Home Health Agency and Hospice Facility Workshops October 2015 - PowerPoint PPT Presentation

Home Health Agency and Hospice Facility Workshops October 2015 Presented by Blue Cross and Blue Shield of Kansas

Agenda  Communicating with our providers  BCBSKS Website  Availity Web Portal  Provider Manual  Member ID Card  Billing Instructions  Home Health Agencies  Hospice Agencies  Case Management  Electronic Data Interchange (EDI)  Question and Answers (Q&A)

Institutional Provider Relations Department  Functions of the Institutional Provider Relations Dept:  Liaison between the provider and BCBSKS  Manage facility contracts  Provide Training and Education  Communication  Provider Inquiries

Institutional Provider Relations Department  Functions of the Institutional Provider Relations Dept:  Provider Types:  Ambulatory Surgery Centers (ASCs)  Birthing Centers  Dialysis Centers  Home Health Agencies  Hospice Facilities  Hospitals (Acute, Rehab, Psych, Military and VA)  Substance Abuse

Institutional Provider Relations Department  Institutional Provider Relations Department Staff  Director – Angie Strecker  Manager – Teresa Van Becelaere  Provider Consultants:  Janne Denton – Topeka – Ancillary Provider  Cindy Garrison – Topeka – Northern KS Hospitals  Sally Stevens – Wichita – Southern KS Hospitals  Education and Communication Coordinator – Connie Winkley  Provider Program Specialist – Brent Matile

Institutional Provider Relations Department  Institutional Provider Relations Department Staff:  Claims Research Analyst – Katie Dennison  Support Staff:  Administrative Coordinator – Topeka – Dona Hewes  Administrative Assistant – Topeka - Melanie Moriarty  Administrative Assistant – Wichita – Kristi Donelan

Communicating with our Providers  How we communicate with our providers…..  Website tools and resources  One-on-one provider consultant visits  Inquiries by:  Mail  Email  Phone

BCBSKS Website, and the BlueAccess and Availity Web Portals  BCBSKS Public Website – www.bcbsks.com  Includes information for providers that which does not require secure access.  eNews – Primary means of communication for institutional providers. Sign up so that you are not left behind!

Glossary  Glossary  As you view the BCBSKS Website, you may come across an unfamiliar word or term. We've developed a glossary that we hope will help you.  http://www.bcbsks.com/help/glossary.shtml

BCBSKS Website, and the BlueAccess and Availity Web Portals  BlueAccess – BCBSKS Secure Website  Accessible only by logging onto the Availity Web Portal  Some of the secure information found on BlueAccess include:  Remittance Advice  Institutional Provider Manual  Patient ID (BCBSKS Member) Search  Pre-Service Review  Institutional Providers General Polices and Procedures

BCBSKS Website, and the BlueAccess and Availity Web Portals  Availity Web Portal - Secure Website  BCBSKS moved secure information to Availity in August 2013  Information found on the Availity Web Portal include :  BCBSKS Member Eligibility and Benefits  BCBSKS Member Claims Status  Requires secure log in and access is granted from the facility's Availity Primary Access Administrator (PAA)  Several payers use Availity, including CMS/Medicare

BCBSKS Membership  BCBSKS ID Card:  Provides important information that healthcare providers need to know to submit a claim.  Front of card contains information on the type of coverage and a brief description of the out-of-pocket amounts.  Back of the card contains information on plan contact numbers and mailing address and the plan's website.  Are for identification purposes only; they do not guarantee eligibility or payment of claims. Providers should always verify patient eligibility for BCBSKS members on the Availity web portal.  BCBSKS Members receive an updated ID card whenever their benefits change or BCBSKS information on the card changes.

BCBSKS Membership  BCBSKS ID Card:  Includes a 3-character alpha prefix, plus a 9-digit randomly selected number. Current On and Off Exchange BCBSKS member alpha-prefix and description Alpha Prefix Network and Product Description XSA BCBSKS CAP XSB Blue Choice Small Group Off Market XSC Individual Exchange Solutions XSD BlueCap – SHOP (On Exchange) Select XSE Blue CAP – Individual On Exchange XSF Blue Choice Select Individual Off Exchange XSG SHOP Exchange Solutions XSH Blue Choice Select Small Group Off Exchange XSI Bleu Choice Individual Off Exchange XSJ BlueCap – SHOP (On Exchange) XSK BlueCap – MultiState Individual On Exchange XSL BlueCap – Individual On Exchange Select

BCBSKS Membership  BCBSKS ID Card:  Includes a 3-character alpha prefix, plus a 9-digit randomly selected number. Current On and Off Exchange BCBSKS member alpha-prefix and description Alpha Prefix Network and Product Description XSM Plan 65 XSQ Individual Solutions Off Exchange XSR Small Group Solutions Off XSV Value Blue ARX AirXcel HEH Harris Enterprises IPH and PHF Pizza Hut KGS OneOK KSE State of Kansas LSR Del Frisco's Restaurant Group SPA Spirit AeroSystems TOE City of Topeka

