new york state insurance department howard mills superintendent of insurance presented by: eileen...
TRANSCRIPT
New York StateInsurance Department
Howard MillsSuperintendent of Insurance
Presented by: Eileen Fox and Sandy AndersonConsumer Services Bureau
Prompt Pay Complaints
• Expanded on existing technology – CIIMS
• Built new and secure applications – – On-Line Provider Registration– OCCRS
• Utilizes clearly defined business rules for automatic closing of cases.
……Web Case ProcessingWeb Case Processing
CIIMS
Web Server
http://www.ins.state.ny.us
http://www.ins.state.ny.us
……New Case ProcessingNew Case Processing
CIIMS
Web Server
http://www.ins.state.ny.us
http://www.ins.state.ny.us
The provider files their complaint at www.ins.state.ny.us:The provider files their complaint at www.ins.state.ny.us:
First time users register with us. First time users register with us.
Once registered, the provider enters a user name and password to access. Once registered, the provider enters a user name and password to access.
Click on Edit Account, Prompt Pay or No Fault.Click on Edit Account, Prompt Pay or No Fault.
Provider data populates from log in and can add additional information. Provider data populates from log in and can add additional information.
Enter information on the insurance company or HMO.Enter information on the insurance company or HMO.
Enter patient information.Enter patient information.
Enter Date of Service information.Enter Date of Service information.
……Web ResponsesWeb Responses
CIIMS
Web Server
http://www.ins.state.ny.us
http://www.ins.state.ny.us
The company responds at www.ins.state.ny.us:The company responds at www.ins.state.ny.us:
Company representative enters user name and password to access form.
Password and account information can be changed by clicking on Edit Account Information.
After entering the user name and password correctly the following screen appears.
To respond to par provider complaints click on the Respond
to P/P complaints.
This will bring you to a listing of all open prompt pay complaints on record for the NAIC number connected with the user registration.
Please note the ‘dots’ next to the case number which will tell you the status of the complaint.Green means a response has been received and processed. These files will appear only for a short time after the response has been processed.Yellow means a response has been received and has not been processed yet OR not all dates of service have been responded to.Red means no response has been received.
To respond click on the “respond” button next to the
complaint.
Please note that this screen contains a section where you can search for a particular filenumber. This function provides access to files that are open or closed.
This will bring you to the response form.
If the response is missing required information, the system will not accept the complaint the first time you hit submit. It will explain what information is
missing.
The missing information can be added. Click the Submit button again.
The system will also check to make sure the information submitted makes sense. For instance if the dates of service are after the date the claim was submitted and paid you will receive notification. If you enter a paid date that falls before the date of service, the system will also notify you.
The required information can be left out and the response submitted by clicking on the Submit Response Anyway. You can click Cancel to stop the response process for this date of service all together. These buttons are located at the bottom of the response screen.
If you click submit anyway this screen will appear:
This is the screen you see after you respond to one date of service and hit done. The
yellow check mark indicates that you submitted a response to the first date of service.
Please note: the system will not consider a file complete until all dates ofservice have received a response.
The system will indicate which dates of service have been responded to by the color of the check mark next to the date of service.
* Green - the response has been received and processed. * Yellow - the information has been received but not processed. * No check mark - a response has not been received.
When you are finished responding to this file and you are ready to respondto another file click on Respond to another complaint and you will bebrought back to the list of complaints for this NAIC number.
If you want to log-out and you are at the screen below click Doneresponding to complaints.
……Automatic ClosingAutomatic Closing
CIIMS
Web Server
http://www.ins.state.ny.us
http://www.ins.state.ny.us
Based upon business rules, cases can automatically close by the System and a disposition letter is sent to the provider.
Based upon business rules, cases can automatically close by the System and a disposition letter is sent to the provider.
……Human interventionHuman intervention
CIIMS
Web Server
http://www.ins.state.ny.us
http://www.ins.state.ny.us
Cases that cannot be automatically closed are reviewed by an examiner.Cases that cannot be automatically closed are reviewed by an examiner.
Patient Information:Patient Information:
Service Dates:Service Dates:
Dates of Service List:Dates of Service List:
Provider Information:Provider Information:
A web based complaint: A web based complaint:
For more information contact Sandy Anderson
Eileen [email protected]
For more information contact Sandy Anderson
Eileen [email protected]