Welcome to ClaimsLink

(Last update 5 June 2009)

ClaimsLink Updates

AutoEnrollment Users - You are now able to cancel dependents from multiple sections in one session. Click the section and the member you want to cancel and choose 'cancel this dependent from selected section' option. Repeat this procedure for all sections to be canceled.

AutoEnrollment Users - As of 2/1/2009 the spouse's Social Security number is required for all new contracts. Please enter the Social Security number in the field marked Dependent SSN. You can find this field after clicking the 'More' button on the dependent detail screen.

The Explanation of Benefits (EOB) screens have been updated. ClaimsLink EOB screen heading descriptions have been changed to be consistent with the terminology in the new paper EOB that is sent to members. The screen has remained the same, only the headings have changed. Previously the EOBs that a member would have received may not have had the "patient liability" specifically noted. As a result, the ClaimsLink EOB screen never displayed the "patient liability" field, but it is still displayed on the claim header information screen along with the other administrative claim information such as paid date and check number. You may have to continue to review this screen as you did in the past. The EOB screen also does not include the pictures and graphs that may be present on the actual members EOB and is not intended to exactly duplicate the look only convey the values of the members EOB.

Coordination of Benefits information has been updated. This information has been moved from the member detail screen to a new link off the subscriber summary page. The link is called COB Information and can be found below the member detail link on the pop up menu. COB information now includes 18 months of data and will provide a real time look at COB data for the member.

Autoenrollment users will notice a new enhancment to the application. If a person is being updated with Medicare you will be able to specify if Medicare is primary or secondary. If you are entering a person where Medicare is primary, key a medicare date and click the 'Medicare Primary' check box. If you would like to make Medicare secondary simply enter a Medicare date and leave the 'Medicare Primary' box unchecked.

ClaimsLink has been updated to allow you to view the date the actual claim payment check has cleared the bank. This will assist you in responding to member and provider inquiries

A new “All” option is now available for the membership reports that will allow them to be run for the entire group in addition to an individual group-section. A report user guide has been added and is available under the User Guides link.

We are pleased to announce an enhancement to ClaimsLink. You can now view and print claim images of the original claim in a PDF format. ClaimsLink will still maintain the capability to request a fax of the claim.

In order to utilize this enhancement:
1) Your PC must have Adobe Acrobat Reader version 7. This is a free download available at www.adobe.com.
2) You must make a change to the Adobe settings. This change will insure the claims will be viewed in a separate window from ClaimsLink. That way you will not lose your ClaimsLink session while trying to view claim images. After you have located or downloaded the software and it is running click the 'Edit' tab at the top of the screen. Then go to 'Preferences' and choose 'Internet' on the left side. Under Web Browser Options make sure the box labeled 'Display PDF in browser' is NOT checked and click ok. Your PC will have to be rebooted before the change takes effect.

In the interest of protecting the identity and private medical information of our members, Medical Mutual is issuing our members new ID cards, starting January 1, 2006. The new numbers will be system generated, random, 12-digit numbers. We will no longer be using Social Security numbers as we generally have in the past. However, we will still be including SSN numbers in our communications with you. Therefore new members will still need to provide social security numbers on applications. (If the current ID card does not show a social security number, the ID number will stay the same.) Until the member receives a new ID card, use the old ID number if he or she has any questions about health coverage.

Although we may be changing the ID number, we want to stress that nothing else is changing with Medical Mutual healthcare coverage. Current of future claims will not be processed any differently. Member's benefits will remain the same.

Remind members to carry their new ID card with them at all times, and use it whenever they receive medical services from doctors, hospitals and other healthcare facilities.

Protecting the privacy of our members is important to us, and changing the ID numbers is another vital step in ensuring the safety of personal information.

A new function has been added to ClaimsLink. On the menu bar, you will see new option titled 'Remark Code'. Clicking this will open a window where you can enter a claim related remark code and look up its meaning. This capability is available from anywhere in the site, making it easier to find a specific definition.

To better serve you, new improvements to ClaimsLink have been completed including the addition of a Custodial Parent Indicator and updated Addenda.

Dependents with a custodial parent will now have an indicator beside their name. By clicking on the Custodial Parent Indicator, the name and address of the custodial parent will display.

In addition, the ClaimsLink Addenda have been updated. The new addenda are easier to complete and understand and now include a new security profile, Eligibility Only. The Eligibility Only profile is provided for groups who wish to view member eligibility only and no claims data. Groups may continue to use Auto Enrollment with Eligibility Only.

Service representatives are being asked to discard any old versions of the ClaimsLink Addenda by October 1, 2004. Any former versions of the Addenda submitted after October 1 will not be applicable. Download the new Addenda under the Getting Started section.

A new Claimslink message was recently added to the Autoenrollment process that says you do not have to request an ID card on newly added members. If Carolina Care Plan does not generate ID cards for your group, this message can be ignored. This is only a message and does not affect any of your currently defined processes.

