Transcript Document

Professional Provider Back to Basics Seminar
CareFirst BlueCross BlueShield Updates
AAHAM Third Party Payer Meeting
November 16, 2012
7/21/2015
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Agenda
Electronic Services- Updates and Coming
Attractions
Federal Employee Program (FEP)
Changes 2013
CareFirst General Updates
7/21/2015
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EDI Information
Electronic Claim Submission
(837)
Electronic Remittance
Advice (835/ERA)
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Electronic Claims Submission
Who should submit claims
electronically?
• All Acute Care facilities
Don’t get buried in paper
• ASC, Skilled Nursing Facility,
Lithotripsy, ESRD, Birthing
Centers, DME, HIT, Home
Health, Hospice & Substance
Abuse
• Any facility that submits
electronically will benefit
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EDI On the CareFirst Website
Refer to the CareFirst website for information on:
 CareFirst preferred clearinghouses and contact information
 EDI manuals and reference guides
 Hints for successful submission
 Frequently asked questions
 News & Updates
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Helpful Hints - Critical to Success of EDI
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Submit claims using your NPI number
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Include patient’s entire prefix & membership number
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Verify patient name and birth date
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Use HIPAA standard data code sets
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Review all reports daily
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Correct all claims with errors and resubmit electronically
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Review website regularly for news and updates
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Refer to the website or BlueLink for a list of the preferred vendors
that can be used to submit claims to CareFirst
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EDI Support
Difficulties with submissions?
• Contact your vendor/clearinghouse first.
CareFirst:
• EDI Service Line
1-877-526-8390
[email protected]
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For better assistance, use one of the following terms when
placing your call:
835 ERA's/enrollment
NPI
837 claim status for NCOF (no claim on file) or front end rejections
from CareFirst
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Electronic Fund
Transfer (EFT)
Information
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Get Your Payment Fast Though
Electronic Fund Transfer (EFT)
• Get paid faster through electronic delivery of your payments
• Reduce paperwork
• Receive secure payment distribution
• Avoid mail delay
• To be eligible for EFT you must:
 Submit claims electronically
 Receive an 835/ERA (Electronic Remittance Advice)
Enroll Today for Electronic Fund Transfer
(EFT)*
The following clearinghouses also offer electronic fund transfer (EFT)
enrollment services:
• Emdeon (formerly known as Webmd) at 866-369-8805
• Allscripts (formerly known as Payerpath) at 877-623-5706, ext. 1 or
ext. 2
• RealMed at 877-927-8000, ext. 1201
Contact your clearinghouse with all questions regarding EFT capabilities
and enrollment
•
For more information refer to the CareFirst website at
www.carefirst.com/providers>QuickLink>Ancillary&ElectronicClaims
(EDI/EFT)
*Note: If you currently receive automated payments from CareFirst there are no changes and no need to
re-enroll
New Look to the Website
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Quick Links
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Coming Soon!
CareFirst Direct 835
Remittance Advice
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835 Remittance Enhancements
Log into CareFirst Direct
11/8/2012
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835 Remittance Enhancements
Click on Medical Claim Status
11/8/2012
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835 Remittance Enhancements
Click on Provider Remittances
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835 Remittance Enhancements
Complete the Information below
11/8/2012
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835 Remittance Enhancements
11/8/2012
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835 Remittance Enhancements
11/8/2012
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CareFirst Direct 835 Webinars
We are currently testing, and getting feedback from
the provider community on the changes.
Instructional webinars will be available when we
get closer to the “go live” date.
We will let you know when the Notice of Payment
(NOP) is available on CareFirst Direct.
It could be active as early as December.
Facet Voucher Changes
The Facets Voucher/Notice of payment(NOP) for both
professional and institutional providers will be changing
during the 1st quarter of 2013.
This change was done to make the voucher easier to
interpret, and to make sure all of the necessary
information is available.
A firm date has not yet been determined, however
training will be conducted via webinar sessions.
Please check the website periodically and register when
these sessions are listed.
CareFirst.com
“One-Stop” shopping for CareFirst information –
www.carefirst.com.providers and physicians.
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7/21/2015
Product and General Information manuals
Access to CareFirst’s Medical Policy
Access to CareFirst’s bi-monthly newsletter- BlueLink
Credentialing information in the “Quick Links” section of the website
Job Aids
Forms
Critical News blasts
Access to CareFirst Direct
Register for instructional Seminars and Webinars
Companion Guide for the 5010 Transaction sets
ICD10 updates
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New Series of Webinars
Suggested Curriculum for new providers or providers that would like a refresher:
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Session 1- New Provider Introduction- overview of the expectations and training available for providers
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Session 2 - Specialty Specific Contract Information (Institutional Ancillary Providers only)
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Session 3 – Programs and Products – overview of CareFirst Products and corresponding membership cards
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Session 4 - Claims Submission Requirements- overview of how to file claims to CareFirst
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Session 5 – Corrected Claims Submission, Inquiry and Appeal Procedures- a “how to” for electronic claim
correction. Also includes how to file an inquiry or an Appeal.
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Session 6 – Self-Service Tools - CareFirst Direct – Eligibility and Benefits
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Session 7 – Self-Service Tools – CareFirst Direct – Claims Status and Inquiry
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Session 8 - Voice Response Unit (VRU)
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Additional topic specific webinars we encourage you to take:
– Blue Card , Blue Choice, HealthyBlue,
Federal Employee 2013 Changes
Changes to both Standard and Basic
Option Plans
Standard Option
• 104 Standard Option – Self Only
• 105 Standard Option - Self and Family
Basic Option
• 111 Basic Option – Self Only
• 112 Basic Option – Self and Family
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Residential Treatment Centers
Benefits are not available for services performed or billed
by Residential Treatment Centers.
