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eMedNY Submitter Dashboard User Manual

1. dle Fide Sent Mile tive Sale Date Undate Accepted Validated Lo Aij Adj nbr ated 4 1 Completed m woii O 6 5 9 7 1 File Accepted TA1 Error A TA1 error occurs when eMedNY rejects the Interchange Envelope of the transaction sent by the submitter The batch was rejected due to an EDI Syntax error in the envelope As a result the batch will not be processed Here is an example of a TA1 error displayed on the Dashboard ie re T he Tir ie un Fi er woe Mir Var to Ape Ache ated HEISETIRUEMESAE AU BER 1zMERTERDIZE a sme Completed oni oma To determine the cause of the TA1 error 1 Click on 2 The Errors Pop Up window will display as shown in the example below eMedNY Submitter Dashboard User Manual Version 2012 1 Page 18 of 31 u O ANALYSIS OF DASHBOARD INFORMATION FOR 837 SUBMISSIONS Error Code 022 Error Description Im Control Structure TA1 File SAS 00 II EMEOHTRAT ZI 1PP Baal 11222 D607 90501 1135500 70 l 0 1 1122 00S fea 0 11T 7 1 1 Errors Pop Up Window Error Code This area will show the code of the error being reported Error Description This area shows the description of the error encountered by eMedNY TA1 File A description of the error returned to the user will be relayed here 7 2 File Validated Error When appears in the File Validated column the file is not processed due to an EDI Syntax error in the batch This could be due to an
2. please refer to the eMedNY Trading Partner Information Companion Guide Note Ensure the submission source selected matches the method used to submit batch files to eMedNY 6 Check the Agree check box This must be checked before clicking the Login Button 7 Click the Login button After the second unsuccessful login attempt the user will be presented with the following ee INWViashGoara soo LOACOTIVC CO eMed NY Invalid Credentials Username muuser13 Password Submission source I EMEX Exchange 1 _ e Please type the characters as shown I Please Note Medicaid recipient level data is confidential and is protected by state and federal laws and regulations It can be used only for the Purposes directh connected to the administration of the Medicaid program You are required to read understand and comply with these regulations There are significant state civil and federal criminal penalties for wiolations Ihave read and I agree to the Medicaid Confidentiality Regulations If you are having trouble logging in please call 800 343 9000 for assistance Home Privacy Policy 8 Enter the characters shown in the image and check the Agree check box 9 Click the Agree Login button If the non scannable image is unreadable click the refresh button to refresh the image shown Note Users cannot lock themselves out of their submission source by entering invalid login information eMedNY Submitter Das
3. in the raw data the error occurred in Error This is the error being reported in the raw data Element Section This section details the element within the Loop and segment of raw data submitted that encountered the error Reference The Data Element Reference is the number of the Segments in error Position This is the Data Element position in error Error This is the error being reported in the raw data eMedNY Submitter Dashboard User Manual Version 2012 1 Page 24 of 31 NALYSIS OF DASHBOARD INFORMATION FOR 277 RESPONSES 8 Analysis of Dashboard Information for 277 Responses To view error information from the 277 response the file must complete the adjudication process Complete the following steps to view the 277 errors I ile Ir Submitted Last ie de Ihe Gent file Sie Status Dake Update Accepted Wabdated to Adjud Adjudicated 4 ern ar Hp a ea re Pr w i iasaeun Here a IK Competed osyoz 11 ososi ess O 0 1 Click on the File ID to pull up the GS Sub panel 2 Click on the GS Seq Number to be reviewed The ST Seq sub panel will appear iie File Ide file Fie em fe ii sane qire Stator Dale Lipdate Accepted Validated to Adjud Adjudicated i Pii 4 wir gm ee ee a e 7 IK Completed so een O Note The Status of Accepted does not guarantee that errors were not encountered during the processing of the submitted claims 3 Click the 1 hyperlink under ST Seq
