Provider Portal Overview Provider Portal - Basics Website address: www.countycare.com/providers/login Log In Access and User Set Up is TIN driven On-site administrator access will be set up by Valence Health/County Care Requires completion of access form Administrator will issue usernames/passwords to office/practice staff Users will have access 24/7 to utilize the system at their convenience. Releases (updates) occur every 4-6 weeks Prior notice will be posted © 2015 Valence Health. All rights reserved. 2 Portal Access Form – For Admins ONLY • Basic form, basic information needed: – Demographic information for onsite administrator – TIN(s) requesting access for – Available for download at: www.countycare.com/transition • Once completed fax to: 312-637-3114 © 2015 Valence Health. All rights reserved. 3 Provider Portal Overview Functionality: Submit and View Prior Authorization Status Check Prior Authorization Requirements by CPT Code Access Key Documents and Forms Member Eligibility (Effective Date/PCP Assignment) Provider Lookup Claims Status Search View EOP Provider Rosters © 2015 Valence Health. All rights reserved. 4 Provider Portal Log In Page Access the Provider Portal via countycare.valencehealth.com Save to your browser Favorites – easy access 1. 2. 3. 4. 1 2 Enter Your “Login ID” Enter your “Password” Click the “Sign In” Tab If you forget your password, click “Forget Password” and enter the answer to your security questions to obtain instructions for changing your password 3 4 © 2015 Valence Health. All rights reserved. 5 Log In Procedures After a new user has been created in the provider portal, the user will receive an email which contains the user id, a temporary password and a link to the provider portal. The user will be immediately prompted to change the temporary password to a permanent one. NOTE: Passwords expire every 90 days, users will receive an email to remind them to change their passwords when they expire. Once the user has successfully created a new password, they will receive a prompt to the login screen to log into the system. 2 Setting Security Questions 1 © 2015 Valence Health. All rights reserved. 1. Click on the “Profile” Link to provide individual security questions. 2. During the first time login to the provider portal, it is important for users to set up security questions and answers. These questions will be presented to the user and are required to reset the password 6 Setting Up Practice Users (Practice Administrators) Practice Administrators are responsible for creating Practice Users who submit referrals, authorizations and view benefit statements. Practice administrators may also submit referrals. 1 1. Click on the “Management link” at the top of the page 2. Select “Create User” 3. Provide the users’ first and last name, a unique email address and assign a user name. User names must be between 6 and 20 characters in length 4. Click the “Submit” Tab. The user will be notified via email of their username and will receive a temporary password once the user setup process is complete. 2 3 4 © 2015 Valence Health. All rights reserved. 7 Setting Up Practice Users – Assigning TINs and NPIs Practice Users inherit the same Tax ID numbers (TIN). The National Provider Identifier (NPI) Number is an individual identification number and is used to grant access to the an individual Practice User within each TIN. For minimal maintenance, the following best practice is prescribed: 1. Practice Admins – When creating Practice Users, choose “Inherit PA NPIs” for each TIN in the Practice User’s profile. 1 © 2015 Valence Health. All rights reserved. This ensures that when new NPIs are added to a TIN through batch provider file updates, the access to the new NPIs will automatically be granted for the users who have that selection. 8 Submitting Authorizations 1. To submit a request for prior authorization, click on the new authorization link located in the blue header bar at the top of the page. 2. Complete the form with required information. Use the select buttons to locate the Patient, Referring Provider (usually PCP), Referred To Provider and Referred To location. 1 2 © 2015 Valence Health. All rights reserved. 9 Submitting Authorizations (continued) Use the “Select a Service” drop down list to choose the appropriate “Type of Service” being requested. 3 4 1 2 1. Enter the correct date of service 2. Use the find button(s) to search for the correct diagnosis 3. Select the looking glass tab to search for the correct procedure codes (CPT). 4. Click the “Add” button to enter the CPT code, multiple CPT codes may be added by clicking the “Add” button after each code is selected 5. Enter the correct enter the # of days or services being requested, (e.g., 12 for the # of PT visits) 5 © 2015 Valence Health. All rights reserved. 10 Submitting Authorizations (continued) 1. Click the “Attach File” button to attach clinical information or any document(s) that provide details to support the authorization request. 2. Additional information or history may be added in the “Comments/Clinical History” free text field 3. Check the “I Agree” box to agree to the terms 4. Click the “Submit Referral Request tab to send authorization for review 1 2 3 4 NOTE: Include as much clinical information as possible to support medical necessity. If additional information is required the request for Prior Authorization will be delayed while the necessary information is obtained. Remember: You will never be told you submitted too much clinical information. © 2015 Valence Health. All rights reserved. 11 Checking Authorization Status Practice Administrators and Practice Users may also check the status of an authorization request.