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WINASAP5010 User Manual (Version 1.00)

1. STEPS ACTIONS 1 From the WINASAP5010 Main Menu Bar select the Tools option 2 Select the Security option This will open the WINASAP5010 User Security List window 3 Click on the Add button This will open the WINASAP5010 Security Data window 4 In the User ID field enter the alphanumeric user ID you want to create It can be up to eight characters long 5 In the User Name field enter the name of the user 6 In the Password field enter the eight character alphanumeric password you want to assign to the new user T In the Confirm Password field re enter the password you entered in Step 6 4 29 WINASAPS5010 Software Installation STEPS ACTIONS Select the appropriate security level for the user by clicking on the following options e Inquiry the user will only be able to view data e Update the user will be able to view and change data e Administrator the user will be able to view and modify all tables within the database including the user ID and password table Click on the Save button NOTE If you change WINASAP5010 s default user ID and password and then forget the modified combination the ACS EDI Gateway Support Unit can assist you in resetting the system s default user ID and password 4 30 WINASAPS5010 Software Installation 4 6 Setting Up Trading Partner Data The data you enter in the Trading Partner Information window uniqu
2. 1 From the WINASAP5010 Main Menu bar select the Reference option 2 Select one of the options listed above e g Patient This will open that particular option s List window 3 Highlight the specific entry you want to update 4 Click on the Change button This will open a detail Data window 5 Make the necessary changes to the information displayed in the Data window 6 Click on the Save button 5 27 WINASAPS5010 Maintaining Reference Data 5 17 Deleting a Reference Table Entry As necessary you can delete information you have previously entered into WINASAPS5010 s reference tables You may delete entries in the following reference tables Provider Patient Anesthesia Code Condition Code Diagnosis Code External Cause of Injury Code Occurrence Code Patient s Reason For Visit Code Procedure Code Revenue Code Surgical Code Taxonomy Code Treatment Code Value Code Procedure Modifier STEPS ACTIONS 1 From the WINASAP5010 Main Menu bar select the Tools option 2 Select one of the options listed above e g Patient This will open that particular option s List window Highlight the specific entry you want to delete Click on the Delete button Click on the OK button to confirm that you really want to delete this table entry 5 28 WINASAPS5010 Maintaining Reference Data 5 18 Preloaded Taxonomy Codes WINASAPS01
3. 50 are required only if the situation applies to the claim e Certification Condition Indicator e Conditions up to 3 Note If Certification Condition Indicator is set to No then Condition 1 should be set to NU Not Used EPSDT Information Certification Condition Indicator Yes C No Conditions Delete Data OK Cancel 51 Click the Template Line Items tab or Next Page button 7 24 WINASAPS5010 Adding a Nursing Facility Template Nursing Facility Template Data Template Data Template Codes Template Line Items Clam Line ttems Sermicelne Product Service ir Revenue Code 1D Qualfier Procede Modtiers Description 1 z E a S S a Line item Char Unitor Basisfor Service Units amount Measurement Code Count trem hens Service Dateis Bate le a ee OO o Line item Repriced Line AdustedRepticed Service Tax Foctiy Ta Tax Corttoltt item Ret Line ltem Ref Acnourt pl m Operating Physiciarr Ne og Rendering Provider Refening Provider a af z z et ae ee saipe Sovico Daes evens HCPCS Modifies Service Units Line liam To ode Code 1 2 3 4 Count a Additional Line ltem Infcematon Total Claim Charges First Page Previous Pagel Save Cancel Step Actions 52 In the Template Line Items section if necessary complete the following fields e Service Line Revenue Code This is a required field e Product Service ID Qual
4. 6 65 WINASAPS5010 Claims Entry Step Actions a Product or Service ID Identification Type Identification Number 58 Line Pricing Repricing Information Window This is a situational window The fields listed below are required only if the situation applies to the claim e Pricing Methodology This is a required field e Repriced Allowed Amount This is a required field e Repriced Saving Amount e Repriced Organization ID e Repricing Per Diem or Flat Rate Amount e Repriced Approved Ambulatory Pat Group e Repriced Approved Amount e Repriced Approved Revenue Code e Unit or Basis for Measurement Code e Repriced Approved Service Unit Count e Reject Reason Code e Policy Compliance Code e Product or Service ID Qualifier e Repriced Approved HCPCS Code 6 66 WINASAPS5010 Claims Entry Step Actions Line Precing Ke pricing Inlarmation Clim Pricing Rapeizing lnficerncticey Repiced Allowed amcect a RepicedSavingtment Repin Oeean D Repiicing Pes Diem ci Fiet Rate Amak Farissd ppovad DRG Cock E FiepicsdApovedAmout Rlepiced Approved eves Cods Eo j UrdceBaretcckienuenem Cof y Rapid Aoroa Sarna Ure Coni Read Resan Coda Foley Cenpbanse Code Exceplion Coda Product ct Service ID Qualtier Repiioed Aanecmee HCPCS Code Debts om c 59 In the Claim Line Items tab the Total Claim Charges field will be automatically cal
5. STEPS ACTIONS assigned to you by ACS EDI Gateway This is a required field 4 In the Trading Partner Name section complete the following fields e Entity Type Select the appropriate choice from the drop down list box This is a required field e Organization Name This is a required field if Non person is selected OR e Last Name and First Name These are required fields if Person is selected e Middle Name 5 In the Contact Information section complete the following fields e Contact Name This is a required field e Telephone This is a required field e Ext e Fax e Email 6 In the Additional Contact Information section complete the following fields e Contact Name e Telephone e Ext e Fax e Email In the WINASAP5010 Communications section the entire section is required e In the Host Telephone field enter ACS s data telephone number from your Logon Information Sheet For example enter 1800XXXXXXX If you must dial 9 to access an outside line enter the telephone number as 9 1800XXXXXXX The comma causes a one second pause You MUST enter the comma between the 9 and the first digit of the telephone number If your phone line has the call waiting feature you must disable it Refer to your local telephone book for instructions The following is an example of a number with call waiting disabled 70 9 1800XXXXXXX Note If your office has a long distance access code and you are unsur
6. Step Actions Line Adjudication Information a Proceduse Modtiers 2 a Service Aduustmert Product of Sevice ID Proc Code Description Pad Service Unk Count Service Line Ths Line t4 as Bundled Into E5 Revenue Code Flemaining Pabent Lisby pais faa Sa Ps eS S o ea 56 Service Adjustment Window This is a situational window The fields listed below are required only if the situation applies to the claim e Group Code This is a required field e Reason Code drop down list up to 6 e Adjusted Amount up to 6 e Adjusted Units up to 6 Claim Adjustment Information Group Code I Resson Code Adusted Amount Adusted Units Reason Code Adjusted Amount Adhusted Units Resson Code AdustedAmaunt i Adustedtns SESS Reason Code Adjusted Amount Adueted Units Reason Code Adjusted Amount Adusted Units Reason Code Adjusted Amount Adhusted Units Delete First Previous OK Cancel S Product or Service ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type e Identification Number 8 28 WINASAPS5010 Adding a Nursing Facility Claim Step Actions a Product or Service ID Identification Type Identification Number 58 Line Pricing Repricing Information Window This is a situat
7. 45 Other Operating Physician ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e ID Qualifier up to 4 e Secondary ID up to 4 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank 7 21 WINASAPS5010 Adding a Nursing Facility Template Other Operating Physician ID Qualifier Secerday ID 1D Qualtier Secondey ID i 10 Quer Seconday ID 1D Qus er Seconday ID Delete Data OK Cancel 46 Other Reference Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Service Auth Exception Code e Payer Claim Control Number e Repriced Claim Reference Number e Adjusted Repriced Claim Reference Number e Investigational Device Exemption Number up to 5 e Demonstration Project ID e Peer Review Authorization Number Other Reference Information Service Auth Exception Code Payer Claim Cor e Number Repriced Clam Refarence Number Adusted Repticed Clam Reference Number i i Investigational Device Exemption Number 1 Investgahonal Device Exemption Number 2 Investigational Device Exemption Number 3 Investigational Device Exemption Number 4 Investigational Device Exemption Number S Damonstiation Projec
8. Before you can use the program you must restart Windows or Yes wart to restart my computer now C No wil restart my computer later i Remove ary disks from their hives and then click Finish to complete setup RAT Rr An Eten neste Al ie Seaham Ts s 8 Insesti 4 19 WINASAPS5010 Software Installation STEPS ACTIONS 12 If you chose not to restart your computer or if you did not get the Restart window you will now see the option to launch the program If you place a checkmark in this box and click Finish it will start WINASAP If you choose to launch the program after you click Finish go to Step 16 Otherwise go to Step 15 Setup Complete Setup has finished installing Winasap Application on your computer Setup can launch Winasap Application Loader by choosing the option belove and clicking fin sh I Launch Winasap Application Loader Click Finish to complete Setup 13 Click the Finish button 14 You have now installed the WINASAP2003 and WINASAP5010 versions Choose the WINASAP5010 button When WINASAPSO10 opens enter asap as the password for the Admin User ID click OK and then select the payer you will be submitting claims to This will become the default payer K winasap Eel Please choose the version you want to run J winasaP2003 Cancel If you did not select Yes Launch the program file then follow these steps to
9. Ga Poet Proust Sender item Pigs Pria iaa T thede Othe Fagen Rama Fieri Uuw Eha Pees Hartas 38 Billing Provider ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e Entity Type Auto populated e ID Qualifier up to 2 e Secondary ID up to 2 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank 39 Referring Provider ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e Entity Type Code Auto populated e Entity Type Auto populated e Identification Type drop down list up to 3 e Identification Number up to 3 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank 6 55 WINASAPS5010 Claims Entry Referring Provider ID information Erat 1D Code Entity Type F Identical Type identiication Number Identification Type identiicaton Number identification Type Identification Number Delete Previous Next Dae Peia _ Nea 40 Operating Physician ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e ID Qualifier up to 4 e Secondary ID up to 4 Note If one field is f
10. 3 Save the installer in your desired location and wait until the download is complete 4 Double click on the self extracting installation icon for WinasapApplication exe j Winasap pplic ation exe 4 15 WINASAPS5010 Software Installation STEPS ACTIONS 5 When the first Welcome window displays click the Continue button Winasap Application Welcome ACS EDI GATEWAY INC elcome to WINASAP Application Installer o install the software follow the installation prompts When completed launch the software and enter ASAP for the password Be sure you have at least 40 megabytes of free disc a f you have any problems during the installation process please contact the EDI Helpdesk I Helpdesk ACS EDI GATEWAY INC Welcome to WINASAP Application Installer InstallShield When the second Welcome window displays click the Next button 4 16 WINASAPS5010 Software Installation STEPS ACTIONS Welcome Welcome to the Winasap Application Setup program This program will install Winasap Application on pour computer it is strongly recommended that you exit all Windows programs before running this Setup program Click Cancel to quit Setup and then 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 reprodu
11. e Enter the correct information and click on the Save button If there are other user errors WINASAP5010 will continue to provide you with error messages until all of the problems are resolved System Errors A system error message identifies a conflict within the WINASAPSO010 software that usually requires the assistance of an ACS EDI Gateway Support Unit Representative WARNING rN E340 System Error selecting Claim record 3 11 WINASAPS5010 General Information When you receive a system error message you should immediately contact the ACS EDI Gateway Support Unit However it is important that you do the following before you acknowledge the error message by clicking on the OK button e Print a copy of the window containing the error message by using your lt Print Screen gt key If you cannot print the window write down the entire error message Write down the actions you took just before getting the error message for example what window you were in when you received the error message what data fields you entered or changed before getting the error message what window you were in before coming to the window in which you received the error message etc e Contact your ACS EDI Support Unit Note Sometimes during transmission of claims you may encounter this type of error E371 System Error opening Transmit Claims form When you see this type of error and the claim status becomes Submitted this means
12. WINASAPS5010 Adding a Nursing Facility Claim Non Payable Professional Component Billed Amount Medicare Outpatient Adjudication Information Reimbursement Rate HCPCS Payable Amount Claim Payment Remark Code Claim Payment Remark Code i Claim Payment Remark Code Claim Payment Remark Code Claim Payment Remark Code End Stage Renal Disease Payment Amount Non Payable Professional f Component Billed Amount Delete Data OK Cancel 34 Inpatient Adjudication Info Window This is a situational window The fields listed below are required only if the situation applies to the claim Covered Days Lifetime Psychiatric Days Remaining Patient Liability Amt Claim Payment Remark Code Claim Disproportionate Share Amount Claim MSP Pass Through Amount Claim PPS Capital Amount PPS Capital FSP DRG Amount PPS Capital HSP DRG Amount PPS Capital DSH DRG Amount Old Capital Amount PPS Capital IME Amount PPS Operating DRG Amount Cost Report Day Count PPS Operating Federal DRG Claim PPS Capital Outliner Amt Claim Indirect Teaching Amt NonPayable Professional Component Billed Amount Claim Payment Remark Code up to 4 PPS Capital Exception Amt 8 15 WINASAPS5010 Adding a Nursing Facility Claim Medicare Inpatient Adjudication Information Covered Days of Viats Court PPS Capital IME Amount Lifetime Psychistic Days oa Claim DRG Amt Cost Repost Day
13. Dein sts Billing Provider ID Window This is a situational window The fields listed 38 below are required only if the situation applies to the claim e Entity Type Auto populated e ID Qualifier up to 2 e Secondary ID up to 2 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank Enip Typa D uiia Teorii E Dike Teorii o m 39 Referring Provider ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e Entity Type Code Auto populated e Entity Type Auto populated e Identification Type drop down list up to 3 e Identification Number up to 3 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank 8 18 WINASAPS5010 Adding a Nursing Facility Claim Referring Provider ID information Ertity1O Code ier Entity Type G identijcalion Type identiication Number Identification Type Identification Number identiication Type Identification Number Delete Previous Next 40 Operating Physician ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e ID Qualifier up to 4 e Secondary ID up to 4 Note If one field is filled up the other field is required to
14. Principal Diagnosis Pinna Qiaqnos Present on Other Diagnosis Codes Admission Indicator DRG Code Patient Reason for Vist Codes External Cause of Inur Codes acl Occurence Span Codes Occurence Codes Condition Codes Treatment Codes Claim Pacing Repnicing into Additonal Clam Information Patient Responsibity Claim Notes __ BitingNotes Other Subsctiber Info _ Other Reference Info Saunt Supplemental Info Contract info File Info EPSDTInvo Next Page reviews Page Save Cancel 13 In the Procedure Codes section if necessary complete the following fields e Principal Procedure Qualifier e Principal Procedure Code e Principal Procedure Date 8 4 WINASAPS5010 Adding a Nursing Facility Claim Note If one or two of the three above fields are filled up the remaining fields are required to be filled up Either fill them all up or leave them blank 14 Other Procedure Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Qualifier up to 24 e Code up to 24 e Date up to 24 Note If one or two of the three above fields are filled up the remaining fields are required to be filled up Either fill them all up or leave them blank Other Procedure Codes J z a zal E g aa pl Eu 3 15 In the Diagnosis Code secti
15. WINASAPS5010 Claims Entry Occurrence Span Codes nD mt us 11 Code al la Ca _al a Ca ANA aa asasisis JIJI AonAnRDARNA i 21 Occurrence Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Code up to 24 e Date up to 24 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank Occurrence Codes Code Date Code Date 1 ER j x at Cal _ Tar as Cats Tar es Caras E u O oo an a f adil Ei arn aa Cats Cals a an H f al a Jat e a0 _ 30 m lam 22 Value Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim 6 45 WINASAPS5010 Claims Entry e Code up to 24 e Amount up to 24 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank 23 Condition Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Code up to 24 Condition Codes 24 Treatment Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Code up to 24 6 46 WINASAPS5010 Claims Entry l
16. e Other Operating Physician ID e Rendering Provider ID 8 25 WINASAPS5010 Adding a Nursing Facility Claim Step Actions e Referring Provider ID If you are done entering all of the information for this line item click the Add line Item button to add the line item to the grid bellow Then click Save If another line item needs to be entered continue filling in the appropriate information and clicking add line item until all line items have been entered for this claim and then click Save Other line item choices e Delete Deletes the current line item e Copy Copies the current line item This does not copy any line item situational information e First Scrolls you to the first line item e Previous Scrolls you to the previous line item e Next Adds a line item or scrolls you from one line to the next e Last Scrolls you to the last line item Note All the buttons on the Additional Line Item Information would become enabled after the required items have been inputted 53 Drug Information Window This is a situational window The fields listed below are required only if the situation applies to the claim e National Drug Code e National Drug Unit Count e Code Qualifier Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank e Reference Identification Qualifier e Prescription Number Note If one field is filled up the other field
17. 6 11 WINASAPS5010 Claims Entry e Fixed Format Information File Information Fixed Format Infoemationc f EC 26 Miscellaneous Dates window This is a situational window The fields listed below are required only if the situation applies to the claim e Onset of Current Illness Symptom Date e Date Last Seen e Admission Date e Date Last Worked e Date Authorized Return to Work e Assumed Care Date e Relinquished Care Date e Hearing and Vision Prescription Date e Discharge Date e Disability Dates Begin and End e Property and Casualty Date First Contract e Repricer Received Date Miscellaneous Dates rewsimpemoate al Dote Last Seer f o Dederission Date 24 a Date Last Worked 7 Date Authorized Retanito Werk 7 7 a Asumed Care Date Reinguihed Care Date Heating and Vision Presoupbon Date p a Discharge Date 7 a Diabity Dates Beon End B B E T 27 Rapicer Recatred Date 7 7 Delete cares 2m Other Subscriber Info Window This is a situational window The fields listed below are required only if the situation applies to the claim On Other Subscriber Page 1 tab under Insured s Name section complete the following 6 12 WINASAPS5010 Claims Entry fields e Patient Relationship to Insured This is a required field e Entity Type This is a required field e Organization Name This is a required field if Non Person is selected
18. The system also allows you to delete claims from the claims database regardless of the claim status 2011 ACS EDI Gateway 6 1 WINASAPS5010 Claims Entry 6 1 Adding a Professional Claim Data from a Professional claim form is entered into WINASAP5010 through 4 tabs When you select the Add option for a Professional claim the system displays a Professional Claim Data window Once you complete the Claim Data tab you will continue to complete the Claim Codes Claim Information and Claim Line Items tabs Professional Claim Data Claim Data Claim Codes Claim Information Clam Line Items BaDate 77 GE User Batch User Claim Number Claim Status Keyed v am ar Encounter Chargeable z Patient information Patient ID Patient Accourt W Date of Biti 7 Sex Last Name FistNone MiddieNamedInitioth Provider Intoemahon BiingPoviderf z Pay toAddess Rendering Provider vy S taice Signatus on Fis C No C Yes raone Retemng Provider 1 SupermsingProvide x Claim Dat 7 Health Care Diagnosis Codes Anesthesia Related Procedure Condition Information Anesthesia Related Procedise Code 1 Condition Code List Anesthesia Related Procedure Code 2 Other Diagnosis Codes Place of Sevice Next Page Save Cancel STEPS ACTIONS 1 From the WINASAP5010 Main Menu select the Claims option 2 On the Claims Submenu select the Professional option This w
19. al 15 In the Diagnosis Code section complete the following fields e Principal Diagnosis Code Qualifier This is a required field e Principal Diagnosis Code This is a required field e Present on Admission Indicator e Admitting Diagnosis Code Qualifier e Admitting Diagnosis Code Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank WINASAPS5010 Adding a Nursing Facility Template 16 Other Diagnosis Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Code Qualifier up to 24 e Other Diagnosis Code up to 24 e Present on Admission Indicator up to 24 Note If Code Qualifier or Other Diagnosis Code is filled up the other is required Other Diagnosis Codes Code Qualifier Other Diagnosis Code Aiea Wosbee Code Quafitier Other Disanosis Code Acie techn r iz P ao all El 17 In the Additional Claim Codes section complete the following fields e Assignment or Plan participation Code This is a required field e Release of Information Code This is a required field e Delay Reason Code e Claim Filing Indicator Code This is a required field e Assignment of Benefits Indicator This is a required field e DRG Code 18 Patient Reason for Visit Codes Window This is a si
20. e Principal Diagnosis Code Qualifier This is a required field e Principal Diagnosis Code This is a required field e Present on Admission Indicator e Admitting Diagnosis Code Qualifier e Admitting Diagnosis Code Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank 16 Other Diagnosis Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Code Qualifier up to 24 6 42 WINASAPS5010 Claims Entry e Other Diagnosis Code up to 24 e Present on Admission Indicator up to 24 Note If Code Qualifier or Other Diagnosis Code is filled up the other is required Other Diagnosis Codes Present on i gt Presert on Code Qualifier Othes Diagnosis Code Admission Indicator Code Qualifier Other Diagnosis Code Admission Indicator zji Fa f Ei zi nAi gt a CJ CJ Let eb el teele teftehtelte teltet tele tetetete bal ke Edet 17 In the Additional Claim Codes section complete the following fields e Assignment or Plan participation Code This is a required field e Release of Information Code This is a required field e Delay Reason Code e Claim Filing Indicator Code This is a required field e Assignment of Benefits Indicator This is a requi
21. in Entity Type field e Last Name This is a required field if Person is selected in Entity Type field e First Name This is a required field if Person is selected in Entity Type field e Middle Name Initial This will be enabled when Person is selected in Entity Type field e Suffix This will be enabled when Person is selected in Entity Type field Under the Insured s Address complete the following fields e Address e Address con t e City e State e Zip Code Under Insured s Identification complete the following fields e Insured s Primary ID Type This is a required field e Insured s Primary ID This is a required field Other Subscriber Information Other Subsceber Page 1 Other Subscriber Page 2 incwed s Name Pobent Relationship Seppe r v Enti Tye insweds Addiess Address Address tcon tt City Zip Code Insured s Iderdfication insureds Primary ID Type E Secondary identilicaton niured s Poma ID T Previous i 6 13 WINASAPS010 Claims Entry 28 If necessary click on Secondary Identification button This is a situational window The fields listed below are required only if the situation applies to the claim Under the Insurance Information section complete the following fields e Insured s Secondary ID Type e Insured s Secondary ID Note If one of the two above fields is filled up th
22. Adding a New Occurrence Code You can enter frequently used occurrence codes into WINASAPS5010 s table WINASAPS5010 uses these codes to fill a drop down list box that may be used during claims entry to select the appropriate occurrence code for institutional and nursing claims STEPS ACTIONS 1 From the WINASAP5010 Main Menu bar select the Reference option 2 Select the Occurrence Code option This will open the Occurrence Code List window 3 Click on the Add button This will open the Occurrence Code Data window 4 In the Occurrence Code field enter the code that Enter all valid values do not include decimals or zeroes S In Occurrence Code Description field enter a description of the occurrence code 6 Click on the Save button 5 18 WINASAPS5010 Maintaining Reference Data 5 8 Adding a New Patient Reason For Visit Code You can enter frequently used patient reason for visit codes into WINASAPS010 s table WINASAPS5010 uses these codes to fill a drop down list box that may be used during claims entry to select the appropriate patient reason for visit code for institutional and nursing claims STEPS ACTIONS 1 From the WINASAP5010 Main Menu bar select the Reference option 2 Select the Patient Reason for Visit Code option This will open the Patient Reason for Visit Code List window 3 Click on the Add button This will open the Patient Re
23. Claim Line tems Claim Information Additional Claim Level Information EPSDT Into Service Facility Info File Into Vision Into Miscellaneous Dates 19 Ambulance Transport Info Window This is a situational window The fields listed below are required only if the situation applies to the claim Under Ambulance Transport Information complete the following fields e Transport Reason Code This is a required field e Transport Distance This is a required field e Round Trip Purpose Description e Stretcher Purpose Description e Patient Weight e Certification Indicator up to 3 e Conditions up to 15 WINASAPS5010 Claims Entry Ambulance Transport information Ambulance Transpott Reason Code a Transport Distance Miles Round Tip Purpose Description Stretcher Purpose Descnptiore PatiekWeot bs NOTE If the patient was admitted to the hosptal please enter the Admission Date in the Miscellaneous Dates Window AddttionalT ansport Information Certification Condition Indicator F Yes Certification Condition Indicator T 7 Certification Condition Indicator I Conditions Conditions Conditions Delete Data OK Cancel 20 Transport Information Window This is a situational window in the Ambulance Transport Information The fields listed below are required only if the situation applies to the claim Under Transport Information complete the following
24. Code End Stage Renal Disease Payment Amount Non Payable Professional Component Billed Amount Delete Data OK Cancel 32 In the Other Payer Information section complete the following fields if necessary e Payer Name This is a required field e Payer Address e Payer Address cont This will be enabled if payer Address has a value e Payer City e Payer State This will be enabled if payer City has a value e Payer Zip Code This will be enabled if payer City has a value e Adjudication or Payment Date e Claim Adjustment Indicator 33 Payer Primary ID Window This is a required window e Identification Type This is a required field e Identification Number This is a required field 34 Payer Secondary ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type up to 3 This is a required field e Identification Number up to 3 This is a required field 6 80 WINASAPS5010 Claims Entry Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both or leave them blank Payer Secondary ID Identification Type Identification Number Other Payer Prior Authorization Window This is a situational window The 35 fields listed below are required only if the situation applies to
25. Codes Code Qualfier Code dmission Indicator Dae Codo Admitting f z Diagnoss Code Delay Reason Code Claim Fina invicator Code pone Assignment of Benefits Indicator T DRG Code Patient Reason for Vist Codes External Cause of injury Codes Occurrence Span Codes Occurence Codes Value Codes Corndtion Codes Treatment Codes Claim Pricing Repeicing Info Addiional Claim Infomation Belt ea _ Cia ies atest ce eee a Diebooencen Supplemental Into Cartract Info File into EPSDTinio 13 In the Procedure Codes section if necessary complete the following fields e Principal Procedure Qualifier e Principal Procedure Code 6 41 WINASAPS5010 Claims Entry e Principal Procedure Date Note If one or two of the three above fields are filled up the remaining fields are required to be filled up Either fill them all up or leave them blank 14 Other Procedure Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Qualifier up to 24 e Code up to 24 e Date up to 24 Note If one or two of the three above fields are filled up the remaining fields are required to be filled up Either fill them all up or leave them blank Other Procedure Codes a E a 2 a 15 In the Diagnosis Code section complete the following fields
26. Do not change this information This will be populated with the appropriate payer ID based on the payer you selected during installation This is a required field Payer Responsibility Sequence Code This is a required field Insurance Type 5 12 WINASAPS5010 Maintaining Reference Data 12 Payer Secondary ID Window This is a situational window e Identification Type up to 3 e Identification Number up to 3 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank Payer Secondary ID iderttication Type identification Number Delte 13 Click the Save button 5 13 WINASAPS5010 Maintaining Reference Data 5 3 Adding a New Anesthesia Code You can enter frequently used anesthesia codes into WINASAP5010 s table WINASAPS010 uses these codes to fill a drop down list box that may be used during claims entry to select the appropriate anesthesia code for professional claims FIINASAPUOIG BRUCKSTREET KUTUAL INSURANCE Fic hwe Shei Took Window ta STEPS ACTIONS 1 From the WINASAP5010 Main Menu bar select the Reference option 2 Select the Anesthesia Code option This will open the Anesthesia Code List window 3 Click on the Add button This will open the Anesthesia Code Data window 4 In the Anesthesia Code field enter the anesthesia code that is appropriate 5 In
27. E Repricet Received gt Auto Accident State Medcal Record spies E A STEPS ACTIONS 1 From the WINASAP5010 Main Menu select the Claims option De From the Claims Submenu select the Nursing Facility option This will open the Nursing Facility Templates List Window 3 Click on the Add button This will open the Nursing Facility Template Data window At the top left hand portion of the window you will see three tabs e Template Data e Template Codes e Template Line Items 2011 ACS EDI Gateway 7 1 WINASAPS5010 Adding a Nursing Facility Template STEPS ACTIONS In the Bill Date field enter the date the claim is billed to the payer If you press F5 the system will pre fill the date field with the current system date This is a required field In the User Batch field you may enter your own batch number up to four digits in length In the User Claim Number field you may enter your own claim number up to nine digits in length In the Claim Status drop down list select the appropriate status By default it is selected as Template Note T Hold statuses are not built to a nursing claim when using the Build Nursing Facility Claims function In the Patient Information section select the appropriate patient from the drop down list box To select the patient double click on the patient name Once you have selected the appropriate patient this will
