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1. Insured Miscellaneous Payer Address amp Miscellaneous Address City SvZip Paper Source PPO HMOIndiD Claim Edit Ind TRICARE Sponsor Claim Office Ho Branch Grade Status E Employer Information Address Cipi Stip Employer ID Supplemental Ins Ind Ing Location Ident Medicaid ID a Card Eff Trm Date thru Ez Retire Date Prior 4uth No Type Add l Ref No Type Add l Ref Ho Type Patient ID Insurance Type JA je Spouse Retire fi EEE Ily Figure 6 9 Professional Claim Form Extended Payer Insured Tab 12 To enter MSP claims you must first enter Y in the COB field from Patient Info amp General tab see Figure 6 3 Note This will generate two new sub tabs to the Extended Payer Insured tab On the COB Info Primary and COB Info Secondary sub tabs Figure 6 10 complete the fields under Common Payer MSP Information if Medicare is tertiary Also note the generated MSP COB sub tab on the Billing Line Items tab Figure 6 11 Potent Inia Genga Insured Infomation Bing Line lema Ext PatertAierseal Ext Patten 2 Ext Payerne Line hem Detali Extended Detads Line 1 fit Dead Silane 1 9 MSPYCOE flee 1 Abarca Common Payer MSP Infomation Additional Aduner J COD agunis EE Comman Lina MS Araria Eriein Likra cuckrahion COG Inian ASIA Ue Gr Alwad im Clin Lewel Argustinen
2. Figure 2 2 Drive Selection Window Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 3 Getting Started 4 The Password dialog box Figure 2 3 will display In the Password field enter the installation password medicare This password is case sensitive so be sure to E ates This installation i password protected Please enter use all lower case letters the installation password into the field below Password 5 PC ACE Pro32 Setup begins copying the program files to DT your computer A status of the copy process is shown on the Installing window Press the OK button to continue Press Cancel to abort the installation cereal Figure 2 3 Password Dialog Box 6 When the file copying is complete the Read Me SA Read Me File File window Figure 2 4 will display Read the information be sure to use the scrollbar on the right of the screen to scroll down and read all of the text and click Next to continue Thank you for installing MedLink Technologies PC ACE Pro32 Claims Processing System fou have just completed the PC ACE Pro32 server installation single PC ACE Pro32 client has also been installed on this system Additional PC ACE Pro32 clients can be installed at each individual workstation by executing the CLIENT32 EXE program from the server s WINPCACE directory This client installation will create a local WINPCACE directory and configure the workstation
3. ccccsssseeeeeeeeeeeeeees Deleting an Existing Physician UPIN Record ccecceeessseeeeeeeeees Facility Reference File Codes Misc Professional ccccceeeeeeeees Adding or Modifying a Facility Record ccccccccceeeeeeeeeeeseeeeeeeeeees Delenns an Existing Facility RECO i secdartesescasisisizecisisties ieee tathiadessonss Charges Master Reference File Codes Misc Professional Adding or Modifying a Charges Master Code ccccccccccscsssssssseeeeeeeees Deleting an Existing Charges Master Code cccccccccscsssssseeeeseeeeees Palmetto GBA November 2004 Table of Contents Page i Table of Contents PC ACE Pro32 User s Manual SECTION 5 INSTITUTIONAL PART A CLAIMSPROCESSING 20 Using the Institational C lamin Formoes ena cena aaa 20 Entermme Institutional Claim Data eena E masse udwaweNaUugarahass 21 Toe TS CCU al Clan EiS eein a a Ea 26 VAI NC ROMS a a a E I A EE EREE AA 26 Claim LIS REDONS ocorrer reesen EEEE EEEE E DEEE ESEE EEE EDE ZT Automated G lars Process 1 0 anosa sns geet bel uanien R 28 Preparing Claims Tor Electronice TF ransimiSSiOM yresienaeceasiel cousin nese ne ucees titer haveean edule 28 SECTION 6 PROFESSIONAL CMS 1500 PART B CLAIMS PROCESSING 30 Using the Professional lain F OfMiisursscswa readin sais a aS 30 Entering Professional Claim Data vnsecessiancceccrnsnsedvancsncnpeasnesaupnctied uecauentaxboutacateacbetsupedinduedansweauees 31
4. 11 To archive a A single claim highlight the desired claim b Several claims place a check in the left column next to each desired claim Select Actions from the Claim List toolbar and choose a Archive Selected Claim for a single claim b Archive All Checked Claims for more than one claim The claim s will disappear from the current claim list To view the claims you just archived toggle back to the claim archive by selecting File from the Claim List toolbar and choosing View Archived Claims When you are finished reviewing the claim archive select File from the Claim List toolbar and choose View Current Claims Select File from the Claim List toolbar and choose Close Claim Archive to close the open claim archive You will be prompted to pack the claim archive before closing We recommend packing a claim archive database occasionally as it minimizes the disk space requirements and enhances performance Note The packing process can be lengthy for large databases Once the packing operation has started it must continue to completion Click the Yes button to pack and close the archive the No button to close the archive without packing or the Cancel button to leave the archive open Note If you close the Claim List form without first closing an open claim archive the archive is closed automatically and you will receive the pack prompt Unarchiving Claims To unarchive claims 1 Open the claim archive see st
5. Fly Over Hints While entering data into the various Reference Files and Claim Forms you can view helpful fly over hints for most entry fields Simply hold your mouse cursor still over a field and a small pop up will display with a description of the data to be entered into that particular field Fixed or Variable List Lookups A number of fields in the Reference Files and Claim Forms support data entry using fixed list or variable list lookups If you know the options for a particular field you can type in the selection or you can access the lookup list by right clicking the mouse over the field or click in the field and press F2 Once the list is visible you can use your mouse to highlight and then click on your choice and it will be entered into the field Context Sensitive Access Press F1 from anywhere in PC ACE Pro32 to display help information relevant to your current location in the program Conventional Access Select Help on the PC ACE Pro32 toolbar and choose Help Topics From the Help Topics window choose one of the following tabs e Contents Presents all help topics in a nested table of contents format e Index Alphabetically lists all available index entries e Find Perform a free form text search of all topics Logging Out of PC ACE Pro32 You can log out of PC ACE Pro32 without exiting to allow another user to log on and use the system To log out select Security from the PC AC
6. Name Address o axl City State Claim Notes NTE File Information K3 zs Num Type Narrative Zip Country Facility Type raj 1 Tax ID Type mie Figure 5 9 Institutional Claim Form Extended Patient General Tab 13 Complete the additional patient and general claim level fields as needed 14 Enter data into any required authorization fields This tab also includes fields for MSP and other secondary claims where COB information is required Figure 5 10 Institutional Claim Form X Patient Info amp Codes Billing Line Items Payer Information Diagnosis Procedure Extended Patient General Extended Payer Payer Address amp Miscellaneous Insured Address amp Miscellaneous Address Address City St Zip City St Zip IE i f_ CoD 0 nco _o cip _o tarp o Bithdate o Sex Patient ID Payer Source Code Claim Office Number Payer Indicator Contractor ID m Extended Authorization IDE Information 34 Record Provider SOF i Provider Accepts Assign Set 1 Set2 Set 3 37a ICN DCN Type Auth IDE Num Reference Number Type Treatment Authorization Period Rev Code EN thru az HCPCS Save Cancel Figure 5 10 Institutional Claim Form Extended Payer Tab Palmetto GBA Page 25 November 2004 Section 5 Institutional Claims Processing PC ACE Pro32 User s Manual 15 After completing all of the data entry
7. field identifies the service line on the original claim to which this SVD line applies This reference identifier should be included on the remittance and is primarily used in scenarios where procedure code bundling unbundling has occurred Line Adjustment CAS amp Miscellaneous Adjudication Info Permits entry of several additional Service Line Adjudication SVD fields for the current SVD line The fields in this control group track the currently selected SVD line The control group s caption indicates the current SVD line e g for SVD 1 above Line Level Adjustments CAS Permits entry of one or more line level adjustments as reported by the payer for the current Service Line Adjudication SVD line Adjustments are defined by a specific Group code and Reason code combination Enter these codes manually or select them from the available lookup lists Each line level adjustment must specify a non zero Amount value and may also specify an optional Units value Common Line MSP Information This field group exists primarily to provide a bridge between the MSP COB reporting standards defined in the older NSF format and those defined in the ANSI X12 implementation Only the Approved and OTAF Obligated To Accept In Full amount fields are actually needed to process COB claims in the newer ANSI X12 format All remaining fields in this group can be reported using equivalent values i
8. Preparing Claims for Electronic Transmission Claim preparation generates a transmission ready Electronic Media Claims EMC file EMC files contain submission details for one or more processed claims Only claims in the to be transmitted CL location that have an electronic E media setting are eligible for preparation When a claim is prepared into an EMC file it is automatically moved to the transmitted TR location which prevents the claim from being inadvertently retransmitted Note Before preparing claims for the first time you will need to set up your Submitter Reference File This file contains important data that will be used to build the EMC file To generate an EMC file Professional Claim Prepare For Transmission Include Claims Matching 1 Select the Prepare Claims option from the o zz Professional Claims Menu The Professional Prepare For Transmission window will display Payer lt lt All Payers for LOB s gt gt Figur e 6 1 3 Provider lt lt All Providers for Payer s gt gt 2 Sp ecify fr om the dr op down list if you want Output Format Submission Status Include Error Claire only a single line of business LOB to be NSF Production C Yes considered or select lt lt All gt gt to include claims i ANEIB37 C Test No for any line of business If you specify an LOB Prepare Claime Cancel Figure 6 13 Professional Claim Prepare for Transmission a Choose
9. ARCHIVING 52 Unarchivine TaS aemeemne eeerderme reenter rertone a eran Me et Me eee er re eC ee eee 53 Page ii Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 1 Introduction SECTION 1 INTRODUCTION PC ACE Pro32 is a complete self contained electronic processing system for healthcare claims submission and management It can be used in a stand alone configuration or in conjunction with your existing claims management system The system has been designed to work exclusively with the Microsoft Windows operating system The PC ACE Pro32 program is available on a CD ROM which will be mailed to you Minimum System Requirements Pentium 133 MHz processor Pentium I I 350 for larger claim volume 64 MB system memory 128 MB recommended CD ROM drive recommended for server installation SVGA monitor resolution 800 x 600 Windows 95 98 2000 Me XP or NT 4 0 operating system gt gt Adobe Acrobat Reader Version 4 0 or later for overlaid claim printing This free software can be downloaded from the Adobe Web site www adobe com When the Windows Large Fonts display setting is enabled the screen resolution must be 1024 x 768 or higher The Institutional Claim Form UB 92 and Professional Claim Form CMS 1500 will not display properly at lower screen resolutions Technical Support Palmetto GBA technical support is available by calling the Electronic Data Interchange EDI Tec
10. For Ohio and West Virginia Part B inquiries use the following e mail address ohwv edi palmettogba com Palmetto GBA Page 47 November 2004 Section 11 Claim Activity Log PC ACE Pro32 User s Manual SECTION 11 CLAIM ACTIVITY LOG The Claim Activity Log files provide details of all claim import process prepare and transmission activities The log files also record any abnormal activities that may occur in the course of operation Separate log files are maintained for Institutional and Professional claim activities The log files can be useful when researching past claim processing activity or reviewing the outcome of scheduled claim activities To view a claim activity log file 1 Open either the Institutional or the Professional Claims Menu 2 Select View from the Claims Menu toolbar and then choose Claim Activity Log 3 Windows WordPad will launch and open the applicable log file Activities are logged chronologically with the most recent entries at the end of the file 4 When you are finished reviewing the log close the WordPad program Page 48 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 12 Claim Printing SECTION 12 CLAIM PRINTING Claims can be printed in PC ACE Pro32 using either the traditional pre printed forms method or an advanced image overlay technique The pre printed forms method prints just the actual claim field values at positions on the page that should line up with pre
11. Date f Service Date Claim List Filter Options 7 Location cL to be transmitted Status B Alls LOB B All 33 Checked claim count 0 Clear Filters Advanced Filter Options ail Hew ia if IE Fc Copy Close Figure 6 12 Professional Claim List Window Delete Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 6 Professional Claims Processing CLAIM ACTIONS To perform an action on one or more claims 1 Highlight the single selected claim or choose multiple claims by clicking in the left hand column to place a checkmark next to each selected claim 2 Perform the desired action Primary actions have conveniently placed buttons located at the bottom of the form Additional actions can be chosen by selecting the Actions menu on the Claim List toolbar you can also right click over a selected claim to view a pop up menu Available claim actions are described in the following table An X in the M column indicates that the action menu option can be performed on multiple claims Menu Option M Description of Action a err or New button a OE or View Update button ages agile The Professional Claim Entry form will display containing details of the or Copy button highlighted claim Some fields are cleared automatically in the new claim Delete Selected Claim X Deleted claims are assigned DEL status or Delete button Note DE
12. Edit Validation Errors List form will display indicating fatal and non fatal errors You may correct the errors or save the claim with errors Note If a fatal error exists in the LOB PCN or TOB field you must correct the error before being allowed to save the claim i To save a claim that contains only non fatal errors click the Save With Errors button These claims are saved with a has errors ERR status u To save aclaim that contains fatal errors click the Save With Fatal button Such claims are assigned the has fatal errors ERF status Claims with an ERF status are not eligible for preparation into an electronic EMC file 14 If edit validation errors occur several Save attempts may be required to correct and save a clean claim At any time you can click the Errors List button to review remaining edit validation errors The Professional Claim List The Professional Claim List Figure 6 12 provides versatile access to create list modify print and otherwise maintain claims To access the Claim List form l Select the List Claims option from the Profes sional Claims Menu Choose one of the Sort By options radio buttons shown just below list If you want to filter the claim list select the desired filters from the Claim List Filter Options drop down lists Page 36 Ei Professional Claim List File Filter Actions Reports Bil Provider Type Entered Se Sot By i Patient Name PCN Entry
