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Checking for Eligibility and Successfully Completing a Claim with the OHCA Secure Site For ResCare Providers Department of Mental Health and Substance.

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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:

1 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

2 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

3 Sign In

4 Your Agency Your Prov Number Your Number

5 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 Searching for a Member ID

6 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.

7 Click on ‘ODMHSAS Customer Enrollment’

8 Enter Name, Date of Birth, Gender, SSN and Address then click ‘Submit’

9 Donald Duck

10  This is NOT enrollment for Medicaid  You should encourage customer to go to to fill out for Medicaid benefits You still need to be cautious to not create duplicate Customer IDs Entering in for the SSN should be the very last resort  Remember: you cannot back date eligibility

11 Services Manual ARC WEBSITE

12 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.

13 Submitting a CDC in Care Connection

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17 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.

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26 For providers with multiple locations like Red Rock, Just click one and you are finished, you do not have to know the location.

27 Start of Section II of the CDC General Information:

28 Section II cont.

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32 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 , the CDC update needs to be dated ). Please do not do (enter) CDC updates prior to the first date of the new PA (ex: if existing CDC/PA is ending on , you should not enter the CDC update until ). 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 , and the new PA should begin on You can complete the CDC update anytime between and , but would need to make sure that the transaction date on the CDC is dated ).

33 Submit a Claim

34 Your Agency Your Prov Number Your Number

35 Computer generated

36 Go to Screen 2 No Decimal Point Complete Member ID and Diagnosis

37 Use 1 Use 99 – Other Unlisted Facility DOS = Date of Service T2033 HE The claim info you enter below, will populate the box above

38 Leave this area blank

39 4 Digit Contract Source Double Click in the Rendering NPI box and the system will generate the rest of the information required. Click Submit

40 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.

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42 If your claim(s) is successfully submitted by noon Wednesday, you will receive an electronic remittance by midnight the following Wednesday.

43 Your Agency Your Prov Number Your Number

44 Checking Denied Claims for a particular consumer (Member ID) You can limit the search by adding dates

45 Searching by Member ID, Date of Service and Any Status Choose the ICN with highest number. It is the most recent claim.

46 ICN The “Denied” claim looks like this. Note the Error Codes below the ICN

47 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

48 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 Just type it in the Patient Account Box

49 Checking Denied Claims for your Account Number “JonesMary” JonesMary etc TIP 1b: You can also ‘Search’ by Patient Account Number

50 Checking your Prior Authorization in Care Connection

51 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’)

52 Checking your Prior Authorization on the OHCA Secure Site

53 Click Here or Here to check for prior authorizations

54 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.

55 easy 123a Or for ALL of the members PAs easy 123a You can search for PAs for individual members by date

56 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.

57 Checking your Budget on the OHCA Secure Site

58 Click Here to Select the Contract Source you want to review The Budget information will appear here.

59 If you have a problem with a claim, call the OHCA Helpdesk or in OKC APS Helpdesk for questions concerning CDC and Prior Authorization – toll free – OKC

60 Contact Information: Van Rhodes Work Cell David Melton Work Please Note, there is lots of help available. OHCA/Claims, APS Healthcare And ODMHSAS All have trainers and field representatives to assist you.


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