28. Faulty Seo D Type Fond Seconda ID I Banis Cordgot Nore Taboos 1 Esera Deters DID 45 Vision Info Window This is a situational window The fields listed below are required only if the situation applies to the claim Under Patient Vision Information complete the following fields e Code Category up to 3 e Certification Condition Indicator up to 3 e Conditions up to 15 6 22 WINASAPS5010 Claims Entry Patient Vision Information Code Category z Code Category Code Category z Certification Condition Indicator Yes Certification Condition Indicator M Yes Delete Data OK Carcel Professional Claim Data Claim Data Claim Codes Claim information Claim Line Items Claim Line items Dekte Copy e a tor vet Units of Service Charges 46 Under the Claim Line Items section complete the following fields e Service Date s This is a required field e Service Qual This is a required field e Proc Code This is a required field e Procedure Modifiers up to 4 e Unit Code This is a required field e Units This is a required field 6 23 WINASAPS5010 Claims Entry e Charges This is a required field e Diagnosis Code Pointers up to 4 This is a required field e Place of Service e Line Item Description If you are done entering all of the information for this line item cl
29. Orgeneation ID if Repncing Pet Diem or Flat Rate Amount Repaced Approved Ambulatory T Patient Group Code J Repeiced Appeoved Ambulatory Patent Group Amount Reject Reason Coda Policy Compliance Code Exception Coda N 23 Contract Info Window This is a situational window The fields listed below are required only if the situation applies to the claim 6 10 WINASAPS5010 Claims Entry e Contract Type Code This is a required field e Contract Amount e Contract Percent e Contract Code e Terms Discount Percent e Contract Version Identifier Contract Information Contract Type Code Contract Amount E Contact Percent f Contract Code Tame Discount Percent Contact Version Identifier Delete Data 24 EPSDT Info Window This is a situational window The fields listed below are required only if the situation applies to the claim Under EPSDT Information complete the following fields e Certification Condition Indicator e Conditions up to 3 Note If Certification Condition Indicator is set to No then Condition 1 should be set to NU Not Used EPSDT Information Certification Condition Indicator C Yes C No r Conditions 1 v 2 v 3 v Delete Data OK Cancel 25 File Info Window This is a situational window The fields listed below are required only if the situation applies to the claim Under File Information complete the following fields
30. Pricing Repricing Information Window This is a situational window The fields listed below are required only if the situation applies to the claim Pricing Methodology This is a required field Repriced Allowed Amount This is a required field Repriced Saving Amount Repriced Organization ID Repricing Per Diem or Flat Rate Amount Repriced Approved Ambulatory Pat Group Repriced Approved Amount Repriced Approved Revenue Code Unit or Basis for Measurement Code Repriced Approved Service Unit Count Reject Reason Code Policy Compliance Code Exception Code 7 10 WINASAPS5010 Adding a Nursing Facility Template Claim Pricing Hepricing Information r Dam Peers Repicrginiomater Pogng Yelhocu iow Flepiced Saving Amourk Seprcing Oiganatinn ID Rexicing Per Dism or Flat Rate run Repiced Approved ORG Coda Repiced Approved Amari Fiemiced Approved Revenue Coce Unt ot Rash lor Mezeuemart Code Reprced Apgieved Service Uri Cork Reet Sean Tode Polep Camalierce Code Exeption Code 26 In the Additional Claim Information section complete the following fields e Patient Responsibility Amount 27 Claim Notes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Note Reference Code up to 10 e Notes up to 10 Note If one field is filled up the other field is required to be filled up Ei
31. Proc Code Description e Paid Service Unit Count This is a required field e Service Line This Line Was Bundled Into e Revenue Code This is a required field e Remaining Patient Liability 6 64 WINASAPS5010 Claims Entry Step Actions Line Adjudication Information x Procedure Modiiers a a Service Aduustmert Product Sevice ID Proc Code Description Pad Service Unk Count Service Line Ths Line t4 as Bundled Into E5 Reverie Code Remaining Pabent Lisbity Be Les bass p me tet Cancel E Service Adjustment Window This is a situational window The fields listed below are required only if the situation applies to the claim e Group Code e Reason Code drop down list up to 6 e Adjusted Amount up to 6 e Adjusted Units up to 6 Claim Adjustment Information GoupCode Reason Code Adusted Amount Adusted rit Reason Code AdustedAmount Adusted Units Resson Code AdustedAmout Adusted Units Resson Code AdustedAmount Aduzted Units Reason Code Adjusted Amount Adusted Units Reason Code Adjusted Amount Adiusted Units Delete 57 Product or Service ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type e Identification Number Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank
32. Proc Moditiers Units of Service Code 1 25 23 2 Service Charges e First Page Previous Page Save 55 In the Claim Line Items Section complete the following fields e Date of Service Not used when Predetermination of Benefits Indicator is checked Claim Information Tab e Proc Code This is a required field e Procedure Modifiers up to 4 e Units This is a required field e Charge This is a required field e Place of Service e Sales Tax Amount e Rendering Provider ID Provider ID has a value Provider ID has a value e Diagnostic Code Pointer Provider and Assistant Surgeon has value e Assistant Surgeon ID This can t be entered when Supervising e Supervising Provider ID This can t be entered when Assistant Beside the Rendering Provider and Assistant Surgeon there is a Taxonomy Code button There is no required field in this window The values displayed on the Reference list could be set in the Reference menu gt Taxonomy Code Note The corresponding button is only enabled when Rendering Note A preloaded value is obtained from the Provider Taxonomy Code entered in Provider Data Form see Adding a New Provider section of this document of the values filled Its value can be changed by double 6 89 WINASAPS5010 Claims Entry clicking a value from the list displayed in the Reference List lt Lode HEIDI LIETIE Vaeorceg Code tes oF de SEES I co
33. Record WINASAPS5010 helps you to quickly enter claims through a Copy function The Copy function lets you create a new claim from a claim already entered into WINASAPS5010 s claim database Once the claim has been copied you can change any field on the new claim STEPS ACTIONS 1 From the WINASAP5010 Main Menu select the Claims option 2 From the Claims submenu select the claim type of the claim you want to copy This will open a Claim List window that displays one line for each claim entered to date for the claim type you selected 3 Highlight and click on the claim you want to duplicate 4 Click Copy WINASAP5010 will create a copy of the claim and display the duplicated claim for you modify S When you have completed your changes click on the Save button 9 31 WINASAPS010 Copying A Claim Record 9 1 Deleting a Claim Record You can delete claims from the WINASAP5010 claims database regardless of the claim status that is the claim may be in a Hold Keyed Billed Accepted Rejected or Errored status STEPS ACTIONS 1 From the WINASAP5010 Main Menu select the Claims option 2 From the Claims submenu select the claim type of the claim you want to delete This will open a Claim List window that displays one line for each claim entered to date for the claim type you selected 3 Click on the Delete button A window will prompt
34. Related Causes Codes 1 This is a required field e Related Causes Codes 2 This will be enabled when Related Causes Code 1 has a value e Auto Accident State or Province Code Required when Related Cause Code 1 or 2 has a value of Auto Accident e Accident Country Code 15 Service Facility Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Laboratory or Facility Name This is a required field e Facility Address This is a required field e Facility Address cont This will be enabled when Facility Address has a value e Facility City This is a required field e Facility State This is a required field e Zip Code This is a required field Service Facility Information Laboratory or Facilty Name Laboratory ot Facility Primary ID Laboratory or Facility Secondary ID Facility Address Fac ty Address cont z Facility Ci Faciity State z Zip Code poo Cancel 16 Laboratory or Facility Primary ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type 6 72 WINASAPS5010 Claims Entry e Identification Number Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank bisvinir Taas kiraia H raka 17 Laboratory or Facility Sec
35. Report selection procedures described below WIWASAP 200 3 MISSISSIPPI MEDICA Po Retwerce Cure Ton wri pep SELECT THE DESIRED REPORT sitet Nit CA ha Craipeaantices Reset AOV age Vb Os C1 01M see 16 2008 OTD PLEASE NOTE Seung f acty Chae wall De gare by ocon rebar STEPS ACTIONS 1 From the WINASAP5010 Main Menu select the Tools option Zo Select the Reports option This will open the Report Selection window 3 Click on the Claim Transmission Summary Report box 4 You can view the claim status listing using three different criteria e Claim Status e Date of Service e Patient ID You can choose just one two or all three to determine what information is on 11 8 WINASAPS5010 Reporting your report Ss To select a status first place a checkmark next to claim status click on the drop and select the status you want reported and then click Run 6 To select a date place a checkmark next to Date of Service enter the range of dates and then click Run Te To select a particular patient place a checkmark next to Patient ID click on the drop down and select the patient and then click Run WINASAP DIO MISSISSIPPI MEDICAID Po Retwerce Care Ton wnis h Date eter ACS Bost Systen Wier Mane WiNSAPZeR Woese tn Ve we nr 75 08 Test eer Messages em File received will net Se precessed for paymrat WIMRSAP 7080 v5 15 is now walladle
36. Repriced Identifier Identification Type Identification Number 54 Claim Pricing Repricing Information Window This is a situational window The fields listed below are required only if the situation applies to the claim Pricing Methodology This field is required Repriced Allowed Amount This field is required Repriced Saving Amount Repricing Organization ID Repricing Per Diem or Flat Rate Amount Repriced Approved Ambulatory Patient Group Code Reject Reason Code Policy Compliance Code Exception Code Claim Pricing Repricinag Information Claim Pricing Repricing Infomation Repiced Saving Amount Ra Repiicng Organization ID Repricing Per Diem or Flat Rate Amount i Repeiced Appeovead Ambulatory Paent Group Code Reject Reason Code Policy Compliance Code Exception Code Click on the Claim Line Items tab or the Next Page button 6 88 WINASAPS5010 Claims Entry Dental Clam Data Claim Data Clam Information Claim Line Items Claim Line Rems _ Date of Service Proc Code Procedure Modfiers ee Units hages Place of Sevice 22 E H A Al x Sales Tax Amourk Rendeting Provider Assistant Surgeon Supervising Provides Pea andini ai Zj io Leori taae Add ine tem Addibonal Line Iter Information Sea ae ck Tal Diagnosis Code Pointer i ra Delete Copy First Previous Neat Last Date al
37. STEPS ACTIONS 1 Double click My Computer 2011 ACS EDI GATEWAY INC All rights reserved 12 3 WINASAPS010 Database Maintenance STEPS ACTIONS 2 Double click your C drive 3 Double click Program Files 4 Double click ACS 5 Double click W5010 6 Double click db de Double click backup 8 Copy the winasap5010 zip file DO NOT move this file from this location The restore function will only look for the backup file in this location 2011 ACS EDI GATEWAY INC All rights reserved 12 4 WINASAPS5010 Database Maintenance 12 2 Restoring the Database WINASAPS5010 s Restore Database function restores a backup database including all Claims and References tables This is very useful when a database you are using becomes corrupted Since you have a backup database you will not need to use a blank database and re enter all the information that you have lost Exercise caution when restoring your database make sure that you are using the correct database backup file and that you select the appropriate Restore option STEPS ACTIONS l From the WINASAP5010 Main Menu select the Tools option a Select the Restore Database option This will open the Restore Database window 3 Click Yes if you want to continue with restore or No if you want to exit the restore process 4 In the Data Source Location field enter the location name of the database ba
38. Service pack 2 Also check the Privilege Level so it would always as run as Administrator whenever it is selected Below is a screen shot of the Properties Window 4 23 WINASAPS5010 Software Installation F Winasap2003 Properties General Shortest Compatibilty if you have problems wih this program and t worked corectly on an earlier version of Windows select the compatiblity mode that matches that eadier version Compatibiity mode V Run this program in compatibiity mode for Windows XP Service Pack 2 a Settings F Run in 256 colors E Run in 640x 480 screen resoktion Disable visual themes F Disable desktop composition E Disable display scaling on high DPI settings Priv ege Level IF Run this program as an administrator I Show settings for all users ox cance When trying to send claims you may encounter problems regarding the Modem regardless if it is an internal or external one The usual problems regarding the Modem not being used properly are displayed below g 5 WE send Ciaims feathers Submission Clam Status Selection Send KEYED Came Claims That Have Not Been Bited Send REJECTED Claims Claims That Have Been Biled But Rejected C Send ERRORED Cilame Claims That Have Been Bied But Enored Submission Type Selection Test C Production In this display it shows here that WINASAPS5010 did not detect a Modem installed If you select OK on this scenar
39. Status Into Refera t Prior Authorization Other Subsciiber Info Orthodontic Info File into Repnced Qaim Adusted Repriced Claim Claim Pricing Reprcing Exception Code 12 In the Claim Information section complete the following fields e Release of Information Code This is a required field e Special Program Indicator Code e Delay Reason Code e Claim Filing Indicator This is a required field e Accident Date e Repricer Received Date e Date of Service Not used when Predetermination of Benefits Indicator is checked e Patient Amount Paid e Service Authorization Exception Code e Predetermination of Benefits Indicator If checked Date of Service is not used e Claim Original Reference This will be enabled and required when Claim Frequency Type Code in Claim Data tab has a value of Replacement Replace Prior Claim e Benefit Assignment Certification Indicator This is a required field 13 In the Additional Claim Level Information section complete the following information 6 71 WINASAPS5010 Claims Entry 14 Related Causes Information Related Cautes 1 z Auto Accident Stale ot M Requred t Related Causes code iz Province Code AA Arto Accident Accident County Code Related Causes Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e
40. What is important here is the sending of claims which is controlled by WINASAP While on the receiving part it just gets what the Host sends and interprets it 10 8 WINASAPS5010 Reporting 11 Reporting WINASAPS5010 provides you with reports that you can use to monitor and balance the submission of health care claims to ACS EDI Claims Clearinghouse The system also produces summary and detail reports to help you analyze and manage the data stored in WINASAPS5010 s claim database Reports are produced automatically when you run certain functions such as a Transmit You can also produce reports using the system s Report Selection window or by using certain submenu options WINASAPS5010 provides you with the following reports Claim Status Summary This summary report is only produced when you request it The report provides a count by claim type and claim status of all claims currently on the WINASAP5010 claims database Claims Status Listing This detail report is only produced when you request it The report displays one line per claim found on the WINASAP5010 claims database that meets the selection criteria you specify If you do not want to run this report for all claims on the system s claims database you can select claims by either a date of service or claim status for all or just one particular patient Claim Billing Detail and Claim Submitted Detail This detail report is automatically produced by WINASAPS5010 e
41. a a a MULU eases 21 Occurrence Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Code up to 24 e Date up to 24 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank Occurrence Codes Code Date Date 1 Ei Ps Bs a a4 BR a o a a Ez za H E al bi Ei m a sd EA E an i a ae E Ei E E a 22 Value Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim 8 8 WINASAPS5010 Adding a Nursing Facility Claim e Code up to 24 e Amount up to 24 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank 4 Ee aj beled bole 23 Condition Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Code up to 24 Condition Codes a 24 Treatment Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Code up to 24 WINASAPS5010 Adding a Nursing Facility Claim Treatment Codes 25 Claim Pricing Repricing Information Window This is a situational windo
42. be filled up Either fill both fields or leave them blank Operating Physicion 1D Quabties Secorday ID 1D Quaker Seconda I0 1D Quatfior Seconday IO ID Quebtier Seconday 1D _Delete Data N i Cancel 41 Service Facility ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e Entity Type Code Auto populated e ID Qualifier drop down list up to 3 e Secondary ID up to 3 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank 8 19 WINASAPS5010 Adding a Nursing Facility Claim Service Facility ID Information Entity 1D Code 1D Qualities Secordary i0 ID Quaiser Secondary ID 1D Quaker Secondary 1D f _Dekte Data OK Cancel Adjustment Info Window This is a situational window The fields listed 42 below are required only if the situation applies to the claim e Group Code e Reason Code up to 6 e Adjusted Amount up to 6 e Adjusted Units up to 6 Claim Adjustment Information Group Code isi Reason Code Adusted Amount Adusted Units Reason Code fi Adusted Amount Adusted Units Resson Code AdjstedAmount Adusted Units Ressor Code Adusted Amount dusted Units Reason Code Adjusted Amount Adus
43. below are required only if the situation applies to the claim e Note up to 5 21 Supplemental Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Attachment Report Type Code up to 10 e Attachment Transmission Code up to 10 e Attachment Control Number up to 10 Note If one of the three above fields is filled up the remaining fields are required to be filled up Either fill them all or leave them blank except when the Transmission Code is set to Available on Request the Identification Code field must not be filed up 6 74 WINASAPS5010 Claims Entry Supplemental Information Bopo Type Code Report Transmission Code a Mest Lact Tooth Status Information Window This is a situational window The fields 22 listed below are required only if the situation applies to the claim e Tooth Number Type up to 35 e Tooth Status Code up to 35 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank 23 Referral Number Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type Auto populated field e Identification Number Note If one of the two above fields is filled up the other field is required to be filled up Ei
44. e Service Tax Amount e Facility Tax Amount e Operating Physician ID e Other Operating Physician ID e Rendering Provider ID 6 62 WINASAPS5010 Claims Entry Step Actions e Referring Provider ID If you are done entering all of the information for this line item click the Add line Item button to add the line item to the grid bellow Then click Save If another line item needs to be entered continue filling in the appropriate information and clicking add line item until all line items have been entered for this claim and then click Save Other line item choices e Delete Deletes the current line item e Copy Copies the current line item This does not copy any line item situational information e First Scrolls you to the first line item e Previous Scrolls you to the previous line item e Next Adds a line item or scrolls you from one line to the next e Last Scrolls you to the last line item NOTE All the buttons on the Additional Line Item Information would become enabled after the required items have been inputted 53 Drug Information Window This is a situational window The fields listed below are required only if the situation applies to the claim e National Drug Code e National Drug Unit Count This is a required field e Code Qualifier This is a required field Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank e
45. field e Test Date Qualifier up to 2 e Test Date up to 2 Test Result Information Test Results Measuremert Reference ID Code Measuremert Qualifier Measurement Value First Previous Next Test Dates Test Date Qualifier 1 Test Date 1 a7 Tast Date Qualifier 2 TestDate 2 77 Delete Data OK Cancel E eee 71 The Total Claim Charges field will be automatically calculated based on the line item charges 72 Click Save to save the claim 6 37 WINASAPS5010 Claims Entry 6 2 Adding an Institutional Claim Data from an Institutional claim form is entered into WINASAP5010 through 3 tabs When you select the ADD option for an institutional claim the system displays an Institutional Claim Data window Once you complete the Claim Data tab you will continue to complete the Claim Codes and Claim Line Items tabs Institutional Claim Data Claim Data Clan Codes Claim Line Items Bill Date ee A User Batch ae Claim Number z Cain Status Koed ee Chargeable Patient Intormation Li ai Patient Account Date of Beth Sex Last Name First Name Midde Name nitiak Provider Informabory Billing Provider X Pato Address v Service Facity Location X Attending Provider x Operating Physiciaey xl xj Rendering Provides xl Reterring Provider xl zi Chim Oaa Admission Discharge Statement Coverage Penod En Dae BB H
46. fields From the Ambulance Pick Up Location Group e Address This is a required field e Address cont d e City This is a required field e State This is a required field e Zip Code This is a required field Srtedrce Pict Up Locos autos tiesi contd wx sef zl Zu Lode Arbtuarce Drop OH Locator Facity Hore Adrii Ahen cerid Bx i z alai Delete Das p coed 6 9 WINASAPS5010 Claims Entry 21 Claim Note Window This is a situational window The fields listed below are required only if the situation applies to the claim Under Claim Level Note complete the following fields e Note Reference Code This is a required field e Note Textl This is a required field Note Petes Code Nois Tat f 22 Claim Price Reprice Window This is a situational window The fields listed below are required only if the situation applies to the claim e Pricing Methodology This is a required field e Repriced Allowed Amount This is a required field e Repriced Saving Amount e Repriced Organization ID e Repricing Per Diem or Flat Rate Amount e Repriced Approved Ambulatory Patient Group Code e Repriced Approved Ambulatory Patient Group Amount e Reject Reason Code e Policy Compliance Code e Exception Code Claim Pricing Repricing Information Claim Pricing Repricing Infomation Bepriced Alloyed Amount Repriced Saving Amount Reproing
47. fields is filled up the remaining fields are required to be filled up Either fill them all or leave them blank 6 35 WINASAPS5010 Claims Entry Service facility Information Epiity identifier Code Service Location x EN 00 Ci S S S S Faty Pma De o Faciity Sec ID Type 1 l p Factty Secondary D 1 Facility Sec IO Type 2 oe Facity Secondary ID 2 Facihy Sec ID Type 3 Other Paver Priiman ID 3 1 Factly Secondary ID 3 Delete Dats 69 Supplemental Info Window This is a situational window The fields listed below are required only if the situation applies to the claim Under Supplemental Information complete the following fields e Report Code up to 10 e Transmission Code up to 10 e Identification Code up to 10 Note When the Transmission Code is set to Available on Request the Identification Code field must not be filed up Supplemental Information i Transmission Code Miz dul gl X ef al rd g w i a a Delete Data OK caai 4 4 6 36 WINASAPS5010 Claims Entry 70 Test Results Window This is a situational window The fields listed below are required only if the situation applies to the claim e Measurement Reference ID Code This is a required field e Measurement Qualifier This is a required field e Measurement Value This is a required
48. it displays one line per claim transmitted to the Clearinghouse you may not want to review the report each time you transmit claims Therefore WINASAPS5010 does not display the report online as a result of the Transmit process Whenever you want to review the Claim Billing Detail report from your last transmission you can do so using an option on the Report Selection window STEPS ACTIONS 1 From the WINASAP5010 Main Menu select the Tools option 2o Select the Reports option This will open the Report Selection window 3 Click on the Claims Billing Detail box 4 Click on Run 5 WINASAPS5010 displays the Claim Billing Detail report See the report example on the following page 11 6 WINASAPS5010 Reporting Report View Report ID WINASAP CB WINASAPS010 Date 01 27 2011 Time 07 56 pm Claim Billing Detail Page 1 r ID ame Patient II Provider I Patient frst n 000000003 2222222222 12 15 2010 Total Claim Amounts Total Number of Claims End of Report 11 7 WINASAPS5010 Reporting 11 4 Viewing Transmission Confirmation Reports A Transmission Confirmation Report is automatically produced by the ACS EDI Gateway host system and is displayed online at the end of each Send process WINASAPS5010 stores the 50 most recent reports in the system s Transmission Confirmation Report folder You can view any of these reports online using the Transmission Confirmation
49. listed below are required only if the situation applies to the claim e Patient Reason for Visit Code Qualifier up to 3 e Patient Reason for Visit up to 3 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank Patient Reason for Visit Potert Reason Foe Visit 19 External Cause of Injury Codes Window This is a situational window The 8 6 WINASAPS5010 Adding a Nursing Facility Claim fields listed below are required only if the situation applies to the claim e Code Qualifier up to 12 e External Cause of Injury Code up to 12 e Present on Admission Indicator up to 12 Note If Code Qualifier or External Cause of Injury Code is filled up the other is required External Cause of Injury Codes Present on tese Code Qualifier Extemal Cause of Ingey Code Admission Indicator 20 Occurrence Span Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Code up to 24 e From up to 24 e Through up to 24 Note If one or two of the three above fields are filled up the remaining fields are required to be filled up Either fill them all up or leave them blank 8 7 WINASAPS5010 Adding a Nursing Facility Claim Occurrence Span Codes f JIJIA ee J Code 2 E EE a z _ a x
50. open WINASAP5010 15 Click on the Windows Start button and select Programs 4 20 WINASAPS5010 Software Installation STEPS ACTIONS 16 Select WINASAP Application Then WINSAP Application Loader This will open the Login Window 17 In the User ID field select the user name from the drop down list box ADMIN is the initial default Winssap O10 Ligh Usin Tareas Parent 18 In the Password field enter your password asap is the initial default for the ADMIN user ID Note The default password is case sensitive Make sure that Caps Lock is not on 19 Click on the OK button 20 The Select Payer drop down box will appear Select the payer you will be submitting claims to Once you make this selection it will become your default payer You will not need to choose it each time Click on the OK button Open Payer You must select the appropriate Payer from the Payer ist OK Select Payer BRICKSTREET MUTUAL INSURANCE Cancel Show Payer Edits FREEDOM HEALTH GEORGIA MEDICAID PEACHCARE FOR KIDS HAWAI FEE FOR SERVICE WAIL WAIVER MISSISSIPPI MEDICAID MONTANA DPHHS 4 21 WINASAPS010 Software Installation STEPS ACTIONS 21 The WINASAPS5010 Desktop with the Main Menu Bar will display You are now ready to begin updating reference tables or entering claims Note WINASAP5010 has a d
51. reference lt Delete All button would delete the all items on the left side of the window from the Taxonomy Code reference 5 29 WINASAPS5010 Claims Entry 6 Claims Entry Using WINASAP5010 you can bill for health care services for the following claim types e Dental e Institutional e Nursing Facility e Professional WINASAPS010 has a number of features designed to help you enter claims quickly and easily Claim windows feature drop down list boxes to help you select frequently used data such as recipient and provider names procedure and diagnosis codes When you select a recipient or provider name the system automatically pre loads the remaining required recipient and provider data from WINASAPS010 s Reference database The system also allows you to quickly enter claims through a copy function This function allows you to create a new claim from a claim already entered into WINASAPS5010 s claim database You can then modify the new claim as necessary You can also enter a partially completed claim into WINASAP5010 s claims database by placing the claim in a Hold status This special claim status prevents the claim from being selected in the Send processes Note At a minimum all required fields will need to be completed When you complete the claim you can change the status to Keyed and WINASAP5010 will automatically select the claim the next time you perform a Send process for that claim type
52. set to No then Condition 1 should be set to NU Not Used EPSDT Information Certification Condition Indicator Yes C No Conditions Delete Data OK Cancel 51 Click the Claim Line Items tab or Next Page button 6 61 WINASAPS5010 Claims Entry Institutional Claim Data Claim Data Claim Codes Claim Line Items Claim Line Items Service Line Product Service Procedwe 1D Qualifier Codec Procedure Modifiers Description 1 zl zi af sf sf sf sl Service Date s a7 i Adjusted Rlepeced ieee rad Line Item Ret 8 Amount Operating Physician me bd aeneagl Rendering Provider Relening Provider Add ine item ireen Service Dates Reverue in Modfies Service Units Charge Fiom To Code 1 2 3 4 Com Amour Addtional Line itam Informator Total Claim Charges Fist Page Previous Page Save Cancel Step Actions 52 In the Claim Line Items section if necessary complete the following fields e Service Line Revenue Code This is a required field e Product Service ID Qualifier e Procedure Code e Procedure Modifiers up to 4 e Description e Line Item Charge Amount This is a required field e Units or Basis for Measurement This is a required field e Service Units Count This is a required field e Non Covered Charge Amount e Service Date s e Line Item Control e Repriced Line Item Ref e Adjusted Repriced Line Item Ref
53. steps and guidelines of this chapter of the manual WINASAPS5010 allows users from WINASAP2003 to convert all the reference table information such as claim patient and provider After the conversion it will still be necessary to open each claim patient and provider record in WINASAP5010 to enter any additional information now required by HIPAA since this information either did not exist or was not required in WINASAP2003 The information that will have to be added is listed below e Additional Claim Information that will need to be added to each record converted from WINASAPS5010 e Additional Patient Information that will need to be added to each record converted from WINASAP5010 e Additional Provider Information that will need to be added to each record converted from WINASAPS5010 STEPS ACTIONS 1 Click on the Windows Start button 2 Select Programs Highlight WINASAP5010 then select Convert WINASAP2003 files to WINASAP5010 3 Click the convert button This will now copy the database of WINASAP2003 and then convert it to a format which is usable in WINASAP5010 Note WINASAP2003 should also be installed in the same machine since the converter would copy its database then convert it to WINASAPS010 format 2011 ACS EDI GATEWAY INC All rights reserved 12 12 WINASAPS5010 Database Maintenance STEPS ACTIONS Once the conversion is complete open WINASAP5010 and verify that
54. that an error occurred during transmission The claim may or may not be transmitted successfully because of this problem For further details regarding the Submitted claims please refer section 10 3 titled Regarding Claims with Submitted Statuses 3 12 WINASAPS5010 General Information 3 8 Regarding Insurance TPL Information If you receive the following error message you must check the validity of the Payer Responsibility Sequence Code for all payers on the claim System Message i There is an error with the insurance information that has been entered on this claim Please see Help Topic Insurance TPL Information for further clarification a Within a given claim the various values for the Payer Responsibility Sequence Number Code other than value Unknown may occur no more than once STEPS ACTIONS 1 From the WINASAP5010 Main Menu select the Reference option Zz Select the Patient option This will open the Patient List screen 3 In the list highlight the patient that corresponds with the claims that generated the error then click Change 4 Click on the Insured s Data tab You will find the Payer Responsibility Sequence Code at the bottom right corner of the screen Make the necessary changes S For corrections to the Payer Responsibility Sequence Code for other payers from the WINASAP5010 Main Menu select the Claims option 6 Select the appropriate claim type for the c
