Provider Workshop Training 2017 1
INTRODUCTION PORTAL CLAIMS EFT TODAY’S AGENDA • Passport Provider Portal (New!) • Claims System (NEW PAYER ID)! • ERA/EFT InstaMed (NEW!) • Packet Information – Title VI – Fraud, Waste and Abuse – FAQs – Quick Reference – Checkpoint Questions – 2017 FACT SHEET 2
INTRODUCTION PORTAL CLAIMS EFT MIGRATION TO A NEW MEDICAL INFORMATION MANAGEMENT SYSTEM • Continuous improvement toward value-based delivery of Medicaid Managed Care • Operational changes to enhance provider experience with stronger Service Level Agreements 3
INTRODUCTION PORTAL CLAIMS EFT WHAT’S CHANGING? • New Payer ID 61325 • New Provider Portal • New EFT/ERA: InstaMed • Passport Provider ID’s – new NPI based system • PCP Assignments – Group level • PCP Panel Status and Limitations – Group level • WHEN? 10.1.17 4
INTRODUCTION PORTAL CLAIMS EFT EDUCATIONAL OPPORTUNITIES Lunch and eNews and Online Personal Learn OCTOBER 1 Information Presentations Direct Mail Workshops • 11 Statewide •Self-registration for Workshops per •New Claims System • CLAIMS Portal Account Set-up Region (invitations •Personal Outreach with •New Provider ID SYSTEM •eNews posted sent to each office Provider Relations •New Portal Specialists •PowerPoint and online GO LIVE DATE •New EFT Vendor Presentation registration) • 2 Webinars Provider Relations Specialists http://passporthealthplan.com/providers/contact-providers-and-services/ Provider Services (800) 578-0775 Available Monday through Friday, between 8 a.m. and 6 p.m. (EDT) 5
INTRODUCTION PORTAL CLAIMS EFT • When is the new system effective? • Who do I contact for questions? • Will my provider ID be changing? 6
INTRODUCTION PORTAL CLAIMS EFT Provider Portal 7
INTRODUCTION PORTAL CLAIMS EFT NEW PASSPORT PROVIDER PORTAL • Getting Started • Portal Improvements • Administrator vs. User • Basic Navigation • Claims Status • Referrals Submission and Inquiry • Member Eligibility and Benefits • Reports Available 8
INTRODUCTION PORTAL CLAIMS EFT GETTING STARTED • New portal name – Passport Provider Portal • Accessing the new portal – Passport website: http://passporthealthplan.com/providers/provider-portal/ – Direct URL: https://phkyportal.valence.care/ 9
INTRODUCTION PORTAL CLAIMS EFT GETTING STARTED Main Functions • Verify member eligibility and benefits • Referrals submission and inquiries • Claims status • Reports 10
INTRODUCTION PORTAL CLAIMS EFT PORTAL IMPROVEMENTS What are some improved features of the new portal? • Panel roster reports • Verify member eligibility for multiple members at a time • Historical member eligibility & PCP assignments available • Referrals limitations • Address indicators from the DMS file will be present • Diagnosis List – search ICD codes • Procedure List – search procedure codes 11
INTRODUCTION PORTAL CLAIMS EFT OFFICE ADMINISTRATOR ROLE • What is an Office Administrator? • How do I choose one for my office? • Responsibilities of an Office Administrator o Create user accounts o Grant access to user accounts o Modify user accounts o Delete user accounts o Unlock user accounts 12
INTRODUCTION PORTAL CLAIMS EFT OFFICE ADMINISTRATOR SET-UP Passport can assist you in setting up your Office Administrator account. Step 1: Go to http://passporthealthplan.com/providers/new-claims- system/ Step 2: Complete the fillable form, check Office Administrator box. Step 3: Email the form to providerinquiries@passporthealthplan.com 13
INTRODUCTION PORTAL CLAIMS EFT OFFICE USER ROLE • What is an Office User? • Multiple user accounts allowed within one practice. • User accounts can view information within the portal • Passport can assist you in setting up your Office Administrator account. 14
INTRODUCTION PORTAL CLAIMS EFT OFFICE USER SET-UP • Passport can assist you in setting up your Office User accounts. Step 1: Go to http://passporthealthplan.com/providers/new-claims- system/ Step 2: Complete the fillable form, check Office User box. Step 3: Email the form to providerinquiries@passporthealthplan.com 15
INTRODUCTION PORTAL CLAIMS EFT BASIC NAVIGATION – HOME PAGE 16
INTRODUCTION PORTAL CLAIMS EFT BASIC NAVIGATION – TOP NAVIGATION MENU BAR • Home • Tools & Resources • Inbox • Claims • Diagnosis List • Claims Status List • Procedure List • Remittance Advice Search • Provider List • Patient • Office Administration • Online Referral Submission • User Profile • Referral List • Member Eligibility Search • Access Other Offices • Panel Roster 17
