novitasphere portal overview part a and part b
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Disclaimer
▪ All Current Procedural Terminology (CPT) only are copyright 2018 American MedicalAssociation (AMA). All rights reserved. CPT is a registered trademark of the AmericanMedical Association. Applicable Federal Acquisition Regulation/ Defense FederalAcquisition Regulation (FARS/DFARS) Restrictions Apply to Government Use. Feeschedules, relative value units, conversion factors and/or related components are notassigned by the AMA, are not part of CPT, and the AMA is not recommending theiruse. The AMA does not directly or indirectly practice medicine or dispense medicalservices. The AMA assumes no liability for data contained or not contained herein.
▪ The information enclosed was current at the time it was presented. Medicare policychanges frequently; links to the source documents have been provided within thedocument for your reference. This presentation was prepared as a tool to assistproviders and is not intended to grant rights or impose obligations.
▪ Although every reasonable effort has been made to assure the accuracy of theinformation within these pages, the ultimate responsibility for the correct submissionof claims and response to any remittance advice lies with the provider of services.
▪ Novitas Solutions’ employees, agents, and staff make no representation, warranty, orguarantee that this compilation of Medicare information is error-free and will bear noresponsibility or liability for the results or consequences of the use of this guide.
▪ This presentation is a general summary that explains certain aspects of the Medicareprogram, but is not a legal document. The official Medicare program provisions arecontained in the relevant laws, regulations, and rulings.
▪ Novitas Solutions does not permit videotaping or audio recording of training events.
Novitas Solutions IHS Education
▪ Education specific to Indian Health Services (IHS) providers in
Medicare Administrative Contractor (MAC) Jurisdiction H (JH), which
includes:
• Tribally owned and operated facilities electing to bill as IHS
• Tribally operated IHS facilities
• IHS owned and operated facilities
• Tribally owned and IHS operated facilities
▪ Tribally owned and operated facilities electing to bill the MAC
serving their specific geographic location should look to that MAC for
guidance on billing.
Acronym List
Acronym Definition
BOA Billing Office Approver
BOBA Billing Office Back-up Approver
EIDM Enterprise Identity Management
MBI Medicare Beneficiary Identifier
MFA Multi-Factor Authentication
NPI National Provider Identifier
OA Office Approver
OBA Office Back-up Approver
POA Provider Office Approver
POBA Provider Office Back-up Approver
PTAN Provider Transaction Access Number
Today’s Presentation
▪ Agenda:
• Novitasphere Portal:
✓ Portal Enrollment
✓ Features
▪ Objectives:
• Understand the benefits of using the Novitasphere portal
What is Novitasphere?
▪ Definition:
• Free, secured web-based Portal which allows enrolled users access to
time-saving features
▪ Purpose:
• Allows enrolled users access to Eligibility, MBI Lookup, Claim
Information, Remittance Advice, Appeal Requests, Medical Review
Records and much more
▪ For demonstrations and more information on Novitasphere visit:
• JH Providers
Novitasphere Features: Part A and
Part B (part 1)
Feature/Functionality Part A Part B
835 ERA x x
Appeals Development
Letter
x x
Claim Correction n/a x
History Corrections n/a x
Claim Status n/a x
Claim Summary n/a x
Comparative Billing
Report (CBR)
n/a x
Credit Balance Report
Submission
x n/a
