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Online Provider Services User Manual

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1. Figure 3 Password and Validation Questions Choice Screen Palmetto GBA Medicare Q PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provider Services Login Registration Home User ID XXXXXXXX Validation Question 1 SELECT A QUESTION x Validation Answer 1 Validation Question 2 x SELECT A QUESTION Validation Answer 2 Validation Question 3 E SELECT A QUESTION x Validation Answer 3 Validation Question 4 SELECT A QUESTION x Validation Answer 4 Validation Question 5 SELECT A QUESTION x Validation Answer 5 Validation Question 6 SELECT A QUESTION x Validation Answer 6 Enter New Password Re enter New Password Submit Clear Need Help 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Rev August 2015 16 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual 2 4 Someone from my office has already registered How do I get access You must contact your provider administrator to request access to the system If you do not know who your provider administrator is you will want to contact your provider s staff to find out if they have registered to the system and who is the provider administrator If you are a provider administrator you can see who else is designated as provider administrators o
2. Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Figure 24 Eligibility Hospice Home Health Tab Palmetto GBA Medicare amp PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH ahii Privila Serviss amp User JANE DOE Provider TEST PROVIDER 9 Home Claims Remittance Eligibility Financial Tools Messages Forms Support Admin My Account You have 0 unread message s and 0 alerts Help Smith John J XXXXXXXXXX DOB MM DD YYYY DOD MM DD YYYY Inquiry Eligibility Deductibles Caps Preventive Plan Coverage MSP Hospice Home Health Inpatient Home Health Care HHEH Start Date 01 01 2014 HHEH End Date HHEH DOEBA Date HHEH DOLBA Date Provider Number XXXXXXXKKK Provider Number Type NPI Contractor Number XXXXX Cert Date XX XXIXXXX Recert Date XUXXIXXXX Hospice Total Occurrence Count 2 Effective Date Termination Date Provider Number Provider Number Type Revocation Code 03 02 2013 03 28 2013 NPI 0 01 01 2013 03 01 2013 1 2014 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER The Home Health Care section provides information for each episode start and end date and the corresponding billing activity dates The Hospice section provides eligibility information when the hospice benefit is effective and when it terminates in addition to the tot
3. If you do not click on the validation link and you try to log in you will see your profile screen where you can update or correct your email address and submit If your email address is correct you may click on the link to request a new email Please make sure your email address is correct on your profile before calling Palmetto GBA for assistance If you are sure your email address is correct but you do not receive your email your company s email security settings may need to be updated to allow incoming emails from Palmetto GBA The email address you will be receiving the validation email from is ops no reply palmettogba com If you experience password errors during the above process please use the Forgot or Change Your Password link on the login page to reset your password 3 0 Login 3 1 How do log in to Online Provider Services OPS You must have either registered for OPS or been given access to OPS by a provider administrator for your provider If you have completed these steps you will have a user ID Access our OPS introduction screen and enter your user ID and password See Figure 4 A log out link is located in the upper right of each screen once you have logged in You must log out to end your session If you do not log out your user ID will be locked for one hour If you were assigned a password by your provider administrator and this is the first time you have logged in you will be prompted to agree to t
4. OPS recertification and profile verification are two separate processes but users may be due for both during the same time frame Please follow the directions in the notification to complete OPS profile verification and prevent termination of access 9 23 I have completed my profile verification but when I log in I get an error stating that my access to Online Provider Services has been suspended until my provider administrator completes the recertification process How can I get my access restored You must contact your provider administrator on this account and have them recertify your access 10 0 Administration 10 1 How do I administer users The person who registers is the provider administrator Only one provider administrator can register per PTAN NPI combination Provider administrators have access to the Admin tab Through this function they can administer users The provider administrator grants access for additional users to access view and print from OPS the information related to registered provider Provider administrator responsibilities include the following e Creating the provider user e Assigning a temporary password to the provider user Rev August 2015 08 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Assigning application permissions to the provider user Creating additional provider administrators Modifying the provider user profile Terminating provider users or additio
5. The following tables provide information for the Preventive Tab Smoking Cessation Information Number of Sessions in Benefit Period Number of smoking cessation counseling sessions available for a beneficiary during the benefit period Benefit Period Sessions Remaining Number of smoking cessation counseling sessions remaining for a beneficiary Next Session Date The next available begin date for smoking cessation counseling session program if there are no sessions remaining in their current period Preventive Information A Healthcare Common Procedure Coding System HCPCS code The date a beneficiary is next eligible for professional services associated with the indicated HCPCS code Next Technical Date The date a beneficiary is next eligible for technical services associated with the indicated HCPCS code associated with the indicated HCPCS code Co insurance The patient s portion of responsibility for the indicated HCPCS code represented as a percentage 6 6 How do I use the Plan Coverage Tab The Plan Coverage tab provides information regarding the beneficiary s enrollment under MA and Part D contracts and or MA Managed Care Plans Part C contracts that provide Part A and B benefits for beneficiaries enrolled under a contract See Figure 19 Whenever OPS indicates that a beneficiary has coverage through a non Medicare entity MA or Medicare Drug Benefit plans the inquiring provider should always contact the non Medicare ent
6. available The city of the beneficiary if available The state of the beneficiary if available ZIP The ZIP code of the beneficiary if available End Stage Renal Disease ESRD Information Effective Date The date that indicates the start of eligibility for ESRD services The Type of Dialysis 14 or 15 services that are being rendered discharged 6 4 How do use the Deductibles Caps Tab The Deductibles Caps sub tab provides information regarding the beneficiary s Part B deductibles coinsurance blood deductibles occupational therapy caps physical and speech therapy caps pulmonary cardiac and intensive cardiac rehabilitation sessions Part B free services and mental health co insurance amounts See Figure 17 Rev August 2015 38 PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Figure 20 Eligibility Deductibles Caps Tab Palmetto GBA Medicare No PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH a f Diiia Provider S User JANE DOE p Provider TEST PROVIDER L jt Eligibility Financial Tools Messages Forms Support Admin My Account You have O unread message s and O alerts Heip Smith John J XXXXXXXXXX DOB MM DD YYYY DOD MM DD YYYY Inquiry Eligibility Deductibles Caps Preventive Plan Coverage MSP _ Hospice Home Health Inpatient Part B Deductible Calender Year Deductible Amount R
7. 271 system we are required to access for eligibility allows date requests up to 27 months in the past In cases of claim appeals or other scenarios which may involve the need for eligibility information older than 2 7 months please contact your provider contact center If a single hospital inpatient SNF spell spans more than one calendar year OPS will return the daily copayment amounts associated with the beginning year of the spell lf there is no hospital inpatient SNF spell within 60 days of the requested date s of service OPS will return default values for Part A spell data The tables below describe the Inpatient Tab fields Deductible Remaining By Spell DOEBA Date The date of earliest billing activity for the spell of illness DOLBA Date The date of latest billing activity for spell of illness Deductible Amount The amount of the deductible remaining to be met for the spell of illness Rev August 2015 53 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Spell DOEBA Date a date of earliest billing activity for the spell of illness DOLBA Date The date of latest billing activity for the spell of illness Inpatient Days Remaining Full Inpatient Days The full inpatient days remaining in the spell Full Inpatient Co Pay Days The full inpatient co payment days remaining in the spell SNF Days Remaining By Spell __ DOEBA Date a eepto o e date of ear
8. Field Submit Inquiry New Inquiry Clear 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER 6 1 How do successfully perform an eligibility inquiry The first step is to perform the inquiry When you click on the Eligibility tab you will be directed to the Inquiry sub tab first You can use the Inquiry sub tab to enter beneficiary information and submit a Medicare beneficiary eligibility request See Figure 15 The user should enter a beneficiary s information into the fields below To protect the privacy of beneficiary data all fields entered including optional fields must match the beneficiary s data as it is maintained in CMS HIPAA Eligibility Transaction System HETS otherwise eligibility data will not be returned The following fields are required e Subscriber s Last Name The suffix i e Jr Sr etc should be entered if the beneficiary has a suffix printed on their Medicare health insurance card The suffix may be necessary to receive a valid eligibility response e Subscriber s First Name e Subscriber Birth Date e Subscriber Primary ID HICN You may enter data into optional fields but these fields are not required to receive a valid Medicare beneficiary eligibility benefit response If data entered into an optional field does not match the beneficiary s data maintained in CMS HETS system eligibility data will not be returned on the
9. blue just below the second drop down menu Once you click the link you will be directed to the Cost Report form Figure 34 Cost Report Form Navigation Home Claims Remittance Eligibility Financial Tools Messages Forms Support Admin My Account Get Status You have 0 unread message s and 0 alerts Help Go To page Select Form nd Contract Id 11501 Secure Forms Welcome to secure forms You can now submit forms to Palmetto GBA securely through OPS You may attach up to five PDF attachments to each form Each attachment can be up to 5MB in size The forms and attachments are automatically entered into our workflow This makes form processing more efficient and cost effective To begin please select an answer to the questions from the drop down selections below Based upon the answer given for each of the questions the available form s will appear at the bottom of this box At this time only Appeals forms are available Select a Topic Audit and Reimbursement v Select a Type Cost Report Form v Cost Report AR J11 A 7000 2015 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER The Provider Information section will be pre filled with the information related to the OPS user ID that you are logged in under You may then complete the Cost Report Data section and upload attachments For Cost Report forms OPS users may
10. default All provider users must contact their provider administrator to gain access to the Messaging Forms tab 8 3 How do I submit a form The form is pre populated with the information we know from your registration record See Figure 29 This will save you several steps Complete all of the required information Then add any attachments You may add up to five attachments Each attachment can be up to 5 megabytes MB in size All attachments must be in PDF format unless otherwise noted For MR ADR Response Cost Report Appeals eCheck and eOffset forms OPS users may submit attachments up to 40 MB in size While there is no longer a limit to the number of files that can be attached to this form the combined size of all attachments cannot exceed 150 MB Once you have submitted the form you will receive a message either advising you on how to correct the form for resubmission or that the form was received by Palmetto GBA Once the form has been accepted into our processing system the received date will be assigned and an additional message will be generated with the Document Control Number DCN If a form is submitted over the weekend the DCN may not be assigned until the next business day Rev August 2015 61 WO PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Figure 32 Appeals Form Example Palmetto GBA Corporate Palmetto GBA Medicare Ne PALMETTO GBA A CELERIAN GROUP COMPANY PALM
11. is a Required Field 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER 6 2 How do use the date range optional fields in the eligibility Inquiry tab The Date From and Date To fields are optional fields you can input to request beneficiary eligibility data for a specific time period If no Date From or Date To is entered the system will automatically use the current calendar date for the inquiry You will receive an invalid format error message when an invalid character or an invalid date is entered on the Medicare Eligibility Benefit Inquiry screen You are prompted to correct the date and submit a new inquiry Rev August 2015 35 V PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual To retrieve all information available you must enter a valid date range The HETS 270 271 system we are required to access for eligibility allows allow date requests up to 27 months in the past In cases of claim appeals or other scenarios which may involve the need for eligibility information older than 27 months please contact your provider contact center Based on the Date From and Date To the system will determine the beneficiary data to display The application will display an error message if you enter a date and or date range within one of the following scenarios e A Date From that is before the date of eligibili
12. over each field or click the Provider Zip Code Provider NPI 0000000000 question mark icon to view helpful tips on how to Federal Tax I D Type SSN EIN complete each field Federal Tax I D Number Provider Signature Indicator No Enter the provider of service or supplier Federal Accept Assignment Yes No Tax Id Employer Identification Number or Social Security Number Patient Information Patient Medicare Number Patient Account Number Patient Last Name Patient First Name Users may attach up to five PDF files up to 5 MB in size each to their claim The attachments must be in PDF format and created using appropriate PDF creation software Failure to create the PDF correctly can result in a corrupt file that could prevent the user from successfully submitting their eClaim Once the user successfully submits their eClaim form they will be directed to a Claim Submission Summary page that will provide them with the OPS Transaction ID for this eClaim submission The OPS transaction ID will serve as a confirmation number for the eClaim submission until the submission is accepted Rejected claims will not receive an ICN Figure 14 Claim Submission Summary Home Claims Remittance Eligibility Financial Tools Messages Forms Support Admin My Account Get Status You have 1 unread message s and O alerts He Go To page Select Form Claim Submission Summary HIC
13. validation link and you try to log in you will see your profile screen where you can update or correct your email address and submit If your email address is correct you may use the request new email button to have another email sent Please make sure your email address is correct on your profile before calling Palmetto GBA for assistance If you are sure your email address is correct but you do not receive your email your company s email security settings may need to be updated to allow incoming emails from Palmetto GBA The email address you will be receiving the validation email from is ops no reply palmettogba com If you experience password errors during the above process please use the Forgot or Change Your Password link on the login page to reset your password 9 10 I have requested a new validation email several times but never receive it What do I need to do to complete OPS profile verification You must click the link in the validation email to complete your profile verification Please verify that the email address listed on your Online Provider Services OPS profile is entered correctly If the email address is correct please add our email address to your safe senders list Then log into your OPS account and use the request new email button to receive a new email to complete your profile verification You may need to get the email address added so you will be allowed to receive the email Your company s email secu
