Verifying eligibility prior
to rendering services is important in avoiding claim denials for members
who are not eligible under CenCal Health's programs. In this tutorial, you will
learn how to verify eligibility; see if a member has Other Health Coverage or
is considered Special Class (CCS or residing in a Long Term Care facility).
Click here to view this tutorial.
Submitting a "clean claim" is important in order for your claim to be considered by CenCal Health for payment. These tutorials will teach you how to enter information into a CMS-1500 claim screen as well as how to make a correction when your claim requires additional information (requires a modifier etc.). If your claim requires additional information, or has denied for a specific reason, this tutorial will show you how you can fix most denials directly on our portal. Click here to view this tutorial.
Running an Authorization report
By running the Authorization Report, you can see what authorizations have been received and of those, which ones have been approved or denied. Verifying authorizations prior to submitting your claims will assist in delayed payments or claim denials. This tutorial will show you how to run an authorization report for your member and will provide you with the authorization number needed to submit with your claim. Click here to view this tutorial.
Running a Claim Status Report
Verifying the status of your
claims and ensuring that all corrections are submitted timely is important
for your claim to be considered for payment. This can eliminate possible payment
reductions in claims that are submitted in an untimely manner. This tutorial will show you
how you can run the Claim Status Report by choosing claims for your
provider or group that are currently in our system as "paid", "denied",
or "pended". Claims that are denied, and have not yet appeared on an
EOP, can be corrected on the portal to eliminate the need to resubmit your
claim with a correction. Click here to view this tutorial.
Running a Patient Profile Report
Running a Claim Status Report for a specific patient, during a specific date range, provides you with a condensed look at the status of each claim submitted. If the claim is denied, and has not yet appeared on an EOP, the claim can be corrected on the portal. This will eliminate the need to resubmit your claim with a correction. Click here to view this tutorial.
Running an Explain Code list/report
Having a complete list of CenCal Health's explain codes will help you identify how your claim was processed and understand the status of your claim. To help you understand why your claim was pended or denied, we encourage you to view this tutorial and run an explain code list for your office. Click here to view this tutorial.
Before rendering a service, it is advised that you determine if a TAR is required for the procedure. This tutorial will show you how to enter a procedure code and confirm if a TAR is required; in turn this can help avoid a claim denial. Once you have verified if a TAR is required for your procedure, you can submit your authorization request on the provider portal. Click here to view this tutorial.