Interactive Voice Response Medicare Part B Provider

Transcription

1 Interactive Voice Response Medicare Part B Provider Hours of Availability Mon - Fri: 6:00 a.m. to 7:00 p.m. CT for the states of: CO, IA, ND, SD & WY. Mon Fri: 6:00 a.m. to 9:00 p.m. CT for the states of: AK, AZ, HI, NV, OR & WA The following pages will provide you with instructions for making telephone calls using our Interactive Voice Response System (IVR) known as STAR (Speak To an Automated Representative). STAR is a system that enables you to obtain information through a speech-enabled, self-service telephone interface driven by your voice. Providers can obtain claim and deductible information and obtain pricing for the current and prior year. On June 10, 2005, Noridian Administrative Services implemented the new Interactive Voice Response (IVR) phone system as required by Change Request (CR) 3376 issued on September 10, 2004 by the Centers for Medicare & Medicaid Services (CMS). CR 3376 states, "With an increasing claims volume comes an increasing number of Medicare provider inquiries. One important way to successfully manage the workload is to increase and enhance the self-service technology tools available to Medicare providers and to require providers to use these tools when appropriate." They also state, "Contractors shall improve the quality and number of self-service options they make available to providers." CR 3376 also outlines that contractors shall offer, as a self-service technology, Interactive Voice Response applications for telephone inquiries. The IVR application must provide, at a minimum, patient eligibility, claim status, the top 100 remittance advice code definitions and other helpful information to help providers to resolve issues. As a result of the implementation of the IVR and the verbiage of CR 3376, providers will be required to utilize the IVR application to access basic inquiries such as eligibility, claim status, and certain financial information such as check information and the breakdown of payments and withholdings for specific remittance dates. CMS also states in CR 3376, "Provider telephone CSRs are not intended to answer questions that can be answered on the IVR; they shall refer the callers to the IVR. Contractors shall identify and contact providers who

2 repeatedly call CSRs for information that is available on the IVR to assist them to effectively use the IVR, including transferring providers back into the IVR. At a minimum, such education should happen at the time of the inquiry to the CSR, but may, in some cases, require post-call reinforcement." Our customer service representatives will still be available to serve you, and to assist you with the new IVR application. There will be a transition period for providers to adjust to the new IVR system. After the transition period, customer service representatives will only be available to answer questions that cannot be answered by the IVR. What are the benefits of the IVR? Per CR 3376, the Centers for Medicare and Medicaid Services (CMS) stated, "Contractors shall improve the quality and number of self-service options for Medicare providers." The IVR will give you access to patient eligibility, claim status, payment status and other valuable information. CR3376 and its provisions require providers to use self-service options. Our goal is to make this change a positive one for you. We now have expanded hours of service through the IVR and all routine questions can be handled quickly and easily. No more waiting on hold and no more limits to the number of status checks that a CSR can do! In addition, our call center staff will still be there to serve you on your most difficult inquiries. What is the IVR? IVR stands for Interactive Voice Response. The IVR application will allow you to speak directly into the telephone instead of pushing buttons to make a selection when prompted. This application uses natural language and text-to-speech technology to make it easier to receive the information you need quickly. The IVR will be maintained on a separate line from our regular customer service line and will be available beyond the normal customer service hours. As a result, you will have greater access to the information you need when you need it. If you haven't already used this service, we hope you will try it soon and let us know how you like it. We welcome your comments and suggestions via mail, using the following address. Noridian Administrative Services

3 Medicare Part B P. O. Box XXXX Fargo, ND XXXX (Substitute XXXX with the applicable PO Box Number listed below) Part B State PO Box Number Alaska 6703 Arizona 6704 Colorado 6028 Hawaii 6701 Iowa 6712 Nevada 6705 North Dakota 6706 Oregon 6702 South Dakota 6707 Washington 6700 Wyoming 6708 Format for the state you are calling from. Say or press the following for the state you are calling from: 1 North Dakota 7 Oregon 2 Arizona 8 South Dakota 3 Washington 9 Wyoming 4 Alaska 10 Colorado

4 5 Hawaii 11 Iowa 6 Nevada Speak or Touch the Following Options: Eligibility - Part B effective and termination dates, Part B deductible; Information about HMOs, MSP.

