AN ONLINE TOOL FOR PROVIDERS

Transcription

1 ACCESSPOINT OVERVIEW AN ONLINE TOOL FOR PROVIDERS

2 AccessPoint Features What is AccessPoint? AccessPoint is a secure online interface to claims and eligibility information. It is a location for proprietary information such as product fee schedules and capitation payment information. AccessPoint is a shared resource and contains information used by State Sponsored and Commercial lines of business. 2

3 Why Should A Provider Use AccessPoint? AccessPoint is free online tool that gives providers a fast and convenient way to look up: Member eligibility and benefits Claims status t Remittance Advice Eligibility and/or Capitation Reports 3

4 How does a provider get to AccessPoint? Providers can access the site from and select Providers 4

5 Finding AccessPoint Select State Sponsored Plan providers for all Medicaid information. Note: Providers should NOT use the COMMERCIAL website for information on Medicaid business. 5

6 Finding AccessPoint The State Sponsored Business page has links to AccessPoint and state-specific specific program information and resources. To go to AccessPoint: Select Medical in the dropdown menu Click Login 6

7 Login Page On the Login page you can: Enter a User ID and Password for an existing user. Reset forgotten Passwords. Click Register for AccessPoint Pitfor new users. Have an Account Need an Account Reset Password 7

8 Registering for an AccessPoint Account 8

9 How to request an account To request an account you must have a valid tax ID. The system will first check to see if an account already exists for the tax ID. If an account does not exist, the requestor must confirm that he/she can make a legally binding agreement for the provider or organization. 9

10 Complete a Short Form The form requests general information about the user and provider/organization. Any required information must be completed, including a valid address. 10

11 Agree to Terms and Conditions The final registration step requires acceptance of an Agreement outlining the terms and conditions for using the website. Once the account has been approved an will be sent to the user at the address provided. Account approvals usually take 1-2 business days. 11

12 Access to the site Once the provider account has been approved, you can login to AccessPoint. 12

13 AccessPoint Eligibility ibilit Inquiries i 13

14 Eligibility & Benefits Inquiry There are two ways to check a member s Eligibility: 1. Enter the member s ID and date of birth into the Eligibility & Benefits panel located on the right side of the home page, or 2. Click on the Eligibility & Benefits Tab at the top of the web page and then click on the Eligibility and Benefits Inquiry Link 14

15 Eligibility & Benefits Inquiry Selecting the Eligibility & Benefits Tab allows you to search for eligibility information on one or more members. Enter the member ID and the date of birth. Select the type of benefit. Click Search. 15

16 Eligibility & Benefits Summary The Eligibility and Benefits Summary page will display the member and plan information. The effective date of an active member will show the end date as 12/31/9999. Terminated members will not have benefit information. Note: You can only do eligibility inquiries for the current year s benefit information. Most of our plan benefits are based on calendar year so only 1/1-12/31 of the current year will be available. 16

17 Eligibility & Benefits Summary A dropdown selection on the Eligibility & Benefits Summary panel will have links to: Contact Customer Service for contact and billing information. Perform Claims Status Inquiry for claims details. View Eligibility & Benefits Details for additional information on the member s coverage. 17

18 Eligibility and Benefits Detail Page Plan Information fields show a member s Active coverage. PMG/PCP and Benefit information are available as you scroll to the bottom of the page. Note: The PMG/PCP Information panel only shows a small number of providers at a time. If a member has an extensive history, please select next or view all to see additional information. To find the active PMG/PCP/IPA, look for the term date 12/31/

19 Lets Review Helpful Hints 1. To view Eligibility and Benefits you must include the member s ID and birthday. 2. Active members have a term date of 12/31/ You can only search eligibility and benefits for the current calendar year (1/1-12/31). 4. Click View All on the Eligibility ibilit and Benefits Detail page to see the complete PMG/PCP/IPA list. 5. To find the active PMG/PCP/IPA look for term date 12/31/ Terminated members will not have benefit information. 19

20 AccessPoint Claim Inquiries i 20

21 Claims Inquiry You can access Claim Status information on the Eligibility & Benefits Summary drop down and under the Claims tab on the AccessPoint website. The Claims tab has links to: Claim Status Inquiries for member claim searches Claims Reporting for a list of submitted claims by tax ID and NPI Remittance Advice Inquiry for PDF copies of payment details. 21

22 Claims Inquiry Claims Inquiry is a search for claims for a specific member. Note: The service date must be an actual date of service. It can not be a general date range search. Select the tax ID then wait while the Servicing Provider field updates. Select the billing NPI from the drop down or type it into the Refine Servicing Provider Search Enter the member ID, DOB, and service dates. Click Search 22

23 Claims Inquiry The member name will populate and then you can click Continue 23

24 Claims Summary The Claims Summary page will give you a list of claims that fall within the selected service date and will include : Service Date Claim Number Charged Amount Amount Paid Date Processed Claim Status Claims with additional information will have a link available on the Claim DCN number. 24

25 Claims Reporting Claims Reporting is available under the Claims tab and provides a list of submitted claims by a particular tax ID and NPI. Select the Report type and enter in the date range for the search. Please note the date range search can not be greater than 90 days from Received Date From to Received Date To. Claims information is available for two years. Select the Tax ID and NPI from the drop down and click Search. You will receive a list of claims received in that date range. 25

26 Remittance Advice (RA) Inquiry Remittance Advice Inquiry is available under the Claims tab and allows a provider to see a PDF copy of an RA. Select the tax ID Enter in a date range no greater than 7 days Click Search Results will contain all RAs for that tax ID. Then click on View Remittance 26

27 Lets Review Helpful Hints 1. To view Claims Inquiries you must select the tax ID and billing NPI as well as enter the member s ID and birthday. 2. When searching for a claim you must use an actual date of service. The search will not return results with random dates. 3. Claim information is available for 2 yrs, however date ranges entered into the search fields must be entered correctly and vary for each type of search: Claim inquires Search can have a 6 month span between service date from and service date to Claim reports Search can have a 90 day span between een Received ed Date From and Received Date To Remittance Advice Search can have a 7 day span between service date from and service date to 27

28 AccessPoint Additional Resources 28

29 Member Eligibility and Capitation Reports Eligibility Rosters and Capitation Reports are available under the Reports tab of AccessPoint. These provider reports are created monthly by the HMO Finance and Membership departments and are available on the web approximately the tenth of each month. 29

30 Data Dictionary and Site Code Complete the following fields to download your report: Select Date AccessPoint stores reports for six months Select File Type Print Ready (PDF) A version that is ready to read. Raw Data A file in csv format that should be uploaded into a data management system like Microsoft Access. Data Dictionary Explains the fields that are contained in the raw data file report in order to set up the data management system. Select Medicaid or CHIP as the Line of Business Select the site code for your office and click search to download the report 30

31 Home Page Resources There are many additional resources available on the AccessPoint Home Page Some of the items you will find include: Provider Operations Manuals SSB Fee Schedules Code lists for Prior Authorization Note: Information, tools and resources that apply to and can be used by State Sponsored Business are clearly identified. 31

32 AccessPoint gives providers a fast and convenient way to look up information. Using this site allows you to get answers quickly and without a phone call. Log into the site to access information on: Member eligibility ibili and benefits Claims status Remittance Advice Eligibility and/or Capitation Reports State Sponsored Resources When you get a chance, come visit the site at: UniCare Health Plan of Kansas, Inc., Registered mark of WellPoint, Inc. UniCare Health Plan of West Virginia, Inc., Registered mark of WellPoint, Inc. 32 WLP3435