Health Services provider user guide
Contents
1. yeni i online claims submission convenient service delivered oe through an easy to use secure web site htto provider ab bluecross ca health ALBERTA BLUE CROSS February 2014 ALBERTA BLUE CROSS Health Services provider user guide Online claims submission Alberta Blue Cross is pleased to offer online claims submission for health service providers This convenient service is delivered through an easy to use secure web site and is available at no cost to health service providers including chiropractic massage therapy and physiotherapy providers across Alberta Online submission provides the convenience of direct billing for eligible services for your customers with coverage through Alberta Blue Cross group and individual benefit plans and ASEBP You are assured of prompt payment directly from Alberta Blue Cross while retaining existing customers and gaining a competitive advantage over providers who may choose not to submit claims online When submitting claims online this service will predetermine the patient s coverage and confirm the amount Alberta Blue Cross will pay to your office and the amount you will need to collect from the patient Registering for site access To register for online claims submission please complete the Request for Secure Web Site Access form If you want payments to be deposited directly into your bank account please complete the Applica2. Jack 2013 12 04 Lee Jack 2013 12 08 Lee Jack 2013 12 18 Lee Jack http orovider ab bluecross ca health Product or service Payment History Report for December 24 2013 January 14 2014 Amount claimed Alberta Blue Cross paid Document number 12 24 2013 Chiropractic assessment Chiropractic treatment Chiropractic treatment Chiropractic assessment Acupuncture Treatment Chiropractic x ray Chiropractic treatment Chiropractic treatment Chiropractic treatment Acupuncture Treatment Chiropractic treatment Total Product or service 12 24 2013 Acupuncture Treatment Physiotherapy treatment Acupuncture assessment Physiotherapy assessmnt Acupuncture Treatment Acupuncture assessment Physiotherapy treatment Physiotherapy treatment Physiotherapy treatment Physiotherapy treatment Total Product or service 12 24 2013 Massage therapy Massage therapy Massage therapy Massage therapy Massage therapy Massage therapy Massage therapy Massage therapy Massage therapy Amount claimed Alberta Blue Cross paid Document number 47762452 47762470 47762479 Amount claimed Alberta Blue Cross paid Document number 47762475 Easy steps to cancel a claim Outstanding Payment Report ABC Health Clinic oo Reports If your clinic is registered with multiple N OEE E T S provider types and has single sign on please select the provider type for this View all claims
3. Not registered yet Alberta Blue Cross 10009 108 Street NW Edmonton Alberta T5 3c5 Phone 780 498 8082 i 808 A 3 in Edmonton and area or toll free at 1 800 588 1195 secure login ID and temporary password will be sent in two separate e mails to the e mail address provided on your registration form Once you have received both of these e mails you can begin serving your customers through online claims submission http orovider ab bluecross ca health Claiming online IS quick easy and secure Help If you have questions about a screen click on the blue button with a question mark The help button has answers to questions that are frequently asked about the section Claiming online is quick easy and secure After validating a patient s identity and predetermining results as confirmed by the patient you simply submit the claim for processing Within seconds of submission results are displayed The patient will be required to pay only the portion not covered under their benefit plan The transaction is then complete http orovider ab bluecross ca health Easy steps to submit and process a claim Steps for online submission Enter the patient s information Navigate to the Enter claim menu option and enter the patient s ID number and group number exactly as they appear on their Alberta Blue Cross or ASEBP ID card then ask the patient for his or her date of birth e
