Provider relations seminar october 7 2009
This presentation is the property of its rightful owner.
Sponsored Links
1 / 89

PROVIDER RELATIONS SEMINAR OCTOBER 7, 2009 PowerPoint PPT Presentation


  • 147 Views
  • Uploaded on
  • Presentation posted in: General

PROVIDER RELATIONS SEMINAR OCTOBER 7, 2009. SEMINAR AGENDA. Welcome – Jeanne Wisnewski, Director Provider Relations Blue Health Plan Updates – Jill Jenkins 5010/ICD 10 Updates – Dawn Reece Medical Director Updates – Thomas A. Curry, M.D. EDI Tips – Rebecca Krasson

Download Presentation

PROVIDER RELATIONS SEMINAR OCTOBER 7, 2009

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Provider relations seminar october 7 2009

PROVIDER RELATIONS SEMINAROCTOBER 7, 2009


Seminar agenda

SEMINAR AGENDA

  • Welcome – Jeanne Wisnewski, Director Provider Relations

  • Blue Health Plan Updates – Jill Jenkins

  • 5010/ICD 10 Updates – Dawn Reece

  • Medical Director Updates – Thomas A. Curry, M.D.

  • EDI Tips – Rebecca Krasson

  • NaviNet/NPO Initiative – Cheryl Hashagen


Blue health plan updates presenter jill jenkins

BLUE HEALTH PLAN UPDATESPresenter: Jill Jenkins


Bcnepa updates

BCNEPA UPDATES

BCNEPA UB-92 Claim System Shutdown

  • In January 2008 BCNEPA converted its internal UB-92 claims processing system to another claims processing platform.

  • Products affected by the change were:

    • Blue Cross (non-FPLIC)

    • BlueCard

    • FEP claims

  • Affected claims with dates of service prior to January 1, 2008.

  • This did not apply to First Priority Health or First Priority Life Insurance Company claims.


Bcnepa updates1

BCNEPA UPDATES

  • Due to the UB-92 Claim System Shutdown, BCNEPA is requesting providers submit all claims and claim adjustments by January 31, 2010 for dates of service prior to January 1, 2008.

  • Timely filing guidelines will apply to both claim and claim adjustment submissions.

  • Eligible claims or claim adjustments received after the system shutdown date will be handled administratively and will require additional time for completion.


First priority health fph updates

FIRST PRIORITY HEALTH (FPH) UPDATES

  • YZH is the alpha prefix for all First Priority Health (FPH) products

  • Provider Services – 1-800-822-8752

  • Member Services – 1-800-822-8753


Fph authorization updates

FPH AUTHORIZATION UPDATES

  • As of 7/1/09, FPH participating hospitals are no longer required to submit FPH Maternity Admission fax sheets

    • All newborn admissions not covered under the mother’s insurance and detained babies must continue to be phoned into FPH’s Utilization Management Area.

  • Effective 8/1/09, FPH no longer requires prior authorization for behavioral health care outpatient services for participating providers.

    • Prior authorization is still needed for non-participating providers.

    • Prior authorization is still needed for inpatient and partial hospitalization services.


Fph updates

FPH UPDATES

  • 9/1/09 Geisinger Health System Hospital and Physicians became participating with FPH

    • Geisinger Medical Center in Danville is not participating with FPH.

    • The Outpatient Laboratory and Radiology Program remains in effect.

      • If a member has a Primary Care Physician (PCP) office located in Luzerne or Lackawanna County, they must continue to have outpatient laboratory services performed at one of the Pennant Laboratories’ designated outpatient laboratory sites.

      • If a member has a PCP office located in Luzerne County, they must continue to have outpatient radiology services performed at Wilkes-Barre General Hospital, the Saxton Pavilion in Edwardsville, etc. PCP offices located in either Hazleton or Berwick are respectively excluded.


Fph claim submission

FPH CLAIM SUBMISSION

  • Please remember to include your FPH legacy number when submitting a paper claim to FPH.