14. words including nonsense words combined with obscure character substitutions Rev August 2015 15 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Use the following guidelines to protect your password and your information e Don t use something easily identifiable such as your birthday child s birthday phone number or street address e Don t use letters or numbers that are near each other on the keyboard e g hjkl or appear in a logical sequence e g 123456 or abcdefg e Don t ever share your password with anyone else e Don t leave your password written down in any place where someone could find it e lf you absolutely must write down your passwords keep them in a secure locked place e f your browser supports password storage you may want to disable this feature for security purposes e Don t leave the OPS system accessible on your computer when you are away from the computer e Log off and close your browser each and every time you exit the system 2 3 How do I choose my security questions You have several questions from which to choose Answers to your security questions are case sensitive and include spaces Enter your answers carefully You must answer these questions exactly as they were entered to change your password or reset your password if you cannot remember it You can verify or change your security questions and answers through your My Account tab once you are logged in
15. ACT US E MAIL UPDATES SEARCH Online Provider Services Registration Registration Home Provider Name Contact Name Last First E mail Address Phone Number Extension am work for Choose One PTAN Click here to learn more NPI Click here to learn more Tax ID Most Recent Medicare Click here to learn more Payment Amount Received Line of Business Billing Service ClearingHouse Name Company Address 1 Company Address 2 Company City Company State Company Zip Code I lagree to the Terms of Use Submit Clear 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER 2 2 How do choose my password You will automatically be assigned a user ID in a format defined by CMS You will be allowed to choose your own password Your password Is case sensitive and Must be at least eight characters long Must contain an uppercase letter Must contain a lowercase letter Must have at least one of these special characters or Must contain numbers 0 9 and letters A Z a z Must start with a letter No leading portion of first or last names may occur Must contain at least four changed characters from the previous password Must be changed every 60 days Cannot contain spaces Cannot use same password as the previous 13 passwords More secure passwords are those which are based on pass phrases and or non dictionary
16. ETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Rev August 2015 J2 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual The system will return hospital inpatient default deductibles based on the requested start year when the following occurs e No inpatient spell data returned from the database overlaps or falls within 60 days of the requested date range e Entitlement period and request date period overlap e Part A Entitlement start year is less than the requested start year In addition the system will continue to return the hospital inpatient default deductible remaining amounts inpatient copayment days and SNF copayment days based on the beneficiary s Part A entitlement start year when the following occurs e No inpatient spell data returned from the database overlaps or falls within 60 days of the requested date range e Entitlement period and request date period overlap e Part A Entitlement start year is less than or equal to the requested start year Depending on the date s range requested multiple inpatient and SNF spells might be displayed The data returned on this screen is directly impacted by timely submission of claims by the provider The data returned is compiled from claims that have been processed by the Common Working File CWF To make sure you see all of the information enter a date range in the inquiry screen The HETS 270
17. ETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provider Services S amp User JANE DOE ZB Provider TEST PROVIDER Logout Home Claims Remittance Eligibility Financial Tools Messaging Forms Support Admin My Account You have 1 unread message s and 1 alerts Help Redetermination 1 Level Appeal J11 Part B Provider Information Conract Region XXXXXXXXXXX Provider Number Provider Name XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX PTAN XXXXXXXXXXX National Provi Identifi ational Provider Identifier ences Provider Address 1 NPI Provider Address 2 Provider City Provider State 4 Provider Zip Code Provider Phone Number Tax ID XXXXXXXXXXX Requestor Information Requestor Name Requestor Phone Number Requestor Address 1 Requestor Address 2 Requestor City Requestor State 4 Requestor Zip Code Patient amp Claims Information Patient Name Health Insurance Claim HIC Number Date From Ea x Date To EM x Claim Numbers DCN Add Claim CPT Code s ICD 9 Code s Add ICD Code Reason for Appeal Characters Left Attachment 1 Browse X Attachment 2 Browse X Attachment 3 Browse X Attachment 4 Browse X Attachment 5 Br
18. H AAAAAAAAA Patient s Name FirstName LastName Provider NPI 0000000000 DATE OF SERVICE DOS Primary Date From Primary Date To Secondary Date From Secondary Date To 11 13 2013 11 13 2013 11 13 2013 11 13 2013 11 13 2013 11 13 2013 Users will receive messages regarding their eClaim submission in their OPS inbox This can be accessed by selecting the Messages tab The first message is the Submission Confirmation This message confirms that the eClaim form was sent A second message will be available once the eClaim submission is accepted or rejected This may take 24 48 hours not including weekends or holidays to receive If the submission is accepted an ICN and DCN if attachments are submitted will be provided in the message Rev August 2015 28 V PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Receiving an accepted message does not mean that the claim was approved to be paid Once the claim is processed the approval or denial information will be on the remittance A rejected message will include the corresponding error messages informing the user what to correct If the user needs to contact the TSC regarding questions about a rejected claim they must provide the file name listed in the rejected inbox message Any eClaim submissions that were rejected will display on the Rejected Claims sub tab From the Rejected Claims sub tab users can correct their rejected eClaims and resubmit it
19. IAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Rev August 2015 71 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual A provider user may be granted administrative access by the provider administrator Keep in mind that provider administrators have access to all functions of OPS Granting administrative access to a provider user also gives them access to all functions including the ability to modify or delete the original provider administrator Provider administrators can create and delete additional provider administrators The provider administrator will receive the provider user s user ID and create a temporary password for the provider user The provider administrator is responsible for giving the provider user their user ID and password lf a user does not know who their provider administrator is they need to contact the provider s staff to find out if they have registered to the system and who is designated as the provider administrator Provider administrators can see who is designated as provider administrators on the Admin tab If you are a provider administrator and are leaving the office or are no longer functioning as the provider administrator you must assign an additional provider administrator before leaving the role Once a new provider administrator is assigned he or she can log in and delete the old provider administrator or change the provider administrator to a
20. Information Calendar Year calendar year associated with the used dollar amount applied to the capitation limit Remaining Amount Physical and Speech Therapy services used dollar amount applied to the capitation limit associated with the calendar year indicated Rev August 2015 40 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Pulmonary Rehabilitation Services Information Calendar Year The calendar year associated with the remaining sessions for pulmonary rehabilitation services Professional Sessions Remaining The number of pulmonary rehabilitation sessions remaining for the professional component Technical Sessions Remaining The number of pulmonary rehabilitation sessions remaining for the technical component Cardiac Rehabilitation Services Information Calendar Year The calendar year associated with the remaining sessions for cardiac rehabilitation services Professional Sessions Remaining The number of cardiac rehabilitation sessions used for the professional component Technical Sessions Remaining The number of cardiac rehabilitation sessions used for the technical component Intensive Cardiac Rehabilitation Information Calendar Year The calendar year associated with the ne remaining sessions for intensive cardiac rehabilitation Professional Sessions Used The number of intensive cardiac rehabilitation sessions used for the Technical Sessions Used The number of intensiv
21. L e Check Form Tue Apr 30 10 28 53 EDT 2013 e Check Payment Received XXXXXXXXXXX C e check Form Fri Apr 12 13 47 02 EDT 2013 e Check Payment Confirmation XXXXXXXXXXX L e Check Form Fri Apr 12 13 39 43 EDT 2013 e Check Payment Received XXXXXXXXXXX 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Rev August 2015 63 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual 8 6 How do I check the status of a submitted form You can use the Document Control Number DCN that is assigned to your form to look up form processing status and view your submitted forms When you open the confirmation email that has the DCN you can click on the DCN in the message to look up the status of your form In addition you may view the form and list of attachments you submitted by clicking on the View Documents button When you are logged into Online Provider Services you can also access the status look up tool by clicking the Get Status button on the Messaging Forms tab You will need to input the DCN to view the status through this screen 8 7 Submitting a Cost Report Form in OPS You can access the Audit and Reimbursement Cost Report Form via the Forms tab in OPS Once on the Forms tab choose Audit and Reimbursement from the Select a Topic drop down menu and Cost Report Form from the Select a Type drop down menu The link to the form should appear in
22. MS information security policies standards and procedures Your usage of this system may be monitored recorded and audited Your use of this information system established your consent to any and all monitoring and recording of your activities Unauthorized user is prohibited and subject to criminal and civil penalties Refer to the Terms of Use RETURNING USER NEW USER Enter your User ID and password to access your account Palmetto GBA is pleased to offer secure and fast access to your Medicare information through our Online Provider Services System Through this system User ID Ys you can view beneficiary eligibility claims status online remittances and Pacoword Ys financial information Forgot or Change Your Password Palmetto GBA offers our Online Provider Services program to providers who have an EDI Enrollment Agreement on file with us One Provider Administrator is Clear allowed to register for each enrollment agreement on file Once Provider Administrators successfully register they can grant access to their associates Get started by clicking the Register Now button Need Help egister want to learn more 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Rev August 2015 8 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual 1 2 How much does Online Provider Services OPS cost There is no cost to the provider for regist
23. Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual 2 11 am getting an error message that I do not have an EDI Enrollment Agreement on file What do I do You can participate in OPS if you have a signed electronic data interchange EDI Enrollment Agreement on file with Palmetto GBA If you receive an error that you do not have an EDI enrollment agreement on file with Palmetto GBA please double check your records and make sure you are choosing the line of business that relates to your EDI Enrollment Agreement The EDI Enrollment Agreement is a form that is included in the EDI Enrollment Packet which can be located under the EDI areas of PalmettoGBA com Medicare 2 12 am a new Medicare provider When can I register New providers must have an Electronic Data Interchange EDI Enrollment Agreement on file with Palmetto GBA and wait until they receive a payment from Medicare to register for Online Provider Services If you are new to Medicare and you call technical support for registration assistance you will be asked to wait until your first Medicare payment is issued to enroll 2 13 What do do if did not receive my validation email Once you register or update your profile you will receive an email with a link to validate your access Make sure that you log out of your profile update before clicking on the link in your email Once this is completed you will be able to log in to Online Provider Services OPS
24. PALMETTO GBA A CELERIAN GROUP COMPANY Online Provider Services User Manual Rev August 2015 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Table of Contents FIEVISION FIISLORY siceccsesssescisccoseneseceseenesenteseseovicisceceesgerevdesaostestaasssedsciesecaesonsccuddsantsedecessudseacssssenees 5 GIGS SAI QING ACTON VIN Sac cca asia rssied cece E E E E EG 6 MeO GEMS Tal I Ora ON en EE EE E 7 1 1 What is Online Provider Services OPS c ccccssssseeeescessseeeeeceesseeesecosseeeseoensseeeseoenes 7 1 2 How much does Online Provider Services OPS cost cccssssssseeesseesseeeseeesseeeeseoeees 9 1 3 Who can participate in Online Provider Services OPS sccssssseecsssseeseenseeseennees 9 1 4 How to report misuse or suspicious use of the Online Provider Services OPS 9 1 5 How do I contact technical SUpport cccccsessseeeeeeeneseeeeeeenseeeeeeeesseeeseoeenseeeseoeeneeessooenes 9 1 6 How do I report a PHI disclosure that occurred in OPS ccccessseeesseeeeeeeeeeneneneeeeeeeeenes 9 1 7 Why can t I view or print information in Online Provider Services OPS 05 9 1 8 When is OPS available and what are the maintenance times secesseessseeeseeeees 9 1 9 Can I use the back button in my browser to view the previous screen in OPS 10 1 10 OPS Lockout and Logout SCENALPIOS ccceesecseeeeeeeenseeeeeee
25. RIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Figure 10 List of Claims Status Information Palmetto GBA Corporate Palmetto GBA Medicare amp PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provider Services 2 User JANE DOE A Provider TEST PROVIDER c Claims Remittance Eligibility Financial Tools Messaging Forms Support Admin My Account You have 2 unread message s and 1 alerts Help List of Claim Status Information XXXXXXXXXXA Provider Number XXXXXXXXXX HIC Number XXXXXXXXXX Claim Status Information Claim Number Date of Service Process Check Claim Status Details Amt Date Number XXXXXXXXXXX 02 08 2013 38 00 02 25 13 XXXXXXXX Claim Status information is not available for this non tink 02 08 2013 assigned claim XXXXXXXXXXX 02 11 2013 38 00 03 07 13 XXXXXXXX Claim Status information is not available for this non tink 02 11 2013 assigned claim XXXXXXXXXXX 02 14 2013 38 00 05 01 13 XXXXXXXX Claim Status information is not available for this non link 02 14 2013 assigned claim XXXXXXXXXXX 02 19 2013 38 00 05 01 13 XXXXXXXX Claim Status information is not available for this non tink 02 19 2013 assigned claim New I 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Rev August 2015 25 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY
26. User Manual Figure 11 Claim Line Details Palmetto GBA Medicare Ne PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provider Services S amp User JANE DOE A Provider TEST PROVIDER i Home Claims Remittance Eligibility Financial Tools Messaging Forms Support Admin My Account You have 2 unread message s and 1 alerts Help List of Claim Status XXXXXXXXXA Information Provider Number XXXXXXXXX HIC Number XXXXXXXXX Claim Status Information Claim Number Date of Service Bill Claim Status Co Ded Blood Paid Diag Amt Ins Ded XXXXXXXXXXX 02 08 2013 38 00 Claim Status information is not available for this non assigned 33 09 0 00 0 00 0 00 02 08 2013 claim Line REV HCPCS Sve Dates Total Allowed Non Denial Text Amount Covered 1 98941 02 08 2013 38 00 33 09 4 91 Charge exceeds our fee schedule or maximum allowable amount AT 02 08 2013 2 G8730 02 08 2013 0 00 0 00 0 00 To obtain the reason for denial please refer to the Medicare 02 08 2013 Remittance Notice 3 G8539 02 08 2013 0 00 0 00 0 00 To obtain the reason for denial please refer to the Medicare 02 08 2013 Remittance Notice Gr uo 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER 4 2 am getting a message that there is no information to display for the date period chosen What should I do If no claims are
27. a it means the beneficiary is not eligible to receive Medicare benefits for the requested period on the inquiry screen The ESRD section only displays active ESRD data and will not be available if notification has not been received by CMS indicating an ESRD period is active The following tables provide information for the Eligibility Benefit tab Part A Eligibility Benefit Information Effective Date A date that indicates the start of eligibility for Medicare Part A benefits Termination Date A date that indicates the termination of eligibility for Medicare Part A benefits No date in this field means Medicare Part A eligibility has not terminated Rev August 2015 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Part B Eligibility Benefit Information Effective Date A date that indicates the start of eligibility for Medicare Part B benefits Termination Date A date that indicates the termination of eligibility for Medicare Part B benefits No date in this field means Medicare Part B eligibility has not terminated Inactive Periods Effective Date A date that indicates the start of an inactive period due to unlawful deported or incarcerated reasons Termination Date A date that indicates the end of an inactive period due to unlawful deported or incarcerated reasons Beneficiary Address The address line 1 of the beneficiary if available The address line 2 of the beneficiary if
