Maryland Health Advantage Effective January 1, 2016 Agenda - PowerPoint PPT Presentation

University of Maryland Health Advantage Effective January 1, 2016

Agenda  Introduction  History  ProviderConnect SM Overview  Resources  Contact Info  Questions University of Maryland Health Advantage 2

History University of Maryland Health Advantage 3

History  On May 24, 2015 University of Maryland Medical System acquired Riverside Health, Inc.  Riverside Advantage, Inc. is Riverside’s Medicare Advantage subsidiary, a Maryland Managed Care Organization (MCO)  Launched Medicare Advantage line of business January 1, 2016 called UNIVERSITY OF MARYLAND HEALTH ADVANTAGE (UMHA) University of Maryland Health Advantage 4

Membership Overview  Anticipated Membership: 10,000 to 12,000 lives by end of year 2016 13 of the 24 Maryland Counties Anne Arundel Baltimore Caroline Baltimore City Carroll Cecil Dorchester Harford Howard Kent Queen Anne’s Montgomery Talbot University of Maryland Health Advantage 5

ProviderConnect Overview University of Maryland Health Advantage 6

ProviderConnect - Overview Services of ProviderConnect: • • Verify member benefits and eligibility View and print forms • • Request and view authorizations Download and print authorization letters • • Submit claims and view status Access Provider Summary Vouchers (PSV) • • Request payment for EAP services Submit EAP case activity forms (CAF) • • Submit updates to provider Submit recredentialing applications demographic information • • Submit customer service inquiries Access ProviderConnect message center University of Maryland Health Advantage 7

ProviderConnect - Benefits Free and secure online Reduces paper files application, available 24 / 7 Reduces the need to call Mobile Device friendly for routine information Mac and Windows Quicker Payment compatible INCREASED CONVENIENCE, DECREASED ADMINISTRATIVE PROCESSES University of Maryland Health Advantage 8

ProviderConnect - Claim Submission  Accepts claims files from any Practice Management System outputting HIPAA formatted 837p or 837i batch files, and from EDI claims submission vendors  Offer Direct Claims Submission on website to providers who do not have own software or who wish to submit certain claims outside their batch files • These claims are processed immediately, and you are provided the claim number • You may submit batch claims files or Direct Claims interchangeably  No charge for electronic claims submission  Access to support: • http://www.valueoptions.com/providers/Provider_Connect.htm • EDI Helpdesk: 888.247.9311 between 8:00 a.m. – 6:00 p.m. ET University of Maryland Health Advantage 9

How to Access ProviderConnect  Go to www.ValueOptions.com, choose “Providers”  Existing users select “Log In”  New users can click “Getting Started” to self register using provider ID number  Multiple logons from same provider ID number available University of Maryland Health Advantage 10

Role-Based Security: Features  Allows administrator (Super User) for ProviderConnect accounts who can: • Create new users • Manage existing users • Deactivate accounts  Password Verification • Required for first time login users • Increased security for new accounts created by Super User • Managed user can change password University of Maryland Health Advantage 11

ProviderConnect Webinars  Scheduled monthly or as needed  Topics include: high level overview, authorizations, claims, enhancements, etc.  Upcoming ProviderConnect Webinars: • An Overview of ProviderConnect • Wednesday, 1/20/16 from 2:00 p.m. – 3:00 p.m. • Authorizations on ProviderConnect • Thursday, 2/4/16 from 2:00 p.m. – 3:30 p.m.  Registration available by clicking “Education Center” from the Provider Homepage  Additional webinars may also be offered for particular contracts, so bookmark or visit Network Specific pages as needed. University of Maryland Health Advantage 12

ProviderConnect Resources  Free demonstration: http://www.valueoptions.com/PMC_prototype/ProviderConnect/pvd.html  Quick Start Guide and Comprehensive User Guide  Short Video Tutorials: • Viewing Member’s Eligibility • Viewing and Submitting Authorizations • Direct Claim Submission Process • Batch Claim Submission Process • Recredentialing  Personal assistance available • Contact the EDI Help Desk for more information University of Maryland Health Advantage 13

Additional Resources  University of Maryland Health Advantage Network Specific Page: http://www.valueoptions.com/providers/Network/University-of- Maryland-Health-Advantage.htm  Achieve Solutions: https://www.achievesolutions.net/achievesolutions/en/umha/Ho me.do  Claims Mailing address: Beacon Health Options, Inc. P.O. Box 1347 Latham, NY 12110 *We encourage all providers to submit claims via ProviderConnect University of Maryland Health Advantage 14

Contact Information University of Maryland Health Advantage 15

Contact Us University of Maryland Health Advantage Customer Service (Claims, Authorizations, Referrals) Monday through Friday, 8:00 a.m. – 8:00 p.m. ET Phone: 888.397.3887 Provider Service Line (Credentialing and Contracting) Monday through Friday, 8:00 a.m. – 8:00 p.m. ET Phone: 800.397.1630 EDI Helpdesk (ProviderConnect Technical Questions) Monday through Friday, 8:00 a.m. - 6:00 p.m. ET Phone: 888.247.9311 Email: e-supportservices@beaconhealthoptions.com University of Maryland Health Advantage 16