october 2009 web interchange advanced functions presented by the eds provider field consultants
TRANSCRIPT
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October 2009
Web interChange Advanced FunctionsPresented by theEDS Provider Field Consultants
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2 October 2009Web interChange Advanced Functions
Agenda
• Session Objectives• Administrator Request Form• Administrator Functions• Provider Profile Updates• Paperless Remittance Advice• User List Functions• Void and Replacement Features• Claim Attachments• Prior Authorization Submission and Inquiry• TPL Updates• Crossover Claim Billing• Helpful Tools - Avenues of Resolution • Questions
Welcome and Announcements
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3 October 2009Web interChange Advanced Functions
Session Objectives
Following this session, providers will:•Understand how to obtain Web interChange
administrator access•Understand Web interChange administrator functions•Know how to view and print your provider profile•Know what can be updated in the provider profile, and
how to update the information•Know how to view/print/save Paperless Remittance
Advice•Know how to develop user lists•Understand void and replacement functions•Understand how to add claim attachments•Understand prior authorization inquiry and submission•Understand how to update TPL information•Understand crossover claim billing
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4 October 2009Web interChange Advanced Functions
Web interChange Accesshttps://interchange.indianamedicaid.com
Logon Screen
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5 October 2009Web interChange Advanced Functions
Administrator Request Form
•Complete and mail the Administrator Request Form to:
Electronic Solutions Help Desk950 N. Meridian StreetSuite 1150Indianapolis, IN 46204-4288
•Request Form and letter may be faxed to (317) 488-5185
•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
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6 October 2009Web interChange Advanced Functions
Web interChange Administrator MenuWeb interChange Home Page
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7 October 2009Web interChange Advanced Functions
Administrator Functions
•User Administration– Create User
– Update User
– Reset Password
– Reactivate User
•Group Administration– Administer Groups
• Group Maintenance• Group Member Maintenance• View Group Report
» Review the Group Report every 90 days
» Compliance is tracked by OMPP and EDS
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8 October 2009Web interChange Advanced Functions
Administrator Functions
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9 October 2009Web interChange Advanced Functions
Administrator FunctionsCreate a User
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10 October 2009Web interChange Advanced Functions
Administrator FunctionsGroup Administration
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11 October 2009Web interChange Advanced Functions
Administrator FunctionsGroup Member Maintenance
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12 October 2009Web interChange Advanced Functions
Administrator FunctionsReports
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13 October 2009Web interChange Advanced Functions
Administrator Functions
•Create user
•Establish groups and security levels
•Add users to group
•View group report
Group Administration
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14 October 2009Web interChange Advanced Functions
Password Resets
•Necessary when user has not logged on for more than 90 days
•Administrator may reactivate an inactive user
•Administrator gets e-mail from the EDI Solutions Help Desk when user is reactivated
•An inactive administrator must be reactivated by the EDI Solutions Help Desk
Reactivate User
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15 October 2009Web interChange Advanced Functions
Password ResetsBy User
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16 October 2009Web interChange Advanced Functions
Password ResetsBy User
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17 October 2009Web interChange Advanced Functions
Administrator FunctionsProvider Profile
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18 October 2009Web interChange Advanced Functions
Select “View” or “Edit”
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19 October 2009Web interChange Advanced Functions
Must respond
to ‘CHOW’ question
Change of Ownership?
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20 October 2009Web interChange Advanced Functions
Update Provider Address
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21 October 2009Web interChange Advanced Functions
Update Provider Specialty
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22 October 2009Web interChange Advanced Functions
Begin or Update Electronic Funds Transfer
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23 October 2009Web interChange Advanced Functions
Click “Edit”
Update Rendering Provider Information
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24 October 2009Web interChange Advanced Functions
Profile Maintenance
•Using Web interChange, providers can also make the following profile updates:
– Ownership information
– Changes in members of a Board 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 an enrollment via Web interChange
Other Types of Updates
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25 October 2009Web interChange Advanced Functions
Paperless Remittance Advice
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26 October 2009Web interChange Advanced Functions
Paperless Remittance Advice
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27 October 2009Web interChange Advanced Functions
Paperless Remittance Advice
Accessing Paperless RAs Through Web interChange *Three Easy Steps
Step 1 – From the Web interChange Home page, select Check/RA Inquiry. On the Check/RA Inquiry page, enter the desired search criteria and click Submit. A list of checks and RAs (most recent first) displays.
