Provider Web Portal User Manual - El Paso First Health Plans Inc.
Contents
1. 16 Submit Clam Prace dure cscs car oe coor rs cots enorme tne svete cee rasta intuenti A nud tbe E FON POUND NEUE 17 S bmit Claim Submit SU m 17 SUID PEC lal SUG Sco e E 18 Submit lame aims lr E 18 Medical Managemen E 19 Medical Management Find Outpatient Services 19 Medical Management Auth ID Hyperlink cccccsssscssssssecconsssccucnssscueusesestousseceessseneussscneoussessoussscencussscneusssessousecuesesensuss 20 PUN CEOS P T O 21 Blog 1S WO NR 21 Page 2 of 22 Change EE ge TT DE 22 Page 3 of 22 Introduction he El Paso First Provider Web Portal service is designed specifically to meet the e business needs of providers in providing secure web enabled role based access data inquiry and update transactions services The Provider Web Portal has real time integration to El Paso First s core system Through use of the portal providers can view member insurance coverage view providers payments view authorization approvals view claims status and submit professional claims This manual provides instructions on how to use the El Paso First Provider Web Portal Benefits o Replaces paper based manual processes with an automated e business solution o Improves productivity by decreasing phone calls required for benefit coverage and other service requests o Allows Providers to perform indep2. 01 27 2011 HORNET GREEN 11056HO0 02 16 2011 SPIDER MAN 11104E0 04 12 2011 HORNET GREEN 11151C0 05 26 2011 SPIDER MAN 11151bE0 05 26 2011 HORNET GREEN 11157C0 06 02 2011 SPIDER MAN 11167E0 06 13 2011 CAPTAIN AMERICA 11182s00 06 25 2011 CHARLIE BROWN 11041E0 02 08 2011 WONDER WOMAN 11041E0 b 02 08 2011 WONDER WOMAN 11048bE01 01 27 2011 HORNET GREEN 11048E01 01 27 2011 HORNET GREEN 11054E0 02 16 2011 SPIDER MAN 11056HO0 02 22 2011 WONDER WOMAN 11056HOI 01 25 2011 WONDER WOMAN 11N7NHM es n3 n3 2n41 SPINER MAN PROVIDER TESI PROVIDER TES PROVIDER TES PROVIDER TES PROVIDER TES PROVIDER TES PROVIDER TES PROVIDER TES PROVIDER TES PROVIDER TES PROVIDER TES PROVIDER TES PROVIDER TES PROVIDER TES PROVIDER TES PRAVINER TEC Status Denied Denied Denied Denied Denied Denied Denied In Process Paid Paid Paid Paid Paid Paid Paid Daid Claims Center Search for Claims The Claims Center link on the left hand navigation bar is to search for claims Only claims where the logged in Provider rendered services will be returned in the search results From the Claims Center menu a Provider can Search for a claim or Submit a claim Notice that all the claims are listed with a hyperlink They may be clicked on for additional information Page 12 of 22 e El Paso First Health Plans Inc Home Patient Inquiry Claim Center Medical Management Prov
3. Gl ape ep orrec EL PASO FIRST ADMINISTRATORS Health Plans inc El Paso First Health Plans Inc Windows Internet Explorer Remittance 1 of 1 for Claim ID 11032E01 Search for Claims View Payment Payment Details D etails EI Paso First Health Plans Inc You are logged in as TE Description Paid on 02 21 2011 Pay To A Provider may click on the View Payment Details to view additional information regarding the claim payment Close The Payment Details menu will pop up d d Charge Allowed Deductible Copay Co Insuran 1 90806 INDIVIDUAL PSYCHOTHERAPY INSIGHT ORIENTED BEHAVIOR MODIFY 110 00 0 00 0 00 0 00 0 00 Totals 110 00 0 00 0 00 0 00 0 00 Deny Reason s Line 1 Authorization number invalid for DOS ADMINISTRATORS Health Plans ine Wa 1 Claim Center Submit Claim Find a Patient Submit Claim Search For Member Search Results 4 Record Found Patient poe Address A Provider may enter Professional Claims via the CHARLIE BROWN 01 01 2001 13 PENNSYLVANIA AVENUE EL PASO TX 79905 1 H di H AP paced portal by clicking on the Submit Claim menu Search Options for Submit Claim Search by Last Name or ID Limit Search by The first thing a provider has to do is find the rom Ti to chario member record with the corresponding service Minimum first 2 letters City State A
