webmd user guide 5 1 - fh · webmd office user guide 2005.1 (rev.4/05) 4 manual objectives after...

® Office

©2005 ALL RIGHTS RESERVED

No part of this manual may be copied, photocopied, or reproduced in any form or by any means without the express written permission of Coventry Health Care.

First Health User Guide

WebMD Office User Guide 2005.1 (Rev.4/05) 2

Manual Objectives .........................................................................................................................4

Claims 101 – A Quick Refresher ..................................................................................................5 Basic Claim Terminology......................................................................................................................... 5 Rejected vs. Denied .................................................................................................................................. 5 What is a Clearinghouse? ......................................................................................................................... 5

Security Issues ................................................................................................................................6

Logging into WebMD® Office .......................................................................................................7

Edit Payer List................................................................................................................................9

Favorite Lists................................................................................................................................10

Check Eligibility...........................................................................................................................13 Check Eligibility Response .................................................................................................................... 16

Check Claims................................................................................................................................17 Check Claims Response ......................................................................................................................... 19

Secure eMail .................................................................................................................................20 Mail Messages ........................................................................................................................................ 20 Folders List ............................................................................................................................................. 21 Messages List ......................................................................................................................................... 22 Open Messages....................................................................................................................................... 24 Forward Messages .................................................................................................................................. 26 Reply Message........................................................................................................................................ 27 Copy Messages To.................................................................................................................................. 29 Move Messages To................................................................................................................................. 30 Search Folder.......................................................................................................................................... 31 Search Results......................................................................................................................................... 32 Messages List ......................................................................................................................................... 32 Extend Message...................................................................................................................................... 35 Print Messages........................................................................................................................................ 35 Claim Network News ............................................................................................................................. 36

New Claim Entry..........................................................................................................................37

Send Claims ..................................................................................................................................38

Batch Manager .............................................................................................................................39 To manually create a batch:................................................................................................................... 40 To import files to create a batch: ............................................................................................................ 41 Customize Batch Services ...................................................................................................................... 42 To View Batch Results ........................................................................................................................... 43

Logging off WebMD® ..................................................................................................................45

Glossary of Terms ........................................................................................................................46

Support Numbers.........................................................................................................................49


System Requirements ..................................................................................................................50


Manual Objectives

After completing this manual, you will:

��Be able to access the WebMD® website log-on (provided you have been signed-up)

��Have a basic understanding of WebMD®’s Secure Mail

��Demonstrate each of the functions in Check Eligibility, Check Claims, Batch

Manager, Find Provider.

��Build a favorite list of payers, providers and service types

��Understand the Payer List

��More complete users guides can be found by logging into WebMD Office once a

user ID and password is made available.


Claims 101 – A Quick Refresher

Basic Claim Terminology • Payer - The organization responsible for paying a healthcare claim (eg: First Health,

First Health Mailhandlers) • Provider – The person delivering service to a patient. • Adjudication - The process of paying or processing a claim, including determining

the appropriate level of reimbursement. • EOMB - Explanation of Medical Benefits - A statement mailed to a member/insured

and the provider explaining how a claim was paid, or why it was not paid.

Rejected vs. Denied • A rejected claim is unable to be processed and never reaches adjudication. (for

example, claim is illegible or there is an empty box on the HCFA) • A denied claim has been processed/adjudicated by the payer and it had been

determined that the claim is not going to be paid due to a possible variety of reasons. (Additional information requested, more specific ICD9 or modifier required, non-covered service, etc.)

Direct

Vendor PartnersVendor PartnersVendor Partners

OR throughProvider Office

Provider Provider OfficeOffice � Clearinghouse �

Acknowledgement reports R022 R026

generated here Payer processing, claim status response &

ERA’s

PayersPayersPayers

Claim and Report Flowchart

What is a Clearinghouse? Clearinghouse – An organization that acts on the behalf of providers to submit claims to payers.


Security Issues • Log-off of the system gracefully. Please use the logoff button. • Protect and keep secret your password • Account Administrators are responsible for adding and deleting user IDs


Logging into WebMD® Office Step 1: Double click on your icon for Internet Explorer. Step 2: Enter in www.webmdenvoy.com into your web browser.