55. the claim Under Supervising Provider ID Information complete the following fields e Identification Type up to 3 e Identification Number up to 3 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank Supervising Provider ID Information ID Quatlier Secondary I0 ID Qualifier Secondary IO ID Quatfier Secondary ID Delete Data ox 38 Service Facility ID Window This is a situational window The fields listed below are required only if the situation applies to the claim Under Service Facility ID Information complete the following fields e Entity ID Code Auto populated field e Identification Type up to 3 e Identification Number up to 3 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank 6 18 WINASAPS5010 Claims Entry Service Facility ID Information Entity 1D Code 1D Qualities Secondary iD ID Quatar Secondary I0 f ID Quebier Seconday 10 Dekio Data ak Cancel 39 Adjustment Info Window This is a situational window The fields listed below are required only if the situation applies to the claim Under Claim Adjustment Information complete the following fields e Group Code drop down list This is a required field
56. window you will see three tabs e Claim Data e Claim Information e Claim Line Items 4 In the Bill Date field enter the date the claim is billed to the payer If you press F5 the system will pre fill the date field with the current system date 5 In the User Batch field you may enter your own batch number up to four digits in length 6 In the User Claim Number field you may enter your own claim number up to 6 68 WINASAPS5010 Claims Entry STEPS ACTIONS nine digits in length Te In the Claim or Encounter Identifier drop down you could choose Chargeable Reporting or Subrogation Demand claims 8 In the Patient Claim Information section select the appropriate patient from the drop down list box To select the patient double click on the patient name Once you have selected the appropriate patient this will pre fill the name DOB gender and patient account number fields These fields cannot be edited on the claim form This information can only be changed in the patient reference window This is a required field Note If the patient has not been added to the Patient database refer to the Maintaining Reference Data procedures Follow the steps for Adding a New Patient to complete this step in adding a dental claim 9 In the Provider Information section complete the following fields e Billing Provider ID This is a required field e Pay To Address Provider ID e Rendering Provider ID Can on
57. you may prefer to print a hard copy listing rather than review the report online STEPS ACTIONS ik From the WINASAP5010 Main Menu select the Tools option 2 Select the Reports option This will open the Report Selection window 3 Click on the Claim Status Listing box 4 The report can also be sorted alphabetically Click the Sort Alphabetical 5 Select a status from the drop down 6 Click on the Run button T If you want to restrict the report to listing claims in a certain date range place a checkmark in Date of Service then enter the applicable dates in the Date Range boxes 8 If you want to restrict the report to a particular patient place a check mark in Patient ID the select the patient from the drop down 11 4 WINASAPS5010 Reporting Report View Report ID WINASAP CL 000000000 000000001 000000088 000000000 000000083 WINASAP5010 Claim Status Listing Begin 12 01 2010 000000003 12 01 2010 12 01 2010 000000002 01 02 2011 a 01 03 2011 900000002 End of Report 11 5 Date 01 27 2011 Time 07 50 pm Page 1 Ins last name Ins frst name Patent last na Patient first n Patent last na Patient first n WINASAPS5010 Reporting 11 3 Running a Claim Billing Detail and Claim Submitted Detail Report When you run the Send function WINASAPS010 automatically produces a Claim Billing Detail report Because of the potential size of this report
58. your data is there Then you will need to go into each patient and provider record and add any additional required information as explained above Note Don t use the Restore Database of WINASAP5010 when converting the database of WINASAP2003 WINASAPS5010 would not be able to read the restored database 12 7 1 Notes in Using Converted WINASAP2003 db on WINASAPS5010 WINASAPS5010 and WINASAP2003 which uses the previous 4010 standard has a different structure in their database such as new columns increased length and deleted values of the fields qualifiers Therefore before creating and sending claims in WINASAPS5010 users must first check and review the following windows to ensure that there would be no errors in using WINASAP5010 and compliance errors when the claims have been sent to ACS EDI Trading Partner Information the information from WINASAP2003 in this window was designed not to be copied to WINASAP5010 to ensure that the users would not accidentally transmit WINASAP2003 files to WINASAP5010 system and vice versa Fill the necessary fields and then Click the Save button to ensure that the values entered are compliant Provider Data there are several changes and corrections done in this window The biggest change which is essential here is the changes in the Secondary Identification information There is a new Identification Type Provider Tax Identification Number which is required and needs to be filled u
59. 0 has a preloaded set of Taxonomy Codes Users can use it and add to the list of Taxonomy Codes which could be used for Providers HP AS Hesteren File Nointrnenr twat cers Banay Healy oa Aa Ucawark WMhibgiiiiis 101 Aare Exharroral Heath Saver P z Copumke ems Day J sap FA 101yeenix TOTP IGOR Bahrawa Hasha 5 Sav rada Comes P SOD strove s lt F 101 Pie San Dales Selecon 1OY PZI lt Dae d Cas Saree Balatoni taS 10200 103G00000 lt 077 Sooo 103T A040 1037 BIDAI S 1037 COA SET iy Savke Parejas Papah F torera Sead Sevre Pirsdas Pr J J J 10sTeorD r J wrt cows Date eet Mah amp N Carra Dreis P STEPS ACTIONS 1 From the WINASAP5010 Main Menu bar select the Tools option a Select the Update Reference Files then Taxonomy Codes option This will open the HIPAA Reference File Maintenance Taxonomy Codes window 3 On the right side of the window are the preloaded Taxonomy Codes Mark the items using the checkboxes beside the Taxonomy Code you want to include in your Taxonomy Codes 4 Click on the lt Save Selections button to load the items 5 Clear lt Clear All gt button would remove the items in your Taxonomy Code reference This would not delete the items selected in the preloaded list 6 While lt Delete Selection button would delete the highlighted items on the left side of the window from the Taxonomy Code
60. 2Micro quardian2 SmartCardReader 02 05 2007 1 1 3 7 Windows Internet Explorer 8 Windows Media Format 11 runtime Windows Media Player 11 G Windows Media Player 9 Series TweakMP PowerToy oe Windows Search 4 0 jE Windows XP Service Pack 3 B wirrar archiver o winzip 11 2 Yahoo Software Update Yahoo Toolbar STEPS ACTIONS 1 Click on the Windows Start button 2 Select the Control Panel option 3 Click on Control Panel 4 Double click on Add Remove Programs S Scroll down the list of software programs listed in the Install Uninstall window and highlight Winasap5010 2011 ACS EDI GATEWAY INC All rights reserved 12 10 WINASAPS5010 Database Maintenance STEPS ACTIONS 6 Click on the Add Remove button T Click on the Yes button when you get the Are you sure you want to completely remove the selected application and all of its components message 8 Follow the instructions displayed by the Windows Uninstall process 2011 ACS EDI GATEWAY INC All rights reserved 12 11 WINASAPS010 Database Maintenance 12 7 Converting WINASAP2003 db to WINASAP5010 db Note for WINASAP2003 users It is strongly suggested that WINASAP2003 database should not be converted for WINASAPS5010 due to the different file and database structures of the applications used If a conversion of database is extremely needed ensure to read and follow the
61. 7 Adjusted Amount Adusted Units Reason Code Adjusted Amount Adusted Units Delete First Previous Next OK Cancel 43 Rendering Provider ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e Entity Type Code Auto populated e Identification Type up to 3 e Identification Number up to 3 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank 6 57 WINASAPS5010 Claims Entry Enlty Type idrica Tapa Ideniication Herbe iderliicaion Typs Identicebon Hurde Idrissi Type fi Ideniticelion Hube Attending Provider ID Window This is a situational window The fields 44 listed below are required only if the situation applies to the claim e ID Qualifier drop down list up to 4 e Secondary ID up to 4 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank Attending Provider Secondary info 1D Qualifier Seconday iD 10 Quaitier Seconda tD 1D Quer Seconday ID 10 Qualities Seconday ID Dete Data w Gencel 45 Other Operating Physician ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e ID Qualifier up to 4 e Secondary ID up to 4 Note
62. Benefits Indicator Other Subscriber Information Other Subscriber Page Other Subscriber Page 2 Insurance Information Group Poley amp Group ot Plan Name Clam Fitng f Indicator Release of a Infcemation Code Assignment of Benefits eet X COB Amounts Other Payer Intomatiorr Qutpatiert Adudication Info Inpatient Adjudication Into Paves Name Payer Resoonstilty Sequence Code zl Paves Primary 1D Tugel xl Paver Pima ID wf Paper Addese Paper Address cont ge Sael Z boar lam EM ms Remittance Date aA Clam Adustment Indicator Yes Claim Control Number Secordar ID Information PiiocAuth RefenalNumber Bling ProviderID Retemirg Provider ID Operating Physician Service FacityiD Aductment into Rendering Provider Attending Provider Other Operating Physician Delete First Previous Next J Last OK Carrel 32 COB Amounts Window This is a situational window The fields listed below are required only if the situation applies to the claim e COB Payer Paid Amount e Remaining Patient Liability e COB Total Non Covered Charges ea Panna wey Por Liat eae COW fado Chg Soke Daa F o 33 Outpatient Adjudication Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Outpatient Reimbursement Rate e HCPCS Payable Amount
63. Code up to 10 Note Note When the Transmission Code is set to Available on Request the Identification Code field must not be filed up Claim Supplemental Information Report Code Transmission Code Identification Code Delete Data 48 Contract Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Contract Type Code This is a required field e Contract Amount e Contract Percent e Contract Code e Terms Discount Percent e Contract Version Identifier e Contract Version Identifier Contract Information Contract Type Code fs Contract Amount Contract Percent f Contract Code ooon Teme Discount Percent i pi Contract Version Identiter i Delete Data OK Cancel 8 23 WINASAPS5010 Adding a Nursing Facility Claim File Info Window This is a situational window The fields listed below are 49 required only if the situation applies to the claim e Fixed Format Information up to 10 Fimect Forest Irdarmaton 50 EPSDT Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Certification Condition Indicator e Conditions up to 3 Note If Certification Condition Indicator is set to No then Condition 1 should be set to NU Not Used EPSDT Information Certification Cond
64. Contact your ACS EDI Support Unit 3 2 Hardware Telecommunication Requirements To use WINASAP5010 your personal computer must meet the following minimum configuration e Windows 98 Second Edition Windows NT Windows 2000 Service Pack 3 Windows XP operating system Windows Vista or Windows 7 operating system e Pentium processor e 25 megabytes of free disk space e 128 megabytes of RAM e Monitor resolution of 800 x 600 pixels e Hayes compatible 9600 baud asynchronous modem e Telephone connectivity 3 2 WINASAPS5010 General Information 3 3 System Navigation Whether you are a clicker or a keyboarder navigating WINASAPS5010 is easy You can use your mouse to move to any field or to click on buttons or icons to perform specific functions If you feel more comfortable using a keyboard you can navigate using the following keys Keys Action e Ona Menu window lt ENTER gt selects the menu item that is highlighted e Ona List window lt ENTER gt adds a new record ENTER e On the Reference window lt ENTER gt performs a command function e On data entry windows lt ENTER gt advances the cursor to the next field e On data entry windows lt TAB gt advances the cursor to TAB the next field e On list windows lt TAB gt advances the cursor to the next command function button e On data entry windows lt SHIFT gt lt TAB gt returns the cursor to the previous field p
65. Count Clam Payment Remak Code tats re gpg Claim Disproportionate Share Art Chon PPS Capetal Outher Amt Claim MSP Pass Through Am Clarn Indirect Teaching Amt Clan PPS Capital Amount Coe PPS Capital FSP DRG Amt Clam Payment Remark Code PPS Capital HSP ORG Art Clam Payment Remark Code PPS Capita OSH DAG Amt Cisim Payment Remark Code Old Capital Amount Claim Payment Remark Code PPS Capital Exception Amt Delete Data Ok Cancel 35 In the Other Payer Information section complete the following fields Payer Name This is a required field Payer Responsibility Sequence Code This is a required field Payer Primary ID Type This is a required field Payer Primary ID This is a required field Payer Address Payer Address con t Payer City Payer State Payer Zip Code Claim Check or Remittance Date Claim Adjustment Indicator Claim Control Number 8 16 WINASAPS5010 Adding a Nursing Facility Claim Other Subscriber Information Other Subscriber Page Other Subsceber Page 2 inaurance Information Group Policy f Group ot Play Name Claim F ng f Indicator Release of Infcemation Code Sai nian zj COB Amounts Other Payer Intoematicey Paver Name Outpatient Adudication Info Inpatient Adjudication Into Paver Responsibility Sequence Code x Paves Primary i Tugel Paver Piimaw 1D Papar Addess f Paper Address cont P P Ae IBS
66. DRG Amt Cost Repost Day Count PPS Opetating Federal Spacilic DRG Ant Claim PPS Capital Outer Amt Claim Indirect Teaching Amt NonPayable Professional Component Biled Ant Lifetime Psychiatric Days Clan ORG Amt Claim Payment Remak Code Claim Disproportionate Share Amt Clan MSP Pass Through Am Clam PPS Capital Amount PPS Capital FSP DRG Amt PPS Capital HSP ORG Amt PPS Capital OSH DAG Amt Old Capital Amount Claim Payment Remak Code Clam Payment Remark Code Cisim Payment Remark Code Claim Payment Remark Code PPS Capital Exception Amt Delete Data Ok Cancel BRE In the Other Payer Information section complete the following fields Payer Name This is a required field Payer Responsibility Sequence Code This is a required field Payer Primary ID Type This is a required field Payer Primary ID This is a required field Payer Address Payer Address con t Payer City Payer State Payer Zip Code Claim Check or Remittance Date Claim Adjustment Indicator Claim Control Number 6 53 WINASAPS5010 Claims Entry Other Subscriber Information Other Subscriber Page Other Subscriber Page 2 Instance Information Group Policy amp Group ot Plan Name j Cam Fitrg f Indicator ae f Infcemation Code COB Amounts Other Payer Intoematicer Payee Named Payee Primary i Tyce Outpatient Adudicaton Info Inpatient Adiudication
67. Dn acs A X fOX Company ACS EDI Gateway Inc WINASAPS5010 User Manual Version 1 00 December 7 2011 ACS EDI Gateway Inc Prerequisite for using WINASAP5010 BEFORE USING THIS APPLICATION THE USERS SHOULD HAVE KNOWLEDGE ON HOW TO BILL CORRECTLY AND REFER TO THEIR OWN STATE MEDICAID BILLING MANUAL IT IS STRONGLY SUGGESTED THAT WINASAP2003 USERS SHOULD NOT DO DATABASE CONVERSION FROM WINASAP2003 TO WINASAPS5010 DUE TO THE DIFFERENT FILE AND DATABASE STRUCTURES OF THE TWO STANDARDS THE APPLICATIONS USE IF A DATABASE CONVERSION IS EXTREMELY NEEDED REFER TO SECTION 12 7 Converting WINASAP2003 db to WINASAP5010 db AND SECTION 12 7 1 Notes in Using Converted WINASAP2003 db on WINASAPS5010 WINASAPS5010 Table of Contents 1 Table of Contents 1 TABLE OF CONTENTS 2 DOCUMENT REVISION TABLE 3 GENERAL INFORMATION 3 1 ACS EDI Gateway Support Unit 3 2 Hardware Telecommunication Requirements 3 3 System Navigation 3 4 Helpful Hints 3 5 Understanding the WINASAP5010 Menu Bar 3 6 Understanding Inquiry List Windows 3 6 1 Function buttons 3 6 2 Summary of Statuses 3 7 Resolving Error Messages 3 8 Regarding Insurance TPL Information 4 SOFTWARE INSTALLATION 4 1 WINASAPS010 Welcome Package 4 2 WINASAPSO010 Installation Process Overview 4 3 Installing WINASAP5010 4 4 When installing on Window7 Vista 4 5 Signing On to WINASAPS5010 4 5 1 Setting Up User IDs and Passwords 4 6 Setting Up Trading Partne
68. EPORTING 11 1 11 1 Running a Claim Status Summary 11 2 11 2 Running a Claim Status Listing 11 4 11 3 Running a Claim Billing Detail and Claim Submitted Detail Report 11 6 11 4 Viewing Transmission Confirmation Reports 11 8 12 DATABASE MAINTENANCE 12 1 12 1 Performing a Database Backup 12 3 12 2 Restoring the Database 12 5 12 3 Repair Claim Provider Data 12 6 12 4 Database Repair Tool 12 7 12 5 Purging Claim Data 12 8 12 5 1 Importance of Purging Claim Data 12 9 12 6 Uninstalling WINASAP5010 12 10 12 7 Converting WINASAP2003 db to WINASAP5010 db 12 12 12 7 1 Notes in Using Converted WINASAP2003 db on WINASAPS5010 12 13 ii WINASAPS5010 Document Revision Table 2 Document Revision Table uRhorof Page s Revision Purpose Date Change Kaizhan Joseph M Olarte 1 00 Base Version 12 07 2011 The contents of this manual and the associated WINASAP5010 software are the property of ACS Any reproduction of the WINASAP5010 software or this manual in whole or in part is strictly prohibited This software may be used only for the submission of healthcare claims to the Program through ACS iii WINASAPS5010 General Information 3 General Information Windows Accelerated Submission And Processing WINASAP5010 is a Windows based Windows 98 NT 2000 XP Vista and Windows 7 software application developed by ACS EDI Gateway WINASAP5010 allows you to submit claim data electronically from your pe
69. Hs e On list windows lt SHIFT gt lt TAB gt moves the cursor back to the previous command function button e Within a field the lt BACKSPACE gt key moves the cursor back one character space at a time and deletes that BACKSPACE character If the data in the field is highlighted the lt BACKSPACE gt key moves the cursor back to the beginning of the field and deletes the highlighted data HOME e Moves the cursor to the beginning of the field ALT e Highlights the first option on any Menu bar e Moves the cursor one character space to the right or left RIGHT LEFT within a field ARROWS e Within the Menu bar it moves the cursor one menu option to the right or left CTRL C e Copies highlighted text only and not numerical fields CTRL V e Pastes copied text only and not numerical fields WINASAPS5010 General Information 3 4 Helpful Hints Here are some simple guidelines to follow when entering data into WINASAPS5010 fields Do not enter dashes or slashes between numbers in the following fields o Telephone number o Social Security Number and o Date fields Do not enter decimal points in diagnosis code entries Do not add extra zeros to procedure codes or diagnosis codes When using the calendar button to select a date double click the applicable date or use the spacebar to exit the calendar window if you choose not to select a date WINASAPS5010 allows you to enter and retain partially completed claims on the syst
70. If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank 6 58 WINASAPS5010 Claims Entry Other Operating Physician ID Quaker Seconday ID f 1D Qus er Seconday tD 10 Qualifier Seconday ID f IO Quatfier Seconday iD Delete Daa OK Cancel Other Reference Info Window This is a situational window The fields 46 listed below are required only if the situation applies to the claim e Service Auth Exception Code e Payer Claim Control Number e Repriced Claim Reference Number e Adjusted Repriced Claim Reference Number e Investigational Device Exemption Number up to 5 e Demonstration Project ID e Peer Review Authorization Number Other Reference Information Service Auth Exception Code Payer Claim Cortial Number Le Repriced Clam Reference Number Adusted Repticed Clam Reference Number Investigational Device Exemption Number 1 Investgahonal Device Exemption Number 2 f Investigational Device Exemption Number 3 Investigational Device Exemplion Number 4 Investigational Device Exemption Number 5 Demonstration Project ID Pees Review Authorization Number OK Cancel 47 Supplemental Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Report Code up to 10 e Transmission Code up
71. Info Paver Resncesbilty Sequence Code zj Paver Piimaiy ID Paper Addese Paper Address con t ay P Paya Z ea lam k Remittance Date a Claim Adiustment indicator Yes Claim Control Number _ Retemirig Provider 1D Operating Physician Secondary ID Information Pior Auth Refenal Number Bling Provider ID Service FacityiD Adustmert Into Rendering Provider ID Attending Provider Other Operating Physician Delete Fist Previous Next OK Cancel 36 Secondary ID Information Window This is a situational window The fields listed below are required only if the situation applies to the claim e Payer Secondary ID Type up to 2 e Payer Secondary ID up to 2 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank Subscriber Secondary Identification Inswed s Secondary ID Type E xj Insuted s Secondary 10 Inswed s Secondary ID Type Inswed s Secondary ID i Delete Data 37 Prior Auth Referral Number Window This is a situational window The fields listed below are required only if the situation applies to the claim e Other Payer Prior Authorization Qualifier Auto populated e Other Payer Prior Authorization Number e Other Referral Number Qualifier Auto populated e Other Referral Number 6 54 WINASAPS5010 Claims Entry
72. Items tab Line Item Charge Amount computed using the Rate field from the template and Service Units Count Service Units Count computed using the difference of Statement Coverage Period From and Date fields Service Date s 66 To make changes to an individual claim that was created select Claims Nursing Facility and Nursing Facility Claim 67 Select the claim to change and click Change 68 Make the necessary changes and click Save 7 31 WINASAPS5010 Adding a Nursing Facility Claim 8 Adding a Nursing Facility Claim Data from a Nursing Facility claim form is entered into WINASAP5010 through 3 tabs When you select the ADD option for a Nursing Facility claim the system displays a Nursing Facility Claim Data window Once you complete the Claim Data tab you will continue to complete the Claim Codes and Claim Line Items tabs Nursing Claim Data Alia leg Claim Data Ciam Codes Claim Line Items Bil Date RE fa User Batch 8 Claim Number Fo o Claim Status Keyed vj er Chargeable Patient Information Patient ID a Patient Account Date of Bithe 7 Sex Last Name F Fist Name f Middle Name Irebat ii Provider Information Biling Provider Pay to Address xi Service Faciity Locatiorc Attending Provader B X a Operating Physician xl Rendering Provider x Referting Provider xl Clam Data Admission Discharge Statement Coverage Period From Thiou
73. J Code 2 E EE a z _ a x a a a assist eases Jidd sass 21 Occurrence Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Code up to 24 e Date up to 24 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank Occurrence Codes Code Date Date 1 Ei Ps Bs a a4 BR a o a a Ez za H E al bi Ei m a sd EA E an i a ae E Ei E E a 22 Value Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim 7 8 WINASAPS5010 Adding a Nursing Facility Template e Code up to 24 e Amount up to 24 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank 4 Es a bebe bole 23 Condition Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Code up to 24 Condition Codes 24 Treatment Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Code up to 24 WINASAPS5010 Adding a Nursing Facility Template Treatment Codes 25 Claim
74. Line lems l Procedwe Codes Erano oj ircesPoceae n piee Peeve 77 E pce Diagnosis Codes Principal Diagnosis Pincina Dinanosia Present on Other Diagnosis Codes Admission Indicato Assianmert of Benefits Indicator DRG Code Patient Reason for Vist Codes External Cause of Injury Codes Occurence Span Codes Occurence Codes Vake Codes Condition Codes Treatmert Codes Claim Pricing Repeicing Info Additional Claim Information kaaneni m i L a telstra oia ine Supplemental Into Contract Info Fie Into EPSDTinto New Page Previous Page Save Cancel WINASAPS5010 Adding a Nursing Facility Template 13 In the Procedure Codes section if necessary complete the following fields e Principal Procedure Qualifier e Principal Procedure Code e Principal Procedure Date Note If one or two of the three above fields are filled up the remaining fields are required to be filled up Either fill them all up or leave them blank 14 Other Procedure Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Qualifier up to 24 e Code up to 24 e Date up to 24 Note If one or two of the three above fields are filled up the remaining fields are required to be filled up Either fill them all up or leave them blank Other Procedure Codes F a aal 2
75. Please go te WAU ACT CORO CON Cot of Report WINASAPS5010 Database Maintenance 12 Database Maintenance To ensure the security of the information you have entered into WINASAPS5010 and to help your software operate most efficiently it is recommended that you establish a regular schedule for performing a few simple database maintenance activities By periodically backing up the WINASAP5010 database you will reduce the effort necessary to recover from a hardware failure And by periodically purging historical claim data and reorganizing the WINASAP5010 database you will ensure that your software application continues to respond as quickly as possible ACS EDI Gateway recommends the following minimum database maintenance schedule ACTIVITY DESCRIPTION Back Up It is recommended that you back up the WINASAP5010 database at Database least weekly Depending on the amount of information you enter in any given period of time you may want to perform a backup more often Restore You only need to restore the WINASAP5010 database when you have Database inadvertently deleted information that you wanted to keep you used the wrong date when purging claims or after you have re installed WINASAPS5010 when recovering from a hardware failure such as a loss of a hard disk drive Repair Claim Provider information which is found in the Reference menu can be Provider changed anytime however those changes would not be refl
76. Reference Identification Qualifier e Prescription Number Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank Drug Information National Drug Code National Drug Unit Court Code Quabtier Reference Identiication Guabher Prescnption Number Delete OK Cancel 6 63 WINASAPS5010 Claims Entry Step Actions 54 Line Supplemental Info Window This is a situational window The fields listed below are required only if the situation applies to the claim Under Supplemental Information complete the following fields e Report Code up to 10 e Transmission Code up to 10 e Identification Code up to 10 Note If one of the three above fields is filled up the remaining fields are required to be filled up Either fill them all or leave them blank except when the Transmission Code is set to Available on Request the Identification Code field must not be filled up Line Supplemental Information Repon Code Transmssion Code Identification Code Delete Data oK Cancel 55 Adjudication Information Window This is a situational window The fields listed below are required only if the situation applies to the claim e Payer ID This is a required field e Service Line Paid Amount This is a required field e Procedure Modifiers up to 4 e Adjudication or Payment Date This is a required field e
77. S ACTIONS 1 From the WINASAP5010 Main Menu bar select the Reference option 2 Select the ICD 9 ICD 10 Surgical Code Then choose either ICD 9 or ICD 10 as the code s qualifier This will open the Surgical Code List window 3 Click on the Add button This will open the Surgical Code Data window 4 In the Surgical Code field enter the surgical code that represents the procedure performed 5 In the Surgical Code Description field enter a description of the surgical procedure 6 Click on the Save button 5 22 WINASAPS5010 Maintaining Reference Data 5 12 Adding a New Taxonomy Code You can enter frequently used value codes into WINASAP5010 s Taxonomy Code table The system uses these codes to fill a drop down list box that may be used during entering providers or claims to select the appropriate taxonomy codes STEPS ACTIONS 1 From the WINASAP5010 Main Menu bar select the Reference option 2 Select the Taxonomy Code option This will open the Taxonomy Code List window 3 Click on the Add button This will open the Taxonomy Code Data window 4 In the Taxonomy Code field enter a taxonomy code value code 5 In the Taxonomy Code Description field enter a description of the taxonomy code 6 Click on the Save button 5 23 WINASAPS5010 Maintaining Reference Data 5 13 Adding a New Treatment Code You can enter frequently used treatment codes into WINA
78. S Capital IME Amount PPS Dperating Hospital Specific DRG Amt Cost Repost Day Count PPS Opetating Federal Spacie DRG Amt Claim PPS Capital Outer Amt Claim Indirect Teaching Amt NonPayable Professional Component Biled Ant Clam Payment Flemark Code Clam Payment Remark Code Cisim Payment Remark Code Claim Payment Remark Code PPS Capital Exception Amt Date ue Ok Cancel Lifetime Psychiatric Days Claim DRG Amt Clam Payment Remark Code Claim Disproportionate Share Amt Claim MSP Pass Through Amt Clam PPS Capital Amount PPS Capital FSP DRG Amt PPS Capital HSP ORG Amt PPS Capita OSH DAG Amt Old Capital Amount m BRE In the Other Payer Information section complete the following fields Payer Name This is a required field Payer Responsibility Sequence Code This is a required field Payer Primary ID Type This is a required field Payer Primary ID This is a required field Payer Address Payer Address con t Payer City Payer State Payer Zip Code Claim Check or Remittance Date Claim Adjustment Indicator Claim Control Number 7 16 WINASAPS5010 Adding a Nursing Facility Template Other Subscriber Information Other Subscriber Page Other Subsceber Page 2 inaurance Information Group Policy f Group ot Play Name Claim F ng f Indicator Release of Infcemation Code Sai nian zj COB Amounts Other Payer Intoem
79. SAP5010 s table WINASAPS5010 uses these codes to fill a drop down list box that may be used during claims entry to select the appropriate treatment code for institutional and nursing claims ISO PLSeSAISO NO ARSTEXTE ASEM SARC a i 1 STEPS ACTIONS 1 From the WINASAP5010 Main Menu bar select the Reference option 2 Select the Treatment Code option This will open the Treatment Code List window 3 Click on the Add button This will open the Treatment Code Data window 4 In the Treatment Code field enter the treatment code that is appropriate 5 In the Treatment Code Description field enter a description of the treatment code 6 Click on the Save button 5 24 WINASAPS5010 Maintaining Reference Data 5 14 Adding a New Value Code You can enter frequently used value codes into WINASAP5010 s table WINASAPS5010 uses these codes to fill a drop down list box that may be used during claims entry to select the appropriate value code for institutional and nursing claims STEPS ACTIONS 1 From the WINASAP5010 Main Menu bar select the Reference option 2 Select the Value Code option This will open the Value Code List window 3 Click on the Add button This will open the Value Code Data window 4 In the Value Code field enter the code that is appropriate 5 In the Value Code Description field enter a description of the value code 6 Click
80. SAPS5010 Claims Entry Other Subscriber Information Other Subscriber General Other Subcaber Ineurance Other Subscnber Name Payer Responsbiity f Sequence Code Patent Flelstionstup f To insured Entity Troe Organization Name Other Subsenber Address Address City f Inswred s Secondary ID 26 Insured s Primary ID Window This is a required window e Identification Type This is a required field e Identification Number This is a required field Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank Insured s Primary ID identification Type f Identification Number 27 Insured s Secondary ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type drop down list Auto populated field e Identification Number up to 2 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank 6 77 WINASAPS5010 Claims Entry iderthcation Type idertilicstion Number 28 Click the Other Subscriber Insurance Page tab In the Other Subscriber Insurance Information section complete the following fields if necessary e Ins
