1 Professional Provider Back to Basics Seminar CareFirst BlueCross BlueShield Updates AAHAM Third Party Payer Meeting March 15, /15/2013

Agenda EDI Updates and Reminders Electronic Funds Transfer CareFirst Direct 835 Remittance Advice ICD10 Preparations Pharmacy Preauthorizations iEXCHANGE Replacement Update CareFirst General Updates 2 3/15/2013

3 EDI Updates and Reminders 3/15/2013

Electronic Services 4 3/15/2013

5 Electronic Services 3/15/2013

6 Submit claims using your NPI number Include patient’s entire prefix & membership number Verify patient name and birth date Use HIPAA standard data code sets Review all reports daily Correct all claims with errors and resubmit electronically Review website regularly for news and updates Refer to the website or BlueLink for a list of our preferred vendors EDI Helpful Hints 3/15/2013

7 Difficulties with submissions? Contact your vendor/clearinghouse first. CareFirst: EDI Service Line For better assistance, use one of the following terms when placing your call: 835 ERA's/enrollment NPI 837 claim status for NCOF (no claim on file) or front end rejections from CareFirst EDI Support 3/15/2013

8 Electronic Funds Transfer (EFT) 3/15/2013

Get Your Payment Fast Though Electronic Funds Transfer (EFT) Get paid faster through electronic delivery of your payments Reduce paperwork Receive secure payment distribution Avoid mail delay To be eligible for EFT you must: Submit claims electronically Receive an 835/ERA (Electronic Remittance Advice) 9 3/15/2013

Enroll Today for Electronic Fund Transfer (EFT)* *Note: If you currently receive automated payments from CareFirst there are no changes and no need to re-enroll The following clearinghouses offer electronic fund transfer (EFT) enrollment services:  Emdeon (formerly known as Webmd) at  Allscripts (formerly known as Payerpath) at , ext. 1 or 2  RealMed at , ext Contact your clearinghouse with all questions regarding EFT capabilities and enrollment. Refer to the CareFirst website for more information Contact your clearinghouse with all questions regarding EFT capabilities and enrollment Go to for more informationwww.carefirst.com/electronicclaims 10 3/15/2013

11 CareFirst Direct 835 Remittance Advice 3/15/2013

Remittance Advice 12 Log into CareFirst Direct 3/15/2013

Remittance Advice 13 Click on Remittance. 3/15/2013

Remittance Advice 14 Click on Claim Status. 3/15/2013

Remittance Advice 15 Click on Provider Remittances 3/15/2013

Remittance Advice 16 3/15/2013

Remittance Summary 17 Search by Date, Check/EFT Trace#, Paid Amount, Source System. Please note: Reviewing Billing NPI/Payee – You can search 90 days at a time. When reviewing All Billing NPI’s – you have the same filtering capabilities, however you can only search 7 days at a time due to the amount of data from all billing NPIs. For each you can search back to 1/1/2012. Search by Date, Check/EFT Trace#, Paid Amount, Source System. Please note: Reviewing Billing NPI/Payee – You can search 90 days at a time. When reviewing All Billing NPI’s – you have the same filtering capabilities, however you can only search 7 days at a time due to the amount of data from all billing NPIs. For each you can search back to 1/1/ /15/2013

Important Reminders for the 835 The provider must be registered to receive an 835 through their trading partner in order to view Remittances Data through CareFirst Direct. Note: You will see the Remittance Tab even if you are not registered, however you will only see No Checks Found. We plan on making the message more clear in the future. For information about electronic billing and receipt of 835 visit You cannot import the CareFirst Direct 835 into your practice management system. Please sign up for 835 instructional webinars on CareFirst.Com in the Provider and Physician’s section under Seminar and Training. 18 3/15/2013

ICD10 Preparations 3/15/

Health and Human Services (HHS) has announced a final rule that delays the ICD-10 compliance date from October 1, 2013 to October 1, CareFirst will be compliant with this date. Updates will be provided on the CareFirst website under Provider and Physicians under the Quick Link 5010/ICD10. Please work with your clearing house to be ready for the changes. Additional information is available at the CMS website. More detail will be available at the Hospital Quarterly Meetings to be held in April. Go online and register to attend one of these sessions. 20 ICD10 3/15/2013

