PINNACOL Provider Portal User Guide

Provider Portal
User Guide

Provider Portal

More patient time, less phone time.

Pinnacol’s provider portal gives you secure, convenient access to online resources. Once you register, you can:
// check claims status
// search bills, bill history, and print EOBs
// appeal a bill and upload supporting documentation
// search active Pinnacol policies
// request clinic designation, clinic profiling and opioid prescribing reports (not available to all providers)
// email Claim and Medical Reviewers from the claims search
// make a referral to return to work consultants
Working with Pinnacol has never been easier. Pinnacol’s provider portal is available to all providers who treat Pinnacol injured workers. Our customer service and provider relations teams are still here to provide personalized, compassionate customer service over the phone or by email.

Registration

Before users can log in to the provider portal, they must complete registration. Registration is a multi-step process.
STEP 1: Visit the portal at providerportal.pinnacol.com or click on Provider Portal in the upper right corner of provider.pinnacol.com.
STEP 2: Click on Not a member. Complete the fields and submit. You may be contacted by a Pinnacol employee who will verify your information and approve your registration request.
STEP 3: You will receive an email with a link to the provider portal. The link is only good for 24 hours. Click the link to sign off on the terms and conditions and create a password.
STEP 4: From the portal home screen, click on the Add Tax ID button. A pop-up window will appear where you can enter the Tax ID number for your primary or physical location. You can add additional Tax IDs by clicking on the Add Tax ID button again. Users must submit a bill Id for each Tax ID. Enter the bill number from an explanation of benefits (EOB) received within the past 120 days.

Search Bills

Users can search submitted bills either in groups or individually.
STEP 1: From the home screen, click on Search Bills. STEP 2: Select a Tax ID from the drop-down menu. If users are only associated with one Tax ID, it will default to that Tax ID. Then enter valid search criteria in at least one of the search fields in the web form. Users may enter a claim number, EFT/check number, bill Id or dates of service. If users are searching for bills by date of service, enter both the start date and end date. Searches are limited to 30 days’ worth of bills at a time.
STEP 3: Click on Search to receive results. STEP 4: Click on a bill Id to view bill details. STEP 5: If the bill status is closed, the user can click Print EOB. EOBs are only available for closed bills.
STEP 6: The EOB opens in a new tab and can be saved or printed using the download or print buttons in the upper right of the browser. STEP 7: From the results, click on Print EOB and a new tab with that EOB will open. To print another EOB, go back to the original tab and click Print EOB on another bill.
STEP 8: From the Search Bills tab, search by EFT/Check number to see all bills associated with a specific EFT/Check number. Multiple pages of results may be returned. During a session, users can move within tabs and previous searches can be re-executed. When you logout, the search info will be cleared.
If you have questions about a specific bill, please contact the Pinnacol bill processor listed on the explanation of benefits (EOB).

Search Claims

Users can obtain detailed claim information or determine whether a claim has been filed.
STEP 1: From the home screen, click on Search Claims. STEP 2: Search for a specific claim or group of claims by entering at least three pieces of valid criteria in the search form. Users can enter a specific claim number, the date of injury, a policy number associated with the claim, or the injured worker’s last name, Social Security number or date of birth.
STEP 3: Click on Search to receive results. STEP 4: Click on a claim number to view claim details. STEP 5: Click Print to generate a PDF of the claim. The PDF opens in a new tab and can be saved or printed using the download or print buttons in the upper right corner of the browser.
STEP 6: Scroll to the bottom of the results window to view Medical Reviewer name, phone number and email address.
STEP 7: If no Medical Reviewer is assigned to the claim, the user will see this message: STEP 8: Click Claim Reviewer or Medical Reviewer email link to open an email to that address.
During a session, users can move within tabs and previous searches can be re- executed. When you logout, the search info will be cleared.
If you have questions about a specific claim, please contact the Pinnacol Claims Representative or Medical Case Reviewer assigned to the claim.
If you have questions about a specific claim, please contact the claim reviewer or medical reviewer assigned to the claim.

Search Active Policies

Users can search by policy number or policy name to verify an employer has an active policy with Pinnacol.
STEP 1: From the home screen, click on Search Active Policies. STEP 2: Enter the policy number or policy name.
STEP 3: Click on Search to receive results. During a session, users can move within tabs and previous searches can be re-executed. When you logout, the search info will be cleared.
Note: Policy status is based on information we have at the time the search was conducted. Please check this site frequently to confirm the status, as it may change. Due to factors beyond our control, such as delayed reporting, we cannot guarantee the accuracy of the information retrieved on this site, including whether a listed policy was in effect at the time of an injury.

