Home

PC-ACE Pro32 User`s Manual - Empire Blue Cross Blue Shield

1. cccceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeaeeeeeeneees Recovering from an interrupted claim prepare run Introducing PC ACE Pro32 Welcome to MedLink Technologies PC ACE Pro32 Claims Processing System the system of choice for electronic healthcare claims submission and management PC ACE Pro32 is a complete self contained electronic claims processing system It can be used in a stand alone configuration or in conjunction with your existing claims management system Designed exclusively for Microsoft Windows PC ACE Pro3z2 is the latest generation of MedLink Technologies electronic claims processing systems that have been successfully serving the healthcare community for over ten years Key Features PC ACE Pro32 is a comprehensive claims management system Some of the more prominent features include e Combined Medicare Part A UB92 All Payer and HCFA 1500 system e Electronic submission of claims and documents in NSF or ANSI 837 formats e Flexible claim import from existing systems e Remittance translation export to existing systems e Comprehensive real time claims editing minimizes rejected claims e Field level edit validation provides immediate user feedback e Automatic code validation diagnosis procedure etc e Detailed claim import amp edit validation error reporting e Context sensitive pop up selection lists speed claim entry and promote accuracy e Prints UB92 and HCFA 1500 forms on plain paper or pre printed
2. Actually both the UB92 and HCFA 1500 Data Communications Control Files are created each time any of the launch buttons are clicked This approach relieves PC ACE Pro32 from needing to know whether a certain launch button is configured as a UB92 activity a HCFA 1500 activity or an activity common to both claim types If your system is licensed for a single claim type then only the appropriate control file will be created The Data Communications Control File can be read by the external data communications program to obtain the needed transmission parameters phone number password etc The layout of this control file is defined in a separate document and is available to distributors or facilities developing their own data communications scripts As explained earlier in this topic the Data Communications reference file supports multiple records defined for specific LOB and or LOB Payer combinations For example a Data Communications record can be defined for LOB MCA and Payer 00190 Another might be defined for LOB MCA and no Payer i e left empty The Data Communications Control File will be built using data from the record that most precisely describes the filter options used to prepare the current EMC file For example if the last EMC file was prepared to include only claims for LOB MCA and Payer ID 00190 then the Data Communications reference file will be searched for a record specific to this LOB Payer combinat
3. e To copy an existing data communications record select the desired record from the list and click the Copy button The copy feature provides a convenient means of creating new LOB specific or LOB Payer specific data communications records Enter the desired LOB and optional Payer ID and make any other required changes to the copied fields e To delete an existing data communications record select the desired record from the list click the Delete button and confirm the deletion Entering Data Communications Information The Data Communication Information Form contains three tabs e General specifies the LOB optional Payer ID and a description of this data communications record e Host Info specifies up to 3 distributor defined data communications variables as well as several Host Phone fields The distributor receiving your electronic claims transmission will define the communications variable names and content requirements e Local specifies up to six additional data communications fields to be defined by the distributor This tab will only be visible if the distributor has defined one or more of these local fields Contact your distributor for completion details S You should add and or modify data communications information only under the supervision of your distributor or an authorized technical support specialist Incorrectly configuring data communications records will result in EMC file transmission problems LOB
4. ececeeeeeeeeee tree eee tree ee ee eres saee eres saaeeeeeaaaeeeeeaaeeeeeeaaeeees 9 Migrating UB92 All Payer Systems 0 ceececeeeeeee ee eeee cece ee ee ee eeee nese eeaaeeeeeeaaeeeeeeaaeeeeeeaaeeesenaees 14 Miscellaneous FUNCTIONS issie in a y a a aens 192 193 196 197 200 202 Adding or modifying a System USED seiri iniiai eki anniina iii eia EAA RES AAEN AAEE AREAK 192 Launching the ANSI835 Electronic Remittance Module ccceeeeeeeeeeeeeeeeeeeeeeeeeeees 196 Packing and re indexing the databases ccceeceeeeeeeeeee ee eeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaaeees 200 210 Performing system backupS restOres 2 00cecceeeeeneeceeeeceeeeeaaeeeeeeeecaeeeeaeeeeseeeeaaeeeeaeeeeaeees 197 Scheduling unattended claim activities 2 0 0 eeceeeeeee ee eeeeee eee eeeeeeeeeeeeeeaaeeeeeeaaeeeseeaaeeeeeeeees 193 Sending support mail to your istriDUtOr eee cece eee ee eect ee eeee cece ae eeeeeeaeeeeeeeaaeeeeeeeaeeeeeeeaes 202 miscellaneous Preferences cersanit E AA EEEN EEE AREEN EiS 103 O Gne Ne leaa EA E AEAEE EEAS 6 optimizing your claims databasesS seeeeseeeetisettiisstt seca eeeeseeeeeeeaaaeeeeeaaaeeeesaaaeeeeeaaeeeees 200 P Packing and re indexing the databases eesseeiiseeii iestr iieetrtissttiisetttisstttiettrttestrrreetnnt 200 patient setup and MAINTENANCE sessista cii eiii eeee ence ae eeeeeeaaeeeeeeaaeeeeseaaeeeeseaaeeeeeeaaeeeeeaaes 155 payer setup ANd MAINTENAN
5. cccceeeeceeeeeeeeeeeeeeeseeeeeeeeeeaes UPIN Physician File Maintenance cccseeeeeeneeeeeeeeeeeeeeeaaeeeees Type of Bill TOB File Maintenance cceeceeeeeeeeeeeeeeeeeeeeeeeeeees Condition Occurrence Span Value Codes File Maintenance Revenue Codes File Maintenance 2 0 cccseeeeeeeeeeeeeeseeeeeeeeeeaes Place of Service POS File Maintenance 2 sseeeeeeeeeeeeeeees Type of Service TOS File Maintenance 0 c ceeeeeeeeeeeeeeeeees Facility File Maintenance cccceeceeeeeceeeeeceeeeeeeeeeeeeeesaeeeeaeeeeaes Charges Master File Maintenance cccseeeeeeneeeeeeeeeeeeeeeaaeeeeeees Provider Specialty File Maintenance 2 c cceeeeeeeeeeeeeeeeeeeeeees Provider Taxonomy Codes File Maintenance s eeeeeeeeee es Miscellaneous Functions 192 Adding or modifying a System USED ecceeeeeeeeneeeeeeeeeeeeeeaneeeeeeaaeeeeeeaa Scheduling unattended claim activities cccccceeeeeeeeeeeeeeeeeeeeeeeneeees Launching the ANSI835 Electronic Remittance Module 5 Performing system backupS restores 2 0 cecceeeeeeeeeeeeeeeeeeeeaeeeeeeeeeeaes Packing and reindexing the databases ccccceeeeeeeeeeeeeeeeeeeeeeeeeeaes Sending support mail to your distriDUtOr ccceceeeeeeeeeeeeeeeeeeeeeeeeees Troubleshooting 204 Reviewing the claim activity logs
6. sssssesceeeeiisseertisetiiieetriisstrtiastttinsttirnsrrtrnertrrnnnt 79 V validating a PC ACE Pro32 ackUpas sirep ra o A a E E 197 Viewing and maintaining claim status response files eseeeeeeeeeeeeeerr iestr iieerriresrrreserrennnt 128 Viewing and maintaining the claim status request response history ceeeeeeeeeeeeeeeeeeeee es 131 Viewing and maintaining transmission acknowledgment files ecceeeeeeeeeeeeeeeeeeeeeeeeeees 122 W WeICOMG caai denne dae Hae hiv dagdbivvedeceneedguliv dy E Aaa A ree EE A T eraa tN 3 wWhatisan Cite aasa E EA E att dunes ARE RAEE A AEN E E ct 87 213
7. As shipped PC ACE Pro32 is configured with a single default user with full system access rights The default user s User ID is SYSADMIN and password is SYSADMIN as well If you are logging into PC ACE Pro32 for the first time use this default login unless instructed otherwise by your distributor If the default login does not work review the installation guidelines provided by your distributor Distributors often pre configure the security system according to their own internal specifications If you still have difficulties logging into the system contact your distributor for assistance IMPORTANT You should change the default user s password as soon as possible if you are concerned about controlling user access at your facility Audit Tracking lan integrated audit tracking feature tracks modifications to user claim and reference files records You will see these audit buttons throughout PC ACE Pro32 Click the button to display the date the record was added the date the record was last changed and the User ID responsible for the last change System Security Level The Set Security Options on the main Security menu provides access to PC ACE Pro32 s security level setting Three security levels are available K Full password protection requires users to enter a valid User ID and Password to log in User activity permissions are enforced at this security level c Password required no function checking requ
8. E IMPORTANT Deleted medical attachments are permanently purged from PC ACE Pro32 they cannot be recovered e Reactivating Medical Attachments Choose the Reactivate Selected Attachment action to reactivate the selected medical attachment This action will move the previously transmitted medical attachment from the transmitted TR location into the to be transmitted CL location The reactivated medical attachment will be assigned the unprocessed UNP status See the Reactivating previously transmitted claims topic for more details on reactivating claims and medical attachments e Refreshing the Medical Attachment List Choose the Refresh Attachment List action or press the F5 function key to refresh the current UB92 Medical Attachment List form contents This action can be useful in a multi user installation to be sure that the list properly reflects medical attachment additions and or modifications made by other users You will notice that only applicable actions are enabled for use in the main Actions menu or pop up menu For example the all checked actions will be enabled only when one or more medical attachments in the list are checked 78 Actions on Multiple UB92 Medical Attachments Some actions can be performed on multiple medical attachments at once Multiple attachment selection is accomplished by checking the medical attachments of interest and subsequently performing one of the All Checke
9. Related Topics The following hyperlinks provide additional information related to this topic b gt Refer to the Setup of HCFA 1500 Systems topic for a suggested approach to initial setup of the provider reference file b gt Refer to the Reference File Maintenance Form topic for a discussion of the common reference file form features and filter options b Refer to the Claim amp Reference File Edit Validation topic for a discussion of the edit validation process 166 Maintaining Codes amp Miscellaneous Reference Files 167 Codes amp Miscellaneous Reference Files Overview The Codes Misc tab of the Reference File Maintenance form provides access to many of the core PC ACE Pro32 reference files Most of these files will be pre loaded and ready for use when PC ACE Pro32 is installed Others are optional and will require setup before use The buttons on this tab are grouped as Shared UB92 and HCFA 1500 UB92 only and HCFA 1500 only The following reference file topics apply to both UB92 and HCFA 1500 claims Submitter File Maintenance maintain submitter identification and related information Data Communications File Maintenance maintain data communications parameters HCPCS Codes File Maintenance maintain HCPCS procedure codes and descriptions HCPCS Modifiers File Maintenance maintain HCPCS procedure code modifiers descriptions and assignments ICD9 Codes File Maintenance maintain ICD 9 diagnosis c
10. When the focus leaves a claim form field either by pressing the TAB key or clicking ona new field an edit validation process is performed on the field losing the focus Edits performed at this time are referred to as field level edits If a field level edit validation error occurs you will receive an audible response and the edit validation error message will be displayed in the lower left corner of the claim form In addition the focus will remain on the field so that you can correct the problem if desired If you choose not to correct the data at this time simply press the TAB key again to move to the next field Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the claim edit validation process Saving amp Canceling Claims After completing data entry on the claim form click the Save button or type lt ALT gt S to save and exit the claim Alternatively click the Cancel button to abandon any changes and exit the claim When an attempt is made to save a claim the following occurs e Submission Payer Determination At least one of the payers specified on a claim must have the same LOB line of business as the claim itself You will not be allowed to save a claim unless this condition is met If only one of the claim payers has a LOB that matches the claim LOB then this payer is automatically designated as the submission payer the payer to which the claim is to be submitte
11. has errors ERR or has fatal errors ERF Deleting Claims Click the Delete button or choose the Delete Selected Claim action to delete the selected claim Deleted claims are assigned a DEL status and can be recovered i e un deleted if needed See the Purging Claims action description below for instructions on permanently removing claims from the PC ACE Pro32 database Copying Claims Click the Copy button or choose the Copy Selected Claim action to copy the selected claim The claim entry form will be displayed containing the details of the newly copied claim A few key claim fields LOB for example are cleared automatically in the new claim This claim copy function is often used to create duplicate claims for submission to secondary and tertiary payers Holding Claims Choose the Hold Selected Claim action to change the status of the selected claim to hold HLD Held claims are not considered for future claim activities such as automated claim processing or claim preparation Releasing Claims Choose the Release Selected Claim action to release a previously held claim In addition to releasing the claim this action also sets the status of the selected claim to unprocessed UNP Printing Claims Choose the Print Selected Claim action to print the selected claim Claims may be printed using either a plain paper image overlay technique or the traditional pre printed forms method See the
12. Claim Prepare amp Transmit Considerations This section describes setup considerations that should be reviewed before you attempt to prepare and transmit claims using PC ACE Pro32 Your distributor may have already performed some or all of this setup for you Consult your distributor s installation instructions or contact the distributor if it is unclear how to proceed 1 Setup default UB92 submitter information in the PC ACE Pro32 Submitter reference file Information from this reference file is required during preparation of Electronic Media Claims EMC files Consult your distributor s installation instructions or contact the distributor for assistance in setting up this critical reference file x Refer to the Submitter File Maintenance topic for more information on setting up the default Submitter record 2 If required by your distributor setup default UB92 data communications parameters in the PC ACE Pro32 Data Communications reference file This reference file contains the UB92 data communications parameters exported to the bcdatcom dat file prior to the launch of any external data communications program e g file transmission These parameters are used by the third party data communications program to control the file transmission etc hS Refer to the Data Communications File Maintenance topic for more information on setting up the default Data Communications record 41 This completes the required setup steps
13. Entering Submitter Information The Submitter Information form contains three tabs e General specifies the LOB line of business Payer ID submitter name address and IDs e Prepare specifies flags used to control the claim preparation process as well as information to be placed directly in the EMC transmission file The currently defined prepare control fields include Include Error Claims specifies whether claims with non fatal errors will be included in the electronic transmission file by default This default setting may be overridden when the claims are prepared Submission Status specifies if the electronic transmission file will be flagged as a Production or a Test file by default This default setting may be overridden when the claims are prepared EMC Output Format specifies the default electronic file format Currently supported formats include NSF and ANSI837 This default setting may be overridden when the claims are prepared Submission Type HCFA 1500 only specifies the Submission Type code used in the EMC file header Multiple Provider UB92 only specifies the Multiple Provider Billing File Indicator field value used in the EMC submitter record A default value of 1 will be used if this field is left blank EMC Version UB92 only specifies the desired NSF version of the EMC file For example a value of 50 indicates that a NSF 5 0 output file should be generated 16
14. I When unchecked the revenue code does not represent an accommodation for claims having the specified LOB TOB combination Evaluating Revenue Code Assignments During the claim edit validation process revenue code assignment records are considered in order from most specific to least specific i e from bottom to top as they appear on the Revenue Code Assignments form As soon as an acceptable match is found the search ends and edit validation decisions are made based on control settings for the matching assignment record if any For example if the following 3 detail assignment records exist for revenue code 0022 LOB lt lt ALL gt gt TOB lt lt ALL gt gt LOB lt lt ALL gt gt TOB 11 183 LOB MCA TOB 11 Case 1 Medicare claim LOB MCA with a TOB 112 claim lines with a revenue code of 0022 would use control settings from the third record above during edit validation since both the LOB and TOB are an exact match Case 2 Commercial claim LOB COM with a TOB 112 claim lines with a revenue code of 0022 would use control settings from the second record above during edit validation since the TOB matches and the LOB of lt lt ALL gt gt matches any claim LOB The third record was rejected because of the LOB mismatch MCA versus COM Case 3 Medicare claim LOB MCA with a TOB 122 claim lines with a revenue code of 0022 would use control settings
15. Sorting Plans of Care The plan list may be sorted by Patient Control Number PCN Patient Name Entry Date and Start of Care SOC Date Simply select the desired sort order from the available Sort By radio buttons Filtering Plans of Care The Plan of Care List may be filtered to display a select subset of plans using the Advanced Filter Options accessible from the Filter main menu item These advanced options permit filtering on the plan s patient PCN patient name provider as well as a selection of date fields When multiple filter criteria are specified only those plans that meet all filter criteria will be displayed A convenient Clear Filters item is also available from the Filter main menu to quickly remove any existing filter criteria Plan of Care Actions The Plan of Care List form may also be used to perform specific actions on any individual plan or a group of selected plans To perform an action on an individual plan simply select the plan from the list and click the desired action button along the lower edge of the form The complete list of plan actions can be accessed from the Plan of Care List form s main Actions menu or from the convenient pop up menu accessed by right clicking the mouse over the selected plan Available plan actions include e Creating New Plans of Care Click the New button or choose the Create New Plan of Care action to create a new plan See the Adding a new Home Health Plan
16. item from the Claim List form s main Actions menu Refer to the Claim List Form Features topic for more information on multiple claim selection The Claim Print Options form allows the user to override default preferences for things like destination printer printing method pre printed forms versus image overlay and miscellaneous options Click the Preview button to preview the claim s before printing available with image overlay method only Click the Print button to print the claim s without previewing them Claim previewing for claims printed using the image overlay method employs the Adobe Acrobat Reader Use the Acrobat Reader s print option to print a previewed claim When you have previewed and optionally printed the claim close the Acrobat Reader program This will signal PC ACE Pro32 that you are ready to continue E You will not be able to resume activities in PC ACE Pro32 until the Acrobat Reader program has been exited Simply closing the claim document within the reader is not enough to signal PC ACE Pro32 to continue If you have selected multiple claims they will be printed in sequence based on the current Claim List form s Sort By selection A progress form will display details about the claim currently being printed Click the Cancel button on this progress form to cancel the printing session following the claim currently being printed A Few Technical Notes Here is some additional technical inform
17. A acknowledgment file S riiit iiai ee eae iaaea ia Soi p a Eaa 122 123 actions on multiple claims at ONCE earren neiaa EREA AA A AE EA AEE A EEEE RA 52 activity logs viewing and purging ssssesssssssscirsiesrriissttttesrrttesattteettttetntteennteesanteeenntneean 204 adding a new lalli eesriie ei Taen EA oE A REE A a ET O AN ATA 106 adding a new Home Health Plan of Care eeeeecceeeeeeceeeeeeeeeeeeeeeeeeeeeeeeeeaeeeeeeaaeeeeeeeeeeeeeeeees 145 Adding a new roster biNg orrip en e aaa E NETTER Ea A AET ERR EAE UAE ERREAREN 142 Adding a new UB92 Medical Attachment 0c ce eeeceeeeeeeeeeeeeeceeeeeeaaeeeeeeaaeeeeeeaaaeeeeeaaeeeees 150 Adding and maintaining patients seseirriscrriiieiiiadanin nei iiair iiaa a AAR AA ARRS RAAR E TRAA RA 155 Adding and maintaining payers cececeeeeeeeeeeeeeeeeeeeeeeeceeeeeeeseeeeeeesaaeeeeeaaeeeeeeaaeeeeesaaneees 157 Adding and maintaining providers HCFA 1500 eceeeeeeeeeeeeeeeeeeeeeeeeeeeaaeeeeeeaaeeeeeeaaeeeees 163 Adding and maintaining providers UBQ2 ceceeeceeeeeeeeeeeee cece etree saeeeeeeaaeeeeeeaaeeeeeeaaeeeees 160 Adding or modifying a system USEF seasea areae eect ee eeeeeeeeeeeeeeceeeeeeeaaeeeeeeaaeeeeesaaeeeeesaaeeees 192 Adobe Acrobat Reader path setup cceeeeceeeeeeeeeeeeeeeeeeee eres cede eeeesaeeeeeeaaeeeeesaaeeeeeaaneees 103 alternate payer Printing 208 222 reoni ea aA a eae AAE aN ea ORATE Eua tee sania 134 Ambulance medical at
18. Supplement this setup topic with any installation notes provided by your distributor If you are in doubt about exactly which steps you need to perform contact your distributor for assistance hS You may want to print this help topic and refer to the printed version as you perform these setup steps You can check off the steps as they are completed This technique also frees you to jump around between on line help topics without losing your place in the setup procedure To print the topic just click the Print button at the top of this on line Help screen Payer Reference File Setup This section describes the process of setting up the Payer reference file This file contains information about the valid payers in your system All payers to be specified on your UB92 claims must exist in the Payer reference file with the exception of a special dump payer Complete the following steps as needed hS You may want to refer to the Adding and maintaining payers topic for more information on entering Payer records If you do make sure and return to this topic to continue the setup steps 1 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form Select the Payer tab to display a list of all existing Payer records E One or more Payer records may already exist in the system if you have migrated to PC ACE Pro32 from the DOS version of PC ACE or if your distributor has
19. amp Payer Specific Data Communications Records In addition to the default record the Data Communications Setup form allows you to create data communications records that are specific to a particular line of business LOB or a specific LOB Payer combination This feature provides flexibility in cases where the claims for specific LOBs and or payers must be transmitted to different locations For example you might use this feature if you are required to prepare and submit your Medicare MCA MCB claims to a different physical location than claims for other LOBs Read the Data Communications Control File section below to see how these specific data communications records are used 173 The Data Communications Control File Transmission of the electronic claim files generated by PC ACE Pro32 will be performed by a third party communications package The Data Communications Options form provides launch buttons by which users can initiate claims transmission terminal emulation sessions or any other data communication function defined by your distributor Each time any of these data communications launch buttons are clicked PC ACE Pro32 automatically creates a Data Communications Control File containing applicable parameters from the Data Communications reference file This control file will be located in the server s Winpcace directory and will be named bcdatcom dat for UB92 claim activities and bsdatcom dat for HCFA 1500 claim activities
20. claim prepare run There are two possible scenarios Silent recovery No user interaction is required PC ACE Pro32 automatically detects that a prepare run was interrupted restores the affected claims to their pre prepare state and simply notifies the user that this recovery process has taken place o Verbose recovery Upon detecting that a prepare operation has been interrupted the user is presented with the Claim Prepare Recovery Options form This form notifies the user that a prepare run was interrupted and provides specific details of the prepare operation in progress including time date EMC filename EMC file format and the prepare filter and option settings specified by the user when the prepare run was initiated In the verbose recovery mode the user has 3 options represented by buttons on the recovery options form e Perform Recovery Performs the prepare recovery process without further prompting All affected claims will be restored to their pre prepare state This is the recommended course of action unless a technical support specialist has instructed you otherwise e Skip Recovery Skips the recovery process and leaves the affected claims in an undetermined state You will be warned that some affected claims may be flagged as transmitted and may need to be reactivated Skipping the recovery process should only be done under the instruction of a technical support specialist e Cancel Cancels the prepa
21. drugs administered t Outpatient Rehabilitation Plan of Treatment Update Form 701 The fields on this form are identical to those on the Outpatient Rehabilitation Plan of Treatment 700 form te Ambulance Medical Data Attachment The fields on this form are grouped logically on two major tabs e General Information includes the Ambulance attachment s general claim and patient information Justification codes mileage and various costs are also included on this tab e Pickup Destination Remarks includes the codes facility and address information for the ambulance service pickup origin and destination A free form narrative used to provide additional information or justification is also included on this tab t End Stage Renal Disease ESRD Attachment The fields on this form are grouped logically on two major tabs e General Info amp Lab Tests includes the ESRD attachment s general claim and patient information as well as the ESRD lab test results e Medical Documentation includes ESRD medical documentation e g medication extra dialysis and other services Click the appropriate tab or simply press the PAGE UP and PAGE DOWN keys to move between tabs on the specific UB92 Medical Attachment Form Entering UB92 Medical Attachment Data Click on any field to activate it for data entry or press the TAB key to move from field to field in a predefined sequence generally l
22. if John D Solo is a HCFA 1500 solo provider for Medicare Part B MCB and Blue Shield BS patients two separate provider records must be added However since these 2 records really represent the same provider they should be associated with each other The Provider tab of the Reference File Maintenance form provides a convenient inheritance option that makes creation of associated provider records a snap Simply click the New button and create the first John D Solo provider record from scratch start with all fields blank assign the MCB line of business complete all applicable fields on the HCFA 1500 Provider Information form and save the provider record Then select the newly created provider record in the provider list and click the New button again When prompted select the Inherit name address information from the selected provider option Also check the Associate the new provider with the selected provider checkbox and click the OK button A duplicate of the selected provider will be created and displayed Enter BS in the LOB field and save the new provider record These provider records are now associated with each other to reflect that they represent the same entity Repeat this inherit and associate process to create additional John D Solo provider records for other LOBs if desired Associations are used during the claim preparation process to identify the various lines of business applicable to a specific provider
23. new UB92 claim is created Upon patient selection the claim s LOB will be assigned automatically from the primary payer s LOB specified on the patient record The provider associated with the claim s primary payer will also be populated automatically if it has been specified on the patient record M When unchecked the cursor focus will be positioned normally on the LOB field The user is expected to enter or select the desired LOB for the new claim Automatically focus on Patient PCN field for new HCFA 1500 hand keyed claims Determines whether or not the cursor focus should be forced directly to the Patient PCN field when the user manually creates a new HCFA 1500 claim Enable this patient centered configuration option for installations that make extensive use of the Patient reference file Upon patient selection the claim s LOB field and billing rendering provider fields optional will be populated automatically from information on file in the patient record M When checked the cursor focus will be forced to the Patient PCN field when a new HCFA 1500 claim is created Upon patient selection the claim s LOB will be assigned automatically from the primary payer s LOB specified on the patient record The claim s billing provider and rendering provider will also be populated automatically if they have been specified on the patient record I When unchecked the cursor focus will be positioned normally on the LOB field The user
24. second EMC file containing the UB92 medical attachments Some installations may be configured to disallow preparation of UB92 medical attachments in ANSI837 format If your system is also configured to prepare UB92 claims in ANSI 837 format then any eligible claims will always be prepared first into the ANSI 837 format transmission file Simply transmit the EMC file containing the claims and then perform a subsequent prepare operation to build a second EMC file in NSF format containing the UB92 medical attachments In this scenario the UB92 medical attachments will always be prepared in NSF format even if the default EMC file output format is set to ANSI 837 Related Topics The following hyperlinks provide additional information related to this topic b gt Refer to the Preparing claims for transmission topic for more information on how to prepare claims and medical attachments b Refer to the Transmitting electronic claim files topic for more information on transmitting the prepared EMC file b gt Refer to the Reactivating previously transmitted claims topic to learn how transmitted claims can be selectively reactivated for re transmission The UB92 Medical Attachment List Form provides a similar reactivation capability for standalone medical attachments b gt Refer to the Recovering from an interrupted claim prepare run topic to see how PC ACE Pro32 can recover from an interruption in the preparation process 154 Common R
25. select the Attachments and Maintain HH Plans of Care menu items to open the Home Health Plan of Care List form Most actions to be performed on a Plan of Care may be executed from the Plan of Care List form Plans of Care can be created viewed modified copied deleted and printed from the list Refer to the Home Health Plan of Care List Form Features topic for complete details on the features and operation of the powerful Plan of Care List form Viewing amp Modifying Plans of Care Viewing and or modifying existing plans from the Plan of Care List form can be performed with these general steps 1 Use the Plan of Care List form s sorting and advanced filtering capabilities to locate the plan of interest in the list 2 Select the desired plan in the list and click the View Update button to display the plan details Alternatively just double click the desired plan record in the list 3 Make all desired changes to the Plan of Care Refer to the Home Health Plan of Care Form topic for details on the many productivity enhancing features available on this powerful form 4 When all changes have been made click the Save button to save the Plan of Care record and close the form Review and correct any edit validation errors as needed Alternatively click the Cancel or Close button to cancel any pending plan changes Actions On Multiple Plans of Care Many of the actions available in the Plan of Care List form are app
26. this form as desired By default the list will contain all claims migrated from your DOS MEDA claims entry database Double click any record to view the migrated claim details If the Save button lower right is disabled make a superficial change to one of the claim s fields in order to enable this button e g overtype the same patient sex value Click the Save button to save the updated claim An edit validation process will be performed to check for problems with the claim information When prompted correct any missing or invalid field values and re save as needed If you receive edit validation errors indicating an invalid Payer ID or Provider ID you may need to perform additional Payer and or UB92 Provider reference file setup Depending on how many migrated claims these reference file changes will affect you may choose to re migrate the claims rather than correcting these problems on each claim individually 3 By changing the Location selector to TR transmitted only or PD paid only you can list claims migrated from the DOS MEDA tracking and history databases respectively If desired repeat the review process for claims in these locations 4 When finished with your claims review click the Close button on the UB92 Claim List form Select the Close item from the UB92 Claims Menu form s main File menu to return to the PC ACE Pro32 Main Toolbar Completing the Setup Process Additional steps will be
27. you will be prompted to select whether you want a completely new provider all fields blank to start with or whether you would like to inherit the name address information from the currently selected provider If you choose the inherit option you will also have the option to associate the new provider record with the selected provider record Provider records should be associated when they represent the same entity For example if a solo provider supports multiple lines of business one solo provider record for each LOB should be created and these related provider records should be associated with each other The inherit and associate options can be a real timesaver when setting up providers that support multiple lines of business In this scenario select an existing provider in the list click the New button and choose the inherit and associate options You will see that the top portion of the Provider Information form will be completed automatically Simply tab through or overwrite the Provider ID No field may be the same or different enter a unique line of business identifier in the LOB field and click the Save button When you have finished adding HCFA 1500 Provider records you should have one record for each applicable line of business LOB for each solo group or individual in group provider entity When all desired Provider records have been added click the Close button on the Reference File Mainten
