HEALTHCARE LINK PAYER
J.P. Morgan 1 CMP New York NY 10005 Revision history Last modified: Thursday, November 27, 2008 Version: Healthcare Link Payer v6.0 This document contains information that is confidential and is the property of J.P. Morgan Chase. It may not be copied, published, or used in whole or in part for any purpose other than as expressly authorized by J.P. Morgan Chase. All trademarks, trade names, and service marks appearing herein are the property of their respective owners. 2008 J.P. Morgan Chase & Co. All rights reserved.
Table of Contents Overview... 1 Introduction to Healthcare Link Payer... 2 SUMMARY OF PAYER AND PROVIDER USER ROLES... 3 DOCUMENTATION CONVENTIONS... 5 Getting Started... 6 REGISTERING TO USE HEALTHCARE LINK PAYER... 7 LOGGING INTO HEALTHCARE LINK PAYER... 10 Logging in for the First Time... 11 Updating Your Challenge Questions... 12 Changing Your Password... 14 Forgot Your Password?... 15 Updating Your E-Mail Address... 17 General Navigation... 18 The Healthcare Link Payer Home Page - Dashboard View... 19 Dashboard - Notifications Section... 19 Dashboard - Plans Section... 20 CONTACTING THE HEALTHCARE LINK PAYER SUPPORT... 20 LOGGING OFF FROM HEALTHCARE LINK PAYER... 21 Payments... 22 VIEWING AND/OR SAVING PAID PAYMENT INFORMATION... 22 Viewing and/or Saving the EDI 835 (Healthcare Claim Payment/Advice)... 24 Viewing, Saving, and/or Printing the Explanation of Benefits (EOB)... 25 SEARCHING FOR PAYMENTS... 27 Providers... 33 VIEWING AND EDITING THE MASTER PROFILE AND/OR REQUESTING CHANGES FOR INDIVIDUAL PROFILES... 34 Viewing the Master Profile Details... 35 Editing the Master Profile... 38 Requesting Changes for Individual Profiles... 43 Plans... 45 REQUESTING ACCESS TO PLANS... 46 i
Communications... 48 VIEWING ROLE-SPECIFIC NOTIFICATION MESSAGES... 48 Users... 50 VIEWING AND/OR EDITING YOUR USER PROFILE... 50 SEARCHING FOR, VIEWING, AND/OR DELETING OTHER PROVIDER USERS... 53 Glossary of Terms and Acronyms... 54 Index... 60 ii
Overview The Healthcare Link Payer: is intended for providers who have been assigned a Basic User (BU) role. A provider refers to any person or business entity that provides or delivers health services to a patient or member within a healthcare setting. An individual provider may be a physician, practitioner, nurse, or any caregiver within a structured healthcare environment. Institutional providers are primarily hospitals or outpatient care facilities. Other institutional providers may be SNF (Skilled Nursing Facility) ambulatory care centers, hospices, and therapy clinics. Providers may also be referred to as payees, as they are the receiver of the payment made by the payer. The provides information on: Viewing and/or searching for received payments and viewing/saving EDI 835s (i.e., Healthcare Claim Payment/ Advice) and Explanation of Benefits (EOB) images. Viewing and/or updating your master provider profile and requesting changes to individual provider profile details for other plans that you have registered for. Requesting plan access to plans on which you are activated, but not yet registered. Once your request is approved, you can view the payment and EOB information for that plan. Viewing system-generated notification messages. Viewing and/or editing your own user profile. Viewing and/or deleting other provider user profiles. 1
Introduction to Healthcare Link Payer J.P. Morgan is committed to delivering value-added solutions that positively impact the entire healthcare revenue cycle for all its constituents. The Healthcare Link Payer application provides claim payments services to insurance companies, health plans, third-party administrators, and pharmacy benefit managers (commonly referred to as payers) for making payments to hospitals, physicians, dentists, and pharmacists (i.e., providers) who render medical, dental, and prescription drug services. Healthcare Link Payer was designed and developed to address healthcare payers' and providers' common goals of streamlining claim reimbursements to eliminate processing errors while reducing administrative costs throughout the revenue cycle. J.P. Morgan receives data via a secure electronic data interchange (EDI) connection that complies with the standard mandated by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. J.P. Morgan is the first financial services company to achieve accreditation by the Electronic Healthcare Network Accreditation Commission (EHNAC) for electronic healthcare processing. For payers, Healthcare Link Payer delivers an integrated payment service that processes healthcare claims payment files. The system determines the method of payment and medium for information delivery based on rules and preferences configured for the provider within Healthcare Link Payer. J.P. Morgan then executes the payment and presents or delivers the associated adjudicated claim data. These services are implemented with payers enabling the providers served by those payers to participate in an integrated information and payment process. The system enables the providers to specify their payment and explanation of payments (EOP) preferences to facilitate managing the claims reimbursement processing relationship between the payer and provider. Key Advantages of Using Healthcare Link Payer Automates electronic and paper payments to reduce costs and errors. Coordinates the migration of your providers from paper to electronic methods of payment and explanation of payments (EOPs) efficiently and securely. Enhances your providers' ability to manage the receipt of payments and EOPs. Improves your company's cash flow management and days in claims payable. 2
Key Features Validates against HIPAA edits and all payment dates, checks for duplicates, and sends you confirmation via EDI ASCX12 997 (Functional Acknowledgement) and EDI 824 (Application Advice) transaction sets and online via the World Wide Web. Provides secure electronic storage and online retrieval of all files, payment history, and explanation of payment information for seven years. Consolidates payments based on frequency and dollar amount thresholds. The Healthcare Link Payer service consists of two major components: The core database and transaction processing engine that seamlessly interfaces to the various J.P. Morgan systems that handle payment and information transactions. The front-end web-based application that allows payers to track, manage, and deliver payment along with payment information to their providers. This guide describes the functionality of the front-end Healthcare Link Payer application for a provider user with the Basic User (BU) role. Summary of Payer and Provider User Roles The role that is assigned to a user determines the functionality available to that user. The following table provides information on the payer and provider user roles within Healthcare Link Payer: Role / Description Payer Onboarding Coordinator (OBC) Responsible for overseeing all aspects of setup and system administration of the payer for onboarding and user management including user security maintenance and operational activities. Entitlements Users with this role are created by a J.P. Morgan Operations Coordinator. Users with an OBC role can: Assign Payer Operations Coordinator (OC), Provider Relationship Representative (PRR), Payer Plan Administrator (PA), and Customer Support Representative (CSR) roles to users. Delete any users created under that payer except users assigned with an OBC role. Supply the provider with the plan registration code. 3
Role / Description Payer Plan Administrator (PA) Responsible for overseeing the system administration for the plan. Payer Operations Coordinator (OC) Responsible for operations. Provider Relationship Representative (PRR) Handles provider activation and manages provider preference change requests. Customer Service Representative (CSR) Read-only role that can view provider information and preferences. Entitlements The PA role is assigned by a Payer Onboarding Coordinator. Users with a PA role can: View and/or modify the payment information and instructions. Update the provider preference profile. Supply the provider with the plan registration code. Search, view, and/or approve the payment instructions. View the Explanation of Benefits (EOB). Set up and manage day-to-day payment files. View payment errors. The OC role is assigned by a Payer Onboarding Coordinator. Users with an OC role can: Set up and manage day-to-day payment files. View payment errors. Search, view, and/or approve the payment instructions. View the Explanation of Benefits (EOB). The PA role is assigned by a Payer Onboarding Coordinator. Users with a PRR role can: View and/or modify the payment information. Update the provider preference profile. Generate the plan registration code for the provider. Search and view the payment instructions. Approve a provider to update the payment instructions. View the Explanation of Benefits (EOB). The CSR role is assigned by a Payer Onboarding Coordinator. Users with a CSR role have read-only access to functionality. 4
Role / Description Provider User (BU) The Basic User (BU) role is assigned to provider users to enable them to create default preference profiles, maintain plan preference settings, and access remittance information and reports. Entitlements The BU role is assigned by the self-registration process. Provider users with a BU role can: Access and maintain their provider profile and preferences. View and/or search for received payments, and view and/or download the associated EDI 835 and/or Explanation of Benefits (EOB) image. View notification messages. Request plan access. View and/or update his/her user profile. View and/or delete other provider user details. Documentation Conventions The documentation uses the following conventions: Convention Italic font represents the following: Application page names Section titles on an application window or page Documentation guides, chapters, and sections Bold font represents elements comprising a page in the application, the tab/subtab names, and links. Check boxes Drop-down lists Field labels Bold and italic font represents command buttons/options. Examples The Dashboard. The View User page. The Plans section of the Dashboard. The Getting Started chapter. Select the Send email alerts check box. Use the State drop-down list to select the appropriate state. Enter your User ID and Password. Click View. Click OK. Click SAVE. 5
