Secure Provider Website

Secure Provider Website
Secure Provider Website
Instructional Guide
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Table of Contents
Introduction ................................................................................................................................................ 4
How to Use the Manual ........................................................................................................................... 4
Registration................................................................................................................................................ 5
Update Account ........................................................................................................................................ 8
User Management .................................................................................................................................. 10
Disable a User......................................................................................................................................... 12
Enable a User.......................................................................................................................................... 13
Manage TINs ........................................................................................................................................... 14
Checking Patient Eligibility .................................................................................................................... 15
Patient List ............................................................................................................................................... 17
Overview .............................................................................................................................................. 20
Coordination of Benefits .................................................................................................................... 21
Assessments ....................................................................................................................................... 22
Health Record ..................................................................................................................................... 23
Claims................................................................................................................................................... 24
Authorizations...................................................................................................................................... 25
Authorizations.......................................................................................................................................... 25
Create Authorizations ............................................................................................................................ 28
Claims....................................................................................................................................................... 34
Correct Claim .......................................................................................................................................... 37
Copy Claim .............................................................................................................................................. 40
Saved Claims .......................................................................................................................................... 42
Claim Errors............................................................................................................................................. 43
Fix a Claim ............................................................................................................................................... 44
Batch Claims ........................................................................................................................................... 45
Payment History...................................................................................................................................... 48
Claims Audit Tool.................................................................................................................................... 50
Professional Claims................................................................................................................................ 53
Institutional Claims ................................................................................................................................. 60
Secure Messaging .................................................................................................................................. 67
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Introduction
The Secure Provider Web is a secure website developed to allow Providers across
Centene health plans to perform a variety of functions from their office. By registering
and creating an account, a Provider can easily check patient eligibility, and view their
patient list. Providers can view and submit both authorizations and claims through the
website. A secure messaging feature allows a Provider to communicate with the
health plan without having to pick up the telephone.
How to Use the Manual
This manual is intended to be a quick reference for using a tool or function offered on
the website when a Provider or staff member needs assistance. The manual also
explains many ways to use the site in order to get the most out of the resource.
System Requirements
Access the secure provider website using Internet Explorer 7.0 or higher, Firefox
and/or Google Chrome. Each browser should be updated to the most recent version
available optimal performance.
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Registration
To create an account:
1. Click the Create An Account button.
2. Start your registration by entering your Tax ID number, First Name, Last Name,
Email, and Password.
***Passwords must be at least 6 characters in length, with at least one
uppercase and lowercase letter, and at least 1 number or symbol ([email protected]#$%^&*).
3. Click Register.
4. Registration is complete, and an email verification link is emailed to the address
provided during registration.
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5. Click the link in the email to finish setting up your account.
***If you cannot find the email, please be sure to check your spam/junk folder.
6. Login using the email address and password you created when you signed up.
7. Click Login.
8. Finish setting up your account by selecting 3 security questions and answers, and a
telephone and fax number.
9. Click Submit.
10. Validate your registration by entering your NPI and billing zip code.
11. Click Validate Registration.
Note: If the message “We could not match what you entered into our system, please
check and try again” is received Click Skip Validation. A Health Plan employee must
validate your account before it can be used.
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12. Once logged in, from your Dashboard you can access various tools to do the
following:
•
•
•
•
•
Verify patient eligibility
View and print your patient list
Submit and view authorizations
Submit and view claims
Send secure messaging
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Update Account
To make updates to your account:
1. Log in to the secure website.
2. Select the drop-down arrow next to your name in the upper right corner, and click
Account Details.
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3. To update your account, click the Update Account button. You are able to update
the details of your account, and your security information.
4. Under Your TINs you see the Primary Current Default TIN for the account, and can
select another TIN to Mark As Default or Remove a TIN.
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User Management
To manage users of your account:
1.
2.
Log in to the secure website.
Select the drop-down arrow next to your name in the upper right corner. Select
User Management. If you do not have a User Management option it means you
are not set up to manage the account.
3. Using this feature you can disable users, and manage permissions for your
account. To manage permissions, click Permissions next to the user name.
4. On the Modify Permissions screen, you can view all permissions granted to a user.
It is the responsibility of the Account Administrator to manage the account.