81. This is a required field e Round Trip Purpose Description e Stretcher Purpose Description e Patient Weight 6 24 WINASAPS5010 Claims Entry e Patient Count e Obstetric Anesthesia Count e Certification Indicator up to 3 e Conditions up to 15 Ambulance Transport Information Ambulance Transpeet Reason Code Transport Distance Round Trip Purpose Description Stretcher Pwpose Description Patient Weight bs Obstetric Anesthesia Count AddbanalT ransport information Certification Condition Indicator Yes Certification Condition Indicator I Certification Condition Indicator I Conditions 49 Transport Information Window This is a situational window The fields listed below are required only if the situation applies to the claim Under Transport Information complete the following fields From the Ambulance Pick Up Location Group e Address This is a required field e Address cont d e City This is a required field e State This is a required field e Zip Code This is a required field From the Ambulance Drop Off Location Group e Facility Name e Address This is a required field e Address cont d e City This is a required field e State This is a required field e Zip Code This is a required field 6 25 WINASAPS5010 Claims Entry Ambulance Pick Up Location
82. a Response File After you send claim files to the clearinghouse for processing all the claims in that batch are now in a Billed status Claims in a Billed status mean that the ACS EDI Gateway host system accepted them Within a few hours you need to receive a response file which will tell you that the claims were processed by the clearinghouse When you receive the response file any Billed claims accepted by the clearinghouse can have several statuses Accepted Rejected Accepted Adjudication or Errored If you see a Rejected or Errored status contact your ACS EDI Support Unit Receive Response File If You Wouk Like To Receive Clam Responses Cick On The Receive Button Below If You Do Not wish To Receive Clam Respormes At The Time Oick On The Cancel Button Below Receive Cancel STEPS ACTIONS 1 From the WINASAP5010 Main Menu select the Tools option 2 Select the Receive Response File option This will open the Receive window 3 Click on the Receive button 4 WINASAP5010 will now dial your modem and receive the response which is called a 999 and 277CA Once the response is received the claim status is changed to either Accepted or Rejected If you ever see a Rejected or Errored claim status contact your ACS EDI Support Unit 10 4 WINASAPS5010 Sending Claim Files 10 2 1 Regarding Claims with Accepted and Rejected Statuses After performing the Receive Response Fil
83. ach time you run a Send The report created is based on the claim with status Billed or Submitted Two tabs on the report would be displayed to distinguish the detail report The created report sorted by patient displays one line per claim transmitted to ACS EDI Claims Clearinghouse and also provides totals for the number of claims transmitted and the submitted charges Because of the potential size of the report WINASAPS010 does not automatically display the report online as a result of the Send process Claim Confirmation Report This summary report is automatically produced by ACS EDI Claims Clearinghouse host system and displayed online as a result of each Transmit The report contains one line per file transmitted that confirms the acceptance or rejection of the file by the host system WINASAPS5010 uses the report to change the claim status for all claims successfully received by the Clearinghouse The system changes the claim status on the claims database from Keyed to Billed for each claim in each file accepted by the Clearinghouse For all claims in those files rejected by the Clearinghouse WINASAPS5010 leaves the claim status as Generated on the claims database WINASAPS5010 stores the 50 most recent reports in the system s Transmission Confirmation Report folder You can view any of these archived reports Note Except as noted above all reports are initially displayed online You can use the Windo
84. acters Address icona Ciz 5 ba Ambulanca Deop Off Locatiory Fanity Nome Addkecs Address feont de Oh Sige Zoco Delete Dat x e 50 Contract Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Contract Type Code This is a required field e Contract Amount e Contract Percent e Contract Code e Terms Discount Percent e Contract Version Identifier Contract Information Contract T Contract Amount i Contract Percent Contract Code Tame Discount Parcent Contract Version Identifier Delete Data 51 DMERC Condition Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Code Category e Certification Condition Indicator e Conditions up to 2 6 26 WINASAPS5010 Claims Entry DMERC Condition Information Code Category Certification Condition Indicator M Yes Conditions Delete Data 52 Drug Information Window This is a situational window The fields listed below are required only if the situation applies to the claim e National Drug Code e National Drug Unit Count This is a required field e Code Qualifier This is a required field Note If one field is filled up the other field is required to be filled up Either fill bo
85. ad Claim Adustment Indicator Yes Claim Control Number 3 i F Biing Provide ID Retemirg Provider Rendering Provider 0 Attending Provider Secondary ID Ir omation Print Auth Referral Number Service Fac y iD Aduetmert Into Operating Physician Other Operating Physician Delete Fast o x Sere Previous Next ai Last 36 Secondary ID Information Window This is a situational window The fields listed below are required only if the situation applies to the claim e Payer Secondary ID Type up to 2 e Payer Secondary ID up to 2 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank Subscriber Secondary Identification Inswed s Secondary ID Type f Inswed s Secondary 10 Inswed s Secondary ID Type Insuted s Secondary ID I Delete Data oK Cancel 37 Prior Auth Referral Number Window This is a situational window The fields listed below are required only if the situation applies to the claim e Other Payer Prior Authorization Qualifier Auto populated Other Payer Prior Authorization Number Other Referral Number Qualifier Auto populated e Other Referral Number 8 17 WINASAPS5010 Adding a Nursing Facility Claim Ga Maa Pra ara Tirkis Dii Pages Pria aia T hed Othe Fagen ama iria Uie Dia Rie a Maree
86. aded values are obtained from the Provider Tax Identification Number entered in Provider Data Form see Adding a New Provider section of this document Thru this window its value can be changed by the user if needed Billing Provider Tax ID Number Identification Type fE mployer s Identification Number Identification Number 11 In the Claim Data section complete the following fields e Place of Service This is a required field e Assignment or Plan Participation Code e Claim Frequency Type Code This is a required field In the Diagnosis Codes section complete the following fields e Diagnosis Qualifier up to 4 e Diagnosis Code up to 4 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank Click on Next Page or Claim Information Tab 6 70 WINASAPS5010 Claims Entry Dental Claim Data Claim Data Claim Information Cain Line Items Claim Information FelessectinfumatonCode a Special Program Indicator Delay Reason Code Dain Fina lodicate Code Accidert Dae 77 RepeicerRecevedDate A Date of Sevice 7 z Patient Amount Paid Service Authorization x Predetermmation of Benefits Indicator 7 Benefits Assanment O Certification inckeator z Additional Claim Level Infomation Related Causes Info Service Facilty Info Predetermination identification Contract Info Clam Notes Supplemental Info Tooth
87. allow you to access that reference table s list inquiry window Common functions that can be performed on each of these inquiry windows include Add Copy Change Inquire and Delete Claims menu option By simply highlighting and clicking on the claim type WINASAP5010 will take you to that claim type s inquiry list window Tools menu option Send Claim File Allows you to transmit claims to the EDI Claims Clearinghouse Receive Response File Allows you to receive the 999 and 277CA response from the EDI Claims Clearinghouse Reports Allows you to run different reports on the claims you have processed through WINASAP5010 Backup Database Allows you to back up your WINASAP5010 database Performing this function on a regular basis is highly recommended so that you don t lose valuable data Restore Database In the event you have to re install or upgrade your WINASAPS010 application this function allows you to restore your system database from a backup previously made using the Backup Database function Purge Claims Allows you to permanently remove claims from the WINASAPS5010 database Security Allows you to add change delete and inquire on WINASAP5010 user ID numbers and passwords Window menu option If you have multiple WINASAP5010 windows open for example Patient Information Professional Claim and Procedure Code List this option allows 3 5 WINASAPS5010 General Information you to view all thr
88. am Indicator Code e Claim Filing Indicator This is a required field 16 In the Claim Indicators section complete the following fields e Homebound Indicator e Assignment of Benefits Indicator This is a required field 17 In the Claim Amounts section complete the following fields e Patient Amount Paid 18 In the Claim Numbers section complete the following fields WINASAPS5010 Claims Entry STEPS ACTIONS e Mammogram Certification Number e Medical Record Number e CLIA Number 1 e Referral Number e Prior Authorization Other Claim Level Numbers Window This is a situational window The fields listed below are required only if the situation applies to the claim e Service Authorization Exception Code e Payer Claim Control Number e Investigational Device Exemption ID e Demonstration Project Identifier e Care Plan Oversight e Repriced Claim Number e Adjusted Repriced Claim Number Miscellaneous Claim Level Numbers Service Authorization Exception Code Payer Claim Control Number i Investigational Device Exemption ID Demonstration Project Ideniifier Care Pla Repriced Claim Number Adusted Repriced Claim Number Delete oK Cancel Click on the Claim Information tab or click the Next Page button 6 7 WINASAPS5010 Claims Entry Professional Clam Data Caim Data Claim Codes Claim Information
89. ason for Visit Code Data window 4 In the Patient Reason for Visit Code field enter the code Enter all valid values do not include decimals or extra zeroes 5 In the Patient Reason for Visit Description field enter a description of the patient reason for visit 6 Click on the Save button 5 19 WINASAPS5010 Maintaining Reference Data 5 9 Adding a New Procedure Code You can enter frequently used procedure codes into WINASAP5010 s table The system uses these codes to fill a drop down list box that may be used during claims entry to select the appropriate procedure code for the claim Information in the Procedure Code table is also used by the system to automatically calculate the line item charge amount during claims entry Note Do not include decimals or extra zeros STEPS ACTIONS 1 From the WINASAP5010 Main Menu bar select the Reference option a Select the Procedure Code option This will open the Procedure Code List window 3 Click on the Add button This will open the Procedure Code Data window 4 In the Procedure Code field enter the code Enter all valid values do not include decimals or extra zeroes S In the Procedure Description field enter a description of the procedure 6 In the Procedure Code Charge Amount field enter your standard charge amount for the procedure Te Click on the Save button 5 20 WINASAPS5010 Main
90. aticey Paver Name Outpatient Adudication Info Inpatient Adjudication Into Payer Responsibility Sequence Code Payee Primary iO Tugel Paver Piimaw 1D Papar Addess f Paper Address cont P P Ae IBS ad Claim Adustment Indicator Yes Claim Control Number 3 i F Secondary ID Infomation PiiorAuth Referal Number Bing Provide ID Reteming ProviderIO Operating Physician Service FacityiD Adjuctmert into Rendering ProvderiD Attending Provider _ Other Operating Physician Delete Fast Previous Next Last a ee 36 Secondary ID Information Window This is a situational window The fields listed below are required only if the situation applies to the claim e Payer Secondary ID Type up to 2 e Payer Secondary ID up to 2 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank Subscriber Secondary Identification Inswed s Secondary ID Type Inswed s Secondary 1D Insured s Secondary ID Type Inswed s Secondary ID i Delete Data ox Cone On Prior Auth Referral Number Window This is a situational window The fields listed below are required only if the situation applies to the claim e Other Payer Prior Authorization Qualifier Auto populated Other Payer Prior Authorization Number Other Referral Number Qualifier Auto populated
91. below are required only if the situation applies to the claim e Prosthetic Prior Placement Date e Orthodontic Appliance Placement Date e Orthodontic Replacement Date e Treatment Start Date e Treatment Completion Date A mereri iai iya j T kaimi Corgishior Dea 58 Miscellaneous Information Window This is a situational window The fields listed below are required only if the situation applies to the claim e Line Item Control Number e Repriced Claim Reference Number e Adjusted Repriced Claim Reference Number e Prosthesis Crown or Inlay Code e Procedure Code Description 6 91 WINASAPS5010 Claims Entry Miscellaneous Line Item Information Line Item Control Numbes Repriced Claim Reference Numbex Aduusted Repriced Claim Reference Number Prosthesis Crown or Inlay a Code Procedure Code Description Predetermination of Benefits Price Authorization Referral Number ge f Cancel 59 Predetermination of Benefits Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type Auto populated field e Identification Number up to 5 e Primary Identifier up to 5 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both or leave them blank 60 Prior Authorization Window This is a situational wi
92. cation Type up to 3 e Identification Number up to 3 6 85 WINASAPS5010 Claims Entry Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both or leave them blank Other Payer Assistant Surgeon Secondary Identification Identification Type Identification Number Bete Next Last Other Payer Billing Provider Window This is a situational window The 48 fields listed below are required only if the situation applies to the claim e Entity ID Code Auto populated field e Entity Type This is a required field Other Payer Billing Provider 3 Payer Provider Info Entity ID Code Entity Type bd Provider Identification Numbers 49 Other Payer Billing Provider Secondary Identification Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type up to 2 e Identification Number up to 2 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both or leave them blank Other Payer Billing Provider Secondary Identification identification Type Idenbhication Number Next Last 50 Orthodontic Services Window This is a situational window The fields listed below are required only if the situation applies to the claim 6 86 WINASAPS5010 Claims E
93. ccurring data corruption is always a risk on any computing device In addition the database which handles the WINASAPS5010 application cannot handle huge amount of data Though cannot be avoided purging old and or unused claims is one of the best methods in order to prevent this from happening thus prolonging the lifespan of the database As a final note on purging claims make it a habit to purge old and or unused claims data is not lost from doing this anyway since it is placed in a zip file which can also be restored later using the Restore Database tool of WINASAP5010 2011 ACS EDI GATEWAY INC All rights reserved 12 9 WINASAPS5010 Database Maintenance 12 6 Uninstalling WINASAP5010 You should remove the WINASAP5010 software from your PC only under two circumstances When you no longer want to use the software or when directed to by ACS EDI HELP Desk during problem resolution If you plan to reinstall WINASAP5010 at some future date be sure use the Backup Database function to create a complete database backup file prior to running the uninstall process Add or Remove Programs Access and Defaults Currently installed programs pay opoe Winasap5010 change this program or T Windows Driver Package Dell Inc PBADRY System 09 25 2006 6 0 0 0 Windows Driver Package Nokia WUDFRd WPO 03 19 2007 6 83 31 1 SE Windows Driver Package Nokia Modem 02 15 2007 3 1 TE Windows Driver Package O
94. ch do not have a corresponding entry of information with the claims This is very useful to ensure that database from old versions of WINASAP would experience no errors when adding new entries Jotabase Repair Tool Database Repar Complete D ta backup created Fulenarne C Pr AMT SEGMENT DB Table open success gt Cursor retrieve ce index add successful gt Index regenerated Q gt Table open successtul gt Cursor retrieved successtully gt Index add successful Index regenerated CAS SEGMENT db gt Table open successtu gt Cursor retrieved successfully gt Index odd successful gt Index regenersted STEPS ACTIONS l From the WINASAP5010 Main Menu select the Tools option 2 Select the Database Repair Tool option 3 This will repair and update the claims and will prompt the user if there were errors encountered during the process 2011 ACS EDI GATEWAY INC All rights reserved 12 7 WINASAPS010 Database Maintenance 12 5 Purging Claim Data WINASAPS5010 s Purge Claims function allows you to manage the volume of claim information stored in the system s claims database Using the Purge Claims function you can delete information from the system s Claims Tables claims adjustments and voids but not from any other WINASAP5010 database table Purp Claims Cwt Cate A i ohn Sau Sda On Ty Saai Seke by Cin Sisus C Select Al Sisus Coces Hod 7 Ra
95. ckup file from which you want to restore or click on the drop down list box to select the correct drive directory folder and backup file name 2011 ACS EDI GATEWAY INC All rights reserved 12 5 WINASAPS5010 Database Maintenance 12 3 Repair Claim Provider Data When a user updates a detail in the Provider reference changes made don t immediately reflect on the claims in which that provider was used To fix this WINASAPS010 s Repair Claim Provider Data function allows users to automatically update the claim with the updated information of the provider Unlike resaving the claim this tool does not perform compliance checks but is still useful if the provider is used in multiple claims and if the user is certain that the changes made are compliant STEPS ACTIONS l From the WINASAP5010 Main Menu select the Tools option pas Select the Repair Claim Provider Data option 3 This will update the claims and will prompt the user if there were errors encountered during the process 2011 ACS EDI GATEWAY INC All rights reserved 12 6 WINASAPS5010 Database Maintenance 12 4 Database Repair Tool This tool is similar to Repair Claim Provider however unlike it Database Repair Tool only updates segments associated with address city state and zip codes if there were any changes in the provider used in claims It also removes any trailing spaces and removes entries in the database whi
96. could only be entered if Identification Type and Identification Number are both filled up Provider Data Provider Data Secondary Identification Identification Type z idertilication Type ia Identification Number Identification Number Payer iO t Identification Type f Identification Number Payer ID Identification Type Idertihestion Number Payer iO Identification Type Idertification Number f Payer ID Payer iD identification Type Identification Number Payer ID Idertiication Type Identification Number Payer iD Prev Page 11 Click the Save button WINASAPS5010 Maintaining Reference Data 5 2 Adding a New Patient WINASAPS5010 allows you to maintain information on each of your patients When you select a patient from a drop down list box during claims entry the system automatically fills the remaining patient related data fields in the claim window from the information stored in the Patient table Note You must enter all patients in the Patient table prior to keying and saving claim information STEPS ACTIONS 1 From the WINASAP5010 Main Menu bar select the Reference option 2 Select the Patient option This will open the Patient List window 3 Click on the Add button This will open the Patient Data window 4 In the Patient Identification section complete the following fi
97. ction or distribution of this program of any portion of may result iri severe civil and criminal penalties and will be prosecuted to the maximum extent possible under law The Software License Agreement window will display next Read through the agreement and click Yes to accept the terms of the agreement and continue installing WINASAP Click No if you want to terminate the install program Software License Agreement Please read the following License Agreement Press the PAGE DO WN key to see the rest of the agreement WINASAP Appbeation User License Agreement WHEREAS ACS has developed WINASAP2003 and WINASAPSO1O an electronic billing software package that enables medical providers to file claims with ACS hereinafter WINASAP2003 and WINASAPSO10 snd NOW THEREFORE in consideration of the mutual promises and covenants contained herein and other good and valuable consideration the receipt and sufficiency of which is hereby acknowledged the parties hereto agree to as follows 1 License ACS hereby grants and Provider hereby accepts a non transferable non exclusive license to use WINSSAP2003 and WINASAPSO10 solely Do you accept all the terms of the preceding License Agreernert If you choose No Setup will close To install Winasap Application you must accept this agreement _ cto eT ve i 4 17 WINASAPS5010 Software Installation STEPS ACTIONS 8 The User In
98. culated based on the line item charges This is a required field 60 Click Save to save the claim 6 67 WINASAPS5010 Claims Entry 6 3 Adding a Dental Claim Data from a dental claim form is entered into WINASAP5010 through 3 tabs When you select the ADD option for a dental claim the system displays a Dental Claim Data window Once you complete the Claim Data tab you will continue to complete the Claim Information and Claim Line Items tabs Dental laim Data Cisim Data Clam Infomation Claim Line Items BuDate Use Batch Use Claim Number Claim Status Keyed gt rt oa a Chargeable x Patent Information Patient ID a E Patient Accourt H ii Date of Bith 7 ae en E z Last Name E Fest Name Midde Name intial Provider Information Biling Provides l PaytoAddress X Rendering Provider Sigue on Fic No C Yes Retenng Provider r Assistant Surgeon Supervising Provider Clam Date Place of Service x Qaim Frequency Type Code Diagnosis Codes Principal Diagnosis f Next Page STEPS ACTIONS 1 From the Winasap5010 Main Menu select the Claims option 2 From the Claims Submenu select the Dental option This will open the Dental Claim List window 3 Click on the Add button This will open the Dental Claim Data window At the top left hand portion of the
99. d Exa Oy Leies ate Laboratory or Facility Primary ID Window This is a situational window 66 The fields listed below are required only if the situation applies to the claim e Identification Type e Identification Number Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both or leave them blank 67 Laboratory or Facility Secondary ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type e Identification Number Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both or leave them blank e Primary Identifier Laboratory or Facility Secondary ID Identification Type Identtication Number Primacy Identifier bees Cancel 68 Line Adjudication Information Window This is a situational window The fields listed below are required only if the situation applies to the claim e Other Payer Primary ID This is a required field e Service Line Paid Amount This is a required field e Procedure Modifiers up to 4 6 95 WINASAPS5010 Claims Entry e Adjudication or Payment Date This is a required field e Proc Code Description e Paid Service Unit Count This is a required field e Service Line This Line Was Bundled Into e Remaining Patient Liability Line A
100. d Amount Adiusted Units Delete First Previous Next Last OK Cancel S Product or Service ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type e Identification Number 7 28 WINASAPS5010 Adding a Nursing Facility Template Product or Service ID Identification Type identification Number 58 Line Pricing Repricing Information Window This is a situational window The fields listed below are required only if the situation applies to the claim Pricing Methodology This is a required field Repriced Allowed Amount This is a required field Repriced Saving Amount Repriced Organization ID Repricing Per Diem or Flat Rate Amount Repriced Approved Ambulatory Pat Group Repriced Approved Amount Repriced Approved Revenue Code Unit or Basis for Measurement Code Repriced Approved Service Unit Count Reject Reason Code Policy Compliance Code Product or Service ID Qualifier Repriced Approved HCPCS Code 7 29 WINASAPS5010 Adding a Nursing Facility Template Line Prcingfe pricing Inlarmation Clim Pricing Repeicing lnfcenatice Reseed Allowed meuri EO O OO y d Repiced Saving Amoni Repiicing Oegaedzaton D Repicing Pes Diem ci Fiat Rete Amak Fecriced Opproved DRG Codes A Rlepriced Approved Amount a Flepiced Approved Revenue Co
101. d below are required only if the situation applies to the claim Under Spinal Manipulation Information complete the following fields e Nature of Condition This is a required field e Condition Description 1 e Condition Description 2 e Is Medicare the Payer e Initial Treatment Date e Last X ray Date e Acute Manifestation Date Spinal Manipulation Information Nature of Condition Condtiori Description 1 Condon Description 2 is Medicare the Payer Yes Intial Treatment Dae 77 FEY LastXneyDate 77 Accute Mantestaton Date 7 7 E Delete OK Cancel 42 Supplemental Info Window This is a situational window The fields listed below are required only if the situation applies to the claim Under Supplemental Information complete the following fields e Report Code up to 10 6 20 WINASAPS5010 Claims Entry e Transmission Code up to 10 e Identification Code up to 10 Note If one of the three above fields is filled up the remaining fields are required to be filled up Either fill them all or leave them blank except when the Transmission Code is set to Available on Request the Identification Code field must not be filled up Supplemental Information Transmssion Code Identification Code zif 43 Related Causes Info Window This is a situational window The fields listed below are required only if the situation applies to the claim Under Related Ca
102. d to be filled up Either fill them all or leave them blank Claim Adjustment Information Group Code f l Resson Code Adjusted Amount Adusted Units Reason Code Adjusted Amount Adusted Units RessonCode AdistedAmount Adusted Units Resson Code S Adjusted Amount Adueted Units Reason Code Adjusted Amount Adusted Units Resson Code Adjusted Amount Adusted Units Delete ist Previous Nert OK Cancel 30 COB Amounts Window This is a situational window The fields listed below are required only if the situation applies to the claim e Payer Paid Amount e Remaining Patient Liability e Total Non Covered Amount COB Information Payer Paid Amount Remaining Patient Liability Total Non Covered Amount 31 Medicare Outpatient Adjudication Information Window This is a situational window The fields listed below are required only if the situation applies to the claim e Reimbursement Rate This is a required field e HCPCS Payable Amount e Claim Payment Remark Code up to 5 e End Stage Renal Disease Payment Amount e Non Payable Professional Component Billed Amount 6 79 WINASAPS5010 Claims Entry Medicare Outpatient Adjudication Information Reimbursement Rate HCPCS Payable Amount Claim Payment Remark Code Claim Payment Remark Code Claim Payment Remark Code Claim Payment Remark Code Claim Payment Remark
103. da E o o j Urko Emate heassnem cee z Hepi Aona Sarias Lire Count Read Resan Coda Eoo MA Poey Cenpianse Code Exception Cods Poo Product or Service ID Qasi o a i sl RepiicedAapemee HEES Cady Delos ok Cara 59 In the Claim Line Items tab the Total Claim Charges field will be automatically calculated based on the line item charges This is a required field 60 Click Save 61 To build claims for billing select Tools Build Nursing Facility Claims Create Nursing Facility Claims Payer 77025 BRICKSTREET MUTUAL INSURANCE Biling Type j Statement Coverage Period mmn coyy Batch Number When finished press F1 or click Buld to creste clams 7 30 WINASAPS5010 Adding a Nursing Facility Template 62 Choose Monthly or Other Monthly will build all templates on the specified month Other will give you two date fields all the templates specified in between the dates will be built to a claim 63 Enter appropriate dates in the Statement Coverage Period field s An optional Batch Number can be entered the built claims will have that specified batch number 64 Click Build 65 One claim will be created for each patient in that billing period The created claims from the templates will auto populate the following e In Claim Data tab Statement Coverage Period Through date if none was entered in the template e In Claim Line
104. dded to the Patient database refer to the Maintaining Reference Data procedures Follow the steps for Adding a New Patient to complete this step in adding a professional claim In the Provider Information section complete the following fields e Billing Provider ID This is a required field e Pay to Address Name e Rendering Provider ID e Pay to Plan ID This is enabled only if the Claim or Encounter Identifier is set to Subrogation Demand Note For Pay To Plan providers only providers with Employer s ID Number can be selected in the claims e Signature on File This is a required field e Referring Provider ID 1 e Referring Provider ID 2 This will be enabled when Referring Provider ID 1 has a value e Supervising Provider ID WINASAPS5010 Claims Entry STEPS ACTIONS 10 Under the Billing Provider and Rendering Provider there is a Taxonomy Code button There is no required field in this window The values displayed on the Reference list could be set in the Reference menu gt Taxonomy Code Note The corresponding button is only enabled when Billing Provider or Rendering Provider has value Note A preloaded value is obtained from the Provider Taxonomy Code entered in Provider Data Form see Adding a New Provider section of this document of the values filled Its value can be changed by double clicking a value from the list displayed in the Reference List nay Code SIL
105. de up to 5 e End Stage Renal Disease Payment Amount 6 51 WINASAPS5010 Claims Entry Non Payable Professional Component Billed Amount Medicare Outpatient Adjudication Information Reimbursement Rate HCPCS Payable Amount Claim Payment Remark Code Cisim Payment Remaik Code Gaim Payment Remark Code Claim Payment Remark Code Claim Payment Remark Code End Stage Renal Disease Payment Amount Nor Payable Professional f Component Billed Amount Delete Data OK Cancel 34 Inpatient Adjudication Info Window This is a situational window The fields listed below are required only if the situation applies to the claim Covered Days Lifetime Psychiatric Days Remaining Patient Liability Amt Claim Payment Remark Code Claim Disproportionate Share Amount Claim MSP Pass Through Amount Claim PPS Capital Amount PPS Capital FSP DRG Amount PPS Capital HSP DRG Amount PPS Capital DSH DRG Amount Old Capital Amount PPS Capital IME Amount PPS Operating DRG Amount Cost Report Day Count PPS Operating Federal DRG Claim PPS Capital Outliner Amt Claim Indirect Teaching Amt NonPayable Professional Component Billed Amount Claim Payment Remark Code up to 4 PPS Capital Exception Amt 6 52 WINASAPS5010 Claims Entry Medicare Inpatient Adjudication Information Covered Days or Viats Count PPS Capital IME Amount PPS Dperating Hospital Specific
106. ders Global reference tables contain information used for all payers e Anesthesia Code Maintains code value and description for Professional anesthesia codes Anesthesia Code Data Anedthesa Code Description 2011 ACS EDI Gateway 5 1 WINASAPS5010 Maintaining Reference Data e Condition Code Maintains code value and description for Institutional condition codes e Diagnosis Code Maintains code value description and standard charge amount for ICD 9 ICD 10 diagnosis codes e External Cause of Injury Code Maintains code value and description for Institutional ICD 9 ICD 10 external cause of injury codes External Cause Of Inaasy Code Description WINASAPS5010 Maintaining Reference Data e Occurrence Code Maintains code value and description for Institutional occurrence codes Patient S Reason For Visit Code Data Patient S Reason For Vist Code Patient S Reason For Vist Code Descsiption e Patient s Reason for Visit Code Maintains code value and description for Institutional ICD 9 ICD 10 patient reason for visit codes Patient S Reason For isit Code Data Patient S Reason For Vist Code Patient S Reason For Vist Code Description e Procedure Code Maintains code value description and standard charge amount for procedure codes Procedure Code Data WINASAPS5010 Maintaining Reference Data e Revenue Code Maintai
107. djudication Information Other Payer Primary ID E Procedure Modhers Service Line Pad Amount a Adudication Payment Date 77 E Service dutmart Product os Sevice ID Proc Code Description Paid Service Unk Count Service Line Ths Line Was Burdied Into Remaining Patient Liabity Newt Last Cancel 69 Service Adjustment Window This is a situational window The fields listed below are required only if the situation applies to the claim e Group Code This is a required field e Reason Code up to 6 e Adjustment Amount up to 6 e Adjustment Units up to 6 Note If one of the three above fields is filled up the other fields are required to be filled up Either fill them all up or leave them blank Claim Adjustment Information Group Code X Resson Code A Adusted Amount Adusted Units Reason Code Adjusted Amount Adusted Units Reason Cade AdnstedAmount SSC ltd Units Reason Code Adjusted Amount Aduzted Units Adjusted Amount Adusted Units Reason Code Adjusted Amount Adiusted Units Delete 6 96 WINASAPS5010 Claims Entry 70 Product or Service ID Window This is a required window e Identification Type This is a required field e Identification Number This is a required field Note If one of the two above fields is filled up the other field is required to be filled up Either fill th
