1 / 39

Health Net Federal Services HNFS

Who Is Health Net, Inc.. One of the nation's largest publicly traded managed health care companies (NYSE Symbol: HNT)Health Net's HMO, insured PPO and government contracts subsidiaries provide health benefits to approximately 6.5 million individualsComprehensive behavioral health (MHN) and pharmac

peregrine
Download Presentation

Health Net Federal Services HNFS

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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Health Net Federal Services (HNFS) TRICARE Service Center (TSC) & Beneficiary Counseling & Assistance Coordinator (BCAC) Interaction

    2. Who Is Health Net, Inc. One of the nation’s largest publicly traded managed health care companies (NYSE Symbol: HNT) Health Net’s HMO, insured PPO and government contracts subsidiaries provide health benefits to approximately 6.5 million individuals Comprehensive behavioral health (MHN) and pharmacy benefit management subsidiaries 20+ years delivering health care coverage 17+ years supporting military families through the delivery of both CHAMPUS and TRICARE

    3. Health Net Federal Services Overview Nearly 3 million TRICARE eligible beneficiaries in the North Region Nearly 1800 associates plus our partners Operations in 32 states 23 states and DC in TRICARE North Region VA business National PPO Network 19 Community Based Outpatient Clinics National DRG Audit and Recovery Services

    4. A Day in the Life of Health Net… 2,000 TRICARE Service Center walk-ins 2,100 Enrollment transactions 20,000 Phone calls to 1-877-TRICARE 4,200 Referral and authorization requests 50,000 Provider claims received

    5. Communication & Coordination Communication is an essential component between successful HNFS, MTF and BCAC relationships Coordination via monthly meetings ensure successful implementation of MTF and HNFS goals

    6. TSC – BCAC Flow

    7. Communication Use team approach, instead of “Us” versus “Them” Successful communication occurs when HNFS and MTF staff view themselves as one team BCAC and TSC Staff work closely together on potential beneficiary problems Community Representative, BCAC and TSC Manager work to develop briefing opportunities/topics Unilateral “Open Door Policy” between MTF and HNFS Positive recognition of “job-well done”; highlighting individual and team accomplishments, often shared between MTF and HNFS in group settings

    8. Role of TRICARE Service Center Enrollments: PCM changes, acceptance of enrollment fees, provide provider lists Claims correction: (when appropriate), EOB explanation, assistance with debt collection issues Explanation of benefits: customer interaction, community briefing, printed material, TFL guidance Authorization/Referrals: Program process education to beneficiaries, civilian network providers. Provide copies of approved ASAP/STAT/Urgent requests

    9. TSC – What Do We Do

    10. Working Together BCAC to TSC Question on enrollment Question on Ref/Auth Covered Benefit verification Provider Questions – Status Potential problem patient Dental (medical) Claims if extreme Joint briefings TSC to BCAC MTF procedures Dental – material request Potential problem patient CHCS inquiry – verify if patient data in MTF system Joint briefings Issues concerning patient complaints

    11. BCAC – Customer Service POC BCAC/DCAO Services: BCAC/DCAO Priority Phone Line: 800.929.9220 BCAC/DCAO Priority Fax Line: 888.250.4510 BCAC/DCAO Correspondence Address: North Region BCAC/DCAO Support Team P.O. Box 870146 Surfside Beach, SC 29587-9746

    13. Overview Introduction myTRICARE.com functionality BCAC and DCAO access to myTRICARE.com® What’s available for a BCAC and DCAO North Region service contacts Closing remarks/questions

    14. Introduction PGBA, LLC is a subsidiary company of BlueCross BlueShield of South Carolina Subcontractor for claims processing, claims customer service, fiscal management and information system technologies Health Net Federal Services for the North Region, and Humana Military Health Systems for the South Region Our TRICARE offices are in Columbia, Camden, Florence and Surfside Beach, South Carolina Health Net, partnered with PGBA, is delivering a new level of excellence to North Region customers

    15. What’s available at myTRICARE?

    16. TRICARE North Region Tools Electronic Funds Transfer Revenue Codes with Valid HCPCS Codes 2005 State Prevailing Rates Discuss all that is available on site forms, links as well as above information etcDiscuss all that is available on site forms, links as well as above information etc

    17. myTRICARE.com Functionality Content includes: Forms General benefits information Links FAQs GlossaryContent includes: Forms General benefits information Links FAQs Glossary

    18. How Does a BCAC and DCAO Gain Access to This Functionality? A PGBA RACF-ID with Web access is required for access to our secure Web site. Select Register now located in the left navigation of the myTRICARE Web site.

    19. How Does a BCAC and DCAO Gain Access to This Functionality? Select Are you a TRICARE government agent? Read and accept the terms and conditions

    20. How Does a BCAC and DCAO Gain Access to This Functionality? 3. If you do not already have a PGBA RACF -ID or if you need to update your RACF-ID for access to our Web site, select North Region Government Agent

    21. How Does a BCAC and DCAO Gain Access to This Functionality? 4. Complete the form and return to Health Net Federal Services (address is included on the form).

    22. How Does a BCAC and DCAO Gain Access to This Functionality?

    23. Government Agent Secure Home Page Review top tabs hereReview top tabs here

    24. Obtain Patient Information To get patient information: Sponsor’s SSN Patient’s date of birth Eligibility date

    25. Patient Information

    26. Check Claim Status

    27. Claim Summary

    28. Claim Details

    29. TRICARE Explanation of Benefits

    30. Search for Authorizations and Referrals To view Auths and Referrals: Sponsor’s SSN Patient’s date of birth Provider’s tax ID (optional) Date range or authorization number

    31. Authorization and Referral Summary Auths and Referrals include: Authorization number Dates of service Place of service Decision Servicing Provider

    32. Authorization and Referral Details Auth and Referral Details include: Requested procedure Decision reason Approved procedure, units & frequency Servicing provider Referring provider Facility

    33. AskUs a Question To AskUs a question: Select AskUs on any page or the tab at the top to send a secure, confidential question to customer service Receive a prompt answer in your myTRICARE mailbox

    34. myTRICARE Mailbox To view answers to your questions in your secure mailbox Select PGBA Answer Search mail by subject Save mail to Old Mail folder Move mail to Deleted Mail folder

    36. North Region General Contact Information

    37. North Region General Contact Information

    38. Service Contacts – BCAC & DCAO Please state that the numbers are reserved for BCAC use only…not to be disclosed to benes and providers.Please state that the numbers are reserved for BCAC use only…not to be disclosed to benes and providers.

    39. Joey make sure you say: Important: These numbers are reserved for BCAC use only. Please do not disclose to beneficiaries or providers. Joey make sure you say: Important: These numbers are reserved for BCAC use only. Please do not disclose to beneficiaries or providers.

    40. Closing Remarks PGBA is a customer-driven organization relentlessly focused on innovation and continuous improvement We are proud to work with Health Net Federal Services to deliver outstanding service to TRICARE North Region customers Advanced systems and web-transactions improve customer service while reducing administrative cost We learn from our mistakes and improve our processes every single day Our mission is to make using TRICARE easy and stress-free for the military, their dependents and the retirees we are privileged to serve Questions?

More Related