Web interchange. UB-04 Institutional Claim Submission HP Provider Relations/May 2013

Transcription

1 Web interchange UB-04 Institutional Claim Submission HP Provider Relations/May 2013

2 Agenda Session Objectives Advantages to Electronic Claim Filing Providers Using the UB-04 Password Reminders Submitting a Claim Crossover Claims and Third Party Liability (TPL) Attachments Claim Notes Questions Helpful tools 2

3 Objectives Following this session, providers will have knowledge of Benefits of electronic billing Resetting passwords Submitting a claim on the Web interchange Complete crossover and TPL billing Add claim attachments Add claim notes 3

4 Benefits of Submitting Electronic Claims

5 Why file electronically? More timely reimbursement Ability to view claims within hours of submission Correct claim errors electronically instead of written adjustment Eliminate possibility of keying errors or illegible writing Control of information submitted on claim Web interchange is FREE 5

6 Providers Using the UB-04 Claim Format

7 Providers Using the UB-04 Form IHCP Provider Manual, Chapter 8, Section 2 Ambulatory surgical centers (ASCs) End-stage renal disease (ESRD) clinics Home health agencies (HHAs) Hospices Hospitals Long-term care (LTC) facilities Rehabilitation hospital facilities 7

8 Password Reminders

9 Password Reminders Individual users can reset their own password Web interchange administrator can perform the following: Reset user passwords that have been disabled due to lack of use Reset user passwords that are locked out due to failed logon attempts Reactivate or deactivate user passwords Administrator passwords are no longer reset over the telephone by the Electronic Solutions help desk Under the new policy, the administrator can call the help desk if they are locked out After the administrator correctly answers his or her security questions, the Electronic Solutions help desk will a new temporary password to the user s address on file Sharing user IDs and passwords violates Health Insurance Portability and Accountability Act (HIPAA) security regulations and the Web interchange user agreement Personal information associated with a user ID must belong only to the specific user 9

10 UB-04 Electronic Claim Submission

11 Accessing Web interchange Web interchange is accessible from the Indiana Health Coverage Programs (IHCP) website at indianamedicaid.com under the Provider link Click inside the box to access the logon page of the Web interchange 11

12 Web interchange Click here for general billing instructions 12

13 Claim Filing Assistance 13

14 Choose Form 14

15 OPR 15

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20 Claim Information OPR (Ordering, Prescribing, and Referring) Claims with dates of service on or after October 1, 2012, will deny if: The National Provider Identifier (NPI) on the claim, for the OPR practitioner, is not correct (other provider NPI) The OPR practitioner is not enrolled in the IHCP program Reference BT for additional information Type of bill See IHCP Provider Manual, Chapter 8, Section 2 for link to code set Code set is maintained by the National Uniform Billing Committee Patient Status Enter the code indicating the member discharge status as of the ending service date on this claim Admission type, date and hour Note: Reference IHCP Provider Manual, Chapter 8, Section 2 for additional billing information (provider.indianamedicaid.com) 20

21 Crossover and TPL Billing

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23 Benefit Information Crossover Claims 23

24 Medicare and Replacement Plans 24

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28 Crossover Claim Information Payer ID = Replacement Plan- Payer identification (ID) will be Medicare s payer ID Payer Name = Wisconsin Physician Services or WPS Replacement Plan name in the Payer Name Field Medicare Paid Amount = the total amount paid by Medicare for the claim Subscriber Name = Name of policy holder for primary insurance Primary ID = Medicare number with an alpha character Replacement Plan policy holder ID Relationship Code = 18 (self) Claim Filing Code = MA Click Save Benefits at the bottom of the screen Click Save and Close at the top of the screen Note: Obtain coordination of benefits (COB) information, including payer IDs from the HELP tab, Reference Materials on Web interchange 28

29 Benefit Information Third Party Liability (TPL) 29

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31 BLANK 31

32 Claim Attachments

33 Claim Attachment Feature 33

34 Claim Attachment Feature 34

35 Claim Attachment Feature Left click on Report Type Code to display a list of available codes or to find out field definition Created by the provider 35

36 Claim Attachment Feature Attachment window Create the attachment control number (ACN) Unique number assigned by provider Claim- and document-specific Each ACN may only be used one time Select the appropriate Report Type code Report Type describes the document being sent Transmission Code defaults to BM by mail Electronic and ed attachments are not accepted 36

37 Claim Attachment Cover Sheet Information in this area must match your claim exactly Must match the information on the claim Do not count the cover sheet 37

38 Claim Attachment Cover Sheet Available on the Forms page of indianamedicaid.com or on Web interchange by going to the Help link > Reference Material section > Attachment Cover Sheet link Complete one cover sheet for each claim Include provider information Include the member ID (RID) List each ACN pertaining to specific attachment Indicate the page count for the attachment (do not count the cover sheet) Write ACN # and the assigned ACN on each page of documentation corresponding to that number Mail cover sheet and supporting documentation to: HP P.O. Box 7259 Indianapolis, IN

39 Use Claim Notes

40 Claim Notes 40

41 Claim Notes 41

42 Claim Notes When to submit notes 90-day provision When a third-party insurance carrier fails to respond within 90 days of the billing date, you can submit the claim to the IHCP for payment consideration. However, to substantiate attempts to bill the third party, the following must be documented: Date of the filing attempts The phrase NO RESPONSE AFTER 90 DAYS The member s identification number (RID) Your National Provider Identifier (NPI) number Name of primary insurance carrier billed Abortion diagnosis/procedure indicated In the claim note, the IHCP accepts indication of medical documentation that supports the need to save the mother s life or a police report that indicates rape or incest 42

43 Claim Notes When to submit notes Consultation billed 15 days before or after another consultation In the claim note, indicate the medical reason for a second opinion during the 15 days before or after the billed consultation Joint injections (four per month) In the claim note, document that the injections were performed on different joints (for example, left and right) and indicate the injection sites Pacemaker analysis (two within six months) Use the claim note to document the medical reason for the second analysis in the sixmonth time frame, such as a dysfunctional pacemaker Assistant surgeon not payable when cosurgeon is paid In the claim note, the IHCP accepts information that documents the medical reason for the assistant surgeon, such as the problem requiring assistance 43

44 Claim Notes When to submit notes Excessive nursing home visits or more than one per 27 days In the claim note, the IHCP accepts documentation supporting the treatment of emergent, urgent, or acute conditions or symptoms with the new diagnosis code Retroactive eligibility Use claim notes when billing a claim that is past the filing limit and the member was awarded retroactive eligibility In the case of retroactive member eligibility, claims must be submitted within one year of the eligibility determination date In the claim note type, Member has retroactive eligibility. Please waive timely filing. 44

45 Find Help

46 Helpful Tools IHCP website at indianamedicaid.com Electronic Solutions Service Desk (toll-free) (317) (local) Customer Assistance (toll-free, use in Indiana [except 317 area code], Illinois, Michigan, Ohio and Kentucky) (317) (use in all other areas) Written Correspondence HP Provider Written Correspondence P. O. Box 7263 Indianapolis, IN Provider Relations field consultant provider.indianamedicaid.com/contact-us/provider-relations-fieldconsultants.aspx

47 Q&A