WNYHealthENet Univera

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Introduction

• What is WNYHealtheNet? A consortium whose
  members studied the feasibility of jointly
  developing a community-wide approach to
  addressing compliance with Title II of the Health
  Insurance Portability and Accountability Act of
  1996 (HIPAA).
• Who comprises WNYHealtheNet? 4 regional
  providers and 3 payers Catholic Health System ,
  Erie County Medical Center Corporation, BlueCross
  BlueShield of Western New York, Independent
  Health, Kaleida Health, Roswell Park Cancer
  Institute and Univera.
• Why was a consortium formed? HIPAA is
  NON-COMPETITIVE which means that all PAYERS and
  PROVIDERS have to be compliant. With a
  collaborative approach to HIPAA, there was an
  opportunity to lower development and operating
  costs particularly because all of the members
  were already connected to each other via a
  semi-private network.
• What are the benefits of this approach to HIPAA
  compliance? The creation of a community culture
  which values cooperation while developing a
  technical model with open access to address not
  only the needs of the consortium members, but
  also the needs of independent physicians, and
  members of physician practice plans in the WNY
  community. The collective ability to coordinate
  implementation with common community-wide
  standards enabled members to gain significant
  business value from transactions by utilizing
  MORE than just the minimum elements. Lastly,
  this technical infrastructure also provides the
  forum for future initiatives.

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Home Page
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Secure Login Page
Enrollment in WNYHealtheNet please contact the
PCI Helpdesk at 1-877-895-4724, between the hours
of 7am and 7pm, Monday through Friday. Once a
provider has enrolled with WNYHealtheNet, a
secure login name and password is issued. Each
login name has a subset of specific transactions
associated with it. These assignments are based
on provider tax id and transaction availability
at the time of application.
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Available Transactions

• 270/271 Eligibility and Benefits Inquiry
  Response
• 276/277 Claim Status Inquiry Response
• 278 Referral Request Response
• 278 Referral/Authorization Inquiry Response
• Tip sheets for each transaction are also
  available on the Getting Started /Sign-up tab
  under the Printable Forms heading

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270/271 Eligibility Inquiry Response

• The first transaction set to be implemented on
  WNYHealtheNet was the 270/271 Eligibility Inquiry
  Response.
• Inquiry Criteria By entering at least two of
  the following items Member Name (First and
  Last), Member Number, Date of Birth and Social
  Security Number a provider can immediately
  verify eligibility and benefits for their
  patients using a real time web-based tool.
• Future Release The following payors will have
  different inquiry criteria and offer different
  responses Blue Cross Blue Shield of Western
  New York NASCO FEP and ITS and NOVA Healthcare
  Administrators

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Eligibility Request Screen
The user can access a tip sheet which contains
payor specific rules by clicking on the tip sheet
hyperlink.
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Eligibility Response Screen Patient and Plan
Benefit Summary
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Eligibility Response Screen Continued,Plan
Benefit Detail
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276/277 Claim Status Inquiry Response

• The second WNYHealtheNet transaction set to be
  implemented was the Claim Status Inquiry.
• By entering either of the following combinations
  of data provider ID number and the claim number
  OR provider ID number, patient/member ID number
  and a range of dates of service, a provider can
  immediately inquire on the status of one or more
  claims submitted by the inquiring provider for a
  specific patient.
• Future Release The following payors will have
  different inquiry criteria and offer different
  responses Blue Cross Blue Shield of Western New
  York NASCO FEP and ITS and NOVA Healthcare
  Administrators

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Claim Status Inquiry Screen
The user can access a tip sheet which contains
payor specific rules by clicking on the tip sheet
hyperlink.
The user can either select a provider from a list
of providers associated with specific tax ids...
..Or the user can enter the applicable provider
id directly, if known.
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Claim Status Multiple Response Screen
The user can view claim detail by clicking on the
Payor Claim hyperlink in the left hand column
below.
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Claim Status Claim Level Detail Response Screen

03/17/2004 03/17/2004 123456789
The user can view line detail by clicking on the
Line hyperlink in the left hand column below.
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Claim Status Line Level Detail Response Screen
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278 Referral Request Response

• This was the third and most recent transaction
  set to be implemented on WNYHealtheNet.
• Provider offices can now enter patient referral
  information into WNYHealtheNet and create
  referrals on a real-time basis.

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Referral Request Screen
The user can access a tip sheet which contains
payor specific rules by clicking on the tip sheet
hyperlink.
The user can either select a provider from a list
of providers associated with specific tax ids...
..Or the user can enter the applicable provider
id directly, if known.
Additionally, provider searches can be performed
by any combination of name, city, zip code,
specialty or provider id number.
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Referral Request Screen Continued
The user can enter the diagnosis code, if known,
or search from a reference list.
Duration options will be listed in a dropdown
menu based upon the payor that was chosen
The Related Causes Code box is where the user
can indicate whether the referral is a work or
auto accident related injury.
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Referral Request Confirmation Screen
This screen presents all of the information that
the user input from the prior screen(s).
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Referral Request Confirmation Screen Continued
if all of the information looks accurate, you
can submit the referral and
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Referral Response Screen - Approved
Certification Number 0123456 Action Code
Approved (A1)
if approved, you will receive an action code of
A1 with an approved description in
conjunction with a certification number
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Referral Response Screen - Approved Continued
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Referral Response Screen - Rejected
Reject Reason Code Requested Information Not
Received(90)
WNYHealtheNet 278 Reject Reason Code Tip Sheet
or you can click on the WNYHealtheNet 278 Reject
Reason Code Tip Sheet hyperlink to see why the
Referral was rejected
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278 Referral / Authorization Inquiry

• Referral and pre-authorization details can be
  retrieved using WNYHealtheNet as long as the
  requesting provider is either the referring or
  servicing provider.
• Providers can search for specific referrals or
  pre-auths or can use a date range to search for
  multiples for a specific member.

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Referral / Authorization Inquiry Screen
The user can access a tip sheet which contains
payor specific rules by clicking on the tip sheet
hyperlink.
The user can either select a provider from a list
of providers associated with specific tax ids...
..Or the user can enter the applicable provider
id directly, if known.
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Referral / Authorization Response Screen
Certification Number 0123456 Action Code
Approved (A1)
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Referral / Authorization Response Screen -
Continued
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Additional Materials
The user can access additional help documentation
/ tip sheets by clicking on the Getting Started
/ Sign-up tab and viewing/downloading printable
forms.