CSHCN Services Program Automated Inquiry System (AIS) User Guide

Transcription

1 CSHCN Services Prgram Autmated Inquiry System (AIS) User Guide The Children with Special Health Care Needs (CSHCN) Services Prgram Autmated Inquiry System (AIS) prvides prmpt answers t questins abut enrllment, eligibility, claim status inquiries, and check amunts fr CSHCN Services Prgram-enrlled clients and prviders. It is recmmended that yu prepare fr yur call by having the infrmatin yu will need readily accessible befre yu dial. Depending upn the ptin selected, AIS may prmpt yu t enter the CSHCN Services Prgram Natinal Prvider Identifier (NPI), Atypical Prvider Identifier (API), and if necessary the CSHCN Services Prgram Texas Prvider Identifier (TPI), the client s nine-digit CSHCN Services Prgram client number, r the 24-digit claim number. Main Menu Optins The fllwing ptins are available n the AIS Main Menu: T chse the CSHCN Services Prgram AIS, press 1. Fr enrllment, press 2. Fr authrizatin inquiries, press 3. If yu are calling frm a rtary phne, please hld. When chsing Optin 1 (the CSHCN Services Prgram AIS) frm the main menu, the caller will hear the fllwing: Press 1 t enter yur Natinal Prvider Identifier. Press 2 t enter yur atypical prvider identifier. (Enter the CSHCN prvider identifier number when prmpted.) If nt available, please wait n the line and yu will be transferred t an agent. Please wait while the requested infrmatin is being retrieved. (The number will be repeated back fr verificatin.) Imprtant Nte: If the NPI has been attested t multiple CSHCN r Traditinal Medicaid numbers AIS will request the prviders CSHCN legacy prvider identifier number. If this is crrect, press 1. If this is nt crrect, press 2. The caller is asked t reenter the prvider s ten-digit Natinal Prvider Identifier (CSHCN prvider identifier). Once AIS has verified the ten-digit NPI that was entered, the caller will hear Thank yu fr calling the TMHP CSHCN Autmated Inquiry System. The caller will then be prmpted t chse frm the AIS Menu ptins listed belw. AIS Menu Optins Optin AIS Respnse 1 Claim status 2 Eligibility 3 Current check amunt 4 Fax-back service 5 AIS appeals 6 T enter a anther prvider number (CSHCN Services Prgram prvider identifier number) 7 Custmer service representative 8 T repeat the AIS main menu 1 f 8 Effective Date_ /Revised Date_

2 Optin 1: (CSHCN) Claim Status When chsing Optin 1 (Claim Status) frm the AIS Menu, the caller will hear the fllwing: Fr claim status infrmatin, please enter client s nine-digit CSHCN number fllwed by the # buttn. Please enter the date f service in an eight-digit MM/DD/YYYY frmat fllwed by the # buttn. (The date f service will be repeated fr verificatin.) If this is crrect, press 1. If this is nt crrect, press 2 (The caller is asked t reenter the date f service). Please enter the ttal billed amunt in a dllar and cents frmat excluding the decimal fllwed by the # buttn. Please wait while the requested infrmatin is being retrieved. The CSHCN Services Prgram client number, date f service, and claim billed amunt is given. The status f the claim is prvided and any f the applicable details, such as status date and payment amunt. Claim status respnse menu: Fr an explanatin f benefit messages, press 1. T research anther claim status, press 2. T receive a ticket number, press 3. T speak with a custmer service representative, press 4. T cmplete the call, please discnnect. Optin 2: Eligibility When chsing Optin 2 (Eligibility) the caller will hear the fllwing: T enter the client s CSHCN number, press 1. (Please enter the nine-digit CSHCN Services Prgram client number when prmpted.) Please wait while the requested infrmatin is being retrieved. T enter the client s nine-digit Scial Security number, press 2. (Please enter the client s ninedigit Scial Security number when prmpted.) Please wait while the requested infrmatin is being retrieved. Chse the date f service: Fr current eligibility, press 1. Fr a prir date f service, press 2. (Please enter the date f service in an eight-digit MM/DD/YYYY frmat.) AIS will prvide the CSHCN Services Prgram eligibility status fr the client n the dates f service given. Eligibility respnse menu: T research anther client s eligibility, press 1. T receive a ticket number, press 2. T speak with a custmer service representative, press 3. T cmplete the call, please discnnect. 2 f 8 Effective Date_ /Revised Date_