4. 25 2005 which addresses electronic PHI ePHI and establishes the requirements to protect the confidentiality integrity and availability of PHI created maintained and transmitted in electronic format and Health Information Technology for Economic and Clinical Health Act of 2009 HITECH which strengthens the HIPAA regulations HIPAA is intended to Provide better access to health insurance Limit fraud and abuse Reduce the administrative costs of providing health care Standardize the content and format of electronic health care transactions and promote their use eeeee Ensure privacy amp security of paper and electronic Protected Health Information PHI Under HIPAA users are to Utilize unique user id and passwords for each user Share PHI with co workers who have a need to know and the appropriate access Discuss PHI in private areas not in public areas or in telephone conversations that can be easily overheard by others Keep and protect written and electronic health information from the eyes of others who do not need the information in order to perform their assigned jobs Make sure that casual visitors cannot wander into areas in which clinical or billing information is kept Know when a person s PHI can be shared without the person s permission and when written or oral permission is required Ensure that all policies or procedures for safeguarding the confidentiality of PHI or other sensi
5. 277 Errors The search will only return batches that contain 277 errors Batches that have positive 277 responses are NOT included Note To view other results after Completed In Process or 277 errors have been selected users must change the option selected in this field and click the Find button Outbound Select the type of file returned to the user from the following options This field is optional 820 Health Plan Remittance Advice 8208S Health Plan Supplemental Remittance Advice Proprietary formatted file 835 Health Care Claim Remittance Advice 835S Health Care Claim Supplemental Remittance Advice Proprietary Formatted file Remittance PDF PDF Formatted Paper Remittance Advice PA PDF Formatted Paper Prior Approval Roster 277U Unsolicited 277 response to a 4010 version batch 277 Claim status response to a 276 Request FRSP Response due to a corrupt file that was submitted to eMedNY 277C Unsolicited Claim Acknowledgement to a5010 version batch MEDA MEDS Acknowledgment Report MCR MEDS CLAIMS RESPONSE FILE NPIR NPI Batch Affiliation Response 278P Batch Prior Approval DVS Response NCPD NCPDP Batch Pharmacy Response 271 Response for 270 Eligibility File DWPX Internal CSC use only MEDS Med Encounter Data from Health Plans 999 Functional Acknowledgment for a version 5010 batch This is the same as the R file or 997 released for eeececeeeeeeeeee eee ee claims processed in 4010 f
6. A GS 1 Sub Panel Status Events Response Type of secondary response returned will be one of the following 277 277U for 4010 formatted response transaction 277C for a 5010 formatted response transaction eMedNY Submitter Dashboard User Manual Version 2012 1 Page 20 of 31 YSIS OF DASHBOARD INFORMATION FOR 837 SUBMISSIONS Completed If the file has finished processing it will indicate Yes If the file did not finish processing it will indicate a No Note This does not mean that all claims were accepted for adjudication Claims may have hit pre adjudication edits This is why it is vital that submitters review process their 277 response files 7 3 AllSteps Completed fie File ee Lav Hale Pike File 5em File Sire Status gt Date Update Accepted Walkdated to Adjud Adjudicated amp 198 Completed 10 04 11 10 04 11 1 39 o To view details about the transaction sets in this batch 1 Click the 1 under GS Seq to open the ST Sub panel File File Guben Last File File File Sen File Are alin Date Ika Accepted Validated to Adpel Adjpodicated ere Kennen wu mn um ui wur un mars a Sal iK Completed osogai as A GSSeq GSCHllNum Werken Tun Type ST Gount Tan Count Ack Status ri Li ib ie ta 1 BATCH RESPONSE oe DIESE ao 1 l Fa BATCH RESPONSE ir Tan Count Status eMedNY Submitter Dashboard User Manual Version 2012 1 Page 21 of 31 i LYSI
7. ION TRACKING 4 1 2012 Version 2012 1 Reformatted the User Manual style to match Provider Billing Guidelines Added information to Section 3 2 regarding new CAPTCHA functionality Expanded Previous section 5 3 Viewing Reponses into sections 5 through 9 of the current document eMedNY Submitter Dashboard User Manual Version 2012 1 4 1 2012 Page 31 of 31
8. NY Submitter Dashboard is designed to assist Trading Partners in tracking the status of batch submissions made to New York Medicaid Trading Partners can follow the progress of their batch submissions here This manual is designed specifically for submitters of electronic transactions and describes the eMedNY Submitter Dashboard features including Ge de te Logging In Viewing Status Searching for Files Viewing Errors Each section includes screen shots field definitions and instructions on how to perform the various tasks This manual does not go into detail about the specific errors that occur with submitted files The errors are viewable through the Submitter Dashboard however these issues must be resolved by downloading and processing the response files returned to the submitter by eMedNY Where appropriate we have provided links to other manuals or web pages for further information and or clarification eMedNY Submitter Dashboard User Manual Version 2012 1 4 1 2012 Page 5 of 31 HIPAA SECURITY AND PRIVACY 2 HIPAA Security and Privacy Health Insurance Portability and Accountability Act of 1996 HIPAA is a federal law that protects health insurance coverage for workers and their families when they change or lose employment It includes the Privacy Rule enacted April 14 2003 which establishes regulations for the use and disclosure of Protected Health Information PHI the Security Rule enacted April
