October 2009 Web interChange Advanced Functions Presented by the EDS Provider Field Consultants

2October 2009 Web interChange Advanced Functions Agenda Session Objectives Administrator Request Form Administrator Functions Provider Profile Updates Paperless Remittance Advice User List Functions Void and Replacement Features Claim Attachments Prior Authorization Submission and Inquiry TPL Updates Crossover Claim Billing Helpful Tools - Avenues of Resolution Questions Welcome and Announcements

3October 2009 Web interChange Advanced Functions Session Objectives Following this session, providers will: Understand how to obtain Web interChange administrator access Understand Web interChange administrator functions Know how to view and print your provider profile Know what can be updated in the provider profile, and how to update the information Know how to view/print/save Paperless Remittance Advice Know how to develop user lists Understand void and replacement functions Understand how to add claim attachments Understand prior authorization inquiry and submission Understand how to update TPL information Understand crossover claim billing

4October 2009 Web interChange Advanced Functions Web interChange Access Logon Screen

5October 2009 Web interChange Advanced Functions Administrator Request Form Complete and mail the Administrator Request Form to: Electronic Solutions Help Desk 950 N. Meridian Street Suite 1150 Indianapolis, IN Request Form and letter may be faxed to (317) Submit a letter of acknowledgement on your company’s letterhead from the organization’s owner, indicating you are approved as an administrator for your organization Each provider should assign an administrator to oversee the daily functions of the individual practice or group

6October 2009 Web interChange Advanced Functions Web interChange Administrator Menu Web interChange Home Page

7October 2009 Web interChange Advanced Functions Administrator Functions User Administration –Create User –Update User –Reset Password –Reactivate User Group Administration –Administer Groups Group Maintenance Group Member Maintenance View Group Report » Review the Group Report every 90 days » Compliance is tracked by OMPP and EDS

8October 2009 Web interChange Advanced Functions Administrator Functions

9October 2009 Web interChange Advanced Functions Administrator Functions Create a User

10October 2009 Web interChange Advanced Functions Administrator Functions Group Administration

11October 2009 Web interChange Advanced Functions Administrator Functions Group Member Maintenance

12October 2009 Web interChange Advanced Functions Administrator Functions Reports

13October 2009 Web interChange Advanced Functions Administrator Functions Create user Establish groups and security levels Add users to group View group report Group Administration

14October 2009 Web interChange Advanced Functions Password Resets Necessary when user has not logged on for more than 90 days Administrator may reactivate an inactive user Administrator gets from the EDI Solutions Help Desk when user is reactivated An inactive administrator must be reactivated by the EDI Solutions Help Desk Reactivate User

15October 2009 Web interChange Advanced Functions Password Resets By User

16October 2009 Web interChange Advanced Functions Password Resets By User

17October 2009 Web interChange Advanced Functions Administrator Functions Provider Profile

18October 2009 Web interChange Advanced Functions Select “View” or “Edit”

19October 2009 Web interChange Advanced Functions Must respond to ‘CHOW’ question Change of Ownership?

20October 2009 Web interChange Advanced Functions Update Provider Address

21October 2009 Web interChange Advanced Functions Update Provider Specialty

22October 2009 Web interChange Advanced Functions Begin or Update Electronic Funds Transfer

23October 2009 Web interChange Advanced Functions Click “Edit” Update Rendering Provider Information

24October 2009 Web interChange Advanced Functions Profile Maintenance Using Web interChange, providers can also make the following profile updates: –Ownership information –Changes in members of a Board of Directors –Name of office manager or other management personnel –Ownership in subcontractor entities Group providers may not remove rendering provider linkages via Web interChange –Complete the IHCP Provider Termination Form Note: EFT deposits occur 18 days after submitting an enrollment via Web interChange Other Types of Updates

25October 2009 Web interChange Advanced Functions Paperless Remittance Advice

26October 2009 Web interChange Advanced Functions Paperless Remittance Advice

27October 2009 Web interChange Advanced Functions Paperless Remittance Advice Accessing Paperless RAs Through Web interChange *Three Easy Steps Step 1 – From the Web interChange Home page, select Check/RA Inquiry. On the Check/RA Inquiry page, enter the desired search criteria and click Submit. A list of checks and RAs (most recent first) displays. –The link to download the RA displays regardless of check availability –If no check was issued in conjunction with the RA, the check number displays as “ ” –The Provider/National Provider Identifier (NPI) fields populate based on the user’s security

28October 2009 Web interChange Advanced Functions Paperless Remittance Advice Step 2 – Click on the PDF icon to the right of the check number (in the “Download RA” column) –A PDF of the RA opens in a new window –Downloaded RAs have a Family and Social Services Administration (FSSA) watermark –If users wish to save copies of RAs for their records, they can use the “Save a Copy” feature of Adobe Acrobat Reader RAs can also be printed from Adobe Acrobat Reader