108. dow are the e User Batch Claim These are optional fields that you may use to track your claims e Patient ID The patient s state assigned Medicaid ID number e Patient Account Number e Begin DOS The beginning date of service for the claim e Patient s Name The Patient s last and first name e Claim Amount The total amount being billed e Ind A system indicator of O for an original claim or A for an adjustment e Status the status of the claim within WINASAPS5010 o KEYED Claim has been keyed into the system but not generated o HOLD Claim is on hold for further user modification o BILLED Claim has been transmitted to EDI o REJECTED Rejected 999 has been received Contact your ACS EDI Support Unit o ACCEPTED Accepted 999 has been received WINASAPS5010 General Information o ERRORED Rejected 277CA has been received Contact your ACS EDI Support Unit o ACCEPTED ADJUDICATION Accepted 277CA has been received o DENIED Claims with REJECTED or ERRORED status can be changed to DENIED for marking purposes WINASAP allows REJECTED or ERRORED claims to be fixed and then resubmit it This was an option given to users so that they will not resubmit unwanted REJECTED or ERRORED claims o PAID Claims with ACCEPTED or ACCEPTED ADJUDICATION status can be changed to PAID for marking purposes o SUBMITTED Claims which were transmitted to EDI but had a transmission error during the sending of the file Refer to s
109. e Other Referral Number 7 17 WINASAPS5010 Adding a Nursing Facility Template Ga Pa Pra Aster Seale tem Pigs Pria ia ede the Pam ama Miria Uuw the paaa a Marshes Dehio cts w Gavel 38 Billing Provider ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e Entity Type Auto populated e ID Qualifier up to 2 e Secondary ID up to 2 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank 39 Referring Provider ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e Entity Type Code Auto populated e Entity Type Auto populated e Identification Type drop down list up to 3 e Identification Number up to 3 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank 7 18 WINASAPS5010 Adding a Nursing Facility Template Referring Provider ID information Ertity1O Code ier Entity Type G identijcalion Type identiication Number Identification Type Identification Number identiication Type Identification Number Delete Previous Next 40 Operating Physician ID Window This is a situational window The fields listed be
110. e Reason Code up to 6 e Adjusted Amount up to 6 e Adjusted Units up to 6 Note If one of the three above fields is filled up the remaining fields are required to be filled up Either fill them all or leave them blank Claim Adjustment Information Group Code Resson Code Adustedamout AdustedUnits ReasonCode AdustedAmount Adusted Units Resson Code AdjstedAmount AdustedUnis Resson Code AdustedAmount Aduzted Units Reason Code Adjusted Amount Adusted Units Resson Code Adjusted Amount Adusted Units Delete First Previous Nert 40 Rendering Provider ID Window This is a situational window The fields listed below are required only if the situation applies to the claim Under Rendering Provider ID Information complete the following fields e Entity Type This is a required field e Identification Type up to 3 6 19 WINASAPS5010 Claims Entry e Identification Number up to 3 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank Rendering Provider ID Infermatian Erhity Tyne identification Type Idertihostion Number Idertiication Type il idertiication Number idertlication Type idertihoaton Number _ Delete Data 41 Spinal Manipulation Info Window This is a situational window The fields liste
111. e Remarks Code up to 5 e End Stage Renal Disease Payment Amount 7 14 WINASAPS5010 Adding a Nursing Facility Template Non Payable Professional Component Billed Amount Medicare Outpatient Adjudication Information Reimbursement Rate HCPCS Payable Amount Claim Payment Remark Code Claim Payment Remark Code i Claim Payment Remark Code Claim Payment Remark Code Claim Payment Remark Code End Stage Renal Disease Payment Amount Non Payable Professional f Component Billed Amount Delete Data OK Cancel 34 Inpatient Adjudication Info Window This is a situational window The fields listed below are required only if the situation applies to the claim Covered Days Lifetime Psychiatric Days Remaining Patient Liability Amt Claim Payment Remark Code Claim Disproportionate Share Amount Claim MSP Pass Through Amount Claim PPS Capital Amount PPS Capital FSP DRG Amount PPS Capital HSP DRG Amount PPS Capital DSH DRG Amount Old Capital Amount PPS Capital IME Amount PPS Operating DRG Amount Cost Report Day Count PPS Operating Federal DRG Claim PPS Capital Outliner Amt Claim Indirect Teaching Amt NonPayable Professional Component Billed Amount Claim Payment Remark Code up to 4 PPS Capital Exception Amt 7 15 WINASAPS5010 Adding a Nursing Facility Template Medicare Inpatient Adjudication Information Covered Days or Viats Court PP
112. e either ICD 9 or ICD 10 as the code s qualifier This will open the Diagnosis List window 3 Click on the Add button This will open the Diagnosis Code Data window 4 In the Diagnosis Code field enter the code Enter all valid values do not include decimals or zeroes 5 In the Diagnosis Code Description field enter a description of the diagnosis 6 Click on the Save button 5 16 WINASAPS5010 Maintaining Reference Data 5 6 Adding a New External Cause of Injury Code You can enter frequently used external cause of injury codes into WINASAPS5010 s table WINASAPS5010 uses these codes to fill a drop down list box that may be used during claims entry to select the appropriate external cause of injury code for institutional and nursing claims STEPS ACTIONS 1 From the WINASAP5010 Main Menu bar select the Reference option 2 Select the Diagnosis option Then choose either ICD 9 or ICD 10 as the code s qualifier This will open the External Cause of Injury List window 3 Click on the Add button This will open the External Cause of Injury Code Data window 4 In the External Cause of Injury field enter the code Enter all valid values do not include decimals or zeroes 5 In the External Cause of Injury Code Description field enter a description of the diagnosis 6 Click on the Save button 5 17 WINASAPS5010 Maintaining Reference Data 5 7
113. e other field is required to be filled up Either fill them both up or leave them blank Silco Siero dle haii he bin lated y Seporsi T pe j hared Besooredny D eie Das When finished click on the Other Subscriber Page 2 button 29 Under the Insurance Information section and complete the following fields e Group or Policy e Group or Plan Name e Insurance Type Code e Claim Filing Indicator e Release of Information Code This is a required field e Patient Signature Source Code This is a required field e Assignment of Benefits Coordinator If nothing is checked a No will be assumed and sent with the claim 6 14 WINASAPS5010 Claims Entry Other Subscriber Information Other Subscriber Page 1 Other Subscriber Page 2 Insurance Information Group or Policy i Group o Plan Named Insurance fM Type Code Release of information Code ERR Angane A Parels zj COB Amounts Oupasent Adiudcation info Other Payer Information i Names Paper Responsibly Sequence Code x Pavar Nama 2 Baver Primary 1D Type Payer Primay tb Payee Addiess r P r E Payee Address cont Pesca r ad Gam Cheka po Remittance Date g fz Claim Adusmer Indicator Yas Claim Control Number Secondary ID Infomation Price Aut Referral Number Bling Provides ID Relening Provider ID Supervising Provider ID Service Facilty ID Aduetment Into Rende
114. e tool the status of the Billed claims will be changed depending on the response file you have received A Rejected status means that a rejected 999 has been received contact your ACS EDI Support Unit no 277CA will be produced for the sent file in this case An Accepted status meanwhile means that an accepted 999 has been received but the 277CA has not yet been received To get the 277CA wait for a few hours then use the Receive Response File tool again or contact your ACS EDI Support Unit For more information on 277CA proceed to the next sub chapter of this document 10 5 WINASAPS5010 Sending Claim Files 10 2 2 Regarding Claims with Accepted Adjudication and Errored Statuses An accepted 999 which changes the Billed claim to Accepted status would be further changed to Accepted Adjudication or Errored depending on the 277CA Response File the sent file has received A status of Accepted Adjudication means that 10 6 WINASAPS5010 Sending Claim Files 10 3 Regarding Claims with Submitted Statuses After sending claims the status may become Submitted This usually indicates that a transmission problem occurred This status was created just to prevent the user to resubmit of claims and duplicates without verifications done by the submitter When sending a log file Apro his is created and this could be found on the User s computer on the directory below C Progra
115. e where to enter that number in this field please contact your ACS EDI Support Unit 4 32 WINASAPS010 Software Installation STEPS ACTIONS e Inthe User ID field enter your 9 digit User ID e Inthe User Name field enter your User Name exactly as it appears on your logon form 8 Click on the Save button to record update your trading partner data 4 33 WINASAPS5010 Maintaining Reference Data 5 Maintaining Reference Data WINASAPS5010 allows you to maintain reference tables to help you key claims faster Information from the reference tables is used by the system to automatically fill claim fields or to create drop down list boxes to help you select data field values WINASAP5010 BRICKSTREET MUTUAL INSURANCE File PAGGISA Claims Tools Window Help Provider Patient Anesthesia Codes Condition Code Diagnosis Code gt External Cause of Injury Code gt Occurrence Code Patient s Reason For Visit Code gt Procedure Code Revenue Code Surgical Code gt Taxonomy Code Treatment Code Value Code Error Text Procedure Modifiers There are two types of reference tables Payer specific reference tables contain information used for a single payer e Patient Maintains ID numbers demographic data insurance information and employer data on each of your patients e Provider Maintains ID numbers demographic data organization and contact person on each of your provi
116. ecrcey Code TACT Tanners Code 237 learene Code 737 Tarore Cox INUA Ternera fry j Under the Billing Provider and Pay To Plan there is a Tax ID button The fields in it are required Preloaded values are obtained from the Provider Tax Identification Number entered in Provider Data Form see Adding a New Provider section of this document Thru this window its value can be changed by the user if needed Billing Provider Tax ID Number Identification Type fE mployer s Identification Number Identification Number 11 In the Claim Data section complete the following fields e Diagnosis Type Code This is a required field e Principal Diagnosis This is a required field e Anesthesia Related Procedure Code 1 6 4 WINASAPS5010 Claims Entry STEPS ACTIONS e Anesthesia Related Procedure Code 2 This will be enabled when Anesthesia Related Procedure Code 1 field has a value e Place of Service This is a required field e Claim Frequency Type Code This is a required field 12 In Other Diagnosis Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim The fields would only be enabled if their preceding fields are already entered e Qualifier up to 11 e Code up to 11 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them b
117. ect WINASAP5010 This will open the WINASAP5010 Logon window 3 In the User ID field select the user name from the drop down list box 4 27 WINASAPS5010 Software Installation STEPS ACTIONS ADMIN is the initial default 4 In the Password field enter your password asap is the initial default for the ADMIN user ID S Click on the OK button The WINASAP5010 desktop with the Main Menu Bar will be displayed Note If this is the first time you start WINASAP5010 you will need to select the default payer from the drop down list box Open Payer You must select the appropriate Payer from the Payer list BRICKSTREET MUTUAL INSURANCE Cancel BRICKSTAEET MUTUAL INSURANCE CENPATICO BEHAVIORAL HEALTH Show Payer Edits FREEDOM HEALTH GEORGIA MEDICAID PEACHCARE FOR KIDS HAWAJl FEE FOR SERVICE Wall WAIVER MISSISSIPPI MEDICAID MONTANA DPHHS You are now ready to begin updating reference tables or entering claims 4 28 WINASAPS5010 Software Installation 4 5 1 Setting Up User IDs and Passwords WINASAPS5010 has a default user ID of ADMIN and password of asap If you want to use the default user ID you may However if you want to establish different security levels for different users you may do so by using the following procedures YINASSP5010 ORICKSTRECT MUTUAL INSURANEL Fle Reference Jans cos Winds Hep
118. ected in the Data claims immediately in which that provider was used In order to change the entries in the database Repair Claim Provider Data should be used to reflect the changes done in the provider window Though it is advisable to resave the claims after a provider information has been edited so that compliance checks would be performed but if the provider is used in several number of claims this tool can be used to change them all at once if you are certain that the changes are still compliant Database Database Repair Tool does several things to fix the database It updates Repair Tool the segments in claims associated with the address city state and zip codes if there were any changes in the provider used in claims Also it removes any trailing spaces if there were any entries from older versions of WINASAP as well as deletes any entries in the database segments which is not associated in any claims due to data corruption or deleting errors if any This is advisable to perform in order to ensure that old databases restored does not create any errors when adding new 2011 ACS EDI GATEWAY INC All rights reserved 12 1 WINASAPS5010 Database Maintenance ACTIVITY DESCRIPTION entries in claims Purge Claims Depending on your claim volume you may want to periodically purge claims from the WINASAPS5010 claims database to reduce the amount of information displayed on claim inquiry windo
119. ection 10 3 Regarding claims with Submitted statuses section of this manual for further information e Status Date The Bill Date entered on the claim e Trans Set A unique identification assigned automatically by WINASAP5010 during sending of claims WINASAPS5010 General Information 3 6 1 Function buttons At the bottom of each inquiry list window is a row of function or command buttons While highlighting the database record you want in the list window you can click on the appropriate function button to perform one of the following actions e Add Allows you to add a record patient provider claim etc to the database e Copy Allows you to copy the highlighted database record to create a new database record to modify e Change Displays the highlighted database record in a change mode for you to modify e Delete Allows users to delete a record patient provider claim etc When deleting a claim it displays a sub window The buttons in the window are as follow Yes Deletes the highlighted record from the WINASAPS5010 database Selective Allows a user to delete multiple claims by clicking on a checkbox at the first column of the table All Allows a user to delete all claims by in the database Cancel Closes the sub window e Inquiry Displays the highlighted database record in an inquiry mode e Cancel Closes the inquiry list window and returns to the WINASAPS5010 desktop WINASAPS5010 G
120. ection of this document of the values filled Its value can be changed by double clicking a value from the list displayed in the Reference List HIII Heavens Heber inc lecrerg Code EBT T3436 SST TTS TV corcey Code tes oF Under the Billing Provider and Pay To Plan there is a Tax ID button The fields in it are required Preloaded values are obtained from the Provider Tax Identification Number entered in Provider Data Form see Adding a New Provider section of this document Thru this window its value can be changed by the user if needed Billing Provider Tax ID Number Identification Type fE mployer s Identification Number Identification Number 11 In the Claim Data section complete the following fields Admission e Date e Hr e Min e Type This is a required field e SRC Discharge WINASAPS5010 Adding a Nursing Facility Claim STEPS ACTIONS e Stat This is a required field e Hr e Min Statement Coverage Period e From Through fields This is a required field e Referral e Prior Authorization e Type of Bill This is a required field e Auto Accident State e Medical Record e Repricer Received Data 12 Click the Claim Codes tab or Next Page button Nursing Claim Data Claim Data Claim Codes Claim Line Items Procedure Codes Principal Procedure Principal Procedize Principal Procedure Gade usien Z Coder bate 77 EE Other Procedure Codes Diagnosis Codes
121. ee windows by tiling them horizontally vertically or cascading Help menu option e Contents Allows you to view the Help file on WINASAPS5010 where most of your procedural and functional questions can be answered e About Tells you which WINASAPS5010 version you are using This can be very helpful to know when contacting the ACS EDI Gateway Support Unit WINASAPS5010 General Information 3 6 Understanding Inquiry List Windows Each Reference Table and Claim Type has its own inquiry list window that provides you with an overview of the data stored within the WINASAPS5010 database Using inquiry list windows you can highlight the database record you want and click on the appropriate function command button to perform the desired action This section gives you examples of the three most common list windows and describes the data fields displayed in the windows A brief explanation of the function buttons found on the bottom of each inquiry list window follows the window examples Data fields displayed on the Patient List Inquiry Window are the e Patient ID e Sex e Patient Account number assigned by the provider e Patient Name e Date of Birth e Property and Casualty Telephone Number Data fields displayed on the Provider List Inquiry Window are the e ID Type e Provider ID Number e Provider Name or Organization Name e City e State e Provider Telephone Number Data fields displayed on the Claim List Inquiry Win
122. efault user ID of ADMIN and password of asap If you want to use the default user ID you may However if you want to establish different security levels for different users you may do so by following the procedures in section 4 6 of this user manual 4 22 WINASAPS5010 Software Installation 4 4 When installing on Window7 Vista When installing on these types of OS it is important to have administration rights If you do not have administration rights but have successfully installed WINASAPS5010 this is an error message you would receive when you try to run it WAI Pee arse mi Error displaying error message It would display an error message since it could not load the User Id on the database If you try to press OK it would just look like the one below As you can see there is no User ID displayed If you try to cancel it would just continue to display the error message and the application would close To solve this issue make sure that when the software is installed you should run this as an Administrator To do this simply right click on the WINASAP5010 icon and select Run as administrator as shown below Open Open file location Run as administrator After installation you may need to change the compatibility version of the application To do this on the WINASAP5010 icon right click on it and select Properties On the Properties select the Compatibility tab select the Windows XP
123. eld e Assignment of Benefits Indicator Other Subscriber Information Other Subscriber Paged Other Subscriber Page 2 inswarce Information Group Poley amp Group ot Plan Name Glam Fiirg f Indicate Release of l Information Code ene nia z COB Amounts Qurpatiert Adjudication Info Inpatient Adjudication info Other Payer Intoematices Paver Named Paver Resoonstilty Sequence Code 7 Payee Phimasy iD Tuse f zl Paver Piman ID Paper Addess Paper Address cont f P Paye Ciy aef zea Claim Check or 77 A Remittance Date r Claim Adiustment indicato Yes Claim Control Number Secondary ID Ir crmation Prior Auth Referral Number Biting Provider ID Reteming Provider ID Operating Physician Service FacityiD __Aduetmert into Rendering Provider iO Attending Provider _ Other Operating Physician Delete Fact _ Previous Next Lost ok Carel 32 COB Amounts Window This is a situational window The fields listed below are required only if the situation applies to the claim e COB Payer Paid Amount e Remaining Patient Liability e COB Total Non Covered Charges OH Figs Pai dane Emran Pari liabi G8 Taake bem a Dewa Daa 33 Outpatient Adjudication Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Outpatient Reimbursement Rate e HCPCS Payable Amount e Remarks Co
124. elds e Patient ID enter the patient s Medicaid number This is a required field e Patient Account enter the patient s account number This is a required field Patient Data Patient Data Insured s Data Patient Identification Paer Patient Accourt Patient Name and Demographic Information ast Nome Sate of Bith 77 i fal Medicare Recipient T Fist Name i DeectDesth 77 Middle Name waa Sette Sex z Property and Casualty Information Sane Telephone E taf asst sa Pope J Patient Address Information Adiress Civ Stax 5 In the Patient Name and Demographic Information section complete the following fields e Last Name This is a required field 5 9 WINASAPS5010 Maintaining Reference Data STEPS ACTIONS e First Name This is a required field e Middle Name Initial e Suffix e Date of Birth This is a required field e Date of Death e Weight e Sex This is a required field e Medicare Recipient e Is Patient Pregnant Applicable only when Sex field has a value of Female 6 In the Property and Casualty Information section complete the following fields e Contact Name e Telephone e Ext e Property and Casualty Claim e Property and Casualty Patient Code e Property and Casualty Patient Identifier 7 In the Patient Address Information section complete the following fields Address This is a required field Address con
125. ely identifies you as an entity that ACS EDI Gateway has authorized to submit claims electronically This is a one time only procedure that you complete when you initially install WINASAPS010 on your PC The information you need to complete this screen is contained in the Logon Sheet sent to you from the EDI Support Unit In the event that your name address telephone numbers or identification numbers change you can perform these procedures again to update your Trading Partner data Trading Partner Information Trading Partner Identification a Primary identification Secondary identihcatior Trading Partner Name Contact Information Entity Type o y Contact Name Telephone I Ext axe Emait Additional Contact Information WINASAP5010 Communications Contact Name Host Telephone Usero t Telephone f i et User Name Fat jf Ema STEPS ACTIONS 1 From the WINASAP5010 Main Menu bar select the File option 2 Select the Trading Partner option This will open the Trading Partner Information window 3 In the Trading Partner Identification section complete the following fields e Primary Identification Enter your 5 or 6 digit Trading Partner ID assigned to you by ACS EDI Gateway This is a required field e Secondary Identification Enter your 5 or 6 digit Trading Partner ID 4 31 WINASAPS5010 Software Installation
126. em s claims database through the use of a special hold claim status For example if you are entering a claim and determine that some required information is missing you can change the claim status field to hold save the claim and complete the missing information at a later date The system will edit a claim for the minimum required fields but not for any situational fields when the claim status is hold When you are ready to complete a claim in a Hold status or to release a previously held claim simply change the claim status field to Keyed and WINASAP5010 will select the claim the next time you perform a Send for that claim type You can also delete a claim in a Hold status WINASAPS5010 General Information 3 5 Understanding the WINASAP5010 Menu Bar The Menu Bar is always displayed across the top of the WINASAP5010 desktop window Listed below are explanations of the different menu options available to you File menu option Open Payer Allows you to activate a new payer for the claims you are processing Trading Partner Allows you to create and update your trading partner information e g demographic data and dial in features Print Setup Allows you to establish printing options Print Allows you to print window information and reports Exit Closes the WINASAPS5010 application Reference menu option Choosing any of the reference tables displayed in this drop down menu will
127. em both up or leave them blank Product or Service ID Identification Type Identification Numbes 71 In the Claim Line Items tab the Total Claim Charges field will be automatically calculated based on the line item charges This is a required field 72 Click Save to save the claim 6 97 WINASAPS5010 Adding a Nursing Facility Template 7 Adding a Nursing Facility Template Data from a Nursing Facility Template form is entered into WINASAP5010 through 3 tabs When you select the ADD option for a Nursing Facility Template the template system displays a Nursing Facility Template Data window Once you complete the Template Data tab you will continue to complete the Template Codes and Template Line Items tabs Nursing Facility Template Data Template Data Template Codes Template Line Items Bil Date 77 a User Batch fs Claim Number z Pater Information Pao o PatentAccomtt DateofBrth 77 Sef Last Name First Name Middle Named ritiat Provider Infeemation Biling Provider f Papto Address Service Facilty Location ki Attending Provider Bad Operating Physician Rendening Provider K zj Retesnng Provider 5 n Pay To Plar ig Clam Data Admissiory Discharge Statement Coverage Penod r Erc Through Datel 77 af Minf Twe src Stat H mnf 77 ar A Referral Pnor Authorization ype o B State a
128. eneral Information 3 6 2 Summary of Statuses To better understand the usage of statuses below are the possible scenarios in which a claim is saved with a current status and the other possible statuses it can be saved Current Status Can Be Changed To Accepted Paid or Denied Accepted Adjudication Paid or Denied Rejected Hold Keyed or Denied Errored Hold Keyed or Denied 3 10 WINASAPS5010 General Information 3 7 Resolving Error Messages WINASAPS5010 displays error messages in standard dialog boxes There are two types of error messages e User errors that require some action on your part to correct and e System errors that may require some action on ACS s part Examples of user and system errors are given below with a description of the typical actions you would take to resolve each type of error User Errors User error messages identify a specific problem that you must resolve in order to complete the function you are performing For example if you leave a required field blank on a claim window and attempt to save a claim WINASAP5010 displays an error message for each missing required field System Message 1 E021 Edit ID Qualifier Required When you receive a user error message for a missing required field you should take the following actions e Click on the OK button to acknowledge the error WINASAP5010 automatically places the cursor on the field where the error exists
129. epriced Approved Ambulatory Patient Group Code e Repriced Approved Ambulatory Patient Group Amount e Unit or Basis to Measurement Code e Repriced Approved Service Unit Count e Reject Reason Code e Policy Compliance Code e Exception Code 6 30 WINASAPS5010 Claims Entry Product or Service ID Qualifier Repriced Approved HCPCS Code Claim Pricing Repricing Information Claim Pricing Repncing Information p SrA H 4 r Bepticed Allowed Amount Repnced Saving Amount Repricing Organization ID Repricing Per Diem or Flat Rate Amount Repriced Approved Ambulatory EF Patient Group Code Repriced Approved Ambulatory Patient Group Amount Unit or Basis for Measurement Code X Repiiced Approved Service Unit Count Exception Code v Product or Service ID Qualiier Repnced Approved HCPCS Code Delete OK Cancel 61 Medical Equipment Info Window This is a situational window The fields listed below are required only if the situation applies to the claim Proc Code Auto populated field Length of Medical Necessity This is a required field DME Rental Price This is a required field DME Purchase Price Rental Unit Price Indicator Certification Type Code DME Duration Certification Revision Date 6 31 WINASAPS5010 Claims Entry Medical Equipment Information Proc Code O Length of Medical Necessity an Days DME Rental Price tw DME Purc
130. er ID This is a required field e Service Line Paid Amount This is a required field e Procedure Modifiers up to 4 e Adjudication or Payment Date This is a required field e Proc Code Description e Paid Service Unit Count This is a required field 7 27 WINASAPS5010 Adding a Nursing Facility Template e Service Line This Line Was Bundled Into e Revenue Code This is a required field e Remaining Patient Liability Line Adjudication Infarmation Emap z Procedure Moditiers sasian _ Adindication o Pamant Date Eg Service Adjustment Product o Service ID Proc Code Description Paid Service Unk Court Service Line This Line a as Bundled inte Revenue Code Remaining Patent Lisbity Be pO Bevis Nee et v f ca 56 Service Adjustment Window This is a situational window The fields listed below are required only if the situation applies to the claim e Group Code This is a required field e Reason Code drop down list up to 6 Adjusted Amount up to 6 Adjusted Units up to 6 Claim Adjustment Information Group Code f lt Resson Code Adjusted Amount Adusted Units Reason Code Adjusted Amount Adlusted Units Reason Cade AdjstedAmount lt C C sted ints SPS Resson Code Adjusted Amount Aduzted Units Reason Code xl 4 F i Adpsted Amount Adusted Units Reason Code Adjuste
131. erence 1 Code Claim Note Text Delete First Previous Next Last OK Cancel 28 Billing Notes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Note Text 8 11 WINASAPS5010 Adding a Nursing Facility Claim Billing Notes Note Reference Code Adeona ink Note Test 1 Delete Data 29 On Other Subscriber Page 1 tab under the Insured s Name section complete the following fields Patient Relationship to Insured This is a required field Entity Type This is a required field e Organization Name This field is required if Non Person in Entity Type field is selected e Last Name This field is required if Person in Entity Type field is selected e First Name This field is required if Person in Entity Type field is selected Middle Name Initial This field is enabled if Person in Entity Type field is selected Suffix This field is enabled if Person in Entity Type field is selected Under the Insured s Address section complete the following fields e Address This is a required field Address con t e City State Zip Code Under Insured s Identification section complete the following fields e Insured s Primary ID Type This is a required field e Insured s Primary ID This is a required field 8 12 WINASAPS5010 Adding a Nursin
132. es WINASAP5010 installation and trading partner setup are one time only events that take place when you initially install the software on your PC The only time you would have to reinstall WINASAP5010 is if your PC s hard drive is damaged or if the WINASAP5010 software becomes corrupted The remainder of this chapter will walk you through everything you need to do to get started using WINASAP5010 4 14 WINASAPS5010 Software Installation 4 3 Installing WINASAP5010 Once WINASAPS5010 is installed it should not be reinstalled unless your PC suffers a hard drive failure or the WINASAP5010 software becomes corrupted WARNING Reinstalling the software re initializes the WINASAP5010 database You will LOSE all of the data you entered unless you have previously saved the database using WINASAPS5010 s Backup function If WINASAPS5010 does not load correctly or does not execute properly after following the installation procedures in this section please contact your ACS EDI Support Unit WINDOWS NT WINDOWS 2000 WINDOWS XP WINDOWS VISTA AND WINDOWS 7 USERS You must have administrator rights to your system in order to install WINASAP5010 Please contact your system administrator for assistance STEPS ACTIONS 1 Terminate all active programs applications before you install WINASAPS5010 in order to avoid potential system conflicts or errors 2 Download the latest version of WINASAP5010 in www acs gcro com
