Presentation on theme: "Checking for Eligibility and Successfully Completing a Claim with the OHCA Secure Site For ResCare Providers Department of Mental Health and Substance."— Presentation transcript:
Checking for Eligibility and Successfully Completing a Claim with the OHCA Secure Site For ResCare Providers Department of Mental Health and Substance Abuse Services Van Rhodes and David Melton
Checking Eligibility To check eligibility, obtain a member ID, submit claims and check PAs, go to: https://www.ohcaprovider.com/Oklahoma/Security/logon.xhtml Generating a Member ID
Eligibility Can Be Checked with any combination of 2 of the following: Name Date of Birth Social Security Number or you may check by the Member ID if it is known. This member is fine. No further action required. Their member ID is 045359933 Searching for a Member ID
What if: the customer does not have a member ID, OR the customer has a member ID, but does not have DMH (MHSAS) Eligibility, OR the customer has a Member ID, MHSAS eligibility, but the eligibility is going to expire soon.
This is NOT enrollment for Medicaid You should encourage customer to go to www.mysoonercare.org to fill out for Medicaid benefits www.mysoonercare.org You still need to be cautious to not create duplicate Customer IDs Entering in 000-00-0000 for the SSN should be the very last resort Remember: you cannot back date eligibility
Helpful Reports Related to the CCP Go To ICIS Click on CCP Reports (Middle Column) The reports with the red arrows (1004 and 1006) will be particularly important in keeping eligibility and Prior Authorizations up to date.
STEP 2: Determining what ‘ADD’ you need to use to create a CDC Transaction Type: After clicking ‘Search’, it will either show the consumer’s CDC(s) from your search in the CDC Search Result screen. If the customer appears in the search then click the blue ‘Add’ on the corresponding row.
Things to Remember When updating CDCs for the PA, the date of the CDC transaction needs to be the date directly following the date that the last PA was to end (ex: PA ends on 4-1-2011, the CDC update needs to be dated 4-2-2011). Please do not do (enter) CDC updates prior to the first date of the new PA (ex: if existing CDC/PA is ending on 4-1-2011, you should not enter the CDC update until 4-2-2011). If you enter the updates earlier than that it can cause system problems. You have 15 days after the date that the new PA should begin to enter your CDC update. Be sure that when you do the update the transaction date is the date that the new PA should have begun (ex: existing CDC/PA is ending on 4-1-2011, and the new PA should begin on 4-2-2011. You can complete the CDC update anytime between 4-2-2011 and 4-17-2011, but would need to make sure that the transaction date on the CDC is dated 4-2-2011).
4 Digit Contract Source Double Click in the Rendering NPI box and the system will generate the rest of the information required. Click Submit
When you press the SUBMIT button at the bottom of the page, you will be told if the claim is Paid or if you have an error that needs to be corrected and what you need to correct. You can immediately correct the claim and resubmit it.
Checking Denied Claims for a particular consumer (Member ID) You can limit the search by adding dates
Searching by Member ID, Date of Service and Any Status Choose the ICN with highest number. It is the most recent claim.
ICN The “Denied” claim looks like this. Note the Error Codes below the ICN
Checking Denied Claims for ALL claims for your provider ID You can limit the search by adding dates Choose the “Claim Status” you want to search or choose ‘ALL’ Click Search
200000000 If you use JonesMary as your account number it will make subsequent Claims Inquiries much easier, as you will not have to know what the Client ID means when do an “ALL Claims” inquiry. TIP 1a: Create a “Patient Account Number” when you submit a claim 2000000 00 Just type it in the Patient Account Box
Checking Denied Claims for your Account Number “JonesMary” JonesMary etc TIP 1b: You can also ‘Search’ by Patient Account Number
Checking your Prior Authorization in Care Connection
For ResCare facilities: Authorizations are instantly created by CDCs If you get a billing error, check the last CDC entered for the customer What you are looking for: transaction date of CDC (authorization is only good six months out from transaction date) service focus of CDC (needs to be 11) Level of Care (needs to be ‘CL’)
Checking your Prior Authorization on the OHCA Secure Site
Click Here or Here to check for prior authorizations
You will see these 3 choices. For Behavior Health Claims, you can ONLY check Status Inquiry. You cannot submit a PA Request This is done on APS CareConnection As you have seen in an earlier slide.
easy 123a Or for ALL of the members PAs easy 123a You can search for PAs for individual members by date
Enter ID and check all PAs and click Search Click on the PA number and you will find information on the number of units or dollars allotted per month and the amounts used. This is updated as you submit claims, so it will be up to date. I am sorry we do not have an example of that screen, but we believe it will be self explanatory when you see it.
Click Here to Select the Contract Source you want to review The Budget information will appear here.
If you have a problem with a claim, call the OHCA Helpdesk 800-522-0114 or in OKC 522-6205 APS Helpdesk for questions concerning CDC and Prior Authorization 1-800-762-1560 – toll free 405-556-9700 – OKC
Contact Information: Van Rhodes email@example.com Work 405.522.8876 Cell 405.795.1724 David Melton firstname.lastname@example.org Work 405-522-3821 Please Note, there is lots of help available. OHCA/Claims, APS Healthcare And ODMHSAS All have trainers and field representatives to assist you.