Getting Started with EDISS and Total OnBoarding (TOB)

Transcription

1 Getting Started with EDISS and Total OnBoarding (TOB) Teleconference Number: (866) Note: Today's presentation will also be available at under the Workshop section of the Training and Help page in approximately one business week.

2 Housekeeping Connecting to WebEx. When possible, use a quiet location. Phone line is muted upon login to workshop. Do not place the call on Hold. Identify yourself when asking questions. 2

3 Intent of EDI Workshops Interactive learning for providers and the employee s who work for them. An opportunity for providers to ask any EDIrelated questions. An opportunity to see EDI demonstrations. 3

4 Getting Started with EDISS and Total OnBoarding (TOB)

5 Agenda Getting Started with EDI Define TOB Components of TOB TOB Advantages Security Added Value System Demonstration 5

6 Getting Started with EDI Two Simple Steps! STEP ONE: Complete registration through Total OnBoarding (TOB) STEP TWO: Complete the Testing Process (if applicable) Note: These steps are broken down in detail on the Getting Started with EDI page of 6

7 Step One: Registration through Total OnBoarding (TOB) Enter basic facility information (e.g., address, contact , phone number, etc.) TOB requires accurate facility information to be entered upon registration. If any information changes, simply log into TOB and update your profile. Add billing NPI EDISS requires providers to register their billing NPI s for electronic transactions. Rendering NPI s are not required in TOB. Add appropriate lines of business (LOB) Any LOB that has electronic transactions must be added to the appropriate NPI. Select desired electronic transactions for their profile Depending on the LOB, EDISS supports multiple electronic transactions. Electronic Claim Submission, Electronic Remittances, Claim Status, and Eligibility Benefit Inquiry are a few of the transactions providers may choose from. Select a HIPAA compliant vendor EDISS defines a vendor as an entity that provides hardware, software and/or ongoing technical support. There are three types of vendors EDISS works with. Complete the Digital Certificate process (if applicable) Users who have a direct transaction that requires testing with EDISS must complete the Identity Validation Form process to obtain a Digital Certificate. 7

8 What is TOB? A secure URL/web application where providers can register, add, modify, and test electronic transactions A new technology that removes the majority of manual work tied to paper registration and gives submitters complete control of their trading partner profile Allows providers to have the ability to test quickly and identify issues on their own, which provides faster service and reduces calls. 8

9 TOB Advantages Easy control/management of user profile Demographics NPIs, Tax IDs Adding submitters Cost savings (Administrative and Operational) Real-time registration Changes to profile are immediate driven notifications Security 9

10 Security (Digital Certificate) Proven Track Record Proven model developed by Visionshare Inc. that was approved by CMS Military-grade encryption Various authentication points Initial online account creation Identity Validation & Certificate (IVF) Acts as ID Card for access to TOB features 10

11 Added Value Real-time testing status Efficiencies in customer support reminders Instant notifications Real-time validation of EDI status Future Enhancements: Scenario based testing suites 5010 Trading Partner certification Cost and resource reduction 11

12 Step Two: Testing The testing process verifies the format and structural accuracy of the electronic claim file sent by a Trading Partner. EDISS requires all providers to test their electronic health care claim transactions through TOB before being granted production status. If providers selected a billing service or clearinghouse to do their billing, the billing service or clearinghouse tests through TOB on the provider s behalf. 12

13 TOB Registration and Testing vs. Production Claim Submission 13

14 Testing vs. Production It is important to note the differences between testing claims and live production claims. TOB is for Testing claims and online registration only. Production claims cannot be sent over the internet (TOB). CMS mandates a direct modem to modem connection. Providers are responsible for reviewing reports that are generated from production file submissions. 14

15 Additional Resources Visit the Total OnBoarding page of to for the additional resources of: User Guide TOB Tutorials 15

16 System Demonstration NOTE: If you did not attend the live EDISS workshop for this topic, the next series of slides will be screen shots of what was covered during the live presentation. We recommend that you reference the EDISS TOB User Guide that is found under the Online Registration and Testing header on the Forms page of if you have questions. You may also contact EDISS at and speak to a Customer Service Specialist. 16

