SCAN Member Eligibility & Benefits Interactive Voice Response (IVR) 

Available 24 hours a day, 7 days a week



Toll free number is 877-270-SCAN (7226)

Online Eligibility Verification 

For initial setup, contact the SCAN Administrator at 888-450-7226 or [email protected]



Once you have an account, go to www.scanhealthplan.com, click on CA Provider Tools and then Eligibility Lookup.

SCAN® ILP Ancillary Provider Operations Manual Revised: October 2010

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SCAN® ILP Ancillary Provider Operations Manual Revised: October 2010

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Authorizations New Services Provider will receive a SCAN Referral for each new service authorized to be provided to a member. The Referral will include the member’s name, address, telephone #, description of services and number of services/per month (e.g. 3, 4hr personal care visits/per month). This Referral will be faxed to Provider and then followed within 3-5 days with a hard copy Authorization to confirm services to be provided.

Notice of Service Changes and/or Cancellations If an Authorization is changed for any reason during the month, Provider will receive notice via e-mail. If services are cancelled for any reason during the month, Provider will receive a phone call and a notice via e-mail.

Ongoing Services On or about the 20th of each month, SCAN will run an Ongoing Authorization Summary Report, which will reflect services to be rendered during the following month (e.g. report run July 20th will be for August services.) The Ongoing Authorization report will be emailed to Provider. If Provider does not receive the report, please send an e-mail to [email protected] or call 562-997-1516.

Authorization Questions If Provider has any concerns regarding SCAN Authorizations or requires another copy of their Provider Authorization Summary Report, please send an e-mail to [email protected] or call 562-997-1516.

Daily Summary Reports and Ongoing Authorization Reports via E-Mail All ILP authorizations are submitted to our Providers via e-mail, these reports include Daily Summary Reports, Cancellations and Ongoing Authorization Reports. These documents will be available for Provider to open and print out in two (2) versions, Excel, which will allow Provider to sort and manipulate the data and in an Acrobat PDF format. In order to comply with HIPAA regulations, all e-mails transmitted are password protected and encrypted via WinZip. Provider must have access to the most recent WinZip program, Adobe Reader and Provider’s system must allow the receipt of encrypted files. Passwords will be provided by SCAN Ancillary Contract Specialist. Please note that Provider is responsible for distributing this information to Provider’s internal department contacts and/or distributing to different locations, as necessary, in order to ensure that authorized services are provided, and billings and required account reconciliation are performed timely. SCAN® ILP Ancillary Provider Operations Manual Revised: October 2010

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Authorizations Reports “Samples” ILP Referral Form Please note that this same form is used to indicate initial referrals, changes in Authorized services as well as cancellation of services. Reference made in the section entitled Services will provide the specific purpose of the form. Date:

Urgent:

7/21/06

From:

Scan Staffing Coordinator and planner name here)

To:

(Provider Contact Name Here)

Phone:

Phone number of planner here

(Provider's Name Here)

Fax:

Fax # of agency

Jane Doe

Member ID:

123456789-01

7894 Any Street

Height:

Company Client Name: Address: Address 2: Cross Street: City, State: Zip:

Languages Spoken: Sunyvale and Clover

Pets (Type and #)

City, CA

Home Phone:

Mary Doe

Relationship:

Daughter

Phone:

Contact (for arrangements):

(XXX) 803-9876

Diagnoses: Medications: Diet Restrictions: Limitations: Service Type: Homecare

Physician:

F

Sex:

English Smokes:

None

Yes

(XXX) 803-5678

Jane Doe

Phone

Phone:

Dr. Smith

(XXX) 803-5678

(XXX) 987-6654

Members diagnoses entered here No longer required. None

Date Services to Begin:

7/1/06

Cancellation of services with the LDOS on 7/6/06, 4 visits were provided as per (Fist and last name of person @ agency giving information.

Service Code S9122 U4

110

90012

Emergency Contact Name:

Services:

Weight:

5' 1"

01-01-1929

DOB :

Last Authorized Date of Service: Authorization #:

7/6/06 xxxxxxxxx

Copay/Unit

Co-Pay

Cost/Unit

Amount

Members per visit co-pay

Total co-pay per auth

Contracted rate here

Amount SCAN will pay.

Expected Duties: Personal Care

Homemaker

Expected duties listed here

Expected duties listed here

Access Instructions or other Special Instructions (HOLIDAYS NOT AUTHORIZED): PERSONAL CARE PLANNER: DO NOT CHANGE SERVICES SCHEDULE WITHOUT PRIOR AUTHORIZATION OF Personal Care Planner Phone number (800) 207 – 1054 Facsimile (562) 989-0719

SCAN® ILP Ancillary Provider Operations Manual Revised: October 2010

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Ongoing Authorizations Report

SCAN® ILP Ancillary Provider Operations Manual Revised: October 2010

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ILP Authorization Report CONFIDENTIAL

Run Date: 01/03/2008 Page 1 of 1

ILP Provider Authorization Summary Report ABC PROVIDER – Any Where USA (001234)

Please verify Member Eligibility every 30 days at (877) 778-7226 Include eligibility confirmation number on claim form.

