Transcript Slide 1

Checking for Eligibility
and
Successfully Completing a Claim
with the
OHCA Secure Site
For ResCare Providers
Department of Mental Health and
Substance Abuse Services
Van Rhodes and David Melton
Checking Eligibility
Generating a Member ID
To check eligibility, obtain a member ID, submit claims and check PAs, go to:
https://www.ohcaprovider.com/Oklahoma/Security/logon.xhtml
Sign In
Your Agency
Your Prov Number
Your Number
Searching for a Member ID
Eligibility Can Be Checked with any
combination of 2 of the following:
Name
Date of Birth
Social Security Number
or you may check by the
Member ID if it is known.
This member is fine.
No further action required.
Their member ID is
045359933
What if:
the customer does not have a member ID,
OR
the customer has a member ID, but does not
have DMH (MHSAS) Eligibility,
OR
the customer has a Member ID, MHSAS
eligibility, but the eligibility is going to expire soon.
Click on ‘ODMHSAS Customer Enrollment’
Name, Date of Birth, Gender, SSN and
Address then click
‘Submit’
Enter
Donald Duck
555555589

This is NOT enrollment for Medicaid
 You should encourage customer to go to
www.mysoonercare.org to fill out for Medicaid benefits
• You still need to be cautious to not create duplicate
Customer IDs
• Entering in 000-00-0000 for the SSN should be the very
last resort

Remember: you cannot back date eligibility
ARC WEBSITE http://www.odmhsas.org/arc.htm
Services Manual
Helpful Reports Related to the CCP
Go To ICIS
Click on CCP Reports (Middle Column)
The reports with the red arrows (1004 and
1006) will be particularly important in keeping
eligibility and Prior Authorizations up to date.
Submitting a CDC
in
Care Connection
STEP 2: Determining what ‘ADD’ you need to use to create a CDC Transaction Type:
•
•
After clicking ‘Search’, it will either show the consumer’s CDC(s) from your search in
the CDC Search Result screen.
If the customer appears in the search then click the blue ‘Add’ on the corresponding
row.
For providers with multiple locations like Red Rock,
Just click one and you are finished, you do not have to know the location.
Things to Remember
When updating CDCs for the PA, the date of the CDC transaction needs to be the date directly
following the date that the last PA was to end (ex: PA ends on 4-1-2011, the CDC update needs
to be dated 4-2-2011).
Please do not do (enter) CDC updates prior to the first date of the new PA (ex: if existing CDC/PA
is ending on 4-1-2011, you should not enter the CDC update until 4-2-2011). If you enter the
updates earlier than that it can cause system problems.
You have 15 days after the date that the new PA should begin to enter your CDC update. Be sure
that when you do the update the transaction date is the date that the new PA should have
begun (ex: existing CDC/PA is ending on 4-1-2011, and the new PA should begin on 4-2-2011.
You can complete the CDC update anytime between 4-2-2011 and 4-17-2011, but would
need to make sure that the transaction date on the CDC is dated 4-2-2011).
Submit a Claim
Your Agency
Your Prov Number
Your Number
Computer generated
200000000
Computer generated
200000000
Complete Member ID and Diagnosis
2000000
00
No Decimal Point
200000000
Go to Screen 2
The claim info you enter below, will populate the box above
DOS = Date of Service
Use 99 – Other Unlisted Facility
T2033
Use 1
HE
1.00
10.00
Leave this area blank
4 Digit Contract Source
Double Click in the Rendering NPI box and
the system will generate the rest of the
information required.
Click Submit
When you press the SUBMIT button at the
bottom of the page, you will be told if the
claim is Paid or if you have an error that
needs to be corrected and what you need to
correct.
You can immediately correct the claim
and resubmit it.
If your claim(s) is successfully submitted
by noon Wednesday,
you will receive an electronic remittance by
midnight the
following Wednesday.
Your Agency
Your Prov Number
Your Number
Checking Denied Claims for a particular consumer (Member ID)
You can limit the search by adding dates
Searching by Member ID, Date of Service and Any Status
Choose the ICN with highest number. It is the most recent claim.
The “Denied” claim looks like this. Note the Error Codes below the ICN
ICN
Checking Denied Claims for ALL claims for your provider ID
Choose the “Claim Status” you want
to search or
choose ‘ALL’
Click Search
You can limit the search by adding dates
TIP 1a: Create a “Patient Account Number” when you submit a claim
200000000
2000000
00
2000000
00
Just type it in the Patient Account Box
200000000
If you use JonesMary as your account number
it will make subsequent Claims Inquiries
much easier, as you will not have to know
what the Client ID means when do an “ALL
Claims” inquiry.
Checking Denied Claims for your Account Number “JonesMary”
JonesMary
TIP 1b: You can also
‘Search’ by Patient
Account Number
JonesMary
JonesMary
JonesMary
JonesMary
JonesMary
JonesMary
JonesMary
etc
Checking your
Prior Authorization
in
Care Connection
For ResCare facilities:
Authorizations are instantly created by CDCs
If you get a billing error, check the last CDC entered for the customer
What you are looking for:
transaction date of CDC (authorization is only good
six months out from transaction date)
service focus of CDC (needs to be 11)
Level of Care (needs to be ‘CL’)
Checking your
Prior Authorization
on the
OHCA
Secure Site
Click Here or Here to check for
prior authorizations
You will see these 3 choices.
For Behavior Health Claims,
you can ONLY check Status Inquiry.
You cannot submit a PA Request
This is done on APS CareConnection
As you have seen in an earlier slide.
You can search for PAs
for individual members
by date
Or
for ALL of the
members PAs
Enter ID and check all
PAs and click Search
Click on the PA number and you will find information on the number of units
or dollars allotted per month and the amounts used. This is updated as you
submit claims, so it will be up to date.
I am sorry we do not have an example of that screen, but we believe it will be
self explanatory when you see it.
Checking your
Budget
on the
OHCA
Secure Site
Click Here to Select the
Contract Source you want to review
The Budget information
will appear here.
If you have a problem with a claim,
call the OHCA Helpdesk
800-522-0114
or in OKC
522-6205
APS Helpdesk for questions concerning CDC
and Prior Authorization
1-800-762-1560 – toll free
405-556-9700 – OKC
Contact Information:
Van Rhodes
[email protected]
Work 405.522.8876
Cell 405.795.1724
David Melton
[email protected]
Work 405-522-3821
Please Note, there is lots of help available.
OHCA/Claims, APS Healthcare
And ODMHSAS
All have trainers and field representatives to assist you.