CA Public Health Billing Workgroup February 26, 2013 Private Health Plans: Part 2

Agenda Welcome/ Introductions Private Health Plans: Part 2 Blue Cross Enrollment Checklist Online Verification Cigna Updates Question and answer Workgroup Schedule Workgroup Contact info

Presenters Robyn Davis, MPH State Coordinator, CA PH Billing Project Athina Kinsley, CMBS-I Health Insurance Specialist, CA PH Billing Project Timi Granados, BA Billing Project Coordinator, CA PH Billing Project

Out-of-Network Benefits In-Network Benefits Why does it matter if we are “in-network”? Health Plans vary with coverage Deductibles – met or not met Co-insurance – what % is the patient responsible for In-Network Benefits Reimbursement Rate Out-of-Network Benefits

Online Vs. Calling Online Calling Pros Pros Cons Cons Faster Download document or print and scan Cons Out-of-network may not be clear Deductible met or not met may not be listed Pros Out of network information Deductible met or not met C.S. Representative answer questions you may have Cons Timeliness

Understand a PPO card PPO (Preferred Provider Organization)

Blue Cross

Blue Cross Enrollment Checklist Developed to assist LHD’s initiate a BC contract Complete Checklist and fax to: 818-234-3148 (PPO) 888-438-6811 (State programs) Specialty Lines of business Healthy Families update

Select “California” and click enter Online verification Go to: http://www.anthem.com/ca/home-providers.html Select “California” and click enter

Online Verification (cont.) Select “Medical” from the drop down menu

Online Verification (cont.) Individual User ID Individual Password Contact System Administrator

Online Verification (cont.) Enter member ID

Online Verification (cont.) Select Subscriber or Dependent Enter Service Date

Online Verification (cont.) Select the Service type from the drop down menu Ex: immunizations, well child, LAB, Family Planning etc.

Online Verification (cont.) Select “View Eligibility & Benefits Details” from the “Action” drop down menu

Online Verification (cont.) Print & scan or save

Online Verification (cont.) This example shows Laboratory coverage as unknown. In this case, call the insurance to get benefits.

Cigna Updates Contact Donna Dojan (860) 226-5725 Progress

Workgroup Schedule 3/26 2:00 PM – Third Party Administrators 4/30 2:00 PM – TBD 5/28 2:00 PM - TBD 6/25 2:00 PM - TBD

Contact Information CA Public Health Billing Team Toll Free (877) 818-4787 phbillingteam@co.kern.ca.us