4. Pu Servicing Facility Referring Provider 4 Referring Provider Provider Authorizations Nan Claim Information Coordination of Benefits Phone Fax Authorizations a e Prior Auth Referrak Coordination of Benefits El Paso First requires Claim Information that all COB Claims be submitted to them on a Date of Onset Ayyy Is Patient s Related To Cl Employment E Auto Accident C Other pa per claim COB claims should be mailed to El Similar Illness Il emer State Select v Local Use IP Admit Date 8 mrs m Paso First along with the Primary Carriers Nc DM a v Remittance Advice or Explanation of Benefit Patient Control K information for validation and payment Coordination of Benefits TT Provide COB Information Page 15 of 22 Submit Claim Submit Claim ICD9 submit Claim for CHARLIE BROWN anos Validation and Edits cole Description Fields that are labeled with an asterisk are r I emo required fields Users may use the search function for Code look ups gt El Paso First Health Plans Inc Windows Internet Explorer Find Diagnosis Codes ICD 9 Search for I CD 9 codes by a partial diagnosis code or by words in the code description Code 301 4 EE To insert a DX code the user may search for a DX Click a code to T cR C GR OR Hemowe code by Code or DX Description Description OBSESSIVE COMPULSIVE PERSONALITY DISO
5. two 2 working days El Paso First Health Plans Inc will uphold this determination Page 20 of 22 El Paso First Health Plans Inc c oU de Pager Safel referred EL PASO FIRST ADMINISTRATORS Health Plans inc El Paso First Health Plans Inc Providers Provider links web portal directories Windows Internet Explorer You are logged in as TESTPROV2 KT EL PASO FIRST p a 1p ans inc Click on Picture to Download You need Adobe Acrobat to read a PDF If you dont have Adobe Acrobat you can download it for free here Providers We are proud of our extensive network of providers and the quality health care they provide our members Our network currently has more than 800 providers including physician groups and specialists and 8 hospitals offering comprehensive care to our members Not all physicians are enrolled in all plans If you are not yet a member of our network and would like information about joining rm A El Paso First please click here to email a provider relations representative or call provider relations at 915 532 3778 CHIP Star and CHIP Perinate Provider Manual Posted Revised version Heh crisis line for STAR is 1 877 377 6147 For April 26 2011 UPDATE Members right to file a complaint directly to HHSC Provider Newsletter New Medicaid ID Card Information MEMO Your Texas Benefits Medicaid Card IMPORTANT NOTICE TO ALL MEDICAID PROVIDER CHIP B
6. 915 532 3778 Manage Patients a Find a Patient or Member Claims and Services View Recent Claims a View Outpatient Services a View Inpatient Stays Submit Claim Provider Look up Provider Directories Code Look up Find Procedure Code Find a Diagnosis Code a Find Revenue Code Provider Home Screen This is the Provider Home screen It displays the basic information about the Provider Note The Physical and Mailing Address are displayed The Navigation Menu Options are Home Patient Inquiry Claim Center Medical Management Provider Directories Change Password Change Plan Program Log Off Log In Page 7 of 22 El Paso First Health Plans Inc Home Patient Inquiry Claim Center Medical Management E mE EC Page e Safety v Tools e Find a Patient You are logged in as amp Print this page Provider Directories Change Password Search Options Log Off Search by Last Name or ID Log In Again Last Name El Paso First Health Es first 2 FEN Health Plan ID SSN JOOC XXX El Paso First Health Plans Inc Limit Search by First Name City State ALL v ZIP KH Effect Birthdate ive 33 mwoo YYYY MM DD YYYY f 7 L e Pager Safety T referred EL PASO FIRST ADMINISTRATORS Health Plans inc You are logged in as TESTPR