29October 2009 Web interChange Advanced Functions Paperless Remittance Advice Step 3 – If the desired RA is not displayed, change the search criteria at the top of the Check/RA Inquiry page –RAs are available in Web interChange for four weeks

30October 2009 Web interChange Advanced Functions User List Functions

31October 2009 Web interChange Advanced Functions User List Functions

32October 2009 Web interChange Advanced Functions User List Functions Features of a User List: –May create user lists to alleviate keying information manually in specific claim submission fields –Allows information to be added or deleted as needs change –Can only be created for fields listed with a drop-down arrow in the claim submission screen

33October 2009 Web interChange Advanced Functions Void and Replacement Features Void

34October 2009 Web interChange Advanced Functions Void and Replacement Features Void requests can be submitted electronically using the 837 transaction or Web interChange Void requests submitted electronically can be for a previously submitted electronic claim or paper claim Voids cannot be performed on a claim in a denied status Void is a HIPAA term for adjustment Void is the cancellation of an entire claim whether same day, same week, or post financial Void

35October 2009 Web interChange Advanced Functions Void and Replacement Features A void can be performed on claims in a paid or suspended status If the void of a claim occurs the same day or week that the original claim was submitted, a new ICN is not created –The same ICN assigned to the claim applies to the void –The original claim denies with edit 0120 – Claim denied due to an electronic void request If the original claim being voided is a historical claim, a new claim with a new ICN is created –The new ICN starts with 63 Check-related voids (adjustments) continue to be submitted on paper Void

36October 2009 Web interChange Advanced Functions Void and Replacement Features Pre-FinancialPost-Financial – Paid User voids the claim Voided claim denies EOB – Paid Today’s date: 10/10/ – Denied with EOB 0120 RA/835 shows: Claim shows on the denied page only – same ICN RA/835 shows: Mother Claim: and Daughter Claim: Both appear on the adjustment page Void

37October 2009 Web interChange Advanced Functions Void and Replacement Features Replacement

38October 2009 Web interChange Advanced Functions Void and Replacement Features Replacement is a change to an original claim, whether same day, same week, or post financial –Original claim indicates the most recent ICN assigned to that claim An electronically submitted replacement claim can be for a previously submitted electronic or paper claim Only noncheck-related replacements are accepted electronically Check-related replacements continue to be submitted on paper Replacement

39October 2009 Web interChange Advanced Functions Void and Replacement Features If the IHCP receives a replacement claim for an original claim that has been through a financial process (has appeared on an RA), the replacement claim ICN starts with one of the following: ―61 – Provider initiated replacement containing attachments and/or claim notes ―62 – Provider initiated replacement with no attachments and/or claim notes Replacement

40October 2009 Web interChange Advanced Functions Void and Replacement Features No filing limit for void requests One-year filing limit for replacement requests Web interChange will not display a Replace This Claim button on claims that are past the filing limit –These replacements must be submitted on paper The system compares the last date of claim activity and the date of the current activity to make sure that a year has not passed –If the date of service of the claim is greater than one year, proof of timely filing is required to avoid a payment take back on the paid claim The filing limit does not apply to crossover claims Filing Limits for Voids and Replacements

41October 2009 Web interChange Advanced Functions Claim Attachment Feature

42October 2009 Web interChange Advanced Functions Claim Attachments

43October 2009 Web interChange Advanced Functions Claim Attachments Unique number assigned by provider Claim and document specific Each ACN may only be used one time Write “ACN #” and the assigned ACN on each page of documentation corresponding to that number Attachment Control Number (ACN)

44October 2009 Web interChange Advanced Functions Claim Attachments Select the appropriate Report Type –Report Type describes the document being sent Transmission Code defaults to “BM” – by mail –Electronic and ed attachments are not accepted Text Box –Applies to institutional claims only Report Type and Transmission Code

45October 2009 Web interChange Advanced Functions Claim Attachments Attachment Control Cover Sheet

46October 2009 Web interChange Advanced Functions Claim Attachments Available on IHCP home page, under Forms Complete cover sheet for each claim Include provider information Provide member ID List each ACN pertaining to specific attachment Indicate the number of pages of documentation submitted per attachment (not including the cover sheet) Mail cover sheet and supporting documentation to the appropriate P.O. Box (P.O. Box 7259) Attachment Control Cover Sheet

47October 2009 Web interChange Advanced Functions Prior Authorization Inquiry and Submission 278 Prior Authorization Inquiry