13. GBA November 2004 PC ACE Pro32 User s Manual 3 Determine if you plan to add or modify a record a To adda new Provider record click the New button The New Provider Options window will display Figure 4 6 Choose one of the options and click OK b To update an existing Provider record highlight the record and click the View Update button or double click on the record 4 The Institutional Provider Figure 4 7 or Professional Provider Figure 4 8 Name JONES MEMORIAL Phone _ 214 555 1212 be Information window will display Address PALMERSST FAX ye Complete the fields Contact CONTACT NAME HERE City St Zip ANYWHERETOWN Tx 74123___ County Site T POOO Provider ID No ooo LOB MCA noe Fed Tax ID POOS Sub ID 001 Payer ID Tag i i Tax Type le Include In Lookups Remarks Provider Associations Select None Note Professional field requirements will vary based on the Provider Type chosen radio buttons at top of Provider Type Group Name Lagt First Ml window Part B Set up Group ee Practices before adding Individuals in Group DMERC Use only the Solo City St Zip Practice provider type Phone Contact Group ID Mo Paver ID Remarks Palmetto GBA November 2004 Section 4 Reference File Maintenance Hew Provider Options As a convenience the new provider may inherit the basic name and address information from the currently selected provider This facilitates the creat
14. Maintenance window will display with the default tab Patient displayed The central field will display a list of existing patients 2 Highlight the desired record from the list click the Delete button and confirm the deletion C O d es M SC it Reference File Maintenance The Codes Misc tab Figure E le View Reports 4 14 of the Reference File Patient Paper Provider nat Provider Prof Codes Misc Maintenance form provides Shared Institutional Professional access to many of the core TOR Pos PC ACE Pro32 reference l DATA COMM CONAOCC SP VAL TOS files The reference file buttons are grouped under MERES AIMENEIE LHE CHARGES MASTER Shared files used by both MODIFIERS SPECIALTY Institutional and Professional E Institutional only and Professional only Page 12 PHYSICIAN l FACILITY Many of the reference files o mury require setup before use TAXONOMY while others are optional Figure 4 14 Reference File Maintenance Codes Misc Tab Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 4 Reference File Maintenance Submitter Reference File Codes Misc Shared Submitter information in PC ACE Pro32 is maintained from the Submitter Setup form for Institutional Part A and Professional CMS 1500 Part B claim types Information from the Submitter Reference File is required during preparation of Electronic Media Claims EMC files At least one de
15. Preferences window will display Prefere Figure 4 26 If you are using the General Claim List Claim Import Printing Data Comm Misc HCPCS Reference file click once on E E Use Charge Master reference file for W Automatically tab at maximum field length during data entry W Tab key jumpe between controls with edit errors when displayed Professional procedure code lookups W Enable flashing notification method for controls with edit errors wi Warm on close when deferred claims tasks are scheduled 9 Click the OK button n EDRN W Show descriptive field hints on claim and reference file forms Present claims with errors for immediate editing during process runa Mw Use Charge Master reference file for Professional procedure code lookups Interpret Enter key as save request on claim entry and other editable forms I Automatically display Edit Validation Error List when saving a claim that contains errors W Automatically prompt for selection of non unique Payer Provider and Physician IDs Automatically focus on Patient PCN field for new Institutional hand keyed claims Automatically focus on Patient PCN field for new Professional hand keyed claims Auto populate zero service line Units value to 1 during Professional claim entry Figure 4 26 Preferences Window DELETING AN EXISTING CHARGES MASTER CODE To delete an existing code 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu Th
16. a single Payer or lt lt All Payers for LOB s gt gt to include claims for all payers b Choose one or more Providers or lt lt All Providers for Payer s gt gt to include claims for all providers 3 Specify whether a You want ANSI 837 EMC file output format b The EMC file should be designated as a production or test submission c Claims with non fatal errors ERR are to be eligible for preparation When unchecked only processed claims will be eligible for preparation 4 Click the Prepare Claims button Confirm your intention to prepare all eligible claims by clicking OK on the displayed confirmation Running totals of the count and dollar value of all prepared claims will be displayed on the Claims Prepare For Transmission form You will be notified when the claim preparation operation completes 5 You can click View Results and or View Errors to view reports of the successfully prepared claims and rejected claims respectively These reports can be printed from the report previewer if desired Page 38 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 6 Professional Claims Processing 6 When you have completed your review of the claim preparation reports click the Close button on the Claim Prepare For Transmission form Roster Billing The PC ACE Pro32 Roster Billing List form provides a versatile interface from which the user can create list modify print and otherwise maintain Professional ro
17. and Total Non Covered Charges fields from the current claim line item charges values 6 When you have finished with the information on this tab click on the Payer Information tab to display that section of the claim entry form Figure 5 5 Institutional Claim Form Ei Patient Info amp Codes Billing Line Items Payer Information Diagnosis Procedure Extended Patient General Extended Payer as 5a BA FSB ai ai Al Sub Paver ID Paver Hame Provider Mo ROIL AOB Prior Payments Amount Due S A A E E E O o YE O LT ay a Clear Payer o_o a FL57 Due From Patient gt 0 00 0 00 P Fel 58 lnsured s Name Last First Ml 60 nsured s ID 61 Group Name 62 Group Number 63 Authorization Code Type ESC 65 Employer Hame 66 Employer Address City State Zip AEE Save Cancel Figure 5 5 Institutional Claim Form Payer Information Tab Page 22 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 5 Institutional Claims Processing 10 Begin entering payer data Fields that require free form text are shown on the tab as Form Locator buttons e g FL56 To enter information into these fields a Click the FL56 button and the Form Locator 56 popup window will display b Type in the related information Press to start a new line if needed c When you have completed your entry press TAB to close the pop up window d Follow the same steps with each For
18. available lookup lists Each line level adjustment must specify a non zero Amount value and may also specify an optional Units value Page 24 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 5 Institutional Claims Processing Common Line MSP Information This field group exists primarily to provide a bridge between the MSP COB reporting standards defined in the older NSF format and those defined in the ANSI X12 implementation Only the Approved and OTAF Obligated To Accept In Full amount fields are actually needed to process COB claims in the newer ANSI X12 format All remaining fields in this group can be reported using equivalent values in the SVD or CAS field groups For backward compatibility PC ACE Pro32 will continue to recognize and report values in these obsolete fields whenever it is practical to do so 11 Enter a Y in the ANSI 837 HH CR6 Attachment field if required for claim submission 12 When you have completed entering information into the Diagnosis Procedure tab click on the Extended Patient General tab to display that section of the claim entry form Figure 5 9 Institutional Claim Form X Patient Info amp Codes Billing Line Items Payer Information Diagnosis Procedure Extended Patient General Extended Payer M Facility Information Claim Supplemental Information PWK Er Num Type Trans Attachment Control Number Description ype A EE
19. create claim archives a To create a new archive click the New button and the MA EE yeni Create New Claim Archive dialog box will display T K P NS Figure 14 1 Enter a descriptive name for the new ee e e archive Archive names can contain only alphabetic and numeric characters the underscore _ cancel _ character and spaces You will receive an error message if the chosen archive name is unacceptable Click the OK button and the empty archive will be created and the corresponding entry will be added to the selection list Figure 14 1 Create New Claim Archive Dialog b To open a claim archive highlight the desired archive and click the Open button or double click the new list entry You will be returned to the Claim List form with the new claim archive open in the window To archive a claim 1 Open a claim archive into the Claim List form see steps above 2 Select File from Claim List toolbar and then choose View Archived Claims The claims in the open claim archive will display 3 Select File from Claim List toolbar and then choose View Current Claims to toggle back to the current claims 4 Only transmitted and paid claims can be archived Therefore under Claim List Filter Options at the bottom of the window choose TR transmitted only or TR PD transmitted paid from the Location field Page 52 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 14 Archiving 10
20. existing Payer record highlight the record and click the View Update button or double click on the record 4 The Payer Information window Figure 4 3 will display Complete each of the following fields the table below has values for each of these fields Payer ID LOB Full Description and Flags The other fields should remain empty Payer Information Payer ID LOB Receiver ID 5408 Override Full Description Flags Source EditInd Media w Address Usage Address amp Contact Information Address m m City State ip ME Contact Hame Phone Ext Fax a Printlink Matching Descriptions jave Cancel Figure 4 3 Payer Information Window i Payer ID LOB ISA08 Override UA Pescripiion Field value Field Value Field Value Field Value Part A SC amp RHHI 00380 C00380 Part A NC 00382 C00382 5 After you have completed your additions changes click the Save button located on the bottom right of the window The system will perform an edit validation on the entered information If you have not completed or incorrectly completed one or more required fields the Edit Validation Errors List will display This form lists all fatal and non fatal errors that occurred Fatal errors indicated by a red X must be corrected before the system will allow you to save the information a Double click on a listed error to go to that loc
21. for shared database access 4 default user SYSADMIN with password SYSADMIN can be used to evaluate PC ACE Pro32 From the PC ACE Pro32 main Security menu use the Add Update User option to add additional user accounts if desired 7 The Installation Complete window displays indicating that PC ACE Pro32 has been successfully installed Click Finish to close the window This README TXT file can also be viewed by double clicking the PC ACE Pro32 README TXT gt Cancel 8 The installation process automatically places a PC ACE Pro32 shortcut icon Figure 2 5 on your desktop which can be used to open the program PC ACE Pro32 Figure 2 5 PC ACE Pro32 Startup Icon Palmetto GBA Page 3 November 2004 Section 3 Getting Started PC ACE Pro32 User s Manual SECTION 3 GETTING STARTED Logging Into the PC ACE Pro32 Claims Processing System Users are required to log into PC ACE Pro32 before performing any system activities The login process involves entering a User ID and Password Your PC ACE Pro32 software has been configured with a single default user the system administrator who has full system access rights The default User ID is SYSADMIN and the password is SYSADMIN as well If you are logging into PC ACE Pro32 for the first time you should use this default login Important You should change the default user s password as soon as possible if you are concerned about controlling user ac
22. on the claim form click the Save button or press ALT s to save and exit the claim Note clicking the Cancel button will abandon all changes made to the claim When you click the Save button PC ACE Pro32 begins an Edit Validation process One or more of the following edits may be required a At least one of the payers specified on a claim must have the same LOB line of business as the claim itself b If no edit validation errors occur the claim is saved with a clean CLN status c If one or more edit validation errors occur the Edit Validation Errors List form will display indicating fatal and non fatal errors You may correct the errors or save the claim with errors Note If a fatal error exists in the LOB PCN or TOB field you must correct the error before you will be allowed to save the claim i To save a claim that contains only non fatal errors click the Save With Errors button These claims are saved with a has errors ERR status ii To save a claim that contains fatal errors click the Save With Fatal button Such claims are assigned the has fatal errors ERF status Claims with an ERF status are not eligible for preparation into an electronic EMC file 16 If edit validation errors occur several Save attempts may be required to correct and save a clean claim At any time you can click the Errors List button to review remaining edit validation errors The Institutional Claim List The Institutional Cl
23. service line The P S field identifies the payer primary secondary reporting this line adjudication notice The procedure code and modifier fields identify the specific procedure being adjusted The practice of procedure code bundling and unbundling utilizes these fields to provide specific information regarding how the payer has grouped the procedures for payment The Paid Amount indicates the amount the payer has paid on this procedure The Paid Units value permits reporting of payments for less than the originally billed units Finally the B U Line field identifies the service line on the original claim to which this SVD line applies This reference identifier should be included on the remittance and is primarily used in scenarios where procedure code bundling unbundling has occurred Line Adjustment CAS amp Miscellaneous Adjudication Info Permits entry of several additional Service Line Adjudication SVD fields for the current SVD line The fields in this control group track the currently selected SVD line The control group s caption indicates the current SVD line e g for SVD 1 above Line Level Adjustments CAS Permits entry of one or more line level adjustments as reported by the payer for the current Service Line Adjudication SVD line Adjustments are defined by a specific Group code and Reason code combination Enter these codes manually or select them from the
24. 109 10008 Qual field The Receiver Name NM103 1000B Acknowledgement 2 Receiver Primary Identifier NM103 10008 Requested field must contain 1 iv No updates required on the ANSI Info 2 tab Figure 4 17 Professional Submitter Setup Window 7 After you have completed your additions changes click the Save button located on the bottom right of the window 8 During the submitter save operation an edit validation process is performed on all submitter record files If no edit validation errors occur the submitter record is saved If one or more edit validation errors occur the Edit Validation Errors List will display This form lists all fatal and non fatal errors that occurred If any fatal errors exist you must correct them before the submitter record can be saved If only non fatal errors exist you can either correct the errors or save the submitter record with errors Click on Save with Errors to save a submitter record with non fatal errors Several Save attempts may be required to correct and save a clean submitter record DELETING AN EXISTING SUBMITTER RECORD To delete an existing record 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display 2 Click the Codes Misc tab 3 Under the Shared list click the Submitter button The central field of the Submitter Setup window will display a lis
25. 32 main menu The Reference File Maintenance window will display Click the Codes Misc tab Under Shared click the HCPCS button The HCPCS Code window will display Choose Global Codes or Local Codes from the radio buttons at the top of the window Highlight the desired code from the list click the Delete button and confirm the deletion Physician UPIN Reference File Codes Misc Shared Note This reference file does not apply to Institutional Claims The Physician UPIN Setup form provides access to maintain the optional UPIN or Physicians reference file The list of physicians and associated UPIN and address information is made available via lookups to speed the claims entry process The Physician UPIN Setup can be sorted by Name or UPIN ADDING OR UPDATING A PHYSICIAN UPIN RECORD iF DELETING AN EXISTING PHYSICIAN UPIN RECORD To delete an existing record 0 BEEE Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display Click the Codes Misc tab Under the Shared list click the Physician button The Physician UPIN window will display Figure 4 20 iat Physician UPIN Setup Physician ID Physician Mame Determine if you plan to add or modify a record a Toaddanew record click the New sor By of Name Last First Ml f Physician ID button f List Filter Options ae f Show all physicians no filter applied b To update an existing rec
