WINASAP: A step-by-step walkthrough. Updated: 2/21/18

WINASAP: A step-by-step walkthrough Updated: 2/21/18

Welcome to WINASAP! WINASAP allows a submitter the ability to submit claims to Wyoming Medicaid via an electronic method, either through direct connection over a modem or via upload through our website https://edionline.portal.conduent.com/edionline/redirect.action Minimum Requirements: Windows 98 (or higher) operating system Pentium processor 25 megabytes of free disk space 128 megabytes of RAM Monitor resolution 800 x 600 pixels If submitting via modem Hayes-compatible 9600-baud asynchronous modem and telephone connectivity If submitting via upload internet connection Note: WINASAP is stand-alone software it does not run on a network, and does not transfer information among users. Users can back-up their databases and restore them on the same or another computer as needed. You will need: EDI Welcome Letter If you do not have your welcome letter, contact EDI Services to have it resent 800-672-4959, press 3. Data Entry areas of each screen that must be completed are underlined. Information not underlined is optional. Each section of this tutorial will tell you the minimum information that must be entered in order for a claim to successfully transmit. 2

Table of Contents Chapter 1 Downloading and Installing WINASAP... 4 Chapter 2 Submitter Set-Up... 20 Chapter 3 Provider Entry... 25 Chapter 4 Client Entry... 36 Chapter 5 Diagnosis Codes... 41 Chapter 6 Procedure Codes... 44 Chapter 7 Modifiers... 47 Chapter 8 Condition Codes... 50 Chapter 9 Occurrence Codes... 53 Chapter 10 Surgical Codes... 56 Chapter 11 Value Code... 59 Chapter 12 Building a Professional Claim (claims billed on the CMS-1500 form when on a paper claim)... 62 Chapter 13 Institutional Claims (claims that would be billed on the UB04 claim form if sent on paper)91 Chapter 14 Creating a Dental Claim (claims that would be billed on the ADA claim form if billed on paper)... 116 Chapter 15 Building a Nursing Home Template and Generating Nursing Home Claims... 135 Chapter 16 Submitting Claims via dial-up... 166 Chapter 17 Billing through EDI Online... 177 Chapter 18 File Maintenance, Updating and Deleting Claims and Troubleshooting... 185 3

Chapter 1 Downloading and Installing WINASAP Navigate to the Wyoming Medicaid website at https://wymedicaid.portal.conduent.com. Choose Provider at the bottom of the screen. 4

From the left hand menu, select WINASAP. 5

Scroll to the bottom of the page and choose the Download WINASAP button. This will take you to the web site to download the WINASAP software. 6

Select Software Downloads 7

Choose the link for the WINASAP5010 software. Please note, depending on your operating system and web browser, the following information may be slightly different for your system. If you need assistance, call EDI Services at 800-672- 4959, press 3. Select RUN 8

Depending on the speed of your internet connection, it may take anywhere from 5 30 minutes. If you see this box, choose RUN 9

Choose CONTINUE This is a progress screen. The final 1% will take a little bit, be patient. 10

Select NEXT 11

Select YES, after reading the Software License Agreement 12

Enter your name and company name 13

It is recommended to allow WINASAP to install in the default directory. WINASAP is not built to run on any kind of a networked drive and may not function correctly if not installed on the local hard drive. Select NEXT 14

If you previously installed WINASAP, you may get this warning. If you do, select YES. Unfortunately, there is no way to convert the information stored in your previous versions of WINASAP to the new 5010 version. You will need to re-enter all information. 15

Select NEXT 16

This is a progress screen as the program installs. Be patient as it installs the program. 17

When the installation is complete, you will see this screen. Select FINISH. 18

If you see this box, select This program installed correctly. 19

Chapter 2 Submitter Set-Up After installation, the W5010 icon will be found on your desk top. Double click to open the WINASAP program. The user ID will default to ADMIN it is recommended that no changes be made to the user ID. The password for all users is ASAP. When you key it in, it will be hidden, and display as ****. Select OK. You will see a confirmation of your successful sign on. Select OK. 20

A box with helpful tips to keep your WINASAP running smoothly will display. After reviewing the information, select OK. The first time you open WINASAP, the Open Payer box will display. Use the drop down arrow to select WYOMING MEDICAID from the list, and select OK. From the top left hand corner, select the File menu 21

If you did not select WYOMING MEDICAID in the Open Payer box, OR if you accidently closed the Open Payer box before selecting WYOMING MEDICAID, you can reopen the box by choosing Open Payer from the File menu. Otherwise, choose Trading Partner 22

The following information must be entered onto the Trading Partner Information screen: Trading Partner Identification: Primary Identification Trading Partner / Submitter ID from your EDI Welcome Letter Secondary Identification The same as Primary Identification Trading Partner Name: Entity Type o Choose Non-Person if you are a business entity or facility, or group provider Organization Name enter your organization s name o Choose Person if you are a single individual, submitting claims under only your own name. Last Name Enter your last name First Name Enter your first name Middle Name optional 23

Contact Information: Contact Name Enter the name of the person that should be contacted in the event of an error in claims submission Telephone Number Enter the phone number where this person can be reached Fax # - Optional Email Enter the email where this person can be reached Additional Contact Information Optional WINASAP5010 Communications: If submitting through the internet via https://edionline.portal.conduent.com/edionline/redirect.action leave this area blank If submitting through dial-up service via an analog modem: o Host Telephone # - Enter the telephone number indicated under Submission Telephone Number(s) on your EDI Welcome Letter o User ID # - Enter the Password/User ID as indicated on your EDI Welcome Letter o User Name Enter the User Name as indicated on your EDI Welcome Letter Select SAVE 24