– The link to download the RA displays regardless of check availability
– If no check was issued in conjunction with the RA, the check number displays as “000000000”
– The Provider/National Provider Identifier (NPI) fields populate based on the user’s security
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28 October 2009Web interChange Advanced Functions
Paperless Remittance Advice
•Step 2 – Click on the PDF icon to the right of the check number (in the “Download RA” column)
– A PDF of the RA opens in a new window
– Downloaded RAs have a Family and Social Services Administration (FSSA) watermark
– If users wish to save copies of RAs for their records, they can use the “Save a Copy” feature of Adobe Acrobat Reader
• RAs can also be printed from Adobe Acrobat Reader
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29 October 2009Web interChange Advanced Functions
Paperless Remittance Advice
•Step 3 – If the desired RA is not displayed, change the search criteria at the top of the Check/RA Inquiry page
– RAs are available in Web interChange for four weeks
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30 October 2009Web interChange Advanced Functions
User List Functions
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31 October 2009Web interChange Advanced Functions
User List Functions
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32 October 2009Web interChange Advanced Functions
User List Functions
•Features of a User List:
– May create user lists to alleviate keying information manually in specific claim submission fields
– Allows information to be added or deleted as needs change
– Can only be created for fields listed with a drop-down arrow in the claim submission screen
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33 October 2009Web interChange Advanced Functions
Void and Replacement Features Void
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34 October 2009Web interChange Advanced Functions
Void and Replacement Features
•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 a HIPAA term for adjustment
•Void is the cancellation of an entire claim whether same day, same week, or post financial
Void
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35 October 2009Web interChange Advanced Functions
Void and Replacement Features
•A void can be performed on claims in a paid or suspended status
• If the void of a claim occurs the same day or week that the original claim was submitted, a new ICN is not created
– The same ICN assigned to the claim applies to the void
– The original claim denies with edit 0120 – Claim denied due to an electronic void request
• If the original claim being voided is a historical claim, a new claim with a new ICN is created
– The new ICN starts with 63
•Check-related voids (adjustments) continue to be submitted on paper
Void
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36 October 2009Web interChange Advanced Functions
Void and Replacement Features
Pre-Financial Post-Financial
2009010000002 – Paid
User voids the claim
Voided claim denies EOB 0120
2009242001001 – Paid
Today’s date: 10/10/09
6300252001000 – Denied with EOB 0120
RA/835 shows:
Claim shows on the denied page only – same ICN
RA/835 shows:
Mother Claim: 2009242001001 and Daughter Claim: 6309252001000
Both appear on the adjustment page
Void
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37 October 2009Web interChange Advanced Functions
Void and Replacement Features Replacement
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38 October 2009Web interChange Advanced Functions
Void and Replacement Features
•Replacement is a change to an original claim, whether same day, same week, or post financial
– Original claim indicates the most recent ICN assigned to that claim
•An electronically submitted replacement claim can be for a previously submitted electronic or paper claim
•Only noncheck-related replacements are accepted electronically
•Check-related replacements continue to be submitted on paper
Replacement
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39 October 2009Web interChange Advanced Functions
Void and Replacement Features
• If the IHCP receives a replacement claim for an original claim that has been through a financial process (has appeared on an RA), the replacement claim ICN starts with one of the following:
―61 – Provider initiated replacement containing attachments and/or claim notes
―62 – Provider initiated replacement with no attachments and/or claim notes
Replacement
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40 October 2009Web interChange Advanced Functions
Void and Replacement Features
No filing limit for void requests
One-year filing limit for replacement requests
•Web interChange will not display a Replace This Claim button on claims that are past the filing limit
– These replacements must be submitted on paper
•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
– If the date of service of the claim is greater than one year, proof of timely filing is required to avoid a payment take back on the paid claim
•The filing limit does not apply to crossover claims
Filing Limits for Voids and Replacements
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41 October 2009Web interChange Advanced Functions
Claim Attachment Feature
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42 October 2009Web interChange Advanced Functions
Claim Attachments
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43 October 2009Web interChange Advanced Functions
Claim Attachments
•Unique number assigned by provider
•Claim and document specific
•Each ACN may only be used one time
•Write “ACN #” and the assigned ACN on each page of documentation corresponding to that number
Attachment Control Number (ACN)
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44 October 2009Web interChange Advanced Functions
Claim Attachments
•Select the appropriate Report Type
– Report Type describes the document being sent
•Transmission Code defaults to “BM” – by mail
– Electronic and e-mailed attachments are not accepted
•Text Box
– Applies to institutional claims only
Report Type and Transmission Code
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45 October 2009Web interChange Advanced Functions
Claim AttachmentsAttachment Control Cover Sheet
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46 October 2009Web interChange Advanced Functions
Claim Attachments
