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Cigna-HealthSpring Orientation Session HealthSpring Overview 2014 Medicare Advantage Benefits HealthSpring Connect Office Orientation More from Medicare.

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Presentation on theme: "Cigna-HealthSpring Orientation Session HealthSpring Overview 2014 Medicare Advantage Benefits HealthSpring Connect Office Orientation More from Medicare."— Presentation transcript:

1 Cigna-HealthSpring Orientation Session HealthSpring Overview 2014 Medicare Advantage Benefits HealthSpring Connect Office Orientation More from Medicare. More from life.

2 Key: We are dedicated to improving the health of the communities we serve by delivering the highest quality & greatest value in health care benefits & services. OUR MISSION Over 2 million seniors served Improved compliance in quality measures by over 30% High quality results with lower medical cost Better customer satisfaction OUR RESULTS OUR BELIEF is a leading health service company committed to helping our nation’s seniors live healthier, more active lives through personalized, affordable and easy-to-use health care solutions We Develop and Manage Medical Care Delivery Systems Cigna-HealthSpring… Existing Key Markets 2013 Inorganic Expansion 2014 Potential Expansion We believe in revolutionizing the health care experience for our customers by empowering physicians Go Deep Go Individual Go Global Continue Delivery System Engagement Build Deep Insights & Reach Accelerate Product Diversification & Market Expansion 2 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2013 by Cigna.

3 Southern Regional Northside Grady Memorial Emory Healthcare DeKalb Medical HCA Tenet Gwinnett Medical Southern Regional Northside Grady Memorial Emory Healthcare DeKalb Medical HCA Tenet Gwinnett Medical Cigna-HealthSpring Georgia Service Area 3 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2013 by Cigna.

4 Cigna-HealthSpring’s Focus on Quality Physical Provides thorough documentation of patient history Prompts completion of recognized standards of care Establishes chronic conditions Promotes early detection Provides thorough documentation of patient history Prompts completion of recognized standards of care Establishes chronic conditions Promotes early detection Care Transition Team Provider Education Specialist Community Case Manager Hospital On-site Nurse Specialist Partnership for Quality Nurse (P4Q) Provider Education Specialist Community Case Manager Hospital On-site Nurse Specialist Partnership for Quality Nurse (P4Q) Partnership for Quality (P4Q) Provides an additional resource at point of care Focuses on preventive care and management of chronic conditions Works with Provider offices to ensure completion of quality metrics Provides an additional resource at point of care Focuses on preventive care and management of chronic conditions Works with Provider offices to ensure completion of quality metrics Cigna-HealthSpring is achieving the triple aim of better health results, improved affordability and enhanced customer satisfaction Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2013 by Cigna.

5 Examples 1 & 2 5

6 HSConnect Training Need More Help? Call the HSConnect Help Line: Call the HSConnect Help Line: OR the HSConnect Help Desk: the HSConnect Help Desk:

7 HealthSpring Connect 7 Features: Check Member Eligibility & Copay Check Claims Status Create Referrals and Pre-certifications –In-network providers are pre-loaded in the system –CPT codes and diagnosis codes are pre-loaded in the system –Ability to copy & paste and/or attach documents from EMR –Homepage will show status of referrals requests (approved or pending) Search a repository of all referrals and pre-certifications Get alerts from Cigna-HealthSpring 24-hour help desk available

8 Activating your Account Once all the information has been verified and loaded, users will receive an notification with usernames and a link to create a password from: If you do not receive the notification, please check any spam or junk mail folders you may have.

9 Adding staff or Forgot Password In your URL entry box type the address: https://healthspring.hsconnectonline.com/HSConnect https://healthspring.hsconnectonline.com/HSConnect From the Sign-In page, click “Need an Account? click here...” You will be directed to the “New Account Request” page to enter your information.

10 Registering your HSC Account Enter the first and last name of the person requesting the account, practice Phone number, as well as the address. Note: Failure to provide valid information could delay access to the portal. Next, enter the coverage group name & description. Coverage Group Name - Operating name and/or name used with general public. Coverage Group Description - The provider type of the requesting group. Enter practitioner, facility or ancillary.

11 Logging in to HSConnect You must accept the terms & conditions, prior to entering the portal. Note: There have been reported compatibility issues with HSConnect and Internet Explorer 10. This can be remedied by enabling compatibility view.

12 HSConnect Home Page The home page will show all the navigation links for the page. The user logged in will display in the upper right corner. The 30 Most recent authorizations will populate. You can navigate through them. Any important alerts will populate on the right side of the page

13 HSConnect Home Page You also will see your recent draft authorizations (authorization started, but not submitted) You can click the authorization ID, to pick up where you left off, or delete the auth. The right hand corner will include any pertinent documentation under Documents and Forms.