    • Your FPH legacy number must contain six digits (leading zeros are required)

    • NUCC-1500 form – Box 19

    • UB-04 form – Locator 57

    • Paper claims submitted without the FPH legacy number will deny with one of the following:

      • XBD “Provider/Tax ID is invalid or missing”

      • XHN “Provider legacy # not reported in field 19. This # is required.” (NUCC-1500)

      • XHO “Provider legacy # not reported in field 57. This # is required.” (UB-04)

    • If your claim denied for one of the above reasons, the claim must be submitted as a new claim.


First priority life insurance company fplic

FIRST PRIORITY LIFE INSURANCE COMPANY (FPLIC)

  • BCNEPA’s medical policy can be found in two (2) locations.

  • Providers should primarily reference Blue Cross of NEPA’s website at www.bcnepa.com for FPLIC medical policy.

  • In situations where a medical policy is not on Blue Cross of NEPA’s website, providers should defer to Highmark Blue Shield’s website at www.highmarkblueshield.com for FPLIC medical policy.

  • To view either BCNEPA or HBS medical policies, visit:

    • BCNEPA medical policies www.bcnepa.com

    • HBS medical policies www.highmarkblueshield.com


Fplic product expansion

FPLIC PRODUCT EXPANSION

  • BlueCare Direct Select

    • PPO individual product

      • QFD alpha prefix

  • BlueCare Direct Essentials

    • PPO individual product

      • QFD alpha prefix

  • BlueCare EPO

    • EPO product

      • QFI or QFO alpha prefix


What is an epo

WHAT IS AN EPO?

  • Exclusive Provider Organization

    • A form of PPO in which patients must visit with a caregiver that is on the EPO’s panel of providers. If a visit to an outside provider is made, the EPO will offer limited or no coverage for the office or hospital visit.


Bluecare epo

BLUECARE EPO

  • A group product BCNEPA began offering in January 2009

  • Offered in our 13-county service area

    • Members may reside and/or work either inside or outside of our 13-county region

  • BlueCare EPO prefixes:

    • QFIalpha prefix indicates a member resides or works inside our 13-county service area

    • QFO alpha prefix indicates a member resides or works outside our 13-county service area


Bluecare epo frequently asked questions

BLUECARE EPOFREQUENTLY ASKED QUESTIONS

  • Am I an EPO participating provider?

    • If you currently contract with FPLIC PPO or have a direct contract with FPLIC EPO, you are part of the FPLIC EPO network.

  • How will I be reimbursed?

    • The FPLIC EPO reimbursement rates will be your then-current FPLIC PPO or your direct contracted EPO rates.


What is the difference between qfi and qfo members

WHAT IS THE DIFFERENCE BETWEEN QFI AND QFO MEMBERS?

  • QFI is for members who reside or work within BCNEPA’s 13 county service area.

    • QFI members must seek service from a FPLIC EPO provider in order to obtain the highest level of benefits.

    • QFI members do not have a benefit for services provided by a non-participating FPLIC EPO provider within BCNEPA’s 13 county service area (with the exception of emergency services).

    • QFI members have a lower-level benefit available outside of BCNEPA’s 13 county service area if the member receives services from a participating BlueCard PPO Provider.


What is the difference between qfi and qfo members1

WHAT IS THE DIFFERENCE BETWEEN QFI AND QFO MEMBERS?

  • QFO is for members who reside or work outside BCNEPA’s 13 county service area.

    • A QFO member may seek services from a FPLIC EPO provider.

    • A QFO member may also see any BlueCard PPO network provider outside of BCNEPA’s 13 county area and still receive the higher-level benefit.

      Are there precertification requirements?

  • Yes.

    • Within BCNEPA’s 13 county area, please refer to the listing of FPLIC EPO diagnosis/procedure codes found in the November 2008 BCNEPA Provider Bulletin.

    • Providers outside of BCNEPA’s 13 county area (i.e. Lehigh Valley and Berwick) must follow full precertification requirements.


Fplic epo claim submission

FPLIC EPO CLAIM SUBMISSION

  • FPLIC EPO providers should file all claims directly with FPLIC.

    • All paper claims are sent to:

      Claims

      P.O. Box 890179

      Camp Hill, Pa 17089-0179

    • Electronic claims

      • Facility – business as usual. Please continue to send UB04 electronic claims through your vendor/clearinghouse to BCNEPA/FPLIC as you do today.