9. S OF DASHBOARD INFORMATION FOR 837 SUBMISSIONS ST Seq This area shows the total number of transaction sets in the submitted batch ST Cntl Num This is the Transaction Set Control Number TXN Count Transaction count is the number of transactions in the ST group displayed Status The status field will display Accepted if the file was accepted into adjudication Rejected if the file was rejected Show Errors if there were errors in the batch See section 7 3 2 for information on viewing errors 7 3 2 Viewing Errors Errors encountered during the processing of a submitted batch file may be viewed with the Submitter Dashboard Errors are only visible to users after following the steps detailed below The Step Completed icons shown in the last 4 columns of the Dashboard page do not guarantee that the claims submitted were accepted into adjudication 1 Click on file name This will bring up the GS Seq subpanel See Section 7 3 2 1 for more information 2 Click on the 1 hyperlink under GS Seq The ST Seq subpanel will appear AU SER LODO 2 120 Competed DI JI IZ 02 01 12 13H GS Seq 65 Cntl Num Wersion Tan Type ST Count Ten Count Ack Status EAE 46 1 SS D040 0S ail 1 125 a BATCH RESPONSE ST se ST Cnt hhmm i Tan Comt GOOC0S 347 125 3 Click on the show errors link found in the status section of the ST Seq sub panel 4 The GS Functional Group Pop up will be displayed See section 7 3 3 belo
10. cal I Notice September 29 2011 er Attention PHARMACY BENEFITS TO BE BUNDLED INTO MEDICAID MANAGED CARE Beginning October 1 2011 Self Help members enrolled in Medicaid Managed Care and Family Health Plus plans will receive pharmacy benefits directly through their plans Members were issued new health plan cards by their plans and were instructed to present Training their new cards at the pharmacy rather than their eee SPECES 2 Click the Submitter Dashboard button to access the application The Login Page appears Username Password Submission source Please Note Medicaid recipient level data is confidential and is protected by state and federal laws and regulations It can be used only for the purposes directly connected to the administration of the Medicaid program You are required to read understand and comply with these regulations There are significant state civil and federal criminal penalties for VEREINE C I have read and I agree to the Medicaid Confidentiality Regulations 3 Enter the assigned username 4 Enter the password eMedNY Submitter Dashboard User Manual Version 2012 1 Page 8 of 31 ACCESSING THE EMEDNY SUBMITTER DASHBOARD 5 Choose the Submission Source EMEX Exchange eMedNY eXchange FTP File Transfer Protocol FTS SOAP File Transfer Service via Simple Object Access Protocol SOAP VPN Virtual Private Network For more information on submission sources
11. eMedNY Submitter Dashboard User Manual Version 2012 1 4 1 2012 eMedNY is the name ofthe electronic New York State Medicaid system The eMedNY system allows New York Medicaid providers to submit claims and receive payments for Medicaid covered services provided to eligible clients eMedNY offers several innovative technical and architectural features facilitating the adjudication and payment of claims and providing extensive support and convenience for its users CSC is the eMedNY contractor and is responsible for its operation The information contained within this document was created in concert by eMedNY DOH and eMedNY CSC More information about eMedNY can be found at www emedny org eMedNY Submitter Dashboard User Manual Version 2012 1 Page 2 of 31 00 00 TABLE OF CONTENTS TABLE OF CONTENTS L ZPUFBOSESESLe MER ee see ee re ee ee 5 2 APAN S ccur ana PIV ACY ee ee ee reger 6 3 Accessing the eMedNY Submitter Dashboard cscccccsssccsssssccsssscccssecccnsseccussccucesescusseceessseneueseneusseseensss 7 3 1 FRSC UI SIA S ee ee ee nee Eee 7 3 2 NECESEINE THE ABI UCHEN b ae ee ae ee er 7 A PONEC ON er RER 10 a TME Ubm Das OO een 11 5 1 PA lei eek pec cece seme A T T A E a SER 12 5 2 Fe SUDMITLEA Seah Cr CIOS ee nee 13 5 3 File Submitted Search ResUl S isise eniros nn ai E A E EEA EE AEE ETENEE 15 6 Downloading and Viewing Raw Data ee i 17 6 1 DOW lO AGI SA a ee ee ee Eee 17 7 Analysis of Dashboard I
