Claims Web Portal User Guide

Claims Web Portal User Guide
Claims Web Portal
User Guide
Table of Contents
Website Information & Registration ............................................................................................ 2
Signing Up ................................................................................................................................. 3
Signing Up-Username and Password Creation .......................................................................... 5
Homepage .................................................................................................................................. 6
General Services Claim Form………….…….………………………………………….…………….. 7
Residential Claim Form ............................................................................................................ 10
Search History ....................................................................................................................... . 13
Eligibility & Benefits .. ............................................................................................................. . 15
Claim Status ............................................................................................................................ 16
Claim Status-Payment Details ................................................................................................. 17
Claim Status-Access to Explanation of Benefits ....................................................................... 17
Claim Status-Processed/Paid .................................................................................................. 18
Forms & Resources Links ........................................................................................................ 18
1
Log on to: https://secure.healthx.com/carewisconsin
Supported Browsers include:
Firefox 25 on Windows 7
Internet Explorer 9.0, 10.0 on Windows 7
Internet Explorer 10.0 on Windows 8
Chrome latest stable version on Windows 7 and Windows 8
Safari 6 on Mac OSX Mountain Lion
For first time users, please choose the Sign up option to register.
To register you will need your Federal Tax Identification (TIN) and Care Wisconsin Provider ID. Follow the simple
instructions below to complete the forms as they relate to you.
If you are already registered enter your user name and password and click Login.
2
Sign up – Step 1
Please review the License Agreement. You must agree to the License Agreement to continue with the registration.
Click Agree to continue.
Sign Up – Step 2
Please complete the Personal Information section. The address should be the practice address, not your personal
address.Click Next to continue.
3
Sign Up – Step 3
Care Wisconsin Provider ID – Please provide your Care Wisconsin Provider ID number. If you do not have your Provider
ID please contact the Provider Help Desk at 855-878-6699.
Click Next to continue.
Sign Up – Step 4
Please enter your Tax Identification Number. Do not include dashes. You must certify the information before clicking
Next, by clicking the in box indicated below.
Sign Up – Step 4 continued
In this section, you may enter a NPI if it is applicable to you, however this is not required.
4
Sign Up – Step 5 Username and Password Creation
All usernames must be unique. Should you receive an error message that the username is already in use, please note it
is a system wide message and does not mean you have already registered on the site. It only means the desired
username is already in use in our system. For example, John Doe and Jane Doe both cannot have username jdoe.
Please choose the 3 required security questions and answers before clicking “Next.”
You will have the option to review your information before submitting.
5
Home page –
The Home Page will include the toolbar with access to Eligiblity & Benefits, Claim Forms, Claim Status, and Forms &
Resources. You will also notice links to the Provider News, Provider Directory, and General Claims Information.
The upper right hand corner will show your login status as well as easy access to your Profile and new message alerts will
display here. You may Logout by clicking Logout.
You will also have the option to choose the General Services Form or the Residential Form without using the Claim Form
dropdown feature, see below:
Please note: Only Residential services are to be billed on the Residential Claim Form, this includes Room & Board and
Care & Supervision codes.
6
General Services Claim Form - Member and Provider Information
You are asked to specify if this is a new or adjusted claim by using the drop down circled below. There is also a link to
the Claim Form instructions for your reference.
New Claim: First submission or resubmission of a previously denied claim.
Adjusted Claim: Also referred to as a Corrected Claim would be a second submission with corrections (i.e. code or date
of service needed correction). Use “Adjusted Claim” only when the original claim was paid or partially paid. If it was
denied in full, please choose “New Claim” for your resubmission.
Complete the Member information as requested.
The diagnosis code will auto fill at every submission.
The Provider Information will also autofill based on the information submitted during your initial registration.
If you find the Provider Information is incorrect, please email the Provider Help Desk to update
[email protected]
7
General Services Claim Form – Service Information
Complete the Service location name and address as requested.
If your service location is the same as your Provider Information please choose “copy address from above”.
If you have multiple service locations use this field to specify the location where the services were provided.
8
General Services Claim Form –Service Details
From and To dates of service are required. You must choose a place of service by using the drop down. If a modifier is
not applicable, please leave blank. If you are unsure if a modifier is required, please reference your contract.
Enter service description, units, and rates. If you do not have access to the authorization number please call the
Administrative Assistant on the member’s care team. For Family Care members you can access this information on the
MIDAS Authorization Portal.
After all fields are completed, electronically sign your name by typing it in the box, then and click “Submit Form.”
*If there is missing information your claim will not successfully submit, a red box will appear around the missing field.
Please be sure all required fields are completed before clicking Submit Form.
After your claim is received you will receive an email notification. The email will be sent to the address that was included
in the registration for the account.
9
Residential Claim Form – Member and Provider Information
You are asked to specify if this is a new or adjusted claim by using the drop down circled below. There is also a link to
the Claim Form instructions for your reference.
New Claim: First submission or resubmission of a previously denied claim.