Chapter 3 Provider Entry To enter your taxonomy (ies) for use when entering your provider information, select the reference menu. Select Taxonomy Code 25

Select ADD Enter your 10 character taxonomy code. Enter the description to help you remember what the taxonomy is for (it is not using in the billing process and does not have to match anything registered). Select SAVE 26

Repeat for all taxonomies that may be used for billing. When you have entered all of them, select CANCEL. This will close the box; your entries were already saved when you selected SAVE after entering each one. To make corrections, highlight the item and select CHANGE, then select SAVE when you are done making changes. To delete an entry, highlight the item and select DELETE. To enter your provider information, select the Reference menu 27

Select Provider 28

Select ADD 29

For a provider that bills with an NPI (most providers, exception are those providing non-medical services such as waiver services meals, housekeeping, etc.) the following information must be entered: Provider Identification: NPI Number Enter your 10 digit NPI number Provider Taxonomy Code select the appropriate taxonomy from the drop down list Provider Name Entity Type o Choose Non-Person if you are a business entity or facility, or group provider Organization Name enter your organization s name o Choose Person if you are a single individual, submitting claims under only your own name. Last Name Enter your last name First Name Enter your first name 30

Provider Address: Address enter the physical address of the provider City enter the city State select the state from the drop down list Zip code Enter the 9 digit zip code all pay-to entities MUST enter a full 9 digit zip code Provider Tax Identification Number: ID Type o Select Employer s ID number if this is a pay-to provider. Even if you are receiving payments under your SSN, you must label it an EIN for payment purposes o Select SSN if this is a rendering/treating provider only Contact Information: ID Number Enter the EIN or SSN as appropriate Contact Name Enter the name of the person that should be contacted in the event of an error in claims submission Telephone Number Enter the phone number where this person can be reached Fax # - Optional Email Enter the email where this person can be reached Additional Contact Information Optional Do not enter anything on the 2 nd page select SAVE 31

For a provider that bills with 9 digit Wyoming Medicaid provider ID (non-medical services providers such as waiver services meals, housekeeping, etc.) the following information must be entered: Provider Identification: NPI Number Leave Blank Provider Taxonomy Code select the appropriate taxonomy from the drop down list Provider Name Entity Type o Choose Non-Person if you are a business entity or facility, or group provider Organization Name enter your organization s name o Choose Person if you are a single individual, submitting claims under only your own name. Last Name Enter your last name First Name Enter your first name 32

From the drop down next to Identification Type, select Provider Commercial Number. Identification Number Enter the 9 digit Wyoming Medicaid provider ID. No spaces or punctuation should be entered. Select SAVE This warning will display when no NPI is entered for billing. Select YES. 34

Repeat for each provider that will be used on claims submissions. This includes all pay-to, rendering, referring and attending providers. Once all have been entered, select CANCEL. This will close the provider entry box. Each of your providers was saved when you selected SAVE. 35

Chapter 4 Client Entry To enter client information, select the Reference menu Select Patient 36

Select ADD 37

To enter the client s information, the following must be completed: Patient Identification: Patient ID Enter the client s 10 digit Medicaid ID number this will either begin with 0600 or with 00000 Patient Account # - Enter your identification for this client Patient Name and Demographic Information: Last Name enter the client s last name First Name enter the client s first name Date of Birth enter the client s date of birth Sex select the client s sex from the drop down list Patient Address Information: Address enter the client s address City enter the client s city 38

State select the client s state from the drop down list Zip enter the 5 or 9 digit zip code for the client Select INSURANCE Complete the following: Patient Relationship to Insured select Self from the drop down list. Selecting anything other than self will cause the claim to reject Payer Responsibility Sequence Code select Primary from the drop down list Select SAVE 39

Repeat until all clients have been entered. Select CANCEL. This will close the box. Each of the clients was saved when SAVE was selected previously. 40

Chapter 5 Diagnosis Codes To enter your diagnosis codes, select the Reference menu Select Diagnosis Code, and select ICD-9-CM or ICD-10-CM, whichever is appropriate 41

Select ADD Enter the diagnosis code do not use any periods or spaces Enter the description does not have to match anything official is not used in billing for your reference only Select SAVE 42

Continue with this process until all diagnosis codes have been entered. When you have entered all of them, select CANCEL. This will close the box; your entries were already saved when you selected SAVE after entering each one. To make corrections, highlight the item and select CHANGE, then select SAVE when you are done making changes. To delete an entry, highlight the item and select DELETE. Please Note: There are other Reference files that relate to diagnosis codes where you can enter information, which will function just as the above: External Cause of Injury Code Patient s Reason For Visit Code 43

Chapter 6 Procedure Codes To enter your procedure codes, select the Reference menu Select Procedure Code 44

Select ADD Enter the 5 digit procedure code Enter the description does not have to match anything official is not used in billing for your reference only Enter the charge for 1 unit of this procedure code (optional will allow the claim to calculate charges for you). Select SAVE 45

Continue with this process until all procedure codes have been entered. When you have entered all of them, select CANCEL. This will close the box; your entries were already saved when you selected SAVE after entering each one. To make corrections, highlight the item and select CHANGE, then select SAVE when you are done making changes. To delete an entry, highlight the item and select DELETE. 46

Chapter 7 Modifiers To enter Value Codes, select the Reference menu Select Procedure Modifiers 47

Select Add Enter the Procedure Modifier Enter the description does not have to match anything official is not used in billing for your reference only Select SAVE 48

Continue with this process until all procedure modifiers have been entered. When you have entered all of them, select CANCEL. This will close the box; your entries were already saved when you selected SAVE after entering each one. To make corrections, highlight the item and select CHANGE, then select SAVE when you are done making changes. To delete an entry, highlight the item and select DELETE. The following chapters (8 11) are items that are only necessary to bill Institutional Claims. If you are not billing Institutional claims, skip to chapter 12. 49