Getting Started You, the provider user, must perform a self-registration process to access Healthcare Link Payer using a plan registration code to identify yourself as an authorized provider and to complete the self-registration process. The plan registration code is a unique code that is generated for a plan and issued to you by the payer. On submitting the self-registration details, payer users with appropriate roles can approve or reject your registration details. On approval, a web service call is made to the SMU (Site Minder Utility) to create your user ID. On successful creation, the SMU Account Management Team sends an e-mail containing the activation code (with a temporary password) to you to enable you to log into Healthcare Link. On logging into Healthcare Link Payer for the first time, you must change your password and provide the responses to three selected challenge questions. Once complete, the system updates your enrollment status as Pending and notifies the Payer Provider Relationship Representative (PRR) to approve you as a new provider user. If approval is granted, the system updates your user enrollment status to Active and sends you a notification e-mail. 6
The following diagram portrays the user life cycle: Registering to Use Healthcare Link Payer To perform the self-registration process to access Healthcare Link Payer, proceed as follows: 1. Using Internet Explorer v6.0.x or a compatible web browser, use the following URL to access the self-registration URL: https://healthcarelink.jpmorgan.com/hcp. The system displays the Log On page. 7
2. Click the Register as Provider User link. The system displays the Register as Provider User page. 3. Enter the following details: Note: The system marks mandatory fields with a red asterisk (*). Field Label Plan Registration Code User ID Description Enter the unique 16-digit plan registration code that is generated for a plan and issued to you by the payer. Enter a unique user ID, i.e., an ID not used by any other user within Healthcare Link Payer. The User ID must be: Between 6 and 32 alphanumeric (a-z, A-Z, 0-9) characters. Contain at least one letter and one digit. Note: You cannot enter any symbols or spaces. First Name Enter your first name using a maximum of 30 alphanumeric (a-z, A- Z, 0-9) characters. You can also enter spaces and symbols. Last Name Enter your last name using a maximum of 30 alphanumeric (a-z, A- Z, 0-9) characters. You can also enter spaces and symbols. 8
Field Label Email Address Description Enter your e-mail address using the standard format, i.e., a local and domain part separated by an @ symbol. Example: john.smith@testcompany.com Notes: A non-quoted local part may consist of alpha (a-z, A-Z) and/or numeric (0-9) characters and may including the following symbols:! # $ % & ' * + - / =? ^ _ ` { } and ~. Periods (.) may also be present in the local part, but cannot be the first or last character, or be adjacent to another period. Domain parts consist of labels separated by periods with between 1 and 63 characters for each part (including the period delimiter). Domain labels must start and end with an alpha (a-z, A-Z) or numeric (0-9) character and may include hyphens (-). The last domain label must contain at least one alpha character or hyphen and have a minimum of 2 characters. No spaces are allowed in the e-mail address. The e-mail address cannot exceed 80 characters. Phone Number Enter your phone number (in U.S. format) using 10 or 12 digits (i.e., with or without hyphens, but no spaces). Example: 123-123-1234 or 1231231234. Office Address 1 Office Address 2 Enter the first line of your address using a maximum of 55 alphanumeric (a-z, A-Z, 0-9) characters. You can also enter spaces and symbols. Where appropriate, enter the second line of your address using up to 55 alphanumeric (a-z, A-Z, 0-9) characters. You can also enter spaces and symbols. (This field is optional). City Enter the city where you reside using a maximum of 30 alphanumeric (a-z, A-Z, 0-9) characters. You can also enter spaces and symbols. State From the drop-down list, select the appropriate U.S. state. 9
Field Label Zip Code Description Enter your zip code (in U.S. format) using a maximum of 10 digits. Note: You can use hyphens, but no spaces. 4. Once entered, click REGISTER (or click CANCEL to abort). The system displays a confirmation message. The system validates the information: If any of the required fields are missing, or you have entered invalid information, the system displays an error message providing details of the erroneous field(s). If the details are correct, the system submits the data to the SMU (Site Minder Utility) application, which authenticates your user details, and where valid, creates a user record for you. If the SMU fails to create a user record for you, Healthcare Link Payer displays the reason. However, where successful, the Account Management Team sends an e-mail to you containing the activation code (with a temporary password) to enable you to log into Healthcare Link Payer. Logging into Healthcare Link Payer 1. Using Internet Explorer v6.0.x or a compatible web browser, use the following URL to access Healthcare Link Payer: https://healthcarelink.jpmorgan.com/hcp. 2. The system displays the Log On page. 10
3. Enter your User ID and Password. Note: If you are a new user, your initial temporary password (i.e., activation code) will have been communicated to you via e-mail. For information, refer to Logging in for the First Time on page 11. Logging in for the First Time Once you are registered as a user within Healthcare Link Payer, the Account Management Team sends you e-mail messages containing your activation code and URL to enable you to log onto Healthcare Link Payer. 1. Go to https://healthcarelink.jpmorgan.com/hcp/app. 2. Enter your unique user ID in the User ID field. 3. In the Password field, enter the 8-digit activation code provided to you by the Account Management Team. 4. Click Log On. Having successfully logged on, the system requires you to change your password and provide responses to three selected challenge questions. For information, refer to: Providing Responses to Selected Challenge Questions on page 12. Changing Your Password on page 14. 11
Updating Your Challenge Questions On successfully logging onto Healthcare Link Payer for the first time and using the activation code provided to you by the Account Management Team as your password, the system displays the Update Challenge Questions page. You must select three challenge questions and provide the appropriate responses. If you forget your password and attempt to recover your password online (by clicking the Forgot Your Password? link on the Log On page), the system prompts you to enter the responses matching your selected challenge questions. Note: For subsequent logons, you can access this page to update your challenge questions by clicking the Update Challenge Questions link from the Log On page. Enter your User ID and Password, and click LOG ON. The system displays the Update Challenge Questions page for you to update your challenge questions and responses, as detailed below. 12
1. From each of the drop-down lists (i.e., Challenge Question 1, Challenge Question 2, and Challenge Question 3), select a different challenge question. Options include: What is your mother's maiden name? What is the name of the high school that you attended? What is your father's middle name? What is the name of your first pet? What is the street name your work or office is located on? What city were you born in? 2. Enter the answers corresponding to your selected challenge questions in each of the Enter Answer fields. 3. Confirm your answers by entering the same answers in each of the Re-enter Answer fields. Note: Be sure you will remember the answer that matches the chosen challenge question. If you forget your password and attempt to recover your password online, the system prompts you to enter the answers supplied here. 4. Click SUBMIT to save (or CANCEL to abort). The system displays a confirmation message. 5. Click CONTINUE. If this is the first time you have logged onto Healthcare Link Payer, the system displays the Change Password page, which prompts you to enter a new password to replace the temporary password (i.e., activation code) supplied to you by the Account Management Team. For information, refer to Changing Your Password on page 14. If this is not the first time you have logged onto Healthcare Link Payer, the system displays the Dashboard (i.e., Healthcare Link Payer's Home page). 13
Changing Your Password On successfully logging onto Healthcare Link Payer for the first time, using the activation code provided to you by the Account Management Team as your password, the system displays the Change Your Password page, which prompts you to change your password. Note: For subsequent logons, you can access this page to change your password (e.g., where your password is about to expire) by clicking the Change Your Password link from the Log On page. Enter your User ID and Password, and click LOG ON. The system displays the Change Your Password page for you to update your password, as detailed below. 1. In the Enter New Password field, enter your new password using between 7 and 32 alphanumeric (a-z, A-Z, 0-9) characters, and including at least one letter and one number. Note: The password must be different from your User ID and different from your last five passwords used to access Healthcare Link Payer. 2. In the Re-enter New Password field, enter your new password in precisely the way you entered it in the Enter New Password field. 3. Once entered, click SUBMIT. Where successfully updated, the system displays a confirmation message. 4. Click CONTINUE. The system displays the Dashboard (i.e., Healthcare Link Payer's Home page). 14