3 Optin 3: Current Check Amunt- Available frm 7am-7pm- Mnday- Friday When chsing Optin 3 (Current Check Amunt) the system immediately searches the current week s payment infrmatin fr the CSHCN Services Prgram prvider identifier number entered int AIS at the start f the call. The caller will hear the fllwing: Please wait while the requested infrmatin is being retrieved. AIS will repeat the Texas (CSHCN Services Prgram) Prvider Identifier, check amunt (if applicable), and payment date. Check amunt respnse menu: T enter anther prvider identifier, press 1. (Enter the CSHCN Services Prgram prvider identifier). Press 1 t enter yur Natinal Prvider Identifier. Press 2 t enter yur atypical prvider identifier. (Enter the CSHCN prvider identifier number when prmpted.) If nt available, please wait n the line and yu will be transferred t an agent. Please wait while the requested infrmatin is being retrieved. (The number will be repeated back fr verificatin.) Imprtant Nte: If the NPI has been attested t multiple CSHCN r Traditinal Medicaid numbers AIS will request the prviders CSHCN legacy prvider identifier number. If this is crrect, press 1. If this is nt crrect, press 2. The caller is asked t reenter the prvider s ten-digit Natinal Prvider Identifier (CSHCN prvider identifier). T cmplete the call, please discnnect. Optin 4: Fax-Back- Available frm 7am-7pm- Mnday- Friday When chsing Optin 4 (Fax-Back) the caller will hear the fllwing: T btain a faxed list f instructins and available dcuments, press 1. Please enter a ten-digit fax number beginning with the area cde and fllwed by the # buttn. (The fax number will be repeated fr verificatin.) If this is crrect, press 1. If this is nt crrect, press 2 (asked t re-enter). If yu knw the dcument number, press 2. Enter the dcument yu wuld like faxed fllwed by the # buttn. Yu will be limited t a selectin f fur dcuments. (The dcument number will be repeated fr verificatin.) If this is crrect, press 1. Fax-back respnse menu: If this is nt crrect, press 2 (asked t re-enter). T request additinal dcuments, press 1. If n ther dcuments are needed, press 2. Please enter the ten-digit fax number, beginning with the area cde, fllwed by the # buttn. (The fax number is repeated fr verificatin.) If this is crrect, press 1. If this is nt crrect, press 2. AIS will end the call with the message, Thank yu fr calling the fax-back service, yur fax will be sent shrtly. 3 f 8 Effective Date_ /Revised Date_

