provider portal user's guide - claim status · 2017-10-16 · v facility claims cochng • nia...
TRANSCRIPT
PROVIDER PORTAL USER’S GUIDE
CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. which are independent licensees of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association.
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Welcome
,,.,.,,,a,,1,,m,,1w+mu1r,,:+it1lifilillll ~ I Member Search
Ehg1b1lrty / Benefits & Claims status Remittance/ NOP Fee Schedules
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Find by Member ID
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Date Of service •
09/14/2017
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Claim Status
CareFirst Direct provides detailed claim status information for our providers in real time.
The following walks through the steps to take when reviewing the status of a claim.
>Log in to the Provider Portal at
provider.carefrst.com.
>
>
Once logged in, yo will see the
CareFirst Direct home page and the
‘Member Search’ screen.
The tabs across the top will appear
based on the access yo have within
CareFirst Direct.
To begin the process of checking
the stat s of a claim ens re the
‘Eligibility/Benefts & laims Status’
tab is selected and then enter
the following information in the
feld provided:
• Member ID
• Date of Birth
• Date of Service (this will
a tomatically defa lt to
today’s date)
and click ‘Next’.
CFD002-1E (9/17)
Claim Status
Welcome
Pnor Auth / Not1ficahons
~ Member Search Results
Eligibllity/Benerrts & Claims Status Remittanc
< Back Member Search Results
hedules
8 Help O senings , Log Out
- • AA
Aug 10. 2017 303 PM
You searched for.
Member ID: ABC123456789 Date Of Birth : 09/2511999 (18yrs) Date Of service : 08/ 10/2017
Search Results
• .&. MEMBER LAST NAME, FIRST NAME Male
I would Ilk• to SH
Eligibility/Be
Back
I would like to see
Eligibility / Benefits
Date Range '
Last 30 days
Back +t@M
123/JJIJY STREET TOWSON. MD 21086
• Claims status
Remember for my next search.
•
em.,.mber or my ne, search.
>
> >
>
> >
The res lts of yo r search will
then display.
Select the correct Member by
clicking on the next to his/
her name.
Under ‘I would like to see’, select
‘ laim Status’.
Note: Yo can set Claim Stat s as
yo r defa lt selection for f t re
searches by clicking on
Once yo select laim Status, a drop
down will appear allowing yo to
enter a Date Range. Yo have the
following options:
• Last 30, 60 or 90 days
• Year to Date
• C stom Range
Make yo r selection and click ‘Next’.
Claim Status
Carefir-st: ~ Q Welcome
8 Help 0 Setting1n Log Out
- AAA ,,..,, Pnor Auth / Not1ficabons mMr:++ 111111111 ~ I aa1ms StatllS Results
EligIbilrty / Benefits & Claims Status Remittance I NOP Fee Schedules
< Back Claims Status Results Sep 11. 2017 916AM
Upclate Tax ID/ OrganiZation View All
PROVIDER NAME 03J01f2017-)()()()()(J()() 03J01f1017
PROVIDER NAME 03.(11(2017- S400.00
JOOOOOOOO( 03Al1/2017
PROVIDER NAME 0:Wl/2017- $400.00
)()()()()(J()() 03AJ1/2017
PROVIDER NAME 03J01/2017- S400.00
JOOOOOOOO( 03J01/2017
PROVIDER NAME 03.(11/2017- $-400.00
JOOOOOOOO( 03..U112017
QIsplaym111-5of12
EllgibIlrty / Benefits & Claims Status Remittance hedules
< Back Claim Status Summary
1.1.1111.111111
111 111 1 11111
11111111ll11
111111111111
, ... 1
Pending PCN123465
Pending PCN123465
Pending PCN123465
Pending PCN123465
of3 .
ViewE1ig1bihty
Pnor Auth/Not1flcat1on
New Member Search
Sep 11. 2017. 916AM
.!., MEMBER LAST NAME, FIRST NAME DOB: 02/01/1965 (52 yrs) Female Member ID: ABC123456789
G Medical
Claim Information
Claim Number 1111111111111
Claim Status F1 -Finallzed/Payment 65 • ClaI1Mine has been paid
Check/EFT Date 0Jn4/2019
Providar Information
Provider Name/Provider kl
PROVIDER NAME JOOOOOO(J()(
Total Charges
Total Non-Allowed amount
Total Al lowed amount
Total Paid Amount
Total Member ResponsibIIIty
Claim Other Blue Ni.mber NIA
Date or service 03A)1/2017-03A)1'2017
Chee le/ EFT Number 000000
Tu.ID 111111111
Claim Adjusted? No
Adjudleation Dale 03A)4(2019
Sys1em source NASCO
Pay10NPI
000000000
Amount Amount
S16.000.00 Oeducl!ble Amount S000
NIA Copay Amount S000
S15.271.88 coinsurance Amount $000
S15.271.88 COB Amount $000
$000 Penat1tyAmount $000 -.-,··•·· ,· .. . ' 0.1EofServ1ce I ~~ceof """'MCe
0210 $8,000.00 $15,271.88 $15,271 .88 $0.00
0260 $8.00000 $0.00 S000 S000
'NIA NotAva1labIe
03A)1f2017-03A)1f2017
03A)1f2017-
t-HospItal inpabenl
1-Hospital 03.IOt/2017 mpal!enl
-ViewEl1gabihty
Prior Auttv'Not1ficat1ons
Submit Oaim Inquiry
New Member Search
>
>
>
> >
Based on yo r search criteria,
general claim stat s res lts will
display, incl ding:
• Provider Name and ID
• Date of Service
• Total Claim
• Claim N mber
• Claim Stat s
• Patient Acco nt #
To view a specifc claim, click on
the corresponding ‘ laim Number’
hyperlink.
Clicking on the ‘ laim Number’
hyperlink will open more detailed
information, which incl des:
• Claim Information (Claim N mber,
if it was adj sted, Stat s, Date of
Service, Adj dication Date, Check/
EFT Date and N mber)
• Provider Information
• S mmary of Payment Information
(Total Charges, Total Non-Allowed
and Allowed amo nt, Total Paid
amo nt, Ded ctible, Copay,
Coins rance, etc.)
Claim Status
<
Claim Number
Line service Dates 03/01'2017·03/01'2017
Line Status 65 - Cla1ml'llne has been paid F1 - Finalized I Payment
line Explanatioo 58012009999- NIA
Charges $8.000.00
Deductible Amount NIA
Hospital Discount Amount N/A
Place of Service - 1 - Hospital inpatient
Revenue Code 0210
Diagnosis Codes 110
v Facility Claims Cochng
• NIA Not Available
- Line 0010
Units 1
Allowed Amount NIA
Copay Amount $000
Penalty Amount $000
Medical Record Number N/A
Non Allowed Amount NIA
Coinsurance Amount S000
COB Amount SOOD
Type Of Service - R-Accommodabons
CIOse
View Eligibility
Prior A uth/ otifi cations
Submil Claim Inquiry
ew Member Search
line Paid Amount NIA
Member Liabili SOOD
X
>
>
>
> From here, yo can click on the line
n mber hyperlink to view the details
of that line.
Yo can also navigate to any
additional lines of information for
the claim by clicking on the .
>‘I would like to’ Navigation
Yo will notice thro gho t the
Claim Stat s search screens yo are
provided helpf l navigation options
nder the ‘I would like to’ heading.
From there, yo are able to do
the following:
• View Eligibility for the Member yo
have searched for
• Go directly to the Prior
A thorization/Notifcations page
• S bmit a Claim Inq iry
• Complete a search for a New
Member