how to submit institutional and secondary claims on the provider … to submit ub-04 and...

Indiana Health Coverage ProgramsDXC Technology

How to submit Institutional and Secondary Claims on the Provider Portal

October 2017

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Session Objectives

• Provider Healthcare Portal Overview• Submitting UB-04/Institutional Claims• Submitting Medicare Secondary Claims• Submitting TPL Secondary Claims• Searching for Claims• Searching Payment History • Completing the IHCP Other Insurance (TPL)/Medicare Special Attachment

Form• How to submit Other Insurance (TPL) updates• What is appropriate to send to Provider Written Correspondence• Updates• Helpful Tools• Questions

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Provider Healthcare PortalOverview

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Log into the Portal with User ID

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Home Page showing User Functions

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How to Submit a UB-04/Institutional Claim

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Two ways to access Claims Submission

OR

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Institutional Claim Step 1

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Enter Required Claim Information

Click “Include Other Insurance” box before clicking Continue

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Enter codes, dates, and amounts (if applicable) - Click “Add”

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Submit Institutional Claim Step 2

Enter the first three alpha characters or diagnosis characters. A suggested list populates.

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Enter Diagnosis Codes

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Primary/Other Insurance Information

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Enter Other Insurance Details

The red asterisk * indicates a required field

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Other Insurance Details

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Medicare Payment Information

Not all claim types require detail information

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Adjustment Amount = Balance due

1 = Deductible2 = Coinsurance3 = Copayment amount

For Medicare claims – use the PR option when entering Claim Adjustment Group Code

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TPL Other Insurance

For TPL claims – Enter the name of the Primary Insurance in the CarrierName. If Carrier ID is not known – enter the Carrier Name in Carrier ID Field.

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Adding Surgical Procedure Code

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Scan and Upload Claim Note and Attachments

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Review Claim for Accuracy/Errors

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Click Submit & Confirm

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Confirmation Page

The claim ID/ICN populates here. You can view the claim details, copy the member or claim information, or click New to submit a new claim.

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Search Claims

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Search Claims

OR

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Search Claims by Claim ID, Member, or Date Range

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Claims Search Display

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Search Payment History

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Completing the IHCP TPL/Medicare Special Attachment Form

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TPL and Medicare Crossover Billing Paper Claims

• The IHCP encourages providers to use electronic transactions or the Portal for submitting claims that contain TPL or Medicare information.

• For providers that choose to submit claims on paper, the Third-Party Liability (TPL)/Medicare Special Attachment Form must be submitted to provide detail-level TPL and Medicare information. www.indianamedicaid.com > Forms > Claim Forms (Nonpharmacy)

• Paper claim forms require this form be attached. − Claims received without this form will deny for explanation of benefits

(EOB) 655 ̶ Missing/Invalid other payer reject code.

Form is NOT required for inpatient or long-term care claims

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IHCP Third-Party Liability (TPL)/Medicare Special Attachment Form

Refer to www.indianamedicaid.com > IHCP Third Party Liability (TPL)/Medicare Special Attachment Form Instructions

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Submitting Other Insurance (TPL) updates on the Portal

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Submitting Other Insurance (TPL) Updates

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How to submit Other Insurance (TPL) Updates

Responses to previous inquiries are listed

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How to submit Other Insurance (TPL) Updates

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How to submit Other Insurance (TPL) Updates

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How to submit Other Insurance (TPL) Updates

Add any available attachments to support the request

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What is appropriate to send to Provider Written Correspondence

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When to use Written Correspondence

Providers should submit Written Correspondence requests via the Portal for the same reasons they submit paper inquiries or administrative review requests for the following reasons:

• Provider disagrees with claim payment or denial• Provider is requesting a copy of an RA from before

February 13, 2017

• Provider disagrees with claim denial due to benefit limit having been reached

• Provider is requesting administrative review of an NCCI claim denial

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When to use Written Correspondence

Include all pertinent documentation supporting reconsideration with the secure correspondence, form, including the claim form and proof of timely filing, if required. • The unusual circumstances in which the provider believes the claim was

coded correctly and would like a reconsideration of the NCCI editing

• The reason for disagreement• The denial reason and the reason the payment is being disputed • File the formal administrative review request within 60 calendar days of

notification of claim payment or denial from DXC Technology. The date of notification is considered the date on the RA

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When not to use Written Correspondence

Providers should not use Written Correspondence to: • Check claim status

Claim status can be determined by checking RA statements or inquiring through the Portal or Interactive Voice Response system

• Submit claims, unless specifically directed to do so

The provider should exhaust routine measures to obtain payment before filing an administrative review request.

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Updates

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Red-and-white claim form requirement

• Effective January 1, 2018 the IHCP will require the below claim types to be submitting for processing on the appropriate red and white forms.

– CMS-1500 (02-12) – professional claims – UB-04 (CMS-1450) – institutional claims

• The IHCP will no longer accept copied (black and white) claim forms on or after January 1, 2018.

• Claims not received on the red-and-white claim form on or after January 1, 2018, will be returned to the provider.

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Stay Informed!

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New Look for Subscribers!

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IHCP Medical Policy Manual

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Helpful Tools

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Helpful Tools

• IHCP website at indianamedicaid.com– IHCP Provider Reference Modules– Medical Policy Manual• Customer Assistance available 8am-6pm EST Monday –

Friday – 1-800-457-4584• IHCP Provider Relations Field Consultants– See the Provider Relations Field Consultants page at

indianamedicaid.com • Secure Correspondence via the Provider Healthcare

Portal • Written Correspondence– DXC Technology Provider Written Correspondence

P.O. Box 7263Indianapolis, In 46207-7263

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QuestionsFollowing this session please review your schedule for the next session you

are registered to attend