28. 1500 All Payer patient payer and claims data into PC ACE Pro32 This time when migrating the patient and payer data specify your desire to merge with existing data in the PC ACE Pro32 Patient and Payer reference files By choosing the merge option you have instructed the migration utility to assume that the current reference files contain UB92 information When subsequently migrating the HCFA 1500 data the migration utility will automatically separate the patient payer insured sections as needed The payer Usage flags will also be set correctly based on whether each specific Payer IDs existed in only one or both DOS systems When the migration steps have been completed proceed with any additional setup tasks outlined in the Setup of HCFA 1500 Systems topic 25 26 PC ACE Pro32 Setup Procedures 27 Current DOS PC ACE Users Read This First If you are moving to PC ACE Pro32 from one of MedLink Technologies DOS based PC ACE Claims Management Systems you do not need to setup your system from scratch PC ACE Pro32 provides an easy to use utility to migrate your patient payer amp claims data from your existing system Once you have completed the migration process you will be directed back to one of these sections to complete any remaining setup tasks If you are migrating to PC ACE Pro32 from a DOS PC ACE system proceed to the appropriate migration section b gt Medicare Part A users proceed to the Migrating Medicare Part
29. 22 0cccceeeeeeeeee ee eeeeeeeeeeeeeeaeeesneees 126 Preparing claims for tranSMiSSiON c ceceeeneeeee ERARE ANES AAEE ERNEA EEE 117 Preparing UB92 Medical Attachments for transmission eeeeeenneeeeeeeeeeeeeeaaeeeeeeaneeeees 153 Printing claims inas de eiei oye des iv eect ane adie MO eee ieee 134 Printing Home Health Plans of Care ccceeeccseeececeeneeeeeenaeeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaeeeesaaaeeees 148 Processing claims automatically ssas oiis a a AEA S pia 114 Reactivating previously transmitted ClaiMS e cece ee cece neeeeeee ne eeeeeeaaeeeeeeaaeeeeeeaaeeeeesaaaeeees 124 Reversing the most recent Claim iMpPoOrt FUN 00 2 ieee cece ee eteeee cece eeeeeeaaeeeeeeaaeeeeeeaaeneeeeaaaeeees 113 Transmitting electronic claim files sosind ninen eee tees ee ee A a i 120 Unarchiving Clalmsss irira entar aana aa aAA AE AEE E TAARA EREE AIARA 140 Viewing ANSI277 claim status response fil S e ee eeeeee cece eeeeee eee eeeeeeeeeeeeeeaeeeeeeeaaeeeeeeeees 128 Viewing ANSI997 transmission acknowledgment files ceceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeees 122 Viewing the status request response history for a claim ceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeees 131 Common Reference File Procedures eeeceeeeeeeeeeeeeeeeaeeeeeeaaeeeees 155 157 160 163 167 Adding and maintaining patients cecceeeeeeeeeeeeeeee eter ee eeeeeeeeseeeeeeeaaeeeeeesaaeeeeeaaaaeeeeaa
30. ACE Pro32 can be configured to launch external data communications programs or scripts to perform electronic claim file transfers or other data communication related operations The identical Option tabs correspond to each of the available launch buttons on the Data Communications Options form The controls on each tab include Option N Program specifies the complete path and filename of the program or batch file with corresponding Windows PIF file to be launched X Use the convenient browse button adjacent to this control to easily locate and retrieve the full path of the desired program or batch file Enclose paths that contain spaces i e Windows long file and directory names in double quotes to ensure proper launch interpretation Button Caption specifies the desired button caption text AS Use a single amp character in the button caption to define a windows shortcut key Place the amp character immediately before the desired shortcut character Once a valid program script path and button caption are defined on any of these tabs the corresponding launch button will be enabled on the Data Communications Options form Your distributor may have already configured these data communication launch paths and captions The distributor can determine which data communications settings if any a user can modify Therefore some of the tabs controls may be disabled or even hidden S You should modify these data communi
31. Adding a Mew Clalitysicecssavectolasiceneredacestiasnceny ceteeodtersicend EAEN NAS 107 Listing modifying and maintaining claims ccceeeeeeeeeeeeeeeeeeeeeeaeeees 108 Importing ClaiiMS si sce cee a a ei nde tien OE tetera ene eee ee 110 Reversing the most recent claim import run eeeeeeeeeeeeeeeeeeeeeeeeeeeeeee es 114 Processing claims automatically ccceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeenenes 115 Preparing claims for transmission ceceeeeeeeeeeeeeeeeeeeeeeeeeeeaeeeeeeneees 118 Transmitting electronic Claim files cece ee cece neeeeeeeaeeeeeeeaaeeeeeeaaeeeeeeaa 121 Viewing and maintaining transmission acknowledgment files Reactivating previously transmitted Claims ceeeeeeeeeeeeeeeeeeeeeees Preparing claim status request files for transmission 2 eeeeeee Viewing and maintaining claim status response files cseeeeeeeeeeeees Viewing and maintaining the claim status request response history Printing claims esan ce deatiesteden Meetin A SE an eect E Deuter aes Posting claim payments UB92 ssssssessesieseeennenesrreneernrreerrereerrrreenneeee Posting claim payments HCFA 1500 sseeeeeeeeseerreeerrreerrrresrreen Archiving and unarchiving claims ecceeeeeeeenneeeeeeaeeeeeeeaaeeeeeeaaeeeeeeaa Adding a new roster DillING cee eeeeeeeeeeeeneeeeeeeaaeeeeeeaaeeeeeeaaeeeeeaaeeeeeeaa List
32. CLIENT32 EXE to your local system 3 Follow the on screen wizard steps to complete the client installation You will be prompted to select a local destination drive The PC ACE Pro32 program and client support files will be installed to the WINPCACE directory on the selected local drive In addition a PC ACE Pro32 shortcut icon will be created and placed on your Windows desktop Logging In The First Time Users are required to log into PC ACE Pro32 before performing any system activities The login process involves entering a User ID and optional Password As shipped PC ACE Pro32 is configured with a single default user with full system access rights The default user s User ID is SYSADMIN and password is SYSADMIN as well If you are logging into PC ACE Pro32 for the first time use this default login unless instructed otherwise by your distributor If the default login does not work review the installation guidelines provided by your distributor Distributors often pre configure the security system according to their own internal specifications If you still have difficulties logging into the system contact your distributor for assistance IMPORTANT You should change the default user s password as soon as possible if you are concerned about controlling user access at your facility How To Use This Help System This on line help system provides instant access to helpful information from anywhere in the PC ACE Pro32 system Features of th
33. Charges Master entry This value is automatically brought forward to the claim line item Charges field when a valid Charges Master code is entered or looked up during claim entry Maintenance operations available include e To add anew Charges Master code click the New button and optionally select a specific line of business LOB from the dropdown list if the charge is specific to claims for a particular LOB Enter an optional Payer ID value if the charge is specific to claims billed to a particular payer See the discussion of LOB Payer specific Charges Master records below for more information Enter a valid HCPCS Code Alternatively the Payer ID and HCPCS Code values can be selected from a lookup list by pressing the F2 key or right clicking the mouse while positioned on the respective control Enter the desired Charges value and click the OK button to save the new record e To view or modify an existing Charges Master record select the desired record and click the View Update button or double click the desired record Only the description and charge amount fields may be modified e To delete a Charges Master record select the desired record from the list click the Delete button and confirm the deletion LOB Payer Specific Charges Master Records The Charges Master reference file allows you to create multiple records for the same HCPCS code each applicable to a specific line of business LOB and optionally to a spe
34. Claim processing in PC ACE Pro32 refers to the application of a specific set of edit validation rules to the claim A processed claim is pronounced as either clean contains non fatal errors or contains fatal errors This claim is assigned a status code of CLN ERR or ERF respectively to indicate the state of the processed claim In addition to processing or working claims one by one from the Claim List form PC ACE Pro32 also provides an automatic processing function that can sequentially process all or a filtered selection of unprocessed claims in the to be transmitted CL location Automatic claim processing is an ideal way to quickly work a batch of imported claims Once automatic processing has completed the user can focus attention only on the claims with errors greatly improving user productivity To process claims automatically follow these simple steps 1 From the PC ACE Pro32 Main Toolbar click either the UB92 Claims Processing or HCFA 1500 Claims Processing button to open the desired Claims Menu form 2 From the Claims Menu form click the Process Claims button to open the Automated Claim Processing form This form provides the following processing options gt Claim Filter Parameters claims must meet all specified filter criteria to be considered for automatic processing e LOB specifies a single line of business LOB to be considered Only claims with this LOB will be eligible for auto
35. Claims Menu form Click the New button on the UB92 Medical Attachment List form This form can be accessed by selecting the Attachments and Maintain Medical Attachments menu items on the UB92 Claims Menu form K Ww You will be prompted to select the desired attachment type PC ACE Pro32 supports the following standalone UB92 Medical Attachments Outpatient Rehabilitation Plan of Treatment Form 700 Outpatient Rehabilitation Plan of Treatment Update Form 701 Ambulance Medical Data Attachment End Stage Renal Disease ESRD Attachment Standalone UB92 Medical Attachments are entered on the appropriate UB92 Medical Attachment Form for the specified attachment type The data fields are typically entered in the order presented from left to right and top to bottom on each tab of the UB92 Medical Attachment form Edit validation errors may be encountered during this entry process if the data entered violates any of the predefined UB92 Medical Attachment edits Correct any such edit errors and click the Save button to save the UB92 Medical Attachment UB92 Medical Attachments containing unresolved edit errors may be saved if desired by clicking either the Save With Errors button visible if only non fatal errors exist or Save With Fatal button visible if any fatal errors exist Only one of these buttons will be visible at any given time If neither button is visible then fatal errors exist on one or more key UB92 Med
36. Click the Check All and Clear All buttons to quickly check or un check all user permission checkboxes 3 Repeat the previous step to create additional user accounts If changes are made to a user profile the changes will not go into effect until the next time that user logs into system Select the Logout Current User item on the main Security menu to manually log out without exiting the system S You should change the default user s password as soon as possible if you are concerned about controlling user access at your facility Claim Import Considerations This section describes setup considerations that should be reviewed only if you intend to import claims into PC ACE Pro32 from an upstream system If you will not be importing claims skip this section entirely Three methods are available for importing claims Print Image PrintLink Intermediate Delimited Format and Electronic Media Claims EMC Format Getting setup to import claims into PC ACE Pro382 typically involves coordination with your distributor If you are interested in importing claims using the PrintLink print image method but your distributor does not provide PrintLink support ask that they refer you directly to the software manufacturer for assistance PrintLink functionality may be licensed and supported as an add on to your base PC ACE Pro32 system hS You may want to refer to the Importing claims topic for a discussion of these claim import me
37. For claims that contain more than 6 line items the user may scroll through the claim line items one line at a time or one page i e 6 lines at a time using the buttons provided along the right edge of this tab AS You can also use the up down arrow keys to move from line to line scrolling when appropriate Type lt ALT gt lt PAGE UP gt press the Page Up key while holding the ALT key down or lt ALT gt lt PAGE DOWN gt to scroll up down through all claim line items one page at a time Line Item Features The following productivity features are available on the Billing Line Items tab e Current Line Tracking The Billing Line Items tab contains a number of second level tabs The first second level tab Line Item Details displays the claim diagnosis codes as well as the basic line item fields available on the hard copy HCFA 1500 claim form The remaining second level tabs are linked to the currently selected line on the Line Item Details tab As the cursor moves from one line to another on the Line Item Details tab the remaining second level tabs will track the new current line This technique provides an efficient method of providing access to a large number of data elements on a potentially large number of claim lines Notice that the Extended Details tab caption always reports the current line for reference e Line Duplication Press the F5 key while positioned on any field on a line to copy the values in all fields of th
38. HCFA 1500 only specifies whether to print the provider signature on file date from the HCFA 1500 Claim Form or to instead allow the user to override the signature block date by default This default setting can be overridden when a claim is printed M When checked the provider signature on file date on the HCFA 1500 Claim Form will be ignored by default during claim printing An alternate date or no date at all may be specified instead when a claim is printed I When unchecked the provider signature on file date on the HCFA 1500 Claim Form will be printed by default to the claim form signature block Print line items using single spacing when appropriate HCFA 1500 only specifies whether single spacing of line items is to be used when appropriate on HCFA 1500 claim forms The standard HCFA 1500 form layout implies that double spacing is to be used by default M When checked all HCFA 1500 claims containing more than 6 line items will be printed with the line items single spaced This technique accommodates up to 11 line items per claim form page M When unchecked all HCFA 1500 claims will be printed using the standard pre printed form line item spacing 6 line items per page Print claim attachments by default HCFA 1500 only specifies whether HCFA 1500 claim attachments should be printed by default This default setting can be overridden when a claim is printed if desired M When checked any existing claim attach
39. Printing claims topics for more details Posting Claim Payments Choose the Show Selected Claim Payments action to post view or modify payments for the selected claim Claim posting may also be performed from the appropriate claim entry form See the Posting claim payments UB92 and Posting claim payments HCFA 1500 topics for more details Purging Claims Choose the Purge Selected Claim action to purge the selected claim Claims in the to be transmitted CL location must be deleted before being purged E IMPORTANT Purged claims are permanently deleted from PC ACE Pro32 they cannot be recovered Reactivating Claims Choose the Reactivate Selected Claim action to reactivate the selected claim This action will move the previously transmitted claim from the transmitted TR or paid PD location into the to be transmitted CL location The reactivated claim will be assigned the unprocessed UNP status See the Reactivating previously transmitted claims topic for more details Archiving Claims Choose the Archive Selected Claim action to move the selected claim from the current claim database to the open claim archive database Only claims in the transmitted TR and paid PD locations are eligible for archiving Refer to the Archiving and unarchiving claims topic for more information on the PC ACE Pro32 claim archiving feature e Unarchiving Claims Choose the Unarchive Selected Claim acti
40. Pro32 from the DOS version of PC ACE your Patient records may already be on file If so you can skip the remainder of this section If the list is not empty and you have not migrated from a DOS version of PC ACE any existing Patient records are likely there as samples only Once you have confirmed that this is the case delete all sample Patient records To delete a Patient record select the desired record in the list click the Delete button and confirm the deletion 3 Click the New button to display the Patient Information form Enter the patient information taking advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse bS Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator The Patient reference file contains general patient information as well as optional primary secondary and tertiary insured details Enter as much information as you have available for the patient 4 Click the Save button to save the new Patient record An edit validation process will be performed to check for problems with the patient information When prompted correct any missing or invalid field values if present and re save as needed The new Patient record should now be visible in the Patient list 5 Repeat the relevant steps to create additional P
41. Provider ID and LOB Line of Business fields and optionally by the Payer ID field as well These critical fields are defined as follows e Provider ID No or Group ID No for group providers The provider group identifier to be used on claims for the line of business specified in the LOB field e LOB Specifies the line of business applicable to this provider record e Payer ID An optional field that if specified identifies this provider record as payer specific to the payer identified by this Payer ID The Provider Type selection and LOB field value are used to filter the list of providers presented to the user during claim entry lookup operations Only provider records with an LOB value matching the claim s LOB will be available for selection Claim billing provider lookup lists will include only group and solo providers while rendering provider lookup lists will include only individual in group providers If required this provider record s associations may be maintained from this form using the Select adds a new association and None deletes all associations buttons adjacent to the Provider Associations listbox hS When setting up provider records for a group and its members always create the Group Practice provider record s first Associated group provider records must be created for each line of business LOB in which the group or any of its members will participate Once the group pr
42. Selected Roster action to purge the selected roster billing Roster billings in the to be generated RL location must be deleted before being purged gt IMPORTANT Purged roster billings are permanently deleted from PC ACE Pro32 they cannot be recovered Refreshing the Roster Billing List Choose the Refresh Roster List action to refresh the current Roster Billing List form contents This action can be useful in a multi user installation to be sure that the roster billing list properly reflects additions and or modifications made by other users You will notice that only applicable actions are enabled for use in the main Actions menu or pop up menu For example it makes no sense to view the roster report of a roster billing that has yet to be generated so this action will be disabled for roster billings in the RL location The HCFA 1500 Roster Billing Form The HCFA 1500 Roster Billing Form provides access to all data elements of an HCFA 1500 roster billing New roster billings are entered and existing roster billings are viewed and or modified from this form The HCFA 1500 Roster Billing Form is divided into 2 sections The top section of the form presents those fields that will be common to all claims generated from the roster billing The lower section of the form presents those fields that are unique to each claim generated from the roster billing Entering Roster Billing Data Click on any field to activate it for
43. Support for ANSI997 transmission acknowledgment files may not be available on all installations If the Purge archived ANSI 997 acknowledgment files after NN days option is disabled grayed out on the PC ACE Pro32 Miscellaneous preferences form then this capability is not available on your installation Staging Acknowledgment Files For Automatic Archiving At program startup PC ACE Pro32 automatically scans separate UB92 and HCFA 1500 staging directories looking for new ANSI997 transmission acknowledgment files to be archived If new ANSI 997 files are present in the staging directories they are checked for proper format and archived automatically This automatic archiving process is also performed when the ANSI 997 Acknowledgment File Log form is opened or when the user manually refreshes the ANSI997 Acknowledgment File list see next section for details On most PC ACE Pro32 installations the user will be required to manually copy the ANSI 997 files received from the intermediary into the appropriate staging directory The UB92 and HCFA 1500 staging directories are UB92 winpcace ansi997 ackub92 HCFA 1500 winpcace ansi997 ack1500 For single user installations these directories will reside on the local drive letter to which PC ACE Pro32 was originally installed For multi user networked installations these directories will reside on the shared network drive letter to which PC ACE Pro32 was originally installed Sp Care must b
44. To modify an existing payment record select the desired record click the View Update button or double click the selected record and modify the payment field values as required Click the OK button to save the modified payment record 139 The Date Paid value for an existing claim payment record cannot be modified To change the payment date you must delete the existing payment record and add a new one with the correct date e To delete a payment record select the desired record click the Delete button and confirm the deletion 6 The Claim Payment History form maintains running totals of all claim payments posted to the selected claim When you have completed the payment posting activities for this claim click the Close button to return to the previous form The HCFA 1500 Claim List form will reflect the most recent payment date and total amount paid in the Paid Date and Paid Amount columns respectively 140 Archiving and unarchiving claims Transmitted claims in PC ACE Pro32 can be optionally moved off line to any number of user defined claim archives Claim archiving provides the following advantages Ke Archiving claims reduces the size and optimizes the performance of the current claims database t oe Archiving claims eliminates claims that are no longer of interest from the current claims database making it easier to locate and work with the current claims K ee Archiving promo
45. already setup this reference file for you Consult the distributor s installation notes or contact your distributor for assistance before continuing this Payer setup procedure 2 Click the New button to display the Payer Information form Enter the new payer s information taking advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse AS Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator The Payer ID LOB and Usage fields together serve as the identification key for this Payer record A specific Payer ID LOB combination may exist for a maximum of two Payer records If two such Payer records are defined then their Usage settings must not overlap Valid Usage settings include U UB92 use only H HCFA 1500 use 36 only and B or blank unrestricted use The only valid situation where two Payer records with the same Payer ID LOB combination may exist is when one of the records specifies a Usage value of U UB92 use only and the other record specifies a Usage value of H HCFA 1500 use only This feature permits Payers for shared LOBs such as Commercial COM to optionally have distinct settings and PrintLink matching strings for UB92 versus HCFA 1500 use An individual Payer record must be setup for e
46. archive feature e Include archived EMC files specifies whether or not to include all archived EMC files in the backup Once the desired destination and options have been specified click the Start Backup button to proceed You will be notified upon successful backup completion Exclusive system access is required to perform backups in PC ACE Pro32 If this program is in use on another client workstation you will be notified when the Start 198 Backup button is clicked You can either instruct the other users to exit PC ACE Pro32 and then continue the backup or simply cancel the backup request K3 Validate validates an existing backup file The backup archive s integrity is confirmed and the archive details date of backup etc are presented to the user No data will be restored during the validation process so it is always safe and advisable to validate an archive before attempting a subsequent restore operation The following controls and options apply to the validate operation e Source Drive or Folder specifies the drive or Windows folder directory from which the backup archive file will be read This path may point to a removable media device diskettes writeable CDROM or to a standard Windows directory on a hard disk drive local or remote Disk spanning is supported for backup archives on diskette The user will be prompted to insert specific diskettes from the backup archive as needed hS When vali
47. be added to PC ACE Pro32 using any of these techniques 7 Import the claims from a print file or other supported source See the Importing claims topic for more details Click the Enter Claims button on the Claims Menu form UB92 or HCFA 1500 to enter claims manually The system will automatically create and display new empty claims in succession until a claim is cancelled Use this technique to enter multiple claims in a single session Click the New button on the Claim List form UB92 or HCFA 1500 to enter a single claim manually The new claim will automatically be selected in the list when it is saved c o 9 Claims are manually entered on the UB92 Claim Form or HCFA 1500 Claim Form The data fields are typically entered in the order presented from left to right and top to bottom on each tab of the claim form Edit validation errors may be encountered during this entry process if the data entered violates any of the predefined edits for the specific claim type Correct any such edit errors and click the Save button to save the claim Claims containing unresolved edit errors may be saved if desired by clicking either the Save With Errors button visible if only non fatal errors exist or Save With Fatal button visible if any fatal errors exist Only one of these buttons will be visible at any given time If neither button is visible then fatal errors exist on one or more key claim fields The
48. be any valid filename with a map extension The map file must be placed in the server s winpcace impub92 directory 3 Confirm the existence of the required map control file This file provides a control interface between the output of the PrintLink translator and the PC ACE Pro32 claim import routines The map control file is always named mapcntlu win and should be located in the server s winpcace impub92 directory 4 Setup all required PrintLink Matching Description strings in the Payer reference file These strings are used to match payer descriptions from claims in the print file to specific Payer reference file records Refer to the Adding and maintaining payers topic for details on setting up your PrintLink Matching Description strings 5 Each time you want to import claims copy the new print image file generated by your upstream system into the server s winpcace impub92 directory The first line of the map file provided by your distributor dictates what the print image file must be named typically ub92 prt Intermediate Delimited Format imports claims from a file in intermediate delimited format If using this claim import method complete the following steps 40 1 Work with your distributor to develop the programs necessary to produce a file in intermediate delimited format from your upstream system Your distributor should have detailed specifications of this internal file format Verify that the generat
49. ccceeeceeeeeeeeeeeeeeeeeeeeeeaaeeeeeeaaeeeees 67 The HCFA 1500 Roster Billing Form cceeecceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeees 69 Home Health Plan of Care List Form Features cccsseeeeeeneeeeeeeaneeeees 72 The Home Health Plan of Care Form ccceceeceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeneees 74 UB92 Medical Attachment List Form Features 77 The UB92 Medical Attachment Forms ccceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeneees 80 Reference File Maintenance Form cccececeeeeeeeeeeeeeeeeeeeeeeeaneeeeeeaneeeees 84 Claim amp Reference File Edit Validation ceeceecceeeeeeeneeeeeeeeaeeeeeeaaeeeeeeaa 88 Security amp User Maintenance cccceeeeeeenneeeeee ee eeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaa 90 System Preferences 92 Preferences Ovario W ccecceeeeeeceeeeeeeceeeeeeeeeeeeeeeceaaeeeecaaaeeeeaaaaeeesaaaa ees 93 General Preferences cccececenneeeececceeeeeeaaeeeeeeaaaeeeeeaaaeeeeeaaaeeeeeaaaeeeeeaa 94 Claim List Preferences cecececceeeeceeceeeeeeaaeeeeeeaaeeeeeeaaaeeeeeaaaeeeeeaaaeeeeeaa 97 Claim Import Preferences cccececesceeeeceaeeeeeeeaaeeeeeeaaaeeeeeaaaeeeeeaaeeeeeeaa 98 Printing Preferences ceicc ccceedecsteeececcaed ine eri a E 99 Data Communication Preferences ccseceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeneees 103 Miscellaneous Preferences cececeeeeeeeeeeeeeeeeeeeeeeeeesaeeeeeeaaaeeeeeaaeeees 104 Common Claim Activities 106
50. claim for which status was requested no longer exists The claim has been purged archived or reactivated from the TR transmitted only or PD paid only location e Multiple claim status responses have been returned by the intermediary for the same unique claim trace number This typically indicates that the intermediary could not uniquely identify the claim of interest based on the identifying information included in the 130 ANSI 276 claim status request file Multiple responses may be returned at the discretion of the intermediary PC ACE Pro32 will not post any of the ambiguous responses directly to the claim but will instead post an attention notification which directs the user back to the original archived claim status response file report The user must review this report manually to determine which one of the multiple responses is applicable if any The ANSI277 claim status response post report will display an explanatory error message for each response that could not be posted Related Topics The following hyperlinks provide additional information related to this topic b gt Refer to the Claim List Form Features topic for more information on adding claims to the status request queues UB92 and HCFA 1500 b gt Refer to the Preparing claim status request files for transmission topic for information on creating ANSI 276 claim status request files to send to your claims processor gt Refer to the Viewing and maint
51. define system user preference settings for example Unless otherwise instructed by a technical support specialist this option should always be checked Once the desired source drive folder path and option settings have been specified click the Start Restore button to proceed S The restore operation will overwrite your current database files with older data from the specified backup You should perform this operation only under the supervision of authorized technical support personnel You will be notified when the restore operation completes PC ACE Pro32 will terminate automatically following a restore operation The restored database files and configuration settings will be available the next time the program is executed Exclusive system access is required to perform a restore operation in PC ACE Pro32 If this program is in use on another client workstation you will be notified when the Start Restore button is clicked You can either instruct the other users 199 to exit PC ACE Pro32 and then continue the restore operation or simply cancel the restore request 200 Packing and reindexing the databases PC ACE Pro32 uses proven database technology that is for the most part self maintaining Database files or tables contain the data records that define a claim patient provider etc Most tables are equipped with indexes that organize the records in the table for optimal access As records are added to modified
52. different enter a unique line of business identifier in the LOB field and click the Save button When you have finished adding Provider records you should have one record for each applicable line of business LOB for each provider entity When all desired Provider records have been added click the Close button on the Reference File Maintenance form to return to the PC ACE Pro32 Main Toolbar Patient Reference File Setup This section describes the process of setting up the Patient reference file Setup of the Patient reference file is optional If you choose to setup patients the complete patient list will be 31 accessible during claim entry using the variable list lookup feature When a patient is selected from the lookup list during claim entry all applicable patient information will be automatically loaded into the appropriate claim form fields Complete the following steps as needed hS You may want to refer to the Adding and maintaining patients topic for more information on entering Patient records If you do make sure and return to this topic to continue the setup steps 1 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form Select the Patient tab to display a list of all existing Patient records 2 If you have just installed PC ACE Pro32 the Patient list should be empty If so skip to the next step S If you have migrated to PC ACE
53. down until it contains only the desired claims Then select the Check All Claims action from the main or popup menu to instantly mark i e Check all the claims of interest A number of actions are available from the main or popup menu to operate on the entire group of claims in a single session Refer to the Claim List Form Features topic for complete details on selecting and acting on multiple claims at once Related Topics The following hyperlinks provide additional information related to this topic b gt Refer to the Claim List Form Features topic for details on using the Claim List form b gt Refer to the UB92 Claim Form and HCFA 1500 Claim Form topics for more information on using the UB92 and HCFA 1500 claim forms 108 b gt Refer to the Claim amp Reference File Edit Validation topic for more information about the edit validation process and associated forms b Refer to the on line help Common Claim Activities folder for hyperlinks to other claim related topics of interest 109 Importing claims Claims are introduced into PC ACE Pro32 by either entering them manually or by importing them from an external source The claim import method is ideal for facilities that maintain their claims in an upstream claims management system Using our versatile claim import capabilities these claims can be quickly and accurately loaded into the PC ACE Pro32 database for subsequent processing preparation and transmis
54. entirely Three methods are available for importing claims Print Image PrintLink Intermediate Delimited Format and Electronic Media Claims EMC Format Getting setup to import claims into PC ACE Pro32 typically involves coordination with your distributor If you are interested in importing claims using the PrintLink print image method but your distributor does not provide PrintLink support ask that they refer you directly to the software manufacturer for assistance PrintLink functionality may be licensed and supported as an add on to your base PC ACE Pro32 system AS You may want to refer to the Importing claims topic for a discussion of these claim import methods If you do make sure and return to this topic to continue the setup steps Review only the setup considerations applicable to the claim import method you intend to use Print Image PrintLink imports claims from a print image file If using this claim import method complete the following steps 1 Have your distributor perform a one time PrintLink mapping procedure on a sample print image file that you have supplied This mapping process defines the template used to extract and interpret fields from your print image file Since all upstream systems print claims in a slightly different format this mapping process is required to build your custom template 2 Obtain the resulting map file from your distributor This file is typically named ub92 map but can
