Electronic Claim Status

You now have the ability to check Claim Status through the Department of Human Services (DHS) Web Site. To obtain the claim status response (277 transaction) a Trading Partner Number and password is required. If you do not have a Trading Partner Number, please download the Trading Partner Agreement form, complete, and mail for processing to the address provided on the last page of the agreement. 

For your convenience DHS/EDS has made available a crosswalk of RI Medical Assistance explanation of benefits (EOB’s) to HIPAA EOB’s that are displayed in the claim status response. This list can be found by selecting HIPAA from the DHS menu, and then selecting EDI. Double click on the Claim Status Response - Explanation of Benefits List that may be printed for your reference. 

The DHS web site is available 24 hours a day to obtain client eligibility, claim and prior authorization status, your remittance advice payment amount, and for National Drug Code searches. 

For any questions, please contact the customer service help desk at 401-784-8100 for local or long distance or dial 1-800-964-6211 for in-state toll calls and bordering communities. 

2003 Provider Satisfaction Survey Results

Thank you to the providers who recently responded to the EDS 2003 Provider Satisfaction Survey. The ninth annual Survey was conducted in January 2004 to gather feedback on our performance as the Fiscal Agent for the Rhode Island Medical Assistance Program. The surveys were mailed to a random sampling of 580 providers; 28% of the providers responded, including hospitals, physicians, nursing homes, behavioral health providers, dentists, pharmacies, and other service providers.

The results are positive. 96% of the respondents are satisfied with EDS’ performance as Fiscal Agent for the Rhode Island Medical Assistance Program. Our service and accessibility received high marks from the respondents. We are glad for the positive responses because they validate our continued focus on timely, accurate processing of claims, effective customer service, and our 2003 focus on meaningful provider support for the transition to HIPAA compliant transactions. 

2003 was a challenging, busy year for you and us due to the implementation of HIPAA compliant transactions. Phone calls to the Customer Service Help Desk increased 26%. You heard HIPAA news from us often through the monthly Provider Update, 4 HIPAA related mailings, 22 workshops and Labs. Thank you for your responsiveness and participation. Our 2003 Survey included questions on our HIPAA support. You’ll see all the 2003 Survey results on page 4. Some highlights are discussed below.

The surveys also show us areas for improvement and provide suggestions for our service to you. The comments are very helpful and range from “You are the best insurance payer we deal with” to questions and suggestions on provider reference manuals, suspended claims, continued workshops and the Remittance Advice. 

You will find it interesting that we learned through the 2003 Survey that 79% of the respondents had access to the Internet. Access to the Internet enables providers to check client eligibility, claim status, prior authorization status, and scheduled financial payments for the Medical Assistance Program through the DHS web site. In upcoming weeks, you will see new features and enhancements to the available Web functionality; our goal is to tailor the Web transactions to be an efficient 24 by 7 resource for your daily operations. Please be on the look out for future news in upcoming Provider Updates.

2003 Provider Survey Results

Provider Services

Customer Service Help Desk (CSHD) and Provider Representatives

• Over 96% of the respondents are satisfied with the accessibility of the CSHD and 99% are satisfied with the professionalism of the CSHD. Our team answered 181,766 calls in 2003, including calls to the Help Desk, provider representatives, and over 10,000 calls for electronic billing and Trading Partner Agreement support. The 2003 phone call volume was 26% higher than total incoming calls in 2002. The highest volumes of calls were for the status of hospital and physician claims and dental limits. 97% of all incoming calls were answered, exceeding the industry standard.
  

• Our HIPAA support received high marks: Over 98% of the responding providers are satisfied with the availability of our HIPAA workshops and 96% are satisfied with the clarity of our 2003 written HIPAA communications. Also 97% of the respondents are positive about the phone and representative support for the HIPAA implementation
  

• 97% of the respondents are satisfied with the quality and relevancy of information contained in the provider update. Please know we welcome suggestions from you on topics or information that would be helpful to you for future updates.

Claims Processing

In 2003, EDS processed 5,620,160 claims:

• 95% of the respondents are satisfied with the timeliness and accuracy of electronic claims 
  

• There was a 7% increase in satisfaction from 2002 in the comparison of our Claims Processing compared to Other Insurers.

In 2004 we are committed to provide you responsive, excellent service from the correct, efficient processing of claims to quality information and support obtained through the Department of Human Services Website and our Customer Service Help Desk and Provider Representatives. Feedback from you helps us focus on your needs. Click here to contact the Rhode Island Customer Service Helpdesk

	Total %	5	4	3	2	1
	5,  4,  3	Superior	Good	Satisfied	Fair	Poor
Accessibility of Customer Service HelpDesk	96%	37%	50%	10%	2%	1%
Accuracy and Clarity of Customer Service Help Desk	94%	26%	55%	12%	6%	0%
Courtesy and Professionalism of Customer Service Help Desk	99%	50%	43%	7%	1%	0%
Timeliness of Claims Research Inquiries	90%	21%	52%	18%	8%	1%
Timeliness of Provider Enrollment Process	91%	15%	52%	24%	6%	3%
Customer Service Compared to Other Insurers	94%	32%	51%	11%	5%	1%
Accuracy and Clarity of Provider Representatives	93%	25%	54%	13%	5%	3%
Provider Representatives Give Consistent Information	92%	23%	54%	16%	6%	1%
Courtesy and Professionalism of Provider Representatives	98%	38%	49%	10%	3%	0%
Accessibility of Provider Representatives	93%	27%	49%	16%	4%	3%
Timeliness of Response from Provider Representatives	92%	24%	48%	20%	6%	3%
Effectiveness of Provider Relations Workshops	91%	17%	55%	18%	6%	3%
Frequency of Provider Relations Workshops	85%	9%	45%	31%	11%	4%
Quality and Relevancy of Information contained in the Provider Update	97%	19%	57%	22%	2%	1%
Quality of Billing Assistance Obtained from Provider Representatives	90%	21%	51%	18%	8%	3%
Timeliness and Accuracy of Paper Claims	83%	4%	46%	34%	9%	8%
Timeliness and Accuracy of Electronic Claims	95%	30%	52%	13%	3%	1%
Clarity and Value of Explanation of Benefits on the Remittance Advice	89%	15%	43%	31%	8%	4%
Timeliness of Claim Resolution	79%	5%	37%	38%	11%	10%
Claims Processing Performance Compares to Other Insurers	90%	24%	47%	20%	4%	5%
EDS Performance As Fiscal Agent for the RI Medical Assistance Program	96%	21%	56%	18%	4%	0%
Clarity of Reference Manuals	93%	14%	53%	26%	5%	2%
Clarity and accuracy of Website informtion	93%	15%	53%	25%	4%	4%
Total %	92%	22%	50%	20%	5%	3%

Additional 2003 Survey Questions

Total %