INTRODUCTION PORTAL CLAIMS EFT BASIC NAVIGATION – MEMBER LOCK • Member Lock – New Feature – Located above the top navigation menu bar 18
INTRODUCTION PORTAL CLAIMS EFT CLAIMS STATUS – CLAIMS STATUS LIST PAGE Searching previously submitted claims: 1. Select the Claims drop- down from your menu bar 2. Select the Claim Status List option • Input search criteria to populate values in the Results section 19
INTRODUCTION PORTAL CLAIMS EFT CLAIMS STATUS – RESULTS PAGE 3. Select the Claim number link to view the Claim Detail page 4. Select the View EOB link to view the Explanation of Benefits 20
INTRODUCTION PORTAL CLAIMS EFT CLAIMS STATUS – REMITTANCE ADVICE SEARCH Remittance Advice Search 21
INTRODUCTION PORTAL CLAIMS EFT REFERRAL SUBMISSION Submitting an electronic referral: 1. Select the Patient drop-down from your menu bar 2. Select the Online Referral Submission option. 22
INTRODUCTION PORTAL CLAIMS EFT REFERRAL SUBMISSION 3. Select Show Full Roster check mark box and complete appropriate member information 4. Click the Search button 23
INTRODUCTION PORTAL CLAIMS EFT REFERRAL SUBMISSION 5. Click the Select link to the left of the appropriate members name 6. Select the appropriate provider record from the Provider Last Name drop-down in the Referring Provider Information section 7. Search (and select) the appropriate provider from the Refer to Provider Information section 24
INTRODUCTION PORTAL CLAIMS EFT REFERRAL SUBMISSION 8. Enter any other necessary information 9. Select the Review button 10. Confirm information is accurate and select the Submit button to complete your request and receive a system generated Referral number. 25
INTRODUCTION PORTAL CLAIMS EFT REFERRAL INQUIRY Searching previously submitted referrals: 1. Select the Patient drop- down from your menu bar 2. Select the Referral List option 26
INTRODUCTION PORTAL CLAIMS EFT REFERRAL INQUIRY RESULTS 27
INTRODUCTION PORTAL CLAIMS EFT REFERRAL CROSSOVER • Referral crossover in new claims system – Yes • Referral crossover in new portal – Dual access with Navinet 28
INTRODUCTION PORTAL CLAIMS EFT MEMBER ELIGIBILITY AND BENEFITS Verifying member eligibility and benefits: 1. Select the Patient drop-down from menu bar, and choose member eligibility search link. 29
INTRODUCTION PORTAL CLAIMS EFT MEMBER ELIGIBILITY AND BENEFITS Verifying member eligibility and benefits: 2. Select the Member name link 30
INTRODUCTION PORTAL CLAIMS EFT MEMBER ELIGIBILITY AND BENEFITS Verifying member eligibility and benefits: 3. Member Eligibility and Benefits can be validated from the Member Detail page 31
INTRODUCTION PORTAL CLAIMS EFT REPORTS What reports are available? – Panel Listing Reports 1. Select the Patient drop-down from your menu bar 2. Select the Panel Roster option 32
INTRODUCTION PORTAL CLAIMS EFT NAVINET vs NEW PASSPORT PROVIDER PORTAL • Access to Navinet post 10/1/17 • Historical Information o Navinet o Limited access until 3/31/18 o New Passport Provider Portal o Full access beginning 10/1/17 33
INTRODUCTION PORTAL CLAIMS EFT • What is an Office Administrator for the provider portal? • Can we set-up multiple users on the new provider portal? • Will Passport set-up an account for me in the new portal prior to 10/01/17? User Name and Password will be emailed to you after 9.15.17 34
INTRODUCTION PORTAL CLAIMS EFT Claims System 35
INTRODUCTION PORTAL CLAIMS EFT CLAIMS SYSTEM – PAYER ID Passport Health Plan’s new Payer ID is 61325 . • Please let your internal systems know of this change: o Practice Payment Administrators o Internal EDI (electronic data interchange) o HIS (Hospital Information System) such as Epic 36
INTRODUCTION PORTAL CLAIMS EFT CLAIMS SYSTEM - TRANSITION • The transition to a new claims payment system is intended to better serve you: – Quicker turnaround times – Quicker system changes – Local support • DOS prior to 10/1/17 – Use Payer ID 61129 • DOS on or after 10/1/17 – Use Payer ID 61325 37
INTRODUCTION PORTAL CLAIMS EFT CLAIMS SYSTEM • You will still call the same phone number for claims questions o Provider Claims Service Unit at (800) 578-0775 • This claims system change will not impact behavioral health, dental, vision, pharmacy claims, or Passport Advantage 38
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