WebMD® displays the following screen:

Step 3: Click on WebMD Office Log-In.


Step 4: Enter your WebMD® User Name at the User ID prompt.


Step 5: Enter your password at the Password prompt. If you cannot remember your password, contact WebMD at 1-877-gowebmd (1-877-469-3263).

Step 6: Click on Log In.

Step 7: Upon logging in, the user may see a Flash Message from the system.

WebMD® may display a Flash Message (see sample below):

Step 8: Click on Home.



Edit Payer List

To view a list of participating and non-participating WebMD® payers, click any of the Edit Payer List buttons. The list will display the payer’s name and the transactions that are available in WebMD®. WebMD® displays the following screen:

To add payers to the payers to the dropdown box click on the “Select” Box � along side of the payer you wish to include. • Submit – Makes your choices available in the dropdown menu • Reset – This button is basically an “undo” if you change your mind • Select All – Selects all health plans • Clear All – Clears all choices • Cancel – Cancels request.


Favorite Lists WebMD® provides the user with four (8) different types of favorite lists: • Requesting Provider • Service Provider • Procedure Codes • Diagnosis Codes • CDT4 (ADA) Codes • Place of Service Codes (not shown here) • Specialty Codes (not shown here) • Service Type (not shown here) A favorite list provides a shortened list of these different areas in which to use in eligibility or claims. The two different provider favorite lists can be set up for selected payers or all payers. For example: to add a provider to a favorite list, click on the Find Provider and the user will be branched to the Find Providers section of the system. WebMD® displays the following screen:

• Find Provider (or code) - will allow you to put a � in the box will add to the favorite list you are

setting up.


• New Provider - will allow you to set up a provider who is not currently available or listed in the lookup (Find Provider).

• Edit - will allow you to add critical information to a specific provider record such as contact name and phone number that may not otherwise be available in WebMD Office.

Provider IDs are clearly identified alongside the payer that that provider is set up under.


General Information

•Information is available for the payers “First Health” and “First Health Mail Handlers”. •Fields with a red asterisk are REQUIRED fields. •When entering a birth date prior to 1930, you must fill in the 19xx or the year will default to 20xx. •When entering a (regular) date, slashes (/) are not necessary, Enter the 6-digit date and hit tab, this will default the slashes. •TIN # is the Provider’s Tax Identification Number and is 9 digits.


Check Eligibility

Select how you wish To Search (Step 2 on the screen print above)


When Searching by Subscriber:

• Subscriber ID - Enter the Subscriber ID listed on the Insurance card • Subscriber Last Name – Enter the subscriber last name exactly as appears on the

insurance card. • First Name – Enter the subscriber first name exactly as appears on the insurance card. • Date of Birth – Enter the date of birth as listed on the insurance card • Service Start Date - Today’s date will default unless a specific date is requested. • Provider Tax ID - Requires the Federal tax ID number.


When Searching by Dependent:

• Subscriber ID - Enter the Subscriber ID listed on the Insurance card • Dependent Last Name – Enter the dependent last name exactly as appears on the

insurance card. • First Name – Enter the dependent first name exactly as appears on the insurance card. • Date of Birth – Enter the date of birth as listed on the insurance card • Service Start Date - Today’s date will default unless a specific date is requested. • Provider Tax ID - Requires the Federal tax ID number.


Check Eligibility Response

Note: The response will give you the last period of eligibility. If you wish to view eligibility for a specific date of service, you will need to enter that date in the “Service Start Date” field.

Patient’s who are termed will be noted here with an entry marked “Eligibility End” and the corresponding date.


Check Claims

Note: All claims that are received by the health plan are available online whether they are received electronically or via paper.

