Professional Provider Back to Basics Seminar
CareFirst BlueCross BlueShield Updates
AAHAM Third Party Payer Meeting
March 15, 2013
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Agenda
• EDI Updates and Reminders
• Electronic Funds Transfer
• CareFirst Direct 835 Remittance Advice
• ICD10 Preparations
• Pharmacy Preauthorizations
• iEXCHANGE Replacement Update
• CareFirst General Updates
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EDI Updates and Reminders
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Electronic Services
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Electronic Services
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EDI Helpful Hints
•
Submit claims using your NPI number
•
Include patient’s entire prefix & membership number
•
Verify patient name and birth date
•
Use HIPAA standard data code sets
•
Review all reports daily
•
Correct all claims with errors and resubmit electronically
•
Review website regularly for news and updates
•
Refer to the website or BlueLink for a list of our preferred vendors
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EDI Support
Difficulties with submissions?
• Contact your vendor/clearinghouse first.
CareFirst:
• EDI Service Line
1-877-526-8390
edidirectsubmission@carefirst.com
•
For better assistance, use one of the following terms when
placing your call:
835 ERA's/enrollment
NPI
837 claim status for NCOF (no claim on file) or front end rejections
from CareFirst
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Electronic Funds
Transfer (EFT)
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Get Your Payment Fast Though
Electronic Funds Transfer (EFT)
• Get paid faster through electronic delivery of your payments
• Reduce paperwork
• Receive secure payment distribution
• Avoid mail delay
• To be eligible for EFT you must:
 Submit claims electronically
 Receive an 835/ERA (Electronic Remittance Advice)
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Enroll Today for Electronic Fund Transfer
(EFT)*
The following clearinghouses offer electronic fund transfer (EFT)
enrollment services:
 Emdeon (formerly known as Webmd) at 866-369-8805
 Allscripts (formerly known as Payerpath) at 877-623-5706, ext.
1 or 2
 RealMed at 877-927-8000, ext. 1201
• Contact your clearinghouse with all questions regarding EFT
capabilities and enrollment.
• Refer to the CareFirst website for more information
• Contact your clearinghouse with all questions regarding EFT
capabilities and enrollment
• Go to www.carefirst.com/electronicclaims for more information
*Note: If you currently receive automated payments from CareFirs
there are no changes and no need to re-enro
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CareFirst Direct 835
Remittance Advice
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Remittance Advice
Log into CareFirst Direct
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Remittance Advice
Click on Remittance.
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Remittance Advice
Click on Claim Status.
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Remittance Advice
Click on Provider Remittances
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Remittance Advice
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Remittance Summary
Search by Date, Check/EFT Trace#,
Paid Amount, Source System.
Please note: Reviewing Billing NPI/Payee – You
can search 90 days at a time. When reviewing All
Billing NPI’s – you have the same filtering
capabilities, however you can only search 7 days
at a time due to the amount of data from all
billing NPIs. For each you can search back to
1/1/2012.
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Important Reminders for the 835
• The provider must be registered to receive an 835
through their trading partner in order to view
Remittances Data through CareFirst Direct.
Note: You will see the Remittance Tab even if you are not registered, however you
will only see No Checks Found. We plan on making the message more clear in the
future. For information about electronic billing and receipt of 835 visit
www.carefirst.com/electronicclaims
• You cannot import the CareFirst Direct 835 into your
practice management system.
• Please sign up for 835 instructional webinars on
CareFirst .Com in the Provider and Physician’s section
under Seminar and Training.
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ICD10 Preparations
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ICD10
Health and Human Services (HHS) has announced a final rule that delays
the ICD-10 compliance date from October 1, 2013 to October 1, 2014.
CareFirst will be compliant with this date. Updates will be provided on
the CareFirst website under Provider and Physicians under the Quick
Link 5010/ICD10. Please work with your clearing house to be ready for
the changes.
Additional information is available at the CMS website.
More detail will be available at the Hospital Quarterly
Meetings to be held in April. Go online and register
to attend one of these sessions.