26. Billing e G m E Form The data fields are Tax ID Type E typically entered in the order E EEEE presented from left to right and tye J top to bottom Enter the Common Name FO roster billing information in the top section of the Patient Info amp O B a General tab Figure 6 14 Enter TaxID Type Facility Type patient specific information for any number of patients in the lower section of this tab Enter supplemental information on the Extended Roster Info tab Figure 6 15 if required Figure 6 15 Prof Roster Billing Form Extended Roster Info Tab LISTING MODIFYING AND MAINTAINING ROSTER BILLINGS 1 Professional roster billings in PC ACE Pro32 are listed modified generated printed and otherwise maintained from the Professional Roster Billing List Form To access this form Palmetto GBA Page 39 November 2004 Section 6 Professional Claims Processing PC ACE Pro32 User s Manual a Click the Professional Claims Processing button on the PC ACE Pro32 Main Toolbar to display the Professional Claims Menu form b From the Professional Claims Menu form select the Maintain Roster Billings item from the main Roster menu to open the Professional Roster Billing List Form 2 All actions to be performed on a roster billing may be executed from the Roster Billing List form Roster billings can be created viewed modified copied deleted undeleted a
27. COB Info Secondary Figure 5 7 and one new sub tab to the Billing Line Items tab MSP COB Figure 5 8 Poteet Indo Codes Bling Line tiem Popes Indoenation Dingess Proseka Exieeded Paent iera Extended Payer Piima Papii Secondary Paper Tertiary Papas EDE indo iPr COD ints Seconda Cisim Adenimenis CE Amounts J ALS WIDA radcwrretiony AN SIEI finie Ciam Level Adirtrerts ILAT COB HIA F HDA Amgunty Pai Info t Coda Ding Lire liena Fie Irorun Dungeness Prieka E dreta Firat irreal Ediki Payot Line hem Dietsd Extended Datat Line 1 HSP CO Line 1 Lireelervoed fulbe CINE Indera UNISI HEI Lice Chay Sivan Larch Arpali A fl edhe WD PS Aav Cel Pree Gui s Cida Pmj Aari Padria BU Lee O E E E a a a i ei rf f ff aff ff ff T Pe ff xy Line Auchutirreend C05 Micele Acuehestion ints io SVO 1 asv Pracka Traba Checeapbicn Line Lavel Auduotmesnts LAS Hum Grows Reston Medicare lngeaterd Adeucke ation HIA emake Cokes E ee ee eee ee Mecicare Ouipatiend Arucication MEM Rirmasks Codes a ee eee ee Clam Aduckcaton Date fof Figure 5 7 COB Info Primary Sub Tab Figure 5 8 MSP COB Sub Tab Two distinct levels of Coordination of Benefits reporting are supported Claim Level COB Reporting Remittance data that is not specific to a particular service line is reported at the claim level The claim form provides claim level COB fields for both the primary and se
28. Close button to cancel any pending roster billing changes GENERATING ROSTER BILLING CLAIMS l A roster billing defines both the common and patient specific details required to create the corresponding set of claims Once you are satisfied with the roster billing contents and no fatal edit validation errors exist you can generate claims for this roster billing using either of the following techniques a When a new Professional roster billing is created from the New Roster Billing menu item and saved error free you will be prompted to proceed automatically to the claim generation step b Claims for existing Professional roster billings can be generated from the Roster Billing List Form To be eligible for generation a roster billing must reside in the to be generated RL location and have a clean CLN or has errors ERR status Select the desired roster billing record and click the Generate button or choose the Generate Selected Roster action to initiate the claim generation process 2 You will be prompted to confirm your intent to generate claims for this roster billing As the operation proceeds running totals of the count and dollar value of all generated claims will be displayed on the Roster Claim Generation form You will be notified when the claim generation operation completes Page 40 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 6 Professional Claim
29. E Pro32 toolbar and choose Logout Current User To log back onto the system click on any button and the Sign On Sin On window will display Figure 3 3 Enter your user ID and password and then click OK User ID Fassword Cancel Figure 3 3 Sign On Window Palmetto GBA Page 5 November 2004 Section 4 Reference File Maintenance PC ACE Pro32 User s Manual SECTION 4 REFERENCE FILE MAINTENANCE To streamline and improve the accuracy of claims entry PC ACE Pro32 automatically fills fields on the Claims Entry screens based on information previously entered into the various Reference Files For example when you enter a Patient Control Number PCN on the Professional Claim Form all fields related to that PCN e g patient s name address telephone etc will automatically be filled with data from the Patient Reference File For this reason it is very important that you update all Reference Files before creating claims Be sure to complete the Reference Files in the following order 1 Payer Reference File 2 Provider Reference File 3 Patient Reference File mi PC ACE Pro32 Claims Processing System 4 Submitter Reference File Dis tew aes ndi To begin editing the reference files sign on and from the PC ACE Pro32 Claims Processing toolbar Figure 4 1 click on the Reference File button file folder Reference File Maintenance Figure 4 1 PC ACE Pro32 Claims Pr
30. ERR status 3 After each eligible claim is printed you will be prompted to move the claim to the transmitted TR location When multiple paper claims are eligible for submission you may use the Yes To All No To All buttons to move not move all eligible paper claims to the transmitted TR location after printing Adobe Acrobat Reader version 4 0 is required for this function Note Since paper claims will never be prepared into an EMC file this prompt provides the only available mechanism for moving these claims out of the pre transmitted CL location Palmetto GBA Page 27 November 2004 Section 5 Institutional Claims Processing PC ACE Pro32 User s Manual Automated Claims Processing The Process Claims feature allows you to run front end edits on claims being submitted To process claims 1 Select the Process Claims option from the Institutional Claims Menu The Automated Claim Process Claims Matching leave blank for all claims Processing window will display Figure 5 12 LOB TOB Provider Reprocess claims with errors 2 If you want to process only specified claims complete the top portion of the window Place a check in the box next to the options in the lower portion of the window if desired Present claims with errors for immediate editing Include edit error details in process error report Process Close Figure 5 12 Automated Claim Processing Window Preparing Claims for Elec
31. IMPORTANT NOTICE CONCERNING THIS DOCUMENT Should you have accessed this document as a result of a search engine or other link be advised that these files contain material that is copyrighted by the American Medical Association You are forbidden to download the files unless you read agree to and abide by the provisions of the copyright statement Read the copyright statement now and you will be linked back to here CENTERS for MEDICARE amp MEDICAID SERVICES PC ACE Pro32 User s Manual For ANSI X12N 837 v4010A1 oh Age CPT codes descriptors and other data only are copyright 1999 American Medical Association or such other date of publication P a m etto G B A of CPT All Rights Reserved Applicable FARS DFARS apply A CMS Contracted Intermediary and Carrier November 2004 PC ACE Pro32 User s Manual TABLE OF CONTENTS SECTION 1 INTRODUCTION Minimum System Requirements cccccccccssssessseceeecceeaaeseeeeceeeeeeeaas eChimi Cal SUP POM esne SECTION 2 ACCESSING amp INSTALLING PC ACE PRO32 Accessing PC ACE Pro32 from a CD ROM ccccccessseeeeeeeeeeeeeeees Installation INS tC OMS nanena a SECTION 3 GETTING STARTED Logging Into the PC ACE Pro32 Claims Processing System System USCIS is scteactrentnoranyaceadgseb dew a E ip tadepadebsesnaaes Adding or Modifying a User siisiccdieathciiioiasniiissliasihaialisatabanadshisadesvedonetons Building Your Reference Piles
32. L status claims can be recovered undeleted Purge Selected Claim X Claims in the pre transmitted CL location with a DEL status will be purged from the system Note Purged claims cannot be recovered Move selected claim s from the previously transmitted TR or paid PD location into the pre transmitted CL location The reactivated claim will be assigned the unprocessed UNP status Changes the status of the selected claim to hold HLD Held claims are not considered for future claim activities such as automated claim processing or claim preparation Print Selected Claim Claims may be printed using either a plain paper image overlay Reactivate Selected Claim Hold Selected Claim Moves the selected claim s from the transmitted TR and paid PD locations to the open claim archive database Allows you to post view or modify payments for the selected claim technique or the traditional pre printed form method Adobe Acrobat Archive Claims X Reader version 4 0 is required for this function Show Selected Claim Payments Media Only claims with a media setting of electronic E will be eligible for preparation into an EMC file Claims with a media setting of paper P can be printed and submitted in hardcopy form When a paper claim is printed you will be given the option to move the claim from the pre transmitted CL location to the transmitted TR location set Selected Claim Designates the selected claim
33. MOA use Enter or select the Code which defines the amount type to be reported and enter the corresponding Amount value Medicare Outpatient Adjudication MOA Remarks Codes Permits entry of up to 5 remarks codes for Medicare Outpatient Adjudication MOA use These optional codes may be entered manually or selected from the available lookup list Claim Adjudication Date Permits entry of the date on which the payer adjudicated the claim This date is typically required at either the claim or line level The line level COB data is entered on the MSP COB sub tab of the Billing Line Items tab Figure 6 11 The purpose and use of the various field groups on this sub tab are as follows Service Line Adjudication SVD Information Permits entry of one or more Service Line Adjudication SVD lines as reported by the payer for the current service line The P S field identifies the payer primary secondary reporting this line adjudication notice The procedure code and modifier fields identify the specific procedure being adjusted The practice of procedure code bundling and unbundling utilizes these fields to provide specific information regarding how the payer has grouped the procedures for payment The Paid Amount indicates the amount the payer has paid on this procedure The Paid Units value permits reporting of payments for less than the originally billed units Finally the B U Line
34. S PROCESSING Once your reference files have been igi PC ACE Pro3 Claims Processing System established you can begin claims processing File View Security Help The Professional Claims Processing option on the PC ACE Pro32 main menu button highlighted in Figure 6 1 gives you access to the Professional Claims Menu Figure 6 2 FP From the Professional Claims Menu the following operations are available Import Claims from a print file Note Claim importing is not supported Refer to on line help for information Enter Claims manually List Claims to maintain existing claims from a comprehensive list Process Claims imported or reactivated automatically Prepare Claims into an EMC file for sa transmission Process Claims Prepare Claims Figure 6 2 Professional Claims Menu Using the Professional Claim Form The Professional Claim Form has been designed to provide a data entry flow resembling that of the printer Professional CMS 1500 claim form The following information will help you as you complete the claim form To move between the five major claim form sections click on the associated tab or press the and keys To move through the claim form fields you can click on a field to activate it or you can press the key to move from field to field in a predefined sequence generally left to right and top to bottom Use the UP ARROW and DOWN ARROW keys to move up and down t
35. TMG Professional Chim TASC soca steaks cetsed anata a duvate uae shadecet wat eietnamerneens 36 caImAC CIONS tc ala eect laced eae ae cee ace ese eee ecu 37 clam LEER pO ananasen 37 Preparing Claims for Electronic Transmission ccccsssssseccceccceeeeessesecceeeecaeeeeseeeeeeseeeaeesees 38 ROCE UITE ea A N Srcueernn 39 Addn Anew Toser DINS anyana nan E EEE RRON A A 39 Listing Modifying and Maintaining Roster Billings 0 0 0 0 eeeeeeeeeeeeeeeeeeeeseeseseeeeeseeeeeeeeens 39 Gretieraune Roster Bing Clann Ss pias eal ere EE E EEG 40 Aut mated Claims ProCeESsSiNg xi ioieiacsiesdSoasbanihessoandtand hondtdadtess tans ienn Sond kan ia n E ania 4 Preparing Claims for Electronic TranSMission cccccccsssssssssssssseeeccceeceeeeeeeeeeaaeeessseeeseseeeees 4 SECTION 7 DATA COMMUNICATIONS 43 SECTION 8 EXITING PC ACE PRO32 44 SECTION 9 SYSTEM UTILITIES 45 Ba IU ag scart nace eu susadtesnanetetacysaneusonech scat E A acta wi nventaudaanses 45 NA e E A E cee Rt E S E hoe hea Ae TE 46 FRESIORG saie i E EE E a 46 SECTION 10 SENDING AN E MAIL 47 SECTION 11 CLAIM ACTIVITY LOG 48 SECTION 12 CLAIM PRINTING 49 SECTION 13 REACTIVATING PREVIOUSLY TRANSMITTED CLAIMS 50 Individually Reactivating Transmitted Claims cccccccccssessseccccecceeeeeeeeceeeeeeeaaeeeseeeeeeeeeaaas 50 Reactivating an Entire EMC File for Retransmission cccccccccsssseeseeeeeceeceeaeeseeseeeeeeeaaas 50 SECTION 14
36. ab to complete the field entries for this portion of the claim form Palmetto GBA Page 21 November 2004 Section 5 Institutional Claims Processing PC ACE Pro32 User s Manual 4 When you have completed entering information into the Patient Info and Codes tab click on the Billing Line Items tab to display that section of the claim entry form Figure 5 4 Patient Info amp Codes Billing Line Items Paver Information Diagnosis Procedure Extended Patient General Extended Payer Line Item Details Extended Details Line 1 ee E E gS a i TL ILIC C CE E T E i T Ut i i i Ep E i T i i I i i E p E i T i i i i p E i T i i i i i __ E i 6h i i i g pjg i 1 1 1 C E p iE Recalculate m i Sa o o mm Save Cancel Figure 5 4 Institutional Claim Form Billing Line Items Tabs To enter a new line you can enter data into each field of the line or to facilitate your entry you can a Duplicate all the fields from the previous line by pressing F5 b Duplicate a single field from the previous line by clicking in the selected field and pressing F4 c Delete an entire line by pressing F7 Note Claim lines are automatically re sequenced by Revenue Code when a claim is saved 5 When you have completed line item entries click the Recalculate button located near the bottom of the tab adjacent to the Totals field This will recalculate and update the Total Charges
37. ag display SotBy LOB ProviderName ProviderID Tag M List Filter Options Show all providers no filter applied C Show only providers associated with selected provider Filter list to include Provider IDs starting with Filter list to include Provider Names starting with New View Update Delete Close Figure 4 4 Institutional Part A Provider Tab iat Reference File Maintenance Mi x File View Reports 2 Click on either the Provider Inst tab for Part A providers Figure 4 4 Patient Payer Provider Inst Provider Prof Codes Misc Tag or Provider Prof tab for Part B providers Figure 4 5 On each of MCB Indiv ALLEN PAUL XXXXX 22222222 34 these tabs the central field will MCB Solo SOLO JOHN D XXXXXX 2 display a list of existing providers if MCB Indiv PETERSON JILL A XXXXXX 22222222 1 any Use the radio buttons just below the list to sort by the options zl provided SotBy LOB Type Provider Group Name ProviderlD GroupLabel Tag M List Filter Options a Show all providers no filter applied Show only providers associated with selected provider Filter list to include Provider IDs starting with Filter list to include Provider Names starting with New View Update Delete Close Figure 4 5 Professional CMS 1500 Part B Provider Tab Page 8 Palmetto