Forgot Your Password? If you forget your password for logging onto Healthcare Link Payer, the system allows you to reset your password if you supply the correct answers to your previously selected challenge questions, as follows: 1. Click the Forgot Your Password? link on the Log On page. The system displays the Forgot Password page. 2. Enter your user ID in the field provided. 15
3. Click SUBMIT (or CANCEL to abort). The system displays the three challenge questions you selected via the Update Challenge Questions page. 4. Provide the answers to the challenge questions, which must match those entered via the Update Challenge Questions page. Note: For information on entering/updating your challenge questions, refer to Updating Your Challenge Questions on page 12. 5. Click SUBMIT (or CANCEL to abort). If your answers do not match, the system prompts you to re-enter them, else if they do match, it allows you to reset your password to enable you to access Healthcare Link Payer. 16
Updating Your E-Mail Address The system allows you to update your e-mail address via the Log On page, as follows: 1. Click the Update Email Address link from the Log On page. The system displays the Update Email page. 2. Before you can update your e-mail address, you must enter your User ID and Password in the fields provided. 17
3. Once entered, click LOG ON. The system displays the Update E-mail Address page, which displays your Current e-mail Address. 4. Enter your new e-mail address in both the New e-mail Address and Confirm new e- mail Address fields. 5. Once entered, click SUBMIT (or click CANCEL to abort). The system displays a confirmation message. 6. Click CONTINUE. The system displays the Dashboard (i.e., Healthcare Link Payer's Home page). General Navigation The Healthcare Link Payer application displays a number of tabs representing the different areas of functionality determined by your user role (e.g., payment, payer, provider, userrelated functionality, etc.). On clicking a tab, the system displays a subset of options (or subtabs) that are available for that tab (based on your user role). On clicking a subtab, the system opens the appropriate page to enable you to perform the desired action, e.g., view data, search for data, etc. 18
The Healthcare Link Payer Home Page - Dashboard View Upon logging in, Healthcare Link Payer displays the Dashboard. Note: You can navigate to the Dashboard at any time by clicking the Healthcare Link Home tab. The Dashboard displays items that require your immediate attention and items that you most frequently use. Dashboard - Notifications Section The Notifications section displays the most recent system-generated notification messages (up to a maximum of 10). A notification is a message from Healthcare Link Payer regarding: The status of processed files, e.g., payment and enrollment files received from a payer. The status of requests, e.g., requests by providers for plan access and profile changes. Overdue tasks. The notification messages displayed on the Dashboard are not specific to your User ID. To view the notifications specific to your role, click More >> from the bottom right of the Notifications section (see below). Note: Notification messages that have not been read are displayed in bold font, whereas overdue notification messages are displayed in red font. Notification message details include the Date/Time the notification was created, the Plan Name associated with the notification, and the Description of the notification. Click View adjacent to a notification message to view the full notification details including the unique Notification ID, Payer Name, Payer Account Number, Plan Account Number, File ID, and File Name. Note: Click CLOSE to close the pop-up window displaying the full notification details. 19
Click More >> from the bottom right of the Notifications section to open the Notifications page, which enables you to view the notification messages specific to your role. The Notifications page also allows you to filter the notification messages based on a selected date range. For further information, refer to Viewing Role-Specific Notification Messages on page 48. To return to the Dashboard, click the Healthcare Link Home tab. Dashboard - Plans Section The Plans section displays the plans, which you are entitled to view. Plan details include the Payer Name, Payer Account Number, Plan Name, Plan Account Number, Plan Contact Name, Plan Phone Number, and the Role Name. Contacting the Healthcare Link Payer Support To contact the Support team for any issues regarding Healthcare Link Payer click Contact Healthcare Link Payer from the top right of the application. The system displays the Contact Healthcare Link Payer page, which provides information on obtaining support. For assistance on using the Healthcare Link Payer portal, choose one of the following options: If you are a J. P. Morgan client, contact your Client Service Representative, or send your comments or questions via e-mail to HCP.feedback@jpmorgan.com using the feedback link on the Contact Healthcare Link Payer page. If you are a healthcare provider, contact your Plan Administrator. For technical assistance: Initially contact your Client Service Representative. If you have a valid username and password but are experiencing technical or login problems, send the details of the problem via e-mail to HCP.support@jpmorgan.com using the support link on the Contact Healthcare Link Payer page (or using your e-mail application where you do not have access to this page). Note: Click to close the Contact Healthcare Link Payer page. 20
Logging Off from Healthcare Link Payer To log off from Healthcare Link Payer, click LOG OFF from the top right of the application. The system displays a Log Off Confirmation page to confirm successful log off. Note: You can log back into the application again by clicking the log on link on the Log Off Confirmation page, or else close your browser and log in under the usual method. For information on logging on, refer to Logging into Healthcare Link Payer on page 10. 21
Payments The Payments section of the guide provides information on: Searching for received payments. Viewing and/or saving EDI 835s (i.e., Healthcare Claim Payment/Advice) and Explanation of Benefits (EOB) images. Viewing and/or Saving Paid Payment Information To view a list of paid payments, click the Paid subtab from the task bar of the Payments tab. The system opens the Paid Payments page, which by default, displays a list of the most recently paid payments for all plans that you are entitled to view. You can use the search criteria filters at the top of the page to find paid payments matching your selected criteria. 22
Example: From the Plan Name drop-down list, select a specific plan (where available) to view payments made for that plan. From the Period drop-down list, select "Yesterday", "7 Days", "15 Days", or "30 Days" to view payments made yesterday, within the last 7 days, 15 days, or 30 days. Once selected, click GO. The system displays the paid payments matching your search criteria. The following table provides information on the displayed fields for the paid payments: Note: You can click on the column headings to sort the data by that heading in ascending/descending order. Field Name Payment ID Plan Name NPI Provider Name Payment Date Cleared Date Payment Type Description Unique identifier, which the system generates for each payment. The name of the payer plan. The National Provider Identification (NPI), which uniquely identifies the provider. The name of the provider to whom the payment was/is to be made (i.e., your name). The date on which the payment is/was due to be paid. The date on which the payment was cleared for payment to the provider. The payment type can be one of the following: ACH (Automated Clearing House) - payment by electronic transfer of funds. CHK - payment by check. Trace/Check Number EOB Type The trace number for ACH payments, or check number for check payments, is a unique identifier allowing Healthcare Link Payer to link payments to their corresponding EOB. Indicates the method used to submit to you the Explanation of Benefits (EOB) associated with the payment, i.e., electronically or on paper. 23
Field Name Claims Description Consolidated payments are made from one payer to one of their providers. These consolidated payments comprise of multiple claim payment instruction files, which are aggregated into one payment. The Claims field displays the number of claim payment instructions files, which comprise the consolidated payment. Payment Amount The total payment amount in U.S. dollars. You can download the data to Microsoft Excel by clicking EXCEL and specifying the location and name of the file. In addition, you can: View the EDI 835 (i.e., Healthcare Claim Payment/Advice) by clicking the 835 link to the right of the payment record. The system displays the EDI 835 data, which you can save to a file on your computer. For further information, refer to Viewing and/or Saving the EDI 835 (Healthcare Claim Payment/Advice) on page 24. View the Explanation of Benefits (EOB) associated with the payment by clicking the EOB link to the right of the payment record. The system displays the EOB image, which you can view, save, or print in PDF format. For further information, refer to Viewing, Saving, and/or Printing the Explanation of Benefits (EOB) on page 25. Viewing and/or Saving the EDI 835 (Healthcare Claim Payment/Advice) You can view the EDI 835 (i.e., Healthcare Claim Payment/Advice) for a particular payment by clicking the 835 link to the right of the payment record in the Search Result section of: The Paid Payments page, which is accessible on clicking the Paid subtab from the task bar of the Payments tab. For information, refer to Viewing and/or Downloading Paid Payment Information on page 22). The Search Payments page, which is accessible on clicking the Paid subtab from the task bar of the Payments tab. For information, refer to Searching for Payments on page 27. 24