12. ed on submitted search criteria From Date eS SS ee O ESA Ciri Hum i GS Cii Num E sbr Fie Gent Pile W alia ted to Adjud Adpodicated Legend J Zerlomgiete CF Aujerten Pertiaiiy roepe Deweizei fie CF TAI ere Submitters can search for only those files that were submitted under the User ID and Submission Source used to login All searches require A From To Date Range A selection from the Status drop down list For files submitted within 28 days from the current system date the submitted files and the corresponding raw data are available See Section 6 for instructions Raw data is not available through the eMedNY Submitter Dashboard for any batch file submitted beyond the 28 day window Home The Home link will bring the submitter back to the eMedNY Dashboard page eMedNY Submitter Dashboard User Manual Version 2012 1 Page 11 of 31 THE SUBMITTER DASHBOARD UserInfo This link will bring display information pertaining to the submitter that is currently logged into the application Help This link will open the eMedNY Submitter Dashboard User Manual in anew window Logout Click this link to log out of the application New York State Department of Health Clicking this will display the New York State Department of Health home page in anew window Privacy Policy This link displays the New York State Department of Health s Privacy Policy page in anew window 5 1 Legend Legend S
13. extra segment or the batch is missing a required data element or segment The batch will not be processed File File Submitted Last File File File Sent file Size Status Date Update Accepted Validated bo Adjad Adjudicated 17345678M012345ABE SAMMY SAMPLE 1234567890 752 Completed n a 6a 1 0651 1 Click on the File ID 2 The GS Sub Panel will be displayed AUSER 123345678912 255K Completed 10 18 11 10 18 11 13 05 eMedNY Submitter Dashboard User Manual Version 2012 1 Page 19 of 31 LYSIS OF DASHBOARD INFORMATION FOR 837 SUBMISSIONS 7 2 1 GS Sub Panel for 837 X12 Transactions GS Seq GS Functional Group Occurrence is a hyperlink When clicked the link will open further details about the file See section 7 3 2 1 for this information GS Cntl Num The Group Control Number comes from the GS06 field in the batch Version The X12 Version of the submitted batch will either begin with 005010 indicating it is in a 5010 format or a 004010 for a 4010 transactions TXN Type The TXN Type indicates the type of X12 transaction submitted When clicked the raw data from the submitted file can be accessed See section 6 ST Count Total number of transaction sets TXN Count Number of transactions included in the set ACK If submitter clicks on the hyperlink the file that was sent will display here Status This indicates the type of file returned in for the GS Sub Panel See Appendix
14. hboard User Manual Version 2012 1 Page 9 of 31 PROFILE CREATION 4 Profile Creation After successfully entering login credentials for the first time the user must create a profile Until there is at least a First and Last Name entered in the profile this will always be the homepage To create a profile 1 Enter their First Name Required Enter their Last Name Required 3 Enter at least one valid email address This will be used to notify eMedNY Submitter Dashboard users of any changes to the application 4 Click the Save button Hy Profile This page appears as v our homepage till the Selda First Name of Lact Name ic not empty First Name Last Name Email address 1 Email address 2 Email address 3 Email address 24 Email address 25 5 The following message will appear when the profile was successfully saved or updated hy Profile Such updated Firat Hane Last hame Emad address 1 Emad address 7 Email address 3 Emad address 4 Email address 5 6 To navigate to the Dashboard screen click on the Home link in the upper right corner of the screen eMedNY Submitter Dashboard User Manual Version 2012 1 4 1 2012 Page 10 of 31 THE SUBMITTER DASHBOARD 5 The Submitter Dashboard The Dashboard screen will display the progress of all files for providers that were submitted by the User logged in for the current day as well as the previous day bas
