May 2009 Electronic Transactions: The Green Alternative Presented by the EDS Provider Field Consultants

2May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE Agenda Session Objectives Why Bill Electronically Paper Billing Misconceptions How to Begin What Can Be Performed Electronically Helpful Tools Questions Welcome and Announcements

3May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE 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

4May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE Why Bill Electronically?

5May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE 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

6May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE Paper Billing Misconceptions

7May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE 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

8May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE How to Begin

9May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE Web interChange Access Logon Screen

10May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE Administrator Request Form Complete and mail the Administrator Request Form to: EDI Solutions Help Desk 950 N. Meridian Street Suite 1150 Indianapolis, IN 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

11May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE What Can Be Performed Electronically?

12May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE 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

13May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE 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

14May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE Select “View” or “Edit”

15May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE 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

16May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE Update Third Party Liability

17May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE Verifying Member Eligibility The following enhanced features are available through Web interChange: Detailed TPL information Online TPL update requests

18May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE Prior Authorization Submission

19May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE 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

20May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE Web interChange Claim Submission

21May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE 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

22May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE 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

23May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE 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

24May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE 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

25May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE Claim Attachments

26May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE Claim Attachment Information

27May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE 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

28May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE Claim Attachments Attachment Cover Sheet

29May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE 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

30May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE Claim Inquiry

31May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE 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

32May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE 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

33May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE 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

34May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE Check Inquiry Window

35May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE Initiate or Update Electronic Funds Transfer

36May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE 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

37May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE Banners, Bulletins, Newsletters Effective September 1, 2009 paper communications will no longer be mailed –Banners –Bulletins –Newsletters –Claim Correction Forms (CCF)

38May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE Helpful Tools Provider Relations Field Consultant –View a current territory map and contact information online at EDI Solutions Help Desk –Local (317) –Toll-free Avenues of Resolution

39May 2009 ELECTRONIC TRANSACTIONS: THE GREEN ALTERNATIVE Questions

May 2009 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. EDS, an HP Company 950 N. Meridian St., Suite 1150 Indianapolis, IN 46204