Professional Web Portal Tutorial. Revised 5/11/17

Transcription

1 Prfessinal Web Prtal Tutrial Revised 5/11/17 1

2 Cntents PROFESSIONAL CLAIMS... 3 PROVIDER INFORMATION... 8 SUBSCRIBER/CLIENT INFORMATION... 9 CLAIM INFORMATION DIAGNOSIS CODES BASIC LINE ITEM INFORMATION EDITING OR DELETING A LINE ITEM ENTERING A NATIONAL DRUG CODE (NDC) Entering Rendering, Referring, Ordering, r Supervising Prvider Infrmatin SUBMITTING AN ATTACHMENT TO A CLAIM SUBMITTED THROUGH THE WEB PORTAL MEDICARE SECONDARY/CROSSOVER TPL (OTHER THAN MEDICARE) ADJUSTING A CLAIM

3 PROFESSIONAL CLAIMS Navigate t and select Prvider Select Prvider Prtal frm the left hand navigatin bar. 3

4 Enter yur User ID and Passwrd. Nte: If yu have nt yet registered fr the Web Prtal, yu must d this first. Reference the Registratin Tutrial r cntact EDI Services at fr assistance. 4

5 Select Claims. Select Create Prfessinal Template 5

6 Name the template If making a template fr each client, it is recmmended that yu name the template after each client i.e. Jane Smith. If making a template fr a cde, it is recmmended that yu name the template after the cde i.e r Office Visit. Nte: When creating a template nly fill ut thse selectins that are nt ging t change frm claim t claim such as NPI and taxnmy. 6

7 NOTE: If using this tutrial t create a claim t submit, make a selectin at each and fill ut the necessary additinal infrmatin. Nte: There are red + signs befre certain areas that allw additinal infrmatin t be entered. Selecting the red + sign will expand the area. Only expand and enter infrmatin that is required, as entering invalid/incrrect infrmatin can cause a claim t reject. The belw infrmatin will instruct yu in which areas are required t be cmpleted. 7

8 PROVIDER INFORMATION Are yu resubmitting this claim? Select Yes t submit a claim adjustment Select N if creating a template r submitting an riginal claim. BILLING/PAY-TO PROVIDER Prvider ID drpbx - Select the Billing/Pay-T Prvider s NPI Select the red + sign fr Additinal Billing Prvider Infrmatin and enter the Billing/Pay-T Prvider s taxnmy cde in the Taxnmy Cde bx Nte: Entering any additinal infrmatin in this sectin may cause yur claim t reject. Is the Billing Prvider r Pay-T Prvider als the Rendering Prvider? Select Yes if the Billing Prvider is als the Rendering Prvider Select N if the Billing Prvider is different frm the Rendering Prvider a. Prvider ID bx Enter the Rendering Prvider s NPI b. Select XX: Natinal Prvider Identifier frm the drpdwn bx c. Select the red + sign fr Additinal Rendering (Perfrming) Prvider Infrmatin and enter the Rendering Prvider s taxnmy cde in the Taxnmy Cde bx 8

9 SUBSCRIBER/CLIENT INFORMATION Is this service the result f a referral? Select Yes if this claim is the result f a referral a. Enter the Prvider infrmatin fr the referring prvider Select N if this claim is nt the result f a referral Recipient ID bx - Enter the Wyming Medicaid Client ID Des the subscriber have insurance ther than Medicaid? Select Yes if the client has insurance ther than Medicaid a. Please refer t the Medicare/Secndary Crssver r TPL (Other than Medicare) sectin fr directins n hw t cmplete this sectin Select N if the client des nt have insurance ther than Medicaid 9

10 CLAIM INFORMATION Select the red + sign fr Prir Authrizatin Prir Authrizatin number bx Enter the prir authrizatin number if necessary Is this claim accident related? Select Yes if claim is accident related a. Related Causes drpdwn-select the related cause b. Aut Accident State bx-enter the state where the accident tk place c. Accident Date bx-enter the date the accident tk place Select N if the claim is nt accident related Des this claim have backup dcumentatin? Select Yes if the claim has backup dcumentatin i.e. invice, p ntes, etc. a. Select BM: By Mail if sending the backup dcumentatin by mail i. If BM: By Mail is selected, enter the mst apprpriate selectin in the Type Attachment drpdwn bx b. Select EL: Electrnic Attachment Only if sending the backup dcumentatin electrnically Select N if the claim des nt have backup dcumentatin Patient Accunt N. bx Enter the patient accunt number Select the red + sign fr Additinal Claim Data. 10

11 Place f Service Select the apprpriate place f service frm the list Prvider Signature n File Select Yes Medicare Assignment Cde: Select the apprpriate assignment cde Benefits Assignment Certificatin Select Yes Release f Infrmatin Cde Select Y:Prvider Has Signed Release Patient Signature Surce Cde Select P: Signature generated by prvider; patient nt present fr services DIAGNOSIS CODES Enter all apprpriate diagnsis cdes. DO NOT use pints (perids) when entering the diagnsis cde BASIC LINE ITEM INFORMATION 11

12 Enter Service Frm T dates Place f Service drpdwn Select the apprpriate place f service Prcedure Cde/Mdifiers Enter the prcedure cde and any apprpriate mdifiers Submitted Charges bx Enter the submitted charges Diagnsis Pinters drp dwn bx Chse the apprpriate pinters Units Enter the number f units Select the Add Service Line Item buttn EDITING OR DELETING A LINE ITEM T edit a line item Select the number next t the line item that needs edited The infrmatin will reppulate under the Basic Service Line Items sectin Make any necessary changes Select the Update Service Line Item buttn T delete a line item Select the Delete link fr the line item that needs deleted ENTERING A NATIONAL DRUG CODE (NDC) Select the Other Svc Inf link fr the service line which needs an NDC 12