15. in the NYS Medicaid Conditions Column In the example above the error is Invalid client ID CIN The description found in this column corresponds with the Description field shown in section 8 1 above In the example above the description would be states and provinces subscriber for line 1 This is described in Section 8 above eMedNY Submitter Dashboard User Manual Version 2012 1 Page 27 of 31 ANALYSIS OE D OF DASHBOARD INFORMATION FOR NCPDP AND NPI SUBMISSIONS 9 Analysis of Dashboard Information for NCPDP and NPI Submissions When viewing these files through the Submitter Dashboard hyperlinks are not available to allow users to view further information about the batch because these files are processed in real time As a result submitters receive an instant response back from eMedNY submited Last File File File Sent Fie Date Update Accepted Valiiated to Adjud Adjudicated IAOONOOOOOOOOOVE P ormsa ZPO WERE u Completes 01 06 12 01 06 12 Lata 9 o IMOMMOOOOOOOIOOVE P crre 2IP GD001 VOO ampleted 01 06 12 o os iet O o ar 1200600000000I00VF Poms ZIP GOODI VOO Completed 0 06 12 01 06 12 a4 O 3 o eMedNY Submitter Dashboard User Manual Version 2012 1 4 1 2012 Page 28 of 31 10 Resources The eMedNY Submitter Dashboard User Manual is intended to assist submitters track the progress of their batch The additional features presented are not to be used as a substitute for following normal busine
16. layed in the users default text viewer 2 Look for the STC Example STC A7 33 IL 20111115 138 68 0 00 3 Note the A7 33 IL and go to eMedNY 5010 Crosswalks Open the NYS Medicaid Pre Adjudication Crosswalk for Health Care Claims Adobe Reader is required eMedNY Submitter Dashboard User Manual Version 2012 1 Page 26 of 31 E ANALYSIS OF DASHBOARD INFORMATION FOR 277 RESPONSES 5 Look for the error using the STCO1 1 2 and 3 columns that correspond to each of the values in the data separated by a NYS MEDICAID PRE ADJUDICATION CROSSWALK FOR HEALTH CARE CLAIMS VERSIONS 5010 4010 BATCH AND REAL TIME 277CA OR U277 OUTBOUND RESPONSE TO VERSION 5010 INBOUND VERSION 4010 CLAIMS CLAIM INBOUND CLAIM CLAIM LEVEL LINE LEVEL 12 REAL ed era sro T stc e sro alalslalalsl l2 13 NYS Medicaid Conditions INST ProF Dent ProF inst PROF DENT PROF Zee BERNER Claim is out of balance charges Coordination of Benefits payer at line level loop 2430 5VD01 not matched to claim level loop 23308 NM109 Coordination of Benefits payer at line level loop 2430 SVD0d not matched to claim level loop 23308 NM109 Billing Provider NPI or Medicaid ID not on file or not active on date of service for Inpatient claims with Rate Codes 2946 or 2953 the Through Statement Viv v i a a casas AAA EA gt H eee KAKAA KA KAKALA KA ne aa O N Dt Nat certified for tise aad d 6 The error is described
17. nformation for 837 Submissions cccccsseccceeseecesececeesceceeececaueceesueeeseaecesseeeessees 18 7 1 File FCO Oy TAT EI ee ee ee 18 71 1 Errors Pop sa VV OW a ee 19 7 2 FIle Valldated ETOT ar E A E E T ie couetannut E cee 19 7 21 GSSsup Panel1or837 22 Transactions ne A EEE er er er 20 7 3 AM P CODE LE ee ee eens 21 Peed STSUD Pan enlarge 21 7 22 N EWNEEITO e A EE O er 22 8 Analysis of Dashboard Information for 277 Responses eeeneeeesnensesnensnennnnnonennnnnnnnnennnnnnnnnnnnnnnnsnennsnnennennnnnenn 25 8 1 Error PROB UDAN NOO N ee ee ee E nee 26 8 2 Using the Pre Adjudication Crosswalks ccccsssccccssseccccesececcescceceesececcueceeeeecceseusececeuaecesseeceesaeeeessuaecetsunecessenes 26 9 Analysis of Dashboard Information for NCPDP and NPI SUDMISSIONS ssccccssececeeeeeceeseeeeeeceeseeceeeenees 28 tO RE OC acts eee atin ATE E EE E EE 29 Appendix A GS 1 Sub Panel Status EV Nts ccccccsssecccsececssccceeseceeesececeeeceseesceeeeeceeeaeceseucesseecesenecessgecesseneeees 30 Appendix B Modilication Trackin aigeann ee EEE NEE ENET EEE EEOAE 31 eMedNY Submitter Dashboard User Manual Version 2012 1 4 1 2012 Page 3 of 31 Te ees For eMedNY Submitter Dashboard questions please contact the eMedNyY Call Center at 1 800 343 9000 or email eMedNYProviderServices csc com eMedNY Submitter Dashboard User Manual Version 2012 1 Page 4 of 31 PURPOSE STATEMENT 1 Purpose Statement The eMed
18. o the next stage of processing When a file has a status of Complete this is the file completion date See the discussion of the File Status field above for further information File Accepted This column indicates whether the file has passed or failed TA1 Envelope Standards editing File Validated This column indicates whether the file has passed or failed Standards editing File Sent to Adjud This column indicates whether the file was forwarded to eMedNY for further adjudication File Adjudicated This column indicates whether the adjudication process has completed and a response has been sent Notes It is important to note that a Step Completed icon in any of these four columns for an 837 claim batch does not indicate that the claims submitted within the file have been paid only that the acceptance validation and adjudication steps have been completed by the eMedNY system Submitter must review the weekly remittance for final claim determination See section 7 for more details For NCPDP claims only response files do contain adjudication information eMedNY Submitter Dashboard User Manual Version 2012 1 Page 16 of 31 _ DOWNLOADING AND VIEWING RAW DATA 6 Downloading and Viewing Raw Data 6 1 Downloading Data The search result panel will have File ID and File Name hyperlinks 1 Click on File Name 2 The File Download dialog box is displayed It is not recommended that a submitter use this functi
