Web Portal Overview

1. Web Portal Overview Presented by Xerox State Healthcare, LLC Provider Relations

2. Important Update- ICD-10 • Oct. 1, 2014 will be the compliance date for use of new codes that classify diseases and health problems. These code sets, known as the International Classification of Diseases, 10th Edition diagnosis and procedure codes, or ICD-10, will include codes for new procedures and diagnoses that improve the quality of information available for quality improvement and payment purposes.

3. Resources • When online use: Ask Service Representative • HIPAA.Desk.NM@xerox.com • NMPRSupport@xerox.com • Call Center 505-246-0710 or 800-299-7304 • New Mexico Web Portal • Provider Information section • Links and FAQ section • Provider Login section

5. Electronic Funds Transfers (EFT) Step One: Click on Email EFT Administration Step Two: Enter EIN (Federal Tax ID) or SSN and click on submit

6. The Xerox New Mexico Medicaid Web Portal Non Secure Features Secure Features requires login

7. The Xerox NM Medicaid Web Portal Login Page

8. Web Registration • Large Organizations with Multiple Billing Provider Numbers • Organizations with multiple billing provider numbers have to register each billing provider number in the web portal in order to inquire on claims, Prior Authorizations (PA) and payment history, as well as to access Remittance Advices (RA) and PAs used unit reports for each of their billing provider numbers.

9. Web Registration – “How-To” Complete every field that contains an asterisk

10. Web Administration Organizational Chart Master Administrator Supervisor has “User Admin” privileges Supervisor has “User Admin” privileges Supervisor has “User Admin” privileges Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff have Inquiry privileges only

11. User Privileges All privileges authorized for the user are listed in the left hand navigation bar.

12. Types of Inquiries Eligibility Claim Status Prior Authorization Payment History

13. Eligibility Inquiry

14. Eligibility Inquiry • The system will default the current date for date of service. • You can use any DOS within the past 2 years. • Date spans can be used. • Recipients can be searched using: • Recipient ID (this is the “SSN” style ID number, Medicaid ID, temporary SSN etc. 942XXXXXX) • SSN and date of birth OR…. • Last name, first name, date of birth (information needs to match what is on the Omnicaid system)

15. Eligibility Inquiry The “SSN-style” ID number

16. Eligibility Inquiry • If the recipient is eligible on the date entered, the response will include: • Category of Eligibility (COE) and description • All lock-ins • Medicare information • Third Party Liability (TPL) information • Long Term Care information, IF there is a long term care span (abstract) on file for the date entered that matches the inquiring provider number.

17. Eligibility Inquiry

18. Eligibility Inquiry

19. Types of Inquiries Eligibility Claim Status Prior Authorization Payment History

20. Claim Status Inquiry

21. What is a Transaction Control Number (TCN)? The twelfth digit in an adjustment/ void TCN will either be: 1= Debit 2= Credit 91308700085000001 The first digit indicates what the claim “media” is: 2 = electronic crossover 3 = other electronic claim 4 = system generated claim or adjustment 8 = paper claim 9 = Web portal claim entry Batch number The last two digits of the year the claim was received The claim number within the batch. The numeric day of the year. This is the Julian Date - this represents the date the claim was received by Xerox: this claim was received the 87th day of 2013, or March 28, 2013

22. Single DOS Inquiry This simple search might not find the claim if the DOS on the claim was mis-keyed or the recipientID was not correctly entered. Be sure you are entering the correct data.

23. Note: Unless you are a small provider, this search will probably result in more than 200 claims. Date Range Inquiry

24. Claim Summary Click on TCN to view specific claim detail Click on the Recipient ID to go to Recipient Inquiry

25. More on Claim Inquiry • Keep the following in mind as you use claim inquiry: • You will only see claims paid and denied to the provider number you are logged in under or have selected if you are logged in with an NPI. • If your search yields more than 200 results, you will only see the first 200 and a message will appear telling you that has happened. Narrow your criteria if this happens.

26. Types of Inquiries Eligibility Claim Status Prior Authorization Payment History

27. Prior Authorization Inquiry Current PA’s are available

28. Prior Authorization Summary

29. Types of Inquiries Eligibility Claims Status Prior Authorization Payment History Remittance Advice FAQ’s

30. Payment History Inquiry

31. Payment History Inquiry

32. Types of Inquiries Eligibility Claim Status Prior Authorization Payment History Remittance Advice FAQ’s

33. Reports and Data Files Select PDF Reports to retrieve Remittance Advices Providers can pull the last 8 RA’s from the Web Portal

34. Reports and Data Files Enter Provider ID or NPI and click submit

36. Types of Inquiries Eligibility Claim Status Prior Authorization Payment History Remittance Advice FAQ’s/ Links/Contact Us

37. FAQ Feature

38. FAQS

39. Provider Information

40. Submitting a ClaimAdd/Manage Templates

41. CMS-1500 - Add Claim Template Create Name for template

42. CMS-1500 Manage Templates Edit or Delete created templates

43. Online Claim Entry/Re-Bill/Adjustment

44. Online Claims Entry To begin the claim submission, all field with a RED asterisk (*) must be completed.

45. Online Claims Entry Primary Claim (Cont.) Click on the RED text for the CMS-1500 Claim form instructions

46. Claim Attachments Providers can now attach information with all claims submissions

47. Online Claims Entry Primary Claim (Cont.) Indicate the Total charge x Verify Total charge is correct If total change is missing or does not match up with the line item provided on the claim, the claim will deny or post additional edits.

48. Claims - Rebill Providers can make changes to existing claims that have denied, and rebill the claim. If used on a previously paid TCN, the claim will deny for duplicate. • Enter the Recipient ID and TCN of the claim you would like to rebill. • Once this information is submitted, all data associated with the previously submitted • TCN will appear. • All claims submitted with the re-bill function will receive a new TCN.

49. Adjustments Enter the Recipient ID, TCN, Action & Adjustment Reason Once this information is submitted, all data associated with the previously submitted TCN will appear.

50. Adjustments • A paid claim can be adjusted. • Providers CAN NOT Adjust a denied claim. • ONLY Claims that have been processed through Online Claims Entry can be adjusted online. Claims processed through EDI or on paper CAN NOT be adjusted on the web portal • Attach any new attachments necessary pertinent to the adjustment.