7. EL PASO FIRST HEALTH PLANS INC Provider Web Portal User Manual O E Paso First Health Plans Inc 1145 Westmorland El Paso Texas 79925 Phone 915 532 3778 Toll Free 1 877 532 3778 www epfirst com Page 1 of 22 Table of Contents IEE FCN O ME 4 Hd VAS a preg ek eg 4 IVI AIO e ME 4 PElrezuei pearsepc Mete 4 OD i PC CSS RT EU G M 5 SI WOU INCE IS Cl rcuciseracdencesecranpeasecopecnapnchptcnnt 6 wi zie iae PROS A IE E E 6 POVOS een dedi EE 7 Patent Nguy RR RR 8 Bug MOI e OTIS SCAG E 8 Patient inauirv Record EE 9 Patient Inquiry Patient Information ME 9 Patent inauiry Phon BENEI EE 10 Patent inaus VIEW Recent RE EEN 10 Patient Inquiry View Recent Claims Search Results 11 Patient Inquiry View Recent Claims Details 11 Clalins e en 10 CIGIMNS m T T UT mE 12 Search Tor Claims Cam SUE osos ees enacts te E ISupIE ce NE MEUM EE UE E MEE D E nee 13 Search Tor Clamms View Een d EE 14 EE leider E 14 Submit ClamissSearch For E e EE 14 Submit Clam e Demos dDilES eosssseusdu serra E E ne ID SUR ECKE TT dM LU SUIVI PLUMIS ONU NEUE ODIO UN SUE 15 ees aep m 16 Submit Claim Medical Services
8. LL v date SSN JOQCXX2O00K ZIP Health Plan ID ee CNN 000 Important To identify the appropriate member Birthdate MM DD YYYY 1 coverage segment for the claim enter the service To identify the appropriate coverage for the claim enter the service start date in Date of Service field above System will default to current date if no Date of Service entered sta rt date in the Date of Se rvice field The system will default to the current date if no Date of Service is entered UBO04 Claims are not accepted on the Portal Page 14 of 22 Submit Claim for CHARLIE BROWN Submit Claim Demographics Dates of Service Entered in the Medical Services Section on Page Two Must Be Within the Enroll overage Range Selected Below Coverage Premier Plan STAR HMO Benefit 01 2010 Active J Member CHARLIE BROWN Address 13 PENNSYLVANIA AVENUE EL PASO TX 79905 Healthplan ID i e e e Birthdate Phone Validation and Edits Servicing Provider e Fields that are labeled with an asterisk Provider PROVIDER TEST I are required fields ID PRV2266023 Address 300 Pennsylvania Avenue EL PASO TX 79912 Phone 915 645 0000 Fax 915 845 0000 The Pay To Field is a required field and must be Pay to Provider Name Select populated Servicing Facility Provider E us The screen selections Phone e Pay To Provider
9. Long Descnption Total of 77 Descriptions Total of 60 ADMINISTRATORS Health Plans inc Patient Inquiry View Recent Claims Find a Patient Patient Information Claim Center 5 Search Claims Search Options When a Provider selects the View Recent Claims hyperlink the following information is Advanced Search Claim ID Search Type Select v Claim ID i 20 From 01 22 2011 gg displayed to initiate a claims search To 07 22 2011 faa Status Any Status The Provider has the displayed search parameters Member CHARLIE BROWN ER as options to refine the claims search Provider NPI Note Only records where the Provider who is logged in rendered the service are viewable Page 10 of 22 EI Paso First Health Plans Inc ei 7 d v Pager Safety aferred EL PASO FIRST ADMINISTRATORS Health Plans ine You ae logged in as srv Patient Inquiry View Recent Claims Search Results Find a Patient gt Patient Information gt Claim Center 5 Pri DG Search Claims Search Results 1 Record Found Claim ID 11182500001 Note the returned results of a claim search The Services Dates Patient Service Provider NPI Status i d 06 25 2011 CHARLIE BROWN PROVIDER TEST In Process search criteria can be further refined if necessa ry Search Options Advanced Search Cl