***It is recommended for only 1-2 staff members to have permission to Manage
Account at each entity.
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5. Uncheck the box next to Manage Account, and click Save Permissions.
6. Instantly the identified user will not be able to manage account.
7. After clicking save permissions, you return to the Support Users screen to manage
additional users if necessary.
8. To invite a user to join your account, enter their Email Address in the email
address field and click Send Invitation.
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Disable a User
To disable a user from an account:
1. Log in to the secure website.
2. Select the drop-down arrow next to your name in the upper right corner. Select
User Management.
3. Select Disable User next to the user name that you wish to disable access.
4. After a user is disabled, you receive a Success message. Under the Actions
column you have an Enable User function if necessary.
***Once a user is disabled, their login and password are disabled immediately
and the user is unable to access the account.
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Enable a User
To enable a user previously disabled:
1. Log in to the secure website.
2. Select the drop-down arrow next to your name in the upper right corner. Select
User Management.
3. Next to the disable user’s name, click Enable User.
4. You receive a Success message, and the user is enabled immediately.
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Manage TINs
To manage Tax Identification Numbers for your account:
1. Log in to the secure website.
2. Manage TINs by selecting the drop-down arrow next to the Viewing Dashboard
For, or selecting Add a TIN to My Account.
3. To add a TIN enter the Tax ID, NPI, and Zip Code in the fields provided.
4. Click Add TIN.
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5. Note: If the message “We could not match what you entered into our system,
please check and try again” is received only add TIN and Click Add TIN. A Health
Plan employee must validate your account before it can be used.
Checking Patient Eligibility
To verify patient eligibility:
1. Select Eligibility at the top of your screen.
2. Enter the Date of Service (DOS), Member ID/Last Name, and DOB of your
patient.
3. Click Check Eligibility.
4. The eligibility information appears below the fields. The view contains: eligibility
status, date of service, patient name, and the date checked.
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***To check additional patients’ eligibility status continue to add the DOS,
Member ID/Last Name, and DOB for each additional patient.
5. To print the eligibility information click Print.
6. To open the Patient Record, click on the blue Patient Name.
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Patient List
To view, and download a patient list:
1. Click Patients at the top of your screen.
2. Click the drop-down arrow next to Viewing Patients For: and select the desired
TIN.
3. The Patient List appears displaying Eligibility Status, Member Name, Medicaid #,
DOB, Phone Number and Care Gaps.
4. To download the patient list to Excel, click Download. This allows for you to
manage your patient information as desired in Excel.
***Downloading the patient list to Excel allows you to see all patients for that
TIN, including the Physician’s Name.
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5. To filter the patient list, click Filter. You can filter by NPI and Provider Medicaid #.
***Filtering the patient list allows you to view the patients per NPI or Provider
Medicaid # that belong to a single TIN.
6. To search for a specific patient, click Find Patient. Enter the Medicaid ID/Last
Name and DOB of the patient, and click Find.
7. To open the patient record, click the blue member name.
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8. The Patient Record opens; the Overview appears providing detailed information for
the patient.
Patient (Member) Record Components
Overview
1. From the Eligibility Check or Patient List, select the blue Patient Name to open the
Patient Record.
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2. The Patient Record opens to the Overview tab displaying the Patient
Information, PCP Information, Eligibility History, and the most recent Medical
Activity.
Coordination of Benefits
1. Inside the Patient Record, select Coordination of Benefits on the left.
2. The Coordination of Benefits (COB) tab of the patient record displays the other
insurance information for the patient. If the patient has no other insurance, the
web indicates it does not have any COB information.
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Assessments
1. Inside the patient record, select Assessments on the left.
2. The Assessments tab of the patient record, allows you to fill out a Notification of
Pregnancy Assessment.
3. Click the Fill Out Now!
4. A confirmation appears confirming the submittal, stating the assessment
information displays within 24 hours
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Health Record
1. Inside the patient record, select Health Record on the left.
2. The Health Record tab allows you to view a record of visits or medications for the
patient.
3. Click on Visits to view any visit information (i.e. Office Visits, ER visits, etc.) for the
patient.
