maryland medicaid providerconnect claims:...
TRANSCRIPT
Maryland Medicaid ProviderConnectClaims:
Applied Behavior Analysis
Agenda
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Maryland Website
Direct Claim Submission
Coordination of Benefits
Batch Claim Submission
Claim Search
Reprocessing a Claim
Viewing Provider Summary Vouchers and PaySpan registration
Note: throughout this document you may see the term “ValueOptions”. ValueOptions merged with Beacon Health Strategies to form Beacon Health Options.
Beacon Maryland Medicaid Website
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To access the Maryland specific site please go to: http://maryland.beaconhealthoptions.com/index.html
Choose Behavioral Health Providers
Beacon Maryland Medicaid Website (cont.)
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• Choose Autism Provider
Beacon Maryland Medicaid Website (cont.)
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Choose Autism Providers Menu
Beacon Maryland Medicaid Website (cont.)
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ProviderConnect
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ProviderConnect is an easy-to-use online application that providers can use to complete everyday service requests. Providers have the ability to access information 24 hours a day/7 days a week.
Providers can use ProviderConnect to:
• Obtain information about member eligibility and benefit status
• Enter authorization/notification requests
• Search claims and authorizations
• View and print correspondence
• Access and update practice profiles
• Submit EDI claims and inquiries to the Beacon Customer Service Department
• Send messages to and receive messages from Beacon
• Attach documents
How to Access ProviderConnect
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Unregistered providers can self register using a provider ID number and clicking “Register” on the login screen.
Multiple logons available for the same assigned provider ID
Contact Information:Beacon Health Options EDI Helpdesk
Monday through Friday, 8:00 a.m. – 6:00 p.m. ESTPhone: 888.247.9311
Email: [email protected]
Claims Submission
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There are four ways to submit claims to Beacon Health Options:
• Direct Claims Submission through ProviderConnect
• Batch Claims Submission through ProviderConnect
• 837 Claim submission through your Clearing House
• Paper Claim submission (on a CMS 1500 form)
Paper Claims Address: P.O. Box 1850 Hicksville, NY 11802-1850(Paper Claims are the least preferred method)
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Direct ClaimSubmission
Direct Claim Submission
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Provides ability to enter a claim directly into ProviderConnect portal without using special software
Expedites processing of the claim and payment
Recommended for providers submitting a lower volume of outpatient claims
ABA Assessment and ABA Services are outpatient services billed using CMS1500 format within ProviderConnect
Direct Claim Submission
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Direct Claim Submission
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Direct Claim Submission
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Direct Claim Submission
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Direct Claim Submission
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Direct Claim Submission
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Direct Claim Submission
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Summary Page
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Coordination of Benefits (COB)
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Maryland Medicaid is the payer of last resort. All other insurance policies must be exhausted before Maryland Medicaid will pay out benefits.
Prior authorization is not required if the member has a primary insurance carrier that covers ABA services.
Providers need to submit their claims with a copy of the explanation of benefits that they receive from the primary insurance carrier. Medicaid will reimburse up to the Medicaid fee schedule for the services provided.
Participants (with active Medicaid) cannot be billed any balance for co-pays or deductibles for covered Medicaid services.
COB Examples
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Provider ABC has authorization for ABA services through Aetna, participant has Aetna as primary. The participant is also eligible for Medicaid. The provider bills Aetna for ABA services first, then sends the EOB to Beacon to seek payment.
Scenario 1: Provider Cost for 1 hour RBT service = $60.00
Medicaid Fee Schedule for 1 hour RBT service= $55.00
Commercial insurance reimburses provider $45.00.
In this scenario, Beacon pays the provider $10.00, which is the difference from what the commercial insurance paid to the Medicaid fee schedule. A provider cannot collect the $5.00 remainder from the family.
COB Examples
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Provider ABC has authorization for ABA services through commercial insurance, the participant has commercial insurance as primary. The participant is also eligible for Medicaid. The provider bills commercial insurance for ABA services first, then sends the EOB to Beacon to seek payment.