55. field Helpful fly over hints are also available for many fields Saving amp Canceling Payer Updates After completing data entry on the Payer Information form click the Save button or type lt ALT gt S to save and exit the form Alternatively click the Cancel button to abandon any changes and exit the form During the payer save operation an edit validation process is performed on all payer record fields If no edit validation errors occur the payer record is saved without further user intervention If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List form This form lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the reference file edit validation process and the Edit Validation Errors List form If any fatal edit errors exist you must correct them before the payer record can be saved If only non fatal edit errors exist you will have the option to correct the errors or save the payer record with errors Click the Save With Errors button to save a payer record that contains only non fatal errors If edit validation errors occur several Save attempts may be required to correct and save a clean payer record PrintLink Matching Descriptions PrintLink refers to a unique process by which claims can be i
56. following steps 1 Complete the pre transmit procedures provided by your distributor if any 2 From the PC ACE Pro32 Main Toolbar click the Data Communications Functions button to open the Data Communications Options form Each pre configured data communications function will be represented by one of the available launch buttons AS Only the pre configured launch buttons will be enabled These available buttons may be presented on up to 3 distributor defined tabs If all buttons are disabled then your system has not been setup for any data communications functions Refer to the Data Communication Preferences topic for information on configuring these launch buttons 3 For this example let s assume the first button is labeled Transmit Claims and is pre configured to launch the EMC file transmission program Your button labels and functions may be different but the launch procedure is basically the same Simply click the Transmit Claims button to initiate the transmission process PC ACE Pro32 only initiates or launches the third party file transmission program It does not monitor the transmission program s progress nor is it informed of the transmission s completion status All exception handling must be done by the third party data communications program or script e g re dial restart on dropped line etc 4 Click the Close button on the Data Communications Options form when the file transmission has co
57. for more discussion of these common filter options 189 Provider Specialty File Maintenance The Provider Specialties form provides an interface to maintain the Provider Specialty codes Provider Specialty codes apply exclusively to HCFA 1500 providers The Provider Specialty is a required field on the HCFA 1500 Provider Information form These codes are pre loaded and should require minimal maintenance Maintenance operations available include e To add a Provider Specialty code click the New button and enter the new code information e To view or modify an existing Provider Specialty record select the desired record and click the View Update button or double click the desired record e To delete a Provider Specialty record select the desired record from the list click the Delete button and confirm the deletion Related Topics The following hyperlinks provide additional information related to this topic b gt Refer to the Adding and maintaining providers HCFA 1500 topic for a discussion of HCFA 1500 provider maintenance 190 Provider Taxonomy Codes File Maintenance The Provider Taxonomy Codes form provides an interface to maintain the Provider Taxonomy codes Provider Taxonomy codes may be required for submission of EMC files in ANSI 837 format These codes currently apply exclusively to HCFA 1500 providers The Provider Taxonomy code is a field on the HCFA 1500 Provider Information form These codes are pre l
58. forms e Maintains claim payment history e Unattended scheduling of claims activities e Integrated backup restore and file maintenance functions e Familiar Microsoft Windows look and feel e Comprehensive on line help system e Fully Year 2000 compliant e Technical support through direct customer service line and Internet web site e Ongoing maintenance updates and enhancements Thank you for choosing PC ACE Pro32 as the electronic claims processing system for your facility or organization It is our commitment to provide you with a quality product and outstanding support We will strive to constantly improve and enhance PC ACE Pro32 to serve the ever changing needs of the healthcare community well into the 21 century Getting started with PC ACE Pro32 The PC ACE Pro32 Claims Processing System was designed from the ground up for the Windows environment Special care has been taken to ensure that PC ACE Pro32 looks and feels like other popular Windows programs This means that you can concentrate on PC ACE Pro32 s features rather than worrying about how to navigate the program This section describes the recommended minimum system requirements for PC ACE Pro32 Follow the steps to install the PC ACE Pro32 server and client optional modules The final paragraphs of this Getting Started section will direct you to the relevant migration and or setup tasks required to get you operational with PC ACE Pro32 Minimum System Requirement
59. from the first record above during edit validation since the TOB of lt lt ALL gt gt matches any claim TOB and the LOB of lt lt ALL gt gt matches any claim LOB The third and second records were rejected because of the TOB mismatch 12 versus 11 In our example the first record was a catch all record since it matched all LOBs and TOBs If that assignment record were not present then Case 3 above MCA 122 would not have matched any of the detail assignment records When this occurs the revenue code is considered valid and the remaining control setting flags will assume their default values during edit validation processing Revenue Code Assignment records that include a specific TOB value take precedence over records with the special IP inpatient and OP outpatient TOB values This evaluation sequence makes it possible to define an inpatient outpatient group assignment that is valid for most TOBs in the group Separate assignment records with specific TOB values can be created as needed to handle exceptions to the group rule By understanding this matching process it is possible to build a revenue code assignment details set that can be as open or as specific as required 184 Place of Service POS File Maintenance The Place of Service POS Codes form provides an interface to maintain the Place of Service POS codes and assignments POS codes apply exclusively to HCFA 1500 claims The POS codes are pre lo
60. functions are available from the Maintain menu These include the ability to reverse the most recent claim import run to review and reactivate previously prepared EMC files for re transmission to review and maintain ANSI 997 transmission acknowledgment files to prepare an ANSI 276 claim status request file and to review and maintain ANSI 277 claim status response files 52 Claim List Form Features The PC ACE Pro32 Claim List form provides a versatile interface from which the user can create list modify print and otherwise maintain claims Click either the UB92 Claims Processing button or HCFA 1500 Claims Processing button on the PC ACE Pro32 Main Toolbar to open the corresponding Claims Menu form Then click the List Claims button on the Claims Menu form to open the desired Claim List form You may reposition and resize this form if desired The list can be easily sorted and filtered to display only the claims of interest The UB92 and HCFA 1500 Claim List forms are virtually identical All procedures described in this section pertain to both claim types unless otherwise specified Sorting Claims The claim list may be sorted by Patient Name Patient Control Number PCN Entry Date Service Date and Transmit Date Simply select the desired sort order from the available Sort By radio buttons Filtering Claims The claim list may be filtered to display a select subset of claims by manipulating the Claim List Filter Option
61. however you must correct the error before saving the claim Click the Save With Errors button to save a claim that contains only non fatal errors Such claims are assigned the has errors ERR status Click the Save With Fatal button to save a claim that contains fatal errors Such claims are assigned the has fatal errors ERF status Claims with an ERF status will not be eligible for preparation into an electronic EMC file If edit validation errors occur several Save attempts may be required to correct and save a clean claim At any time click the Errors List button to review the remaining edit validation errors Miscellaneous Claim Form Topics 60 The following comments cover a few miscellaneous features of the UB92 Claim Form Entering Form Locator Data In order to preserve space on the UB92 Claim Form most of the fields that permit free form text entry have been implemented as pop up windows These fields are activated by clicking the associated button e g the FL1 button at the top of the Patient Info amp Codes tab activates the Form Locator 1 popup window Simply enter the text in this pop up window pressing the ENTER key to start a new line if desired and press the TAB key to exit and close the window Viewing Home Health Plans of Care Type lt ALT gt H to display a list of Home Health Plans of Care Form No HCFA 485 HCFA 486 on file for the patient specified in the claim The plan info
62. in a predefined sequence generally left to right and top to bottom Use the UP ARROW and DOWN ARROW keys to move up and down through the claim form fields respectively A number of productivity enhancing features are available during claim data entry e Fixed List Lookups The claim entry form supports fixed list lookups on many of the claim s fields Fixed list lookups apply to fields whose list of valid values can be determined in advance For example Patient Sex typically has 3 possible values M male F female and U unknown USAGE Access the lookup list for a field by positioning the cursor on the field and pressing the F2 function key or right clicking the mouse When an item from the list is selected its value is automatically entered in the claim form field hS Type lt ALT gt F2 press the F2 key while holding the ALT key down to identify all fields that support a lookup list Press the ESC key to disable the flashing notification e Variable List Lookups The claim entry form supports variable list lookups on a number of the claim s fields Variable list lookups apply primarily to fields whose values are selected from reference files Most variable list lookups use other claim field values the specified claim LOB for example to filter the presented list For example provider lookups attempt to present only those provider records applicable to the claim being entered In addition variable list
63. information You can choose to either modify these existing records to add any missing information or delete them and build your Provider reference file from scratch If the list is not empty and you have not migrated from the DOS PC ACE system contact your distributor to confirm that the existing Provider records can be safely deleted To delete a Provider record select the desired record in the list and click the Delete button Click the OK button on the Provider Deletion Confirmation form to confirm the deletion request Make sure the list is empty before continuing with the next step Click the New button to display the UB92 Provider Information form Enter the first provider s information taking advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse AS Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator Enter the provider s name and address information Enter the Provider ID in the Provider ID No field and the line of business in the LOB field probably MCA The Payer ID field is only needed if you want to restrict assignment of this provider to a specific payer Normally the Payer ID field will be left blank You can also leave the Tag field blank Complete entry of the remaining provider fields as desired Click
64. is expected to enter or select the desired LOB and Billing Provider for the new claim Auto populate zero service line Units value to 1 during HCFA 1500 claim entry Enables or disables auto population of the service line Units value to one 1 during HCFA 1500 claim entry This auto population will occur when the user exits the 24d Procedure Code field only if the Units value is currently zero M When checked the service line Units value will be initialized to 1 if currently zero when the service line s procedure code is entered When unchecked the service line Units value will not be initialized and must always be entered by the user if a non zero value is desired Claim List Preferences PC ACE Pro32 preference settings are organized on a tabbed dialog accessible from the PC ACE Pro32 Main Toolbar s main File menu The Claim List Preferencestab allows the user to customize the UB92 amp HCFA 1500 Claim List form column configurations Columns are configured separately for the UB92 Claim List form and HCFA 1500 Claim List form In addition unique column configurations exist for each of the primary claim locations to be transmitted CL transmitted TR and paid history PD If your installation is licensed for both UB92 and HCFA 1500 claim activities then you will need to select the appropriate claim type from the UB92 Claim List or HCFA 1500 Claim List radio buttons near the top of this tab If y
65. lookups often retrieve data used to fill in other claim form fields For example selection of a Patient from the variable list lookup completes numerous patient related fields on the claim Access variable list lookups using the same method described above for fixed list lookups 58 e Automatic Field Tabs When entering data in a field an automatic tab will occur when the field has been completely filled For example entering a single character in a one character field will automatically position the cursor on the next field in the tab sequence This feature can be disabled in the general preferences settings if desired e Intelligent Groups Tabs The UB92 claim form contains a number of field groups Examples of such groups include Condition Occurrence Span Value Diagnosis and Procedure codes Fields in these groups are always completed sequentially Therefore when a field in one of these groups is left empty it can be assumed that data entry in the group is complete When the TAB key is pressed the remaining fields in that group will be skipped and the cursor will be positioned on the first field in the tab sequence beyond the group fields e Cancel Field Changes If a change is inadvertently made to the contents of a field press the ESC key to cancel this change and restore the field s value to what it was when the field received the focus This feature is available for most claim form fields e Date Completion Date va
66. menu provides access to the Preferences dialog used to customize PC ACE Pro32 to your particular installation and style The main Security menu provides access to the system s user maintenance and security features and also allows the current user to logout The main Help menu provides access to this on line help system the Online Software Update utility and the PC ACE Pro32 About box containing the PC ACE Pro32 program version number and important copyright information 51 UB92 amp HCFA 1500 Claims Menus Most claim activities in PC ACE Pro32 are initiated from one of 2 essentially identical claim activity menu forms one each for UB92 and HCFA 1500 claim activities The menu s action buttons provide access to the most commonly used claim activities I Import claims from a print file PrintLink or alternate source Enter claims manually Maintain existing claims from a comprehensive list Process imported or reactivated claims automatically Prepare claims into an EMC file for transmission The form s View menu provides access to the most recent claim import and claim status request reports as well as the claim activity log The Attachments menu UB92 only includes options to create and maintain Home Health Plans of Care Form No HCFA 485 HCFA 486 Options to create and maintain UB92 Medical Attachments Rehab 700 701 Ambulance ESRD are also provided In addition a few handy claim activity maintenance
67. method complete the following steps 1 2 Confirm that your upstream system is capable of producing a supported version Electronic Media Claims EMC format file Contact your distributor for the list of supported EMC file versions Each time you want to import claims copy the new EMC file generated by your upstream system into the server s winpcace imp1500 directory The file must have a dat file extension e g EMC320 DAT Claim Prepare amp Transmit Considerations This section describes setup considerations that should be reviewed before you attempt to prepare and transmit claims using PC ACE Pro32 Your distributor may have already performed some or all of this setup for you Consult your distributor s installation instructions or contact the distributor if it is unclear how to proceed 1 Setup default HCFA 1500 submitter information in the PC ACE Pro32 Submitter reference file Information from this reference file is required during preparation of Electronic Media Claims EMC files Consult your distributor s installation instructions or contact the distributor for assistance in setting up this critical reference file 48 bS Refer to the Submitter File Maintenance topic for more information on setting up the default Submitter record 2 If required by your distributor setup default HCFA 1500 data communications parameters in the PC ACE Pro32 Data Communications reference file This reference file co
68. of business identifier in the LOB field and click the Save button When you have finished adding UB92 Provider records you should have one record for each applicable line of business LOB for each provider entity When all desired Provider 17 records have been added click the Close button on the Reference File Maintenance form to return to the PC ACE Pro32 Main Toolbar Select the Exit item from the main File menu to exit PC ACE Pro32 Cancel the system backup request when prompted Claims Migration This section describes the steps required to migrate your current DOS UB92 All Payer claims entry tracking and history into the PC ACE Pro32 system To migrate your claims complete the following steps amp It is critical that setup of the Payer and UB92 Provider reference files has been completed prior to migrating your claims The key payers and providers referenced on these claims must be present in these reference files to insure a smooth migration In practice it may be necessary to review and re migrate the claims multiple times correcting problems in the Payer and UB92 Provider reference files between migration attempts Make sure that PC ACE Pro32 is closed before beginning this migration process From the Windows Start menu select the PC ACE Pro32 Migration Utility item in the MedLink Technologies PC ACE Pro32 programs folder This will start the migration utility and display its main form Select
69. of the Reference File Maintenance form provides access to maintain the providers to be referenced on UB92 claims NOTE If you are licensed for UB92 claim activities only then this tab will be labeled simply Provider Setup of the UB92 Provider reference file is mandatory if you intend to process UB92 claims All providers referenced on UB92 claims must be represented in this reference file The Provider tab provides a convenient Sort By selection that quickly sorts the Provider list by LOB Provider Name Provider ID or Tag Operations available include e To add a new provider record click the New button and enter the new provider s information If providers already exist in this reference file you will have the option to create a completely new provider record or to inherit and associate the new provider record with the provider record currently selected in the list Select the desired creation options and click the OK button to continue See the discussion below for more information on provider inheritance and association e To view or modify an existing provider record select the desired record from the list and click the View Update button or double click the desired record e To delete an existing provider record select the desired record from the list click the Delete button and confirm the deletion E Claims are linked to provider records by an internal control number Deleting a provider record will irrev
70. or View Rejects buttons to view the accepted and rejected claim reports respectively These reports can be printed from the report previewer if desired bS Refer to the Printing Preferences topic for information on configuring claim import reports to be printed automatically or to a specific printer 6 When you have completed your review of the claim import reports click the Close button on the Claim Import form You may now proceed to process the imported claims automatically or work the claims one by one from the Claim List form Optional Import Preprocessor Feature Additional claim import flexibility is available with PC ACE Pro32 s optional import preprocessor feature A user developed executable program or a DOS batch file with associated PIF file can be configured for execution prior to standard claim import processing The PC ACE Pro32 import sequence will launch this preprocessor automatically and wait for completion before continuing with standard import processing The preprocessor might simply copy a print image file from one directory to another Alternatively it might perform a complex data translation operation to generate the supported claim import file Claims preprocessing can be performed with any of the 3 claim import methods described above See the Claim Import Preferences topic for information on configuring a claim import preprocessor Related Topics The following hyperlinks provide additional information r
71. or deleted from a database table the PC ACE Pro32 database engine performs all necessary housekeeping For example all indexes are maintained to reflect the current set of records after one or more records has been added modified or deleted Having said this there are certain situations when the system administrator may be required to perform manual database maintenance operations The most common scenarios include e Frequently updated tables claim tables for example may require periodic maintenance to keep their size at a minimum and their performance optimized e Indexes may become out of date due to an abnormal system or network problem that interferes with the PC ACE Pro32 database engine s self maintenance tasks In these scenarios and others that occur less frequently database tables s may require manual packing and or reindexing Database Packing As records are deleted from PC ACE Pro32 database tables the file disk space consumed by these deleted records is not automatically recovered Over time this unrecovered space can result in a table that consumes more disk space that it really needs In addition the unnecessarily large table can have an impact on database performance When a database table is packed this unrecovered space is eliminated resulting in a table that is as small as possible and optimum performance is restored As an example of when packing would be recommended consider the claim archiving p
72. payer insured and employer fields for the associated payer When the focus leaves a claim form field either by pressing the TAB key or clicking ona new field an edit validation process is performed on the field losing the focus Edits performed at this time are referred to as field level edits If a field level edit validation error occurs you will receive an audible response and the edit validation error message will be displayed in the lower left corner of the claim form In addition the focus will remain on the field so that you can correct the problem if desired If you choose not to correct the data at this time simply press the TAB key again to move to the next field Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the claim edit validation process Claim Attachments Claims submitted for certain types of professional services require supporting data that is not included on the basic HCFA 1500 claim In the world of paper claims this supporting data is usually submitted on separate forms know as attachments PC ACE Pro32 has extended this attachment metaphor into the world of electronic claims submission The HCFA 1500 Claim Form supports most of the commonly used attachment types Claim attachments can be triggered activated for a claim s line item in one of 2 ways Automatically Triggered Attachments Since the procedure HCPCS code on a claim s line item describes
73. press the PAGE UP and PAGE DOWN keys to move between tabs The HCFA 1500 provider structure defines 3 distinct provider types 164 K Group Practice Identifies the provider record as representing a group practice for billing purposes When creating group provider records the user must assign a unique Group Label to identify the group It is assumed that a group provider will be assigned members see Individual in Group provider type below o d Individual in Group Identifies the provider record as representing an individual provider that is a member of one of the existing group providers see Group Practice provider type above When creating individual in group provider records the user can select the desired Group Label from a lookup list of applicable group providers Claims may not be billed directly to individual in group providers rather these providers are specified as rendering providers on HCFA 1500 claims A Solo Practice Identifies the provider record as representing a solo practice provider Solo practice providers are not associated with any provider group and will bill claims directly HCFA 1500 claims require a billing provider that can be either a group or solo provider but not an individual in group The HCFA 1500 claim entry provider lookup and claim editing process will enforce this requirement Provider records are uniquely defined by the Provider ID No
74. provide additional instruction on several common plan activities b Refer to the Adding a new Home Health Plan of Care topic for more information on adding plans b Refer to the Listing modifying and maintaining Plans of Care topic for tips on maintaining plans from the Home Health Plan of Care List form b Refer to the Printing Home Health Plans of Care topic to learn about printing plans 76 UB92 Medical Attachment List Form Features The PC ACE Pro32 UB92 Medical Attachment List form provides a versatile interface from which the user can create list modify and otherwise maintain standalone UB92 Medical Attachments Click the UB92 Claims Processing button on the PC ACE Pro32 Main Toolbar to open the UB92 Claims Menu form Then select the Attachments and Maintain Medical Attachments menu items on the UB92 Claims Menu form to open the UB92 Medical Attachment List form You may reposition and resize this form if desired The list can be easily sorted and filtered to display only the medical attachments of interest Sorting UB92 Medical Attachments The medical attachment list may be sorted by Patient Name Patient Control Number PCN Entry Date Service From Date and Transmit Date when applicable Simply select the desired sort order from the available Sort By radio buttons Filtering UB92 Medical Attachments The medical attachment list may be filtered to display a select subset of attachments by manipulating the
75. recent transmission files with the most recent automatically selected Select the desired transmission file entry and click the Select button Upon return to the Claim List form the program will automatically check all claims included in the selected transmission This feature is especially useful in situations where all claims from a previous transmission need to be reactivated modified and then re prepared into a new transmission file After selecting the desired transmission file entry the user would simply choose the Reactivate All Checked Claims item from the form s main Actions menu to complete the reactivation process Refer to the Reactivating previously transmitted claims topic for more information on reactivating previously transmitted claims e Check All Queued Claims For Status Request This is simply a convenience feature that will check all claims that are currently queued for inclusion in the next ANSI 276 56 claim status request file It can be used as a reminder of which claims have already been added to the queue See the Preparing claim status request files for transmission topic for information on how to use the ANSI 276 277 claim status request response feature Clear Claim Status Request Queue Clears the ANSI276 claim status request queue See the Preparing claim status request files for transmission topic for information on how to use the ANSI276 277 claim status request response feature Sup
76. records in the list are displayed Filter list to include starting with When selected the list is filtered to include only those records whose PCN ID code name or description starts with the pattern entered in the adjacent filter control The filter is dynamically re applied as characters are added to or deleted from the pattern AS This filter option is invoked automatically if the user types one or more alphanumeric characters while the focus is on the list which it is by default when the form is opened This behavior permits the user to easily filter the list if the first few characters of the code or description are known The user may then use the up down arrow keys to move around in the filtered list Once the desired record is selected the user may press the ENTER key to view update or select in a lookup context the highlighted record These features are designed to increase operator efficiency by minimizing the need to use the mouse e Filter list to include descriptions containing When selected the list is filtered to include only those records whose description field value contains the pattern entered in the adjacent filter control Click the Apply button or press the ENTER key after entering the search string to perform the filter operation e Show only providers associated with selected provider When selected filters the list to include only those provider records associated with the curr
77. required to complete the PC ACE Pro32 setup and get the system ready to process your claims Proceed at this time to the Setup of Medicare Part A Systems topic and review the steps outlined there Make additional changes if needed to the migrated reference file records and complete any other applicable setup tasks that were not addressed in this migration procedure 14 Migrating UB92 All Payer Systems A goal of PC ACE Pro32 is to provide users with a smooth transition from their existing DOS UB92 All Payer systems The PC ACE Pro32 Migration Utility permits you to easily migrate your current DOS UB92 All Payer patient optional and payer reference file data as well as your existing claims into the PC ACE Pro32 system Once you have performed this migration procedure you will be directed to proceed to the appropriate topic to complete any additional setup tasks required E Your distributor may choose to supplement or replace these migration procedures Refer to any installation notes provided by your distributor before continuing If you are in doubt about whether or not you need to perform these steps contact your distributor for assistance hS You may want to print this help topic and refer to the printed version as you perform these migration steps You can check off the steps as they are completed This technique also frees you to jump around between on line help topics without losing your place in the migration procedure To print the to
78. response file Support for the ANSI 276 277 claim status request response feature may be disabled by the distributor If the Request Selected Claim Status action item is not visible then your system does not support the claim status request response feature e Show Selected Claim Status History Choose the Show Selected Claim Status History action to view and maintain the claim status request response history for the selected claim This action is available for claims in the transmitted TR and paid PD locations only Refer to the Viewing and maintaining the claim status request response history topic for more information on how to use the Claim Status Request Response History form Support for the ANSI 276 277 claim status request response feature may be disabled by the distributor If the Show Selected Claim Status History action item is not visible then your system does not support the claim status request response feature e Refreshing the Claim List Choose the Refresh Claim List action or press the F5 function key to refresh the current Claim List form contents This action can be useful in a multi user installation to be sure that the claim list properly reflects claim additions and or modifications made by other users You will notice that only applicable actions are enabled for use in the main Actions menu or pop up menu For example it makes no sense to reactivate a claim that has yet to be t
79. roster billing being entered In addition variable list lookups often retrieve data used to fill in other roster billing form fields For example selection of a Patient from the variable list lookup completes numerous patient related fields on the roster billing form Access variable list lookups using the same method described above for fixed list lookups e Automatic Field Tabs When entering data in a field an automatic tab will occur when the field has been completely filled For example entering a single character in a one character field will automatically position the cursor on the next field in the tab sequence This feature can be disabled in the general preferences settings if desired e Cancel Field Changes If a change is inadvertently made to the contents of a field press the ESC key to cancel this change and restore the field s value to what it was when the field received the focus This feature is available for most roster billing form fields e Date Completion Date values may be entered with or without the century for convenience PC ACE Pro32 uses a user definable century pivot year to automatically derive the century when omitted To insure accuracy birthdate fields require that a full 4 digit year be entered e Descriptive Field Hints Most roster billing form fields have field hints that provide a brief description of the field s purpose These hints are often called fly over hints since they become visible whe
80. start date is left blank but the end date is completed the HCPCS code is valid for all dates of service up to and including the end date Related Topics The following hyperlinks provide additional information related to this topic b Refer to the HCPCS Modifiers File Maintenance topic for information on maintaining HCPCS code modifiers and their assignments 175 HCPCS Modifiers File Maintenance The HCPCS Modifiers form provides an interface to maintain the HCPCS modifiers and their assignments HCPCS modifiers and assignments are pre loaded and should require minimal maintenance The HCPCS Modifiers form includes two tabs K Ka A 176 Descriptions displays a list of HCPCS modifiers and their descriptions Maintenance operations available include To add a modifier click the New button and enter the new modifier information Enter the effective date range using a 4 digit year format To view or modify an existing HCPCS modifier select the desired modifier from the list and click the View Update button or double click the desired HCPCS modifier in the list To delete a HCPCS modifier select the desired modifier from the list click the Delete button and confirm the deletion Assignments defines the list of valid modifiers for each line of business LOB These assignments will also determine which modifiers will be included in the modifier lookup lists presented during claim entry The modifier assig
