WV TPA Trading Partner Account Getting Started

Transcription

1 WV TPA Trading Partner Account Getting Started User Guide Date of Publication: 11/22/2013 Document Version: 1.0 Privacy Rules Page 1 of 17

2 The Health Insurance Portability and Accountability Act of 1996 (HIPAA Public Law ) and the HIPAA Privacy Final Rule 1 and the American Recovery and Reinvestment Act (ARRA) of 2009 provides protection for personal health information. Protected Health Information (PHI) includes any health information and confidential information, whether verbal, written or electronic, created, received, or maintained by Molina Healthcare. It is health care data plus identifying information that allows the data to tie the medical information to a particular person. PHI relates to the past, present and future physical or mental health of any individual or member; the provision of health care to an individual; or the past, present or future payment for the provision of health care to an individual. All member information including but not limited to claims data, prior authorization information, and attachments such as medical records and consent forms are all PHI CFR Parts 160 and 164, Standards for Privacy of Individually Identifiable Health Information; Final Rule Page 2 of 17

3 Revision History Version Date Author Action/Summary of Changes Status /07/2013 Joseph White Initial Creation Draft 11/21/2013 Scott Twigg SME Review Draft 11/22/2013 Joseph White Final QA Draft Page 3 of 17

4 Table of Contents 1. Introduction Sign In as Provider/Trading Partner Navigation Pane for Provider/Trading Partner Form Entry Frequently Used Functions Find Member (Participant) Code Search Table of Figures Figure 2-1 Home Page... 7 Figure 2-2 Provider/Trading Partner Welcome Screen... 8 Figure 3-1 Lower Portion of the Navigation Pane, Available to All Users... 9 Figure 3-2 Navigation Pane for Provider and Trading Partners... 9 Figure 4-1 Form Entry in the Navigation Pane Figure 4-2 Screen Help Information Figure 4-3 Billing Provider and Member Search Figure 4-4 Find Member for Claim Form Figure 4-5 Results for Find Member Figure 4-6 Diagnosis Code Search Window Figure 4-7 Search Results for a Diagnosis Code Figure 4-8 Entering a second Diagnosis Code Figure 4-9 Service Code Search Figure 4-10 Service Code Search Results Figure 4-11 Code Search for Service or Revenue Code Figure 4-12 Search Results Page 4 of 17

5 This document and information contains proprietary information and copyrighted works of third parties. Authorization is hereby provided to you to copy documents published by Molina Medicaid Solutions on the Health PAS-OnLine portal provided such copies are used for non-commercial purposes and solely for use within your organization. This authorization is specifically conditioned upon including all legends, copyright, proprietary, and other notices that appear herein on all copies you make of such documents whether they pertain to Molina Medicaid Solutions or another party. No license is granted herein expressly, impliedly, by estoppel or otherwise under any patent or to use any trademark of any party. No other rights under any copyrights are granted herein, except as expressly stated above. The documents herein may refer to products and/or services that are neither available nor planned for availability in your particular locality. In referring to such products and/or services, Molina Medicaid Solutions incurs no obligation to subsequently make them available in your locality. DOCUMENTS PUBLISHED HEREIN ARE FURNISHED TO YOU "AS IS." THERE ARE NO WARRANTIES, EXPRESS, OR IMPLIED, BY OPERATION OF LAW OR OTHERWISE. MOLINA MEDICAID SOLUTIONS DISCLAIMS THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NON- INFRINGEMENT AS TO BOTH MOLINA MEDICAID SOLUTIONS AND NON-MOLINA DOCUMENTS FURNISHED HEREIN. Some states or territories do not allow the exclusion of implied warranties and the foregoing exclusions may not be applicable to you. Any communication provided by you to Molina Medicaid Solutions relating to the documents furnished herein by Molina Medicaid Solutions will be received only on a non-confidential basis. There shall be no obligation on the part of Molina Medicaid Solutions with respect to use or disclosure of any information in such communication. Molina Medicaid Solutions shall have the unrestricted right to copy, use and distribute any information you communicate including but not limited to any ideas, concepts, know-how, techniques, software, documentation, diagrams, schematics or blueprints. Additionally, Molina Medicaid Solutions may use all such information in any manner or for any purpose including but not limited to developing products or providing services. The documents furnished herein by Molina Medicaid Solutions are subject to change without notice. All brand names and product names are acknowledged to be the trademarks or registered trademarks of their respective owners. Page 5 of 17

