may 2009 electronic transactions: the green alternative presented by the eds provider field...

May 2009

Electronic Transactions:The Green AlternativePresented by the EDS Provider Field Consultants

2 May 2009ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE

Agenda

• Session Objectives

• Why Bill Electronically

• Paper Billing Misconceptions

• How to Begin

• What Can Be Performed Electronically

• Helpful Tools

• Questions

Welcome and Announcements


Session Objectives

Following this session, providers will:

• Understand the advantages of electronic transactions

• Be familiar with misconceptions that exist regarding paper billing

• Learn what transactions can be performed electronically

• Know who to contact for assistance


Why Bill Electronically?


Why Send Claims Electronically?

•Reduce cost

– Paper

– Ink

– Postage

•Decrease claim processing errors

•Web interChange is free

– Batch submission through Web interChange / File Exchange is available

•Expedite claim adjudication

– Increased cash flow

– Reduction in accounts receivable

– Cash availability


Paper Billing Misconceptions


Common Misconceptions

•Copy of explanation of benefits (EOB) must be submitted with secondary claims

•Corrected claims must be sent on paper

•Copy of previous submission must be submitted with corrected claims

•Letters explaining correction must be sent on paper

•Adjustments must be submitted on paper

•Attachments must be sent with a paper claim


How to Begin


Web interChange Accesshttps://interchange.indianamedicaid.com

Logon Screen


Administrator Request Form

•Complete and mail the Administrator Request Form to:

EDI Solutions Help Desk950 N. Meridian StreetSuite 1150Indianapolis, IN 46204-4288

•Submit a letter of acknowledgement on your company’s letterhead from the organization’s owner, indicating you are approved as an administrator for your organization

•Each provider should assign an administrator to oversee the daily functions of the individual practice or group

•Providers are reminded to assign a new administrator for Web interChange if the administrator leaves the practice

•Users performing functions for multiple National Provider Identifiers (NPIs) must ensure all the NPIs are added to the user’s existing login access


What Can Be Performed Electronically?


Electronic Transactions Available

• Provider Profile Inquiry• Provider Profile Updates• Eligibility Verification

– Update third-party liability (TPL) information• Prior Authorization (PA) Submission and Inquiry

– Physician– Dentist– Home health– Hospice– Optometry– Mental health– Chiropractor– Hospital– Transportation

NOTE: All provider types may perform PA Inquiry


Electronic Transactions Available

•Claim Submission

– Crossover claims

– TPL claims

– Medicare Replacement Policy Claims

– Attachments

– Claim notes

•Claim Inquiry

•Void/Replace/Copy claims

•Check Inquiry

•Electronic Funds Transfers

•Electronic Remittance Advice


Select “View” or “Edit”


Profile Maintenance

•Using Web interChange, you can make the following profile updates:– Provider Mail To, Pay To, and Service Location– Add or change electronic funds transfer (EFT)– Add and end-date specialties– Ownership information– Changes in members of boards of directors– Name of office manager or other management personnel– Ownership in subcontractor entities

•Group providers may not remove rendering provider linkages via Web interChange– Complete the IHCP Provider Termination Form

Note: EFT deposits occur 18 days after submitting anenrollment via Web interChange


Update Third Party Liability


Verifying Member Eligibility

The following enhanced features are available through Web interChange:

•Detailed TPL information

•Online TPL update requests


Prior Authorization Submission


Prior Authorization Inquiry

•Allows the requesting provider to inquire about all non-pharmacy prior authorizations via the Web

– It does not matter if the PA was submitted via paper, telephone, fax, or Web

•The requesting provider and the named service provider may view a PA without the PA number

•All other providers must have the PA number to view a PA


Web interChange Claim Submission


Batch Submission through Web interChange / File Exchange

•Batch claim submission is performed by a provider creating a HIPAA compliant 837 transaction claim file from their software and downloading it through the File Exchange option on Web interChange

– Free

– Available 24/7

– Secure


Batch Claim Submission

•Complete a Trading Partner Profile

•Complete a Trading Partner Agreement

•Use an approved IHCP software vendor, billing service, clearinghouse, or Value Added Network