BCBSKS Membership

BCBSKS Membership  Kansas Solutions Membership:  A new BCBSKS subsidiary  Effective January 1, 2015  Limited network – BCBSKS' 103-county service area only! Excludes Johnson & Wyandotte Counties in KS  Represented by an empty suitcase  Sold to individuals on and off the exchange and small group (SHOP) markets  Claims for Solutions members will have its own remittance advice (RA)

BCBSKS Membership  Kansas Solutions Membership:  Blue Solutions is not a traditional HMO:  Members will NOT choose a Primary Care Provider (PCP)  No referral is needed for visiting a specialty provider  Members have open access through the BCBSKS Blue Choice network  Providers reimbursed using Blue Choice payment rates

BCBSKS Membership  Providers can learn more about the BlueCross and/or Blue Shield member ID cards by using the following resources available on our website.  http://www.bcbsks.com/CustomerService/Providers/Public ations/institutional/manuals/pdf/Quick-Guide-to-BCBS- Member-ID-Cards.pdf  http://www.bcbsks.com/CustomerService/Providers/Public ations/institutional/manuals/pdf/inst_Exchange-BlueCard- and-Kansas-Provider-Networks.pdf

Remittance Advice (RA) PATIENT RESPONSIBILITY R I.D. CARD E NO. M PATIENT PROVIDER O D OTHER C A TOTAL NAME PATIENT STANDARD T A PROVIDER PROVIDER'S ADJUSTMT TOTAL N ADJUST R AMT DEDUCTIBLE AMT BCBS ACCOUNT SERVICE CODE L Y TOTAL AMOUNT CONTRACTUAL PAYER AMT T REASON K NOT ------------- PATIENT CLAIM NO. NUMBER DATE SET R S CHARGE ALLOWED OBLIGATION INITIATED PAID R CODE S COVERED CO-INSUR CO-PAY OWES XSP123456789 0000006998 121514 92002 0000 54.00 64.00 0.00 -10.00 0.00 15.00 0.00 15.00 49.00 BC 1 94 Claim, Ima 92015 0.00 CH 0000006998 121514 92002 0000 10.00 0.00 0.00 10.00 0.00 0.00 0.00 0.00 0.00 BC 97 M15 0.00 CH 0.42 255556300299 SUBTOTAL 64.00 64.00 0.00 0.00 0.00 15.00 0.00 15.00 49.42 DAYS TOTAL AMOUNT CONTRACTUAL ADJUSTMT AMOUNT DEDUCTIBLE PATIENT AMT CHARGES ALLOWED OBLIGATION NOT & CO-PAY OWES PAID COVERED CO-INSUR Claim TOTALS 64.00 64.00 0.00 0.00 0.00 15.00 15.00 49.42 Control CHECK NO. PAY DAY PROV. NO. Number 5555650035 03/06/14 555555

Claim Control Number  Claim Control Number Format  LLYYJJJNNNNZ-S  LL - Internal Number  YY - Year  JJJ - Julian Date  NNNNZ - Sequential Number  S - Suffix (optional)

Claim Control Number Examples  Claim Number 201500500001  20 – Paper claim  15 – It was received in 2015  005- It was received on January 5 th  00001 – It was the first claim in the sequence

Clean Claim Processed PATIENT RESPONSIBILITY R I.D. CARD E NO. M PATIENT PROVIDER O D OTHER C A TOTAL NAME PATIENT STANDARD T A PROVIDER PROVIDER'S ADJUSTMT TOTAL N ADJUST R AMT DEDUCTIBLE AMT BCBS ACCOUNT SERVICE CODE L Y TOTAL AMOUNT CONTRACTUAL PAYER AMT T REASON K NOT ------------- PATIENT CLAIM NO. NUMBER DATE SET R S CHARGE ALLOWED OBLIGATION INITIATED PAID R CODE S COVERED CO-INSUR CO-PAY OWES XSP123456789 0000101555 010314 80053 0000 40.00 12.39 27.61 0.00 0.00 0.00 0.00 0.00 12.39 BC 45 Claim, Ima 00134555-0005555 0.00 0000101555 010314 83036 0000 40.00 25.18 14.82 0.00 0.00 0.00 0.00 0.00 25.18 BC 45 00134555-0005555 0.00 0000101555 010314 36415 0000 12.00 7.60 4.40 0.00 0.00 0.00 0.00 0.00 7.60 BC 45 45 00134555-0005555 0.00 255556300299 SUBTOTAL 92.00 45.17 46.83 0.00 0.00 0.00 0.00 0.00 45.17 DAYS TOTAL AMOUNT CONTRACTUAL ADJUSTMT AMOUNT DEDUCTIBLE PATIENT AMT CHARGES ALLOWED OBLIGATION NOT & CO-PAY OWES PAID COVERED CO-INSUR TOTALS 92.00 45.17 46.83 0.00 0.00 0.00 0.00 0.00 45.17 http://www.wpc- edi.com/reference/ CHECK NO. PAY DAY PROV. NO. 5555650035 03/06/14 555555

Remittance Advice Resource  A list of Remittance Advice codes can be found at the Washington Publishing Company  www.wpc-edi.com/reference