Credentialing Submission Tracker. Mary Jones Network Administration, Director

Transcription

1 Credentialing Submission Tracker Mary Jones Network Administration, Director September 10, 2014

2 Welcome and Introductions Welcome to Wellmark s provider webinar hosted by Network Engagement Title of Presentation: Credentialing Submission Tracker Phones have been muted due to many participants This webinar is being recorded; a link to the recording will be posted on Wellmark.com under the Quick Link labeled Education The webinar will be available within the next two weeks You may submit questions using the Q/A feature at the top of your screen Following the webinar, a Question/Answer document will be created and posted along with the slides and recording of the webinar The speaker for today s webinar is: Mary Jones, Network Administration, Director 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 2

3 Agenda Welcome and Introductions Background What is the Credentialing Submission Tracker? Accessing the Credentialing Submission Tracker How is the Credentialing Submission Tracker Used? Examples Recap Tips from Wellmark Other Network Administration Updates Resources Questions 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 3

4 Agenda Welcome and Introductions Background What is the Credentialing Submission Tracker? Accessing the Credentialing Submission Tracker How is the Credentialing Submission Tracker Used? Examples Recap Tips from Wellmark Other Network Administration Updates Resources Questions 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 4

5 Background Many inquiries are received daily via and phone calls. Most are inquiring about the status of applications. To better assist you, we recognized that a more efficient and consistent way was needed. A tool where you are able to check the status of common submissions was made. This tool also allows you to view Wellmark s average processing time of submissions. Tool allows you to view what we view to help save you time. 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 5

6 Agenda Welcome and Introductions Background What is the Credentialing Submission Tracker? Accessing the Credentialing Submission Tracker How is the Credentialing Submission Tracker Used? Examples Recap Tips from Wellmark Other Network Administration Updates Resources Questions 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 6

7 What is the Credentialing Submission Tracker? New online tool for providers which will provide real-time status in three main areas: Credentialing Application Recredentialing Application Change Request Instant notification on where your credentialing or recredentialing applications and change requests are within Wellmark s process. Only National Provider Identifier (NPI) number of provider in question is needed. Items received after 8/31/14 will be displayed through tool. Previously, no online tool to check status existed. 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 7

8 Agenda Welcome and Introductions Background What is the Credentialing Submission Tracker? Accessing the Credentialing Submission Tracker How is the Credentialing Submission Tracker Used? Examples Recap Tips from Wellmark Other Network Administration Updates Resources Questions 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 8

9 Accessing the Credentialing Submission Tracker The Credentialing Submission Tracker can be accessed two ways: 1. Public Wellmark.com provider page (no login required) 2. Secure Wellmark.com provider page (for providers who contract with Wellmark; login required) Scope of the tool 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 9

10 Accessing the Credentialing Submission Tracker Public page: 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 10

11 Accessing the Credentialing Submission Tracker Credentialing and Contracting page Two options: Apply Check Status Check Status option leads to Credentialing Submission Tracker 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 11

12 Accessing the Credentialing Submission Tracker Provider Secure Page Link available for Credentialing and Contracting Information 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 12

13 Accessing the Credentialing Submission Tracker Credentialing Submission Tracker link is provided 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 13

14 Accessing the Credentialing Submission Tracker Whether accessed on Wellmark.com public provider page or through provider secure page, both will lead to the Credentialing Submission Tracker tool. 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 14

15 Agenda Welcome and Introductions Background What is the Credentialing Submission Tracker? Accessing the Credentialing Submission Tracker How is the Credentialing Submission Tracker Used? Examples Recap Tips from Wellmark Other Network Administration Updates Resources Questions 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 15

16 How is the Credentialing Submission Tracker Used? 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 16

17 How is the Credentialing Submission Tracker Used? Current Average Processing Time box is located to the right of the search box. Indicates average time of processing for all submissions. Credentialing applications Recredentialing applications Current Average Processing Time: This time frame is based on an average of all submissions. Yours may take longer if additional research is needed. Change requests 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 17

18 How is the Credentialing Submission Tracker Used? Enter up to 10 NPI numbers in field. Separate each NPI by a comma. Click Next. Results will be displayed. Dates of key activities associated with your submission will appear. 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 18

19 How is the Credentialing Submission Tracker Used? What s this? icon below each step provides description of what each step means. 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 19

20 How is the Credentialing Submission Tracker Used? Credentialing Application Application Received Application Accepted Credentialing Complete Notification Sent Source Verified This shows the date the credentialing application was received by Wellmark. It is not an indication regarding the completeness of the submission. This status indicates that all required information was successfully submitted. Processing can now begin. The Credentialing Committee has reviewed the application and verified the status of the pertinent licenses, certifications and accreditations. This status indicates that a final determination was made regarding whether the applicant meets all credentialing requirements. Please refer to the notification itself for more details, including network effective dates and claims submissions. Notification should be received within 7 working days of date shown. This status indicates that all pertinent licenses, certifications and accreditations have been verified. 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 20