Adjusted Claim: Also referred to as a Corrected Claim would be a second submission with corrections (i.e. code or date
of service needed correction). Use “Adjusted Claim” only when the original claim was paid or partially paid. If it was
denied in full, please choose “New Claim” for your resubmission.
Complete the Member information as requested. The Admit Start must be completed, this day will be the first
enrollment date with Care Wisconsin for those who resided at your facility upon enrollment or the date that the
member entered your facility. The diagnosis code will auto fill at every submission.
You must choose the Discharge Status and Type of Bill using the drop downs.
The Provider Information will also autofill based on the information submitted during your initial registration.
If you find the Provider Information is incorrect, please email the Provider Help Desk to update
[email protected]
10
Residential Claim Form – Service Information
Complete the Service location name and address as requested.
If your service location is the same as your Provider Information please choose “copy address from above”.
If you have multiple service locations use this field to specify the location where the services were provided.
11
Residential Claim Form – Service Details
From and To dates of service are required, as well as your contracted Revenue and/or HCPCS codes. If a HCPCS code is
not applicable, please leave blank. When entering Revenue Codes, please enter the 4 digit Revenue Code only. All other
alphabetic characters mut be entered in uppercase.
You must include your authorization number for processing. If you do not have this information please call the
Administrative Assist from the member’s care team. For Family Care members you can access this information on the
MIDAS Authorization Portal.
Note: Dates of Service span and Units must match in order for the claim to process.
After all fields are completed, please electronically sign your name by typing it in the box, then and click “Submit Form.”
After your claim is received in our system you will receive an email notification. The email will be sent to the address
that was included in the registration for the account.
12
Search History-Quick Search
You will receive an email notification when your claim is successfully received. The notification will also include a
Tracking Number that will allow you to view what was sent and the time and date of submission.
To access history of claims submitted, go to your messages and choose Search History.
You will have 3 different options to search: Quick Search, Date Range Search, and Tracking Number Search.
Quick Search will allow you to view the last 10 claims submitted
Click Search to display the last 10 claims sent.
Below is an example of what information will display, click on the Tracking ID link to display claim information.
You will then need to choose an Action by using the drop down, choose View to display the claim information.
The claim information will appear and will include a summary of the information submitted on the General Service or
Residential Claim Form.
13
Search History - Date Range Search
Enter the date range you would like to view, click Search. Claims history will be displayed.
Note: the date range is referring to the date of claim submission, not date of service provided.
Search History – Tracking Number Search
Enter the Tracking Number and click Search. The Claim History will display for tracking number linked.
Note: Your tracking number can be found in your messages located on the Claims Web Portal or in your email response
received.
14
Eligibility & Benefits
To verify a member’s eligibility you must enter the Member ID, or the Member’s Last Name and Date of Birth.
After entering the required information click Search.
The member Name, Member ID, DOB, Gender, Effective and Term Dates will display.
Click on the member name link and this will bring you to a more detailed view of the eligibility information and will
include the member’s address.
You will also have the option to Print the member information from this screen.
Note: If you have additional eligibility questions please contact the Provider Help Desk for assistance at 855-878-6699.
15
Claim Status
To view claim history you must enter a Member ID, Member Name and Date of Birth or Claim Number. You also have
the option to search a specific date range. Press Submit to display Claim History.
If no claim history is displayed please verify the Tax ID in your Provider Profile. If the Tax ID number is incorrect please
contact the Provider Help Desk to update at [email protected]
Please Note: Claim history will only generate the Member Information for those claims that have processed using the
Tax ID entered during your initial registration.
You have the ability to view your claim after it is processed, but before a check cycle has completed. While the claim
is PROCESSING you will see no movement on the Claims Web Portal. You must wait until the claim has Processed or
Paid to view claim status.
The displayed Claims history will include the Claim Number, Member ID, Service Date and Total Charge. To see claim
details, click on the claim number link. This will open the Payment Details screen.
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Claim Status-Payment Details
Additional Claim Details will display, including codes, charges and ineligible amounts. If charges are denied, this screen
will display the ineligible amount as well as the reason code description.
If the claim has paid you can view and print the Explanation of Benefits by clicking the Original EOB link at the bottom
right-hand corner of the screen.
You can also print a copy of your claim by clicking the Print View and following the prompts to Print your claim.
Claim Status-Explanation of Benefits Access
To access a copy of your Explanation of Benefits please enter the EFT number or Check number in the Check # field and
click Search. A list of Claims paid to that specific check or deposit will display. Click on the first claim number link and
follow the directions above to view a copy of the Original EOB.
17
Claim Status-Processed/Paid
Note: You have the ability to view your claim after it is processed, but before a check cycle has completed. While the
claim is PROCESSING you will see no movement on the Claims Web Portal. You must wait until the claim has
Processed or Paid to view claim status.
The Payment amount will remain at zero until a check cycle has completed. If your claim is PROCESSED as seen below,
this means your claim has not yet paid and is waiting for a check run. This does not necessarily mean that your claim
has denied.
Please wait until the check run is complete to determine exact payment.
Processed Example:
Paid Example:
Forms & Resources
Links to the fillable PDF Appeals and Refund form are available under Forms & Resources.
18
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