      • Professional/Ancillary – Please refer to the FPLIC Billing Guidelines on page 3 of the June 2008 BCNEPA Provider Bulletin.


Highmark blue shield updates

HIGHMARK BLUE SHIELD UPDATES

Highmark CMS-1500 Paper Claim Form

  • Only original (red) NUCC-1500 (08/05) claim forms will be accepted.

    • Do not submit photocopies of claim forms.

  • Highmark has a target date of January 1, 2010 to accept only original (red) NUCC -1500 (08/05) version.


Reminder

REMINDER

  • Highmark Blue Shield does not process (professional provider) Independence Blue Cross (IBC) Personal Choice claims.

  • BCNEPA/Highmark does not have access to professional provider IBC Personal Choice claim information.

  • Personal Choice members can be identified by the following prefixes:

    • ADQ AEK AEV AEW AHJ BMEBYN CDJ CDQ CDZ CQA CQXDAZ DGR DPX DVU EEN EGDETF GCY GEA GMA HAJ HXTINW MGL NFY NLR PCX QCAQCB WCM SDA SEZ SFU SHQSKH SQT WYK TFE TLG TRXUBF UFN UFP UFT UTR


Reminder continued

REMINDER (continued)

  • IBC Personal Choice Professional Claims should be sent to:

    Personal Choice Claims

    P.O. Box 69352

    Harrisburg, PA 17106-9352

  • Electronic Billers must utilize NAIC 54704

  • Provider Services for IBC Personal Choice claims

    • 1-800-ASK-BLUE

      (800-275-2583)


General updates

GENERAL UPDATES

Medicare Advantage PPO Network Sharing

  • Beginning January 1, 2010 all Blue Medicare Advantage PPO Plans will participate in a reciprocal network sharing.

  • The MA in the suitcase on the member’s card will help you identify these members.

  • Benefits and eligibility can be verified by calling BlueCard eligibility at 1-800-676-BLUE (2583).


Medicare advantage ppo network sharing how to submit claims

MEDICARE ADVANTAGE PPO NETWORK SHARINGHOW TO SUBMIT CLAIMS

Contracted BCNEPA/HMBS Medicare Advantage PPO Providers

  • Submit all Medicare Advantage PPO claims to BCNEPA/HBS as you currently bill for FreedomBlue members.

    • Electronic claims are to be submitted directly to Highmark via trading partner agreement with 378 plan code / NAIC # 54771C.

    • Paper Claims:

      FreedomBlue

      P.O. Box 890170

      Camp Hill, Pa 17089-0170

    • DME, Respiratory Supplies, Orthotics/Prosthetics:

      DMEnsions Inc

      P.O. Box 81460

      Rochester Hills, MI 48308-1460


Medicare advantage ppo network sharing how to submit claims1

MEDICARE ADVANTAGE PPO NETWORK SHARINGHOW TO SUBMIT CLAIMS

Non-Contracted BCNEPA/HBS Medicare Advantage PPO Providers

Submit the claims to your local Blue Plan as you do for all out-of-area Blue members.

  • Paper Claims

    Claims

    P.O. Box 890179

    Camp Hill, PA 17089-0179


Pennsylvania s autism insurance act act 62

PENNSYLVANIA’S AUTISM INSURANCE ACT (ACT 62)

Act 62 required private health insurance companies to cover the cost of diagnostic assessment and treatment of autism spectrum disorders (ASD).

  • Coverage information:

    • Children under the age of 21

    • Insured employer groups having 51 or more employees

      • Customer service can assist in determining if the group has 51+ employees.

    • Maximum benefit of $36,000 per year

      • Coverage is subject to copayment, deductible and coinsurance as it would be for other covered medical services and any other general exclusions or limitations.

      • Once the member reaches $36,000, he/she may be eligible for additional Medical Assistance (MA) program benefits.


Pennsylvania s autism insurance act act 621

PENNSYLVANIA’S AUTISM INSURANCE ACT (ACT 62)

  • Pharmacy

    • Prior authorization is required for employer groups that do not have a pharmacy benefit

      • Prior authorization can be obtained by contacting Express Scripts at 1.877.603.8399.