10. OV2 Help Find a Patient Print t Search Results Search Options Search by Last Name or ID Minimum first Health Plan ID SSN Last Name brown There is more than one member who matches the information you have entered Please add more information to uniquely identify the patient or member you wish to find and search again 2 letters XXX XX XKXX Limit Search by First Name City State ZIP Effective Birthdate ALL v 3 wwoD vvvv MM DD YYYY Patient Inquiry Providers can conduct a Member Search via use of the Patient Inquiry on the left hand navigation menu or by selecting Find a Patient or Member on the right hand menu This is what a Provider will see if they select Find a Patient or Patient Inquiry Note all of the criteria available to refine the search The Provider must populate the minimum necessary information needed to return only ONE member record Patient Inquiry Refine Search If the system finds more than one member who matches the search criteria the system will prompt you for additional information Note the message on the screen shot The Provider must add additional information about the Member until the system finds only ONE match Page 8 of 22 srrec EL PASO FIRST ADMINISTRATORS Health Plans in You are logged in as TESTPROV2 Find a Patient f Pr Search Result
11. RDER The User may select the returned results on the screen by clicking on the hyperlink Submit Claim Medical Services MONS Next the user must enter the Medical Services pen DOS To Modifier See e EPSDT Auth DOS From DOS To CPT Modifiers Diag Charge Units EPSDT e Auth Validation and Edits 1 Fields that are labeled with an asterisk are required fields All date fields must be entered using the following format mm dd yyyy Users may also select a date from the calendar Page 16 of 22 Medical Services Submit Claim Procedure Codes DOS From DOS To POS CPT Modifier s Diag Charge Units EPSDT Auth d Em Ir j ELI p eem To insert a Procedure code the user may search e o P El Paso First Health Plans Inc Windows Internet Explorer fe Ji Lj Nero for a Code by Code or Code Description Find Procedure Codes CPT um The User may select the returned results on the Search for CPT codes by a partial procedure code or by words in the code description screen by clicking on the code hyperlink Code 30801 3 1 Record Found Click a code to use CPT Code De Description PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION Medical Services Submit Claim Submit Claim DOS From DOSTo POS CPT Modifiers Diag Charge Units EPSDT Auth In the Modifier box double modifiers are 2 wi os oe tt Bene accepted and can be separated by space or co
12. VED 90847 CPT FAMILY PSYCHOTHERAPY CONJOINT PSYCHOTHERAPY WITH PATIENT 06 21 2011 09 21 2011 Patient Details Authorization for SPIDER MAN Address 1 SPIDER WAY Member ID CANUTILLO TX 79835 Group Phone Date of Birth Fax Age Email Physicians Authorization to Requested by PROVIDER TESTI NPI NPI 300 Pennsylvania Avenue No practice address can be found Click on the Provider Name for detailed information EL PASO TX 79912 UNITED STATES 915 845 0000 Office is handicapped accesible Disclaimer zk The authorization status reflected at this time is not the final status Pre authorization is based on information provided to El Paso First at the time of request and does not guarantee payment of benefits nor verify eligibility Payment for services is PI ease read Discla imer subject to all terms conditions limitations and exclusions related to the member s eligibility and subsequent medical review Regardless of pre authorization status medical decisions concerning a course of treatment are solely between the physician and the patient The provider will be notified of the final authorization status via fax If you do not agree with the medical determination please contact the Pre Authorization Department at 915 532 3778 extension 1500 for Medicaid extension 1536 for CHIP extension 1538 for Preferred Administrators and extension 1537 for Health Care Options If no action is taken within