Novitasphere Features: Part A and
Part B (part 2)
Feature/Functionality Part A Part B
Electronic Claim
Submission- Direct Data
Entry
n/a x
Electronic Claim
Submission- File Upload
x x
Eligibility x x
MBI Lookup Tool x x
Medial Review Claims
View Copies of ADR
letters and more
x x
Medical Review Records
Submission to ADR
Letters
x x
Novitasphere Features: Part A and
Part B (part 3)
Feature/Functionality Part A Part B
Overpayment Letters x x
Redetermination Notices x x
Retrieve Remittances
Advice Copies
n/a x
Submit Appeal Requests x x
Submit General
Information Requests
n/a x
Submit Immediate
Recoupments
x x
Submit Provider Audit &
Reimbursement
Documents
x n/a
Coming in 2019
▪ Provider Enrollment Welcome Letters (Part A & Part B)
▪ Paper Remittance Copies (Part A)
▪ Financial Information (Part B)
▪ Claim Status (Part A)
Roles and Responsibilities
Office Approver (OA)
Does not have to be the
Provider/Owner
Office Back-up Approver
(OBA)
Does not have to be the
Provider/Owner
End User
Has access to all features Has access to all features Has access to all
features
Must be listed as the OA on
the EDI Portal Enrollment
form
Must be listed as the OBA on
the EDI Portal Enrollment form
Should NOT be listed on
the EDI Portal
Enrollment form
Responsible for creating the
Organization in EIDM
Will enroll in EIDM after the
OA has been approved
Will enroll in EIDM after
the OA has been
approved
Responsible for approving
all End Users access
request
Responsible for approving all
End Users access request
Access is granted by the
OA or OBA
Responsible for certifying all
End User access annually
Responsible for certifying all
End User access annually
Annual Certification
completed by OA/OBA
Enrollment Forms
▪ Step 1: Provider Novitasphere Enrollment form:
▪ Providers in JH will complete the 8292PJH
▪ Carefully follow the instructions for the completion of your form:
▪ Instructions for completing the form (JH)
▪ Step 1: Billing Service/Clearinghouse Novitasphere Enrollment form:
• JH Third Party billers will complete the 8291PJH
• Carefully follow the instructions for the completion of your form:
✓ 8291P/8291PJH instructions
EIDM Registration
▪ Provides user identity:
• Ensures only authorized/registered user can access protected
information
▪ Step 2: Office Approver (OA) will create a User ID and password
▪ Step 3: OA will request the appropriate Novitasphere role for access:
• Register a Multi-Factor Authentication (MFA) Device
▪ OBA and End Users will enroll for access under organization:
• OA or Office Backup Approver (OBA) MUST approve the EIDM request
for End Users
▪ Novitasphere Frequently Asked Questions:
• Part A
• Part B
EIDM Registration Information
▪ The Novitas Solutions’ EIDM Help Desk staff will approve or reject
the request:
• Approved:
✓ Will receive a confirmation email indicating the request has been processed
✓ You will now be able to log into the Novitasphere Portal
✓ Please allow 24 hours before attempting to log in:
➢ Novitasphere
• Rejected:
✓ You will receive an email detailing the rejection reason
▪ Novitasphere End Users will need to complete one additional step:
• Request/Confirm your POA/POBA (provider offices) or BOA/BOBA
(billing groups) has approved your EIDM request
Enrollment References
▪ Novitasphere Enrollment Form (JH)
▪ Third Party Novitasphere Enrollment Form (JH)
▪ EIDM Instructions (JH):
• EIDM Enrollment Overview Training Module
▪ MFA Device Instructions: (JH)
Keep your Novitasphere Access
Active
▪ All users must log in at least once every 30 days, or their
Novitasphere access will be removed
▪ Please feel free to print out this graphic to hang by your computer.