Scenario 2: Provider Cost for 1 hour RBT service = $60.00
Medicaid Fee Schedule for 1 hour RBT service= $55.00
Commercial insurance reimburses $55.00 per hour.
In this scenario, Beacon does not pay because Medicaid rate is the same as what the primary paid. Provider cannot collect the $5.00 remainder from family.
Coordination of Benefits (cont.)
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Coordination of Benefits (COB) Provider Alerts:
Below is a link to the COB Provider Alert that specifically addresses this topic as it relates to ABA.
• http://maryland.beaconhealthoptions.com/provider/alerts/2017/5-5-17-Benefits-for-ABA-Providers.pdf
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Batch ClaimSubmission
Batch Claim Submission
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Allows you to upload HIPAA 5010 compliant files directly to Beacon Health Options
Expedites processing of the claim and payment
Available for all levels of care
Recommended for facilities and providers submitting a higher volume of claims
Batch Claim Submission
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Batch Claim Submission
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Batch Claim Submission
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Batch Claim Submission
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Batch Claim Submission
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Batch Claim Submission
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EDI Claims Link
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Free Beacon Health Options software that submits HIPAA 5010 compliant files
Used only for claims submitted directly to Beacon Health Options
Available for download in our “Claims Resources” section of our Helpful Resources Page
Only available for Windows platform
Additional EDI Information
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Beacon Health Options Companion Guide
• Located on the Compliance Information page
• Shows Beacon specific batch file requirements
Reprocess and Voids
• Beacon Health Options accepts frequency indicators of Original (1), Replacement (7), and Void (8)
Corrected claims can be completed as a replacement claim
Replacement and Voided claims require original claim number
Payer ID
• FHC & Affiliates
• Clearinghouses may provide their own 5 digit payer ID for Beacon Health Options
Contact your clearinghouse to see what payer ID is needed
Batch Submission Configuration
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Providers and facilities can submit Batch claims directly or indirectly:
• To submit 837 files directly a provider must register for ProviderConnectand note they would like to submit claims to Beacon
• To submit 837 files indirectly a provider must register for ProviderConnectand also submit an intermediary authorization acknowledging a Clearinghouse or Billing Organization will submit files on their behalf
ProviderConnect Account Request Form and Intermediary Authorization Form can be found in the administrative forms section at https://www.beaconhealthoptions.com/providers/beacon/forms/administrative-forms/
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ClaimSearch
Review a Claim
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Search Claims
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Claim Search Results
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Claims Summary
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Service Line Detail
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Searching for aSpecific Member
Searching for a Specific Member
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Searching for a Specific Member
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Viewing Member Claims
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Correcting aClaim
Reasons to Correct a Claim
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Change Claim Data
• Incorrect diagnosis code, service date, etc.
• Incorrect service address
• Voiding one line of the claim
Resubmit Previously Denied
Charge
• Member eligibility was updated
• Authorization was updated
Void Entire Claim
• Claim was entered for incorrect member
• Entire claim was incorrect and a new claim is needed or requested
Change/Reprocess Claim
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Change/Reprocess Claim
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Change/Reprocess Claim
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Change/Reprocess Claim
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Disclaimer
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Type of Adjustment
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Select Service Address
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Member Search
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Service Line Entry
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Attaching an EOB
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Summary Page
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Viewing ProviderSummaryVouchers
Provider Summary Vouchers
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Search by Provider
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Search by Check
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Provider Summary Voucher Results
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Provider Summary Voucher Sample
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Electronic Funds Transfer
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ABA providers may elect to receive their payments electronically. If you are interested, please visit www.payspanhealth.com to complete registration after receiving your first payment.
Contact Information
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Beacon Health Options EDI Helpdesk (ProviderConnect Technical Questions)
Monday through Friday, 8:00 a.m. - 6:00 p.m. ETPhone: 888.247.9311
Email: [email protected]
Claims Customer Service Line Monday through Friday, 8:00 a.m. – 6:00 p.m. EST
Phone: 800.888.1965
Provider Relations
Email: [email protected]