Provider ID Type Must correspond with the number entered

By using the select button, the Provider ID will automatically populate

The subscriber/member name must be spelled correctly

By checking this box, these required fields will automatically populate with the Requesting Provider Info

The organization name does NOT have to be spelled correctly


Step 2 Enter Search Criteria: Required fields are in red, optional fields are in black. The optional fields allow you to narrow your search, particularly if there are multiple claims submitted for the same patient for the same date of service. Claim Information Subscriber ID - The member ID number listed on the Insurance card. Last Name - The subscriber/member last name must be spelled exactly as it in their card. First Name - The subscriber/member first name must be spelled exactly as it in their card. Date Of Birth - The subscriber/member date of birth as it appears on their card. Gender - Select male or female. Service Start Date - The beginning date of service as it appears on the claim. Claim Number - The claim number. Total Submitted Charges - Total billed charges. Requesting Provider Info These fields will automatically populate with the last information that was entered even though you have logged out of the system. Provider ID Type - Federal Tax ID of the site requesting the information. Be sure this corresponds to the number you enter into Provider ID Provider ID - Federal Tax ID of the site requesting the information. Individual/Org - Use this field to identify whether the provider name you are entering is an individual or institution. Last/Organization Name - Either the last name of the provider or name of the institution that matches the Federal Tax ID. First Name - First name of the requesting provider if appropriate. Service Provider Info � Same as Requesting Provider - This field automatically populates the Service Provider Information fields with the same information in the Requesting Provider Information fields. Provider ID Type - Federal Tax ID of the site performing the service (i.e. billing provider). Be sure this corresponds to the number you enter into Provider ID Provider ID - Federal Tax ID of the site performing the service. Individual/Org - Use this field to identify whether the provider name you are entering is an individual or institution. Last/Organization Name - Either the last name of the provider or name of the institution that matches the Federal Tax ID First Name - First name of the service provider if appropriate.


Suggestion: If you are aware the patient had several services performed on the same date, search by the Payer Claim Number, or (Total) Submitted Charges. A search by service date could possibly retrieve information for a different claim for that day.

Check Claims Response Effective Date = Date the Remittance Advice created Claim Statement Period Start = Date of Service

These responses are HIPAA mandated


Secure eMail •When sending email from your WebMD® account to a cvty.com or webmd.com email account, it is secure email. WebMD® Office uses 128-bit encryption, which is the strongest security available today. •When you are logged-in to WebMD® Office, and send email to an “outside” email account (such as an AOL or Yahoo address), it cannot be considered secure. •Emails are kept for 90 days and will notify you when they are ready to be deleted. You will then have the option to save them for a longer period of time.

Mail Messages When the user selects the mail messages link from the home page, the Email and Reports Messages view replaces the Home Page. The Inbox folder is selected and Inbox messages are displayed with the first message selected.

General Features • All new messages are delivered to the Inbox folder. • The Inbox folder cannot be deleted, or renamed. • Folders display all messages that are not expired.


• Unread messages appear in bold. • Expiring messages that are within 3 days of the current date are displayed in red

font. • User may sort messages by any of the display columns. • A count of unread messages appears above the display in bold. • A count of expiring messages appears above the display in red. • Subject for messages is built from a combination of Payer Name, original mail

subject, and date. • No built in Forwarded folder or history of forwarded messages exists. • All error messages are displayed as pop-up windows.

Folders List

General Features • Only a single level of folders is supported. Hierarchies of sub-folders are not

supported. • All folders for this user are displayed in the order in which the user added them. • The Inbox folder always appears first on the list. • Only one folder may be selected at one time. • User may Add, Delete, or Rename any folder except the Inbox. • Each folder displays a status in parenthesis containing a count of unread messages

in bold and a count of expiring messages in red separated by a comma.

Folders Buttons

Description

Add • Short-cut key is ALT +A. • Choosing this button causes a new row to appear in edit mode at the

end of the folders list with the default name of “New Folder” selected so that any typing overwrites the selected text.

• User may press the enter key or click anywhere on the screen to accept the name and exit edit mode.

• Duplicate folder names are not permitted.


Rename • Short-cut key is ALT +R. • Choosing this button causes the selected folder to appear in edit

mode so that any typing overwrites the selected text of the folder name.

• User may press the enter key or click anywhere on the screen to accept the name and exit edit mode.

• User may press the escape key or click anywhere on the screen to undo and keep the original name and exit edit mode.