13. aim ID Search Type Select v Claim ID From D n iy Notice how the Claim ID s are underlined This iH T means that they are a hyperlink You must click atus Any Status Member CHARLIE BROWN Ab on the hyperlink in order to view the claim Provider NPI Find a Patient Patient Information Claim Center S Print this page e Claim ID 11182500001 for CHARLIE BROWN i i l l ee Patient Inquiry View Recent Claims Patient ID CHARLIE BROW D etails Subscriber CHARLIE BROWN Policy 37 Group STAR SPONSOR Covered Under Premier Plan STAR HMO Benefit Service Dates 06 25 2011 to 06 25 2011 07 01 2011 OPEN Payments No remittance found Received Status This screen displays the specific claim information Cim Home when selecting the hyperlink This claim has 1 item s Item Code Modifier Description Charge Allowed Deductible Copay Co Insurance Plan Paid 1 90801 PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINATION 150 00 75 00 0 00 0 00 0 00 75 00 Totals 150 00 15 00 0 00 0 00 0 00 15 00 Page 11 of 22 ad EL PASO FIRST ADMINISTRATORS Health P lans inc You are logged in as TESTPROV2 t Claim Center 5 Pri Search Claims Search Results 34 Records Found Claim ID Services Dates Patient Service Provider NPI 11032E01
14. alance Billing Letter Rael CHIP Co Pay Increase Memo Nk Immunization Administration Procedure Codes Changes Effective 532 3778 4 April 1 2011 a CHIP Perinatal Refresher Training Availity 5010 Survey February 2011 Provider Reimbursement Reduction You are logged in a Find a Patient or Member Claims and Services View Recent Claims View Outpatient Services P View Inpatient Stays H Submit Claim Provider Look up a Provider Directories Code Look up Find Procedure Code P Find a Diagnosis Code H Find Revenue Code es Change Password C Your new password must use A minimum of eight 8 characters Use a combination that has at least three of the four following character types Upper case letters Lower case letters Numbers Special characters 56 18 8 2 Current Password New Password Confirma New Password Provider Directories When selecting to view Provider Directories the Provider will be routed to El Paso First Website On Provider screen page on the right hand side the Provider Directories can be found Change Password A Provider may also change their passwords at any time by clicking on the Change Password link from the left hand navigation menu Page 21 of 22 jeter Prefe EL PASO FIRST ADMINISTRATORS Health Plans ine Change Plan Program When a Provider needs to search for a member from one of our different product l
15. ealth Plans CHIP Perinate 7a Print this page Sign In or Register This is the first screen Provider will see when selecting the Web Portal link Web Portal users will be able to use their username but the passwords will be defaulted to ElPasol Web Portal users will then be required to change their passwords Select Plan Program If a provider has requested access to all of our product lines CHIP STAR HCO and Preferred Administrator this is the screen that they will see once they log in The Provider is to select the Program they wish to access from this menu If a Provider ONLY has access to either CHIP and STAR or only HCO and Preferred Administrators they will not see this screen They will automatically be defaulted into the single region they have access to Page 6 of 22 Navigation Men u SO FIRST Health P lans inc Navigation Menu Bs TESTPROV2 Provider Home SP Provider Snapshot Provider PROVIDER TEST I ID PRV2266023 NPI Type OFESSIONAL COUNSELOR Speciality LICENSED PROFESSIONAL COUNSELOR Languages SPANISH Physical Location 300 Pennsylvania Avenue EL PASO TX 79912 UNITED STATES 915 845 0000 Mailing Address 300 Tinseltown Parkway EL PASO TX 79912 UNITED STATES Associated Providers Contact Us Contact Customer Service If you have questions or need assistance Contact the Provider Relations Department at
