How to Submit Electronically

1
How to Submit Electronically
2
Why File Electronically ??

• Filing Electronically can potentially lead to the
  following results
• Improved Operating Efficiency
• Improved Staff Productivity
• Rapid Notification of claim acceptance
  rejection
• Lower Administration Cost
• Increased Business / Financial Control

3
Submission Options

• Options to submit electronically to Wellmark
• CMS-1500 Professional Claims
• Submitter - Create Submit Claims
  (www.wellmark.com)
• All 837 Transactions
• Submitter INet Wellmark (Direct)
• Submitter Billing Service INet Wellmark
• Submitter Clearinghouse INet Wellmark

4
HIPAA-ANSI Transactions

• HIPAA Transaction Wellmark is capable of
  receiving and sending
• Health Care Eligibility / Benefit Inquiry
• (ANSI Format 270)
• Health Care Claim (Professional, Institutional,
  and Dental)
• (ANSI Format 837)
• Health Care Claim Status Request
• (ANSI Format 276)
• Health Care Electronic Remittance Advice
• (ANSI Format 835)

5
Using EC Solutions

• EC Solutions offers software for submitting
  claims electronically.
• EC Solutions does not charge a per claim fee to
  submit electronically to Wellmark.
• EC Solutions can receive most commercial lines
  of business, along with your Wellmark claims in a
  single 837 transaction.

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What is INet?

• InterChange Network (INet) is the electronic
  service that provides a secure environment for
  sending claims and receiving reports. INet is
  available 24 hours a day, seven days a week,
  including holidays.

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How does INet work for me?

• After claims are correctly prepared and
  collected into an electronic file, the claims are
  transmitted from your office to INet via the Web
  Bulletin Board System (Web BBS Internet).
• INet edits the file to ensure it is in the
  correct HIPAA format and checks for common
  errors.
• A message is posted within seconds of your
  transmission to let you know your submission was
  successful.
• A report with INet claim acceptance and rejection
  (Transaction Summary Status) is available for
  you to download within two six hours from
  submission.
• INet separates the claims based on payers.
  Wellmark claims are sent on to Wellmark.

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Reports available via INet

• Below are a listing of reports you will receive
  within 24 hours of your file submission
• .txn Transaction Status Report lists all
  claims accepted and/or rejected within the file
  transmission for all payers that are accepted by
  EC Solutions. In addition, this report will also
  list any eligibility errors for all Wellmark
  claims. At the top of this report is a summary
  which lists the total number of claims submitted,
  the total number of claims accepted, and
  rejected. It also shows the total dollar amount
  for each of these listings. This detail report
  lists activity by submitter, provider, and payer.
• .z16 Payer Response lists all claims accepted
  and/or rejected by the payer. (Note This is not
  a guarantee of payment, the report only shows
  that the payer has accepted your claim file into
  their system.)

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Checking Claim Status

• Claim status on Wellmark claims can be verified
  by the following ways
• Healthcare Claim Status-Electronic Transaction
• Healthcare claim status request (ANSI 276)
• Healthcare claim status notification (ANSI 277)
• Wellmark Website (www.wellmark.com)
• BlueConnection Tools - Claims Status Inquiry for
  Wellmark members

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Electronic Claim Filing Diagram
11
Electronic Transaction Report Flow
12
Report Timeline
Wellmark Blue Cross, Blue Shield, Aware Dental
and Blue Dental
You will only receive a .997 if your entire file
has completely failed.
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Example .txn Transaction Status
TRANSACTION SUMMARY BY STATUS Total
Txns 2 Total Charges
121.50 Total Reject Txn 1
Total Reject Charges 76.00
Total Accept Txn 1 Total Accept
Charges 45.50 TRANSACTION
STATUS REPORT Page1