4. Click on Medications to view any medication information (i.e. Medications
prescribed to a Member) for the patient.
***Visits and Medications appearing in the Patient Record are based on the last 18
months of claims data.
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Claims
1. Inside the patient record, select Claims on the left.
2. The Claims tab of the patient record allows you to view any recent claims for the
patient, and also create a new claim. If the patient has any recent claims, they
display on this tab.
3. To create a new claim, click the Create a New Claim button.
***Please reference the Claims section of this manual for additional information
on how to create a new claim through the website.
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Authorizations
1. Inside the patient record, select Authorizations on the left.
2. The Authorizations tab of the patient record allows you to view current
authorizations, and create new authorizations for the patient. If there are current
authorizations for this patient, they display on this tab.
3. To create a new authorization, click the Create a New Authorization button.
***Please reference the Authorizations section of this manual for additional
information on how to create a new authorization on the website.
Authorizations
To view an authorization:
1. Log in to the secure website.
2. Select Authorizations at the top of your screen.
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3. To view an authorization that has been processed, enter the Authorization
Number in the field, and click Search.
4. The Authorization Status, Auth ID, Member Name, Type of Service, and Mentioned
As details display.
5. To view Processed Authorizations, select Processed. You see a list of
authorizations that have been processed, along with the Status, Auth ID, Member
Name, and Service provided.
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6. To view Authorizations which have errors, select Errors. You see a list of
authorizations that have a Status of Error, along with the Auth ID, Member Name,
Service provided, and Mentioned As information.
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Create Authorizations
To create an authorization:
1. Log in to the secure website.
2. Select Authorizations at the top of the screen.
3. Click Create Authorization.
4. Enter the patient’s Member ID/Last Name and DOB. Click Find.
5. Populate the 6 sections of the Authorizations with the appropriate information
starting with the Service Type section.
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6. Select a Service Type from the drop-down list.
7. Enter the Contact Information of an individual to contact for questions related to the
Authorization being requested.
8. Click Next.
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9. Enter the Service Start Date and End Date.
10. Enter the Total Units/Visits/Days for the service.
11. Enter the Primary Diagnosis and Additional Diagnosis by typing the code or
description in the field and clicking Find.
12. After the diagnosis is found, it appears to the right of the field.
13. To Add Additional Additional Diagnosis, click the button.
14. Select the Place of Service from the drop-down options.
15. Click Next.
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16. Enter the Requesting Provider Information using either the Provider NPI or Provider
Last Name to Find the Provider.
***Enter either the Provider NPI or Provider Last Name and click Find Provider
to initiate your search. Once the Provider Name is found and selected, the
remaining fields will populate.
17. Select your Provider from the list of results.
18. Enter the Servicing Provider Information using NPI or First Name, Last Name to
Find the Provider.
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19. Click Next.
20. Enter Additional Information in the Questionnaire section.
21. Click Next.
22. Browse and Attach any relevant documents (i.e. Medical Records) for this
authorization.
23. Click Next.
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24. In the Review and Submit section, review your information and make any
corrections that are necessary.
25. Click Submit Authorization.
26. The confirmation number for your Authorization submittal appears.
***Please check back for response to your authorization within 24 hours.
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Claims
To view the most recent submitted claims:
1. Log in to the secure website. On the Dashboard you see the 5 most Recent Claims
displayed.
2. To view additional claims, click Claims at the top of the screen.
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To view all claims submitted:
1. Click Claims at the top of the screen, and select Individual.
2. The list of individual claims appears displaying the Claim Number, Member Name,
Service Date, Amounts Billed/Paid, Status, and Check Number.
***Hover your mouse over the Status column and a Paid or Pending status
displays.
3. To view the details of the Individual claim, click the blue Claim Number to open the
claim.
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4. The Claim Details appear allowing you to see which services were covered and
which were denied. You can view the payment amount and payment date, along
with check number.
5. To return to the list of claims, click the Back to Claims button.
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Correct Claim
To correct a claim:
1. Click Claims at the top of the screen.
2. Select an individual paid claim to see the details.
3. The claim displays for you to correct as needed. Click Correct Claim.
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4. Proceed through the claims screens correcting the information that you may have
omitted when the claim was originally submitted.