16. endent self service tasks reducing time spent calling the health plan Registration and Access 7 n order to use to the El Paso First Provider Web Portal Providers must sign up and register for the service Registration forms can be obtained by going to the El Paso First Website located at www epfirst com Providers should click on the Forms link from within the Provider navigation options The Web Portal registration form is titled Web Portal User Agreement amp Web Portal Registration Form Providers may also receive Web Portal enrollment information by contacting their Provider Relations Representative Completed forms are to be faxed to the Provider Relations Department at 915 532 2877 Once the account is activated Providers can access the Web Portal at www epfirst com Navigation Users have the following navigation options within the Provider Web Portal 1 Cancel Cancels the transaction without saving the transaction User is reminded that cancel will completely cancel the transaction and not save the data before cancel is committed 2 Back The Back button will take the user to the previous screen whether it s a listing or a multi step process No data entered on current page will be saved and no rules will be run 3 Continue Executes all page level rules saves all page data within the session and takes the user to the next page in the navigation 4 Finish Submits a transaction for processing T
17. his is a sample of what a Provider will see when v Reference ID they select Medical Management from the left From 02 22 2011 _ E uwDD vvvv navigation bar To 08 22 2011 31 imwooyYYY pd D Notice how they have two options Find Outpatient Services and Find Inpatient Stays Type A o This screen displays the search criteria available for the Provider when conducting a Medical Management document search retferred EL PASO FIRST DMINISTRATORS Health Plans inc You are logged in as TESTPROV2 Help Lo Find Outpatient Services D Print this p Medical Management Find Outpatient Services Search Results 0 referral s and 7 outpatient pre authorization s found Auth ID 0000141 Primary Diagnosis Referred Bv Referred To From Status ADJUSTMENT DISORDER WITH MIXED ANXIETY AND DEPRESSED MOOD PROVIDER TEST I 05 16 2011 APPROVED ATTENTION DEFICIT DISORDER WITH HYPERACTIVITY PROVIDER TEST I 04 17 2011 APPROVED ADJUSTMENT DISORDER WITH MIXED DISTURBANCE OF EMOTIONS AND C PROVIDER TEST I PROVIDER TEST I 06 15 2011 APPROVED BIPOLAR I DISORDER MOST RECENT EPISODE OR CURRENT MANIC MO PROVIDER TEST I PROVIDER TEST I 06 02 2011 APPROVED Th IS IS a sa m p e of W h at a P rov l d e r WI see afte r ADJUSTMENT DISORDER WITH MIXED DISTURBANCE OF EMOTIONS AND C PROVIDER TEST PROVIDER TEST 05 16 2011 APPROVED t h ey h ave e nte red Sea rc h C r
18. ider Directories Change Password Log Off Log In Again El Paso First Health Plans Inc hp CU de Pager Safety Toos You are logged in as Claim Center gt S Print this page E Claim ID 11060D000 Claim Summary Patient ID Subscriber Policy 001 Group R E THOMASON HOSPITAL Covered Under R E Thomason Benefit Plan Service Dates 02 18 2011 to 02 18 2011 Received 03 01 2011 Status DENIED See deny reasons at bottom Payments 29 250 86 View Payment Details Claim Items This claim has 1 item s Co Plan EECH 26650 FA PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL FRACTURE D 1 303 00 0 00 0 00 0 00 0 00 0 00 Totals 1 303 00 0 00 0 00 0 00 0 00 0 00 Deny Reason s Line 1 Prior authorization is not for same provider Line 1 Authorization number invalid for DOS Line 1 Prior Authorization Services do not match claim Search for Claims Claim Summary This is an example of a Denied claim that has been selected by clicking on the claim ID hyperlink Note the claim denial reasons listed at the bottom of the screen Page 13 of 22 Ww Favorites 3 sl CHIP Perinatal ous Login or Register Free Hotmail A Google NPR National Public Radio Online Banking Loans and P Pandora Radio Listen to Fr Li Sign In e Suggested Sites CG Texas Medicaid amp Healthcar Upgrade Your Brc fe gt
