HP Provider Relations October 2010 Web interChange Advanced Functions

Web interChange Advanced FunctionsOctober Agenda –Session Objectives –Indiana Medicaid Web site –Administrator Request Form –Administrator Functions –User Functions –Billing –Prior Authorization Submission and Inquiry –Helpful Tools - Avenues of Resolution –Questions

Web interChange Advanced FunctionsOctober Objectives Following this session, providers will: –Be familiar with the Indiana Medicaid Web site –Understand how to obtain Web interChange administrator access and functions –Know how to view and edit your provider profile –Know how to view/print/save Paperless Remittance Advice –Know how to reset passwords –Know how to develop user lists –Understand void and replacement functions –Understand how to add claim attachments –Understand when to add claim notes –Understand crossover claim billing –Understand TPL billing and TPL updates –Understand prior authorization inquiry and submission

Introduce Indiana Medicaid Web site

Web interChange Advanced FunctionsOctober Indiana Medicaid Member Web Site

Web interChange Advanced FunctionsOctober Indiana Medicaid Member Web Site

Web interChange Advanced FunctionsOctober Indiana Medicaid –Qualification Guidelines –Medicaid Programs –Apply for Medicaid Benefits –Search for a Provider –Choose a Health Plan –Presumptive Eligibility –Pharmacy Information Member tab

Web interChange Advanced FunctionsOctober Indiana Medicaid Provider Web Site

Web interChange Advanced FunctionsOctober Indiana Medicaid Provider Web Site

Web interChange Advanced FunctionsOctober Provider Tab

Web interChange Advanced FunctionsOctober Provider Tab –Link to the Web interChange –Provider Enrollment –Banners – Bulletins – Newsletters –Workshop Information –Provider Education and Assistance –News and Announcements

Request Administrator access

Web interChange Advanced FunctionsOctober Web interChange Access

Web interChange Advanced FunctionsOctober Administrator Request Form –Each provider should assign an administrator to oversee the daily functions of the individual practice or group –Link to the form can be found on the "How To Obtain an ID" page –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 Providers may have multiple administrators A separate form for each administrator is required Multiple administrators may be listed on the letter of acknowledgement –If the organization has multiple provider numbers (LPIs), only one Administrator Request Form for each administrator is needed List the individual LPIs and provider names to the letter of acknowledgement Administrators are linked to the nine-digit LPI, not to individual locations

Web interChange Advanced FunctionsOctober Administrator Request Form –Complete and mail the Administrator Request Form to: Electronic Solutions Help Desk 950 N. Meridian Street Suite 1150 Indianapolis, IN –Request Form and letter may be faxed to (317) –Submit a letter of acknowledgement on your company's letterhead signed by the organization's owner, indicating you are approved as a Web interChange administrator –To remove an administrator, mail or fax a letter signed by the owner The letter should include the provider LPI(s) and administrator’s name and user ID

Web interChange Advanced FunctionsOctober Password Reset – Administrator –Administrators may reset their users’ passwords –Administrators may reactivate their users’ IDs when "Inactive - For Lack of Use" (not logged on for 90 days) –Administrators may reset their own password utilizing the "Reset Password" function –An administrator who is "Inactive - For Lack of Use" must be reactivated by the EDI Solutions Service Desk –An administrator who is "Inactive" must be reactivated by the EDI Solutions Service Desk as directed by the organization’s owner Contact EDI Solutions at (317)

Learn Administrator functions

Web interChange Advanced FunctionsOctober Web interChange Administrator Menu Web interChange home page

Web interChange Advanced FunctionsOctober Administrator Functions Create user HIPAA compliance mandates that each user have an individual user ID

Web interChange Advanced FunctionsOctober Administrator Functions Group administration Assign users to a group with the appropriate level of access

Web interChange Advanced FunctionsOctober Administrator Functions View group reports

Web interChange Advanced FunctionsOctober Administrator Functions –User Administration Create User Update User Reset Password Reactivate User –Group Administration Administer Groups  Group Maintenance  Group Member Maintenance  View Group Report  Review the Group Report every 90 days  Compliance is tracked by OMPP and HP

Web interChange Advanced FunctionsOctober Administrator Functions Provider Profile

Web interChange Advanced FunctionsOctober Administrator Functions Provider Profile – select View or Edit The Edit button will only appear when user has "Provider Maintenance" access

Web interChange Advanced FunctionsOctober Administrator Functions Provider Profile – change of ownership? Must respond to ‘CHOW’ question