14 HSConnect Home Page In the upper right corner, you can click “Profile”. From here you can: Update display name, or phone number View your user security role View the providers loaded in your coverage group Reset your password Request user reactivations, deletes or adds.

15 HSConnect Member Search Select the Member Search link at the top of the Home Page. The Member Quick Search screen displays. Enter a search term in at least one field. If you enter multiple fields, the search results only display those members where all fields match. Member Last or First Name: Enter a full or partial name. Member DOB: Use with the Name to narrow the search results. Member ID: Enter the number with nine digits, an asterisk, and followed by the two digit suffix. For example *01. Note: Member ID is the preferred and most accurate search term. Select Search. If needed, select Reset to clear and enter new search terms.

16 HSConnect Member Search The following details apply to the search results: If there are more than 100 matching search results, a message displays stating you have exceeded the current limit of 100. Partial name matches may display, such as Rosemary when you only entered Mary. Use the First, Previous, Next, or Last links to page through the search results if there are multiple pages. From the Member Search Results, select the Member ID, Member Name, or DOB link to display that member’s profile.

17 HSConnect Member Search View the member’s demographic information. Member ID: Number assigned by HealthSpring to the member. This number also displays on the member’s ID Card. Social Security: Only the last four digits of the member’s SSN display. View the member’s eligibility information.

18 HSConnect Member Search PCP Name: Name of the member’s PCP. This field is blank if the member is PDP (prescription drug plan) or if the member has not yet selected a PCP. PCP Region: The abbreviation for the member’s PCP region affiliation. PCP Effective: Date the member became effective with the PCP. Group ID: Number assigned by HealthSpring to the benefit plan. In the example, TN002*MA, TN = Tennessee plan, 002 = Healthy Advantage, MA = Medicare Advantage. Benefit Plan: Number and name of benefit plan. Status Code: Eligible or Disenrolled Effective: Date the member’s benefit plan became effective. Expiration: Date the member’s benefit plan was terminated. A blank field means the benefit plan is still in effect.

19 HSConnect Member Search View the co-pays the member pays for in- network, out-of-network, and referral services. Note: Select the View Additional Copay and Plan Information link to go to the website to select the member’s plan and view specific details concerning the co-pays. For example, the Urgent Care co-pay in this example is $30, but the co-pay is waived if admitted to the hospital within 24 hours. CTCT Scan EREmergency Room IPInpatient Stay MRIMagnetic Resonance Imaging OOPOut of Pocket Maximum OPSOutpatient Surgery OVPOffice Visit PCP OVSOffice Visit Specialist UCUrgent Care

20 HSConnect Member Search (Optional) From the Eligibility section of the screen, select the view history link to view the member’s eligibility history. This screen displays all the enrollment segments since the member first enrolled with HealthSpring. Note: An example of the Eligibility section is located at the bottom of the first page on this Quick Reference Card. (Optional) Select the hide history link to hide this section of the screen.

21 HSConnect Member Search View the member’s recent authorizations (referrals and precertifications). Note: This section only displays if the member’s PCP is part of your coverage group. Select the Authorization ID link to display the details of the authorization. Note: Refer to the Search for Authorizations and View Details Quick Reference Card for more information on viewing an authorization.

22 HSConnect Searching Authorizations Select the Authorization Search link at the top of the HSConnect Home Page. The Authorization Search screen displays. Select the Find Member link to search for an authorization using the member’s information OR, Enter or select a search term in at least one field. If you enter multiple fields, the search results only display those members where all fields match. Authorization ID: Number assigned by HealthSpring to the referral or precertification. Authorization Status: Approved, Pending, or Denied. Member Last Name or First Name: It is best to search for the member using the member ID.

23 HSConnect Searching Authorizations Referred from or Referred to Provider: Select Find. The Search for Provider screen displays. Enter or select one or more of the fields. Then select Search to display the matching results. Select the applicable NPI or Provider Name link for the authorization. Name or NPI: Enter a partial or full name or NPI and select from the matching results. Market: Select one of the HealthSpring markets. Region: Not applicable Specialty: Enter a partial or full specialty code or description and select from the matching results. Provider Type: PCP, Specialist, Facility, or Ancillary. From Date: Starting date for the authorization. To Date: Ending date for the authorization. Select Search. The matching authorizations display in the Results section.

24 HSConnect Searching Authorizations Perform one of the following: Select an Authorization ID link to view the details for the selected authorization (refer to the back side of this card for more information). Select a Member Name link to view the details for the member’s profile. Note: Refer to the Locate a Member Quick Reference Card for details.