19. il us directly by clicking here Please provide us with your username for faster service New Providers If you are not a registered user visit the Registration page to submit a request for access If you have any difficulty accessing this information call our helpline at 532 3778 or 1 877 532 3778 if outside the area If you continue to have problems getting into your account please email us directly by clicking here Please provide us with your username for faster service D Forgot your login credentials or need help View password recovery options Members Only You are not logged in help 75 Print this page Registered users sign in using your user id and password User ID Password Forgot Password Members Only Not Registered D New member users can register here Select the registration link below a Member Home You are logged in as TESTPRV1 Help Log Qut Patient Inquiry Claim Center Medical Management Provider Search Current Plan Program Groupings Provider Home Track Requests Change Password Please select one of the radio buttons below and click Continue Message Center Log Off Oo Preferred Administrators R E Thomason Hospital Log In Again Preferred Administrators HCO Benefit Plan TriZetto Web Solutions El Paso First Health Plans Premier Plan STAR Medicaid El Paso First Health Plans Children sHealth Insurance Program El Paso First H
20. ines they must Provider Plan Program Selection always come back to this menu option Current Plan Program Groupings If a provider serves and has requested access to Please select one of the radio buttons below and click Continue all of our product lines CHIP STAR HCO and Preferred Administrators R E Thomason Hospital Preferred Administrator when they click on this El Paso First Health Plans Children s Health Insurance Program menu option they will select the Program they El Paso First Health Plans Premier Plan STAR Medicaid wish to access If a Provider ONLY has access to either CHIP and STAR or only HCO and Preferred Administrators they will not be able to access the environment they do not have access to Page 22 of 22
21. ite ri a fo r a IMI ed i ca ATTENTION DEFICIT DISORDER WITHOUT MENTION OF HYPERACTIVITY PROVIDER TEST I 05 16 2011 APPROVED ATTENTION DEFICIT DISORDER WITHOUT MENTION OF HYPERACTIVITY PROVIDER TEST I 06 20 2011 APPROVED Mana geme nt Find O utpati ent Services search Search Options Select a type and enter a date range OR enter a specific ID N ote how t h e Aut h D Sea rc h res u Its a re Type amp Date Search ID Search Type A1 Y Reference ID hyperlinked A Provider may click on the From 02 22 2011 MM DD YYYY Searchby1D y N i a la mm hyperlink to access the document Provider NPI Patient amp Page 19 of 22 Pre Authorization Details 2 Print this page CS verification ID 000014 Verification Stats APPROVED Medical Management Auth ID Hyperlink Covered Under CHIP BENEFIT Service Details Service Level Elective Place of Service Office Visit Inpatient Hospital Outpatient Hospital Primary Diagnosis 296 90 UNSPECIFIED EPISODIC MOOD DISORDER RequestedLOS 0 Actual LOS 0 Requested Service Requested Authorized Units Status Codes Modifier Type Description From Te Attached E d n exa m ple of what a P rovide r Wi see 12 APPROVED 90806 CPT INDIVIDUAL PSYCHOTHERAPY INSIGHT ORIENTED BEHAVIOR MODIFY 06 21 2011 09 21 2011 W he n t h ey se ect t h e Aut h D hype rl j n k 4 APPRO
22. mma Page 17 of 22 Submit Claim Submit Claim for CHARLIE BROWN Diagnosis di Code Description 1 301 4 p OBSESSIVE COMPULSIVE PERSONALITY Add Remove 2 p Add Remove Medical Services amp DOSFrom DOSTo POS CET Modifier s Diag amp Charge Units EPSDT Auth T 07 22 2011 eg 07 22 2011 1 90801 1 15000 1 Add Remove 2 5j Gy P 0 00 Add Remove H ma CPT Code Description PSYCHIATRIC DIAGNOSTIC INTERVIEW EXAMINAT Home gt Find a Patient gt Submit Claim Total Charges 150 00 Total Units 1 Your Claim has been successfully submitted and can be viewed as Claim ID 1120350 Claim Center Submit New Claim Submit Claim Submit Claim Once a Provider has completed filling in all the claim information they must select the Submit button at the bottom of the screen to submit the claim Submit Claim Claims Number Immediately after you have clicked Submit your claim number will be displayed From here You may return to the Claim Center main menu or Submit a New Claim Page 18 of 22 ADMINISTRATORS Health Plans ine Find Outpatient Services eee on Medical Management Select a type and enter a date range OR enter a specific ID M e COUTE ONUS T