Chapter 8 Condition Codes To enter Condition Codes, select the Reference menu Select Condition Code 50

Select ADD Enter the Condition Code Enter the description does not have to match anything official is not used in billing for your reference only Select SAVE 51

Continue with this process until all condition codes have been entered. When you have entered all of them, select CANCEL. This will close the box; your entries were already saved when you selected SAVE after entering each one. To make corrections, highlight the item and select CHANGE, then select SAVE when you are done making changes. To delete an entry, highlight the item and select DELETE. 52

Chapter 9 Occurrence Codes To enter your Occurrence Codes, select the Reference Menu Select Occurrence Code 53

Select Add Enter the Occurrence Code Enter the description does not have to match anything official is not used in billing for your reference only Select SAVE 54

Continue with this process until all occurrence codes have been entered. When you have entered all of them, select CANCEL. This will close the box; your entries were already saved when you selected SAVE after entering each one. To make corrections, highlight the item and select CHANGE, then select SAVE when you are done making changes. To delete an entry, highlight the item and select DELETE. 55

Chapter 10 Surgical Codes To enter Surgical Codes, select the Reference menu Select Surgical Code, ICD-9-CM 56

Select ADD Enter the Surgical Code Enter the description does not have to match anything official is not used in billing for your reference only Select SAVE 57

Continue with this process until all surgical codes have been entered. When you have entered all of them, select CANCEL. This will close the box; your entries were already saved when you selected SAVE after entering each one. To make corrections, highlight the item and select CHANGE, then select SAVE when you are done making changes. To delete an entry, highlight the item and select DELETE. 58

Chapter 11 Value Code To enter Value Codes, select the Reference menu Select Value Code 59

Select ADD Enter the Value Code Enter the description does not have to match anything official is not used in billing for your reference only Select SAVE 60

Continue with this process until all value codes have been entered. When you have entered all of them, select CANCEL. This will close the box; your entries were already saved when you selected SAVE after entering each one. To make corrections, highlight the item and select CHANGE, then select SAVE when you are done making changes. To delete an entry, highlight the item and select DELETE. 61

Chapter 12 Building a Professional Claim (claims billed on the CMS- 1500 form when on a paper claim) Select Claims Select Professional 62

Select Add Items which are underlined are required for claims completion. Other areas are optional and may or may not be needed depending on the type of claim you are submitting. Complete: Bill Date: The date you are billing the claim Patient Information: Patient ID: Select the client s Medicaid ID from the drop down list. This will automatically fill in the rest of the Patient Information Section. Provider Information: Billing Provider: Select the Pay-to Provider from the drop down list. 63

Rendering Provider: Select the Rendering Provider from the drop down list only if different from the Pay-to/Billing Provider Signature on File: Select YES Referring Provider: Select the Referring Provider from the drop down list if one is required for your claim Claim Data: Health Care Diagnosis Codes: Diagnosis Type Code: Select ICD-9-CM or ICD-10-CM Principal Diagnosis: Select your diagnosis code from the drop down list o If you have additional diagnosis codes, select OTHER DIAGNOSIS CODES and continue entering until you have entered all appropriate diagnosis codes, and select OK Place of Service: Select the appropriate place of service code from the drop down list. If certain codes are selected, other information may be required i.e. inpatient hospital requires hospital admission date and appropriate boxes will pop up to allow you to enter this information Claim Frequency Type Code: Select 1: Original (Admit thru Discharge Claim) Select NEXT PAGE (or select the Claim Codes tab at the top) 64

Items which are underlined are required for claims completion. Other areas are optional and may or may not be needed depending on the type of claim you are submitting. Complete: Claim Codes: Medicare Assignment Code: Select the appropriate answer from the drop down Release of Information Code: Select Yes, Provider has a signed Statement Permitting Release of Medical Billing Data Related to a Claim from the drop down Claim Filing Indicator: Select Medicaid from the drop down Claim Indicators: Benefits Assignment Certification Indicator: Select the appropriate answer from the drop down 65

If your claim requires a Prior Authorization Number - Claim Numbers: Prior Authorization: Enter the 10 digit prior authorization number Select the Claim Line Items Tab at the top 66

Items which are underlined are required for claims completion. Other areas are optional and may or may not be needed depending on the type of claim you are submitting. Complete: Claim Line Items: Service Date(s): Enter or use the calendar option to select the from and to dates of service for your line item Service Qual: Select HCPCS from the drop down list Proc Code: Select the procedure code for your line from the drop down list Procedure Modifiers: Select any appropriate modifiers from the drop down list Unit Code: Select Unit Units: Enter the number of units Charges: Will automatically fill in for you you may change the amount if need be 67

o Please Note: If you change the procedure code or units, you will need to tab through the remainder of the fields to cause the charges to update correctly. Diagnosis Code Pointers: Enter the appropriate pointers to the diagnosis codes previously entered Place of Service: Select the appropriate place of service code from the drop down list Select the ADD LINE ITEM button this will move your line item down to the numbered list, and increase your Total Claim Charges appropriately. To make changes/corrections or delete a line item double click the line this will enter the information from the line back to the entry area make changes and select ADD LINE ITEM or to delete select the DELETE button. This will bring up a confirmation box to complete the delete. Repeat the above until all line items are entered. Select SAVE if there are any errors, WINASAP will indicate and show you the location of the error make corrections and select SAVE again. Once you have entered all of your claims, select CANCEL to close the claims window. Your claims were saved when you selected SAVE after entering each claim. CANCEL will only close the window. 68