21 How is the Credentialing Submission Tracker Used? Recredentialing Application Application Received Application Accepted Credentialing Complete Notification Sent Source Verified This shows the date the recredentialing application was received by Wellmark. It is not an indication regarding the completeness of the submission. This status indicates that all required information was successfully submitted. Processing can now begin. The Credentialing Committee has reviewed the application and verified the status of the pertinent licenses, certifications and accreditations. This status indicates that a final determination was made regarding whether the applicant meets all recredentialing requirements. Please refer to the notification itself for more details, including network effective dates and claims submissions. Notification should be received within 7 working days of date shown. This status indicates that all pertinent licenses, certifications and accreditations have been verified. 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 21

22 How is the Credentialing Submission Tracker Used? Change Request Request Received Request Accepted Notification Sent This shows the date the change request was received by Wellmark. It is not an indication regarding the completeness of the submission. This status indicates that all required information was successfully submitted. Processing can now begin. This status indicates that the information Wellmark keeps on file for the applicant has been updated. Notification should be received within 7 working days of date shown. 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 22

23 Agenda Welcome and Introductions Background What is the Credentialing Submission Tracker? Accessing the Credentialing Submission Tracker How is the Credentialing Submission Tracker Used? Examples Recap Tips from Wellmark Other Network Administration Updates Resources Questions 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 23

24 Examples Application Example #1 This box indicates the NPI number that was entered, the name of the provider that the NPI belongs to, the type of submission, and the status of the submission. Dates appear on applicable steps to advise when each step was completed. 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 24

25 Examples Application Example #2 In this example, all steps are completed. This is indicated by checkmarks and dates, when applicable. 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 25

26 Examples Recredentialing Example 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 26

27 Examples Change Request Example 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 27

28 Examples Missing Information Example Status indicates returned for missing information. The red checkmark also is an indication that this is in regards to missing information. 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 28

29 Agenda Welcome and Introductions Background What is the Credentialing Submission Tracker? Accessing the Credentialing Submission Tracker How is the Credentialing Submission Tracker Used? Examples Recap Tips from Wellmark Other Network Administration Updates Resources Questions 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 29

30 Recap This tool is now live and available to use. Real-time status. Two ways to access the tool. Only items received after 8/31/14 will be displayed. Current Average Processing Time is displayed to give you a general idea of our processing timeframe. Each step provides a What s this? link which provides additional information explaining each step. 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 30

31 Agenda Welcome and Introductions Background What is the Credentialing Submission Tracker? Accessing the Credentialing Submission Tracker How is the Credentialing Submission Tracker Used? Examples Recap Tips from Wellmark Other Network Administration Updates Resources Questions 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 31

32 Tips from Wellmark Using the Credentialing Submission Tracker allows you to see the same information Wellmark staff sees. Calling or ing to inquire about status will not expedite any process. You will receive the same information you see online. Written notification will be sent to the requestor: When process is complete. All materials are returned for missing information. Other issues have been found. 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 32

33 Tips from Wellmark Network Administration analysts go through the process of completing a request. Once each step is completed, the Credentialing Submission Tracker will display the progress (checkmarks). Have multiple sessions of a browser (e.g., Internet Explorer) open? If you close only the window for the Credentialing Submission Tracker, you will see your previous results if you go back to the Credentialing Submission Tracker page. Simply close all open browser windows if you do not want to see your previous results. Reopen for next time to check. 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 33

34 Agenda Welcome and Introductions Background What is the Credentialing Submission Tracker? Accessing the Credentialing Submission Tracker How is the Credentialing Submission Tracker Used? Examples Recap Tips from Wellmark Other Network Administration Updates Resources Questions 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 34

35 Other Network Administration Updates Wellmark Addendum Updates were made to reduce the amount of time it takes to complete applications. Checklists were updated to help you determine some of the most common reasons why a document may not be accepted by Wellmark. Updated Wellmark addendums and checklists available online 11/1/14. Be sure to access the most current documents at Wellmark.com to avoid delays and/or returned applications. Outdated applications and addendums will be returned beginning 1/1/15. 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 35

36 Other Network Administration Updates Missing Information Letter This letter is provided if the application submission is incomplete or documents/contracts are missing. Indicates what pieces of information are missing. You will then need to provide complete information and resubmit all materials. 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 36

37 Other Network Administration Updates Common Reasons Applications Are Returned Incorrect applications or contracts submitted Effective date missing Work history missing or incomplete Not using the most current application documents from the website Hospital admitting privileges Malpractice insurance information Health status/quality focus questions not answered Answers of yes must provide explanations NPI number(s) not provided or invalid 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 37

38 Agenda Welcome and Introductions Background What is the Credentialing Submission Tracker? Accessing the Credentialing Submission Tracker How is the Credentialing Submission Tracker Used? Examples Recap Tips from Wellmark Other Network Administration Updates Resources Questions 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 38

39 Resources Contracts and Credentialing Provider Guide CredentialingProviderGuide.pdf BlueInk Hot Topics 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 39

40 Agenda Welcome and Introductions Background What is the Credentialing Submission Tracker? Accessing the Credentialing Submission Tracker How is the Credentialing Submission Tracker Used? Examples Recap Tips from Wellmark Other Network Administration Updates Resources Questions 9/10/2014 Confidential and Proprietary Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota 40

41 Wellmark Blue Cross and Blue Shield of Iowa and Wellmark Blue Cross and Blue Shield of South Dakota are Independent Licensees of the Blue Cross and Blue Shield Association.