6 1. Introduction Health PAS-OnLine, the online portion of the Healthcare Payer Admiration System, permits providers to view the Bureau for Medicaid Services (BMS) approved information by means of an Internet Web site and portal. Providers may access reference materials, provider enrollment applications, provider bulletins and manuals, payment status, member eligibility information, Web-based training, surveys, and many other documents or processes. Health PAS-OnLine enables the submission of claims via Web form and by uploading X12 compliant claim files. Remittance advices are returned to providers through the portal, as well. Health PAS-OnLine is an Internet-based healthcare administration system that permits secure, real-time completion of healthcare transactions over the Internet. This user guide is provided for the entities using the MyHealth PAS, a component within Health PAS-OnLine. MyHealth PAS is only accessed through a secure Trading Partner Account. If you have not registered as a Trading Partner, please refer to the Trading Partner Registration User Guide found in the User Guide area of the website. This user guide is provided as a step-by-step manual for Providers and Trading Partners using their Trading Partner Accounts. The manual has been broken into separate documents for your convenience in accessing instructions for each activity you may perform in MyHealth PAS. This manual, Trading Partner Account Getting Started Guide, gives you an overview of the navigation in the MyHealth PAS portal and describes frequently performed functions such as searching for participant records. The other manuals are: WV TPA-Trading Partner Account Check Eligibility Guide WV TPA-Trading Partner Account Claim Status Guide WV TPA-Trading Partner Account Claim Submission Guide WV TPA-Trading Partner Account EDI File Exchange Guide WV TPA-Trading Partner Account Patient Roster Guide WV TPA-Trading Partner Account Registration User Guide WV TPA-Trading Partner Account Remittance Advice Reports Guide 2. Sign In as Provider/Trading Partner For detailed information about screen layout and how to navigate in Health PAS-Online, please see the WV Welcome Guide. To access the Guide, on the left side of the screen (navigation pane), under References click on User Guides to see the available user guides. Click on WV Welcome Guide to open the guide. Page 6 of 17

7 To start a session on Health PAS-OnLine, enter the Web address, in the address window of the browser and click on the Go or Forward buttons or press the Enter key. The Home Page will display. Refer to Figure 2-1. Figure 2-1 Home Page Page 7 of 17

8 Select the Provider Tab just above the navigation pane. The Welcome screen will display. Refer to Figure 2-2. Figure 2-2 Provider/Trading Partner Welcome Screen NOTE: Provider must be enrolled and in a credentialed status with Medicaid before registering as a Trading Partner. If you have not yet registered as a new user, please consult the WV TPA-Trading Partner Account Registration User Guide for detailed registration steps. To access the user guide on the left side of the screen (navigation pane), click on User Guides to see the available user guides. Click on WV TPA-Trading Partner Account Registration User Guide to open the guide. (In the same guide you will also find information on account maintenance, provider associations and password issues.) If you have already registered, enter your User Name and Password in the top portion of the navigation pane on the left side of the screen, and then click on the Sign In button. The Trading Partner Tab will appear and you will have access to the secure trading partner portal. If you have any questions or problems, please consult the WV TPA-Trading Partner Account Registration User Guide or a Provider Representative at Navigation Pane for Provider/Trading Partner The navigation pane for the Provider/Trading Partner secure portal contains two parts. The lower section, refer to Figure 3-1, is available to anyone who visits the Web site. The items listed are described in full in the WV Welcome Guide (in the lower portion of the navigation pane, click on User Guides to access the Guide). Page 8 of 17