4. 180 75 180 75 85 00 0 00 95 75 0 00 180 75 0 00 Physiotherapy Assessment Physiotherapy Treatment By accepting this claim summary certify that the information on this claim summary is complete and accurate and the services and or products listed have been received by the patient indicated also acknowledge that by presenting my Alberta Blue Cross identification card or my identification number for a benefit plan administered by Alberta Blue Cross to the named Service Provider consent and agree to The Service Provider submitting a claim containing my personal information to Alberta Blue Cross on my behalf and authorize payment of this claim by Alberta Blue Cross directly to the Service Provider Alberta Blue Cross using my personal information to determine my eligibility for benefits to adjudicate pay claims to administer the terms of my benefit plan and to verify audit paid claims as described in the Alberta Blue Cross Privacy Policy posted st www ab bluecoss ca and The Service Provider disclosing my personal information to Alberta Blue Cross for the above purposes Please retain for your records The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans an association ofindependent Blue Cross plans Licensed to ABC Benefits Corporation for use in operating the Alberta Blue Cross Plan http orovider ab bluecross ca health O 9 Steps for online submission
5. remaining to be paid as of January 14 2014 report from the drop down menu Provider of service choose one X If your clinic is registe red as an Please note If there are any claims to be cancelled they can be viewed and cancelled within this report individual provider type the Provider of service field will be populated a gt automatically ABC Health Clinic Cancel To cancel a claim click the epwi hyperlin k Outstanding payment report Prowder of service Chiropractor Need help cancelling a caim Details If the cancellation hyperlink is inactive Aide details either the payment run isin progress po Service date Patents seniel Amoum Alberta Blue Document Cancel r the d cument has exceeded the YYY TiD D s z f claimed Cross paiujs numbers claim cancellation timeframe and the claim 2014 01 01 Smith Jo Chiropractic Assessment 58 58 0 00 47763025 Cancel cannot be cancelled online Please refer 2013 12 20 Smith John Chiropractic Treatme 00 00 100 00 47762909 Cancel i 2013 12 29 Smith Joh Chiropractic Treatment 100 00 100 00 477629 to the help icon for further instructions EE naaa aiad co ones t el ies 2014 01 05 Smith John Chiropractic Treatment 100 00 100 00 47762909 Cancel about Now to cancel your ClalM iiai E aiaia Click here to print gt Reports Outstanding payment report If a payment run is in progress you Sara a will receive notification that the claim Cancellation o
6. 62909 47762909 47762909 47762885 Cancel Cancel Cancel Cancel Total Provider of service Details bide details Service date YYYY MM DD Patients 2014 01 14 2014 01 14 2013 10 30 2013 12 01 2013 12 03 Total Provider of service Details bHide details Service date YYYY MM DD 2013 12 29 Total Patients Smith Mary Combined total http orovider ab bluecross ca health Document number Alberta Blue Cross paid Amount Service claimed Physiotherapy Assessment 47762953 47762953 47762529 47762529 47762529 Cancel Physiotherapy Treatment Cancel Physiotherapy Treatment Cancel Acupuncture Treatment Cancel Physiotherapy Treatment Cancel Document number 47762912 Alberta Blue Cross paid Amount Service claimed Massage Therapy 0 00 Cancel 0 00 Amount Alberta Blue claimed Cross paid 1 198 75 728 75 Click here to print Q Payment History Report If your clinic is registered with multiple provider types and has single sign on please select the provider type for this report from the drop down menu If your clinic is registered as an individual provider type the Provider of service field will be populated automatically Enter a start date and an end date for the claim information you wish to display these dates must be within the previous six months All transactions that have been paid by Alberta Blue
7. Cross to your office within the specified time are listed on a printer friendly screen Statement IDs and document numbers are included for your reference as well as details about each patient s claim Payment history report Provider of vance LE gt 7 act date YYYYMMDD End date YYYymmpp 201401714 Sis Please note Only date ranges within the previous 6 months can be entered d Create report J Se ALBERTA BLUE CROSS ABC Health Clinic 10009 108th Street NW Edmonton AB T5J3C5 Provider of service Chiropractor Service date Patient YYYY MM DD StatementID 34171331 Date 2013 11 27 Lee Jack 2013 12 05 Lee Jack 2013 12 19 Lee Jack 2013 12 20 Lee Jack 2013 12 05 Smith Jane 2013 12 05 Smith Jane 2013 12 05 Robinson Mark 2013 12 15 Robinson Mark 2013 12 21 Robinson Mark 2013 12 22 Robinson Mark 2013 12 23 Robinson Mark Provider of service Physiotherapist Service date Patient YYYY MM DD StatementID 34171382 Date 2013 10 25 Lee Jack 2013 12 05 Lee Jack 2013 12 05 Lee Mark 2013 12 05 Lee Mark 2013 12 01 Robinson Mark 2013 12 01 Robinson Mark 2013 12 01 Robinson Mark 2013 12 02 Robinson Mark 2013 12 03 Robinson Mark 2013 12 05 Robinson Mark Provider of service Massage Therapist Service date Patient YYYY MM DD StatementID 34171333 Date 2013 12 05 Smith Billy 2013 12 16 Smith Billy 2013 12 19 Smith Billy 2013 10 25 Lee Jack 2013 12 01 Lee Jack 2013 12 03 Lee
