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Provider Secure Portal User Manual

1. esssseeseeeennnnnnnnnn nnne nnnm nnn nnn nnn nnn nns 70 Create Professional Claim Select Member cccccccesessseeeeeeeeeeeeeeeeeessesssssesseaeeeeeeeeeeeeeeees 71 Create Professional Claim Enter Patient Details eseeeeseseeeeeeeeeeee 72 Create Professional Claim Enter Diagnosis and Service Details 73 Create Professional Claim Enter Diagnosis and Service Details 76 Create Professional Claim Enter Provider Detalls cc sssccccccccceceeeeeeesesssessessneeeeeeeeeeeeeeeees 77 Create Professional Claim R VIQW sssssssssssssssssssssesssssesssessssssseesessesssessessssesesesseesteees 79 Create Institutional EIU MM M 82 Copy Claim Function susssssssessssssesseee enne nnne nennen nnne nnn nnns nnn 99 Galatea Tages re etre 27s 7 eg Rep pR rpm earn DUM er ee ONE DN DNE DEN DNE DNE DNE DONE DONE DONE DONE DONE DONO DONO 09000 Oe 104 CeO SIS d COU T 105 VIEW WED CINE eritis insi bbb Un ee ee eee 107 Poetene kE a p e TE TTE 107 NeompEtEe SI SINS acento tes tata EEEN REEE EEROR AREE utn udi needs 108 Claims Ready to be Submitted temo uuo tenete ERE 109 SUDBHIHESC OaM S ern aa 111 Batch Glalms SUDMIS SIO firmer 121 Batch Claims Reports ccccccccccccccccceeecessssssessssseeeeeeeeeeeeeeeeeseesses
2. State in which automobile accident occurred Previous Step N A Save Draft amp Start New Claim Next Step Create Institutional Claim Enter Claim Codes Screen Operational Training 89 August 201 1 Occurrence Codes Add Additional Span Codes Add Additional Occurence Codes Enter Occurrence Codes Section Click the link marked Add Additional Span Codes to enter data for this section optional Occurrence Codes Code Description From Date To Date Span Code From Date Through Date Add Im done adding Span Codes Add Additional Occurence Codes Enter Additional Span Codes Section Enter the Span Code From Date and Through Date Click the link marked Add Additional Occurrence Codes to enter data for this section optional Code Description Date Occurrence Code pate 5 Add Im done adding Occurence Codes Enter Additional Occurrence Codes Section Enter the Occurrence Code and Date When you have completed adding Occurrence Codes click the link marked l m done adding Occurrence Codes Operational Training 90 August 201 1 Patient Reason for Visit Add Additional Visit Codes Enter Additional Visit Codes Section Click the link marked Add Additional Visit Codes optional Patient Reason for Visit Code Description Visit Code Ada I m done adding Visit Codes Enter Visit Code Section Enter the
3. 12 PM 01 Discharged to home or self care vj Previous Step Save Draft amp Start New Claim Save Draft Next Step Patient Details Section Enter Patient Control Number required Enter Medical Record optional Create Institutional Claim Enter Patient Details Select Type of Bill from the drop down menu required Once the type of bill information is selected the Admission and Discharge Information section appears on the screen Enter Statement Covers Period From and To required Operational Training 84 August 201 1 Admission and Discharge Information Section Enter Admission Date required Enter Admission Hour from the drop down menu required Select Admission Type from the drop down menu required Select Admission Source from drop down menu required Select Discharge Hour from drop down menu required Select Discharge Status from drop down menu required Click Next Step to continue or you can click Save Draft amp Start New Claim or Save Draft B Tip Your work will be saved automatically each time you click the Next Step button to continue to the next step In addition you may click the Save Draft link at any time to save your work Saved claims will be moved to the View Claims Unsubmitted Claims list Click Save Draft amp Start New Claim to save your work and return to Step 1 to begin another claim Click Previous Step butt
4. Service Line 1 Delete this service Line Procedure difi Diagnosis h J e Fam Code Modifier Pointer Charges Days Unit EPSDT pis 05 0 7011 05710 2011 11 O OOOO 100 00 1 o v From Date To Date Place EMG Show Member s Eligibility NDC billing requirements to be entered in the Supplemental Information text box below Add Supplemental Information Add another Service Line Previous Step Save Draft Save Draft amp Start New Claim Next Step Enter Diagnosis and Service Details When you are finished completing all required fields click Next Step Operational Training 76 August 201 1 Create Professional Claim Enter Provider Details Provider Secure Portal Welcome Greg Tester Log Out Account W Eligibility W X Health Record Authorization W Claims Y Online Forms W Reports W ContactUs Create Professional Claim Step 4 of 5 Enter Provider Details Name L49288225 F05001861 Date of Birth Required Referring Provider 08 01 2010 Please enter a minimum of 3 characters in Last Name to search providers Last Name First Name Tax ID NPI Taxonomy Rendering Provider NPI Taxonomy Tax ID 640911702 Name REESE LINDSEY Billing Provider Name Tax ID NPI Taxonomy Street Address City State Zip Code Service Facility Location Name Tax ID NPI Taxonomy Street Address City State Zip Code DAVE
5. Addictional Clinical Info freeform text Additional Clinical Information Procedure Information Please list all procedure codes being considered for this member request must include at least one primary procedure code DO TWEE THI PO BOX 640242 Minimum 2 characters required CINCINNATI OH 45264 HOSPITALITY HOUSE 100275040 1100 S CURRY PIKE Minimum 3 characters required jl BLOOMINGTON IN 47403 eOvectoryStudipecheDvectoryStudiowa32 1 3120100330 exe Browse UPed ae Rem sow om Please note Member eligibility and authorization of services are conditions of reimbursement not a guarantee of payment Create Authorization Service Detail Operational Training 59 August 201 1 Submit Authorizations 9 Next complete the diagnosis information Enter the Primary ICD 9 Code If you are uncertain of the code a lookup library is provided You can use a partial ICD 9 code to find the correct code You will need to look up a valid code using the lookup table The diagnosis box populates with the numeric and text description of the code Select the appropriate diagnosis code Check the Primary Diagnosis code box once the code as been entered 10 Enter the Additional Clinical Information such as Actual Admission Date Place of Service oymptoms Medication etc 11 Complete the Procedure if applicable and Provider Information sections 12 You can add att
6. Operational Training 120 August 2011 Batch Claims Submission From the Navigation menu select Claims Batch Claims Submission Operational Training Administration Registration Admin My Account Eligibility Health Record Authorization Claims Check Claim Status View Web Claims Create Professional Claim Create Institutional Claim Batch Claims Submission Payment History Payment History Downloads Claim Auditing Tool Online forms Reports Contact Us Navigation Menu 121 August 201 1 Provider Secure Portal Log Out My Account Eligibility W Authorization W Claims W Reports W Resources W ContactUs EDI Documentation Batch Claims o Companion Guides o Batch Claims FAQs pi Submission Status Please note that we currently accept formatted 837 claims files only We apply HIPPA level 4 edits If you are not familiar with generating or submitting an 837 file please use a clearinghouse or our single claims submission module We are continually developing new claims submission tools to allow you other formats by which to submit claims to use directly both individually and in bulk Please choose a file format of dat or edi no larger than 5MB The Submitter ID for the ISA06 must be WebBatch The receiver ID for ISA08 must be 39186 Required File Type Upload File Browse Submit Cancel Batch Claims Submission Screen Blank EDI Electronic
7. Taxonomy Street Address 444 N WABASH AVE City MARION State Indiana Zip Code 469522612 Service Facility Location Same as Billing Provider Name MARION GENERAL HOS Tax ID NPI 1770679201 Taxonomy Street Address 441 N WABASH AVE City MARION State Indiana Zip Code 469522612 Previous Step Save Draft Save Draft amp Start New Claim Next Step Enter Provider Details Operational Training 118 August 2011 Provider Secure Portal Welcome Test Provider Log Out ly Account V Eligibility W Authorization Y Health Record Claims W Online Forms W Reports W Resources W ContactUs Adjust Professional Claim Step 5 of 5 Review Name SIMS BRIDGET N Date of Birth Claim Number K136INE01953 Review Claim Information then click Submit to finish Member Edit Patient s Account Number Claim Amount Paid Address Status Condition Related to Service Edit Date of current illness injury or pregnancy Date of similar illness Dates of patient unable to work in current occupation Hospitalization dates related to current services Outside lab charges Prior Authorization number Service Line 1 Date of Service Place EMG Procedure Code Modifier s Diagnosis Code s Charges Days Unit EPSDT Family Planning Supplemental Information Providers Edit Referri
8. NINABAHEN 208512947 1669665881 1669484515 NPI 1669484515 Ninabahen Dave 208512947 1669665881 1212 North 21th Street Jackson Mississippi 45454 Ninabahen Dave 208512947 1669665881 1212 North 21th Street Jackson Mississippi 45454 Medicaid ID Medicaid ID 00125782 1231879552 remove Same as Rendering Provider Same as Billing Provider Previous Step Save Draft Save Draft amp Start New Claim Next Step Enter Provider Details Operational Training 11 August 2011 Inthe Referring Provider section enter information as needed Inthe Rendering Provider section enter the required NPI number and select the Provider from the drop down list Inthe Billing Provider section enter required information Inthe Service Facility Location section enter information as needed Click Same as Billing Provider to automatically copy the billing provider information into the service facility fields Click the Next Step button Operational Training 78 August 201 1 Create Professional Claim Review Provider Secure Portal Create Professional Claim Welcome Greg Tester My Account V Eligibility X Health Record Authorization Y Claims Y Online Forms W Reports ContactUs Log Out Step 5
9. WINTERS SUSIE A FISHER SABINA G BRUNS DONALD DEAN JOHN GANDY PAUL E BRUNS DONALD BRUNS DONALD DEAN JOHN BRUNS DONALD BRUNS DONALD BRUNS DONALD DOS Range 05 05 2011 05 05 2011 05 05 2011 05 05 2011 05 06 2011 05 06 2011 05 05 2011 05 05 2011 05 06 2011 05 06 2011 05 05 2011 05 05 2011 05 06 2011 05 06 2011 05 06 2011 05 06 2011 05 06 2011 05 06 2011 05 05 2011 05 05 2011 Receipt Date 05 16 2011 05 16 2011 05 16 2011 05 16 2011 05 16 2011 05 16 2011 05 16 2011 05 16 2011 05 16 2011 05 16 2011 Billed Payment Amount Amount 140 00 360 00 20 00 38 00 60 00 250 00 360 00 38 00 38 00 119 00 33 31 S77 81 6 73 Payment Date 05 19 2011 Status 05 19 2011 05 19 2011 05 19 2011 05 19 2011 05 19 2011 05 19 2011 07 21 2011 05 19 2011 05 19 2011 Headers to Sort Click headers to sort results above Select a claim number Claim No J155INEO1151 Adjust Claim 2010 06 04 268 00 1925 2010 06 07 PAID Ref Acct No Medicaid ID Member Name Servicing Provider DOS Range 26196V2310 Receipt Date Billed Amount Payment Amount Payment Date 2010 06 02 2010 06 02 Status DOS 2010 06 02 81025 V0488 Proc Dx Modifiers Place of Service Billed Amount Payment Amount Payment Date Check No Status Status Description LC1
10. it and submit it Accepted The claim has been received and entered into the adjudication system Operational Training 112 August 2011 Adjust Claim The Adjust Claim feature is accessible from Check Claim Status Administration S eigiatraeion Ads Registration Admin My Account Create New User Eligibility Health Record Status Last Name Search Authorization User List Download To Excel Check Claim Status User Id First Name Last Name Account Status NPI Tax ID Physician or Clinic Viu Weh Claims Group Practice Name asdasdasd123 asdas dasdas REPCREATED 640506107 Create Professional Claim One item found Page 1 1 1 Create Institutional Claim Batch Claims Submission Payment History Payment History Downloads Claim Auditing Tool Online forms Reports Contact Us Adjust Claim The Adjust Claim feature allows you to submit adjustments for previously submitted professional and institutional claims online In order to adjust claims they must have passed through the adjudication process and be in a Paid or Denied status In addition Claims can only be adjusted online once a day Claims can not be adjusted if an adjustment has already been created but not yet submitted Claims can not be adjusted if an adjustment has already been submitted but not yet processed Operational Training 113 August 201 1 Check Claim Status Provider Secure Portal Welcome Test Provider Log
11. Incomplete Claims List Claims listed here are unsubmitted and are missing information or contain errors BENHNHENHHEHEHEEHEHEHEEHEEHEHEEHEHEEEHEEHEEEEHEBHEEEBHEHEEHEEHEHEEEBHEBHEEEHEBHEEHEEHEEHEHEEEHEBHEEHEBHEHEEHEHEBHEEEEHEBHEEHEBHEEEEHEBHEEHEBHEHEEEHEEHEEHEHEm m Tip You can re sort the list by any column by clicking on the columns title To reverse the order of the sort click the column title again Edit Click the claim s Edit link to complete claim submission information or to fix its errors The claim will be displayed starting with the last visited page of the Professional Institutional Claim submission wizard o finish and submit the claim navigate throughout the wizard Institutional or Professional claims and click the Submit Claim button at the bottom of the page f you choose not to submit the claim at this time click the Save Draft button at the bottom of the page If the claim is now complete and contains no errors it will be moved the Claims Ready to Be Submitted list see below You may access saved claims at any time by returning to the View Claims page Delete To permanently delete an Incomplete Claim click the claim s Delete link Operational Training 108 August 201 1 Claims Ready to be Submitted Claims Ready to be Submitted Instructions Claims listed below are complete and contain no errors Click checkboxes to select claims then click the Submit Selected Claim s button Select All Date Or
12. Operational Training 34 August 201 1 Audit Users Providers Office Managers can audit all users associated with their TIN They can also generate reports for these users This is an important feature for providers office managers as they are responsible for auditing their staff records to ensure accuracy and guarantee HIPPA compliance Registration Admin Status NPI Tax ID Last Name E 7 NEN Search User List Download To a User Id First Name Last Name Account Status NPI Tax ID Physician or Clinic Office Registration Date Group Practice Name Manager nmisir1 Naresh Misir APPROVED 201017034 Mercy Medical E 07 28 2011 11 52 21 AM myuser1311867718589 Fname Lname EMAIL_VERIFICATION 1639192743 262101949 stlukes mercymed Jennifer Hester LOCKED 201017034 Mercy Medical Group in_provider_test04 FName LNameFour EMAIL_VERIFICATION 263083364 Test Group in_provider_test5080 TestFirstName TestLastName APPROVED 201017034 Test Group torrence1 Torrence Hatch OMCREATED 201017034 in_provider_test53 Greg Tester EMAIL_VERIFICATION 203904383 Test Group in_test_19 Prasad Balla DISABLED 351116775 Test Account in_test_18 Prasadab Ballaab APPROVED 351116775 in_test_17 Prasad Balla APPROVED 351116775 Test Account 07 28 2011 10 42 35 AM 07 28 2011 10 32 02 AM 07 22 2011 07 03 11 AM 07 21 2011 02 30 20 PM 07 21 2011 06 45 18 AM 07 20 2011 02 53 26 PM 07 20 2011 11 47 31 AM 07 20 2011 11 41 24 AM 07 20 2011 11 41 20 AM A U
13. to Managed Health Services you automatically grant Managed Health Services the royalty free perpetual irrevocable non exclusive right and license to use reproduce modify adapt publish translate create derivative works from distribute redistribute transmit perform and display such content in whole or part worldwide and or to incorporate it in other works in any form media or technology now known or later developed for the full term of any rights that may exist in such content Further Managed Health Services is free to use any ideas concepts know how techniques and suggestions contained in any communications you send to this Site for any purpose whatever including but not limited to creating and marketing products and or services using such information Access to or use of certain areas of this web site e g Member or Provider Web Portals is for authorized personnel only Managed Health Services reserves the right to monitor and record all activities on this Site specifically regarding protected areas such as the Member and Provider Web Portals No one using these web portals should expect any privacy despite the use of passwords or other such protections By registering to use the Member or Provider Web Portals on this Site you acknowledge that you are an authorized user and that you will adhere to all terms and conditions of use set forth and proscribed herein Managed Health Services reserves the right to inactivate any unauthorized regi
14. 03 2011 Effective Date 08 01 2011 DOS Eligibility ACTIVE Term Date Member Eligibility Details PDF The PDF opens allowing you to Print or Save Operational Training 48 August 201 1 To Print the Member Eligibility Details gi MembertligibilityDetails 1 pdf Adobe Acrobat File Edit View Document Comments Forms Tools Advanced Window Help Open Ctrl O Organizer Create PDF Portfolio Member Eligibility Details Modify PDF Portfolio E 08 03 2011 Date Searched 08 03 2011 Program Hoosier Healthwise Create PDE mi Combine REED Date of Birth com Medicaid ID l Collaborate Ctrl 5 Save As Shift Ctrl S 2 Save as Certified Document G5 Export Attach to Email Revert Close Ctrl F Properties Ctrl D Print Setup Shift Ctrl P 08 03 2011 Print of A Ctrl P 08 01 2011 4 History ACTIVE 1C AMembertEligibility Details 1 pdF 2 Ct AMembertEligibility Details 1 pdF 3 C 1110801 Sth 6th TEMPORARY SPACE pdf 4 CA AT May Business Cards Proof pdf rc 5 C MemberEligibilityDetails 1 pdf 12 31 9999 Exit Ctrl Q Print Option Select File on the Menu bar Select Print from the list of options The Member Eligibility Details page prints To return to the Eligibility Search screen Use the Back Browser button on the Internet Explorer toolbar Operational Training 49 August 2011 Patient List The Patient List feature allows you to
15. Administrator Manager Skip this section and click Continue To complete the registration process we will be contacting your manager to verify your information Provide your Manager s information below Contact First Name Contact Last Name Vincent Vaughn Phone Number Ext 3 146543215 Fax Number 3146539856 Email Address tmay centene com Role Access Role Access V AUTHORIZATIONS CLINICAL INFORMATION The Authorizations role allows you to submit requests for authorization of service and allows you to submit referrals to other service providers OFFICE MANAGER The Office Manager role allows you to manage access of the website privileges for users belonging to your group practice associated with your Tax Identification Number TIN NOTE By checking this box you acknowledge and agree that you will only activate users who i belong to your group practice ii have a need to know the information that is available through this site and iii will access such information for reasons relating only to your group practices treatment of Members payment from the Health Plan or other lawful and legitimate purpose in connection with the business arrangement between your group practice and the Health Plan and that you will immediately deactivate any user in the event any of the above conditions cease to apply to such user You will also need to assist in any user status audits as requested by the Health Plan You further ac
16. Member s Eligibility Effective Date Term Date Plan 04 01 2011 12 31 9999 Magnolia Health Plan 08 01 2010 03 31 2011 Magnolia Health Plan NDC billing requirements to be entered in the Supplemental Information text box below Add Supplemental Information Add another Service Line Previous Step Save Draft Save Draft amp Start New Claim Next Step Add Supplemental Information Hyperlink To add notes to the Service Line click Add Supplemental Information Enter up to 60 characters You may then hide the notes by clicking Hide Supplemental Information Hiding the notes will not delete them Operational Training 74 August 201 1 Service Line 1 Delete this service Line Procedure Diagnosis e ne F Code Modifier Charges Days Unit EPSDT From Date To Date Place EMG Plan Pointer 05 10 2031 051020313 pn Xr fz23 a whe 100 00 1 MC Show Member s Eligibility NDC billing requirements to be entered in the Supplemental Information text box below Add Supplemental Information Service Line 2 Delete this service Line Procedure difi Diagnosis h ae me Fam Code Modifier Pointer Charges Days Unit EPSDT PES L 1L C ioi LL TTL NEN Mr From Date To Date Place EMG Show Member s Eligibility NDC billing requirements to be entered in the Supplemental Information text box below Add Supplemental Information Add another Service Line Save Draft Save Draft amp Start New Claim
17. Mw asd obit flute rationi Views Paymari History Provider Home Page The Provider home page appears allowing access to the Navigation bar on the left side of the Screen Operational Training 28 August 2011 Creating New Users As a Member Provider Service Representative you have the ability to register providers office managers on their behalf This includes ability to add one user or multiple users at one time Registration Admin Status i Last Name o o rT Search User List Download To Excel User Id First Name LastName Account Status NPI Tax ID Physician or Clinic Office Registration Date Group Practice Name Manager jhester Jennifer Hester APPROVED 592766165 asdasdaduytyut 86876ugtuty798678 eetetetr rwtretrewtre OMCREATED 1043213234 263661663 asdasdasdasd adasda123123123asdasdadasdasdasd asdadasdsa dasdasdas OMCREATED 1043213234 263661663 asdasdasdasd asdasd12312sadasd12312asdads asdasda sdasdasd OMCREATED 1043213234 263661663 asdasdasdasd asdasd12312asasd1231231asdasda asdasda sdasd OMCREATED 1043213234 263661663 asdasdasdasd myflprov07 121 asdad sadad APPROVED 1043213234 263661663 fl provider test03 FName LName APPROVED 592766165 Test Group fl provider test02 FName LName EMAIL VERIFICATION 592766165 Test Group fl provider testO1 FName LName APPROVED 592766165 Test Group fl provider test51 Greg Tester APPROVED 562544450 Test Group 07 25 2011 04 19 57 PM 07 12 2011 03 56 59 PM 07 12 2011 03 56 45 PM 07 12 201
18. Out Account V Eligibility W Authorization W Health Record Claims W Online Forms W Reports W Resources W ContactUs Check Claim Status To search enter one or more of the following search criteria The Date of Service range you provide is limited to a three month span Only the last 18 months of claims data is available online Claims update every 24 hours Required Date of Service From 05 05 2011 g To 08 04 011 Member Information Last Name First Name Medicaid ID Claim Information S Claim Status Claim Number Ref Acct Number Providerinformation gt gt NPI Medicaid ID Check Claim Status Operational Training 114 August 201 1 Claim No K138INE01953 K136INE01966 K136INE01992 K138INE01978 K136INE01995 K138INE01944 K138INEO0 1990 K136INE01996 K136INE01994 K1261NE0 1960 Ref Acct No MGR10105370401 MGR10105416601 MGR10105459701 MGR10105420601 MGR10105477701 MGR10105358601 MGR10105438701 MGR10105474601 MGR10105445101 MGR10105374101 Medicaid Member Servicing ID Name Provider 101384586099 100354881399 102410054599 102922834199 103071162499 100300418999 100422429999 104010519799 103261028799 100422429999 SIMS BRIDGET DEAN JOHN N NOONER VALESKA D PARKER HAYLI A WIDMEYER JR JASON L ORTEGA DORA S MALDONADO SARAE FISHER SABINA G HITCHINGS JORDAN R
19. Patient Last Name Administration Patient List Search My Account Eligibility Eligibility Search atl NPI f Patient List Patient List Downloads Provider Medicaid ID Authorization Health Record Members Last Name Claims Last Name needs to be Online forms exact match Reports Programs Resources Contact Us Patient List Search by Member Last Name Limit the Patient List Results by entering any combination of the designated search criteria i e NPI Provider Medicaid ID Member s Last Name Programs and or Alert Types When searching by Alert Types select the drop down arrow and choose the appropriate Alert Type Alert Types Adult Preventive Asthma Cardiac Child Preventive Diabetes Flu Vaccine Other Chronic Alert Types Options Click Search button to access Search Results Operational Training 52 August 201 1 Patient List Results The result of your search lists all patients that meet the criteria entered Administration Patient List Search Eligibility Eligibility Search NPI Patient List Patient List Downloads Provider Medicaid ID Authorization Health Record Member s Last Name i Allgood Claims Last Name needs to be Online forms exact match Reports Programs Resources Alert Types Contact Us H Search Patient List Download to PDF Download to Excel E Alerts Member Name Member Id Effective Date End Date Progr
20. Visit Code When you have completed adding Visit Code click the link marked fm done adding Visit Codes Condition Codes Add Additional Condition Codes Enter Additional Condition Codes Section Click the link marked Add Additional Condition Codes to enter data for this section optional Condition Codes Code Description Condition Code Add I m done adding Condition Codes Enter Condition Code Section Enter Condition Code When you have completed adding Condition Codes click the link marked l m done adding Condition Codes Operational Training 91 August 201 1 Value Codes Code Description Amount Value Code Amount Add I m done adding Value Codes Enter Value Codes Section Enter the Value Code and Amount When you have completed adding the Value Codes click the link marked I m done adding Value Codes Procedure Codes Principle Procedure Code NENNEN pat 5 Enter Procedure Codes Section Enter the Principle Procedure Code and Date When you have completed adding Principle Procedure Codes click the link marked l m done adding Procedure Codes Code Description Date Other Procedure Codes Date Add I m done adding Other Procedure Codes Enter Other Procedure Codes Section Enter the Other Procedure Codes and Date When you have completed adding Other Procedure Codes click the link marked l m done adding Other Procedure Codes Operati
21. by clicking the corresponding checkbox see Role Access Options below Once you have completed the Create New User Page click the Submit button Note This screen allows you to enter up to 10 providers managers at one time Operational Training 30 August 201 1 Role Access Options Eligibility View Member Details View and Print PCP Panel Patient List Claims Search and View Claims Check Claims status View Payment History Submit Claims Submit Claims Adjustments if applicable Authorizations Search and View Authorizations Submit Authorizations Office Manager Manage accounts within group practice that belongs to the Tax Identification Number TIN Note An office manager cannot grant office manager privileges to another office manager Each office manager must go through the registration process accepting the terms and conditions Reminder Please refer to your health plan s P amp P for granting providers office managers access Remember if you approve an office manager you must provide them with training and set expectations around managing accounts including auditing You will provide the User Name for all providers office managers you have created via a separate process The new provider and or office manager will receive an email containing their temporary password Operational Training 31 August 201 1 Manage Users Unlock Update Reset Password Disable Enable Administratio
22. claims The status can be checked on claims which have been submitted via the portal clearinghouse or paper Claims submitted via the portal will indicate any front end rejections Administration Registration Admin My Account Eligibility Authorization Health Record Claims Check Claim i Navigation Menu From the Navigation menu select Claims Check Claim Status Operational Training 103 August 2011 Check Claim Status Search The Check Claim Status feature allows you to search for claims using a variety of different search criteria You can search for claims within a specific three month span based on the Date of Service DOS In addition you can search for claims by certain member claim and or provider information Provider Secure Portal Welcome Ryan Blah Log Out y Account V Eligibility W Authorization W Claims Y Online Forms ContactUs Check Claim Status To search enter one or more of the following search criteria The Date of Service range you provide is limited to a three month span Only the last 18 months of claims data is available online Claims update every 24 hours Required Date of Service 06 01 2010 08 02 2010 ca Member Information Last Name First Name Medicaid ID Claim Information Claim Status PAID Claim Number J2071NE00751 Ref Acct Number 851446 Provider Information NPI 1457366189 Medicaid ID Search Clear Form Ch
23. complete registration 1 Log in to your e mail account 2 You should have received a confirmation email Note Be sure to check your spam or junk mail folders for this email if you are not able to find it in your inbox 3 This email has a verification code that you need to complete your registration Write down the Verification Code 4 Please return to the Provider Portal and log in Please use the username and password that you created when you signed up 5 The next screen after you login will ask for your Verification Code Enter the code and click submit 6 Your sign up will be complete Step 4 Click the Finish button Step 4 Click the Finish button Operational Training 12 August 201 1 Provider Self Support User Name mercymed Password Forgot Password Unlock Acct Hyperlink f you have lost or forgot your password or your account is locked click the Forgot Password Unlock Account hyperlink User Name 1 Poo 0 07 0 0 9 0 03 07 0 904 0 00 To reset your password enter your username below and click Continue Please contact your provider services representative if you have forgotten your username User Name waughn Required Information Enter your User Name User Name Entry Enter your User Name Click the Continue button Operational Training 13 August 201 1 Verification Question Answer the verification questions below and click Continue Required Info
24. h cs ProviderList 1 Billows Wilks Johnson Johnson lindbeck lindbeck lindbeck lindbeck lindbeck Ryan Jenkins Wilks Jones lindbeck First Name Last Name Account St Tax Id REPCREA 641E 08 DENIED 6 41E 08 APPROVE 6 41E 08 EMAIL VE 6 41E 08 APPROVE 6 41E 08 APPROVE 6 41E 08 APPROVE 6 41E 08 APPROVE 6 41E 08 APPROVE 6 41E 08 APPROVE 6 41E 08 EMAIL_VE 6 41E 08 APPROVE 6 41E 08 REPCREA 6 41E 08 APPROVE 6 41E 08 provMsEle APPROVE 641E 08 testdeny EMAIL_VE 6 41E 08 Carter Amt APPROVE 6 41E 08 Dobbs lindbeck lidbeck lindbeck ms ms Balla Balla lindhouse lindbeck lindbeck Dobbs Dobbs lidbeck Dobbs Dobbs lindbeck shern FMAIL VF RAF DR8 DISABLEL 2 6E 08 DENIED 6 41E 08 DISABLEL 6 41E 08 APPROVE 6 41E 08 DENIED 6 41E 08 APPROVE 6 41E 08 APPROVE 6 41E 08 APPROVE 2 05E 08 NEW 6 4E 08 EMAIL VE 64E 08 REPCREA 64E 08 APPROVE 64E 08 APPROVE 64E 08 APPROVE 64E 08 REPCREA 6 46E 08 DENIED 6 46E 408 NEW 6 4E 08 Operational Training NPI Physician c Role Acces Email Registratio Last Login Date CLAIMS EI njohnson THAREHAEHRE THAHHHHBE Ba Humbur CLAIMS AI njohnson SHARBHHHBE TEST Grou CLAIMS AI niohnsonG SHEHEHHHE HAE Test 11 CL AIMS AI njohnson AHHH CLAIMS Al rlindbeck G HEHEHHE dia HHH CLAIMS Al rlindbeck 44HHHH THARHHHRHE CLAIMS Al rlindbeck 444HHHH THARHHHHBE test CLAIMS Al rlindbeck G HEHEHHE THAHHHHBE test CL AIMS AI rlindbeck HEHEHHE THRHHHHRBE Matt Ryan t CL
25. material risk factors which may or may not be disclosed herein Disclaimer of Warranty and Liability USE OF THIS SITE IS ENTIRELY AT YOUR OWN RISK NEITHER Managed Health Services NOR ITS AFFILIATES ARE RESPONSIBLE FOR THE CONSEQUENCES OF RELIANCE ON ANY INFORMATION CONTAINED IN OR SUBMITTED TO THE SITE AND THE RISK OF INJURY FROM THE FOREGOING RESTS ENTIRELY WITH YOU THESE MATERIALS ARE PROVIDED AS IS WITHOUT WARRANTY OF ANY KIND EITHER EXPRESS OR IMPLIED INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY FITNESS FOR A PARTICULAR PURPOSE OR NON INFRINGEMENT Managed Health Services SHALL NOT BE LIABLE FOR ANY DIRECT SPECIAL INDIRECT INCIDENTAL CONSEQUENTIAL OR PUNITIVE DAMAGES INCLUDING WITHOUT LIMITATION LOST REVENUES OR LOST PROFITS WHICH MAY RESULT FROM THE USE OF ACCESS TO OR INABILITY TO USE THESE MATERIALS Corrections and Changes While we endeavor to keep these materials up to date Managed Health Services cannot assume responsibility for any errors or omissions in these materials Managed Health Services further does not warrant the accuracy or completeness of the information text graphics links or other items contained within these materials Managed Health Services may make changes to these materials or to the products or services described herein at any time without notice and makes no commitment to update the information contained herein Managed Health Services reserves the right to terminate your access
26. need security questions If you forget your password we will ask you for the answer to your security questions Tips Choose questions that only you know the answers to Answers should be easy to remember but not easy to guess Password Reminder Question1 What is your mothers maiden name Password Reminder Answer1 1 Password Reminder Question2 What is your favorite sports team Password Reminder Answer2 1 Password Reminder Question3 What is your fathers middle name Password Reminder Answer3 1 cme Step 1 Operational Training 7 August 2011 Provider Hegistration Enter Physician Group Name Enter Tax ID Enter NPI Optional Enter First Name Enter Last Name Enter Phone Number Enter Fax Number Optional Enter Email Address Enter Confirm Email Address Enter User Name At least five characters Enter Password At least six characters with a number Enter Confirm Password Select Password Reminder Question Enter Password Reminder Answer Select Password Reminder Question 2 and Password Reminder Answer Select Password Reminder Question 3 and Password Reminder Answer Click the Continue button Operational Training 8 August 201 1 Provider Registration a Step 2 Required Information Populate the fields with your information and check Administrator Manager Contact Information the applicable boxes Iv am the
27. reporting issues to the Service Desk Support A User My Account As a User with Administrative rights you can view the following data for any provider This information may not be the same that the provider can view Eligibility Member Eligibility Authorization Claims Patient List Claims Authorizations Online forms Using the form below after you submit all of your search functions will see data for the given provider only Reports You are viewing data for Contact Us TIN 561919748 To view a user information please provide a valid username or TIN Username Support A User From the Administration drop down list select Support A User Enter either the Provider s User Name or TIN Click the Submit button to activate Support A User functionality If you search by User Name you can access the information associated with that Provider TIN Depending on the access permissions you have you will be able to see the SAME things that the Provider can see Operational Training 37 August 2011 Menu Options My Account Not All Health Plans Account Home Update Account Change Password Eligibility Eligibility Search Patient List Patient List Downloads Authorizations Create Authorizations Search Saved Check Auth Status Claims Check Claim Status View Web Claims Create Professional Claim Create Institutional Claim Batch Claims Submission Payment History Dow
28. view a roster of patients that have selected you as their primary care provider PCP You can access patient lists by providing your NPI Provider Medicaid ID Member s Last Name must be exact match Programs and Alert Types Administration Patient List Search Eligibility Eligibility Search NPI f Patient List Patient List Downloads T Sect UTENTE Provider Medicaid ID Authorization Health Record Member s Last Name Claims Last Name needs to be Online forms exact match Reports Programs Resources Alert Types Contact Us H Patient List Search Screen From the Navigation menu click the drop down arrow next to Eligibility and select Patient List Operational Training 50 August 201 1 The Patient List screen displays two sections Patient List Search fields and Patient List Results Administration My Account Eligibility NPI Patient List Provider Medicaid ID Authorization Health Record Members Last Name Claims Last Name needs to be Online forms exact match Reports Programs ud Resources Alert Types Contact Us H Search Patient List Download to PDF 7 Download to Excel Alerts Member Name Member Id Effective Date End Date Program Date of Birth Phone Number 09 01 2009 12 31 9999 oosier Healthwise 10 15 2007 06 08 2011 12 31 9999 oosier Healthwise 12 24 2003 04 23 2010 12 31 9999 04 23 2010 12 31 9999 04 23 2010 12 31 9999 06 17 2011 12 31 9999 09
29. while using the View Web Claim feature The Web Reference Number may also be useful in discussing a claim with your Provider Relations Representative Click the Start New Claim hyperlink if you have other claims to submit Operational Training 81 August 2011 Create Institutional Claim The Create Institutional Claim process allows you to create and submit an institutional Medicaid claim online Administration Registration Admin My Account Eligibility Authorization Health Record Claims Check Claim Status View Web Claims Create Professional Claim Batch Claims Submission Payment History Payment History Downloads Claim Auditing Tool Online forms Reports Resources Contact Us Navigation Menu From the Navigation menu select Claims Create Institutional Claim Operational Training 82 August 2011 Create Institutional Claim Select a Member Provider Secure Portal Welcome FName LNameThree Log Qut Eligibility Authorization W Health Record Claims Y Online Forms Reports W Resources Create Institutional Claim Step 1 of 6 Select Member F I verify that I am submitting a new Institutional claim and not adjusting a previously submitted claim or entering information for reconsideration of a previously submitted claim Enter Member information then click the Continue button Required Member Information Medicaid ID 111526515739 Continue Create Institutional Claim Sel
30. 0 06 01 2010 06 02 2010 06 02 2010 Receipt Date 06 04 2010 06 05 2010 06 05 2010 06 05 2010 06 05 2010 06 05 2010 06 05 2010 06 05 2010 06 08 2010 06 09 2010 Billed Amount 268 00 80 00 159 00 80 00 80 00 157 00 267 00 142 00 80 00 118 00 Payment Amount 19 25 26 75 70 94 36 75 36 75 83 84 127 36 71 30 Payment Date 06 07 2010 06 07 2010 06 07 2010 06 07 2010 06 07 2010 06 07 2010 06 07 2010 06 07 2010 06 10 2010 06 14 2010 Status PAID PAID PAID PAID PAID PAID PAID PAID PAID PAID 259 items found displaying 1 to 10 Page 126 1 2 3 4 Check Claim Status Results 5 7 8 Next Last You can navigate the list of claims using the following controls Page Number displays the corresponding page of results 10 claims per page Next displays the next page of the results listing Last displays the last page of the results listing Click Claim Number hyperlink to access the corresponding claim s detailed information Check Claim Status Details This view provides claim data and adjudication details for the selected claim number Claim No J155INE01151 Adjust Claim Ref Acct No 26196V2310 Receipt Date 2010 06 04 Medicaid ID Billed Amount 268 00 Member Name Payment Amount 19 25 Servicing Provider Payment Date 2010 06 07 DOS Range 2010 06 02 2010 06 02 Status PAID DOS Proc Dx Modi
31. 0 Zi Diagnosis Information Principal Ds Code 482 46 Erimrinal Cre Dare zktaph praumoania ac 7I Service Information Service Type Diageaoctic Tezt Tmaging Prnecmpal Frec Code 43114 Prmrinal Gast ede sacual rarmeval ef BO he Se Service Detail Information Provider Information e Provida MEEEEEENN FATHOLCGY Fartcinalinra a ind BEEN I INDEDENHCENT Participating M LABOBZTORGIY Dlazca note Mambar eligibility and authorization of earuirac ara conditions of raimbarcamant neta guarantae of paymant Operational Training 68 August 201 1 Example of Denied Authorization functionality Authorization Details Reference 80000500010000001 A After review of the submitted clinical information your request is not authorized at this time Comments Auth Information Status Not Authorized Reg Date of Service 03 30 2009 Decision Date 03 20 2008 Subm Date 03 20 2008 Member Information Name Po Date of Birth 12 29 1997 Eff Date 03 01 2008 ecr EREMEENNEENENNEENN Member ID RR Term Date 12 31 2050 Diagnosis Information Principal Dx Code 474 02 Principal Dx Desc chronic tonsilshadenaids Service Information Service Type Medical Principal Proc Code 99499 Principal Proc Desc unlis e m svc Service Detail Information Provider Information Adm Provider m Address mE Phone z a Speci
32. 01 1 Create Professional Claim Enter Diagnosis and Service Details Provider Secure Portal Welcome Greg Tester Log Out My Account V Eligibility W Health Record Authorization W Claims W Online Forms W Reports ContactUs Create Professional Claim Step 3 of 5 Enter Diagnosis and Service Details Name L49288225 F05001861 Date of Birth 08 01 2010 Medicaid ID 1231879552 Enter physician or supplier information then click the Next Step button Required Date of current illness injury or 04 16 2011 MM DD YYYY pregnancy Date of similar illness Dates of patient unable to work in current occupation Hospitalization dates related to current services Outside lab charges Ex 225 95 Prior Authorization number 154789787 Diagnosis Codes Hint Enter Diagnosis Codes in any format Ex 100 or 100 1 or 1001 Check corresponding Diagnosis Pointer boxes below to assign diagnosis to Service Line s Diagnosis Code ij 789 00 ABDOMINAL PAIN UNSPECIFIED SITE Diagnosis Code Diagnosis Code 3 Diagnosis Code X Create Prof Claim Enter Diagnosis and Service Details Enter any optional physician or supplier information e g Date of current illness or injury or pregnancy Date of similar illness etc Inthe Diagnosis Codes section enter Diagnosis Code 1 required The diagnosis code may be in any of the following formats 100 or 100 1 or 1001 A description
33. 01 2009 12 31 9999 04 01 2011 12 31 9999 11 19 2010 12 31 9999 01 26 2011 12 31 9999 oosier Healthwise 1 12 20 oosier Healthwise 2 05 20 oosier Healthwise 9 20 20 oosier Healthwise 4 23 1988 oosier Healthwise 5 19 20 oosier Healthwise 11 01 2004 oosier Healthwise 1 21 1992 oosier Healthwise 11 15 1998 H H H H H H H H H H 581 items found displaying 1 to 10 Page 1 59 1 2 34 5 6 7 8 Ne Patient List The Patient List Results is a complete listing of patients who have selected you as their PCP Note For groups with multiple providers associated with a single Tax ID you will receive a Patient List of all patients who have chosen the providers linked to your Tax ID as their PCP You have the ability to Search the listing by individual NPI or sort the listing by Provider Name You can navigate the list of matching transactions using the following controls Download to PDF enables you to download patient list to a PDF file Download to Excel enables you to download patient list to Excel file Page Number displays the corresponding page of results 10 transactions per page Next displays the page of results immediately following the currently displayed page Last displays the last page of the results listing Operational Training 51 August 201 1 Patient List Search The Patient List feature allows you to search for patients by the following search criteria NPI Member ID and or
34. 1 Grant Access Registration Admin Status Tax ID Last Name NEW i 1 NEM Search User List Download To Excel User Id First Name Last Name Account Status NPI Tax ID Physician or Clinic Office Registration Date Group Practice Name Manager user1311867718589 Lname 1639192743 262101949 stlukes I 07 28 2011 10 42 35 AM a 07 06 2011 01 35 25 PM 06 30 2011 10 45 05 AM 06 21 2011 04 36 15 PM 06 21 2011 04 33 27 PM 06 21 2011 04 32 03 PM 06 21 2011 01 02 15 PM 06 21 2011 11 38 38 AM 05 16 2011 12 49 09 PM 05 16 2011 12 21 15 PM in provider teste 100 lindbeck 352048141 Test Group X E myuser06305 asda 363683493 asdasdasdasd myinprov123123 asd 352045239 sdfsdfsdf a myinprov06231 asda 352045239 jkdhakjsdh xl myinprov0621 11 Iname 352045239 mygroup test 6 21 383390434 a asdasdasdasdad 123123123214 rEEETITTITTITTTTETIITITITITETETETIT asdasdsa 1558301614 383380434 asdasdasd bbbbb b b 351069822 b aaaaa a a 351069822 a XI XI RI E EI 2 071 items found displaying 1 to 10 Page 1 208 New Account Results After locating all NEW accounts Click on the User ID link for each new user and review their information and access request The health plan and or Office Manager will review access requests and either approve or deny the requests Note Please refer to your health plan s P amp Ps for the proper way to validate a provider Operational Training 21 August 201 1 Approve Deny Upd
35. 1 19 00 10 05 2010 06 07 0000828221 PAD PAID IN FULL 2010 06 02 90471 V04898 LC11 26 00 0 00 2010 06 07 0000828221 DENIED DENY THIS SERVICE IS NOT COVERED 2010 06 02 90649 V0488 LC11 223 00 39 20 2010 06 07 0000828221 PAID PAID IN FULL Return to Search Results Print Claim Detail Adjust Claim search Again Click Adjust Claim hyperlink Operational Training 115 August 2011 Adjust Professional Claim Step 2 of 5 Enter Patient Details Name SIMS BRIDGET N Date of Birth 09 27 1993 Medicaid ID 101384586099 Claim Number K136INE01953 Enter Patient information then click the Next Step button Required Patient s Account Number MGR10105370401 Amount Paid Patient Status C Single Married CI Other C Employed C Full Time Student Part Time Student Patient s condition related to Employment C Auto Accident Location of Accident Other Accident Previous Step Save Draft Save Draft amp Start New Claim Next Step Adjust Claim Enter Patient Details The Adjust Professional Claim feature functions in a similar manner to the Create Professional Claim process The only difference is that upon selecting a professional claim to adjust you will be taken to Step 2 of 5 within the Adjust Professional Claim process instead of Step 1 Note that you will not be able to access changing a member Step 1 while adjusting professional claims To change
36. 1 03 53 39 PM 07 12 2011 03 53 35 PM 07 12 2011 03 49 53 PM 06 17 2011 02 50 52 PM 06 17 2011 02 36 35 PM 06 15 2011 04 01 44 PM 05 03 2011 03 53 15 PM r r r r r r E 7 v r 105 items found displaying 1 to 10 Page 1 11 Registration Admin o add providers office managers as new users click the Create New User button Operational Training 29 August 201 1 Creating New Users Create New User Required User 1 User Name Phone Number Role Access AUTHORIZATIONS User 2 User Name one Phone Number Role Access AUTHORIZATIONS User 3 User Name pam Phone Number First Name pe Extension ___ OFFICE MANAGER First Name ___ Extension ____ OFFICE MANAGER First Name Extension p Last Name Tax ID E ELIGIBILITY Last Name Tax ID eoo ELIGIBILITY Last Name Tax ID E Create New User Screen Email Address NPI CLAIMS Email Address NPI CLAIMS Email Address NPI E You must enter the required information for each user you are creating You need to create a unique user name for each user User Names are shared across all health plans within Centene Populate the user s First Name Last Name Email Address Phone Number and TIN Specify their Role Access
37. 2 3 4 5 Next Last Claims Ready to be Submitted Instructions Claims listed below are complete and contain no errors Click checkboxes to select claims then click the Submit Selected Claim s button SelectAll Date 1 Created Member Name Medicaid ID Ref Acct Sriginal Claim Total Charges F 12 21 2010 BRITTANY L BROCK 101077587299 134 11 Edit e Delete One item found Page 1 1 1 Submit Selected Professional Claim s SelectAll Date d Created L1 02 01 2011 BRITTANY L BROCK 101077567299 101077567299 33 33 Edit an Delete Member Name Medicaid ID Ref Acct Original Claim Total Charges L 12 06 2010 CORDEL A SIMPSON 101915644599 123 100 00 Edit e Delete 2 items found displaying all items Page 1 1 1 Submit Selected Institutional Claim s Copy Hyperlink Click the Unsubmitted Claims tab the option to copy a claim that is ready to be submitted by clicking the Copy hyperlink Operational Training 100 August 2011 View Web Claims Provider Secure Portal Welcome Test Provider Log Out My Account Eligibility W Authorization W Health Record Claims Y Online Forms W Reports W Resources W ContactUs View Web Claims Unsubmitted Claims Submitted Claims Display Search Criteria Date Web Ref Amisys Claim Submitted Nbr Type 08 04 2011 1991453 CMS 1500 BRIDGET N SIMS 101384586099 MGR10105370401 K136INE01953 200 00 In Progress Name Medicaid Original Claim Total Nbr ed Char
38. 9 02 05 2004 Before you access the Patient List Downloads you must select Eligibility Patient List Perform a Patient List Search and retrieve your results The results appear at the bottom of the screen Click the Download to Excel hyperlink Your request has been received Go to Eligibility gt Patient List Downloads to retrieve your file or check the status of your download request Message A message appears providing instructions as to retrieve your file or check the status of your download request Operational Training 54 August 201 1 Patient List Downloads n Instructions To retrieve your file click the Download link My Account Your file will be available for 7 days afterwards the link will no longer display Eligibility Date Requested Type Status Archive Date L 08 04 2011 15 28 PATIENT LIST COMPLETED 08 11 2011 St ee 08 04 2011 15 28 PATIENT LIST COMPLETED 08 04 2011 15 46 PATIENT LIST COMPLETED Download Link download 08 11 2011 download 08 11 2011 download Patient List Downloads 3 items found displaying all items Page 1 1 1 Authorization Health Record Claims Online forms Reports Resources Contact Us Patient List Downloads Select Eligibility from the Navigation menu and then Patient List Downloads To download the Patient List click the download hyperlink Operational Training 55 August 201 1 Submit Authorizations The Submit Authorization
39. AIMS Al njohnson z 2HARRREHE EHHHRHHHE Health Plar CL AIMS AI njohnson SEEHHHHHE CL AIMS AI njohnson THAERBEHEBE THARHHHHRBE CL AIMS AI njohnson SHEHHHRREE 1 12E 09 teste CLAIMS Al rlindbeck G 44HHHH THARHHHHBE Test Accou CLAIMS Al JHARRALS 444444 THREAT CL AIMS AI rindbeck 4HHHH 1 37E 09 Mississipp CLAIMS Al rlindbeck 44448 EHEHHHRHHE Dobbs Doc CLAIMS Al jdobbs ce THARRHHEBE THRHHHBRHE trest CL AIMS AI rlindbeck a 44HHHH test CL AIMS IAI rlindbeck a SRERRRBEHBE 1 37E 09 test CLAIMS Al rlindbeck G HEHEHHE THAHHHHBE provider2 CLAIMS Al gblackshee HAREHHBBE provider1 CLAIMS AI gblackshee 3HEHHHHHE THEHHHHHE CLAIMS Al pballa ce SHAHHHHHE HHHHHHHBE Test Mag L CLAIMS Al pballa ce SEEBHHHHE HHH test CL AIMS AI rlindbeck a HRHHH test CL AIMS AI rlindbeck ZHERRBEBE CL AIMS AI rlindbeck HHRHH CLAIMS Al jdobbs ce AHHH EEHHRHHHE Doc AUTH OFF jdobbs ce SHAHEHHBE THRHHHHBE test CLAIMS Al rlindbeck a 4444444 PERHRBHHE CLAIMS Al jdobbs ce HERHEREBRE Docs OFFICE Iv jdobbs ce THERRREHE test CL AIMS AI rindbeck 44HHHH test CLAIMSIAL snfannersti see Excel Document 36 August 201 1 Support a User oupport a User is functionality meant for a Support Role at the health plan to assist providers with questions additional training opportunities i e how to submit review claims authorizations payment history This functionality also gives the user the ability to access provider s information for screen captures needed when
40. D for the patient for which you are requesting services Patients who are not eligible on the day of the request or requests for services already rendered cannot be submitted via the web portal You will need to contact the health plan via the toll free authorization line and speak with a Medical Management representative 3 Enter the member s Birth Date 4 Enterthe date you are requesting the service to begin For admissions this would be the proposed admission date For outpatient services this is the day the services are to begin This date must be a future date For services beginning on the current or past date you must call the toll free Medical Management phone number 5 Click the Continue button Operational Training 57 August 2011 Submit Authorizations Provider Secure Portal Welcome FName LName Admewstrabon Y My Account Y Ebpbdity T Authonzabon FY Hemi Recond Clams Y OnhneForms Y Reports Resources Co Us Create Authorization Step 2 of 3 Select Service Requred Member Information Medicaid ID Date of Birth Member Name Effective Date End Date 101068871999 04 17 1993 BEARD JAIRUS L 06 01 2009 12 31 2050 Contact Information The inde dual ksted i considered the pont of contact ver y contact informmabon r correct f the case manager has quesbon s regarding thes authonzabon request they wil contact the person bated NOTE The cortact infeematon insted below does not update your pipade information on
41. Data Interchange Documentation Companion Guides Standard guides on the 837i 837p 997 etc The link directs you to EDI page of health plan site Batch Claims FAQs Standard documents for all health plans created by EDI and EDI support staff Header Section This section provides details regarding submission guidelines and parameters needed before submitting a batch claim HIPAA level edits by health plan Acceptable file formats File max size Required submitter ID standard across all health plans Receiver ID health plan specific Urge ON c Note Be sure to direct all 837 and other batch claim specific questions to EDI support 800 225 2573 ext 25525 The hours of operation are Monday thru Friday 8am 5pm CST Operational Training 122 August 201 1 Provider Secure Portal My Account V Eligibility W Authorization W Claims W Reports W Resources W ContactUs EDI Documentation Batch Claims f Submission Status o Companion Guides o Batch Claims FAQs Please note that we currently accept formatted 837 claims files only We apply HIPPA level 4 edits If you are not familiar with generating or submitting an 837 file please use a clearinghouse or our single claims submission module We are continually developing new claims submission tools to allow you other formats by which to submit claims to use directly both individually and in bulk Please choose a file format of dat or edi no larger than 5MB The Submitter
42. Draft amp Start New Claim Save Draft Next Step Create Institutional Claim Enter Billing Information Operational Training 86 August 201 1 g HHEHEEBNRA SZJ UBBEBRBERBE Enter NPI of the Billing Provider and then select the Billing Provider Information from the box that appears required Enter the Taxonomy Code optional ue If the displayed Billing Provider information is incorrect click Clear Selected Provider link Then enter the correct NPI of the Billing Provider n ns vip Click the Same as Billing Provider link billing provider information will be populated to the Pay To Provider Information section Enter data into the Pay To Provider Information section if it is different from the Billing Provider Be sure to populate all required fields Enter Attending Provider or Operating Provider information e g NPI Taxonomy Code etc These are optional fields Click the Next Step button You arrive at the Enter Claim Codes screen Operational Training 87 August 201 1 Create Institutional Claim Enter Claim Codes Date of Birth Medicaid ID Enter Code information then click the Next Step button Required Diagnosis Codes Use valid ICD 9 codes only Admitting Diagnosis Code 769 00 ABDOMINAL PAIN UNSPECIFIED SITE Principle Diagnosis Code 78900 Code Description Additional Diagnosis Code I m done adding Diagnosis Codes Occurrence Codes Create Instituti
43. ID for the ISA06 must be WebBatch The receiver ID for ISA08 must be 39186 Required File Type Upload File Cancel Batch Claims Submission Screen Submitting a Batch Claim Step 1 Select File Type 837i Institutional claims 837p Professional claims Step 2 Upload a file Step 3 Click Submit button Operational Training 123 August 2011 Batch Claims Submission Provider Secure Portal AccountHome Elgib ty Authorization F Clams Y Onine Forms Y Tools F Resources F Contact Us EDI Documentation Batch Claims Results File sucessfully uploaded m Click here for You will be able to check the status of your submission on the status tab within 24 hours A 997 functional acknowledgement will be provided reflecting HIPAA edt pass fall status companion qui de and FAQs 241 Wed Mar G9 17 05 01 CST 201i Batch Claims Status A Submission receipt will be provided after submitting the Batch Claim This is only confirmation of successful upload To submit another claim Click on the Submit another Batch Claim button Repeat Steps1 3 on the previous page on Submitting a Batch Claims To check the status of a submitted file Click on the Status tab Note The Web Reference can be used for tracking the submission until a claim number is provided Operational Training 124 August 201 1 Provider Secure Portal Accu Hore Ehgodht F Aughorzati n F Glave T Onb
44. Next Step Add another Service Line Hyperlink To add another Service Line click Add another Service Line A new blank Service Line section will appear Enter all required information The claim may include a total of six Service Lines Operational Training 75 August 2011 Create Professional Claim Enter Diagnosis and Service Details Provider Secure Portal Welcome FName LNameOne Log Out Administration W My Account V Eligibility Ww Health Record Authorization W Claims W Online Forms W Reports W ContactUs Create Professional Claim Step 3 of 5 Enter Diagnosis and Service Details Name L49288225 F05001861 Date of Birth 08 01 2010 Medicaid ID 1231879552 Enter physician or supplier information then click the Next Step button Required Date of current illness injury or 05 10 2011 sk ne 98 MM DD YYYY Date of similar illness m Dates of patient unable to work in H to Em current occupation Hospitalization dates related to current services 2 to E Outside lab charges S Ex 225 95 Prior Authorization number Diagnosis Codes Hint Enter Diagnosis Codes in any format Ex 100 or 100 1 or 1001 Check corresponding Diagnosis Pointer boxes below to assign diagnosis to Service Line s Diagnosis Code Mi 789 00 ABDOMINAL PAIN UNSPECIFIED SITE Diagnosis Code Diagnosis Code 3 Diagnosis Code W
45. Provider Secure Portal User Manual Copyright 2011 Centene Corporation All rights reserved Operational Training 2 August 201 1 Table of Contents Provider Secure Portal ssssssssssssssssesesseennnnnnn nnne nennen nnn a anas nnns 5 REJIS ll 0 9 BR NR RR ER REA RE RE RERE RE RE A EE EE RERE EE AIEI IEEE RE PENORTOR NONE 6 Provider lt Se O UPOO socie TETTRE TRET TERET TERET T R T 13 CON U EEA 16 EGOI ena 19 Grant ACCESS CREE 20 APPO AL OS Se eemene ete ete ee ete eee MCN Mee Mee Mee Mee MCR MCR Mee Mee Me Mee Meee Mee Mee Me Mee MC MC Me ee Men R 23 Deny ACCES ANNE 25 Voe OnE P a A IRR URURGPOR DEUM UR es oe Do en oe RN RR TRUNK 26 PDDIOVOOCHTHOOISIFIMOI dee inna ce ee eR ne nn Re eee Ne Re ne ee eee ee 27 Creating New USES ue oo nen d Duis ered onde ulead dln de adres ud le den inh edd demande oe asc adde 29 Mana 201 crc RS MR E E E E 32 PANTS B cis NETT OCTO DTE 9b E1183 01 AE E E c scat eee ee cater E E Sets rae Sem beeps adele deen ee O E ETONE 37 EEE AEE E Gee sie nn etum E uum MN neon 39 Memper ElgbIIN DEAS ER 43 Patient List cccccccccccesesssseeceeeeeeeeessseeeeeeeeeeeeussseceeeeeeseeeusaseeeeseeseeeauaseeeeeeesseeaasaseeeeesetseeagaeeeeeeeesseas 50 PETELE Oa O oa a OAOA 52 Patent Mig PI RR 53 Patient List DownloadS REP EET 54 DE AIC AVEC AUITOHZatIDITS Sb uuu uc uU EU UU UN DUI IU IU OX GIU UU GU QU OGU GOU GG EO DU D 64 Ceca uiae cett tM MEE 66 Create Professional Claim
46. Reports W ContactUs Create Professional Claim Step 2 of 5 Enter Patient Details Name L49288225 F05001861 Date of Birth 08 01 2010 Medicaid ID 1231879552 Enter Patient information then click the Next Step button Required Patient s Account Number 1212121 Amount Paid 350 00 Patient Status l Single Iv Married Iv Employed l Full Time Student Part Time Student Patient s condition related to Employment Auto Accident Location of Accident Iv Other Accident Save Draft Save Draft amp Start New Claim Create Prof Claim Enter Patient Details Enter Patient s Account Number required Enter any optional information that would apply in the Patient Status and Patient s condition related to sections Click the Next Step button vip Your work will be saved automatically each time you click the Next Step button or press Enter u on the keyboard to continue to the next step In addition you may click the Save Draft button at any time to save your work Saved claims will be moved to the View Claims Unsubmitted E Claims list see below Click Save Draft amp Start New Claim to save your work and return to Step 1 to begin another claim While in the Create Professional Claim process the Member s Name Member ID and Date of Birth DOB are displayed at the top of each page Instructions and error messages are displayed just below this area Operational Training 72 August 2
47. U S A a 2 424 items found displaying 1 to 10 Page 1 243 Download to Excel Hyperlink To create a report click on the Download To Excel hyperlink Operational Training 35 August 201 1 File Download Do you want to open or save this file 2 Mame ProwviderList csv Type Microsoft Office Excel Comma Separated Values File From bestoortal61 centene com While files from the Internet can be useful some files can potentially harm Your computer IF you do nat trust the source do nat open or save this file v hat s the risk File Download Window To open the document in Excel click the Open button Your Excel file opens gt Edt View Insert Format Tools Data Window Help Ad B e mT M y fe User ID D E DOES dj 4 100 T Arial F G H Type a question for help User ID nbilows Natalia kwilky1 Korisha testgroup1 Nathan test11 Nathan ms prov cryan ms providi ryan ms providiryans ms providi ryan ms providi ryan mryan2 Matthew njenkins2 Natalie kwilks 1 Korisha njohnson4 Nathan ms_provideryan provms11 john ms test diryan ms providi Tarsha juiedoc1 Julie ms prov teryan ms test mryan ms prov teryan provider2 provider2 provider1 provider ms test ai Prasad test_ms_us Prasad ms_prov_teryan ms_provideryan ms_prov_teryans magtest301 Julie mag30ttest Julie ms_provideryan magtest10 Julie magtest9 Julie ms providi ryan R inroyaR tam gt
48. a new blank claim it may be easier to start with a copy of a previously submitted claim This function is helpful when creating a new claim that varies only slightly from a previously submitted claim Operational Training 99 August 2011 Provider Secure Portal Welcome Test Provider Log Out y Account V Eligibility W Authorization W Health Record Claims W Online Forms W Reports W Resources VW ContactUs View Web Claims f Unsubmitted Claims Submitted Claims Incomplete Claims Instructions Claims listed below have missing information or contain errors Click Edit to view a claim then fix any errors or complete it before submitting Date Type Created 01 12 2011 CMS 1500 BRITTANY L BROCK 101077567299 101077567299 S 123 00 Delete Member Name Medicaid ID Ref Acct Original Claim Total Charges 12 29 2010 CMS 1500 BRITTANY L BROCK 101077567299 1 S 100 00 Delete 12 23 2010 CMS 1500 AMY D ALBERTS 100004239899 100004239899 50 00 Delete 12 22 2010 Institutional BRAYDEN L VANHOOSIER 103587125899 MGR10089971601 J134INE07408 129 00 Delete 12 17 2010 CMS 1500 BRITTANY L BROCK 101077567299 100 00 Delete 12 15 2010 CMS 1500 BRITTANY L BROCK 101077567299 4 00 Delete 12 06 2010 Institutional 0 00 Delete 12 06 2010 Institutional 0 00 Delete 12 06 2010 Institutional HANK R ABBOTT 104419387699 0 00 Delete 12 06 2010 Institutional HANK R ABBOTT 104419387698 0 00 Delete 48 items found displaying 1 to 10 Page 15
49. achments to support you authorization requests Select Browse to search for you file attachment Next select Upload to attach it to this page You can select the Delete button to remove an attached document 13 Click Continue Operational Training 60 August 201 1 Provider Information Admitting Provider DO TWEE THI PO BOX 640242 Specialty Select w 2 CINCINNATI OM 45264 Last Name Marumum 2 characters required Admitting Facility 3 3 y HOSPITALITY HOUSE 1002 5040 1100 amp CURRY PIKE Name Marumum 3 characters required BLOOMINGTON IN 47403 Attachments Attach Fie eDerectoryStucho ApacheDwectoryStudio mwind 15 3v20100330 exe Browse Upload Please note Member eligibility and authorization of services are conditions of reimbursement not a guarantee of payment Create Authorization Buttons Add Click Add to add new authorization information Remove Click Remove to clear authorization information from the screen Save Click Save to save entered information This will allow you to exit the Create Authorization screen and return at a later time Continue Click Continue to progress to the next step of the create authorizations process Operational Training 61 August 2011 Welcome FName LName Log Out Administration Y My Account Y Eligibility Y Authonzation Y HealhRecord Claims F Onhne Forms Y Reports W Resources T C U Create Authorization Step 3 of 3 Review Memb
50. act Us Member Eligibility Details Date of Service Date Searched 08 03 2011 Program Hoosier Healthwise Member Name Date of Birth Medicaid ID Member Details Phone Number Address Eligibility Details Date of Service Effective Date 08 01 2011 DOS Eligibility ACTIVE Term Date 12 31 9999 Member IDs Medicaid ID Current Primary Care Provider Provider Name CONNORS JAMES Address 545 S BOEHNE CAMP ROAD EVANSVILLE IN 47712 Phone 812 429 1818 Provider ID History Effective Date 08 01 2011 06 01 2011 02 01 2011 08 15 2010 COB History Nothing found to display Eligibility History Effective Date 08 01 2011 06 01 2011 02 01 2011 08 15 2010 Operational Training Term Date 12 31 9999 07 31 2011 05 31 2011 01 31 2011 Member Eligibility Details Term Date 12 31 9999 07 31 2011 05 31 2011 01 31 2011 Program Hoosier Healthwise Hoosier Healthwise Hoosier Healthwise Hoosier Healthwise Provider Name CONNORS JAMES CONNORS JAMES CONNORS JAMES CONNORS JAMES Member Eligibility Details 43 Class SUBSCRIBER SUBSCRIBER SUBSCRIBER SUBSCRIBER The Member Eligibility Details displays various details about the Member s PCP COB and History Download to PDF 4j August 201 1 Member Eligibility Details Member Details Phone Number 812 629 8332 Address 7927 CIRCLE FRONT EVANSVILLE IN 477150000 Gender F Member Detail
51. al information such as your address or social security number Age and Responsibility You represent that you are of sufficient legal age to use the Site and to create binding legal obligations for any liability you may incur as a result of the use of the Site You understand that you are financially responsible for all uses of the Site by you and those using your login information Privacy You have read the Managed Health Services Privacy Policy the terms of which are incorporated herein and agree that the terms of such policy are reasonable You consent to the use of your personal information by Managed Health Services and or its third party providers and distributors in accordance with the terms of and for the purposes set forth in the Managed Health Services Privacy Policy Securities Information This Site and the information contained herein does not constitute an offer or a solicitation of an offer for the purchase or sale of any securities The Site contains information and press releases about Managed Health Services and although this information was believed to be accurate as of the date prepared Managed Health Services disclaims any duty or obligation to update such information To the extent that any information is deemed to be a forward looking statement as defined in the rules and regulations of the Securities Act of 1933 as amended such information is intended to fit within the safe harbor for forward looking information and is subject to
52. alty PEDIATRICS Participating Specialty Participating Y Please note Member eligibility and authorization of services are conditions of reimbursement not a guarantee of payment Operational Training 69 August 201 1 Create Professional Claim The Create Professional Claim process allows you to create and submit a professional Medicaid claim online Registration Admin Registration Admin My Account Create New User Eligibility Authorization DE Search Check Claim Status User List Download To Excel Www d User Id FirstName LastName Account Status Tax ID Physician or Clinic E ofessional Group Fractice Name ga provider test53 Greg Tester53 NEW 581273850 Greg Group Create Institutional ga provider test52 Greg Test EMAIL VERIFICATION 581273850 Greg Group Claim ga member jam1000 Jerome Mullner REPCREATED 1073570305 581279850 Batch Claims ga provider test 2 FName L Name NEW 581279850 Test Group Submission bigshot test person EMAIL VERIFICATION 581279850 ga provider test01 FName LName APPROVED 581279850 Payment History ga user p53 Greg Tester APPROVED 581279850 Greg Group ENDE hpmga ecao jam1000 J Mullner APPROVED 1073570305 581279850 ga user p52 Greg Tester APPROVED 581273850 Test Group ga provider test ryan lindbeck NEW 581279850 Payment History Claim Auditing Tool Online forms Reports 207 items found displaying 1 to 10 Page 1 21 Contact Us Create Professional Claim From the Navig
53. am Date of Birth Phone Number 06 17 2011 12 31 9999 Hoosier Healthwise ri One item found Page 1 1 1 Patient List Results Click Member Name hyperlink to access the Member Eligibility Details page Refer to Page 43 for information on Member Eligibility Details Download to PDF To download the patient list results into a PDF document click the Download to PDF hyperlink Download to Excel To download the patient list results into an Excel spreadsheet click the Download to Excel hyperlink Operational Training 53 August 201 1 Patient List Downloads The Patient List Downloads feature allows you to download a file of Members The file is available through this link for seven days after which the link no longer displays Administration Patient List Search Eligibility Eligibility Search Patient List Patient List Downloads NPI Provider Medicaid ID Authorization Health Record Member s Last Name Claims Last Name needs to be Online forms exact match Reports Programs Resources Alert Types Contact Us rr Search Patient List Alerts Member Name Member Id Effective Date End Date 09 01 2009 12 31 9999 06 08 2011 12 31 9999 04 23 2010 12 31 9999 04 23 2010 12 31 9999 Patient List Download to PDF 5 Download to Excel E Program Date of Birth P Hoosier Healthwise Hoosier Healthwise Hoosier Healthwise Hoosier Healthwise 10 15 2007 12 24 2003 01 12 200
54. ate Requests Administration Registration Admin Registration Admin My Account Physician Practice Clinic Group Information Reports Physician Group Resources Name stlukes t Contact Us Tax ID 262101949 NPI 1639192743 Administrator Manager Contact Information Admin Yes Contact First Name Fname Contact Last Name Lname Phone Number 9999999999 Fax Number Email Address sbachina centene com User Information First Name Fname Lname Phone Number Extn Fax Number 9999999999 Email Address sbachina centene com Login Name myuser1311867718589 Date Registration ubmitted 07 28 2011 10 42 35 AM User Administration LDAP User ID Last Login Date 15737 Role Access V AUTHORIZATIONS CLINICAL INFORMATION I4 OFFICE MANAGER v ELIGIBILITY IV CLAIMS Comments 4000 characters left Verification Question What city were you born in 1 What is your mothers maiden name 1 What is your father s middle name 1 Access Request Management Once provider is proven valid be sure to check or uncheck any role access that matches or does not match their job function From here you can Approve Deny or Update requests by clicking on the appropriate button Cancel Button Click the Cancel button to exit the registration request Operational Training 22 August 201 1 Approve Access To approve access to the portal for a Provider Registration Admin Physician Prac
55. ation menu select Claims Create Professional Claim Operational Training 70 August 201 1 Create Professional Claim Select Member Provider Secure Portal Welcome Greg Tester Log Out My Account Eligibility W Health Record Authorization W Claims W Online Forms W Reports W ContactUs Create Professional Claim Step 1 of 5 Select Member I verify that I am submitting a new Professional claim and not adjusting a previously submitted claim or entering information for reconsideration of a previously submitted claim Enter Member information then click the Continue button Required Member Information Medicaid ID 1231879552 Create Prof Claim Select Member n order to select a member you have to click the check box to verify you are submitting a new Professional claim Once this box is checked the Member s ID field and Continue button are activated Enter the Member s Medicaid ID Click the Continue button Vip You will only be able to submit online claims for members who have current coverage with the State s health plan You can verify member eligibility by utilizing the Eligibility Search option located under the Eligibility menu item eee ee BEER HER HEHEHE Operational Training 71 August 201 1 Create Professional Claim Enter Patient Details Provider Secure Portal Welcome Greg Tester Log Out My Account V Eligibility V Health Record Authorization W Claims W Online Forms W
56. b Ref Amisys Claim Na Medicaid Account Original Claim Total Claim Submitted Nbr Type Nbr Nbr Charges Status 04 08 2011 1988481 institutions MEE 22722420575 NJH test 2 222 22 In Progress One item found Page 1 1 1 Submitted Claims Tab Submitted Claims displays a list of web claim submissions made during the past seven days You can change your Submitted Claims list by entering new search criteria i e Date Submitted Web Ref and Status and clicking the Search button Clear Click the Clear hyperlink to clear the search criteria entered Copy Rather than starting with a new blank claim see Create Professional Institutional Claim above it may be easier to start with a copy of a previously submitted claim This can be helpful when creating a new claim that varies only slightly from a previously submitted claim Click the claim s Copy link Step1 of the newly copied claim will be displayed Complete the claim as described in Create Professional Institutional Claim Operational Training 111 August 2011 Status The status of a submitted claim may be displayed as In Progress The claim has been submitted for processing Rejected The claim has been rejected and not entered into the adjudication system Hover the mouse cursor over the icon to view reasons for the rejection Currently rejected claims cannot be adjusted online You may choose to make a copy of the rejected claim see Copy above fix
57. ded only to the Network Providers Registration Admin Status Tax ID m Last Name Account Status PI Misir Lname APPROVED NEW APPROVED EMAIL_VERIFICATION APPROVED OMCREATED EMAIL_VERIFICATION APPROVED APPROVED APPROVED 1639192743 Jennifer Hester in_provider_test04 FName LNameFour in_provider_test5080 torrence1 TestLastName Hatch TestFirstName Torrence Tester Balla Ballaab Balla in_provider_test53 Greg in test 19 Prasad Prasadab Prasad in test 18 in test 17 2 424 items found displaying 1 to 10 Last Name Tax ID 201017034 262101949 201017034 263083364 201017034 201017034 203904383 351116775 351116775 351116775 Page 1 243 1 2 3 4 5 6 7 8 Physician or Clinic Group Practice Name Mercy Medical stlukes Mercy Medical Group Test Group Test Group Test Group Test Account Test Account Test Account Next Last Registration Admin Main Screen Office Manager r XE Up RS RI X SI E mi Registration Date 07 28 2011 11 52 21 AM 07 28 2011 10 42 35 AM 07 28 2011 10 32 02 AM 07 22 2011 07 03 11 AM 07 21 2011 02 30 20 PM 07 21 2011 06 45 18 AM 07 20 2011 02 53 28 PM 07 20 2011 11 47 31 AM 07 20 2011 11 41 24 AM 07 20 2011 11 41 20 AM Check the user list page daily for new requests for access or simply log into the Provider Portal Select New from the Status drop down field Click the Search button Operational Training 20 August 201
58. e Information Admission Date 06 10 2011 Admission Hour 17 Admission Type Admission Source Discharge Hour Discharge Status 121212121 111 05 10 2011 to 07 10 2011 Provider Information Edit Billing Provider Information Billing Provider NPI Taxonomy Code Billing Provider Address 1376748160 SHRINERS HOSPI TALS FOR CHILD 12502 USF PINE DR TAMPA FL 33612 Pay To Provider Information NPI Taxonomy Code Pay To Name Address 1376748160 121212112 SHRINERS HOSPI TALS FOR CHILD 12502 USF PINE DR TAMPA FL 33612 Additional Provider Information NPI 1376748160 Taxonomy Code 1212121221 Attending Provider Name William Brown IRS Tax ID Number 362193608 Operating Provider Information NPI Taxonomy Code Operating Provider Name IRS Tax ID Number Other Provider Information Codes Edit Diagnosis Codes Admitting Diagnosis Code Principle Diagnosis Code Occurrence Codes Patient Reason for Visit Condition Codes Value Codes Procedure Codes Principle Procedure Code Date PPS Code DRG PPS Code DRG External Cause Code Cause Code Treatment Authorization Prior Authorization Number Auto Accident Information State in which automobile accident occurred Revenue Codes and Charges Edit HCPCS Rate HIPPS NDC Modifier Code Code s 111 06 01 2011 Total Charges Service Date Revenue nai Description Previous Step Save Draft amp Start New Claim Save Draft Submit Claim Review Claim and Submit 97 N
59. e LName APPROVED 581279850 ga user p53 Greg Tester APPROVED 581279850 Greg Group hpmga ecao jam1000 J Mullner APPROVED 1073570305 581279850 ga user p52 Greg Tester APPROVED 581279850 Test Group ga provider test1 ryan lindbeck NEW 581279850 HB mmm HN 207 items found displaying 1 to 10 Create Authorization From the Navigation menu select Authorization Create Authorization Operational Training 56 August 201 1 Submit Authorizations Provider Secure Portal Welcome FName LName Log Out Administration Y My Account Eligibility W Authorization W Claims W Online Forms W Reports W ContactUs Create Authorization Step 1 of 3 Select Member Ihave received written permission to request the following services on the members behalf Enter Membership Information and Date of Service then click the Continue button Required Member Information Medicaid ID or Member ID is requirec Date of Service Admission Requests can only be backdated three days and may not be for service more than 30 days Please note Member eligibility and authorization of services are conditions of reimbursement not a guarantee of payment Create Authorization Select Member 1 In order to select a patient you must check the Permission Box stating you have been authorized to act on his her behalf Once this box is checked the fields for entering the Member ID will be activated 2 Enter the Medicaid ID or Member I
60. e s a chart of status statements that will appear as a result of batch claim submissions Status Definition Filesattached Nextsteps _ Accepted Batch submission 987 TAT and Frovider can passed HIPAA Audit file check web claims edits for status of adjudication In Process Batch submission None Walt until received ands submission pending HIP AA amp processes and EDI validation status updates Rejected Batch submission 997 and TA Contact EL failed HIPAA edits support for assistance Error An unexpected None Contact ELI error due to a support for system Issue or assistance failure to pass HIPPA edits Upload Error A system issue None Contact ELI occurring during support for data upload assistance Incorrect Type Provider selected Mone Contact EDI the wrong file type support for e selected 33 assistance posted 837p Reminder Data spans for searches are limited to a three month period and batch claim data is available for the last eighteen months Special Note Provider will need a Practice Management System to read the 997 TA1 and Audit files Operational Training 126 August 201 1 Batch Claims Reports Batch claim reports are mainly for managers provider relation specialists claims and EDI support staff to access This report can be accessed by clicking on the appropriate link These reports display usage and functionality of this system Note This link will be provided once it is avai
61. eck Claim Status Search Enter Date of Service DOS range Enter at least one other Search Criteria i e Member Information Claim Information and or Provider Information Click Search to access the Search Results Operational Training 104 August 2011 Clear Form vi g SENHENMN Click the Clear Form button to reset the Date of Service DOS range to the current date and two months prior and to clear any information entered in the Member Information Claim Information and or Provider Information sections Check Claim Status Results p Use the convenient calendar function BEI to set the Date of Service DOS fields The result of your search displays claims that meet your search criteria You can sort results by clicking on any of the headers in this view Click headers to sort results below Claim No J155INE01151 J156INE00669 156 F J156 J156 NE00704 NE00997 NE00671 156INE00686 156INE00670 159INE01389 J160 NE00239 Ref Acct No 26196V2310 26767V2310 26819V2310 26787V2310 26770V2310 26803V2310 26790V2310 268 15V2310 27078V2310 27488V2310 Medicaid ID Member Name Servicing Provider DOS Range 06 02 2010 06 02 2010 06 01 2010 06 01 2010 06 01 2010 06 01 2010 06 01 2010 06 01 2010 06 01 2010 08 01 2010 06 01 2010 06 01 2010 08 01 2010 06 01 2010 06 01 2010 06 01 2010 06 01 201
62. ect Member In order to select a member you have to click the check box to verify you are submitting a new Institutional claim Once this box is checked the Members ID field will be activated Enter the Member s Medicaid ID Click the Continue button Ip You will only be able to submit online claims for members who have current coverage with the State s plan You can verify member eligibility by utilizing the Eligibility Search option located under the Eligibility menu item Operational Training 83 August 2011 Create Institutional Claim Enter Patient Details Provider Secure Portal Welcome TestFName Testi Name Log Out Administration W My Account V Eligibility W Authorization W Claims W Online Forms W Reports W ContactUs Create Institutional Claim Step 2 of 6 Enter Patient Details Name HOSELTON SARA L Date of Birth 01 10 1984 Medicaid ID 111526515739 Enter Patient information then click the Next Step button Required Patient Details Patient Control amp Medical Record Type of Bill Statement Covers Period From To Prior Payments 111 05 10 2011 07 15 2011 Admission and Discharge Information Admission Date Admission Hour Admission Type Admission Source Discharge Hour Discharge Status 06 01 2011 5PM 3 Elective 1 Physician Referral or Newborn Normal Delivery
63. ed you to confirm the disablement by clicking Yes or No Click Yes to disable Update Information Ausers account information can be updated Enter any appropriate updates to Phone Numbers Fax Numbers Email Address etc Click the Update button to save your work Operational Training 33 August 201 1 Important Reminders Changes to the Providers demographic information on this screen WILL NOT update Amisys or Portico This will only update the registration information on the user Providers will be required to re agree to the Terms and Agreement the next time they log in after you made any demographic updates You have the ability to change passwords and role access You also have the ability to select unlock activate reset disable and enable users as needed Note If you enable an office manager after they have already had an account they will be prompted to agree to the Office Manager Terms and Agreements before they will be allowed to log in User Management Tips A user s account will lock after five incorrect login attempts The user will retain the ability to reset their password from their login page or they may contact you requesting assistance If the user has not accessed the portal site for ninety days their account will automatically move into inactive status Refer to your Health Plans P amp Ps for additional guidance Inactive or disabled accounts can be enabled The user will not have to re register
64. ents to be entered in the Supplemental Information text box below 05 05 2011 05 05 2011 22 O 76700 26 Show Member s Eligibility Add Supplemental Information Add another Service Line Previous Step Save Draft Save Draft amp Start New Claim Next Step Enter Diagnosis and Service Details From this screen you can make all your necessary adjustments as you proceed through the remaining steps of the Adjust Professional Claim process to you get to Step 5 of 5 Operational Training 117 August 201 1 Provider Secure Portal Welcome Test Provider Log Out y Account V Eligibility W Authorization W Health Record Claims W Online Forms W Reports W Resources W ContactUs Adjust Professional Claim Step 4 of 5 Enter Provider Details Name SIMS BRIDGET N Date of Birth 09 27 1993 Medicaid ID 101384586099 Claim Number K136INE01953 Required Referring Provider Please enter a minimum of 3 characters in Last Name to search providers Last Name BEDFORD First Name ADRIENNE Tax ID NPI 4134398183 Taxonomy Rendering Provider NPI 720008394 Taxonomy 2085R0202X Name Tax ID NPI Medicaid ID JOHN DEAN 351163141 1720008394 remove Billing Provider Same as Rendering Provider Name DEAN TaxID 351163141 NPI 4801895081
65. er Health Record View and submit claims Submit batch claims View and submit adjustments View and submit authorizations View payment history Submit online forms j Click the New Provider New Provider Registration at Registrati on button Questions feel free to Contact Us p M i m ami uar P P al P m LI New Provider Registration Operational Training 6 August 201 1 Provider Registration We are happy to provide online transactions that save you time and increase your office efficiency Signing up is an easy four step process Enter your information in the fields below and continue on to the next step Once all your information is submitted and confirmed we will contact you to let you know your account is activated Step 1 Populate the fields with your information Required Information Physician Practice Clinic Group Information Physician Group Name Buc Medical Group Tax ID NPI 201017034 Personal Information First Name Last Name Vincent Vaughn Phone Number Ext 114654321 5 Numbers Only No Dashes Ex 1234567890 Fax Number 3146539856 Email Address tmay centene com Confirm Email Address tmay centene com Passwords are case sensitive Make note of the username and password that you create They will be required each time that you log in to the website User Name waughn Password Confirm Password Why do I
66. er Information Medicaid ID Date of Birth Member Name Effective Date End Date 101068871999 04 17 1993 BEARD JAIRUS L 06 01 2009 12 31 2050 Service Type Hospice Edit Details Diagnosis Information Code ICD 3 Description 100 8 Leptospirosis NOS Inpatient Clinical Information Symptoms Symptoms freeform text Medication Medication freeform text Additional Clinical Information Addictional Chnical Info freeform text Transition of Care Code CPT Description 10081 incision amp drainage pilonidal cyst complicated Provider Information Admitting Provider Admitting Facility HOSPICE OF DARKE COUNTY INC HOSPITALITY HOUSE 100275040 410 W VOTAW 1100 5 CURRY PIKE PORTLAND IN 47371 BLOOMINGTON IN 47403 Contact Information Name FHame LName Phone 555 555 5555 Fax 314 555 5555 Back to Select Serice Submit Please note Member eligibility and authorization of services are conditions of reimbursement not a guarantee of payment Create Authorization Review 14 Verify the authorization information e g member information service type and contact information 15 Click Submit button to complete process Operational Training 62 August 201 1 Submit Authorizations Welcome FName LName Admanistrabon Y My Account Y Eligiblity Y Authorizabon Health Record Claims Y Online Forms Y Reports Y Resources W Con Us Create Authorization Thank you for submitting your Authonzabon Request Your authon
67. er jhester has been successfully approved OK Registration Admin Confirmation You receive a confirmation that the provider has been approved Click OK Operational Training 24 August 2011 Deny Access To deny access to a Provider User Administration LDAP User ID Last Login Date 14477 Role Access AUTHORIZATIONS CLINICAL INFORMATION OFFICE MANAGER ELIGIBILITY CLAIMS Comments 4000 characters left Verification Question What is your mothers maiden name 1 What is your favorite sports team What is your father s middle name 1 1 Registration Admin Click the User ID to open and review the provider access request Inthe Comments field enter your Initials and the Date Denied Click the Deny button to deny the request By denying the user the registration will be cancelled Are you sure you want to inactivate this user Access Denial Verification You are asked to confirm the inactivation of the user by clicking Yes or No Click Yes Operational Training 25 August 2011 Verification Email Once the registration request has been approved denied or updated the user will receive an email providing additional information instructions EE Email Verification Message Plain Text File Edit View Insert Format Tools Actions Help J portal centene com Sent Tue 7 26 2011 4 03 PM Tammy May cr Subject Email Verification Dear Jennifer Hester Your
68. esesseseeaeeeeeeeeeeeeeeessseseeeas 127 ReCO SNOB Cer ae 218 glo O DO tee NANA NA ERE EER ER EEE EEA e doute 127 Payment AVC ii EEEE 129 Operational Training 3 August 201 1 Operational Training 4 August 201 1 Provider Secure Portal From the landing page you are able to perform various functions including New Provider Registration Provider Self Support Contact Us Login to the Secure Portal Using the latest technology we provide you with easy access to secure online information and ndis la lame interactive tools User Name What Providers Can Do Coming Soon Check member eligibility o View member Health Record View your member panel o Submit batch claims View and submit claims o View and submit adjustments View and submit authorizations View payment history Login Submit online forms g Forgot Password Unlock Account New Provider Registration Questions feel free to Contact Us Provider Secure Portal Landing Page Operational Training 5 August 2011 Registration A user account is required to access the Provider Secure area If you do not have a user account click New Provider Registration to complete the 4 step registration process below Using the latest technology we provide you wih easy access to secure online mformation and interactive tools What Providers Can Do Coming Soon Check member aligibility o View member gaps in care View your member panel e View memb
69. fiers Place of Service Billed Amount Payment Amount Payment Date Check Mo Status Status Description 2010 06 02 81025 Vv0489 LC11 19 00 10 05 2010 06 07 0000828221 PAID PAID IN FULL 2010 06 02 90471 V0489 LC11 26 00 0 00 2010 06 07 0000828221 DENIED DENY THIS SERVICE IS NOT COVERED 2010 08 02 90649 V0489 LC11 5223 00 9 20 2010 06 07 0000828221 PAID PAID IN FULL Return to Search Results Search Again Print Claim Detail Claim Status Details Adjust Claim To adjust claim click on the Adjust Claim hyperlink to access the five step claims adjustment wizard Be sure to complete all required fields Return to Search Results o return to Check Claim Status Results page click the Return to Search Results button Search Again To check the status of another claim s click the Search Again button This will return you to the Check Claim Status Search page Print Claim Detail To print the claim status details click the Print Claim Detail button Operational Training 106 August 201 1 View Web Claims The View Web Claims feature allows you to re open and continue working on saved unsubmitted claims It also allows you to track the status of claims submitted using the Portal Administration Registration Admin My Account Eligibility Authorization Health Record Claims Check Claim Status View Web Claims Ly reate Professional Navigation Menu From the Navigation menu select Claims View Web Cla
70. fle FName LName 555 555 5555 314 555 5555 Service Information Select Serice Type below G inpas Outpatient Service Type Select Please note Member eligibility and authorization of services are conditions ol reimbursement not a guarantee of payment Create Authorization Select Service 6 Validate the correct Member Name DOB and effective coverage for reference 7 Enter the Contact Information for the Authorization 8 Select the Service Type of Inpatient or Outpatient Only Outpatient authorizations are able to be submitted via the secure web portal for behavioral health Note The Service Type selected for Outpatient Authorization requests will result in the appropriate behavioral health options to appear in the drop down menu Operational Training 58 August 201 1 Submit Authorizations Welcome FName LName Log Out Administration Y My Account Y Eligibility Y Authorization Y HealhRecod Claims Y Online Forms Y Reports Y Resources Y Create Authorization Step 2 of 3 Service Detail Selected Service Type Hospice Requires Providers for this Service Member Information Medicaid ID Date of Birth End Date 101068871999 04 17 1993 12 31 2050 Leptospirosis NOS L Date of Serace Admission 07 26 2011 Scheduled Actual Admission Date 07 26 2044 3 Place of Senice INPATIENT HOSPITAL Symptoms freeform text Symptoms Medication freeform text t
71. ged Health Services nor its affiliates will be liable for any loss resulting from a cause over which they do not have direct control including but not limited to failure of electronic or mechanical equipment or communication lines telephone or other interconnect problems computer viruses unauthorized access theft operator errors severe weather earthquakes natural disasters strikes or other labor problems wars or governmental restrictions Governing Law and Jurisdiction These Terms and Conditions will be governed by and construed in accordance with the laws of the Indiana without reference to its choice of law rules By accessing viewing or using the material on the Site you consent to the jurisdiction of the federal and state courts presiding in the Indiana and agree to accept service of process by mail and hereby waive any and all jurisdictional and venue defenses otherwise available This Site is controlled and operated by Managed Health Services from its offices within the United States Managed Health Services makes no representation that materials in the Site are appropriate or available for use in other locations and access to them from territories where their contents are illegal is prohibited Those who choose to access this Site from other locatio o on their own volition and are responsible for compliance with applicable local laws at any time modify these terms and conditions and your continued use of this site will be conditioned upon
72. ges _ Status 08 02 2011 1991293 Institutional HANK R ABBOTT 104419387699 111 11 11 In Progress Copy 2 items found displaying all items Page 1 1 1 Copy Hyperlink Click Submitted Claims tab the option to copy a claim that has been previously Submitted by clicking the Copy hyperlink Operational Training 101 August 2011 Provider Secure Portal Welcome Test Provider Log Out y Account V Eligibility W Authorization W Health Record Claims W Online Forms W Reports W Resources W ContactUs Create Professional Claim Step 2 of 5 Enter Patient Details Name BROCK BRITTANY L Date of Birth 05 14 1990 Medicaid ID 101077567299 Enter Patient information then click the Next Step button Required Patient s Account Number 1 Amount Paid Patient Status Single Married Other Employed Full Time Student Part Time Student Patient s condition related to Employment Auto Accident Location of Accident Other Accident Save Draft Save Draft amp Start New Claim Next Step Step 2 Enter Patient Details after Copy Selected The Copy link will take you directly to the Professional or Institutional Claim starting with Step 2 to create a new Claim with the copied information already populated Operational Training 102 August 2011 Check Claim Status The Check Claim Status feature allows you to check the status and to view detailed information of your submitted
73. have been approved for an account at http vwrww sunshinestatehealth com 1 Use the verification code in this email to complete your sign up Please write it down Verification Code GTzBy6YC 2 Please return to the Provider Portal at http vrvwrw sunshinestatehealth com and log in Please use the username and password that you created when you signed up 3 The next screen after you login will ask for your Verification Code Enter the code and click submit 4 Your sign up will be complete Thank you for signing up If you have any questions please call Provider Services at 7 Email Verification Note In the approved account email verification there is a Verification Code for the provider to use upon their initial login attempt Operational Training 26 August 2011 Approved Registrations The Provider receives the verification email and returns to the portal to login User Name mercymed Password Forgot Passward Unlack Account Login Window Enter the User Name and Password created Click the Login button Email Verification Enter the Verification Email Verification Code Code bFrh nSqT Email Verification Code Field Enter their Email Verification Code Click the Submit button Operational Training 27 August 2011 The Provider can access all of the navigation tools View Mambier EBbgibilimg Wiee Patera Liy Views a Wembe s Caps in Care View aru Sabet C lairi
74. iginal Claim Total Charges M Created Member Name Medicaid ID Ref Acct 0543 2041 APRIL J GILBERT 100174279899 83757V2310 K049INE00753 90 00 Edit Delete 05 41 2011 CORDEL A SIMPSON 101915644599 1018 100 00 Edit Copy Delete 0541 2011 CORDEL A SIMPSON 101915644599 1019 100 00 Edit Copy Dele 0541 2011 CORDEL A SIMPSON 101815844588 1019 100 00 Edit Copy 05 1 2011 CORDEL A SIMPSON 1019156844599 1019 100 00 Edit Copy Delete 05 1 2011 CORDEL A SIMPSON 101815844588 1019 100 00 Edit Copy Delete 0541 2011 CORDEL A SIMPSON 101915644599 1019 100 00 Edit Copy Delete 05 11 2011 CORDEL A SIMPSON 101915844588 1018 100 00 Edit Copy Delete E 05 11 2011 CORDEL A SIMPSOW 101915844588 1019 3100 00 Edit Copy Delete Li 05 11 2011 CORDEL A SIMPSON 1019158445988 1019 100 00 Edit Copy Delete 22 items found displaying 1 to 10 Page 13 1 2 3 Next Last Submit Selected Professional Claim s Claims Ready to be Submitted List Claims listed here are complete contain no errors and are ready to be submitted This section is broken down into two lists of claims Professional and Institutional Submitting Ready to be Submitted Claims Click check boxes to select one or more claims for submission Click the Submit Selected Professional Institutional Claim s button at the bottom of the page A Claim s Submitted confirmation will be displayed A record of the submission including the status of each claim that was par
75. ims The View Web Claims page includes two tabs Unsubmitted Claims and Submitted Claims View Web Claims Unsubmitted Claims Submitted Claims Tabs Unsubmitted Claims amp Submitted Claims Unsubmitted Claims The Unsubmitted Claims tab is selected by default If it is not selected simply click Unsubmitted Claims tab Unsubmitted Claims displays two lists of claims Incomplete Claims and below it Claims Ready to be Submitted Operational Training 107 August 2011 Incomplete Claims View Web Claims Unsubmitted Claims Submitted Claims Incomplete Claims Instructions Claims listed below have missing information or contain errors Click Edit to view a claim then fix any errors or complete it before submitting Date Created 05 11 2011 CMS 1500 101915844599 1019 S 100 00 t Delete Type Member Name Medicaid ID Ref Acct Original Claim Total Charges 05 11 2011 CMS 1500 101915844599 1019 S 100 00 Delete 05 11 2011 CMS 1500 101915644599 1019 S 100 00 Delete 05 11 2011 CMS 1500 101915844599 1019 S 0 00 Delete 05 11 2011 CMS 1500 101915644599 1019 S 100 00 t Delete 05 11 2011 CMS 1500 101915844599 1019 S 100 00 Delete 05 11 2011 CMS 1500 101915844599 1019 S 0 00 Delete 05 11 2011 CMS 1500 101915644599 1019 0 00 Delete 05 11 2011 CMS 1500 101915644599 1019 0 00 t Delete 05 11 2011 CMS 1500 101915644599 1019 0 00 Delete 162 items found displaying 1 to 10 ss Boy ee Si ow m wmv Next Last
76. indicate that you understand and intend these Terms and Conditions to be the legal equivalent of a signed written contract and equally binding and that you accept such Terms and Conditions and agree to be legally bound by them If you do not agree with the Terms and Conditions you are not granted permission to use the Site and should exit immediately 1 Proprietary Rights All material contained in this Site is protected by law including but not limited to United States copyright law Except as indicated the entire content including images text and look and feel attributes of this Site is Managed Health Services All rights reserved Removing or altering the copyright notice on any material on the Site is prohibited Managed Health Services also owns a copyright in this Site as a collective work and or compilation and in the selection coordination arrangement organization and enhancement of such content Any commercial use of this content is prohibited without the prior written consent of Managed Health Services All trademarks and logos are proprietary to Managed Health Services Use or misuse of these trademarks is expressly prohibited and may violate federal and state trademark law Please be advised that Managed Health Services actively and aggressively enforces its intellectual property rights to the fullest extent of the law Use of Site By transmitting any suggestions information material files or other content collectively content
77. ine Forms W Reports ContactUs Search Saved Create Status Submitted Y Medicaid ID 1231879552 Web Reference Number 1986501 Search Member Name Medicaid ID Submission Date Web Reference Number L49288225 F05001861 1231879552 07 26 2011 1986501 One item found Page 1 1 1 Search Saved Criteria Note Create Status defaults to Submitted You can change Create Status search options by selecting the drop down menu for this field The Create Status field can be Submitted Complete or Incomplete Enter the appropriate search criteria i e Create Status Medicaid ID and Web Reference Select Search button The Search Results provide the Member Name s Medicaid ID Submission Date and Web Reference s applicable to the Saved Search performed Click on the Member Name to access the complete incomplete submitted authorization request Operational Training 65 August 201 1 Check Auth Status From the Navigation menu select Authorization Check Auth Status Operational Training Administration Registration Admin My Account Eligibility Authorization Create Authorization Search Saved Check Auth Status Claims Online forms Reports Contact Us Check Auth Status 66 August 201 1 Check Auth Status Welcome FName LNameOne Log Out Administration Y My Account V Eligibility W X Health Record Authorization W Claims W Online Forms W Reports W ContactUs Check A
78. ission Payment History Payment History Downloads Claim Auditing Tool Navigation Menu From the Navigation menu select Claims Payment History You are directed to the Payment History page Payment History Display Search Criteria Transactions All activity posted to your account between 05 06 2011 and 08 05 2011 Instructions To view transaction details click the check date Check Number Payment Amount 0000907616 3 785 19 05 19 2011 0000909078 0 00 05 19 2011 0000909078 2 857 59 05 26 2011 0000910622 1 817 64 06 02 2011 0000912146 1 496 73 06 09 2011 0000913552 80 20 06 09 2011 0000913552 999 93 06 16 2011 0000914959 3 858 78 06 23 2011 0000916461 172 66 06 23 2011 0000916461 3 304 11 06 30 2011 0000917910 06 30 2011 0000917910 7 21 2011 0000922139 13 items found displaying all items Page 1 1 1 Click on the appropriate check date hyperlink Operational Training 129 August 2011 Explanation of Payment EOP Details Explanation of Payment Details Check Trace Number 0000035077 Check Date 06 23 2011 EOP reprint requests cannot be processed at this time for Capitation CAP checks and Statistical Non Payment adjustments The Request ERA link is intended for use by providers currently registered for ERA with Centene If you are not registered then no ERA will be generated In order to register for ERA please follow the instructions under Electronic Transactions or contact your
79. ity History Eligibility History Effective Date Term Date Program Class 08 01 2011 12 31 9999 Hoosier Healthwise SUBSCRIBER 06 01 2011 07 31 2011 Hoosier Healthwise SUBSCRIBER 02 01 2011 05 31 2011 Hoosier Healthwise SUBSCRIBER 08 15 2010 01 31 2011 Hoosier Healthwise SUBSCRIBER Eligibility History The History information displays the following Effective Date Term Date Program Class Operational Training 46 August 2011 Download to PDF Member Eligibility Details Date of Service Download to PDF fj Date Searched 08 03 2011 Program Hoosier Healthwise Member Name Date of Birth uj Medicaid ID Download to PDF hyperlink A copy of a member s Eligibility Details can be downloaded and printed in its entirety by clicking the Download to PDF hyperlink File Download Do you want to open or save this file i Mame MemberEligibilityDetails pdf oe Type Adobe Acrobat Document From kestporkal amp i centene com C om gt see tad While files from the Internet can be useful some files can potentially harm your computer IF you do nat trust the source do not open or save this File What s the risk File Download Window Atthe prompt to open or save the file click Open Operational Training 47 August 201 1 r MembertligibilityDetails 1 pdf Adobe Acrobat File Edit View Document Comments Forms Tools Advanced Window Help Eligibility Details Date of Service 08
80. kne Forms T Took Y Retources F Cowads Batch Clams uma s 25252522 2127 2 h las 1H months of babch clas submito data rs deadible onbne Fibi the loemat vidsic abon process i mot guarantee of lards payment Claemis paymi r contingent upor accuracy of data submitted You will receiw an anabon of ant EO or E35 lor your cams subreson depending on your conract acrargement For questions garding mon please contact 880 nin Lir Subs be ED Suppor or contact up hen selecting Contact Stat Date lovin 8 Us wil send an End Date 09092011 E9 nate pae levted tea I morth period mail ta EDI Wish Rilerorr o i uppart Bach Cham La r ET w Okra ty 241 d DEQTIDITAD ai vac ERS iiin HA x 21 a 201 242711749 Dr md suh feel 4j DRF avt LI 2O3 TEQTRITU emoaai aal EFAA Jj art ari 18 i181 TEIT ipag DAETIT gir H DEOTAD RH di wacoaRECT Ter Bieta an i ILER dititi _ pi ae aed BESART T ba rE an 121 _ Tay a_i aei aedi aca TS azoanit Wire 1D2 AITSITAD dbec aed aci PRCORRECT Tre Peete ie am TTOTaETAQUaB ebat app pp BiaUzu dini TB MIN gan Bene rep Tg ua aptis dtu an TH Tag tas BasgeChpernCmen Tea da ach 43 hems found spaying 11010 Paa i5 4 2 3 4 5 het LiH Contact Us Link to EDI Support Search criteria can be used to track specific submissions File postings are listed and responses are posted as applicable Operational Training 125 August 201 1 Batch Claims Submissions continued Her
81. knowledge and agree that your use of this site and that of any user for whom you activate website privileges is subject to the terms and conditions set forth in this Registration process ELIGIBILITY The Eligibility role allows you to check the plan eligibility of your patients for specific dates of service CLAIMS The Claims role allows you to find and view the details of specific patient claims Continue Cancel Step 2 If you are the Administrator Manager Click the I am the Administrator Manager checkbox This will auto populate the contact information and allow you to skip that section Note If you are not the Administrator Manager complete the contact section with your administrator s manager s information Operational Training 9 August 201 1 Provider Hegistration Enter Contact First Name Enter Contact Last Name Enter Phone Number Enter Fax Number Optional Enter Email Address Click the Continue button Back Click the Back button to return to Provider Registration Step 1 screen Cancel Click the Cancel button to return to the Provider Secure Login screen Operational Training 10 August 201 1 Provider Registration 2 c 0 MMEEENENNNND Required Information Terms and Conditions The following terms and conditions Terms and Conditions govern your use of this web site the Site and by accessing viewing or using the material on the Site you
82. lable in production Accessing Batch Claims Report Navigate to http devviewattachment centene com FileAttachmentWeb claimBatchStats htm this is the only test link Choose Start Date Choose End Date Select Health Plan Click the Show Stats button To See TIN level reporting select that report Accepted Reports Errors amp Processing Batch Claims Statistics im Print Page Start Date End Date Select Plan T Superior SUPERIOR TOTAL ACCEPTED ERRORS PROCESSING Claim Type Total Count Accepted Processing Errors Professional Institutional Total Operational Training 127 August 201 1 jiki Print Page Select Plan HE Superior SUPERIOR TOTAL ACCEPTED ERRORS PROCESSING Provider Claim Type Total Count 752970981 Professional 271302877 Professional Total Batch Claims Statistics La Print Page Start Date End Date Select Plan TES TL Show Stats 7 SUPERIOR TOTAL ACCEPTED ERRORS PROCESSING Provider Claim Type Error Type Total Count 900047406 Professional ERROR 043797989 Professional REJECTED Total Operational Training 128 August 2011 Payment History The Payment History feature allows providers to view online explanation of payment information Administration Registration Admin My Account Eligibility Health Record Authorization Claims Check Claim Status View Web Claims Create Professional Claim Create Institutional Claim Batch Claims Subm
83. less of the way it is accessed Operational Training 17 August 201 1 Administration Contact Us My Account Eligibility To submit a question or comment complete the form below and click Submit Health Record Subject Request Provider Relations Visit Claims First Name Last Name Online forms FName LName Reports Practice Clinic Facility Name Resources Mercy Medical Group metus O e 201017034 Phone Number 314 254 4757 Email Address GFey centene com County Question Comments Our group would like someone from your health plan to visit and explain how to submit claims properly EE Contact Us Form Logged Into Portal Operational Training 18 August 201 1 Login A user account is required to access the Provider Secure Portal If you do not have a user account click New Provider Registration to obtain one If you have an established user account do the following to log in User Name mercymedical Password Forgot Password Unlock Account Login Window Enter your User Name Enter your Password Click the Login button Operational Training 19 August 2011 Grant Access This section outlines the functions that Provider Service Representatives and Office Managers can perform Please refer to your health plan s P amp P for operational specifics Note Only Providers who are Par on the Network should be granted access to the Secure Portal This benefit is provi
