performcare nj csa service desk and billing request may 3, 2011 1
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PerformCare NJCSA Service Desk and Billing
Request
May 3, 2011
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The CSA Service Desk and Billing Request Form was created as a tool to streamline
communication and simplify the process of requesting assistance from the Service
Desk.
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The new form can be found under the menu item For Providers, Service Desk Request Form.
Accessing the Form
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1.0 Introduction
Each of the required fields must be completed (designated by an asterisk - *).
Date and Time of Request will update with the current date/time when the form is submitted.
The field that states “Briefly describe why you are contacting us today” will act as the subject of request. ◦ The submitter of the form will
see this in the subject line of the email they receive once the form is submitted.
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1.1 Type of Request
Type of Request must be selected to complete and submit the form.
When an option is selected, the bottom portion of the screen will expand with additional information that will need to be entered/provided.
◦ The options Authorization/Billing, Eligibility, and 3560 will display the same additional information requirements at the bottom of the screen.
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2.0 Authorization/ Billing, Eligibility, 3560
The following illustrates the data elements required for the Authorization/Billing, Eligibility and 3560 types of requests.
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2.1 Type of issue
Type of Issue dropdown contains the following options and must be completed in order to submit the request.
If “claim denied” is selected, another data element will be added to the right of it, (Remittance Advice), that is a required field. Please enter a Remittance Advice number(see below for example).
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Authorization/Billing, Eligibility and 3560
Types of Issue Definitions
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Attach Medicaid Number – The Medicaid Number was not attached when the youth was registered. Contact with the CSA should be initiated if the Prior Authorization was created more than 10 days ago.
Authorization Modification – Must be specific on what needs to be modified (dates, number of units) and must include justification for the request. (Please include this detail in the Comments field at the bottom of the top half of the screen.)
Claim Denied – PerformCare will handle the following rejection codes:
774 – PA not on file775 – PA record on file is not active779 – Medicaid PA number invalid
Any other rejection code or Remittance Advice number MUST be directed to Molina Medicaid Solutions System for resolution.
Gap in Eligibility – Notify the CSA of a gap; please include dates
not covered in the Comments field, located below the Type of Request drop-down menu. Service providers will be referred to the Case Management Entity for resolution.
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Not Feeding to Molina – Notifying the CSA that the Billing
information for service is not being fed to Molina.
PA Not on File – Check when the Prior Authorization was created
prior to submitting a request. Authorizations transmit to Molina Tuesdays and Thursdays by 3 PM.
Wrap/Flex Payment – Keep in mind that claims may take up to
two weeks to process; if payment has not been made, contact AtlantiCare directly.
3560 Status – Inquiry regarding the status of a 3560 Application; please include the dates for the eligibility, as well as the date the
Application was submitted.
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3.0 Customer Service
The following illustrates the data elements required for the Customer Service type of request.
When the Type of issue dropdown is selected, the following options will appear and one must be selected in order to submit the request.
◦ The Youth ID and Youth DOB fields are not required, but will assist in researching and resolving the request.
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3.1 Certificate of Need
The following illustrates the data elements required when the user selects Certificate of Need.
Users must choose the provider (CYBER user) type from the pull-down menu.
◦ All fields are required.
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3.2 Provider Set-Up - Medicaid
The following illustrates the data elements required when the user selects Provider Set-Up, Medicaid.
◦ Note: Providers that have Medicaid ID’s can request to be set-up as both Medicaid and Non-Medicaid providers if they provide both types of service.
◦ Each form submitted to the Service Desk is for one individual request; multiple requests cannot be completed on one form.
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3.2 Provider Set-Up – Non- Medicaid
The following illustrates the data elements required when the user selects Provider Set-Up Non-Medicaid.
◦ Only a Medicaid provider, CME or Mobile Response agency can enter a Non-Medicaid provider’s information.
◦ Each form submitted to the Service Desk is for one individual request; multiple requests cannot be completed on one form.
◦ Note: Providers that have Medicaid ID’s can request to be set-up as both Medicaid and Non-Medicaid providers if they provide both types of service.
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Customer Service Types of Issue
Definitions
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Authorization Number – Request for an authorization number.
Certificate of Need – Completed by the provider that is requesting a
Certificate of Need for an OOH placement.
Close in Tracking – Request by the provider to close their access to
a youth’s record.
Open in Tracking – A request to open the provider in tracking so
they may access a youth’s record.
Provider Setup-Medicaid - New provider in the System of Care
that has a Medicaid number.
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Provider Setup-Non-Medicaid – New provider in the System of
Care that does not have a Medicaid number or that provides Non-Medicaid services.
Referral Turn Back– Notifying CSA of Turn Back; provide provider’s name, youth’s CYBER ID, date of birth, date of authorization and reason for turn back.
Request for Authorization not Previously Generated – Request to have an authorization generated that should have been created previously by the CSA.
Retro-Authorization – Request for a Retro-Authorization to be generated.
Status of Review – Inquiry on the status of a Treatment Plan/Assessment/Clinical Summary that has been submitted for review.
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4.0 CYBER Technical Support
The following illustrates the data elements required for CYBER technical support.
When the Type of issue dropdown is selected, the following options will appear and one must be selected to submit the request.
If “Other” is selected, please enter additional information in the Comments box.◦ Any additional information
related to the request may be entered into the Comments box.
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CYBER Technical Support Types of Issue
Definitions
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Cannot install Silverlight – Usually an issue with downloading
the application needed for CYBER.
CYBER general assistance – Issues with navigation, training
questions, redirection of other CYBER-related questions or issues, clarification of procedure(s).
CYBER is slow/down – This request should be submitted after
Internet connection issues have been ruled out.
Login/Password Issues – Lost user ID/password, issues with
logging into CYBER, difficulty creating new user ID/password.
Loss of Data – Report when data that has been entered and saved has been lost.
MAC user – Issues encountered when using CYBER on a MAC.
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5.0 IIC Provider Registration
The following illustrates the data elements required for IIC Provider Registration (submitted once WebEx training has been completed).
In order to select more than one county served, hold down the CTRL key and click on additional counties. (Counties are listed in alphabetical order.)
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6.0 Provider Information Form (PIF)
The following illustrates the data elements required for Provider Information Form (PIF) change/update request. After the PIF request form is received, it is forwarded to DCBHS for review and approval.
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7.0 Other
The following illustrates the data elements required for “Other” type of request.
This option should be used when nothing else is applicable. Please use the Request box at the bottom of the screen to describe the request, in detail.◦ The request cannot be
submitted without including information in the Request box.
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Complaints/Compliments Enhancements/Suggestions for CYBER Security Incident (loss of computer, hacking) CYBER Training schedule
Examples of “Other” include;
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Please click the “Submit” button once and wait for confirmation; clicking multiple times may create multiple requests.
Shortly after the confirmation page appears (see slide 22), users will receive an email with the details of the request.◦ Users will also receive a follow-up email that will
includes the work order number.
Submitting a Request
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This message will appear if the request was successfully submitted (with the date and time of the submittal).
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DYFS Continued Need for OOH Progress Note IRTS, EDRU, DAP Admissions; Out of State
Provider Admissions and Discharges Certificate of Need Requests
Other Clinical requests (IOS disputes, etc.) should be done over the phone.
Please contact the CSA at 1-877-652-7624.
When to Email Service Desk Directly
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This form replaces a number of email addresses that go to Service Desk;
◦ [email protected]◦ [email protected]◦ [email protected]◦ [email protected]◦ [email protected]
These email addresses will no longer be functional effective April 1, 2011. After
this date, please only use [email protected].
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