8. aim details Service date YYYY MM DD Total cost Other plan paid Practicing Pk Last name siotherapist gt name Physiotherapist Lo Service Co Cim Service date Other plan Practicing yyy mm pp 2 vice Total cost 9 aid physlotheraplet Rhysiotherapy 2013 12 25 Te 125 00 50 00 Smith Joe Modi Remove Physiotherapy 2014 01 01 treatment 125 00 50 00 Smith Joe Modi Remove 100 00 Cancel 4 Predetermine http orovider ab bluecross ca health Predetermine his is a simple inquiry ABC Health Clinic into the patient s benefit plan s to Enter claim Predetermine determine the coverage available u eon Patient information You can click Modify to go back sip aa ale to step 2 Cancel to exit without oo eo oupnumber 1 saving or Process claim to submit the s l ummary claim online to Alberta Blue Cross for isi let E E Sti el ns A EA im med iate processi ng Please note that eligibility of coverage may change based on the date of service change in benefit maximum being reached coordination of benefits or coverage terminates Total amount submitted Plan s will pay Balance remaining 250 00 150 00 100 00 This is not a receipt Your daim has not been submitted Please click the Modify e a ey ee Ringe re Details bHide details Patient John Service provider ABC Health Clinic Service date ONES oi Claimed Eligible Ot
9. crypting all information securely delivering your login ID and password denying access to web site users after five consecutive unsuccessful sign in attempts automatically signing site users out after 30 minutes of inactivity and requiring written authorization before granting access to the Health Services Provider web site http orovider ab bluecross ca health ALBERTA BLUE CROSS For more information about access to the Health Services Provider web site contact Alberta Blue Cross Health Services Provider Relations at e 780 498 8083 Edmonton and area e toll free at 1 800 588 1195 all other areas or e e mail at healthinq ab bluecross ca http provider ab bluecross ca health The online claims submission system is available Monday to Sunday 8 a m to 9 30 p m Mountain Time Our regular office hours are Monday to Friday 8 30 a m to 5 p m Mountain Time eThe Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans an association of independent Blue Cross plans Licensed to ABC Benefits Corporation for use in operating the Alberta Blue Cross Plan ABC 82666 generic guide 2014 01
10. e column title ALBERTA BLUE CROSS Health provider Contactus Help Sign out Overview Enter claim Reports Resources Your profile ABC Health Clinic Reports Outstanding payment report View all claims remaining to be paid as of January 14 2014 Provider of service Chooseone Please note If there are any claims to be cancelled they can be viewed and cancelled within this report Payment history report Provider of service Chooseone f Start date YYYYMMDD End date YYYYMMDD Please note Only date ranges within the previous 6 months can be entered Create report Patient claim statements Find a patient and reproduce a Claim statement Please note Only claim statements obtained by the patient within the last year will appear Details bHide details Service date Patient 4 Rashes i Amount Alberta Blue Document Cancel YYYY MM DD js claimed i Cross paid 4 number claim Physiotherapy Assessment 85 00 85 00 47762953 Cancel Physiotherapy Treatment 95 75 95 75 47762953 Cancel Physiotherapy Treatment 125 00 125 00 47762529 Cancel 2013 12 01 Smith John Acupuncture Treatment 120 00 0 00 47762529 Cancel 2013 12 03 Smith John Physiotherapy Treatment 123 00 123 00 47762529 Cancel Total 548 75 428 75 2014 01 14 2014 01 14 2013 10 30 Smith John Smith John Smith John Help For additional information click on the help button blue button with a question mark The help bu
11. h Joe Contactus Help Sign out Resources Your profile ABC Health Clinic ABC Health Clinic Remove Remove lt lt http orovider ab bluecross ca health Predetermine This is a simple inquiry Eare into the patient s benefit plan s to Predetermine determine the coverage available Patient information You can click Modify to go back Name Smith John ji i ID number 1234567 22 to step 2 Cancel to exit without Group number 1 saving or Process claim to submit the Summary claim online to Alberta Blue Cross for Predetermination results as of Jan 14 2014 10 05 AM Mountain Standard Time i i F Please note that eligibility of coverage may change based on the date of service change in benefit IM med late PrOCess ng maximum being reached coordination of benefits or coverage terminates Total amount submitted 180 75 Plan s will pay 180 75 Balance remaining 0 00 This is not a receipt Your claim has not been submitted Please click the Modify Cancel or Process Claim button at the bottom of this page Details bdHide details Patient John Service provider ABC Health Clinic Service date Ronis Claimed Eligible Other plan Thisplan Explanation YYYY MM DD amount amount paid paid number 2014 01 14 Physiotherapy Assessment 65 00 65 00 0 00 85 00 014 01 14 Physiotherapy Treatment 95 75 95 75 0 00 95 75 Total 180 75 180 75 0 00 180 75 Click here to print M