Request Reports

Pinnacol produces various reports for provider use. Availability is based on network participation and type of provider. If eligible, users can subscribe to automatic monthly reports, which are sent monthly to the report requester’s email address.
When a user has more than one Tax ID, the option to select a Tax ID is now required before subscribing to reports. A selection is only required if the user has more than one Tax ID.
STEP 1: From the home screen, click on Request Reports.
STEP 2: Select a Tax ID if more than one is available. STEP 3: Click on the slider box for the reports you wish to receive, and a check mark will indicate that you are now subscribed. Click on the slider box again to unsubscribe, and the check mark will disappear. Be sure to click Save Changes.
STEP 4: Click Unsubscribed on the Designation Report to see the available clinic options. Scroll to see additional options. STEP 5: Click Unsubscribe on any clinic if the report is wanted. The selection will change to subscribed.
STEP 6: Click Save Changes to finalize your selections and receive a confirmation. At least one clinic must be selected to save changes and request a designation report.

Refer to Return to Work

Users can generate a direct referral to a return to work consultant by clicking on the return to work icon from the home screen within the Provider Portal.
This opens a new screen where your username, email and phone number are prefilled. These entries can be edited if necessary. After the claim number, the injured worker’s name, your clinic name and the reason for the request are inserted, click submit. A green flash bar will appear at the top of the screen to indicate the request has been sent.
A Pinnacol return to work consultant will contact the requester within two business days to start the process.
They’ll help identify appropriate modified-duty tasks for the injured worker and educate the employer about working with restrictions, facilitating a safe return to work outcome for your patient.

Clinics/Practitioners

Users can view clinic information for multiple Tax IDs. A roster of credentialed providers can be viewed by clinic location. Updates can be made from this tab.
STEP 1: From the home screen, click on Clinics/Practitioners. STEP 2: From the drop-down menu, select a Tax ID to receive results.
If users are only associated with one Tax ID, it will default to that Tax ID. STEP 3: Click on the drop-down arrow to display clinic or practitioner detail.
STEP 4: Select the practitioner detail to view providers associated with the selected clinic.
STEP 5: The practitioner credentialing status is indicated. “Current” indicates the practitioner’s recredential date is more than 120 days in the future. “Needs renewal” indicates the recredentialing date is within the next 120 days. “In Progress” indicates the practitioner is currently going through credentialing.
STEP 6: Click Edit Locations to update the clinics associated with a practitioner. STEP 7: Click Add New Practitioner to access required credentialing documents and for instructions to credential a new provider.
STEP 8: Click Remove to request a practitioner be removed from a specific clinic. Multiple selections can be made at one time.
STEP 9: Click Next to continue. STEP 10: After adding or removing a practitioner from a clinic a window opens. It requires the user to indicate the effective date and reason for change. After the user has made changes, click Save.
A pop-up notifies the user the request has been submitted.
STEP 11: Click Remove All to request a practitioner be removed from all clinics associated with the selected Tax ID. A pop-up will indicate that removing the practitioner from all clinics will remove the practitioner from the SelectNet contract.
STEP 12: Click Next. The user must indicate the effective date and reason for the changes as above.

Manage My Tax IDs

Users can set up and manage additional Tax IDs using our portal.
STEP 1: From the home screen, click on Manage My Tax IDs. STEP 2: Click on the ADD Tax ID button. Users must submit a bill Id for each Tax ID. Enter the bill number from an explanation of benefits (EOB) received within the past 120 days.       STEP 3: To deactivate a Tax ID, click on the down arrow to the right of the Tax ID and select Deactivate.

Contact Pinnacol

Users can submit a question or comment to our provider network management team.
STEP 1: From the home screen, click on Contact Us. STEP 2: Enter a subject and description in the open text fields. Both fields are required.
STEP 3: Click on Submit and our team will contact you soon.

