W
hen you log in to
the Alliance website
to use the Eligibility
Verification application or the
Claims Search application, you are
accessing what we call our “Web
Account Services.” Exciting changes
are under way with Web Account
Services at the Alliance.
Starting in December, Web
Account Services will be renamed
“
Provider Portal.” You will see a
few minor visual differences on the
Alliance website due to this wording
change, but all applications and
links within the provider portal will
work the same.
Provider Portal
Update Version 3
With the revision of the Alliance
Provider Portal coming soon, several
long-awaited features for primary
care physicians and specialty care
providers will be available. Updates
will include the ability to submit
treatment authorizations for various
inpatient (i.e., long-term care, acute)
and outpatient procedures, durable
medical equipment, and pharmacy
needs.
Furthermore, a new set of video
tutorials will be included for the
authorization entry function to ease
the transition for new users of the
Provider Portal.
In addition, a new feature will
allow providers to change or cancel
a submitted request via the Provider
Portal. The Alliance is also planning
to implement a new service that
will allow providers to view all
their correspondence electronically
without relying on faxes.
Alliance contracted providers are
welcome to register for portal access for
themselves and their staff members.
Onsite Provider Portal training can
be provided upon request.
If you have not yet activated
your Provider Portal account or
would like to learn more about the
Provider Portal, please contact our
Provider Services Web and EDI
Specialist or your Provider Services
Representative.
Important Reminder
Submitting
Claims with
Explanation
of Benefits
●●
A separate copy of the explanation
of benefits (EOB) must be submitted
with each claim form.
●●
EOBs must be complete, legible
and unaltered.
●●
Crossover claims must not be
combined. Examples of common
errors that can result in rejections,
delays, possible wrong payments or
denials include:
■■
Multiple recipients on one claim
form.
■■
One EOB for multiple claim
forms.
■■
Multiple claims (on one or more
EOB) for the same recipient on
one claim form.
■■
Multiple claim lines from more
than one EOB for the same
recipient on one claim form.
Web Changes
Coming Soon
‘
Web Account Services’
Replaced with
‘
Provider Portal’
National Drug
Code Numbers:
Claims and
Invoices
A reminder: When billing codes
like J3490 (unclassified drugs) the
national drug code (NDC) required
on the claim must match the NDC
on the invoice submitted. If the
NDCs do not match, the claim
might be denied.
UB 04 Claim Line Limits Expanded
The Alliance system can accept up to 22 claim lines when
submitting crossover claims on the UB 04 claims form
before splitting the claim. This is expanded from Medi-Cal’s
limit of 15 lines.
DECEMBER 2012
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C L A IMS AND T ECHNO LOGY FORUM