Resources for interChange April 2017 1 Provider Enrollment - PowerPoint PPT Presentation

Overview of Online Provider Resources for interChange April 2017 1

Provider Enrollment Overview • As of April 11th, more than 44,505 providers are enrolled  An additional 8,000 providers enrolled between September 30 th and March 1 st .  From March 1 st – March 31 st , we added more than 1,300 new providers. • Providers who meet state and federal requirements can enroll anytime  Go To https://www.colorado.gov/hcpf/provider- enrollment to find out more about enrollment 2

Trainings Recordings of Trainings are Available Online  Session 1 – Access the new Portal, Registration, Log In, My Profile, Manage Accounts (including delegates)  Session 2 – Provider Maintenance (including updates and affiliations), EFT/ERA Enrollment, Disenroll  Session 3 - Member Information & Eligibility Verification  Session 4 – Remittance Advice (RA), Search Payment History, Accounts Receivable Records, Make a Payment  Session 5 – Notify Me, Alerts, Secure Correspondence  Session 6 – Files Exchange, Resources  Session 7 – Search & Submit CMS 1500, UB-04, Emergency Dental Claims, Prior Authorizations (Nursing Facility PETI PARs only)  Bridge – Bridge training for Community Centered Boards (CCBs) only • FAQs and Cheat Sheets supplement trainings and were developed based on Hot Topics from Providers 3

Helpful Resources: Training Cheat Sheets Visit https://www.colorado.gov/hcpf/provider- resources for: Aid Code and Benefit Plan Acronyms Updating your EFT/ERA Information Copy, Adjust, or Void a Claim Validating a Trading Partner ID (TPID) Delegates Verifying Member Eligibility, including: Managed Care Assignments Primary Care Provider Medicare Coverage Member Co-pay amounts Delegate Access Definitions Web Portal Registration Provider Maintenance, including: Updating contact information Opt-out of Provider Directory Managing Affiliations 4

FAQ Topics • Batch (X12), EDI, & Trading Partner Questions • Reports Questions • Training Questions • General Provider Web Portal Questions • EFT/ERA Questions • Updating Provider Information/Affiliations • Member Information/Verification Questions • Provider Web Portal Registration/Delegation • Claims Questions • PAR Questions • Eligibility Questions • Enrollment Questions • Alerts & Secure Correspondence • Online bill pay We are adding new resources daily - check back often! 5

Check Provider Resources Page for Updates • Updates are posted on the top of the Provider Resources Landing Page: https://www.colorado.gov/hcpf/provider- resources • Current topics include: Remittance Advice (RAs) are the new Provider Claim Reports (PCRs), Third Party Liability, Logging into the correct account to submit claims appropriately, Change your EFT information, Member Focused View, Clearinghouses, QMB Claims, Claim denials due to EOB 1473 Multiple Provider Locations for Billing Provider Specialty • Check back often as new topics are being added regularly 6

Provider Payments Update • Claims are being paid, we had claims successfully processing on Day 1 • More than $600 million paid since March 1  On pace with averages from the old system • The top reasons for a claim to deny are:  The provider did not complete revalidation, so is not in the system.  The provider is using the wrong combination of provider type, specialty and taxonomy.  The provider used the wrong NPI. 7

Top Denial Reasons – Quick Checklist  Are you enrolled/revalidated?  Did you correctly enter your provider type, specialty and taxonomy and include the 9-digit ZIP code of your service location?  Are you billing from the correct provider ID and NPI number? If the answer to any of the above is “no”, your claim will be denied. 8

Other Resources & Staying Informed • Provider Bulletins - published monthly, with special bulletins in between • Billing Manuals – are available online • Sign up for our provider newsletter 9