Major Changes to 'Claims Status' + Minor Changes to 'Referral by Provider'
The following is the list of topics presented in this communication:
- Claims Status – Instant Access in Real Time, No Need to Call (New Functionality)
- Referral by Provider - New Name, New Functionality (Modified Functionality)
- Sending Questions to the Affiliate Link team
Claims Status - Instant Access in Real Time, No Need to Call
View 'real time' Claims Status 24/7. Use your mouse, not your phone.
You asked for a easier way to see the status of claims. We listened. We are delivering. Starting March 21st, Network Providers will have access to claim status information through Affiliate Link - 24/7. You no longer need to call into the Provider Customer Service for claim status. No waiting on hold. Just log into Affiliate Link to find claim information, such as status, claim and check information, and payment amounts.
The Patient Header appears after searching for a patient and selecting their record.
Important: To search for member specific information within Affiliate Link, you must first search for the patient’s record. After the member’s information appears in the Patient Header, you can perform either of the following searches: By Member (Patient) or By Provider/Vendor.
Search My Patients field on the Patient Search activity.
To quickly view a Member's (Patient’s) Claim Status
- Open the Member's Record.
- Click the Claims option.
- Click the Claims by Members option.
- Use the Select a Provider picklist to ensure the correct provider is selected.
- Click the Claim Number hyperlink.
Clicking the Claim # hyperlink on the Claims Inquiry opens the Claims Details display. The Claims Details screen displays the patient's KP identifiers, claim identifiers, the claim's status, the associated service dates, and the codes applied during processing.
Important: Though the new claims status function should cover most of your needs, we realize that it may not provide what you need in certain circumstances. If you have questions specific to claims you can call MSCC at 1-800-382-4661. As always, if your issue needs to be escalated you can call your Provider Representative at 1-866-866-3591.
To quickly view a Claim Status based on Provider or Vendor or Claim ID
For those circumstances when you need to see all the claims associated to your group instead of a specific member, you can use the following instructions:
- Open the Member's Record.
- Click the Claims option.
- Click the Claims by Provider option.
The Claim Search has three tabs (Providers, Vendor, Search by Claim ID) that allow you to search on specific criteria. Clicking a claim # hyperlink opens the Claim Status detail screen. (Follow-up: this screen is different than that shown by Cynthia during her presentation. Which one should be used? )
Searching by Vendors: For those circumstances when you need to see all the claims associated to your larger organization instead of specific department or a specific member, you can use the following instructions:
On the Vendors tab, you can search by vendor name or tax ID. Also, you can enter a date range to search against.
Searching by Claims ID: Use this search function when you or a member of your staff has the ID for a specific claim.
On the Search by Claims ID tab, you can search for a specific claim by searching against its ID. Note: Though Submitted ID may be selected as search criterion, currently it is not operational.
After you perform your claim search: After you perform your search and select the hyperlink associated to the claim your wish to review. The Claims Detail screen displays the claim's status, account information, check information, payment amounts, and the service date(s) associated to the claim.
The Claims Detail screen appears after you find the record you wish to view and clicking its Claim # hyperlink.
Referrals by Provider - Now Referrals Search
The Referral by Provider activity, many of you have used in the past, has been replaced with a new activity called Referral Search.
This function still allows you to search the referrals you created (Outgoing) and referrals received (Incoming) from Kaiser Permanente.
Now, you have complete control over the search criteria submitted to the system. You can search referrals based on a specific status or multiple statuses. If you want to see just authorized referrals., you can do that. If you want to see just pending referrals, you can do that too. If you want to see authorized and pending referrals and nothing else, yeah, you can do that too.
Using the Referral Search function:
- Click the Referrals option.
- Click the Referrals Search option.
- Click the Incoming radio button to search for referrals coming from Kaiser Permanente Colorado. Or, click the Outgoing radio button to search for referrals you have sent to Kaiser Permanente Colorado.
- Select the provider whose referral(s) you wish to view.
- Select a specific status or click the Select All checkbox.
- Enter a date range to search against.
- Make sure the Select All checkbox is selected for the Scheduling Status.
- Click Search.
Sending Questions to the Affiliate Link Team
Remember you can send a HelpDesk question to the Affiliate Link team.
You don't need to enter an IT ticket. You can use send an In Basket 'HelpDesk' message directly to the Affiliate Link admin team. This message is to be used for non-urgent requests, questions, or problems. For urgent requests, please call (Toll Free): 1-866-866-3951
To send a HelpDesk message to the Affiliate Link Admin team:
- Open the Affiliate Link In Basket.
- Click the drop-down arrow affixed to the New Message button.
- Click the HelpDesk option.
- Enter a Subject Line.
- (Optional) If the inquiry is associated to a patient use the search function to find the patient's name.
- (Optional) If you want an Affiliate Link Admin to contact you via phone, enter the phone number you wish to be contacted at, and then check the Call Me box.
- Provide an answer to the first two questions presented in the Note box.
- Describe the issue and provide relevant details within the spaced provided after the next two questions.
- Click Send Message.
Thank you for being a member of the Network Provider Network and using Affiliate Link.
The Affiliate Link team and your Provider Relationship consultants believe the enhanced functionality provided by the 'New' Affiliate Link allows you to do more in less time. Let us know what you think.
If you have questions regarding this communication or the tasks you can perform with Affiliation Link, contact your Provider Relations consultant by calling (toll free) 1-866-866-3951, and then selecting one of the following options:
- Option 1: Hospital, Ancillary, Behavioral Health, DME, SNF
- Option 2: Physician-based (Denver/Boulder)
- Option 3: Physician-based (Northern Colorado)
- Option 4: Physician-based (Southern Colorado)
- Option 5: Physician-based (Mountain Colorado)