17 Users in TOB New users to EDI, (providers or vendors) are not auto loaded into TOB. The difference between a new user and auto loaded user are: A new user will: Provide facility information and a contact person Enter in appropriate Billing NPI number(s) A user will be prompted to complete these steps automatically if they are not auto loaded into TOB. Create User ID and password for facility Agree to Visionshare Service Agreements Complete the Digital Certificate process (if applicable) Take control and build their Provider profile Select Line of Business Assign Transactions Assign Vendors, if applicable Complete testing, if applicable Auto loaded users will: Create User ID and password for facility Agree to Visionshare Service Agreements Complete the Digital Certificate process (if applicable) Take control and update their Provider profile if necessary 17

18 The TOB Process for Users 2 Main Login Options *The Login option is for providers who have already created a TOB profile. Anyone new to TOB will need to create an account. 18

19 Existing User in TOB *Provider s and Vendor s use the same login page for TOB. 19

20 Existing Providers or Vendors If a provider has been previously enrolled with EDISS, their information will be auto loaded into TOB. The provider will need to verify their Tax Identification Number and EDISS Submitter ID combination in order to access their profile. A vendor will need to verify a security pass code that will be distributed by EDISS in order to take control of their profile. 20

21 Existing User Continued NOTE: If No is selected the Provider will begin as brand new to EDISS, please see Slide

22 Existing User Continued NOTE: If No is selected the Provider will begin as brand new to EDISS, please see Slide

23 Existing User Continued *EDISS recommends that you use your unique submitter id for a User ID* 23

24 Existing User Continued (Agreements) 24

25 Existing User Continued (IVF) 25

26 IVF Process The IVF process relates directly to obtaining a Digital Certificate. Visionshare requires paperwork to be completed for validation and Digital Certificate assignment. A Digital Certificate only needs to be obtained by a provider who will be interacting directly with EDISS for transactions. Vendors who will be testing on the behalf of providers will need to obtain a Digital Certificate. 26

27 Provider Summary Page *The Provider Summary page is a overview of your profile, and is where profile management will occur. 27

28 Provider Summary Page Cont. The Provider Summary page acts as a home base for providers. Within this page providers will have control to: Manage Testing View Testing Scorecard View Production Options/Status Manage Profile/Facility View Forms Add/Delete/Edit Facility Information Manage LOB s Add, Remove, Change Add NPI Manage Transactions Add, Remove, Change Manage Vendors - Add, Remove, Change 28

29 Steps to Building Profile Add Line of Business (LOB) Manage appropriate LOBs Select desired transactions for each LOB Manage Vendors Select Vendor for applicable transactions If handling transactions direct, this step will differ. Submit the Required EDISS forms Multiple forms could be needed if multiple LOB s are selected. 29

30 Selecting a Line of Business *More then one LOB can be selected per NPI/Profile if applicable. 30

31 Selecting and Adding a Vendor NOTE: If submitting directly, this process will be omitted by selecting next with a blank search field in the first screen. 31

32 Selecting Transaction Screen 32

33 Assigning Transactions to Vendors 33

34 PC-ACE Pro32 Option NOTE: The prompt for PC-Ace will only appear if Direct is selected as a transmission type. 34

35 Submitting Required Forms Note: Enrollment forms are still required to be turned into EDISS for each LOB that applies. They can be downloaded, completed, and faxed in 35

36 Submitting a Test File Test files can be saved anywhere electronically. Users just need to browse to that specific location to complete submission. 36

37 Test File Results/Scorecard 37

38 Test File Results/Scorecard Cont. If the Details option is selected in the scorecard screen, the provider suite scorecard screen will appear. Both the Scorecard and Scenarios options will pull open additional screens within the testing profile. 38

39 Provider Scorecard Details Page G O O D B A D 39

40 EDISS Analysis Report *The EDISS Analysis Report can be used for viewing the raw electronic data that was sent to EDISS. 40

41 Getting Started with Total OnBoarding (TOB) Question & Answer Session

42 Thank you for attending! Getting Started with Total OnBoarding (TOB) Phone: Fax: Website: