Transcription of OPTIMUM TRAINING MANUAL
1 OPTIMUM TRAINING MANUAL OPTIMUM TRAINING NOTES Please make sure that your practice is registered to use the OPTIMUM website. This website allows you to: VALIDATE MEMBERSHIP CONFIRM BENEFITS capture CLAIMS REJECTIONS VIEW CLAIM LISTING AND RESUBMISSIONS VALIDATE-IT CREDIT NOTES VIEW REMITTANCES RECEIVE PPN NEWS/UPDATES OPTIMUM SUPPORT 1. HOW TO REGISTER: Contact Denise Johnson at PPN on 041-506 5938 or request one of the agents at the PPN call centre on 086 0103 529 or 086 1101 477 to fax the registration form to your practice.
2 Once you are registered as a user, you can LOGIN to the website: 2. HOW TO LOG IN: Enter the Practice Number, Username and Password and then CLICK on Proceed **NB: PLEASE READ THROUGH THE INFORMATION ON THE LOGIN PAGE WHICH WILL LIST THE MEDICAL AIDS THAT CAN NOT BE CAPTURED ON OPTIMUM . THE FOLLOWING HOME PAGE WILL BE DISPLAYED INCLUDING LINKS TO RECENT NEWS, HELP & TRAINING : 3. PPN NOTIFICATIONS Should there be any new PPN Notifications; a pop up box will appear.
3 Click CONFIRM once you have read the notification and it will not pop up again. Click IGNORE if you wish not to read immediately but would like to read the next time you log in. 4. HOW TO VALIDATE A MEMBER CLICK ON MEMBERSHIP VALIDATION TO EITHER VALIDATE A MEMBER OR TO CONFIRM BENEFITS: After completion; click on SEARCH to VALIDATE the MEMBERSHIP NUMBER. The next screen should automatically be displayed. If NOT, and the screen is not responding, the incorrect information was supplied and the membership is NOT VALIDATED as example below, phone the PPN call centre on 086 0103 529 for assistance.
4 Should the correct information be supplied, the following screen will be displayed confirming the dependant s membership details. IMPORTANT INFORMATION: When entering: BANKMED & POLMED the membership number MUST have 9 digits; add 00 in front of the membership number until it is 9 digits. Please ensure you capture the Carecross Bankmed Basic under Carecross Bankmed Basic and NOT under Bankmed BP SOUTH AFRICA the 0 in front of the membership number falls away. All the other Medical aid numbers should be entered as displayed on the MEMBER Medical aid card.
5 5. HOW TO CONFIRM BENEFITS: Once the Membership has been validated, you can click on the AVAILABLE BENEFIT ICON, allocated under options on the right hand side of the page to confirm the benefits available. When the line item displays (No Benefit available) , then the member has used his benefit entitlement within his current benefit cycle and he has no benefits available at that point in time. The dates on which the member will be in benefit again will be displayed at the bottom of the page as per the below screenshot reflects: Should the member have available benefits it will be displayed as in the screen shot below: 6.
6 HOW TO CLAIM A capture : To go to the capturing screen by selecting one of 2 options: a. Option 1 - Click on the capture CLAIM ICON on the right hand side b. Option 2 - Click on the CLAIM capture TAB at the top of the page The following screen will be displayed complete the Practice & Invoice information and click on VALIDATE MEMBERSHIP to continue: Group practices only: The Optom # field has been added to the capturing site for those practices operating under a group practice number. Group practices MUST specify the optometrist number of the optometrist that consults the patient.
7 Normal optometric providers will ignore this field. Discounts on your invoice: If you have to capture a discount amount on your invoice, then please check the Discount Apply block to activate the discount column on the capturing screen. Click on Validate Membership. This screen will extend, please select the correct dependant as well as who the payment should be made to: Practice or Patient. Click on Validate Patient. Once you have clicked on Validate patient you will enter the Line Item Information: Please ensure that you have ticked both tick boxes before clicking on the Submit icon.
8 The claim will not be submitted should these tick boxes be left unchecked. Remember to invoice the following: 1. Correct tariff structure PPN1/2 2. ICD 10 information 3. Correct pricing as per the tariff structure 4. Script, VA, Visual Fields, IOP, NVS tag and Lab information Important script validations Sphere can be either Plus (+) or Minus (-) Cyl ALWAYS Minus (-) , can never be Plus (+) Axis between 1 and 180, can be a decimal ( : ) Add ALWAYS Plus (+), can never be Minus (-) Prism can be a decimal ( : ) Base should be alpha characters V/A must be either a fraction (6/6) or a decimal ( ) cannot be a single digit only (.)
9 1 or 6) IOP cannot be a fraction (6/6), but it can be a decimal ( : ) Visual Fields can never be 0 or a slash only (/), a dash (-), a hash (#) or a comma (,) Example: Full / Normal / Compromised / NAD / WNL 150/80, 155/85 Script examples: When capturing the script, only complete the fields that are supplied 1. If the lens prescription is plano - capture only under the Sphere and leave the remaining fields BLANK 2. If the lens prescription is + - capture + under the Sphere and leave the remaining fields BLANK (never capture the cyl or axis as or 0) 3.
10 If there is no reading add capture only the prescribed information and leave the reaming fields BLANK 4. If there is a cyl script, then the AXIS must be captured and vice versa Ready Made Readers: Should a patient claim for Ready-Made readers as well as either spectacles, or contact lenses, please advise the member that the spectacles / contact lenses will be processed for payment by the Medical Scheme and the ready-made readers will form part of their co-payment. Lab Information: Lab Name select the lab from the drop down box - if selecting lab 131 (Other), please specify the lab details in the notes facility on the capturing screen Order Number supply the order number used to order the lenses from the lab.