25 HSConnect Searching Authorizations View the details for the authorization. (Optional) Select any of the hyperlinks to perform other tasks related to this authorization: Create a referral for this member. Create a precertification for this member. Extend the end date for an approved referral that has not been previously extended for up to 30 more days. Add additional clinical information for a pended authorization. View a message from another provider on the authorization (this task is based on the user’s role and may not display as an option). Send a message to another provider on the authorization (this task is based on the user’s role and may not display as an option). Print the authorization or page. Search for another authorization.

26 HSConnect Enter a New Referral If a PCP wants to send a member to see a Specialist, he or she should complete this task for a one time visit or a specific number of visits before making the appointment with the Specialist. Log into the HSConnect portal and accept the terms and conditions. Select the Enter New Referral link at the top of the HSConnect Home Page. The Member Quick Search screen displays. Perform the following to select the member: a.Locate the member for the referral. Note: Member ID is the preferred method. Note: If searching by Member Name, please include, Last Name and First Name. For quicker results, include the Member DOB. Do not include Member ID with member name in the search. b.Select the Member Name link from the search results. Note: Only the members assigned to the PCPs in your coverage group display in the search results. c.The Referral screen displays with the member defaulted based on your selection. Verify you selected the correct member.

27 HSConnect Enter a New Referral (Optional) If the referral request is expedited, select the Expedite Request link. The Expedited Request Questionnaire displays. Otherwise, skip to the next step. If the member’s health is in jeopardy, select Yes from the drop-down list. Select Done to close the questionnaire. This field defaults to the PCP name that is assigned to your login credentials. To change, enter a partial or full name or NPI for the Referred from Provider. As you enter the name or NPI, the matching search results display in the drop-down list. Select the provider who is referring the member to visit a Specialist. Note: This field only displays the physicians in your coverage group. (Optional) Enter or select the Last PCP Visit Date. Enter a partial or full diagnosis code or description in the first Diagnosis Codes field. As you enter the code or description, the matching search results display in the drop-down list. Select the diagnosis applicable to the member’s condition. (Optional) Enter and select additional Diagnosis Codes (up to three additional ones) in the other blank fields. Enter a partial or full specialty code or description in the Referred to Specialty field. As you enter the code or description, the matching search results display in the drop- down list. Select the specialty applicable to the specialist you want the member to visit. Note: You most likely will not know the specialty codes initially, only the specialty descriptions. Once you use a code repeatedly, you might memorize the code.

28 HSConnect Enter a New Referral Use one of the following methods to select the Referred to Provider or Specialist you want the member to visit. a.The first preference is to select a Specialist from the Directory Providers section. Up to 15 Specialists will display in the directory results at a time. The Specialists display alphabetically by last name. Select the Next, Last, First, or Previous links to page through the search results. b.You can also select the Search Providers link to search directly by NPI or Name. Last name, first name works best for name searches. Note: If you search by name, partial name searches will yield results for all providers in that specialty, for all Cigna-HealthSpring Markets, containing that value searched. Note: Only contracted providers will populate search results. c.If the specialist you want to send the member to is non-par or out-of-network, select the Enter Non-Participating Provider checkbox. Complete all the fields, including the Reason why this member needs to go to a non-par provider. Once selected, the name of the Referred to Provider displays with his or her NPI.

29 HSConnect Enter a New Referral Select one of the following options from the Type of Visit drop-down list: Consult Only - single visit Office Visits - multiple visits If you need to modify the Start Date and/or End Date, enter or select the new dates. Note: If you extend or make the dates retroactive, the referral will most likely pend when submitted. Enter or use the arrows to select the Number of Visits. Note: If you extend a default (other than 0), the referral will most likely pend when submitted. If you selected Consult Only in Step 11, this field is 1. Document the reason for the referral by using one or both of the following methods: Enter free text Clinical Notes to document why this request is medically necessary. Copy (Ctrl/C) the clinical notes from your EMR and paste (Ctrl/V) the notes. Type in a statement that you will fax the clinical to Health Services. If you select this option, reference the Authorization ID on the fax. Attach the clinical information as a file. Select Browse… to select the file. Select Upload File(s) to attach the file to the referral.

30 HSConnect Enter a New Referral Perform one of the following: If you are not ready to send the request to HealthSpring for processing, select Save Draft. Note: You can select the referral from the HSConnect Home Page, under the Drafts section to view or edit at a later time. To submit the referral to HealthSpring for processing, select Submit. Review the confirmation message at the top of the screen (Approved or Pending) and note the Authorization ID. If Pending, HealthSpring must review for a final determination. Note if the Service Provider was sent a message or if you will notify him/her manually.

