Mississippi State and School Employees' Health Insurance Plan

Transcription

1 Mississippi State and School Employees' Health Insurance Plan Claim Status Guide to PC-Based Transactions v Pub # 72539

2 This publication is the proprietary property of Emdeon and is furnished solely for use pursuant to a license agreement giving the user the right to use the Emdeon product(s) referenced in this document. All uses of this document are subject to the terms of such license agreement. This document may not be used except as permitted by such license agreement or changed, copied, photocopied, reproduced, translated, or reduced to any electronic medium or machine readable form without the prior consent of Emdeon. Copyright is held by Emdeon Business Services, LLC. Emdeon is not liable for any losses or damages that result from the use of this material, including loss of profit or indirect, special, or consequential damages.

3 Table of Contents Table of Contents Overview About the Transaction Customer Support Requests Patient Data Input Prompts Responses About Your Responses Status Input and Response Information Additional Response Information Claim Detail Error Messages Index Emdeon Business Services LLC. All rights reserved. Page i

4 Overview Overview About the Transaction This transaction allows you to inquire about the status of a patient s healthcare claim submitted to Mississippi State and School Employees Health Insurance Plan (SEHP). Disclaimer: This verification response does not constitute a guarantee of payment by Mississippi SEHP. Note: If you are using Emdeon MAX shell versions prior to 2.3 or Server versions prior to 4.11, you must run this transaction using dialup. Period Date Restrictions Up to one year in the past (366 days including the day on which you run the transaction). Future dates are not allowed. National Provider Identifiers In order for you to use a National Provider Identifier (NPI) as the requesting provider ID, the following conditions must exist: The payer must be ready to accept NPI. Consult our payer lists at for this payer s NPI-readiness status. The provider must have fulfilled all of the payer s NPI registration requirements. Consult the payer to determine whether you should submit the service provider s NPI at this time. Customer Support Emdeon Customer Support customer.service@emdeon.com 2011 Emdeon Business Services LLC. All rights reserved. Page 1

5 Requests Requests Patient Data The following patient data is used to locate the patient s claim records: Subscriber ID Subscriber s date of birth See Input Prompts on page 2 for specific input requirements. Input Prompts Prompts are listed in alphabetical order. Account # Requirement: Optional; not sent to the payer. The account number you have assigned to this account, for your internal use only. Amount Requirement: Optional; not sent to the payer. The amount of the claim, for your internal use only. Date of Birth Requirement: Required. The patient s date of birth, in MMDDCCYY format. Date of Svc Requirement: Required. The date of service included in the claim, in MMDDYY or MMDDCCYY format. Note: The date of service must be within the past year (366 days including the day on which you run the transaction) and cannot be in the future. Provider ID Requirement: Required. The information requestor s provider ID. Subscriber ID Requirement: Required. The patient s SEHP subscriber ID Emdeon Business Services LLC. All rights reserved. Page 2

6 Responses Responses About Your Responses All of the items described in the following response explanation may not appear in every response. Payers typically return only the information that is applicable to your query. If the payer does not return a particular piece or section of information in a specific response, the headings for that information will not print. Items will shift position to fill the vacancy. Your username appears in the upper left corner of the response. See your product User s Guide for information about creating usernames. Additional Reference Document More information about your response can be found in the Dictionary-of-Transaction-Error- Messages.pdf a complete dictionary of error messages. This document is available on your installation CD, and on the Web at: Note: The above document is in Portable Document Format (.pdf). You must have the Adobe Acrobat Reader to view this document. If you do not have the Reader, you can download it for free at Status Closed Emdeon received a valid response from the payer. Retry The request could not be processed, usually because invalid data was entered. Read the message in the response for clarification. Error A communications-related error or error of greater severity occurred. Read the message in the response for clarification. Input and Response Information The input area shows the data you sent in the request. For some of the input fields, the response area displays what the payer actually has on file. This arrangement enables you to verify what you entered against what is on file. Depending on your software product and report settings, response information fields can appear in one of two locations: They can appear in a column to the right of the input fields. They can appear beneath the input fields, with the heading (On File). An asterisk to the left of an input field indicates that the mirrored response data did not match your input data. No information is displayed in the Response Information section Emdeon Business Services LLC. All rights reserved. Page 3

7 Additional Response Information The Additional Response Information section appears once. Includes: - The patient s first and last names. Mississippi State and School Employees' Health Insurance Plan Claim Status Responses - If there are more than 15 claims on file for the requested date of service, the message More claims on file Please call BCBS for details appears. Call BCBS of Mississippi to obtain information on the remaining claims. Claim Detail The Claim Detail section gives summary information about each member claim matching the requested date of service. A maximum of 15 claim summaries can appear. If more than 15 claims were filed for the member on the requested date of service, the message More claims on file Please call BCBS for details appears. Call BCBS of Mississippi to obtain information on the remaining claims. Includes: - A DCN number assigned to the claim by the payer. - The earliest date of service included in the claim. - The latest date of service included in the claim. - The total amount of the provider s submitted charges on the claim. This amount reflects the total of all charges for all line items on the claim, not just those line items corresponding to the requested date of service. - The dollar amount of the total charge that will be paid by the payer. All zeroes will appear if the claim has not yet been finalized. - The status of the claim, as of the current date. Possible values are as follows: Finalized - Provider: Payment was sent to the provider. Finalized - Member: Payment was sent to the member. Denied: Payment was denied. Deductible: The claim amount applies to the member s deductible. Pending: The claim is pending. - If the claim was rejected, a rejection code and explanation are listed. If the message Description Not Available appears, call Emdeon Customer Support. - The Process/RA Dt indicates one of the following: If the status is approved, the date the check was or will be issued. If the status is pending or denied, the date the claim was either denied or put in a pending status. If the status is deductible, the date the claim amount was applied toward the member s deductible. Error Messages Transaction-related error messages begin with CL, HT, RH, or another alphabetic prefix, followed by a number and a line or so of text. Messages are self-explanatory. For a comprehensive description of all error messages, see the document Dictionary of Transaction Error Messages. This document is available on your installation CD, and on the Web at: Emdeon Business Services LLC. All rights reserved. Page 4

8 Index Index A About the Transaction, 1 About Your Responses, 3 Account #, 2 Additional Response Information, 4 Amount, 2 C Claim Detail, 4 Closed, 3 Customer Support, 1 D Date of Birth, 2 Date of Svc, 2 E Emdeon Customer Support, 1 Error, 3 Error Messages, 4 I Input and Response Information, 3 Input Prompts, 2 N National Provider Identifiers, 1 P Patient Data, 2 Period Date Restrictions, 1 Provider ID, 2 R Retry, 3 S Status, 3 Subscriber ID, Emdeon Business Services LLC. All rights reserved. Page 5

9 Emdeon is a leading provider of revenue and payment cycle solutions that connect payers, providers, and patients to improve the healthcare business processes. To learn more about our company, our services, and our commitment to improving healthcare, visit our website at Emdeon Business Services LLC. All rights reserved Lebanon Pike, Suite 1000 Nashville, TN EMDEON.6 ( )