What You Need To Know About the Requesting Provider List

As of Thursday, December 15th, new Emdeon Office security enhancements are in place so that only site administrators have the ability to add or remove providers from your requesting provider favorites list. This ensures that only valid providers are available for use in real-time transactions. For most payers, you are now required to select the requesting provider from your favorites list. For those payers that do not yet require a provider to be selected from favorites, this change will be coming soon. If you’re still unsure about how to use the requesting provider list, please review the instructions below.

Claims Only Customers If you use Emdeon Office only for claim submission or claim reporting then the requesting provider list changes do not apply to you. The requesting provider list is used only in the ‘real-time’ transactions which are eligibility, check claims and the health care service reviews.

Real-Time Customers The instructions in this message are long and detailed. If you would prefer to download this information in a Microsoft Word format, please click here . Printing and saving this message is recommended.

What Do All Of These Messages Mean?

Provider ID was not found in favorites. Use the select button next to the provider ID field to review your favorites list. If the ID you need is not present, please have the administrator for your site add the provider ID you wish to use to your favorites list. You must select an ID from your favorites list to complete this request.

The message above will display as an alert when you try to send a real-time transaction using a provider ID that is not stored in favorites for your group. This is true even if the provider ID was pre-filled by Emdeon Office when you opened the page. An ID displayed in the provider ID field is not necessarily stored in your favorites list. Please follow the instructions provided in the alert to resolve the problem.

The site administrator for your office is responsible for ensuring that only providers affiliated with your office are included in this list. This list must be validated by a site administrator before 1/31/2006 or all saved providers will be deleted.

The message above will display when you view the requesting provider favorites list, if you are not an administrator. Its purpose is to alert you that the requesting provider list you use has not yet been confirmed by an administrator in your organization. If your administrators do not frequently use Emdeon Office, we

recommend that you alert them that they need to log-in to perform this task. A list of your administrators is available form the User Account Information service, on the Office Home Page. As a site administrator you are responsible for ensuring that only providers affiliated with your office are included in this list. This list must be validated by 1/31/2006 or all saved providers will be deleted. Please select Manage Favorites List from the Emdeon Office Home Page, and then choose "Requesting Providers" to begin the validation process.

The message above will display when you view the requesting provider favorites list from a request page, if you are an administrator. Its purpose is to remind you of the importance of reviewing and confirming your provider list. You will not be permitted to add new providers until your current list has been confirmed. Follow the instructions provided in the alert to validate your list.

Please confirm that all provider information is accurate. You are not permitted to add new providers until you have confirmed that all existing providers are valid for your location. This list must be affirmed by 1/31/2006 or all saved providers will be deleted. As the site administrator you are responsible for ensuring the validity of this list for all users in your location. Inclusion of a provider who is not associated with your location will be considered a HIPAA violation.

The message above will display when you view the requesting provider favorites list from manage favorites list, if you are an administrator. As with the prior message, its purpose is to remind you of the importance of reviewing and confirming your provider list. However, the urgency of the task should not negate the importance of a careful review. Misrepresenations as to the accuracy of your provider list for your organization may have serious consequences such as the loss of access to certain payers within Emdeon Office or complete loss of access to Emdeon Office. After you've cleaned-up your list, you can re-display the affirmation prompt just by re-displaying the requesting provider list.

What And Where Is The Requesting Provider ID ?

For Customers Of Payers That Use A Tax ID Many payers will use a provider’s federal tax identifier as a way of tracking who you are. Typically only a single tax ID is assigned to an entire health care providing organization, and not to each and every doctor in the organization. Unless you are a billing service, if you do business with payers who use the Tax ID as the requesting provider identifier, than you may not even have noticed the

requesting provider ID field, which is present on virtually every real-time request page.

Today in Emdeon Office, you can enter the tax ID once and Emdeon Office will remember it and default it into the tax ID field for every transaction you do thereafter. Since this information is being entered into Emdeon Office automatically and rarely needs to be updated, it is often overlooked by our customers. Take a minute to look closely at the pages you use the most, or at the examples below, to make sure that you know where to find the requesting provider ID field.

In the example below, the requesting provider ID is labeled "Provider Tax ID." Notice also the small button with the downward pointing arrow next to the Provider ID field. This button opens the requesting provider drop down list.

In the following example, the requesting provider ID is labeled "Provider Tax ID/SSN." Notice here that there is NOT a small downward pointing arrow next to the Provider ID field. The absence of the arrow indicates that the enhanced requesting provider features have not yet been made available for this payer.

