UPMC Vision Advantage Online Provider Manual
Contents
1. Online Claim List Date From Date To Patient Last Name Patient First Name E ji L i Total Recofds 3 Page No 1 1 Search 08 15 2011 VISION MEMBER TEST Submitted GQ 08 08 2011 VISION MEMBER TEST Submitted Q 08 08 2011 VISION MEMBER TEST Submitted This is the View screen which shows the details of the submitted claim The only available user actions on this screen are e Click on the Procedure Code 1 at the lower left portion of the screen to see a description of the procedure code entered on the claim for the service performed on this patient Once the description is displayed click Close 2 to close the pop up window e Click on the Go Back button when review of the claims detail has been completed 3 Name DrHoward OO Nereis OP FIC Retivorte _ rei Brome Progon Profile Change Password Eligibility Claims Claims Status Vision Benefit Request Vision Benefit Request Status Claim Details Subscriber SSN 111 22 2223 Patient Name VISION MEMBER TEST Patient DOB 06 09 1970 Member 200000968 01 Gender M lRealationship Code SUBSCRIBER Patient Account Location ID Name Bright Eyes 1500 McKnight Road PA Billing provider name organization Dr Ron Howard MD name Servicing provider first name Ron Servicing Provider NPI 4234567890 Servicing providerLegacy Number 101010 Diagnosis Code d001 Diagnnaia Code 2 d002 Diagnosis Code 4 Diagnosis Code 3 Deteot senseo cedure2. UPMC Vision Advantage Declarations would be made by the user if using the online credentialing application to declare any negative determinations associated with e Licenses e Privileges e Law enforcement e Liabilities gb oR F t r _ Netwo 1 UPMC Change Password Eligibility Claims Claims Status Vision Benefit Request Vision Benefit Request Status answer Provider Name Nes Bill Primary Specialty Declarations As you consider the questions include all past and present issues i Have you ever had any of the following denied revoked suspended restricted lost limited placed on probation including but not limited to disciplinary action s or have you voluntarily relinquished any of the following in anticipation of any of these actions or are any of these actions now pending i License in any State 3 Other professional registration license A Aune REE ANT E em hs Som oor 7 Other institutional affiliation status a Dekh te ht ek aban tee ea at Proressional society membership 9 Professional liability insurance 11 Have any complaints been filed against you with a professional association or dental medical society i 2 Hay e you ver been advi sed that you should not perform your p ofes sional or der al me jical staff duties 13 Have you used illegal drugs in the last ten years ing a plea of nolo contendere a r f 5 Hove on oem the subject of a
3. ieforena inks 3 Sivdeyes 123446789 When checking the Profile screen if no practice or location exists example below follow these steps to add your practice and location Enter your tax identification number in the Tax ID field and then click the Search button Close the No Practice Found Adding New by clicking OK Complete the Add Practice as on the following page and continue the steps Provider Name Nes Bill SSN 222222222 Primary Specialty Provider Practice Tax ID Vision Advantage Online Manual 11 14 11 Edition 1 30 UPMC Vision Advantage If your tax identification number is already pre loaded you will be able to select from a list of office addresses to assign to the tax identification number If the applicable address is not within the list follow the directions below to add a new address to the tax identification number If your tax identification number is not loaded complete the practice screen by filling out the practice name for the tax identification and then click on the Save button _ a a i aa ge at ll x a Change Password Eligibility Claims Claims Status Vision Benefit Request Vision Benefit Request Status Practice Microsoft Internet Explorer provided by UPMC Provider Name Nes Bill Add Practice Ti E aian Tax ID 10 1223344 Main ion Supporting Information Demographics Practice Speciaty Lic Pr
4. Address 2 City State and Zip code e Phone Number e Phone Number 2 and Fax are optional fields Once added click the Save button and your office location will automatically be saved under the tax ID number From this screen please identify your primary office location by clicking the Primary box next to the location then click Save Lf Aa Name Nes Bill Network UPMC Network z N Date 10 11 2011 Heip Home Logoi Change Password Provider Office Location Total Records 1 Page No 1 1 E gt gt E A aa Bright Eyes 1500 McKnight Pittsburgh Pennsylvania 15229 412 630 0300 ie e Click on Add to select your applicable locations from the list of locations already defined for your practice You may add as many physical locations to this tax ID number as needed by clicking the Add button and repeating the steps above Vision Advantage Online Manual 11 14 11 Edition 1 32 UPMC Vision Advantage Once your tax ID number is on file with a corresponding practice and location you may submit claims directly through Vision OnLine If you have more than one tax ID number repeat the process for each tax ID number you use in your practice To begin a claim submission 1 Place the cursor over the Claims button to make the drop down selections visible 2 Click on Submit Claim to activate the claim entry screen Change Password i Claims Claims Status _ Vision Benefit Request
5. E Total Records 3 Page No 1 1 Search Q 08 15 2011 VISION MEMBER TEST Submitted Q 08 08 2011 VISION MEMBER TEST Submitted Q 08 08 2011 VISION MEMBER TEST Submitted Vision OnLine provides the user with the ability to refine the search and narrow the results as described here Enter a submitted date range by populating the Date From and Date To fields using the calendar icon OR Enter the Patient Last Name and or Patient First Name in the respective search field Click on the Search button after the pertinent information has been populated in the search field s It is important to note that not all fields have to be populated to initiate a search Vision OnLine allows the user to choose one or multiple fields on which a search can be performed Claims submitted for Joseph Smith can be viewed by entering Smith or Smi in the Patient Last Name field Online Claim List Date From Total Records 3 Page No 1 1 Q 08 15 2011 VISION MEMBER TEST Submitted Q 08 08 2011 VISION MEMBER TEST Submitted Qa 08 08 2011 VISION MEMBER TEST Submitted Vision Advantage Online Manual 11 14 11 Edition 1 42 UPMC Vision Advantage Click on the magnifying glass of the claim that you would like to view Name Dr Howard network UPMC Network Date 11 08 2011 Heip Home Logot Change Password igibili i Claims Status Vision Benefit Request Vision Benefit Request Status Payments
6. Procedure Code the procedure code can be manually entered if known and tabbing to the next field will populate the description or utilizing the notepad icon to the right of this field will bring up a complete list of codes for viewing and selection to be populated To view a list of codes accepted by the plan please refer to the UPMC Vision Advantage Provider Fee Schedule Vision Advantage Online Manual 11 14 11 Edition 1 37 UPMC Vision Advantage e Filter by Code and put a partial code in Description Click the Search button Procedure Code Lookup e Filter by Description and put in a partial Filter By description ex frames e Click on Code of desired procedure to populate form That will automatically close the pop up box gt S POLARIZATION ANY LENS MATERIAL PER LENS a V2ii0 OCCLUDER LENS PER LENS V2fo0 OVERSIZE LENS PER LENS V2 si PROGRESSIVE LENS PER LENS LENS INDX 1 54 1 65 PLSTC 1 60 1 79 GLASS LENS LENS INDX gt 1 66 PLSTC gt 1 80 GLASS LENS LENS POLYCAAFONATE OR EQUAL ANY INDEX PER LENS PROCESSING PRES amp TRANSPORTING CORNEAL mu EF SPECIALTY OCCUPATIONAL MULTIFOCAL LENS PER LENS ASTIGMATISM CORRECTING FUNCTION INTRAOCULAR LENS PRESBYOPIA CORRECTION FUNCTION _ INTRAOCULAR LENS AMNIOTIC MEMBRANE SURGICAL RECONSTRUCT PER PROC VISN SPL ACSS amp SRVC CMPNT ANOTHER CPCS CODE VISION SERVICE MISCELLANEOUS 7 Mod
7. UPMC Vision Advantage Profile This information can be accessed from the Profile tab e Main Information pertaining to demographic and practice specifics e Supporting Documentation of provider s credentials e Declarations of provider s history e Review capabilities of the electronic credentialing form Vision Advantage Online Manual 11 14 11 Edition 1 14 UPMC Vision Advantage The Provider s Profile and all the associated information are proprietary and protected Once initial registration has been completed whether by entry by provider or transfer of information from credentialing application the provider profile information is locked down and not accessible by users to protect the confidentiality of the information Name Bill Nes Change Password Welcome to the UPMC Provider Portal ATTENTION PROVIDER If you are registering as a user in order to submit an application for credentialing please be sure to complete all tabs under the Profile section of this portal Incomplete information could result in a delay in processing your application Please click the HELP button for instructions on navigating the portal and for instructions on completing an online application To Start the application process please click the profile tab UPMC Vision Advantage has pre populated the Profile tab with data received on the initial application If there are any changes in the populated data needs
