Besides being a new platform for eligibility and processing claims, the system will introduce new provider portals and require submission of paper claims to a new post office box. As the system go-live date approaches, your staff will have access to multiple training opportunities on the new processes.
Providers access Adaptis Connect to download rosters, check eligibility, claims status, submit referral requests, etc. Upon activation of the new system:
The process and destination location for submitting electronic claims will continue, including the ongoing use of Availity and other clearinghouses. The new portal, however, does offer an optional method to directly submit e-claims.
The location for submission of all paper claims will change. Effective January 1, 2010, providers are asked to mail all paper claims (before and after January 1, 2010, service dates) to:
CHP Claims
PO Box 269002
Plano, Texas 75026-9002
The new system is scheduled for activation on the first business day of 2010, which is January 4. The Adaptis system will continue to operate but will no longer be the system of record for eligibility and will process claims with service dates prior to January 1, 2010 only.
The first time you access the Perot provider portal (HIP) directly, you will need to have a user ID and password. (Please note: This is not the same as access via OneHealthPort, where no separate user ID or password will be required).
For users who have Adaptis Connect accounts, we will carry forward the IDs you were assigned for Adaptis Connect. You will initially be assigned a default password. The system will challenge you to change it the first time you access the portal.
If you are a brand new portal user and did not have an Adaptis Connect account, the first time you access HIP you will be asked to complete a request form. This form will be processed within a few days. You will then be notified of your assigned user ID and initial password.
User IDs and default passwords are being issued for existing Adaptis Connect users during the last two weeks of December. Brian Berry, our portal trainer, is coordinating this effort with the site contacts established for Adaptis Connect. Most users will be able to use their former Adaptis user ID. However, we had to change IDs in a few cases to eliminate duplicates.
Multiple training opportunities are being planned. For example:
All system-related queries may be submitted to Customer Service via email or telephone. As required, Customer Service will route the questions and issues to other departments in the company if they unable to resolve the question.
Community Health Plan anticipates lower administrative costs and increased efficiency.
Providers will get new functionality, such as:
The ability to enter referrals, prior authorization requests, and inpatient notifications online.
RAs are currently not available in Adaptis Connect. However, member rosters will be available for download from the portal and from a password-protected CD. Rosters through Adaptis Connect will be discontinued because the new system will be the system of record for eligibility.
The roster format is the same, minus social security number. Community Health Plan will comply with regulations pertaining to when rosters must be available to providers. As is the case now, paper rosters will not be available.
From the beginning, the Perot Provider Portal (HIP) will be accessible through OneHealthPort, as with Adaptis Connect.
The same will not be true of the Care Management Portal. For the first few months, you will need to access the Care Management Portal directly. After the first few months, that portal will be accessible via OneHealthPort.
In both cases, the portals may be entered directly. The URLs for both sites will be posted on this site within a few days of the system activation. Adaptis Connect will also have links to the new sites after January 1, 2010.
There is no limit to the number of staff from each site who can register for the communications system. We encourage as many staff to register with our communication system as needed. The communication registration site is: www.chpw.org/claimsinfo.
Visit www.chpw.org/claimsinfo to register for our project communication system. Only one registration is required. After a staff member registers from any site, they will be on the mailing list to receive all updates.
We encourage clinic managers, front desk, referral coordinators, and billing staff to register with our communication system. All interested parties should go to www.chpw.org/claimsinfo and complete the brief registration form.
Yes. The system change requires us to generate and issue new member ID cards and to assign new member IDs. ID cards will be mailed to existing Medicare enrollees the last week of December 2009. ID cards for new Medicare enrollees and for all current state program members will be mailed the first week of January 2010.
See the new Medicare Advantage ID card. (Medicaid samples to come.)
Community Health Plan will continue to accept any member identification information to match claims to members. You will be able to search member records by PIC number, client ID number (post Provider One), date of birth, or a combination. However, when claims are billed with the member's old ID number, the system will need to add the new member ID during processing, which results in slower processing.
The new member ID numbers will be printed on the new member ID cards. The new member ID will be 10 numeric characters. The first character will be 1. The last two digits will be the person ID, a unique number pertaining to the member of the family unit. The new member ID numbers can be viewed through the provider portal and on the provider's member rosters. We will post images of the new cards on this site in the future.
Browser requirements:
Operating system requirements:
Minimum hardware and settings for optimal performance:
1024 x 768 screen resolution.
No, you will only need to have an internet browser. For information, see the system requirements.
Community Health Plan has removed social security numbers from all records to meet future compliance requirements. Community Health Plan will provide all other patient identifiers.
No. Both the Adaptis and Perot systems and portals have been modified to be in compliance with Provider One requirements.
Appeals will not be available. Consult notes will be available if you send them to a specialist.
Yes. Medicare and state program member eligibility will be available through the portals, as well as referrals and authorizations. All lines of business will be running on one system compared to the two with Adaptis.
Yes, as well as prior authorizations and hospital admission notifications. Hospital providers will have the same access online rather than FAX.
Yes, you will have access to check status if you are the provider connected with the patient.
Adaptis Connect will continue to be available through the claims run out period:
Retro referrals for claims with service dates prior to January 1, 2010, can be submitted via Adaptis Connect. If the member is still eligible as of the current date, you may enter the retro referral through the Care Management Portal.
It is true that the Perot provider portal (HIP) is not certified to work with Apple operating systems and internet browsers.
As long as your practice management system is submitting your claims through an electronic claims clearinghouse, you will not have to do anything differently.
If you are currently submitting your electronic claims to Adaptis directly, contact us immediately.
OneHealthPort users will have access to the Perot provider portal (HIP) immediately at system activation or directly, your choice.
You can use your OneHealthPort user ID and password to access HIP. Or, if you wish to access HIP directly and not through OneHealthPort, you can use your existing Adaptis Connect User ID.
Access is different at first for the Care Management portal. For the first few months it can only be accessed directly.
For more information about logins, see questions 3 and 8.
After a very thorough search and evaluation process for a replacement TPA system, Perot/Dell Systems was selected because of their excellent reputation in the business and their very competitive pricing. Lower claims processing costs are important to everyone. Perot/Dell's processing center is in Plano, Texas.
Community Health Plan, Adaptis, and Perot have been working closely with the state to make all necessary changes to their systems to achieve compliance with Provider One. We do not anticipate problems.
To meet future compliance requirements, Community Health Plan has removed social security numbers from all records associated with the Perot system. Community Health Plan will provide all other patient identifiers. The Care Management portal will have visible social security members for a while.
Appeals notes will not be available through the Care Management Portal. Consult notes will be available if the specialist submits the documentation to Community Health Plan or uploads the consult report through the Care Management Portal.
Yes. You can create referrals through the Care Management Portal for all service dates after January 1, 2010. Retro referrals for claims with service dates before January 1, 2010, can be sent through Adaptis Connect. If the member is still eligible as of the current date, you may enter the retro referral through the Care Management Portal.
If you create a referral to a PAR provider and submit it through the Care Management Portal, 4 visits over a 90-day timeframe will be automatically populated and approved.
If the referral submitted through the Care Management Portal is to a non-PAR provider or is for more than 4 visits to a PAR provider or for a timeframe greater than 90 days, then the request will be pended for Care Management Staff review.
New and renewing Community Health Plan members will receive ID card and renewal packet message inserts explaining the business system changes effective at the turn of the year. Two key messages are conveyed