Please be aware that some request pages will lack the drop down list for some time. This is necessary because Emdeon Office must update and test the addition of the provider drop down list to every payer page individually.

In cases where the drop down list has not been added, you will still be allowed to use provider IDs not present in your requesting provider favorites. Despite not having the drop down list, you can use the requesting provider list to select a provider ID in these pages by clicking the "Select" button next to the Provider ID field and then clicking on the ID that you want to use.

As soon as a given payer is updated to include the drop down list, the restriction will go into effect automatically. The new rule that allows only administrators to add providers to favorites will apply to these payers.

For Customers of Payers That Use Payer Assigned IDs Many payers assign their own identifiers to their providers. In these cases, they may choose to assign an ID to the entire organization or to each doctor in the organization. In cases where the proprietary provider ID is assigned to the entire organization, you may not have noticed the requesting provider ID field, which is present on every real-time request page.

Today in Emdeon Office, you can enter a payer assigned provider ID once and Emdeon Office will remember it and default it into the provider ID field for every transaction you do thereafter. Since this information is being entered into

Emdeon automatically, it tends to be overlooked by customers unless they are required to change it. In cases where a payer gives a separate ID to each provider in your organization, you’re likely to be in the habit of changing the provider ID to match the individual who actually provided service for a given patient. If not, take a minute to look closely at the pages you use the most, or at the examples below, to make sure that you know where to find the requesting provider ID field.

In the example below, the requesting provider ID is labeled "Provider ID." Notice also the small button with the downward pointing arrow next to the Provider ID field. This button opens the requesting provider drop down list. (Specifically with respect to all Coventry plans, the drop down list feature will not be available for these payers until after the first of the year.)

In the next example, the requesting provider ID is labeled "Provider ID." Notice here that there is NOT a small downward pointing arrow next to the Provider ID field. The absence of the arrow indicates that the enhanced requesting provider features have not yet been made available for this payer.

Still Can’t Find The Requesting Provider ID Field? The Requesting Provider ID field can be found in different places in different types of requests. As depicted above, for the eligibility transaction, this field is normally the last field on the page. Similarly, in the HCS Review Inquiry transaction, the requesting provider ID field is typically the last one as well. However, there are a small number of HCS Review Inquiry screens where the requesting provider ID field does not appear at all.

On the Check Claims transaction, several pieces of information are required about the requesting provider and these fields are grouped together in the middle of the page, below the patient information and above the service provider information.

On the HCS Review Request transaction, there is more variation due to the wide range of payer requirements. For some payers, only an ID is needed while for others, additional provider information can or must accompany the requesting provider ID. In all cases, the requesting provider ID, and if applicable the

requesting provider section, will follow the patient section but precede service provider and service detail fields.

OK, I Found The Requesting Provider ID, But What’s This List You Keep Talking About? Emdeon Office currently allows you to store a list of every provider ID that you use when submitting real-time transactions. There are two such lists available, one for requesting providers and one for service providers. A requesting provider may be you, the provider you work for or the provider on who’s authority you are accessing payer systems. The service provider is the provider who has or will provide services and is not necessarily directly associated with your organization.

For most payers, you are now required to use the requesting provider list. If, like many of our users, you rarely enter the provider ID because it is usually defaulted correctly, you will still need to make sure that the ID you use is also stored in the requesting provider list. Although Emdeon still continues to default the most recently used provider information, we will not permit that ID to be sent to the payer if it does not match a provider ID stored in favorites.

How Do I Create A Requesting Provider List? The primary contact for your organization, along with any administrator, can add, edit or delete a provider to the requesting provider list. If you do not know who your administrators are, select the User Account Information service on the Home Page to obtain a list.

If you are an administrator, there are two ways in which to add to or change the requesting provider list. The first method is through the "Edit" or "Select" button located next to the Provider ID field on each request page. The second option is via the "Manage Favorites Lists" link on the Home Page. If you have never previously used the requesting provider list and you utilize a large number of payers, Emdeon recommends that you use Manage Favorites List to generate your list. If you have fewer payers, it may be simpler to build the list on an "as needed" basis, through the Edit/Select buttons on the request pages. Detailed instructions for both methods can be found below.

Adding Providers on The Fly, (From A Request Page) - The following instructions can only be carried out by an administrative user. From any request page, the favorites list can be accessed via the button next to the field. In the case of the requesting provider favorites list this button will be labeled either "Edit" or "Select," depending on your role.