8. Browse to find a file that is stored in the submission software or common folder that may have been created according to the submitting office procedures 5 When the user is satisfied the correct file has been selected and is visible in the File 1 field click on the Attach button The user can now click on the Close button Vision Benefit Request Status Payments 837 File Upload Provider ID 121900 Provider Name _DrHoward Date 11 08 2011 E5 Document Type 837 Files z Vision File 1 2 i E Ej Attach or Remove File s 4 Description Required Fields atah i O j 5 Close Vision Advantage Online Manual 11 14 11 Edition 1 46 UPMC Vision Advantage The file has been successfully uploaded and submitted to UPMC Vision Advantage Now that the claims pre determination file has been attached and uploaded the following actions are required to complete the transaction 1 A pop up box will appear stating Files Uploaded Successfully Click the OK button 2 Click the Close button as the final step Change Password igibili 837 File Upload Provider ID azi9 sid Provider Name Date 11 08 2011 E5 Document Type 837 Files z Attach or Remove File s xX File Upload Microsoft Internet Explorer provided by UP 5 x Description SELECT FILES AND ATTACH E T Title vision Claim 1 File1 Browse Required Fields Windows
9. Cade Momiter ueigtmits Dlegnosispoimter ChargsAmowt 08 08 2011 1 1 1 2 00 Vision Advantage Online Manual 11 14 11 Edition 1 43 UPMC Vision Advantage Uploading an Electronic Claims File In this chapter the user will learn how to e Upload submit a HIPAA compliant 837P claims file e Check the list of submitted files Vision Advantage Online Manual 11 14 11 Edition 1 44 UPMC Vision Advantage Uploading an 837P File The 837P file can be submitted if the office practice billing software has the capability to create a HIPAA compliant 837 claims transaction file This file can be used to submit actual claims The benefit of submitting an 837P file is an increased turnaround time for claims adjudication and payment Electronic transactions have been proven to expedite the reimbursement request process enabling the practice to receive claim determinations more rapidly In order to be able to submit an 837P transactional file the submitter must complete a successful test cycle with the UPMC Vision Advantage EDI support team to ensure accurate placement of data in these files In order to do this the submitter needs to contact us via e mail at HRPEDINOTIFY upmc edu to set up the testing cycle The following functionality will be used for the submission of claims via your txt file 1 Place the cursor over the Claims tab and the three options available will be visible 2 Click on the 837 File
10. Ee Te E a Se A TA N a ee ee ee ee er of the data that you submitte m IMPORTANT You must use the provider s SSN when registering Do not enter the practice s tax ID number Clicking on Begin Registration initiates one of the following scenarios depending on the existence of registration data in the system User already exists Disclaimer i Haneda ht cokes PSE SE OA EAE ONDARO IE OPO OE PR SE AER POA EN Y ONE TER PTER RIAI BE EEEE EI ARE NOAN O daha sind Vision Advantage Online Manual 11 14 11 Edition 1 6 UPMC Vision Advantage Social Security Number already entered in the system but no user ID exists A temporary password is provided Write down the user ID and password The user will be asked to change the password First time login requires the password to be changed New Password ee Confirm Password es baam Lems Vision Advantage Online Manual 11 14 11 Edition 1 7 UPMC Vision Advantage Social Security Number SSN doesn t exist Registration information entered here will provide a temporary password as in the screen above Vision Advantage Online Manual 11 14 11 Edition 1 8 UPMC Vision Advantage Adding Location Managers This chapter explains how Practice Managers or their authorized representatives can create users responsible for individual or multiple office locations The user will learn e How to access office locations under their Fe
11. Internet Explorer x Vision Advantage Online Manual 11 14 11 Edition 1 47 UPMC Vision Advantage Functionality is still available in the event claims submission is not complete Here are the options that the user can perform After closing the File Upload Box the user can upload additional files remove a file just entered during this session or Save to exit the upload session as demonstrated below 1 The Description file type and file name are visible for a user to ensure that the correct information data has been uploaded 2 Ifthe user wants to add an additional file to this upload the arrow would be selected again and the process from above should be repeated to attach the additional files If after review of the screen it is determined that an error in data entry or file attachment has been made or a change is necessary the X can be selected to remove the file 3 Ifno additional action is required and tasks are complete click the Save button and the file will appear on the list __ eto Hone Wion Provider Name Dr Ron Howard MD 11 08 2011 Document Type s37Files wa 4 i Attach or Remove File s x ision claim1 bt November 2011 7 Required Fields The file that has just been loaded 1s now shown in the File Name list with the name entered during the upload process The fields File Name and Display Name are user entered while the Document Type and Creation Date
12. UPMC Network Heip Home P ES T Change Password Submit Online Claim Header V Member Contraa s W 200000968 Member Name VISION MEMBER TEST Patient First Name Patient Middle Name Patient Last Name Member Relationship Code Patient Account Location ID Name TaxID Address2 City Zip Billing provider name organization name Servicing provider first name Bill Servicing provider last name Servicing Provider NPI 4234567890 Servicing provider Legacy Number Diagnosis Code ___4 Diagnosis Code 2 Diagnosis Code 3 Diagnosis Code 4 Submit Online Claim Detail Date Of Service Procedure Code Modifier Quantity units Diagnosis pointer Charge Amount 5 e Set 7 amp 8 9 3 _ 40 a 1 Patient Account Number not required but helpful in correspondence and office record keeping 2 Location ID Name The notepad to the right of the field is incorporated for the user to select the place of service from a multiple location practice By selecting the location it will auto populate the location s demographics Each claim submission must have a Location ID Name selected The notepad must be used to populate this field The following actions will complete the location selection process Click the notepad Location ID Name Vision Advantage Online Manual 11 14 11 Edition 1 36 UPMC Vision Advantage E e e LOY Microsoft Internet Explorer prov
13. Vision Benefit Request Status Payments Claim List 837 File Upload Welcome to the UPMC Provider Portal ATTENTION PROVIDER If you are registering as a user in order to submit an application for credentialing please be sure to complete all tabs under the Profile section of this portal Incomplete information could result in a delay in processing your application Please click the HELP button for instructions on navigating the portal and for instructions on completing an online application To Start the application process please click the profile tab There are two paths a user can choose to select a patient from the drop down menu e Subscriber Social Security Number SSN or e Member Contract Number V Member Name Patient First Name Pn Patient Middle Name Patient Last Name Patient DOB Member aT Navigation through the claim entry screen is best done by utilizing the Tab key on the keyboard and traveling left to right We do not recommend utilizing the computer s mouse as this may bypass a required field that will initiate a prompt to return to that field and enter the necessary information Once the patient is correctly identified either method will initiate auto population of the remaining necessary demographic fields Vision Advantage Online Manual 11 14 11 Edition 1 33 UPMC Vision Advantage The Member Contract can be found on the eligibility tab under the View icon The Member Contract
14. after entry the same demographic information was auto populated Name Nes Bill _ Change Password Vision Benefit Request Status i Vision Benefit Request Submit Online Claim Header i l Claim Type V Search By 200000958 Member Name Patient First Name Testy oO ooo Patient Middle Name MON VENDET ES Patient Last Name Patient DOB Member 200000968 0 Gender Relationship Code SUBSCRIBER The next illustration shows how to select the actual patient from the member name drop down list It is important to select the member name on each claim submission To do this click on the drop down arrow of the member name field and the additional eligible member names attached to the subscriber s policy will be visible 1 For this demonstration the subscriber will be selected 2 and his information will be populated Submit Online Claim Header Claim Type Search By Member Contract x 200000968 Member Name VISION MEMBER TEST Patient First Name Patient Middle Name Patient Last Name Member Relationship Code Vision Advantage Online Manual 11 14 11 Edition 1 35 UPMC Vision Advantage The Claim Entry Screen On this screen the subscriber s name has been populated with his information There are additional fields at the header to complete that aid in a successful claim submission An example is listed below Nai me Nes Bill z Netw or k
