003 99215 HC oooi p4o 00 20 00 Fi b5 10 16 20 002 09 16 2003 09 16 2003 72050 HC oooi pos 00 64 60 F1 Bo 10 16 20 Tip By placing your mouse directly over the Status Catgy i a window is displayed obtaining the Detail of the code NOTE Place your mouse directly over the Status Catgy option or the Status Code option to see the Detail In this example the Status category of F1 shows that the claim has been finalized paid ar BlueCross BlueShield ey of Alabama The Caring Company CUSTOMERS EMPLOVERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES Agour Us CONTACT Us Providerticcess hlienu Sign Out Professional Claim Status Listing You are signed in as 51099999 Contract Number XAA123456789 View Mew Patient Service From Date 09 01 2005 Another ex ample Provider ID 51099999 Service Thru Date 10 10 2003 shows that if a These are the claims found for the i Detail view the details for a Status im i i Cat Status Code pl iew
25. ling Invoices Download WSF Remittance File Institutional Activity Summary Report BlueCrossBlueShield of Alabama The Caring Company CUSTOMERS EMPLOVERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES Agour Lis CONTACT Us Provwiderticoess Wdenu Sign Out Professional Summary Plan Description Request You are signed in as 51099999 Enter the Group Number and Group Division and then click Required iei slice with an o yi Submit Enter the information of the group tor which this request is being made Group Number 12345 If no date is entered in the Group Division ABC Service Date field today s Service Date MMDD date will be defaulted Disclaimer The information provided is only general benefit information and is not a guarantee of payment Benefits are always subject to the terms and limitations of the plan and no employee of Blue Cross and Blue Shield of Alabama has authority to enlarge of expand the terms of the plan The availability of benefits is always conditioned upon the patients coverage and the existence of a contract for plan benefits as of the date of semice A loss of cowerage as well as contract termination can occur automatically under certain circumstances There will be no benefits available if such circumstances occur LS Reset Customers Employers Healthcare Providers Product amp Senmices About Us Contact Us Blue Cross and Blue Shield of Alabama This sit
26. lueCrossBlueShield of Alabama The Caring Company HEALTHCARE PROVIDERS 20 KE BlueCrossBluecShiekl i ie of Alabama Hot Tonics Une PROVIDE APPU ATHOM IMIPOSOLUTIONS Pravo Asu AgouTUs CONTACTUS SIARCH Healthcare Providers Glue Cross appreciates the opportunity to work wah you in prowding the best available health care for FOR YOUR A you palais ard our subenkiers Abi est of rawiri Mhal carn help make d taser for you te HEALTH reach us Information For a Healthy s Safe Lifestyle i SARII Frequently Used Phone Numbers Provider Inquiry Custonien Sereia General Prowider Inquiry o 205 93 23 Automated voice Response Unt only 000 Hema Automated Voice Respon e Une only o AB 93 016 Aubornited Voce Bespoke Une wilh Hipnesirialme aeadakilily for prnaders who do mot hawe access to ihe toll free number e Group Specific Prowider inguin o Federal Employee Program FEF R prefix B00 492 8872 Bellsouth 0S and DLS prafizes OUD 292 0002 o FAR pim AO 735 4164 ALABAMA DOCTOR FINDER NATIONAL DOCTOR FINDER PHARMACY FINDER CAREER OPPORTUNITIES EMERGENCY PATIENT INFORMATION PREFERRED LONG TERM CARE COMMUNITY RELATIONS e INFOSOLUTIONS ELECTRONIC DATA INTERCHANGE SEARCH Uniroyal 800 334 9041 o aero BOD SAOS This site and all contents are Copyright 2003 by Blue Cross and Blue Shield of Alabama o General Electric 800 655 532 an Independent Licensee
27. nal Online Remittance Repart Institutional Refund Balance Activity Report Professional Online Remittance Report Professional Refund Balance Activity Report Pharmacy Online Remittance Report Payment History Refund Billing Invoices Download NWSE Remittance File Institutional Activity Summary Report e Fee Schedules oOo oO oO OOO OOO GD PID Fee Schedule Chiropractor Fee Schedule DME Fee Schedule Home Health Fee Schedule Hospice Fee Schedule Preferred CAT Fee Schedule Preferred MRI Fee Schedule Preferred OT and HT Fee Schedule Preferred PET Fee Schedule Preferred PT Fee Schedule Fee schedule Individual Code e Guidelines and Policies a a a Fragmented Coding Edits Medical Policies CURP Medical Necessity Guidelines Primary Care Network PCN a a D D D Covering Physicians PCH Cost Profile Review Referral Submit Referral IMPORTANT NOTE This field confirms the provider number that you are signed in as If you wish to sign in to ProviderAccess as a different provider number choose the Sign out option on the yellow menu bar and sign in with another provider number Unique Provider Identification Number UPIN Reference ProviderAccess Patient amp Claim Information 10 13 2003 Page 4 of 18 BlueCrossBlueShield j of Alabama The Caring Company CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES ABOUT Us Contact Us Enter the appropriate information in the fields