81. tab and Billing Line Items tab respectively Displaying Audit information Click the picture button in the upper right corner of the Patient Info amp General tab to display audit information for this claim This audit information includes the date the claim was created the last modification date and the User ID of the user that modified the claim last Common Claim Activities The following hyperlinks provide additional instruction on several common claim activities gt Refer to the Adding a new claim topic for more information on adding claims b Refer to the Listing modifying and maintaining claims topic for tips on maintaining claims from the HCFA 1500 Claim List form b Refer to the Printing claims topic to learn about printing claims b gt Refer to the Posting claim payments HCFA 1500 topic to learn about HCFA 1500 claim 66 payment posting Roster Billing List Form Features The PC ACE Pro32 Roster Billing List form provides a versatile interface from which the user can create list modify print and otherwise maintain HCFA 1500 roster billings Click the HCFA 1500 Claims Processing button on the PC ACE Pro32 Main Toolbar to open the corresponding Claims Menu form Then select the Maintain Roster Billings item from the HCFA 1500 Claims Menu form s main Roster menu to open the Roster Billing List form You may reposition and resize this form if desired The list can be easily sorted and filtered to display
82. the Add Update User item Only users with User Add Modify privileges can perform these maintenance functions which include e To add a new user click the New button on the Security List form and assign the user a User ID Password and Name Assign permissions to this user and save the new user record e To modify an existing user select the desired user from the Security List form and click the View Update button or double click the user record Modify the Password User Name and User Permissions fields as desired When all changes have been made save the modified user record X Check the checkbox next to the permission to allow access to the activity Click the Check All and Clear All buttons to quickly check or un check all user permission checkboxes S If changes are made to a user profile the changes will not go into effect until the next time that user logs into system Select the Logout Current User item available from the main Security menu to manually log out without exiting the system Related Topics The following hyperlinks provide additional information related to this topic b gt Refer to the Security amp User Maintenance topic for more information about the PC ACE Pro32 security implementation and the User Security Update form 193 Scheduling unattended claim activities Claim import processing and transmission activities may be scheduled for unattended operation if desired This feature c
83. the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the reference file edit validation process and the Edit Validation Errors List screen If any fatal edit errors exist you must correct them before the provider record can be saved If only non fatal edit errors exist you will have the option to correct the errors or save the provider record with errors Click the Save With Errors button to save a provider record that contains only non fatal errors If edit validation errors occur several Save attempts may be required to correct and save a clean provider record Provider Inheritance and Associations PC ACE Pro32 requires that each HCFA 1500 provider record be defined for a single line of business LOB As such if a provider supports multiple LOBs then separate records for each are required This hierarchy results in greatly enhanced flexibility by allowing the user to define unique IDs and support information addresses etc on a per LOB basis If necessary provider records may even be defined such that the information is unique to a single payer within the LOB by completing the Payer ID field on the HCFA 1500 Provider Information form In order to link provider records that represent the same entity PC ACE Pro32 has introduced the concept of provider associations For example
84. the mouse When an item from the list is selected its value is automatically entered in the Plan of Care form field X Type lt ALT gt F2 press the F2 key while holding the ALT key down to identify all fields that support a lookup list Press the ESC key to disable the flashing notification e Variable List Lookups The Plan of Care form supports variable list lookups on a number of the plan s fields Variable list lookups apply primarily to fields whose values are selected from reference files Some variable list lookups use other plan field values 74 to filter the presented list For example treatment code lookups present only those codes applicable to the specified discipline In addition variable list lookups often retrieve data used to fill in other Plan of Care form fields For example selection of a Patient PCN from the variable list lookup completes numerous patient related fields on the plan Access variable list lookups using the same method described above for fixed list lookups Automatic Field Tabs When entering data in a field an automatic tab will occur when the field has been completely filled For example entering a single character in a one character field will automatically position the cursor on the next field in the tab sequence This feature can be disabled in the general preferences settings if desired Intelligent Groups Tabs The Plan of Care form contains a number of field groups Examples of s
85. this claim The Claim Payment History form lists all existing payments made to the selected claim if any Perform the desired payment related tasks from this list including e To post a new payment click the New button and enter the payment date and amount on the Claim Payment Details form The Date Paid field is defaulted to the current system date and can be changed if desired Complete some or all of the optional payment record fields if desired When all desired payment fields have been entered click the OK button to save the payment record e To modify an existing payment record select the desired record click the View Update button or double click the selected record and modify the payment field values as required Click the OK button to save the modified payment record e To delete a payment record select the desired record click the Delete button and confirm the deletion The Claim Payment History form maintains running totals of all claim payments posted to the selected claim When you have completed the payment posting activities for this claim click the Close button to return to the previous form The UB92 Claim List form will 137 reflect the most recent payment date and total amount paid in the Paid Date and Paid Amount columns respectively 138 Posting claim payments HCFA 1500 PC ACE Pro32 maintains an optional HCFA 1500 claim payments database for organizations that wish to track paymen
86. when the mouse pointer moves over the specified field without actually selecting the field This feature can be disabled in the general preferences settings if desired e Line Item Scrolling A variable number of Lab Test Result lines and Medical Documentation lines may be entered on the End Stage Renal Disease ESRD medical attachment form This form displays four Lab Test Result lines and three Medical Documentation lines at a time For ESRD medical attachments that contain additional line items the user may scroll through the line items one line at a time or one page at a time using the buttons provided along the right or bottom edge of the respective tabs AS You can also use the up down arrow keys to move from line to line scrolling when appropriate Type lt ALT gt lt PAGE UP gt press the Page Up key while holding the ALT key down or lt ALT gt lt PAGE DOWN gt to scroll up down through all line items one page at a time e Line Item Deletion Press the F7 key while positioned on any field of the End Stage Renal Disease ESRD medical attachment s Lab Test Result line or Medical Documentation line to delete the line You will be prompted to confirm the deletion When the focus leaves a medical attachment form field either by pressing the TAB key or clicking on a new field an edit validation process is performed on the field losing the focus Edits performed at this time are referred to as field level edits If a f
87. 0 0 cccceeeeeeeeeeeeeceeeeeeeeeeeeeeeaaeeeeeeaaeeeeeeaaaeeees 27 Setup oft HCFA 1500 SYSteMSs s ccssucticaut cancels AEAEE EAE anes Dee dich reed 42 Setup of Medicare Part A SysSteMS seirena eean Ee a Aae E EAA Ei anaa Eaa 28 Setup of UB92 All Payer SystemS ssssssesissesrrsiesrriinsrrrresrttrsrnninsrnttunanttnanttunnntnanantennnnna 35 Submitter File Maintenance rra a eE E AARE EAE E E AN ATREA EAREN 168 submitter information 2 2 0 0 ccc cc cece cece cc eece ee seceeeneceeeneceeeseceeeuecseenenseesecseeneceeeseceeeseneeenenes 168 170 system requireMent incicertete ceed n ive eee cing divi ned a indent 5 system level security setting 0 2 eee cece eece eee ee cece ce ee ee ee cane tees cane tees caaaeeeeaaaaeeeeaaaaeeseaaaaeeeeaaaa tees 89 212 T tOOIbar is ee tte WAS ein eee te ee eta 50 Transmission acknowledgment files 0 cceceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeaaeeeeeesaeeeeeeaaeeeeesaaeeess 122 transmission filG archive a rs aa aE AE ens pile aa acd eonre tallest Queens AA agtbewet ian eaten 124 Transmitting electronic Claim TeS eccoir eia cece ener seca Ei eai E aR aa ei 120 Troubleshooting isi en iiare oranie Bee Nees ined E Peaid Bee paia SATIP 204 205 Recovering from an interrupted claim prepare rUn ce eeeeeeeeceeeeeeeeeeeaeeeeeeeaaeeeeeeaaeeeeeeaaeeeees 205 Reviewing the claim activity l0gS ccccceeeeeceaneeeeeeeeeeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaaeeees 204 Type of Bill TOB
88. 00 Provider reference files between migration attempts 1 Make sure that PC ACE Pro32 is closed before beginning this migration process 2 From the Windows Start menu select the PC ACE Pro32 Migration Utility item in the MedLink Technologies PC ACE Pro32 programs folder This will start the migration utility and display its main form 3 Select the HCFA 1500 system type 4 Select the drive containing the BSACE directory from which you intend to migrate the HCFA 1500 All Payer claims data For example if you select the C drive then the migration utility will expect to find the files BSENTRY IDX the DOS claims entry database BSTRACK IDX the DOS claims tracking database and BSHIST IDX the DOS claims history database in the directory C BSACE For each of these expected files found in this directory the corresponding checkbox in the Select the databases to migrate radio group will be enabled 5 Click the Migrate the selected claims databases checkbox Also click the Entry Tracking and History checkboxes those that are enabled Finally click the Migrate button to proceed The migration utility will proceed to dump the contents of your claims 23 databases into temporary files that will then be imported into the PC ACE Pro32 claims database 6 When the migration process has completed click the Close button to exit the PC ACE Pro32 Migration Utility Reviewing the Migrated Claims This
89. 9 170 EMC National Version HCFA 1500 only specifies the desired NSF version of the EMC file For example a value of 00301 indicates that an NSF 3 01 output file should be generated EMC Local Version HCFA 1500 only specifies a local version number required by some distributors ANSI Version 837 specifies the desired version of the ANSI 837 transmission file You should change this value only under instructions from your distributor ANSI Version 276 specifies the desired version of the ANSI 276 claim status request file if this feature is enabled on your installation You should change this value only under instructions from your distributor EMC File specifies the desired EMC filename using the standard DOS 8 3 naming convention Leave this field blank to use the default EMC filename Vendor specifies an optional Vendor number required by some distributors Code No specifies an optional Submitter Code Number required by some distributors Password HCFA 1500 only specifies a submission password required by some distributors Acknowledge Request HCFA 1500 specifies whether or not a functional acknowledgment is requested Some distributors require this option Intermediary specifies the unique Intermediary distributor identification number of the organization processing your electronic claims This identifier is used to trigger distributor specific claim prepare rules Next Serial No spec
90. A Systems section gt UB92 All Payer users proceed to the Migrating UB92 All Payer Systems section b HCFA 1500 users proceed to the Migrating HCFA 1500 Systems section gt Dual system users UB92 and HCFA 1500 proceed to the Migrating Dual Systems UB92 and HCFA 1500 section New PC ACE Family Users If you are not currently using one of MedLink Technologies DOS PC ACE products you will need to perform a complete setup of PC ACE Pro32 before beginning claim processing New PC ACE family users should proceed to the appropriate setup section gt Medicare Part A users proceed to the Setup of Medicare Part A Systems section b UB92 All Payer users proceed to the Setup of UB92 All Payer Systems section b HCFA 1500 users proceed to the Setup of HCFA 1500 Systems section 28 Setup of Medicare Part A Systems This section describes the setup procedures required to prepare your PC ACE Pro32 system for Medicare Part A Only claims processing Topics to be covered include setting up the Payer Provider and Patient optional reference files A section on claim import considerations is included for users who will be importing claims from an upstream claims management system Finally a section covering considerations for claims preparation and transmission should be reviewed E Your distributor may have already completed some of the setup steps described in this section Supplement this setup topic with any installation notes provided by y
91. B92 and HCFA 1500 claims during the patient lookup process e Separate UB92 amp 1500 When selected instructs the system to maintain separate payer insured information sets for UB92 and HCFA 1500 use The single Insured tab will be replaced by separate UB92 and 1500 Insured tabs The appropriate payer insured information will be brought forward into the UB92 or HCFA 1500 claim during the patient lookup process The decision as to whether common or separate payer insured information is required can be made separately for the primary secondary and tertiary Insured tabs Related Topics The following hyperlinks provide additional information related to this topic b gt Refer to the Reference File Maintenance Form topic for a discussion of the common reference file form features and filter options b gt Refer to the Claim amp Reference File Edit Validation topic for a discussion of the edit validation process 157 Adding and maintaining payers The Payer tab of the Reference File Maintenance form provides access to maintain system payer information Setup of the Payer reference file is mandatory although it may be setup in advance by your distributor Payers are accessible during claim entry using the variable list lookup feature When a payer is selected from the lookup list during claim entry all applicable payer information will be automatically loaded into the appropriate claim form fields Payers are uniquely
92. B92 claim New claims are entered and existing claims are viewed and or modified from this form The UB92 Claim Form has been designed to provide a data entry flow resembling that of the printed UB92 HCFA 1450 claim form Claim fields are grouped logically on these major tabs e Patient Info amp Codes includes fields for general claim and patient information Also includes the Condition Occurrence Span and Value code fields e Billing Line Items includes all claim line item fields e Payer Information includes payer provider insured and employer fields for the primary secondary and tertiary payers e Diagnosis Procedure includes fields for diagnosis codes procedure codes and dates physician information and a few miscellaneous data elements e Extended Payer includes less frequently used payer insured and authorization fields for the primary secondary and tertiary payers e Home Health situational includes additional certification data elements which may be required for submission of Home Health claims in ANSI 837 format This tab will be shown or hidden based on the value in the associated ANSF837 Home Health indicator located on the Diagnosis Procedure tab Click the appropriate tab or simply press the PAGE UP and PAGE DOWN keys to move between these major claim form sections Entering Claim Data Click on any field to activate it for data entry or press the TAB key to move from field to field
93. CE eee ee cece eee eect eee eect ee ee ee eeeeea ee eeeeaaeeeeeeaaeeeeeeaaeeeseeeaeeeeeeeaes 157 PC ACE Pro32 Features stcccliseiet nies ee bey dels ie el eee ide Seen 3 PG AGE Pro32 Main T00Ibatsccicetecsscsseneuccie weeds stat AnA ERA A AEREA ARRS ARAARA 50 PC ACE Pro32 Setup Procedures cccececceeeeeeeeeeeeecaeeeeaeeeeeeeeeaaeeeeaeeeeneeees 27 28 35 42 Current DOS PC ACE Users Read This FirSt 0 0 ccceeeeeeeeeeeeeeceeeeeeeeeeeeeeeaaeeeeeeaaeeeeeeaaeeeees 27 Setup of HCFA 1500 Systems eiri rieni ina DAE n Aa EE E EATE taser AERA 42 Setup of Medicare Part A SySteMS cccceeeeee eee ee ee eee eeeeeeee eres saeeeeeeaaaaeeeeaaaeeeesaaeeeeesaaeeees 28 Setup of UB92 All Payer System S seinninn ienien esia eee ee eeee nese E Aa AAE AAEE AEEA ees 35 performance suggestion packing claims databases 2 ccccceeeeeeeceeeeeeeeeeeeeeseeeeeeeeesaes 200 Performing system backups restoreS sesssceessssrriieerrtecerrtteerrttecnrttceatttecantteenntecennnneennnt 197 permissions USET karieri heripaas anina EAEE AAEN AAAA E ANAA AE EA EA AA 89 Place of Service POS File Maintenance ccccceeeeeeeaneeeeeeaeeeeeeeaaeeeeeeaaeeeeeeaaeeeeesaaaeees 184 Pianot Cate 485 486 Formic cietieeces i aae eaea EE A REES EE E 73 Posting claim payments HCFA 1500 eecseeeeee a eeeeee ee eeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaaeeees 138 Posting claim payments UBQ2 eecececeeeeeee ne
94. DA systems The PC ACE Pro32 Migration Utility permits you to easily migrate your current DOS MEDA submitter payer and patient optional reference file data as well as your existing claims into the PC ACE Pro32 system Once you have performed this migration procedure you will be directed to proceed to the appropriate topic to complete any additional setup tasks required E Your distributor may choose to supplement or replace these migration procedures Refer to any installation notes provided by your distributor before continuing If you are in doubt about whether or not you need to perform these steps contact your distributor for assistance Your distributor has the option to configure the PC ACE Pro32 Migration Utility to migrate the 12 providers in the DOS MEDA system Submitter file SUBMIT DAT into the PC ACE Pro32 system If this migration option has been pre selected the records in the optional DOS MEDA Provider file PROV IDX will be migrated as well It should be evident whether or not your provider information has been migrated when you complete the section below on setting up your UB92 Provider reference file records If the provider records have been migrated you will simply need to update each record to add any additional required information Address Tax ID etc hS You may want to print this help topic and refer to the printed version as you perform these migration steps You can check off the steps as they are completed Th
95. File Maintenance 00 ceeceeeeeeceeeee cece eeeeeeee ee eeeeeaeeeeeeaaaeeeeeaaaeeeeeaaaeees 179 Type of Service TOS File Maintenance ceceeeeeeeeeeeeeeeeeeeeeeeeeeeaeeeeeesaaeeeeeaaeeeeeeaaeeees 185 U UB92 Claim FOrMicsssciscdshieteastendacedeotaseenandddceteus yadendiarawardedbacantaatideiandieeantionaaaidetaawenes 57 58 60 UB92 Medical Attachment Forms ccccccceesscceeeseneeeneceeeneceeeneneesseneeeneneesneneeanenesenes 79 81 UB92 Medical Attachment List Form Features ccecceeeeeeeeeeeeeeeeeeeeeeeeaeeeeeeeeaeeeeeeeeeeeeeeeees 76 UNArCHIVING CLAIMS 222 sic ed eea anan EAE dacedd tnsd coe oe shane ny lena ced dnc aawene hast eees oe sheen tata eeaten 140 UPIN Physician File Maintenance ccceeeeeeenneeee eee eect ee aaeeeeeeaaeeeeeeaaeeeeeaaeeeeeaaeeeeeeaa 178 USEF permissions oncer itai erie ati Eina deve ddd ay ANA hee Mav sideveveg dd davies eeees EE CE Aa 89 USING ClaiM arChIVES wc 2 02 err e eirean ea eden iter a eiaa ea Aaka A Ea NE EARE ea FOAN 140 using the HOFA 1500 Glaim TOn oeo enas EE A EE EA AEE AAEE E EEAS EEAS 61 using the HCFA 1500 roster billing fOrm 2 0 0 0 cece eeeeeeeee ee eeee cece ee ee cess ae eeeeeeaaeeeeeeaaeeeeeeaeeeeeeeeees 68 using the Plan of Care fOr oont seiate eataa tees aa eeeeeeaeeeeeeeaaeeeeeeaeeeeeeeeeeeeeeeaeeeeeeeeees 73 using the UBI clati i eaea Ee aea adh EEAS TEEN RERA AE TIR NEAS E EAAS KEENE 57 using the UB92 Medical Attachment forms
96. Medical Attachment List Filter Options drop down lists Basic filter options include e Location filters the medical attachment list to include only attachments in the to be transmitted CL or transmitted TR locations e Status filters the medical attachment list to include only attachments assigned a specific status The possible status codes are clean ready CLN has fatal errors ERF has errors ERR held HLD and unprocessed UNP e Type filters the medical attachment list to include only attachments of a specific type Supported attachment types are Outpatient Rehab Plan of Treatment 700 Outpatient Rehab Plan of Treatment Update 701 Ambulance Medical Data AMB and End Stage Renal Disease ESR In addition to these basic filter options the UB92 Medical Attachment List form also provides a number of Advanced Filter Options These advanced options permit filtering on the medical attachment s patient payer provider date ranges batch information and bill types When multiple filter criteria are specified only those medical attachments that meet all filter criteria will be displayed A convenient Clear Filters item is also available from the Filter main menu to quickly remove any existing filter criteria UB92 Medical Attachments Actions The UB92 Medical Attachment List form may also be used to perform specific actions on any individual medical attachment or a group of selected medical attachmen
97. Menu form From the Claims Menu form select the main menu Maintain and Reverse Claim Import items to display the Claim Import Reversal Utility form Select the Reverse most recent claim import operation radio button and click the Continue button to proceed The Claim Import Reversal Confirmation form will be displayed containing a list of all claims imported in the most recent run If the Reverse most recent claim import operation radio button is disabled the system cannot determine the specific details of the most recent claim run Also notice the Delete all unprocessed claims for date range radio button which provides an alternate technique for selectively deleting unprocessed claims by date range Click the Check All Claims button to mark all claims from the previous claim import run for deletion Click the Delete Checked Claims button to perform the deletion E Claims can only be reversed if they remain unprocessed i e their claim status UNP Once a claim has been processed or materially changed it is no longer eligible for reversal If any claims in the selected deletion list are no longer eligible for reversal you will receive a notification message for each such claim These ineligible claims must be located and deleted manually from the Claim List form When the reversal operation completes the Claim Import Reversal Confirmation form will close automatically Processing claims automatically
98. PC ACE PRO32 CLAIMS PROCESSING SYSTEM USER S MANUAL Release 1 53 August 2002 Copyright 1998 2002 MedLink Technologies Inc All Rights Reserved Table of Contents Introducing PC ACE Pro32 4 Getting started with PC ACE Pro32 6 Migrating from a DOS PC ACE System 9 Migrating Medicare Part A SystemS ceccceeeeeeeeneeeeeeaaeeeeeeaaeeeeeaaeeeees 10 Migrating UB92 All Payer Systems eeeeeeeeeeeeeeaneeeeeeaaeeeeeeaaeeeeeeaaeeeees 15 Migrating HCFA 1500 SyStems eceeceeeceeeeeeeeeeaeeeeeeeaaeeeeeeaaeeeeeeaaaeeees 20 Migrating Dual Systems UB92 and HCFA 1500 cc ceeeeeeeseeeeeeeaeeeeees 25 PC ACE Pro32 Setup Procedures 27 Current DOS PC ACE Users Read This First enerne 28 Setup of Medicare Part A SySteMS ccceeeeeeeneeeeeeeeaeeeeeeaaeeeeeeaaeeeeeeaa 29 Setup of UB92 All Payer SySteMS cccceeeeeeeneeeee cena eter eeaaeeeeeeaaeeeeeeaa 36 Setup of HCFA 1500 SySteMS 0 ccceeeeeeeneeeeeee ee eeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaa 43 Main Toolbar amp Forms 50 The PC ACE Pro32 Main Toolbar ccceeeeeeeceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeees 51 UB92 amp HCFA 1500 Claims Menus cceeeeeeeeeeeeneeeeeeaeeeeeeeaaeeeeeeaaea ees 52 Claim List Form Features noeneen in A aea i ke ea eaaa a iari eiia 53 The UB92 Claim Form iiinis eiiieaen ania dea eaa ai ea a ai Tiia 58 The HCFA 1500 Claim Form eiiie a E Ee N E A 62 Roster Billing List Form Features
99. PC ACE Pro32 Main Toolbar Provider Reference File Setup This section describes the process of setting up the UB92 Provider reference file This file contains information about the valid providers in your system All providers for whom you will be billing Medicare Part A claims must exist in the UB92 Provider reference file The UB92 Provider reference file is organized such that each record describes a valid provider for a singleline of business LOB This organization allows for greater flexibility in specifying Provider IDs and support information Tax ID address etc that can vary across multiple LOBs for a single provider Complete the following steps as needed bS You may want to refer to the Adding and maintaining providers UB92 topic for more information on entering UB92 Provider records If you do make sure and return to this topic to continue the setup steps 1 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form Select the Provider tab to display a list of all existing Provider records 2 If you have just installed PC ACE Pro32 the Provider list should be empty If so skip to the next step 30 amp If you have migrated to PC ACE Pro32 from the DOS version of PC ACE you may already have one or more Provider records on file depending on whether or not your distributor has configured the PC ACE Pro32 Migration Utility to migrate the provider
100. Place of Service POS Codes amp ASSIQNMENTS ccceceeneeeeeeeeeeeeeeaaeeeeeeaaeeeeeeaaeeeeeananeess 184 Provider Specialty ooie Sv hec tives lee ae ovis beg daw ae VEA cated eae E oe NDANE ENE 189 Provider Taxonomy CodeS nids cious tence eta EEA ARA ated ae dices EE ernie cadet 190 Revenue Codes amp ASSIQNMeNtS ccccecceecece cc eeeeee cece eeeecaaeeeeecaaaeeeeaaaaeeeeaaaaeeeeaaaaeeeeaaaa ees 181 SUDMtle his neiiv naate ecclesia ees 168 169 170 171 TPS f Bill Qi B sa cise a a acaetete ret A las eee Aes eed A oat eC a tat at 179 Type of Service TOS Codes amp ASSIQNMENTS cceeeeeeeeeeeeeceeeeeeeeaeeeeeeaaeeeeesaaaeeeeaaeeeees 185 UPIN PAYSICIAN aricii ge aaa deduce deveeveden N e a EA 178 Rehab 700 701 medical attachment 0 ccccceeeeeeeeneeeeeeaaeeeeeenaeeeeeaaeeeeeeaaeeeeseaaeeeeeeaaaeees 150 repot Printing PlETELENCSS eani E E A fedhedadededy eta 98 restoring from a PC ACE Pro32 backup ssssssssscssesssrreeserrriserrrieerrtesentteeenntneennteeennterennreee 197 retransmitting an EMG Tile scceecsfoeectestvetenninenttentadtes r a Aaa Ea e eea aa a 124 Revenue Codes File Maintenance ceceecnneeeeee ee eeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaeeeeesaaeeeesaaeneees 181 Reversing the most recent Claim import PUN 000 2 cece eee cece cence eeee ee eeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaeeeees 113 reviewing a claim s status request response history ceeeeeeeeeeeeeeeeeeeeeaeeeeeeaaeeee
101. Plan of Care Form vies vase eet neni dese Mice a a a a ee a 73 Home Health Plan of Care List Form Features 0 ccecceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeaeeeseneees 71 host phone and lOGin SCtUD ccceeeeeeeneeeee eee ee cece nate ee ee canes ea Aa EEan A Cae AAA AET AAN 172 how to Complete a claims nussii iea orgi akira a EEE KN A a ANE 106 how to complete a Home health Plan of Care cceeeececeeeeeeeeneeee cena eeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaa 145 how to complete a roster DIMMg srana eaen E EEEa ERA ORTE eA AA AEE EAEE EE e 142 how to complete a UB92 Medical Attachment ccceeeeeeeneeeeeeeaeeeee tena eeeeeeaaeeeeeeaaeeeeeeaa 150 howto getstarted ecn aeea rece ATena ces ene ebes ths ALEAR ARAT EEA IA Cap ALEE reaa TA NOATE 5 How to use the on line help SyStem esssssssrssesrrsrssrrrreerrtrssrnrnesnnttnsantnuenntensantneenntensantneennnt 5 l ICD9 Codes File Maintenance sensein eiei n RT R AN EEE 177 image overlay claim print method sssesesssesessesnreesenreesernresenttteernteeennteeenntecennteeennterenneeee 133 imparino clais renauit AA E RATE eA e ERT E 109 Installing PEACE PEIZ are R AE A AAE EAA REE AE ER ANNS 5 Intermediate Format File claim import method cceceeeeseeeeeeaeeeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaeeees 109 fnroducing FOC ACE ProS2 ooa a aarep N E ARKE nate oh elim atte 3 L launching data communications functions ce ceee cece ee neee cece ee eeeeeea
102. Plan of Care action to delete the selected plan gt IMPORTANT Deleted plans are permanently purged from PC ACE Pro32 they cannot be recovered e Printing Plans of Care Choose the Print Selected Plan of Care action to print the selected plan See the Printing Home Health Plans of Care topic for more details e Refreshing the Plan of Care List Choose the Refresh Plan of Care List action or press the F5 function key to refresh the current Plan of Care List form contents This action can be useful in a multi user installation to be sure that the list properly reflects plan additions and or modifications made by other users You will notice that only applicable actions are enabled for use in the main Actions menu or pop up menu For example the all checked actions will be enabled only when one or more plans in the list are checked Actions on Multiple Plans of Care Some actions can be performed on multiple plans at once Multiple plan selection is accomplished by checking the plans of interest and subsequently performing one of the All Checked Plans of Care actions To check a plan click the left mouse button over the checkbox in the first column of the desired list row Alternatively all plans in the current list can be checked using the Check All Plans of Care item from the list s pop up menu Use the form s flexible advanced filter techniques to display only the subset of plans to be printed deleted e
103. PrintLink mapping procedure on a sample print image file that you have supplied This mapping process defines the template used to extract and interpret fields from your print image file Since all upstream systems print claims in a slightly different format this mapping process is required to build your custom template 2 Obtain the resulting map file from your distributor This file is typically named h1500 map but can be any valid filename with a map extension The map file must be placed in the server s winpcace imp1500 directory 3 Confirm the existence of the required map control file This file provides a control interface between the output of the PrintLink translator and the PC ACE Pro32 claim 47 2 import routines The map control file is always named mapcentlh win and should be located in the server s winpcace imp1500 directory Setup all required PrintLink Matching Description strings in the Payer reference file These strings are used to match payer descriptions from claims in the print file to specific Payer reference file records Refer to the Adding and maintaining payers topic for details on setting up your PrintLink Matching Description strings Each time you want to import claims copy the new print image file generated by your upstream system into the server s winpcace imp1500 directory The first line of the map file provided by your distributor dictates what the print image file must be named ty
104. S codes if any can be maintained by the distributor or user and include any additional HCPCS codes valid in your area but not included in the global list Select the Global codes or Local codes radio button to display the desired list Then perform one of the following functions e To add anew HCPCS code click the New button and enter the new HCPCS code information Enter the effective date range using a 4 digit year format e To view or modify an existing HCPCS code select the desired code from the list and click the View Update button or double click on the desired code e To delete an existing HCPCS code select the desired code from the list click the Delete button and confirm the deletion AS The HCPCS Codes form provides several List Filter Options that can be helpful in locating specific codes Refer to the Reference File Maintenance Form topic for more discussion of these common filter options Effective Date Range The Effective Date Range dates are compared to the claim s date of service range during the claim edit validation process If the effective date range for a HCPCS code falls outside the claim s service date range an edit validation error will be reported If the effective date range is left blank the HCPCS code is valid for all dates of service If the start date is completed but the end date is left blank the HCPCS is valid for all dates of service from and including the start date forward If the
105. Select the map print file to be imported from this list If you are using the PrintLink claim import method but only one map file is defined this drop down list will not be visible If you are using the Intermediate Delimited Format claim import method the system assumes that the file to be imported has already been placed in the claim import directory This file must be named plink out If you are using the Electronic Media Claims EMC File claim import method and you have multiple EMC files in the server s claim import directory with dat extensions you will see a drop down list labeled Select EMC File Select the EMC file to be imported from this list If you are using the EMC File claim import method but only one EMC file is present in the claim import directory this drop down list will not be visible 4 Click the Import button to initiate the claim import operation As the import proceeds running totals of the count and dollar value of all imported and rejected claims are displayed on the Claim Import form You will be notified when the claim import operation completes Claims are rarely rejected during import into PC ACE Pro32 The most common reason for rejecting a claim is that the claim is a duplicate of an existing unprocessed UNP claim in the to be transmitted CL location This can sometimes occur if the same file is inadvertently re imported into the system 5 If desired click the View Results and
106. Selected Transmission item from the form s main Filter menu The UB92 or HCFA 1500 Claim Transmission Log form will display a list of recent transmission files with the most recent automatically selected Select the desired transmission file entry and click the Select button Upon return to the Claim List form the program will automatically check all claims included in the selected transmission You may then simply choose the Reactivate All Checked Claims item from the form s main Actions menu to reactivate these checked claims Refer to the Claim List Form Features topic for more information Refer to the Claim List Form Features topic for more information on using the UB92 and HCFA 1500 Claim List forms Reactivating an Entire EMC File for Retransmission PC ACE Pro32 archives all prepared EMC files for a duration determined by a Miscellaneous Preferences setting Until an EMC file is purged from the archive it is available for reactivation and subsequent retransmission Retransmission of an EMC file might be required for 125 example if the receiver has determined that a previously sent file was somehow corrupted during transmission Reactivation of an EMC file consists of restoring the selected file from the archive to its original prepared filename in the server s winpcace directory After reactivation the EMC file and other associated system settings exist just as they did when the file was originally prepared for
107. Submitter File Maintenance topic for details on configuring the Submitter reference file b Refer to the Transmitting electronic claim files topic for more information on transmitting the prepared EMC file b gt Refer to the Reactivating previously transmitted claims topic to learn how transmitted claims can be selectively reactivated for re transmission b gt Refer to the Recovering from an interrupted claim prepare run topic to see how PC ACE Pro32 can recover from an interruption in the preparation process 120 Transmitting electronic claim files PC ACE Pro32 interfaces seamlessly with third party communications packages to transmit Electronic Media Claims EMC files This approach assures maximum flexibility for the distributor and eliminates any PC ACE Pro32 dependencies A convenient launch facility makes it easy for the user to initiate file transmissions and other data communications functions terminal emulation sessions for example PC ACE Pro32 may be configured to launch any required data communications functions without exiting the program Before you are ready to transmit you must have already entered or imported and processed one or more claims and prepared these claims into an EMC file suitable for transmission Let s assume your system has been configured to launch a data communications program that will transmit the prepared EMC file to your claims processor You can initiate this file transmission with the
