Transcript PerformCare CSA Service Desk and Billing Request

May 3, 2011
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The CSA Service Desk and Billing Request Form
was created as a tool to streamline
communication and simplify the process of
requesting assistance from the Service Desk.
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
The new form
can be found
under the
menu item
For Providers,
Service Desk
Request
Form.
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1.0 Introduction



Each of the required fields
must be completed
(designated by an asterisk - *).
Date and Time of Request will
update with the current
date/time when the form is
submitted.
The field that states “Briefly
describe why you are
contacting us today” will act as
the subject of request.
◦ The submitter of the form will
see this in the subject line of the
email they receive once the form
is submitted.
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1.1 Type of
Request


Type of Request must be
selected to complete and
submit the form.
When an option is selected,
the bottom portion of the
screen will expand with
additional information that
will need to be
entered/provided.
◦
The options Authorization/Billing,
Eligibility, and 3560 will display the
same additional information
requirements at the bottom of the
screen.
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2.0 Authorization/
Billing,
Eligibility, 3560

The following illustrates the
data elements required for
the Authorization/Billing,
Eligibility and 3560 types of
requests.
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2.1 Type of issue


Type of Issue dropdown
contains the following
options and must be
completed in order to
submit the request.
If “claim denied” is
selected, another data
element will be added to
the right of it, (Remittance
Advice), that is a required
field. Please enter a
Remittance Advice
number(see below for
example).
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
Attach Medicaid Number – The Medicaid Number was not attached

Authorization Modification

Claim Denied – PerformCare will handle the following rejection codes:
when the youth was registered. Contact with the CSA should be initiated
if the Prior Authorization was created more than 10 days ago.
–
Must be specific on what needs to be
modified (dates, number of units) and must include justification for the
request. (Please include this detail in the Comments field at the bottom
of the top half of the screen.)
774 – PA not on file
775 – PA record on file is not active
779 – Medicaid PA number invalid
Any other rejection code or Remittance Advice number MUST be directed
to Molina Medicaid Solutions System for resolution.

Gap in Eligibility – Notify the CSA of a gap; please include dates not
covered in the Comments field, located below the Type of Request dropdown menu. Service providers will be referred to the Case Management
Entity for resolution.
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
Not Feeding to Molina
–
Notifying the CSA that the Billing
information for service is not being fed to Molina.

PA Not on File
–
Check when the Prior Authorization was created prior
to submitting a request. Authorizations transmit to Molina Tuesdays and
Thursdays by 3 PM.

Wrap/Flex Payment
–
Keep in mind that claims may take up to two
weeks to process; if payment has not been made, contact AtlantiCare
directly.

3560 Status
–
Inquiry regarding the status of a 3560 Application;
please include the dates for the eligibility, as well as the date the
Application was submitted.
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3.0 Customer
Service


The following illustrates
the data elements required
for the Customer Service
type of request.
When the Type of issue
dropdown is selected, the
following options will
appear and one must be
selected in order to submit
the request.
◦
The Youth ID and Youth DOB
fields are not required, but will
assist in researching and
resolving the request.
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3.1 Certificate
of Need


The following illustrates
the data elements
required when the user
selects Certificate of Need.
Users must choose the
provider (CYBER user) type
from the pull-down menu.
◦
All fields are required.
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3.2 Provider SetUp Medicaid

The following illustrates
the data elements required
when the user selects
Provider Set-Up, Medicaid.
◦
Note: Providers that have
Medicaid ID’s can request to be
set-up as both Medicaid and
Non-Medicaid providers if they
provide both types of service.
◦
Each form submitted to the
Service Desk is for one individual
request; multiple requests
cannot be completed on one
form.
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3.2 Provider SetUp – NonMedicaid

The following illustrates
the data elements required
when the user selects
Provider Set-Up NonMedicaid.
◦
Only a Medicaid provider, CME or
Mobile Response agency can
enter a Non-Medicaid provider’s
information.
◦
Each form submitted to the
Service Desk is for one individual
request; multiple requests
cannot be completed on one
form.
◦
Note: Providers that have
Medicaid ID’s can request to be
set-up as both Medicaid and
Non-Medicaid providers if they
provide both types of service.
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– Request for an authorization number.