133. f maf Twe sae Sutff Mif T m fa Referral aT Prot Authorization e uaua ype ot Bil ee Auto Accident State Medical Record t nae cece yz o Next Page Save Cancel STEPS ACTIONS 1 From the WINASAP5010 Main Menu select the Claims option 2 From the Claims Submenu select the Institutional option This will open the Institutional Claim List Window 3 Click on the Add button This will open the Institutional Claim Data window At the top left hand portion of the window you will see three tabs e Claim Data e Claim Codes e Claim Line Items 6 38 WINASAPS5010 Claims Entry STEPS ACTIONS In the Bill Date field enter the date the claim is billed to the payer If you press F5 the system will pre fill the date field with the current system date This is a required field 5 In the User Batch field you may enter your own batch number up to four digits in length 6 In the User Claim Number field you may enter your own claim number up to nine digits in length Te In the Claim Identifier drop down list select the appropriate transaction type By default it is selected as Chargeable 8 In the Patient Information section select the appropriate patient from the drop down list box To select the patient double click on the patient name Once you have selected the appropriate patient this will pre fill the name DOB gender and patient account numbe
134. field e Insured s Primary ID This is a required field 6 49 WINASAPS5010 Claims Entry 30 Other Subscriber Information Other Subsceber Page 1 Other Subscaber Page 2 inswed s Name Pabent Relationship f To insured I inewed s Address Addiess Addess con t City f a Zip Code Insured s Identification Inculed s Primary ID Type a Secondary identilicaton insureds Primacy ID Delete Fast ok Corea Previous 31 When finished click on the Other Subscriber Page 2 tab Secondary Identification Window This is a situational window The fields listed below are required only if the situation applies to the claim Under the Insurance Information section complete the following fields e Insured s Secondary ID Type up to 2 Insured s Secondary ID up to 2 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank Other Payer Secondary Identification Payer Secondary ID Type Payer Secondary ID f Payer Secondary ID Type Payer Secondary ID Delete Dato Ok Cancel Under the Insurance Information section complete the following fields e Group or Policy e Group or Plan Name e Claim Filing Indicator 6 50 WINASAPS5010 Claims Entry e Release of Information Code This is a required fi
135. field e State This is a required field e Zip Code This is a required field T In the Provider Tax Identification Number section complete the following fields e ID Type e ID Number This will be enabled when ID Type field has a value Note The values on these fields would only be submitted when used as Billing Provider and or Pay To Plan If not then the values would not be reflected on the Reference Information of the provider Note For Pay To Plan providers only providers with Employer s ID Number can be selected in the claims 8 In the Contact Information section complete the following fields e Contact Name e Telephone e Ext e Fax e Email Note Contact Name and one of the other three contact information fields Telephone Fax or Email is required if the provider is the Billing Provider WINASAPS5010 Maintaining Reference Data STEPS ACTIONS 9 In the Additional Contact Information section complete the following fields e Contact Name e Telephone e Ext e Fax e Email 10 Click the Next Page button to enter Secondary Information You may enter up to 7 unique secondary identifications e Identification Type e Identification Number e Payer ID Note For Identification Type and Identification Number if one field is filled up the other field is required to be filled up Either fill both fields or leave them blank For Payer ID this is a situational field This
136. formation window will display next Enter your name and the name of your company and then click Next User Information Please enter your name and the name of the company for whom you work Name ACS ACS lt Back Cancel a The Start Copying Files window follows displaying the current settings you have chosen so far during the installation Click the Next button if you want to continue or the Back button if you wish to make corrections Choose Destination Location Setup vall install Winasap Application in the following folder To instal to this folder click Next hs instal to a different folder click Browse and select another ider You can choose not to instal Winasap Application by checking Cancel to exit Setup r Destination Folder C ACS Winasap Application lt Back 4 18 WINASAPS5010 Software Installation STEPS ACTIONS 10 WINASAPS5010 will begin copying its files to your hard drive i aaja Anoyi SeS ea 11 The first Setup Complete window will display Depending on your PC you may see the Restart option or the Launch option If you see the Launch option skip to Step 13 otherwise follow these steps e The system will default to the Yes I want to restart my computer now Option Itis not necessary to restart your computer in order to use WINASAP If you choose not to restart your computer go to Step 13 Otherwise go to Step 14 Setup Complete
137. g Facility Claim Other Subscriber Information Other Subsceber Page 1 Other Subscaber Page 2 inswed s Name Pabent Relationship To insured r l inewed s Address Address Addess con t Cy a lt s Zip Code Insured s Iderbfication insureds Pomaty ID Type ij Secondary identilicaton Delete Fat OK Carei Previous Secondary Identification Window This is a situational window The fields listed below are required only if the situation applies to the claim Under the Insurance Information section complete the following fields e Insured s Secondary ID Type up to 2 Insured s Secondary ID up to 2 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank Other Payer Secondary Identification Payer Secondary ID Type i Payer Secondary ID f Payer Secondary ID Type i Payer Secondary 10 Delete Data __ ok Cancel When finished click on the Other Subscriber Page 2 tab Group or Policy Group or Plan Name Claim Filing Indicator Under the Insurance Information section complete the following fields e e 8 13 WINASAPS5010 Adding a Nursing Facility Claim e Release of Information Code This is a required field e Assignment of Benefits Indicator Other Subscriber Information Other Subscriber Page O
138. g a New Provider section of this document of the values filled Its value can be changed by double clicking a value from the list displayed in the Reference List z Helper ine Taxoreary Code FA DIE IAT 239 IR ZITI Vcorcee Code tes ar 5 SGS09002 Teorore Code PSSSIE EES I mory Code IIU Tener frets Under the Billing Provider and Pay To Plan there is a Tax ID button The fields in it are required Preloaded values are obtained from the Provider Tax Identification Number entered in Provider Data Form see Adding a New Provider section of this document Thru this window its value can be changed by the user if needed Billing Provider Tax ID Number Identification Type Employer s Identification Number Identification Number 11 In the Claim Data section complete the following fields Admission e Date This is a required field e Hr 7 3 WINASAPS5010 Adding a Nursing Facility Template STEPS ACTIONS e Min e Type This is a required field e SRC Discharge e Stat This is a required field e Hr e Min Statement Coverage Period e From Through fields From field is auto populated with Admission Date field e Referral e Prior Authorization e Type of Bill This is a required field e Auto Accident State e Medical Record e Repricer Received Data 12 Click the Template Codes tab or Next Page button Nursing Facility Template Data Template Data Template Codes i Template
139. gender and patient account number fields These fields cannot be edited on the claim form This information can only be changed in the patient reference window This is a required field Note If the patient has not been added to the Patient database refer to the Maintaining Reference Data procedures Follow the steps for Adding a New Patient to complete this step in adding a nursing claim In the Provider Information section complete the following fields e Billing Provider ID This is a required field e Pay To Address ID e Service Facility Location e Attending Provider ID e Operating Physician ID e Other Operating Physician ID This is enabled when Operating Physician ID field has a value e Rendering Provider ID e Referring Provider ID e Pay To Plan ID This is enabled only if the Transaction Type is set to Subrogation Demand Note For Pay To Plan providers only providers with Employer s ID Number can be selected in the claims 10 Taxonomy Code Window This is a situational window The fields listed below are required only if the situation applies to the claim e Taxonomy Code Note The corresponding button is only enabled when Billing Provider 8 2 WINASAPS5010 Adding a Nursing Facility Claim STEPS ACTIONS or Attending Provider has value Note A preloaded value is obtained from the Provider Taxonomy Code entered in Provider Data Form see Adding a New Provider s
140. gte Datel 7 fa He mi Tef src staf Hf Min TE ar Referal tt Price Authorization tt 7 Type of Bit Auto Accident State Medical Record Fane mee 77 A STEPS ACTIONS 1 From the WINASAP5010 Main Menu select the Claims option De From the Claims Submenu select the Institutional option This will open the Institutional Claim List Window 3 Click on the Add button This will open the Institutional Claim Data window At the top left hand portion of the window you will see three tabs e Claim Data e Claim Codes e Claim Line Items 2011 ACS EDI Gateway 8 1 WINASAPS5010 Adding a Nursing Facility Claim STEPS ACTIONS In the Bill Date field enter the date the claim is billed to the payer If you press F5 the system will pre fill the date field with the current system date This is a required field In the User Batch field you may enter your own batch number up to four digits in length In the User Claim Number field you may enter your own claim number up to nine digits in length In the Claim Identifier drop down list select the appropriate transaction type By default it is selected as Chargeable In the Patient Information section select the appropriate patient from the drop down list box To select the patient double click on the patient name Once you have selected the appropriate patient this will pre fill the name DOB
141. hase Price Rental Unit Price Indicator o r Certification Information Certification Type Code DME Duration Months Certification Revision Date A Delete Data OK Cancel 62 Miscellaneous Amounts Window This is a situational window The fields listed below are required only if the situation applies to the claim e Sales Tax Amount e Postage Claimed Amount Miscellaneous Amounts Sales Tax Amount Postage Claimed Amount Delete Data OK Cancel 63 Miscellaneous Dates Window This is a situational window The fields listed below are required only if the situation applies to the claim e Therapy Begin Date e Last Certification Date e Date Last Seen e Shipped Date e Prescription Date e Initial Treatment Date e Last X ray Date 6 32 WINASAPS5010 Claims Entry Miscellaneous Dotes Therapy Bagn Date Fi Last Cetlficsion Dats 7 7 Daelet Sem 77 ShppedOals 27 Pessoeption Date 7 7 India Tesstert Dae Yk Be eee Lada Data 7 7 Dass Daa 64 Miscellaneous Indicators Window This is a situational window The fields listed below are required only if the situation applies to the claim e Is this a Medicare claim involving physician services to a hospice patient e Is the physician employed by the Hospice e Was the service a result of a screening referral e Family Planning e Was the service an emergency e Is the patient co pay exempt Misce
142. ick the Add line Item button to add the line item to the grid below Then click Save If another line item needs to be entered continue filling in the appropriate information and clicking add line item until all line items have been entered for this claim and then click Save Other line item choices e Delete Deletes the current line item e Copy Copies the current line item This does not copy any line item situational information e First Scrolls you to the first line item e Previous Scrolls you to the previous line item e Next Adds a line item or scrolls you from one line to the next e Last Scrolls you to the last line item NOTE All the buttons on the Additional Line Item Information would become enabled after the required items have been entered 47 Under the Additional Line Item Information section complete the following fields under each button All of the buttons in this section are situational If the situation applies to the claim enter the appropriate information Attachment Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Transmission Code Attachment Information Transmission Code Delete Data f Cancel 48 Ambulance Transport Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Transport Reason This is a required field e Transport Distance
143. ification section complete the following field e NPI Number e Provider Taxonomy Code Provider Data Provider Data Secondary Identification Provider Identification NPI Numbes Provider Taxonomy Code Provider Name Provider Address Adcress cis Saef x ue ree Billing and Service Facility Zin Coda Provider Zip MUST be 9 digits Provider Tax Identification Number ID Type f l Contact Information Additional Contact Intormation Contact Name i Cortact Name i Telephone t Ext 7 Telephone Fax ti o 7 Fax 4 E 3 Emait Emst Next Page 5 In the Provider Name section complete the following fields e Entity Type This is a required field e Organization Name This is a required field if Non Person is selected in Entity Type field OR WINASAPS5010 Maintaining Reference Data STEPS ACTIONS e Last Name This is a required field if Person is selected in Entity Type field e First Name This is a required field if Person is selected in Entity Type field e Middle Name Initial This will be enabled when Person is selected in Entity Type field e Suffix This will be enabled when Person is selected in Entity Type field 6 In the Provider Address section complete the following fields e Address This is a required field e Address cont d This will be enabled when Address field has a value e City This is a required
144. ifier e Procedure Code e Procedure Modifiers up to 4 e Description e Line Item Charge Amount e Units or Basis for Measurement This is a required field e Service Units Count e Non Covered Charge Amount e Service Date s e Rate This is a required field e Line Item Control e Repriced Line Item Ref e Adjusted Repriced Line Item Ref e Service Tax Amount e Facility Tax Amount 7 25 WINASAPS5010 Adding a Nursing Facility Template e Operating Physician ID drop down list e Other Operating Physician ID drop down list e Rendering Provider ID drop down list e Referring Provider ID drop down list If you are done entering all of the information for this line item click the Add line Item button to add the line item to the grid bellow Then click Save If another line item needs to be entered continue filling in the appropriate information and clicking add line item until all line items have been entered for this claim and then click Save Other line item choices e Delete Deletes the current line item e Copy Copies the current line item This does not copy any line item situational information e First Scrolls you to the first line item e Previous Scrolls you to the previous line item e Next Adds a line item or scrolls you from one line to the next e Last Scrolls you to the last line item NOTE All the buttons on the Additional Line Item Information would become enabled after the req
145. ill open the Professional Claim List window 3 Click on the Add button This will open the Professional Claim Data window At the top left hand portion of the window you will see four tabs e Claim Data e Claim Codes e Claim Information e Claim Line Items 4 In the Bill Date field enter the date the claim is billed to the payer If you press F5 the system will pre fill the date field with the current system date 6 2 WINASAPS5010 Claims Entry STEPS ACTIONS or click the calendar button to select the applicable bill date To select the date double click this will enter the date and close the calendar window This is a required field In the User Batch field you may enter your own batch number up to four digits in length In the User Claim Number field you may enter your own claim number up to nine digits in length In the Claim or Encounter Identifier drop down you could choose Chargeable Reporting or Subrogation Demand claims In the Patient Information section select the appropriate patient from the drop down list box To select the patient double click on the patient name Once you have selected the appropriate patient this will pre fill the name DOB gender and patient account number fields These fields cannot be edited on the claim form This information can only be changed in the Patient reference window This is a required field Note If the patient has not been a
146. illed up the other field is required to be filled up Either fill both fields or leave them blank Operating Physicion 1D Quabties Secorday ID ID Quahfer Secenday IO 1D Quabfier Seconday ID ID Quabtier Seconday 1D 41 Service Facility ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e Entity Type Code Auto populated e ID Qualifier drop down list up to 3 e Secondary ID up to 3 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank 6 56 WINASAPS5010 Claims Entry Service Facility ID Information Enty 10 Code 1D Quatis Secorday iD ID Quaitier Secondary 0 ID Quaker Secondary 1D f Dete Dana QK Cancel Adjustment Info Window This is a situational window The fields listed 42 below are required only if the situation applies to the claim e Group Code This is a required field e Reason Code up to 6 e Adjusted Amount up to 6 e Adjusted Units up to 6 Claim Adjustment Information Group Code E Resson Code Adusted Amount Adusted Units Reason Code on Adjusted Amount Adusted Units Resson Cade AdustedAmount Adusted Units Ressorn Code Adjusted Amount Aduzted Units Reason Code
147. ing Documentation Question Number Letter H Question Response x Question Response R Question Response E 2 E Question Response i New Previous Copy Delete Page Delete All oK Cancel 56 Line Adjudication Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Other Payer Primary ID This is a required field e Service Line Paid Amount This is a required field e Procedure Modifiers up to 4 e Adjudication or Payment Date This is a required field 6 28 WINASAPS5010 Claims Entry e Proc Code Description e Paid Service Unit Count This is a required field e Service Line this Line Was Bundled Into e Remaining Patient Liability Note You need to input values on the Product or Service ID window in order to save values on this window Line Adjudication Information ther Payer Primary ID Procedure Modiiers Sorice Line Paid Amount i l Adudicaton Payment Date E Service Advuetmert Productor SevicelD Proc Code Description Pad Service Unk Count Service Line Ths Line Was Bundled Into Remaining Patient Liabiiy Newt Last Carel 57 Service Adjustment Information Window This is a situational window The fields listed below are required only if the situation applies to the claim e Group Code This is a required field e Reason Code up to 6 e Adjustment Amount up to 6 e Adjus
148. io you would receive an error message display Meanwhile the Modem here could not be used by WINASAP5010 and generates an error message 4 24 WINASAPS5010 Software Installation There i RB send Claims sez Submission Clar Status Selection Send KEYED Claims Clams That Have Not Been Billed C Send REJECTED Clams Claims That Have Been B ed But Rejected C Serd ERRORED Claims Claims That Have Been Biled But Exceed Submission Type Selection Tea C Pioductiori OK Test Submencn Selecta Deselect an f Send Cancel may be some problems displayed but generally if there is a problem on the Modem an error message similar to the one shown above would always be displayed Before using the Modem ensure first if it is working properly or correctly installed Below are some of the procedures that could be used to verify the Modem operation Verify first if the Modem being used is compatible with Windows7 Vista If an external modem is to be used make sure that it has some information that it could be used for Windows7 Vista Make sure that the drivers for the Modem to be used internal or external is updated for Windows7 Vista You could check online for the updates Check on the Device Manager if the Modem was correctly recognized by the computer A sample screen shot of a Modem being detected is shown below 5 253 Human In
149. ional window The fields listed below are required only if the situation applies to the claim e Pricing Methodology This is a required field e Repriced Allowed Amount This is a required field e Repriced Saving Amount e Repriced Organization ID e Repricing Per Diem or Flat Rate Amount e Repriced Approved Ambulatory Pat Group e Repriced Approved Amount e Repriced Approved Revenue Code e Unit or Basis for Measurement Code e Repriced Approved Service Unit Count e Reject Reason Code e Policy Compliance Code e Product or Service ID Qualifier e Repriced Approved HCPCS Code 8 29 WINASAPS5010 Adding a Nursing Facility Claim Step Actions Line PrecingHepricing Inlarmation Claim Pricing Repricing Infomasi nadae A Rericsd byusd meen SS Repiced Saving Ameen Repiiag Dezean Df Repikig Pe Deme Fe Rae amak Faivsd pmoved DRG Cock Reprised Approved Amount Flepiced Approved Revere Coda Und ce Barret fee Keasuiement Coce Reid Avo Service Lire Conni Raad Hesan Coda Poky Cempianos Code Exception Coda Product cf Service ID Qus tier Repriced Aneecmee HCPCS Code Delos Ok Cara 59 In the Claim Line Items tab the Total Claim Charges field will be automatically calculated based on the line item charges This is a required field 60 Click Save to save the claim 8 30 WINASAPS010 Copying A Claim Record 9 Copying A Claim
150. is required to be filled up Either fill both fields or leave them blank Drug Information National Drug Code National Drug Unit Court Code Quabtier Reference Identiication Guabher Prescnption Number Delete OK Cancel 8 26 WINASAPS5010 Adding a Nursing Facility Claim Step Actions 54 Paperwork Window This is a situational window The fields listed below are required only if the situation applies to the claim e Report Code up to 10 e Transmission Code up to 10 e Identification Code up to 10 Note When the Transmission Code is set to Available on Request the Identification Code field must not be filed up Line Supplemental Infonnation Report Code Transmission Code Identification Code i 1 2 a 4 S ef 7 amp 9 a gt 55 Adjudication Information Window This is a situational window The fields listed below are required only if the situation applies to the claim e Payer ID This is a required field e Service Line Paid Amount This is a required field e Procedure Modifiers up to 4 e Adjudication or Payment Date This is a required field e Proc Code Description e Paid Service Unit Count This is a required field e Service Line This Line Was Bundled Into e Revenue Code This is a required field e Remaining Patient Liability 8 27 WINASAPS5010 Adding a Nursing Facility Claim
151. ition Indicator Yes C No Conditions 1 2 3 Delete Data OK Cancel 51 Click the Claim Line Items tab or Next Page button 8 24 WINASAPS5010 Adding a Nursing Facility Claim Nursing Clam Data Claim Data Claim Codes Claim Line Items Claim Line Items Description t Service Date s 77 wal o Line ltem Repriced Line AdustedReptced Service Tax Facility Tax Control kem Ret Line ltem Ref H Amount Amount E a ea le Operating Physician ee pole aa Rendering Provider Fleleinng Provider J a z Taaa Dewe coy __firt_ Previous New tat Service Dates Revenue HCPCS Moditiess Sevice Units Charge From To Code Code 1 2 3 amp Cour Aman Additional Line Item Intoimationy Total Claim Charges m First Page Previous Page Save Cancel Step Actions 52 In the Claim Line Items section if necessary complete the following fields e Service Line Revenue Code This is a required field e Product Service ID Qualifier e Procedure Code e Procedure Modifiers up to 4 e Description e Line Item Charge Amount This is a required field e Units or Basis for Measurement This is a required field e Service Units Count This is a required field e Non Covered Charge Amount e Service Date s e Line Item Control e Repriced Line Item Ref e Adjusted Repriced Line Item Ref e Service Tax Amount e Facility Tax Amount e Operating Physician ID
152. itted 3 When the claims have not been transmitted completely it would look like the one below modem transmit started on 6 22 2011 10 37 50 PM C PROGRAM FILES ACSIWINASAP APPLICATIONIWINASAPSO1OIDB 7 704477044 BIL Zmodem transmit started on 6 22 2011 10 54 31 PM C PROGRAM FILESWCSIWINASAP APPLICATIONIWINASAPSO1OIDBI77044177044 BE modem transmit finished OK 6 22 2091 10 54 32 PM CAPROGRAM FILESIACSIWINASAP APPLICATION WINASAPSOIOIDR 7704417 7044 BIL Elapsed time 0 07 CPS 984 Size 984 There is only the transmit started logged described above which means that during transmission of claims there must have been a line interruption that cut off the communications and did not finish the transmit On the process of updating the Submitted claims this is usually done by running the Receive Response function But it does not always update the status due to the description that was given above Usually the 3rd scenario would not update the status since this clearly describes that the file was not completely transmitted As for 1st and 2nd scenario the claims may or may not be updated because it depends on the Host if it would give out a 999 for the claim or not WINASAP has no control over this since it just reads the given 999 being received If the claim is on the file then it would update it The description here just explains on how WINASAP handles the transmission of claim and scenarios on why the Submitted status occurs
153. jado Kepesd 1 Deia Aipha P Enia f I f Bed 1 Poa Suhted STEPS ACTIONS 1 From the WINASAP5010 Main Menu select the Tools option 2 Select the Purge Claims option This will open the Purge Claims Database window 3 Enter the cutoff date Select the claim status and the claim type of the claims that you would like to purge Claims that meet the criteria prior to the purge date you enter will be deleted from the WINASAP5010 claims database Note The claim type and the claim status must be selected for the purge to work correctly 4 Click Purge Click Yes to continue or No to stop the purge process If you click yes WINASAP5010 will prompt you to perform a backup of your database It is necessary to perform the backup in order to complete the purge process 2011 ACS EDI GATEWAY INC All rights reserved 12 8 WINASAPS5010 Database Maintenance 12 5 1 Importance of Purging Claim Data One of the most common problems users encounter when using WINASAP5010 and its previous versions is data corruption Error window shows up upon opening the claim provider patient and or reference listings and then the list does not show any existing claims users have entered before as shown below WARNING A E340 System Error selecting Claim record This reason for this kind of error is due to the tables in the database not being aligned to each other There is no way to avoid this from o
154. laim that generated the error message This will open the claim list for the type of claims you selected Ta In the list highlight the claim that generated the error then click Change 8 You will find the Payer Responsibility Sequence Code for the other payer in the Other Subscriber Info window Make the necessary changes 3 13 WINASAPS5010 Software Installation 4 Software Installation 4 1 WINASAP5010 Welcome Package Your WINASAP5010 welcome package should include the following items e Welcome letter e Log on Form e Quick Reference Guide for WINASAP5010 e WINASAPSO10 Quick Tips Note If you are missing any one of these items please contact the ACS EDI Gateway Support Unit 4 2 WINASAPS5010 Installation Process Overview The installation and setup of WINASAP5010 is an easy three step process 1 Install the WINASAP5010 software on your PC Instructions are provided in section 4 3 of this user guide WINASAP5010 installation is similar to installation of other Windows based software applications Just follow the installation prompts 2 Select the appropriate payer see Section 4 3 step 21 3 Start WINASAPSO10 and set up your trading partner data Instructions are provided in Sections 4 6 of this document WINASAPS5S010 must have your trading partner data in order to communicate with ACS EDI Gateway The latest version of WINASAP5010 and user manual can be downloaded in www acs gcro com In most cas
155. lank 13 In Condition Code Window This is a situational window The fields listed below are required only if the situation applies to the claim The fields would only be enabled if their preceding fields are already entered e Condition Code up to 24 Condition information Condition Code 7 Principal Code 1 14 Click on the Claim Codes tab or Next Page button 6 5 WINASAPS5010 Claims Entry STEPS ACTIONS Professional Claim Data Claim Dats Claim Codes Cisim Infomation Cisim Line Items Claim Codes Medicare Assignment Code Release of Information Code Patient Signature Source Code Special Program Indicator Code f Delap Reason Code f Claim Filing indicator Claim Indicators Hemebound Indicator Yes Benefits Acsinment Cemtfication Indicator x Claim Numbers Mammogram Certlication Number Medical Record Number CUA Number 1 Claim Amounts Patiert Amount Paid Fletetral Number Prior Authorization f Other Claim Level Numbers Nest Page Previous Page Save STEPS ACTIONS 15 In the Claim Codes section complete the following fields e Delay Code e Medicare Assignment Code This is a required field e Release of Information Code This is a required field e Patient Signature Source Code e Special Progr
156. ld e Payer Primary ID This is a required field e Payer Address e Payer Address cont d e Payer City e Payer State e Payer Zip Code e Claim Adjustment Indicator 33 Secondary ID Information Window This is a situational window The fields listed below are required only if the situation applies to the claim Under Other Payer Secondary Information complete the following fields e Payer Secondary ID Type up to 2 e Payer Secondary ID 2 up to 2 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank Other Payer Secondary Identification Paper Secondary ID Type Payer Secondary ID Payer Secondary ID Type Payer Secondary ID Delete Data gk Cancel 34 Prior Auth Referral Number Window This is a situational window The 6 16 WINASAPS5010 Claims Entry fields listed below are required only if the situation applies to the claim In the Prior Auth Referral Information section complete the following fields e Other Payer Prior Authorization Qualifier Auto populated e Other Payer Prior Authorization Number e Other Payer Referral Number Qualifier Auto populated e Other Payer Referral Number Oaa Paget fer Asame D nadie Cote Panes Pree Dfwo neim Ohw Paget Add Free sal we Dte Reks n Nater 35 Billing Provider ID Information Window This is a situational window The fields listed below are
157. lected in Entity Type field OR e Last Name This is a required field if Person is selected in Entity Type field e First Name This is a required field if Person is selected in Entity Type field e Middle Name Initial e Suffix e Date of Birth e Sex e Insured s SSN 5 11 WINASAPS5010 Maintaining Reference Data STEPS ACTIONS e Insured s Primary ID This is a required field e Insured s Group or Plan Name e Insured s Group or Policy e Insured s Address This is a required field e Insured s Address con t This will be enabled when Address field has a value e Insured s City e Insured s State This will be enabled when Insured s City field has a value e Insured s Zip Code This will be enabled when Insured s City field has a value 10 In the Property and Casualty Information section complete the following fields e Contact Name e Telephone e Ext e Telephone 11 In the Payer Information section complete the following fields Payer Name Do not change this information This will be populated with the appropriate payer name based on the Payer you selected during installation This is a required field Payer Address Payer Address con t This will be enabled when Payer Address field has a value City State This will be enabled when City field has a value Zip This will be enabled when City field has a value Payer Primary ID
158. led up the other field is required to be filled up Either fill both fields or leave them blank Claim Notes Note Reference 1 Code Claim Note Text Delete First Previous Next Last OK Cancel 28 Billing Notes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Note Text 6 48 WINASAPS5010 Claims Entry Billing Notes Note Reference Code l d ra Intormatic Note Test 1 Delete Data 29 On Other Subscriber Page 1 tab under the Insured s Name section complete the following fields Patient Relationship to Insured This is a required field Entity Type This is a required field e Organization Name This field is required if Non Person in Entity Type field is selected e Last Name This field is required if Person in Entity Type field is selected e First Name This field is required if Person in Entity Type field is selected Middle Name Initial This field is enabled if Person in Entity Type field is selected Suffix This field is enabled if Person in Entity Type field is selected Under the Insured s Address section complete the following fields e Address This is a required field Address con t e City State Zip Code Under Insured s Identification section complete the following fields e Insured s Primary ID Type This is a required