Entering TPL (Third Party Liability) To enter TPL there are changes to be made first to the client s file, and then additional items to be entered into the claim. When entering your client under Reference Patient, on the 2 nd page (Insured s Data) the Payer Responsibility Sequence Code should indicate if Medicaid is secondary, tertiary, etc. 69

In your claim: Select the Claim Information tab at the top of the claim, and select OTHER SUBSCRIBER INFO 70

Complete: Insured s Name: Patient Relationship To Insured: Select the correct relationship from the drop down list Entity Type: Select Person Last Name: Enter the insured party s last name First Name: Enter the insured party s first name Insured s Identification: Insured s Primary ID Type: Select Member Identification Number from the drop down list Insured s Primary ID: Enter the ID valid for the other insurance Select the Other Subscriber Page 2 tab at the top 71

Complete: Insurance Information: Claim Filing Indicator: Select the type of insurance from the drop down list Release of Information Code: Select Yes, Provider has a signed Statement Permitting Release of Medical Billing Data Related to a Claim from the drop down list Patient Signature Source Code: Select Signature generated by provider because the patient was not physically present for Services Benefits Assignment Certification Indicator: Select the appropriate answer Other Payer Information: Payer Name: Enter a name for the other insurance Payer Responsibility Sequence Code: Select appropriate indicator from the drop down list 72

Payer Primary ID Type: Select Payor Identification from the drop down list Payer Primary ID: Enter an ID for the other payor (how you will identify this payor) Select the COB AMOUNTS button Enter the total amount paid by the other insurance and select OK 73

Select OK if this is the only other insurance, or select NEXT if there is another insurance to enter for this claim. 74

Entering Medicare Information To enter TPL there are changes to be made first to the client s file, and then additional items to be entered into the claim. 75

When entering your client under Reference Patient, on the 1st page (Patient Data), select the Medicare Recipient check box. When entering your client under Reference Patient, on the 2 nd page (Insured s Data) the Payer Responsibility Sequence Code should indicate if Medicaid is secondary, tertiary, etc. 76

In your claim: Select the Claim Information tab at the top of the claim, and select OTHER SUBSCRIBER INFO 77

Complete: Insured s Name: Patient Relationship To Insured: Select the correct relationship from the drop down list Entity Type: Select Person Last Name: Enter the insured party s last name First Name: Enter the insured party s first name Insured s Identification: Insured s Primary ID Type: Select Member Identification Number from the drop down list Insured s Primary ID: Enter the ID valid for Medicare Select the Other Subscriber Page 2 tab at the top 78

Complete: Insurance Information: Claim Filing Indicator: Select Medicare Part B from the drop down list Release of Information Code: Select Yes, Provider has a signed Statement Permitting Release of Medical Billing Data Related to a Claim from the drop down list Patient Signature Source Code: Select Signature generated by provider because the patient was not physically present for Services Benefits Assignment Certification Indicator: Select Yes from the drop down list Other Payer Information: Payer Name: Enter Medicare Payer Responsibility Sequence Code: Select appropriate indicator from the drop down list 79

When entering your line item information, before selecting ADD LINE ITEM select the LINE ADJUDICATION INFO button 83

Other Payer Primary ID: Select Medicare from the drop down list Service Line Paid Amount: Indicate how much Medicare paid on this line Adjudication or Payment Date: Enter or select from the calendar Medicare s paid date on the EOMB Paid Service Unit Count: Enter the units paid by Medicare Select the PRODUCT OR SERVICE ID button Identification Type: Select HCPCS from the drop down list Identification Number: Enter the procedure code for this line item 84

Select OK If there is coinsurance or deductible amounts to indicate for this line item, select the SERVICE ADJUSTMENT button 85

Group Code: Select Patient Responsibility from the drop down list Reason Code: Select Deductible or Coinsurance Amount from the drop down list Adjusted Amount: Enter the amount indicated by Medicare Select OK Complete the remainder of the claim as indicated in the first part of chapter 12, repeating these steps as necessary. 86

Entering an NDC While entering the Claim Line Items information, before selecting the ADD LINE ITEM button: Select DRUG INFORMATION 87

Complete: National Drug Code: Enter the NDC in the correct format (5-4-2) National Drug Unit Count: Enter the units according to the NDC definition Code Qualifier: Select the unit indicator from the drop down list Select OK Select ADD LINE ITEM, and continue entering your claim as indicated in the first part of Chapter 12. 88

Indicating a Mailed or Electronic Attachment Claims that require attachments can be billed through WINASAP. The claim must indicate an attachment is coming, and by what method (mail or electronic options are available). Select the 3 rd tab of the claim (Claim Information) and select SUPPLEMENTAL INFO 89

Completing this information will place your claim on hold for up to 30 days waiting for your attachments to be mailed or uploaded. If they are not received in 30 days, the claim will be denied whether or not any attachments were necessary for the claim to process. Complete: Report Code: Select from the drop down list the best match for the type of attachment you are sending. If there is no exact match, use the closest item. Transmission Code: Indicate whether you will be sending the attachment By Mail or Electronically Only. Identification Code: Enter a unique ID for the item you are sending. If you are uploading an electronic attachment through our Secure Web Portal there cannot be any spaces in the name of the attachment. Select OK Continue entering your claim as indicated in the first part of Chapter 12. 90

Chapter 13 Institutional Claims (claims that would be billed on the UB04 claim form if sent on paper) Select CLAIMS Select Institutional 91

Select ADD Items which are underlined are required for claims completion. Other areas are optional and may or may not be needed depending on the type of claim you are submitting. Complete: Bill Date: Enter or select using the calendar the date you are entering the claim Patient Information: Patient ID: Select your client from the drop down list. This will fill in the remainder of the information for this section for you Provider Information: Billing Provider: Select the Pay-to provider from the drop down list Attending Provider: Select the attending provider from the drop down list 92