Authorization Number

Certificate of Need – Completed by the provider that is requesting a
Certificate of Need for an OOH placement.

Close in Tracking
– Request by the provider to close their access to a
youth’s record.

Open in Tracking
–
A request to open the provider in tracking so they
may access a youth’s record.

Provider Setup-Medicaid - New provider in the System of Care that has
a Medicaid number.
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
Provider Setup-Non-Medicaid – New provider in the System of Care
that does not have a Medicaid number or that provides Non-Medicaid
services.

Referral Turn Back– Notifying CSA of Turn Back; provide provider’s
name, youth’s CYBER ID, date of birth, date of authorization and
reason for turn back.

Request for Authorization not Previously Generated – Request to
have an authorization generated that should have been created
previously by the CSA.

Retro-Authorization – Request for a Retro-Authorization to be
generated.

Status of Review – Inquiry on the status of a Treatment
Plan/Assessment/Clinical Summary that has been submitted for
review.
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4.0 CYBER
Technical
Support



The following illustrates the
data elements required for
CYBER technical support.
When the Type of issue
dropdown is selected, the
following options will appear
and one must be selected to
submit the request.
If “Other” is selected, please
enter additional information
in the Comments box.
◦
Any additional information
related to the request may be
entered into the Comments box.
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
Cannot install Silverlight
–
Usually an issue with downloading the
application needed for CYBER.

CYBER general assistance – Issues with navigation, training
questions, redirection of other CYBER-related questions or issues,
clarification of procedure(s).

CYBER is slow/down – This request should be submitted after
Internet connection issues have been ruled out.

Login/Password Issues – Lost user ID/password, issues with logging
into CYBER, difficulty creating new user ID/password.

Loss of Data – Report when data that has been entered and saved has

MAC user
been lost.
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Issues encountered when using CYBER on a MAC.
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5.0 IIC Provider
Registration


The following illustrates
the data elements required
for IIC Provider
Registration (submitted
once WebEx training has
been completed).
In order to select more
than one county served,
hold down the CTRL key
and click on additional
counties. (Counties are
listed in alphabetical
order.)
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6.0 Provider
Information
Form (PIF)

The following illustrates
the data elements required
for Provider Information
Form (PIF) change/update
request. After the PIF
request form is received, it
is forwarded to DCBHS for
review and approval.
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7.0 Other


The following illustrates
the data elements required
for “Other” type of request.
This option should be used
when nothing else is
applicable. Please use the
Request box at the bottom
of the screen to describe
the request, in detail.
◦
The request cannot be submitted
without including information in
the Request box.
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



Complaints/Compliments
Enhancements/Suggestions for CYBER
Security Incident (loss of computer, hacking)
CYBER Training schedule
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

Please click the “Submit” button once and wait for
confirmation; clicking multiple times may create
multiple requests.
Shortly after the confirmation page appears (see
slide 22), users will receive an email with the details
of the request.
◦ Users will also receive a follow-up email that will
includes the work order number.
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
This message will
appear if the
request was
successfully
submitted (with
the date and time
of the submittal).
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


DYFS Continued Need for OOH Progress
Note
IRTS, EDRU, DAP Admissions; Out of State
Provider Admissions and Discharges
Certificate of Need Requests
Other Clinical requests (IOS disputes, etc.)
should be done over the phone. Please
contact the CSA at 1-877-652-7624.
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This form replaces a number of email
addresses that go to Service Desk;
◦
◦
◦
◦
◦
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
These email addresses will no longer be functional
effective April 1, 2011. After this date, please only
use [email protected].
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