9 Figure 3-1 Lower Portion of the Navigation Pane, Available to All Users The upper section of the navigation pane includes those items that are available only to registered uses of the Provider/Trading Partner secure portal. Refer to Figure 3-2 for the items in this upper section of the navigation pane. As with other Windows applications, clicking on the will expand the list of items and clicking on the will collapse the list. Figure 3-2 Navigation Pane for Provider and Trading Partners Account Maintenance is discussed in full in the WV TPA-Trading Partner Account Registration User Guide (located in the lower portion of the navigation pane under Documents, click on User Guides). Providers and Trading Partners are allowed multiple logins per office under the same Trading Partner Account, and these can be set up from Account Maintenance. Page 9 of 17

10 For information on File Exchange, see WV TPA-Trading Partner Account EDI File Exchange Guide and the Companion Guides found in the lower portion of the navigation pane under Reference. 4. Form Entry Information in this section of the portal concerns the online entry of forms. The Form Entry list automatically displays in the navigation pane. The user can click on the to either expand or collapse the lists located within the navigation pane. Refer to Figure 4-1. Figure 4-1 Form Entry in the Navigation Pane 4.1 Frequently Used Functions Some functions are used often in a variety of different forms on MyHealth PAS in your Trading Partner Account. Each of them is explained in detail here. They include: Find Member: see Section in this document; used as an initial step in the creation of most forms described below; process used in the following sections: o WV TPA-Trading Partner Account Claim Submission Guide, Claim Information for the Professional Claim o WV TPA-Trading Partner Account Claim Submission Guide, Claim Information for the Dental Claim o WV TPA-Trading Partner Account Claim Submission Guide, Claim Information for the Institutional Claim o WV TPA-Trading Partner Account Check Eligibility Guide Page 10 of 17

11 o WV TPA-Trading Partner Account Patient Roster Guide Code Search: see Section in this document. o Diagnosis Code Search: See Section in this document, process used in the following sections: WV TPA-Trading Partner Account Claim Submission Guide, Diagnoses for the Professional Claim WV TPA-Trading Partner Account Claim Submission Guide, Diagnosis, Visit, and Injury Codes for the Institutional Claim o Service Code Search Professional and Dental: see Section in this document, process used in the following sections: WV TPA-Trading Partner Account Claim Submission Guide, Services for the Professional Claim o Service Code Search Institutional: see Section in this document, process used in the following sections: WV TPA-Trading Partner Account Claim Submission Guide, Service Codes for the Institutional Claim NOTE: For Procedure Code searches for the institutional claim, see WV TPA-Trading Partner Account Claim Submission Guide. For Condition, Occurrence and Value Code searches for the institutional claim, see WV TPA- Trading Partner Account Claim Submission Guide. NOTE: When needing help with the page you are currently viewing (for example Manage Users) you can click on the help icon located in the upper right hand corner of the page. Refer to Figure 4-2. Page 11 of 17

12 Figure 4-2 Screen Help Information Find Member (Participant) The first step in finding a participant is to identify the Pay-To/Billing Provider. In the Select Billing Provider field, click on the arrow in the drop-down menu. Refer to Figure 4-3. From the drop-down list provided, click on the name of the Pay To/Billing Provider. Figure 4-3 Billing Provider and Member Search Page 12 of 17

13 NOTE: If you are attempting to find a recipient for claim entry, take the following additional step: After identifying the Billing Provider, the next line is a series of radio buttons to designate the type of claim to be entered. If it hasn t pre-populated, click on the radio button which identifies whether the claim is Professional, Dental, or Institutional. Refer to Figure 4-4 Figure 4-4 Find Member for Claim Form Locating a member in the database requires entering at least two of the following four key values. Refer to Figure 4-4. Member ID Name (Last and First): Taken together the Last and First Name count as one key value (entering just one of the two could yield a list that is too long to use easily). Enter the first five letters of the Last Name in the first field and enter the first three letters of the First Name in the field just to the right. Date of Birth: Must be entered as MM/DD/YYYY. For example, February 14, 2008, would be entered as 02/14/2008. Social Security Number: Must be entered with the dashes; for example, To restart the database search, click on the Reset button, to clear all the values, then re-enter two of the four key values. After entering two key values, click on the Submit button, or press Enter. The results of the search will display all participants with information that match the search criteria. The columns in the results are: Page 13 of 17