Claim Data: Admission: o Date: Enter or select from the calendar the client s admission date o Hr: Enter the admission hour, using the 24 hour calendar (00 = midnight) o Min: Enter the minutes of the admission o Type: Enter the admission type o SRC: Enter the admission source Discharge: o Stat: Enter the discharge status o Hr: Enter the hour of discharge, using the 24 hour calendar (00=midnight) o Min: Enter the minutes of the admission Statement Coverage Period: o From: Enter the first date of service referenced on this claim (admit date) o To: Enter the last date of service referenced on this claim (discharge date) Type of Bill: Enter the 3 digit type of bill Select NEXT PAGE 93

Items which are underlined are required for claims completion. Other areas are optional and may or may not be needed depending on the type of claim you are submitting. Complete: Procedure Codes (complete if you have ICD-9 Surgical Codes to indicate on the claim): Principle Procedure Code Qualifier: Select ICD-9-CM from the drop down list Principle Procedure Code: Select your code from the drop down list Principle Procedure Date: Enter or select the date from the calendar for the date on which the procedure occurred If you have additional surgical codes to enter, select OTHER PROCEDURE CODES and continue entering until all have been entered, then select OK. Diagnosis Codes: 94

Principal Diagnosis Code Qualifier: Select ICD-9-CM from the drop down list Principle Diagnosis Code: Select the correct diagnosis code from the drop down list Present on Admission Indicator: Select the appropriate indicator from the drop down list Admitting Diagnosis Code Qualifier: Select ICD-9-CM from the drop down list Admitting Diagnosis Code: Select the correct diagnosis code from the drop down list If you have additional diagnosis codes to enter, select OTHER DIAGNOSIS CODES and continue entering until all have been entered, then select OK. Additional Claim Codes: Assignment or Plan Participation Code: Select the appropriate response from the drop down list Release of Information Code: Select Yes, Provider has a signed Statement Permitting Release of Medical Billing Data Related to a Claim from the drop down list Claim Filing Indicator Code: Select Medicaid from the drop down list Assignment of Benefits Indicator: Select the appropriate response from the drop down list If you have Patient Reason for Visit Codes, External Cause of Injury Codes, Occurrence Span Codes, Occurrence Codes, Value Codes, or Condition Codes, select the appropriate buttons and enter the codes from the drop down lists, and if required, enter appropriate dates or select them from the calendar. Select NEXT PAGE 95

Items which are underlined are required for claims completion. Other areas are optional and may or may not be needed depending on the type of claim you are submitting. Complete: Claim Line Items: Service Line Revenue Code: Select the appropriate revenue code from the drop down list Product/Service ID Qualifier: If a CPT/HCPCS code is required to be billed on the line, select HCPCS Procedure Code: Select the appropriate CPT/HCPCS code from the drop down list if required Procedure Modifiers: Select any necessary modifiers from the drop down list Line Item Charge Amount: Enter the total charge for all units on the line Unit or Basis for Measurement Code: Select Unit from the drop down list 96

Service Units Count: Enter the number of units Service Date(s): Enter or select from the calendar the from and to dates for this line item Select the ADD LINE ITEM button this will move your line item down to the numbered list, and increase your Total Claim Charges appropriately. To make changes/corrections or delete a line item double click the line this will enter the information from the line back to the entry area make changes and select ADD LINE ITEM or to delete select the DELETE button. This will bring up a confirmation box to complete the delete. Repeat the above until all line items are entered. Select SAVE if there are any errors, WINASAP will indicate and show you the location of the error make corrections and select SAVE again. Once you have entered all of your claims, select CANCEL to close the claims window. Your claims were saved when you selected SAVE after entering each claim. CANCEL will only close the window. 97

In your claim: Select the Claim Codes tab at the top of the claim, and select OTHER SUBSCRIBER INFO 99

Select OK if this is the only other insurance, or select NEXT if there is another insurance to enter for this claim. Complete the remainder of the claim as indicated in the first part of chapter 13. 103

Entering Medicare Information To enter TPL there are changes to be made first to the client s file, and then additional items to be entered into the claim. 104

In your claim: Select the Claim Information tab at the top of the claim, and select OTHER SUBSCRIBER INFO 106

Complete: Insured s Name: Patient Relationship To Insured: Select the correct relationship from the drop down list Entity Type: Select Person Last Name: Enter the insured party s last name First Name: Enter the insured party s first name Insured s Identification: Insured s Primary ID Type: Select Member Identification Number from the drop down list Insured s Primary ID: Enter the ID valid for Medicare Select the Other Subscriber Page 2 tab at the top 107

Complete: Insurance Information: Claim Filing Indicator: Select Medicare Part A from the drop down list Release of Information Code: Select Yes, Provider has a signed Statement Permitting Release of Medical Billing Data Related to a Claim from the drop down list Patient Signature Source Code: Select Signature generated by provider because the patient was not physically present for Services Benefits Assignment Certification Indicator: Select Yes from the drop down list Other Payer Information: Payer Name: Enter Medicare Payer Responsibility Sequence Code: Select appropriate indicator from the drop down list 108

Select OK if this is the only other insurance, or select NEXT if there is another insurance to enter for this claim. Once all insurance information is entered, select the Claim Line Items tab at the top Complete the remainder of the claim as indicated in the first part of chapter 13, repeating these steps as necessary. 111

Entering an NDC While entering the Claim Line Items information, before selecting the ADD LINE ITEM button: Select DRUG INFORMATION 112