13 Select the red + sign next t DRUG IDENTIFICATION Natinal Drug Cde bx Enter the NDC Natinal Drug Unit Cunt bx Enter the unit cunt Unit Cde drpdwn Select the unit cde Entering Rendering, Referring, Ordering, r Supervising Prvider Infrmatin Select the Other Svc Inf link fr the service line which needs an NDC Select the red + sign next t the type f prvider infrmatin t be added Enter the Prvider s NPI in the Prvider ID Select XX: Natinal Prvider Identifier frm the drpdwn bx if a drpdwn bx is available SUBMITTING AN ATTACHMENT TO A CLAIM SUBMITTED THROUGH THE WEB PORTAL Des this claim have backup dcumentatin? Select Yes if the claim has backup dcumentatin i.e. invice, p ntes, etc. Once the claim is keyed, select the Verify Claim buttn. This will help identify any errrs that exist with the claim. Once any errrs are crrected if there are any, select the Submit Claim buttn. 13

14 MEDICARE SECONDARY/CROSSOVER Des the subscriber have insurance ther than Medicaid? Select Yes. 14

15 Select the red + sign fr Additinal Other Subscriber Infrmatin Claim Filing Cde drpdwn - Select MB: Medicare Part B Payer Respnsibility Sequence Number Cde drpdwn - Select P: Primary Nte: The Wyming Medicaid Web Prtal was nly built t allw ne additinal insurance besides Medicaid. If the client has mre than ne additinal insurance, please submit the claim n paper as an appeal stating why it cannt be billed thrugh the Wyming Medicaid Web Prtal alng with all necessary paperwrk t prcess the claim. Select the red + sign fr Other Insurance Cverage Benefits Assignment Certificatin - Select Yes Release f Infrmatin Cde drpdwn - Select Y:Prvider Has Signed Release Signature Surce Cde drpdwn - Select P: Signature generated by prvider since patient was nt physically present Payer/Insurance Organizatin Name bx Enter Medicare Entity Qualifier drpdwn - Select 2: Nn-Persn Entity Other Payer Primary ID bx - Enter Medicare ID Type drpdwn - Select PI:Payr Identificatin Adjudicatin Date bx - Enter the adjudicatin date COB Payer Paid Amunt bx - Enter the COB payer paid amunt Select the Other Svc Inf link fr each line separately 15

16 Select the red + sign fr Service Line Adjudicatin Other Payer Primary ID bx - Enter Medicare Service Line Paid Amunt bx - Enter the service line paid amunt Adjudicated r Pay Date bx - Enter the adjudicatin date Paid Service Unit(s) bx - Enter the units Prcedure Qualifier drpdwn - Select the apprpriate prcedure qualifier Prcedure Cde bx - Enter the prcedure cde Select eh red + sign fr Service Adjustment Adjustment Grup Cde drpdwn - Select PR: Patient Respnsibility Adjustment Amunt bx - Enter the adjustment amunt Adjustment Reasn bx - Enter the adjustment reasn cde a. 1 Deductible b. 2 Cinsurance c. 122 Psych Deductible Select the Add Line item buttn Select the Basic Claim Frm buttn t return t the Basic Claim Inf page Nte: When verifying a claim, if the errr cde 265 The recipient has TPL n file and n TPL amunt is indicated n the claim psts and the abve infrmatin has been entered, please submit the claim. 16

17 TPL (OTHER THAN MEDICARE) Des the subscriber have insurance ther than Medicaid? Select Yes Select the red + sign fr Additinal Other Subscriber Infrmatin under Other Subscriber Infrmatin Claim Filing Cde drpdwn Select the apprpriate insurance type Payer Respnsibility Sequence Number Cde drpdwn Select P: Primary Nte: The Wyming Medicaid Web Prtal was nly built t allw ne additinal insurance besides Medicaid. If the client has mre than ne additinal insurance, please submit the claim n paper as an appeal stating why it cannt be billed thrugh the Wyming Medicaid Web Prtal alng with all necessary paperwrk t prcess the claim. Other Payer Infrmatin 17

18 Payer/Insurance Organizatin Name bx Enter the name f the insurance Additinal Other Payer Infrmatin Entity Qualifier drpdwn Select 2:Nn-Persn Entity Other Payer Primary ID bx-enter the name f the insurance ID Type drpdwn Select PI:Payr Identificatin COB Mnetary Amunts COB Payer Paid Amunt bx-enter amunt paid by the insurance Select the Other Svc Inf link fr the 1 st line n the claim Select the red + sign fr SERVICE LINE ADJUDICATION Other Payer Primary ID bx Enter the name f the insurance Service Line Paid Amunt bx Enter the amunt paid by the insurance fr this line item Adjudicated r Pay Date bx Enter the paid date frm the insurance s EOB Paid Service Unit(s) bx Enter the number f units paid by the insurance Prcedure Qualifier drpdwn Select HC:HCPCS Prcedure Cde bx Enter the prcedure cde n this line item 18

19 Select the Basic Claim Frm buttn frm the bttm f the page and repeat the abve fr each line item ADJUSTING A CLAIM Are yu resubmitting this claim? Select Yes t submit a claim adjustment Resubmissin Type Cde bx Select 6:Adjustment ICN t Credit/Adjust bx Enter the ICN/TCN frm the claim t be adjusted Nte: If 7:Replacement is selected frm the Resubmissin Type Cde bx, this will vid the riginal claim and submit a clean new claim. This shuld nly be used when the riginally paid claim needs vided r the riginally paid claim s paid date is past the six mnth timely filing adjustment limit. 19