If no one in your organization has ever added a provider to favorites, then the first time you click the Edit/Select button you should see the following :

Select the New Provider button to add a provider. You will see a form like the one below:

As shown above, you must enter a provider name and a provider ID. The provider name must include both a first and a last name unless you choose the "Organization" option from the Individual/Organization list, located in the middle of Step 2. With respect to provider ID you must provide either a Tax ID or a Payer Assigned Provider ID. No other information is required, but the more information you complete, the more will be available for auto-completion in Emdeon Office. If you perform claim inquiry or health care service review transactions in Emdeon Office, auto-completion can be a major time saving feature.

In the example above, note that CIGNA displays in the title of the window. This is because this window was opened from a CIGNA eligibility request page. Any information entered in Step 3 of this screen is assumed to apply specifically to CIGNA and no other payers. Any information in Step 2 is considered to be applicable to all payers. It is highly recommended that you enter the Tax ID, and when available the NPI, of every provider you create as this may save you the effort of editing this provider for a different payer at a later point in time.

Once you’ve completed the form and clicked Save, you should see a screen similar to this:

In the above list, the name in parentheses is the provider nickname. This nickname is never sent as part of a transaction but can be useful to differentiate between two providers who have very similar names. Occasionally there are cases in which an organization has multiple payer assigned IDs from the same payer or multiple tax IDs. In order to store multiple IDs in such a situation, multiple provider entries would need to be created. The nickname field is also useful to distinguish between such entries. In the second column, the ID prefixed with T: is the tax ID. The ID prefixed with P: is the ID assigned by CIGNA. The ID prefixed by N: is the NPI. Since one has not been entered, the text "ID Unavailable" displays instead. A user can select either the Tax ID or Payer Assigned ID to be retrieved into the eligibility screen, which is open in another window, simply by clicking on which ever ID they prefer to use.

Once a provider has been entered for a given payer, CIGNA in our example, if you have entered a tax ID, the provider will be available for use with other payers as well. After switching to the Aetna eligibility screen, you would see the following:

Clicking on the arrow next to Provider ID caused the provider dropdown list to open so that the provider just added to CIGNA, John Smith, is now available for your use.

Notice the "Provider ID Type" list box in the picture above, to the left of the Provider ID field. This option box is provided for payers that allow the use of different types of provider ID. For Aetna, like many payers, the options are Provider ID and Tax ID. In the image below, the value for Provider ID Type is changed to "Provider ID".

Notice that in the picture above, the Provider ID list now reads "ID Unavailable" next to John Smith’s name. That’s because no Aetna specific Provider ID has yet been entered for this provider. To add the Aetna Provider ID, click the "Edit" button.

The requesting provider list for Aetna looks just like the screen previously shown for CIGNA, except that "ID Unavailable" appears after the P. The provider ID entered previously for CIGNA hasn’t been lost, it just isn’t applicable to Aetna. To add one that is, click the "Edit" link in the Action column.

The Edit screen looks very much like the Add screen used to create John Smith previously, and all of the previously entered information will display in Steps 1 and 2. In Step 3 add the Aetna Provider ID, as shown above, then click Save.

John Smith now has an Aetna Payer ID stored for use.

If no Tax ID had been entered for John Smith, things would work a little differently. Click New Provider to add another provider:

In the example above, the provider is an organization rather than an individual and therefore has no first name. Notice that the Individual/Organization option in Step 2 is set to Organization. Additionally, an Aetna Provider ID has been entered in Step 3 but neither a Tax ID or an NPI was entered. Click Save.

The Favorites List now has two entries. Notice that neither the Tax ID nor the NPI are available for the new entry since they weren’t entered in the last screen. However Madison Community could still be selected for use with the payer assigned ID.

Close this window to return to eligibility and then change to a different payer, Blue Cross Blue Shield of Massachusetts:

BCBSMA is an example of a payer that requires that the BCBSMA assigned provider ID be used. Unlike the previous Aetna and CIGNA examples, BCBSMA does not support inquiries with provider Tax ID. Because of this, when you access the favorites list as shown above, it again displays ID Unavailable next to John Smith’s name. No BCBSMA provider ID has yet been saved for John Smith. This time there is no provider ID type field and therefore no option to select the Tax ID already stored for John Smith. To use Dr. Smith, the only option would be to edit the provider list and add the BCBSMA ID.

Notice also above that the last provider entered, Madison Community Hospital, isn’t listed at all. That’s because neither a Tax ID nor an NPI was saved for the Madison Community. In order to select Madison Community in this transaction you would follow these steps: First, click Edit to open the provider favorites list window.

Next, click "New Provider".

In Step 1 of the New Provider window, notice the drop down list labeled "Select from existing providers." Select Madison Community Hospital from this list. After doing so, enter the BCBSMA provider ID in step 3 and click Save.

