professional provider back to basics seminar
DESCRIPTION
Professional Provider Back to Basics Seminar. CareFirst BlueCross BlueShield Updates DC/VA AAHAM Meeting April 26, 2013. Agenda. EDI Updates and Reminders Electronic Funds Transfer CareFirst Direct 835 Remittance Advice ICD10 Preparations Pharmacy Preauthorizations - PowerPoint PPT PresentationTRANSCRIPT
1
Professional Provider Back to Basics Seminar
CareFirst BlueCross BlueShield UpdatesDC/VA AAHAM Meeting
April 26, 2013
4.26.2013
2
Agenda• EDI Updates and Reminders
• Electronic Funds Transfer
• CareFirst Direct 835 Remittance Advice
• ICD10 Preparations
• Pharmacy Preauthorizations
• iEXCHANGE Replacement Update
• CareFirst General Updates3/15/2013
3
EDI Updates and Reminders
3/15/2013
Electronic Services
43/15/2013
5
Electronic Services
3/15/2013
6
• Submit claims using your NPI number• Include patient’s entire prefix & membership number• Verify patient name and birth date• Use HIPAA standard data code sets • Review all reports daily• Correct all claims with errors and resubmit electronically• Review website regularly for news and updates • Refer to the website or BlueLink for a list of our preferred
vendors
EDI Helpful Hints
3/15/2013
7
Difficulties with submissions? • Contact your vendor/clearinghouse first.
CareFirst:• EDI Service Line
• For better assistance, use one of the following terms when
placing your call:835 ERA's/enrollment NPI837 claim status for NCOF (no claim on file) or front end
rejections from CareFirst
EDI Support
3/15/2013
8
Electronic Funds Transfer (EFT)
3/15/2013
9
Get Your Payment Fast ThoughElectronic Funds Transfer (EFT)
• Get paid faster through electronic delivery of your payments
• Reduce paperwork
• Receive secure payment distribution
• Avoid mail delay
• To be eligible for EFT you must:
Submit claims electronically
Receive an 835/ERA (Electronic Remittance Advice)
3/15/2013
10
Enroll Today for Electronic Fund Transfer (EFT)*
*Note: If you currently receive automated payments from CareFirst there are no changes and no need to re-enroll
The following clearinghouses offer electronic fund transfer (EFT) enrollment services:
Emdeon (formerly known as Webmd) at 866-369-8805 Allscripts (formerly known as Payerpath) at 877-623-
5706, ext. 1 or 2 RealMed at 877-927-8000, ext. 1201
• Contact your clearinghouse with all questions regarding EFT capabilities and enrollment.
• Refer to the CareFirst website for more information
• Contact your clearinghouse with all questions regarding EFT capabilities and enrollment
• Go to www.carefirst.com/electronicclaims for more information
3/15/2013
11
CareFirst Direct 835 Remittance Advice
3/15/2013
Remittance Advice
12
Log into CareFirst Direct
3/15/2013
Remittance Advice
13
Click on Remittance.
3/15/2013
Remittance Advice
14
Click on Claim Status.
3/15/2013
Remittance Advice
15
Click on Provider Remittances
3/15/2013
Remittance Advice
163/15/2013
Remittance Summary
17
Search by Date, Check/EFT Trace#, Paid Amount, Source System. Please note: Reviewing Billing NPI/Payee – You can search 90 days at a time. When reviewing All Billing NPI’s – you have the same filtering capabilities, however you can only search 7 days at a time due to the amount of data from all billing NPIs. For each you can search back to 1/1/2012.
3/15/2013
Important Reminders for the 835
• The provider must be registered to receive an 835 through their trading partner in order to view Remittances Data through CareFirst Direct.
Note: You will see the Remittance Tab even if you are not registered, however you will only see No Checks Found. We plan on making the message more clear in the future. For information about electronic billing and receipt of 835 visit www.carefirst.com/electronicclaims
• You cannot import the CareFirst Direct 835 into your practice management system.
• Please sign up for 835 instructional webinars on CareFirst .Com in the Provider and Physician’s section under Seminar and Training.
183/15/2013
19
ICD10 Preparations
3/15/2013
Health and Human Services (HHS) has announced a final rule that delays the ICD-10 compliance date from October 1, 2013 to October 1, 2014. CareFirst will be compliant with this date. Updates will be provided on the CareFirst website under Provider and Physicians under the Quick Link 5010/ICD10. Please work with your clearing house to be ready for the changes.
Additional information is available at the CMS website.