28. a eE EE R EE EA ET AN 32 6 1 How do I successfully perform an eligibility inquiry c sssseeessssssseeeseeeeseeesseeeees 33 6 2 How do use the date range optional fields in the eligibility Inquiry tab 35 6 3 How do use the Eligibility sub tab cccccessseesseeeeeeeesseeeseoeenseeeseoeseeeeseoenseeessooenss 36 6 4 How do use the Deductibles Caps Tab ccccssssseccsssessseeesecessseeeeeenseeeeseeeeseeessooenes 38 6 5 How do I use the Preventive tab cccccsssseecsesseeseensseeceenseeeceseeeeosseseoanseesonnseeseonnees 42 6 6 How do I use the Plan Coverage Tab 7 ccccccssssssseeesccesseeeeeeeensseeeseeenseeesseoenseeessonenes 44 6 7 How do I use the MSP Tab as ca rococe cscs cities tic accel euecdccaiae cats etdnccace nnmnnn nnnm nnmnnn nnna 47 6 8 How do I use the Hospice Home Health Tab cccccssssssseeesesessseeeseeessseeeeeeesseeesseoenss 48 6 9 How do use the Inpatient Tab ccccssssessseeesceessseeeeeeensseeeeeoeseeeeeeoeesseesseoenseeeseoonees 51 6 10 When do I need to call the IVR for eligibility information ccsceesessssseeeseeeees 55 7 0 Financial TOOLS vacescessvevececescsnccasvecscccucasnccseccvrcecccsssseaseccscccgeauecesvexeeescnvassesteacrecasasescssasseasesones 55 7 1 How do l use the Financial Tools tab cccsssseessssseeeceeseeesenseesceseeseossessoenseeseonees 55 7 2 What is the payment floor a
29. account is due to complete recertification of access We appreciate your effort to help us keep Medicare data secure 9 3 Do I have to complete profile verification for each of my OPS user IDs Yes Online Provider Services OPS profile verification is completed on the user ID level Users will only be able to verify and or update the profile for the OPS user ID they are currently logged in under 9 4 Do I have to complete recertification for all of my OPS accounts Yes Each PTAN NPI combination must be registered separately in Online Provider Services OPS Therefore recertification of user access is completed on the OPS account level Provider administrators will only be able to recertify access for the active users listed for the PTAN NPI combination associated with their OPS user ID 9 5 How often will profile verification occur To ensure that Medicare data is kept safe CMS requires this process to occur at least once a year 9 6 How often will recertification occur To ensure that Medicare data is kept safe CMS requires this process to occur at least once a year Palmetto GBA must adhere to this requirement in order to continue offering Online Provider Services 9 7 What happens if I do not verify my OPS profile lf your profile has not been verified and or updated within 30 days of entering the profile verification period your access will be restricted to your My Account tab until this process is completed If your profile has
30. addition to the other required fields you must enter a HIC number and the date range of date of service for the claims you seek The claims status date range will default to 45 days from the beginning date You can choose a smaller date range but you cannot choose a larger date range than 45 days lf claims are found for the date range entered you will receive a list of claims found Each claim line will have a link to the claims details See Figure 10 and 11 Retrieving claims information older than six months may take additional time In addition offline claims will not be displayed Many claims are offline after three years sometimes earlier Rev August 2015 24 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Figure 9 Claims Tab Palmetto GBA Corporate Palmetto GBA Medicare Qo PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provider Services amp User JANE DOE Provider TEST PROVIDER Claims Remittance Eligibility Financial Tools Messaging Forms Support Admin My Account You have 0 unread message s and 1 alerts Help Claim Status Inquiry To view claim data for a patient please enter the following information HIC Number Select a Specific Date Range Date From EM X Date To EM x Required Field 9 Submit Clear 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER P
31. al hospice occurrence count for the listed beneficiary If the patient has any gap in their episode of care or changes providers at any time or if their hospice provider has sent the final claim revoking hospice care you will see more than just a single effective date being returned Once the final claim has been submitted the hospice termination or revocation date is returned along with the revocation code If the patient is still in hospice care but has changed providers the start and termination date with each provider will be returned Therefore if no termination date is returned it is to be assumed that the patient is still under hospice care as no claim has yet been processed that revokes that period of care Rev August 2015 49 Qo PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual The Hospice Home Health tab only displays active Hospice and or Home Health data and will not be accessible when there have been no claims received by CMS indicating Hospice or Home Health coverage is active and is in effect per the date s requested To make sure you see all of the information enter a date range in the inquiry screen The HIPAA Eligibility System HETS 270 271 system we are required to access for eligibility allows allow date requests up to 27 months in the past In cases of claim appeals or other scenarios which may involve the need for eligibility information older than 27 months please contact your provide
32. al information Forgot or Change Your Password Palmetto GBA offers our Online Provider Services program to providers who have an EDI Enrollment Agreement on file with us One Provider Administrator is Submit Clear allowed to register for each enrollment agreement on file Once Provider Administrators successfully register they can grant access to their associates Get started by clicking the Register Now button lk inate want to learn more Need Help 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER 3 2 Once I log in some of my tabs are grayed out or cannot be accessed What should I do If you have been granted access by the provider administrator for your office your provider administrator has chosen the tabs you can access Please contact your provider administrator If you are the provider administrator for your office you automatically have access to all the functions If you are the provider administrator and are having problems accessing the tabs please call the Technology Support Center TSC at 866 749 4301 3 3 How do I receive a user ID If you are a provider administrator your user ID is assigned when you register If you are a provider user meaning you have been granted access by your provider administrator your provider administrator will give you a user ID 3 4 What if do not know my user ID If you are a provider user mean
33. allows offset information to be sent electronically to Palmetto GBA Users have the option to request an immediate offset when they receive a demanded overpayment or make a permanent request for all future demanded overpayments More information regarding this is located on the form page The eOffset function can be accessed two ways e Select the Financial Tools tab Then select the eCheck eOffset sub tab e Select the Messaging Forms tab Then from the Go to Page drop down menu select the option for eOffset eCheck Once on the form landing page select the option for eOffset from the Payment Type drop down menu Then select the eOffset form link The form will pre populate the Contract Region Provider Number PTAN and National Provider Identifier NPI fields with the data associated with the user ID that is logged in See Figure 26 Rev August 2015 98 PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Figure 29 eOffset Form Palmetto GBA Corporate Palmetto GBA Medicare Ne PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provider Services 2 User JANE DOE Provider TEST PROVIDER Logout Home Claims Remittance Eligibility Financial Tools Messaging Forms Support Admin My Account You have 1 unread message s and 1 alerts Help Immediate Offset Request Beginning July 1 2012 a new standard imme
34. am an OPS user and I completed profile verification Why am I now receiving a notification that my provider administrator must complete recertification Online Provider Services OPS recertification and profile verification are two separate processes but users may be due for both during the same time frame Please follow the directions in the notification to have your provider administrator complete OPS recertification and prevent termination of access 9 20 I am a provider administrator and completed profile verification Why am now receiving a notification that must complete recertification Online Provider Services OPS recertification and profile verification are two separate processes but users may be due for both during the same time frame Please follow the directions in the notification to complete OPS recertification and prevent termination of access 9 21 My provider administrator completed recertification Why am I now receiving a notification that must complete profile verification Online Provider Services OPS recertification and profile verification are two separate processes but users may be due for both during the same time frame Please follow the directions in the notification to complete OPS profile verification and prevent termination of access 9 22 am a provider administrator and completed recertification Why am I now receiving a notification that must complete profile verification Online Provider Services
35. application pack button or They can select Cancel to stay on the page and remain active or properly logoff lf a user becomes inactive for 30 minutes while logged into OPS their session will timeout If they become active again during that time the session will User is inactive in OPS for 30 remain open until activity stops again in which case the 30 minutes minute inactivity clock starts again After 20 minutes of inactivity the user is prompted with a pop up reminding them of the timeout limit and gives them 10 minutes to become active again before they are logged off 1 11 OPS System Requirements To optimize usability of OPS we recommend that users verify their system adheres to the following requirements Operating System e Windows 7 or later e Mac OS X 10 x or later Supported Internet Browsers e Internet Explorer Version 10 x or later e Mozilla Firefox Version 30 x or later e Google Chrome Version 35 x or later e Safari Version 5 X or later Recommended Screen Resolution 1024 x 768 Additional Requirements e Adobe Acrobat Reader Version X or later or Adobe Acrobat Pro Version X or later e JavaScript enabled e Compatibility view disabled e Pop up blocker disabled Rev August 2015 12 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Please note Although OPS may still be accessible without meeting these requirements only the options ab
36. as been received in OPS You will receive a message when the form is submitted and another message with the Document Control Number DCN when the form has started processing See Figure 30 You can use the DCN to look up form processing status and view your submitted forms If a form is submitted over the weekend the DCN may not be assigned until the next business day Figure 33 Secure Messaging Inbox Palmetto GBA Medicare Qo PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provider Services amp User JANE DOE xs Provider TEST PROVIDER Logout Home Claims Remittance Eligibility Financial Tools Messaging Forms Support Admin My Account Get Status You have 1 unread message s and 1 alerts Help ALERT MESSAGE INBOX ARCHIVED MESSAGES Click on the subject links to view messages Bold links indicate new unread messages Delete Selected _ Message Inbox Table Displaying 1 8 of 28 First Prev 1 2 3 4 Next Last Date Subject DCN F e Check Form Tue Apr 30 10 50 33 EDT 2013 e Check Payment Confirmation XXXXXXXXXXX LI e Check Form Tue Apr 30 10 45 50 EDT 2013 e Check Payment Received XXXXXXXXXXX o e Check Form Tue Apr 30 10 43 03 EDT 2013 e Check Payment Confirmation XXXXXXXXXXX L e Check Form Tue Apr 30 10 41 51 EDT 2013 e Check Payment Confirmation XXXXXXXXXXX Fi e Check Form Tue Apr 30 10 37 58 EDT 2013 e Check Payment Received XXXXXXXXXXX
37. as described in section 5 2 Rev August 2015 30 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual 5 4 I do not see a remittance for the deposit date am searching for What should I do Remittances are listed in OPS by the remittance upload date and not the deposit date so you may need to search a few days earlier or later in the remit list to find the specific remittance you are looking for You will only be able to view remits for the one PTAN NPI combination associated with your user ID If you have additional NPls they will need to be registered separately 5 5 How do print a remittance View your remittance by clicking on the Portable Document Format PDF link in the remittance list You may sort the list of remittances by clicking on the date column header See Figure 13 Once your remittance is displayed click on the print icon in the menu of your Acrobat Reader to print the remittance If you do not have Acrobat Reader software you can download it at no cost You must use Acrobat Reader X or Acrobat Pro X to successfully print remittances in Online Provider Services Figure 16 Remittance Look up Results Palmetto GBA Medicare amp PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provider Services S amp User JANE DOE A Provider TEST PROVIDER o Home Claims Remittance Eligibility Financial Tools Messaging Form
38. ation in the past 180 days complete Provider user or administrator The user will be directed to their My Account tab and will be has not completed profile locked out of other functions of OPS until profile verification is verification in the past 180 days complete If no provider administrators on the account complete the recertification within 210 days the entire account including all users are terminated To regain access to OPS the provider must re register Provider administrator failed to complete recertification within 210 days Rev August 2015 11 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual If a provider user does not complete profile verification at least once every 210 days their account is terminated To regain access the user must have an active provider administrator Provider user or administrator assign them a new user ID and temporary password has not completed profile verification in the past 210 days If no provider administrators on the account complete profile verification at least once in the past 210 days the entire account including all users are terminated To regain access to OPS the provider must re register The user will be prompted with a pop up telling them they have either selected the back button or are trying to improperly logout out of the system They can select OK to continue and get logged off of the User selects the browser s
39. cess lf you are a provider administrator you must call the Technology Support Center TSC at 866 749 4301 to verify your identity and regain access 3 9 Can my Online Provider Services OPS access expire Palmetto GBA and CMS are dedicated to keeping your information safe To achieve this access to Online Provider Services OPS must be limited to users who use the system on a regular basis Palmetto GBA will disable any user ID that has not been used in 60 days per CMS security requirements If you are a provider user and have been given access to OPS by the provider administrator in your office your user ID will be disabled if you or your provider administrator have not logged in within the last 60 days If you are a provider administrator and you have not logged in within the last 60 days your user ID and the user IDs of your provider users will be disabled Rev August 2015 23 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual To keep your OPS access current please log in to OPS with your user ID and password If you have forgotten your password please use the Forgot or Change Your Password link on the returning user screen If you are a provider administrator please log in to make sure the access for your provider users Is not disabled If you have been disabled you will receive the following error message Your OPS access has expired and your user ID is now invalid If you are a provid
40. de Internet Explorer 8 0 note 08 31 2010 Updated 4 1 to include note about processed date and check number 08 31 2010 Updated section 5 0 with more complete eligibility information Updated all sections for J11 MAC relevance 03 21 2011 Updated section 5 0 with date look up information and home health and hospice updates note in eligibility section 6 6 Updated remittance section 5 3 06 06 2013 Updated all sections to coincide with current updates and Version 2 enhancements 07 05 2013 Updated section 3 9 with 60 day lockout information Added sections 1 9 and 3 10 12 10 2013 Removed J1 references and added section for profile verification and recertification 01 09 2014 Updated eligibility section to include information about new fields 03 18 2014 Added section 4 6 03 20 2014 Added note to section 6 0 about the HETS eligibility data update schedule 05 07 2014 Added section 1 10 and updated appeals form verbiage 06 27 2014 Added section 1 11 and 1 12 10 23 2014 Updated password requirements in section 2 2 12 16 2014 Added section 10 5 04 29 2015 Updated compatibility information 05 21 2015 Added section 8 7 and updated attachment information 08 26 2015 Updated J11 references to JM JJ D 2 O m T O lt Rev August 2015 5 Qo PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Glossary and Acronyms Medicare Common Working File EDDC Electr