4 CSHCN Services Prgram-specific dcument numbers are prvided belw: CSHCN Services Prgram Dcument Numbers 100 Instructins fr Using the Fax-Back Server 201 Instructins fr Appealing a Claim n the AIS 204 CSHCN Services Prgram Prvider Enrllment Applicatin 205 Prvider Infrmatin Change Frm 206 CSHCN Services Prgram Prir Authrizatin Request fr Inpatient Surgery Fr Surgens Only 207 CSHCN Services Prgram Quick Reference Guide 208 CSHCN Services Prgram Authrizatin Request fr Hemphilia Bld Factr Prducts 209 CSHCN Services Prgram Prir Authrizatin Request fr Inpatient Hspital Admissin Fr Use by Facilities Only 211 CSHCN Services Prgram Wheelchair Seating Evaluatin Frm 213 CSHCN Services Prgram Prir Authrizatin Request fr Inpatient Rehabilitatin Admissin 214 CSHCN Services Prgram Prir Authrizatin and Authrizatin Request fr Durable Medical Equipment (DME) 215 CSHCN Services Prgram Prir Authrizatin Request fr Dental r Orthdntia Services 216 CSHCN Services Prgram Authrizatin Request fr Diapers, Pull-ups, Briefs, and Liners 217 CSHCN Services Prgram Hme Health (Skilled Nursing) Referral and Treatment Plan 218 CSHCN Services Prgram Dcumentatin f Receipt 220 CSHCN Services Prgram Authrizatin Request fr Initial Outpatient Therapy (TP1) 221 CSHCN Services Prgram Authrizatin Request fr Extensin f Outpatient Therapy (TP2) 222 CSHCN Services Prgram Physician/Dentist Assessment Frm 223 CSHCN Services Prgram Prir Authrizatin Request fr Stem Cell r Renal Transplant 224 CSHCN Services Prgram Prir Authrizatin Request fr Augmentative Cmmunicatin Devices (ACDs) 225 CSHCN Services Prgram Prir Authrizatin Request fr Renal Dialysis Treatment 226 CSHCN Services Prgram Authrizatin Request fr Apnea Mnitr 4 f 8 Effective Date_ /Revised Date_

5 CSHCN Services Prgram Dcument Numbers 227 CSHCN Services Prgram Authrizatin Request fr Chest Physitherapy Devices 228 CSHCN Services Prgram Prir Authrizatin Request fr Pulse Oximeter Devices 229 CSHCN Services Prgram Prir Authrizatin Request fr Respiratry Care CRCP (Certified Respiratry Care Practitiner) 230 CSHCN Services Prgram Authrizatin Request fr Omalizumab 231 CSHCN Services Prgram Reimbursement Request fr Transprtatin f the Remains f Deceased Clients 232 CSHCN Services Prgram Prir Authrizatin Request fr Palivizumab (Synagis) 233 Electrnic Funds Transfer (EFT) Infrmatin and Authrizatin Agreement 234 Claims Status Inquiry (CSI) Authrizatin 235 Electrnic Remittance and Status (ER&S) Agreement 236 CSHCN Services Prgram Prir Authrizatin Request fr Inpatient Psychiatric Care 237 CSHCN Services Prgram Prir Authrizatin Request fr Hspice Services 238 CSHCN Services Prgram Prir Authrizatin Request fr Medical Fds 239 CSHCN Services Prgram Prir Authrizatin Request fr Additinal Medical Nutritinal Services 240 CSHCN Services Prgram Criteria fr Dental Therapy Under General Anesthesia 241 CSHCN Services Prgram Dcumentatin f Receipt (Spanish) 242 CSHCN Services Prgram Visin Care Eyeglass Client Certificatin Frm 243 CSHCN Services Prgram Visin Care Eyeglass Client Certificatin Frm (Spanish) 244 CSHCN Services Prgram Authrizatin Request fr Nn-Face-t-Face Clinician- Directed Care Crdinatin Services 245 CSHCN Services Prgram Prir Authrizatin and Authrizatin Request fr Outpatient Surgery Fr Outpatient Facilities and Surgens 246 CSHCN Services Prgram Authrizatin and Prir Authrizatin Request Frm 247 CSHCN Services Prgram Refund Infrmatin Frm 248 Trt Respnse Frm 249 Department f State Health Services Frm t Release CSHCN Services Prgram Claims Histry 5 f 8 Effective Date_ /Revised Date_