    • If a group does have a pharmacy benefit, no prior authorization is required.

  • Reimbursement

    • BCNEPA/FPH/FPLIC standard fee schedules and contracted rates apply.


Pennsylvania s autism insurance act act 622

PENNSYLVANIA’S AUTISM INSURANCE ACT (ACT 62)

Medical Policy and Information

Is available on BCNEPA’s Provider Center at www.bcnepa.com or via the link on Navinet.

If you do not have access to the Internet, please contact your Provider Relations Consultant for a hard copy of the medical policy.

Check your BCNEPA Provider Bulletins for updates.

Another resource is the DPW’s site

http://www.dpw.state.pa.us/servicesprograms/autism/act62/

The Frequently Asked Question and Answers section maybe helpful.


Federal mental health parity and equity act of 2008

FEDERAL MENTAL HEALTH PARITY AND EQUITY ACT OF 2008

  • The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 was signed into law as part of the Federal Emergency Economic Stabilization Act and becomes effective beginning November 1, 2009 upon group renewal.

  • The legislation requires group health insurers to apply the same mental health and substance abuse benefits, if they are provided, in parity with (or equal to) medical benefits, including:

    • member cost-sharing – such as deductibles, copayments, out-of-pocket expenses;

    • treatment limitations – such as the maximum number of outpatient visits, days of coverage, limits on the frequency of treatment;

    • out-of-network coverage – group plans are required to provide out of network mental health/substance abuse benefits if the group provides out of network medical/surgical benefits.

  • Please contact customer services to verify benefits and eligibility.


Discussion and comments

DISCUSSION AND COMMENTS


5010 icd 10 updates

5010/ICD 10 UPDATES

HIPAA 5010

Presenter: Dawn Reece


5010 general information

5010 GENERAL INFORMATION

  • 5010 is the next version of HIPAA mandated electronic transactions.

  • Currently, the industry is using version is 4010a1.

  • All HIPAA mandated EDI transactions conducted after January 1, 2012 must be in version 5010.

  • The following are HIPAA mandated EDI transactions:

    • Professional Claims (837P)

    • Institutional Claims (837I)

    • Remittance Advice (835)

    • Claim Status Inquires & Responses (276/277)

    • Benefit Inquires & Responses (270/271)

    • Request for Authorization (278)


How is 5010 different

HOW IS 5010 DIFFERENT?

  • NPI Subpart reporting changes.

  • Clarifies business usage rules for Billing, Rendering, and Service Facility Location provider loops.

  • Supports ICD-9 and ICD-10 Code Sets.

  • Added POA “Present on Admission” indicators.

  • Clarifies COB “Coordination of Benefits”.

  • Allows for the submission of two Anesthesia Related Surgical Codes.

  • Clarifies and strengthens Remittance Advice balancing rules.

  • Additional benefit categories for benefit inquiries.


5010 billing provider

5010 BILLING PROVIDER

The subpart reported as the Billing Provider MUST always represent the most detailed level of enumeration as determined by the organization health care provider and MUST be the same identifier sent to any trading partner.


Npi subpart analysis

NPI SUBPART ANALYSIS

Analyze Your Subparts !!

  • Revisit your NPI subpart enumeration strategy.

  • Analyze how you report NPI subparts for all payers.

  • Develop one common reporting scheme that satisfies requirements for all your payers.

  • Consult with all of your payers before making any changes.


Rendering service facility provider

RENDERING/SERVICE FACILITY PROVIDER

The NPI used to identify the Rendering Provider or the Service Location must be external to the entity identified as the Billing Provider (for example; reference lab).

It is not permissible to report an organization health care provider’s NPI as the Rendering Provider or the Service Location if the Rendering Provider or Service Location is a subpart of the Billing Provider.


Billing rendering service facility

BILLING/RENDERING/SERVICE FACILITY

Analyze Provider Data !!

  • Review Billing, Rendering, and Service Facility reporting to ensure you are compliant with new usage requirements.

  • Verify the billing provider address you are using – 5010 requires this address to be a physical street address. Post Office (P.O.) boxes are not allowed.