15. are assigned by the system e Name Dr Howard Network UPMC Network Date 11 08 2011 Heip Home Logoft Change Password Eligibility i Claims Status Vision Benefit Request Vision Benefit Request Status i Payments 837 File upload List Total Records 2 Page No 1 1 Search vision claim txt November 2011 837 Files 11 08 2011 11 08 2011 Vision Advantage Online Manual 11 14 11 Edition 1 48 UPMC Vision Advantage Claim Status In this chapter the user will learn how to e View all claims submitted by the provider s billing office whether entered online through direct entry in the provider portal on paper sent to UPMC Vision Advantage or through a clearinghouse and confirm Status e Review claim detail information to ensure the correct data has been submitted e Maintain a history of submitted claims Vision Advantage Online Manual 11 14 11 Edition 1 49 UPMC Vision Advantage Claim Status Vision OnLine provides the ability to view and check the status of submitted claims using the Internet Once a claim has been submitted Vision OnLine also provides the user with functionality that lists and displays all claims that have been submitted by the provider s billing office no matter the submission method Click on the Claim Status tab on the home screen of Vision OnLine This will allow the user to view all claims that have been submitted hist
16. submitted Vision Benefit Requests e Enter From and To dates using the calendar icon 1 or e Enter Patient Last Name and Patient First Name 2 e Click on the Search 3 button after the required information has been entered e To view the selected Vision Benefit Request click on the magnifying glass under the View column Online Vision Benefit Request Status Date From Date To Patient Last Name Patient First Name M 3 Total Records 20 Page No 1 1 Vision Advantage Online Manual 11 14 11 Edition 1 61 n 98 9N19 Drarcecced A 00012563 VAN BUREN MARTIN 11 07 2011 02 05 2012 Cancelled Q 00013259 TATAR TOMAS 11 07 2011 02 05 2012 Cancelled A 00012759 MARX DANTE 11 02 2011 01 31 2012 Expired Q 00013825 RICK ALLISON 11 01 2011 01 30 2012 Processed Q 00013169 PAPER CHELSEA 10 27 2011 01 25 2012 Processed ey 00013189 ROTH ZACK 10 27 2011 01 25 2012 Processed Q 00013207 REYES MARIA 10 27 2011 01 25 2012 Processed GQ aes SE eee zl UPMC Vision Advantage Each benefit request will have a status The status codes are Submitted Processed Cancelled and Expired Submitted will show as the benefit request status as soon as the request is submitted to UPMC Vision Advantage and will continue to stay in this status until it is fully processed UPMC Vision Advantage turnaround time is within 48 hours of submission If you need assistance with your benefit request status plea
17. the user will learn how to e View and research payment information made to the provider on behalf of the member patient including claim and check information Vision Advantage Online Manual 11 14 11 Edition 1 64 UPMC Vision Advantage Payments From the Home Screen click on the Payments tab to view payments claim determinations that have been processed Change Password Eligibility i Claims Status Vision Benefit Request Vision Benefit Request Status Payment Provider Payments Check EFT No Payment Date The user can now review payments made based on claims submitted but the default list of payments displayed includes all payments processed for this provider Vision OnLine provides the user with the ability to refine the search to yield more defined specific results This can be accomplished by using the following search tools 1 The search can be refined by entering the Check EFT No or Payment Date 2 Click on the Search button after the search criteria have been entered in the selected field s The more data that is entered the more refined the search results will be Claims Status Vision Benefit Request Vision Benefit Request Status Payment Total Records 1 Page No 1 1 L scorn A 00025072 146 20 11 04 2010 Click on the magnifying glass in the Payment Details column that the billing office staff wants to review Click the Home button to return to the Home Screen or selec
18. to be updated please contact Network Management or the UPMC Vision Advantage Vision Benefits Advisory Team to communicate those changes Vision Advantage Online Manual 11 14 11 Edition 1 15 UPMC Vision Advantage Main Information By clicking on the Profile tab the user will see additional available tabs As illustrated the user 1s reminded the profile information is proprietary and confidential and therefore not viewable s Practice Specialty Licensure Professional Liability Provider profile information is confidential The first tab available from left to right is Main Information which contains e Demographics Confidential information pertaining to the user provider that is secure and proprietary e Practice Displays the practice and location information of the user provider e Specialty e Licensure e Professional Liability Vision Advantage Online Manual 11 14 11 Edition 1 16 UPMC Vision Advantage Supporting Information presents five additional tabs of information for the user Declarations Review and Submit Hospital Privileges Education Training Certification Documents Employment History Practice Employer L Page No 1 1 The five tabs listed under Supporting Information are e Employment History e Hospital Privileges e Education Training e Certification e Documents Vision Advantage Online Manual 11 14 11 Edition 1 17
19. 11 14 11 Edition 1 2 UPMC Vision Advantage Vision OnLine provides comprehensive data security with Secure Socket Layer SSL Windows Authentication Login Management username and password Access Rights Allocation and more thus allowing only authorized users to access the application information How to Log in by Provider Vision Care Providers will access the UPMC Vision Advantage website at www upmchealthplan com Vvision or click on the link Are you a Vision Care Provider to be directed to the UPMC Vision Advantage login screen UPMC HEaAtrH PLAN MEMBERS PROVIDERS EMPLOYERS DROKER HEALTH amp WELLNESS MEMBER LOGIN Are you an employer Are you 65 or older Are you an individual Enter your User ID here PMC for Life SHORT TERM GROUP QUOTE UPMC for Life QUOTE LOGIN Login instructions Forgot your User ID Are you a Dentist Health Care Reform New User Registration tor information considering the UPMC Dental Advantage Network x a pos ewan ea cake P tnd bE Are you a Vision Care Provider considering the UPMC Vision Advantage Network amp FIND A DOCTOR Rx INFORMATION Are u an Employee deciding on health insurance eNEWSLETTERS y PROVIDER EMPLOYERS MEMBERS News amp Announcements Health Plan Options for employers Discounted Tickets to Vatican Splendors Rx Prior Authorization Forms Spending Account Services Covered medications formularie
20. Enter the Patient Last Name and or Patient First Name in the respective search field 3 Click on the Search button after the pertinent information has been populated in the search field s 4 It is important to note that not all fields have to be populated to initiate a search Vision OnLine allows the user to choose one or multiple fields on which a search can be performed Claims submitted for Joseph Smith can be viewed by entering Smith or Smi in the Patient Last Name field understanding that all claims for a patient with the last name of Smith will return in the list Vision Advantage Online Manual 11 14 11 Edition 1 51 UPMC Vision Advantage Submitting a Vision Benefit Request A vision benefit request commonly referred to as a pre authorization is a process where a provider submits a request for services before treatment begins The vision benefit request provides a valuable estimate to both the member and provider by identifying covered services coinsurance rates and amounts payable on the potential claim Upon submission a request number will be issued that can later be used for tracking purposes It is important to note that when submitting a vision benefit request planned services should never be combined on the same claim as actual services Vision benefit requests and actual claims need to be submitted as separate transactions Vision benefit requests are only valid for 90 days UPMC Vision Advantage does not r
21. SBYOPIA CORRECTION FUNCTION INTRAOCULAR LENS AMNIOTIC MEMBRANE SURGICAL RECONSTRUCT PER PROC VISN SPL ACSS amp SRVC CMPNT ANOTHER b To view a list of codes accepted by the plan please refer to the UPMC Vision Advantage Provider Fee Schedule V2TST CPCS CODE V2799 VISION SERVICE MISCELLANEOUS 7 Modifier can be manually entered if known or utilize the notepad icon to the right of the field to initiate a look up box e There are 20 records per page as all medical modifiers l may be available b i e The user can click the arrow to Go to page e achiwataate OR e The user can type 590 in place of the 20 and scroll E FA Left hand thumb through all available records r e Geaaee e Click on the desired modifier as shown and the look up D KV _DMEPOS item profession serv box will close automatically and populate the form ka a EEE O SY Contact w high risk pop a ZE Termed 20020101 a 2P PQRI EXCLUSION PATIENT i 5K MJD commonly called Ataxin 3 m AA Anesthesia perf by anesgst a AB Termed 20020101 O AC Termed 20020101 m AD MD supervision gt 4 anes proc C AE Registered dietician AF Specialty physician 8 Quantity Units field is auto populated with 1 unit The user can change the number and add additional units if it is appropriate for the service submitted Vision Advantage Online Manual 11 14 11 Edition 1 56 UPMC Vision Advantage 9 Diagnosis Pointer is auto populated with 1 uni
22. UPMC Vision Advantage Vision OnLine Training Manual Version 111411 UPMC Vision Advantage UPMC Vision Advantage Table of Contents How to Log in By Provider 3 Sign on screen to log in as a returning user or register for the first time 4 Begin registration if your Social Security number SSN is not in the system 5 User already exists 6 Social Security number SSN already entered in the system but no user ID exists 7 Social Security number SSN doesn t exist 8 Adding Location Managers 9 Profile 14 Main Information 16 Supporting Information 17 Declarations 18 Review and Submit 19 Change Password 20 Verifying and Viewing Patient s Eligibility 22 Eligibility 23 Spending Summary Field Descriptions 28 Submitting a Claim 29 To begin a claim submission 33 The Claim Entry Screen 36 Claim List 40 Uploading an Electronic Claims File 44 Uploading an 837D File 45 Claim Status 49 Submitting a Vision Benefit Request 52 To begin to submit a vision benefit request pe The Vision Benefit Request Entry Screen 53 Viewing Vision Benefit Request Entered Through Vision OnLine 58 Vision Benefit Request List 59 Checking a Vision Benefit Request Status 60 Vision Benefit Request Status 6l Vision Benefit Request Field Descriptions 62 Payments 64 Using the I answer Informational Tool 66 Vision Advantage Online Manual
23. Upload option to view a listing of previous submissions 3 To find a specific file that has already been submitted the user can refine the results by entering a specific date in the Creation Date field by using the calendar icon 4 After entering the Creation Date click on the Search button 5 To submit upload a new 837P claims file click on the Add button Name Dr Howard Network UPMC Network Date 11 08 2011 Heip Home Logoff Change Password Eligibility Claims Status Submit Claim Claim List i i senate Denes oe 27 Fie union Creation Date Cas 2 Once the Add button has been clicked the user is directed to the Add or Remove screen Vision Advantage Online Manual 11 14 11 Edition 1 45 UPMC Vision Advantage The following numbered instructions will guide the user through the process of adding an electronic file for submission 1 To attach a new file click on the upward pointing arrow that appears on the screen The user is then prompted to enter some transaction information 2 Enter a description that helps to identify the transaction 3 Inthe Select Files and Attach pop up window enter the Title name the file using a simple naming convention one that is meaningful to the user but be consistent with the type of files submitted recommended file type or extension is TXT format This creates ease of use for ongoing identification among submissions Title is a required field 4 Click
24. VIDER If you are registering as a user in order to submit an application for credentialing be sure to complete all tabs under the Profile section of this portal Incomplete information could result in a delay in processing your application Please click the HELP button for instructions on navigating the portal and for instructions on completing an online application To Start the application process please click the profile tab There are two paths a user can choose to select a patient from the drop down menu e Subscriber Social Security Number SSN or e Member Contract Navigation through the request entry screen is best done by utilizing the Tab key on the keyboard and traveling left to right We do not recommend utilizing the computer s mouse as this may bypass a required field that will initiate a prompt to return to that field and populate the necessary information Once the patient is correctly identified either method will initiate auto population of the remaining necessary demographic fields The Search By field is automatically defaulted to the Subscriber SSN 1 option When this is the selected method of submission the user will manually enter the SSN 2 in the field When the user tabs to the next field after entry in field 2 the system will auto populate e Member Name e Patient First Name e Patient Last Name e Patient DOB Date of Birth e Member e Gender e Relationship Code C Netwo
25. actice Name ee Required Fields Provider Practice Tax ID 10 1223344 E I RIN Once Save is selected you will be able to add the physical office address es for the tax identification number by clicking on the magnifying glass under the Location heading ER Name Nes Bill Hear UPC Hetworke pate 10 11 2011 heip Pome Logo Profile Change Password Eligibility Claims Claims Status Vision Benefit Request Vision Benefit Request Status Payments Provider Name Nes Bill SSN 101223344 Primary Specialty Main information Supporting information Declarations Review and Submit Demographics Practice Specialty Licensure Professional Liability Provider Practice Page No 1 1 North Hills Eyes 101223344 Vision Advantage Online Manual 11 14 11 Edition 1 31 UPMC Vision Advantage Select Add from the following screen If addresses are populated you may select a location to tie to your tax identification number If not hit the Add button again and you will see the following screen Provider Office Location Microsoft Internet Explorer provided by UPMC Add Practice Office Location Practice Name Norti Tax ID Location Name o Address1 City Zip Phone 2 Required Fields antech ie oa a Ze e Complete the location tab by adding the data for your office location e Location Name name of your physical office e Address 1
26. an benefits grid for the patient Vision Advantage Online Manual 11 14 11 Edition 1 25 UPMC Vision Advantage e Clicking on the Cancel button will close the pop up box 999999199 02 tak is ZA y toma tn ew pois tele pan deona Please input SSH or first and last name From the View Details screen click on the Spending Summary button to view the eligible benefits for the current benefit year Payments i answer forms links SMITH MARY Member 111111111 01 04 16 1960 Gender F SUBSCRIBER Address 101 Sth St Address3 Ross Township State Pennsylvania 15229 Phone 412 630 1111 SMITH MARY Subsoriber 111111111 01 01 01 2011 End Date Group ID Name 008792 UPP Plan 5 Vision Advantage Online Manual 11 14 11 Edition 1 26 UPMC Vision Advantage Once the Spending Summary List screen appears click on the magnifying glass to view the vision spending summary Change Password Eligibility A Vision VISION PREMIUM Below is an example of a patient s Spending Summary for the current benefit year The page that follows the view gives a description of the fields on the summary The only additional user action available is the Go Back button to return to the member demographics page Vision Benefit Request Status Vision Benefit Request VISION PREMIUM VISION MEMBER TEST 200000968 01 y VISION PREMIUM 52 Yy Y 12 Months g 12 Mont
27. and Date To 3 utilizing the calendar icons available to the right of each date box date entry is format sensitive so we recommend using the calendars 4 The user can also enter the Patient Last Name 4 and Patient First Name 4 5 Click the Search 5 button to initiate the search of records 6 Select the desired Vision Benefit Request record by clicking on the magnifying glass 6 in the View column The user can also Cancel the request by clicking the red circle with X Name Dr Howard _ Network UPMC Network a Date 11 10 2011 Profile Change Password Eligibility Claims Claims Status Vision Benefit Request Vision Benefit Request Status Payments answer Submit Vision Benefit Request Online Vision Benefit Request List Date From Date To Patient Last Name Patient First Name Cs Cas m 5 Total Records 58 Page No 1 3 gt i gt Cancel R60 1000374149866488257 Peach Mary 11 09 2011 02 07 2012 Submitted The user actions available are 1 Click on the Notepad icon 1 to open a pop up window that displays a description of the procedure code submitted 2 View the Procedure Code Description 2 click Close to return to the Details screen 3 Click the Go Back button to return to the search results 3 M o PN San tis aes Wiss 165554430 067121359 F Peach02355 112223344 Sute 200 Fasdwgh 15229 Cragnesis Code 99009 Servicing provider inst name Howa
28. arn how to e View all claims submitted online through direct entry in the provider portal and confirm submission status e Review claim detail information to ensure the correct data has been submitted e Maintain a history of submitted claims Vision Advantage Online Manual 11 14 11 Edition 1 40 UPMC Vision Advantage Claim List Vision OnLine provides the ability to submit claims via direct web entry using the Internet Once a claim has been submitted Vision OnLine also provides the user with functionality that lists and displays all claims that have been submitted through the online portal The Claim List function is found under the Claims tab on the home screen of Vision OnLine and will allow the user to view all claims that have been submitted history displaying the following data The date submitted The patient s name The submission status of the claim This is the Home Screen to which the user can return at any time during navigation by clicking on the Home button Claims Claims Status _ Vision Benefit Request _ Vision Benefit Request Status Payments Welcome to the UPMC Provider Portal ATTENTION PROVIDER If you are registering as a user in order to submit an application for credentialing please be sure to complete all tabs under the Profile section of this portal Incomplete information could result in a delay in processing your application Please click the HELP button for in
29. ber of services submitted for each corresponding submitted code is listed 3 Provider s Charge This field shows the billed amounts for the corresponding codes 4 Allowance This field will show the allowance or payable amount Vision Advantage Online Manual 11 14 11 Edition 1 62 UPMC Vision Advantage 5 6 7 8 9 10 Approved Amount This amount represents what is approved for payment for each corresponding service per the contractual agreement with UPMC Vision Advantage for each corresponding service Copay Amount This amount represents the patient copayment for the corresponding services It will be the difference between the allowed amount and the approved amount if applicable Ded Amount This field is populated with an amount applied to the individual s plan deductible if it has not yet been satisfied for the benefit year If it has not been satisfied the approved amount will be represented here instead of in its field until that deductible has been met if applicable Amount Not Approved This field designates the amount not covered by the member patient s plan Remarks This field shows the explanation codes for the corresponding procedures submitted in the line item Remark Description This field explains the respective code s for the corresponding procedures submitted Vision Advantage Online Manual 11 14 11 Edition 1 63 UPMC Vision Advantage Payments In this chapter
30. der to a new location or an office he or she may start to practice in e Remove Provider from the Location can only be utilized for offices the Location Manager has access to This action can be used to disassociate a provider from an office where he or she no longer practices e Enable to Submit Claims for Provider allows the Location Manager to submit claims on behalf of an authorized provider of services e Enable to Submit Vision Benefit Request for Provider allows the Location Manager to submit a Vision Benefit Request authorization for services The main thing to remember is though all Location Managers may work under the same practice they can only see the locations and providers to which they have been given access rights Network UPMC Network Date 11 30 2011 Heip Home Logos aaa ua maae aaaea aaia muai mamaaa Providera Place Pittsburgh PA 13219 L 4 9 z Vision 112 Washington Pisce i Provider 2 Pittsburgh PA 19219 oS B g o E vision Test 112 washington Pisce is PA LA a a al o o 0 rw a j vision Lz Washington Place _ Provicer 3 Pittspurgn PA 19219 o o o o o a E When the user has completed granting rights clicking the Save button will display a message that Access Rights saved successfully The user will click OK to close the message Windows Internet Explorer E3 A Access Rights saved successfully ae Vision Advantage Online Manual 11 14 11 Edition 1 13
31. deral Tax Identification Number e How to create usernames and passwords for selected employees e How to grant hierarchal privileges to each individual Vision Advantage Online Manual 11 14 11 Edition 1 9 UPMC Vision Advantage Location The location tab and functionality gives Practice Managers and their authorized users the ability to add Location Managers to offices for which they are responsible and to control their access rights The Location Managers can then manage the providers practicing at those offices Pe When the cursor is placed over the location tab two options for further action will appear e Access Rights to control levels of management of providers at the specified location e Location Manager to create usernames and passwords to be given to selected employees to act as authorized users to manage locations for which they are responsible Vision Advantage Online Manual 11 14 11 Edition 1 10 UPMC Vision Advantage Location Manager will be used first Welcome to the Internal User Portal Click on Location Manager By clicking on the Location Manager tab the user will see locations listed under the practice The user can now select a location by clicking on the magnifying glass icon under the User column In the illustration the last location has no entries in the User ID or Password fields This indicates that a Location Manager has not been assigned Access Rights Click on the magnify
32. equire submission of vision benefit requests Vision benefit requests may only be submitted through the Vision Online portal In this chapter the user will learn e How to select the correct subscriber or member e The population of all required data fields e What fields will be auto populated by entering data in the first required fields e The mechanisms that are available to select proper coding of services rendered e How to correct data before finalizing a Vision Benefit Request submission e How to verify the completion of a submitted Vision Benefit Request This chapter demonstrates all the steps required to submit a UPMC Vision Advantage Vision Benefit Request Vision Benefit Requests are not required but provide a way to determine if benefits are available for a specific member IMPORTANT Vision Benefit Requests can only be submitted through Vision Online the portal Vision Advantage Online Manual 11 14 11 Edition 1 52 UPMC Vision Advantage To begin to submit a Vision Benefit Request 1 Place the cursor over the Vision Benefit Request button to make the drop down selections visible 2 Click on Submit Vision Benefit Request to activate the entry screen Name Dr Howard Network UPMC Network sSs ate 1 09 2011 Heip Home Logoff Profile Change Password Eligibility Claims a_i Vision Benefit Request List Welcome to the UPMC Provider Portal ATTENTION PRO
33. h pertinent information relating to e Frequently Asked Questions e Contact Information e UPMC Vision Advantage Policies and Procedures e Newsletters Provider Eligibility Claims Claims Status Pre D Pre D Status Vision Benefit Request Vision Benefit Request Status Location FAQ List Date From Date To E E Total Records 10 Page No 1 1 UPMC Vision Advantage Benefits Advisory team members are always available to assist you with questions or issues related to Vision OnLine Call 1 877 648 9621 Monday through Friday between the hours of 8 a m and 5 p m Vision Advantage Online Manual 11 14 11 Edition 1 67 UPMC Vision Advantage UPMC Vision Advantage Copyright 2011 UPMC Health Plan Inc All rights reserved VISION PROVIDER ONLINE MANUAL C20111201 10 MFS 12 02 11 1 5M HP Vision Advantage Online Manual 11 14 11 Edition 1 68
34. he member s benefit eligibility as of the date services are rendered If you would like to check a member s eligibility for services please visit the Eligibility section of Vision Online or contact the UPMC Vision Benefit Advisory team at 1 877 648 9621 during normal business hours Vision Benefit Request Header Claim Type A Claim Type e _ Member Name l OO Patient First Name Patient Middle Name E Patient Last Name Sa Patient DOB Member SSH Gender iF Relationship Code E i Patient Account Claim Type The next illustration shows how to select the actual patient from the member name drop down list It is important to select the member name on each request submission To do this click on the drop down arrow of the member name field and the additional eligible member names attached to the subscriber s policy will be visible 1 For this demonstration Mary the spouse will be selected 2 and her information will be populated Vision benefit determinations can take up to 24 hours for processing Creation and receipt of a vision benefit request number does not guarantee eligibility for services Payment is contingent upon the member s benefit eligibility as of the date services are rendered If you would like to check a member s eligibility for services please visit the Eligibility section of Vision Online or contact the UPMC Vision Benefit Advisory team at 1 877 648 9621 during normal b
35. he user can still Change 1 or Delete 2 a line as long as the Save button has not been clicked e The final step will be to Cancel Save or Reset the form 3 Vision Advantage Online Manual 11 14 11 Edition 1 57 UPMC Vision Advantage Viewing Vision Benefit Request Entered Through Vision OnLine Vision Benefit Request List In this chapter the user will learn How to access all Vision Benefit Requests submitted through Vision OnLine the portal How to read the form How to view the status of each entered benefit request How to view descriptions of submitted procedure codes on the form Vision Advantage Online Manual 11 14 11 Edition 1 58 UPMC Vision Advantage Vision Benefit Request List The Vision Benefit Request List provides the user the ability to view all benefit requests submitted through Vision OnLine and the submission status of those requests The available user actions are listed below with corresponding numbers on the screen image 1 Click on Vision Benefit Request List 1 under the Vision Benefit Request tab this option will appear when the cursor 1s placed over the tab a list of all benefit requests submitted by this specific user provider will be populated 2 To narrow the list of benefit requests to find specific ones the user can click Reset 2 to clear the screen and new search criteria can be entered 3 The user can refine the search by entering specific Date From 3
36. hs Y M me 12 Months 12 Months 1 Contact lens available in lieu of glasses 2 Please refer to your plan document for plan details a list of covered benefits and out of network reimbursement a ee Vision Advantage Online Manual 11 14 11 Edition 1 27 UPMC Vision Advantage Spending Summary Field Descriptions 1 2 3 4 5 6 1 8 9 Co Pay In Network the member s copayment amount for an examination or lenses depending on the member s benefit plan for in network services Eligible for Vision Exam whether the member s plan provides coverage for a vision examination designated by Y or N or P Exam Frequency if eligible how often the member s plan will cover a vision examination Frames Allowed whether a member s plan has a frame allowance designated Y or N or P Frames Frequency if eligible how often the member s plan will cover frames Lens Allowed whether a member s plan has a lens allowance designated by Y or N or P Lens Frequency if eligible how often the member s plan will cover lenses Contacts Allowed whether a member s plan has a contact lens allowance designated by Y or N or p Contacts Frequency if eligible how often the member s plan will cover contact lenses Values for Spending Summary Y Yes Benefit is available N No Benefit is not availab
37. ia button the Show Criteria button will replace the Hide button e Click on the Reset button to enable entry of new search criteria The user can now verify the patient s information The following actions can now be performed e Click on the magnifying glass in the View column to see the patient s demographic information and effective and termination dates Or e Click on the magnifying glass in the View Plans column to see the patient s benefit plan details including copayment information if applicable Vision Advantage Online Manual 11 14 11 Edition 1 24 UPMC Vision Advantage Subscreer ember Lis Aiiki Z3 486 789 mary i as smm vittt444 02 04 14 1949 SuSSCRISER SMITH May Meese input SSN or fest and last name The patient s demographic screen is shown below and the additional actions available from this screen are e Click on the Plan icon to view the plan benefits information e Click on Spending Summary to view benefit frequencies and limitations for vision services e To return to the eligibility search screen click on the Go Back button e To print the member s demographics click on the Print button 11111111T F Wiens Penasyhania 42 B 0999 LLEREREES N E The screen shot below shows the Plan View pop up box and lists the Benefit Type Plan Effective Date and End Date of the plan e Clicking on the Adobe icon under Plan will provide the user with a pl
38. ide the user through the login process e New Registration For a new user click on the Register Now button to register with UPMC Health Plan Upon the completion of the registration process the user will create a user ID and be given a temporary password which can be used to log in to the application Vision Advantage Online Manual 11 14 11 Edition 1 4 UPMC Vision Advantage Once the user logs in to Vision OnLine the homepage appears as shown below The homepage displays the following details e Login User Name e Network e Date e Help Click on Help to open a user manual for guidance through the application e Home Click on Home to bring the user back to the homepage e Logoff Click on Logoff to return to the login screen Sa an aa AAE aa Aa EEEO am amc aa To Start the apphcation process please chck the th Begin registration if your Social Security number SSN is not in the system Disclaimer Please note that your Social Secunty Number entered on our secure provider portal ts needed to complate our credentialing process and wil not be shared with any outside entities This portal is secured with SSL encrypten to ensure Me security and confidentallty of fe cata that you sutenitic UPUC Health Plan Vision Advantage Online Manual 11 14 11 Edition 1 5 UPMC Vision Advantage Input your SSN and click on Begin Registration as shown below Drsclaimer Se ee
39. ided by UPME 0 x Filter By would be used by large corporate practices with many locations 1 Description is the same as Location Name Filter By if searching many locations 2 al 7 1 2 Search is used when filtering is used or Description added 3 In this case it wasn t necessary because only two locations Bright Eyes exist 1500 McKnight 5927 4 Bright Eyes 101223344 Total Records 1 Page No 1 1 Location Code is clicked for the desired Pittsburgh PA 15229 location 4 3 All data fields designated with the number 3 on the illustration will populate upon selecting the Location Name if that information 1s appropriate and on file for the vision provider The data fields designated by Servicing Provider are auto populated based on the user log on 4 Diagnosis Code At least one valid diagnosis code is required but as many as four can be populated by the user 5 Date of Service The date can be manually entered using the DD MM YYYY format or utilize the calendar icon to the right of the field to select the date services were provided Two date selection methods can be used Using the available dropdown box for Month Date ioj xj and Year and clicking OK November al e E o0 E Ifthe visible month is the month desired click on a the block of the day required aipa amp Either action will populate the date on the form and automatically close the box 6
40. ider NPI Servicing provider Legacy Number Vision Benefit Request Detail Procedure Code Modifier Quantity units Diagnosis pointer Charge Amount ee lt 4 The remaining fields to complete a successful Vision Benefit Request submission are listed below 1 Patient Account Number not required but helpful in correspondence and office record keeping 2 Location ID Name The notepad to the right of the field is incorporated for the user to select the place of service from a multiple location practice By selecting the location it will auto populate the dentist s location demographics The notepad must be used to complete this part of data entry correctly The following actions will complete the location selection process Filter By would be oe by large LOY Microsoft Internet Explorer provided by UPME Me Ea corporate practices with many A locations 1 Description is the same as Location 4 F Name if searching many locations 2 3 Total Records 1 Page No 1 1 Search is used when filtering is used or Description added 3 In this case it wasn t necessary Bright Eyes 1500 McKnight 5927 4 Bright Eyes 101223344 because only two locations exist Pittsburgh PA 15229 Location Code is clicked for the desired location 4 Vision Advantage Online Manual 11 14 11 Edition 1 55 UPMC Vision Advantage 3 All data fields designated with the number 3 on the illustra
41. ifier Select RT right or LT left when billing lenses individually 8 Quantity Units field is auto populated with 1 unit The user can change the number and add additional units if it is appropriate for the procedure billed 9 Diagnosis Pointer field is auto populated with one unit and is appropriate to be billed for a single service 10 Charge Amount Enter the charge amount for the service Click the Add button to add the service line to the claim This process will be repeated for any and all additional services billed Vision Advantage Online Manual 11 14 11 Edition 1 38 UPMC Vision Advantage The completed claim form is illustrated next with the added service line at the very bottom Additional service lines would be shown below these lines with totals for claims and charge amount Lastly the user can e Save the claim if all data entered is accurate this also submits the claim e Reset the form to begin again e Cancel to terminate the claim submission Saleereit Onine i Le TEST VISION MEMBER A sentei nomata i man _ 2202009 48 01 1520 Mew reghe Pernaylere Nort miis Eves Subant Online laim Oetail Dote Of Dorriee Procedure Code Lanata Seen ante Capra peter Choga armine oS WJ oR 1 t Bs 9 3 32 2035 son 3 5 00 Vision Advantage Online Manual 11 14 11 Edition 1 39 UPMC Vision Advantage Claim List In this chapter the user will le
42. ing glass Vision Advantage Online Manual 11 14 11 Edition 1 11 UPMC Vision Advantage The Location Manager Login entry screen will appear for the user to complete required fields Once the information has been entered click on the Save button An e mail notification will be sent to the e mail address supplied with your user name and password Access Rights can now be granted to the Location Manager The following actions will initiate that process e Pass the cursor over the Location tab again e Click on Access Rights e Click on the magnifying glass of the selected location Beni Dorta LII eet amy pete y Herrera IL osas 53 tras Best Ontedorta GED Lonag Reed Patios Pa 18229 magt derali One hehe Crie Lid Meshongher Mamie Mis Pervwyhvmrne 1719 ete traii w tent Pim Perewrtverne 112 9 eri terest Vision Advantage Online Manual 11 14 11 Edition 1 12 UPMC Vision Advantage After clicking the magnifying glass check boxes are presented to the user that can be selected to determine the levels of security to be granted to the Location Manager The levels and description of functionality are e Attach Practice allows the manager to attach locations to the practice associated with the Practice Manager granting privileges e View Provider Locations allows the Location Manager to view other locations where a specific provider may practice e Attach Location to the Provider is used to connect a vision provi
43. is the first 9 characters of the 11 byte Member zd e P EN k Dates Hep O Home HLogor Change Password Eligibility _ Claims Claims Status Vision Benefit Request Vision Benefit Request Status j answer Name Nes Bill View Details VISION MEMBER TEST Member 06 09 1970 Gender SUBSCRIBER address 4 112 WASHINGOTN PLACE Address3 PITTSBURGH State Pennsylvania 15219 Phone Subscriber Name VISION MEMBER TEST Subscriber 200000968 01 Effective Date 01 01 2011 End Date Group ID Name V00021 TEST VISION GROUP Plan By The Search By field is automatically defaulted to the Subscriber SSN 1 option When this is the selected method of submission the user will manually enter the SSN 2 in the field When Member Contract is selected from the drop down the first 9 digits are entered minus the person code When the user tabs to the next field after entry in field 2 the system will auto populate Member Name Patient First Name Patient Last Name s Patient DOB Date of Birth Member Gender Relationship Code V Member Name z Patient First Name ooo Patient Middle Name Sess Patient Last Name SSE Patient DOB ca Member C Vision Advantage Online Manual 11 14 11 Edition 1 34 UPMC Vision Advantage In this example the Member Contract was selected in the Search By drop down field 1 and the 9 digit member contract number was input in field 2 By hitting tab
44. le P Benefit Request for services was submitted by you or another vision provider and the benefit type is pending If you have questions regarding these services contact the UPMC Vision Advantage Benefits Advisory team for details Vision Advantage Online Manual 11 14 11 Edition 1 28 UPMC Vision Advantage Submitting a Claim This module will demonstrate the thorough steps required to submit a UPMC Vision Advantage claim The patient will first need to be determined as having active coverage with their plan in order to initiate this process The tutorial will illustrate e Selecting the correct subscriber or member e The population of all required data fields e Showing what fields will be auto populated by entering data in the first required fields e Mechanisms available to select proper coding of services rendered e The ability to correct data before finalizing a claim submission e Verifying the completion of a submitted claim Vision Advantage Online Manual 11 14 11 Edition 1 29 UPMC Vision Advantage Note To submit a claim using Vision OnLine a location must be set up on the Profile tab Please review these steps prior to submitting your first claim Click on the Profile tab and then select the Practice tab If a practice name exists with a location then you may begin submitting claims through Vision OnLine Claires Seasus Vision Senet Request Vision Benefit Request ttanes Payments Lanavenr
45. ny Medicaid Medicare or other governmental or third party payer sanctions or has your participation in these or any other government programs n aenied p lt 5 Vision Advantage Online Manual 11 14 11 Edition 1 18 UPMC Vision Advantage Review and Submit is the final step a user would execute for the purposes of submitting an online credentialing application It offers the ability to review all data populated on the various screens and compiled in a facsimile of a physical application Claims Status Vision Benefit Request Vision Benefit Request Status Payments Enter your name here By clicking the red check mark the user will open the application for review Vision Advantage Online Manual 11 14 11 Edition 1 19 UPMC Vision Advantage Change Password In this chapter the user will learn how to e Change the password for the user currently logged in to Vision Online e Use the correct password complexity in the event the user did not satisfy the predesigned requirement Vision Advantage Online Manual 11 14 11 Edition 1 20 UPMC Vision Advantage The user will select the Change Password tab if a password change is desired the HELP button for ee retention instrections on completing an online appScation Please dkck To Start the apphcatinn process please chek New Password Confirm Password The user is required to satisfy the password complexity as stated belo
46. ory displaying the following data The Claim that is assigned by the claims adjudication system The Patient Name The Provider Name The Date of Service The Claim Status e Accepted The claim submitted has electronically migrated to the transactional system e Pending The claim is under review by UPMC Vision Advantage claims processors e Processed The claim has gone through the adjudication process and has been finalized The Amount Paid Vision Advantage Online Manual 11 14 11 Edition 1 50 UPMC Vision Advantage The user begins by clicking on the Claims Status 1 tab A list of all claims displays on the screen as in the illustration below s lt lc aM Name Dr Howard Network UPMC Network Date 11 09 2011 uelp Home Logort Vision Benefit Request 1 Change Password Eligibility Claims Vision Benefit Request Status Payments Claim Search ide Criteria Date From Date To Patient Last Name Patient First Name 2 Ce C3 4 Total Records 3 Page No 1 1 A 00014613 DENNY DAWNA Howard Ron 10 21 2009 Accepted Q 00014611 CHAPMAN CHARLIE Howard Ron 02 01 2011 Accepted A 00013823 VAN BUREN MARTIN Howard Ron 10 31 2011 Processed 0 00 Vision OnLine provides the user with the ability to refine the search and narrow the results as described here Enter a submitted date range by populating the Date From and Date To fields using the calendar icon 2 OR
47. ptions e To view the entire family subscriber and eligible dependents enter the subscriber s SSN Sehecribar SSY Patient First Nome Patient Lart Nose Date OF Birth 123 356 760 Total Records 3 Page No 1 1 Q Q sum naar ALLEELE 0 28 1940 susscarsen SurTH MARY A Q su we qnto 08 30 2860 SPOUSE SHITH MARY Q Qo sum Kim 1111191103 05 29 1962 DEFENDENT SHITH MARY Please input S9 or first aed last name Or e To view a specific member s eligibility record enter that patient s first and last name in the appropriate fields e Entering a date of birth will further refine the results of the search When entry of the relevant data is complete click on the Search button to see the results Vision Advantage Online Manual 11 14 11 Edition 1 23 UPMC Vision Advantage Once the subscriber and or dependent data results are displayed the following actions can be performed by the user to view plan or demographic information Sebreriber 55N i Pariana firn Xama Pasians Lan Xema Deis Of Binh a _ mm Tr Total Records 3 Page Ne 1 1 L aeann A Q smh nary 1999997102 04 14 1040 SUSSCRISEA SMITH MaRy Please input SSH or Arst and last name e View a patient s eligibility and demographic information by clicking on the magnifying glass in the View column e View the plan information by clicking on the magnifying glass in the View Plans column e Hide the search boxes by clicking on the Hide Criter
48. rd Servicing Provider Legacy Number 101010 Vision Advantage Online Manual 11 14 11 Edition 1 59 UPMC Vision Advantage Checking a Vision Benefit Request Status In this chapter the user will learn how to e Search for desired Vision Benefit Request to view e Check on submitted services for exact amounts that will be available for disbursement to the providers submitting the request Vision Advantage Online Manual 11 14 11 Edition 1 60 UPMC Vision Advantage Vision Benefit Request Status The benefit request will inform both the member and provider how the submitted service will be processed From the Home Page the user will click on the Vision Benefit Request Status tab to check the status of a submitted benefit request E E e ai CARAT WAPENETR Care ia Change Password Eligibility Claims Claims Status _ Vision Benefit Request Welcome to the UPMC Provider Portal ATTENTION PROVIDER If you are registering as a user in order to submit an application for credentialing please be sure to complete all tabs under the Profile section of this portal Incomplete information could result in a delay in processing your application e Please click the HELP button for instructions on navigating the portal and for instructions on completing an online application To Start the application process please click the profile tab To refine the search of
49. rks uP HCHetwork ate 12 09 2011 Hep PHome Logo Name Dr Howard Change Password Eligibility Claims _ Payments ianswer Vision benefit determinations can take up to 24 hours for processing Creation and receipt of a vision benefit request number does not guarantee eligibility for services Payment is contingent upon the member s benefit eligibility as of the date services are rendered If you would like to check a member s eligibility for services please visit the Eligibility section of Vision Online or contact the UPMC Vision Benefit Advisory team at 1 877 648 9621 during normal business hours Vision Benefit Request Header A Claim Type Subscriber SSN i 4 Member Name VISION MEMBER TEST z Patient First Name Patient Middle Name iz Patient Last Name Member Relationship Code Patient Account Claim Type Vision Advantage Online Manual 11 14 11 Edition 1 53 UPMC Vision Advantage In this example the Member Contract was selected in the Search By drop down field 1 and the 9 digit subscriber number was input 2 after tabbing from left to right Name Dr Howard Profile Change Password Eligibility Claims Claims Status Vision Benefit Request Vision benefit determinations can take up to 24 hours for processing Creation and receipt of a vision benefit request number does not guarantee eligibility for services Payment is contingent upon t
50. s Health amp Productivity Solutions TUVO TS ER S032900 NMS anON Policies amp Procedures E our all electronic option Cie hean MSU mans Medicare PFFS Terms amp Conditions MyHealth monthly See CIR eae as ae Print Post Promote package Prescription drug information Provider OnLine Vision Advantage Online Manual 11 14 11 Edition 1 3 UPMC Vision Advantage Sign on screen to log in as a returning user or register for the first time Login Login As Provider Provider Network UPMC Network Login Name Password Reset Home Forgot Password How to Login Not registered with UPMC Health Plan Register Now gt gt To register as a new user select the Register Now button and then follow the additional steps on the next page under Begin registration if your Social Security Number SSN is not in the system Returning or authorized users take the following steps e Enter your login name e Enter your password Note Passwords are case sensitive e Click the Login button Additionally you can utilize the following links e Reset Click on the Reset button to clear the details entered in the login screen e Home Click on the Home button User is redirected to the UPMC Health Plan website at www upmchealthplan com e Forgot Password Click on Forgot Password to retrieve a forgotten password e How to login Click on the How to login button to retrieve a Login User Manual PDF to gu