159. llaneous Indicators Hospice Infcemation bs thes a Medicare Clas rreaiving T Yee piyacan semices to a Hospice patent l2 the phyacian employed by the Hospice Othes indicators Was the sernce a tecult ol 4 ecreerang talana M Yes Famy Manning Yes Was the service sn emergency Yes le the padent co pay exempt Yes Delte Data OK Cancel 65 Miscellaneous Numbers Window This is a situational window The fields listed below are required only if the situation applies to the claim e Line Item Control Number e Mammography Certification Number e Immunization Batch Number e Repriced Line Item e CLIA Number e Referring CLIA Number 6 33 WINASAPS5010 Claims Entry e Adjusted Repriced Line Item e Under Prior Authorization Reference ID up to 5 Secondary ID up to 5 e Under Referral Numbers Reference ID up to 5 Secondary ID up to 5 Miscellaneous Numbers Information Line Item Coevtrot Number T Mammogaphy Certification Number imenurization Batch Number Repnoed Line item Price Austhorizahior Reference ID Secondary ID CLIA Number Refeming CUA Number Adusted Repaced Line tte Referal Numbers Reference ID Secondary ID 2f af f s r 66 Miscellaneous Providers Window This is a situational window The fields listed below are required only if the situation applies to
160. low are required only if the situation applies to the claim e ID Qualifier up to 4 e Secondary ID up to 4 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank Operating Physicion 1D Quabties Secorday ID 1D Quaker Seconda I0 1D Quatfior Seconday IO ID Quebtier Seconday 1D _Delete Data N i Cancel 41 Service Facility ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e Entity Type Code Auto populated e ID Qualifier drop down list up to 3 e Secondary ID up to 3 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank 7 19 WINASAPS5010 Adding a Nursing Facility Template Service Facility ID Information Entity 1D Code 1D Qualities Secordary i0 ID Quaiser Secondary ID 1D Quaker Secondary 1D f _Dekte Data OK Cancel Adjustment Info Window This is a situational window The fields listed 42 below are required only if the situation applies to the claim e Group Code e Reason Code up to 6 e Adjusted Amount up to 6 e Adjusted Units up to 6 Claim Adjustment Information Group Code isi Reason Code Adusted Amount Adusted Units Reas
161. lue can be changed by double clicking a value from the list displayed in the Reference List Tanne Code ERDO Teorore x ANIM Tananan fni Under the Billing Provider and Pay To Plan there is a Tax ID button The fields in it are required Preloaded values are obtained from the Provider Tax Identification Number entered in Provider Data Form see Adding a New Provider section of this document Thru this window its value can be changed by the user if needed Billing Provider Tax ID Number identification Type fE mployer s Identification Number Identification Number 11 In the Claim Data section complete the following fields Admission e Date e Hr e Min e Type This is a required field e SRC 6 40 WINASAPS5010 Claims Entry STEPS ACTIONS Discharge e Stat This is a required field e Hr e Min Statement Coverage Period e From Through fields This is a required field e Referral e Prior Authorization e Type of Bill This is a required field e Auto Accident State e Medical Record e Repricer Received Data 12 Click the Claim Codes tab or Next Page button Institutional Claim Data Claim Data Claim Codes Claim Line Items Procedure Codes Principal Procedure Pincipal Procedure Principal Procedure f7 Code Guaiier Code Z Oae 77 EE _Other Procedure Codes Diagnosis Codes PiincipalDiegnose S Binsin Dionas S Paio M a Other Diagnosis
162. ly be set when there is no Assistant Provider ID e Pay To Plan Provider ID This is enabled only if the Claim or Encounter Identifier is set to Subrogation Demand Note For Pay To Plan providers only providers with Employer s ID Number can be selected in the claims e Signature on File This is a required field e Referring Provider ID e Other Referring Provider ID This will be enabled when Referring Provider ID has a value e Assistant Surgeon ID Can only be set when there is no Rendering Provider ID e Supervising Provider ID 10 Under the Billing Referring Other Referring and Assistant Provider there is a Taxonomy Code button There is no required field in this window The values displayed on the Reference list could be set in the Reference menu gt Taxonomy Code Note The corresponding button is only enabled when Billing Referring Other Referring and Assistant Provider has value Note A preloaded value is obtained from the Provider Taxonomy Code entered in Provider Data Form see Adding a New Provider section of this document of the values filled Its value can be changed by double clicking a value from the list displayed in the Reference List 6 69 WINASAPS5010 Claims Entry STEPS ACTIONS wnmy Code Tanorewye Code eneret tamanco ebanak Taree Devt Under the Billing Provider and Pay To Plan there is a Tax ID button The fields in it are required Prelo
163. m Files ACS W5010 db lt PAYER CODE gt Below are some scenarios that could happen during transmission which could result to a Submitted claim 1 A successful transmission claims sent and Confirmation Report received should look like the detail presented below Zmodem transmi started on 6 22 2011 10 37 50 PM C PROGRAM FILESIACS WINASAP APPLICATIONIWINASAPSO 10WWE 7 70447 7044 BIL Zmodem transmit finished OK 6 22 2011 10 37 52 PM C PROGRAM FILES WACSIWINASAP APPLICATIONIWINASAPSOIOIDBI77044177044 BR Elapsed time 002 CPS 492 Size 64 Zmodem receive started on 6 22 2011 10 38 03 PM LINEOS TXT Zmoderm receive finished OK 6 22 2011 10 38 05 PM C Program Files ACSiWinasap Application WinasapS010 db 77044 201 10622223803 txt Elapsed time 001 CPS 632 Size 32 When this happens claims would become Billed On the display you could see the transmit started and finished which indicates that claims have been transmitted completely while the receive started and finished means that the Confirmation Report was already received completely But there are times that even when receiving the Confirmation Report the status would still be on Submitted Below is a display on what a normal Confirmation Report should look like Date 06 22 11 ACS Host System Time 10 37 User Name DOLTEST1 User Number File Number Payor Frmt Type Claims Batches Tot Charges Status Msg 06220022 G03 77044 X12 837P 1 1 12 34 Tes
164. ms Clearinghouse For all claims rejected by the Clearinghouse WINASAPS5010 leaves the claim status as Keyed on the claims database WINASAPSO010 also stores the most recent fifty 50 Transmission Confirmation Reports in a Report folder so that you may view them at a later date If the Transmission Confirmation Report indicates the entire transmission was successful no further action is required If the transmission was not successfully completed i e no Transmission Confirmation Report was received you need to re execute the Send process If the transmission was partially successful meaning at least one line of the Transmission Confirmation Report was received but not all of the files were accepted you must make the necessary changes to the claims in error and then re execute the Send function to regenerate all claims remaining in a Keyed status When WINASAP5010 receives a Transmission Confirmation Report the system automatically renames the transmitted X12N claim transaction file to a standard audit trail file name This process ensures that you do not accidentally resend a previously sent file It also ensures that a copy of the most recently sent X12N claim transaction file is retained for use in problem resolution The send process can take quite a few minutes and at times it may seem like nothing is happening The length of time depends on the number of claims being sent Due to the large amount of information required t
165. n confirmation report that you can balance to your WINASAPS5010 report to further ensure that your transmission was successful An overview of this report is provided below Refer to Chapter 11 Reporting for a more detailed description and an example of each of these reports When You Send Claims During the process two reports are created one by WINASAP5010 and one by the EDI Claims Clearinghouse e WINASAPS5010 produces a Claim Billing Report which displays one line per claim transmitted a total for the number of claims transmitted and a total claim amount for the transmission e The ACS EDI Clearinghouse produces a Transmission Confirmation Report that confirms the acceptance or rejection by claim type of the claims transmitted 2011 ACS EDI Gateway 10 1 WINASAPS5010 Sending Claim Files 10 1 Sending a Claim File When you send you are sending all claims that have been previously copied from the WINASAPS5010 claims database and converted into ANSI X12N transaction formats When ACS EDI Claims Clearinghouse host system receives your transmitted file it returns a Transmission Confirmation Report which acknowledges whether or not the logical files created by the Send process were accepted by the host system WINASAPS5010 uses the returned Transmission Confirmation Report to automatically change the claim status on the system s claims database from Keyed to Billed for all claim types accepted by the EDI Clai
166. ndow The fields listed below are required only if the situation applies to the claim e Identification Type Auto populated field e Identification Number up to 5 e Primary Identifier up to 5 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank bitte gies Fe Air iba ts Harma ea ade 6 92 WINASAPS5010 Claims Entry Referral Number Window This is a situational window The fields listed 2 below are required only if the situation applies to the claim e Identification Type Auto populated field e Identification Number up to 5 e Primary Identifier up to 5 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank 62 Claim Pricing Repricing Information Window This is a situational window The fields listed below are required only if the situation applies to the claim e Pricing Methodology This is a required field e Repriced Allowed Amount This is a required field e Repriced Saving Amount e Repriced Organization ID e Repricing Per Diem or Flat Rate Amount e Product or Service ID Qualifier e Repriced Approved HCPCS Code e Unit or Basis for Measurement Code e Repriced Approved Service Unit Count e Reject Reason Code e Policy Compliance Code e Exception Code 63 Contract Info Window This is a situati
167. ns code value description and standard charge amount for revenue codes e Surgical Code Maintains code value and description for Institutional ICD 9 ICD 10 surgical codes ae Surgical Code Description e Taxonomy Code Maintains code value and description for a provider s taxonomy code WINASAPS5010 Maintaining Reference Data e Treatment Code Maintains code value and description for Institutional treatment codes Treatment Code Data e Value Code Maintains code value and description for Institutional value codes Value Code Data e Procedure Modifiers Maintains code value and description for procedure modifiers Procedure Modifier Data Pangaos 5 5 WINASAPS5010 Maintaining Reference Data 5 1 Adding a New Provider WINASAPS5010 allows you to maintain information on each of your providers When you select a provider from a drop down list box during claims entry the system automatically fills the remaining provider related data fields in the claim window from the information stored in the Provider table Note You must enter all providers in the provider table before keying and saving claim information STEPS ACTIONS 1 From the WINASAP5010 Main Menu bar select the Reference option 2 Select the Provider option This will open the Provider List window 3 Click on the Add button This will open the Provider Data window 4 In the Provider Ident
168. ntry e Orthodontic Treatment Indicator e Orthodontic Total Months Indicator e Orthodontic Total Months Remaining e Orthodontic Banding Date This is a required field Tota Marte of Theawerd Ontrodarte wstmart Incite D odir otal Mortu of Teamet Dosye Nonu of loore Pherusrerg Ovfeder s Pondro Owe 51 File Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Fixed Format Information up to 10 File Information Fixed Format Intoematiorc 52 Repriced Claim Identifier Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type Auto populated field e Identification Number Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank Repriced Claim Identifier Identification Type fp Identification Number 53 Adjusted Repriced Claim Identifier Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type This is already set e Identification Number Note If one of the two above fields is filled up the other field is 6 87 WINASAPS5010 Claims Entry required to be filled up Either fill them both up or leave them blank Adjusted
169. o create an X12N transaction it takes a bit longer to create the file to be sent Be patient and let WINASAP5010 take the time it needs to create the file Note Before you click on the Send button be sure that your PC s modem is connected to the proper telephone line If the telephone line you are using is connected to a PBX system you may need to change the pre loaded dial up telephone number and telephone prefix 10 2 WINASAPS5010 Sending Claim Files Send Claims Submission Clam Status Selection Bend KEYED Cams Clams That Have Not Been Billed C Send REJECTED Claims Claims That Have Been Biled But Rejected Send ERRGRED Clams Claims That Have Bean Sted But Errored Submission Type Selection af C Select by Claim Typa PLEASE NOTE Nursing Facity Claims wil be generated by selecting Institutions ean poe STEPS ACTIONS 1 From the WINASAP5010 Main Menu select the Tools option Zz Select the Send Claim File option This will open the Send Claims window 3 Modify the necessary details e Submission Claim Status Selection sorts claims according to their statuses e Submission Type Selection sends the sorted claims to either Test for testing purposes or Production for billing and processing e Select by Claim Type sorts claims according to type 4 Click on the Send button 10 3 WINASAPS5010 Sending Claim Files 10 2 Receiving
170. on complete the following fields e Principal Diagnosis Code Qualifier This is a required field e Principal Diagnosis Code This is a required field e Present on Admission Indicator e Admitting Diagnosis Code Qualifier e Admitting Diagnosis Code Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank 16 In the Other Diagnosis Codes button complete the following fields e Code Qualifier up to 24 e Other Diagnosis Code up to 24 e Present on Admission Indicator up to 24 WINASAPS5010 Adding a Nursing Facility Claim Note If Code Qualifier or Other Diagnosis Code is filled up the other is required Other Diagnosis Codes Present on Admission Indicator J J i ididtdtetelte tattle 4 tebe eel Leh kel tel Heel bel ed kel gt 85 tlt Wl Le Le eet Le eel bel Lee kell 17 In the Additional Claim Codes section complete the following fields e Assignment or Plan participation Code This is a required field e Release of Information Code This is a required field e Delay Reason Code e Claim Filing Indicator Code This is a required field e Assignment of Benefits Indicator This is a required field e DRG Code 18 Patient Reason for Visit Codes Window This is a situational window The fields
171. on Code fi Adusted Amount Adusted Units Resson Code AdjstedAmount Adusted Units Ressor Code Adusted Amount dusted Units Reason Code Adjusted Amount Adusted Units Reason Code Adjusted Amount Adusted Units f Delete First Previous Next 43 Rendering Provider ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e Entity Type Code Auto populated e Identification Type up to 3 e Identification Number up to 3 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank 7 20 WINASAPS5010 Adding a Nursing Facility Template Rendering Provides D Information Enlty Type sordtication Tapa Ideniication Herbe idericsion Typs Identicebon Humbe Idrissi Type f Ideniticelion Hube 44 Attending Provider ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e ID Qualifier drop down list up to 4 e Secondary ID up to 4 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank Attending Provider Secondary info 1D Quer Seconday 1D 1D Qualities Secondey ID 1D Quser Secorday ID 10 Quaier Seconday ID Dewe Da ax Cancel
172. on Type up to 3 This is a required field e Identification Number up to 3 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both or leave them blank 6 83 WINASAPS5010 Claims Entry Other Payer Rendering Provider Identification Identification Type Identiioation Number Next Last Other Payer Supervising Provider Window This is a situational window 42 The fields listed below are required only if the situation applies to the claim e Entity ID Code This field is already set e Entity Type Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank Other Payer Supervising Provider ed Payer Provider Info Entity ID Code Entity Type X Provider Identification Numbers 43 Other Payer Supervising Provider Identification Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type up to 3 This is a required field e Identification Number up to 3 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both or leave them blank Other Payer Supervising Provider Secondary Identification Identification Type Identification Number pace 44 Service Facility Info Windo
173. on the Save button 5 25 WINASAPS5010 Maintaining Reference Data 5 15 Adding a New Procedure Modifier Code You can enter frequently used value codes into WINASAP5010 s Procedure Modifier table The system uses these codes to fill a drop down list box that may be used during claims entry J010 BRUICKSTREET KAI TUAL INSURANCE Sum Took Windia Ha STEPS ACTIONS 1 From the WINASAP5010 Main Menu bar select the Reference option Zs Select the Procedure Modifiers option This will open the Procedure Modifier List window 3 Click on the Add button This will open the Procedure Modifier Data window 4 In the Procedure Modifier field enter the procedure modifier that is appropriate 5 In the Procedure Modifier Description field enter a description of the procedure modifier 6 Click on the Save button 5 26 WINASAPS5010 Maintaining Reference Data 5 16 Changing a Reference Table Entry Whenever necessary you can update the information you have previously entered into WINASAPS5010 s reference tables You may change data in the following reference tables Provider Patient Anesthesia Code Condition Code Diagnosis Code External Cause of Injury Code Occurrence Code Patient s Reason For Visit Code Procedure Code Revenue Code Surgical Code Taxonomy Code Treatment Code Value Code Procedure Modifier STEPS ACTIONS
174. onal window The fields listed below are required only if the situation applies to the claim e Contract Type Code This is a required field e Contract Amount e Contract Percent e Contract Code e Terms Discount Percent e Contract Version Identifier 6 93 WINASAPS5010 Claims Entry Contract Information Contract T Contract Amount Contract Percent f C Contract Code Tame Discount Percent j Contract Version Identifier ii Delete Data OK Carcel 64 Tooth Information Window This is a situational window The fields listed below are required only if the situation applies to the claim e Tooth Code This is a required field e Tooth Surface Codes up to 5 Tooth Information Tooth Code Tooth Surface Codes i sy 3g a sf a 5 bd Dates 65 Service Facility Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Laboratory or Facility Name This is a required field e Facility Address This is a required field e Facility Address cont This will be enabled when Facility Address has a value e Facility City This is a required field e Facility State This is a required field e Zip Code This is a required field 6 94 WINASAPS5010 Claims Entry haces st Faki tam f Laborato cs Facility Prawy 10 Labaca nfaca Seconda D Lat hitai Fedi Adder cor
175. ondary ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type up to 3 e Identification Number up to 3 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank Celeron Durem eas kh Fi 18 Predetermination of Benefits Identifier Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type Auto populated field e Identification Number Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank Prodesermniiatios of Benetits Mantith 19 Contract Information Window This is a situational window The fields listed below are required only if the situation applies to the claim e Contract Type Code This is a required field e Contract Amount 6 73 WINASAPS5010 Claims Entry e Contract Percent e Contract Code e Terms Discount Percent e Contract Version Identifier Contract Information Contract Type Code Contract Amount Contract Percent f i Contract Code Teme Discount Parcent Contract Version Identifier Delete Data OK Carcel 20 Claim Notes Window This is a situational window The fields listed
176. p first in order to use that provider Some Identification Types were also deleted which would show as blanks in 5010 as a resolution delete their respective Identification Number or update them with their corresponding new Identification Types Click the Save button to ensure that the values entered are 5010 compliant Patient Data new fields such as Property and Casualty Information can be seen in both the Patient Data and Insured s Data tabs these fields are situational so leave them blank if no information is available Additionally there is a new button named Payer Secondary ID in the Insured s Data tab These fields are also situational Click the Save button to ensure that the values entered are 5010 compliant Claims Data Dental Claim Institutional Claim Nursing Facility Claim Nursing Facility Template and Professional Claim several fields and dropdown items were deleted in WINASAPS5010 There are also some new fields which are required and needs to be filled up first before sending the 2011 ACS EDI GATEWAY INC All rights reserved 12 13 WINASAPS5010 Database Maintenance claim WINASAP5010 has its checking to ensure that the entered values are 5010 compliant Click the Save button to perform the checking 2011 ACS EDI GATEWAY INC All rights reserved 12 14
177. pre fill the name DOB gender and patient account number fields These fields cannot be edited on the claim form This information can only be changed in the patient reference window This is a required field Note If the patient has not been added to the Patient database refer to the Maintaining Reference Data procedures Follow the steps for Adding a New Patient to complete this step in adding a nursing template In the Provider Information section complete the following fields e Billing Provider ID This is a required field e Pay To Address ID e Service Facility Location e Attending Provider ID e Operating Physician ID e Other Operating Physician ID This is enabled when Operating Physician ID field has a value e Rendering Provider ID e Referring Provider ID e Pay To Plan ID This is enabled only if the Transaction Type is set to Subrogation Demand Note For Pay To Plan providers only providers with Employer s ID Number can be selected in the claims WINASAPS5010 Adding a Nursing Facility Template STEPS ACTIONS 10 Taxonomy Code Window This is a situational window The fields listed below are required only if the situation applies to the claim e Taxonomy Code Note The corresponding button is only enabled when Billing Provider or Attending Provider has value Note A preloaded value is obtained from the Provider Taxonomy Code entered in Provider Data Form see Addin
178. quired field 7 12 WINASAPS5010 Adding a Nursing Facility Template 30 Other Subscriber Information Other Subsceber Page 1 Other Subscaber Page 2 inswed s Name Pabent Relationship f Toinwed r l inewed s Address Address Addess con t City a lt s Zip Code Insured s Iderbfication insureds Pimaty ID Type ij at Secondary identilicaton Delete Fat OK Carcel Previous When finished click on the Other Subscriber Page 2 tab 31 Secondary Identification Window This is a situational window The fields listed below are required only if the situation applies to the claim Under the Insurance Information section complete the following fields e Insured s Secondary ID Type up to 2 Insured s Secondary ID up to 2 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank Other Payer Secondary Identification Payer Secondary ID Type Payer Secondary ID Payer Secondary 1D Type Payer Secondary ID Delete Data OK Cama Under the Insurance Information section complete the following fields e Group or Policy e Group or Plan Name e Claim Filing Indicator 7 13 WINASAPS5010 Adding a Nursing Facility Template e Release of Information Code This is a required field e Assignment of
179. r Data 5 MAINTAINING REFERENCE DATA 5 1 Adding a New Provider 5 2 Adding a New Patient 5 3 Adding a New Anesthesia Code 5 4 Adding a New Condition Code 5 5 Adding a New Diagnosis Code 5 6 Adding a New External Cause of Injury Code 5 7 Adding a New Occurrence Code 5 8 Adding a New Patient Reason For Visit Code 5 9 Adding a New Procedure Code 5 10 Adding a New Revenue Code 5 11 Adding a New Surgical Code 5 12 Adding a New Taxonomy Code 5 13 Adding a New Treatment Code 5 14 Adding a New Value Code 5 15 Adding a New Procedure Modifier Code 5 16 Changing a Reference Table Entry 5 17 Deleting a Reference Table Entry 5 18 Preloaded Taxonomy Codes 6 CLAIMS ENTRY 6 1 Adding a Professional Claim 6 2 Adding an Institutional Claim 6 3 Adding a Dental Claim 7 ADDING A NURSING FACILITY TEMPLATE 8 ADDING A NURSING FACILITY CLAIM HI 3 1 3 2 3 3 3 4 3 5 3 7 3 9 3 10 3 11 3 13 4 14 4 14 4 14 4 15 4 23 4 27 4 29 4 31 5 1 5 6 5 14 5 15 5 29 6 1 6 2 6 38 6 68 7 1 8 1 WINASAPS5010 Table of Contents 9 COPYING A CLAIM RECORD 9 31 9 1 Deleting a Claim Record 9 32 10 SENDING CLAIM FILES 10 1 10 1 Sending a Claim File 10 2 10 2 Receiving a Response File 10 4 10 2 1 Regarding Claims with Accepted and Rejected Statuses 10 5 10 2 2 Regarding Claims with Accepted Adjudication and Errored Statuses 10 6 10 3 Regarding Claims with Submitted Statuses 10 7 11 R
180. r fields These fields cannot be edited on the claim form This information can only be changed in the patient reference window This is a required field Note If the patient has not been added to the Patient database refer to the Maintaining Reference Data procedures Follow the steps for Adding a New Patient to complete this step in adding an institutional claim 9 In the Provider Information section complete the following fields e Billing Provider ID This is a required field e Pay To Address ID e Service Facility Location e Attending Provider ID e Operating Physician ID e Other Operating Physician ID This is enabled when Operating Physician ID field has a value e Rendering Provider ID e Referring Provider ID e Pay To Plan ID This is enabled only if the Transaction Type is set to Subrogation Demand Note For Pay To Plan providers only providers with Employer s ID Number can be selected in the claims 10 Taxonomy Code Window This is a situational window The fields listed below are required only if the situation applies to the claim e Taxonomy Code 6 39 WINASAPS5010 Claims Entry STEPS ACTIONS Note The corresponding button is only enabled when Billing Provider or Attending Provider has value Note A preloaded value is obtained from the Provider Taxonomy Code entered in Provider Data Form see Adding a New Provider section of this document of the values filled Its va
181. reatment Codes 25 Claim Pricing Repricing Information Window This is a situational window The fields listed below are required only if the situation applies to the claim Pricing Methodology This is a required field Repriced Allowed Amount This is a required field Repriced Saving Amount Repriced Organization ID Repricing Per Diem or Flat Rate Amount Repriced Approved Ambulatory Pat Group Repriced Approved Amount Repriced Approved Revenue Code Unit or Basis for Measurement Code Repriced Approved Service Unit Count Reject Reason Code Policy Compliance Code Exception Code 6 47 WINASAPS5010 Claims Entry Claim Pricing Hepricing Information r Dam Peers Repicrg iniomatar Pogng Yelhocy iow j Repiicec Sicwes Amour Zz FRepiced Saving Amour Repicing Digan cation Ii a Rexicing Per Dism x At Rate Arcunt Repiced Agueved DRG Coda Repiced Approved Amari f Risxicsd Approved Revenue Coce Lint oi Rash lor Masaremert Code Repiced Appvd Service Und Cort Reet Kearon Dode Polep Camalierce Code B a Epcepton Tode 26 In the Additional Claim Information section complete the following fields e Patient Responsibility Amount 27 Claim Notes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Note Reference Code up to 10 e Notes up to 10 Note If one field is fil
182. red field e DRG Code 18 Patient Reason for Visit Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Patient Reason for Visit Code Qualifier up to 3 e Patient Reason for Visit up to 3 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank 6 43 WINASAPS5010 Claims Entry Patient Reason for Visit 19 External Cause of Injury Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Code Qualifier up to 12 e External Cause of Injury Code up to 12 e Present on Admission Indicator up to 12 Note If Code Qualifier or External Cause of Injury Code is filled up the other is required External Cause of Injury Codes Present on Code Qualifier Extemal Cause of Ingey Code Admission Indicator J g Le be Leis jj 0 6 al 20 Occurrence Span Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Code up to 24 e From up to 24 e Through up to 24 Note If one or two of the three above fields are filled up the remaining fields are required to be filled up Either fill them all up or leave them blank 6 44
183. required only if the situation applies to the claim Under Billing Provider ID Information Window complete the following fields e Entity Type e ID Qualifier up to 2 e Secondary ID up to 2 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank Endy Typa E Dustin Seconda ID D Jibs Seconda ID i ee 36 Referring Provider ID Window This is a situational window The fields listed below are required only if the situation applies to the claim Under Referring Provider ID Information complete the following fields e Entity ID Code Auto populated field When Next is pressed it would change to Primary Care Provider e Entity Type Auto populated field e Identification Type up to 2 6 17 WINASAPS5010 Claims Entry e Identification Number up to 2 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank Referring Provider ID Information Ertity 10 Code ie ror Enty Type idantiication Type identitcation Number identification Type 5 Identhcaton Number identification Type Identification Number Delete Previous Next 37 Supervising Provider ID Window This is a situational window The fields listed below are required only if the situation applies to
184. ring Provide ID Delete First OK Lancel 30 COB Amounts Window This is a situational window The fields listed below are required only if the situation applies to the claim Under COB Information complete the following fields e Paid Amount e Total Non Covered Amount e Remaining Patient Liability COB Information Paid Amount Total Non Covered Amount Remaining Patient Liability Delete Data OK Cancel 31 Outpatient Adjudication Window This is a situational window The fields listed below are required only if the situation applies to the claim Under Medicare Outpatient Adjudication Information complete the following fields e Reimbursement Rate This is a required field e HCPCS Payable Amount e Remarks Code up to 5 e End Stage Renal Disease Payment Amount e Non Payable Professional Component Billed Amount 6 15 WINASAPS5010 Claims Entry Remburrerert fate HCPCS Papahia Arsani Cin Parwa Rosai Cone Chain Panoni Rasat code Cian Parei Ranst Code Cian Pogreart Aarset Coce Ciun Pamuri Freee Coce End Stags Aera Dietse aproat Arcert Min Fayot Proteenonel Comporart filed Arsart 32 In the Other Payer Information section complete the following fields e Payer Name This is a required field e Payer Responsibility Sequence Code This is a required field e Payer Primary ID Type This is a required fie
185. rsonal computer to ACS EDI Gateway In order to electronically submit claim data to ACS EDI Gateway you must be enrolled as either e A provider e An authorized billing agent for actively enrolled providers This will vary by payer Please contact your Medicaid office for more information During the enrollment process you must complete an ACS EDI Gateway enrollment form and sign an EDI Trading Partner Agreement if you wish to submit claims electronically As part of the EDI registration process ACS EDI Gateway will assign you a Trading Partner ID User Name and User ID For EDI registration and technical support contact your ACS EDI Support Unit You may obtain the EDI enrollment form from our Web site at http www acs gcro com 2011 ACS EDI Gateway 3 1 WINASAPS010 General Information 3 1 ACS EDI Gateway Support Unit The ACS EDI Gateway Support Unit will assist you with e Electronic claim submission methods e Information on system vendors clearing houses and billing services that use EDI technology that is accepted by ACS EDI Gateway e Requests for FREE copies of WINASAP5010 e Questions concerning WINASAPS010installation e Identifying and troubleshooting WINASAP5010problems When you contact for assistance please have your Trading Partner ID available Your Trading Partner ID is a 5 digit or 6 digit numeric identification number assigned by ACS EDI Gateway when you register for electronic claim submission