41. diate offset process is implemented for all Part A providers and all Part B physician and other suppliers This new process allows you to request an immediate offset each time you receive a demanded overpayment or you can make a permanent request for all future demanded overpayments You can elect the immediate offset process to avoid making a payment by check and or avoid the assessment of interest if the immediate offset satisfies the overpayment in full before aging 31 days from the initial demand Please Note An immediate offset request will be processed as soon as possible however this request does not guarantee that interest will not accrue on the overpayment To eliminate the risk of interest accruing your request should be submitted as soon as possible after being notified of the debt as interest automatically accrues 31 days from the date of the initial demand letter REQUESTING AN IMMEDIATE OFFSET To request an immediate offset for an already established account receivable Option 1 Attach copy of the first page of the overpayment demand letter and enter the letter number and all associated Account Receivable Number s Option 2 To request immediate offset for all existing and future accounts receivable choose Yes under the All Eligible ARs heading of this form Conract Region XXXXXXXXXXXXXXXXXXXXXXX Provider Number PTAN XXXXXXXXX National Provider Identifier NPI XXXXXXXXXX Requestor Name Reques
42. displayed for the date period you have chosen you may want to choose a different date range or double check your records to make sure you have entered the correct HIC number Claims that are paid in process returned or denied are displayed Information is retrieved from CMS standard systems and is as current as the standard systems Claims that are offline or returned without processing will not appear The claims status date range will default to 45 days from the beginning date You can choose are smaller date range But you are cannot choose a larger date range than 45 days Retrieving claims information older than six months may take additional time In addition offline claims will not be displayed Many claims are offline after three years sometimes earlier 4 3 I think my claim information is incorrect What should I do If you believe the information is incorrect you must contact your provider contact center Provider contact center telephone numbers are listed in the Contact Us pages of PalmettoGBA com Medicare 4 4 How far back can I look for claims status information Retrieving claims information older than 6 months may take additional time In addition offline claims will not be displayed Many claims are offline after 3 years sometimes earlier The claims status date range will default to 45 days from the beginning date You can choose a shorter date range But you cannot choose a date range longer than 45 days 4 5 am bein
43. do recertify the provider users on my account scat spo eae cite ip sin oe ne gc ane cient AE A A e vee ue sete A OE ance sueee E A 67 9 14 Who Should I recertlfy essensies ananin a a aa aa 67 9 15 How do recertify access for users who are not displaying on my recertification CLO AE S g A ONON EEE E ONTA AEE EE O A N EAO 67 Ne PALMETTO GBA Online Provider Services User Manual A CELERIAN GROUP COMPANY 9 16 I am a provider administrator and mistakenly left off one of my users when I was trying to recertify their access How can I restore their ACCESS cssceeseeesseeeeeeeeeeeees 67 9 17 Once I recertify users am taken to a Terms and Conditions screen How do get back to my account aepmener eemeeterter em menrct Genesee erin artneni en nero mere oir mennun nnmnnn nnnm nnmnnn nnaman tren et 67 9 18 I am receiving a message that my provider administrator must recertify my access How do find out who is listed as the provider administrator for my account 67 9 19 I am an OPS user and I completed profile verification Why am I now receiving a notification that my provider administrator must complete recertification 68 9 20 I am a provider administrator and completed profile verification Why am now receiving a notification that must complete reCertifiCatiOnN sccceeeeeeeeeeeeeeneeeeeeeeenes 68 9 21 My provider administrator completed recertification Why am I now receivin
44. e PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Figure 27 eCheck Form Palmetto GBA Medicare Q PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provider Services amp User JANE DOE A Provider TEST PROVIDER Logout Home Claims Remittance Eligibility Financial Tools Messaging Forms Support Admin My Account You have 1 unread message s and 1 alerts Refund Overpayment Electronic Check e Check Form Provider Information Conract Region XXXXXXXXXXX Provider Name XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX sag nasia XXXXXXXXXXX ae Provider Identifier 31000000000X Provider Address 1 Provider Address 2 Provider City Provider State Provider Zip Code 7 D Provider Phone Number Tax ID XXXXXXXXXXX Contact Name oO Yes we have a Corporate Integrity Agreement with OIG Do you have an overpayment demand Yes O No Did you receive an over payment letter Yes O No Letter Number Account Receivable Number s Please attach your demand letter or other documentation if you do not have a demand letter Attachment 1 jf Browse x Transaction Information Amount Payable Confirm Amount Payable Transaction Fee 0 00 Total Amount to be Paid 0 00 Bank Account Number i Bank Routing Number Acco
45. e cardiac ee rehabilitation sessions used for the technical component Part B Free Services STC Codes The STC codes associated with Part B services that have a 0 co insurance amount Value The patient s portion of responsibility for a benefit represented as a percentage Start Date The start date of the benefit period typically the first day of the calendar year indicated End Date The end date of the benefit period typically the last day of the calendar year Rev August 2015 41 Qo PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Mental Health Co insurance STC Codes The mental health STC codes that are listed as having a co insurance amount that is different than the plan level co insurance Value The patient s portion of responsibility for a benefit represented as a percentage Start Date The start date of the benefit period typically the first day of the calendar year indicated End Date The end date of the benefit period typically the last day of the calendar year 6 5 How do use the Preventive tab The Preventive tab provides information regarding the beneficiary s smoking cessation and preventive services The information on the screen is organized into the Healthcare Common Procedure Coding System HCPCS categories e g Cardiovascular Colorectal and Diabetes See Figure 18 Only HCPCS codes for which a particular beneficiary is eligible will be displayed and grouped together u
46. e you can update or correct your email address and submit If your email address is correct you may click on the link to request a new email Please make sure your email address is correct on your profile before calling Palmetto GBA for assistance lf you are sure your email address is correct but you do not receive your email your company s email security settings may need to be updated to allow incoming emails from Palmetto GBA The email address you will be receiving the validation email from is ops no reply palmettogba com Generic user names are not permitted Each user of OPS must have a unique user ID and password This means that we expect each user to have a legitimate first and last name Generic first and last names are not permitted Examples of generic user names are Front Desk Account Coordinator Billing Department User A or the name of your provider office No sharing of user IDs and passwords is permitted Palmetto GBA will delete without notice any user names we find that are generic You must register each PTAN NPI combination separately If you have multiple NPls associated with a PTAN you must register each PTAN NPI combination Each combination will have a unique user ID Rev August 2015 14 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Figure 2 OPS Registration Screen Palmetto GBA Medicare Ne PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONT
47. eligibility response tabs Rev August 2015 33 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual The optional fields are as follows e Subscriber Name Suffix The beneficiary s suffix may be entered in this field if the beneficiary has it printed on their Medicare health insurance card e Subscriber Gender e Date From e Date To The Subscriber is the patient The patient is also referred to as a beneficiary by Medicare To successfully submit an eligibility inquiry you are required to enter either the Subscriber s First Name or Subscriber s Birth Date in addition to the Subscriber s Last Name and Subscriber Primary ID The Health Insurance Claim Number HICN is the Medicare beneficiary identifier assigned by Medicare When looking at the Medicare Health Insurance card the HICN is the Medicare Claim Number displayed on the card To retrieve all information available you must enter a valid date range The HETS 270 271 system we are required to access for eligibility allows allow date requests up to 27 months in the past In cases of claim appeals or other scenarios which may involve the need for eligibility information older than 27 months please contact your provider contact center Once you have successfully retrieved the beneficiary s information all of the other sub tabs will display information related to that beneficiary Rev August 2015 34 Ne PALMETTO GBA Online Provider S
48. eligibility to receive Medicare benefits based on permanent kidney failure requiring dialysis or a kidney transplant See Figure 16 Rev August 2015 36 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Figure 19 Eligibility Eligibility Tab Palmetto GBA Medicare Q amp Q PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provider Services 2 User JANE DOE A Provider TEST PROVIDER Logout Home Claims Remittance Eligibility Financial Tools Messaging Forms Support Admin My Account You have 0 unread message s and 1 alerts Help Doe John XXXXXXXXXA DOB XX XX XXXX DOD Inquiry Eligibility Deductibles Caps Preventive Plan Coverage MSP Hospice Home Health Inpatient Part A Eligibility Effective Date 09 01 2004 Termination Date Part B Eligibility Effective Date 09 01 2004 Termination Date Inactive Periods Effective Date Termination Date Beneficiary Address Address Line 1 1001 Any Street Address Line 2 Apt 22 State CA End Stage Renal Disease ESRD Effective Date Benefit Description Service Type Code Transplant Discharge Rate Insurance Type 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER If either the Part A Eligibility benefit information or Part B Eligibility benefit information does not contain dat
49. emaining Deductible Amount Part B Deductible Calender Year Deductible Amount Remaining Deductible Amount Part B Deductible Calender Year Deductible Amount Remaining Deductible Amount Co insurance Amount 20 Start Date 01 01 2013 12 31 2013 Co insurance Amount 20 Start Date 01 01 2012 12 31 2012 Co insurance Amount 20 Start Date 01 01 2011 12 31 2011 Blood Deductible Calendar Year Number Of Units Remaining Calendar Year Number Of Units Remaining Calendar Year Number Of Units Remaining Occupational Therapy Cap Calendar Year Amount Used 249 29 Calendar Year Amount Used 3402 97 Calendar Year Amount Used 1870 Physical And Speech Therapy Cap Calendar Year Amount Used 2084 7 Calendar Year Amount Used 3770 03 Calendar Year Amount Used 1057 11 Pulmonary Rehabilitation Services Calendar Year Professional Sessions Remaining Technical Sessions Remaining Cardiac Rehabilitation Services Calendar Year Professional Sessions Used Technical Sessions Used Intensive Cardiac Rehabilitation Services Calendar Year 2014 Professional Sessions Used Technical Sessions Used o Part B Free Services List of STC Codes STC Codes Value Start Date End Date AJ 67 5 42 o 01 01 2014 12 31 2014 AJ 67 5 42 0 01 01 2013 12 31 2013 AJ 67 5 42 o 01 01 2012 12 31 2012 AJ 67 5 42 0 01 01 2011 12 31 2011 Mental Health Co insurance if d
50. emittances please enter the following information Check Number Paid Date X Remit Load Date required Last 30 Days Select Specific Range O Date From Er xX Date To Er X F Submit Clear Note A request for remittance over 30 days old may take additional processing time Thank you for your patience while we process your request Remittances over 1 year old may not be available 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER 5 2 How far back can I view remittances Remittances are readily available for approximately one year If you need to retrieve remittances over one year old Online Provider Services OPS may experience a delay Palmetto GBA does not guarantee that older remittances are available 5 3 do not see remittances online for the date range I have chosen What should I do If you have chosen to view remittances for the last 30 days you will only see those remittances If no remittances are displayed you may want to select a specific date range You will only be able to view remits for the one PTAN NPI combination associated with your user ID If you have additional NPls they will need to be registered separately The remittance date range will default to 45 days from the beginning date You can choose a shorter date range However you cannot choose a longer date range than 45 days Remittances are readily available online
51. er Services S amp User JANE DOE BS Provider TEST PROVIDER Logout Home Claims Remittance Eligibility Financial Tools Messaging Forms Support Admin My Account You have 0 unread message s and 2 alerts Create New User Name First Name Last Temporary Password Permissions D Admin I Claims I Remits 7 Eligibility I Financial Tools I Secure Messaging I Secure Forms I e Check e Offset Forms User s Business Type Choose One gt Return tort clear 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Rev August 2015 70 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Figure 37 Administration Tab Modifying a User Palmetto GBA Corporate Palmetto GBA Medicare amp PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provider Services 3S User JANE DOE A Provider TEST PROVIDER Logout Home Claims Remittance Eligibility Financial Tools Messaging Forms Support Admin My Account You have 0 unread message s and 2 alerts Modify User User ID XXXXX Name First JACK Name Last SMITH Temporary Password Permissions T Admin M Claims M Remits M Eligibility M Financial Tools I Secure Messaging I Secure Forms I e Check e Offset Forms ciear 2013 PALMETTO GBA LLC SITE TUTOR
52. er administrator please register again If you are a provider user please contact your provider administrator for access If you receive this error message and you are a provider user your provider administrator must add you again as a new user You will receive a new user ID from your provider administrator If you receive this error message and you are the only provider administrator on the account you must register again You will receive a new OPS user ID You must also add any provider users to OPS as new users If you are a provider administrator but there are other active provider administrators on your account you must contact one of the active provider administrators The active provider administrator must add you again as a new user You will receive a new user ID for the active provider administrator lt is recommended that all users and provider administrators log into their account at least once every 30 days to keep their access current 3 10 Will my OPS session timeout Yes To be in compliance with CMS security requirements your Online Provider Services OPS session will timeout after 30 minutes of inactivity A notification box will display when you are approaching your inactivity limit 4 0 Claims Status Claims Submission 4 1 How do use the claims status feature If you have access to claims status and are successfully logged in click on the Claims tab The claims status screen will appear See Figure 9 In
53. er an organization or a solo practice Organization 5 Solo Practice Provider Communication Phone Provider Contact Name Number Provider Address 1 Provider Address 2 Provider City Provider State 2 Provider Zip Code Provider NPI 0000000000 Federal Tax D Type SSN EIN Federal Tax D Number Provider Signature Indicator Yes No Accept Assignment Yes No The eClaim form is dynamic so the fields that display will vary based on the data that is entered on the form All required fields will be marked with a red asterisk There are also tool tips that will display as users hover on the field or question mark icon to help them determine how to complete the field Rev August 2015 27 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Figure 13 Claim Submission Tool Tips Home Claims Remittance Eligibility Financial Tools Messages Forms Support Admin My Account Get Status You have 0 unread message s and 0 alerts Help Claims Claim Submission Rejected Claims ls Medicare Primary Or Secondary Primary Secondary Billing Provider Information ls your provider an organization or a solo practice Organization Solo Practice Ao Cheuk We g Provider Communication Phone rovider Contact Name Number Provider Address 1 Provider Address 2 You can hover the mouse EEAS Provider State Fl
54. ering and using Online Provider Services OPS 1 3 Who can participate in Online Provider Services OPS You can participate in OPS if you have a signed Electronic Data Interchange EDI Enrollment Agreement on file with Palmetto GBA The EDI Enrollment Agreement is a form that is included in the EDI Enrollment Packet which can be located under the EDI areas of PalmettoGBA com If you do not have an EDI Enrollment agreement on file with us please go to PalmettoGBA com and select your line of business from the left hand menu Then select EDI from the left hand menu Select Enrollment from the expanded menu for online articles about EDI enrollment Only one provider administrator per EDI Enrollment Agreement related to a PTAN NPI combination performs the registration process The provider administrator grants permissions to additional users related to that PTAN PTAN combination 1 4 How to report misuse or suspicious use of the Online Provider Services OPS If you Suspect misuse or suspicious use of the system contact the Technology Support Center TSC at 866 749 4301 immediately Palmetto GBA reserves the right to terminate any user s access if Suspicious or improper activity is determined Access can be terminated without notice 1 5 How do contact technical support Please use this manual to answer your questions and troubleshoot problems If you need additional support with registering logging in administration or viewing infor