Indicating a Mailed or Electronic Attachment Claims that require attachments can be billed through WINASAP. The claim must indicate an attachment is coming, and by what method (mail or electronic options are available). Select the 2nd tab of the claim (Claim Codes) and select SUPPLEMENTAL INFO 114

Completing this information will place your claim on hold for up to 30 days while waiting for your attachments to be mailed or uploaded. If they are not received in 30 days, the claim will be denied whether or not any attachments were necessary for the claim to process. Complete: Report Code: Select from the drop down list the best match for the type of attachment you are sending. If there is no exact match, use the closest item. Transmission Code: Indicate whether you will be sending the attachment By Mail or Electronically Only. Identification Code: Enter a unique ID for the item you are sending. If you are uploading an electronic attachment through our Secure Web Portal there cannot be any spaces in the name of the attachment. Select OK Continue entering your claim as indicated in the first part of Chapter 13. 115

Chapter 14 Creating a Dental Claim (claims that would be billed on the ADA claim form if billed on paper) Select Claims Select Dental 116

Items which are underlined are required for claims completion. Other areas are optional and may or may not be needed depending on the type of claim you are submitting. Complete: Claim Information: Release of Information Code: Select Yes, Provider has a signed Statement Permitting Release of Medical Billing Data Related to a Claim from the drop down Claim Filing Indicator: Select Medicaid from the drop down Date of Service: Enter or select from the calendar the date of service for this claim Benefits Assignment Certification Indicator: Select the appropriate answer from the drop down Select NEXT PAGE or the Claim Line Items Tab at the top 119

Items which are underlined are required for claims completion. Other areas are optional and may or may not be needed depending on the type of claim you are submitting. Complete: Claim Line Items: Date of Service: Enter or use the calendar option to select the date of service for your line item Proc Code: Select the procedure code for your line from the drop down list o Note you can key in a procedure code, however, the charges will not auto complete if it was not pre-entered in the reference file Procedure Modifiers: Select any appropriate modifiers from the drop down list Units: Enter the number of units Charges: Will automatically fill in for you you may change the amount if need be Place of Service: Select the appropriate place of service code from the drop down list 120

If you need to enter tooth codes select TOOTH INFORMATION Tooth Code: Select the appropriate tooth from the drop down list Tooth Surface Codes: If necessary, select the appropriate tooth surface code from the drop down list Select OK If you need to enter Oral Cavity Codes, select ORAL CAVITY CODES 121

Select the appropriate Oral Cavity Code from the drop down list Select OK Select the ADD LINE ITEM button this will move your line item down to the numbered list, and increase your Total Claim Charges appropriately. To make changes/corrections or delete a line item double click the line this will enter the information from the line back to the entry area make changes and select ADD LINE ITEM or to delete select the DELETE button. This will bring up a confirmation box to complete the delete. Repeat the above until all line items are entered. Select SAVE if there are any errors, WINASAP will indicate and show you the location of the error make corrections and select SAVE again. Once you have entered all of your claims, select CANCEL to close the claims window. Your claims were saved when you selected SAVE after entering each claim. CANCEL will only close the window. 122

In your claim: Select the Claim Information tab at the top of the claim, and select OTHER SUBSCRIBER INFO 124

Complete: Other Subscriber Name: Payer Responsibility Sequence Code: Select appropriate indicator from the drop down list Patient Relationship To Insured: Select the correct relationship from the drop down list Entity Type: Select Person Last Name: Enter the insured party s last name First Name: Enter the insured party s first name Select INSURED S PRIMARY ID: 125

Identification Type: Select Member Identification Number from the drop down list Identification Number: Enter the ID number for the client under the other insurance Select OK Select the Other Subscriber Insurance tab at the top 126

Complete: Insurance Information: Release of Information Code: Select Yes, Provider has a signed Statement Permitting Release of Medical Billing Data Related to a Claim from the drop down list Claim Filing Indicator: Select the type of insurance from the drop down list Benefits Assignment Certification Indicator: Select the appropriate answer Other Payer Information: Payer Name: Enter a name for the other insurance Select PAYER PRIMARY ID 127

Payer Primary ID Type: Select Payor Identification from the drop down list Payer Primary ID: Enter an ID for the other payor (how you will identify this payor) Select OK Select the COB AMOUNTS button Enter the total amount paid by the other insurance and select OK 128

Select OK if this is the only other insurance, or select NEXT if there is another insurance to enter for this claim. 129

When entering your line item information, before selecting Add Line Item select the Line Adjudication Info button 130

Other Payer Primary ID: Select the insurance ID from the drop down list Service Line Paid Amount: Indicate how much the insurance paid on this line Adjudication or Payment Date: Enter or select from the calendar the insurance s paid date on the EOB Paid Service Unit Count: Enter the units paid by the insurance Select the PRODUCT OR SERVICE ID button Identification Type: Select American Dental Association Codes from the drop down list Identification Number: Enter the procedure code for this line item 131

Select OK Select OK Complete the remainder of the claim as indicated in the first part of chapter 14, repeating these steps as necessary. 132

Indicating a Mailed or Electronic Attachment Claims that require attachments can be billed through WINASAP. The claim must indicate an attachment is coming, and by what method (mail or electronic options are available). Select the 2 nd tab of the claim (Claim Information) and select SUPPLEMENTAL INFO 133

Completing this information will place your claim on hold for up to 30 days while waiting for your attachments to be mailed or uploaded. If they are not received in 30 days, the claim will be denied whether or not any attachments were necessary for the claim to process. Complete: Report Type Code: Select from the drop down list the best match for the type of attachment you are sending. If there is no exact match, use the closest item. Report Transmission Code: Indicate whether you will be sending the attachment By Mail or Electronically Only. Identification Number: Enter a unique ID for the item you are sending. If you are uploading an electronic attachment through our Secure Web Portal there cannot be any spaces in the name of the attachment. Select OK Continue entering your claim as indicated in the first part of Chapter 14. 134