84. n Registration Admin Registration Admin My Account Physician Practice Clinic Group Information Reports Physician Group Resources Name Test Account Contact Us Tax ID 351116775 NPI Administrator Manager Contact Information Admin No Contact First Name Contact Last Name Phone Number Fax Number Email Address User Information First Name Last Name Prasad Balla Phone Number Extn Fax Number 1231231231 Email Address pballa centene com Login Name in_test_19 Date Registration Status Submitted APPROVED 07 20 2011 11 47 31 AM User Administration LDAP User ID Last Login Date 15373 07 20 2011 11 48 38 AM Role Access V AUTHORIZATIONS CLINICAL INFORMATION OFFICE MANAGER ELIGIBILITY CLAIMS Comments 3957 characters left 2011 Jul 20 11 48 56 Setting to approval Verification Question What is your mothers maiden name What is your favorite sports team What is your father s middle name Reset Password Update Cancel e Registration Admin Screen Operational Training 32 August 201 1 Reset Password Ausers password can be reset by clicking the Reset Password button from the Registration Admin screen Aconfirmation email is sent to the Provider letting them know that their password has been reset Disable Ausers account can be disabled by clicking the Disable button from the Registration Admin Screen A prompt ask
85. need to click in the field and populate the date using the calendar provided Click the Search button Operational Training 40 August 201 1 To search by Last Name First Name Eligibility Search Note portal Medicaid ID or Member ID Date of Birth or Last Name Q First Name and Date of Service 12 17 2006 cox niv 07 25 2011 E Search by Last Name First Name Enter Date of Birth and Enter the Last Name First Name and Enter the Date of Service You need to click in the field and populate the date using the calendar provided Click the Search button When you search by Last Name First Name you must enter it exactly how it is listed in the Operational Training 41 August 201 1 The results of your eligibility search lists all patients that meet the criteria you entered Eligibility Search Medicaid ID or Member ID Date of Birth and or Last Name First Name and Date of Service 12 17 2006 co NN GN 07 25 2011 NM Gender Date of Birth Medicaid ID Provider Name Effective Date Term Date DOS Eligibility a peee OBEN connors ENG 06 01 2011 07 31 2011 ACTIVE One item found Page 1 1 1 Eligibility Search Results Click on the Member Name hyperlink to access their record Operational Training 42 August 201 1 Administration My Account Eligibility Eligibility Search Patient List Patient List Downloads Authorization Health Record Claims Online forms Reports Resources Cont
86. ng Provider Name Tax ID NPI Taxonomy Rendering Provider Name NPI Taxonomy Billing Provider Name Tax ID NPI Taxonomy Address Service Facility Location Name Tax ID NPI Taxonomy Address 09 27 1993 Medicaid ID 101384586099 MGR10105370401 1021 W TERRACE AV MARION IN 469530000 None None 05 05 2011 05 05 2011 22 No BEDFORD ADRIENNE None 1134398183 None DEAN JOHN 1720008394 2085R0202X DEAN 351163141 1801895081 None 441 N WABASH AVE MARION GENERAL HOSPITAL 201017034 1770679201 None 441 N WABASH AVE Previous Step Save Draft amp Start New Claim Submit If all information is correct click Submit and the claim will be transmitted A Claim oubmitted confirmation will be displayed Operational Training 119 August 201 1 Provider Secure Portal Welcome Test Provider My Account V Eligibility W Authorization W Health Record Claims W Online Forms W Reports W Resources W ContactUs Adjust Professional Claim Claim Submitted Successfully Thank you for submitting a claim via the web We have received your transmission and will process your claim in a timely manner Web Reference Number for this claim submission is 1991453 Start New Claim Adjust Claim Submission Claim submitted successfully Note the Web Reference Number Note Once you receive the web reference number you can not go back to the claim and make any changes on the same day
87. nloads Claim Auditing Tools Online Forms Member Search Reports Patient Cost Reports Contact Us Operational Training 38 August 201 1 Eligibility Search The Eligibility Search functionality allows you to instantly verify a patient s Eligibility Status and view his or her Eligibility Details for a specified Date of Service DOS Administration gt Registration Admin My Account Eligibility Eligibility Search Patient List Patient List Downloads Authorization Health Record Claims Online forms Reports Resources Contact Us Navigation Menu From the Navigation Menu at the left on the Home Page select the drop down arrow next to Eligibility and select Eligibility Search The Eligibility Search screen appears Eligibility Search Medicaid ID or Member ID Date of Birth and or Last Name First Name and Date of Service Er 08 12 2011 Search Eligibility Search Screen Operational Training 39 August 201 1 In the Eligibility Search screen you must search by Date of Birth Medicaid ID Member ID or Last Name First Name and Date of Service as they are required fields Eligibility Search Medicaid ID or Member ID Date of Birth and or Last Name First Name and Date of Service 12 17 2006 105165138699 07 25 2011 Search Search by Date of Birth Medicaid ID and Date of Service Enter Date of Birth and Enter the Medicaid ID and Enter the Date of Service You
88. ns feel free to Contact Us Contact Us Hyperlink To access our contact information and other helpful numbers click the Contact Us hyperlink Operational Training 16 August 2011 ContadUs Contact Us Phone Directory amp Hours Who are you Populate all required fields Subject in the form eve ss S Name ester First Last Phone fa 4 522 2500 Email Your Message I m interested in providing primary care services for your palth plan Please contact me with additional information i The Contact Us form above will send your message to Managed Health Services MHS as an e mail The e mail is not encrypted and is not transmitted in a secured format By communicating with MHS through e mail you accept the risks associated thereof MHS does not accept responsibility or liability for any loss or damage arising from the use of e mail To ensure the safety of your PHI please contact Member Services at 877 MHS 4U4U 647 4848 Monday through Friday 8 a m to Contact Us Form Not Logged Into Portal Enter all the required information red asterisk and click the Submit button Note The Contact Us link can be accessed with and without logging in to the Secure Portal The screen above shows the Contact Us Form when the Provider is not logged in The screen below shows the Contact Us Form when the Provider is logged in The same fields are offered to capture the same information regard
89. of 5 Review Name 149288225 F05001861 Review Claim Information then click Submit to finish Member Edit Patient s Account Number Claim Amount Paid Address Status Condition Related to Service Edit Date of current illness injury or pregnancy Date of similar illness Dates of patient unable to work in current occupation Hospitalization dates related to current services Outside lab charges Prior Authorization number Service Line 1 Date of Service Place EMG Procedure Code Modifier s Diagnosis Code s Charges Days Unit EPSDT Family Planning Supplemental Information Providers Edit Referring Provider Name Tax ID NPI Taxonomy Rendering Provider Name NPI Taxonomy Billing Provider Name Tax ID NPI Taxonomy Address Service Facility Location Name Tax ID NPI Taxonomy Address Date of Birth 08 01 2010 Medicaid ID 1212121 350 00 123 MAIN JACKSON MS 39208 Married Other Accident 04 16 2011 None None None None 154789787 05 10 2011 05 10 2011 11 No Dave Ninabahen 208512947 1669665881 None LINDSEY REESE 1669484515 None Ninabahen Dave 208512947 1669665881 None 1212 North 21st Street Ninabahen Dave 208512947 1669665881 None 1212 North 21st Street Previous Step Save Draft amp Start New Claim Create Prof Claim Review Operational Training 79 1231879552 August 201 1 This Review Screen displays all
90. of the diagnosis code will appear when you move the cursor from the field Enter additional diagnosis codes in Diagnosis Code 2 Diagnosis Code 3 and Diagnosis Code 4 as needed Tip Please remember to include decimal points in all monetary fields e g Outside lab charges and Charges within the Service Line details Operational Training 73 August 2011 Service Line 1 Delete this service Line Procedure Diagnosis Code Modifier 05 10 2011 05 10 7203 11 rens EI F Charges Days Unit X EPSDT From Date To Date Place EMG Plan Pointer irr Show Member s Eligibility NDC billing requirements to be entered in the Supplemental Information text box below Add Supplemental Information Add another Service Line Previous Step Save Draft Save Draft amp Start New Claim Next Step Show Member s Eligibility Hyperlink oview the Member s Eligibility spans click Show Member s Eligibility Hide Member s Eligibility hides the eligibility span information Inthe Service Line 1 section enter all of the required information Note Use the Diagnosis Pointer checkboxes to associate the previously entered Diagnosis Code 1 2 3 amp 4 with the Service Line as needed Service Line 1 Delete this service Line Procedure Diagnosis Code Modifier 05 10 2011 05 10 2031 41 C fos TT TT Fam From Date To Date Place EMG Charges Days Unit EPSDT Pointer Plan vee r Hide
91. of the information entered during the previous steps Review it to ensure that all information is correct f information is incorrect click the Edit hyperlink to change the information within a section For example to change a Diagnosis Code click Edit in the Service section The Step 3 page displays When finished modifying information click the Next Step button or press Enter on the keyboard to continue to the next step Continue to click Next Step on each step until returning to Step 5 of 5 Click Save amp Start a New Claim to save the claim and begin a new claim with the Step 1 of 5 page The saved claim will be available in the Claims Ready to Be Submitted list see Unsubmitted Claims in the View Web Claims section below If all information is correct click Submit and the claim will be transmitted A Claim Submitted confirmation displays Operational Training 80 August 201 1 Provider Secure Portal Welcome Greg Tester Log Out My Account V Eligibility w Health Record Authorization W Claims W Online Forms W Reports W ContactUs Create Professional Claim Claim Submitted Successfully Thank you for submitting claim via the web We have received your transmission and will process your claim in a timely manner Web Reference Number for this claim submission is 1991373 Start New Claim Create Prof Claim Successful Submission Take note of the Web Reference Number which may be used to identify the claim
92. on Covered Charges 0 00 0 00 Log Out Charge Amount 100 00 100 00 August 2011 Please review to ensure that all information is correct f information is incorrect click Edit to change the information within a section For example to change a Diagnosis Code click Edit in the Codes section It will take you to the Step 4 of 6 Enter Claim Codes screen When you are finished modifying information click the Next Step button to continue to the next step Continue to click Next Step on each step until returning to Step 6 of 6 Provider Secure Portal Welcome TestFName Testi Name Log Out Administration Y My Account V Eligibility W Authorization W Claims W Online Forms W Reports W ContactUs Create Institutional Claim Thank you for submitting your claims via the web We have received your transmission and will process your claims in a timely manner Your Web Reference Number for this submission is 1991435 Start a New Claim Web Reference Number lf all information is correct click Submit Claim and the claim will be transmitted A Claim Submitted confirmation appears Operational Training 98 August 2011 Copy Claim Function My Account Update Account Change Passwort Eligibility Authorization Health Record Claims Click Here Online forms Reports Resources Contact Us Navigation Menu From the Navigation menu select Claims View Web Claim Rather than starting
93. on to go back to the previous screen K While in the Create Institutional Claim process the Member s Name Member ID and Date of Birth DOB are displayed at the top of each page Instructions are displayed just below this area gEUSHEHHHEHEHEHHEHHEHHEHHEHHEHEBERHEENEERJ su HENHNEHNENEEHEHHEHHEHHEHEEEHEEHEEEEEHEHN Operational Training 85 August 201 1 Create Institutional Claim Enter Billing Information Provider Secure Portal Welcome TestFName TestLName Log Out Administration W My Account V Eligibility W Authorization W Claims W Online Forms W Reports W ContactUs Create Institutional Claim Step 3 of 6 Enter Billing Information Name Date of Birth Medicaid ID Enter Provider information then click the Next Step button Required Billing Provider Information Select Billing Provider by searching for NPI Selected Billing Provider NPI 1376748160 Name SHRINERS HOSPI TALS FOR CHILD Medicaid ID 003106616A Clear Selected Provider Pay To Provider Information Same as Billing Provider NPL 137674810 Taxonomy Code 1321201012 Pay To Name SHRINERS HOSPI TALS IRS Tax ID Number 3621936008 State Florida wj Zip Code 33612 Additional Provider Information Taxonomy Code Taxonomy Code First Name DO O O First Name DoOo O O Last Name O O Last Name DO O OES ixi LAM eS Add Other Providers Previous Step Save
94. on to submit a new authorization for this member New Member Select New Member button to submit a new authorization for a different member Operational Training 63 August 2011 Search Saved Authorizations Administration Registration Admin Registration Admin My Account Create New User Eligibility N e Search Create Authorization 4 Search Saved User List Download To Excel Check Auth Status User Id First Name Last Name Account Status Tax ID Physician or Clinic Group Practice Name ga provider test53 Greg Tester53 NEW 581279850 Greg Group ga provider test52 Greg Test EMAIL VERIFICATION 581279850 Greg Group ga member jam1000 Jerome Mullner REPCREATED 1073570305 581279850 Contact Us ga provider test02 FName LName NEW 581279850 Test Group bigshot test person EMAIL VERIFICATION 581279850 ga provider test01 FName LName APPROVED 581279850 ga user p53 Greg Tester APPROVED 581279850 Greg Group hpmga ecao jam1000 J Mullner APPROVED 1073570305 581279850 ga user p52 Greg Tester APPROVED 581279850 Test Group ga provider test1 ryan lindbeck NEW 581279850 Claims Online forms Reports 207 items found displaying 1 to 10 Page 1 21 1 2 34 5 6 7 8 Next Last Search Saved Authorizations From the Navigation menu select Authorization Search Saved Operational Training 64 August 201 1 Welcome FName LNameOne Log Out Administration W My Account V Eligibility V Health Record Authorization W Claims W Onl
95. onal Claim Enter Claim Codes Enter the Admitting and Principal Diagnosis Codes required Ip Once Diagnosis Codes have been entered its associated diagnosis descriptions will be MESS VI USE AN ES eee C E BENHBNHBEEHEHEHEEHEEEEHENHEENHEEHEHEEHEHEEHEHEEHEEHEHEEEHEEHEEHEEHEEEHENHEEHEEHEHEEEHEEHEEHEEHEEHEEHEHN When you have completed adding Diagnosis Codes click the link titled I m done adding Diagnosis Codes Operational Training 88 August 2011 Provider Secure Portal Welcome TestFName TestL Name Administration Y My Account V Eligibility W Authorization W Claims W Online Forms Y Reports ContactUs Create Institutional Claim Log Out Step 4 of 6 Enter Claim Codes Date of Birth Enter Code information then click the Next Step button Required Diagnosis Codes Medicaid ID Use valid ICD 9 codes only Principle Diagnosis Code Add Additional Diagnosis Codes Occurrence Codes Add Additional Span Codes Add Additional Occurence Codes Patient Reason for Visit Add Additional Visit Codes Condition Codes Add Additional Condition Codes Value Codes Add Additional Value Codes Procedure Codes Principle Procedure Code Date Add Additional Other Procedure Codes PPS Code DRG PPS Code DRG External Cause Code Cause Code Treatment Authorization Prior Authorization Number Auto Accident Information
96. onal Training 92 August 201 1 PPS Code DRG PPS Code DRG External Cause Code Cause Code Treatment Authorization Prior Authorization Number Auto Accident Information State in which automobile accident occurred N A Previous Step Save Draft amp Start New Claim Save Draft Next Step Enter Remaining Options Enter the fields listed above optional When you have completed adding the optional fields click the Next Step button It will take you to the Enter Service Details screen Operational Training 93 August 2011 Create Institutional Claim Enter Service Details Provider Secure Portal Welcome TestFName TestLName Log Out dministration W My Account V Eligibility W Authorization Claims W Online Forms W Reports W ContactUs Create Institutional Claim Step 5 of 6 Enter Service Details Name Date of Birth Medicaid ID Enter Service Line information then click the Next Step button Required Revenue Codes and Charges Revenue CUENCA NE HCPCS Rate HIPPS NDC Modifier Service Service Charge Non Covered Code P Code Code s Date Units Amount Charges Total Charges 0 0 Revenue Code MED SUR GY PVT INCISION OF CORNEA HCPCS Rate HIPPS Code NDC Code m I Claim submission may be denied if NDC billing requirements are not met and or missing Modifier s Service Date 96 01 2011 Im Service Units 1 Charge Amo
97. plan representative Note Online EOP format may not be consistent with paper EOP formatting Back Download Excel Format Request EOP Request ERA Print Page Sort By Insured Name dM Insured Name Group EXPRESS CARE SOUTH Patient Name ID 601859866 Control Number K167MSE00004 Account DAVDOO01 Service Provider oe DM VES NPI 1851331805 Service Lines Serv Date Proc Days Cnt Charged Allowed Deduct Coinsur Discount Med Allow Denied ANSI Payment Proc2 Qty Copay Interest Med Paid Codes 10 06 13 2011 99214 0 1 0000 110 0 78 05 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 92 78 05 20 06 13 2011 J1885 0 4 0000 38 0 1 04 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 92 1 04 30 06 13 2011 96372 0 1 0000 16 67 0 0 0 0 0 0 0 0 0 0 0 0 0 0 l 00 92 16 67 40 06 13 2011 72100 0 1 0000 97 0 29 45 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 06 13 2011 85025 0 1 0000 30 0 9 03 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Sub Total 310 0 134 24 0 0 0 d 0 RU 0 0 One item found Page 1 1 1 EOP Details Back Click on appropriate check date hyperlink to return to payment history transaction page Download Excel Format Click on Download button to request EOP in excel format Go to Payment History downloads to retrieve file or check request status Request EOP Click Request EOP button to request a hard copy of the Explanation of Payment Please allow 24 hours to process request A reference number will be provided Request ERA Click Request ERA but