108. The roster billing entry form will be displayed containing the details of the newly copied roster billing The Service Date field is cleared automatically in the new roster billing This roster billing copy function is often used to duplicate a previous roster billing greatly simplifying the process of billing for periodic immunizations on a relatively consistent set of patients Generating Roster Billing Claims Click the Generate button or choose the Generate Selected Roster action to automatically generate claims for the selected roster billing Upon completion of the claim generation process you may view the roster billing report if desired A successfully generated roster billing is automatically moved to the generated GR location Refer to the Listing modifying and maintaining roster billings topic for more information on this claim generation process PC ACE Pro32 uses the claim import report preference settings to define the default reporting options for the roster billing generation process Refer to the Printing Preferences topic for information on configuring claim import and roster billing generation reports to be printed automatically or to a specific printer Viewing Roster Billing Reports Choose the View Selected Roster Report action to preview the report for a previously generated roster billing The report may be printed from the preview screen if desired Purging Roster Billings Choose the Purge
109. You may want to refer to the Adding or modifying a system user topic for more information on adding and maintaining users If you do make sure and return to this topic to continue the setup steps 1 Select the main Security menu from the P C ACE Pro32 Main Toolbar and choose the Add Update User item The Security List form will display a list of all existing user accounts 2 To add a new user account click the New button on the Security List form and assign the user a User ID Password and Name Assign permissions to this user and click the OK button to save the new user record X Check the checkbox next to the permission to allow access to the activity Click the Check All and Clear All buttons to quickly check or un check all user permission checkboxes 3 Repeat the previous step to create additional user accounts 39 If changes are made to a user profile the changes will not go into effect until the next time that user logs into system Select the Logout Current User item on the main Security menu to manually log out without exiting the system S You should change the default user s password as soon as possible if you are concerned about controlling user access at your facility Claim Import Considerations This section describes setup considerations that should be reviewed only if you intend to import claims into PC ACE Pro32 from an upstream system If you will not be importing claims skip this section
110. a TOB record select the desired record from the list click the Delete button and confirm the deletion To modify an existing TOB record you must delete the existing record and add a new record with the correct information 180 Condition Occurrence Span Value Codes File Maintenance The Condition Occurrence Span Value Codes form provides an interface to maintain the condition occurrence span value codes and assignments This reference file applies exclusively to UB92 claims These codes are pre loaded and should not require frequent additions or modifications The Condition Occurrence Span Value Codes form includes two tabs K K ww Descriptions displays a list of Condition Occurrence Span Value codes and descriptions Maintenance operations available include Type filters the Condition Occurrence Span Value code list to include only those codes of the specified type To add a Condition Occurrence Span Value code click the New button and enter the new code information To view or modify an existing Condition Occurrence Span Value code record select the desired record and click the View Update button or double click the desired record To delete a Condition Occurrence Span Value Code record select the desired record from the list click the Delete button and confirm the deletion Codes TOB displays a list of valid code assignments for specific Line of Business LOB code type and Type of Bill TOB
111. able for transmission to your claims processor This EMC file will contain all relevant submission details for one or more processed claims Only claims in the to be transmitted CL location with an electronic E media setting are eligible for preparation When a claim is prepared into an EMC file it is automatically moved to the transmitted TR location Residence in the transmitted TR location reflects its transmitted state and also prevents the claim from being inadvertently retransmitted Before preparing claims for the first time you may need to setup your Submitter reference file This file contains important data that will be used to build the EMC file Separate submitter details exist for UB92 and HCFA 1500 claim types Since some distributors pre configure the Submitter reference file you should check with them before making any changes Refer to the Submitter File Maintenance topic for more information on configuring this important reference file In addition to standard claims PC ACE Pro32 also supports electronic submission of several commonly used UB92 standalone medical attachments If such medical attachments have been created and are eligible for transmission they will by default be prepared into the same EMC file as the eligible claims See the Preparing UB92 Medical Attachments for transmission topic for more information To prepare claims in PC AC Pro32 follow these simple steps 1 From the PC ACE Pr
112. ach line of business LOB handled by that payer For example if payer 12345 will receive both Medicare and Medicaid claims then two Payer records must be added both with Payer ID 12345 one with LOB MCA and the other with LOB MCD 3 Click the Save button to save the new Payer record An edit validation process will be performed to check for problems with the payer information When prompted correct any missing or invalid field values if present and re save as needed The new Payer record should now be visible in the Payer list If you plan on using the PrintLink feature of PC ACE Pro32 to import claims from print image files then you will also need to add PrintLink Matching Description strings to this Payer record The Claim Import Considerations section later in this topic will lead you through this process 4 Repeat the relevant steps to create additional Payer records as needed This may include records for the same payer and different LOBs or records for additional payers 5 When all desired Payer records have been added click the Close button on the Reference File Maintenance form to return to the PC ACE Pro32 Main Toolbar Provider Reference File Setup This section describes the process of setting up the UB92 Provider reference file This file contains information about the valid providers in your system All providers for whom you will be billing UB92 claims must exist in the UB92 Provider referenc
113. additional information related to this topic gt Refer to the Importing claims topic for a detailed description of the claim import methods and optional preprocessor 98 Printing Preferences PC ACE Pro32 preference settings are organized on a tabbed dialog accessible from the PC ACE Pro32 Main Toolbar s main File menu The Printing Preference tab allows the user to specify options to control the printing of UB92 and HCFA 1500 claim activity reports claim forms and claim attachments If your installation is licensed for both UB92 and HCFA 1500 claim activities first select the appropriate claim type from the UB92 Printing Options or HCFA 1500 Printing Options radio buttons near the top of this tab If your installation is licensed for only one claim type then this selection option will not be visible The printing options are organized in a series of nested tabs as follows e Import settings on this tab control the printing of claim import reports These include Automatically print claim import reports on completion specifies whether claim import reports will be printed automatically i When checked the claim import reports automatically print after the claim import operation has completed M When unchecked the claim import reports will not print automatically You will still have the option to print the reports manually Print claim import rejection report even when all claims accepted specifies w
114. aded and should not require frequent additions or modifications The Place of Service POS form includes two tabs Descriptions displays a list of Place of Service POS codes and their descriptions Maintenance operations available are e To add a POS code click the New button and enter the new POS code information Enter the effective date range using a 4 digit year format e To view or modify an existing POS record select the desired record and click the View Update button or double click the desired record e To delete a POS record select the desired record from the list click the Delete button and confirm the deletion Assignments defines the list of valid Place of Service POS codes for each line of business LOB These assignments will also determine which POS codes will be included in the POS lookup list presented during claim entry The POS assignment maintenance options include e Select LOB filters the assignment list to include only assignments for a specific line of business When a specific LOB is selected it will be used as the default LOB for new POS code assignments e To add a new POS code assignment record click the New button on the Assignments tab Select the default LOB and POS code from the drop down lists e To delete a POS code assignment record select the desired record click the Delete button and confirm the deletion Effective Date Range The Effective Date Range dates are c
115. aeeee senna eeeeaaeeeeeeaaeeeeeeaa 120 Launching the ANSF835 Electronic Remittance Module ee cece ee testes eee e eens 196 Listing and modifying ClAIMS iscrio sviri cece cette cette ee eee e nate eterna Aaa ane eeeeaaeeeeeaaaeeeeeaa 107 Listing and modifying Plans of Care eeeeecceeeeeeeneeeeeeeee ee ee cena eee sean eeeeeaaeeeeeeaaeeeeeaaeeeeeaa 146 Listing and modifying roster DIIINGS 2 0 02 eee eee eee e cette cece ee aea AE E Eare AARI EESE AEEA EE 143 Listing and modifying UB92 Medical Attachment c eecceeeeeeeaneeeeeeaeeeeeeeaaeeeeeeaaeeeeeeaa 151 Logging in for the first tiMe sses arent ea aeina ea e ee aa ee eeeeaaeeeeaeaaeeeeaaaaeeeeseaaeeeeaeaaeeesaaaaeees 5 M MAIN TOOIDAN ssasie sscesasetschesoossckadintahmen ods a AA R AEA E A OAE EAA 50 Maintaining rerent e MeS enaena naea A ES N ORAA E AiE 83 maintaining various code reference files 2 0 0 0 eeeeccee cece ee neee cece ae eeeeeeaaeeeeeeaaeeeeeaaeeeeeaaeeeeeeaa 167 Medical Attachment Forms UBQ2 0 0cececceeeeee ee eeee eect ener ee ee tees eA KATERA REA E ARA 79 Medical Attachments UB92 eire reiii e ea E A OA RRA 150 Migrating from a DOS PC ACE SyStem ccccceeceeeeeceeeeeceeeeeaeeeseeeeesaeeeeeeeeaaees 9 14 19 24 Migrating Dual Systems UB92 and HCFA 1500 sseeeeseerisssrrsssrrrresrriinsrrrresrrrrssrrrreens 24 Migrating HCFA 1500 Systems ornas a A AA ieee AEE E a 19 Migrating Medicare Part A SystemS
116. again to move to the next field Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the plan edit validation process 75 Saving amp Canceling Plans of Care After completing data entry on the Plan of Care form click the Save button or type lt ALT gt S to save and exit the plan Alternatively click the Cancel button to abandon any changes and exit the plan When an attempt is made to save a plan an edit validation process is performed on all fields on the plan This process includes re evaluating all field level edits as defined above In addition all plan file level edits are evaluated File level edits are evaluated only when the plan is saved and are typically those edits that require multiple data elements from the plan in order to be evaluated If no edit validation errors occur the plan is saved with a clean CLN status If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List form This form lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the plan edit validation process and the Edit Validation Errors List form If edit errors exist you will usually have the option to correct the errors or save the plan with errors If a fatal error exists on the PCN f
117. aining the claim status request response history topic for information on viewing and maintaining status request response history for transmitted claims 131 Viewing and maintaining the claim status request response history PC ACE Pro32 keeps a history of claim status requests and responses for each transmitted claim Requests are added to this history log as the final step of the ANSI 276 claim status request prepare operation Responses are recorded in the history log during automatic posting of the ANSI 277 claim status response files returned from the intermediary or clearinghouse PC ACE Pro32 provides a facility by which users can view print and maintain this claim request response history This topic describes how to access and use this advanced capability Refer to the Related Topics links at the end of this topic for more information on how to request claim status and process the returned status response files Support for ANSF276 277 claim status request response files may not be available on all installations If the Purge archived ANSI 277 acknowledgment files after NN days option is disabled grayed out on the PC ACE Pro32 Miscellaneous preferences form then this capability is not available on your installation Determining Status Request Response Availability The UB92 and HCFA 1500 Claim List forms include the following columns for use in determining the availability of status request response history for transmitted c
118. an be used to enhance productivity by automatically performing time consuming tasks that night otherwise require an operator to be present Tasks may be scheduled for either one time deferred execution or daily recurring execution at a specified time by clicking the Claim Activity Scheduling button on the PC ACE Pro32 Main Toolbar This claim activity scheduling feature may not be available in all installations You will be notified when you attempt to enter the scheduling module if the distributor has disabled this feature The Claim Activity Scheduling form consists of 3 tabs each for UB92 and HCFA 1500 claim activity scheduling If you are licensed for only UB92 or HCFA 1500 claim activities but not both then you will see only a single set of 3 tabs A common set of 3 scheduling options are presented on each of the tabs No claim scheduling when selected no claim import processing or transmission activity is currently scheduled A ee Manually initiate deferred claim one time execution when selected the scheduler will initiate a one time claim import processing or transmission activity at the next occurrence of the specified start time lt 7 Automatically initiate deferred claim each day when selected the scheduler will initiate a claim import processing or transmission activity daily at the specified start time In addition to selecting the desired scheduling option each scheduled activit
119. ance form to return to the PC ACE Pro32 Main Toolbar Patient Reference File Setup This section describes the process of setting up the Patient reference file Setup of the Patient reference file is optional If you choose to setup patients the complete patient list will be accessible during claim entry using the variable list lookup feature When a patient is selected from the lookup list during claim entry all applicable patient information will be automatically loaded into the appropriate claim form fields Complete the following steps as needed 45 hS You may want to refer to the Adding and maintaining patients topic for more information on entering Patient records If you do make sure and return to this topic to continue the setup steps 1 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form Select the Patient tab to display a list of all existing Patient records 2 If you have just installed PC ACE Pro32 the Patient list should be empty If so skip to the next step S If you have migrated to PC ACE Pro32 from the DOS version of PC ACE your Patient records may already be on file If so you can skip the remainder of this section If the list is not empty and you have not migrated from a DOS version of PC ACE any existing Patient records are likely there as samples only Once you have confirmed that this is the case delete all sample Patient r
120. ate staging directory The UB92 and HCFA 1500 staging directories are UB92 winpcace ansi277 statub92 HCFA 1500 winpcace ansi277 stat1500 For single user installations these directories will reside on the local drive letter to which PC ACE Pro82 was originally installed For multi user networked installations these directories will reside on the shared network drive letter to which PC ACE Pro32 was originally installed Sp Care must be taken to copy UB92 claim status response files to the UB92 staging directory and HCFA 1500 claim status response files to the HCFA 1500 staging directory In addition if your intermediary assigns the same filename to all ANSI 277 files you will need to make sure that the most recently staged claim status response file has been archived before copying a newer response file into the staging directory hS Installations that use data communications scripts to retrieve the ANSF277 acknowledgment files may also automatically copy them to the appropriate staging directory Your distributor should be able to confirm whether or not automatic ANSI 277 file staging will be performed on your installation Viewing Printing amp Maintaining Claim Status Response Files and Post Reports 129 Archived ANSI277 claim status response files and response post reports can be viewed and or printed from the Claim Status Response Log form To view the currently archived ANSI 277 files select the Maintain and Claim Statu
121. atient records as needed 6 When all desired Patient records have been added click the Close button on the Reference File Maintenance form to return to the PC ACE Pro32 Main Toolbar User Account Setup PC ACE Pro32 requires that a valid login and optional password be entered by anyone desiring access to the system The system administrator must set up a user account for each person that will use PC ACE Pro32 The user account specifies the user s login password values and defines which activities the user has permission to perform As shipped PC ACE Pro32 is configured with a single default user with full system access rights The default user s User ID is SYSADMIN and password is SYSADMIN as well Complete the following steps to add additional user accounts 32 hS You may want to refer to the Adding or modifying a system user topic for more information on adding and maintaining users If you do make sure and return to this topic to continue the setup steps 1 Select the main Security menu from the P C ACE Pro32 Main Toolbar and choose the Add Update User item The Security List form will display a list of all existing user accounts 2 To add a new user account click the New button on the Security List form and assign the user a User ID Password and Name Assign permissions to this user and click the OK button to save the new user record X Check the checkbox next to the permission to allow access to the activity
122. ation that you need to know about printing claims in PC ACE Pro32 K Od Ke K t d The image overlay printing method option will be enabled only if the Adobe Acrobat Reader Version 4 0 or later is properly installed on the system You must exit PC ACE Pro32 before installing the Acrobat Reader A properly installed reader will be detected automatically the next time PC ACE Pro32 is started If necessary you can manually configure the Acrobat Reader executable file ACRORD32 EXE path from the Misc tab of the PC ACE Pro32 Preferences form hS The Adobe Acrobat Reader has its own preference settings that will let you choose the initial document magnification level and get rid of the splash screen that is shown by default every time the reader is started Claim printing default values for destination printer printing method pre printed forms versus image overlay pre printed position and point size adjustments and numerous miscellaneous options can be set from the Printing tab of the PC ACE Pro32 Preferences form Claim printing defaults are set independently for UB92 and HCFA 1500 claim printing if you are licensed for both claim types These default settings will be used during claim print operations unless overridden at print time from the Claim Print Options form Using the Payer Options selections claims may be printed on behalf of the their alternate payers if desired An alternate payer is any payer spec
123. automatically assigned to the appropriate payer record The migration utility will also copy all PrintLink MAP files and the ANSF835 ETRA Intermediary and Provider configuration files from the DOS HCFA 1500 All Payer system to their corresponding directories in PC ACE Pro32 When the migration process has completed click the Close button to exit the PC ACE Pro32 Migration Utility Reviewing the Migrated Patient and Payer Data This section describes the process of reviewing the migrated Patient and Payer reference file data for correctness and completeness Suggestions concerning where and when to supplement the migrated data will be made when appropriate Complete the following steps E It is important to thoroughly review the migrated Patient and Payer reference file data To insure a smooth transition from the DOS HCFA 1500 All Payer system any required modifications or additions to this migrated data should be made prior to migrating your claims data or using PC ACE Pro32 for daily claims processing activities Execute PC ACE Pro32 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form When prompted to login you may enter the default user s User ID SYSADMIN and password SYSADMIN as well Select the Payer tab and review the migrated payer records Double click any record to see the details for that payer If desired enter the missing address and co
124. be presented with the Edit Validation Errors List form This form lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the medical attachment edit validation process and the Edit Validation Errors List form If edit errors exist you will usually have the option to correct the errors or save the medical attachment with errors If a fatal error exists on the PCN field however you must correct the error before saving the medical attachment Click the Save With Errors button to save a medical attachment that contains only non fatal errors Such attachments are assigned the has errors ERR status Click the Save With Fatal button to save a medical attachment that contains fatal errors Such attachments are assigned the has fatal errors ERF status If edit validation errors occur several Save attempts may be required to correct and save a clean medical attachment At any time click the Errors List button to review the remaining edit validation errors Miscellaneous UB92 Medical Attachment Form Topics The following comments cover a few miscellaneous features of the UB92 Medical Attachment Forms e Entering Free Form Narrative Data The free form narrative fields on the UB92 Medical Attachment Forms will automatically wrap to the next line as typing proceeds beyond the rig
125. button on the PC ACE Pro32 Main Toolbar to display the HCFA 1500 Claims Menu form 2 From the HCFA 1500 Claims Menu form select the Maintain Roster Billings item from the main Roster menu to open the HCFA 1500 Roster Billing List Form All actions to be performed on a roster billing may be executed from the Roster Billing List form Roster billings can be created viewed modified copied deleted undeleted and purged from the list In addition claims may be generated for a selected roster billing and the resulting roster billing report may be printed from this list Refer to the Roster Billing List Form Features topic for complete details on the features and operation of the powerful Roster Billing List form Viewing amp Modifying Roster Billings Viewing and or modifying existing roster billings from the HCFA 1500 Roster Billing List form can be performed with these general steps 1 Use the Roster Billing List form s sorting and filtering capabilities to locate the roster billing of interest in the list 2 Select the desired roster billing in the list and click the View Update button to display the roster billing details in the appropriate roster billing form Alternatively just double click the desired roster billing record in the list 3 Make all desired changes to the roster billing Refer to the HCFA 1500 Roster Billing Form topic for details on the many productivity enhancing features available on the powerful roster bi
126. c b gt Refer to the Miscellaneous Preferences topic for more information on the claim activity log auto purge feature 205 Recovering from an interrupted claim prepare run Claim prepare operations in PC ACE Pro32 require exclusive system access No other users may be running the program while claims are being prepared This exclusivity restriction is imposed intentionally in order to help guarantee the integrity of the prepare operation Even with this protection however it is still possible that an abnormal system and or network failure could result in an interruption of the prepare operation prior to successful completion If this were to happen it becomes important to recover from the interruption in such a way that maintains the integrity of the claims being prepared When the user clicks the Prepare button and confirms the request PC ACE Pro32 saves detailed information about the claims to be prepared before the actual prepare work begins If the prepare process is subsequently interrupted this saved information can be accessed to restore all affected claims to their state prior to initiation of the prepare operation The next time PC ACE Pro32 is executed following the system interruption the program will automatically recognize that a prepare operation was in progress when the interruption occurred Claim Prepare Recovery Options The distributor determines the level of user interaction required to recover from an interrupted
127. cations settings only under the supervision of your distributor or a technical support specialist Incorrectly configuring these options will render the data communications feature non functional Related Topics The following hyperlinks provide additional information related to this topic b Refer to the Transmitting electronic claim files topic for more information on a typical application of the PC ACE Pro32 data communications launch capabilities b Refer to the Data Communications File Maintenance topic for information on configuring data communications parameters and the Data Communications Control File 103 Miscellaneous Preferences PC ACE Pro32 preference settings are organized on a tabbed dialog accessible from the PC ACE Pro32 Main Toolbar s main File menu The Miscellaneous Preferences tab includes the following maintenance and configuration settings K K 7 ko 104 Purge archived EMC transmission files after NN days specifies whether archived UB92 and HCFA 1500 EMC transmission files are to be automatically purged by the system If automatic purging is enabled specifies the number of days EMC files are to be retained lM When checked all EMC transmission files older than the specified number of days will be automatically purged from the transmission file archive M When unchecked all EMC transmission files will remain archived until manually deleted Refer to the Reactivating previously transmit
128. ce files can impact a large number of claims is to your advantage to correct these problems at this point and re migrate the claims if necessary 1 Execute PC ACE Pro32 From the PC ACE Pro32 Main Toolbar click the UB92 Claims Processing button to display the UB92 Claims Menu form When prompted to login you may enter the default user s User ID SYSADMIN and password SYSADMIN as well Click the List Claims button to open the UB92 Claim List form Resize and reposition this form as desired By default the list will contain all claims migrated from your DOS UB92 All Payer claims entry database Double click any record to view the migrated claim details If the Save button lower right is disabled make a superficial change to one of the claim s fields in order to enable this button e g overtype the same patient sex value Click the Save button to save the updated claim An edit validation process will be performed to check for problems with the claim information When prompted correct any missing or invalid field values and re save as needed If you receive edit validation errors indicating an invalid Payer ID or Provider ID you may need to perform additional Payer and or UB92 Provider reference file setup Depending on how many migrated claims these reference file changes will affect you may choose to re migrate the claims rather than correcting these problems on each claim individually By changing the Locatio
129. ceceeeneeeeeeeeeeeeeeeaaeeeeeeaaeeeeeeaaeeeeeaaeeeess 190 purging archived transmission fles eee eeeeee ee eeee cece eee teen ee eeeeeeaeeeeeeeeaeeeeeeaaeeeeeeaaeeeseeeees 103 purging Claim activity lOQS reen eri RARER A ARAE RENAA EREA AESA 103 R Reactivating previously transmitted claimS eseeeeseeeeeeeerriieetrteesrriisstritestrrinetrrtsetrrresrnnt 124 Recovering from an interrupted claim prepare rUn ceeeeeeeeeeeeeeneeeeeeaeeeeeeeaaeeeeeaaeeeeeeaaee tees 205 Reference File Maintenance Form cececcsseeeeceaaeeeeeeaaeeeeeeaaeeeeeeaaaeeeeeaaaaeeeeaaaaeeeeaaeeeeeeaa 83 reference file setup and maintenance168 172 174 175 177 178 179 180 181 184 185 186 187 189 190 Charges Masten iiss ccctissiheniiecactieee ncetetececce fats hee p a a eteawd acd obese cede Paar eee 187 188 Condition Occurrence Span Value Codes amp Assignments ceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeees 180 Data COMMUNICATIONS c ccc cecc cece cc seca ee seceeeeceeeeceeeseceeeseceeesecseesecseenecseeneceeeneneeenes 172 173 FAEM Ak aticte creed E tes Akan E tentn tl taka ld ecco tall Cocina ta Aiea aco Ueate tans 186 HEP CS Codes ses cesco A aT roa A Mankind Cie ti A a A e Mandan fete E a T 174 HCPCS Modifiers amp Assignments ceceeeeeee cece eee ee ee nett ee ee nate ee tt itte esse aaeeeeeaaeeeeeaaeeeeeeaa 175 IG D9 COdeS ever ati iecs tele aga eit ate tated Achaea ht Atte Sod A chad a ad cane 177
130. chive UB92 claims HCFA 1500 Claim Activities specifies user permission to view enter modify delete import process prepare and archive HCFA 1500 claims Reference File Activities specifies user permission to view and update reference files Miscellaneous Activities specifies user permission to access data communications and system utilities schedule claim activities perform database maintenance and system restores Security Maintenance Activities specifies user permission to add and modify system users and their permission settings AN Check the checkbox next to the permission to allow access to the activity Click the Check All and Clear All buttons to quickly check or un check all user permission checkboxes Grant Security Maintenance Activities permissions only to users who need access to add delete users and set user permissions To modify the password name or permissions for an existing user select the user from the Security List and click the View Update button or double click the selection To delete a user select the user from the Security List click the Delete button and confirm the deletion E If changes are made to a user profile the change will not go into effect until the next 90 time that user logs into system The Logout Current User option available from the main Security menu provides a convenient way to log out the current user without exiting the system
131. cific payer within that line of business This feature is useful if your standard charge for a procedure varies depending on the claim s LOB or depending on the payer within that LOB In addition a default record for each HCPCS code may be added using the special lt lt All gt gt pseudo LOB option During HCFA 1500 claim entry the HCPCS code lookup lists will include only the most specific record s available for each HCPCS code For example suppose three Charges Master records have been added for HCPCS code 00100 as follows Code 00100 LOB lt lt ALL gt gt Payer ID left blank Code 00100 LOB COM Payer ID left blank Code 00100 LOB COM Payer ID 12345 The HCPCS code lookup list presented during entry of a commercial claim LOB COM would include only the LOB specific COM records for code 00100 i e the last 2 records The same lookup operation performed during entry of claims for all other LOBs would include only the non LOB specific lt lt All gt gt record for code 00100 When an HCPCS code is entered manually in the HCFA 1500 Claim Form as opposed to performing a lookup operation the program will attempt to locate the most specific record match based on the claim s line of business and payer s For example if the HCPCS code 00100 is entered manually on a commercial claim LOB COM for Payer ID 12345 the program will automatically use the charge amount associate
132. claim A summary of the status response is displayed in the list s columns Additional details for this response are available for viewing if desired see below for instructions This includes general claim identification information along with the claim level status response codes and payment details returned by the intermediary Reference information is also available to locate the original claim status response file should it be needed o K x Attention Indicates that a response was available for this claim however could not be posted for some specific reason Additional information directs the user to the original claim status response report The most common cause for this attention condition is an ambiguous claim status response This occurs when the response file contains more than one response referencing the same unique claim trace number The following operations are available on the Claim Status Request Response History form e To view status response details or attention information select the desired record and click the View button or double click the desired record e To delete a request response entry select the desired record click the Delete button and confirm the deletion e To view and or print the complete status request response history for this claim click the Print History button The report may be printed from the preview form if desired Related Topics The following hyperlinks provi
133. claim types Information from the Submitter reference file is required during preparation of Electronic Media Claims EMC files As such at least one default submitter record LOB lt lt ALL gt gt Payer ID lt lt ALL gt gt must be created before claims can be prepared Additional LOB Payer specific submitter records may also be created if required see discussion later in this topic for more details If your installation is licensed for both UB92 and HCFA 1500 claim activities you must first select the appropriate claim type from the UB92 or HCFA 1500 radio buttons near the top of this tab If you are licensed for only one of these claim types this selection will not be available The maintenance options available on this form include e To add a new submitter record click the New button and enter the required submitter information e To view or modify an existing submitter record select the desired record from the list and click the View Update button or double click the desired record e To copy an existing submitter record select the record to be copied from the list and click the Copy button This copy feature provides a convenient means of creating new LOB Payer specific submitter records Enter the desired LOB and or Payer ID and make any other required changes to the copied fields e To delete a submitter record select the desired record from the list click Delete button and confirm the deletion