12. her plan Thisplan Explanation YYYY MM DD amount amount paid paid number 2013 12 25 Physiotherapy Treatment 2014 01 01 Physiotherapy Treatment Total Other Blue Cross coverage Service date Claimed Eligible Other plan Thisplan Explanation YYYY MM DD o amount amount paid paid number 2013 12 25 Physiotherapy Treatment 125 00 125 00 62 50 2014 01 01 Physiotherapy Treatment 125 00 125 00 62 50 Total 250 00 250 00 125 00 Click here to print Cancel Process claim Modify http orovider ab bluecross ca health im i i i Contactus Help Sign out Process claim You will receive a BLUE CROSS Health provider ontactus Help Sign ou 4 Process cat from Alberta Blue Cross within seconds of your submission Overview Enter claim Reports Resources Your profile You must provide the patient with a printed apy ott i tai astatement Please click below to print Print Alberta Blue Cross Statement Print summary A printable copy of the patient s Claim Statement is oy Driny z Date January 14 2014 displayed Click the Print command BLUE CROSS ele bee on the screen You must provide the i iis t patient with a printed copy of the oee as T monton and area 98 8000 Claim Statement Calgary and area 403 234 9666 Toll free 1 800 661 6995 8 30 a m 5 p m MT www ab bluecross ca Patient name Smith John ID number 1234567 22 Group 1 Section P Health claim summary ota
13. ish to cancel the claims listed below press the Back button Details Need help cancelling a claim Q Service date Patient Sane Amount Alberta Blue Document YYYY MM DD claimed Cross paid number Chiropractic 2014 01 01 Smith John Assessment 58 58 0 00 Cancellation reason gt Reports Outstanding payment report Information Claims for John Smith submitted on Jan 1 2014 have been cancelled Provider of service Chiropractor Need help cancelling a claim Details AdHide details Service date Patients Savice Amount Alberta Blue Document Cancel YYYY MM DD x y claimed Cross paid number claim 2013 12 20 Smith John Chiropractic Treatment 100 00 100 00 47762909 2013 12 29 Smith John Chiropractic Treatment 100 00 100 00 47762909 2014 01 05 Smith John Chiropractic Treatment 100 00 100 00 47762909 Total 300 00 300 00 Click here to print http orovider ab bluecross ca health Technical information Using the Health Services Provider web site an Internet connection and your browser you can submit claims online at your convenience Most computer systems today have everything required to use this web site successfully We re serious about privacy and security The confidentiality of your records is very important to you and to us You are responsible for your login ID and password They are intended for your office s use only We protect your information in various ways including en
14. l amount claimed Other plan paid otal amount not paid Amount paid 125 00 Details Each claim you submit is assessed according to the rules of your benefit plan Please refer to the explanations near the end of this statement for descriptions of terms and to your benefit booklet for plan details Patient John Service provider ABC Health Clinic 2013 12 25 Physiotherapy Treatment 125 00 125 00 62 50 2014 01 01 Physiotherapy Treatment 125 00 125 00 62 50 250 00 250 00 125 00 125 00 http orovider ab bluecross ca health Easy steps to access Reports Reports This screen allows you to pull up all claims waiting to be paid history of settled claims and individual statements Outstanding Payment Report Alberta Blue Cross will make payments to your office once every two weeks The Outstanding Payment Report lists all transactions that are remaining to be paid and allows you to cancel a claim Payment History Report Once the transactions have been paid they will be removed from the Outstanding Payment Report and will appear on the Payment History Report You can view payment history for the last six months Patient Claim Statements This allows you to print a copy of the patient claim statements gt Sort This is currently available for Outstanding Payment Reports and Patient Claim Statements You can sort the column by clicking on the double headed arrow located beside th