Web interChange Advanced FunctionsOctober Administrator Functions Provider Profile – update provider specialty

Web interChange Advanced FunctionsOctober Administrator Functions Provider Profile – begin or update electronic funds transfer

Web interChange Advanced FunctionsOctober Administrator Functions Provider Profile – update rendering provider information Click “Edit”

Web interChange Advanced FunctionsOctober Administrator Functions Provider Profile –Using Web interChange, providers can also make the following profile updates: Ownership information Changes in members of a Board 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

Web interChange Advanced FunctionsOctober Administrator Functions Paperless Remittance Advice

Web interChange Advanced FunctionsOctober Administrator Functions Paperless Remittance Advice

Web interChange Advanced FunctionsOctober Administrator Functions Paperless Remittance Advice

Web interChange Advanced FunctionsOctober Administrator Functions Accessing paperless RAs through Web interChange Three Easy Steps –Step 1 – From the Web interChange Home page, select Check/RA Inquiry. On the Check/RA Inquiry page, enter the desired search criteria and click Submit. A list of checks and RAs (most recent first) displays. The link to download the RA displays regardless of check availability If no check was issued in conjunction with the RA, the check number displays as “ ” The Provider/National Provider Identifier (NPI) fields populate based on the user’s security

Web interChange Advanced FunctionsOctober Administrator Functions Accessing paperless RAs through Web interChange –Step 2 – Click on the PDF icon to the right of the check number (in the “Download RA” column) A PDF of the RA opens in a new window Downloaded RAs have a Family and Social Services Administration (FSSA) watermark If users wish to save copies of RAs for their records, they can use the “Save a Copy” feature of Adobe Acrobat Reader  RAs can also be printed from Adobe Acrobat Reader –Step 3 – If the desired RA is not displayed, change the search criteria at the top of the Check/RA Inquiry page RAs are available in Web interChange for four weeks

Describe User functions

Web interChange Advanced FunctionsOctober User Functions Password reset Users may reset their own password utilizing the “Reset Password” function Administrators may reactivate a user who is inactive for lack of use (has not logged on for 90 days)

Web interChange Advanced FunctionsOctober User Functions User Lists

Web interChange Advanced FunctionsOctober User Functions User Lists

Web interChange Advanced FunctionsOctober User Functions User Lists Features of a User List: –May create user lists to alleviate keying information manually in specific claim submission fields –Allows information to be added or deleted as needs change –Can only be created for fields listed with a drop-down arrow in the claim submission screen

Detail Billing

Web interChange Advanced FunctionsOctober Void and Replacement Features Void

Web interChange Advanced FunctionsOctober Void and Replacement Features Void –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 a HIPAA term for adjustment –Void is the cancellation of an entire claim whether same day, same week, or post-financial

Web interChange Advanced FunctionsOctober Void and Replacement Features Void –A void can be performed on claims in a paid or suspended status –If the void of a claim occurs the same day or week that the original claim was submitted, a new ICN is not created The same ICN assigned to the claim applies to the void The original claim denies with edit 0120 – Claim denied due to an electronic void request –If the original claim being voided is a historical claim, a new claim with a new ICN is created The new ICN starts with 63 –Check-related voids (adjustments) continue to be submitted on paper

Web interChange Advanced FunctionsOctober Void and Replacement Features Void Pre-FinancialPost-Financial – Paid User voids the claim Voided claim denies EOB – Paid Today’s date: 10/10/ – Denied with EOB 0120 RA/835 shows: Claim shows on the denied page only – same ICN RA/835 shows: Mother Claim: and Daughter Claim: Both appear on the adjustment page

Web interChange Advanced FunctionsOctober Void and Replacement Features Replacement

Web interChange Advanced FunctionsOctober Void and Replacement Features Replacement –Replacement is a change to an original claim, whether same day, same week, or post-financial Original claim indicates the most recent ICN assigned to that claim –An electronically submitted replacement claim can be for a previously submitted electronic or paper claim –Only noncheck-related replacements are accepted electronically –Check-related replacements continue to be submitted on paper

Web interChange Advanced FunctionsOctober Void and Replacement Features Replacement –If the IHCP receives a replacement claim for an original claim that has been through a financial process (has appeared on an RA), the replacement claim ICN starts with one of the following: 61 – Provider-initiated replacement containing attachments and/or claim notes 62 – Provider-initiated replacement with no attachments and/or claim notes