38. aii essen ine xeaedidaemeudeencdecitaanaiindieaw Getting Help In PG ACE Pro 32 sic soascnetsinebeaiesanee E Logeine Out of PC AGE PLO 52 eisers e aae ae ER SECTION 4 REFERENCE FILE MAINTENANCE Payer Retetence Pile pach taaeseurn Meee ie ahneaeie ean ates Addins or Updatins a Payer RECO ernn wu wae Deletns am Exist ne Payer ReCOn diss y ser usdvodddosses eM dabliatlinlcotlins Provider Institutional and Professional Reference File 0 adding or Updanne a Provider zeuss aaa Deleting an Existin Provider ReECOrd svoe edesin ododd Patient Roier iee Tienen a na Adding or Updating a Patient Record ccccccccccceeceeeeseeeseeeeseeseeeeees Deleting an Existing Patient Record ccccccccccccacessessseeeessssssseeees COGS VIC Oise Arica ae a a aed heat Submitter Reference File Codes Misc Shared ou cece eeesceeeeee Adding or Updating a Submitter Record ccccccesseseeeeeeeeeeeeeees Deleting an Existing Submitter Record ccccccccssssseesseseeeeeeeeees Data Communications Reference File Codes Misc Shared HCPCS Reference File Codes Misc Shared cccccccecceeecceeeseeeseeees Adding or Updating a HCPCS Code uu cccceccccccccccccceceeeeeeeeeeeeeeeesseeeees Deleting an Existing HCPCS Code sccsscosstscstcastnaschabisehosabasaberoboratarabonabs Physician UPIN Reference File Codes Misc Shared ccc cce Adding or Updating a Physician UPIN Record
39. aim List Figure 5 11 provides versatile access to create list modify print and otherwise maintain claims To access the Claim List form 1 Select the List Claims option from the Institutional Claims Menu 2 Choose one of the Sort By options radio buttons below list 3 If you want to filter the claim list select the desired filters from the Claim List Filter Options drop down lists CLAIM ACTIONS iat Institutional Claim List File Filter Acton Reports Status LOB TOBIPCN Patient Last PaveriD Entered Serv Fror a oll Sot By Patient Name i PCN f Entry Date C Service Date Claim List Filter Options Location cL to be transmitted Status k lt All gt gt LOB B All gt gt E E E Clear Filters Advanced Filter Options Close Delete Figure 5 11 Institutional Claim List Window To perform an action on one or more claims 1 Highlight the single selected claim or choose multiple claims by clicking in the left hand column to place a checkmark next to each selected claim 2 Perform the desired action Primary actions have conveniently placed buttons located at the bottom of the form Additional actions can be chosen by selecting the Actions menu on the Claim List toolbar you can also right click over a selected claim to view a pop up menu Available claim actions are described in the table on the following page An X in the M column indi
40. aim Prepare for Transmission for all providers 3 Specify whether a You want ANSI 837 EMC file output format b The EMC file should be designated as a production or test submission c Claims with non fatal errors ERR are to be eligible for preparation When unchecked only processed claims will be eligible for preparation Palmetto GBA Page 41 November 2004 Section 6 Professional Claims Processing PC ACE Pro32 User s Manual 4 Click the Prepare Claims button Confirm your intention to prepare all eligible claims by clicking OK on the displayed confirmation Running totals of the count and dollar value of all prepared claims will be displayed on the Claims Prepare For Transmission form You will be notified when the claim preparation operation completes 5 You can click the View Results and or View Errors buttons to view reports of the successfully prepared claims and rejected claims respectively These reports can be printed from the report previewer if desired 6 When you have completed your review of the claim preparation reports click the Close button on the Claim Prepare For Transmission form Page 42 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 7 Data Communications SECTION 7 DATA COMMUNICATIONS Before you are ready to transmit you must have already entered one or more claims and prepared these claims into an EMC file suitable for transmission Claim files are l
41. al Information Extended Info Primary Insured Inst Primary Insured Prof Secondary Insured 4 gt Last Name First Name MI Gen Patient Control No PCN each of the Patient Information tabs oOo E FE O a General Information Tab Enter AEE Mi ae Address Active Patient lv Discharge Status general patient information such as eo ex ea n the patient s name address birthdate DOB 2 DOD ERa E VALON erste Maes p Cc Marital Status Signature On Fie b Extended Info Tab Enter extended Phone Employment Status Release of Info 7 patient information such as Student Status ROIDate _ _7 information on the patient s legal aoe _ MSACode representative Professional claim use only c Primary Insured Tab s Inst Save Cancel_ and or Prof Enter payer insured and employer information for the primary Institutional Part A and or Professional 1500 Part B payer s If your system is set up for both Institutional and Professional claim activities then you will have the option to enter separate Institutional and Professional insured information Figure 4 12 Patient Information General Information Tab d Secondary and Tertiary Insured Tabs click on the right arrow at the right of the tabs to view the Tertiary Tab See the Primary Insured Tab above for details 5 After you have completed your additions changes click the Save button l
42. al control number Deleting this provider will irrevocably break these links on all claims that reference this provider Click the Check Usage button for a count of affected claims Consider the following options before deleting the provider record Option 7 Ifthe provider is not referenced on any claims it may be safely deleted Option 2 IF the provider ts referenced on one or more claims consider modifying 3 Highlight the desired record from the list and click the Delete button The Provider Deletion Confirmation will display Figure 4 10 and outline alternatives If you determine that you still want to delete the selected provider click OK Patient Reference File Do you still want to delete the selected provider record Check Usage the provider information rather than deleting it altogether Refrain from modifying the 1D or LOB fields Option 33 If the provider is no longer in use set all Provider Roles flags to N The provider will remain on file Gut wall no longer be available from any of the claim entry lookup lists Figure 4 10 Provider Deletion Confirmation Dialog Box The Patient Reference File maintains all necessary general patient information as well as primary secondary and tertiary insured details Patient information that has been entered in the Patient Reference File is available for lookup during claim entry Note To assist you in completing field entries accurate
43. an a Duplicate all the fields from the previous line by pressing F5 b Duplicate a single field from the previous line by clicking in the selected field and pressing F4 c Delete an entire line by pressing F8 Page 32 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 6 Professional Claims Processing 6 When you have completed line item entries click the Recalculate button located near the bottom of the tab adjacent to the Totals field This will recalculate and update the Total Charges and the Balance Due fields from the current claim line item charges values and the Amount Paid field value Professional Claim Form X Patient Info amp General Insured Information Billing Line Items Ext Patient General Ext Pat Gen 2 Ext Payer Insured 7 Click on the Extended Details sub Line Item Details Extended Details Line 1 Ext Details 2 Line 1 Ambulance tabs and review the information in Type of Transport E Services Available Origin Information these fields Transport To For Medically Necessary Stretcher Patient Admitted E E g I f h t d d d Bed Confined Before E Patient Discharged E Destination Information you Aa entered a p rocedure code Bed Confined Afte Patient Admit 2nd Facit that r equires a Professional CMS Unconscious Shock EKG Order UPIN mergency Situation atient Wei Purpose of Round Tri 1500 Attachment or CMN an a a n er i add
44. ation in the Payer Information form and make the necessary corrections fields with errors will be flashing red b If there are no fatal errors that must be corrected now those marked with a red X you may close the Edit Validation Errors List and then click the Save With Errors button on the Payer Information form Palmetto GBA Page 7 November 2004 Section 4 Reference File Maintenance PC ACE Pro32 User s Manual DELETING AN EXISTING PAYER RECORD To delete an existing record 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display Click on the Payer tab The central field will display a list of existing payers 2 Highlight the desired record from the list click the Delete button and confirm the deletion Provider Institutional and Professional Reference File The Provider Inst and Provider Prof tabs of the Reference File Maintenance window provide access to maintain the provider information referenced on claims Setup of the provider reference file s is required to process claims All providers referenced on claims must be represented in the reference file s ADDING OR UPDATING A PROVIDER l Click the Reference File igi Reference File Maintenance Maintenance button on the PC ACE Ee Vew Beratts Pro32 main menu The Reference Patient Payer Provider Inst Provider Prof Codes Misc Fed Tax ID File Maintenance window will T
45. cates that the action menu option can be performed on multiple claims Page 26 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 5 Institutional Claims Processing Menu Option M Description of Action Create New claim Access a blank Institutional Claim Entry form or New button View Selected Claim View and or modify the selected claim or View Update button Copy Selected Claim or Copy button Delete Selected Claim or Delete button The Institutional Claim Entry form will display containing details of the highlighted claim Some fields are cleared automatically in the new claim Deleted claims are assigned DEL status Note DEL status claims can be recovered undeleted purged from the system Note Purged claims cannot be recovered Move selected claim s from the previously transmitted TR or paid PD location into the pre transmitted CL location The reactivated claim will be assigned the unprocessed UNP status Changes the status of the selected claim to hold HLD Held claims are not considered for future claim activities such as automated claim processing or claim preparation Print Selected Claim X Claims may be printed using either a plain paper image overlay technique or the traditional pre printed form method Adobe Acrobat Reader version 4 0 is required for this function Archive Claims X Moves the selected claim s from the transmitted TR and paid PD locations
46. ce 36 Occurence Span 36 Occurence ee Code Date Code Date Code Date Code Date Code From Thru Code From i i p TEA g ERR es g E a E A Pa E TAI E TAA E EET oe E EAN ERN _ E 39 Value 40 Value 41 Value 39 Value 40 Value 41 Value Code Amount Code Amount Code Amount Code Amount Code Amount Code Amount Im pm p u g g G __ m pu g g g M M Save Cancel Figure 5 3 Institutional Claim Form Patient Info amp Codes Tab 2 Begin entering patient and code data using your cursor or the TAB key to move through the fields Note Many fields on this and subsequent tabs will fill automatically as other fields are completed with information pulled from the reference files For example when you enter a Patient Control Number the patient s name address etc will automatically fill the appropriate fields If any of the automatically entered information is incorrect it cannot be changed from this tab You must exit the Claim Form and make the necessary change s directly to the proper reference file 3 Fields that require free form text are shown on the tab as Form Locator buttons e g FL1 To enter information into these fields a Click the FL1 button and the Form Locator 1 popup window will display b Type in the relevant information Press to start a new line if needed c When you have completed your entry press TAB to close the popup window d Follow the same steps with each Form Locator button on the t
47. cess at your facility System Users PC ACE Pro32 requires that a valid login and password be entered by anyone accessing the system The system administrator must set up a user account for each person that will use PC ACE Pro32 The user account specifies the user s login password values and defines the activities that the user has permission to perform Only users with User Add Modify privileges can perform these maintenance functions which include adding a new user and modifying information on an existing user ADDING OR MODIFYING A USER To add a new user or modify an existing user 1 Select Security from the PC ACE 2 To adda new user click the New button on the bottom of Pro32 Toolbar and choose the window To modify an existing user highlight the Add Update User The Security desired user from the Security List and click View Update List form Figure 3 1 will display The User Security Update window will display Figure 3 2 User ID Password User Name ga M User Permissions Institutional Claim Activities __ View Institutional Claims C Enter Institutional Claims Modify Institutional Claims Delete Institutional Claims Import Institutional Claims C Process Institutional Claims __ Prepare Institutional Claims Archive Institutional Claims H Professional Claim Activities zi New View Update Delete Close Check All Clear All Cancel Figure 3 1 Security Lis
48. ckup To ensure minimal problems in the event that a database restoration is required we recommend leaving this option checked for all backups c Specify whether or not to include the claim archive database files in the backup Refer to Section 15 Archiving Claims for more information on the archive feature d Specify whether or not to include all archived EMC files in the backup 3 Click the Start Backup button The system will notify you when the backup is successfully completed Palmetto GBA Page 45 November 2004 Section 9 System Utilities Validate No data is restored during the validation process so it is safe and advisable to validate an archive before attempting a restore operation To validate an existing backup file l From the System Utilities window click the Backup Restore tab and the Validate sub tab Figure 9 3 Specify the drive or folder where the backup file is located Click the Start Validate button Note When validating backup archives that span multiple diskettes insert the last diskette in the set first The system will prompt for the first and subsequent diskettes as the validation proceeds The system will confirm details of the backup archive s integrity and display archive details date of backup etc Restore System Utilities PC ACE Pro32 User s Manual Backup Walidate Restore This utility validates a previously made PC ACE Prose database an
49. condary payers These fields are located on the COB Info Primary Figure 6 10 and COB Info Secondary sub tabs of the Extended Payer Insured tab Palmetto GBA Page 23 November 2004 Section 5 Institutional Claims Processing PC ACE Pro32 User s Manual Line Level COB Reporting Remittance data specific to a particular service line is reported at the line level The claim form provides a set of line level COB fields for each service line These fields are located on the MSP COB sub tab of the Billing Line Items tab Figure 6 11 This sub tab tracks the currently selected service line in the same manner as the other extended line item sub tabs The current service line is identified in the sub tab caption e g Line 4 The claim level COB data is entered on the COB Info Primary and COB Info Secondary sub tabs of the Extended Payer Insured tab The purpose and use of the various field groups on these sub tabs are as follows Common Payer MSP Information This field group exists primarily to provide a bridge between the MSP COB reporting standards defined in the older NSF format and those defined in the ANSI X12 implementation Only the amount Paid by primary payer amount Allowed by primary payer the Insurance Type OTAF Obligated To Accept In Full Amount if applicable Zero Payment Ind and Claim Adjudication Date fields are actually needed to process MSP COB claims i