31 HSConnect New Precertification If you need to create a precertification to perform an outpatient procedure or surgery for a Cigna-HealthSpring member. This applies if the procedure is done in the office, an ambulatory surgery center (ASC), or an outpatient hospital. Note: You cannot create inpatient or behavioral health precertification's in HSConnect at this time. Log into the HSConnect portal and accept the terms and conditions. Review your Recent Authorizations or select the Authorization Search link to find an active authorization (Start Date/End Date range is still open) for the member. If you find an active authorization, select the Create a precertification for this member link to create the request. Skip to Step 11. If you do not find an active authorization, continue to the next step. Select the Enter New Precertification link at the top of the HSConnect Home Page. The Member Quick Search screen displays. Attempt to locate the member for the precertification. Since you are logged into the HSConnect portal as a Specialist, no search results are returned (there are no members assigned to your coverage group) and a link displays. Select the Do you have a paper Referral for the member you are searching for? link. The Green Referral Validation screen displays.

32 HSConnect New Precertification Enter the Member ID assigned to the member by HealthSpring. Note: Enter the number without any spaces. Include the first nine digits, asterisk, and the two-digit suffix. Select the Show Provider Lookup link to search for the member’s PCP. The Search for Provider screen displays where you can enter a partial or full provider name or NPI. From the results that display, select the Provider Name link for the member’s PCP. Select the Show Provider Lookup link to search for the provider who is providing the precertification services (the Specialist). The Search for Provider screen displays where you can enter a partial or full provider name or NPI. From the results that display, select the Provider Name link for the Referred from Provider. Enter or select the calendar icon for the Start Date and End Date when the services are due to start and end. Select Submit. The system validates the information that you entered on the screen. If one of the entries does not match, a Green Referral xxx Not Valid Message displays. Fix the validation error and select Submit again. If the validation is successful, the main Precertification screen displays to continue with the precertification. Note: The information you entered on this screen does not integrate to the main Precertification screen

33 New Precertification If you have an existing authorization you can bypass the Green Referral Validation completely.. Locate Existing authorization from recent authorizations or authorization search Pull up the authorization details by clicking the authorization number. If you are doing a Referral, click Create a referral for this member. If you are doing a Precertification, click Create a precertification for this member. Proceed to the authorization entry screen.

34 HSConnect New Precertification (Optional) If precertification request is expedited, select the Expedite Request link. The Expedited Request Questionnaire displays. Otherwise, skip to the next step. If the member’s health is in jeopardy, select Yes. Select Done to close the questionnaire. Select the Search button to select the Referred from Provider from the list of providers in your coverage group. Select the Provider Name link for the provider who is referring the member to the Referred to Provider. Enter a partial or full diagnosis code or description in the first Diagnosis Codes field. As you enter the code or description, the matching search results display in the drop-down list. Select the diagnosis applicable to the member’s condition. (Optional) Enter and select additional Diagnosis Codes (up to 3 additional ones) in the other blank fields. list.

35 HSConnect New Precertification Enter a partial or full specialty description in the Referred to Specialty field. As you enter the description, the matching search results display in the drop-down list. Select the specialty applicable to the precertification request. Note: The selection in this field determines the providers that display in the Referred to Provider section. If the Specialist is performing the surgery at a hospital or ASC, enter Outpatient Surgery or Hospital. If the Specialist is performing the surgery at the office, enter the name of the Specialty, such as Cardiology or Urology. Select the Service Type that most closely relates to the requested service from the drop-down

36 HSConnect New Precertification Use one of the following methods to select the Referred to Provider or the provider that is rendering the requested services. Note: If the Referred to Specialty = Outpatient Surgery or Hospital, the Referred to Provider is the name of the facility where the procedure or surgery will take place. Note: If the Referred to Specialty = an area of medicine such as Cardiology or Urology, the Referred to Provider is the name of the Specialist. The first preference is to select one of the providers from the Directory Providers section. The providers display alphabetically. Select the Next, Last, First, or Previous links to page through the results. Note: You can also select the Search Providers link to search directly by NPI or Name. The provider must still be one that would have displayed if you paged through the results. The second preference is to select one of the providers from the Extended Directory Providers section. If the provider is non-par or out-of-network, select the Enter Non-Participating Provider checkbox. Complete all the fields, including the Reason why this member needs to go to a non-par provider. Once selected, the name of the Referred to Provider displays with the NPI. If you selected the same provider as the Referred from Provider, the referral may pend when it is submitted to Cigna- HealthSpring.