19. ogin page when the session expires The user is required to login again to access the eMedNY Submitter Dashboard Claim Submitters using any of the following batch access methods are able to use the eMedNY Submitter Dashboard to track the status of a submitted file FTP eMedNY eXchange VPN eMedNY File Transfer Service FTS using SOAP eeee Claims submitted through ePACES paper claim forms or real time transactions are not visible through the eMedNY Submitter Dashboard For more information on available access methods refer to the eMedNY Trading Partner Information Companion Guide 3 2 Accessing the Application In order to utilize the eMedNY Submitter Dashboard the submitter must have an active account with valid credentials to submit transactions to eMedNY The user ID credentials used to log into the Dashboard can ONLY access files submitted by that user To view files submitted through a difference access method the user must log in under that submission type Users cannot access files submitted by another user ID eMedNY Submitter Dashboard User Manual Version 2012 1 Page 7 of 31 R ___ ACCESSING THE EMEDNY SUBMITTER DASHBOARD 1 Goto the www emedny org What s New Information Provider Enrollment Provider Manuals Self Help Training Contacts eMedNYHIPAASupport NYHIPAADESK s What s New Information MEET O sse Provider Enrollment Enter Facilities Practitioner s Pls sas Medi
20. on Do you want to open or save this file Name LOGO OIE x 12 Type HTML Document From dashboard emedny ong L Vite fiss from the intemet can be useful some files can potentisiy g ham your computer F you do not trust the source do not open or save this file What s the ask 3 Click Open and the raw data file will appear in a txt file or in html based on the user s PC settings or click Save This will store the contents of the file to the user s desktop Batch files saved to the desktop contain PHI as defined by HIPAA See section 2 above Alternately the user may click on the icon to the right of the File Name Once clicked the file will be opened in a delimited text file using the user s default application eMedNY Submitter Dashboard User Manual Version 2012 1 4 1 2012 Page 17 of 31 Z YSIS OF DASHBOARD INFORMATION FOR 837 SUBMISSIONS 7 Analysis of Dashboard Information for 837 Submissions This section explains the three most common Dashboard responses and provides instructions on how to analyze each File Accepted Error Tir dar M a Te Accepied Vaelelated to Adped Adele atid b 97020 Completed Pil Ba God TEIHBSTERSIEHESAE AuBER 1296372523 File Validated Error File File Submitted Last File Fir File Sent File Site Statin Date Update Accepted Validated bo Adjud Adpidicated 252 Completed dm 10 11 11 Obst O File File Submitted Law File
21. ormatted transactions e 997 Functional Acknowledgment for a version 4010 batch This is the same as the R file or 999 released for claims processed in 5010 formatted transactions eMedNY Submitter Dashboard User Manual Version 2012 1 Page 14 of 31 e i THE SUBMITTER DASHBOARD TA1 Batch Rejection validates the syntax and format of the outer envelope and functional groups Batches rejected at the front end are not subjected to pre adjudication editing Find Click the Find button to search for and display results which match the desired criteria 5 3 File Submitted Search Results File ID This is a unique ID generated by the eMedNY system in order to identify a submitted file for tracking purposes By clicking the link users may view further information about the file See Section 6 for instructions File Name The File Name varies depending on the submission method used For FTP and VPN it is the name of the ZIP file submitted to CSC For FTS Batch and exchange it is the R file name assigned by eMedNY to the inbound file By clicking the link the user can open up and view the raw data that was submitted for files that are up to 28 days old For more information on downloading and viewing a file see section 6 File Size This is the size of the submitted batch file File size is shown in either megabytes or kilobytes File Status The File Status column indicates whether the batch is being proces