• Duplicate folder names are not permitted.

Delete • Short-cut key is ALT +D. • Choosing this button will cause the selected folder to be deleted. • A confirmation screen allows the user to cancel or delete the folder.

Messages List

The Messages list has these features:

• Multiple messages may be selected. • Selected items are highlighted in blue. • The last item of a block of currently selected items has a black arrow on its first

gray row header selection cell. • User may also select multiple messages using CTRL+ left mouse click, SHIFT+

left mouse click, or left mouse click drag on the first column of gray row header selection cells.

• All button operations affect the currently selected messages. • User may sort by a single column in ascending or descending order by

alternately clicking a column header. • User may Open, Forward, Print, Move To, Copy To, or Delete the selected

messages.

Messages Buttons

Description

Open • Short-cut key is ALT +O.


• Choosing this button will cause the pop-up Open Message view window to display.

• If the Open Message view, or the Forward Message view is already open, the first message in a selection will be opened replacing the contents of the open view.

• This is a modal window. User may not interact with other view windows until this one is closed.

• Multiple messages are supported for this action.

Forward • Short-cut key is ALT + F. • Choosing this button will cause the pop-up Forward Message view window to

display. • If the Open Message view, or the Forward Message view is already open, the

first message in a selection will be opened replacing the contents of the open view.

• User may not interact with other view windows until this one is closed. • Multiple messages are supported for this action.

Print • , short cut key ALT + P. • Choosing this button will cause the pop-up Print Message view window to

display. • Multiple messages are supported for this action. • Multiple Print Message windows are supported.

Move To • Short-cut key is ALT + M. • Choosing this button will cause the pop-up Move Messages To view window

to display. • This is a modal window. User may not interact with other view windows until

this window is closed.

Copy To • Short-cut key is ALT + C. • Choosing this button will cause the pop-up Copy Messages To view window

to display. • This is a modal window. User may not interact with other view windows until

this window is closed.

Delete • Short cut key ALT + D. • Choosing this button will delete the currently selected messages. • A confirmation screen allows the user to cancel or delete selected messages.

Search • Short-cut key is ALT + S. • Choosing this button will cause the Search Folder view to replace the current

view window.


Open Messages User selects the “Open” button. A pop-up Open Messages window appears.

If the message contains an attachment, selecting the Attachment radio button displays it as shown on the next illustration:


General Features

• The first message in a selection is viewed in read only mode for all fields displayed.

• User may print, forward, or extend the currently viewed message. • User may view the next and previous message in a selection (or the entire folder

list if only one message was selected). • User may view either the message or the attachment by selecting the appropriate

radio button. • If only the message or only the attachment exists, the appropriate radio button

will be enabled. • The user may not interact with another view, until this one is closed.

Open Messages Buttons

Description

Print • Short cut key is ALT + P. • Choosing this button causes the pop-up Print Message view window

to display. • Only the current message is supported for this action.

Forward • Short-cut key is ALT + F. • Choosing this button will cause this view to be replaced by the

Forward Messages view window. • The User may not interact with other view windows until this one is

closed. • Only the current message is supported for this action.

Reply • Short-cut key is ALT + F. • Choosing this button will cause this view to be replaced by the Reply

Message view window. • User may not interact with other view windows until this one is

closed. • Only the current message is supported for this action. • The Reply button will only be visible if the from address may be

replied to.

Extend • Short cut key is ALT + E. • Choosing this button causes the pop-up Confirm Extend Message

view window to display. • Only the current message is supported for this action.


Forward Messages When the user selects the Forward button, the pop-up Forward Messages window is displayed. If the Open Messages view window or the Reply Messages view window is currently open, this view will replace the current view window.

General Features

• Multiple messages listed are forwarded with the same message and the characters “FW: “ pre-pended to their individual subjects. Only one “FW:” is ever pre-pended.

• The message is pre-pended to each message’s current message with a header line of hyphens and a second line in the format “Annotated by <current user email address> on <current date>.”

• The To email addresses entered may be separated by spaces, commas, or semicolons which are replaced with semicolons during the send.