In response to numerous requests we have modified ClaimsLink's Auto Enrollment feature to allow you to make more than an ID request in one day. For example, you may change an address and then request an ID card for an individual on the same day and both transactions will be processed. The ID card request must be made AFTER all other changes are made. You do not need to request an ID card for a new add. The system will automatically generate one and mail it out the next day.

What is HIPAA?
HIPAA Law - in August of 1996, the government passed into law the Health Insurance Portability and Accountability Act(HIPAA). As part of the new law objectives were set to improve the efficiency and effectiveness of the American health care system. Within the HIPAA law, under Title II "Preventing healthcare fraud & abuse", subtitle F: Administrative Simplification identifies that the U.S. Secretary of Health and Human Service (HHS) is to develop standards the industry is to follow for: electronic transactions, unique identifiers, standard code sets, security and electronic signature, and privacy. In addition, HIPAA identifies penalties for not following the standards once enacted. Currently, the U.S Secretary of HHS has a final rule for Transactions and Code Sets and a final Rule for Privacy.

The final rule for electronic transactions and code sets was published in the Federal Register on August 17, 2000. MMO has filed for the available one-year extension under HIPAA's regulations. Therefore the date of compliance is October 16, 2003.

The final rule for Privacy was published in the Federal Register on December 28, 2000. Unless the regulations are modified or delayed, MMO will be required to use these standards by April 14, 2003.

How has ClaimsLink changed for HIPAA compliance?
When you are looking at the policyholder summary screen you will notice that any dependent that has chosen to keep their information private is highlighted in red. Second, on the claim header screen there is a new field called Privacy Indicator. If the dependent has opted for privacy the word 'Private' will appear. Lastly, the same privacy indicator shows on the member detail screen. In addition to the privacy indicator on the member detail screen the dependent address will also appear. This allows you to know where any information regarding the health insurance for that dependent has been sent.

If you have any questions please contact your account representative for more information.

In response to numerous requests we are now offering an audit report to auto enrollment users. This report allows the user to enter a date range up to 30 days prior to the current date. The resulting report contains a record of all transactions made during the chosen period. This Audit report will show users all information for policyholders and dependents that have been entered. The information shown is not limited to just what was changed, but provides the entire record for verification. The report also includes the ClaimsLink user ID for the person who made the changes. The report is sorted by transaction date and group section number for the specific group chosen.

For automated enrollment customers who wish to access this report please click your "Auto Enrollment" tab at the top of your screen. Click the "Run Audit Report" button to launch the form. Fill out the form and then click the "Submit" button.

ClaimsLink Addendums to your Carolina Care Plan contractual agreement:
-ClaimsLink Addendum - Fully Insured - Group
-ClaimsLink Addendum - Fully Insured - Third Party
-ClaimsLink Addendum - Self-Insured - Group
-ClaimsLink Addendum - Self-Insured - Third Party

ClaimsLink Updates
	AutoEnrollment Users - You are now able to cancel dependents from multiple sections in one session. Click the section and the member you want to cancel and choose 'cancel this dependent from selected section' option. Repeat this procedure for all sections to be canceled.
	AutoEnrollment Users - As of 2/1/2009 the spouse's Social Security number is required for all new contracts. Please enter the Social Security number in the field marked Dependent SSN. You can find this field after clicking the 'More' button on the dependent detail screen.
	The Explanation of Benefits (EOB) screens have been updated. ClaimsLink EOB screen heading descriptions have been changed to be consistent with the terminology in the new paper EOB that is sent to members. The screen has remained the same, only the headings have changed. Previously the EOBs that a member would have received may not have had the "patient liability" specifically noted. As a result, the ClaimsLink EOB screen never displayed the "patient liability" field, but it is still displayed on the claim header information screen along with the other administrative claim information such as paid date and check number. You may have to continue to review this screen as you did in the past. The EOB screen also does not include the pictures and graphs that may be present on the actual members EOB and is not intended to exactly duplicate the look only convey the values of the members EOB.
	Coordination of Benefits information has been updated. This information has been moved from the member detail screen to a new link off the subscriber summary page. The link is called COB Information and can be found below the member detail link on the pop up menu. COB information now includes 18 months of data and will provide a real time look at COB data for the member.
	Autoenrollment users will notice a new enhancment to the application. If a person is being updated with Medicare you will be able to specify if Medicare is primary or secondary. If you are entering a person where Medicare is primary, key a medicare date and click the 'Medicare Primary' check box. If you would like to make Medicare secondary simply enter a Medicare date and leave the 'Medicare Primary' box unchecked.
	ClaimsLink has been updated to allow you to view the date the actual claim payment check has cleared the bank. This will assist you in responding to member and provider inquiries
	A new “All” option is now available for the membership reports that will allow them to be run for the entire group in addition to an individual group-section. A report user guide has been added and is available under the User Guides link.
	We are pleased to announce an enhancement to ClaimsLink. You can now view and print claim images of the original claim in a PDF format. ClaimsLink will still maintain the capability to request a fax of the claim. In order to utilize this enhancement: 1) Your PC must have Adobe Acrobat Reader version 7. This is a free download available at www.adobe.com. 2) You must make a change to the Adobe settings. This change will insure the claims will be viewed in a separate window from ClaimsLink. That way you will not lose your ClaimsLink session while trying to view claim images. After you have located or downloaded the software and it is running click the 'Edit' tab at the top of the screen. Then go to 'Preferences' and choose 'Internet' on the left side. Under Web Browser Options make sure the box labeled 'Display PDF in browser' is NOT checked and click ok. Your PC will have to be rebooted before the change takes effect.