23. ransaction will go directly to El Paso Firsts core system Validation and Edits 1 Fields that are labeled with an asterisk are required fields All date fields must be valid dates SSN must be in a 9 digit numeric format Phone number s must be in a 10 digit numeric format Monetary values cannot be entered with more than 2 digits precision SS Page 4 of 22 sa Welcome Vision Your community partner leading the way to quality healthcare through service and innovation because we CARE ADMINISTRATORS Log On Process Mission El Pasa First Health Plans promotes community health by providing access to quality healthcare for children families and individuals who need it most We partner and collaborate with community providers and advocates to foster a culture of excellence www epfirst com PROVIDERS Forms Providers will still access the Web Portal through TX Health Steps Resources our main website Upcoming Events Page 5 of 22 L I CMS Login or Register dm 7 Pager Safety Tools e Welcome Sign In or Register ay Current Users Please sign in now using your user id and password if you are already a registered user Er New Users New Members Member Registration If you have any difficulty accessing this information call our helpline at 532 3778 or 1 877 532 3778 if outside the calling area If you continue to have problems getting into your account please ema
24. s Recor Found Patient Inquiry Record Found DOB Address Phone Patient CHARLIE BROWN a 01 01 2001 13 PENNSYLVANIA AVENUE Ta Here is an example of the returned information from a Member search Search by Last Name or ID Limit Search by Last Name brown First Name charlie Minimum frat 2 eter If you want to see additional information about State ALL Y the member click on the member name Notice SSN 300CXX2000X ZIP E f how itis underlined The Underline means that Effective S wwobvvvv Birthdate mapon additional expanded information is available when you click on the hyperlinked name Health Plan ID fy CU de Pager Safety ad EL PASO FIRST ADMINISTRATORS Health Plans inc El Paso First Health Plans Inc You are logged in as TESTPROV2 Hel Find a Patient gt Patient Information CHARLIE BROWN amp Print Patient Inquiry Patient Information Patient Information Name CHARLIE BROWN Address 13 PENNSYLVANIA AVENUE Subscriber ID EL PASO TX 79905 County EL PASO Country UNITED STATES BinhDate vam E Provider will see when selecting to click on the Members hyperlinked name Primary Care Providers PCPs Type Name Pay to Affiliation Phone Notice the hyperlink for PCP Name View Giu e
25. ter and AUPIOCENGORS Recent Claims View Outpatient Services and View Recent Claims M oce sers ER the Plan Name Eligibility Details Clicking on these hyperlinks will display additional Health Plan Id Benefit Type Plan Name Group Policy Order Applied Effective Date d et a e d i nfo rm at i on Medical Premier Plan STAR HMO Benefit STAR SPONSOR 37 Primary 12 01 2010 Other Insurance There is no Other Insurance information found Page 9 of 22 You are logged in as QNXTPROVT Log Qut Help pone Dea Medica a Erin this paga Patient Inquiry Plan Benefits HealthWeb PPO Benefit Plan HEAL THWEB FAMILY6 SUBSCRIBER M Benefits of this Plan Benefit Details When a Provider clicks on the hyperlink for Plan Chiropractic Services Senaces are Covered 80 with Fixed Copay of 10 00 and Capay Max of 80 00 up Benefits they will be able to see a more to 30 days sit MM i gt EE descriptive explanation of the Member s benefits Inpatient Stay Services Senaces are Covered 100 wath Poor Authonzation and 100 indradual or 200 Family deductible up to 30 days visits Dental Services senaces ane Covered 100 for Family Members 5 yrs amp Older Office Visit Services Senaces are Covered 100 with Fixed Copay 15 00 up to Maximum of 100 00 accumulated copay per Calendar year Testing Maximum character length for Testing Maximum character length for
Download Pdf Manuals
Related Search