98. rmation Answer the What is your fathers middle name v rification question Verification Question Enter the Verification Answer to the security question you created at registration Click the Continue button New Password The password must meet the following requirement The password length must be at least six characters with at least one number Required Information Enter and verify your new password New Password Verify New Password Password Entry and Verification Enter and verify the New Password Click the Continue button Operational Training 14 August 201 1 B Your password was successfully changed Click the Finished button Completion of Password Update Click the Finished button You may login using your new password at your convenience Operational Training 15 August 201 1 Contact Us Login Using the latest technology we provide you with easy access to secure online information and 3 ogy yo y User Name interactive tools What Providers Can Do Coming Soon Password Check member eligibility o View member gaps in care View your member panel o View member Health Record gt View and submit claims Submit batch claims View and submit adjustments Login View and submit authorizations o View payment history gt Submit online forms Forgo ward Unlock Click the Contact Us New Provider Registration hyperlink Questio
99. s Member Eligibility Details contains the following information opecific Date of Service providers can confirm eligibility prior to seeing member Health Plan Program information Member s full name Date of Birth Medicaid ID Member Demographics phone address city state and zip Gender Eligibility Details Member ID numbers Operational Training 44 August 201 1 Primary Care Provider PCP Current Primary Care Provider Provider Name CONNORS JAMES Address 421 CHESTNUT ST EVANSVILLE IN 47713 Phone 812 479 6909 Provider ID 807529 History Effective Date Term Date Provider Name 08 01 2011 12 31 9999 CONNORS JAMES 06 01 2011 07 31 2011 CONNORS JAMES 02 01 2011 05 31 2011 CONNORS JAMES 08 15 2010 01 31 2011 CONNORS JAMES Primary Care Provider Info From this hyperlink you can access the following information regarding the current PCP PCP s name PCP s address PCP s phone number Provider ID Amisys provider number History span of PCP assignment or member s eligibility history Operational Training 45 August 2011 Coordination of Benefits COB COB History Nothing found to display COB History The Coordination of Benefit COB information displays if the member had other insurance It would display the following Name of other insurance carrier s or health plan s Effective dates of coverage for other insurance carrier s or health plan s Eligibil
100. s feature allows you to create and submit a medical authorization request for anticipated outpatient services or hospital admissions that will occur on a future date online Urgent and or emergent requests must be submitted by phone or fax Authorization requests can only be submitted via the web portal on patients who are currently eligible and for services that have not yet been rendered The turn around time for web submitted requests can take up to fourteen 14 days but progress of the requests can be viewed in the portal within 1 to 2 days of submission Administration Registration admin t te jig LLTSTE Te LoT My Account Create New User Eligibility Search Saved User List Download To Excel Check Auth Status User Id FirstName LastName Account Status Tax ID Physician or Clinic Office Registration Date Group Practice Name Manager ga provider test53 Greg Tester53 NEW 581279850 Greg Group E 08 03 2011 02 33 30 PM ga_provider_test52 Greg Test EMAIL_VERIFICATION 581279850 Greg Group 07 08 2011 12 37 41 PM ga_member_jam1000 Jerome Mullner REPCREATED 1073570305 581279850 07 06 2011 11 54 28 AM 06 22 2011 02 42 13 PM 06 20 2011 01 34 41 PM 06 19 2011 12 41 45 PM 06 08 2011 03 05 53 PM 05 31 2011 08 32 42 AM 05 26 2011 03 23 06 PM 02 22 2011 10 15 17 AM Claims Online forms EN Reports Contact Us ga provider test02 FName LName NEW 581279850 Test Group bigshot test person EMAIL VERIFICATION 581279850 ga provider test01 FNam
101. st 2011 dministration W My Account V Eligibility W Authorization W Claims W Online Forms W Reports W ContactUs Create Institutional Claim Step 5 of 6 Enter Service Details Name Date of Birth Medicaid ID Enter Service Line information then click the Next Step button Required Revenue Codes and Charges T HCPCS Rate HIPPS NDC Modifier Service Service Charge Description Code Code s Date Units Amount iM Charges MED SUR GY PVT INCISION OF CORNEA 06 01 2011 1 100 00 0 00 Remove Edit Total Charges 100 00 0 00 Add Revenue Codes and Charges Previous Step Save Draft amp Start New Claim Save Draft Added Revenue Codes and Charge When you have completed adding Revenue Codes and Charges click Next Step It will take you to Review Claim and Submit screen Operational Training 96 August 2011 Operational Training Create Institutional Claim Review Claim and Submit Provider Secure Portal Welcome TestFName Testi Name Administration Y My Account V Eligibility W Authorization W Claims Y Online Forms W Reports W ContactUs Create Institutional Claim Step 6 of 6 Review Claim and Submit Review the Claim created and click the Submit Claim button to submit the claim request Patient Information Edit Patient Information Medicaid ID Patient Name Patient Date of Birth Medical Record Patient Control Bill Information Type of Bill Statement Covers Admission and Discharg
102. stered user of the Member or Provider Web Portals No Solicitation or Offer of Medical Services or Advice This Site is designed to provide general information about Managed Health Services and its products and services Information on the Site is not intended to constitute an offer to sell or a solicitation of any particular product or service Some products and or services may not be available in all states and in many instances may be offered only through employers and other plan sponsors No material contained herein should be construed as medical advice Individual inquiries about sensitive or confidential matters should be addressed to appropriate health care professionals No Legal Advice Nothing contained expressed or implied in this Site is intended as nor shall be construed or understood as legal advice guidance or interpretation No attorney client relationship is established between Managed Health Services and you by reason of your use of this Site or under any circumstances whatever The information in this Site is for general informational purposes only If you have questions about any law statute regulation or requirement expressly or implicitly referenced in this Site you should contact your own legal counsel Confidentiality Cannot be Guaranteed Please be advised that the confidentiality of any communication or material transmitted to Managed Health Services via this Site or Internet electronic mail cannot be guaranteed including person
103. t of the submission will be displayed in the Submitted Claims list Operational Training 109 August 2011 Edit Click the claim s Edit link to modify a claim s information The claim summary screen will be displayed on the summary screen Step 5 for Professional and Step 6 for Institutional ofinish and submit the claim click the Submit This Claim button at the bottom of the page f you choose not to submit the claim at this time click Save near the top right of the page If the claim is now complete and contains no errors it will be moved the Claims Ready to Be Submitted list You may access saved claims at any time by returning to the View Claims page Copy Rather than starting with a new blank claim it may be easier to start with a copy of a completed claim This can be helpful when creating multiple claims that vary only slightly e g the claims are identical except for their dates of service Click the claim s Copy link Step 1 of the newly copied claim will be displayed Complete the claim as described in Create Professional Institutional Claim Delete To permanently delete a Ready to Be Submitted claim click the claim s Delete link Operational Training 110 August 201 1 Submitted Claims View Web Claims Unsubmitted Claims Submitted Claims B Stat Date 04 01 2011 za EndDate o4 3020311 EA Web Ref pO Claim Status All Search Clear Hide Search Criteria Date We
104. the member requires that a new professional claim be generated Operational Training 116 August 2011 Provider Secure Portal Welcome Test Provider Log Out Account Y Eligibility W Authorization W Health Record Claims W Online Forms Y Reports W Resources W ContactUs Adjust Professional Claim Step 3 of 5 Enter Diagnosis and Service Details Name SIMS BRIDGET N Date of Birth 09 27 1993 Medicaid ID 101384586099 Claim Number K136INE01953 Enter physician or supplier information then click the Next Step button Required Date of current illness injury or pregnancy E MM DD YYYY Date of similar illness m Dates of patient unable to work in SH to current occupation i i Hospitalization dates related to 05 05 0011 SB to current services Outside lab charges Ex 225 95 Prior Authorization number Diagnosis Codes Hint Enter Diagnosis Codes in any format Ex 100 or 100 1 or 1001 Check corresponding Diagnosis Pointer boxes below to assign diagnosis to Service Line s Diagnosis Code BM 78701 NAUSEA WITH VOMITING Diagnosis Code Bl Diagnosis Code 3 Diagnosis Code W Service Line 1 Delete this service Line Fam Plan O pa z lace Procedure f Diagnosis h n ue From Date To Date Place EMG Code Modifier Pointer Charges Days Unit EPSDT 140 0 1 LEN NDC billing requirem
105. the terms and conditions in force at the time of your use Severability Check the box to be deemed severable In the event that any provision is determined to be unenforceable or invalid such provision shall nonetheless be enforced to the fullest extent permitte agree to the terms Hetermination shall not affect the validity and enforceability of any other remaining provisions and conditions e entire agreement between you and Managed Health Services with respect to your use of the Site You acknowledge that in providing you access to and use of the Site Managed Health Servicgsefas relied on your agreement to be legally bound by these Terms and Conditions Agree to the web site usage terms and conditions and that all information entered to register is valid Back somme Cancel Step 3 Read the web site Terms and Conditions Agreement and click the Agree checkbox Click the Continue button Back Click the Back button to return to Provider Registration Step 1 screen Cancel Click the Cancel button to return to the Provider Secure Login screen Operational Training 11 August 201 1 Provider Hegistration Dear Vincent Vaughn Thank you for registering with MHS Indiana Within 2 business days you will receive a phone call from the Health Plan to verify your information An email will be sent to your email account to notify you that your user account has been activated along with your verification code to
106. tice Clinic Group Information Physician Group Name Mercy Medical Group Tax ID 201017034 NPI Administrator Manager Contact Information Admin Yes Contact First Name Jennifer Contact Last Name Hester Phone Number 3145222500 Fax Number 5142555200 Email Address imayGcentene com User Information First Name Jennifer Phone Number 5145222500 Email Address ftmay centene com Login Name mercymed Date Registration Submitted 07 28 2011 10 32 02 AM User Administration LDAP User ID 15736 Role Access AUTHORIZATIONS CLINICAL INFORMATION OFFICE MANAGER ELIGIBILITY CLAIMS Comments 4000 characters left Verification Question What is your mother s maiden name What is your fathers middle name What is your favorite sports team Operational Training Last Name Hester Extn n Status NEW Last Login Date Fax Number 5142555200 Cancel Registration Admin Review the provider access request 23 Click the User ID link to open the provider access request August 201 1 Note Only Providers who are Par on the Network should have Approved Access to the Secure Portal If a Par Provider leaves the Network for any reason their access to the portal should be immediately terminated Inthe Comments field enter your Initials and the Date Approved Click the Approve button Registration Admin Thank You The us
107. to the Site in the event that you violate these Terms and Conditions or for any reason whatever Indemnification You agree to defend indemnify and hold harmless Managed Health Services its affiliates and subsidiaries and all of their respective directors officers employees representatives proprietors partners shareholders servants principals agents predecessors successors assigns and attorneys from and against any and all claims proceedings damages injuries liabilities losses costs and expenses including attorney s fees and litigation expenses relating to or arising from your use of the Site and any breach by you of these Terms and Conditions Links to Other Web Sites This Site may from time to time contain links to other Internet web sites for the convenience of users in locating information and services that may be of interest These sites are maintained by organizations over which Managed Health Services exercises no control and Managed Health Services expressly disclaims any responsibility for the content the accuracy of the information and or quality of products or services provided by or advertised on these third party sites Managed Health Services does not control endorse promote or have any affiliation with any other web site unless expressly stated herein Use of the Internet Use of the Internet is solely at your own risk and is subject to all applicable state national and international laws and regulations Neither Mana
108. ton to request a hard copy of the Explanation of Payment Please allow 24 hours to process request A reference number will be provided Operational Training 130 August 2011 Print Page Click on Print Page to print a hard copy of the Explanation of Payment Details page Sort By You can sort the Explanation of Details page by the Insured Name Group Name and Servicing Provider Sort By Insured Name Operational Training 131 August 2011
109. unt 100 00 Non Covered Charges iaa I m done adding Revenue Codes and Charges Previous Step Save Draft amp Start New Claim Save Draft Create Institutional Claim Enter Service Details Enter the Revenue Code Service Date Service Units and Charge Amount required Enter HCPCS Rate HIPPS Code and Non Covered Charges optional Click Add button to add Revenue Codes and Charges Tip Once you click the Add button the Revenue Code will be validated E L a a E a E PUR Operational Training 94 August 2011 Revenue Codes and Charges Non Covered Charges Revenue CHE ar BON HCPCS Rate HIPPS NDC Modifier Service Service Charge Code P Code Code s Date Units Amount MED SUR GY PVT INCISION OF CORNEA 06 01 2011 1 100 00 0 00 Remove Edit Total Charges 100 00 0 00 Revenue Code HCPCS Rate HIPPS Code NDC Code Claim submission may be denied if NDC billing requirements are not met and or missing Modifier s Service Date zm Service Units Charge Amount Non Covered Charges l m done adding Revenue Codes and Charges Previous Step Save Draft amp Start New Claim Save Draft Next Step Revenue Codes and Charges When you have completed adding Other Revenue Codes and Charges click the link marked l m done adding Revenue Codes and Charges Operational Training 95 Augu
110. uth Status Web Reference Number 1986501 Note If Status column in results shows ERROR Please contact Health Plan at TTY TDD 1 877 725 7753 No authorizations found Web Reference Number Search Enter the Web Control Web Reference Select Search button Welcome FName LNameOne Log Out Administration W My Account Eligibility W Health Record Authorization W Claims W Online Forms W Reports ContactUs Check Auth Status Web Reference Number 1986501 Search Note If Status column in results shows ERROR Please contact Health Plan at TTY TDD 1 877 725 7753 Web Reference Number Member Name Svc Provider Facility Auth Req Svc Date Service Type Submission Date Status 1986501 L49288225 F05001861 FORREST COUNTY GENERAL HOSPITAL 2011 07 26 00 00 00 0 Hospice 2011 07 26 14 15 51 0 ERROR One item found Page 1 1 1 Web Reference Number Search Results Select the Web Reference to check Authorization Status Operational Training 67 August 2011 Example for Approved Authorization functionality Authorization Details Authorization number Units approved Comments 07 24 2007 10 49 ANM hig i teat note bo elaborate pOor Approved Start Data o2 03 3007 Unite Auth Daca Data 07 24 2027 Ens Dab Da D 2007 kusmi Data OFF tay TOO 1 Member Information hare DE Date of Birth 04 13 1974 EFF Date 10 01 2002 PCP er Member ID eee Te fete 896 12 31 205
111. zaton request was submitted on 2011 07 26 15 08 14 896 Authorization has been submitted successfully Please use below reference number s for future reference Service Type Hospice A Status Under Review Review Reason Medical management is reviewing the information submitted Reference number does not confirm authonzation approval Please check back within the next 1 2 business days for authonzabon status If the authonzaton is approved the authonzaton number needed to file your authonzation will be avaiable Create New authorization for Same Member or Hew Member Create Authorization Reference Number Note After submitting your request a reference number is generated The reference number is not the same as the authorization number It is a confirmation of a successful transaction via the web The request is now under review by the health plan medical management department It can take up to fourteen 14 days but the progress of the requests can be viewed in the portal within 1 to 2 days of submission Successfully submitted authorization requests will produce the following information Time stamped submission notice i e 2011 04 29 14 58 10 848 Confirmation of successful submission Option to print confirmation notice Confirmation of service type requested Web Reference Number also referred to as Web Control Status report Review reason Create New Authorization Same Member Select Same Member butt

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