50. ctronic Media Claims EMC file EMC files contain submission details for one or more processed claims Only claims in the to be generated GL location that have an electronic E media setting are eligible for preparation When a claim is prepared into an EMC file it is automatically moved to the transmitted GR location which prevents the claim from being inadvertently retransmitted Note Before preparing claims for the first time you will need to set up your Submitter Reference File This file contains important data that will be used to build the EMC file To generate an EMC file 1 Select the Prepare Claims option from the Professional Claim Prepare For Transmission Professional Claims Menu The Professional gt Include Claims Matching Prepare For Transmission window will display Los ee ails Figure 6 18 Payer lt All Payers for LOB s gt Specify from the drop down list if you want TERRE lt lt All Providers for Paver s gt gt only a single line of business LOB to be considered or select lt lt All gt gt to include claims Output Format Submission Status Include Error Claims for any line of business If you specify an LOB NSF f Production C Yes a Choose a single Payer or lt lt All Payers for Sees ee f No LOB s gt gt to include claims for all payers ee RE b Choose one or more Providers or lt lt All Providers for Payer s gt gt to include claims Figure 6 18 Professional Cl
51. d Patient General Tab on the Professional Claim Form ADDING OR MODIFYING A FACILITY RECORD 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display 2 Click the Codes Misc tab 3 Under the Professional list click the Facility button The Facility Setup window will display Figure 4 22 iat Facility Setup 4 Determine if you plan to add or modify a record a To add a new record click the New a button Sort By C Facility Name Facility ID New View Update b To update an existing record highlight the record and click the Figure 4 22 Facility Setup Window View Update button or double click on the record Facility Information Facility ID Type Facility Hame 5 The Facility Information window Figure 4 23 will display Complete the fields Address FN City Svzip e E 6 After you have completed your Facility Type Tas ID Type E additions changes click the Save button located on the bottom right of the Figure 4 23 Facility Information Window window DELETING AN EXISTING FACILITY RECORD To delete an existing record 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display 2 Click the Codes Misc tab 3 Under Professional click the Facility button The central field of the Facility Setup window will display a list of exi
52. d configuration setting backup archive file Specity the source drive e g 6A or hard disk folder path containing the backup and click the Start Validate button Note This process simply confirme that the backup archive has the expected format and that all files contained within the archive are readable Wo data will be restored during this validation process Source Drive or Folder containing backup to be validated Start Validate Figure 9 3 Backup Restore Tab Validate Sub Tab Important Note The restore operation will overwrite your current database files with older data from the specified backup To restore database files and configuration settings from a backup file l From the System Utilities window click the Backup Restore tab and the Restore sub tab Figure 9 4 Specify the drive or folder where the backup file is located Place a check next to Restore system and user configuration settings Click the Start Restore button Note When restoring backup archives that span multiple diskettes insert the last diskette in the set first The system will prompt for the first and subsequent diskettes as the restoration proceeds You will be notified when the restore operation completes PC ACE Pro32 will System Utilities Backup Validate Restore This utility perform a restore of the PE ACE Prog databases and configuration settings from a previously made backup Specify the source
53. dive e g 4 4 or hard disk folder path containing the backup and click the Start Restore button Warning This restore operation will overwrite your curent databases with older data from the epecitied backup You should perform thie operation under the supervision of authorized technical support personnel only Source Drive or Folder containing backup to be restored A I Restore system and user configuration settings in addition to database files Start Restore Figure 9 4 Backup Restore Tab Restore Sub Tab terminate automatically following a restore operation The restored database files and configuration settings will be available the next time the program is opened Page 46 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 10 Sending an E Mail SECTION 10 SENDING AN E MAIL In addition to calling the Palmetto GBA Technology Support Center toll free at 1 866 749 4301 or 1 866 308 5438 for Ohio amp West Virginia Part B providers you can also initiate technical support e mail for general software related issues only directly from the PC ACE Pro32 system To send an e mail 1 Click the Send E Mail button on the PC ACE Pro32 main menu 2 PC ACE Pro32 will launch your default e mail program 3 Ensure that the e mail is correctly addressed a For SC Part A NC Part A SC Part B DMERC and Railroad inquiries use the following e mail address medicare edi palmettogba com b
54. e Reference File Maintenance window will display 2 Click the Codes Misc tab 3 Under Professional click the Charges Master button The central field of the Charges Master Setup window will display a list of existing codes 4 Highlight the desired code from the list click the Delete button and confirm the deletion Palmetto GBA Page 19 November 2004 Section 5 Institutional Claims Processing PC ACE Pro32 User s Manual SECTION 5 INSTITUTIONAL PART A CLAIMS PROCESSING Once your reference files have been established you can begin claims processing The Institutional Claims Processing option on the PC ACE Pro32 main menu button highlighted in Figure 5 1 gives you access to the Institutional Claims Menu Figure 5 2 it PC ACE Pro32 Claims Processing System File View Security Help Institutional Claims Processing romano lncnniional Cams Wen the Figure 5 1 PC ACE Pro32 Claims Processing Menu following operations are available M Institutional Claims Menu i gt File vi Attachment Maintal Import Claims from a print file Note Claim Se ei eee hk L importing is not supported Refer to on line help for information Enter Claims manually List Claims to maintain existing claims from a comprehensive list Process Claims imported or reactivated automatically Prepare Claims into an EMC file for transmission Process Claims Prepare Claims Figure 5 2 Instit
55. eps above 2 Highlight single or check multiple the desired claim s 3 Select Actions from the Claim List toolbar and choose a Unarchive Selected Claim for a single claim b Unarchive All Checked Claims for more than one claim Palmetto GBA Page 53 November 2004
56. essional claims into the PC ACE Pro32 system 1 Select Enter Claims from the Professional Claims Menu The Professional Claim Form will display Figure 6 3 Professional Claim Form Fa Patient Into amp General Insured Information Biling Line Items Ext Patient General Ext Pat Gen z Ext Payer Insured LOE MCE Biling Provider 26 Patient Control No i 8 Pat Status Death 12 Legal 2 Patient Last Mame First Name Ml Gen 3 Bithdate Sex MS E5 55 Ind SOF Rep if S E i a e ie 5 Patient Address 1 Patient Address 2 Patient City State Patent zip Patient Phone a L SE 10 Patient Condition Related To ROI ROlDate Otherlns 14 Daterlnd of Curent 15 First Date 16 UTW Disability Dates amp Type ee ee o he ee ee es 17 Referring Physician s Mame Last First Ml 17a Referring Phys ID Type 18 Hospitalization Dates 20 Outside Lab amp Charges E E o vin f oo 15 Reserved For Local Use 22 Medicaid Resubmission Code amp Ref Mo 25 Fed Tax ID SSN EIN 2 Provider Accepts Assignment E 33a PIH No 31 Provider SOF Date _ _ Facility Dental COB Frequency 33b GRP No Save Cancel Figure 6 3 Professional Claim Form Patient Info amp General Tab 2 Begin entering patient and general data using your cursor or the TAB key to move through the fields Note Many fields on this and subsequent tabs will fill automatically as other fields are completed with infor
57. fault submitter record LOB lt lt All gt gt must be available before claims can be prepared Additional LOB specific submitter records may also be created if required ADDING OR UPDATING A SUBMITTER RECORD 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu for the Reference File Maintenance window 2 Click the Codes Misc tab it Submitter Setup ol x 3 Under the Shared list click the Submitter PE TOBE ote Veil e d button The Submitter Setup window will Een Clemens display Figure 4 15 4 Choose the appropriate Claim Type Institutional for Part A claims and Professional for Part B claims 5 Please do not update the default Submitter E record Select New to configure your E Vin Ape a ee T Submitter information Figure 4 15 Submitter Setup Window 6 The Institutional or the Professional Submitter Information window will display a Institutional Submitter Institutional Submitter Information Information Figure 4 16 87er Prepare ANSI Info ANSI Info 2 Institutional Submitter Information i Complete all fields on the General tab except EIN ii No updates required on the Prepare tab ANSI 637 Data Element Overrides ui On the ANSI Info City ER Aut tab enter ZZ in Interchange Sender ID 15406 t jer the Submitter Intchg zo Interchange Receiver ID 15408 e i ID Qual field and Cor AN Application Sender s Code am
58. fessional Claim Form Ei Patient Info General Insured Information Billing Line Items Ext Patient General Ext Pat Gen 21 Est Payer Insured Line Item Details Extended Details Line 1 Ext Details 2 Line 1 Claim Diagnosis Codes 1 a 3 4 S B it a eda Service Pae 24b 24c 24d 4d Modifier 24e Adf 24g LM From hru PS TS Proc 1 2 Diagnosis Charges ls EP FPEMCB AT Rendering Physician a ee O O R O E jf _ sx ee ee ee a in jf jf f fi _f_ jjijj7 o_ _ Jf jf jf f fi _f jjijj7 _ ERMI EETA p J __ _ _ _ J 7 Jes B r jj ff 6 28 Total Charge 0 00 Recalculate 29 Amount Faid 0 00 30 Balance Due 0 00 Save Cancel Figure 6 5 Billing Line Items Tab Line Item Details Sub Tab 5 The Billing Line Items tab contains a number of sub tabs The first sub tab Line Item Details displays the claim diagnosis codes as well as the basic line item fields available on the hard copy Professional CMS 1500 claim form The remaining sub tabs are linked to the currently selected line on the Line Items Details tab As you move from one line to another on the Line Items Details tab the remaining sub tabs will track the new current line Note that the Extended Details tab caption will change based on the current line highlighted i e Ext Details Line 1 Ext Details Line2 etc To enter a new line you can enter data into each field of the line or to facilitate your entry you c
59. for either electronic or paper submission CLAIM LIST REPORTS PC ACE Pro32 gives you the ability to view several reports and a number of special print functions To view a detailed report of the currently listed claims 1 Select Reports from the Claim List toolbar 2 Choose Print Claim Detail Report The previewed report may be printed if desired by clicking the printer button at the top of the report preview form Palmetto GBA Page 37 November 2004 Section 6 Professional Claims Processing PC ACE Pro32 User s Manual To print all or a subset of claims currently eligible for paper submission 1 Select Reports from the Claim List toolbar 2 Choose Print Claims for Paper Submission A claim is eligible for paper submission if it has a media setting of paper P resides in the pre transmitted CL location and has a clean CLN status or optionally a non fatal errors ERR status 3 After each eligible claim is printed you will be prompted to move the claim to the transmitted TR location When multiple paper claims are eligible for submission you may use the Yes To All No To All buttons to move not move all eligible paper claims to the transmitted TR location after printing Adobe Acrobat Reader version 4 0 is required for this function Note Since paper claims will never be prepared into an EMC file this prompt provides the only available mechanism for moving these claims out of the pre transmitted CL location
60. ged database files backup will be larger Backup is designed to protect just the PC ACE Pro32 databases and configuration information The program executable files and other support files are not included in the backup archive It is strongly recommended that you supplement these backups with a Figure 9 2 System Utilities Window comprehensive backup schedule for your server and client systems In the event a full restore is required you would first restore from a full system backup to rebuild the system s directory hierarchy and restore all program and support files The most recent PC ACE Pro32 backup could then be restored to recover your databases and configuration settings Options Start Backup The following sections describe the steps to backup validate and restore Backup To perform a backup of the PC ACE Pro32 database files and configuration settings 1 From the Systems Utilities window click the Backup Restore tab and the Backup sub tab see Figure 9 2 2 Complete the following information a Enter type or click the button to browse the destination drive or folder to which the file will be written You can choose your floppy or writeable CD ROM drive or a hard disk drive local or remote Note Disk spanning is supported for backups to diskette You will be prompted to insert blank diskettes as needed b Specify whether or not to include certain infrequently changed database files in the ba
61. hnology Support Center toll free at 1 866 749 4301 Monday through Friday from 7 30 a m until 5 00 p m ET Ohio and West Virginia Part B providers should call the EDI Technical Support Team at 1 866 308 5438 Palmetto GBA Page 1 November 2004 Section 3 Getting Started PC ACE Pro32 User s Manual SECTION 2 ACCESSING amp INSTALLING PC ACE PRO32 The following step by step instructions will walk you through accessing and installing PC ACE Pro32 to your personal computer Accessing PC ACE Pro32 from a CD ROM l 3 4 5 6 Close all Windows based programs and insert the PC ACE Pro32 CD in your CD ROM drive Click Start lower left corner of your screen and then Run The Run dialog box will open Use the Browse option to select your CD drive highlight the Pro32setup exe file and click Open The setup file will now be listed in the Open field of the Run dialog box Click OK The PC ACE Pro 32 Claims Processing System will begin installing The Welcome screen will display Figure 2 1 Continue with the steps in the Installation Instructions section Installation Instructions The Welcome screen Figure 2 1 displays to remind you to close all programs you may have running on your computer If you have not already done so we recommend that you close any open programs at this time If you are ready to continue the installation click Next The Drive Selection window will display Figure 2 2 request
62. hrough the claim form fields Many fields will have either a fixed list established set of values or a variable list values selected from reference files lookup To access the lookup list move your cursor over the field and right click to display a pop up menu You can also click in the field and press F2 Select the appropriate value from the list and it will automatically be entered in the claim form field If you inadvertently make a change to a field you can press ESC which will un do the change and restore the field s original value Fly over hints provide a brief description of a field s purpose They become visible when the mouse cursor pauses over the field Page 30 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 6 Professional Claims Processing When the focus leaves a particular field for example when you press the key or click on a new field an edit validation is performed on the field losing the focus Edits performed at this time are referred to as field level edits If a field level edit error occurs an audible tone will sound and the error message will display in the lower left corner of the claim form In addition the focus will remain on the field with the error so that you can correct the problem if desired If you choose not to correct the data at this time simply press TAB again to move to the next field Entering Professional Claim Data To enter Prof