Chapter 15 Building a Nursing Home Template and Generating Nursing Home Claims Select CLAIMS Select Nursing Facility -> Nursing Facility Template For each client, you will set up a template that will be used later to generate your monthly nursing home claims. 135

Select ADD 136

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Items which are underlined are required for claims completion. Other areas are optional and may or may not be needed depending on the type of claim you are submitting. Complete: Bill Date: Enter or select using the calendar the date you are entering the claim Patient Information: Patient ID: Select your client from the drop down list. This will fill in the remainder of the information for this section for you Provider Information: Billing Provider: Select the Pay-to provider from the drop down list Attending Provider: Select the attending provider from the drop down list Claim Data: 138

Admission: o Date: Enter or select from the calendar the client s admission date o Hr: Enter the admission hour, using the 24 hour calendar (00 = midnight) o Min: Enter the minutes of the admission o Type: Enter the admission type o SRC: Enter the admission source Discharge: o Stat: Enter the discharge status as 30 (still a patient) Statement Coverage Period: o From: Enter the first date of service for this client (admit date) o To: Leave blank Type of Bill: Enter the 3 digit type of bill Select NEXT PAGE 139

Items which are underlined are required for claims completion. Other areas are optional and may or may not be needed depending on the type of claim you are submitting. Complete: Diagnosis Codes: Principal Diagnosis Code Qualifier: Select ICD-9-CM from the drop down list Principle Diagnosis Code: Select the correct diagnosis code from the drop down list Present on Admission Indicator: Select the appropriate indicator from the drop down list If you have additional diagnosis codes to enter, select OTHER DIAGNOSIS CODES and continue entering until all have been entered, then select OK. Additional Claim Codes: Assignment or Plan Participation Code: Select the appropriate response from the drop down list Release of Information Code: Select Yes, Provider has a signed Statement Permitting Release of Medical Billing Data Related to a Claim from the drop down list Claim Filing Indicator Code: Select Medicaid from the drop down list Assignment of Benefits Indicator: Select the appropriate response from the drop down list If you have Occurrence Span Codes, Occurrence Codes, Value Codes, or Condition Codes, select the appropriate buttons and enter the codes from the drop down lists, and if required, enter appropriate dates or select them from the calendar. Select NEXT PAGE 140

Items which are underlined are required for claims completion. Other areas are optional and may or may not be needed depending on the type of claim you are submitting. Complete: Claim Line Items: Service Line Revenue Code: Select the appropriate revenue code from the drop down list Line Item Charge Amount: Enter the total charge for all units on the line Unit or Basis for Measurement Code: Select Days from the drop down list Service Units Count: Enter the number of units Rate: Enter the daily rate for this revenue code Select the ADD LINE ITEM button this will move your line item down to the numbered list, and increase your Total Claim Charges appropriately. 141

To make changes/corrections or delete a line item double click the line this will enter the information from the line back to the entry area make changes and select ADD LINE ITEM or to delete select the DELETE button. This will bring up a confirmation box to complete the delete. Repeat the above until all line items are entered. Select SAVE if there are any errors, WINASAP will indicate and show you the location of the error make corrections and select SAVE again. Once you have entered all of your templates, select CANCEL to close the template entry window. Your templates were saved when you selected SAVE after entering each template. CANCEL will only close the window. To generate the claims: 142

Select Tools -> Generate Nursing Facility Claims Billing Type: Select Monthly (if you bill on a cycle other than monthly, select Other and enter your dates) Statement Coverage Period: Enter the month you will be billing for Select BUILD This will generate your monthly claims and give you a summary: 143

Select CANCEL to close the window. 144

To review, edit, and prepare claims for submission: Select Claims -> Nursing Facility -> Nursing Facility Claim 145

The claims you just built will be in your claims list (along with any past months you have billed). You can now make any changes necessary due to partial month stays, leave days, other insurance, etc. To make a change to a claim, select the claim by clicking on it to highlight it and select the CHANGE button (the claim must be in a keyed status if it is not, it has already been billed and cannot be changed see Chapter XX regarding updating, copying and deleting claims). This will open the claim for you to make the changes you need. 146

Verify the following: Statement Coverage Period: Was the client in residence for the complete month? If not, correct the dates as necessary. Discharge Stat: Is the client still a patient? If not, correct the discharge status. Type of Bill: Correct if necessary Select NEXT PAGE 147

Do the diagnosis codes need updated? If so, be sure to correct the template as well for future claims. If there are non-covered days, be sure to update the Value Codes as necessary. Select NEXT PAGE 148

Verify that the client was in residence for all the days of the month. If not, correct the dates of service as appropriate. If there are leave days to be billed, enter an appropriate line item with the correct revenue code and dates of service. Select SAVE Repeat with each of this month s built claims. 149

In your claim: Select the Claim Codes tab at the top of the claim, and select OTHER SUBSCRIBER INFO 151

Entering Medicare Information To enter TPL there are changes to be made first to the client s file, and then additional items to be entered into the claim. 156

In your claim: Select the Claim Information tab at the top of the claim, and select OTHER SUBSCRIBER INFO 158

Complete: Insured s Name: Patient Relationship To Insured: Select the correct relationship from the drop down list Entity Type: Select Person Last Name: Enter the insured party s last name First Name: Enter the insured party s first name Insured s Identification: Insured s Primary ID Type: Select Member Identification Number from the drop down list Insured s Primary ID: Enter the ID valid for Medicare Select the Other Subscriber Page 2 tab at the top 159