Since neither a Tax ID nor an NPI have yet been entered for Madison Community, this provider will be available for use with Aetna or Blue Cross Blue Shield of Massachusetts, but not with any other payers, unless these steps are repeated for those other payers.

Conversely, John Smith is shown as available for use with all payers, but yet won’t actually work with a payer like BCBSMA, which requires a payer specific provider ID until that ID is added to the provider record.

Adding and Updating Many Providers At Once (Using Manage Favorites List) - The following instructions can only be carried out by an administrative user. For those who prefer to complete the task of creating the provider list all at once, rather than a little at a time, the Manage Favorites List service will be convenient. To access it, go to the Office Home Page.

Select "Manage Favorites Lists" from the upper right column, under the "Managing Your Office" title.

The Manage Favorites view of the Requesting Provider List will display all of your providers without regard to payer specific configuration. When opened, each and every provider ID stored for each provider will be listed. The small button marked with an "x" next to each payer name allows you to delete just that specific payer assigned provider ID, while retaining the rest of the provider record. To delete the entire provider record, use the "Remove" option in the Action column. If you do not have administrative rights in your group, the remove option will only be available for providers you created personally.

If a provider list becomes very long, it can be helpful to filter the list to just those providers that are configured for a particular payer. The payer drop down list at the top can be used for this purpose. Although the payer drop down list always defaults to the last payer you have used, the filter is not applied until you click the "Selected Payer" button. Clicking the "All Payers" button removes the filter. Using the payer filter makes the Manage Favorites List version of the Requesting Provider List look very much like the Requesting Provider List accessed from request pages, described previously.

To add a New Provider in the Manage Favorites List screen, click the New Provider button.

The New Provider window is very similar to the ones described previously and works in much the same way. Add the provider name and at least one of Tax ID or Payer Assigned Provider ID. If you determine that you really intended to add new information to an existing provider, rather than create a brand new provider,

you can use the "Select from existing providers" list to pull-up the old record and add to it.

The major difference between this page and versions reviewed previously is the payer list in step 3. When entering a payer assigned provider ID, you must specify to which payer the ID applies. For convenience, the list will default to the last payer you have accessed.

Click Save after creating the new provider.

To add a different payer association to the new provider James Brown, click the Edit link in the James Brown row.

The Edit Provider screen is virtually identical to the Add Provider screen except that you no longer have a drop down list of existing providers in Step 1. Since you’ve already identified the provider that needs to be edited, that option is no longer useful.

Under Step 3, if you set the payer to be the same as that used in the Add screen, you will see the ID you entered on the Add screen.

Notice the small button with a right pointing arrow located before the payer drop down list. This button will allow you to jump quickly between each payer on the list for which this provider has payer specific information entered. If you are editing a provider who has payer information entered for many different payers, this button can be a useful short-cut.

By setting the payer drop down list to a new payer, you can add an additional payer assigned provider ID. Select a payer and enter a provider ID as shown above and click Save.

The new payer information will now display in your requesting provider list. Click "Edit" again to add another payer ID.

Notice the "Find Provider" button above. This button can be used to search for a provider in the payer system and add the provider automatically to your favorites list.

The Update Drop down list button should be used sparingly as it can be slow. However if someone other than you is adding providers to your favorites list, you can click this button to get access to the new providers right away. Similarly, changes to providers or deletions of providers may not be apparent to other users in your group until they either click this button or log-out and then log back in again.

A Few Last Tips

• Remove unused providers or duplicate entries. Due to the way in which Emdeon Office has evolved over time, you may find that you have the same provider entered separately under different payers or that you and a co-worker have each created your own versions of the same provider. Consolidate these duplicate entries into one. This will shorten your provider list, making it faster and easier to use.

• Maximize the information stored for each provider. The more information you save for each provider, the more keying you will avoid when submitting transactions later. For the same reason, be sure to correct errors such as first and last name being reversed/combined or Tax IDs stored in the payer assigned provider ID field.

• Verify that you have sufficient active administrative users. Administrative users include both the person listed as the primary contact for your account and also anyone who has been assigned an administrative role. To see a list of administrators, select the Account Information link on the Emdeon Office Home Page. If this list is out of date, there are two ways to make corrections. First, anyone listed as an administrator has access to the Emdeon Office User Management service, which allows administrators to add or remove administrative rights to any other user in the same account. If none of your currently listed administrators are available, contact the Emdeon Office help desk at 877 469-3263, option 2, for assistance in updating the list