15. linic is registered as an individual provider type the Provider of service field will be populated automatically Enter details Select a service and enter the total cost and the provider name then click Add claim Repeat these steps for each service being considered When you are satishled with the details you have entered click the Predetermine button Please refer to article 4 4 in the Online Services Billing Agreement for more information regarding the service date gt There may be some circumstances when a claim cannot be processed electronically You will receive a notification on this screen and these claims will have to be submitted manually by the patient to Alberta Blue Cross pe BLUE CROSS Health provider Overview Enter claim Reports Enter claim Provider of service Patient information Name Smith John ID number 1 Group number 14200 Claim type Provider of service Chooseone Enter claim Enter details Patient information Name Smith John ID number 1234567 22 Group number 1 Claim type Provider of service Claim details Service date YYYY MM DD Service Total cost Practicing physiotherapist Last name Firs game Add claim Practicing physiotherapist Service date YYYY MM DD Physiotherap treatment 95 75 Service Total cost 2014 01 14 Smith Joe Physiotherapy assessment 00 180 75 2014 01 14 Smit
16. nter the date and click the Search button Note Any dates such as service or birth dates can be entered either with or without a slash between numbers The system will accept both formats This applies to all screens Verify whether patient has Coordination of Benefits Confirm if the patient has other active coverage and if payment has been made by another benefit carrier or provincial plan If No continue to next page If Yes continue to page 7 CROSS Health provider Overview Enter claim Reports Enter claim Enter patient ID number Group number P Date of birth YYYY MM DD Overview Enter claim Reports Enter claim Coordination of Benefits Information Patient information Name Smith John ID number 1234567 22 Group number 1 COB information a Is the patient entitled to receive comparable benefits from any other insurance company health benefits company or Alberta Blue Cross Plan http orovider ab bluecross ca health Contact us Help Sign out Resources Your profile ABC Health Clinic Resources Your profile ABC Health Clinic If Yes and the patient has active coverage with another benefit carrier continue to the COB section on page 7 9 Provider type If your clinic is registered with multiple provider types and has single sign on please select the provider type for this report from the drop down menu If your c
17. odify Cancel Process claim http orovider ab bluecross ca health O Process claim You will receive a confirmation from Alberta Blue Cross within seconds of your submission Print summary A printable copy of the patient s Claim Statement is displayed Click the Print command on the screen You must provide the patient with a printed copy of the Claim Statement BLUE CROSS Contactus Help Sign out Health provider Overview Enter claim Reports Resources Your profile You must provide the patient with a printeg aim statement Please click below to print Print Alberta Blue Cross Statement ALBERTA BLUE CROSS Date January 14 2014 Document number 47762953 We re here to help Edmonton and area 780 498 8000 Calgary and area 403 234 9666 Toll free 1 800 661 6995 8 30 a m 5 p m MT www ab bluecross ca Patient name Smith John ID number 1234567 22 Group 1 Section P otal amount claimed otal amount not paid Amount paid 180 75 Details Each claim you submit is assessed according to the rules of your benefit plan Please refer to the explanations near the end of this statement for descriptions of terms and to your benefit booklet for plan details Patient John Service provider Service date YYYY MM DD 2014 01 14 2014 01 14 ABC Health Clinic Product or service Claimed Eligible Other plan This plan Explanation amount amount paid paid number 85 00 85 00 95 75 95 75
18. ptions are unavailable at this time as our payment runs are currently in progress We apologize for this inconvenience and encourage you to review the steps in Need help cancelling a claim cannot be cancelled Provider of service Chiropractor Need help cancelling a claim http orovider ab bluecross ca health Cancellation Review If you choose to cancel a claim you will be asked for the reason A drop down menu lists common reasons When cancelling a claim all claims associated with the document number must be cancelled If you select other please provide the reason Cancellation Once a claim has L successfully been cancelled red text appears at the top of the screen as confirmation ALBERTA BLUE CROSS Cancellation Review Please review claims listed below Enter a cancellation reason and press the Ok button to submit for cancellation If you no longer wish to cancel the claims listed below press the Back button Details Need help cancelling a claim Service date Patient Garvie Amount Alberta Blue Document YYYY MM DD claimed Cross paid number Chiropractic 2014 01 01 Smith John Assessment Select one Claim entered in error ick Other F AAA U TTN Cancellation reasop EAA N ALBERTA BLUE CROSS Cancellation Review Please review claims listed below Enter a cancellation reason and press the Ok button to submit for cancellation If you no longer w