• All To email addresses are validated to a limited set of domains. • Messages (excluding attachments) are limited to approximately seven kilobytes. Forward Messages Buttons

Description


Send • This is a button, short cut key ALT + S. • Choosing this button will cause the messages to be sent. • Choosing this button will return to the previous view. • If returning to the Open Messages view, a status message will be

shown indicating that the message was just forwarded.

Cancel • Short-cut key is ALT + C. • Choosing this button will close this window. • Choosing this button will return to the previous view.

Reply Message When the user selects the Reply button, the pop-up Reply Messages view window is displayed. If the Open Messages view window or the Forward Messages view window is currently displayed, this view will replace the current view window.

General Features

• Multiple messages are not supported. • The message is pre-pended to the message’s current message with a header

line of hyphens and a second line in the format “Annotated by <current user email address> on <current date>.”

• The To email address is automatically set to the original message’s from email address and is not editable.

• Messages (excluding attachments) are limited to approximately seven kilobytes.


Reply Buttons

Description

Send • This is a button, short cut key ALT + S. • Choosing this button will cause the messages to be sent. • Choosing this button will return to the previous view. • When returning to the Open Messages view, a status message will

be shown indicating that the message was just replied to.

Cancel • Short-cut key is ALT + C. • Choosing this button will close this window. • Choosing this button will return to the previous view.


Copy Messages To When the user selects the Copy button the Copy Messages To pop-up view window is displayed.

General Features

• A single destination folder may be selected. • All messages selected are copied to the selected folder. • The user may not interact with other windows until this one is closed. • The currently selected folder is not available in the list.

Copy Messages To Buttons

Description

Copy • This is a button, short cut key ALT + C. • Choosing this button copies the messages to the selected folder.

Cancel • Short-cut key is ALT + C. • Choosing this button will close this window.


Move Messages To When the user selects the Move button the Move Messages To pop-up view window is displayed.

General Features

• A single destination folder may be selected. • All messages selected are moved to the selected folder. • The user may not interact with other windows until this one is closed. • The currently selected folder is not available on the list.

Move Messages To Buttons

Description

Copy • This is a button, short cut key ALT + C. • Choosing this button copies the messages to the selected folder.

Cancel • Short-cut key is ALT + C. • Choosing this button closes this window.


Search Folder When the user selects the “Search” button the Search Folder view window replaces the current view window.

General Features • “Search Folder” is required and only one may be selected. • One other field must be entered. • All other fields are optional. • Partial text searches are supported. • Wildcard or pattern match searches are not supported.

Search Buttons

Description

Search • Short cut key is ALT + S. • Choosing this button will cause the Search Results view

to replace the current window. Cancel • Short-cut key is ALT + C.

• Choosing this button closes this window.


Search Results When the user selects the “Search” button from the Search view window the Search Results view displays.

General Features Unread messages are displayed in bold. Expiring messages that are within 3 days of the current date are displayed in red font. User may sort messages by any of the display columns. Subject for messages is built from a combination of Payer Name and original mail subject.

Messages List The Messages List has the following features: • Multiple messages may be selected. • Selected items are highlighted in blue. • The last item of a block of currently selected items has a black arrow on its first gray

row header selection cell. • User may also select multiple messages using CTRL+ left mouse click, SHIFT+ left

mouse click, or left mouse click drag on the first column of gray row header selection cells.

• All button operations affect the currently selected messages. • User may sort by a single column in ascending or descending order by alternately

clicking a column header.


• User may Open, Forward, Print, Move To, Copy To, or delete the selected messages. Result Messages List Buttons

Description

Open • Short-cut key is ALT +O. • Choosing this button will cause the pop-up Open Message view

window to display. • If the Open Message view, or the Forward Message view is already

open, the first message in a selection will be opened replacing the contents of the open view.



Forward • Short-cut key is ALT + F. • Choosing this button will cause the pop-up Forward Message view

window to display. • If the Open Message view, or the Forward Message view is already

open, the first message in a selection will be opened replacing the contents of the open view.