134. claims You may now proceed to transmit the ANSI 276 claim status request file to your claims processor using their prescribed file transmission procedure Related Topics The following hyperlinks provide additional information related to this topic b Refer to the Claim List Form Features topic for more information on adding claims to the status request queues UB92 and HCFA 1500 Refer to the Viewing and maintaining claim status response files topic for information on viewing and maintaining the ANSI 277 claim status response files that will be returned by your claims processor Refer to the Viewing and maintaining the claim status request response history topic for information on viewing and maintaining status request response history for transmitted claims Refer to the Submitter File Maintenance topic for details on configuring the Submitter reference file 128 Viewing and maintaining claim status response files Intermediaries or clearinghouses receiving ANSI 276 4010 format claim status request files generated by PC ACE Pro32 will retrieve the requested status information from their adjudication system and respond by sending an ANSI277 4010 claim status response file back to the submitter PC ACE Pro32 provides a facility by which users can archive these ANSI 277 claim status response files for subsequent review and or printing In addition to simply viewing the response file PC ACE Pro32 will automatically process this
135. click the Delete button and confirm the deletion AS The ICD9 Codes form provides several List Filter Options that can be helpful in locating specific codes Refer to the Reference File Maintenance Form topic for more discussion of these common filter options Effective Date Range The Effective Date Range dates are compared to the claim s date of service range during the claim edit validation process If the effective date range for an ICD 9 code falls outside the claim s service date range an edit validation error will be reported If the effective date range is left blank the ICD 9 code is valid for all dates of service If the start date is completed but the end date is left blank the ICD 9 code is valid for all dates of service from and including the start date forward If the start date is left blank but the end date is completed the ICD 9 code is valid for all dates of service up to and including the end date 178 UPIN Physician File Maintenance The Physician UPIN Setup form provides an interface to maintain the optional UPIN or Physicians reference file The list of physicians and associated UPIN address and miscellaneous information is made available via lookups to speed the claim entry process The following maintenance operations can be performed e To add a new Physician UPIN record click the New button and enter the new physician information e To view or modify an existing Physician UPIN record select t
136. combinations Code assignments for a specific code type Condition Occurrence Span or Value are made for each applicable LOB TOB combination These assignments are used to filter the code lookup lists during UB92 claim entry and to define the acceptable list of codes during the claim edit validation process To display the current list of valid code assignments for a specific LOB TOB combination select the desired LOB Type and TOB After a selection is made the maintenance operations available will include To add a Condition Occurrence Span Value code assignment record for the selected LOB Type TOB combination click the New button and select the new code from the drop down list To delete a code assignment record for the selected LOB Type TOB combination select the desired record from the list click the Delete button and confirm the deletion To delete all code assignment records for the selected LOB Type TOB combination click the Delete All button and confirm the deletion To copy an existing set of code assignment records from a specified source LOB Type TOB combination into the assignment list for the currently specified LOB Type TOB combination select the desired destination LOB Type TOB and click the Copy button Select the code assignments set from which to copy on the Code Assignments Copy Source form click the Copy button and confirm the copy request If required you may then add delete code assignment record
137. completed click the OK button to close the form and return to the PC ACE Pro32 Main Toolbar 195 bS Don t forget to click the Initiate Deferred Claim button after setting up for a scheduled claim activity You will see a notification message in red at the bottom of the tab when the activity is properly scheduled Scheduled Activity Notification Approximately 5 minutes prior to the start time of a scheduled claim activity the Scheduled Activity Notification form will be automatically displayed on the client workstation This notification form describes the scheduled activity type and displays an approximate countdown timer To insure success of the scheduled claim activity the user should refrain from using the system until the scheduled activity has completed When you see this notification form click the OK button and return to the PC ACE Pro32 Main Toolbar Once the scheduled activity is initiated the status bar along the lower edge of the PC ACE Pro32 Main Toolbar will display messages describing the progress of the scheduled activity The status bar will be blanked when the scheduled activity completes You may then review the claim activity log to see the outcome of the scheduled claim activity if desired Once the scheduled activity has completed you may resume normal use of PC ACE Pro32 S PC ACE Pro32 must be running for scheduled activities to execute If desired minimize the PC ACE Pro32 Main Toolbar on your desktop aft
138. curity menu to manually log out without exiting the system S You should change the default user s password as soon as possible if you are concerned about controlling user access at your facility Claim Import Considerations This section describes setup considerations that should be reviewed only if you intend to import claims into PC ACE Pro32 from an upstream system If you will not be importing claims skip this section entirely Three methods are available for importing claims Print Image PrintLink Intermediate Delimited Format and Electronic Media Claims EMC Format Getting setup to import claims into PC ACE Pro32 typically involves coordination with your distributor If you are interested in importing claims using the PrintLink print image method but your distributor does not provide PrintLink support ask that they refer you directly to the software manufacturer for assistance PrintLink functionality may be licensed and supported as an add on to your base PC ACE Pro32 system hS You may want to refer to the Importing claims topic for a discussion of these claim import methods If you do make sure and return to this topic to continue the setup steps Review only the setup considerations applicable to the claim import method you intend to use Print Image PrintLink imports claims from a print image file If using this claim import method complete the following steps 1 Have your distributor perform a one time
139. cy t Payer The Payer reference file contains a Usage field that permits a specific payer record to be restricted for UB92 use only restricted for HCFA 1500 use only or open for common use The Usage flag for payer records with LOBs that are by definition UB92 only or HCFA 1500 only e g MCA versus MCB will be forced appropriately The user may choose the desired usage rule for all non forced payer records The fact that the Patient and Payer reference files are shared comes into play when migrating both DOS UB92 and HCFA 1500 All Payer systems into PC ACE Pro32 The PC ACE Pro32 Migration Utility permits the user to optionally merge the migrated data into the existing Patient and Payer reference files if desired rather than replacing the data as is the default action The recommended steps for migrating a dual system are 1 Follow the steps in the Migrating UB92 All Payer Systems topic to migrate the DOS UB92 All Payer patient payer and claims data into PC ACE Pro32 When migrating the patient and payer data specify your desire to replace existing data in the PC ACE Pro32 Patient and Payer reference files When all steps in the migration topic have been completed proceed with any additional setup tasks outlined in the Setup of UB92 All Payer Systems topic 2 Once the DOS UB92 All Payer system has been successfully migrated follow the steps in the Migrating HCFA 1500 Systems topic to migrate the DOS HCFA
140. d If you view the claim after saving you will see a checkmark adjacent to the submission payer line on the Payer Information tab It is possible that multiple payers on a claim will have an LOB that matches the claim s LOB In this case you will be prompted to select which of these payers is to be designated as the submission payer e Edit Validation During the claim save process an edit validation process is performed on all fields on the claim This process includes re evaluating all field level edits as defined above In addition all claim file level edits are evaluated File level edits are evaluated only when the claim is saved and are typically those edits that require multiple data elements from the claim in order to be evaluated If no edit validation errors occur the claim is saved with a clean CLN status If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List form unless disabled in the Preference settings This form lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the claim edit validation process and the Edit Validation Errors List form If edit errors exist you will usually have the option to correct the errors or save the claim with errors If a fatal error exists on the LOB PCN or TOB field
141. d Attachments actions To check a medical attachment click the left mouse button over the checkbox in the first column of the desired list row Alternatively all medical attachments in the current list can be checked using the Check All Attachments item from the list s pop up menu Use the form s flexible advanced filter techniques to display only the subset of medical attachments to be deleted reactivated etc Then simply check all medical attachments and perform the desired action on all checked attachments at once 79 The UB92 Medical Attachment Forms The UB92 Medical Attachment Forms provide access to all data elements of the supported standalone UB92 medical attachments New medical attachments are entered and existing attachments are viewed and or modified from these forms PC ACE Pro32 supports the following medical attachment types Ke Outpatient Rehabilitation Plan of Treatment Form 700 The fields on this form are grouped logically on three major tabs e General Information includes the Rehab Plan of Treatment s general claim and patient information The discipline rehabilitation therapist and attending physician information is also included on this tab e Treatment Details includes all specific treatment details e g relevant dates treatment diagnosis frequency duration and certification status e Rehabilitation Narratives includes all free form narratives e g medical history functional goals
142. d Expanded Narrative lines on the Miscellaneous tab may be entered on a Plan of Care form This form displays two Service Treatment lines and three Expanded Narrative lines at a time For plans that contain additional line items the user may scroll through the line items one line at a time or one page at a time using the buttons provided along the right edge of the respective tabs hS You can also use the up down arrow keys to move from line to line scrolling when appropriate Type lt ALT gt lt PAGE UP gt press the Page Up key while holding the ALT key down or lt ALT gt lt PAGE DOWN gt to scroll up down through all line items one page at a time Line Item Deletion Press the F7 key while positioned on any field of a Service Treatment line or Expanded Narrative line to delete the line You will be prompted to confirm the deletion When the focus leaves a Plan of Care form field either by pressing the TAB key or clicking on a new field an edit validation process is performed on the field losing the focus Edits performed at this time are referred to as field level edits If a field level edit validation error occurs you will receive an audible response and the edit validation error message will be displayed in the lower left corner of the plan form In addition the focus will remain on the field so that you can correct the problem if desired If you choose not to correct the data at this time simply press the TAB key
143. d field in the Selected Fields listbox The default width and heading are usually acceptable but the user may change these if desired The width values are in approximate character increments This customization feature may not be available in all installations If the Claim List Preferences tab is visible then the feature is supported 97 Claim Import Preferences PC ACE Pro32 preference settings are organized on a tabbed dialog accessible from the PC ACE Pro32 Main Toolbar s main File menu The Claim Import Preferences tab allows the user to select the processing method used to import claim files from an up stream system or other external source These preferences can be defined independently for UB92 and HCFA 1500 claim types If your installation is licensed for both UB92 and HCFA 1500 claim activities then you will need to select the appropriate claim type from the UB92 Claim Import or HCFA 1500 Claim Import radio buttons near the top of this tab If your installation is licensed for only one claim type then this selection option will not be visible Claim Import Processing Method specifies the preferred claim import method The following claim import methods are available Q Import claims from print file using standard PrintLink mapping technique Import claims from a print image file using our advanced PrintLink mapping technique This is the default claim import method in most installations Import claims di
144. d on these claims must be present in the UB92 Provider reference file From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form Select the Provider UB92 or just Provider tab and delete any sample provider records that may be present To delete a provider record select the desired record in the list and click the Delete button Click the OK button on the Provider Deletion Confirmation form to confirm the deletion request Make sure the list is empty before continuing with the next step Click the New button to display the UB92 Provider Information form Enter the first provider s information taking advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse hS Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator Enter the provider s name and address information Enter the Provider ID in the Provider ID No field and the line of business in the LOB field The Payer ID field is only needed if you want to restrict assignment of this provider to a specific payer Normally the Payer ID field will be left blank You can also leave the Tag field blank Complete entry of the remaining provider fields as desired Click the Save button to save the new UB92 Pro
145. d with the matching payer specific record i e the third record above If the commercial claim is being billed to any other payer however the program will instead use the charge amount from the non payer specific record i e the second record above Finally if the HCPCS code 00100 is entered manually on a non commercial claim the program will use the charge amount from the default i e first 188 Charges Master record If the appropriate Charges Master record cannot be automatically determined with complete certainty then the user will be prompted to select the desired record If your installation does not require LOB specific and or LOB Payer specific charge amounts then simply setup all Charges Master records using the lt lt All gt gt pseudo line of business and leave the Payer ID field empty By default procedure code lookups performed during HCFA 1500 claim entry access the master HCPCS reference file To use the Charges Master file instead you must first create records in this reference file for all desired procedure codes along with their standard Charges amounts Second enable lookups to this file by checking the Use Charges Master reference file for HCFA 1500 procedure code lookups option in the PC ACE Pro32 General Preferences tab hS The Charges Master form provides several List Filter Options that can be helpful in locating specific codes Refer to the Reference File Maintenance Form topic
146. data entry or press the TAB key to move from field to field in a predefined sequence generally left to right and top to bottom Use the UP ARROW and DOWN ARROW keys to move up and down through the roster billing form fields respectively A number of productivity enhancing features are available during roster billing data entry e Fixed List Lookups The roster billing form supports fixed list lookups on many of its fields Fixed list lookups apply to fields whose list of valid values can be determined in advance For example Patient Sex typically has 3 possible values M male F female and U unknown USAGE Access the lookup list for a field by positioning the cursor on the field and pressing the F2 function key or right clicking the mouse When an item from the list is selected its value is automatically entered in the roster billing form field AS Type lt ALT gt F2 press the F2 key while holding the ALT key down to identify all fields that support a lookup list Press the ESC key to disable the flashing notification e Variable List Lookups The roster billing form supports variable list lookups on a number of its fields Variable list lookups apply primarily to fields whose values are selected from reference files Many of the variable list lookups use other roster billing field values to filter the presented list For example the provider lookup presents only those provider records applicable to the
147. dating backup archives that span multiple diskettes insert the last diskette in the set first The system will prompt for the first and subsequent diskettes as the validation proceeds Once the desired source drive folder path has been specified click the Start Validate button to proceed You will be presented with details of the validated backup archive on completion lt 7 Restore restores the PC ACE Pro32 database files and configuration settings optional from an existing backup file The Restore tab will be visible only to users with the appropriate permissions The following controls and options apply to the restore operation e Source Drive or Folder specifies the drive or Windows folder directory from which the backup archive file will be read This path may point to a removable media device diskettes writeable CDROM or to a standard Windows directory on a hard disk drive local or remote Disk spanning is supported for backup archives on diskette The user will be prompted to insert specific diskettes from the backup archive as needed AS When restoring backup archives that span multiple diskettes insert the last diskette in the set first The system will prompt for the first and subsequent diskettes as the restoration proceeds e Restore system and user configuration settings specifies whether or not to restore the system and user configuration settings that were included in the backup archive These settings
148. de a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator The Patient reference file contains general patient information as well as optional primary secondary and tertiary insured details Enter as much information as you have available for the patient 4 Click the Save button to save the new Patient record An edit validation process will be performed to check for problems with the patient information When prompted correct any missing or invalid field values if present and re save as needed The new Patient record should now be visible in the Patient list 5 Repeat the relevant steps to create additional Patient records as needed 6 When all desired Patient records have been added click the Close button on the Reference File Maintenance form to return to the PC ACE Pro32 Main Toolbar User Account Setup PC ACE Pro32 requires that a valid login and optional password be entered by anyone desiring access to the system The system administrator must set up a user account for each person that will use PC ACE Pro32 The user account specifies the user s login password values and defines which activities the user has permission to perform As shipped PC ACE Pro32 is configured with a single default user with full system access rights The default user s User ID is SYSADMIN and password is SYSADMIN as well Complete the following steps to add additional user accounts AS
149. de additional information related to this topic b gt Refer to the Claim List Form Features topic for more information on adding claims to the status request queues UB92 and HCFA 1500 b gt Refer to the Preparing claim status request files for transmission topic for information on creating ANSI 276 claim status request files to send to your claims processor b Refer to the Viewing and maintaining claim status response files topic for information on viewing and maintaining the ANSI 277 claim status response files that will be returned by your claims processor 133 Printing claims Claims can be printed in PC ACE Pro32 using either the traditional pre printed forms method or an advanced image overlay technique These 2 approaches are described below along with suggestions on when each method might be appropriate K ww 7 ko Pre Printed Forms Method This traditional method prints just the actual claim field values at positions on the page that should line up with pre printed HCFA 1450 UB92 or HCFA 1500 claim forms Use this printing method when you require claims to be printed on the actual red pre printed claim forms Most optical character recognition OCR equipment used to scan paper claims requires that these red forms be used This method also provides the quickest means to get a claim printout for hardcopy review Image Overlay Method This advanced method automatically overlays the claim field values onto a gra
150. defined by their Payer ID Line of Business LOB and an optional Usage flag see below All payers referenced on claims must exist in the Payer reference file with the exception of the special dump payer Payer ID 99999 The Payer tab provides a convenient Sort By selection that quickly sorts the payer list by Payer ID Payer Description Payer LOB or Payer State Operations available include e To add a new payer record click the New button and enter the new payer information e To view or modify an existing payer record select the desired record and click the View Update button or double click the desired record e To create a new payer record that is similar to an existing record select the desired payer record click the Copy button and change only the desired fields This feature makes it easy to create multiple payer records for the same payer to support more than one line of business LOB e To delete an existing payer record select the desired record click the Delete button and confirm the deletion hS The Payer Information form provides several List Filter Options that can be helpful in locating specific payers Refer to the Reference File Maintenance Form topic for more discussion of these common filter options Entering Payer Information The Payer Information form provides access to a payer s identification fields Payer ID LOB and Description address information control flags and optiona
151. dit validation process When unchecked the modifier will not be considered valid for use on HCFA 1500 claims for the specified LOB To view or modify an existing HCPCS modifier assignment select the desired modifier from the list and click the View Update button or double click the desired HCPCS modifier Only the Valid flags may be modified To delete a HCPCS modifier assignment select the desired modifier assignment from the list click the Delete button and confirm the deletion Related Topics The following hyperlinks provide additional information related to this topic b Refer to the HCPCS Codes File Maintenance topic for information on maintaining HCPCS codes 177 ICD9 Codes File Maintenance The ICD9 Codes form provides an interface to maintain the ICD 9 diagnosis and procedure codes used in PC ACE Pro32 These codes are pre loaded and should not require frequent additions or modifications Select the desired radio button to display either the Diagnosis codes list or the Procedure codes list The following maintenance options are available e To add a new ICD 9 code click the New button and enter the new code s information Enter the effective date range using a 4 digit year format e To view or modify an existing ICD 9 code select the desired code from the list and click the View Update button or double click the selected ICD 9 code e To delete an ICD 9 code select the desired code from the list
152. ds should be associated when they represent the same entity For example if a provider supports multiple lines of business one provider record for each LOB should be created and these related provider records should be associated with each other The inherit and associate options can be a real timesaver when setting up providers that support multiple lines of business In this scenario select an existing provider in the list click the New button and choose the inherit and associate options You will see that the top portion of the Provider Information form will be completed automatically Simply tab through or overwrite the Provider ID No field may be the same or different enter a unique line of business identifier in the LOB field and click the Save button When you have finished adding Provider records you should have one record for each applicable line of business LOB for each provider entity When all desired Provider records have been added click the Close button on the Reference File Maintenance form to return to the PC ACE Pro32 Main Toolbar Patient Reference File Setup This section describes the process of setting up the Patient reference file Setup of the Patient reference file is optional If you choose to setup patients the complete patient list will be accessible during claim entry using the variable list lookup feature When a patient is selected from the lookup list during claim entry all applicabl
153. ds which are not specifically assigned to an HCFA 485 486 form location but which may be required in certain situations This tab also provides line entry of any expanded narrative information to be associated with a specified form location AS The two Medical Update tabs will be visible only if the Include Medical Update Form 486 checkbox on the Plan of Care 485 1 tab is checked This feature allows the user to optionally include the Medical Update HCFA 486 data with the Plan of Care Click the appropriate tab or simply press the PAGE UP and PAGE DOWN keys to move between these major Plan of Care form sections Entering Plan of Care Data Click on any field to activate it for data entry or press the TAB key to move from field to field in a predefined sequence generally left to right and top to bottom Use the UP ARROW and DOWN ARROW keys to move up and down through the plan form fields respectively A number of productivity enhancing features are available during plan data entry e Fixed List Lookups The Plan of Care form supports fixed list lookups on many of the plan s fields Fixed list lookups apply to fields whose list of valid values can be determined in advance For example the patient s sex field typically has 3 possible values M male F female and U unknown USAGE Access the lookup list for a field by positioning the cursor on the field and pressing the F2 function key or right clicking
154. e PC ACE Pro32 Migration Utility permits you to easily migrate your current DOS UB92 and HCFA 1500 All Payer patient optional and payer reference file data as well as your existing UB92 and HCFA 1500 claims into the PC ACE Pro32 system The DOS UB92 All Payer BCACE and HCFA 1500 All Payer BSACE systems are distinct products with separate screens and databases In contrast PC ACE Pro32 is a combined UB92 All Payer and HCFA 1500 All Payer system Because the UB92 and HCFA 1500 claim processing workflows follow similar but separate paths working in this combined product will seem in most respects like working on separate systems A number of reference files are shared between the UB92 and HCFA 1500 sides of PC ACE Pro32 Examples of shared reference files include the HCPCS codes modifiers and ICD 9 diagnosis procedure codes In addition the Patient and Payer reference files are also common to both UB92 and HCFA 1500 claim activities These reference files are designed specifically for shared use Patient The Patient reference file is organized into a general information section and primary secondary and tertiary payer insured information sections The general patient information is applicable to both UB92 and HCFA 1500 claims The payer insured information can be setup for either independent UB92 versus HCFA 1500 use e g Blue Cross versus Blue Shield carriers or common UB92 and HCFA 1500 use e g a commercial insurance poli
155. e Reference File Maintenance form 2 Select the Provider 1500 or just Provider tab and delete any sample provider records that may be present To delete a provider record select the desired record in the list and click the Delete button Click the OK button on the Provider Deletion Confirmation form to confirm the deletion request You must delete all Indiv type Provider records before deleting Solo and Group type Provider records Make sure the list is empty before continuing with the next step 3 Click the New button to display the HCFA 1500 Provider Information form Enter the first provider s information taking advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse AS Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator 4 Select the desired Provider Type and enter the provider s name address and contact information Enter the Provider ID in the Provider ID No field and the line of business in the LOB field The Payer ID field is only needed if you want to restrict assignment of this provider to a specific payer Normally the Payer ID field will be left blank You can also leave the Tag field blank Enter a unique Group Label for the first group provider record defined for each group When adding an ind
156. e attempt on the attachment This is a shortcut technique equivalent to invoking the View Update action and subsequently clicking the Save button on the medical attachment entry form Eligible medical attachments are those with a status of unprocessed UNP has errors ERR or has fatal errors ERF e Copying Medical Attachments Click the Copy button or choose the Copy Selected Attachment action to copy the selected medical attachment The appropriate UB92 Medical Attachment entry form will be displayed containing the details of the newly copied attachment Make modifications as required and save the new medical attachment AS When copying an Outpatient Rehab Plan of Treatment 700 attachment you will be given the option to create the copy as an Outpatient Rehab Plan of Treatment Update 701 e Holding Medical Attachments Choose the Hold Selected Attachment action to change the status of the selected medical attachment to hold HLD Held medical attachments are not eligible for preparation into an EMC file e Releasing Medical Attachments Choose the Release Selected Attachment action to release a previously held medical attachment In addition to releasing the medical attachment this action also sets the status of the selected attachment to unprocessed UNP e Deleting Medical Attachments Click the Delete button or choose the Delete Selected Attachment action to delete the selected medical attachment
157. e file The UB92 Provider reference file is organized such that each record describes a valid provider for a singleline of business LOB This organization allows for greater flexibility in specifying Provider IDs and support information Tax ID address etc that can vary across multiple LOBs for a single provider Complete the following steps as needed hS You may want to refer to the Adding and maintaining providers UB92 topic for more information on entering UB92 Provider records If you do make sure and return to this topic to continue the setup steps 1 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form Select the Provider UB92 or just Provider tab to display a list of all existing Provider records 2 If you have just installed PC ACE Pro32 the Provider list should be empty If so skip to the next step If the list is not empty contact your distributor to confirm that the existing Provider records can be safely deleted To delete a Provider record select the desired record in the list and click the Delete button Click the OK button on the Provider Deletion Confirmation form to confirm the deletion request Make sure the list is empty before continuing with the next step 3 Click the New button to display the UB92 Provider Information form Enter the first provider s information taking advantage of the built in lookups where possible b
158. e on line help system include K Context Sensitive Access Just press the F1 key from anywhere in PC ACE Pro32 to display help information relevant to your current location in the program For example hitting F1 while entering a UB92 claim will display the UB92 Claim Form topic K Help System Contents The Contents tab of the PC ACE Pro32 help system presents all help topics in a nested table of contents format Just double click on a topic entry to display the topic or double click on a folder entry to reveal the next level of topics and folders K lt 7 Help System Index The Index tab of the PC ACE Pro32 help system lists all available index entries and allows the user to easily jump to the first index entry that matches a user entered search string Just double click on an index entry to display the corresponding topic o d Help System Find The Find tab of the PC ACE Pro32 help system permits the user to perform a free form text search of all topics in the entire help system Simply enter the search word or phrase and the topics that include this search string will be automatically listed Again just double click an entry in the search results list to open the corresponding topic Within the various help topic windows you will encounter several informational icons positioned in the left margin These are used to convey additional information that may be of special interest hS Thi
159. e patient information will be automatically loaded into the appropriate claim form fields Complete the following steps as needed AS You may want to refer to the Adding and maintaining patients topic for more information 38 on entering Patient records If you do make sure and return to this topic to continue the setup steps From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form Select the Patient tab to display a list of all existing Patient records If you have just installed PC ACE Pro32 the Patient list should be empty If so skip to the next step S If you have migrated to PC ACE Pro32 from the DOS version of PC ACE your Patient records may already be on file If so you can skip the remainder of this section If the list is not empty and you have not migrated from a DOS version of PC ACE any existing Patient records are likely there as samples only Once you have confirmed that this is the case delete all sample Patient records To delete a Patient record select the desired record in the list click the Delete button and confirm the deletion 3 Click the New button to display the Patient Information form Enter the patient information taking advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse bS Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provi
160. e payer selection In addition variable list lookups often retrieve data used to fill in other medical attachment form fields For example selection of a Patient PCN from the variable list lookup completes numerous patient related fields on the medical attachment Access variable list lookups using the same method described above for fixed list lookups e Automatic Field Tabs When entering data in a field an automatic tab will occur when the field has been completely filled For example entering a single character in a one character field will automatically position the cursor on the next field in the tab sequence This feature can be disabled in the general preferences settings if desired e Cancel Field Changes If a change is inadvertently made to the contents of a field press the ESC key to cancel this change and restore the field s value to what it was when the field received the focus This feature is available for most medical attachment form fields e Date Completion Date values may be entered with or without the century for convenience PC ACE Pro32 uses a user definable century pivot year to automatically derive the century when omitted To insure accuracy birthdate fields require that a full 4 digit year be entered e Descriptive Field Hints Most medical attachment form fields have field hints that provide a brief description of the field s purpose These hints are often called fly over hints since they become visible