Icd 10

ICD-10

ICD-9 Will No Longer Be Used As Of October 1, 2013

  • The government mandated the usage of ICD-10 DM and ICD-10 CM effective October 1, 2013.

  • ICD-10 CM replaces the ICD-9 DM code set used for reporting diagnosis and ICD-9 CM code set used for inpatient procedure code reporting.


Comparison of icd 9 vs icd 10

COMPARISON OF ICD-9 VS. ICD-10


Diagnosis codes for sprained strained ankles icd 9 cm vs icd 10 cm

DIAGNOSIS CODES FOR SPRAINED & STRAINED ANKLES: ICD-9-CM VS. ICD-10-CM

  • ICD-9 Sprained Ankle has 4 codes

  • ICD-10 Sprained Ankle has 72 codes.


Why replace icd 9

WHY REPLACE ICD-9 ?

  • Almost 30 years old

  • Outdated, obsolete codes

  • Some categories are running out of space

  • Evolving healthcare data needs

  • Most other nations have adopted

  • Comparison with international data is hindered


Icd 10 impact to providers

ICD-10 IMPACT TO PROVIDERS

  • Tremendous impact on both clinical and administrative areas

    • More extensive documentation required

    • Training of clinical and billing Staff

    • Decision support

    • Coding changes

    • Claim form changes

  • Not an issue that can be fully delegated to a billing company or clearinghouse


What can i do to prepare

WHAT CAN I DO TO PREPARE?

  • Talk to your vendors regarding 5010 .

  • Raise awareness of ICD-10 in your clinical office.

  • Train clinical staff on ICD-10 coding so they fully understand how to change their clinical documentation.

  • There is no easy way, ICD-9 to ICD-10 crosswalks are extremely controversial.


Discussion and comments1

DISCUSSION AND COMMENTS


Provider relations seminar october 7 2009

MEDICAL DIRECTOR UPDATESPresenter: Thomas A. Curry, M.D. Medical Director Network Management Provider AdvocacyTransparency Initiative at BCNEPA


Transparency

TRANSPARENCY

The provision of clinical quality and cost information to health professionals and health plan members in a manner that assists in the healthcare decision making and helps to raise the level of quality care.


Drivers

DRIVERS

  • External standards – NCQA/URAC/Government

  • Employer Account expectations

  • Consumer Driven Health Plans

  • Other health plans including major competitors


Consumer research on transparency

CONSUMER RESEARCH ON TRANSPARENCY

  • Seek a variety of information for decision making

  • Rely as much on patient experience as they do clinical quality indicators

  • Value clinical quality and patient experience over cost information


Consumer research on transparency1

CONSUMER RESEARCH ON TRANSPARENCY

  • Need relevant, understandable and actionable quality information

  • Want a credible, comprehensive source for provider information


Provider relations seminar october 7 2009

GOAL

To provide clinical measures and subsequently cost measures, with a peer group comparison that is:

  • Fair

  • Meaningful

  • Usable


Process

PROCESS

  • Professional community will be involved in the development and testing of product.

  • Professional community will have the ability to view and comment prior to member notification.


Development

DEVELOPMENT

Important aspects to be reviewed by professional community:

  • Attribution

  • Peer comparisons

  • Display of data

  • Communication plans


Present

PRESENT

Hospitals: Information based on PHC4 and CMS data is already available as ‘Hospital Advisor’

Professional: Limited information already in place with demographic data under ‘Find a Physician’


Tips to help your practice

TIPS TO HELP YOUR PRACTICE

  • Check-up on the frustration/anger you may experience

  • You cannot do it all yourself

  • Engage your staff/team

  • Consider a disease registry

  • Know your numbers

  • Be willing to experiment


Discussion and comments2

DISCUSSION AND COMMENTS


Edi tips presenter rebecca krasson

EDI TIPSPresenter: Rebecca Krasson


Code descriptions

CODE DESCRIPTIONS

  • A3 – This is the Claim Status Category Code which states “Acknowledgement/Returned as unprocessable claim – The claim/encounter has been rejected and has not been entered into the adjudication system.”