55. ervices A CELERIAN GROUP COMPANY User Manual Figure 18 Eligibility Inquiry Tab Palmetto GBA Medicare Qo PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provider Services 2 User JANE DOE Provider TEST PROVIDER Logout Home Claims Remittance Eligibility Financial Tools Messaging Forms Support Admin My Account You have 0 unread message s and 2 alerts Help Inquiry Eligibility Deductibles Caps Preventive Plan Coverage MSP Hospice Home Health Inpatient New Inquiry You may experience intermittent performance issues when attempting to use the eligibility look up function A high volume of transactions have caused processing delays and higher than normal timeouts within the CMS system that OPS accesses for eligibility data This issue is affecting all eligibility vendors clearinghouses contractors and other third parties that use the CMS eligibility system CMS is working to resolve these issues If you receive a message that the system is unavailable please submit your request again Beneficiary Information Subscriber s Last Name Subscriber s First Name Subscriber Name Suffix Subscriber Gender Subscriber Birth Date EX Subscriber Primary ID HICN Optional Fields for Requesting Historical Data Using Date Range Date From E X Date To Er X Required Field First Name or Date of Birth
56. esseeeseeeenseeesseoenseeeseoeenseessees 10 1 11 OPS System RequireMentS ssscccccsnsnssssccsnssessscccsnsesseccenssasseceenssssaecensesssseeennesseneees 12 1 12 How do I navigate the OPS calendar options using the keyboard cccceeeseeeneees 13 20 RO ONS UE ANON ara ses c se ceate E A E E E 13 2 1 How do providers register for Online Provider Services OPS cccccssssseseeseseeeeeeees 13 2 2 How do choose MY password ccceeeeseceeeeensseeeeeeeeneeeeeeeenseeeeseneaseeeeseoensseeeseosseesseooeeas 15 2 3 How do I choose my security QUESTIONS ccccceeeeeneeeneeeeeeeeeeneeeeneeeeeeeeeeeeeneeeeeeeseeneeness 16 2 4 Someone from my office has already registered How do get access sss 17 2 5 am having trouble with my registration What Should dO cccssssessseeeeeeeeeeeeeeees 17 2 6 have multiple NPIs and PTANs Do I need to register each one ccceeeeeeeeeeeees 17 2 7 How do iind out my PIAN asoras Ea 17 2 8 How GO TDO OUP AVY NPI ina AE EAE 17 2 9 How do find out my tax identification number TIN csececesseeeseesseeeeeeseeseeneees 17 2 10 How do I find out my last payment received ssssssnnnnnnnnunnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn nnna 17 2 11 I am getting an error message that do not have an EDI Enrollment Agreement on Hle What d 1 d0 sissies EE a 18 2 12 am a new Medicare provider When can I register snnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn
57. essly via our website through the OPS application The OPS application provides information access over the Web for the following online services Eligibility Claims Status eClaim Submissions Remittances Online Financial Information payment floor last three checks paid eOffset requests and eCheck payments Appeals Medical Review ADR Response Form Prior Authorization Request Form eDelivery You can participate in OPS if you have a signed Electronic Data Interchange EDI Enrollment Agreement on file with Palmetto GBA Users must have an EDI enrollment agreement on file with Palmetto GBA to participate To find instructions on how to get one go to the EDI section of PalmettoGBA com The OPS home page is https www onlineproviderservices com ecx_improveva Rev August 2015 7 PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Figure 1 Online Provider Services Main Page Palmetto GBA Corporate Palmetto GBA Medicare PALMETTO GBA Gant S A CELERIAN GROUP COMPANY CM S CENTIES POE MEDICARE amp MIDWOAD SECES PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Welcome to Online Provider Services You are accessing a US Government information system The Centers for Medicare amp Medicaid Services CMS maintains ownership and responsibility for this computer system and has allowed Palmetto GBA to provide the services of this system Users of this system must adhere to C
58. g a notification that must complete profile verification ccccssseeeeseeseeeeenseeseeeneeeseees 68 9 22 am a provider administrator and completed recertification Why am now receiving a notification that must complete profile Verification cccssssesesseeeeeeeeees 68 9 23 have completed my profile verification but when I log in I get an error stating that my access to Online Provider Services has been suspended until my provider administrator completes the recertification process How can I get my access restored eee ele ENEE one ee te wc ees ees ee ne es rns cet ne ee aie ee secon coe tena econ E esse se seteeoeaal 68 TOO oana SUN ATION PAA E E E E 68 10 1 How do l administer users sicicccecceccsindeenindacasccusatecnte cwnctcnwendenetedeweunesasbonnbecussecenmndeunbedetate 68 10 2 Who is my provider administrator ssassssnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn nnmnnn 72 10 3 How do I change the provider administrator cccccccssssseeeseeeesseeeeeeeesseeeseeeenneeesees 72 10 4 Can I use generic contact user names for provider administrators or provider USOS a E E E A T E 72 TO DCG i csan E a 72 Qo PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual 06 21 2010 Initial Release 08 31 2010 Updated 1 3 and 2 1 to clarify PTAN NPI combination Added sections 2 6 through 2 11 to clarify registration process 08 31 2010 Updated 3 2 to inclu
59. g told have entered an invalid HIC number What do do You must double check the HIC number It should be entered without spaces dashes or any other special characters Rev August 2015 26 Ne PALMETTO GBA Online Provider Services User Manual A CELERIAN GROUP COMPANY 4 6 Claims Submission Part B users can access the electronic claim submission eClaim feature by accessing the Claim Submission sub tab located under the Claims tab If the Claim Submission sub tab is not displaying the user may not have access to this feature yet While OPS provider administrators will have access to the feature by default provider users must be granted permission by an active provider administrator on their account Additionally new registrants must wait 48 72 hours not including weekends and holidays before the Claim Submission feature is available If the provider administrator still cannot access the Claim Submission sub tab after the 72 hours they will need to call the TSC at 866 749 4301 for assistance Figure 12 Claim Submission Sub tab laims Remittance Eligibility Financial Tools Messages Forms Support Admin My Account Get Status You have 0 unread message s and 0 alerts Help Select the Claims tab and then the Claim Submission sub tab Claims Claim Submission Rejected Claims Is Medicare Primary Or Secondary Primary Secondary Billing Provider Information ls your provid
60. h function is available OPS scheduled maintenance times are also listed below Railroad 8 a m 7 p m ET Railroad 8 a m 7 p m ET Beneficiary Eligibility 24 7 except during established OPS and CMS scheduled maintenance Financial Data JM 8 a m 4 p m ET Railroad 8 a m 7 p m ET If scheduled OPS maintenance is required it will be performed during the times listed below e Monday Friday 6 a m 8 a m ET e Saturday Sunday You may be able to log in to OPS however access to individual functions may not be available e Sunday 5 p m 8 a m Monday ET Our goal is to avoid any service interruptions during normal operating hours However unscheduled maintenance may be necessary in order to immediately address systems security threats or performance issues When you access the OPS website and it is not available you should see a page that indicates maintenance is in progress 1 9 Can I use the back button in my browser to view the previous screen in OPS No When signed into Online Provider Services OPS users should not use the browser s back button Using the back button will cause the user to be logged out of OPS This security requirement ensures the safety of previously viewed submitted data If a user is logged out of OPS due to using the back button the user will just need to log back in 1 10 OPS Lockout and Logout Scenarios The table below discusses some of the most common reasons users ge
61. he IVR for eligibility information The number of psychiatric days remaining and crossover information are not available through the eligibility function of OPS Call the IVR for this information 7 0 Financial Tools 7 1 How do use the Financial Tools tab Open the Financial Tools tab to inquire about your payment floor status and last three checks paid When you first access the screen there will be no information Click the Submit button and information will be retrieved See Figure 23 Figure 26 Financial Tools Tab Palmetto GBA Medicare Qo PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provider Services amp User JANE DOE xs Provider TEST PROVIDER Logout Home Claims Remittance Eligibility Financial Tools Messaging Forms Support Admin My Account You have 1 unread message s and 1 alerts Help Cash Flow Snapshot e Check e Offset Cash Flow Snapshot For Provider Number XXXXXXXXX Payment Floor Status Total Claims 101 Total to be Paid 8652 02 Last 3 Checks Date Paid Amount 05 17 2013 1501 65 05 17 2013 0 00 05 16 2013 2425 23 Submit Clear 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER 7 2 What is the payment floor amount Medicare contractors are required to hold payments for a minimum predetermined number of days The payment floor for electr
62. he terms of use change your password and choose your security questions and answers Once you have successfully completed these steps you will be Rev August 2015 18 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual given access to OPS Figure 4 OPS Registration and Log in Screen Palmetto GBA Medicare Qo PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Welcome to Online Provider Services You are accessing a US Government information system The Centers for Medicare amp Medicaid Services CMS maintains ownership and responsibility for this computer system and has allowed Palmetto GBA to provide the services of this system Users of this system must adhere to CMS information security policies standards and procedures Your usage of this system may be monitored recorded and audited Your use of this information system established your consent to any and all monitoring and recording of your activities Unauthorized user is prohibited and subject to criminal and civil penalties Refer to the Terms of Use RETURNING USER NEW USER Enter your User ID and password to access your account Palmetto GBA is pleased to offer secure and fast access to your Medicare information through our Online Provider Services System Through this system UserID XXXXXXXX you can view beneficiary eligibility claims status online remittances and Password eecececceecce financi
63. hrough our Online Provider Services System Through this system User ID you can view beneficiary eligibility claims status online remittances and Password financial information Forgot or Change Your Password Palmetto GBA offers our Online Provider Services program to providers who have an EDI Enrollment Agreement on file with us One Provider Administrator is Clear allowed to register for each enrollment agreement on file Once Provider Administrators successfully register they can grant access to their associates Get started by clicking the Register Now button want to learn more 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Figure 6 Password Reset Enter User ID Palmetto GBA Medicare O PALMETTO GBA Password Reset Enter User ID El submiz ciear Need Help Return to Login 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Rev August 2015 21 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Figure 7 Password Reset Validate Answering Validation Question Palmetto GBA Medicare Ne PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Password Reset Validate User ID XXXXXXX Validation Question 1 In what city was your father born Validation Answer 1 Validation Q
64. ifferent from the plan level Co insurance List of STC Codes STC Codes Value Start Date End Date AK AI A8 A4 35 01 01 2013 12 31 2013 AK AI A8 A4 40 01 01 2012 12 31 2012 AK AI A8 A4 45 01 01 2011 12 31 2011 2014 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Rev August 2015 39 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual The following tables provide information for the Deductible Caps Tab Part B Deductible Information Calendar Year The calendar year associated with the deductible amounts amount associated with the calendar year The Medicare Part B remaining deductible amount associated with the calendar year indicated Co insurance Amount benefit represented as a percentage the first day of the calendar year indicated typically the last day of the calendar year Blood Deductible Information sz Year ise aire ape irmvaeer aaa calendar year associated with the ee ee a deductible amount Number of Units Remaining The blood deductible units remaining associated with the calendar year indicated Occupational Therapy Cap Information Calendar Year The calendar year associated with the used dollar amount applied to the capitation limit Amount Used Occupational Therapy services used dollar amount applied to the capitation limit associated with the calendar year indicated Physical and Speech Therapy
65. ification for each of my OPS user IDS 0 65 9 4 Do I have to complete recertification for all of my OPS accounts eeseeeeee 65 9 5 How often will profile verification OCCUr ssssssnnunnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn nnmnnn 65 9 6 How often will recertification OCCUP ccccccessseeseesseeecesnseeseenseeeceaseeseoaseessonnseeseonees 65 9 7 What happens if do not verify my OPS profile cccccesseeeeeeeeeeeeeeeeeeeeseeeeeeeeeneeeees 65 9 8 What happens if a provider administrator does not recertify user access 66 9 9 What do do if I did not receive my validation email ccccceeeeeseeteeeeeeeeeeeeeeeeeeeees 66 9 10 have requested a new validation email several times but never receive it What do need to do to complete OPS profile verification cccsssseessesseeeeeesseeecenseeseenees 66 9 11 have completed OPS profile verification but when I log in get the message that my account has not been verified What do I need tO dO cccssseeecesseeeeeenseeseeeneeeseees 66 9 12 have clicked on the link in my validation email and I got the error message This user is already logged in or failed to logout properly How can I log back into my Tex 21010 A eee mee ere cee nee iene nearer rer er enc enTne ee cena ee Oana er ees eo rae creer se renee ae ame eran ane ren 67 9 13 I am a provider administrator how
66. ims status feature cccccsseseeecesseeeseenseeecenseeseenseeesoenseeseoanees 24 4 2 am getting a message that there is no information to display for the date period chosen What should I dO ies aic de sssicct cscs tec cceeia ds decease retenuade ive csedesteseeesaweslasneuataxestececen 26 4 3 think my claim information is incorrect What Should dO cscccssssssseeeseeeneees 26 4 4 How far back can I look for claims Status information cccsceeeeesseesesseeeeeeeeeeeeeees 26 4 5 I am being told have entered an invalid HIC number What do I do 2008 26 Ne PALMETTO GBA Online Provider Services User Manual A CELERIAN GROUP COMPANY 4 6 Claims SUDMISSION coca cee eects cece toes teeceaessete aai aaia 27 S0 REMANC ES cece scou cece vacsecvee E ET E E 29 5 1 How do access remittances online ccccceesseecesseeecesneeeeeenseesceseeseosseesoenseeseeanees 29 5 2 How far back can I view remittances cccceseseeseeeseeseeeseeeeeenseescenseeseosseesoenseeseoanees 30 5 3 I do not see remittances online for the date range I have chosen What should I do sei a ete E es sete S A E E gains weweeeeuenseeeecedeigneeeces 30 5 4 I do not see a remittance for the deposit date am searching for What should I do Sees cele ane ee E E A te sats su se aptan ate E E 31 5 5 HOW d I piint a remittance 2 ecacece cicada cansenreee case caved aaa Ei 31 OO ENCOUN soiree erroni r
67. ing you have been granted access by your provider administrator contact your provider administrator if you do not know your user ID If you are a provider administrator and you cannot find your user ID please call the Technology Support Center TSC at 866 749 4301 Rev August 2015 19 V PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual 3 5 What happens if cannot log into Online Provider Services OPS You must enter your password exactly as it was entered when you chose it If you do not remember your password you can click on the Forgot or Change Your Password link from the returning user box of the OPS introduction screen See Figure 5 You will be presented with two security questions to answer You must answer both security questions correctly to reset your password See Figures 6 7 amp 8 Keep in mind that if you attempt to log in incorrectly three times you will be locked out for an hour If you are locked out three times in a row your access will be revoked If you are a provider user meaning you have been granted access by the provider administrator for your provider contact your provider administrator to verify your identity and regain access If you are a provider administrator you must call the Technology Support Center TSC at 866 749 4301 to verify your identity and regain access You can verify or change your security questions and answers through your My Account tab once you a