28. s Menu link ony BlueCrossBlueShield of Alabama The Caring C any from any ProviderAccess application to The Caring Company return to the main menu CUSTOMERS EMPLOYERS HEALTHCARE Provipers PRoDUCTS amp Services AsouTUs CONTACT Us ProviderAccess Menu Sign Out Professional Benefits You are signed in as 51099999 Contract Number XAA123456789 TIP Click View New Patient to Date of Service 10 08 2003 ee Patient Name JOHN Q TEST View New Patient return to the eligibility and benefits entry Birthday OCTOBER 16 1970 screen Gender MALE DEDUCTIBLE MAJOR MEDICAL THIS PATIENTS DEDUCTIBLE TAKEN FOR THIS CALENDAR YEAR IS 0 00 CO PAYMENT PROFESSIONAL PHYSICIAN VISIT OFFICE ACTIVE COVERAGE HEALTH BENEFIT PLAN COVERAGE PATIENT IS PRIMARY ON CONTRACT PROFESSIONAL PHYSICIAN MAJOR MEDICAL ProviderAccess Patient amp Claim Information 10 13 2003 Page 5 of 18 Patient Information Summar Plan Description SPD A new application has been added called the Summary Plan Description SPD Through SPD plan coverage information is available by group number and division A default set of categories will be returned based upon the provider s specialty Additional category groupings can also be selected to retrieve categories not returned in the default list There are two ways to access the Summary Plan Description ae BlueCross BlueShield 1 Once Eligibility an
29. set Type of Service e Customers Employers Healthcare Providers Products amp Services About Us Contact Us Blue Cross and Blue Shield of Alabama This site and all contents are Copyright 2003 by Blue Cross and Blue Shield of Alabama an Independent Licensee of the Blue Cross and Blue Shield Association BlueCrossBlueShield j of Alabama CUSTOMERS EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES AsouTUs ContactUs lhe Caring Company ProviderAccess Menu Sign Out You are signed in as 91099999 VIEW NEW CODE Procedure Code 99213 Current PMD Fee 45 00 Prior PMD Fee 45 00 CPT4 Text Office or Other Outpatient Visit for the Evaluation and Management of An Established Patient Which Requires at Least Two of These Three Key Com Customers Employers Healthcare Providers Products amp Services About Us Contact Us Blue Cross and Blue Shield of Alabama This site and all contents are Copyright 2003 by Blue Cross and Blue Shield of Alabama an Independent Licensee of the Blue Cross and Blue Shield Association Page 18 of 18
30. the line it details f claim is Pending In i ae Are reac erie a 2 P2 Pendingin Review The claimencounter is e et taiant 1 suspended pending review OO OO 0000 Review that the Paid Amount will Service Claim Pat Date of Submitted Paid Payroll Status Status besh a 0 00 Date Number Init Sex Birth Charges Amount Date Catgy Code ie nee a L 10 06 2003 5510000003 JS M 10 24 1960 46 00 s000 foo o0 0000 and the Payro Se Dat ill be sh Ine Brice Brice roc a Proc Rev o uomitte All tatus tatus ayro Line Seni Serice Proc M O proc Rev of Submitted Paid S S Payroll ate Wl e snown tem From To Code a Mod Code Units Charges Amt Catgy Code Date as 00 00 0000 001 10 06 2005 10 06 2005 992135 HC ooga 45 00 0 00 P2 A OO 00 0000 _ Service Claim Pat Date of Submitted Paid Payroll Status Status Date Number Init Sex Binh Charges Amount Date Catgy Code 09 16 2003 5510000004 JS M 10 24 1960 133 00 84 60 10 16 2003 Line Serice Semice Prac Bie Proc Rev of Submitted Paid Status status Payroll tem From To Code ae Mod Code Units Charges Amt Catgy Code Date 001 09 16 2003 09 16 2003 99213 HC oaoa 45 00 20 00 F1 pS 10 16 2003 ProviderAccess Patient amp Claim Information 10 13 2003 Page 13 of 18 Payment History Click the Payment Histor a CUSTOMERS BlueCrossBlueShield of Alabama EMPLOYERS link from the ProviderAccess menu The Caring Company HEALTHCARE PROVIDERS PRO
31. you are using select Bookmark or Favorites and select the add feature This will allow you to access the ProviderAccess Sign In page directly ProviderAccess Patient amp Claim Information 10 13 2003 Page 3 of 18 Patient Information Eligibility and Benefits By selecting the Provider Access option you will be connected to Blue Cross and Blue Shield of Alabama s web applications to retrieve patient claim and payment information for the Blue Cross Profes sional line of business From the Welcome to Provider Access main menu page click the Patient Information Eligibility and Benefits link CUSTOMERS hy BlueCrossBlueShield of Alabama EMPLOYERS HEALTHCARE PROVIDERS PRODUCTS amp SERVICES Return to Providers ProviderSccess User Mlanuals Sign Out Help Welcome to ProviderAccess The Caring Company Agounr Us CONTACT Us You are signed in as 51099999 Please select the e Practice Management application you would like ta perform from the list below To perform additional transactions please return to this page to select your next function Patient Information ei a e Eligibility and Benefits Summary Plan Description A Patient Medical Information Claim Information a D pi p pi pi Claim Entr ebClaims Mew Audit Trail Audit Trail Audit Trail Error Descriptions Claim Status Upload NSF Claim File Payment Information ooo oO O00 00 6 Institutio
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