161. e previous line except the service date fields into the current line The service date fields in the current line are blanked and the cursor is then positioned on the first field of the current line e Field Duplication Press the F4 key while positioned on a specific field on a line to copy the value of that single field from the previous line into the current line e Line Deletion Press the F7 key while positioned on any field on a line to delete the line You will be prompted to confirm the deletion Alternatively enter the value DEL that s an asterisk plus DEL plus another asterisk without the double quotes into the Procedure Code field 24d on a claim line to delete the line e Advance To Next Line Press the F8 key while positioned on any field on a line to automatically advance the cursor to the first field of the next line skipping over any remaining fields on the current line 63 e Line Item Totals Recalculation The Billing Line Items tab provides a Recalculate button located near the bottom of the tab adjacent to the totals fields Click this button to recalculate and update the Total Charge and Balance Due fields from the current claim line item charges values and the Amount Paid field value NOTE This button may not be available on some installations e Clear Payer Feature The Insured Information tab provides a Clear Payer button for each of the 3 claim payers Click this button to clear all
162. e taken to copy UB92 acknowledgment files to the UB92 staging directory and HCFA 1500 acknowledgment files to the HCFA 1500 staging directory In addition if your intermediary assigns the same filename to all ANSI997 files you will need to make sure that the most recently staged acknowledgment file has been archived before copying a newer acknowledgment file into the staging directory hS Installations that use data communications scripts to retrieve the ANS 997 acknowledgment files may also automatically copy them to the appropriate staging directory Your distributor should be able to confirm whether or not automatic ANSI 997 file staging will be performed on your installation Viewing Printing amp Maintaining Acknowledgment Files Archived ANSI997 transmission acknowledgment files can be viewed and or printed from the ANSI 997 Acknowledgment File Log form To view the currently archived ANSI 997 files select the Maintain and Acknowledgment File Log menu items on either the UB92 or HCFA 1500 Claims Menu form The following operations are available 123 e To view and or print an archived ANSI997 file select the desired record and click the View Report button or double click the desired record The report may be printed from the preview form if desired e To delete an archived ANSI 997 file select the desired record click the Delete button and confirm the deletion By default archived ANSI997 transmission acknowledg
163. e tearde tesa taadaa aiara piedira 136 preferences sc Aire acere at Sees e nth oe heath ieee a aa e ease anti ss 92 93 96 97 98 102 103 GlaNM WM POM AREFE E TT TE ETE sicher E EA E EE E 97 plami Lst FOND eere ecceeesnaze Gay acebavaaydeetaey ee teruanee tay AEE ade ASETETA Sk a NEEE AATE 96 Data COMMUNICATIONS aien teens iia oeir iaiia e E Ea aaier TE aE i ar a akak 102 ETE E e EE ERE EAEE PEE EES EET A AEE PE E NET E A E He oa ES 93 Miscellane Ous soies e eE A E AS EEES EAEE EA SET 103 OETA E E E ETE ES 92 Printing areenaa ine wave saat ea bash aves ea aa aA o Aaa aa Aa bea Aa ATAA EAEan dadi 98 99 100 101 prepare run interruption rECOVETY sceri iiiar aa E a Eae EEA eaaa E EE ET 205 Preparing claim status request files for transmission 2 c0ceceeeee cece ee eeeeeeeeaeeeeeaeeesaeees 126 Preparing claims for tranSMiSSiOn c ceceeeeeeeeeeeeeeeeeeenaeeeeeeaaeeeeeeaaeeeeeeaaeeeeesaaeeeeesaaaeees 117 Preparing UB92 Medical Attachments for transmission eeeeeeaeeeeeeeeeeeeeeeaaeeeeeeaaee ees 153 pre printed form claim print MethOd cece cece eee ee cece eee eeeeee nese eeaeeeeeeeaaeeeeeeaaeeeeeeeaeeeeeeeees 133 printer selection claims amp reports cece eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeesaeeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaeeeess 98 Printing CAINS eitri oc E a E SAE eE nek Disease ead beh aad ee ee a atest relay 133 printing caim attachments oasa EE hed AEE EEE A bate tune ctu AE 133 prin
164. ecords To delete a Patient record select the desired record in the list click the Delete button and confirm the deletion 3 Click the New button to display the Patient Information form Enter the patient information taking advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse AS Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator The Patient reference file contains general patient information as well as optional primary secondary and tertiary insured details Enter as much information as you have available for the patient 4 Click the Save button to save the new Patient record An edit validation process will be performed to check for problems with the patient information When prompted correct any missing or invalid field values if present and re save as needed The new Patient record should now be visible in the Patient list 5 Repeat the relevant steps to create additional Patient records as needed 6 When all desired Patient records have been added click the Close button on the Reference File Maintenance form to return to the PC ACE Pro32 Main Toolbar User Account Setup PC ACE Pro32 requires that a valid login and optional password be entered by anyone desiring access to the system The system administrator mus
165. ected fields list as desired Select the Paid History PD tab and repeat this configuration process Save the preference setting changes This configuration process must be performed separately for the UB92 Claim List form and the HCFA 1500 Claim List form Viewing Printing amp Maintaining Claim Status Request Response History The status request response history for any transmitted claim can be viewed and or printed from the Claim Status Request Response History form Access to this history log is available from the UB92 and HCFA 1500 Claim List forms On either claim list select the TR PD transmitted paid location to display all transmitted claims To access the history log select the claim record of interest in the list and choose the Show Selected Claim Status History 132 item from the form s main Actions menu The Claim Status Request Response History form will display all available status requests and responses for this claim The Claim Status Request Response History form displays a summary of each request or response including the associated date time the Action or type and a few key status response data elements The possible Action types include Request Records the date time a claim status history request was made on behalf of this claim This is actually the date time associated with the ANSI 276 claim status request file prepared by PC ACE Pro32 Response Identifies a posted response for this
166. ed If you receive edit validation errors indicating an invalid Payer ID or Provider ID you may need to perform additional Payer and or HCFA 1500 Provider reference file setup Depending on how many migrated claims these reference file changes will affect you may choose to re migrate the claims rather than correcting these problems on each claim individually 3 By changing the Location selector to TR transmitted only or PD paid only you can list claims migrated from the DOS HCFA 1500 All Payer tracking and history databases respectively If desired repeat the review process for claims in these locations 4 When finished with your claims review click the Close button on the HCFA 1500 Claim List form Select the Close item from the HCFA 1500 Claims Menu form s main File menu to return to the PC ACE Pro32 Main Toolbar Completing the Setup Process Additional steps will be required to complete the PC ACE Pro32 setup and get the system ready to process your claims Proceed at this time to the Setup of HCFA 1500 Systems topic and review the steps outlined there Make additional changes if needed to the migrated reference file records and complete any other applicable setup tasks that were not addressed in this migration procedure 24 Migrating Dual Systems UB92 and HCFA 1500 A goal of PC ACE Pro32 is to provide users with a smooth transition from their existing DOS UB92 and HCFA 1500 All Payer systems Th
167. ed Topics The following hyperlinks provide additional information related to this topic b gt Refer to the Preparing claims for transmission topic for more information on preparing electronic claim files b Refer to the Reference File Maintenance Form topic for a discussion of the common reference file form features and filter options b Refer to the Claim amp Reference File Edit Validation topic for a discussion of the edit validation process 172 Data Communications File Maintenance Data communications information in PC ACE Pro32 is maintained from the Data Communications Setup form for both UB92 and HCFA 1500 claim types This reference file defines the data communication parameter values to be made available to an external data communications program If your installation is licensed for both UB92 and HCFA 1500 claim activities you must first select the appropriate claim type from the UB92 or HCFA 1500 radio buttons near the top of this tab If you are licensed for only one of these claim types this selection will not be available The Data Communications Setup form provides the following maintenance options e To add a new data communications record click the New button and enter the desired information on the Data Communication Information form e To view or modify an existing data communications record select the desired record from the list and click the View Update button or double click the desired record
168. ed files meet these specifications 2 Confirm the existence of the required map control file This file provides a control interface between the intermediate delimited file and the PC ACE Pro32 claim import routines The map control file is always named mapentlu win and should be located in the server s winpcace impub92 directory 3 Setup all required PrintLink Matching Description strings in the Payer reference file These strings are used to match payer descriptions from claims in the intermediate delimited file to specific Payer reference file records Refer to the Adding and maintaining payers topic for details on setting up your PrintLink Matching Description strings 4 Each time you want to import claims copy the new intermediate delimited file generated by your upstream system into the server s winpcace impub92 directory The file must be named plink out Electronic Media Claims EMC Format import claims from a file in Electronic Media Claims EMC format If using this claim import method complete the following steps 1 Confirm that your upstream system is capable of producing a supported version Electronic Media Claims EMC format file Contact your distributor for the list of supported EMC file versions 2 Each time you want to import claims copy the new EMC file generated by your upstream system into the server s winpcace impub92 directory The file must have a dat file extension e g EMC192 DAT
169. ed if exclusive system access cannot be granted i e other users are running PC ACE Pro32 When this occurs you should instruct all users to exit the program before proceeding If desired click the View Results and or View Errors buttons to view reports of the successfully prepare claims and rejected claims respectively These reports can be printed from the report previewer if desired 119 Claims will rarely be rejected during the prepare operation A claim will be rejected for example if the submission payer specified on the claim is no longer present in the Payer reference file Rejected claims must be re processed and corrected before they can be successfully prepared X Refer to the Printing Preferences topic for information on configuring claim preparation reports to be printed automatically or to a specific printer 5 When you have completed your review of the claim preparation reports click the Close button on the Claim Prepare For Transmission form You may now proceed to transmit the EMC file generated during this claim preparation session The prepared EMC file is located in the server s winpcace directory The file is named bctrans dat for UB92 claims and bstrans dat for HCFA 1500 claims by default This default naming convention may be overridden in the Submitter reference file Related Topics The following hyperlinks provide additional information related to this topic gt Refer to the
170. ed list will then be rebuilt to reflect the current archive contents hS Right click the mouse on the desired ANS 277 archive record to access all available actions This popup menu provides several additional actions which allow the user to print post reports containing only the successfully posted responses or only responses that could not be posted Using the Claim Status Response Reports The ANS 277 claim status response file is presented by PC ACE Pro32 in a human readable report format The report presents general identification information along with the claim level status response codes and payment details returned by the intermediary for each claim Since the individual responses are posted directly to the applicable claims this report is typically used as a secondary reference source There may be situations in which ambiguous status responses returned by the intermediary will not be posted to the original claim In these situations you will be referred back to the original claim status response file and this report for additional information Contact your intermediary s support department for assistance in understanding the ANSF277 report nomenclature and claim status code interpretation Using the Claim Status Response Post Reports The ANSI277 claim status response post report presents the claim by claim results of the automatic response posting operation A response posting will fail for either of the following reasons e The
171. eeaaeeeeeeaa 131 Reviewing the claim activity l0gS ceccceeeeeeenneeeeee ne eeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaeeeeesaaeeeeesaaaneees 204 Roster Biling Form HCEA 1500 reserare AEE cae A S A SE 68 Roster Billing List Form Features ccccececeseeeeeeaeeeeeeeaeeeeeeeaaeeeeeeaaeeeeeeaaeaeeeeaaaaeeeeaaaeeeeeaa 66 S saving and canceling claims HCFA 1500 sssssssssssesirisssrriesrriisstrtissrttissttirestrtrnsrtrrsnrten 61 saving and canceling claims UBI2 niies annen rE a eae EEE RERA EEE NEA TETIS 57 saving and canceling Plans of Care ccceececeneeeeeeeeeeeeeeeaeeeeeeeaaeeeeeeaaeeeeeeaaeeeeesaaeeeeeeaaeeeees 73 saving and canceling UB92 Medical Attachment cccceeeeeenneeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaae eres 79 saving and cancelling roster billings HOFA 1500 00 0 eeeeeeeeeeeeeeneeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaee ees 68 Scheduled Activity Notification 0 0 cece cece cette reece teres saeeeeeeaaaeeeeeaaaaeeeeaaeeeees 195 Scheduling unattended claim activities 2 0 0 ceceee cece ee eeee cece eee eeeeaeeeeeeeeaeeeeeeaaeeeeeeaaeeeeenaees 193 Security amp User Maintenance eee eceee ce iaae EAE AAN NEATE CEA EENE EAN 89 Sending support mail to your AisStriDUtOr eee eee cece eee eect eee ee ee ee ae tees eeaeeeeeeeaaeeeeeeaaeeeeeneees 202 SOtUPPrOCCAURSS is ses Sts ce sat nds azgceth leans ane fee on abteaa O N E 27 28 35 42 Current DOS PC ACE Users Read This FirSt
172. eeded to handle overflow from both the Home Health Certification And Plan of Care HCFA 485 and Medical Update And Patient Information HCFA 486 forms o d Home Health Plan of Care printing will be available only if the Adobe Acrobat Reader Version 4 0 or later is properly installed on the system You must exit PC ACE Pro32 before installing the Acrobat Reader A properly installed reader will be detected automatically the next time PC ACE Pro32 is started If necessary you can manually configure the Acrobat Reader executable file ACRORD32 EXE path from the Misc tab of the PC ACE Pro32 Preferences form AS The Adobe Acrobat Reader has its own preference settings that will let you choose the initial document magnification level and get rid of the splash screen that is shown by default every time the reader is started t The default destination printer for UB92 Claims printing is also used as the Plan of Care default destination printer This default can be set from the Printing tab of the PC ACE Pro32 Preferences form This default destination printer setting will be used during Plan of Care print operations unless overridden at print time from the Home Health Plan of Care Print Options form 150 Adding a new UB92 Medical Attachment New standalone UB92 Medical Attachments can be added to PC ACE Pro32 using either of these techniques Select the Attachments and New Medical Attachment menu items on the UB92
173. eeeeaaeeeeeeaaaeeees 87 Claim Archive Feature essiri aeaa e a avian verndis Savile verncdiedsavdedeeerncuss 140 Claim attachments Printing ceeeeeee cece ee ee cece eee e ee eres Ke aae Ana KERE E a a a A iaaa 133 Claim Form HCFA 1 500 ws svsseciieccaes civ errian e rendas uiuen av Ea sinus heeectv ETEEN 61 Claim Form UB I2 Fean Piece lenis weeded tate racial EE EN alate wr eet AULD weed alate aes 57 claim impor m PG ACE ProS2 iscsie eseccees teeeahes indeed cesgeentuc Aae Ae TK ara Ta AA 109 claim import preferences enea ii ee dene ae r e feed E leg AE N E aai 97 Claim List Form configuration a aena a A EEE N E E E E E E 96 Claim List Form Features seis reep arree aea TA EE AA EE aie oes 52 claim payments eieiei radii inie aiia Mee ee eee eee ees 136 138 139 posting to HOFA 1500 Claims i aiae vende stage reece Abita vege whedon eae Miao ANNAR 138 posting to WB92 Claims aera e ea areae cea feted eE E ces neler cele A aeteleea ceed 136 claim printing preferenCes sveininn dene dveeceenedeg sete teed denned Shiv OA E UNE ETEN 98 claim status request respONSe NiStOFy ceeeeeeeeeee cece eeeeeeeeeeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaenees 131 132 Claim status response fil S 1 ccceceeece cece ce eeee cece eee ee caeeeeaeeeeeaeeaaeeesaeeesaeeesaeeeseeeeaes 128 129 claims activity logs viewing ANd purging ceeeee eee eeee ee eeeeeeeeeeeeeeeaeeeeeesaeeeeeeaaaeeeeeaaaeeees 204 208 Claims Menu For
174. eeeees 155 Adding and maintaining Payers ceceeeeceeeeeeeeeeeeee cette eA EEEIEE AAEE AAEE E AEEA EE 157 Adding and maintaining providers HCFA 1500 eceeeceeeeeeeceeeeeeeeeeeeeeesaeeeeeeaeeeeeeaaaeees 163 Adding and maintaining providers UBQ2 ceceeeceeeeeeeeeeeeeee centres aaeeeeeeaaeeeeeeaaeeeeeeaaeeees 160 Maintaining Codes amp Miscellaneous Reference Fil S ccseeeeeenneeeeeeeeeeeeeeaaeeeeeeaaeeeeeeaa 167 Condition Occurrence Span Value Codes File Maintenance eeeeeeeeeeeeeeeeeeeeeeeeeeeeees 180 D Data Communications Control File cc cceececeneeeeeeeae cece iien i a ei 172 173 Data Communications File Maintenance ccecccseeeeeeneeeeeeaeeeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaanees 172 Data Communications preferences ceececeneeeeeee ee eeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaaeeeeeaaeeeeeaaaaeees 102 E edits OXPlAINeSd seers aa T haw e Pe ance eh nall hide tear lal E nese nce AE 87 EMC File claim import mehdi arasa aE E aAA AEEA EE EIT 111 entering claim data HCFA 1500 ceceeecceeeeeeeeeeeeeeeeee eres eeeeeeeeeaaeeeeeaaaeeeeeaaaeeeesaaeeeeeeaaieees 61 entering claim data UW B92 2 a EE hentia fact de staat ete ian ache nce NEATA 57 ONLSMNGsClAIMS EA ade by sa NA nde cua ENA taking ak sewed tee abate web noes 106 entering Plan of Care data 0 cece cece ee keere nate rete eae eres sai eeeeaaaeeeeeaaaeeeeeaaeeeeeaaieeees 73 entering ro
175. efault the list will display claims in the to be transmitted CL location On the UB92 Claim List form select either the transmitted only TR paid only PD or transmitted paid TR PD claims location to display claims eligible for payment Claims are assigned to the transmitted TR location as soon as they are prepared into an EMC file for transmission When the first payment is posted to a transmitted claim the claim is moved to the paid PD location where it will remain indefinitely Payments may be posted to claims in either the transmitted TR or paid PD locations but not to claims in the to be transmitted CL location hS If you plan on posting payments to more than one claim we recommend that you select the combined transmitted paid TR PD claims location Updates to the claim list are more efficient to process from this location since claims being moved from the trans mitted TR to paid PD status will not force a requery of the list s contents Select the desired claim from the list and perform either of the following to access the claim s payment history e Select the Show Selected Claim Payments item from the UB 92 Claim List form s main Actions menu or from the convenient right click popup menu e Click the View button or double click the selected record to display the claim in the UB92 Claim Form Click the Show Payment History button to access the payment history for
176. efer to the Claim Import Preferences topic for more information on claim import configuration Once all scheduling options are completed click the Initiate Deferred Claim Import button to complete the scheduling task If all scheduling tasks have been completed click the OK button to close the form and return to the PC ACE Pro32 Main Toolbar e Claim Process Scheduling To schedule an unattended claim processing operation click the desired UB92 or HCFA 1500 Claim Process tab select either the one time or daily scheduling option and enter the desired Start Time Specify the following process specific scheduling options Include claims with errors When checked instructs the scheduler to process all claims that have been previously saved with errors fatal or non fatal in addition to all unprocessed claims When left unchecked only unprocessed claims will be included in the processing run Process LOB Selection select check one or more lines of business LOB to be considered during the claim processing operation Only claims with the specified LOBs will be processed Select the special lt lt PROCESS ALL LOBS gt gt item to process claims for all LOBs Once all scheduling options are completed click the Initiate Deferred Claim Processing button to complete the scheduling task If all scheduling tasks have been completed click the OK button to close the form and return to the PC ACE Pro32 Main Toolbar I
177. eference File Procedures 155 Adding and maintaining patients The Patient tab of the Reference File Maintenance form provides an interface to add and maintain patient information including the patient s primary secondary and tertiary insured details Setup of the Patient reference file is optional If you choose to setup patients the complete patient list will be accessible during claim entry using the variable list lookup feature When a patient is selected from the lookup list during claim entry all applicable patient information will be automatically loaded into the appropriate claim form fields The Patient tab provides a convenient Sort By selection that quickly sorts the patient list by Patient PCN or Patient Name Operations available include e To add a new patient record click the New button and enter the new patient information e To view or modify an existing patient record select the desired record and click the View Update button or double click the desired record e To delete an existing patient record select the desired record click the Delete button and confirm the deletion e To display a list of the Home Health Plans of Care POCs on file for an existing patient record select the desired record and click the Plan of Care button See the Listing modifying and maintaining Plans of Care topic for more information hS The Patient Information form provides several List Filter Options that can be
178. eft to right and top to bottom Use the UP ARROW and DOWN ARROW keys to move up and down through the medical attachment form fields respectively A number of productivity enhancing features are available during medical attachment data entry e Fixed List Lookups The medical attachment forms support fixed list lookups on many of the form s fields Fixed list lookups apply to fields whose list of valid values can be determined in advance For example the patient s sex field typically has 3 possible values M male F female and U unknown 80 USAGE Access the lookup list for a field by positioning the cursor on the field and pressing the F2 function key or right clicking the mouse When an item from the list is selected its value is automatically entered in the medical attachment form field hS Type lt ALT gt F2 press the F2 key while holding the ALT key down to identify all fields that support a lookup list Press the ESC key to disable the flashing notification e Variable List Lookups The medical attachment forms support variable list lookups on a number of the form s fields Variable list lookups apply primarily to fields whose values are selected from reference files Some variable list lookups use other medical attachment field values to filter the presented list For example provider lookups present only those providers who are setup for the medical attachment s line of business as determined by th
179. elated to this topic b gt Refer to the Claim Import Preferences topic to select the desired claim import method and configure the optional preprocessor b Refer to the Processing claims automatically topic to learn how the imported claims can be processed automatically 112 b gt Refer to the Printing Preferences topic for information on claim import report options automatic printing printer selection etc 113 Reversing the most recent claim import run On occasion it may become desirable to reverse the most recent claim import operation In other words to remove the imported claims from the database as if they had never been imported in the first place Possible scenarios that might give rise to this requirement include A partially corrupted print file resulted in an incomplete claim import run The print file has been repaired and it is desirable to perform the import again from the beginning The PrintLink map file had a minor mapping error that resulted in the truncation of the first character of a specific data field on every claim The map file has now been corrected and the original print file is to be re imported The same claim file was inadvertently imported more than once Follow the steps below to reverse the most recent claim import run 1 2 3 114 From the PC ACE Pro32 Main Toolbar click either the UB92 Claims Processing or HCFA 1500 Claims Processing button to open the desired Claims
180. ence file data for correctness and completeness Suggestions concerning where and when to supplement the migrated data will be made when appropriate Complete the following steps amp It is important to thoroughly review the migrated Patient and Payer reference file data To insure a smooth transition from the DOS UB92 All Payer system any required modifications or additions to this migrated data should be made prior to migrating your claims data or using PC ACE Pro32 for daily claims processing activities 1 Execute PC ACE Pro32 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form When prompted to login you may enter the default user s User ID SYSADMIN and password SYSADMIN as well 2 Select the Payer tab and review the migrated payer records Double click any record to see the details for that payer If desired enter the missing address and contact information If any changes are made click the Save button to save the updated Payer record An edit validation process will be performed to check for problems with the payer information When prompted correct any missing or invalid field values and re save as needed x While viewing a Payer reference file record you may also click the PrintLink Matching Descriptions button to view the PrintLink matching strings migrated for the selected payer This only applies if you have been importing claims from
181. ently selected provider record This filter option is only available with the UB92 and HCFA 1500 provider lists Refer to the Adding and maintaining providers UB92 and Adding and maintaining providers HCFA 1500 topics for a discussion of provider associations Reference File Reports Common reference file reports are accessible from the Reference File Maintenance form s main Reports menu Currently available reports include e Patient List previews and or prints a summary report of all or a selection of patient records The Patient List Report Filter Criteria form will be displayed to allow the user to restrict the patient records to be included in the report Enter any desired report filter criteria and preview or print the report as desired Related Topics The following hyperlinks provide additional information related to this topic b Refer to the Adding and maintaining patients Adding and maintaining payers Adding and maintaining providers UB92 Adding and maintaining providers HCFA 1500 and Codes amp Miscellaneous Reference Files Overview topics for additional information on these core PC ACE Pro32 s reference files b gt Refer to the Claim amp Reference File Edit Validation topic for a discussion of the edit validation process 87 Claim amp Reference File Edit Validation The term edit is commonly used in claims processing to describe a specific rule imposed on a claim field or combinati
182. entry via fixed list or variable list lookups These lookup lists are accessed by right clicking the mouse over the field or pressing the F2 key while focused on the field Helpful fly over hints are also available for many fields 156 Saving amp Canceling Patient Updates After completing data entry on the Patient Information form click the Save button or type lt ALT gt S to save and exit the form Alternatively click the Cancel button to abandon any changes and exit the form During the patient save operation an edit validation process is performed on all patient record fields If no edit validation errors occur the patient record is saved without further user intervention If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List form This form lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the reference file edit validation process and the Edit Validation Errors List form If any fatal edit errors exist you must correct them before the patient record can be saved If only non fatal edit errors exist you will have the option to correct the errors or save the patient record with errors Click the Save With Errors button to save a patient record that contains only non fatal errors If edit validation erro
183. er scheduling claim activities 196 Launching the ANSI 835 Electronic Remittance Module The optional ANSI 835 Electronic Remittance modules provide tools for processing the electronic remittance files returned from your claims processor Electronic remittance data can be viewed printed and or exported using these tools Exported remittance data can for example be used to automatically post payments to an upstream claims management system Separate ANSI835 modules exist for use with UB92 and HCFA 1500 claims e The ANSF835 Electronic Remittance modules expect to find remittance files in the following directory b Place UB92 remittance files in the server s winpcace etraub92 ansi835 directory b Place HCFA 1500 remittance files in the server s winpcace etra1500 ansi835 directory e To launch an ANSI835 program click the ANSI 835 Functions button on the PC ACE Pro32 Main Toolbar Click the desired button to launch either the UB92 ETRA or HCFA 1500 ETRA1500 electronic remittance program S The ANS 835 Electronic Remittance modules are not available on all systems If either or both of these launch buttons are disabled then the corresponding ANSI 835 module is not available Refer to the separate ANSI 835 Electronic Remittance ETRA module manuals for information about the capabilities and operation of these programs 197 Performing system backups restores PC ACE Pro32 provides complete database backup valida
184. eritance and Associations PC ACE Pro32 requires that each UB92 provider record be defined for a single line of business LOB As such if a provider supports multiple LOBs then separate records for each are required This hierarchy results in greatly enhanced flexibility by allowing the user to define unique IDs and support information addresses etc on a per LOB basis If necessary provider records may even be defined such that the information is unique to a single payer within the LOB by completing the Payer ID field on the UB92 Provider Information form In order to link provider records that represent the same entity PC ACE Pro32 has introduced the concept of provider associations For example if Jones Memorial Hospital is a UB92 provider for Medicare Part A MCA and Blue Cross BC patients two separate provider records must be added However since these 2 records really represent the same provider they should be associated with each other The Provider tab of the Reference File Maintenance form provides a convenient inheritance option that makes creation of associated provider records a snap Simply click the New button and create the first Jones Memorial Hospital provider record from scratch start with all fields blank assign the MCA line of business complete all applicable fields on the UB92 Provider Information form and 162 save the provider record Then select the newly created provider record in the provider li
185. ess of the contents of the current field Tab key jumps between controls with edit errors when displayed This option applies to data entry in the UB92 Claim Form HCFA 1500 Claim Form and a number of other editable forms When edit validation errors are encountered during a save operation the fields with errors will display in color and optionally flash to help the user locate them This option will be in effect while these fields are displayed in this manner M When checked the tab sequence will be altered to include only those fields with errors i e those fields that are displayed in color allowing the user to rapidly locate and correct the edit validation errors M When unchecked the normal tab sequence remains in effect at all times hS If this feature is enabled press the ESC key to deactivate the special notification error mode and return to normal tab operation Enable flashing notification method for controls with edit errors This option applies to the UB92 Claim Form HCFA 1500 Claim Form and a number of other editable forms When edit validation errors are encountered during a save operation the fields with errors will display in color and optionally flash to help the user locate them This option controls whether or not the background of these fields will alternate flash between the error color and the standard field color lM When checked the background of the fields with edit validation errors will al
186. evant submission details for one or more processed UB92 claims and or standalone medical attachments Only UB92 medical attachments in the to be transmitted CL location are eligible for preparation When a medical attachment is prepared into an EMC file it is automatically moved to the transmitted TR location Residence in the transmitted TR location reflects its transmitted state and also prevents the medical attachment from being inadvertently retransmitted Eligible UB92 medical attachments will be automatically included along with any eligible UB92 claims whenever a claim prepare operation is performed If no eligible claims are present when the prepare operation is performed then the EMC file will contain only the eligible UB92 medical attachments AS Like claims UB92 medical attachments can be put on hold to prevent them from being inadvertently prepared and transmitted See the UB92 Medical Attachment List Form Features topic for more information on holding and releasing UB92 medical attachments Some installations may require that UB92 claims and medical attachments always be prepared into separate EMC files In such situations the claims will always be prepared first If medical attachments are also eligible for preparation a warning to this effect will be presented at the end of the first prepare operation Simply transmit the EMC file containing the claims and then perform a subsequent prepare operation to build a