	In the interest of protecting the identity and private medical information of our members, Medical Mutual is issuing our members new ID cards, starting January 1, 2006. The new numbers will be system generated, random, 12-digit numbers. We will no longer be using Social Security numbers as we generally have in the past. However, we will still be including SSN numbers in our communications with you. Therefore new members will still need to provide social security numbers on applications. (If the current ID card does not show a social security number, the ID number will stay the same.) Until the member receives a new ID card, use the old ID number if he or she has any questions about health coverage. Although we may be changing the ID number, we want to stress that nothing else is changing with Medical Mutual healthcare coverage. Current of future claims will not be processed any differently. Member's benefits will remain the same. Remind members to carry their new ID card with them at all times, and use it whenever they receive medical services from doctors, hospitals and other healthcare facilities. Protecting the privacy of our members is important to us, and changing the ID numbers is another vital step in ensuring the safety of personal information.

	A new function has been added to ClaimsLink. On the menu bar, you will see new option titled 'Remark Code'. Clicking this will open a window where you can enter a claim related remark code and look up its meaning. This capability is available from anywhere in the site, making it easier to find a specific definition.

	To better serve you, new improvements to ClaimsLink have been completed including the addition of a Custodial Parent Indicator and updated Addenda. Dependents with a custodial parent will now have an indicator beside their name. By clicking on the Custodial Parent Indicator, the name and address of the custodial parent will display. In addition, the ClaimsLink Addenda have been updated. The new addenda are easier to complete and understand and now include a new security profile, Eligibility Only. The Eligibility Only profile is provided for groups who wish to view member eligibility only and no claims data. Groups may continue to use Auto Enrollment with Eligibility Only. Service representatives are being asked to discard any old versions of the ClaimsLink Addenda by October 1, 2004. Any former versions of the Addenda submitted after October 1 will not be applicable. Download the new Addenda under the Getting Started section.

	A new Claimslink message was recently added to the Autoenrollment process that says you do not have to request an ID card on newly added members. If Carolina Care Plan does not generate ID cards for your group, this message can be ignored. This is only a message and does not affect any of your currently defined processes.

	In response to numerous requests we have modified ClaimsLink's Auto Enrollment feature to allow you to make more than an ID request in one day. For example, you may change an address and then request an ID card for an individual on the same day and both transactions will be processed. The ID card request must be made AFTER all other changes are made. You do not need to request an ID card for a new add. The system will automatically generate one and mail it out the next day.

	What is HIPAA? HIPAA Law - in August of 1996, the government passed into law the Health Insurance Portability and Accountability Act(HIPAA). As part of the new law objectives were set to improve the efficiency and effectiveness of the American health care system. Within the HIPAA law, under Title II "Preventing healthcare fraud & abuse", subtitle F: Administrative Simplification identifies that the U.S. Secretary of Health and Human Service (HHS) is to develop standards the industry is to follow for: electronic transactions, unique identifiers, standard code sets, security and electronic signature, and privacy. In addition, HIPAA identifies penalties for not following the standards once enacted. Currently, the U.S Secretary of HHS has a final rule for Transactions and Code Sets and a final Rule for Privacy. The final rule for electronic transactions and code sets was published in the Federal Register on August 17, 2000. MMO has filed for the available one-year extension under HIPAA's regulations. Therefore the date of compliance is October 16, 2003. The final rule for Privacy was published in the Federal Register on December 28, 2000. Unless the regulations are modified or delayed, MMO will be required to use these standards by April 14, 2003. How has ClaimsLink changed for HIPAA compliance? When you are looking at the policyholder summary screen you will notice that any dependent that has chosen to keep their information private is highlighted in red. Second, on the claim header screen there is a new field called Privacy Indicator. If the dependent has opted for privacy the word 'Private' will appear. Lastly, the same privacy indicator shows on the member detail screen. In addition to the privacy indicator on the member detail screen the dependent address will also appear. This allows you to know where any information regarding the health insurance for that dependent has been sent. If you have any questions please contact your account representative for more information.

	In response to numerous requests we are now offering an audit report to auto enrollment users. This report allows the user to enter a date range up to 30 days prior to the current date. The resulting report contains a record of all transactions made during the chosen period. This Audit report will show users all information for policyholders and dependents that have been entered. The information shown is not limited to just what was changed, but provides the entire record for verification. The report also includes the ClaimsLink user ID for the person who made the changes. The report is sorted by transaction date and group section number for the specific group chosen. For automated enrollment customers who wish to access this report please click your "Auto Enrollment" tab at the top of your screen. Click the "Run Audit Report" button to launch the form. Fill out the form and then click the "Submit" button.