The system opens a new window, which displays the EDI 835 data. To save the EDI 835 data file to your computer, click SAVE, and specify the file location and file name for saving the data. To close the window, click CLOSE. Viewing, Saving, and/or Printing the Explanation of Benefits (EOB) You can view the Explanation of Benefits (EOB) associated with the payment by clicking the EOB link to the right of the payment record in the Search Result section of: The Paid Payments page, which is accessible on clicking the Paid subtab from the task bar of the Payments tab. For information, refer to Viewing and/or Downloading Paid Payment Information on page 22). The Search Payments page, which is accessible on clicking the Paid subtab from the task bar of the Payments tab. For information, refer to Searching for Payments on page 27. 25
The system opens a new window, which displays the EOB image. Click PDF to open your Adobe Acrobat Reader/PDF Viewer, which displays the EOB image converted to PDF format, which you can download to your computer and/or print by using the appropriate commands for your Reader/Viewer. 26
To close the Reader/Viewer, click from the top right corner. The system returns to the previous window displaying the EOB image. To close, click CLOSE. Searching for Payments The Search Payments page enables you to use a range of search criteria to find payments matching your selection. To search for a payment(s), proceed as follows: 1. Click the Search subtab from the task bar of the Payments tab. The system displays the Search Payments page. 2. In the Search By section, enter/select one or more of the following search criteria: Note: To clear and redefine your search criteria, click RESET. Search Criteria Payer Name Description This defaults to "All", i.e., set to find payments made to you by all payers. To find payments made to you by a specific payer, select the appropriate payer's name from the Payer Name drop-down list. 27
Search Criteria Plan Name Description The name of the payer plan under which the payment(s) has been made. This defaults to "All", i.e., set to find payments for all plans on which you are registered. To only find payments for a specific plan, select the appropriate plan from the Plan Name drop-down list. Payment ID To retrieve a specific payment, enter the payment's unique identifier, which the system generates for each payment. Note: Where specified, it is not necessary to enter any other search criteria. Search Date You can search for payments based on a particular date by selecting one of the following options from the Search Date drop-down list: Date Received - The date on which Healthcare Link Payer received the payer's payment instruction. Payment Date - The payment date on the payment transaction, i.e., the date on which the transaction is due to be paid. Date Paid - The date on which the payment was paid/cleared. From and To Where you have selected a date from the Search Date drop-down list, use the From and/or To fields to specify the date(s). Examples: To search for payments with a payment date of October 31, 2008, select "Payment Date" from the Search Date drop-down list, then enter 10/31/2008 (i.e., in MM/DD/YYYY format) in both the From and To fields (or click the Calendar icon ( ) to select the dates from the pop-ups). To search for payments with a payment date between October 15, 2008 and October 31, 2008, select "Payment Date" from the Search Date drop-down list, then enter (or select) 10/15/2008 in the From field and 10/31/2008 in the To field. To search for payments with a payment date on or later than October 15, 2008, select "Payment Date" from the Search Date drop-down list, then enter (or select) 10/15/2008 in the From field only. To search for payments with a payment date on or before October 31, 2008, select "Payment Date" from the Search Date drop-down list, then enter (or select) 10/31/2008 in the To field only. 28
Search Criteria Payment and Amount Claim Number Description You can search for payments with a dollar ($) amount equal to, greater than, or less than a specified amount. Examples: To search for payments of $50, select "Equal" from the Payment drop-down list, then enter 50 in the Amount field. To search for payments greater than $70, select "Greater than" from the Payment drop-down list, then enter 70 in the Amount field. To search for payments less than $90, select "Less than" from the Payment drop-down list, then enter 90 in the Amount field. To retrieve payments for a particular claim, enter the unique claim number in the Claim Number field. 3. Once selected, click SEARCH. The system displays the payments matching your search criteria in the Search Result section of the page. Note: You can click on the column headings to sort the data by that heading in ascending/descending order. 29
The following table provides information on the displayed fields for the retrieved payments: Field Name Reason Plan Name File Name Status Description Only populated for payments that have not passed the validation process, or have been rejected by the payer approver, i.e., Failed or Rejected. The name of the payer plan. The name of the EDI 835 file containing the payer's claim payment/advice, which was transmitted to Healthcare Link Payer. The status of the payment can be any of the following: Approved - The payment has been approved, and payment will be made once the payment date is reached. Rejected - The payment has been rejected. Invalid - The payment failed validation, e.g., where the provider details didn't match the details received for the payment, the provider was inactive, the payment is a duplicate payment, etc. Awaiting Approval - The payment must be approved before payment can be made. Paid - The payment has been made to the provider. Failed - The payment failed file-level validation. Payment ID Provider NPI Provider Name Date Received Payment Date Cleared Date Unique identifier, which the system generates for each payment. The National Provider Identification (NPI), which uniquely identifies the provider. The name of the provider to whom the payment was/is to be made (i.e., your name). The date on which Healthcare Link Payer received the payer's payment instruction. The date on which the payment is/was due to be paid. The date on which the payment was cleared for payment to the provider. 30
Field Name Payment Type EOB Type Claims Description The payment type can be one of the following: ACH (Automated Clearing House) - payment by electronic transfer of funds. CHK - payment by check. Indicates the method used to submit to you the Explanation of Benefits (EOB) associated with the payment, i.e., electronically or on paper. Consolidated payments are made from one payer to one of their providers. These consolidated payments comprise of multiple claim payment instruction files, which are aggregated into one payment. The Claims field displays the number of claim payment instructions files, which comprise the consolidated payment. Payment Amount The total payment amount in U.S. dollars. 4. Once the payment data is retrieved, the system displays the following additional search criteria filters in the Search By section of the page to allow you to narrow down the search results: Search Criteria Provider Name or NPI Status Description To show payments for a particular provider, enter the name of the provider in the Provider Name field, or use the NPI field to enter the provider's unique NPI (National Provider Identification). By default, the system retrieves payments regardless of their status (i.e., retrieves all statuses). However, you can search for payments with a particular status by selecting one of the following options from the Status drop-down list: Approved - The payment has been approved, and payment will be made once the payment date is reached. Awaiting Approval - The payment must be approved before payment can be made. Failed - The payment failed file-level validation. Invalid - The payment failed validation, e.g., where the provider details didn't match the details received for the payment, the provider was inactive, the payment is a duplicate payment, etc. Paid - The payment has been made to the provider. Rejected - The payment has been rejected. 31
5. Once selected, click SEARCH. The system refreshes the page, and displays the payments matching your search criteria in the Search Result section of the page (see previous). Note: To clear and redefine your search criteria, click RESET. 6. From the retrieved payments in the Search Result section of the page, you can: View the EDI 835 (i.e., Healthcare Claim Payment/Advice) by clicking the 835 link to the right of the payment record. The system displays the EDI 835 data, which you can save to a file on your computer. For further information, refer to Viewing and/or Saving the EDI 835 (Healthcare Claim Payment/Advice) on page 24. View the Explanation of Benefits (EOB) associated with the payment by clicking the EOB link to the right of the payment record. The system displays the EOB image, which you can view, save, or print in PDF format. For further information, refer to Viewing, Saving, and/or Printing the Explanation of Benefits (EOB) on page 25. 32