63. ified in the sub tab caption e g Line 4 Page 34 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 6 Professional Claims Processing The claim level COB data is entered on the COB Info Primary and COB Info Secondary sub tabs of the Extended Payer Insured tab The purpose and use of the various field groups on these sub tabs are as follows Common Payer MSP Information This field group exists primarily to provide a bridge between the MSP COB reporting standards defined in the older NSF format and those defined in the ANSI X12 implementation Only the amount Paid by primary payer amount Allowed by primary payer the Insurance Type OTAF Obligated To Accept In Full Amount if applicable Zero Payment Ind and Claim Adjudication Date fields are actually needed to process MSP COB claims in PC ACE Pro32 Claim Level Adjustments CAS Permits entry of one or more claim level adjustments as reported by the payer Adjustments are defined by a specific Group code and Reason code combination Enter these codes manually or select them from the available lookup lists Each claim level adjustment must specify a non zero Amount value and may also specify an optional Units value COB MOA Amounts Permits entry of various general claim level COB amount values as well as amount values defined specifically for Medicare Outpatient Adjudication
64. igure 6 8 Patient Info General Insured Information Billing Line Items Est Patient General Est Pat Gen z Est Payer Insured Miscellaneous Patient amp General Information Date of Death z Return To Work Date E Patient Legal Representative Information Name LiF E Address City State zip Code P Fhone SE Facility Information Accident State Hour Functional Status Code Accident Diagnosis Special Program Indicator Responsibility Ird Medical Rec No FL 10d IDE Number Homebound Ind E Doc Ind Typ Sent E E EJ Care Plan Prow Doc ACH l ID Type i E Date Care Assumed ot o Form Loe 31 Name Date Care Relinguished _ Ss EPSDTReferal Address Po Patient Residence Type Referring Physician State B CASA Poo i jo Refer Tax ID Type O E Type Tax ID T ype a Date Last Seen Figure 6 8 Professional Claim Form Extended Patient General Tab Palmetto GBA Page 33 November 2004 Section 6 Professional Claims Processing PC ACE Pro32 User s Manual 11 Enter data into blank fields When you have completed entering information into the Extended Patient General tab click on the Extended Payer Insured tab to display that section of the claim entry form Figure 6 9 Professional Claim Form Ei Patient Info amp H Insured Information Billing Line em Ext Patient General Ext Pat Gen 2 Ext Payer Insured
65. ill display Figure 4 9 This form lists all fatal and non fatal errors that occurred Fatal errors indicated by a red X must be corrected before the system will allow you to save the information Edit alidation Errors List gt TaxlD Must Be 4Position Numeric a Double click on a listed error to go to that location in the Provider Information form and make the necessary corrections fields with errors will be flashing red b If there are no fatal errors that must be corrected now those marked with a red X you may close the Edit Validation Errors List and then click the Save With Errors button on the Provider Information form Double click error to jump to the corresponding held gt Indicates that error must be corrected before saving Figure 4 9 Edit Validation Errors List DELETING AN EXISTING PROVIDER RECORD Important Note Claims are linked to provider records by an internal control number Deleting a provider record will irrevocably break any such links that may exist in claims in the system To delete an existing record 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display Provider Deletion Confirmation 2 Click on either the Provider Inst tab or Provider Prof tab On each of these tabs the central field will display a list of existing providers Claims are linked to provider records by an intern
66. ing claims reduces the size and optimizes the performance of the current claims database Archiving claims eliminates claims that are no longer needed from the current claims database making it easier to locate and work with the other current claims Archiving claims promotes organized storage of older claims without requiring that they be purged Claim archives can be maintained by transmit date line of business submission payer or other preferred criteria Claim archive databases look and act much like the current database With a few minor exceptions the same actions available for transmitted claims in the current database are also available for archived claims For example archived claims can be viewed and printed just like claims in the current database The payment history of archived claims can be viewed as well To create a new claim archive or open an existing claim archive 1 From the PC ACE Pro32 main menu click the Institutional Claims Processing or Professional Claims Processing button to display the corresponding Claims Menu form 2 Click the List Claims button on the Claims Menu to display the Claim List form By default the list will display claims in the to be transmitted CL location SS From the Claim List form toolbar select File and then choose Open Claim Archive The Open Claim Archive form will display listing all existing claim archives if any 4 From the Open Claim Archive form you can open and
67. ing that you choose the drive to which you want to install PC ACE Pro32 The default is set on the C drive If you want to choose a different drive click the down arrow to the right of the Select Destination Drive field scroll through the list and highlight the desired drive Click Next to continue On the Start Installation window click Next to continue Page 2 J3 Welcome Welcome to PC 4CE Pro32 Claims Processing 5 System Setup program This program will install PC ACE Pro32 Claims Processing System on your computer It is strongly recommended that you exit all Windows programs before running this Setup Program Click Cancel to quit Setup and close any programs you have running Click Next to continue with the Setup program WARNING This program is protected by copyright law and international treaties Unauthorized reproduction or distribution of this program or any portion of it may result in severe civil and criminal penalties and will be prosecuted to the maximum extent possible under law 4 Drive Selection i Cancel Figure 2 1 Welcome Screen Setup will install PC 4CE Pro32 Claims Processing System to the drive specified below To install to a different drive select the desired drive from the drop down list You can choose not to install PC ACE Pro32 Claims Processing System by clicking Cancel to exit Setup Select Destination Drive c system Cancel
68. ion of provider recorde which differ only in the specification of ID LOB and Payer ID fields amp Inherit namefaddress information fram the selected provider Associate the new provider with the selected provider Select the desired option and click the DE button to continue Cancel Figure 4 6 New Provider Options Window Institutional Provider Information General Info Extended Info Provider ID Professional Provider Information General Info Extended Info Individual in Group 7 Solo Practice MASTERS CLIC SSC es e f Group Practice l Group Label EEE Tax ID Type Po E 234 ANYSTREET LN UFIN SUITE 450 Specialty Jor Type Org DALLAS Tx rat23 Taxonomy POOH i972 555 1212 Fax 972 555 1213 MASTERS CLINIC CONTACT OOOH LOB MCE Accept Assign ja Participating fr Signature Ind fY Date 03 15 1994 Provider Roles Billing ly Rendering g Tag Provider Associations select Mone Provider ID Provider Group Name Save Cancel Figure 4 8 Professional Provider Window Page 9 Section 4 Reference File Maintenance PC ACE Pro32 User s Manual 5 After you have completed your additions changes click the Save button located on the bottom right of the window The system will perform an edit validation on the entered information If you have not completed or incorrectly completed one or more required fields the Edit Validation Errors List w
69. itional sub tab for that attachment Visible Hemorrhaging o Time of Run El will display Figure 6 6 Note To FEER a s aramedic Name Last First view a drop down list of attachment options right click in the AT field on the Line Item Details sub tab ee ee Figure 6 6 Billing Line Items Ambulance Attachment Sub Tab Ze ee ea e Gar NDC go to the Billing Line Items Patient Info amp General Insured Information Billing Line Items Ext Patient General Ext Pat Gen 2 Ext Payer Insured t ab an d th e Lin e It em D et ail S sub t ab Line Item Details Extended Details Line 1 Ext Details 2 Line 1 Ambulance M Line level Miscellaneous Information and enter XXXXX in the Pr OC field National Drug Code Ref No Type ational Drug Unit Price l ef No e Co 24d Select the Ext Details 2 sub tab i zs as a aT ia a i at Drug Units Type i Figure 6 7 while on the claim line aeai a Enter NDC information under Line Tet play MRI Drug Days Supply o Facility Address level Miscellaneous Information m DME Length of Need Days o0 Fa cyszpo T 10 When you have completed all of the ae ar E a a T a m sub tabs including all additional DME Rental Urit Price Ind E attachments of the Billing Line Items tab click on the Extended Save Cancel Patient General tab to display that Figure 6 7 Billing Line Items Ext Details 2 Sub Tab section of the claim entry form F
70. ive or Folder If you do not want to perform the backup at E this time press Cancel and PC ACE Pro32 I Include infrequently changed database files backup will be larger will close Options Start Backup Figure 8 1 System Backup Prompt Page 44 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 9 System Utilities SECTION 9 SYSTEM UTILITIES To reach the System Utilities click the System Utilities button from the PC ACE Pro32 main menu Figure 9 1 The System Utilities window Figure 9 2 call lll will display You can perform complete database backup validation and restore functions from PC ACE Pro32 System Figure 9 1 PC ACE Pro32 Claims Processing Menu Utilities All claims reference files and System Utilities system configuration settings can be backed Backup Festore File Maintenance up to either removable media diskette writeable CDROM e standard Windows Thi utility performs a backup of the PC 4CE Pros databases and configuration directory local or remote In the event that a settings Specify a destination drive e g 4 4 or hard disk folder path and click the Start Backup button catastrophic system failure results in the loss ee Destination Orive or Folder or compromise of PC ACE Pro32 data a a complete database restore operation can be performed from the most recent backup Backup Validate Restore I Include infrequently chan
71. ly fly over hints display when you stop your mouse cursor over a field Page 10 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 4 Reference File Maintenance ADDING OR UPDATING A PATIENT RECORD igi Reference File Maintenance 1 Click the Reference File Maintenance File View Reports button on the PC ACE Pr 032 Main menu Patient Payer Provider Inst Provider Prof Codes Misc The Reference File Maintenance window PON lastName O Fitnes MI bos oe will display Figure 4 11 2 The Patient tab is the default and will automatically display The central field will display a list of existing patients af any Using the radio buttons just below SortBy Patient PCN Patient Name List Filter Options the list you can sort the list by Patient Show all patients no filter applied PCN or Patient Name Filter list to include Patient PENs starting with Filter list to include Patient Names starting with zz 3 Determine if you plan to add a new New View Update Delete Plan of Care record or modify an existing record Figure 4 11 Reference File Maintenance Form Patient Tab a To adda new Patient record click the New button b To update an existing Patient record highlight the record and click the View Update button or double click on the record 4 The Patient Information window Figure 4 12 will display Comple te the fields on Gener
72. m Locator button on the Payer Information tab to complete the field entries for this portion of the claim form When you have completed all of the fields on the Payer Information tab click on the Diagnosis Procedure tab to display that section of the claim entry form Figure 5 6 Institutional Claim Form X Patient Info amp Codes Billing Line Items Payer Information Diagnosis Procedure Extended Patient General Extended Payer 67 Prin 68 75 76 Admit ii 79 Diag Cd Other Diagnosis Codes Diag Cd Type E Code FormLoc DAG C o T o T T T I E JE 5 p 79 80 Principal Procedure 81 Other Procedure 1 81 Other Procedure 2 ANSI 837 HH P C Code Date Code Date Code Date COB CRE Attachment C e o Oe _ 81 Other Procedure 3 81 Other Procedure 4 81 Other Procedure 5 Code Date Code Date Code Date ETA 2 a 82 Attending ID Type Last Name FirstName Ml Fed Tax ID amp Type 84 Remarks Operating Phys ID Type Last Name FirstName MI Fed TaxID amp Type 83 Other Phys ID Type Last Name FirstName Ml Fed Tax ID amp Type 83 Other Phys ID Type Last Name FirstName MI Fed Tax ID amp Type Save Cancel Figure 5 6 Institutional Claim Form Diagnosis Procedure Tab Enter data into blank fields Enter a Y in the COB field if you have COB related information Note Entering a Y in this field will generate two new sub tabs to the Extended Payer tab COB Info Primary and
73. mation pulled from the reference files For example when you enter a Patient Control Number the patient s name address etc will automatically fill the appropriate fields If any of the automatically entered information is incorrect it cannot be changed from this tab You must exit the Claim Form and make the necessary change s directly to the proper reference file Palmetto GBA Page 31 November 2004 Section 6 Professional Claims Processing PC ACE Pro32 User s Manual 3 When you have completed entering information into the Patient Info and General tab click on the Insured Information tab to display that section of the claim entry form Figure 6 4 Patient Info amp General Insured Information Biling Line Items Ext Patient General Ext Pat Gen z Est Payer Insured E Sub Paver ID Payer Hame Insured s ID F Rel Insured s Last Hame First Hame Ml Gen E A a EE m A a 2 a EE E A a a a eee 2 Bithdate Sex Sig AGE Insured s Address 1 Insured s Address 2 Insured s City State Zip PE EEE E E E E EREN E E i m a A a Insured s Phone ESC Employer Name Group Name Group Number L n E Clear Payer a a Clear Payer a fC O fo P Clear Payer Save Cancel Figure 6 4 Professional Claim Form Insured Information Tab 4 Enter data into blank fields When you have completed the fields on this tab click on the Billing Line Items tab to display that section of the claim entry form Figure 6 5 Pro
74. n PC ACE Pro32 Claim Level Adjustments CAS Permits entry of one or more claim level adjustments as reported by the payer Adjustments are defined by a specific Group code and Reason code combination Enter these codes manually or select them from the available lookup lists Each claim level adjustment must specify a non zero Amount value and may also specify an optional Units value COB MOA Amounts Permits entry of various general claim level COB amount values as well as amount values defined specifically for Medicare Outpatient Adjudication MOA use Enter or select the Code which defines the amount type to be reported and enter the corresponding Amount value Medicare Outpatient Adjudication MOA Remarks Codes Permits entry of up to 5 remarks codes for Medicare Outpatient Adjudication MOA use These optional codes may be entered manually or selected from the available lookup list Claim Adjudication Date Permits entry of the date on which the payer adjudicated the claim This date is typically required at either the claim or line level The line level COB data is entered on the MSP COB sub tab of the Billing Line Items tab Figure 6 11 The purpose and use of the various field groups on this sub tab are as follows Service Line Adjudication SVD Information Permits entry of one or more Service Line Adjudication SVD lines as reported by the payer for the current
75. n the SVD or CAS field groups For Palmetto GBA Page 35 November 2004 Section 6 Professional Claims Processing PC ACE Pro32 User s Manual backward compatibility PC ACE Pro32 will continue to recognize and report values in these obsolete fields whenever it is practical to do so 13 After completing all of the data entry on the claim form click the Save button or press ALT s to save and exit the claim Note clicking the Cancel button will abandon all changes made to the claim When you click the Save button PC ACE Pro32 begins an Edit Validation process One or more of the following edits may be required a Atleast one of the payers specified on a claim must have the same LOB line of business as the claim itself You will not be allowed to save a claim unless this condition is met If only one of the claim payers has a LOB that matches the claim LOB then that payer is automatically designated as the submission payer the payer to which the claim is to be submitted If you view the claim after saving you will see a checkmark adjacent to the submission payer line on the Payer tab It is possible that multiple payers on a claim will have an LOB that matches the claim s LOB In this case you will be prompted to select which of these payers is to be designated as the submission payer b If no edit validation errors occur the claim is saved with a clean CLN status If one or more edit validation errors occur the