  • 247 – This is the Claim Status Code which states the error is with the “Line Information.” This code is always followed by “LN01, LN02,” etc. LN means Line, 01 means Line 1. An example of this is: A3-247/ LN01 A3-475. 475 indicates “Procedure code not valid for patient age.”


Code descriptions continued

CODE DESCRIPTIONS (continued)

  • 85 – This is the Entity code which indicates Billing Provider.

    • 41 = Submitter82 = Rendering Provider

    • 71 = Attending PhysicianDN = Referring Provider

    • 72 = Operating PhysicianIL = Insured or Subscriber

    • 77 = Service LocationPR = Payer

      QC = Patient

      All of these codes can be found on the

      Washington Publishing Company website:

      http:/www.wpc-edi.com


Top 5 first priority life insurance rejections

TOP 5 FIRST PRIORITY LIFE INSURANCE REJECTIONS

  • A3 – 33 Subscriber and subscriber id not found.

  • A3 – 247/ LN01 A3-187 Line 1 – Date(s) of service.

  • A3 – 247/ LN01 A3-475 Line 1 – Procedure code not valid for patient’s age.

  • A3 – 247/ LN02 A3-454 Line 2 – Procedure code for services rendered.

  • A8 – 562/85 A8 – 128/85 Acknowledgement/Rejected for relational field in error. Entity’s National Provider Identifier (NPI). Entity’s tax id. Billing Provider.


Top 5 first priority health rejections

TOP 5 FIRST PRIORITY HEALTH REJECTIONS

  • E50A – No coverage found for date of service

  • E02C – Incorrect patient first name

  • E02D – Incorrect patient last name

  • E03C – Incorrect patient date of birth

  • E33E – Invalid NPI/Tax ID/Taxonomy Code Combination

    EDI rejections are listed in the 2007 BCNEPA Provider Bulletins for January, February, May, September, October and November.


Auto posting

AUTO POSTING

  • This feature is available for providers whose clearinghouse is McKesson or Emdeon.

  • Your clearinghouse is the first point of contact to initiate the process.

  • A letterhead template has been created and is available on the BCNEPA Provider Center/Provider Relations/Forms.

  • Please fax the completed form to EDI Services at 570-200-1700.


Discussion and comments3

DISCUSSION AND COMMENTS


Navinet npo initiative presenter cheryl hashagen

NaviNet/NPO INITIATIVEPresenter: Cheryl Hashagen


Navinet updates

NAVINET UPDATES

Effective June 12, 2009, BCNEPA and NaviNet have redesigned the

Eligibility and Benefits Inquiry screens to make pertinent information

more easily accessible. Here are some highlights:

Eligibility and Benefits Inquiry

  • The Plan Coverage Description field has been renamed Plan Coverage.

  • The Product/Eligibility Information section now includes additional information about coverage.  For example, in the Health Benefit Coverage Status field, Active Coverage now displays as Active Coverage - Family. 


Navinet updates1

NAVINET UPDATES

  • The Product field has been renamed Insurance Type Code.

  • In the Product/Eligibility Information section, the Eligibility field has been renamed Date of Last Update. When you place the cursor over the Date of Last Update field, the following help text appears: "This is the last eligibility update and may not be the original eligibility date."

  • The Product/Eligibility Information section now includes a Group Number field.

  • The Service Type Information section now includes shortcuts that allow you to navigate directly to the desired service type.


Navinet updates2

NAVINET UPDATES

  • Within each service type, benefit information is now grouped into three categories: Professional, Major Medical, and Facility.

  • In the Service Type section, the Eligibility field has been renamed Benefit Begin Date. When you place the cursor over the Benefit Begin Date field, following help text appears: "This is the latest benefit update within the specified service date range."

  • The Service Type results have been enhanced with bulleted lists.


Navinet updates3

NAVINET UPDATES

BlueExchange Eligibility and Benefits Inquiry

The BlueExchange Eligibility and Benefits Inquiry screen has also been redesigned. Here are some highlights:

  • The Product field has been renamed Insurance Type Code.

  • The Service Type Information section now includes shortcuts that allow you to navigate directly to the desired service type.