Appeal a Bill

Users can initiate a bill appeal from the portal and receive confirmation of the appeal request.
STEP 1: From the home screen, click on Search Bills. STEP 2: Select a Tax ID from the drop-down menu, then enter the bill number.
If users are only associated with one Tax ID, it will default to that Tax ID.
STEP 3: Click on Search to receive results. Click on a bill Id to view bill details. A pop-up window will appear. Click on BILL DETAIL. STEP 4: From the bill detail screen, click on the Appeal button. If this button does not appear, this bill is not eligible for online bill appeal.  STEP 5: A pop-up box will appear. Select the Appeal Reason from the drop-down menu. STEP 6: Enter a comment about the bill appeal. STEP 7: Uploading supporting documents is optional. If files are uploaded, a window opens and indicates a file has been uploaded. Click Done to close the window. STEP 10: A pop-up indicates the appeal was submitted and the bill detail will indicate the bill is in appeal.
Users can submit documentation to complete the appeal by fax, 303.361.5820, or mail the documents to Pinnacol Assurance, 7501 E. Lowry Blvd., Denver, CO 80230.
Visit provider.pinnacol.com/resources/how-to-appeal-a-medical- bill.com to initiate a manual bill appeal.

Access Credentialing Forms

Credentialing forms and instructions are available to print or download.
STEP 1: From the home screen, click on Clinics/Practitioners. STEP 2: From the drop-down menu, select a Tax ID to receive results.
If users are only associated with one Tax ID, it will default to that Tax ID. STEP 3: Click on the drop-down arrow to display clinic or practitioner detail.
STEP 4: Select the practitioner detail to view providers associated with the selected clinic. STEP 5: Click on Add New Practitioner.
STEP 6: A pop-up displays the 3 required credentialing documents. Click on each document to view and download. Instructions on credentialing are displayed.

Glossary of Terms

Bill: Provider billing and payment information, searchable at the claim and Tax ID.
Bill Pay Report: Shows clinics a history of billing and payment trends for the most recent rolling 12 months.
Report also shows top 5 reasons for bill line denials and top 5 reasons for bills appealed online. Under the top 5 reasons for bill line denials, claim information is provided to easily see which bills may need to be resubmitted.
Claim: Information about the injured worker’s case, such as claim number, date of injury and employer.
Claims Reviewer: The Pinnacol employee who guides injured workers and policyholders through the claims process. This includes investigation, coordination of care, authorization of benefits, and claims settlements.
Clinic Profiling Report: This report is meant for your practice’s use only. This report includes data related to the number of visits, therapy, TTD days, surgery, and claim costs for different types of body parts and compares that information with other SelectNet provider clinics.
Designation Report: This report is only available for PCP clinics. It provides contact information for employers who have designated the clinic to treat their injured workers and assists the PCP with client-focused marketing efforts. Report includes designations that were added within the last 90 days, designations auto-assigned in the last 90 days and all active designations within the last 12 months.
EOB: The explanation of benefits is a statement sent by Pinnacol to explain the medical treatments and services paid on the injured workers’ behalf. The form usually accompanies a check or electronic payment.
Injured worker: Commonly used term to refer to injured or ill worker or employee who is receiving treatment under workers’ compensation insurance.
Medical Reviewer: The Pinnacol employee who serves as a liaison between medical providers and injured workers by planning and coordinating healthcare services with the goal of rehabilitation.
Opioid Prescribing Report: This report shows your opioid prescribing history with Pinnacol injured workers.
Report displays aggregated data on prescribing patterns over the past 2 years and compares individual provider data with that of your peers.
Pinnacol.com: Pinnacol’s website.
Policyholder: A person or group in whose name an insurance policy is held. Sometimes also referred to as “employer.”
Provider portal: Offers secure online access to view and search sensitive claim and billing information, file billing appeals, request reports and reach out to service teams.
Provider portal home screen: The main landing page of Pinnacol’s provider portal.
Tax ID: Federal Tax ID Number (required for portal registration).

Resources

1. Pinnacol.com houses myriad resources for navigating workers’ compensation processes. provider.pinnacol.com
2. Workers’ Compensation Basics course, Module 8: Pinnacol Processes: pinnacol.com/events-training/workers-compensation-basics-for-providers
3. How to appeal a bill: pinnacol.com/appeal-bill
4. Choosing a designated provider: pinnacol.com/knowledge-center/choosing-designated-medical-provider

Contact us:
Provider Network Management: 303.361.4945, provider_management@pinnacol.com
Billing: 303.361.4820
Pinnacol Customer Service: 303.361.4000

Pinnacol Assurance
Provider Portal User’s Guide

References

• Workers' compensation insurance | Pinnacol
• How to appeal a medical bill
• Workers’ compensation basics for providers | Pinnacol
• Workers' compensation insurance | Pinnacol
• Providers | Pinnacol Assurance
• providerportal.pinnacol.com

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