Advocate Physician Partners

Transcription

1 Advocate Physician Partners Real-Time Claim Status Look Up Training Material Last Updated: 03/18/2009

2 *** Benefits *** 24-hour Real-Time updates compared to weekly updates. "All Claim Inquiry" instead of only those claims in a final status. Easy to use. More details provided such as check number, coding remarks, appeal status and detail denial reasons. Shows historical claim history (if claim submitted multiple times, it provides the status per submission. Ability to import multiple requests when using template provided on website. Future enhancements Ability to export multiple requests via.csv or excel formats. 2

3 Enter the Patients Member ID Number (as displayed on ID cards) The Member ID must always be a 9-digit format: Humana: H HMOIL: (do not include XOH ) Unicare: 123A45678 HealthSpring: WellCare: Aetna: MEBCQ12Y3 Enter the rendering provider s NPI number. The NPI MUST be 10-digits Date of Service Date of Birth Date of Service and Date of Birth MUST be in the following format: MM/DD/YYYY - 12/25/2008 or M/D/YYYY - 1/8/2009 Click Submit button to retrieve requested data. 3

4 After entering the required information, the snapshot of the claim will display. This snapshot will include: APP Claim Number Claim Status Patient Account Number Total Billed Amount Total Approved Amount Total Copay Amount Total Deductible Amount Total Coinsurance Amount Total Rejected Amount Bank Check Number Rejected/Appeal Reason Appeal/iCES Comments APP Comments Statistical Flag APP Physician Vendor Number Paid Date 4

5 If you have another claim to look up, you can enter the information while the system is retrieving the data from the previous request. All claims requested will be displayed on the screen until the X is clicked. Real-Time Claim Status Look Up 5

6 Bulk Import Look Up To upload multiple files at once, click on the link to download the template. 6

7 Bulk Import Look Up Save the file to your computer, in an easy to find location. Open the document and start entering in the required data elements

8 Bulk Import Look Up ****IMPORTANT**** When entering patient data into the spreadsheet, if the member is HMOI and the member number begins with zero s, the member number MUST be entered into the cells with an apostrophe(') preceding the zeros. Otherwise, the data will not be recognized and claims will not be found. Example: ' or ' After entering required information into the template, save and close the document. If you receive a message saying do you want to save before closing, choose Yes. The file type will either read unicode text or can be changed to csv (comma delimited). 8

9 Bulk Import Look Up When the file is ready to be imported, click on the Browse icon, find your file and click Open. The file path and name will appear in the area next to the Browse button. Click on Submit

10 Bulk Import Look Up After submitting the request, a message will appear indicating the results. Example: A total of 6 out of 6 indicates you will see the results of all 6 claims. If the message: A total of 4 out of 6, appears, then only 4 of those claims were found and a message will indicate which line the errors were found and why, along with the listing of the results. Results Message Claim Status search 10

11 Real-Time Claim Status Lookup Bulk Export Tool The claim status lookup tool also has the ability to download the results into a pdf or csv format. After the results are displayed, choose which format is preferred and click 11

12 Real-Time Claim Status Lookup Bulk Export Tool If no claims were found, the export will not have any claims to download and a message will appear above the results. 12

13 Real-Time Claim Status Lookup Bulk Export Tool After clicking the download icon, a message will appear indicating to open or save the file. Choose Save and save to your computer, 13

14 Real-Time Claim Status Lookup Bulk Export Tool Or open to view the data and then choose file saveas. If you are saving the data as a pdf format, each claim snapshot will appear as a separate page in one pdf file. 14