Transcript Slide 1

Electronic Transactions:
The Green Alternative
Presented by the EDS Provider
Field Consultants
May 2009
Agenda
Welcome and Announcements
• Session Objectives
• Why Bill Electronically
• Paper Billing Misconceptions
• How to Begin
• What Can Be Performed Electronically
• Helpful Tools
• Questions
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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
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Why Bill Electronically?
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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
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Paper Billing Misconceptions
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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
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How to Begin
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Web interChange Access
https://interchange.indianamedicaid.com
Logon Screen
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Administrator Request Form
• Complete and mail the Administrator Request Form to:
EDI Solutions Help Desk
950 N. Meridian Street
Suite 1150
Indianapolis, 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
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What Can Be Performed
Electronically?
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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
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May 2009
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
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Select “View” or “Edit”
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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 an
enrollment via Web interChange
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Update Third Party Liability
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Verifying Member Eligibility
The following enhanced features are available
through Web interChange:
• Detailed TPL information
• Online TPL update requests
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Prior Authorization Submission
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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
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Web interChange Claim Submission
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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
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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
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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
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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
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Claim Attachments
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Claim Attachment Information
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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
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Claim Attachments
Attachment Cover Sheet
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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 surgery
Details for claims notes are available in BT200511
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Claim Inquiry
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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
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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
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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
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Check Inquiry Window
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Initiate or Update Electronic Funds Transfer
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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
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Banners, Bulletins, Newsletters
• Effective September 1, 2009 paper
communications will no longer be mailed
–Banners
–Bulletins
–Newsletters
–Claim Correction Forms (CCF)
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Helpful Tools
Avenues of Resolution
• 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
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Questions
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EDS, an HP Company
950 N. Meridian St., Suite 1150
Indianapolis, IN 46204
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.
May 2009