•Available on IHCP home page, under Forms
•Complete cover sheet for each claim
• Include provider information
•Provide member ID
•List each ACN pertaining to specific attachment
• Indicate the number of pages of documentation submitted per attachment (not including the cover sheet)
•Mail cover sheet and supporting documentation to the appropriate P.O. Box (P.O. Box 7259)
Attachment Control Cover Sheet
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47 October 2009Web interChange Advanced Functions
Prior Authorization Inquiry and Submission278 Prior Authorization Inquiry
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48 October 2009Web interChange Advanced Functions
Prior Authorization Inquiry and Submission
•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
278 Prior Authorization Inquiry
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49 October 2009Web interChange Advanced Functions
Prior Authorization Inquiry and Submission278 Prior Authorization Submission
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50 October 2009Web interChange Advanced Functions
Prior Authorization Inquiry and Submission278 Prior Authorization Submission
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51 October 2009Web interChange Advanced Functions
Prior Authorization Inquiry and Submission278 Prior Authorization Submission
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52 October 2009Web interChange Advanced Functions
Prior Authorization Inquiry and Submission278 Prior Authorization Submission
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53 October 2009Web interChange Advanced Functions
Prior Authorization Inquiry and Submission
•The following provider types can submit PA requests via Web interChange:– Chiropractor
– Dentist
– Doctor of Medicine
– Doctor of Osteopathy
– Home Health Agency (authorized agent)
– Hospice
– Hospitals
– Optometrist
– Podiatrist
– Psychologist endorsed as a Health Service Practitioner in Psychology (HSPP)
– Transportation providers
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54 October 2009Web interChange Advanced Functions
Prior Authorization Inquiry and Submission
•Must be given access to submit PAs by the administrator
•Web interChange PA attachments follow the same guidelines as the Web interChange claim attachment process
•Assign a unique Attachment Control Number (ACN) for each attachment
•Enter assigned number into attachment screen in Web interChange
•Documentation must be submitted within 30 calendars days of the request
278 Prior Authorization Submission
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55 October 2009Web interChange Advanced Functions
Prior Authorization Inquiry and Submission
Decision letters:
•The system sends a decision letter for PAs submitted via Web interChange, the same way it does for all PA requests
278 Prior Authorization Submission
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56 October 2009Web interChange Advanced Functions
Prior Authorization
•ADVANTAGE Health Solutions-FFSPrior Authorization DepartmentP.O. Box 40789Indianapolis, IN 462401-800-269-5720 Fax: 1-800-689-2759
•ADVANTAGE Health Solutions-Care SelectPrior Authorization DepartmentP.O. Box 80068Indianapolis, IN 462801-800-784-3981 Fax: 1-800-689-2759
•MDwise-Care SelectPrior Authorization DepartmentP.O. Box 44214Indianapolis, IN 46244-02141-866-440-2449 Fax: 1-877-822-7186
Prior Authorization by Telephone, Fax, or Mail
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57 October 2009Web interChange Advanced Functions
TPL Updates
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58 October 2009Web interChange Advanced Functions
TPL Updates
•Submit an electronic request to the EDS TPL Unit to update a member’s insurance information
•The TPL Unit receives the request, researches, confirms the information, and updates the eligibility screen with corrected information
– Updates are usually made within 20 days
•Confirm that eligibility has been updated by reviewing the Eligibility Inquiry feature
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59 October 2009Web interChange Advanced Functions
Crossover Claim Billing
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60 October 2009Web interChange Advanced Functions
Crossover Claim Billing
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61 October 2009Web interChange Advanced Functions
Crossover Claim Billing
•Submit Medicare crossover claims electronically using Web interChange
•The following header information is required for the claim to process:
– Payer ID and Payer Name
– TPL/Medicare Paid Amount
– Subscriber Name, Primary ID, Relationship Code, Gender, DOB, and Claim Filing Code
– If the Payer ID is a Medicare payer and the Claim Filing Code is MA or MB, the claim is considered to have crossover information
Note: Obtain COB information, including Payer IDs from the HELP tab, Reference Materials on Web interChange
Header Information
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62 October 2009Web interChange Advanced Functions
Crossover Claim Billing
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63 October 2009Web interChange Advanced Functions
Crossover Claim Billing
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64 October 2009Web interChange Advanced Functions
Crossover Claim Billing
•The following detail level elements are requirements for the claim to process:
– Payer ID
– TPL/Medicare Paid Amount
– Group Code, Reason Code, and Amount
Note: Obtain COB information from the HELP tab on Web interChange
Detail Information
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65 October 2009Web interChange Advanced Functions
Helpful Tools
• IHCP Web site at www.indianamedicaid.com
• IHCP Provider Manual (Web, CD-ROM, or paper)
•Customer Assistance
– 1-800-577-1278, or
– (317) 655-3240 in the Indianapolis local area
•Written Correspondence
– P.O. Box 7263Indianapolis, IN 46207-7263
•Provider Relations field consultant
– View a current territory map and contact information online at www.indianamedicaid.com
Avenues of Resolution
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October 2009
Questions
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October 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.
Office of Medicaid Policy and Planning (OMPP)
402 W. Washington St, Room W374
Indianapolis, IN 46204
EDS, an HP Company
950 N. Meridian St., Suite 1150
Indianapolis, IN 46204