76. nd purged from the list In addition claims may be generated for a selected roster billing and the resulting roster billing report may be printed from this list iat Professional Roster Billing List Viewing and or modifying existing roster billings from the Professional Roster Billing List form Figure 6 16 can be performed with these steps File Actions Provider ID Total Chgs Enty Dam a Use the Roster Billing List form s sorting and filtering capabilities to locate the roster billing of interest b Select the desired roster im billing in the list and click the sor By of Service Date f Provider Type Entry Date 66 ja 99 V iew Update button to Roster Billing List Filter Options Location JAL to be generated Status lt lt All gt gt ki g display the roster billing details in the appropriate Close roster billing form Alternatively just double click the desired roster billing record in the list New View Copy Delete Generate Figure 6 16 Professional Roster Billing List c Make all desired changes to the roster billing Refer to the Professional Roster Billing Form topic for details on the many productivity enhancing features available on the roster billing form d When all changes have been made click the Save button to save the roster billing record and close the form Review and correct any edit validation errors as needed Alternatively click the Cancel or
77. ocated on the bottom right of the window The system will perform an edit validation on the entered information Palmetto GBA Page 11 November 2004 Section 4 Reference File Maintenance PC ACE Pro32 User s Manual 6 If you have not completed or incorrectly completed one or more required fields the Edit Validation Errors List will display Figure 4 13 This form lists all Invalid Primary Payer ID Not On File Not Unique Or Restricted Use fatal and non fatal errors that occurred Fatal errors indicated by a red X must be corrected before the system will allow you to save the information a gt Patient Last Name ls Required Frimary Payer LOB Is Required Invalid Alt Primary Payer ID Not On File Not Unique Or Restricted Use Double click on a listed error to go to that location in the Patient Doubled eror to jump to the corresponding fiela S R oon and wate hs gt Indicates that error must be conected before saving necessary corrections fields with Figure 4 13 Edit Validation Errors List errors will be flashing red If there are no fatal errors that must be corrected now those marked with a red X you may close the Edit Validation Errors List and then click the Save With Errors button on the Patient Information form DELETING AN EXISTING PATIENT RECORD To delete an existing record 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File
78. ocated on the same drive on which the software is installed see Installation Instructions in Section 2 step 2 and can be found under winpcace filename The filename for the Professional claim file is bstrans dat The filename for the Institutional claim file is bctrans dat SC Part A NC Part A SC Part B DMERC amp Railroad Claim Submissions To transmit your claim file exit PC ACE Pro32 Go to your communication software to send the file to GPNet Refer to the GPNet Communications Manual for information on GPNet and sending receiving data You may download a copy of the GPNet Communications Manual by visiting the Palmetto GBA Web site at www PalmettoGBA com Select HIPAA then Specifications and Technical Information then GPNet and finally GPNet Communications Manual Or type the following URL into your browser s address field http www palmettogba com palmetto HIPAA nstf 72ff6355873cf7a485256a38004d6 1 be 85256d430053 47te85256c3f0052c004 OpenDocument Ohio amp West Virginia To transmit your claim file exit PC ACE Pro32 Go to your communication software to send the file to the BBS Refer to the BBS guidelines supplied to you with this software These guidelines can also be found at www PalmettoGBA com Under the Providers Menu choose Electronic Data Interchange then Part B Carrier and Ohio amp West Virginia Part B Carrier From the EDI Enrollment bin select Electronic Data Interchange EDI Getting S
79. ocessing Toolbar Payer Reference File The Payer tab of the Reference File Maintenance form provides access to maintain payer information Setup of the payer reference file is required to process claims ADDING OR UPDATING A PAYER RECORD 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display 2 Click on the Payer tab to display the Payer information Figure 4 2 The central field will display a list of existing payers if any Using the radio buttons just below the list you can sort the list by Payer ID Payer Description Payer LOB or Payer State it Reference File Maintenance File View Reports Patient Payer Provider inst Prowider Prof Codes Misc Sorby PaperlD PayerDescription PayerLOB Payer State List Filter Options tf Show all payers no filter applied Filter list to include Payer ID starting with Filter list to include Payer Names starting with New view Update Copy Delete Figure 4 2 Reference File Maintenance Payer Tab Page 6 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 4 Reference File Maintenance 3 Determine if you plan to add a new record or modify an existing record a To adda new Payer record click the New button You can also highlight an existing Payer and click the Copy button to create a new record using information from an existing record b To update an
80. or modify a code a To add anew code click the New button b To update an existing code highlight the code and click the View Update button or double click on the code The HCPCS Code Information window Figure 4 19 will display Complete the fields Enter the effective date range using a 4 digit year format After you have completed your additions changes click the OK button located on the bottom right of the window To delete an existing code Palmetto GBA November 2004 mi HCPCS Codes List includes Globalcodes Local codes HCPCS Code HCPCS Description O01 02 ANESTH REPAIR OF CLEFT LIP 00103 ANESTH BLEPHAROPLASTY 00104 ANESTH ELECTROSHOCK fal 00120 ANESTH EAR SURGERY O01 24 ANESTH EAR Ean 00126 ANESTH TYMPANOTOM Y List Filter Options Show all codes no filter applied Filter list to include codes starting with Filter list to include descriptions starting with up to first 5 characters Filter list to include descriptions containing Hew ViewsUpdate Delete Figure 4 18 HCPCS Codes Window HCPCS Code Information Code Description p000 ANESTHLSBUVARYGLAND Effective Date Range an 701 719958 thn of Cancel Figure 4 19 HCPCS Code Information Window Page 15 a i 2 Section 4 Reference File Maintenance PC ACE Pro32 User s Manual Click the Reference File Maintenance button on the PC ACE Pro
81. ord i C Filter list to include Physician IDs starting with highlight the record and click the re ae ilter list to include Physician Names starting wit View Update button or double click zait on the record Figure 4 20 Physician UPIN Setup Window The Physician UPIN Information window Figure 4 21 will display Complete the fields pie ID 7 Type o After you have completed your additions changes click the Physician s Last Name FirstName Ml OK button located on the bottom right of the window ti a Address ee City State Zip 1 Click the Reference File Maintenance button on the PC Phone Federal Tax ID Type ACE Pro32 main menu The Reference File Maintenance window will display aes 2 CECE odes Mea Figure 4 21 Physician UPIN Info Page16 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 4 Reference File Maintenance 3 Under Shared click the UPIN button The central field of the Physician UPIN Setup window will display a list of existing records 4 Highlight the desired record from the list click the Delete button and confirm the deletion Facility Reference File Codes Misc Professional The Facility Setup form provides access to maintain the optional Facility Reference file You may enter Facility records for each frequently referenced facility if desired The facility reference file is available as a lookup list from the Extende
82. ors are present it will be included in the next EMC file prepared Note Only claims in the transmitted TR location may be reactivated Once a payment has been made on a claim it moves to the paid PD location and is no longer eligible for reactivation To reactive one or more claims 1 Click on the Institutional Claims Processing or Professional Claims Processing button on the PC ACE Pro32 main menu to display the corresponding Claims Menu 2 From the Claims Menu choose List Claims The Claim List will display Under Claim List Filter Options at the bottom of the window choose TR transmitted only from the Location field 4 To reactivate a A single claim highlight that claim record in the list b Several claims place a check in the left column next to each desired claim 5 Select Actions from the Claim List toolbar and choose a Reactivate Selected Claim for a single claim b Reactivate All Checked Claims for more than one claim 6 Confirm the reactivation when prompted The claim s should disappear from the list since it 1s no longer in the transmitted TR location You should now find the unprocessed UNP claim in the to be transmitted CL location Reactivating an Entire EMC File for Retransmission Until an EMC file is purged from the archive it is available for reactivation and subsequent retransmission Retransmission of an EMC file might be required for example if a previously sent file was someho
83. oviders or lt lt All Providers for Payer s gt gt to include claims Figure 5 13 Institutional Claim Prepare for Transmission for all providers Provider lt lt All Providers for Payer s gt gt 3 Specify whether a You want ANSI 837 EMC file output format b The EMC file should be designated as a production or test submission c Claims with non fatal errors ERR are to be eligible for preparation When unchecked only processed claims will be eligible for preparation 4 Click the Prepare Claims button Confirm your intention to prepare all eligible claims by clicking OK on the displayed confirmation Running totals of the count and dollar value of all prepared claims will be displayed on the Claims Prepare For Transmission form You will be notified when the claim preparation operation completes Page 28 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 5 Institutional Claims Processing 5 You can click the View Results and or View Errors buttons to view reports of the successfully prepared claims and rejected claims respectively These reports can be printed from the report previewer if desired 6 When you have completed your review of the claim preparation reports click the Close button on the Claim Prepare For Transmission form Palmetto GBA Page 29 November 2004 Section 6 Professional Claims Processing PC ACE Pro32 User s Manual SECTION 6 PROFESSIONAL CMS 1500 PART B CLAIM
84. p S02 c6 a5 i enter 28 in AN At Application Recenver s Code 0503 Receiver Intchg ID EM Magee Submitter Primary Identifier Mb 109710004 Qual field The m Acknowledgement Recerver Hame NM103 10006 Requested field must H3 Receiver Primary Identifier NM109 10008 contain 1 iv No updates required on the E ANSI Info 2 tab Palmetto GBA Page 13 November 2004 Section 4 Reference File Maintenance PC ACE Pro32 User s Manual b Professional Submitter Information Figure 4 17 Professional Submitter Information i Complete all fields General Prepare ANSI Info ANSI Info t2 on the General tab fi Professional Submitter Information 1i On the Prepare tab General Prepare ANSI Info ANSI Info 2 eee mh id ID fa Professional Submitter Information rm 1e hcl uur ormas Mam General Frepare ANSI Info ANSI Info z to A and change Subr i i i x the ANSI Version Addr leer Professional Submitter Information Ea 837 to A1 General Prepare ANSI Info ANSI Info 12 Subr Rece ANSI 837 Data Element Overrides 111 Cit Auth Mil the am ey arene Serea O S278 tab enter ZZ in 5 ne E gi Interchange Receiver ID 5408 the Submitter Intchg 3 ANS t ui I ID Qual field and on ae x Application Sender s Code S02 i enter 27 in the Application Receivers Code G503 Receiver Intchg ID ANS HT Submitter Primary Identifier NM
85. printed HCFA 1450 Institutional UB92 or CMS 1500 Professional claim forms The image overlay method automatically overlays the claim field values onto a graphical image of the blank claim form resulting in a complete claim image that can be printed on plain paper The image overlay method requires the use of Adobe Acrobat Reader version 4 0 or higher This free software can be downloaded from the Adobe Web site www adobe com To print a claim or selection of claims 1 From the PC ACE Pro32 main menu click either the Institutional Claims Processing or Professional Claims Processing button to open the corresponding Claims Menu 2 Click List Claims on the Claims Menu to display the Claim List form 3 You can print a single claim or a selection of claims a To print a single claim highlight the desired claim Select Actions from the Claim List toolbar and choose Print Selected Claim or right click to access a pop up menu b To print more than one claim place a check in the left column next to the desired claims Select Actions from the Claim List toolbar and choose Print All Checked Claims Multiple claims are printed in sequence based on the current Claim List form s Sort By selection 4 The Claim Print Options form will display Determine if you will use the pre printed forms method or the image overlay method a To use the pre printed forms method ensure that you have loaded pre printed forms into your printer and
86. r the Professional list click on the Charges Master button The Charges Master Setup window will display Figure 4 24 List Filter Options f Show all codes no filter applied f Filter list to include codes starting with Filter list to include descriptione starting with up to first 5 characters Filter list to include descriptions containing Delete b To update an existing code highlight Figure 4 24 Charges Master Setup Window the code and click the View Update button or double click on the code 5 The Charges Master Information window Figure 4 25 will display Enter a valid l 5 HCPCS code or right click in the Code Lon ME Payer iark sapay T 4 Determine if you plan to add or modify a code a To add a new code click the New button New Tomea field to select a code from the master Code HCPCS code reference file Enter change Deerin the desired Charges value Charges oo 6 After you have completed your Lancel additions changes click the OK button Figure 4 25 Charges Master Information Window located on the bottom right of the window 7 Close your Reference File Maintenance tab which will return you to the PC ACE Pro32 Claims Processing System toolbar From menu options at the top of the toolbar click File and then Preferences Page 18 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 4 Reference File Maintenance 8 The
87. s Processing If desired click the View Results or View Rejects buttons to view reports of the successfully generated claims or rejected claims respectively These reports can be printed from the report previewer if desired If any claim rejects occur during the generation process the entire process will be reversed Review the rejects report correct the offense and run the roster billing generation process again Successfully generated roster billings will be moved automatically to the generated GR location AUTOMATED CLAIMS PROCESSING The Process Claims feature allows you to run front end edits on Roster Billing claims being submitted To process claims l Automated Claim Processing x Process Claims Matching leave blank for all claims LOE Provider Reprocess claims with errors Select the Process Claims option from the Professional Claims Menu The Automated Claim Processing window will display Figure 6 17 If you want to process only specified claims complete the top portion of the window Place a check in the box next to the options in the lower portion of the window 1f desired Present claims with errors for immediate editing T Include edit error details in process error report Process Close Figure 6 17 Automated Claim Processing Window Click the Process button PREPARING CLAIMS FOR ELECTRONIC TRANSMISSION Claim preparation generates a transmission ready Ele