Providers A provider refers to any person or business entity that provides or delivers health services to a patient or member within a healthcare setting. An individual provider may be a physician, practitioner, nurse, or any caregiver within a structured healthcare environment. Institutional providers are primarily hospitals or outpatient care facilities. Other institutional providers may be SNF (Skilled Nursing Facility) ambulatory care centers, hospices, and therapy clinics. Providers may also be referred to as payees, as they are the receiver of the payment made by the payer. The provider user within Healthcare Link Payer is assigned a Basic User (BU) role. This role is responsible for accessing and maintaining the provider profile and preferences. Providers are enrolled by the payer on a plan, which is ready to make payments. Payments are made on receiving a claim from a provider. Payers manage the provider preferences of payment and their bank details for each plan. Providers can log into Healthcare Link Payer and check the payment details, and/or download the Explanation of Benefits (EOB) or EDI 835 (Healthcare Claim Payment/Advice) for the payment. Before providers can view the payment details, they must go through three processes: Enrollment - The payer enrolls providers for a plan. This step marks the provider as "ready for payment" for the plan. Activation - When a payer makes a payment to a provider for a plan, the provider is marked as "active" for the particular plan. Being active on any plan makes the provider eligible for registration. Providers receive a Plan Registration Code for each plan they are activated on. Registration - Providers go through a self-registration process (using the Plan Registration Code), which enables them to view payment for that plan. The Providers section of the guide provides information on viewing and/or updating the preferences for your master profile (for the first plan on which you are activated on), and/or requesting preference changes for individual profiles for other plans that you are registered for. 33
Viewing and Editing the Master Profile and/or Requesting Changes for Individual Profiles The Provider Details page, which is accessed on clicking the Details subtab from the menu bar of the Providers tab, displays the following details: Master Profile section - Displays details of your master profile including your provider contact information, payment and EOB type, consolidation details, location and payment addresses, and bank details. By default, the first plan on which you are activated becomes your master profile. For information on the details shown, refer to Viewing the Master Profile Details on page 35. To edit any of the details shown (other than the NPI), click EDIT (from the bottom of the page). For information, refer to Editing the Master Profile on page 38. Request Changes section - Displays a summary of pending, approved, or rejected request changes to individual profiles associated with plans that you are registered for (other than the first plan associated with the master profile), including the name of the payer and plan, the person who requested the change, the date and time of the request, the current status (e.g., pending, approved, or rejected), the person who approved or rejected the request, and the date and time he/she approved or rejected the request. Where a request change was rejected, the reason for rejection is displayed. 34
To view the full details of the request change, click on the Payer Name link. The system opens the View Provider Profile pop-up window, which shows the details of the provider profile for the change request including the name of the modified field(s) and current and previous values. Click CLOSE to close the pop-up. To request additional changes to individual provider profile details for your other registered plans, click REQUEST INFORMATION CHANGE (from the bottom of the page). For information, refer to Requesting Changes for Individual Profiles on page 43. Plan Name subtab - To view the payer and plan details associated with the master profile (i.e., for the first plan on which you are activated), click the Plan Name subtab, which is adjacent to the Master Profile subtab. Viewing the Master Profile Details The Master Profile section of the Provider Details page (accessed on clicking the Details subtab from the menu bar of the Providers tab) shows details of your master profile including your provider contact information, payment and EOB type, consolidation details, location and payment addresses, and bank details. By default, the first plan on which you are activated becomes your master profile. 35
The following table provides information on the details displayed: Field Name PROVIDER DETAILS: NPI Provider Name Tax ID Provider Contact Name Email Address Description The National Provider Identification (NPI), which uniquely identifies the provider. Your name as it appears within Healthcare Link Payer. Your unique tax identification number. For security reasons, the system only displays the last four digits. Your contact details including the name of the person to contact, his/her e-mail address, department, phone and/or fax number. Provider Phone Number Department Provider Fax Number Payment Type Indicates how payment is to be made: ACH (Automated Clearing House) - payment by electronic transfer of funds. Check - payment by check. EOB Type Notification Email Indicates the method used to submit to you the Explanation of Benefits (EOB) associated with the payment, i.e., electronically or on paper. The e-mail address, which Healthcare Link Payer uses to send notifications to you. 36
Field Name Consolidation Days and Consolidation Amount$ Description These fields are only displayed if the payer has set up the plan to allow you to view the consolidation rules. Consolidation requirements can be based on the Payment Date and/or Payment Amount thresholds) for a specific provider or for all providers. Where a plan has consolidation rules, the system identifies all payments for that plan that have reached the threshold and consolidates them into one payment. Where the Consolidation Days is specified, the system consolidates all payments from a payer received on the current day (where set to "1"), or all payments received within the last 7, 15, or 30 days (where set to "7", "15", or "30"). Where the Consolidation Amount$ is specified, the system consolidates all payments from a payer up to the amount specified. The plan may have both consolidation aging (i.e., Consolidation Days) and payment consolidation (i.e., Consolidation Amount$) rules. In this instance, if the dollar ($) threshold is met before the age limit occurs, the payment is released, and vice versa. Note: The system only consolidates payments from one payer to one of their providers; it does not mix payments from multiple payers to one provider. Payments are made on a per provider basis. Last Updated Date LOCATION ADDRESS: PAYMENT ADDRESS: BANK DETAILS: Routing Number The system populates this field with the date and time on which your master profile details were last modified. The address details for your location, i.e., first and second line of your address, city, two-digit state code, and zip code. The address details for sending payments to you, i.e., first and second line of the address, city, two-digit state code, and zip code. The number which the payment system uses to route the payment to you. 37
Field Name Account Number Description Your bank account number. For security reasons, the system only displays the last four digits. Note: The bank account number is unique for each plan. However, a plan can have the same bank account for ACH and check payments. Name on Account Account Type Description The name on your bank account. The bank account type, i.e., checking or savings. Description of the bank account. To edit any of the details shown (other than the NPI), click EDIT (from the bottom of the page). For information, refer to Editing the Master Profile on page 38. Editing the Master Profile To edit the master provider profile associated with the first plan for which you are registered, click EDIT from the bottom of the Provider Details page (accessed on clicking the Details subtab from the menu bar of the Providers tab). The system displays the Edit Provider page. 38
The Edit Provider page enables you to edit the provider details, as displayed on the Provider Details page, with the exception of the following fields: NPI - This is a unique identifier which the system assigns to a provider on enrollment. 835 Distribution and H2H Account ID - These fields can only be modified by a J.P. Morgan Implementation Coordinator (JIC). Note: The system marks mandatory fields with a red asterisk (*). The following table provides information on editing the fields: Field Name PROVIDER DETAILS: Provider Name* NPI* Tax ID* Description Enter your name as it appears within Healthcare Link Payer using up to a maximum of 60 alphanumeric (a-z, A-Z, 0-9) characters. You can also use spaces and symbols. The National Provider Identification (NPI), which uniquely identifies all provider of health care services, supplies, and equipment. This field is read-only and cannot be modified. Enter your unique 9-digit tax identification number. For security reasons, the system only displays the last four digits. Provider Contact Name Enter the name of the person to contact using up to a maximum of 60 alphanumeric (a-z, A-Z, 0-9) characters. You can also use spaces and symbols. Department Enter the contact's department using up to a maximum of 60 alphanumeric (a-z, A-Z, 0-9) characters. You can also use spaces and symbols. Provider Phone Number Enter the contact's phone number in U.S. format. On entering the number, the system automatically inserts the hyphens (-). Example: 123-123-1234 Provider Fax Number If applicable, enter the contact's fax number in U.S. format. On entering the number, the system automatically inserts the hyphens (-). Example: 123-123-1234 39
