provider healthcare portal overview - in.gov · provider healthcare portal overview october 2017. 2...

Indiana Health Coverage Programs

DXC Technology

Provider Healthcare Portal

Overview

October 2017

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Session Objectives• Provider Enrollment transactions

• Home Page

• Member Eligibility

• Prior Authorization

• Claims

• Member Focused Viewing

• Search Payment History

• Helpful Tools

• Q&A

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Provider Enrollment Transactions

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Click Provider

Enrollment on

the left side of

the Provider

Healthcare

Portal home

page

A user account is

NOT needed to

submit an online

provider

enrollment

application

Access the application Home Page

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To check the status of an application, click Enrollment

Status on the left side of the Provider Enrollment page.

Check the Status

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Once enrolled and a Provider

account is established choose from

links on left side of the MY Home

page to perform other enrollment

transactions

Other Enrollment Transactions

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Home Page

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Home page

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Verify Member Eligibility

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Verify Member Eligibility

• To access the Eligibility Verification Request function,

log in to the Provider Healthcare Portal and click

Eligibility on the menu bar.

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Verify Member Eligibility

To perform a search, the Effective From date is required, in addition to

one of the following:

• Member ID

• Social Security number (SSN) and birth date

• Last name, first name, and birth date

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Verify Member Eligibility

The Effective From field is

always required.

– If a date is not entered, the

Portal defaults this field to the

current date

– This field accepts only current

and previous dates

The Effective To field is optional.

– The date entered must be on or

after the Effective From date and

must be within the same calendar

month as the Effective From date

– If a date is not entered, the Portal

will default to the Effective From

date

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Verify Member Eligibility

When an eligibility search returns no results, qualified providers

(QPs) will see an additional option below the message to complete

a Presumptive Eligibility for Pregnant Women (PEPW) or

Presumptive Eligibility (PE) application for the patient.

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Verify Member Eligibility

Viewing coverage details

• From the Eligibility Verification Information panel, click the coverage link for additional details.

• Note: Some searches may have more than one coverage type listed.

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Verify Member Eligibility

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Verify Member Eligibility

Important!The provider’s enrollment period affects the results of a search. The Portal

allows a provider to search for member eligibility information only for date

ranges that fall within the provider’s enrollment period.

For example, if a provider is enrolled starting on 04/01/2016 and attempts an

eligibility verification search with an Effective From date of 01/03/2016 (before

the provider’s enrollment period), the Portal will not display eligibility

information for that member.

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Prior AuthorizationFee-For-Service

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Is a prior authorization needed?BEFORE logging into

the Provider

Healthcare Portal to

create a request, save

time and avoid

submitting codes that

do not require a prior

authorization by

looking up the codes

on the Fee Schedule.

For your convenience,

there is a Search Fee

Schedule link located

on the Portal Home

page.

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Access the prior authorization function from the Care Management

drop-down menu.

Prior Authorization

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Prior Authorization

Complete the

required

information and

submit the

request by

clicking on

Confirm

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Viewing Prior Authorization Status

– The authorization request is assigned an Authorization Tracking Number

(ATN)

– Results list the first 20 authorizations with beginning service dates of

today or greater

– Results list only authorizations where the viewing provider was on the

request as the Requesting provider

Click to view the

authorization

Member name and

ID will be displayed

Requesting provider

will be listed

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Claims

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Search Claims

Two ways to access claim search function

OR

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Search Claims

When searching for claims,

you have the option to

choose which type of claim

to search and a date range

Or…

Search by Claim ID,

Member ID, or Service

Dates and click

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Claim Search Results

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Claim Service Line Details

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Claim Information

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Member Focused Viewing

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Member Focused

Viewing

Quick access to:

– Member details

– Coverage

details

– Claims search

and

submission

– Prior

authorization

search and

submission

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Member Focused Viewing

Member Focused Viewing search

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Member Focused Viewing

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Search Payment History

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Search Payment History

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Search Payment History

Auto populates last 12 weeks, or

Search by 12 week span

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Search Payment History

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Helpful Tools

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Helpful Tools

• IHCP website at indianamedicaid.com

– IHCP Provider Reference Modules

– Medical Policy Manual

• Customer Assistance

– 1-800-457-4584

• IHCP Provider Relations Field Consultants

– indianamedicaid.com > Provider Home

page > Contact Us

• Written Correspondence

– DXC Technology Provider Written

Correspondence

P.O. Box 7263

Indianapolis, In 46207-7263

• Secure correspondence via the Provider Healthcare Portal

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Questions