Print • This is a button, short cut key ALT + P. • Choosing this button will cause the pop-up Print Message view

window to display. • Multiple messages are supported for this action. • Multiple Print Message windows are supported.

Copy To • Short-cut key is ALT + C. • Choosing this button will cause the pop-up Copy Messages To view

window to display. • This is a modal window. User may not interact with other view

windows until this window is closed.

Move To • Short-cut key is ALT + M. • Choosing this button will cause the pop-up Move Messages To view

window to display. • This is a modal window. User may not interact with other view

windows until this window is closed.

Delete • Short cut key ALT + D. • Choosing this button will delete the currently selected messages. • A confirmation screen allows the user to cancel or delete selected

messages.


Folders • Short-cut key is ALT + F. • Choosing this button will cause the Email and Reports Messages

view to replace the current view.


Extend Message This feature is used to extend the life of a message for another 30 days. When the user selects the “Extend” button no user interface is displayed. The Open Messages view window stays open.

Print Messages When the user selects the “Print” button a pop-up Print Messages view window appears.

General Features • Multiple Print Message windows are supported. • Printing defaults to printing just the attachment of the message • User may optionally choose to print just the message, just the attachments, or both. • Messages and attachments are printed on separate pages. • Multiple messages are supported by this action. • If messages are successfully spooled to the printer, they are updated to read status.


Print Buttons

Description

Print • Short cut key is ALT +P. • Choosing this button closes this window and causes the Select

Printer window to appear. Choosing Print from the Select Printer window causes the Printing Messages window to appear while the messages are spooled to the printer.

• If messages are successfully spooled to the printer, they are updated to read status.

• User may cancel printing using the Printing Messages window’s Cancel button.

Cancel • Short-cut key is ALT + C. • Choosing this button will close the view window.

Claim Network News When the user selects the “Claim Network News” link, the Office Home Page is replaced with the Email and Reports view with the Claim Network News folder selected. The Functionality of Claim Network News view is identical to the Email and Reports Messages view with the following additional features and restrictions.

General Features

• Users cannot Forward, Reply, Delete, Copy To, Move To, or Extend Claim Network News Messages and the corresponding buttons for these actions are not on the screens.

• Unread statuses do not apply to messages.


New Claim Entry

If you are interested in this service, please contact WebMD® directly at 1-877-GO-WebMD.


Send Claims

If you are interested in this service, please contact WebMD® directly at 1-877-GO-WebMD.


Batch Manager

Batch Manager is a standard function of WebMD® Office and allows the user to manage inquiries and responses by organizing them into groups or batches. By working in "batch mode" you will automatically be storing inquires and responses into a batch that you created. The user can return later to Batch Manager to view the results of the inquiries and to manage the information. Batches can also be created by importing and exporting files. For example, if your system can create a file in the appropriate format, you can import that file directly as a batch rather than enter each request. For example, files can be uploaded for all claims 90 days outstanding, or eligibility requests can be made for all patients being seen the next day. From here you can view and print responses, modify inquiries and resubmit them, delete inquiries/responses, move them to another batch or rename the batch. Use Batch Manager for working with Check Eligibility, Check Claims, New Authorizations and Check Authorizations.


To manually create a batch:

1. Click the Turn on Batching button located in the upper left corner to activate

batch mode OR Place a check mark (by clicking the adjacent box) to turn a

specific Batch On.

2. Select Create a New Batch from the batch drop-down list.

3. Continue to work in any of the other services (Check Eligibility, Check Claims,

etc.)

4. When performing any function in WebMD, always make certain the Active Batch

header has been set to the desired batch name. The active batch header name

appears in a box below the words WebMD.

5. When clicking Send to Payer, the request is sent to the payer and is then stored

as part of a batch.

6. If it is necessary to resend your batch for processing, complete the following

steps:

a. Return to Batch Manager.

b. Find the appropriate batch in the list of batches.

c. Select send


To import files to create a batch: Follow the instructions on the screen. File formats and directions are available.


