390 likes | 604 Views
Who Is Health Net, Inc.. One of the nation's largest publicly traded managed health care companies (NYSE Symbol: HNT)Health Net's HMO, insured PPO and government contracts subsidiaries provide health benefits to approximately 6.5 million individualsComprehensive behavioral health (MHN) and pharmac
E N D
1. Health Net Federal Services (HNFS) TRICARE Service Center (TSC) &
Beneficiary Counseling & Assistance Coordinator (BCAC) Interaction
2. Who Is Health Net, Inc. One of the nation’s largest publicly traded managed health care companies (NYSE Symbol: HNT)
Health Net’s HMO, insured PPO and government contracts subsidiaries provide health benefits to approximately 6.5 million individuals
Comprehensive behavioral health (MHN) and pharmacy benefit management subsidiaries
20+ years delivering health care coverage
17+ years supporting military families through the delivery of both CHAMPUS and TRICARE
3. Health Net Federal Services Overview Nearly 3 million TRICARE eligible beneficiaries in the North Region
Nearly 1800 associates plus our partners
Operations in 32 states
23 states and DC in TRICARE North Region
VA business
National PPO Network
19 Community Based Outpatient Clinics
National DRG Audit and Recovery Services
4. A Day in the Life of Health Net… 2,000 TRICARE Service Center walk-ins
2,100 Enrollment transactions
20,000 Phone calls to 1-877-TRICARE
4,200 Referral and authorization requests
50,000 Provider claims received
5. Communication & Coordination Communication is an essential component between successful HNFS, MTF and BCAC relationships
Coordination via monthly meetings ensure successful implementation of MTF and HNFS goals
6. TSC – BCAC Flow
7. Communication Use team approach, instead of “Us” versus “Them”
Successful communication occurs when HNFS and MTF staff view themselves as one team
BCAC and TSC Staff work closely together on potential beneficiary problems
Community Representative, BCAC and TSC Manager work to develop briefing opportunities/topics
Unilateral “Open Door Policy” between MTF and HNFS
Positive recognition of “job-well done”; highlighting individual and team accomplishments, often shared between MTF and HNFS in group settings
8. Role of TRICARE Service Center Enrollments: PCM changes, acceptance of enrollment fees, provide provider lists
Claims correction: (when appropriate), EOB explanation, assistance with debt collection issues
Explanation of benefits: customer interaction, community briefing, printed material, TFL guidance
Authorization/Referrals: Program process education to beneficiaries, civilian network providers. Provide copies of approved ASAP/STAT/Urgent requests
9. TSC – What Do We Do
10. Working Together BCAC to TSC
Question on enrollment
Question on Ref/Auth
Covered Benefit verification
Provider Questions – Status
Potential problem patient
Dental (medical)
Claims if extreme
Joint briefings
TSC to BCAC
MTF procedures
Dental – material request
Potential problem patient
CHCS inquiry – verify if patient data in MTF system
Joint briefings
Issues concerning patient complaints
11. BCAC – Customer Service POC BCAC/DCAO Services:
BCAC/DCAO Priority Phone Line: 800.929.9220
BCAC/DCAO Priority Fax Line: 888.250.4510
BCAC/DCAO Correspondence Address:
North Region BCAC/DCAO Support Team
P.O. Box 870146
Surfside Beach, SC 29587-9746
13. Overview Introduction
myTRICARE.com functionality
BCAC and DCAO access to myTRICARE.com®
What’s available for a BCAC and DCAO
North Region service contacts
Closing remarks/questions
14. Introduction PGBA, LLC is a subsidiary company of BlueCross BlueShield of South Carolina
Subcontractor for claims processing, claims customer service, fiscal management and information system technologies
Health Net Federal Services for the North Region, and
Humana Military Health Systems for the South Region
Our TRICARE offices are in Columbia, Camden, Florence and Surfside Beach, South Carolina
Health Net, partnered with PGBA, is delivering a new level of excellence to North Region customers
15. What’s available at myTRICARE?
16. TRICARE North Region Tools Electronic Funds Transfer
Revenue Codes with Valid HCPCS Codes
2005 State Prevailing Rates Discuss all that is available on site forms, links as well as above information etcDiscuss all that is available on site forms, links as well as above information etc
17. myTRICARE.com Functionality Content includes:
Forms
General benefits information
Links
FAQs
GlossaryContent includes:
Forms
General benefits information
Links
FAQs
Glossary
18. How Does a BCAC and DCAO Gain Access to This Functionality?
A PGBA RACF-ID with Web access is required for access to our secure Web site.
Select Register now located in the left navigation of the myTRICARE Web site.
19. How Does a BCAC and DCAO Gain Access to This Functionality? Select Are you a TRICARE government agent?
Read and accept the terms and conditions
20. How Does a BCAC and DCAO Gain Access to This Functionality?
3. If you do not already have a PGBA RACF -ID or if you need to update your RACF-ID for access to our Web site, select North Region Government Agent
21. How Does a BCAC and DCAO Gain Access to This Functionality? 4. Complete the form and return to Health Net Federal Services (address is included on the form).
22. How Does a BCAC and DCAO Gain Access to This Functionality?
23. Government Agent Secure Home Page Review top tabs hereReview top tabs here
24. Obtain Patient Information To get patient information:
Sponsor’s SSN
Patient’s date of birth
Eligibility date
25. Patient Information
26. Check Claim Status
27. Claim Summary
28. Claim Details
29. TRICARE Explanation of Benefits
30. Search for Authorizations and Referrals To view Auths and Referrals:
Sponsor’s SSN
Patient’s date of birth
Provider’s tax ID (optional)
Date range or authorization number
31. Authorization and Referral Summary Auths and Referrals include:
Authorization number
Dates of service
Place of service
Decision
Servicing Provider
32. Authorization and Referral Details Auth and Referral Details include:
Requested procedure
Decision reason
Approved procedure, units & frequency
Servicing provider
Referring provider
Facility
33. AskUs a Question To AskUs a question:
Select AskUs on any page or the tab at the top to send a secure, confidential question to customer service
Receive a prompt answer in your myTRICARE mailbox
34. myTRICARE Mailbox To view answers to your questions in your secure mailbox
Select PGBA Answer
Search mail by subject
Save mail to Old Mail folder
Move mail to Deleted Mail folder
36. North Region General Contact Information
37. North Region General Contact Information
38. Service Contacts – BCAC & DCAO Please state that the numbers are reserved for BCAC use only…not to be disclosed to benes and providers.Please state that the numbers are reserved for BCAC use only…not to be disclosed to benes and providers.
39. Joey make sure you say: Important: These numbers are reserved for BCAC use only. Please do not disclose to beneficiaries or providers.
Joey make sure you say: Important: These numbers are reserved for BCAC use only. Please do not disclose to beneficiaries or providers.
40. Closing Remarks PGBA is a customer-driven organization relentlessly focused on innovation and continuous improvement
We are proud to work with Health Net Federal Services to deliver outstanding service to TRICARE North Region customers
Advanced systems and web-transactions improve customer service while reducing administrative cost
We learn from our mistakes and improve our processes every single day
Our mission is to make using TRICARE easy and stress-free for the military, their dependents and the retirees we are privileged to serve
Questions?