•No additional secure file transfer client software installation needed

•Load directly into Web interChange / File Exchange

The logon ID and password used to access File Exchange are not the same as the logon ID and password used to access the other functions of Web interChange

Call the EDI Solutions Help Desk to begin batch claim submission at 1-877-877-5182


Crossover and TPL Claim Submission

•Coordination of Benefits windows for crossover and TPL claims look the same

– Enter coordination of benefit information at the header level and the detail level for prior payments from Medicare and/or commercial payors

– EOBs are not required if payment is received from the primary payor for all detail lines

– Use the Attachment feature for claims requiring an EOB

•Quick reference guides are available on the Help window to assist with claim submission


Medicare Replacement Policy Claims

•Select Institutional or Medical Claim (Not a Medicare Crossover)

•Enter Claim note: Medicare Replacement Policy

•Use the attachment process to send the Medicare Replacement Policy EOB (make sure you write Medicare Replacement Policy at the top of the EOB)

•Send the Medicare Replacement Policy with the Attachment cover sheet


Claim Attachments


Claim Attachment Information


Claim Attachment Control Number

•Things to know about the Attachment Control Number (ACN):

– Assigned by provider, not EDS

– Claim and document specific

– May be used only one time

•Write the ACN on each page of documentation preceded by the letters ‘ACN’

– Example: ACN: JC5643


Claim AttachmentsAttachment Cover Sheet


Claim Notes•The IndianaAim accepts claim note information for 837 claim transactions:–90 day provision–Supernumerary tooth extractions–Consultations billed 15 days before or after another consultation

–Joint injections, four per month–Excessive nursing home visits or more than one per 27 days

–Assistant surgeon/co-surgeon–Pacemakers/two within 6 months–Post-op care within 90 days of surgeryDetails for claims notes are available in BT200511


Claim Inquiry


Void Claim Feature

•Void requests can be submitted electronically using the 837 transaction or Web interChange

•Void requests submitted electronically can be for a previously submitted electronic claim or paper claim

•Voids cannot be performed on a claim in a denied status

•Void is the cancellation of an entire claim whether same day, same week, or post-financial


Replacement and Copy Claim Features

•Replacement requests have a one-year filing limit

•The system compares the last date of claim activity and the date of the current activity to make sure that a year has not passed

•Crossover claims do not have a one-year filing limit


Replacement Features

•Replacement is a change to an original claim, whether same day, same week, or post-financial

– Original claim refers to the most recent ICN assigned to that claim

•Replacements can be performed for any claim regardless if it was previously submitted as an electronic or paper claim

• If the date of service of the claim is greater than one year, proof of timely filing is required to avoid a payment takeback on a paid claim

•Web interChange will not display a Replace This Claim button on claims that are past the filing limit

– These replacements must be submitted as a paper adjustment


Check Inquiry Window


Initiate or Update Electronic Funds Transfer


Electronic Remittance Advice

•Electronic Remittance Advice posting is available from some electronic vendors

•Effective September 1, 2009, paper Remittance Advice (RA) will no longer be printed and mailed to providers from EDS

•RA will be available via Web interChange for download and print in PDF format

•Paper RA will only be available for a per page fee

•Paper checks will continue to be mailed at this time


Banners, Bulletins, Newsletters

•Effective September 1, 2009 paper communications will no longer be mailed

–Banners

–Bulletins

–Newsletters

–Claim Correction Forms (CCF)


Helpful Tools

•Provider Relations Field Consultant

– View a current territory map and contact information online at www.indianamedicaid.com

•EDI Solutions Help Desk

– Local (317) 488-5160

– Toll-free 1-877-877-5182

Avenues of Resolution


Questions

May 2009

EDS and the EDS logo are registered trademarks of Hewlett-Packard Development Company, LP. HP is an equal opportunity employer and values the diversity of its people. ©2009 Hewlett-Packard Development Company, LP.

EDS, an HP Company

950 N. Meridian St., Suite 1150

Indianapolis, IN 46204

may 2009 electronic transactions: the green alternative presented by the eds provider field...

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