Customize Batch Services Users can customize feature in Batch Manager through the Customize link in the upper right corner of the Batch Manager page. General Features • Change Batch mode and Group settings • Configure what columns appear on the list screen • Indicated the number of transactions in a batch


To View Batch Results

1. Batches can be viewed by clicking on the batch name or by clicking View from the Action column to the right of the batch name. The Search Inquiries field is used ot search for a character string across batches.

2. To view a batch response, click on the Date/Time link for the transaction in the Responses Column.

3. To see multiple individual responses, select 2 or more transactions by clicking the check box to the left of the transactions and then click the link for the first selected transaction.

• Inquiries appear listed in the order they were entered. • The Date/Time shown in the Results column reflects the last date/time the

inquiry was processed. Pending means that the payer has not yet responded to the inquiry. Select Refresh Results to update the status of an inquiry. You may need to refresh the screen several times when a full batch is submitted, as response times will vary.


Results Screen


Logging off WebMD®

ALWAYS remember to log out “gracefully”. This means never close the screen by clicking on the “X” button on the upper right corner of the screen. While this works for many of the software applications you may use every day, it can have adverse effects here. The only appropriate method of logging out is to click on the Logout selection, which is marked above by the arrow.


Glossary of Terms

Adjudication The process of paying or processing a claim, including determination of the appropriate level of reimbursement. Claim A claim is a bill that depicts the medical encounter that is sent to an insurance company (payer) HCFA 1500 (Physician/Professional) – Healthcare Finance Administration UB92 (Hospital/Technical) – Universal Bill Example: When a patient is hospitalized, the hospital bills for supplies, technical charges and medical equipment on a UB92 form, while the physician bills for their services on a HCFA 1500 claim form Clearinghouse An organization that acts on the behalf of a provider to submit claims to payers. Takes claims and places them into a standard format (NSF) and forwards them to payers and other clearinghouses. A “Value Added” Clearinghouse may put claims up against rules specific to state and payer requirements. Denied Claim A denied claim has been processed/adjudicated, but it had been determined that the claim is not going to be paid due to a possible variety of reasons. The reasons are: Additional information requested, more specific ICD9 or modifier required, non-covered service, etc. EDI Electronic Data Interchange. A computer-to-computer transmission of business information in a standard format. EOMB Explanation of Medical Benefits (Sometimes referred to as an EOB) A statement mailed to a member/insured and the provider explaining how a claim was paid, or why it was not paid.


HCFA Health Care Financing Administration The Federal agency responsible for administering Medicare and overseeing states’ administration of Medicaid. HIPAA Health Insurance Portability and Accountability Act. This law amended the Internal Revenue code of 1986 to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery. IDN Integrated Delivery Network A generic term referring to a joint effort of physician/hospital integration for a variety of purposes. Some models of integration include physician-hospital organization, management service organization, integrated provider organization and medical foundation ISP Internet Service Provider. A company that provides access to the Internet for a fee. Examples:

@home MSN Mindspring AOL CompuServe

JCAHO Joint Commission on Accreditation of Healthcare Organizations A private, not-for-profit organization that evaluates and accredits hospitals and other health care organizations providing home care, mental health care, ambulatory care, and long term care services Payer Public or private organizations that pay for or underwrite coverage for health care expenses. (Example: First Health, First Health Mailhandlers) PMS Practice Management System Computer System/Software used by physician office to schedule appointments, bill claims, etc.


Rejected Claim A rejected claim is a claim, which is unable to be processed, and never reaches adjudication. (Examples of what cause a claim to be rejected: illegible, empty box on the HCFA) URL Uniform Resource Locator. In simpler terms, this is the address of the website. Examples:

www.firsthealth.com www.mhbp.com www.cvty.com www.WebMDenvoy.com


Support Numbers

WebMD Office is a very user-friendly system. However, if you have an issue, please contact one of the following. Please be sure to include your name, phone number and email address e-Mail Customer Support [email protected] Toll-free Customer Support 877-GOWEBMD (877-469-3263) available Monday through Friday from 8 am to 7pm Eastern Standard Time


System Requirements

webmd user guide 5 1 - fh · webmd office user guide 2005.1 (rev.4/05) 4 manual objectives after...

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