Field Name Email Address Description Enter the contact's e-mail address using the standard format, i.e., a local and domain part separated by an @ symbol. Example: john.smith@testcompany.com Notes: A non-quoted local part may consist of alpha (a-z, A-Z) and/or numeric (0-9) characters and may include the following symbols! # $ % & ' * + - / =? ^ _ ` { } and ~. Periods (.) may also be present in the local part, but cannot be the first or last character, or be adjacent to another period. Domain parts consist of labels separated by periods with between 1 and 63 characters for each part (including the period delimiter). Domain labels must start and end with an alpha (a-z, A- Z) or numeric (0-9) character and may include hyphens (-). The last domain label must contain at least one alpha character or hyphen and have a minimum of 2 characters. No spaces are allowed in the e-mail address. The e-mail address cannot exceed 80 characters. Payment Type Select one or both of the following check boxes to indicate how the payment is to be made: ACH - electronic payment by ACH (Automated Clearing House). Check - payment by check. EOB Type Indicates how you want the Explanation of Benefits (EOB) associated with the payment to be submitted to you. If you want the EOB to be submitted on paper, select the check box. If you want the EOB to be submitted electronically (i.e., online) to you, clear the check box. Notification Email Enter the e-mail address, which Healthcare Link Payer uses to send notifications to you. 40
Field Name Consolidation Days and Consolidation Amount$ Description These fields are only displayed if the payer has set up the plan to allow you to view the consolidation rules. To change the consolidation settings, select the appropriate number of days from the Consolidation Days drop-down list and/or enter the Consolidation Amount$. Note: For more information about consolidation including examples, refer to Viewing the Master Profile Details on page 35. LOCATION ADDRESS: Address Line 1*, Address Line 2, City*, State*, and Zip Code* PAYMENT ADDRESS: Address Line 1, Address Line 2, City, State, and Zip Code BANK DETAILS: Routing Number Account Number Enter the address details for your location, i.e., first and second line of your address, city, two-digit state code, and zip code. All fields except Address Line 2 are required. For the State, select the appropriate two-digit state code from the State drop-down list. If your payment address is the same as the location address, select the Same as Location Address check box. The system populates the payment address fields with the location address details. However, if the payment address is different, enter your payment address details. Enter the 9-digit number which the payment system uses to route the payment to you. Enter your bank account number using up to a maximum of 18 alphanumeric (a-z, A-Z, 0-9) characters. For security reasons, the system only displays the last four digits. Note: The bank account number is unique for each plan. However, a plan can have the same bank account for ACH and check payments. Name on Account Account Type Enter the name on your bank account using up to a maximum of 50 alphanumeric (a-z, A-Z, 0-9) characters. You can also use spaces and symbols. Select the bank account type (i.e., "Checking" or "Savings") from the Account Type drop-down list. 41
Field Name Description Description Enter the description of the bank account using up to a maximum of 50 alphanumeric (a-z, A-Z, 0-9) characters. You can also use spaces and symbols. Click Save to save your changes (or click Cancel to discard). The system returns to the Provider Details page. Note: On saving your changes, the system updates the fields on the Provider Details page and populates the Last Updated Date field with the current date and time. 42
Requesting Changes for Individual Profiles To request a change to the information for an individual provider profile for your other registered plans, click REQUEST INFORMATION CHANGE from the bottom of the Provider Details page (accessed on clicking the Details subtab from the menu bar of the Providers tab). The system displays the Request Information Change page. 43
The Request Information Change page is divided into two sections: The Provider Detail section displays your provider name, NPI (National Provider Identification), and the last four digits of your Tax ID. This information is read-only. The Select Plan section displays a list of the plans that you have registered. Beneath the plans, the page displays the profile details including payment services, remittance services, notification e-mail, consolidation services, location and payment addresses, bank details, and contact information. To request a change to the profile details for all the displayed plans, or for an individual plan, proceed as follows: 1. From the Select Plan section: To request a change applicable to all the displayed plans, select the first check box adjacent to the column headings (i.e., Payer Name, Plan Name - Plan Account Number, Contact Name, and Contact Number). The system selects the check boxes for each of the plans. (You can click on the first check box again to remove all selections). To request a change applicable to one or more individual plans (but not all), select the check box(es) to the left of the appropriate plan(s). 2. Once selected, in the fields below, modify the information you want to change. For information on the fields, refer to Editing the Master Profile on page 38. 3. On completion, click SEND REQUEST to submit your request (or click CANCEL to discard your changes). On submitting a request change, the system sends a notification message to the Provider Relationship Representative (PRR) and Plan Administrator (PA) payers for them to approve or reject the request change by clicking APPROVE or REJECT on the Pending Provider Profile page. If a request change is rejected, the (PRR or PA) payer user must provide the reason for the rejection. The system displays a summary of the request change in the Request Changes section of the Provider Details page. For information, refer to Viewing and Editing the Master Profile and/or Requesting Changes for Individual Profiles on page 34. 44
Plans Providers are enrolled by the payer on a plan, which is ready to make payments. Payments are made on receiving a claim from a provider. Payers manage the provider preferences of payment and their bank details for each plan. Providers can log into Healthcare Link Payer and check the payment details and/or download the Explanation of Benefits (EOB) and EDI 835 (Healthcare Claim Payment/Advice) for the payment. Before providers can view the payment details, they must go through three processes: Enrollment - The payer enrolls providers for a plan. This step marks the provider as "ready for payment" for the plan. Activation - When a payer makes a payment to a provider on a plan, the provider is marked as "active" for that particular plan. Being active on any plan makes the provider eligible for registration. Providers receive a Plan Registration Code for each plan they are activated on. Registration - Providers go through a self-registration process using the Plan Registration Code, which enables them to view payment for that plan. The Plans section of the guide provides information on requesting access to plans on which you are activated. 45
Requesting Access to Plans Initially the payer enrolls you for a plan. If the payer makes a payment to you on that plan, you become activated on the plan. However, to view the payment details and EOB associated with the plan, you must register for the plan. To request access to plans on which you are activated and thus, obtain registration, proceed as follows: 1. Click the Plans tab. The system displays the Add Plan page. The system lists the plan details for those plans you are activated on and those that you have registered for including the name of the payer for the plan, the plan's name, contact person, and contact telephone number. The Status field displays one of the following: Registered - Indicates that you have registered for the plan and can receive and view payment details for that plan. Active - Indicates that the payer has made payments to you on the plan, but you cannot view payment details for that plan until your request for access has been accepted, and you become registered for that plan. 2. To request access to a plan with an Active Status, enter the Plan Registration Code, which the payer (Onboarding Coordinator (OBC), Provider Relationship Representative (PRR), or Plan Administrator (PA)) provides you with once you become activated on a plan. 46
3. Once entered, click ADD PLAN to submit your request for access (or click CANCEL to abort). On submitting a request, the system displays a confirmation message. The system sends you an e-mail when your request for access to the plan has been approved. Once approved, the system updates the Status of the plan from Active to Registered, and allows you access to view the payments and EOB associated with that plan. 47
Communications The Communications section of the guide provides information on viewing the providerspecific notification messages. For example, notifications regarding processed provider enrollment files received from a payer. Viewing Role-Specific Notification Messages The Notifications page, which is accessed on clicking the Communications tab, displays all system-generated provider-specific notification messages. Example: Notifications regarding the processing of provider enrollment files. Note: The Dashboard, which is accessed on clicking the Healthcare Link Home tab, displays the 10 most recent system-generated notifications, which are not specific to any type of user. You can access the Notifications page via the Dashboard by clicking More >> from the bottom of the Notification section on the Dashboard. 48
