HPHConnect Claims Status Inquiry

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HPHConnect Claims Status Inquiry

• With HPHConnect, you can research claims status
• two ways
• Use the Patient Management Claims link to view
  all claims for the past 12 months for a patient
  on your Patient List, or
• Use the Claims Status Search form, accessible via
  the Office Management Claims link, to limit your
  search by variable criteria such as date of
  service, claim number, status - paid, pended,
  denied, etc.

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HPHConnect Claims Status Inquiry

• It is important to note that
• You can only view claims that you have submitted.
  
• You can not view claims for services submitted by
  other providers.

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HPHConnect Patient Management

• When working in the Patient Management section,
  basic information about the patient selected from
  the Current Patient list is always available on
  the gray bar at the top of the screen
• Patient name
• Date of birth
• HPHC ID
• PCP or Termed, when applicable.
• Depending on the members product and status the
  data displayed here varies as follows
• Active HMO, POS or FSEN member - PCP and the name
  of the current PCP
• Active PPO member - PCP and None
• Terminated member - Termed and the date of
  termination

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HPHConnect Patient Management/Claims

• To access 12 months of claims history for a
  patient from the Patient Management section
• Select the patient from the Current Patient List
• Click on Claims

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HPHConnect Claims Status Search Results
To sort the data, click on the column name link
once for ascending order, or twice for descending
order. Example Claims list sorted by servicing
provider name.
Claim Status displays HIPAA compliant codes,
e.g., Pending/In Process Pending/In Review
Finalized/Payment Finalized/Denial (always
displays in red)
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HPHConnect Claims Status Search Results
To view the Claim Detail, click on the Claim
Number.
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HPHConnect Claims Status Detail

• The Claim Status Detail screen displays
  information about a single claim. Data elements
  that are non-standard for HIPAA are clearly
  identified. Hyperlinks allow quick access to
  additional screens
• Provider name - Provider Detail for the date of
  service on the claim
• Patient name - Eligibility Detail for the date of
  service on the claim
• Line - Claim Service Detail for the line
  selected
• Check/EFT No Remittance Advice Detail of the
  check or EFT number selected
• Print Claim Printer-friendly Claim Status
  Detail record

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HPHConnect Claims Service Detail

• Claim Service Detail by line number Line 1
• Procedure as submitted on the claim
• Location where services was rendered
• If you want to view the detail of a different
  claim line
• Click on Return to Previous Page.
• On the Claim Status Detail, click on the line
  number link.
• Repeat as needed.

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HPHConnect Claims Service Detail
Claim Service Detail by line number Line 2
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HPHConnect Claims Status Search

• The Office Management / Claims option lets you
  research up to 13 months of claims history while
  limiting your search using flexible criteria such
  as
• Claim number
• Date of service or date range
• Claim status - Paid, Pended, Denied, etc.
• Online Help is available for any data field that
  displays this icon Click it to
  view the search parameters for the field.
• The user must define enter at least one search
  criteria prior to hitting the Search button.

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HPHConnect Claims Status Search - Dates

• The dates fields on the Claims Status Search form
  default a date range indicating dates of service
  for the last three (3) months.
• No dates are used to search by claim number.
• Date(s) are required when searching by other
  criteria but may be adjusted to refine the
  search.

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HPHConnect Claims Status Search - Dates

• Users can search for claims by
• start date of service, or
• end date of service, or
• both

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HPHConnect Claims Status Search - Dates

• Default dates display when you access the screen.
  
• To specify the Date of Service,
• enter the date in mm/dd/yyyy format, or
• use the calendar to locate the date (Click on the
  date to display it on the search form.)
• Click on Search to process the request.

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HPHConnect Claims Status Search

• To search by Claim Number, enter the full number,
  or as much of the number as possible (at least
  the initial two (2) digits). Click on Search.
• To search by Patient, select from the Patient
  List or enter any of the following
• patient account number ? last name
• member ID ? Social Security Number (SSN)
• A minimum of two characters is required the
  prefix 2 digits (HP12 or HPF12, etc.)

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HPHConnect Claims Status Search

• To search by Provider, select from the Provider
  list, which is available when there are less than
  20 providers on the users access list, or enter
  the providers
• ? last name ? provider ID ? tax identification
  number (TIN)
• (A minimum of two characters is required for each
  of these.)
• To search by Status, select one of the option
  Paid, Pended, or Denied. The search results will
  display the HIPAA compliant statuses.

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HPHConnect Claims Status Search Results

• Click on the Claim Number to access the Claim
  Detail.
• On claims that have been Denied, the status code
  displays in red.
• On claims that have Paid or are Pended, the
  status code displays in black.

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HPHConnect Claims Status Detail
Reason for denial and suggested follow-up action
for pended and/or denied services, by line item.
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HPHConnect Claims Service Detail
The Claim Service Detail screen displays the
denial information for the specific line.