68. iry screen The HETS 270 271 system we are required to access for eligibility allows allow date requests up to 27 months in the past In cases of claim appeals or other scenarios which may involve the need for eligibility information older than 27 months please contact your provider contact center Figure 23 Eligibility MSP Tab V PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provider Services amp User JANE DOE Bs Provider TEST PROVIDER Logout Home Claims Remittance Eligibility Financial Tools Messaging Forms Support Admin My Account You have 0 unread message s and 2 alerts Help Doe John XXXXXXXXXA DOB XX XX XXXX DOD Inquiry Eligibility Deductibles Caps Preventive Plan Coverage MSP Hospice Home Health Inpatient Medicare Secondary Payer Effective Date Termination Date Insurer Name Policy Number Type of Primary Insurance Address Line 1 City Address Line 2 State Zip Code Effective Date Termination Date Insurer Name Policy Number Type of Primary Insurance Address Line 1 City Address Line 2 State Zip Code 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Rev August 2015 47 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual The following table describes the MSP fields MSP Infor
69. ity for complete beneficiary entitlement information All information provided in the Plan Coverage tab is based on what is or is not entered in the date range fields in the Inquiry tab If you are looking for prior year information adjust your date ranges accordingly Information is available for 27 months from the current date Rev August 2015 44 WE PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Figure 22 Eligibility Plan Coverage Tab Palmetto GBA Medicare Q amp Q PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provider Services 2 User JANE DOE Provider TEST PROVIDER Logout Home Claims Remittance Eligibility Financial Tools Messaging Forms Support Admin My Account You have 0 unread message s and 2 alerts e Doe John XXXXXXXXXA DOB XX XX XXXX DOD Inquiry Eligibility Deductibles Caps Preventive Plan Coverage MSP Hospice Home Health Inpatient Medicare Advantage Plan Type Enrollment Date Disenrollment Date Contract Number Plan Benefit Package ID Plan Name Address Line 1 Phone Number Address Line 2 City State Zip Code Bill Code Medicare Part D Enrollment Date Disenrollment Date Contract Number Plan Benefit Package ID Plan Name Address Line 1 Phone Number Address Line 2 City State Zip Code Enrollment Website Drug Plan Enroll
70. liest billing activity for the spell of illness DOLBA Date The date of latest billing activity for the spell of illness Full SNF Days The full SNF days remaining in the spell Full SNF Co Pay Days The full SNF co payment days remaining in the spell Inpatient Base Summar the calendar year requested Full Co payment Days Allowed The number of inpatient full co payment requested for the calendar year requested Deductible The amount of the inpatient deductible for Pee recta year requesida SNF Base Summar Calendar Year The calendar year requested SNF Full Days Allowed The number of SNF full days allowed for the calendar year requested SNF Full Co payment Days Allowed The number of SNF full co payment days allowed for the calendar year requested SNF Co pay Amount The amount of the SNF co payment for the calendar year requested Lifetime Reserve Days Lifetime Days Allowed The number of lifetime reserve days allowed Lifetime Days Remaining The number of lifetime reserve days remaining Calendar Year The calendar year requested SNF Co pay Amount The co payment amount per lifetime reserve day Rev August 2015 D4 Ne PALMETTO GBA Online Provider Services User Manual A CELERIAN GROUP COMPANY Psychiatric Benefit Data Lifetime Psychiatric Base Days The number of lifetime psychiatric days allowed Lifetime Psychiatric Remaining The number of lifetime psychiatric days remaining 6 10 When do I need to call t
71. mation Effective Date The date that indicates the start of the primary insurer s Coverage Termination Date The date that indicates the termination of the primary insurer s coverage No date in this field means primary insurance coverage has not terminated Insurer Name The name of the insurance company number for the Medicare beneficiary Type of Primary Insurance 12 Medicare Secondary Working aged beneficiary or soouse with employer group health plan 13 Medicare Secondary End stage Renal Disease Beneficiary in the 12 month coordination period with an employer group health plan 14 Medicare Secondary No Fault insurance including auto is primary 15 Medicare Secondary Workers Compensation 16 Medicare Secondary Public Health Service PHS or other Federal Agency 41 Medicare Secondary Black Lung 42 Medicare Secondary Veteran s Administration 43 Medicare Secondary Disabled beneficiary under age 65 with large group health plan 47 Medicare Secondary Other liability insurance Is primary WC Workers Compensation Medicare Set aside Arrangement Address Line 1 The address line 1 of the insurance company Address Line 2 The address Line 2 of the insurance company ZIP Code The ZIP code of the insurance company 6 8 How do I use the Hospice Home Health Tab The Hospice Home Health tab includes two sections See Figure 21 e Home Health Care e Hospice Rev August 2015 48
72. mation on our application contact the TSC at 866 749 4301 1 6 How do I report a PHI disclosure that occurred in OPS If you are able to view PHI for an organization other than the one associated with your user ID please contact the Technology Support Center TSC at 866 749 4301 immediately Please provide the date and time the error occurred in addition to all other details of the disclosure during your call If the PHI has been printed or saved please make sure these copies are properly destroyed and or deleted 1 7 Why can t I view or print information in Online Provider Services OPS Please make sure that your system meets our minimum system requirements as outlined in Section 1 11 You will also want to make sure your JavaScript is enabled In Internet Explorer go to the Tools menu click on Internet Options go to the Security tab and click Reset all zones to default Some Web browser add ons or your security software may be blocking Web page scripts Check your Web browser settings and help sections to troubleshoot display problems 1 8 When is OPS available and what are the maintenance times Online Provider Services OPS will generally be available 24 hours a day seven days a week However access to OPS does not guarantee that all functions will be available Rev August 2015 9 V PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Refer to the availability times below for times when eac
73. ment Date Disenrollment Date Contract Number Plan Benefit Package ID Plan Name Address Line 1 Phone Number Address Line 2 City State Zip Code Enrollment Website Drug Plan Enrollment Date Disenrollment Date Contract Number Plan Benefit Package ID Plan Name Address Line 1 Phone Number Address Line 2 City State Zip Code Enrollment Website Drug Plan 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Rev August 2015 45 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Part D contracts provide prescription drug coverage Part C contracts will return whether the MA is a Health Maintenance Organization Medicare Non Risk HM a Health Maintenance Organization Medicare Risk HN an Indemnity IN a Point of Service PS a Preferred Provider Organization PR or a Pharmacy Part D The response will display only the most current plan description HM HN IN PS PR or Part D and Plan Type Code for a contract This may happen if a contract s plan description and Plan Type Code has changed since the beneficiary Originally enrolled Providers are advised to contact the plan provider if there is any question about the plan s terms and conditions The table below describes the Plan Coverage fields Plan Coverage Information Plan Type A full plan description followed by Plan T
74. mount ssssnnnnnunnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn nnmnnn 55 FOWD IS OCMOCK crnina E E E 56 1 4 What is GOHSOT osiris a aa aia aaa 58 8 0 Secure Messaging and FOrMS essseessecessocessoeesoceesocessoceesoeessocesoceesocessocessoeessoeesseeessoee 60 8 1 What is secure messaging and secure formS ccccceeeseeeeeeeeesseeeeeeeeneeeeeeeesseeesseoenneees 60 8 2 How do l access secure formS ccceeeseeeceeneeeeeenseeseenseeseeanseesenseeseeaseeseonssessonnseeseoanees 60 8 3 How do I submit a form s nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn nnmnnn nnnm nnmnnn nnna 61 8 4 How do upload attachments in secure fOrmS ccceeeesseeeeeeeesseeeeeeeeseeeeseeeeneeessenenneees 63 8 5 How will I know my form has been received in OPS cccsssssseeessssssseeeeeeesseeeeseeenseees 63 8 6 How do I check the status of a submitted form ssaannuunnnnnnnnnnunnnnnnnnnnnnnnnnnnnnnnnnn nnmnnn 64 8 7 Submitting a Cost Report Form in OPS ccccessseseesneeeeeeeeeeeeesseeeeeeeeeeeeesseeeeeeeseoeeenees 64 9 0 Profile Verification and Recertification eessecesssoceessccessscoccesococeesocceesooceessoceessoceesosee 65 9 1 Why am I being asked to complete OPS profile verification ccccsssssseeeseeseseees 65 9 2 Why am I being asked to complete OPS recertification ccccsessseeeeeeeesseeeeeeeeseees 65 9 3 Do I have to complete profile ver
75. n the Forgot or Change Your Password link from the returning user box of the OPS introduction screen You will be presented with two security questions to answer You must answer both questions correctly to reset your password If you want to change or verify your security questions and answers you can update it through your My Account tab once you are logged in Keep in mind that if you attempt to login incorrectly three times you will be locked out for three hours If you are locked out three times in a row your access will be revoked If you are a provider user meaning you have been granted access by the provider administrator for your provider contact your provider administrator to verify your identity and regain access If you are a provider administrator you must call the Technology Support Center TSC at 866 749 4301 to verify your identity and regain access You cannot change your password more than one time for every 24 hour period 3 8 I left the system without logging out and now I cannot get back in What should I do A log out link is located in the upper right of each screen once you have logged in You must log out to end your session If you do not log out your user ID will be locked for one hour If you continue to be locked out and you are a provider user meaning you have been granted access by the provider administrator for your provider contact your provider administrator to verify your identity and regain ac
76. n the Admin tab 2 5 am having trouble with my registration What should I do Only one provider administrator per provider can register for Online Provider Services OPS If an administrator from your office has already registered please contact that person for access to OPS If you are the provider administrator and your registration information is entered in an incorrect format the OPS application will display an error message in red at the top of your screen Carefully read that error message and enter the information again Providers who have a Do Not Forward DNF on file with Palmetto GBA will not be able to register until the DNF is lifted If you are sure you entered all information correctly and cannot register make sure you have an EDI enrollment agreement on file with CMS If you do not please access the EDI section of PalmettoGBA com for helpful articles about how to complete the EDI agreement If you are sure you have an EDI agreement on file but still cannot register please call the Technology Support Center TSC at 866 749 4301 2 6 have multiple NPIs and PTANs Do I need to register each one You must register for each PTAN NPI combination If you have multiple NPIs associated with a PTAN you must register each PTAN NPI combination separately Each combination will have a unique user ID 2 7 How do find out my PTAN You must have a Provider Transaction Account Number PTAN to register for Online Provider ser
77. n your home page If you are a provider user you must be granted permission to these tabs by your provider administrator OPS users have the ability to submit appeals forms a refund overpayment eCheck an Immediate Offset Request eOffset a Prior Authorization form and Medical Review ADR Response form along with attachments through OPS Once you have submitted the form you will receive a message either advising you on how to correct the form for resubmission or that the form was received by Palmetto GBA Once the form has been accepted into our processing system the received date will be assigned and an additional message will be generated with the Document Control Number DCN If a form is submitted over the weekend the DCN may not be assigned until the next business day 8 2 How do access secure forms If the secure forms function is available for you you will see a Messages and Forms tabs as part of the menu once you successfully log in If you do not have permission to these tabs they will appear grayed out Select the Forms tab to access the secure forms page Use the Go to Page drop down box to access forms available to you You must answer the questions on the page The forms available will appear as links at the bottom of the page See Figure 28 Select the link to access the secure form Rev August 2015 60 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Figure 31 Secure Form
78. nal provider administrators Any access granted and maintained by the provider administrator is the sole responsibility of that provider administrator Palmetto GBA has no responsibility for maintaining provider user access and permission to the data assigned to them by the provider administrator See Figures 31 32 and 33 Figure 35 Administration Tab List of Provider Users Palmetto GBA Medicare Ne PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provider Services 2 User JANE DOE A Provider TEST PROVIDER Logout Home Claims Remittance Eligibility Financial Tools Messaging Forms Support Admin My Account You have 0 unread message s and 2 alerts Help Provider User Listing A listing of all registered users associated with your provider account Registered Users First Name Last Name User ID Type Actions JANE DOE XXXXX Admin Edit Delete JIM SMITH XXXXX2 Edit Delete JOHN JONES XXXXX3 Edit Delete JACK PETERSON XXXXX4 Edit Delete 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Rev August 2015 69 D PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Figure 36 Administration Tab Creating a New User Palmetto GBA Medicare Qo PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provid
79. nder their appropriate categories If a service has been rendered it is removed from the list until closer to the time the beneficiary is eligible to receive the service again Rev August 2015 42 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Figure 21 Eligibility Preventive Tab Palmetto GBA Corporate Paksais GBA pong V PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES Online Provider Services S amp User JANE DOE BS Provider TEST PROVIDER Logout You have 0 unread You have 0 unread message s and 2 alerts 0 and 2 alerts o o Doa John XXXXXXXXXA DOB XX XX XXXX Smoking Cessation Number of Sessions in Benefit Period Benefit Period Sessions Remaining 01 01 2011 01 01 2011 01 01 2002 01 01 2002 07 01 2001 07 01 2001 01 01 2005 01 01 2005 07 01 2001 07 01 2001 01 01 2007 01 01 2007 07 01 2001 07 01 2001 01 01 1998 01 01 1998 07 01 2009 07 01 2009 01 01 2004 01 01 2004 07 01 2007 07 01 2007 01 01 1999 01 01 1999 01 01 2005 01 01 2005 11 08 2011 11 08 2011 10 14 2011 10 14 2011 07 01 2001 07 01 2001 01 01 2005 01 01 2005 07 01 2005 07 01 2005 01 01 2005 01 01 2005 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Rev August 2015 43 V PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual
80. ne Provider Services A CELERIAN GROUP COMPANY User Manual Figure 25 Eligibility Inpatient Tab Palmetto GBA Corporate Palmetto GBA Medicare Qo PALMETTO GBA EMS A CELERIAN GROUP COMPANY CENTIES POM MEDICARE amp MEDICAID SERVICES PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH User JANE DOE Bs Provider TEST PROVIDER Online Provider Services Logout Home Claims Remittance Eigibiity Financial Tools Messages Forms Support Admin My Account You have 0 unread message s and 0 alerts Help Smith John J XXXXXXXXXX DOB MM DD YYYY DOD MM DD YYYY Inquiry Eligibility Deductibles Caps Preventive Plan Coverage MSP Hospice Home Health Inpatient Deductible Remaining By Spell DOEBA Date DOLBA Date 04 12 2013 04 25 2013 07 13 2011 10 04 2011 Inpatient Days Remaining By Spell DOEBA DOLBA 04 12 2013 04 25 2013 07 13 2011 10 04 2011 SNF Days Remaining by Spell DOEBA DOLBA 04 12 2013 04 25 2013 07 13 2011 10 04 2011 Inpatient Base Summary Calendar Year Full Days Allowed 2013 60 2012 60 2011 60 SNF Base Summary Calendar Year SNF Full Days Allowed SNF Full Copayment Days Allowed 2013 20 2012 20 2011 20 Lifetime Reserve Days Calendar Year Copayment Amount Per Day Calendar Year Copayment Amount Per Day Calendar Year Copayment Amount Per Day Psychiatric Benefit Data Lifetime Psychiatric Base Days Lifetime Psychiatric Remaining 2014 PALM
81. nnnnnn 18 2 13 What do I do if I did not receive my validation email cscccsessesseeeeeeesseeeeseeeees 18 SO LOO eean E E 18 3 1 How do l log in to Online Provider Services OPS cccsssssseeescsessseeeeeeesseeeeseeneeees 18 3 2 Once I log in some of my tabs are grayed out or cannot be accessed What should 0 8 E AE A E E A E E E E E 19 3 3 How do l receive a user ID nannnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn nnmnnn nenna mnnn mnnn nnna 19 3 4 What if do not know my user ID cecceeseeeesseeeeeeeenseeeseeeenseeeseoesseeeeeeoensseesseoenseeeseooenes 19 3 5 What happens if I cannot log into Online Provider Services OPS essess00 20 3 6 cannot answer my security questions What Should dO cccseseeeeeeeseeeeeneees 23 3 7 How do Change MY password cccseesseeeeeeeesseeesceensseeeeeeensseeeeeoeesseeseeoenseeeeseoenseeeseooenes 23 3 8 I left the system without logging out and now I cannot get back in What should ease ee ese rece create AE E eee es peak cee etn E seine eee E E 23 3 9 Can my Online Provider Services OPS access expire ccccssseeeeesseeeeeenseeseeneees 23 3 10 Will my OPS SESSION timeout siscinscccemneccinciacscuvaecscsnsreeewstssncndeuesusicaudemanclewseeeavendsxucseacesees 24 4 0 Claims Status ClaiMS SUDMISSION sscccssssccssssscsssssccsssscssssssssssssssssssssssssssssesees 24 4 1 How do l use the cla
