Gold Services September 2007

Introduction To begin, you need your assigned ENS user ID, password, and organization ID This should be delivered to you on the ENS welcome letter via fax 3–4 business days after enrolling with ENS for service You can also call Technical Support at (866) 367-9778 to obtain login information What are Gold Services? A service provided by ENS to customers who have selected this product This service allows customers to request and receive status on eligibility, claim status, and referrals in real-time This lesson will show you how to: Find the ENS home page and login Request eligibility Request claim status Request referrals Read the instructions in the gray boxes in this lesson Questions or problems can be reported to Technical Support at: Email: tsupport@ENShealth.com Phone: (866) 367-9778

Click on the client access button. Let’s Get Started From a web browser, locate the ENS home page at: http:// www.enshealth.com. Helpful hint: If you haven’t already done so, save it as a favorite link for future use. Click on the client access button.

Logging In Enter your user ID, password, and organization ID in the appropriate spaces and click on the login button.

Real-time Eligibility Request 1 From the Health-e Network Home page, click on Health-e Eligibility. All payers are listed in alphabetical order. Blue Cross Blue Shield, Medicaid, or Medicare payers are listed by their state. For example, Colorado Medicare will be listed under the letter C. Once you have located your payer, click on the create request button. 2

Real-time Eligibility Request, continued All fields highlighted in green are required and must be populated. 1 Once you have completed entering the necessary data, click on the submit request button. 2

Real-time Eligibility Request, continued An example of a real-time eligibility response (271) sent back from the payer.

Real-time Claim Status Request Click on the real-time claim status button to send a real-time claim status (276) request to a payer. 1 All payers are listed in alphabetical order. Locate the payer you wish to send your claim status request to and then click on the create request button. 2

Real-time Claim Status Request, continued All fields highlighted in green are required and must be populated. 1 Once you have completed entering the necessary data, click on the submit request button. 2

Real-time Claim Status Request, continued An example of a real- time claim status response (277) sent back from the payer.

Real-time Referral Request To send a real-time referral (278) request to a payer, click on the referral request home button. 1 All payers are listed in alphabetical order. Locate the payer you wish to send your referral request to and then click on the create request button. 2

Real-time Referral Request, continued If you wish to send a request to Aetna, you will need to select the type of referral request you wish to send.

Real-time Referral Request, continued All fields highlighted in green are required and must be populated as well as the provider ID and/or provider NPI fields on the referral inquiry page. 1 Once you have completed entering the necessary data, click on the submit request button. 2

Real-time Referral Request, continued An example of a referral inquiry response (278) sent back from the payer.

Congratulations You have now completed Gold Services self-service training Questions or issues can be reported in one of two ways Email Technical Support at tsupport@ENShealth.com Call (866) 367-9778 We appreciate your business