14 Name Gender Date of Birth Member ID (Not displayed in member search for claim submission) Select the correct member by clicking on the radio button in front of the member s name. Refer to Figure 4-5. (If there is only one member in the search results, the radio button is automatically checked.) Click on the Continue button, and continue with the form being entered. Figure 4-5 Results for Find Member If the participant does not appear on the list in Find Member Results, click on the Cancel button, to reset and clear all the values entered in the search. Enter two new key values Code Search Each type of code search is basically the same process whether it is for a diagnosis code, service code, or another code type. See the following sections for the specific details for each kind of code: Diagnosis code (including visit and injury codes), see Section in this document. Service code for professional or dental forms, see Section in this document. Service code for institutional forms, see Section in this document Diagnosis Code Search To search for a Diagnosis Code, click in the Code field in the line or row you wish to fill. Click on the Search icon, near the Line #/Code field, and a diagnosis code search window will open. Refer to Figure 4-6. Figure 4-6 Diagnosis Code Search Window Enter a diagnosis description in the Description field. Click on the Search button, to display a list of results at the bottom of the window. Refer to Figure 4-7. Page 14 of 17

15 NOTE: If you click on the Search button or press the Enter key without entering a description, the entire list of diagnosis codes will display. If none of the Codes and Descriptions is correct, click on the Reset button, to clear the Description field. In the list of search results, click once on the Code ID. The Code ID will appear in the Code field of your form. Press the Tab key or click in the Description field and the Description and Type (professional and institutional claims only) fields will be loaded into your form. Figure 4-7 Search Results for a Diagnosis Code Clicking the Tab key after the Type field will open a second Diagnosis option. Fill out the second Diagnosis fields in the same way you did for the first Diagnosis. Refer to Figure 4-7. Figure 4-8 Entering a second Diagnosis Code Service Code Search Professional and Dental To search for a Service Code for the professional and dental claims, first click on the Code field, then click on the Search icon, to the right of the Line # and a new search window will open. Refer to Figure 4-9. Page 15 of 17

16 Figure 4-9 Service Code Search Enter a Description of the code, and then click on the Search button, to get a list of results. If you click on the Search button or press the Enter key without putting in a description, an entire list of service codes will display. Click on the Reset button, to clear the Description field. The results, refer to Figure 4-10, consist of a list of Service Codes and Descriptions. Click once on the Service Code. The Service Code and the Description will automatically fill the Services fields for the claim form. Figure 4-10 Service Code Search Results Service Code Search Institutional To search for a Service/Revenue Code, click on the Search icon to the left of the Line # field and a new search window will open. Refer to Figure Figure 4-11 Code Search for Service or Revenue Code Enter a description of the code in the Description field, then click on the Search button, and a list of codes and descriptions will display at the bottom of the window. Refer to Figure Click on the Reset button to clear the Description field. Note: By clicking on the Search button or pressing the Enter key without entering a description, the entire list of service or revenue codes will display depending on the type of search. Page 16 of 17

17 Figure 4-12 Search Results The results, refer to Figure 4-11, consist of a list of Service Codes and Descriptions. Click once on the Service Code; the Service Code and the Description will automatically fill the Services fields for the claim form. For Procedure Codes search for the institutional claim, see WV TPA-Trading Partner Account Claim Submission Guide. For Condition, Occurrence and Value Code searches for the institutional claim, see WV TPA- Trading Partner Account Claim Submission Guide. Page 17 of 17