Member Name Auth # Svc Code Amt Total Amt

Svc Description

Svc Start

Svc End

# Visits

Cost/Unit

Copay /Unit

Copay

Doe, Jane: 31000000001, DOB 05/18/1921, Medical Group ABC Medical Group – Any Where USA SR1111 S9122U2 $80.00

HOME HEALTH AIDE 03/01/2008

03/31/2008

4

$35.00

$15.00

$60.00

2hr pc max 4

SCAN® ILP Ancillary Provider Operations Manual Revised: October 2010

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Claims Payment Claims Guidelines Our goal is timely accurate payment of Provider’s claims and to ensure that, DON’T FORGET that: 1. All claims must be submitted on appropriate billing forms (CMS1500 or UB04). 2. All claims must be computer generated or typed. No handwriting except signature on claims will be accepted. 3. All claims must be signed. 4. All claims submitted to SCAN must be accompanied by the following: 

SCAN Authorization number (Authorization numbers change monthly, the correct authorization number must be entered per authorized dates of service)



SCAN Provider ID# (a unique six digit SCAN ID number assigned for each standalone site within your organization that provides services to SCAN members)

Claims received by SCAN without this information will be returned for correction. 5. Claims are paid within the timeframe specified in the respective Ancillary Services Agreement between SCAN and Provider.

Claims Status 1. Claims Customer Service – Status Line: (800) 307-8003 2. Claims submitted to SCAN take approximately 2 weeks to appear in our system. DO NOT re-submit claims to SCAN until after this timeframe and after Provider has called the Claims Customer Service Status Line or used the Provider Tools website at www.scanhealthplan.com to confirm whether Provider’s claims have been received; this will only delay Provider from receiving timely payment. 3. Online Claims Status: Claims status may also be checked online via our Provider Tools website. To set up a log-in account and password please call (888) 450-7226 or contact Provider’s designated SCAN Ancillary Contract Specialist for assistance. 4. Payments Received: Payment to Provider is accompanied by a Remittance Advice, which details claims being paid by that check. Upon receipt of payment, Provider is responsible for auditing this Remittance Advice for accuracy. In the event that SCAN® ILP Ancillary Provider Operations Manual Revised: October 2010

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Provider questions any payments made, Provider is to contact the Claims Customer Service line at (800) 307-8003.

Process for Filing a Claims Appeal/Dispute Each claim appeal/dispute submitted must include the following: 1. Name of Provider and Provider contact information 2. The date(s) of service 3. A clear identification of the disputed item(s), including a clear and concise explanation of the basis upon which the Provider believes the payment amount/ denial is incorrect, the expected outcome, and appropriate documentation included. 4. All appeals/disputes must be submitted in writing to: Claims Disputes/Appeals SCAN Health Plan P.O. Box 22698 Long Beach, CA 90801

Timeframes 1. SCAN will strive to acknowledge receipt of Provider’s claim appeal/dispute within 15 calendar days. In addition, SCAN will strive to resolve the appeal/dispute and send an outcome/decision letter to Provider within 60 calendar days of receiving complete information. 2. If Provider has followed the above process and continues to experience claims issues, please contact Provider’s designated SCAN Ancillary Contract Specialist for assistance. Provider’s SCAN Ancillary Contract Specialist will initially provide Provider with a claims paid report covering a specific timeframe in question that will allow Provider to reconcile accounts against our records. 3. Once Provider has reconciled accounts against the claims paid report, Provider’s SCAN Ancillary Contract Specialist will work as a liaison between the SCAN Claims Department, Provider and, if necessary, the Independent Living Power Authorization Department to ensure that all claims issues are resolved.

If Provider is interested in submitting claims electronically, please call our SCAN HIPAA EDI Hotline at 800-247-5091 x-8646.