Indicating a Mailed or Electronic Attachment Claims that require attachments can be billed through WINASAP. The claim must indicate an attachment is coming, and by what method (mail or electronic options are available). Select the 2nd tab of the claim (Claim Codes) and select SUPPLEMENTAL INFO 164

Chapter 16 Submitting Claims via dial-up Select Tools 166

Select Send Claim File 167

Select Send KEYED Claims. Select the button in front of Production Select SEND This will give a count of claims ready to be sent. Select OK. 168

WINASAP will generate the claims files. WINASAP will begin the transmission and will dial-up and send your claims. After 2 hours, you will be able to retrieve your Response Report, which will give a status of your claims, accepted or rejected. If you receive a rejected status, contact EDI Services for assistance in correcting the errors at 800-672-4959, press 3. Have your Trading Partner ID available when you call. 169

To retrieve your response report: Select Tools 170

Select Receive Response File Select Receive this will cause WINASAP to dial-up to the clearinghouse to retrieve the file information. 171

Once the file has been received, you can review the status of your claims by choosing Claims, and the type of claims you have submitted (Institutional, Professional, Dental, or Nursing Home). 172

The claim status will be updated to Accepted or Rejected. If accepted, this does not indicate a paid claim. This only indicates that the technical requirements for your billing file have been successfully met. You will need to wait until claims are processed for payment information. 173

Reporting: Several reports exist to review billing data. Select Tools 174

Select Reports 175

Select the type of report you wish to run. Select the parameters of the report information you wish to receive. Select Run to view your report. 176

Chapter 17 Billing through EDI Online Be aware that uploading your files through EDI Online removes the need for a dial-up modem or phone connection as the files are uploaded over your internet connection, however, by uploading your files in this method, you will not be able to generate any reporting within WINASAP as there will be no feedback and claim status will not be updated correctly. Also, once you have uploaded your file, you will need to go back into each claim and change the status to HOLD to avoid the claims being included in the next billing file you create or you may delete the claims once you have successfully billed them. Select Tools 177

Select Send Claim File 178

Select Send KEYED Claims. Select the button in front of Production Select SEND This will give a count of claims ready to be sent. Select OK. 179

WINASAP will generate the claims files. WINASAP will begin the transmission and will dial-up and send your claims. Because you will not be submitting via dial-up, select Cancel to stop the transmission. Go ahead and close WINASAP (either File -> Exit or use the X in the top right corner). Connect to the internet if you are not currently connected. Enter the web address: https://edionline.portal.conduent.com/edionline/redirect.action/ 180

Enter your User Name and Password as indicated on your EDI Welcome Letter, and select Log In. Select Send File 181

Select Browse 182

Navigate to your C:Program Files:ACS:W5010:db:77046 and select the 77046 file. 183

Select Submit Once submitted, you can select confirmation report to see that your file was successfully uploaded or if there were errors. If there are errors, please contact EDI Services at 800-672- 4959, press 3 for assistance. You will need to review the online reports for errors as you will not be able to retrieve the Receive Response report via dial-up if you submit via the EDI Online web site. 184

Chapter 18 File Maintenance, Updating and Deleting Claims and Troubleshooting To keep WINASAP running smoothly, it is always a good idea to purge old data this is not needed and to backup and repair your database on a regular basis. This will avoid issues with corrupted data or lost information. To back up the Database: Select Tools Select Backup Database 185

Select Yes Select the location and the name you wish to save the backup under. If you are unsure, just select SAVE and WINASAP will save it where it prefers. Once the backup is complete, you will see this box. Select OK. 186

To Restore a Database Backup: If your database is somehow corrupted or if you need to re-install your WINASAP, upgrade your software, or move your database to another computer, you can restore your database from a backup. PLEASE NOTE: Restoring the database will completely remove anything that you have currently in the WINASAP, and will change everything to match the database that is in the restore file. Select Tools Select Restore Database 187

Select YES Select the location and name of the backup you wish to restore, and select OPEN Select YES 188

Once the database is restored, select OK Your database is now restored. 189

To Purge Claims: All claims entered into WINASAP stay in history unless they are deleted by the user. The easiest way to keep WINASAP running smoothly and quickly is to regularly purge old claims that are no longer needed. During the purge process you will be making a backup before the purge is completed. Select Tools Select Purge Claims 190

Select the last billing date that you wish to have purged. You can then select the other limitations by choosing only certain claim status, or certain claim types. Once you have selected the parameters you would like to use, select PURGE. Select YES 191

Select the location and the name you wish to save the backup under and select SAVE. Once the purge is complete, select OK 192

To Run Database Repair Tool Periodically the Database Repair Tool should be run to find and repair any errors in the database, to prevent problems with corrupt data. Select Tools Select Database Repair Tool 193

The tool will create a backup, and run. 194

When complete it will generate this report. Select CLOSE. Select Tools Select Repair Claim Provider Data it will run and close itself. Running both of these on a regular basis will help keep WINASAP running smoothly. To Copy, Edit, or Delete claims To make changes to already entered and saved claims, first verify the status of the claim. If the claim is in a KEYED status, you can still make changes to the claim. If it is any other status, you will need to make a copy before any changes can be made. 195

To CHANGE a claim in a KEYED status: Verify the status of the claim is keyed, highlight the claim you wish to change, and select CHANGE. This will open the claim, where you can make your changes, and select SAVE. 196

To CHANGE a claim in any other status: Highlight the claim you wish to change, and select COPY. This will open a new copy of the claim, where you can make changes and then select SAVE. 197

If you wish to DELETE a claim: Highlight the claim you wish to delete, and select DELETE. A confirmation box will open. Select YES. OR 198