6 CSHCN Services Prgram Dcument Numbers 250 Department f State Health Services Frm t Release CSHCN Services Prgram Claims Histry (Spanish) 251 CSHCN Services Prgram Prir Authrizatin Request fr External Insulin Pump Optin 5: AIS Appeals- Available frm 7am-7pm- Mnday- Friday When chsing Optin 5 (AIS Appeals) the caller will hear the fllwing message: Thank yu fr chsing autmated appeals. Sme limitatins apply t perfrming autmated appeals. Yu may bypass this message by selecting 1. Only 3 fields may be changed per claim. Only the fields annunced n the ptins menu can be appealed. Yu are allwed 15 transactins [appeals] per call. The billing NPI/API and r TPI n the internal cntrl number (ICN) entered must match the NPI/API/TPI yu entered int AIS. Autmated appeals instructins can be btained by selecting 2 frm the faxback ptin. The dcument number is 101. AIS Appeals steps: Please enter the 24-digit claim number that yu wish t appeal, fllwed by the # buttn. The claim number can be fund n yur R&S reprt. (The claim number will be repeated fr verificatin.) If this is crrect, press 1. If this is nt crrect, press 2 (asked t re-enter). Please wait while the requested infrmatin is being retrieved. (The caller will be prvided with a claim status if the claim cannt be appealed. If the claim can be appealed, the caller will be prmpted t chse frm ne f the ptins listed belw.) Please chse ne f the fllwing ptins. If yu knw yur menu ptin, yu may select it at any time: T change a place f service, press 11. T change a type f service, press 22. T change an authrizatin number, press 33. T change a quantity billed, press 44. T change a client number, press 55. T change a beginning date f service, press 66. T change an ending date f service, press 77. T change an X-ray date, press 88. T change a date f nset, press 99. T change a date f birth, press 00. Depending n the item(s) t be changed, the caller may be prmpted t chse t crrect the same infrmatin n all lines f the claim. If yur claim has multiple line items, press 1. If yu wish t change ne line item, press 2. 6 f 8 Effective Date_ /Revised Date_

7 Depending n the claim type, the caller may be prmpted t enter the line item number. Listen carefully t the messages that fllw. AIS guides the caller thrugh the prcess f making crrectins and submitting the appeal fr review. Be sure t write dwn the ICN f the new claim. AIS appeals respnse menu: T appeal anther claim, press 1. T speak t a custmer service representative, press 2. If n further infrmatin is needed, please discnnect. What fields can be changed thrugh AIS Appeals? Field Enter Place f Service 11 Type f Service 22 Authrizatin Number 33 Quantity Billed 44 Client Number 55 Beginning Date f Service 66 Ending Date f Service 77 X-Ray Date 88 Date f Onset 99 Date f Birth 00 Remember AIS appeal limitatins: Only 3 fields per claim may be changed thrugh AIS. N mre than 15 transactins (appeals) are allwed per call. Optin 6: Enter a new NPI/API and r TPI Number When chsing Optin 6 (enter a New NPI/API and r TPI Number) the caller will hear the fllwing message: Press 1 t enter yur Natinal Prvider Identifier. Press 2 t enter yur atypical prvider identifier. (Enter the CSHCN prvider identifier number when prmpted.) If nt available, please wait n the line and yu will be transferred t an agent. Please wait while the requested infrmatin is being retrieved. (The number will be repeated back fr verificatin.) Imprtant Nte: If the NPI has been attested t multiple CSHCN Services Prgram r Traditinal Medicaid numbers, AIS will request the prvider s CSHCN Services Prgram legacy prvider identifier number. 7 f 8 Effective Date_ /Revised Date_

8 If this is crrect, press 1. If this is nt crrect, press 2. The caller is asked t reenter the prvider s ten-digit Natinal Prvider Identifier (CSHCN Services Prgram prvider identifier). Optin 7: Custmer Service Representative When chsing Optin 7 (Custmer Service Representative) the caller will hear please hld, yur call is being transferred. The call is then transferred t a CSHCN Services Prgram custmer service representative. Optin 8: Repeat Main Menu When chsing Optin 8 (Repeat Main Menu) the caller will hear the AIS Menu ptins repeated. 8 f 8 Effective Date_ /Revised Date_