82. o not unlock accounts that are in the lock out period 9 13 I am a provider administrator how do I recertify the provider users on my account Once you have been notified that your account is in the recertification period you may recertify access for all users including additional provider administrators from your Admin tab Please check the boxes next to all users who need their access recertified Any IDs left unchecked will be permanently deactivated Failure to recertify access for at least one provider administrator will result in termination of the entire account 9 14 Who should I recertify Provider administrators should only recertify access for users who should still have access to Online Provider Services OPS Users must have also participated in basic security awareness training within the past year as outlined in the OPS Terms of Use Any user IDs left unchecked will be permanently deactivated Failure to recertify access for at least one provider administrator will result in termination of the entire account 9 15 How do recertify access for users who are not displaying on my recertification screen Provider administrators can only recertify access for users who have an active user ID for the PTAN NPI combination that corresponds to the user ID they are logged in with They must recertify access for each PTAN NPI combination separately Provider administrators can grant access for any additional users who are not currentl
83. onic Data Interchange gt gt SS o EDI Enrollment Agreement This agreement must be completed by each provider prior to submitting electronic media claims EMC or other EDI transactions to Medicare It is also required to participate in Online Provider Services ESRD ___________________ Endsstage Renal Disease o FAQ Frequently Asked Question _ S HHEH Hom Health Episode Period The Health Insurance Portability and PPA aoouaomyasioniaos n n OOOO The Online Provider Services application This application is available through the Palmetto GBA website m National Provider Identifier The NPI is a unique identification number for covered health care providers Provider administrator The provider representative who registered and who has the authority to add users Provider user A person who has been granted permission by the provider administrator to access information for that provider Provider Contact Center PTAN Provider Transaction Access Number Also called a legacy number or Medicare PIN SNF Skilled Nursing Facility Tax Identification Number Also called a TIN Rev August 2015 6 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual 1 0 General Information 1 1 What is Online Provider Services OPS OPS is an Internet based provider self service secure application Palmetto GBA s goal is to give the provider secure and fast access to their Medicare information seaml
84. onic claims is 14 days and the payment floor for paper claims is 29 days This tab refers to all claims in process and awaiting the Rev August 2015 55 Qo PALMETTO GBA Online Provider Services User Manual A CELERIAN GROUP COMPANY payment floor as of the date of the look up These are payments that have been approved but have not yet been released for payment 7 3 What is eCheck The eCheck function allows payments to be sent electronically to Palmetto GBA Only check payments are accepted through this form eCheck utilizes PHT A Claim technology to make the payment with your financial institution Submitting the form through OPS automatically enters your information into Palmetto GBA s workflow management system iFlow for processing according to current Medicare guidelines There is no transaction fee for submitting a check payment The eCheck function can be accessed two ways e Select the Financial Tools tab Then select the eCheck eOffset sub tab e Select the Messaging Forms tab Then from the Go to Page drop down menu select the option for eOffset eCheck Once on the form landing page select the option for eCheck from the Payment Type drop down menu Then select the eCheck form link The form will pre populate the Contract Region Provider Number PTAN and National Provider Identifier NPI fields with the data associated with the user ID that is logged in See Figure 24 Rev August 2015 96 N
85. ove are supported Failure to meet these requirements may adversely affect the functionality and layout of OPS 1 12 How do I navigate the OPS calendar options using the keyboard To navigate the calendar options in OPS users may utilize the following keyboard shortcuts e Page Up Move to the previous month Page Down Move to the next month Ctrl Home Move to the current month Open the date selector if closed Ctrl Page Up Move to the previous year Ctrl Page Down Move to the next year Ctrl Left Move to the previous day Ctrl Right Move to the next day Ctrl Up Move to the previous week Ctrl Down Move to the next week Enter Select the focused date Ctrl End Close the date selector and erase the date Esc Close the date selector without selection 2 0 Registration 2 1 How do providers register for Online Provider Services OPS You can participate in OPS if you have a signed Electronic Data Interchange EDI Enrollment Agreement on file with Palmetto GBA Only one provider administrator per EDI Enrollment Agreement may register for OPS The provider administrator may then grant access to the different features of the application to their associates who are provider users The provider administrator also has the ability to assign additional provider administrators by selecting the Admin permission for the user If you are a provider user you must contact the provider administ
86. owse X Name Date 05 22 2013 Required Field Clear AP J11 B 1000 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Rev August 2015 62 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual 8 4 How do I upload attachments in secure forms You may add up to five attachments to each form Each attachment can be up to five megabytes MB in size All attachments must be PDF documents Most scanners have the ability to save documents in the PDF format If you receive an error when uploading the file your form will refresh with the error listed at the top of the page and the PDF will no longer be attached Errors can occur if the PDF is corrupt or if it was not created using PDF software For example you cannot change a file extension to PDF It will not be in the correct PDF format and you will be unable to upload it If your file is over five MB you will want to break it down into smaller files in order to attach it to your form You can do this through your PDF software or by changing your original files and creating the PDFs again For MR ADR Response Cost Report Appeals eCheck and eOffset forms OPS users may submit attachments up to 40 MB in size While there is no longer a limit to the number of files that can be attached to this form the combined size of all attachments cannot exceed 150 MB 8 5 How will know my form h
87. provider user by deselecting the Admin box in the role selections of the user s profile Do not delete the provider administrator before assigning an additional provider administrator If you do this your record must be removed and you must register again To request that your record be removed please contact the Technology Support Center TSC at 866 749 4301 Palmetto GBA has the right to terminate any user s access if Suspicious or improper activity is determined Access may be terminated without notice 10 2 Who is my provider administrator If you do not Know who the provider administrator is contact the provider s staff to find out if they have registered to the system and who Is designated as the provider administrator If you are a provider administrator you can see who is designated as provider administrators on the Admin tab 10 3 How do I change the provider administrator If you are a provider administrator and are leaving the office or are no longer functioning as the provider administrator you must assign an additional provider administrator before leaving the role Once a new provider administrator is assigned he or she can log in and delete the old provider administrator or change the provider administrator to a provider user by deselecting the Admin box in the role selections of the user s profile Do not delete the provider administrator before assigning an additional provider administrator If you do this your reco
88. r assign them a new user ID and temporary password lf an error is encountered during the registration process e g incorrect payment amount entered the account will be locked for 60 minutes This is a CMS security requirement The provider may attempt to re register after the 60 minute time period has expired We are unable to unlock accounts that are in the 60 minute lockout period User enters registration information incorrectly three times User tries to register three times before the 60 minute registration lockout has expired The provider s registration record is locked indefinitely The or user will receive a message that they need to call in and verify their identity Please call 866 749 4301 for assistance User tries to incorrectly register and goes through the 60 minute registration lockout three times A registered user who already has a user ID is locked out of their account because of improper log out The user must wait for the 15 minute lockout period to expire before attempting to log in again We are unable to unlock IDs that are in the 15 minute lockout period All users are locked out of their account and must contact one of the active provider administrators on the account to complete recertification and restore access Provider administrators are directed to the recertification screen and will be locked out of other functions of OPS until recertification is Provider administrator has not completed recertific
89. r contact center The tables below describe the Home Health and Hospice Information fields Home Health Information period started terminated illness illness home health facility the source of the provider number home health care services The date the beneficiary was recertified to receive home health care services Rev August 2015 50 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Hospice Information Total Occurrence Count Total number of hospice occurrences on file for the beneficiary including those listed for the period of hospice coverage Termination Date The termination date of a beneficiary s elected hospice coverage No date in this field means the beneficiary s elected period of hospice coverage has not terminated Hospice Facility the source of the provider number for the spell listed 6 9 How do I use the Inpatient Tab The Inpatient sub tab includes Inpatient Skilled Nursing Facility SNF and Psychiatric Benefit Data sections The inpatient section provides hospital inpatient benefit and billing information The SNF section provides SNF benefit and billing information See Figure 22 While the Psychiatric Benefit Data section now displays in Online Provider Services OPS the data is not yet available in CMS HIPAA Eligibility Transaction System HETS 270 271 system we are required to access for eligibility Rev August 2015 51 Ne PALMETTO GBA Onli
90. rator for your provider to request access to the system It s easy to register Just go to the OPS link from PalmettoGBA com You ll see the OPS introduction screen You must enter the information listed below to register e Provider name e Contact name The person assigned to this user ID e Email address e Phone number e Extension e Provider billing service or clearinghouse indicator e PTAN e NPI e Tax ID e Most recent Medicare payment amount received If you have several payments received in one day use the amount related to the highest check number e Line of business choose from drop down selections e Billing service clearinghouse information if required You must also agree to the Terms of Use to register If you have entered registration information in an incorrect format the OPS application will display an error message in red at the top of the screen Carefully read that error message and enter the information again If the information you enter matches the information on file with Palmetto GBA you will be able to choose a password and security questions and answers Rev August 2015 13 V PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Once this is completed you will receive an email at the email address you registered You must access the email and click on the validation link If you do not click on the validation link and you try to log in you will see the profile screen wher
91. rd must be removed and you must register again 10 4 Can I use generic contact user names for provider administrators or provider users Generic contact user names are not permitted Each user of Online Provider Services must have a unique user ID and password This means that we expect each user to have a legitimate first and last name associated with each user ID Examples of generic user names are Front Desk Account Coordinator Billing Department User A or the name of the provider office No sharing of user IDs and passwords is permitted Palmetto GBA will delete without notice any user IDs that are associated with a generic user name 10 5 eDelivery Rev August 2015 72 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Provider Administrators may select to receive letters electronically through OPS After navigating to the admin tab the user will have the option to select the eDelivery Preferences sub tab Figure 38 Administration Tab Selecting eDelivery Preferences Go To page ou have 15 unread message s and 0 ale caed Fom y User Listing Add New User eDelivery Preferences MR ADR US Mail v L From this sub tab providers can opt to receive their letters by US mail or through OPS via eDelivery For providers enrolled in eDelivery a secure inbox message will be sent with a link to the letter There is also a User Pref email Notification option that allows the user to
92. re logged in You cannot change your password more than one time for every 24 hour period Keep in mind that if you are logged in to OPS and you want to exit click on the log out link in the upper right of every page If you do not do this you will be locked out for one hour We do not unlock accounts that are in the one hour lockout period Rev August 2015 20 PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Figure 5 Request to Change or Reset Password Palmetto GBA Medicare amp PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Welcome to Online Provider Services You are accessing a US Government information system The Centers for Medicare amp Medicaid Services CMS maintains ownership and responsibility for this computer system and has allowed Palmetto GBA to provide the services of this system Users of this system must adhere to CMS information security policies standards and procedures Your usage of this system may be monitored recorded and audited Your use of this information system established your consent to any and all monitoring and recording of your activities Unauthorized user is prohibited and subject to criminal and civil penalties Refer to the Terms of Use RETURNING USER NEW USER Enter your User ID and password to access your account Palmetto GBA is pleased to offer secure and fast access to your Medicare information t
93. receive an email when new eLetters are available in OPS Figure 39 Messages Tab Viewing eDelivery Notifications Go To page Select Form ef T MESSAGE INBOX ARCHIVED MESSAGES Click on the subject links to view messages Bold links indicate new unread messages Tie Go Message Inbox Table 2 items found displaying all items 1 0O Fri Geet 12 1008205 EST D4 AR ADR eLetter SOOO amp a z 3 a ee Cs FriDec12 10 08 37 EST 2014 MR ADR eLetter ETETETT TETA a Rev August 2015 73
94. rity settings may need to be updated to allow incoming emails from Palmetto GBA The email address you will be receiving the validation email from is ops no reply palmettogba com The process of receiving the email may take a while and is based on your email client configuration and the security configuration of your network You may have to refresh your inbox to make sure all emails have been received If you still do not receive your validation email please call the PCC at 866 749 4301 for further assistance 9 11 have completed OPS profile verification but when I log in I get the message that my account has not been verified What do I need to do Once you have updated the information on your profile you must log out and click the link in your email to validate your email address and finalize the profile verification process Rev August 2015 66 Qo PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual 9 12 have clicked on the link in my validation email and I got the error message This user is already logged in or failed to logout properly How can I log back into my account If you do not properly log out of Online Provider Services OPS you must wait 15 minutes to log in again Please keep in mind that if you are logged in to OPS and you want to exit OPS you will need to click on the logout link in the upper right of every page If you do not do this you will be locked out for 15 minutes We d
95. rovider Services A CELERIAN GROUP COMPANY User Manual Figure 17 Eligibility Tab Palmetto GBA Medicare Q PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provider Services amp User JANE DOE A Provider TEST PROVIDER Logout Home Claims Remittance Eligibility Financial Tools Messaging Forms Support Admin My Account You have 0 unread message s and 2 alerts Help l Inquiry Eligibility Deductibles Caps Preventive Plan Coverage MSP Hospice Home Health Inpatient New Inquiry You may experience intermittent performance issues when attempting to use the eligibility look up function A high volume of transactions have caused processing delays and higher than normal timeouts within the CMS system that OPS accesses for eligibility data This issue is affecting all eligibility vendors clearinghouses contractors and other third parties that use the CMS eligibility system CMS is working to resolve these issues If you receive a message that the system is unavailable please submit your request again Beneficiary Information Subscriber s Last Name Subscriber s First Name Subscriber Name Suffix Subscriber Gender Subscriber Birth Date EM X Subscriber Primary ID HICN Optional Fields for Requesting Historical Data Using Date Range Date From EJM X Date To ESj X Required Field First Name or Date of Birth is a Required
