Behavioral Health Provider Training: Claims Tutorial
Claims Submissions Claims can be submitted in 3 ways: 1. Paper Claims mailed to: Passport Health Plan Attn: Claims 500 Unicorn Park Drive, Suite 103 Woburn, MA 01801 Out of Network providers must submit paper claims 2. Electronic Data Interchange (EDI) 3. eservices
Electronic Data Interchange (EDI) EDI is the preferred method for receiving claims. We accept the standard HIPAA 837 format and provide 835 transactions. Beacon also uses 270/271 transactions for eligibility purposes. Beacon does allow EDI claims to be submitted from a Clearing House or Billing Agency. EDI claims may also be submitted to Beacon via Emdeon. Beacon s Emdeon payer ID is 43324. Please note payer ID 61126 is incorrect for behavioral health, as it is for medical only. Passport Health Plan s ID is: 028. All EDI claims submitted via Emdeon must include the member s Passport Plan ID and Beacon s Emdeon payer ID. Using just one or the other will cause claims to reject. EDI registration forms are on the Beacon web site at www.beaconhealthstrategies.com/private/pdfs/forms/edi_trading_partner_setup.pdf. Submit the EDI Registration forms and schedule test submissions with the EDI team. After test submissions have been completed, contact EDI Operations to request a production setup. They can be reached at 781-994-7500, or via email at edi.operations@beaconhs.com.
eservices This is a free service for all contracted and in-network Passport providers. The goal of eservices is to make clinical, administrative, and claims transactions easy to do. By using eservices you will be able to: Submit requests for authorization Submit claims Verify member eligibility for Passport Health Plan Confirm authorization status Check claim status To sign up for eservices, please register at https://provider.beaconhs.com/registrationlander.aspx Complete the eservices Terms of Use form..\beacon_eservicestermsofuseaccountauthorization.pdf Submit the eservices Terms of Use form via fax to 1-888-276-6745
eservices - Registration
eservices - Registration
eservices Landing Page
eservices Areas of Focus
eservices Check Member Eligibility
eservices Review Authorizations
eservices Check Auths
eservices Manage Auths
eservices Check Claims by Member
eservices Check Claims by Provider
eservices Check Claims by Auth
eservices Submitting eclaim
eservices Select Submit eclaim link
eservices Select Type of Claim
eservices Blank claim form
eservices Required Elements
eservices Are we forgetting anything?
eservices Add a service line
eservices Error notices
eservices Confirmation
eservices Resubmit an eclaim
eservices Find the claim
eservices Claim Search results
eservices Click Resubmit
eservices Fixing the claim
eservices Make the changes
eservices Required Element Check
eservices Additional Confirmation
eservices Claim Receipt
eservices Managing Users
Important Claim Reminders All claims must be received within Passport s timely filing limit of 180 days. Any corrected claims must be submitted within 24 months of the service date. All clean claim submissions (meaning no missing/incorrect/expired data or information) will be processed and paid within 30 days.
Top Claims Denial Reasons Timely filing. The claim denied as it was not received within 180 days. Missing or incorrect NPI/Taxonomy number. All claims must list the rendering clinicians individual NPI and taxonomy numbers, along with the billing provider s NPI and taxonomy numbers. If any of these numbers are missing, incorrect or expired, the claim will deny. No authorization. If the member has no authorization to see the provider, or the authorization has expired, the claim will deny. It is important to make sure the member has an authorization in place or has the initial benefit visits remaining before seeing them. Code not eligible for payment on the DOS. The claim was submitted with an invalid procedure code / modifier combination. Check to make sure the procedure code is valid and that an appropriate modifier was submitted with it. Remember that lab services must be submitted directly to Passport and not as a behavioral health claim.
PaySpan Payments are issued on a weekly basis in partnership with PaySpan. Paper checks and EOB information is issued to the address on record. If you are interested in participating in EFT payments, please contact PaySpan directly at (877) 331-7154 with your banking information.
Additional Info All claim resubmissions must include the Rec ID from the original claim to prevent unnecessary timely filing denials. Waiver requests (for timely filing) may be submitted within 180 days from the qualifying event and must be accompanied by a claim form (available on www.beaconhealthstrategies.com). Qualifying events include: retroactive member eligibility; retroactive authorization and retroactive provider eligibility. If your request is not for one of these reasons, it will be denied and you must follow the procedure for reconsiderations. Once you have exhausted all other avenues, you can submit a request for reconsideration of the 180 day timely filing limit. Reconsiderations must include: Copy of claim form with a cover letter explaining why claims were not filed in a timely manner, along with supporting documentation. Screen prints of billing ledgers, certified mail receipts or documentation that claims were sent to a clearinghouse are not considered proof of timely filing.
Helpful Passport enews info NCCI edits http://passporthealthplan.com/wp- content/uploads/2015/02/02-19-prov51037-bh- Passport-News-BillingCodeClarification-FINAL.pdf Targeted Case Management http://passporthealthplan.com/wp- content/uploads/2015/03/03-02-hlth40814-non- CMHC-TCM-Update.pdf List of approved modifiers and example claim form http://passporthealthplan.com/wpcontent/uploads/2014/11/10-06-bh-claimmodifier.pdf
Helpful Contact Info Behavioral Health Hotline: (855) 834-5651 Behavioral Health Claims Hotline: (888) 249-0478 eservices Helpline: (866) 206-6120 Your Passport Provider Relations rep does not have access to eservices and cannot reset passwords. Please call the Helpline for assistance. PaySpan Provider Services Hotline: (877) 331-7134 Enrollment hotline: (502) 588-8578 or by email at Passport.credentialing@passporthealthplan.com
Provider Network Contact Info Cindy Bundy, Provider Network Manager (502) 213-8939 cindy.bundy@passporthealthplan.com Micah Cain, Provider Relations Specialist Christine Drake, Provider Relations Specialist (502) 357-8887 (502) 212-6704 micah.cain@passporthealthplan.com christine.drake@passporthealthplan.com Micah serves Region 3 providers Christine serves Regions 5, 6, 7 and 8 Teri Hardman, Provider Relations Specialist Taquitta Porter, Provider Relations Specialist (502) 212-6713 (502) 357-8872 teri.hardman@passporthealthplan.com taquitta.porter@passporthealthplan.com Teri serves CMHC providers Taquitta serves Regions 1, 2 and 4 Brittany Hammonds, Provider Relations Specialist (502) 585-8311 brittany.hammonds@passporthealthplan.com Brittany provides admin support to the team