The displayed notification message details include the Date/Time the notification was created, the system-generated Notification ID, your NPI (National Provider Identification) and Provider Name, the Plan Account Number associated with the notification, and the Description of the notification. Note: The page only displays a maximum of 10 notification messages. If the number of notification messages returned by the search exceeds this number, use the previous, next, or page number links to access additional notification messages. Click View adjacent to a notification message to open the View Notification pop-up window, which displays additional details including the Payer Name, Payer Account Number, Plan Name, File ID (i.e., the unique identifier for the file), and File Name. Note: Click CLOSE to close the pop-up window. You can filter the notification messages by selecting the appropriate date range from the Period drop-down list to view notification messages created Today, within the Last 7 Days, the Last 15 Days, or the Last 30 Days. Once you have selected your criteria, click GO. The system refreshes the page and displays the notification messages matching your criteria. 49
Users The Users section of the guide provides information on: Viewing and/or editing your own user profile details. Searching for and viewing other provider user profile details and/or deleting other provider users. Viewing and/or Editing Your User Profile To view and/or edit your user profile details, click the Users tab, which opens the View User page. To modify your user profile details, click EDIT. The system opens the Edit User Profile page, which displays your user details for modification. 50
The following table provides information on editing your details: Note: The system marks mandatory fields with a red asterisk (*). Field Name User ID First Name* Last Name* Description Your unique User ID, which is for display purposes only; you cannot modify this field. Enter your first name using a maximum of 30 alphanumeric (a-z, A-Z, 0-9) characters. You can also use spaces and symbols. Enter your last name using a maximum of 30 alphanumeric (a-z, A-Z, 0-9) characters. You can also use spaces and symbols. Examples: Harrison Brown, Shand-Kydd, O'Reilly. Email Address* Enter your e-mail address using the standard format, i.e., a local and domain part separated by an @ symbol. Example: john.smith@testcompany.com Notes: A non-quoted local part may consist of alpha (a-z, A-Z) and/or numeric (0-9) characters and may include the following symbols:! # $ % & ' * + - / =? ^ _ ` { } and ~. Periods (.) may also be present in the local part, but cannot be the first or last character, or be adjacent to another period. Domain parts consist of labels separated by periods with between 1 and 63 characters for each part (including the period delimiter). Domain labels must start and end with an alpha (a-z, A-Z) or numeric (0-9) character and may include hyphens (-). The last domain label must contain at least one alpha character or hyphen and have a minimum of 2 characters. No spaces are allowed in the e-mail address. The e-mail address cannot exceed 80 characters. Phone Number* Enter your phone number in U.S. format. On entering the number, the system automatically enters the hyphens (-). Example: 123-123-1234 51
Field Name Office Address 1* Office Address 2 City* State* Zip Code* SID, Cost Center Code, Department, and Location Code* Send email alerts Description Enter the first line of your office address using between 1 and 55 alphanumeric (a-z, A-Z, 0-9) characters. You can also use spaces and symbols. If applicable, enter the second line of your office address using a maximum of 55 alphanumeric (a-z, A-Z, 0-9) characters. You can also use spaces and symbols. Enter the city in which your office is based using a maximum of 30 alphanumeric (a-z, A-Z, 0-9) characters. You can also use spaces and symbols. From the State drop-down list, select the state in which your office is located. Enter the zip code for your office location. The zip code must be in U.S. zip code format. You can use a maximum of 10 numeric (0-9) characters. You can also use hyphens (-), but no spaces. These fields are only required for J.P. Morgan users (i.e., users employed by J.P. Morgan who are assigned J.P. Morgan roles). Select this check box to receive e-mail alerts from Healthcare Link Payer. Note: An alert is a communication about a specific problem requiring a call to action. It specifically tells you what action is required. Click SAVE to save your changes (or click CANCEL to discard). On clicking SAVE, the system validates the field-level information. If any of the information is incorrect, the system displays the reason for the error at the top of the page. Where valid, the system updates the Healthcare Link Payer database and calls the SMU (Site Minder Utility) API to update the profile in the SMU database. If Healthcare Link Payer receives a successful response from SMU, it commits the changes in the database and displays a confirmation message on the Edit User Profile page, and sends you a notification e-mail to confirm the successful update. If Healthcare Link Payer receives an unsuccessful response (i.e., failure) from SMU, it reverses the changes in the Healthcare Link Payer database and displays the reason for failure on the Edit User Profile page. 52
Searching For, Viewing, and/or Deleting Other Provider Users The Search User page, which is accessed on clicking the Search subtab from the Users tab, enables you to search for other provider users created within Healthcare Link Payer and view their user profile details and/or delete them from Healthcare Link Payer. On accessing the Search User page, proceed as follows: 1. To retrieve a specific provider user's details, enter the User ID and/or Last Name, or else leave these fields blank to retrieve a list of all provider users. 2. Click SEARCH (or else click RESET to clear the fields to re-enter the data). 3. The system displays the summary user details for the provider user(s) matching your search criteria including the unique User ID, First Name, Last Name, and Contact Number. To view the full user profile, click on the User ID link. The system opens the View User pop-up window, which displays the user's e-mail address, office location details, and plan name in addition to the summary details. To close the pop-up window, click CLOSE. To view the full user profile and/or delete the user, click View adjacent to the user's details. The system opens the View User page, which displays the user's e- mail address, office location details, and whether they have elected to receive e- mail alerts. To delete the user, click DELETE. The system opens the Delete User - Confirmation page for you to enter the reason for deleting the user. Once entered, click DELETE (or click BACK to abort). On clicking DELETE, the system submits the user data to the SMU (Site Minder Utility) application to delete the user from the SMU database. The SMU application sends a response back to the Healthcare Link Payer application, which either displays a deletion confirmation message, or the error response from the SMU where there was a failure to delete the user. On successfully deleting the user, Healthcare Link Payer marks the user as Deleted in the Healthcare Link Payer database. Note: Deleted users are denied access to Healthcare Link Payer. 53
Glossary of Terms and Acronyms Term/Acronym ACH Active State Definition Automated Clearing House is one of the Federal Reserve Board's mechanisms for the interbank electronic transfer of funds. One of two states for EOP/EOB and payment activity (the other being an Enrolled State), which indicates that the payer is designating Healthcare Link Payer to start sending EOP/EOB and/or payment to a provider. A provider is considered "Active" when at least one of the EOP/EOB and payment activation states is set to "Active". Alert ARP CKO CSV EDI EDI 821 EDI 824 An alert is a communication about a specific problem requiring a call to action. It specifically tells the user what action is required. Account Reconciliation Processing. Check Outsourcing. Comma Separated Values file that represents the beginning and end of variable length fields in flat files used by payers when sending payment information. Electronic Data Interchange. Financial Information Reporting. After Healthcare Link Payer completes the validation of the payer's payment instruction at the transaction level, it sends an 824 Application Acknowledgement file to the payer. The purpose of the Application Acknowledgement is to indicate to the payer that Healthcare Link Payer has received their transaction and the file has been accepted, partially accepted, or rejected. When the received file is error free, the system sends an 824 ACK file for a Positive Acknowledgment. If any errors occur at the transaction level, the system sends an 824 NAK file to the payer containing information about the failed transactions and their associated errors. EDI 827 EDI 835 Financial Return Notice. Healthcare Claim Payment/Advice file (or payment instruction file), which contains information on who to pay and the amount to pay, claim and service line information, and financial adjustments. 54
