PROVIDER WEBSITE SUB USERS GUIDE PATIENT INQUIRY CLAIM CENTER FIND A DOCTOR THE CLAIMS EDITING SYSTEM (CES)

Transcription

1 PROVIDER WEBSITE SUB USERS GUIDE PATIENT INQUIRY CLAIM CENTER FIND A DOCTOR THE CLAIMS EDITING SYSTEM (CES) 2016 WPS Health Plan, Inc. All rights reserved

2 SUB USER GUIDE INDEX Introduction... 3 Accessing the Website... 3 My Account... 3 Logging In... 4 Arise Health Plan Provider Website Features... 4 Patient Inquiry... 4 Patient Information... 6 Claim Center... 6 Claim Editing... 8 CES (Claim Editing System)... 8 Navigating CES... 9 Submit Claims and WTPS Find a Doctor System Notes

3 INTRODUCTION Welcome to the enhanced Arise Health Plan Provider Website. The enhanced website will allow providers access to benefits, patient information, claims, subscriber and policy details, and other insurance information through the Patient Inquiry tab. The Claim Center tab will allow providers to search for claims, check claims for errors or omissions prior to submission and submit claims. You can also view the providers within a patient s current network and look for providers within selected networks. Arise encourages large facilities to utilize the electronic 270/271 Health Care Eligibility/Benefit Inquiry and Information Response transaction and the electronic 276/277 Health Care Claim Status Request and Response transaction. At this time, use of claim status on the website by large facilities with multiple locations will require multiple logins. ACCESSING THE WEBSITE My Account Access the website at 3

4 Logging In Log in with the User ID and Password you created. ARISE HEALTH PLAN PROVIDER WEBSITE FEATURES The Arise Health Plan Provider Website offers the following: Patient Inquiry: benefits, patient information, claims, subscriber and policy details, and other insurance information Claim Center: search for claims, check claims for errors or omissions prior to submission and link to electronic claim submissions. Find a Doctor: view the current providers within a patient s network and look for doctors within selected networks CES: Providers can enter procedure codes, modifiers, diagnosis codes, date(s) of service, patient gender, date of birth, and place of service parameters, in order to review results specific to the procedure codes being queried Patient Inquiry To access patient information, click on Patient Inquiry. 4

5 You may search by Patient ID or by First and Last Name and Birthdate. YOU CAN SEARCH BY EITHER Click on the Patient name from this screen for more patient details. If the search does not yield any results, the following error will be produced. Users will be directed to refine their search or contact Customer Service at or , option 1. Information in regard to the 270/271 Transaction as an alternative option for claim eligibility can be located in the Arise EDI section of our website: 5

6 Patient Information This screen displays information regarding effective and term dates, other insurance, primary care physicians, and more. Claim Center The Claim Center will allow providers to search for claims by patient or claim ID, check claims for errors or omissions prior to submission, submit electronic claims, or access the WPS Trading Partner System. Information regarding the 276/277 Transaction and the Interactive Voice Response (IVR) as alternative options to the Claim Center can be found in the Arise EDI section of our website: WeCareForWisconsin.com/edi/comm_sub.shtml 6

7 You may search for claims by the member name or claim ID. In the Advanced Search you will search by Type (Medical or Hospital) and the service dates (cannot exceed 60 days), Member, and Provider. Clicking on the magnifying glass icon by the Member field will take you to the Patient Inquiry Screen. Once you have located the patient, click on the name and this will populate the Member field on the Advanced Search. YOU CAN SEARCH BY EITHER When the search is complete, you will see the Claim ID, Service Dates, Patient (ID), Service Provider (NPI), and Status for the claim(s) you requested. For additional information, such as ANSI codes, click on the Claim ID number. If no claims are found matching the search criteria, you will be directed to the appropriate claims processing area. If the claim was submitted electronically, you will be directed to contact EDI at to verify receipt of the claims and status of your file. If the claim was submitted on paper, then you will be directed to contact Customer Service at or , option 1. 7

8 Claim Editing Claims Editing System (CES) In the interest of payer transparency, Arise has developed an interactive portal within the Arise Provider Website at Providers can proactively determine how a particular code combination will process. Providers will be able to enter procedure codes, modifiers, diagnosis codes, dates of service, patient gender, date of birth, and place of service parameters, in order to review results specific to the procedure codes being queried. The results and rationale will be displayed and can be downloaded to a PDF. This will allow for greater transparency of the code combination edits being utilized at Arise. Upon entering the CES, this will be the first screen you see. 8

9 Navigating CES 1. Professional Claim Entry Enter all applicable fields and then click Submit. Note: Begin Date of Service, End Date of Service, and patient Date of Birth are each a drop-down calendar; select the mm/dd/yyyy Patient Gender is a drop-down selection Claim type defaults to Commercial 2. Results The results will display on this page. 3. Export to PDF Clicking this button creates a PDF file for the provider to print off the results.. 9

10 Submit Claims and WTPS Submit Claims This button will direct you to Arise Secure EDI, where you can log in and submit your claims electronically. Direct Submitters are required to have a Arise Submitter ID in order to log in and submit claims. WTPS WTPS is the WPS Trading Partner System, which is also used by Arise, where you can register for a Trading Partner number (Arise Submitter ID), which will allow you to submit claims electronically through Arise Secure EDI and receive electronic remittance advice (ERA). This ID is required for claims submission and ERA retrieval. For more information on Submitting Claims or the WPS Trading Partner System, please contact our EDI Help Desk at Find a Doctor This tab allows you to locate an in-network provider by name, specialty, or location. 10

11 Select Existing Subscriber and follow prompts. Used to display providers within the patient s current network Used to display all providers within a selected network If an Arise subscriber number is entered, you ll be directed to this page. Enter Group number and follow prompts

12 System Notes After 30 minutes of inactivity, you will receive the following pop-up warning that you are about to time out. To continue your session, you can click on the Continue Session button to return to your activity or Log Out to quit. If you actually time out, the system will return you to the login screen. 12