5 Claim Status: Summary Info: Dates of Service, Total Charges, Claim Status and Location Detail Info: Reason Codes, Reimbursement, Deductible and Coinsurance, Liability (denied claims), Noncovered Charges, Check #, DCN #

6 Checks - Check Date(s), Check Amount(s), Check Numbers Specific Check: Check Date, Check Amount, Check Number and Earnings to Date Deductible Procedure Code Pricing Seminars Phone Numbers Addresses Appeal Rights Eligibility IVR User Guide For patient eligibility requests, the IVR application will request the following information from the caller: 1. Provider Number 2. Patient Medicare Number 3. Patient Gender 4. Patient First and Last Name 5. Patient Date of Birth 6. Date of Service (only required when file indicates MSP or HMO involvement) The IVR will provide the following information to the caller:

7 1. Part B Effective and Termination Dates 2. HMO Information 3. Money Applied to Current and Prior Year Part B Deductible 4. MSP Information The caller will be allowed to say another Medicare number for multiple patient eligibility requests. Claim Status For claim status requests, the IVR application will request and collect the following information from the caller: 1. Provider Number 2. Patient Medicare Number 3. Patient First and Last Name 4. Dates of Service - Starting and Ending Dates The IVR will provide the following information to the caller: 1. Number of Claims in that Date Range 2. Claim Status (Processed, Denied, Pending, etc ) 3. Dates of Service 4. Total Charges 5. Submitted Amount 6. Allowed Amount For additional claim information, say Claim Details to hear the following information: (if it is applicable to the claim) 1. Finalized Date 2. Processed Medicare Primary/Secondary 3. Reason Code and Narrative

8 4. Provider Reimbursement 5. Deductible and Coinsurance Applied 6. Total Non-covered Charges 7. Check Number 8. Document Control Number (DCN) 9. ADR Issue Dates If multiple claims are available for the dates provided, you will be able to navigate through them to obtain claim details. At any time you may say: Repeat That, Next Claim, Previous Claim, or Claim Details. You can also change the Medicare number or the provider number. Checks A submenu will ask if you want information about the last three checks or a specific check. The IVR application will request the following information from the caller: 1. Provider Number 2. Check Date for Specific Check The IVR will provide the following information to the caller: 1. Check Issue Date 2. Check Amount 3. Check Number Deductible Using Touch-Tone Features The IVR is programmed to allow for the entry of all data using touch-tone in the event the user is unable to successfully speak to the IVR. These instructions detail how to use touch-tone to enter various types of information requested by the IVR.

9 When using the touch-tone feature, you must enter ALL data via the telephone keypad. The system will not recognize a combination of speech and touch-tone entries within the same inquiry. Using Touch-Tone to Enter Letters Use this function to enter the alpha suffix of the Medicare number, provider number, gender or name. Each button on the phone has a corresponding set of letters. Each letter is identified as a 1, 2 or 3 to indicate the position on that key. To enter a letter you must press three keys. Example, to enter Medicare number W Press: digits of the Medicare number The first nine To indicate that you are entering a letter The key containing the letter W The position of the letter on that key (1st position) To indicate you are finished entering the Medicare Number For the letters Q and Z, assume they appear on the 1 button as shown.

10 Touch-tone combinations for common Medicare Number suffixes: Suffix: Press: Suffix: Press: A *21 M *61 B *22 T *81 C *23 W *91 D *31 Using Touch Tone to Enter Provider Numbers If your provider number is all numeric (non-alphanumeric), enter the 6 to 9 digit number. If your provider number is alphanumeric (IE: 55T551), use the following example: The first two digits of the provider number To indicate that you are entering a letter The key containing the letter T (or whichever letter is appropriate) The position of the letter on that key (1st position) The last three digits of the provider number To indicate you are finished entering the provider number Using Touch Tone to Enter Patient Gender

11 When using the IVR for eligibility or deductibles, you will be asked to enter the gender of the patient. Press 1 for Male Press 2 for Female Using Touch-Tone to Enter Names The format for entering the Beneficiary s name is LAST NAME, FIRST INITIAL. Select the number key that represents the letter you wish to enter. For example, to enter the name John Doe, press (entered as DOEJ). To enter the letters Q or Z, use the 1 key. Helpful Reminders Speak clearly in a quiet environment. The IVR can be sensitive to outside noise. When giving your provider number, please include the state code if applicable. When speaking the date use the full format, for example, say July fifth, two thousand five. Do not use cell phones or speaker phones to call the IVR. If services are being billed under a group, provide the group identification number. Be sure to have your information organized before calling. When calling to retrieve eligibility, the following information is required, and must match our records:

12 o Provider number o Beneficiary last name and first name o Beneficiary date of birth o Beneficiary Health Insurance Claim (HIC) number and suffix o Beneficiary Gender You may say Main Menu at any point to return to the first menu In order to obtain accurate information, some Medicare numbers require you to verify the suffix each time, such as B as in Boy, D as in Dog, or T as in Tom. To eliminate repetition, include this information when giving the Medicare number B as in Boy. Remember, throughout most of the system, touch-tone is available. Instructions and examples for using touch-tone are listed above.