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Pharmacy Preauthorizations
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Pharmacy Authorizations Now Online
Providers can now request and track authorizations for
medications requiring pre-authorization online. To access this
new tool, log in to the Provider Portal from
www.carefirst.com/providers and click on the PreAuth/Notifications tab. Within the Provider Portal, providers can:
•
•
•
•
•
Select the desired drug
Enter information about the member’s condition
Attach any applicable documents for medical review
Track the status of a request
We have developed a new webinar to show you how to use this
feature.
Note: This applies to patients with CareFirst BlueCross BlueShield pharmacy
prescription benefit only.
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Pharmacy Authorizations
Click on Pre-Auth/Notifications.
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Create a Preauthorization
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Preauthorization
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iEXCHANGE Replacement Update
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Project Overview
• iEXCHANGE is scheduled to be replaced in the second
quarter of 2013.
• Authorizations will be obtained through our Provider
Portal (CareFirst Direct).
• Training will be offered via webinars and during the
Hospital Quarterly Meetings.
• Provider Relations Representatives will provide
support and individualized training as needed.
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To Ensure Success
•
IEXCHANGE administrators received a spreadsheet with a list of all current
IEXCHANGE users.
•
The administrators were asked to forward the email containing the
spreadsheet to all of the administrators listed in the spreadsheet.
•
They should review the list for accuracy.
•
They should create a CareFirst Direct User ID for any iEXCHANGE user who
does not currently have access.
•
If a user obtains authorizations for multiple tax ids a different user id is
needed for each.
•
If you have a new employee make sure they get a CareFirst Direct user id.
•
Access to authorization entry is granted by virtue of having a user id. No
specific role needs to be granted.
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To Ensure Success
• Allows us to make changes instead of waiting on a
vendor to make changes.
• Allows us to make authorizations available to more
provider types.
• Eliminates a redundant system.
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Next Steps for the iEXCHANGE Replacement
•
Make sure all personnel who obtain authorizations have access to the
Provider Portal (CareFirst Direct).
•
Attend training- Training will be conducted via webinar sessions and at
our second quarter Hospital Quarterlies. We will advertise these
webinars to our providers.
• Please check the website periodically and register when these
sessions are listed.
•
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If you have questions please contact your Provider Relations Hospital
Representative.
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CareFirst General Updates
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Update Your Information
In order to do business
efficiently with our CareFirst
providers, it is essential for us
to have your most current
practice information.
We’ve made it easier than ever
for you to review and update
your information.
Log into the Provider Portal at
carefirst.com under Providers
and Physicians to review and
verify your address, phone
number, location, associated
practitioners and more.
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Update Your Information
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Make Sure Your Practice Information is Current
Review Your Practice Information
Online Today
If any information displayed is incorrect, it is
important for you to submit a Change in Provider
Information form immediately. The form is
available online.
CareFirst
Mailstop CG-41
10455 Mill Run Circle
Owings Mills, MD 21117-0825
or
Fax: 410-872-4107
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Use Your NPI and Keep It Current
Your National Provider Indicator
(NPI) is Required
To improve efficiency of claims
processing, CareFirst requires that all
claims submitted (electronic and paper)
include your NPI so your practice can be
identified. Without your NPI, your claims
may be delayed or rejected. Need an NPI?
Visit www.carefirst.com/providers/NPI to
find out more. Any changes to your NPI?
Report them to CareFirst using the NPI
Submission Form located on the same
page under the NPI and Payer Codes tab.
CareFirst BlueCross BlueShield
Provider Information and Credentialing
10455 Mill Run Circle
P.O. Box 825
Mailstop CG-41
Owings Mills, MD 21117-0825
Send questions to NPI@carefirst.com
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Sign-up to Receive Email from
CareFirst
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Sign-up to Receive Email from
CareFirst cont.
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Facets Voucher Changes
The Facets Voucher/Notice of payment(NOP) for both
professional and institutional providers will be changing
toward the end of the 2nd quarter of 2013.
The changes will make the voucher easier to interpret and
ensure that all of the necessary information is available.
Training will be conducted via webinar sessions. Go to
Training sessions are now available on the website for
enrollment at www.carefirst.com>providersandphysicians
and click on Seminars and Training on the left side.
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Questions
Thank you for your attention
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