Web interChange Advanced FunctionsOctober Void and Replacement Features Filing limits for voids and replacements No filing limit for void requests – One-year filing limit for replacement requests Web interChange will not display a Replace This Claim button on claims that are past the filing limit  These replacements must be submitted on paper 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  If the date of service of the claim is greater than one year, proof of timely filing is required The filing limit does not apply to crossover claims

Web interChange Advanced FunctionsOctober Claim Attachment Feature

Web interChange Advanced FunctionsOctober Claim Attachment Feature Attachment control number (ACN) –Unique number assigned by provider –Claim- and document-specific –Each ACN may only be used one time –Select the appropriate report type Report Type describes the document being sent –Transmission Code defaults to “BM” – by mail Electronic and ed attachments are not accepted –Text Box Applies to institutional claims only

Web interChange Advanced FunctionsOctober Claim Attachment Feature

Web interChange Advanced FunctionsOctober Claim Attachment Cover Sheet –Available on IHCP home page, under Forms –Complete cover sheet for each claim –Include provider information –Provide member ID –List each ACN pertaining to specific attachment –Indicate the number of pages of documentation submitted per attachment (not including the cover sheet) –Write “ACN #” and the assigned ACN on each page of documentation corresponding to that number –Mail cover sheet and supporting documentation to the appropriate P.O. Box (P.O. Box 7259)

Web interChange Advanced FunctionsOctober Claim Attachment Cover Sheet

Web interChange Advanced FunctionsOctober Claim Notes

Web interChange Advanced FunctionsOctober Claim Notes

Web interChange Advanced FunctionsOctober Claim Notes Submit claim notes to Indiana Medicaid ONLY if the notes relate to these situations: –90 Day Rule –When a third-party insurance carrier fails to respond within 90 days of the billing date, you can submit the claim to the IHCP for payment consideration. However, to substantiate attempts to bill the third party, the following must be documented: –Date of the filing attempts –The phrase “NO RESPONSE AFTER 90 DAYS” –The member’s identification (RID) number –Your IHCP provider number –Abortion diagnosis/procedure indicated –In the claim note, the IHCP accepts indication of medical documentation that supports the need to save the mother’s life or a police report that indicates rape or incest. –Consultation billed 15 days before or after another consultation –In the claim note, you can indicate the medical reason for a second opinion during the 15 days before or after the billed consultation.

Web interChange Advanced FunctionsOctober Claim Notes continued Submit claim notes to Indiana Medicaid ONLY if the notes relate to these situations: –Joint injections (four per month) –In the claim note, you can document that the injections are performed on different joints and indicate the injection sites –Excessive nursing home visits or more than one per 27 days –In the claim note, the IHCP accepts documentation supporting the treatment of emergent, urgent, or acute conditions or symptoms with the new diagnosis code. –Pacemaker analysis (two within 6 months) –Use the claim note to document the medical reason for the second analysis in the six-month time frame, such as a dysfunctional pacemaker. –Assistant surgeon not payable when co-surgeon is paid –In the claim note, the IHCP accepts information that documents the medical reason for the assistant surgeon, such as the problem requiring assistance.

Web interChange Advanced FunctionsOctober Claim Notes continued Submit claim notes to Indiana Medicaid ONLY if the notes relate to these situations: –Excessive nursing home visits or more than one per 27 days –In the claim note, the IHCP accepts documentation supporting the treatment of emergent, urgent, or acute conditions or symptoms with the new diagnosis code. –Retroactive eligibility –Use claim notes when billing a claim that is past the filing limit and the member was awarded retroactive eligibility. In the case of retroactive member eligibility, claims must be submitted within one year of the eligibility determination date. Enter information stating, “Member has retroactive eligibility. Please waive timely filing.”

Web interChange Advanced FunctionsOctober Crossover Claims

Web interChange Advanced FunctionsOctober Crossover Claims Submit Medicare crossover claims electronically using Web interChange Crossover header information –Click Benefit Information on the Claim Submission screen –Payer ID = –Payer Name = Medicare Part B –Medicare Paid Amount = the total amount paid by Medicare for the claim –Subscriber Name –Primary ID = Medicare number w/ alpha –Relationship Code = 18 (self) –Gender

Web interChange Advanced FunctionsOctober Crossover Claims Crossover header information Date of birth Claim Filing Code = MB –Click Save Benefits at the bottom of the screen –Click Save and Close at the top of the screen If the Payer ID is a Medicare payer, the Claim Filing Code is MA (Medicare A) or MB (Medicare B) Note: Obtain COB information, including Payer IDs from the HELP tab, Reference Materials on Web interChange

