Online and IVR Features Guide. for physicians, providers & office administrators

Transcription

1 Online and IVR Features Guide for physicians, providers & office administrators

2 Fast and easy access to the information you need With Premera Blue Cross it s easy to get the information you need when you need it. The provider portal at premera.com and our Interactive Voice Response (IVR) phone system offer 24/7 access to the information you require to serve patients, track claim status, check benefits, eligibility and much more. A B C D E F G H I J Provider Home Log In / Register My Premera Tools Find a Doctor Rx Search Eligibility & Benefits Claims Claims Editor Submit Estimate/Claim* Utilization Review Prospective Review Advanced Imaging Admission Notification Close-up of left navigation bar * For contracted providers Library Forms Reference Info Communications Care Facilitation Pharmacy 2

3 A wealth of information at your fingertips Our convenient online provider features reduce paperwork, save time, and make your job easier. Visit our secure provider portal designed especially for physicians, dentists and other providers today. Using the provider portal is easy. To find out more, check out the Getting Started section of this guide. Once you ve followed the simple registration process, go to premera.com and log into the provider portal for instant access to these features: A My Premera Read important information (Alerts!) Get the latest provider news Access secure newsletters and manuals Bookmark claims for easy tracking. Tools B Find a Doctor Quickly find physicians or other providers in our networks Create and print custom directories F G Claims Editor Access the What If Tool to test billing scenarios and code combinations with our claims editing software and the tool shows specific coding rationale Submit Estimate/Claim * Get patient information about their share of cost at the time of service Accurate calculation using your contract pricing and patient eligibility, benefits, deductible, coinsurance, copay, accumulators, and out-of-pocket maximum Option to register for real-time claims submission C D E Rx Search Get info on generic and brand-name drugs Find copay tier information and alternative drugs Eligibility & Benefits Get eligibility and benefit information for members, including deductible and benefit limit accumulators Access benefit and eligibility information for nationwide BlueCard, NASCO and Federal Employee Program (FEP) members Claims Check the status of your claims for Premera members, quickly and easily Access claims status details for nationwide BlueCard, NASCO and Federal Employee Program (FEP) members Claims editing detail. View claim explanation of payment codes, including claims editing rationale (when available). Utilization Review H Prospective Review Check procedure codes to determine if a benefit advisory is recommended I Advanced Imaging Submit a request for review when ordering an advanced imaging service J Admission Notification Learn about our admission notification process Find the list of services that require admission notification * Only for contracted providers. 3

4 Close-up of left navigation bar Provider Home Log In / Register My Premera Tools Find a Doctor Rx Search Eligibility & Benefits Claims Claims Editor Submit Estimate/Claim Utilization Review Prospective Review Advanced Imaging Admission Notification Library Forms Reference Info Communications Care Facilitation Pharmacy Library 1 2 Forms Download and print: Claims and Billing Care management forms Credentialing forms Pharmacy Supporting Documentation Cover Sheet Documentation and Diagnostic Reference Information View reference materials, including: Clinical Practice Guidelines Medical policies Payment policies Reference manuals EOP codes Alpha plan prefixes Clinical review by code list Communications Review physician and provider newsletters for: Regulatory updates New business processes or changes Clinical and disease management information Care Facilitation Learn about our supportive programs and services, including: Care Management Quality Programs Disease Management Pharmacy Pharmacy Mail Service Drug Search epocrates Point-of-Sale Program Generics Program 4

5 Getting started Premera Blue Cross has joined other leading healthcare organizations in standardizing the security of our web sites through onehealthport.com. OneHealthPort offers its security services free of charge to registered subscribers. Step 1 Register* Go to onehealthport.com Click on Register and follow the instructions at the site to register your organization and give designated employees access to premera.com. Register * Registration for first-time users only. Once you re registered, you may skip this step. Step 2 Go to premera.com To access the Providers Home page Click on the For Providers link. Step 3 Log In To access secure information and services Click on the Log In link and then enter: Your User ID* Your Password** * You will receive a User ID when you register at onehealthport.com. ** You create your own Password when you register at onehealthport.com. 5