22. sed or if it has been completed There are two options for this column Completed The batch has finished processing Completed file status occurs in two situations The file has registered an error during one of the Validation steps File Accepted File Validated or File Sent to Adjud The file has completed adjudication Note Some claims may have failed pre adjudication edits Submitters must review and process their 277 response files to see which claims passed on to adjudication and which claims failed pre adjudication eMedNY Submitter Dashboard User Manual Version 2012 1 Page 15 of 31 7 THE SUBMITTER DASHBOARD In the example below the file has completed all four validation steps and is being adjudicated by eMedNY Submitted Last File File File Sent File Date Update Accepted Yalidated to Adjud Adjudicated 1234567891123456AB AUSER 123456739112 215K Completed 10 25 11 10 25 11 21 09 w In Process The batch is still processing Submitted Last File File File Sent File Date Update Accepted Yalidated to Adjud Adjudicated 41234567891 123456A8 AUSER 123456789112 In Process 10 25 11 10 25 11 21 09 Note If a file has been in the In Process status for over 72 hours contact the eMedNY Call Center at 18003439000 Submitted Date This is the date on which the file was uploaded to eMedNY Last Update While a file has a status of In Process this date is updated as the file advances t
23. ss processes with regards to processing X12 NCPDP response files eMedNY encourages submitters to explore these and other resources listed below The ASC X12N Implementation Guides and their associated addenda are available in electronic format at http store x12 org store Pharmacy Providers can acquire the NCPDP Implementation Guide from www ncpdp org HIPAA Health Information Privacy Standards http www hhs gov ocr privac For billing questions contact the eMedNY Call Center at 800 343 9000 For EDI related information specific to NY Medicaid visit the eMedNYHIPAASupport page on www emedny org eeece eMedNY Submitter Dashboard User Manual Version 2012 1 4 1 2012 Page 29 of 31 l APPENDIX A GS 1 SUB PANEL STATUS EVENTS APPENDIX A GS 1 SUB PANEL STATUS EVENTS The table below lists all possible Status Events for the GS Sub panel along with a brief description of each Status Event Statusevent Den FILE EVENT File picked up by FPS and is being processed File validated for envelope structure ISA IEA valid characters VALIDATION proprietary file structures Process to concatenate proprietary files to larger batch files for FILE CONCATENATION PROCESS processing on the mainframe Dispatched X12 277 response for 837 Negative acknowledgement response received eMedNY Submitter Dashboard User Manual Version 2012 1 4 1 2012 Page 30 of 31 ne APPENDIX B MODIFICATION TRACKING APPENDIX B MODIFICAT
24. ted A file is partially accepted when the file has multiple GS segments and one or more of these have been rejected Download file By clicking the download file arrow users can download the associated inbound or outbound file See Section 6 for more information TA1 error A TA1 Interchange Acknowledgment with an error has been returned to the claim submitter This error only occurs in the File Accepted column For more information on this error see Section 7 1 5 2 File Submitted Search Fields From Date To Date Select a date range for the application to find submitted files received after July 21 2011 The From and To dates are required fields To change the date click in either field to display the calendar as shown in this example October 2011 Mo Tu We Th 3 4 rol aal 18 These fields default to prior day and the current day Note Files over 28 days old do not display raw data eMedNY Submitter Dashboard User Manual Version 2012 1 Page 13 of 31 Zn THE SUBMITTER DASHBOARD Name Enter the name of the file submitted if it is known to the user This field is optional Status From the drop down menu select the status of submitted batches from the following list All Status All completed and in process results will be display This is the default selection Completed Searches for only those files that are complete In Process Brings up only files that have not been completed eeee
25. tep Completed Rejected I Partially Accepted Download fie 9 TA1 error The Legend at the bottom of the Submitter Dashboard screen explains icons that may be found in the following columns FileName File Accepted File Validated File Sent to Adjud File Adjudicated Step Completed The Step Completed icon indicates that the submitted file has completed the corresponding stage Step Completed does not mean that the claims were accepted and will be paid it only means that the batch was accepted and processed The submitter will need to review all of their response files related to their submissions to determine if their batches were accepted or rejected Additionally the submitter must review the files related to the batch to see which claims were adjudicated and which were not eMedNY Submitter Dashboard User Manual Version 2012 1 Page 12 of 31 THE SUBMITTER DASHBOARD Note All 5010 claim batches receive a 277CA Response File This response file must be examined with the submitters software to determine which claims passed on to adjudication and which ones did not The Step Completed check mark cannot relay this information to the user E Rejected Rejected indicates that the submitted file will not progress past the corresponding stage Note Files which display the Rejected icon in any of columns are considered to have a status of Complete since processing has stopped 2 Partially Accep