5. Continue clicking Next to move through the screens required to resubmit.
6. Review the claim information you have corrected before clicking Submit.
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7. You receive a success message confirming your submittal.
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Copy Claim
To copy an existing claim:
1. Select Claims at the top of the screen.
2. Click on an Individual claim to open the details.
3. Click Copy Claim to copy the information in the existing claim into a new claim.
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4. The copied claim information appears. Proceed through the claims screens
updating any information that may differ.
5. Click Next to move through the screens.
6. Review your claim and click Submit.
7. A success message appears confirming your submittal.
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Saved Claims
To view saved claims:
1. Click Claims at the top of the screen.
2. Select Saved.
***Saved claims are those that have missing information or contain errors.
3. Click Edit to view a claim, then fix any errors or complete it before submitting.
4. Click Delete to delete a saved claim that is no longer necessary. Click OK to
confirm the deletion.
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Claim Errors
1. Log in to the secure website.
2. Select Claims at the top of the screen.
3. Click on Errors to see any claims submitted that may have encountered errors in
processing.
4. If you receive multiple results, filter the list by clicking the Filter button.
5. To filter the list of claim errors, enter either one or more of the following search
criteria: Date Range, Web/Ref#, and/or Status.
6. Click Go!
***Note: The Submission Date range you provide is limited to a three-month span. Only
the last 18 months of claims data is available online.
7. The filtered list appears allowing you to click on the Claim Number to open the
claim to identify the errors.
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Fix a Claim
To fix a rejected claim:
1. Select Claims at the top of the screen.
2. Click Errors to see the rejected and pended claims.
3. The list of claims appears, and in the Status column you see a Caution icon
indicating a Rejected Claim.
4. In the far right column, you see a Fix link. Click the Fix link.
5. Proceed through the screens fixing any errors or reasons the claim may have been
rejected.
6. Review and Submit the claim again.
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Batch Claims
To upload batch claims:
1. Log in to the secure website.
2. Click Claims at the top of the screen.
3. To upload a batch of claims, click the Upload EDI button.
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4. On the Batch Claims Upload screen, select the File Type of either 837I or 837P.
***For an Institutional Claims batch upload select 837I, for a Professional Claims
batch upload select 837P.
5. Browse and Attach your batch claims file to upload. Be sure to check your codes
before you click Submit.
***Note: On the batch claims upload screen, companion guides and a list of
FAQs are provided as resources. An EDI Support telephone line and email
address is provided for additional support with EDI files.
6. When a file is successfully uploaded, the Web Reference ID # is generated for
your records.
7. Click Submit Another Batch Claim to submit additional batch claims.
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To view submitted batch claims:
1. Click Claims at the top of the screen.
2. Click Batch to view batch claims submitted in a 3-month period.
3. Enter the information to filter your results by Start Date, End Date, Web
Reference#, and Batch Claim Status. Click Search.
4. The submitted batch claims display showing: Submitted Date, Type, Web
Reference #, File Name, and Status.
***Note: Only the last 18 months of batch claims submission history is available
online. You will receive an explanation of payment (EOP) or 835 for your claims
submission depending on your contract arrangement.
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Payment History
To view claims payment history:
1. Click Claims at the top of your screen.
2. Select Payment History to view the claims payment history.
3. Click the Filter button to enter search criteria such as: Check/Trace Date, Amount
Range, and/or Check/Trace number.
4. Click Search.
***For best results, enter the date range to include 2 days before and 2 days
after the targeted date.
5. The claims payment results appear. To view the explanation of payment details,
click the check date.
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6. The explanation of payment details displays the check number and date with all of
the payments made on the check.
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Claims Audit Tool
1. Log in to the secure website.
2. Click Claims at the top of the screen.
3. Select the Claims Audit Tool.
4. The Code Editing Assistant screen appears with terms and conditions to Accept or
Reject.
5. Click Accept.
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6. The Clear Claim Connection screen appears, allowing you to enter the Procedure
Code, Quantity, Modifiers, Date and Place of Service, and Diagnosis for a claim
proactively before you submit or retroactively after you submit.