Tips to Maintain Access
▪ Set a recurring reminder on your calendar or phone
▪ Use the buddy system! Remind your colleagues to keep their access
active, and ask them to remind you too
▪ Review our new Novitasphere Log In Help document if you’re having trouble
successfully logging in
▪ Call for help:
• The Novitasphere Help Desk can assist with password issues, locked Multi-
Factor Authentication (MFA) devices, and adding additional MFA devices. That
number is 1-855-880-8424
▪ Sign up for the Novitasphere email lists. We don’t want to see you lose
your access – so we issue monthly reminders
▪ Check your vacation schedule. Log in before leaving if you will be out of the
office for an extended time
▪ Remember, logging into EIDM at portal.cms.gov to change your password,
or to approve End User access, does not satisfy this requirement:
• You must log in to https://www.novitasphere.com once every 30 days
Eligibility Information
▪ Eligibility
o Part A and B Eligibility Effective and
Termination Dates
o End Stage Renal Disease (ESRD) dates and
information
▪ Deductible
o Part B Total Deductible Remaining for Calendar
year
o Occupational, Physical and Speech Therapy
amounts applied to the capitation limits
o Rehabilitation Session counts
▪ Medicare Advantage Plan (MAP)
o Contract Name, Number, Address and
Telephone Number
o Plan number and Plan name
o Type of Medicare Advantage Plan
o The Bill Option code of the Plan type
o Effective and Termination Dates
▪ Medicare Secondary Payer (MSP)
o The reason Medicare is secondary
o Effective and Termination Dates
o MSP Diagnosis code
o Name of Insurance Company and Address
▪ Hospice/Home Health
o Certification codes and dates
o Home Health Episode Start and End Dates
o Home Health Episode termination date
o Provider NPI Number of the Home Health Facility
▪ Preventive Services
o Number of Smoking Sessions remaining
o Medicare Diabetes Prevention Program (MDPP)
usage
o Preventive Service Procedure Code
o Preventive Technical and Professional Dates
o Deductible Applied for the Calendar Year
o Deductible Remaining for the Calendar Year
o Coinsurance Remaining for the Calendar Year
▪ Inpatient
o Date of earliest and latest billing activity for the spell
of illness
o Hospital Information
o Skilled Nursing Facility Information
▪ QMB
o QMB Effective and Termination Dates
o QMB Deductible and Coinsurance Remaining
QMB Inpatient Spell, Hospital Information and SNF
Information
Medicare Secondary Payer (MSP)
Tab
Current Procedural Terminology (CPT) only copyright 2018 American Medical Association. All rights reserved.
Hospice/Home Health Tab
Current Procedural Terminology (CPT) only copyright 2016 American Medical Association. All rights reserved.
Preventive Tab
Current Procedural Terminology (CPT) only copyright 2018 American Medical Association. All rights reserved.
Part A Miscellaneous
Documentation Submission
▪ Cost Report Reopening: • Used for Submission of reopening
Requests for a cost report after it has been settled
▪ Cost Report Appeals: • Used for the submission of supporting
documents for cost reposts that are under appeal
▪ SSI Realignment Request (DSH):• Used to request an update to a provider’s
disproportionate share statistics
▪ Provider-Based Determination: • Used to request initial setup or change in
a unit’s provider-based status
▪ Wage Index/Occupational Mix Submissions:
• Used to upload documentation for the yearly wage index and occupational mix audits
▪ Desk Review/Audit Additional Documentation:
• Used to upload documentation requested by the Novitas audit staff during the time of a desk review and/or audit
▪ Submit FOIA Request: • Used to submit a Freedom of
Information Act request for Medicare cost reports
▪ Submit PS&R Request:• Used to submit a Provider Statistical &
Reimbursement report request for fiscal years not covered on the CMS PS&R online system. Providers may utilize this selection if they are currently experiencing PS&R access issues as well
▪ General Correspondence: • Used to submit documentation for
items not covered in the above-mentioned table selections; such items include: ✓ Request for Interim Rate Change
✓ Request for Tentative Settlement Change
✓ TEFRA Exception Request
✓ SCH Low Volume Request
✓ Request for Change in Statistical Basis
✓ CMS Tie-In-Notice
✓ Bankruptcy
✓ Other Supporting Documentation
✓ 50%Reduction Request
Novitasphere References
▪ Novitasphere Provider Portal Enrollment Overview Training Module
▪ Novitasphere User Manual
▪ Novitasphere Claims Correction Guide
▪ Novitasphere New User Checklist
Thank You
▪ Gail Atnip
Education Specialist, Provider Outreach and Education
Gail.Atnip@novitas-solutions.com
717-542-6349
▪ Kim Robinson
Education Specialist, Provider Outreach and Education
Kim.Robinson@novitas-solutions.com
717-542-6344
▪ Janice Mumma
Supervisor, Provider Outreach and Education
Janice.Mumma@novitas-solutions.com
717-526-6406
▪ Stephanie Portzline
Manager, Provider Engagement
Stephanie.Portzline@novitas-solutions.com
717-526-6317
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