37 HSConnect New Precertification Depending on your selection for the Referred to Provider, select the Place of Service (POS) or location where the provider will perform the requested service. Example 1: If you selected a Referred to Specialty for Outpatient Surgery and a specific hospital for the Referred to Provider; Inpatient Hospital, Outpatient Hospital, and/or Emergency Room display. Example 2: If you selected a Referred to Specialty for Urology and a specific physician for the Referred to Provider, the office locations for the physician display. Note: Select the Change link to modify the POS. Document the reason for the precertification by using one or both of the following methods: Enter free text Clinical Notes to document why this request is medically necessary. Copy (Ctrl/C) the clinical notes from your EMR and paste (Ctrl/V) the notes. Type in a statement that you will fax the clinical to Health Services. If you select this option, reference the Authorization ID on the fax. Attach the clinical information as a file. Select Browse… to select the file. Select Upload File(s) to attach the file to the precertification. Upload up to 5 files at one time. Each file must be 10MB or smaller. To remove a file before you select the Upload File(s) button, select the remove link. To remove a file after you select the Upload File(s) button, select the Delete link. Once you submit the request, you cannot delete a file attachment.

38 HSConnect New Precertification Perform the following steps to add a CPT/HCPCS/revenue code to indicate the specific procedure request: Select the Click Here to Add a Service or Procedure link. Enter a partial or full CPT/HCPCS/revenue code or description in the Procedure field. As you enter the code or description, the matching search results display in the drop-down list. Select the applicable procedure. Select or enter the number of Units. Select the Unit Type from the drop-down list. Be sure to review all the selections and select the correct one. Enter or select the valid Start Date and End Date range for the precertification. Note: The dates may default based on the selection for the Procedure field. Select the save procedure link to add the procedure to the precertification request. Repeat steps 19a – 19f to add additional CPT/HCPCS/revenue codes to the precertification request. Note: Select the delete link to remove a procedure from the request that you added in error. Perform one of the following options: If you are not ready to send the precertification to HealthSpring for processing, select Save Draft. Note: You can select the precertification from the HSConnect Home Page, under the Drafts section to view or edit at a later time. To submit the precertification to HealthSpring for processing, select Submit. Review the confirmation message at the top of the screen (Approved or Pending) and note the Authorization ID. If Pending, HealthSpring must review for a final determination. Note if the Service Provider was sent a message or if you will notify him/her manually.

39 HSConnect Search & View Claims Select the Claim Search link at the top of the Home Page. The Provider Claim Search screen displays. Search for a claim(s) by using one of the following search methods: Claim ID: Enter the claim number assigned by Cigna-HealthSpring. Check Number: Enter the check number issued by Cigna-HealthSpring for payment on the claim. Member ID and Begin/End Date: Enter the number assigned to the member by Cigna-HealthSpring (nine digits, an asterisk, and two digit suffix - for example *01). If you do not know the number, select the Find Member link to search for the member. (Optional) Enter a Begin Date and End Date range for the Dates of Service on the claim(s) to narrow the search results.

40 HSConnect Search & View Claims Provider and Begin/End Date: Select the Select Provider link. The Search for Provider screen displays with the providers in your coverage group. If the provider you are looking for does not display, select the Next link until the provider displays. If you work in a very large provider group, you can use the text box to search by provider Name or NPI. Select the NPI or Provider Name link for the applicable provider. (Required) Enter a Begin Date and End Date range for the Dates of Service on the claim(s). Select Search. The search results display. Note: If you searched by Member ID or Provider and there are more than 300 claims in the search results, you must narrow the date range.

41 HSConnect Search & View Claims Review the matching claims in the Claims Search Results section. (Optional) Select any of the column headings to sort the search results by that column heading. Select the link for any row on the screen to view additional details specific to the selected claim and for the option to view the remittance advice

42 HSConnect Search & View Claims View the Claim Details specific to the selected claim. (Optional) Select the Member Name link to view the demographic and eligibility information for the member on the claim. Note: If you select this link, you cannot return back to the claim without having to search for the claim again. View the Claim Line Items specific to the selected claim. Select the Remittance Advice link to view the remittance advice for the selected claim. (Optional) Select the Return to claim search link to view another claim from the original search results.

43 HSConnect Search & View Claims View the Remittance Advice Detail that displays the same details included on the original remittance advice to the provider. (Optional) Select the Print Page link to print a copy of the remittance advice. (Optional) Select the Return to Claim Detail link to continue reviewing the details for the previously selected claim.

44 Example ID Card


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