***Date of Service defaults to today’s date, and Place of Service defaults to 11
(Office) if not populated otherwise. Use the Tab key to move through the fields
easily.
***If you have more than 5 procedure codes, click the Add More Procedures
link.
7. Click the Review Claim Audit Results button.
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8. The results of the claim audit display the Recommendation Status of Allow,
Disallow, or Review.
***The results displayed do not guarantee how the claim will be processed, but
assist in claims submittal.
***If the Recommendation Status states Disallow or Review, click the status for
more clinical edit information.
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Professional Claims
To create a Professional Claim:
1. Click Claims at the top of your screen.
2. Enter the Member ID/Last Name, and Birthdate of your member. Click Find.
3. Select Professional Claim by clicking the green button.
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4. In the Patient Info section, populate the Patient’s Account Number, and other
information related to the patient’s condition by clicking the appropriate button.
5. Click Next.
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6. In the General Info section, populate the claim information and dates. You can Add
Coordination of Benefits by selecting the button.
7. Click Service Lines.
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8. In the Service Lines section, add your service line information. You can enter up to
99 service lines.
***Note: When entering charges for the service billed, include the decimal point
to ensure the data is populated accurately.
For example, 99.00 converts to $99.00.
9. To add additional service lines, click the Save/Update button and then click the
New Service Line button.
10. When you are ready to proceed, click Provider Details.
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11. In the Providers section, populate the information for the Referring Provider,
Rendering Provider, Billing Provider, and Service Facility Location.
***Use the blue Search button after entering a Tax ID or NPI for assistance with
your search.
***Required fields are dependent on the type of claim submitted: Professional or
Institutional.
12. Click Attachments.
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13. In the Attachments section you can Browse and Attach any documents to the
claim as desired. If you have no attachments, none are required.
14. Click Review and Submit.
15. In the Review section, you can review the claim once again before clicking Submit.
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16. In the Success section, a confirmation ID displays for your records.
17. Click Submit another to submit another claim.
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Institutional Claims
To create an Institutional Claim:
1. Click Claims at the top of your screen.
2. Click Create Claim.
3. Enter the Member ID/Last Name and Birthdate for the member. Click Find.
4. Select CMS UB-04 Institutional Claim.
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5. In the General section, populate the admission and condition code information. The
fields displayed here reflect those on a UB-04 form.
***Hover over the Claim Field Tabs to the right of the screen to help determine what
field on the UB-04 form from which to obtain the information.
6. Click Provider Details to proceed.
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7. In the Provider Details section, enter the billing and other provider information in the
appropriate fields.
8. Click Service Lines to proceed.
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9. In the Service Lines section, enter the information about the services provided.
***You can enter up to 99 service lines.
10. Click Save/Update, and to add a new service line click the + New Service Line
button on the left.
11. When all necessary service lines have been entered and saved, click the
Insurance button to proceed.
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12. In the Additional Insurance section, enter any additional insurance details as
needed. If there is no additional insurance, you may skip this section.
13. Click Codes to proceed.
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14. In the Diagnosis Codes section, enter all relevant diagnosis information.
15. Click Attachments to proceed.
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16. In the Attachments section, Choose File and Attach any relevant file to the claim.
17. Click Review and Submit.
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Secure Messaging
To send a secure message:
1. Click Messaging at the top of the screen.
2. The Secure Messaging Inbox appears displaying any messages you have.
3. Click Create Message to create a secure message.
4. In the New Message screen, the To field populates and you are able to select a
Subject from the drop-down menu.
5. In the Your Message field you can free text type the message to the Health Plan
staff.
6. Click Send when complete.
7. A confirmation message appears that your message successfully sent.
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To view Sent messages:
1. To see the sent messages, click Messaging at the top of the screen.
2. Click Sent, and your sent messages appear.
3. To send to trash, click the Send to trash button.
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To view messages sent to Trash:
1. To view the messages sent to Trash, click Messaging at the top of the screen.
2. Click Trash, and the messages sent to Trash appear.
***The messages sent to Trash will be deleted after 30 days.
3. If a message is not trash but is found under the Trash tab, you can reverse it by
clicking the not trash button.
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