6 Interactive Voice Response (IVR) Phone System Information available quickly and efficiently Z Premera s IVR phone system allows you to either speak your responses or enter them using your telephone keypad. Within minutes, you can submit and obtain information for our members without waiting on hold for a customer service representative. Tips for Successful IVR use: Use a headset with microphone or handset for creating records. Avoid using a speaker phone. Keep your talking environment as quiet as possible. Before calling, have all the required information on-hand. Speak into the phone as clearly as possible. You may choose to key in numbers for options or codes. Enter the member s date of birth as month (using two digits), day (using two digits) and year (using four digits). Do not use slashes or hyphens. Example: represents March 1, 1995 If you make an error while keying in the member ID number, press the * key and the system will prompt you to re-enter it. Once familiar with the script, you no longer need to listen to the complete prompt. If you request eligibility verification for more than one member at the same time, and you encounter subscriber or birth date errors, note them and wait until you have completed your inquiries before connecting to a customer service representative. Customer Service IVR system The following options are available through our Customer Service IVR phone system by calling , option 2. Retrieve member eligibility and benefit information Check on claims status. Care Management IVR system The following options are available through our Care Management IVR phone system by calling , option 3. Physicians, home health agencies and other providers can enter requests for benefit advisories for inpatient/ outpatient procedures Provide notification of hospital admission Check benefit advisory status Enter specific procedure codes to determine when a benefit advisory is recommended. To complete a benefit advisory request, you will need the numeric procedure code(s), numeric diagnosis code and the date of service (if known). To provide notification of hospital admission request, you will need to provide the date of admission and numeric diagnosis code. To check the status of a benefit advisory, you will need to provide reference number, if known, or date request was submitted and numeric procedure codes submitted. To determine when a benefit advisory is recommended, you will need to provide numeric procedure codes. Be patient! 6 BlueCard and NASCO member information is not available through the IVR phone system.

7 Save Time and Money Using Self-Service Options Premera offers online, voice-activation and self-service options so you can quickly obtain benefits, eligibility and claim status information. Our online tools and Interactive Voice Response (IVR) phone system are quick and efficient. These self-service options provide information even faster than direct calls to our Customer Service representatives. Online Options and Tools Using Premera s secure provider portal can save significant time compared with phone inquiries. Simply register at onehealthport.com for a free ID and password. You can quickly obtain claims information on our secure web site at premera.com/provider. Log on 24 hours a day, 7 days a week to use the following options: Eligibility and Benefits Claim Status BlueExchange (for BlueCard, NASCO, and FEP members) Claims Editor/What If Tool: Test billing scenarios with our claims editing software. OneHealthPort s Training Center To learn more about navigation and functionality of our online tools, watch our video tours at onehealthport.com. We have a link to OneHealthPort s Training Center from our landing page at premera.com/provider. It is located under Resources and Tools. More Time-Saving Tips Electronic Billing Providers who submit claims electronically can also take advantage of other electronic transactions for example, checking eligibility or doing a claims status inquiry. If you are currently billing on paper, billing electronically will improve the turnaround time of your payments. (You can also submit corrected claims electronically.) Electronic submission: 7-15 days Typed standard claim form: days Handwritten standard claim form: 21+ days To get started contact EDI at or EDI@premera.com. Claim Status Inquiries Did you know we process 98 percent of claims within 30 days of receipt? To increase efficiency and minimize phone calls and administrative costs for your office: Submit claims as soon as possible Check the provider portal for claim status before calling Customer Service Wait until the claim is in process at least 30 days before calling us. Questions? If you have questions or comments about our self-service options, please call Premera Physician and Provider Relations at , option 4. IVR Phone System Premera s IVR phone system is another efficient resource you can use to obtain eligibility, benefits and claim status.* To access our IVR phone system, call: Customer Service: , option 2 Care Management: , option 3 FEP (Federal Employee Program): * BlueCard and NASCO member information is not available through the IVR system. 7

8 Important Phone Numbers OneHealthPort Registration For information on how to register, go to onehealthport.com. Questions? Contact OneHealthPort at (toll free) or OneHealthPort Technical Support Technical support for OneHealthPort is provided by PlanIT Technology Group, OneHealthPort s technology partner. Self-help and test your login are available at: onehealthport.com/use_ohp/support.php or by calling (toll free). Customer Service If you have specific questions about a claim, member eligibility or member benefits, please contact Premera Customer Service: , option 2. Provider Relations If you have questions about network participation or contracting, please contact the Premera Physician and Provider Relations Team: , option 4. Technical Problems If you re experiencing technical difficulties with our site, please contact the Premera Web Support Team: , option 5. Recommended Web browsers and screen resolution This site is best viewed using a Windows-based computer system and either Internet Explorer 5.5 or higher or Firefox/Mozilla 1.5 or higher. Premera Blue Cross is an Independent Licensee of the Blue Cross Blue Shield Association ( )