19. tion for Direct Deposit of Funds form These forms can be accessed through our public web site at www ab bluecross ca Please mail or fax your completed form to Provider Relations Alberta Blue Cross 10009 108 Street Edmonton AB T5J 3C5 Fax 780 498 3544 The Health Services Provider Relations team at Alberta Blue Cross will create your web site access based on your completed registration form To protect your security a This site chose VeriSign SSL for e commerce and confidentia communications Getting started online Please refer to the information in the e mails Alberta Blue Cross sends you when your initial registration is approved These e mails will contain your login ID and temporary password Navigate to the Health Services Online Services web site at http provider ab bluecross ca health and enter the login ID and password in the applicable fields You will be asked to agree to the Web Site Policy and Online Billing Agreement set up your two Reminder Questions and change your temporary password This information will be used to verify your identity if you forget your password or require information about your account Subsequent sign ins will only require your login ID and password ALBERTA SR SLUE cross Secure site entrance Sign in Health provider web site Login ID Password _ Forgotten your login ID Please contact us by email or ax using the contact information listed
20. tton has answers to questions that are frequently asked about the section http orovider ab bluecross ca health 2 ABC Health Clinic Outstanding Payment Report Reports If your clinic is registered with several provider types please select the provider type for this report from the drop down menu Outstanding payment report View all claims remaining to be paid as of February 4 2014 Provider of soviet cess ED Please note If there are any claims to be cancelled they can be viewed and cancelled within this report If your clinic is registered as an individual provider type the Provider of service field will be populated automatically Create report Alberta Blue Cross will make payments to your office once every two weeks The Outstanding Payment Report lists all transactions that are remaining to be paid Once the transactions have been paid they will be removed from this report and appear on the Payment History Report Reports Outstanding payment report Provider of service Need help cancelling a claim Details AHide details Chiropractor Alberta Blue Cross paid Document number Amount claimed Service date YYYY MM DD Patients Services 2013 12 20 2013 12 29 2014 01 05 2014 01 01 Smith John Smith John Smith John Lee Mark Chiropractic Treatment Chiropractic Treatment Chiropractic Treatment Chiropractic Treatment 477
21. with Coordination of Benefits between Alberta Blue Cross and another benefit carrier Patient has Coordination of Benefits Click yes if a portion of this claim has already been paid by another benefit carrier and if you would like to submit the remaining amount to this plan Enter the amount paid Enter the amount paid by the other benefits carrier for each claim line If payments have been made by two or more other benefit carriers combine the amount paid and enter one total for each claim line Enter details Select a service enter the total cost and the provider name then click Add claim Repeat the same process until all lines have been entered then click Predetermine Contact us si BLUE CROSS Health provider Overview Enter claim Reports Resources Your profile ABC Health Clinic Enter claim Coordination of Benefits Information Name Smith John ID number 1234567 22 Group number 1 COB information Is the patient entitled to receive comparable benefits from any other insurance company health benefits company or Alberta Blue Cross Plan If the claim was submitted through another benefit carrier or provincial plan would you like to submit the remaining amount to this plan Cancel Next Enter claim Enter details Patient information Name Smith John ID number 1234567 22 Group number 1 Claim type Provider of service Cl
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