48October 2009 Web interChange Advanced Functions Prior Authorization Inquiry and Submission Allows the requesting provider to inquire about all non-pharmacy prior authorizations via the Web – It does not matter if the PA was submitted via paper, telephone, fax, or Web The requesting provider and the named service provider may view a PA without the PA number All other providers must have the PA number to view a PA 278 Prior Authorization Inquiry

49October 2009 Web interChange Advanced Functions Prior Authorization Inquiry and Submission 278 Prior Authorization Submission

50October 2009 Web interChange Advanced Functions Prior Authorization Inquiry and Submission 278 Prior Authorization Submission

51October 2009 Web interChange Advanced Functions Prior Authorization Inquiry and Submission 278 Prior Authorization Submission

52October 2009 Web interChange Advanced Functions Prior Authorization Inquiry and Submission 278 Prior Authorization Submission

53October 2009 Web interChange Advanced Functions Prior Authorization Inquiry and Submission The following provider types can submit PA requests via Web interChange: –Chiropractor –Dentist –Doctor of Medicine –Doctor of Osteopathy –Home Health Agency (authorized agent) –Hospice –Hospitals –Optometrist –Podiatrist –Psychologist endorsed as a Health Service Practitioner in Psychology (HSPP) –Transportation providers

54October 2009 Web interChange Advanced Functions Prior Authorization Inquiry and Submission Must be given access to submit PAs by the administrator Web interChange PA attachments follow the same guidelines as the Web interChange claim attachment process Assign a unique Attachment Control Number (ACN) for each attachment Enter assigned number into attachment screen in Web interChange Documentation must be submitted within 30 calendars days of the request 278 Prior Authorization Submission

55October 2009 Web interChange Advanced Functions Prior Authorization Inquiry and Submission Decision letters: The system sends a decision letter for PAs submitted via Web interChange, the same way it does for all PA requests 278 Prior Authorization Submission

56October 2009 Web interChange Advanced Functions Prior Authorization ADVANTAGE Health Solutions-FFS Prior Authorization Department P.O. Box Indianapolis, IN Fax: ADVANTAGE Health Solutions-Care Select Prior Authorization Department P.O. Box Indianapolis, IN Fax: MDwise-Care Select Prior Authorization Department P.O. Box Indianapolis, IN Fax: Prior Authorization by Telephone, Fax, or Mail

57October 2009 Web interChange Advanced Functions TPL Updates

58October 2009 Web interChange Advanced Functions TPL Updates Submit an electronic request to the EDS TPL Unit to update a member’s insurance information The TPL Unit receives the request, researches, confirms the information, and updates the eligibility screen with corrected information –Updates are usually made within 20 days Confirm that eligibility has been updated by reviewing the Eligibility Inquiry feature

59October 2009 Web interChange Advanced Functions Crossover Claim Billing

60October 2009 Web interChange Advanced Functions Crossover Claim Billing

61October 2009 Web interChange Advanced Functions Crossover Claim Billing Submit Medicare crossover claims electronically using Web interChange The following header information is required for the claim to process: –Payer ID and Payer Name –TPL/Medicare Paid Amount –Subscriber Name, Primary ID, Relationship Code, Gender, DOB, and Claim Filing Code –If the Payer ID is a Medicare payer and the Claim Filing Code is MA or MB, the claim is considered to have crossover information Note: Obtain COB information, including Payer IDs from the HELP tab, Reference Materials on Web interChange Header Information

62October 2009 Web interChange Advanced Functions Crossover Claim Billing

63October 2009 Web interChange Advanced Functions Crossover Claim Billing

64October 2009 Web interChange Advanced Functions Crossover Claim Billing The following detail level elements are requirements for the claim to process: –Payer ID –TPL/Medicare Paid Amount –Group Code, Reason Code, and Amount Note: Obtain COB information from the HELP tab on Web interChange Detail Information

65October 2009 Web interChange Advanced Functions Helpful Tools IHCP Web site at IHCP Provider Manual (Web, CD-ROM, or paper) Customer Assistance – , or –(317) in the Indianapolis local area Written Correspondence –P.O. Box 7263 Indianapolis, IN Provider Relations field consultant –View a current territory map and contact information online at Avenues of Resolution

October 2009 Questions

October 2009 EDS and the EDS logo are registered trademarks of Hewlett-Packard Development Company, LP. HP is an equal opportunity employer and values the diversity of its people. © 2009 Hewlett-Packard Development Company, LP. Office of Medicaid Policy and Planning (OMPP) 402 W. Washington St, Room W374 Indianapolis, IN EDS, an HP Company 950 N. Meridian St., Suite 1150 Indianapolis, IN 46204