Pharmacy Preauthorizations 3/15/

Pharmacy Authorizations Now Online Providers can now request and track authorizations for medications requiring pre-authorization online. To access this new tool, log in to the Provider Portal from and click on the Pre- Auth/Notifications tab. Within the Provider Portal, providers can: Select the desired drug Enter information about the member’s condition Attach any applicable documents for medical review Track the status of a request We have developed a new webinar to show you how to use this feature. Note: This applies to patients with CareFirst BlueCross BlueShield pharmacy prescription benefit only. 3/15/

Pharmacy Authorizations 23 Click on Pre-Auth/Notifications. 3/15/2013

Create a Preauthorization 24 3/15/2013

Preauthorization 25 3/15/2013

26 iEXCHANGE Replacement Update 3/15/2013

Project Overview iEXCHANGE is scheduled to be replaced in the second quarter of Authorizations will be obtained through our Provider Portal (CareFirst Direct). Training will be offered via webinars and during the Hospital Quarterly Meetings. Provider Relations Representatives will provide support and individualized training as needed. 27 3/15/2013

To Ensure Success IEXCHANGE administrators received a spreadsheet with a list of all current IEXCHANGE users. The administrators were asked to forward the containing the spreadsheet to all of the administrators listed in the spreadsheet. They should review the list for accuracy. They should create a CareFirst Direct User ID for any iEXCHANGE user who does not currently have access. If a user obtains authorizations for multiple tax ids a different user id is needed for each. If you have a new employee make sure they get a CareFirst Direct user id. Access to authorization entry is granted by virtue of having a user id. No specific role needs to be granted. 28 3/15/2013

To Ensure Success Allows us to make changes instead of waiting on a vendor to make changes. Allows us to make authorizations available to more provider types. Eliminates a redundant system. 29 3/15/2013

Next Steps for the iEXCHANGE Replacement Make sure all personnel who obtain authorizations have access to the Provider Portal (CareFirst Direct). Attend training- Training will be conducted via webinar sessions and at our second quarter Hospital Quarterlies. We will advertise these webinars to our providers. Please check the website periodically and register when these sessions are listed. If you have questions please contact your Provider Relations Hospital Representative. 30 3/15/2013

CareFirst General Updates 31 3/15/2013

Update Your Information In order to do business efficiently with our CareFirst providers, it is essential for us to have your most current practice information. We’ve made it easier than ever for you to review and update your information. Log into the Provider Portal at carefirst.com under Providers and Physicians to review and verify your address, phone number, location, associated practitioners and more. 32 3/15/2013

Update Your Information 33 3/15/2013

Make Sure Your Practice Information is Current Review Your Practice Information Online Today If any information displayed is incorrect, it is important for you to submit a Change in Provider Information form immediately. The form is available online. CareFirst Mailstop CG Mill Run Circle Owings Mills, MD or Fax: /15/2013

Use Your NPI and Keep It Current Your National Provider Indicator (NPI) is Required To improve efficiency of claims processing, CareFirst requires that all claims submitted (electronic and paper) include your NPI so your practice can be identified. Without your NPI, your claims may be delayed or rejected. Need an NPI? Visit to find out more. Any changes to your NPI? Report them to CareFirst using the NPI Submission Form located on the same page under the NPI and Payer Codes tab. CareFirst BlueCross BlueShield Provider Information and Credentialing Mill Run Circle P.O. Box 825 Mailstop CG-41 Owings Mills, MD Send questions to 35 3/15/2013

Sign-up to Receive from CareFirst 36 3/15/2013

Sign-up to Receive from CareFirst cont. 37 3/15/2013

Facets Voucher Changes The Facets Voucher/Notice of payment(NOP) for both professional and institutional providers will be changing toward the end of the 2 nd quarter of The changes will make the voucher easier to interpret and ensure that all of the necessary information is available. Training will be conducted via webinar sessions. Go to Training sessions are now available on the website for enrollment at and click on Seminars and Training on the left side. 38 3/15/2013

Questions Thank you for your attention 39 3/15/2013