96. s Screen Palmetto GBA Medicare Qo PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provider Services 3 User JANE DOE x Provider TEST PROVIDER Logout Home Claims Remittance Eligibility Financial Tools Messaging Forms Support Admin My Account Get Status You have 1 unread message s and 1 alerts Help Go To page Select Form x Contract Id 11502 Secure Forms Welcome to secure forms You can now submit forms to Palmetto GBA securely through OPS You may attach up to five PDF attachments to each form Each attachment can be up to 5MB in size The forms and attachments are automatically entered into our workflow This makes form processing more efficient and cost effective To begin please select an answer to the questions from the drop down selections below Based upon the answer given for each of the questions the available form s will appear at the bottom of this box At this time only Appeals forms are available Select a Topic Appeals Select a Type First level appeal on a Medicare Claim v ls your appeal late over 120 days for a redetermination or over 365 days for a reopening Redetermination 1 Level Appeal AP J11 B 1000 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Provider administrators will have permission to access the tab by
97. s Support Admin My Account You have 2 unread message s and 1 alerts Help e Remittance Lookup To view a remit click on the link options next to the date you wish to view Lookup Results Remit Load Date Paid Date Check Number 03 28 2013 03 29 2013 XXXXXXXX 4 New Lookup 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Rev August 2015 31 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual 6 0 Eligibility The OPS eligibility functions are based on CMS HIPAA Eligibility Transaction System HETS When you choose the Eligibility tab you will see a new set of tabs to display information related to your inquiry See Figure 14 Information is presented on the following tabs Inquiry Eligibility Deductibles Caps Preventive Plan Coverage MSP Hospice Home Health Inpatient OPS uses CMS s HETS 270 271 system as required by CMS for all eligibility inquiries Although OPS pulls data from HETS in real time the data available in the HETS 270 271 system is only updated at certain times CMS currently pulls the updated data Tuesday through Saturday during the hours of 6 p m and 8 p m This data is then uploaded into HETS during the hours of 9 p m to 6 a m As soon as updated data is available in the HETS 270 271 system users will be able to view it in OPS Rev August 2015 32 Ne PALMETTO GBA Online P
98. still not been verified within 30 days after your access has been restricted your user ID will become permanently deactivated and you must contact your active provider administrator for access If the only provider administrator on the account fails to complete their profile verification the entire OPS account will be terminated Once terminated the provider administrator would need to re register and create new user IDs for any additional users to regain access Rev August 2015 65 Qo PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual 9 8 What happens if a provider administrator does not recertify user access If user access has not been recertified for the account within 30 days of entering the recertification period your access will be suspended until this process is completed If your access has still not been recertified within 30 days after your access has been suspended the entire OPS account will be terminated Once terminated the provider administrator would need to re register and create new user IDs for any additional users to regain access 9 9 What do I do if did not receive my validation email Once you register or update your profile you will receive an email with a link to validate your access Make sure that you are logged out of your account before clicking on the link in your email Once this is completed you will be able to log in to Online Provider Services OPS If you do not click on the
99. submit attachments in one of the following formats PDF Excel xls xlsx or HSF a1 Each attachment may be up to 40 MB in size While there is no limit to the number of files that can be attached to this form the combined size of all attachments cannot exceed 150 MB Rev August 2015 64 Qo PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual 9 0 Profile Verification and Recertification 9 1 Why am I being asked to complete OPS profile verification Palmetto GBA and CMS are dedicated to ensuring that access to Medicare data is secure To do this CMS requires that all users verify and or update the information on their Online Provider Services OPS profile at least once a year This includes validating the user s email address listed on their profile This must occur at least annually for Palmetto GBA to continue to offer OPS Users will be prompted in OPS when their account is due to complete profile verification We appreciate your effort to help us keep Medicare data secure 9 2 Why am I being asked to complete OPS recertification Palmetto GBA and CMS are dedicated to ensuring that access to Medicare data is secure To do this CMS requires that all provider administrators verify access for all of the users on the account at least once a year for security purposes This must occur annually for Palmetto GBA to continue to offer Online Provider Services OPS Users will be prompted in OPS when their
100. t locked out logged out of OPS User attempted to log into OPS The user will be locked out of the application for three hours using an incorrect password This is a CMS security requirement We are unable to unlock three times accounts that are in the three hour lockout period Users who are locked out three The user ID will remain locked until the user calls to verify their times in a row will be denied identity and have their ID unlocked Please call 866 749 4301 access to the application for assistance Rev August 2015 10 Qo PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual If a provider user does not log into OPS at least once every 60 days their account is terminated To regain access the user must have an active provider administrator assign them The user has not logged into a new user ID and temporary password their account within the past 60 days If no provider administrators on the account log into OPS within 60 days the entire account including all users are terminated To regain access to OPS the provider must re register or No provider administrators on the account have logged into their account within the past 60 days If a provider administrator has not logged into their account in the past 60 days but there is another active provider administrator on the account then only their access is terminated To regain access the user must have an active provider administrato
101. through OPS This is considered a separate submission so any required attachments will need to be resubmitted A new transaction ID will also be assigned 5 0 Remittances 5 1 How do I access remittances online If you have access to remittances online and are successfully logged in click on the Remittance tab The remittance screen will appear See Figure 12 To access remittances you can choose to view remittances for the last 30 days or for a specific date range The remittance selection screen defaults to the last 30 days The remittance date range will default to 45 days from the beginning date You can choose a shorter date range but you cannot choose a longer date range than 45 days Additional search parameters such as Check Number and Paid Date can also be entered to narrow down your query results These values will also be displayed in your results screen to help you identify the remittance you are looking for Rev August 2015 29 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Figure 15 Remittance Tab amp PALMETTO GBA A CELERIAN GROUP COMPANY PALMETTO GBA HOME CONTACT US E MAIL UPDATES SEARCH Online Provider Services 2 User JANE DOE BS Provider TEST PROVIDER Logout Home Claims Remittance Eligibility Financial Tools Messaging Forms Support Admin My Account You have 1 unread message s and 1 alerts Help e Remittance Lookup To view e R
102. tor Phone Number All Eligible ARs O Yes No Letter Number Account Receivable Number s Attachment Browse X Signature Date 05 22 2013 Required Field A Submit Clear EQ 122012 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER The form is dynamic and contains edits to ensure that the information needed to process the overpayment is entered Users may attach one or more PDF files up to 5MB in size each to the form Once the form is submitted users will be prompted with a payment confirmation summary pop up where they confirm the payment information for processing See Figure 27 Rev August 2015 59 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Users are only able to submit an eOffset form for the PTAN NPI combination that matches the user ID they are logged in with Figure 30 eOffset Signature Confirmation By clicking on Ok button you are signing the form and are authorized to submit the information Cancel You will receive a message when the form is submitted and another message with the Document Control Number DCN when the form has started processing 8 0 Secure Messaging and Forms 8 1 What is secure messaging and secure forms If you are a provider administrator you will notice the Messages and Forms tabs as well as a message box o
103. ty and no Date To is entered e A Date From that is after the date of termination or date of death e A specified date range s that is outside of the date s of eligibility If you receive the error message because of one of the above scenarios retry the inquiry leaving the date range fields blank If the beneficiary is currently eligible for Medicare benefits and the user leaves the date range fields blank the user will see the effective and termination if applicable dates of eligibility based on the current calendar date All information provided in the Eligibility tab is based on what is or is not entered in the date range fields If you are looking for prior year information adjust your date ranges accordingly Information is available for 27 months from the current date The OPS Eligibility functions are based on the data available in CMS HETS system 6 3 How do use the Eligibility sub tab The Eligibility sub tab provides information regarding the beneficiary s Part A and Part B eligibility inactive periods e g unlawful deported and incarcerated beneficiary address and end stage renal disease ESRD If this tab is available it indicates that the beneficiary has some type of Medicare eligibility If the beneficiary is eligible for Medicare benefits the screen will display the beneficiary s Part A and or Part B Eligibility period s as appropriate The ESRD section provides information regarding a beneficiary s
104. uestion 2 In what city did you meet your spouse Validation Answer 2 clear Need Help Return to Login 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Figure 8 Password Change Screen Qo PALM ETTO GBA ERIAN GROUP COMPANY PALMETTO GBA HOME CONTACTUS E MAIL UPDATES Password Change User ID XXXXXXXX Enter New Password eeeeeseeece Re enter New Password eeeeceeee Submit Clear Need Help 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER Rev August 2015 22 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual 3 6 cannot answer my security questions What should do When you opt to reset your password you will be randomly presented with two of your security questions You must answer both questions correctly to reset your password If you cannot reset your password and you are a provider user meaning you have been granted access by the provider administrator for your provider contact your provider administrator to verify your identity and regain access If you are a provider administrator and you cannot answer your security questions please call the Technology Support Center TSC at 866 749 4301 Keep in mind that you can update your security questions through your My Account tab 3 7 How do change my password Click o
105. unt Type Signature Date 05 22 2013 Required Field Clear Ec 122012 2013 PALMETTO GBA LLC SITE TUTORIAL DISCLAIMER PRIVACY POLICY SITE HELP SITE MAP GET ADOBE READER The form is dynamic and contains edits to ensure that the information needed to process the overpayment is entered Users may attach one or more PDF files up to 5MB in size each to the form Once the form is submitted users will be prompted with a payment confirmation summary pop up where they confirm the payment information for processing See Figure 25 Users are only able to submit an eCheck form for the PTAN NPI combination that matches the user ID they are logged in with Rev August 2015 57 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual Figure 28 eCheck Payment Confirmation Payment Summary You are about to make a payment to Palmetto GBA Please review the information below and click Submit to finalize your payment By clicking on Make a Payment button you are signing the form and are authorized to submit the information If you choose to cancel your payment and return to the payment form click Cancel Payment Amount POCO Routing MOON Account eee ee Cancel You will receive a message when the form is submitted and another message with the Document Control Number DCN when the form has started processing 7 4 What is eOffset The eOffset function
106. vices OPS Palmetto GBA cannot release patient or provider specific information if you do not identify yourself with your PTAN You may access the National Plan amp Provider Enumeration System NPPES NPI Registry to search for the PTANs listed for your office 2 8 How do find out my NPI You must have a National Provider Identifier NPI to register for Online Provider Services OPS Palmetto GBA cannot release patient or provider specific information if you do not identify yourself with your NPI You may access the National Plan amp Provider Enumeration System NPPES NPL Registry to search for the NPIs listed for your office 2 9 How do I find out my tax identification number TIN You must have a tax identification number TIN to register for Online Provider Services OPS Palmetto GBA cannot release patient or provider specific information if you do not identify yourself with your TIN It is referred to as the tax ID on the registration page of OPS If you do not know your tax ID check with your administrative office or refer to your tax records 2 10 How do find out my last payment received Call the IVR to verify your last payment received You must call the IVR related to your line of business IVR telephone numbers are listed in the Contact Us pages of PalmettoGBA com Medicare Providers who have a Do Not Forward DNF on file with Palmetto GBA will not be able to register until the DNF is listed Rev August 2015 17
107. y listed by using the Add New User button on their Admin tab 9 16 I am a provider administrator and mistakenly left off one of my users when was trying to recertify their access How can restore their access You must create a new user ID for this user Once you log in to your Online Provider Services OPS account go to the Admin tab and use the Add New User button to create a new account for this user 9 17 Once I recertify users am taken to a Terms and Conditions screen How do get back to my account After reading the document please check the Il agree box at the bottom and click Submit If you close the browser window without logging out first you will be locked out of your OPS account for 15 minutes We do not unlock accounts that are in the lock out period 9 18 I am receiving a message that my provider administrator must recertify my access How do find out who is listed as the provider administrator for my account If you do not know who the Online Provider Services OPS provider administrator is for your account contact the provider s staff to find out if they have registered to the system and who is designated as the provider administrator Rev August 2015 67 Qo PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual If you are an OPS provider administrator you can see who else is designated as a provider administrator for this account on the Admin tab 9 19 I
108. ype Code Health Maintenance Organization Medicare Non Risk HM Health Maintenance Organization Medicare Risk HN Indemnity IN Preferred Provider Organization PR Point of Service PS Pharmacy Part D enrollment to the coverage plan Disenrollment Date The date that indicates the termination of enrollment to the coverage No date in this field means the plan enrollment has not terminated The contract number followed by the plan number if on file Phone Number The coverage plan s contract telephone ee number if on file displayed as XXX XXX XXXX The coverage plan s state address ZIP Code The coverage plan s ZIP code Bill Code The bill code of the plan type This field only applies to plan tyoes HM HN IN PR and PS Website The coverage plan s website address that will provide information on the beneficiary s insurance Rev August 2015 46 Ne PALMETTO GBA Online Provider Services A CELERIAN GROUP COMPANY User Manual 6 7 How do I use the MSP Tab When a beneficiary has a primary payer other than Medicare the Medicare Secondary Payer MSP tab provides the beneficiary s primary insurance information See Figure 20 The MSP tab only displays active MSP data per the date s requested and will not be accessible if there is no MSP data or if notification of coverage primary to Medicare has not been received by CMS To make sure you see all of the information enter a date range in the inqu

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