88. ssing When the focus leaves a particular field for example when you press the key or click on a new field an edit validation is performed on the field losing the focus Edits performed at this time are referred to as field level edits If a field level edit error occurs an audible tone will sound and the error message will display in the lower left corner of the claim form In addition the focus will remain on the field with the error so that you can correct the problem if desired If you choose not to correct the data at this time simply press TAB again to move to the next field Entering Institutional Claim Data To enter Institutional claims into the PC ACE Pro32 system 1 Select Enter Claims from the Institutional Claims Menu The Institutional Claim Form will display Figure 5 3 Institutional Claim Form Ea Patient Into amp Codes Biling Line Items Paver Information Diagnosis Procedure Extended Patient General Extended Payer LOE Mca FL 1 FL2 3 Patient Control Moa l 4 Type of Bill ia 12 Patient Name Last First Ml B FedTax ID 6 Statement Covers Period Cow D M CDO C D L A D a o N O o o 13 Patient Address 1 Patient Address 2 Patient City State Patentzip Patient Phone L Doo o FL 31 FL 38 14 Birthdate Sex M5 Admission HA Type SAC D HA Stat 23 Medical Record No 24 Condition Codes E i i Tee eT 8 6DhlmrLU CE tf 32 Occurence 33 Occurence 34 Occurence 35 Occuren
89. ster billings Click the Professional Claims Processing button on the PC ACE Pro32 Main Toolbar to open the corresponding Claims Menu form Then select the Maintain Roster Billings item from the Professional Claims Menu form s main Roster menu to open the Roster Billing List form ADDING A NEW ROSTER BILLING 1 New Professional roster billings Sarna PSOE x Patient Info amp General Extended Roster Info can be added to PC ACE Pro32 Payer ID Provider ID No Service Date POS Type HCPCS Refer ID UPIN Vaccine Chg Admin Chg a using either of these techniques E ii oo f oo Patient Control No Insured s ID Patient s Last Name First Name MI Sex Birthdate ad Select the New Roster LN Address Line 1 Address Line 2 City State Zip Code Billing item from the Professional Claims Menu form s main Roster menu The system will automatically create and display an empty roster billing form b Click the New button on the Roster Billing List Form The system will automatically create and display an empty ee Seem roster billing form Figure Figure 6 14 Professional Roster Billing Form Patient Info amp General Tab a eee roe be will automatically be selected PatientInfo General Extended Roster Info in the list when it 1S saved Referring Physician Information Name L F M 2 Professional roster billings are Address manually entered on the Professional Roster
90. sting records 4 Highlight the desired record from the list click the Delete button and confirm the deletion Palmetto GBA Page 17 November 2004 Section 4 Reference File Maintenance PC ACE Pro32 User s Manual Charges Master Reference File Codes Misc Professional The optional Charges Master Setup form provides access to maintain the Charges Master reference file If you choose to use this optional reference file it should be set up to include only those procedure codes that are to be used by the billing office rather than the entire HCPCS code universe Using a Charges Master reference file will reduce the size of the HCPCS code lookup lists during claim entry which promotes accuracy and enhances productivity A dollar amount may also be assigned to each entry This value is automatically brought forward to the claim line item Charges field when a valid Charges Master code is entered during claim entry You can list all Charges Master codes by clicking the top option under List Filter Options You can also filter the Charges Master code list to include codes starting with a particular value descriptions starting with particular value or descriptions containing particular value ADDING OR MODIFYING A CHARGES MASTER CODE 1 Click the Reference File Maintenance i Charges Master Setup x button on the PC ACE Pro32 main menu The Reference File Maintenance window will display 2 Click the Codes Misc tab 3 Unde
91. t Window Figure 3 2 User Security Update Window 3 Complete or make desired changes to the User ID Password and Name fields 4 Assign or change User Permissions such as entering viewing and deleting claims Check the box next to the permission to allow access to the activity Use the Check All and Clear All buttons to quickly check or uncheck all permission checkboxes 5 Click OK to save the new modified user record Note When changes are made to a user profile the changes go into effect the next time that user logs on Page 4 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 3 Getting Started Building Your Reference Files PC ACE Pro32 is an integrated system that automatically pulls information from various databases within the system to assist users in the completion of claims information Therefore It is very important that reference file information be entered into the system before entering claims If you do not create the reference file information before entering your claim vital information necessary for processing and payment may be missing from the claim Please refer to Section 4 Reference File Maintenance for information on how to enter this data Getting Help In PC ACE Pro32 PC ACE Pro32 has a number of helpful features that will assist you while entering information and using the system You can access specific and general PC ACE Pro32 Help from anywhere in the system
92. t of existing submitters 4 Highlight the desired record from the list click the Delete button and confirm the deletion Page 14 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 4 Reference File Maintenance Data Communications Reference File Codes Misc Shared Note This reference file is not used HCPCS Reference File Codes Misc Shared Note This reference file does not apply to Institutional Claims The HCPCS Codes form provides access to maintain the HCPCS codes used in the PC ACE Pro32 software Separate database files are used to maintain global and local HCPCS codes You can add and maintain global and local HCPCS Select the Global codes or Local codes radio button to display the desired list You can list all codes by clicking the top option under List Filter Options You can also filter the HCPCS code list to include codes starting with a particular value descriptions starting with particular value or descriptions containing particular value ADDING OR UPDATING A HCPCS CODE 1 DELETING AN EXISTING HCPCS CODE Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display Click the Codes Misc tab Under the Shared list click the HCPCS button The HCPCS Codes window will display Figure 4 18 Choose Global Codes or Local Codes from the radio buttons at the top of the window Determine if you plan to add
93. tarted Step by Step Ohio West Virginia And either the OH WV Medicare Electronic Data Interchange Communication Guidelines For The Claims BBS System or The RS6000 Medicare Bulletin Board Systems Or type the following URL into your browser s address field http www palmettogba com palmetto Providers nsf 12a24b80b4b368c385256ecb00760037 85256d5800 43e75485256ca80056f5a7 OpenDocument Palmetto GBA Page 43 November 2004 Section 8 Exiting PC ACE Pro32PC ACE Pro32 User s Manual SECTION 8 EXITING PC ACE PRO32 To exit the PC ACE Pro32 Claims Processing System 1 Close any data entry windows by saving or canceling as needed 2 Toclose the Institutional Professional Claims Menu select File from the toolbar and then choose Exit you can also type ALT X or click on the X in the upper right corner of the screen 3 To exit PC ACE Pro32 select File on the PC ACE Pro32 toolbar and then choose Exit you can also type ALT X or click on the X in the upper right corner of the screen Note Every time you exit the program you Perform System Backup will be prompted to perform a backup Figure would you like to perform a backup of the PC ACE Pro32 databases and g 1 For more information on p erformin g configuration settings If so specify a destination drive e g 4 4 or hard disk ee folder path and click the Start Backup button backups see Section 10 System Utilities tela l Destination Dr
94. then click the Print button b To use the image overlay method 1 Click the Preview button The Acrobat Reader program will automatically be launched with the claim displayed li From the Acrobat Reader toolbar select File and then Print to print the previewed claim i When finished close Acrobat Reader You will not be able to resume activities in PC ACE Pro32 until the Acrobat Reader program has been closed Simply closing the claim document within the reader is not enough to signal PC ACE Pro32 to continue Palmetto GBA Page 49 November 2004 Section 13 Reactivating Previously Transmitted Claims PC ACE Pro32 User s Manual SECTION 13 REACTIVATING PREVIOUSLY TRANSMITTED CLAIMS In some situations it may become necessary to reactivate one or more previously transmitted claims for retransmission PC ACE Pro32 provides two techniques for reactivating claims Individual claims in the transmitted TR location may be reactivated for inclusion in a subsequent EMC file An entire EMC file may be reactivated for retransmission Individually Reactivating Transmitted Claims If one or more transmitted claims need to be resubmitted in a future EMC file the claim must first be reactivated Reactivation moves the selected claim s from the transmitted TR location to the to be transmitted CL location and resets the claim status to unprocessed UNP The reactivated claim can then be processed and if no fatal edit validation err
95. to the open claim archive database Reactivate Selected Claim Hold Selected Claim Purge Selected Claim Claims in the pre transmitted CL location with a DEL status will be Show Selected Claim Allows you to post view or modify payments for the selected claim Payments set Selected Claim X Designates the selected claim for either electronic or paper submission Media Only claims with a media setting of electronic E will be eligible for preparation into an EMC file Claims with a media setting of paper P can be printed and submitted in hardcopy form When a paper claim is printed you will be given the option to move the claim from the pre transmitted CL location to the transmitted TR location CLAIM LIST REPORTS PC ACE Pro32 gives you the ability to view several reports and a number of special print functions To view a detailed report of the currently listed claims 1 Select Reports from the Claim List toolbar 2 Choose Print Claim Detail Report The previewed report may be printed if desired by clicking the printer button at the top of the report preview form To print all or a subset of claims currently eligible for paper submission 1 Select Reports from the Claim List toolbar 2 Choose Print Claims for Paper Submission A claim is eligible for paper submission if it has a media setting of paper P resides in the pre transmitted CL location and has a clean CLN status or optionally a non fatal errors
96. tronic Transmission Claim preparation generates a transmission ready Electronic Media Claims EMC file EMC files contain submission details for one or more processed claims Only claims in the to be transmitted CL location that have an electronic E media setting are eligible for preparation When a claim is prepared into an EMC file it is automatically moved to the transmitted TR location which prevents the claim from being inadvertently retransmitted 3 Click the Process button Note Before preparing claims for the first time you will need to set up your Submitter Reference File This file contains important data that will be used to build the EMC file To generate an EMC file 1 Select the Prepare Claims option from the Institutional Claim Prepare For Transmission Institutional Claims Menu The Institutional Include Claims Matching Claim Prepare For Transmission window will Los EA display Figure 5 1 3 lt lt All Payers for LOB s gt gt Payer 2 Specify from the drop down list if you want only a single line of business LOB to be considered or select lt lt All gt gt to include claims for any line of Output Format Submission Status Include Error Claims iC NSF f Production C Yes business If you specify an LOB ANSI B37 C Test No a Choose a single Payer or lt lt All Payers for LOB s gt gt to include claims for all payers Benes tare Gane b Choose one or more Pr
97. ts CAS DDE 7 MIDA Amounts cod A Senice Aei aaa Fad am Mam Group Pawson Amount Ur s Hum Code Amount ee a PAS Proc Qual Code oien Tthud PaidAmount Paid Units WU Line TENN w O ees ll eS es w a i ee TTT TEET Diaalonad har CO if af il Cofraurance fin cr wo Deductie iw Medem Cuipation Adudiestion MOA Flemarks Codes eran s U L otar Line Achattnnan Se aS ae TAF aT Disatow Cent 00 Fucina Code Cucian Hum Gaup Fleston Ur Dita Hayir Ine B Clir Skaar Laha rr neseni AAP pien Dah C Figure 6 10 COB Info Primary Sub Tab Figure 6 11 MSP COB Sub Tab Two distinct levels of Coordination of Benefits reporting are supported Claim Level COB Reporting Remittance data that is not specific to a particular service line is reported at the claim level The claim form provides claim level COB fields for both the primary and secondary payers These fields are located on the COB Info Primary Figure 6 10 and COB Info Secondary sub tabs of the Extended Payer Insured tab Line Level COB Reporting Remittance data specific to a particular service line is reported at the line level The claim form provides a set of line level COB fields for each service line These fields are located on the MSP COB sub tab of the Billing Line Items tab Figure 6 11 This sub tab tracks the currently selected service line in the same manner as the other extended line item sub tabs The current service line is ident
98. utional Claims Menu Using the Institutional Claim Form The Institutional Claim Form has been designed to provide a data entry flow resembling that of the printer Institutional UB92 HCFA 1450 claim form The following information will help you as you complete the claim form To move between the six major claim form sections click on the associated tabs or press the and keys To move through the claim form fields you can click on a field to activate it or you can press the key to move from field to field in a predefined sequence generally left to right and top to bottom Use the UP ARROW and DOWN ARROW keys to move up and down through the claim form fields Many fields will have either a fixed list established set of values or a variable list values selected from reference files lookup To access the lookup list move your cursor over the field and right click to display a pop up menu You can also click in the field and press F2 Select the appropriate value from the list and it will automatically be entered in the claim form field If you inadvertently make a change to a field you can press ESC which will un do the change and restore the field s original value Fly over hints provide a brief description of a field s purpose They become visible when the mouse cursor pauses over the field Page 20 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 5 Institutional Claims Proce
99. w corrupted during transmission Reactivation of an EMC file consists of restoring the selected file from the archive to its original prepared filename in the server s WINPCACE directory After reactivation the EMC file and other associated system settings exist just as they did when the file was originally prepared for transmission Page 50 Palmetto GBA November 2004 PC ACE Pro32 User s Manual Section 13 Reactivating Previously Transmitted Claims To reactivate an EMC file 1 From the PC ACE Pro32 main menu click the Institutional Claims Processing or the Professional Claims Processing button The Institutional or Professional Claims Menu will display 2 Select Maintain from the Claims Menu toolbar and then choose Transmission Log The Claim Transmission Log form will display which lists chronologically all archived EMC files 3 Highlight the EMC file to be reactivated Click the Reactivate button on the bottom of the window and confirm the reactivation when prompted 4 You will be notified when the reactivation operation has successfully completed The EMC file is now ready for retransmission Click the Close button to close the form Palmetto GBA Page 51 November 2004 Section 14 Archiving PC ACE Pro32 User s Manual SECTION 14 ARCHIVING Transmitted claims in PC ACE Pro32 can be optionally moved off line to any number of user defined claim archives Claim archiving provides the following advantages Archiv

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