186. ry Coc SEVTRLETT Terora fryta i If you are done entering all the information for this line item click the Add Line Item button to add the line item to the grid below Then click Save If another line item needs to be entered continue filling in the appropriate information and clicking add line item until all line items have been entered for this claim and then click Save Other line item choices e Delete Deletes the current line item e Copy Copies the current line item This does not copy any line item situational information e First Scrolls you to the first line item e Previous Scrolls you to the previous line item e Next Adds a line item or scrolls you from one line to the next e Last Scrolls you to the last line item 56 Under the Additional Line Item Information Section complete the following fields under each button All of the buttons in this section are situational If the situation applies to the claim enter the appropriate information Oral Cavity Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Oral Cavity Code 5 up to 5 6 90 WINASAPS5010 Claims Entry Oral Cavity Designation Codes Ora Cavity Code 1 Ora Cavity Code 2 Oral Cavity Code 3 Oral Cavity Code 4 Oral Cavity Code 5 57 Miscellaneous Dates Window This is a situational window The fields listed
187. t This will be enabled when Address field has a value City This is a required field State This is a required field Zip This is a required field If you have the patient s insurance information and want to enter it at this time complete those info by clicking on the Insurance button at the bottom of the window or the Insured s Data tab at the top 5 10 WINASAPS5010 Maintaining Reference Data STEPS ACTIONS Patient Data Patient Data Ineweds Data Insured s Information Patient iD a Patient Relationship to insured Entity Type ma EI pa Property and Casualty Information Contact fr r k f x Propesty and Casual Name Telephone Clem i Payer Information Payer Name Payer Primary ID Payer Address Paver Responsitelty j _ Semente Codz Insurance Type Payer Secondary ID iaaiiai Patiert Data Save In the Insured s Information section complete the following field e Patient Relationship to Insured This is a required field Select the appropriate relationship from the drop down list box Note If Self is selected as the relationship all applicable fields will be populated with data from the Patient Data tab Note This screen is not to be used for third party insurance information e Entity Type This is a required field e Organization Name This is a required field if Non person is se
188. t 001 Messages 001 File received will not be processed for payment End of Report WINASAP also checks for the format of the Confirmation Report to determine if the received file is valid before turning in into Billed If the received file does not look like the one above then the claim would still stay on Submitted The usual details that 10 7 WINASAPS5010 Sending Claim Files WINASAP looks for in a file is the File Number and Message string as well as their format 2 When the confirmation report is not received but has already transmitted successfully the claims it would look like the detail below Zmodem transmit started on 6 22 2011 1123 20 PM C PROGRAM FILES ACSIWINASAP APPLICATIONIVANASAPSOIONDB7 7044177044 BR Zmodem transmit finished OK 6 22 2011 11 23 21 PM CPROGRAM FILESIACSIWINASAP APPLICATION WINASAPSOIDIDENTTO44 7 7044 BIL Elapsed time 0 0 CPS 943 Size 943 Zmodem transmit started on 6 29 2011 12 17 24 AM C PROGRAM FILES VACSIWINASAP APPLICATIONIWINASAPSOINIDBI77044177044 Ba Zmodem transmit finished OK 6 29 2011 12 17 26 AM C PROGRAM FILESIACSIWINASAP APPLICATION WINASAPSOT0IDB IT 7044 7 7044 BIL Elapsed time 0 02 CPS 482 Size 965 As you can see above there is only transmit started and transmit finished there was no receive started or finished WINASAP cannot change the status because it cannot read Confirmation Report and as a result it would just stay as Subm
189. t ID Peer Review Authorization Number I OK Cancel 47 Supplemental Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Report Code up to 10 e Transmission Code up to 10 e Identification Code up to 10 7 22 WINASAPS5010 Adding a Nursing Facility Template Note Note When the Transmission Code is set to Available on Request the Identification Code field must not be filed up Claim Supplementat information f 2 3 al 5 amp z g 9 Contract Info Window This is a situational window The fields listed below za are required only if the situation applies to the claim e Contract Type Code This is a required field e Contract Amount e Contract Percent e Contract Code e Terms Discount Percent e Contract Version Identifier Contract Information Contract Amount Contract Percent ConactCode 0 tt S Teme Discount Percent Contract Version Identifier Delete Data 49 File Info Window This is a situational window The fields listed below are required only if the situation applies to the claim 7 23 WINASAPS5010 Adding a Nursing Facility Template e Fixed Format Information up to 10 File Information Fixed Format Infoemationc f EPSDT Info Window This is a situational window The fields listed below
190. taining Reference Data 5 10 Adding a New Revenue Code You can enter frequently used revenue codes into WINASAP5010 s table The system uses these codes to fill a drop down list box that may be used during claims entry to select the appropriate revenue code for the claim Information in the revenue code table is also used by the system to automatically calculate the line item charge amount during claims entry STEPS ACTIONS 1 From the WINASAP5010 Main Menu bar select the Reference option 2o Select the Revenue Code option This will open the Revenue Code List window 3 Click on the Add button This will open the Revenue Code Data window 4 In the Revenue Code field enter the code that identifies the specific accommodation or ancillary service provided 5 In Revenue Description field enter a description of the revenue code 6 In the Revenue Charge Amount field enter the amount that is to be charged for the accommodation or ancillary service 7 Click on the Save button 5 21 WINASAPS5010 Maintaining Reference Data 5 11 Adding a New Surgical Code You can enter frequently used surgical codes into WINASAP5010 s table WINASAPS5010 uses these codes to fill a drop down list box that may be used during claims entry to select the appropriate surgical code for institutional and nursing claims Note Do not include decimals or extra zeroes STEP
191. ted Units Reason Code Adjusted Amount Adusted Units f Delete First Previous Next 43 Rendering Provider ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e Entity Type Code Auto populated e Identification Type up to 3 e Identification Number up to 3 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank 8 20 WINASAPS5010 Adding a Nursing Facility Claim Rendering Provider ID Information Enlty Type sordtication Tapa Ideniication Herbe idericsion Typs Identicebon Humbe Idrissi Type f Ideniticelion Hube Attending Provider ID Window This is a situational window The fields 44 listed below are required only if the situation applies to the claim e ID Qualifier drop down list up to 4 e Secondary ID up to 4 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank Attending Provider Secondary info 1D Quattier Seconday 1D 1D Quaitier Seconday 1D 1D Quer Seconday ID 10 Qualifier Secorday ID Dette Dat Gk Carel 45 Other Operating Physician ID Window This is a situational window The fields listed below are required only if the situation applies to the claim e ID Qualifier up to 4 e Secondar
192. terface Devices ca IDE ATA ATAPI controllers lt Keyboards F Mice and other pointing devices 2 Modems uo DSS E Monitors Update Driver Software i Network adapters Disable gp Other devices Uninstall Ta PCI Serial Port Ia PCI Simple Communication Im SM Bus Controller Ports COM amp LPT Properties m Scan for hardware changes 2 FF Prarecenee There are still other means to check whether the Modem is working on a Windows7 Vista OS These are just general procedures to ensure that Modem was properly installed If the 4 25 WINASAPS010 Software Installation Modem could still not be detected by the computer please contact your System Administrator 4 26 WINASAPS5010 Software Installation 4 5 Signing On to WINASAP5010 When you run WINASAP Application Loader choose the WINASAP5010 button Please choose the version you want to run winasaP2003 Cancel Each time you select WINASAP5010 from the Windows Program menu you must enter a valid user ID and password WINASAP5010 is loaded with a default user ID of ADMIN and a default password of asap You may continue using the default user ID and password combination or you can assign specific user ID and password combinations as described in the Help Topics Index titled Setting Up User IDs and Passwords Winasap5010 Login A Xefre STEPS ACTIONS 1 Click on the Windows Start button and select Programs 2 Sel
193. th fields or leave them blank e Reference Identification Qualifier e Prescription Number Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank Drug information Notional Drug Code Reference Identification T uaklier Prescription Number Delete OK Cancel 53 File Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Fixed Format Information File Information Fived Format Information Delete Data 6 27 WINASAPS5010 Claims Entry 54 File Identification Information Window This is a situational window The fields listed below are required only if the situation applies to the claim e Form ID Code This is a required field e Industry Code This is a required field e Supporting Documentation value in this window is needed to be filled up Form Identification Information Foem D Code ledusty Code Supporting Documertation Next Previous Delete Page Delete Al oK Cancel 55 Support Documentation Window This is a situational window The fields listed below are required only if the situation applies to the claim e Question Number Letter This is a required field e Question Response This is a required field e Question Response e Question Response date e Question Response Percentage Support
194. the Anesthesia Code Description field enter a description of the value code 6 Click on the Save button 5 14 WINASAPS5010 Maintaining Reference Data 5 4 Adding a New Condition Code You can enter frequently used condition codes into WINASAP5010 s table WINASAPS5010 uses these codes to fill a drop down list box that may be used during claims entry to select the appropriate condition code for institutional and nursing claims STEPS ACTIONS 1 From the WINASAP5010 Main Menu bar select the Reference option 2o Select the Condition Code option This will open the Condition Code List window 3 Click on the Add button This will open the Condition Code Data window 4 In the Condition Code field type the condition code 5 In the Condition Description field enter a description of the condition code 6 Click on the Save button 5 15 WINASAPS5010 Maintaining Reference Data 5 5 Adding a New Diagnosis Code You can enter frequently used diagnosis codes into WINASAPS5010 s table WINASAPS5010 uses these codes to fill a drop down list box on claim windows During claims entry you can use this drop down list box to select the appropriate diagnosis code for the claim Note Do not include decimals or extra zeroes STEPS ACTIONS 1 From the WINASAP5010 Main Menu bar select the Reference option 2 Select the Diagnosis option Then choos
195. the claim e Rendering Provider e Purchased Service Provider e Supervising Provider e Ordering Provider e Referring Provider e Primary Care Physician This would be enabled after the Referring Provider is inputted Nenceang Prova j Pachaced Saraca Prossa Saperviang hra Irdmng Aree Ree ro Prradar Latro Dats w 6 34 Cancel WINASAPS010 Claims Entry 67 Purchased Service Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Purchased Service Provider ID This is a required field e Purchased Service Charge Amount This is a required field Purchased Service Provider ID Purchased Service Change Amount 68 Service Facility Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Entity Identifier Code Auto populated field e Facility Name This is a required field e Facility Primary ID Type Auto populated field e Facility Primary ID This is a required field e Facility Address 1 This is a required field e Facility Address 2 e Facility City This is a required field e Facility State This is a required field e Zip Code This is a required field e Facility Secondary ID Type drop down list up to 3 e Facility Secondary ID up to 3 e Facility Secondary ID up to 3 Note If one of the three above
196. the claim e Identification Type Auto populated field e Identification Number Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both or leave them blank biiir Tas kirii aie H iPab 36 Other Payer Referral Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type Auto populated field e Identification Number Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank bieria Tee kiercicasor Harsha 37 Predetermination of Benefits Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type Auto populated field e Identification Number Note If one of the two above fields is filled up the other field is 6 81 WINASAPS5010 Claims Entry required to be filled up Either fill them both up or leave them blank Pm Aerar wian ni redid eee hij bierdi Taps Rennie H araka 38 Other Payer Claim Control Number Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type Auto populated field e Identification Number Note If one of the two above fields is filled up the other field is required to be filled up Ei
197. ther Subscaber Page 2 inaurance Information Group Poley f Group or Plan Name Claim F ng f Indicator Release of Bi Infcemation Code Seme of Benefits a COBA ts Other Payer Intoematicey Paper Named Outpatient Adiuctication Info Inpatiant Adjudication In o Paver Responsibility Sequence Code Paves Primary I Tugel zl Paver Pirmaw ID Papar Addese f Paper Address fcon f f P Pi en lS a laim Cheek of i _ Remittance Date a Claim Adjustment Indicato Yes Claim Control Number Secondary ID In oation Prior Auth Referal Number Bing Provide ID Retenir Provider ID Operating Physician Service FacttyiD Aductmert into _ Rendering Provider Attending Provider Other Operating Physician Delete Fast Previous Next Last eS Ese 32 COB Amounts Window This is a situational window The fields listed below are required only if the situation applies to the claim e COB Payer Paid Amount e Remaining Patient Liability e COB Total Non Covered Charges Cie iia Pawar Ped Lisl COM folate treed Cheer Sele Date 33 Outpatient Adjudication Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Outpatient Reimbursement Rate e HCPCS Payable Amount e Remarks Code up to 5 e End Stage Renal Disease Payment Amount 8 14
198. ther fill both fields or leave them blank Claim Notes Note Reference 1 Code Claim Note Text Delete First Previous Next Last OK Cancel 28 Billing Notes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Note Text 7 11 WINASAPS5010 Adding a Nursing Facility Template Hilling Notes Note Reference Code Note Text 1 _Delete Date 29 On Other Subscriber Page 1 tab under the Insured s Name section complete the following fields Patient Relationship to Insured This is a required field Entity Type This is a required field e Organization Name This field is required if Non Person in Entity Type field is selected e Last Name This field is required if Person in Entity Type field is selected e First Name This field is required if Person in Entity Type field is selected Middle Name Initial This field is enabled if Person in Entity Type field is selected Suffix This field is enabled if Person in Entity Type field is selected Under the Insured s Address section complete the following fields e Address This is a required field Address con t City State Zip Code Under Insured s Identification section complete the following fields e Insured s Primary ID Type This is a required field e Insured s Primary ID This is a re
199. ther fill them both up or leave them blank birria Tas Rees ater Haka 39 Referring Provider Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type Auto populated field e Entity Type Auto populated field e Identification Number up to 3 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both or leave them blank 6 82 WINASAPS5010 Claims Entry Referring Provider D information Entity ID Code fortes Evvity Typa P io Identification Type Identiicaton Numbat Identification Type f Identification Number ldantlicaton Type identification Number Dokte Other Payer Rendering Provider Window This is a situational window k The fields listed below are required only if the situation applies to the claim e Entity ID Code Auto populated field e Entity Type Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank Other Payer Rendering Provider R Payer Provider Info Entity ID Code Renteinahonde Entity Type i y 41 Other Payer Rendering Provider Identification Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identificati
200. ther fill them both up or leave them blank Referral Number Identification Type Identification Number 24 Prior Authorization Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identification Type Auto populated field e Identification Number Note If one of the two above fields is filled up the other field is 6 75 WINASAPS5010 Claims Entry required to be filled up Either fill them both up or leave them blank Prior Authorization Identification Type Identification Number 25 In the Other Subscriber Name and Address section Payer Responsibility Sequence Code This is a required field Patient Relationship to Insured This is a required field Entity Type This is a required field Organization Name This is a required field if Non Person selected in Entity Type field Last Name This is a required field if Person selected in Entity Type field First Name This is a required field if Person selected in Entity Type field Middle Name Initial This will be enabled if Person selected in Entity Type field Suffix This will be enabled if Person selected in Entity Type field Address Address cont This will be enabled if Address has a value City State This will be enabled if City has a value Zip Code This will be enabled if City has a value 6 76 WINA
201. tment Units up to 6 Claim Adjustment Information Group Code m Reason Code Adusted Amount Adusted Unite Reason Code Adjusted Amount Adusted Units Reason Code Adhusted Amount Adjusted Unis Reason Code z Aduusted Amount Adusted Units Reason Code Adiusted Amount Adusted Units Fleason Code Adjusted Amount Adjusted Units Delete Fest Prewous Newt Lat OK Cancel 58 Product or Service Window This is a required window 6 29 WINASAPS5010 Claims Entry e Identification Type This is a required field e Identification Number This is a required field Product or Service ID Identification Type identification Number 59 Line Item Notes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Note Reference Code This is a required field e Note Text This is a required field e Note Text2 Line Hem Note Note Reference Code Note Text 1 Note Tet 2 Dae Beta OK Conca 60 Line Price Reprice Window This is a situational window The fields listed below are required only if the situation applies to the claim e Pricing Methodology This is a required field e Repriced Allowed Amount This is a required field e Repriced Saving Amount e Repriced Organization ID e Repricing Per Diem or Flat Rate Amount e R
202. to 10 e Identification Code up to 10 6 59 WINASAPS5010 Claims Entry Note Note When the Transmission Code is set to Available on Request the Identification Code field must not be filed up Claim Supplementat information Ideevihcation Code ld 7 j z5 ehehehehe 1 2 3 re 5 amp 7 amp 9 5 P J ini Delete Data OK Cancel Contract Info Window This is a situational window The fields listed below 48 are required only if the situation applies to the claim e Contract Type Code This is a required field e Contract Amount e Contract Percent e Contract Code e Terms Discount Percent e Contract Version Identifier Contract Information tract T Contract Amount Contract Percent Contract Code Teme Discount Percent f Contract Version Identifier Delete Data OK Carcel 49 File Info Window This is a situational window The fields listed below are required only if the situation applies to the claim 6 60 WINASAPS5010 Claims Entry e Fixed Format Information up to 10 File Information Fixed Format Information Delete Data EPSDT Info Window This is a situational window The fields listed below 50 are required only if the situation applies to the claim e Certification Condition Indicator e Conditions up to 3 Note If Certification Condition Indicator is
203. tuational window The fields listed below are required only if the situation applies to the claim e Patient Reason for Visit Code Qualifier up to 3 e Patient Reason for Visit up to 3 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank 7 6 WINASAPS5010 Adding a Nursing Facility Template Patient Reason for Visit 19 External Cause of Injury Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Code Qualifier up to 12 e External Cause of Injury Code up to 12 e Present on Admission Indicator up to 12 Note If Code Qualifier or External Cause of Injury Code is filled up the other is required External Cause of Injury Codes Present on Code Qualifier Extemal Cause of Ingey Code Admission Indicator ir 1 20 Occurrence Span Codes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Code up to 24 e From up to 24 e Through up to 24 Note If one or two of the three above fields are filled up the remaining fields are required to be filled up Either fill them all up or leave them blank WINASAPS5010 Adding a Nursing Facility Template Occurrence Span Codes f
204. uired items have been inputted 53 Drug Information Window This is a situational window The fields listed below are required only if the situation applies to the claim e National Drug Code e National Drug Unit Count e Code Qualifier Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank e Reference Identification Qualifier e Prescription Number Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank 7 26 WINASAPS5010 Adding a Nursing Facility Template Drug Information Notional Drug Code onal rte Code Qualtrer Reference Idertiication ual Prescription Number OK Cancel 54 Paperwork Window This is a situational window The fields listed below are required only if the situation applies to the claim e Report Code up to 10 e Transmission Code up to 10 e Identification Code up to 10 Note When the Transmission Code is set to Available on Request the Identification Code field must not be filed up Line Supplemental Information Transmission Code Identification Code Litti telte casi ery 55 Adjudication Information Window This is a situational window The fields listed below are required only if the situation applies to the claim e Pay
205. ured s Group or Plan Name This field will be enabled and is required when Insured s Group or Policy is not used e Insured s Group or Policy e Insured s Type Code e Release of Information Code This is a required field e Claim Filing Indicator Code e Benefits Assignment Certification Indicator This is a required field Other Subscriber Information Other Subscriber General Other Subcriber Insurance Other Subscriber Insurance Information Insured s Group ce Plan Name Insweds Group or Pokey insurance f Type Code Bislease of Infomation Code Chain Filing Inckeator Code er erases x Adustmert Info COB Amounts Cutpabert Adjudication Info Other Payer Intormatice Payer Name Claim Adjustment Indicator Payer Address dd Payer Cy Pamen Dae 77 El gj E Paves Primary ID Payer Secondary ID Paper Price Authorization Paye Reterral Payer Predetesmination Payer Clam Control Payer Retening Payer Rendering Paye Supeevsing Payer Service Faciity Payer Assstant Surgeon Biling Prowder uf Cancel 29 Adjustment Info Window This is a situational window The fields listed e Reason Code up to 6 e Adjusted Amount up to 6 e Adjusted Units up to 6 below are required only if the situation applies to the claim e Group Code This is a required field Note If one of the three above fields is filled up the remaining fields 6 78 WINASAPS5010 Claims Entry are require
206. uses Info complete the following fields e Related Causes Codes up to 2 e Auto Accident State or Province Code e Accident Country Code e Accident County Code Accident Date 1 Related Causes Information Related Causes Codes x gt as dat Sea OF Z Requited above code is Auto Accident Accident Country Code f 44 Service Facility Window This is a situational window The fields listed below are required only if the situation applies to the claim Under Service Facility Information complete the following fields 6 21 WINASAPS5010 Claims Entry e Entity Identifier Code This is a required field e Facility Name e Facility Primary ID type e Facility Primary ID e Facility Address 1 This is a required field e Facility Address 2 e Facility City This is a required field e Facility State This is a required field e Zip Code This is a required field e Facility Secondary ID type up to 5 e Facility Secondary ID up to 5 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank e Submitter Contact Name e Telephone e Extension Service Facility litoneeation Entity decatie Code Garvie Locsin Fact bares Foot Piney iD Tos Fait Pinay D Enty Atdees Faciity Adder 2 TOA Ceis Date Faca Se01D Tape 1 J Fam Sowia D 1 Faulty Soo D Type 2 Fooly Sooma D 2
207. w The fields listed below are required only if the situation applies to the claim Pricing Methodology This is a required field Repriced Allowed Amount This is a required field Repriced Saving Amount Repriced Organization ID Repricing Per Diem or Flat Rate Amount Repriced Approved Ambulatory Pat Group Repriced Approved Amount Repriced Approved Revenue Code Unit or Basis for Measurement Code Repriced Approved Service Unit Count Reject Reason Code Policy Compliance Code Exception Code 8 10 WINASAPS5010 Adding a Nursing Facility Claim Claim Pricing Hepricing Information r Dam Peers Repicrginiomater Pogng Yelhocu iow Flepiced Saving Amourk Seprcing Oiganatinn ID Rexicing Per Dism or Flat Rate run Repiced Approved ORG Coda Repiced Approved Amari Fiemiced Approved Revenue Coce Unt ot Rash lor Mezeuemart Code Reprced Apgieved Service Uri Cork Reet Sean Tode Polep Camalierce Code Exeption Code 26 In the Additional Claim Information section complete the following fields e Patient Responsibility Amount 27 Claim Notes Window This is a situational window The fields listed below are required only if the situation applies to the claim e Note Reference Code up to 10 e Notes up to 10 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank Claim Notes Note Ref
208. w This is a situational window The fields listed below are required only if the situation applies to the claim e Laboratory or Facility Name This is a required field 6 84 WINASAPS5010 Claims Entry Libba pe F pci Mee Loabordanro Paci Seer oiden C il Laboratory or Facility Secondary ID Window This is a situational window 45 The fields listed below are required only if the situation applies to the claim e Identification Type up to 3 e Identification Number up to 3 Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both or leave them blank Laboratory or Facility Secondary ID Identification Type Identification Number Bae Next Last 46 Other Payer Assistant Provider Window This is a situational window The fields listed below are required only if the situation applies to the claim e Entity ID Code Auto populated field e Entity Type Note If one of the two above fields is filled up the other field is required to be filled up Either fill them both up or leave them blank Other Payer Assistant Surgeon ed Payer Provider Info Entity ID Code Entity Type z Provider Identification Numbers 47 Other Payer Assistant Provider Secondary Identification Window This is a situational window The fields listed below are required only if the situation applies to the claim e Identifi
209. ws File Menu Print option to print a report on hard copy 2011 ACS EDI Gateway 11 1 WINASAPS5010 Reporting 11 1 Running a Claim Status Summary When you select the Claim Status Summary report WINASAPS5010 displays a summary count of all claims currently in the system s claims database The report prints one line for each claim type and claim status WIMASA 2093 MISSISSIP MEDICAID METET Can Sey Lag Cies Bing Ostal Depere bow fe bet Transe procect ari Oun Subrates Dott Cary Cadran Fegan PLEASE NOTE arsine F city Oera ni be mpoted by sekectrg iama STEPS ACTIONS 1 From the WINASAP5010 Main Menu select the Tools option 2 Select the Reports option This will open the Report Selection window 3 Click on the Claims Status Summary box 4 Click on Run S WINASAPS5010 displays the Claim Status Summary report See the report example on the following page 11 2 Reporting WINASAPS5010 Report View Report ID WINASAP CS WINASAP5010 Claim Status Summary End of Report 11 3 Date 01 27 2011 Tine 07 52 pm Page 1 aid 9 1 0 1 WINASAPS5010 Reporting 11 2 Running a Claim Status Listing When you select the Claim Status Listing WINASAP5010 displays a detail report containing one line per claim on the system s claims database that meets the selection criteria you specify Due to the potential size of this report
210. ws and reports WINASAPS5010 automatically backs up the database before purging it and automatically reorganizes the database after the purge is finished Uninstall Software WINASAPS5010 should be uninstalled only when you no longer want to use the software or at the direction of the ACS EDI Support Unit during problem resolution 2011 ACS EDI GATEWAY INC All rights reserved 12 2 WINASAPS010 Database Maintenance 12 1 Performing a Database Backup WINASAPS5010 s Backup Database function creates a complete copy of the system s database including all Claim and Reference tables It is a good idea to create backup files on both your hard drive and transportable media such as external hard disk or writable CD Regular and frequent backups will greatly reduce the potential impact of hardware failure or file corruption on your claims billing operations Also a backup database is very useful information when seeking assistance with ACS EDI Gateway Support Unit STEPS ACTIONS 1 From the WINASAP5010 Main Menu select the Tools option 2 Select the Backup Database option This will open the Backup Database window 3 Click Yes if you want to continue with backup or No if you wish to exit the backup process 4 The backup will overwrite any previous backups you may have done If you would like to copy DO NOT MOVE the backup file to another media type follow the steps below
211. y ID up to 4 Note If one field is filled up the other field is required to be filled up Either fill both fields or leave them blank 8 21 WINASAPS5010 Adding a Nursing Facility Claim Other Operating Physician ID Qualifier Seconday ID ID Qualifier Y Seconday ID ID Qualifier sd Seconday ID a ID Qualifier bd Seconday ID Delete Data OK Cancel Other Reference Info Window This is a situational window The fields 46 listed below are required only if the situation applies to the claim e Service Auth Exception Code e Payer Claim Control Number e Repriced Claim Reference Number e Adjusted Repriced Claim Reference Number e Investigational Device Exemption Number up to 5 e Demonstration Project ID e Peer Review Authorization Number Banie dud Eenephon Locke Paget Dars Control H umber Aepeced Cars Anisorea thra Acfutied Aapaced an Aubrence tintan meigos Bernat irmana Deste E mpor Murba 2 meigien bese Eek dunes 0 Ireatigaborad Derace Exampion Humber 4 lnee rip ationa Devos Eeeopeon Huanbes 1 eariinin Propri Passe Pavia dihin Hunte f GR Cd 47 Supplemental Info Window This is a situational window The fields listed below are required only if the situation applies to the claim e Report Code up to 10 8 22 WINASAPS5010 Adding a Nursing Facility Claim e Transmission Code up to 10 e Identification
212. you to select what kind of deletion you want to do Confirm Message Delete claim from the database Selective Cancel 4 Clicking Yes button would delete the highlighted claim Clicking Selective button would allow you to mark claims with a checkbox at the left side of the claim W5010 BRICKSTREET MUTUAL INSURANCE File Reference Tools Window Help Institutional Claim List User Batch Claim Patient ID Patient Account No Begn DOS Patient s Name Mw 000000003 000000002 10 02 2010 Patient Last N ow 000000003 000000002 10 01 2010 Patient Last N B 23 000000003 000000002 1120172010 Patient Last N Clicking All button would delete all claims of the selected type Note Be extra cautious in using the delete button unless you have a backup database there is no way to retrieve the deleted claims 9 32 WINASAPS010 Copying A Claim Record 5 Confirm Message Delete this claim From the database a A warning message will display If you wish to continue with the deletion click on the OK button 9 33 WINASAPS5010 Sending Claim Files 10 Sending Claim Files Sending your claims to ACS EDI Claims Clearinghouse is an easy process WINASAPS010 produces a report during the Send process that helps you ensure that all the claims you entered were transmitted to ACS EDI Gateway In addition the EDI Claims Clearinghouse returns a transmissio

WINASAP5010 User Manual (Version 1.00)

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