26. tive material are followed Investigate and report to the Compliance Officer or designee any incident where the acquisition access use or disclosure PHI is in a manner not permitted or which compromises the security or privacy of PHI Properly dispose of printed and electronic protected health information Access PHI on company owned equipment in secured locations and not in public settings such as the mall or libraries eMedNY Submitter Dashboard users are responsible for the preservation privacy and security of data in their possession While using the application the user has access to data that contains Protected Health Information PHI and must be guarded and disposed of appropriately if downloaded by the user As covered entities or vendors operating on behalf of a covered entity any inappropriate use or disclosure of PHI must be handled as prescribed in the above mentioned federal regulations eMedNY Submitter Dashboard User Manual Version 2012 1 Page 6 of 31 n ACCESSING THE EMEDNY SUBMITTER DASHBOARD 3 Accessing the eMedNY Submitter Dashboard 3 1 Requirements To utilize the eMedNY Submitter Dashboard submitters must have an active eXchange FTP FTS SOAP or VPN account with valid credentials to submit transactions to eMedNY The eMedNY Submitter Dashboard features an automatic logout that is triggered when there is no activity within the application for 15 minutes The user will be routed back to the l
27. to display any pre adjudication edits reported in a U277 for a 4010 submission or a 277CA for a 5010 submission If there are errors the following will be displayed Claim line Error Number Description 70183 States and Provinces Subscriber 70190 2pCode PostalCode Billing provider 70 200 Heatncare Common Procedural Coding System HCPCS Note All of the values reported on this pop up are from either the U277 or the 277CA It is strongly recommended users process that response file and NOT use these screens as anything but confirmation that there may be some rejected claims eMedNY Submitter Dashboard User Manual Version 2012 1 4 1 2012 Page 25 of 31 E i _ ANALYSIS OF DASHBOARD INFORMATION FOR 277 RESPONSES 8 1 Error Pop Up Window Txn This is the transaction number in the batch TCN This is the Transaction Control Number assigned by eMedNY to the claim Claim Line This is the line number in the claim where the error occurred within the transaction set Error Number These error numbers are for eMedNY use only Description The description is the reason for the error 8 2 Using the Pre Adjudication Crosswalks In addition to the dashboard raw data from the 277 response file may be interpreted using the 277 PreAdjudication Crosswalks available on www emedny org Follow the steps below or consult your local library 1 Inthe GS panel click on the 277 under the Response column The raw data will be disp
28. w eMedNY Submitter Dashboard User Manual Version 2012 1 Page 22 of 31 YSIS OF DASHBOARD INFORMATION FOR 837 SUBMISSIONS 7 3 2 1 GS Functional Group Pop Up The GS Functional Group Pop Up displays the validation errors that occurred during processing The example below does not reflect all possible errors that may be encountered during processing and is for informational purposes only All of the values reported on this pop up are from the 999 997 Functional Acknowledgement It is strongly recommended users processes that file and NOT use these screens as anything but confirmation of the rejection information Group Control Number 573461915 Transaction Ib 837 Transaction Control Number 000009280 ment Element CER Reference Poston tror Reference Position Error CLM 1504 3 Mandatory Seen missing Transaction Set Trailer Error ne or More Segments in Error Group Control Number This refers to the GS segment the user clicked on ST Transaction Set This is the ST transaction number Loop Section This area will show the user where in raw data an issue occurred when applicable Segment Section This is the segment within the Loop where an error occurred Reference This area will provide the segment within the Loop where an issue occurred eMedNY Submitter Dashboard User Manual Version 2012 1 Page 23 of 31 e LYSIS OF DASHBOARD INFORMATION FOR 837 SUBMISSIONS Position This is the line with

eMedNY Submitter Dashboard User Manual

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