Behavioral Health Provider Training: Claims Tutorial
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1 Behavioral Health Provider Training: Claims Tutorial
2 Claims Submissions Claims can be submitted in 3 ways: 1. Paper Claims mailed to: Passport Health Plan Attn: Claims 500 Unicorn Park Drive, Suite 103 Woburn, MA Out of Network providers must submit paper claims 2. Electronic Data Interchange (EDI) 3. eservices
3 Electronic Data Interchange (EDI) EDI is the preferred method for receiving claims. We accept the standard HIPAA 837 format and provide 835 transactions. Beacon also uses 270/271 transactions for eligibility purposes. Beacon does allow EDI claims to be submitted from a Clearing House or Billing Agency. EDI claims may also be submitted to Beacon via Emdeon. Beacon s Emdeon payer ID is Please note payer ID is incorrect for behavioral health, as it is for medical only. Passport Health Plan s ID is: 028. All EDI claims submitted via Emdeon must include the member s Passport Plan ID and Beacon s Emdeon payer ID. Using just one or the other will cause claims to reject. EDI registration forms are on the Beacon web site at Submit the EDI Registration forms and schedule test submissions with the EDI team. After test submissions have been completed, contact EDI Operations to request a production setup. They can be reached at , or via at edi.operations@beaconhs.com.
4 eservices This is a free service for all contracted and in-network Passport providers. The goal of eservices is to make clinical, administrative, and claims transactions easy to do. By using eservices you will be able to: Submit requests for authorization Submit claims Verify member eligibility for Passport Health Plan Confirm authorization status Check claim status To sign up for eservices, please register at Complete the eservices Terms of Use form..\beacon_eservicestermsofuseaccountauthorization.pdf Submit the eservices Terms of Use form via fax to
5 eservices - Registration
6 eservices - Registration
7 eservices Landing Page
8 eservices Areas of Focus
9 eservices Check Member Eligibility
10 eservices Review Authorizations
11 eservices Check Auths
12 eservices Manage Auths
13 eservices Check Claims by Member
14 eservices Check Claims by Provider
15 eservices Check Claims by Auth
16 eservices Submitting eclaim
17 eservices Select Submit eclaim link
18 eservices Select Type of Claim
19 eservices Blank claim form
20 eservices Required Elements
21 eservices Are we forgetting anything?
22 eservices Add a service line
23 eservices Error notices
24 eservices Confirmation
25 eservices Resubmit an eclaim
26 eservices Find the claim
27 eservices Claim Search results
28 eservices Click Resubmit
29 eservices Fixing the claim
30 eservices Make the changes
31 eservices Required Element Check
32 eservices Additional Confirmation
33 eservices Claim Receipt
34 eservices Managing Users
35 Important Claim Reminders All claims must be received within Passport s timely filing limit of 180 days. Any corrected claims must be submitted within 24 months of the service date. All clean claim submissions (meaning no missing/incorrect/expired data or information) will be processed and paid within 30 days.
36 Top Claims Denial Reasons Timely filing. The claim denied as it was not received within 180 days. Missing or incorrect NPI/Taxonomy number. All claims must list the rendering clinicians individual NPI and taxonomy numbers, along with the billing provider s NPI and taxonomy numbers. If any of these numbers are missing, incorrect or expired, the claim will deny. No authorization. If the member has no authorization to see the provider, or the authorization has expired, the claim will deny. It is important to make sure the member has an authorization in place or has the initial benefit visits remaining before seeing them. Code not eligible for payment on the DOS. The claim was submitted with an invalid procedure code / modifier combination. Check to make sure the procedure code is valid and that an appropriate modifier was submitted with it. Remember that lab services must be submitted directly to Passport and not as a behavioral health claim.
37 PaySpan Payments are issued on a weekly basis in partnership with PaySpan. Paper checks and EOB information is issued to the address on record. If you are interested in participating in EFT payments, please contact PaySpan directly at (877) with your banking information.
38 Additional Info All claim resubmissions must include the Rec ID from the original claim to prevent unnecessary timely filing denials. Waiver requests (for timely filing) may be submitted within 180 days from the qualifying event and must be accompanied by a claim form (available on Qualifying events include: retroactive member eligibility; retroactive authorization and retroactive provider eligibility. If your request is not for one of these reasons, it will be denied and you must follow the procedure for reconsiderations. Once you have exhausted all other avenues, you can submit a request for reconsideration of the 180 day timely filing limit. Reconsiderations must include: Copy of claim form with a cover letter explaining why claims were not filed in a timely manner, along with supporting documentation. Screen prints of billing ledgers, certified mail receipts or documentation that claims were sent to a clearinghouse are not considered proof of timely filing.
39 Helpful Passport enews info NCCI edits content/uploads/2015/02/02-19-prov51037-bh- Passport-News-BillingCodeClarification-FINAL.pdf Targeted Case Management content/uploads/2015/03/03-02-hlth40814-non- CMHC-TCM-Update.pdf List of approved modifiers and example claim form
40 Helpful Contact Info Behavioral Health Hotline: (855) Behavioral Health Claims Hotline: (888) eservices Helpline: (866) Your Passport Provider Relations rep does not have access to eservices and cannot reset passwords. Please call the Helpline for assistance. PaySpan Provider Services Hotline: (877) Enrollment hotline: (502) or by at
41 Provider Network Contact Info Cindy Bundy, Provider Network Manager (502) Micah Cain, Provider Relations Specialist Christine Drake, Provider Relations Specialist (502) (502) Micah serves Region 3 providers Christine serves Regions 5, 6, 7 and 8 Teri Hardman, Provider Relations Specialist Taquitta Porter, Provider Relations Specialist (502) (502) teri.hardman@passporthealthplan.com taquitta.porter@passporthealthplan.com Teri serves CMHC providers Taquitta serves Regions 1, 2 and 4 Brittany Hammonds, Provider Relations Specialist (502) brittany.hammonds@passporthealthplan.com Brittany provides admin support to the team
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