* 1. Click on “Authorizations” in the 1 blue bar at the top of the Home page to access the “Status” tab 1 2. Search for the authorization by Provider, Date Range, Member ID, or Authorization Reference # 2 4 3. Click on the “Search” tab to 3 query and access the authorization 4. The query results will appear at the bottom of the page *Only authorizations that include a TIN on the User account will appear. © 2015 Valence Health. All rights reserved. 12 Checking by CPT Code if Prior Authorization Required A CPT code list of services requiring prior authorization can be accessed: 1 1. Click on “Authorizations” in the blue bar at the top of the Home page 2 2. Click on “ CPT Code List” to obtain the pa service code information © 2015 Valence Health. All rights reserved. 13 Key Documents and Forms 1 Key documents and forms may be accessed: 1. Click on “Documents” in the blue bar at the top of the Home page 2. The following documents will be available including: – Critical Incident Reporting Form – EFT/ ERA Forms – Quick Reference Guide – Training Materials – Other Reference Documents © 2015 Valence Health. All rights reserved. 14 Checking Member Eligibility – Quick Reference ID Cards are not a guarantee of active member eligibility Provider Options for checking Member Eligibility Secure online provider portal: countycare.valencehealth.com Automated interactive voice response (IVR) member eligibility system 312-864-8200 or 855-444-1661 Toll free Provider Service number & follow prompts to speak to representative (312864-8200 or 855-444-1661). Provide the following: – Member Name – Member ID Number – Member DOB State MEDI system at www.myhfs.Illinois.gov A member should not be denied services if their name does not appear on the eligibility roster, contact Provider Services for further verification © 2015 Valence Health. All rights reserved. 15 Viewing Member Eligibility in Portal - Search Member Eligibility may be viewed (real time) in the Portal 1. Select “Eligibility Search” from the Menu bar 2. Choose “Eligible as of Date”, DOB and Last Name are required fields 3. Its best to leave the “Include Ineligible” on “Yes” to view member eligibility 4. Click the “Search” tab to obtain results 1 2 2 2 3 4 © 2015 Valence Health. All rights reserved. 16 Viewing Member Eligibility in Portal & Details 1. When you click on the Blue Member ID you will see member details including eligibility 2. Details include Family, Member ID, SSN, Gender, Address, Phone #s, Eligibility Dates, Provider Info 2 2 1 © 2015 Valence Health. All rights reserved. 2 17 Provider Lookup Search Tool 1. Click on the “Provider Lookup link in the menu bar, and a new window will open up 2. Search by Type, Location, Name, Gender,- other options 2 1 1 © 2015 Valence Health. All rights reserved. 18 Claim Status - Search 1. Search for Claims by clicking on the “Claims Search” menu bar link 2. Criteria for Search Provider and DOS or Claim Date – May search all NPIs or for a specific NPI within the TIN Member ID Claims Reference # 1 2 © 2015 Valence Health. All rights reserved. 19 Claim Status – Search Results 1. Click on the “Search” tab to access claims 2. All corresponding claims will appear and include information such as Claim #, Type, Member/Provider Name, DOS, Claim Status, and Payment Info 3. Click on the Blue Claim # for Claim details 2 1 3 © 2015 Valence Health. All rights reserved. 20 Claim Detail Status 1. Patient Information & Provider Name 2. Claim Information Claim #, Claim Type, Claim Status, Service Dates, Claim Amount, Received Date, Adjudicated Date 4. Financial Payment Information Payment Amount ,Check/EFT Trace #, Check/EFT Issue Date 5. Service Line Information and Claim Service Details # of Lines, DOS, Service ID, Procedure and Dx Codes, Rev Codes, Days/Units 1 2 3 4 © 2015 Valence Health. All rights reserved. 21 Viewing your Explanation of Payment (EOP) 1. Select EOP from the Statement drop down in the blue menu link 2. Use the From/To Date fields 3. Click the “Search Tab to access EOPs Dates will auto populate with the last month 4. Will show EOP #, Date of EOP, Paid To, and Check Number 5. Click on blue EOP # for detailed EOP – will open PDF image of EOP 1 2 4 3 5 © 2015 Valence Health. All rights reserved. 22 Panel Roster Information 1. Providers may access a list of members that have selected or have been assigned to the physician as their PCP. The Panel Roster selection is located under the “Statements” Menu 1 2. Under the users assigned TIN, a list of all providers associated with the TIN will appear. 3 2 3. A total volume of members assigned to each provider is available * Providers may appear in the list more than once depending on number of practice locations registered.* 4. Click on the provider name to access their members. A list of members assigned to the provider and the member’s demographic details will appear. © 2015 Valence Health. All rights reserved. 4 23 Panel Roster Information 1. Providers may access a list of members that have selected or have been assigned to the physician as their PCP. The Panel Roster selection is located under the “Statements” Menu 1 2. Under the users assigned TIN, a list of all providers associated with the TIN will appear. 3 2 3. A total volume of members assigned to each provider is available * Providers may appear in the list more than once depending on number of practice locations registered.* 4. Click on the provider name to access their members. A list of members assigned to the provider and the member’s demographic details will appear. © 2015 Valence Health. All rights reserved. 4 24 Quick Reference Guide – Key Information In the Documents drop down, select “Quick Reference Guide – CountyCare” for a printable 1 page, 2 sided guide of your key numbers, addresses, and other provider information © 2015 Valence Health. All rights reserved. 25 Questions • Contact Provider Services at 312-864-8200, Option 5 for providers • Visit our Provider website at http://www.countycare.com/providers © 2015 Valence Health. All rights reserved. 26
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