Term/Acronym EDI 997 Definition After Healthcare Link Payer completes the validation of the payer's payment instruction at the file level, it sends a 997 Functional Acknowledgement file (or equivalent) to the payer. The purpose of the Functional Acknowledgement is to indicate to the payer that Healthcare Link Payer has received their file and it was accepted or rejected. If the received file is accepted, the system sends a 997 ACK file. If the received file is rejected, it sends a 997 NAK file to the payer containing information about the encountered errors. EHNAC Enrolled State Electronic Healthcare Network Accreditation Commission. One of two states for EOP and payment activity (the other being an Active State), which indicates that the payer is designating a provider as "entered" into Healthcare Link Payer, but not eligible for receiving EOP and payment. A provider is considered Enrolled when the EOP and payment activation states are set to Enrolled. Enrollment (Self- Enrollment) Payer enrollment refers to payer self-enrollment as part of the initial use of the Healthcare Link Payer system by a new J.P. Morgan payer client (see Initial Payer Enrollment). Provider enrollment is a process whereby the provider signs up for Healthcare Link Payer. This can occur in two ways. Firstly, payers may enable the service for providers in their network, and secondly, providers may execute a self-enrollment set of steps in Healthcare Link Payer. EOB EOP EOB/EOP Delivery Preference EPOS H2H HCL Payer Explanation of Benefits are sent by payers to providers. These EOBs provide necessary information about claim payment information and patient responsibility amounts. Explanation of Payment. A statement the payer issues to the provider detailing the services that are being paid. The EOP (or EOB) is issued in coordination with a manual or electronic payment. The provider's delivery preference for receiving the payer's EOB/EOP, i.e., electronic or paper delivery. Electronic Payment Origination System. Host to Host. Healthcare Link Payer application. 55
Term/Acronym HIPAA Initial Payer Enrollment JMS LPI NACHA NBD NDM NOC Non-JPM Bank Notification Definition Health Insurance Portability and Accountability Act. The Initial Payer Enrollment (as a component of the overall implementation process) for a new payer is performed by the J.P. Morgan Implementation Team. This includes J.P. Morgan branded user security screens necessary to activate the Healthcare Link Payer solution for new users, creation of Payer IDs, input to complete Business Services and Billing Services associated with the contract parameters (SLAs) and protocols for communication with J.P. Morgan processing and core back end applications. Java Message Service. Late Payment Interest. National Automated Clearing House Association. Next Banking Day - same as next business day. Network Data Mover. Notice of Change. Any bank other than J.P. Morgan. A notification is a message from Healthcare Link Payer regarding: Payment files that have been received or processed. Requests. For example, the notification may say that a provider has requested access to a plan, the request to access a plan has been approved, or a provider has requested a preference change, etc. A task that is overdue and requires action. NPI NSF Payer National Provider Identifier. A system for uniquely identifying all providers of health care services, supplies, and equipment. Non-Sufficient Funds. The public or private organization that is responsible for payment for health care expenses. Payers may be insurance companies or self-insured employers. The payer is also the contractual entity who signed a binding agreement for the J.P. Morgan Healthcare Link Payer solution. Payment Instruction File See EDI 835 56
Term/Acronym Payment Notification End of Day File Payment Notification File Payment Preference Plan Definition This is a file that acts as a notification to the Payer Operations Coordinator (OC) regarding a Healthcare Link payer action, process, or activity that has taken place. It is a transaction file representing a processed payment that is generated by the system and sent to the payer indicating the check number and issued date, or ACH information and sent date, and any negative payment notifications. This file is created by Healthcare Link Payer after processing of the payment instruction file (EDI 835) and issuance of the payment. The system sends a payment notification to the payer containing the check paid date and check number, or ACH transaction information. The payer receives updates of this file until all payments in the corresponding payment instruction file are processed. This enables the payer to link this information to his/her submitted payments. The file also includes provider, claims, services, and financial information. A provider's payment preference may be set to Check or ACH. In the Healthcare Link Payer application, a plan consists of the payment units of the payer. A given payer may offer one or more plans targeting multiple consumer markets and/or geographies. Healthcare Link Payer allows you to implement all or selected payer plans. Plan Registration Code Provider A unique code given to a provider for each plan on which they become active. A provider (aka payee) refers to any person or business entity that provides or delivers health services to a patient or member within a healthcare setting. An individual provider may be a physician, practitioner, nurse, or any caregiver within a structured healthcare environment. Institutional providers are primarily hospitals or outpatient care facilities. Other institutional providers may include SNF (Skilled Nursing Facility) ambulatory care centers, hospices, and therapy clinics. The provider is the recipient of payment and accompanying EOB/EOP information and is identified by a Tax ID. If the provider has an NPI number, it is combined with the Tax ID. 57
Term/Acronym Provider Bulk Enrollment File Definition This file contains all payment-related information and preferences for providers that belong to one of the networks of the payer submitting the file. The file includes the provider's Tax ID number, NPI (optional), physical address, ACH information (i.e., ABA Number and Account Number) where ACH payment is desired, payment preference (i.e., payment by check or ACH), EOB/EOP delivery preference (i.e., electronic or paper delivery), and the EOB/EOP and payment activation states (i.e., enrolled or active). As part of the Payer Enrollment into Healthcare Link Payer, an initial Provider Bulk Enrollment file is sent to Healthcare Link Payer. Subsequent files are received including additions or removals of providers and changes to provider preferences. Provider Enrollment Provider Registration Payers may add the provider to the database but not make any payments to the provider. This process of adding the provider to the database is called enrollment. When enrolled providers are paid through Healthcare Link Payer, they become active for the respective plan. This describes the process where a provider is issued with a User ID and Password. Upon receipt of this login information and a Welcome package, the provider may go to the appropriate location and register as a user within Healthcare Link Payer. This access allows the provider to gain access to their profile preferences for viewing and/or editing. Reconciliation Registered State For providers, it is the act of applying payments to the correlating claims submitted using the EOB/Remittance Advice to manage accounts receivables and account for all claims submitted to the payer. Represents a provider belonging to a payer provider network who is identified through a Tax ID or NPI and included in the payer's preference payment file. Also refers to a provider who has received a User ID and Password and has actively registered themselves within Healthcare Link Payer. Registration The one time action of entering new user information into the Healthcare Link Payer registration screens to self-generate a User ID. Registration also includes the process of inputting preference and user details into a User Profile page. 58
Term/Acronym Remittance Advice SMU Trace ID Definition The accompaniment of payment information in summary format regarding a specific transfer of funds, or specific payment action taken by a payer regarding a payment being sent to a provider's financial institution. The transmission of EOP/EOB or remittance advice from a payer to a provider. Site Minder Utility application that manages the user authentication for Healthcare Link Payer. This is a unique identifier allowing Healthcare Link Payer to link payments to their corresponding EOB/EOP. 59
Index C Changing Your Password... 11, 13, 14 Communications... 48 Contacting the Healthcare Link Payer Support... 20 D Dashboard - Notifications Section... 19 Dashboard - Plans Section... 20 Documentation Conventions... 5 E Editing the Master Profile... 34, 38, 44 F Forgot Your Password?... 15 G General Navigation... 18 Getting Started... 6 Glossary of Terms and Acronyms... 54 I Introduction to Healthcare Link Payer... 2 L Logging in for the First Time... 11 Logging into Healthcare Link Payer... 10, 21 Logging Off from Healthcare Link Payer... 21 P Payments... 22 Plans... 45 Overview... 1 Providers... 33 R Registering to Use Healthcare Link Payer... 7 Requesting Access to Plans... 46 Requesting Changes for Individual Profiles... 35, 43 S Searching for Payments... 24, 25, 27 Searching For, Viewing, and/or Deleting Other Provider Users... 53 Summary of Payer and Provider User Roles... 3 T The Healthcare Link Payer Home Page - Dashboard View... 19 U Updating Your Challenge Questions... 11, 12, 16 Updating Your E-Mail Address... 17 Users... 50 V Viewing and Editing the Master Profile and/or Requesting Changes for Individual Profiles... 34, 44 Viewing and/or Editing Your User Profile... 50 Viewing and/or Saving Paid Payment Information.. 22, 24, 25 Viewing and/or Saving the EDI 835 (Healthcare Claim Payment/Advice)... 24, 32 Viewing Role-Specific Notification Messages... 20, 48 Viewing the Master Profile Details...34, 35, 41 Viewing, Saving, and/or Printing the Explanation of Benefits (EOB)...24, 25, 32 60