Web interChange Advanced FunctionsOctober Crossover Claims Coordination of Benefits – header level

Web interChange Advanced FunctionsOctober Crossover Claims Coordination of Benefits – header level

Web interChange Advanced FunctionsOctober Crossover Claims Coordination of Benefits – detail level

Web interChange Advanced FunctionsOctober Crossover Claims Crossover detail information To report detail information, perform the following: –Click Detail Benefits Info –Payer ID = –TPL/Medicare Paid Amount = Enter the amount paid by Medicare for the highlighted detail line only –Click Save Payer –Group Code = Enter PR –Reason Code = Enter 1 for deductible, 2 for coinsurance, and 122 for psychiatric reduction Do not report write-off or contractual adjustment/discount amounts –Amount = Enter the amount of the deductible and/or coinsurance Note:Claims for Federally Qualified Health Centers (FQHCs) that did not cross over electronically must be rebilled on a CMS-1500 form with the code T1015 added to the claim

Web interChange Advanced FunctionsOctober TPL Claims

Web interChange Advanced FunctionsOctober TPL Claims –Submit an electronic request to the HP TPL Unit to update a member’s insurance information –The TPL Unit receives the request, researches, confirms the information, and updates the eligibility screen with corrected information Updates are usually made within 20 days –Confirm that eligibility has been updated by reviewing the Eligibility Inquiry feature

Web interChange Advanced FunctionsOctober TPL Claims Submit TPL claims electronically using Web interChange TPL header information –Click Benefit Information on the Claim Submission screen –Payer ID = ABCINSURANCE –Payer Name = ABCINSURANCE –TPL Paid Amount = the total amount paid by TPL for the entire claim –Subscriber Name –Primary ID = TPL ID –Relationship Code = 18 (self) –Gender –Date of birth –Click Save Benefits at the bottom of the screen –Click Save and Close at the top of the screen

Web interChange Advanced FunctionsOctober TPL Claims Coordination of Benefits – header level

Web interChange Advanced FunctionsOctober TPL Claims Coordination of Benefits – header level

Define Prior authorization

Web interChange Advanced FunctionsOctober Prior Authorization –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 278 prior authorization inquiry

Web interChange Advanced FunctionsOctober Prior Authorization 278 prior authorization inquiry

Web interChange Advanced FunctionsOctober Prior Authorization –The following provider types can submit PA requests via Web interChange: Chiropractor Dentist Doctor of Medicine Doctor of Osteopathy Home Health Agency (authorized agent) Hospice Hospitals Optometrist Podiatrist Psychologist endorsed as a Health Service Practitioner in Psychology (HSPP) Transportation providers 278 prior authorization submission

Web interChange Advanced FunctionsOctober Prior Authorization –Must be given access to submit PAs by the administrator –Web interChange PA attachments follow the same guidelines as the Web interChange claim attachment process –Assign a unique Attachment Control Number (ACN) for each attachment –Enter assigned number into attachment screen in Web interChange – Documentation must be submitted within 30 calendars days of the request Decision letters: –The system sends a decision letter for PAs submitted via Web interChange, the same way it does for all PA requests 278 prior authorization submission

Web interChange Advanced FunctionsOctober Prior Authorization 278 prior authorization submission

Web interChange Advanced FunctionsOctober Prior Authorization 278 prior authorization submission

Web interChange Advanced FunctionsOctober Prior Authorization 278 prior authorization submission

Web interChange Advanced FunctionsOctober Prior Authorization 278 prior authorization submission

Web interChange Advanced FunctionsOctober Prior Authorization 278 prior authorization submission

Web interChange Advanced FunctionsOctober Prior Authorization –Verify eligibility to determine where to send the PA request ADVANTAGE Health Solutions – FFS Prior Authorization Department P.O. Box Indianapolis, IN Fax: ADVANTAGE Health Solutions – Care Select Prior Authorization Department P.O. Box Indianapolis, IN Fax: MDwise – Care Select Prior Authorization Department P.O. Box Indianapolis, IN Fax: Prior authorization by telephone, fax, or mail

Find Help Resources available

Web interChange Advanced FunctionsOctober Helpful Tools Avenues of resolution –IHCP Web site at –IHCP Provider Manual (Web, CD-ROM, or paper) –Customer Assistance Local (317) All others –Written Correspondence HP Provider Written Correspondence P. O. Box 7263 Indianapolis, IN –Provider field consultant View a current territory map and contact information online at

Q&A