51. se contact the Vision Benefits Advisory team at 1 877 648 9621 Processed is the status that will appear after the benefit request has been processed and indicates that it is ready to be viewed The user can click on the View magnifying glass to view a copy of the benefit request once the status is shown as Processed Cancel is the status that will appear if the vision benefit request submitted has been cancelled by the provider or member The user can cancel a request 24 hours after initial entry by utilizing the available red Cancel next to the desired record in the Vision Benefit Request List Expired is the status that will appear when the vision benefit request is no longer valid Vision Benefit Requests are valid for 90 days The benefit request will show an Expired status after 90 days of being active Below is an example of the view of the benefit request that appears when the benefit request is in the Processed status The following user actions are available e To return to the search results use the Go Back button e Use the scroll bars to view additional services if necessary Change Password Eligibility Claims PARKER GLENN Member 20000320402 PARKER PAULETTE Vision Benefit Request 00016289 HOWARD MD RON Date 11 29 2011 02 19 2012 The fields from left to right are 1 Procedure Code Procedure Description The exact codes submitted are listed with their corresponding descriptions 2 Num of Serv The num
52. structions on navigating the portal and for instructions on completing an online application To Start the application process please click the profile tab To begin review of submitted claims place the cursor over the Claims tab and click on Claim List when it appears in the drop down list Lcnenge Password engipty Cii Welcome to the UPMC Provider Portal ATTENTION PROVIDER If you are registering as a user in order to submit an application for credentialing please be sure to complete all tabs under the Profile section of this portal Incomplete information could result in a delay in processing your application Please click the HELP button for instructions on navigating the portal and for instructions on completing an online application e To Start the application process please click the profile tab Vision Advantage Online Manual 11 14 11 Edition 1 41 UPMC Vision Advantage Clicking on the Claim List button opens the list of claims that have been submitted by the billing office most recently submitted claims at the top of the list by default This is referred to as an open search f a oo jc E Dec Howard et work UPMC Network ate 10 23 2011 hep Home I i answer Change Password Eligibility Claims Claims Status Vision Benefit Request Vision Benefit Request Status i Payments Date From Date To Patient Last Name Patient First Name Esl
53. t and is appropriate to be submitted for a single service Keep in mind a diagnosis is not required so this information will not alter the submission ability 10 Charge Amount amount charged for the service 11 Click on the Add button to add the service line to the claim The process will be repeated for all additional services submitted 12 The user will be able to e Save the form if all the data entered is accurate this also submits the Vision Benefit Request e Reset the form to begin again e Cancel to terminate the Vision Benefit Request submission The completed form is illustrated next with the added service lines at the very bottom with totals for the forms and charge amounts tame Dr Howard Change Password Member Name _ Patient First Name MARY is Patient Middle Name CL Patient Last Name PEACH Ooo o Patient DOB 01 02 1983 7 Member 20000320202 Gender fF Relationship Code SPOUSE Patient Account Peach02 355 Claim Type Location ID Name 3891 NorthHistyes E Tax IO 1222344 oo Address1 1100 Meknight Read Address2 Sute200 o Address3 Ss 7 City Pittsburgh State Pennsylvania Zip Ws Hoo o Billing provider name organizationname Howard s Heathy Eyes Diagnosis Code Servicing provider first name Mery OO Servicing provider last name Howard Servicing Provider NPI 1234587890 Servicing provider Legacy Number cl O O O Vision Benefit Request Detail ision Benefit Request Header e T
54. t another tab to perform additional tasks Vision Advantage Online Manual 11 14 11 Edition 1 65 UPMC Vision Advantage Using the i answer Informational Tool In this chapter the user will learn how to e Access informational documents added regularly as an additional conduit of information regarding o Vision OnLine updates o Procedural information o Payment policies e Understand the advantage of checking for possible news that will enhance service to UPMC Vision Advantage members and our network of vision providers Vision Advantage Online Manual 11 14 11 Edition 1 66 UPMC Vision Advantage i answer The i answer tab is a data repository in which UPMC Vision Advantage will upload communication and tools for our vision community to use in Vision OnLine and in your practice Change Password Eligibility Claims Vision Benefit Request Status Payments Welcome to the UPMC Provider Portal ATTENTION PROVIDER If you are registering as a user in order to submit an application for credentialing please be sure to complete all tabs under the Profile section of this portal Incomplete information could result in a delay in processing your application Please click the HELP button for instructions on navigating the portal and for instructions on completing an online application e To Start the application process please click the profile tab UPMC Vision Advantage will regularly update this repository wit
55. tion will populate upon selecting the Location Name if that information is appropriate and on file for the provider 4 All data fields designated by the number 4 are auto populated based on the user login 5 Diagnosis Code This can be entered if applicable for the submitted charges but is not required 6 Procedure Code The procedure code can be manually entered if known and tabbing to the next field will populate the description or utilizing the notepad icon to the right of this field will bring up a complete list of codes for viewing and selection lo1xI e Pull All 1 codes and click the Search 3 button e Filter by CODE 1 and put a partial code in Filter By Description Description 2 Click the Search 3 button m z e Filter by Description 1 and put in a partial search description ex frames Procedure Code Lookup Te Sy W2762 POLARIZATION ANY LENS MATERIAL PER LENS e Click on Code 4 of desired procedure to populate the form That will automatically close the pop up box a aa bare V2780 OVERSIZE LENS PER LENS V2781 PROGRESSIVE LENS PER LENS 2782 INDX 1 54 1 65 PLSTC 1 60 1 79 GLASS LENS INDX gt 1 66 PLSTC gt 1 80 GLASS LENS LENS POLYCAAFONATE OR EQUAL ANY INDEX 7 PER LENS PROCESSING PRES amp TRANSPORTING CORNEAL TISSUE V2783 SPECIALTY OCCUPATIONAL MULTIFOCAL LENS PER LENS 2787 ASTIGMATISM CORRECTING FUNCTION INTRAOCULAR LENS PRE
56. usiness hours Vision Benefit Request Header Claim Type A Claim Type Search By Member Contract H 200003202 Member Name 1 Patient First Name Patient Middle Name Patient Last Name Patient DOB Member Gender lRelationship Code Patient Account Claim Type Vision Advantage Online Manual 11 14 11 Edition 1 54 UPMC Vision Advantage The Vision Benefit Request Entry Screen Wale Boiowad Network UPMC Network Profile Change Password Eligibility Claims Claims Status Vision Benefit Request Vision Vision benefit determinations can take up to 24 hours for processing Creation and receipt of a vision benefit request number does not guarantee eligibility for services Payment is contingent upon the member s benefit eligibility as of the date services are rendered If you would like to check a member s eligibility for services please visit the Eligibility section of Vision Online or contact the UPMC Vision Benefit Advisory team at 1 877 648 9621 during normal business hours Vision Benefit Request Header m Claim Type Claim Type Search By Member Contrate M 200003202 Member Name PEACH maY Patient FirstName Patient Middle Name C Patient Last Name Member Relationship Code Patient Account Claim Type Location ID Name TaxID Address2 City Zip Diagnosis Code Servicing provider first name Ron Servicing provider last name Servicing Prov
57. w Windows Internet Explorer Once the requirements are satisfied the user will receive the following confirmation in addition to an e mail confirmation Vision Advantage Online Manual 11 14 11 Edition 1 21 UPMC Vision Advantage Verifying and Viewing Patient s Eligibility In this chapter the user will learn how to e View subscriber and dependent demographic information including the dependent relationship to the subscriber and group information e View effective dates of coverage e View plan benefit information e View a specific patient s Spending Summary which displays benefit frequencies and limitations for vision services Vision Advantage Online Manual 11 14 11 Edition 1 22 UPMC Vision Advantage Eligibility Determining a patient s eligibility and plan benefits is an important step in the treatment process Vision OnLine provides the provider s office with the ability to check eligibility online as needed The information that is available is driven from the subscriber s employee s Social Security number From the Home page click on the Eligibility tab to begin the search view process Clicking on the Home icon will return the user to the Vision OnLine Home Screen Narrowing the search will speed up the verification process on the part of the office or billing staff To begin the search process to view a patient s eligibility and plan information use the following search o
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