More detail will be available at the Hospital QuarterlyMeetings to be held in April. Go online and registerto attend one of these sessions.
20
ICD10
3/15/2013
21
Pharmacy Preauthorizations
3/15/2013
22
Pharmacy Authorizations Now Online
Providers can now request and track authorizations for medications requiring pre-authorization online. To access this new tool, log in to the Provider Portal from www.carefirst.com/providers and click on the Pre-Auth/Notifications tab. Within the Provider Portal, providers can: • Select the desired drug• Enter information about the member’s condition• Attach any applicable documents for medical review• Track the status of a request• We have developed a new webinar to show you how to
use this feature.
Note: This applies to patients with CareFirst BlueCross BlueShield pharmacy prescription benefit only.
3/15/2013
Pharmacy Authorizations
23
Click on Pre-Auth/Notifications.
3/15/2013
Create a Preauthorization
243/15/2013
Preauthorization
253/15/2013
26
iEXCHANGE Replacement Update
3/15/2013
Project Overview• iEXCHANGE is scheduled to be replaced in the
second quarter of 2013.
• Authorizations will be obtained through our Provider Portal (CareFirst Direct).
• Training will be offered via webinars and during the Hospital Quarterly Meetings.
• Provider Relations Representatives will provide support and individualized training as needed.
273/15/2013
To Ensure Success• IEXCHANGE administrators received a spreadsheet with a list of all
current IEXCHANGE users.
• The administrators were asked to forward the email containing the spreadsheet to all of the administrators listed in the spreadsheet.
• They should review the list for accuracy.
• They should create a CareFirst Direct User ID for any iEXCHANGE user who does not currently have access.
• If a user obtains authorizations for multiple tax ids a different user id is needed for each.
• If you have a new employee make sure they get a CareFirst Direct user id.
• Access to authorization entry is granted by virtue of having a user id. No specific role needs to be granted.
283/15/2013
To Ensure Success
• Allows us to make changes instead of waiting on a vendor to make changes.
• Allows us to make authorizations available to more provider types.
• Eliminates a redundant system.
293/15/2013
Next Steps for the iEXCHANGE Replacement
• Make sure all personnel who obtain authorizations have access to the Provider Portal (CareFirst Direct).
• Attend training- Training will be conducted via webinar sessions and at our second quarter Hospital Quarterlies. We will advertise these webinars to our providers.
• Please check the website periodically and register when these sessions are listed.
• If you have questions please contact your Provider Relations Hospital Representative.
303/15/2013
CareFirst General Updates
313/15/2013
Update Your Information
In order to do business efficiently with our CareFirst providers, it is essential for us to have your most current practice information.
We’ve made it easier than ever for you to review and update your information.
Log into the Provider Portal at carefirst.com under Providers and Physicians to review and verify your address, phone number, location, associated practitioners and more.
323/15/2013
Update Your Information
333/15/2013
Make Sure Your Practice Information is Current
Review Your Practice Information Online Today
If any information displayed is incorrect, it is important for you to submit a Change in Provider Information form immediately. The form is available online.
CareFirstMailstop CG-41
10455 Mill Run Circle Owings Mills, MD 21117-0825
or Fax: 410-872-4107
343/15/2013
Use Your NPI and Keep It CurrentYour National Provider
Indicator (NPI) is Required
To improve efficiency of claims processing, CareFirst requires that all claims submitted (electronic and paper) include your NPI so your practice can be identified. Without your NPI, your claims may be delayed or rejected. Need an NPI? Visit www.carefirst.com/providers/NPI to find out more. Any changes to your NPI? Report them to CareFirst using the NPI Submission Form located on the same page under the NPI and Payer Codes tab.
CareFirst BlueCross BlueShieldProvider Information and Credentialing10455 Mill Run CircleP.O. Box 825Mailstop CG-41Owings Mills, MD 21117-0825
Send questions to [email protected]
353/15/2013
Sign-up to Receive Email from CareFirst
363/15/2013
Sign-up to Receive Email from CareFirst cont.
373/15/2013
Facets Voucher Changes
The Facets Voucher/Notice of payment(NOP) for both professional and institutional providers will be changing toward the end of the 2nd quarter of 2013.
The changes will make the voucher easier to interpret and ensure that all of the necessary information is available.
Training will be conducted via webinar sessions. Go to Training sessions are now available on the website for enrollment at www.carefirst.com>providersandphysicians and click on Seminars and Training on the left side. 383/15/2013
QuestionsThank you for your attention
393/15/2013