Submitter Name HAPPY HOSPITAL
Submitter ID - 800000036 Submission
ID - A5802COZ
Processing Date and Time -
09/27/2004 144437
Provider Name - DR SMILE
Provider ID - 4211111111 Payer Name -
BLUE SHIELD OF IOWA Payer ID - 88848
TXN Format/Version - Professional
Claim A1 X12 4010
_________________________________________________
__________________________ Submitter File
Receipt Date Group Transaction/Trace ECS
Document Member ID Patient
Last Name Initial Patient CTL
Status TOB/POS Charge
From Date To Date ---------------------
--------------------------------------------------
---- 296542000 011024 8001
000000001 500654378 262626262
DOE G
JETSG1111 REJECT 131
76.00 20040927 20040927
Reject Explanation
Segment/Record
Field Name Segment Count
LX
2,376
External Code does not exist or is in an
ineffective service date range. Additional
Explanation 2300 HI01-02(HI01-1BR) is invalid
-----------------------------------
-------------------------200408170 040817
3 0408173 531909349
ETH404040404 DOE
S 0404040 ACCEPT 811
45.50 20040813
20040813 _______________________________________
___________________________________TTotal Txns
2 Total Charges 121.50
Total Reject Txn 1
Total Reject Charges 45.50
Total Accept Txn 1 Total Accept
Charges 76.00 TRANSACTION
SUMMARY BY PAYER

Total Txns Rejected Txns
Accepted Txns Accepted Charges BLUE
CROSS/BLUE SHIELD OF IA
31 0
31 2,222.50
Header
Body of Report
Body of Report
Summary
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Example .z16 Payer Response
4/29/2000 WELLMARK HXAP1251 CLAIM ERROR REPORT
FOR SUB 000099999
PROVIDER NO 000012345
PROVIDER NAME
DR. DOE

BATCH

CREATE F
MEDICAL DATE
LAST...NAME... I LOB DOS REC
041300 FLINTSTONE F
S 041300 10019024ABCDEF
PATIENT RELATIONSHIP IS INVALID
DA017020


THE ABOVE
CLAIMS WERE NOT ACCEPTED FOR PROCESSING
PLEASE RESUBMIT THESE CLAIMS
WITH CORRECTIONS

END REPORT

4/29/2000 WELLMARK HXAP1252 CLAIM ACCEPTANCE
REPORT FOR 0000099999
PROVIDER NO 000012345
PROVIDER NAME
DR. DOE
BATCH CREATE DATE 042900


LAST F L FROM TO MEDICAL
REFERENCE CLAIM NAME I B
DATE DATE REC NUMBER
AMOUNT SMITH M S 041000 041000
123456789AA 050022009692 805.00

SMITH D S
041400 041400 10014250BBB 050022009655
102.00
SMITH
B S 041500 041500 10014417ABC
050022009657 110.00

SMTIH W S 041300 041300
10019826AAA 050022009689 515.00



THE ABOVE CLAIMS WERE ACCEPTED FOR
PROCESSING



0005 0001
0004 1532.00
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The Assistance Center Statistics

• 97 of all calls are answered live
• Average Speed of Answer
• Emails are responded to within 24 hours of
  receipt
• EC Solutions Assistance Center
• Hours of Operation Monday Friday 730 am
  530 pm
• Toll Free- 1-800-407-0267.

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When to Call the Assistance Center?

• Call if you are experiencing the following
  problems
• Problems trying to submit
• Wellmark BCBS and Commercial Insurances
• Software Problems
• PCA-AP Pro32
• Procomm used to submit claims to Wellmark and
  other Commercial Insurances
• Web BBS
• INet Password Resets
• Resetting of .txn and .z16 reports for Wellmark
  and other commercial insurance
• Registration of new Electronic Submitters to
  Wellmark
• Problems accessing the Wellmark Web Applications

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Getting Registered
To Register for Electronic Submission, you must
complete the forms to the left. We require the
Registration Instructions and Form to be
completed, along with the Signature and Audit
Agreement. If you have a billing service or a
Third Party complete your transactions for you
office, we also require the Provider
Authorization for Electronic transactions via
Third Party. All forms can be filled out on line
and printed. Please mail all forms to the address
listed on the forms. If you need assistance you
may contact the EC Solutions Assistance
Center. To access these forms, follow the link
below to the Wellmark website http//www.wellmark
.com/e_business/provider/forms/frmsprovider.htm EC
Solutions Assistance Center 1-800-407-0267.
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Want Additional Training
Wellmark offers Electronic Transaction education
and/or training for those who are currently
submitting electronically and would like to gain
additional knowledge, and for those who are just
beginning. If you would like more information
regarding additional education and/or training,
please contact EC Solutions at 800-407-0267.
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REMINDER
The EC Solutions Assistance Center provides
technical support for Electronic Transaction
Issues and can be reached through a dedicated 800
number 1-800-407-0267.