  • The Service Type results have been enhanced with bulleted lists.


Navinet updates4

NAVINET UPDATES

Other updates effective June 12, 2009 include:

PRIOR AUTHORIZATION SUBMISSION TRANSACTION

  • Patient Search

    • On the Prior Authorization Search screen, the Date of Service field has been renamed Service From Date.

  • Home Health Services Worksheet

    • For added convenience, now when you enter a date in the Service From Date field on the search screen, the date is saved and will appear in the Date of Admission to Home Health field on the Prior Authorization Home Health Services Worksheet.

    • The Drug Card information sections have been removed from the Home Health Services worksheet.


Navinet updates5

NAVINET UPDATES

  • Home Health Services Worksheet (Cont’d.)

    • A new option, Lives with Parent/Guardian, has been added to the Living Arrangements dropdown menu.

  • Rehabilitation Worksheet

    • For several categories, if the Assistance field has the value Not Assessed, then the Level of Assistance field does not require a value. Note: For the Ambulation category, you must always specify the Level of Assistance. 

    • If you select Not Assessed for the following categories, the background color for the Level Assistance field will change from cyan to white:

      • Stairs

      • Transfers

      • Mat/Bed Mobility

      • ADLs


Navinet updates6

NAVINET UPDATES

PROVIDER DIRECTORY

  • On the Provider Directory Search screen, the field labeled Plan Type has been renamed Provider Network.

  • The Provider Directory search results screen includes a new column, Provider Network.

    UB 04 CLAIM ENTRY AND SUBMISSION

  • The Product Name field has been added to the UB 04 Claim Submission Verification and Response screens.


Navinet initiative

NAVINET INITIATIVE

  • NaviNet is the preferred source of BCNEPA’s information for routine eligibility and benefits (E&B) inquiries. Therefore, BCNEPA is planning to transition all routine telephone/facsimile inquiries currently placed in BCNEPA’s BlueCare Customer Service, to NaviNet-based inquiries as the alternative for NaviNet enabled providers.

  • Beginning September 1, 2009, BlueCare Service Representatives are instructing BCNEPA NaviNet enabled providers on the proper use of NaviNet to obtain information specific to routine E&B inquiries.

  • Providers will be redirected to NaviNet in order to take advantage of the tools available to answer the inquiry. Providers have been given a 120 day transition period to ensure you have the proper training and knowledge to utilize BCNEPA’s NaviNet effectively for these inquiries.


Navinet initiative1

NAVINET INITIATIVE

  • Effective January 1, 2010, BCNEPA NaviNet enabled providers will be required to utilize NaviNet for E&B inquiries/questions.

    (Note: Providers who have multiple offices/locations must ensure that NaviNet access is granted to each office/location that may require its functionality. Only the provider’s NaviNet Security Officer has the capability to grant “user” access under each provider’s NaviNet account. Further information on granting NaviNet “user” access is available under the NaviNet Customer Support link once signed into NaviNet.)


Navinet initiative2

NAVINET INITIATIVE

  • Future initiative plans include but are not limited to:

    • Claim Status Inquiries along with the current E&B.

    • Adding a Claims Investigation Transaction capability, allowing providers to enter questions electronically regarding claims payment issues, etc.


Navinet initiative3

NAVINET INITIATIVE

Elimination of Hardcopy Provider Bulletin

To coincide with our dedication to increasing our BCNEPA NaviNet capabilities and our initiative to transition providers to utilize NaviNet as the preferred source of BCNEPA information, BCNEPA will be eliminating the mailing of the hardcopy Provider Bulletin for NaviNet enabled providers.

Beginning January 2010, NaviNet-enabled providers will no longer receive a hardcopy version of the BCNEPA Provider Bulletin via mail. The BCNEPA Provider Bulletin will remain posted and can be reviewed/printed from the BCNEPA Provider Center website that can be accessed through a provider’s NaviNet account.

BCNEPA will post a Blue Alert during the 1st week of each month on NaviNet when a new edition of the Provider Bulletin is available for display.


Discussion and comments4

DISCUSSION AND COMMENTS


Thank you for your attendance

THANK YOU FOR YOUR ATTENDANCE


  • Login