SCAN® ILP Ancillary Provider Operations Manual Revised: October 2010

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Co-payments 1. Member’s Co-payments: SCAN members usually have a co-payment for Independent Living Power services. This co-payment varies by benefit plan. 2. SCAN members have an obligation to pay co-payments for services they accept. Providers are responsible for collecting any applicable member co-payments directly from the member. Provider billing to members must be for only the applicable copayment amount owed by member. Provider should promptly notify the Independent Living Power Department if a member becomes delinquent beyond 45 days in paying the required co-payment. SCAN will work with Provider to remind the member of his/her responsibility for payment of any applicable co-payment. Please do not let the problem build up over several months. It is more difficult to resolve satisfactorily when the co-payment debt has become large. 3. The amount of the co-payment per visit is shown on the initial Referral form that is faxed to Provider to initiate services. This co-payment is also on the Authorization, which is sent to Provider within 2-3 days following the initial Referral, and on the OnGoing Authorization Summary Reports via e-mail. The co-payment amount will not appear on the Remittance Advice that accompanies SCAN payment to Provider. 4. Provider cannot collect the co-payment in advance of providing the service, nor can Provider charge the member more than the amount of his/her SCAN designated copayments, or require “deposit” monies for services provided. 5. Providers will be reimbursed the contracted amount minus any applicable copayment. Gross amount should be specified on the claim form, as our health information system will automatically adjudicate the co-payment deduction.

SCAN® ILP Ancillary Provider Operations Manual Revised: October 2010

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Instructions for Completing CMS 1500 Forms When filing a claim on a CMS 1500, there are certain fields on the form that are required fields and must be completed in order for SCAN to process the claim for payment. Listed below are the required field numbers, along with explanations. The number of the field corresponds with the field number on CMS 1500 claim form.

Field #

Definition

1 1a 2

Program Insured’s ID Number Patient’s Name

3 4

Patient’s Date of Birth/Sex Insured’s Name

5 6 7 8 9 a-c 10a-d 11 11a 11b 11c 11d 12 & 13 14-19 20 21 22 23 24a 24b 24c 24d

Patient’s Address Patient Relationship to Insured Insured’s Address & Telephone # Patient Status N/A Patient’s Condition Insured’s Policy Group or FECA # Insured’s Date of Birth/Sex Employer’s Name or School Name Insurance Plan Name or Program Is there another Health Benefit Plan Patient’s or Authorized Person’s Signature N/A Outside Lab? Diagnosis or Nature of Illness or Injury Code Medicaid Resubmission Code Prior Authorization Number Date(s) of Service – From/To Place of Service EMG (Emergency) Procedures, Services or Supplies

SCAN® ILP Ancillary Provider Operations Manual Revised: October 2010

SCAN Required Entry Enter “X” in appropriate box Enter SCAN Member ID Number Enter Member’s Name (Last Name, First Name, Middle Initial) Enter Member’s Date of Birth and Sex Enter Member’s Name (Last Name, First Name, Middle Initial) Enter Member’s Address Enter “X” in box next to SELF Enter Member’s Address and Telephone # Enter “X” in appropriate box N/A – Leave Blank Response is NO to a-d, enter “X” in each Box next to that response N/A – Leave Blank Enter Member’s Date of Birth and Sex N/A – Leave Blank Enter “SCAN” Response is NO, enter “X” in Box next to that response Response to both is “Signature on File” and the claim date N/A - Leave Blank Response is NO, enter “X” in the Box next to that response Enter “780.99” N/A – Leave Blank Enter SCAN Authorization # Must Enter one date per line Enter “12” Enter “01” Enter SCAN Personal Service Code and Modifier (if Page 10 of 11

Field # 24e 24f 24g 24h& k 24i 24j

Definition CPT/HCPCS Modifier Diagnosis Code Charges Days or Units N/A ID Qualifier Rendering Provider ID#

25

Federal Tax ID Number - SSN/EIN

26

Patient’s Account Number

27 28 29 30 31

Accept Assignment Yes/No Total Charges Amount Paid Balance Due Signature of Physician or Supplier including Degrees or Credentials & Date Name and Address of Facility where services were rendered (if other than patient’s home or office) NPI of Facility where services were rendered Rendering Provider SCAN ID with Qualifier Billing Provider Info & Phone

32

32a 32b 33 33a 33b

NPI of Billing Facility Billing Provider SCAN ID with Qualifier

SCAN® ILP Ancillary Provider Operations Manual Revised: October 2010

SCAN Required Entry applicable) to describe the specific care provided Enter “780.99” Enter Contracted Rate Enter # of days or units, according to Authorization N/A – Leave Blank Enter ”G2” Enter your SCAN Provider Identification number (above NPI) Enter your Tax ID # and mark “X” in appropriate SSN or EIN box Enter member’s reference # assigned by your facility/agency Enter “X” in appropriate box Enter total charge Enter Amount Paid, if applicable Enter Balance Due Signature and Date

Enter Name and Address of facility where services rendered ( if other than member’s home) Enter NPI Enter “G2” followed by your SCAN Provider Identification number Enter Billing Name, Address, City, State, Zip Code and Phone # Enter NPI Enter “G2” followed by your SCAN Provider Identification number

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