*More details can be found on page 91 in the Service Benefit Plan Brochure.
(As soon as the web
page opens, press Ctrl key and the letter “F” key and then type in the page number and press the
Enter key.)
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Inpatient Hospice
Benefits are now provided up to thirty (30) consecutive days of
inpatient hospice care performed in a facility licensed as an
inpatient hospice facility.
Benefits are provided in full for inpatient hospice care performed
at a preferred hospice facility.
*More details can be found on page 83 in the Service Benefit Plan Brochure. (As soon as the web
page opens, press Ctrl key and the letter “F” key and then type in the page number and press
the Enter key.)
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Changes to the Basic Option
Plan
Basic Option
• 111 Basic Option – Self Only
• 112 Basic Option – Self and Family
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Therapy
The copayment for outpatient physical, occupational, and
speech therapy billed for by a preferred hospital is now $25
per day, per facility; limited to a total of 50 visits per person,
per calendar year.
*More details can be found on page 78 of the Service Benefit Plan Brochure. (As soon as the web page opens,
press Ctrl key and the letter “F” key and then type in the page number and press the Enter key.)
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Rehabilitation
The copayment for outpatient cardiac rehabilitation, cognitive
rehabilitation, and pulmonary rehabilitation billed for by a preferred
hospital is now $25 per day, per facility.
*More details can be found on page 78 of the Service Benefit Plan Brochure. (As soon as the web page
opens, press Ctrl key and the letter “F” key and then type in the page number and press the Enter
key.)
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Outpatient Services
Copays for some outpatient diagnostic studies and radiological services are now $100 per day,
per facility when those services are received at a Member or Non-member facility.
Outpatient surgical, diagnostic, and treatment services performed and billed by a hospital or
freestanding ambulatory facility, such as*:
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Operating, recovery, and other treatment rooms
Anesthetics and anesthesia services
Diagnostic bone density tests
CT scans/MRIs/PET scans
Diagnostic angiography
Nuclear medicine
Sleep studies
Chemotherapy and radiation therapy
Renal dialysis
*This list is not all-inclusive.
A more detailed list can be found on page 77 of the Service Benefit Plan Brochure. (As soon as the web page
opens, press Ctrl key and the letter “F” key and then type in the page number and press the Enter key.)
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Change to the Standard Option
Plan
Standard Option
• 104 Standard Option – Self Only
• 105 Standard Option - Self and Family
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Home Hospice
• The copayment for
continuous home hospice
care performed by a
preferred provider is now
$250 per episode.
*More details can be found on page 82 of the Service
Benefit Plan Brochure. (As soon as the web page
opens, press Ctrl key and the letter “F” key and
then type in the page number and press the Enter
key.)
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FEP Contact Information
CareFirst Direct provides free online look up of benefits, eligibility,
claim status, authorizations,
referrals and submission of
administrative appeals.
Go to CareFirst.com>Providers & Physicians
then click on Need Claim Status or Eligibility
in the Solution Center.
FirstLine Voice Response Unit
provides eligibility, benefits and
claim status. This number will also
connect you to FEP Provider
Service.
800-854-5256
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CareFirst General Updates
Split Claims
Please submit: 2012 claims separately from
2013 claims.
Example:
An admission date of 12.28.2012 and a
discharge date of 1.4.2013 should be filed on
two separate submissions. The charges for
2012 on one submission and the 2013 on
another submission.
Note: This process does not apply to the
Federal Employee Program (FEP)claims. The
years can be combined on one claim.
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iEXCHANGE FYI
CareFirst will be replacing iEXCHANGE during the 2nd
quarter of 2013.
Plan on attending the Institutional Quarterly Seminar
in March 2013 for Training on the replacement for
iEXCHANGE.
Register for this or any of the CareFirst webinars and
seminars at www.carefirst.com>provider &
physicians>seminars and training tab.
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CareFirst Administrators
Providers can obtain claim status
information for CareFirst Administrators
accounts by accessing this website:
www.cfablue.com
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NCAS
Providers can obtain claim status information for NCAS
network lease accounts by accessing the NCAS website
at www.ncas.com. This website can be used for
memberships with the prefixes A11, A46 and A51. All
other NCAS prefixes call the numbers on the back of
the card.
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Termination of the BlueWorldWide Expat Product
You should not accept ID cards with Alpha Prefix EXF
after Nov. 30, 2012. Claims for services rendered after
this date will not be reimbursed.
For services rendered on or before Nov. 30, 2012,
submit all claims to CareFirst by April 1, 2013.
Original claims and adjustments submitted after April 1,
2013, for services provided on or before Nov. 30, 2012,
will not be reimbursed through BlueCard.
Termination of the BlueWorldWide Expat Product cont’
As a result, effective Dec. 1, 2012, the Blue System will provide
three separate offerings for international travelers and
expatriates:
• BlueCard Worldwide—Part of domestic coverage for local and
National Account business.
• FEP Overseas—Coverage extended to government employees
overseas.
• GeoBlue—A Blue-branded Licensee administering the
International Solutions Licensee (ISL) products
Please verify eligibility and benefits through 1-800-810-Blue, or
CareFirst Direct.
Self Service Tools
Reminder for CareFirst Direct and the Voice Response Unit (VRU):
CareFirst expects providers to use the self-service channels to obtain
eligibility, benefits or claims status information.. We are moving our
support for these simple, direct and factual queries to electronic
channels and discouraging calls for these purposes.
Ensure that your billing agency (this would not be your EDI vendor)
has access to CareFirst Direct. CareFirst has scheduled webinars for
billing agencies. Have your billing agency/vendor sign up for one of
the CareFirst Direct webinars.
Questions
Thank you for your attention
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