187. exing the databases topic for information on packing the UB92 and or HCFA 1500 current claims database Adding a new roster billing New HCFA 1500 roster billings can be added to PC ACE Pro32 using either of the following techniques Select the New Roster Billing item from the HCFA 1500 Claims Menu form s main Roster menu The system will automatically create and display an empty roster billing form K Click the New button on the Roster Billing List Form The system will automatically create and display an empty roster billing form The new roster billing will automatically be selected in the list when it is saved HCFA 1500 roster billings are manually entered on the HCFA 1500 Roster Billing Form The data fields are typically entered in the order presented from left to right and top to bottom Enter the common roster billing information in the top section of the form Enter patient specific information for any number of patients in the lower section Edit validation errors may be encountered during this entry process if the data entered violates any of the predefined roster billing edits Correct any such edit errors and click the Save button to save the roster billing Roster billings containing unresolved edit errors may be saved if desired by clicking either the Save With Errors button visible if only non fatal errors exist or Save With Fatal button visible if any fatal errors exist Only one of these butt
188. f the Import and process claims option is checked on the Claim Import scheduling tab then the scheduler will initiate claim processing immediately upon completion of the claim import operation The claim process schedule will be reported as controlled by claim import settings e Claim Transmission Scheduling To schedule an unattended claim transmission or other data communication operation click the desired UB92 or HCFA 1500 Claim Transmit tab select either the one time or daily scheduling option and enter the desired Start Time Specify the following transmit specific scheduling options Data Comm Claim Transmission Function specifies the data communication function to be launched at the specified start time Select the desired function from the drop down list provided The scheduler is responsible only for launching the program or batch file associated with the selected claim transmission function It does not attempt to monitor the progress or completion status of this data communications operation If no items are available in the drop down list then no data communications programs have been configured for launch from PC ACE Pro32 Refer to the Data Communication Preferences topic for more information on configuring Data Communications program access Once all scheduling options are completed click the Initiate Deferred Claim Transmission button to complete the scheduling task If all scheduling tasks have been
189. ference file complete the following steps E It is important to correctly setup the UB92 Provider reference file before continuing with this migration process In order for claims to migrate cleanly into PC ACE Pro32 the key providers referenced on these claims must be present in the UB92 Provider reference file Your distributor has the option to configure the PC ACE Pro32 Migration Utility to migrate the provider information from the DOS MEDA system Submitter file SUBMIT DAT and optional Provider reference file PROV IDX into the PC ACE Pro32 system It should be evident when you review the existing Provider reference file records in this step whether or not this migration option has been pre selected If the provider records have been migrated you will simply need to update each record to add any additional required information Address Tax ID etc 1 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form 2 Select the Provider tab and delete any sample provider records that may be present To delete a provider record select the desired record in the list and click the Delete button Click the OK button on the Provider Deletion Confirmation form to confirm the deletion request Make sure the list is empty before continuing with the next step 3 Click the New button to display the UB92 Provider Information form Enter the first provider s informatio
190. fields respectively A number of productivity enhancing features are available during claim data entry e Fixed List Lookups The claim entry form supports fixed list lookups on many of the claim s fields Fixed list lookups apply to fields whose list of valid values can be determined in advance For example Patient Sex typically has 3 possible values M male F female and U unknown USAGE Access the lookup list for a field by positioning the cursor on the field and pressing the F2 function key or right clicking the mouse When an item from the list is selected its value is automatically entered in the claim form field hS Type lt ALT gt F2 press the F2 key while holding the ALT key down to identify all fields that support a lookup list Press the ESC key to disable the flashing notification e Variable List Lookups The claim entry form supports variable list lookups on a number of the claim s fields Variable list lookups apply primarily to fields whose values are selected from reference files Most variable list lookups use other claim field values the specified claim LOB for example to filter the presented list For example provider lookups attempt to present only those provider records applicable to the claim being entered In addition variable list lookups often retrieve data used to fill in other claim form fields For example selection of a Patient from the variable list lookup completes 62
191. file and post the claim status responses directly to the appropriate UB92 or HCFA 1500 claims This topic describes how to stage your ANSI277 files so that they are automatically archived and posted by PC ACE Pro32 as well as the functions available for viewing printing maintaining and using the archived claim status response files and post reports Support for ANSF276 277 claim status request response files may not be available on all installations If the Purge archived ANSI 277 acknowledgment files after NN days option is disabled grayed out on the PC ACE Pro32 Miscellaneous preferences form then this capability is not available on your installation Staging Claim Status Response Files For Automatic Archiving At program startup PC ACE Pro32 automatically scans separate UB92 and HCFA 1500 staging directories looking for new ANSI277 claim status response files to be archived If any ANSI 277 files are present in the staging directories they are checked for proper format and archived automatically In addition the individual responses are automatically posted to the appropriate claims This automatic archive post process is also performed when the Claim Status Response Log form is opened or when the user manually refreshes the Claim Status Response Log list See next section for details On most PC ACE Pro32 installations the user will be required to manually copy the ANSI 277 files received from the intermediary into the appropri
192. formation This value populates element ISA06 of the Interchange Control Header ISA segment in the ANSI 837 4010 format EMC file Leave this override field empty for default ISA06 processing You should change this value only under instructions from your distributor e Local fields specifies up to six additional submitter fields to be defined by the distributor This tab will only be visible if the distributor has defined one or more of these local fields Contact your distributor for completion details bS A number of fields on the Submitter Information form support data entry via fixed list and variable list lookups These lookup lists are accessed by right clicking the mouse over the field or pressing the F2 key while focused on the field E You should add and or modify submitter information only under the supervision of your distributor or an authorized technical support specialist Incorrectly configuring submitter records will result in EMC file incompatibilities Saving amp Canceling Submitter Updates After completing data entry on the Submitter Information form click the Save button or type lt ALT gt S to save and exit the form Alternatively click the Cancel button to abandon any changes and exit the form During the submitter save operation an edit validation process is performed on all submitter record fields If no edit validation errors occur the submitter record is saved without further user intervention If h
193. g a Payer reference file record you may also click the PrintLink Matching Descriptions button to view the PrintLink matching strings defined for this payer PrintLink matching strings are only necessary if you plan to import claims from print image files into the PC ACE Pro32 system Select the Patient tab to review the migrated patient records if any Double click a record to view the migrated details for that patient Confirm that the Patient record appears complete and correct Click the Close button to close the Patient Information form Repeat this review process for a few patients in the list 11 4 When finished with your review of the Patient and Payer reference files click the Close button to close the Reference File Maintenance form and return to the PC ACE Pro32 Main Toolbar Setting Up UB92 Provider Records This section describes how to set up your UB92 Provider reference file This reference file is organized such that each record describes a valid provider for a single line of business LOB This organization allows for greater flexibility in specifying provider IDs and support information Tax ID address etc which can vary across multiple LOBs for a single provider At least one Medicare LOB MCA record must be added for each provider on behalf of whom claims are to be billed If desired an additional record can be added for each line of business in which the provider participates To setup the UB92 Provider re
194. g checkbox in the Select the databases to migrate radio group will be enabled Click the Migrate the selected claims databases checkbox Also click the Entry Tracking and History checkboxes those that are enabled Finally click the Migrate button to proceed The migration utility will proceed to dump the contents of your claims 13 databases into temporary files that will then be imported into the PC ACE Pro32 claims database 6 When the migration process has completed click the Close button to exit the PC ACE Pro32 Migration Utility Reviewing the Migrated Claims This section describes the process of reviewing the migrated claims for correctness and completeness Complete the following steps amp It is important to thoroughly review the migrated claims Pay close attention to any edit validation errors that would indicate incorrect or missing Payer and or UB92 Provider reference fille records Since problems with these key reference files can impact a large number of claims is to your advantage to correct these problems at this point and re migrate the claims if necessary 1 Execute PC ACE Pro32 From the PC ACE Pro32 Main Toolbar click the UB92 Claims Processing button to display the UB92 Claims Menu form When prompted to login you may enter the default user s User ID SYSADMIN and password SYSADMIN as well 2 Click the List Claims button to open the UB92 Claim List form Resize and reposition
195. grate your current DOS MEDA claims entry tracking and history into the PC ACE Pro32 system To migrate your claims complete the following steps amp It is critical that setup of the Payer and UB92 Provider reference files has been completed prior to migrating your claims The key payers and providers referenced on these claims must be present in these reference files to insure a smooth migration In practice it may be necessary to review and re migrate the claims multiple times correcting problems in the Payer and UB92 Provider reference files between migration attempts Make sure that PC ACE Pro32 is closed before beginning this migration process From the Windows Start menu select the PC ACE Pro32 Migration Utility item in the MedLink Technologies PC ACE Pro32 programs folder This will start the migration utility and display its main form If the Select System Type radio button is visible select the Medicare A system type If this selection is not visible the Medicare A system type selection has already been made for you Select the drive containing the PCACE directory from which you intend to migrate the MEDA claims data For example if you select the C drive then the migration utility will expect to find the files ENTRY IDX TRACK IDX and HISTORY IDX the DOS entry tracking and history databases in the directory C PCACE For each of these expected files found in this directory the correspondin
196. have a requirement to define unique submitter identification information Submitter ID address etc for a specific LOB and Payer ID combination When the prepare process generates a new submitter record the Submitter reference file is searched for the most specific match available For example assume that a Submitter reference file record for LOB MCA and Payer ID 12345 is defined in addition to the always present default record which has empty LOB and Payer ID values When the EMC file submission header for a batch of MCA claims for Payer ID 12345 is to be built then the information in this MCA 12345 specific reference file record will be used Submission headers for claims with LOB MCA and Payer IDs other than 12345 as well as claims for all other LOBs will use the default Submitter reference file record If desired the Intermediary value may be specified on LOB specific and or Payer specific submitter records This feature is useful to control custom prepare and claim printing rules defined by a particular distributor If the Intermediary value is left blank default value on an LOB specific and or Payer specific submitter record then the 171 value specified on the next least specific submitter record will be used The Intermediary value on the default submitter record serves as the last resort value The Intermediary values should be modified only when directed to do so by your distributor Relat
197. he ESC key to disable the flashing notification Variable List Lookups Variable list lookups are available on many of the fields on these forms Variable list lookups apply primarily to fields whose values are selected from other reference files Such lookups often retrieve data used to fill in other form fields For example if you use the variable list lookup feature to select a Payer ID on the Primary Insured tab of the Patient Information form the Payer Description and Payer LOB will be retrieved as well Access variable list lookups using the same method described above for fixed list lookups Automatic Field Tabs When entering data in a field an automatic tab will occur when the field has been completely filled For example entering a single character in a one character field will automatically position the cursor on the next field in the tab sequence This feature can be disabled in the General Preferences settings if desired Cancel Field Changes If a change is inadvertently made to the contents of a field press the ESC key to cancel this change and restore the field s value to what it was when the field received the focus This feature is available for most fields on any of the reference file information forms Edit Validation Edit validation rules apply to patient payer provider and submitter reference file records When a new or modified patient payer provider or submitter record is saved an edit validation pr
198. he desired record from the list and click the View Update button or double click the desired record e To delete a Physician UPIN record select the desired record from the list click the Delete button and confirm the deletion hS A convenient Sort By feature quickly sorts the Physician s list by Name or UPIN The Physician UPIN Setup form also provides several List Filter Options that can be helpful in locating specific physician records Refer to the Reference File Maintenance Form topic for more discussion of these common filter options 179 Type of Bill TOB File Maintenance The Type of Bill TOB Codes form provides an interface to maintain the Type of Bill TOB codes used in PC ACE Pro32 TOB codes apply exclusively to UB92 claims The TOB codes are pre loaded and should not require frequent additions or modifications The following maintenance operations can be performed e Select LOB filters the list to include only valid TOBs for a specific line of business When a specific LOB is selected it will be used as the default LOB for new TOB code assignments e To add a new TOB record click the New button and enter the new TOB information On the Type of Bill TOB Information form select or change the LOB in the drop down list and enter a valid TOB first 2 positions only Identify the TOB assignment as either Inpatient or Outpatient by selecting the appropriate Patient Category radio button e To delete
199. he list will display claims in the to be transmitted CL location 3 From the Claim List form s main File menu select the Open Claim Archive item to display the Open Claim Archive form This form will display a list of all existing claim archives if any 4 To open an existing claim archive select the desired archive from the list and click the Open button or just double click the list entry The claim archive will be opened and you will be returned to the Claim List form Skip over the next step 5 To create a new archive if you have archive maintenance permission click the New button and enter a descriptive name for the new archive The empty archive will be created and the corresponding entry will be added to the selection list Select the new archive from the list and click the Open button or just double click the new list entry The new claim archive will be opened and you will be returned to the Claim List form x Claim archive names must adhere to your server s directory naming convention If Windows long file directory names are permitted then you can give the archive a descriptive name Otherwise you may be limited to 8 characters Archive names can contain only alphabetic characters numeric characters underscore _ 141 10 a 11 12 a 142 characters and spaces You will receive an error message if the chosen archive name is unacceptable Once you re back to the Claim List f
200. he problem at that time or leave it for later e File Level Edits that are validated only when an attempt is made to save the claim are referred to as file level edits File level edits are typically those that require multiple data elements from the claim in order to be evaluated For example looking for duplicate procedure codes on all lines of a claim is a task that can only be performed correctly when all lines have been entered As such this type of duplicate check is the ideal candidate for a file level edit All field level edits for the entire claim are re evaluated when an attempt is made to save the claim This is necessary to catch those field level edit errors that were never corrected and to catch any new edit errors that may have been introduced by other changes on the claim Fatal vs Non Fatal Edits Edits in PC ACE Pro32 are defined at the time they are created as either fatal or non fatal e Fatal Edits Fatal edits describe rules that should never be broken For example a claim has no useful meaning until at least one valid payer has been specified Therefore a fatal edit exists to ensure that a valid payer has been specified Claims with fatal errors can be saved unless the fatal errors exist on one of the claim s key fields Key fields include LOB PCN and TOB for UB92 claims and LOB and PCN for HCFA 1500 claims Claims saved with fatal errors will not be eligible for preparation into an electro
201. he user to manually trigger a specific claim attachment on any claim line item Simply enter the appropriate attachment trigger code in the desired claim line item s AT control For convenience you may press the F2 key or right click the mouse while focused on the AT control to display a popup selection menu All manually triggered attachments are line level by definition 64 hS The special Cancel automatic attachment manual trigger code is available to override cancel any automatically triggered claim line item attachment This override is useful in exception situations where it is desirable not to send a typically required claim attachment The manual attachment trigger feature may not be available in all installations If the claim line item s AT control is disabled and will not allow entry of the attachment trigger code then this feature is unavailable Attachments are displayed on second level tabs on the Billing Line Items tab These attachment tabs are shown or hidden dynamically based on the currently selected service line and the attachment type line level or claim level If the procedure code on the current line automatically triggers a particular attachment or if an attachment is manually triggered then the corresponding attachment tab will be shown Since claim level attachments exist only once for the entire claim the associated attachment tabs are visible regardless of the current line position Claim level at
202. helpful in locating specific patients Refer to the Reference File Maintenance Form topic for more discussion of these common filter options Entering Patient Information The Patient Information form provides access to a patient s details on the following information tabs e General Information provides access to general patient information such as the patient s name address birthdate and various status flags e Extended Info provides access to extended patient information such as information on the patient s legal representative HCFA 1500 use only the primary Provider ID UB92 use only and the Billing and Rendering Provider IDs HCFA 1500 use only e Primary Insured provides access to the payer insured and employer information for the primary UB92 and or HCFA 1500 payer s If your system is licensed for both UB92 and HCFA 1500 claim activities then you will have the option to enter separate UB92 and HCFA 1500 insured information See the Common vs Separate Insured Information section below for details e Secondary Insured provides access to insured information for the secondary UB92 and or HCFA 1500 payer s See the Primary Insured information bullet above for details e Tertiary Insured provides access to insured information for the tertiary UB92 and or HCFA 1500 payer s See the Primary Insured information bullet above for details AS A number of fields on the Patient Insured Information tabs support data
203. hether empty claim import rejection reports will be printed automatically This option is only enabled if you have chosen to print claim import reports automatically M When checked the claim import rejection report automatically prints even if there are no rejected claims When unchecked the import claim rejection report will not automatically print if it is empty Import Report Printer specifies the claim import reports printer e Process settings on this tab control the printing of claim processing reports These include Automatically print claim process reports on completion specifies whether claim processing reports will be printed automatically i When checked the claim processing reports automatically print after the claim processing operation has completed When unchecked the claim processing reports will not print automatically You will still have the option to print the reports manually Print claim process error report even when no errors exist specifies whether empty processing error reports will be printed automatically This option is only enabled if you have chosen to print claim processing reports automatically i When checked the claim processing error report automatically prints even if all processed claims were clean I When unchecked the claim processing error report will not automatically print if it is empty Process Report Printer specifies the claim processing reports pr
204. his powerful multi selection capability makes operating on groups of medical attachments a snap Simply use the UB92 Medical Attachment List form s advanced filtering options to narrow the list contents down until it contains only the desired medical attachments Then select the Check All Attachments action from the main or popup menu to instantly mark i e check all the medical attachments of interest A number of actions are available from the main or popup menu to operate on the entire group of medical attachments in a single session Refer to the UB92 Medical Attachment List Form Features topic for complete details on selecting and acting on multiple medical attachments at once Related Topics The following hyperlinks provide additional information related to this topic 152 b gt Refer to the UB92 Medical Attachment List Form Features topic for details on using the UB92 Medical Attachment List form b Refer to the UB92 Medical Attachment Forms topic for more information on using the UB92 Medical Attachment entry forms b gt Refer to the Claim amp Reference File Edit Validation topic for more information about the edit validation process and associated forms 153 Preparing UB92 Medical Attachments for transmission Medical attachment preparation in PC ACE Pro32 refers to the act of generating an Electronic Media Claims EMC file suitable for transmission to your claims processor This EMC file will contain all rel
205. ht margin of the control It is not necessary to enter any manual carriage returns in a narrative field If however a hard carriage return is desired simply press the ENTER key and resume typing on the next line of the narrative control e Displaying Audit information Click the picture button in the upper right corner of the first tab of each UB92 Medical Attachment Form to display audit information for this medical attachment This audit information includes the date the medical attachment record was created the last modification date and the User ID of the user that modified the attachment last Common UB92 Medical Attachment Activities The following hyperlinks provide additional instruction on several common standalone UB92 Medical Attachment activities b Refer to the Adding a new UB92 Medical Attachment topic for more information on adding medical attachments 82 b Refer to the Listing modifying and maintaining UB92 Medical Attachments topic for tips on maintaining medical attachments from the UB92 Medical Attachments List form b Refer to the Preparing UB92 Medical Attachments for transmission topic to learn how to prepare standalone medical attachments into an EMC file ready for transmission 83 Reference File Maintenance Form The Reference File Maintenance form provides an interface to access all PC ACE Pro32 reference files Click the Reference File Maintenance button on the PC ACE Pro32 Main Toolbar to open
206. ical Attachment fields These key fatal edit errors must be corrected before the UB92 Medical Attachment can be saved Related Topics The following hyperlinks provide additional information related to this topic b gt Refer to the UB92 amp HCFA 1500 Claims Menus topic for more information about the UB92 Claims Menu form b gt Refer to the UB92 Medical Attachment List Form Features topic for details on using the UB92 Medical Attachment List form b Refer to the UB92 Medical Attachment Forms topic for more information on using the UB92 Medical Attachment entry forms b gt Refer to the Claim amp Reference File Edit Validation topic for more information about the edit validation process and associated forms 151 Listing modifying and maintaining UB92 Medical Attachments Standalone UB92 Medical Attachments in PC ACE Pro32 are listed modified and otherwise maintained from the UB92 Medical Attachment List form To access the UB92 Medical Attachment List form 1 Click the UB92 Claims Processing button on the PC ACE Pro32 Main Toolbar to display the UB92 Claims Menu form 2 From the UB92 Claims Menu form select the Attachments and Maintain Medical Attachments menu items to open the UB92 Medical Attachment List form Most actions to be performed on a UB92 Medical Attachment may be executed from the UB92 Medical Attachment List form UB92 Medical Attachments can be created viewed modified copied deleted held re
207. ield however you must correct the error before saving the plan Click the Save With Errors button to save a plan that contains only non fatal errors Such plans are assigned the has errors ERR status Click the Save With Fatal button to save a plan that contains fatal errors Such plans are assigned the has fatal errors ERF status If edit validation errors occur several Save attempts may be required to correct and save a clean plan At any time click the Errors List button to review the remaining edit validation errors Miscellaneous Plan of Care Form Topics The following comments cover a few miscellaneous features of the Home Health Plan of Care Form e Entering Free Form Narrative Data The free form narrative fields on the Plan of Care form will automatically wrap to the next line as typing proceeds beyond the right margin of the control It is not necessary to enter any manual carriage returns in a narrative field If however a hard carriage return is desired simply press the ENTER key and resume typing on the next line of the narrative control e Displaying Audit information Click the picture button in the upper right corner of the Plan of Care 485 1 tab to display audit information for this plan This audit information includes the date the plan record was created the last modification date and the User ID of the user that modified the plan last Common Plan of Care Activities The following hyperlinks
208. ield level edit validation error occurs you will receive an audible response and the edit validation error message will be 81 displayed in the lower left corner of the medical attachment form In addition the focus will remain on the field so that you can correct the problem if desired If you choose not to correct the data at this time simply press the TAB key again to move to the next field Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the medical attachment edit validation process Saving amp Canceling UB92 Medical Attachments After completing data entry on one of the UB92 Medical Attachment forms click the Save button or type lt ALT gt S to save and exit the medical attachment Alternatively click the Cancel button to abandon any changes and exit the medical attachment When an attempt is made to save a medical attachment an edit validation process is performed on all fields on the attachment This process includes re evaluating all field level edits as defined above In addition all attachment file level edits are evaluated File level edits are evaluated only when the medical attachment is saved and are typically those edits that require multiple data elements from the attachment in order to be evaluated If no edit validation errors occur the medical attachment is saved with a clean CLN status If however one or more edit validation errors occur you will
209. if any Refer 118 3 to the Submitter File Maintenance topic for more information on this advanced feature Provider specifies one or more Providers to be considered Only claims for the selected provider s will be eligible for preparation Select the lt lt All Providers for Payer s gt gt item to include claims for all providers For UB92 claim preparation the provider to be compared is the one associated with the claim s submission payer For HCFA 1500 claim preparation the provider to be compared is the claim s billing provider Note This selection is only enabled when a specific LOB and Payer have been selected for preparation Choose the lt lt Selected Providers for Payer gt gt item in the drop down list to specify multiple Provider IDs Enter any number of Provider IDs separated by semicolons on the Multiple Provider Selection form If multiple providers are specified claims for any of the specified providers will be included For your convenience the system remembers the last multiple provider filter string specified gt Prepare Options options that control the claim preparation operation Note These options may not be available on some systems Output Format specifies the desired EMC file output format PC ACE Pro32 currently supports NSF and ANSI 837 file formats The initial state of this option is determined by a Submitter reference file setting Submission Status specifies whether
210. ified on the claim other than the submission payer For example if a Medicare payer is specified as primary on a Medicare claim then the primary payer will be designated as the submission payer In this scenario the secondary and tertiary payers are considered alternate payers Alternate Payers 1 and 2 are defined based on the claim s submission payer as follows Submission Primary Secondary Tertiary Alt Payer 1 Secondary Primary Primary Alt Payer 2 Tertiary Tertiary Secondary When a claim is printed for an alternate payer PC ACE Pro32 will attempt to populate the printed fields as though the selected alternate payer was the submission payer In general this means that the payer specific and provider specific information included on the printed claim will reflect the alternate Payer ID and LOB line of business For alternate payer printing to work most effectively all payers specified on the claim must be on file in the PC ACE Pro32 Payer reference file In addition provider records for the alternate claim payer LOBs must also be on file in the PC ACE Pro32 UB92 or HCFA 1500 Provider reference file and must be associated with the submission provider record AS This capability makes it easy to print secondary tertiary claims without requiring the creation of a separate claim for the alternate payer hS If a request is made to print an alternate payer that does not exist on the claim being printed the request will simply be ig
211. ifies the next Serial Number to be assigned during the prepare process This value is automatically updated each time claims are prepared Next File Seq UB92 only specifies the next File Sequence Number to be assigned during the prepare process This value is automatically updated each time claims are prepared Submitter Interchange ID Qualifier specifies the system method of code structure used to designate the Submitter ID in all electronic interchanges This qualifier populates element ISA05 of the Interchange Control Header ISA segment in the ANSI 837 4010 format EMC file The distributor will provide this qualifier if required Receiver Interchange ID Qualifier specifies the system method of code structure used to designate the Receiver ID in all electronic interchanges This qualifier populates element ISA07 of the Interchange Control Header ISA segment in the ANSI 837 4010 format EMC file The distributor will provide this qualifier if required Authorization Info specifies optional Interchange Sender Authorization or identification information This value populates element ISA02 of the Interchange Control Header ISA segment in the ANSF837 4010 format EMC file Security Info specifies optional Interchange Sender Security information This value populates element ISA04 of the Interchange Control Header ISA segment in the ANSI 837 4010 format EMC file ISA06 Override specifies optional Interchange Sender ID in
212. ify the specific EMC file associated with this acknowledgment file To view the Claim Transmission Log form select the Maintain and Transmission Log menu items on either the UB92 or HCFA 1500 Claims Menu form e Status Displays a status code indicating whether or not the ANSI 837 4010 transmission file was accepted or rejected Additional identification information is included in the acknowledgment report to aid in researching transmission errors Contact your intermediary s support department for assistance in understanding the ANSI 997 report nomenclature 124 Reactivating previously transmitted claims In some situations it may become necessary to reactivate one or more previously transmitted claims for retransmission PC ACE Pro32 provides two techniques for reactivating claims e Individual claims in the transmitted TR location may be reactivated for inclusion in a subsequent EMC file e An entire EMC file may be reactivated for retransmission This section will describe the procedures required to perform both types of claim reactivation Reactivating Transmitted Claims Individually If one or more transmitted claims need to be resubmitted in a future EMC file these claims must first be reactivated Only claims in the transmitted TR location may be reactivated Once a payment has been made on a claim it will move to the paid PD location and is no longer eligible for reactivation This reactivation process s
213. im Generation form You will be notified when the claim generation 144 operation completes If desired click the View Results or View Rejects buttons to view reports of the successfully generated claims or rejected claims respectively These reports can be printed from the report previewer if desired If any claim rejects occur during the generation process the entire process will be reversed Review the rejects report correct the offense and run the roster billing generation process again Successfully generated roster billings will be moved automatically to the generated GR location bS The claim billing report for any previously generated roster billing may be previewed and or printed by selecting the desired roster billing record in the Roster Billing List Form and choosing the View Selected Roster Report action PC ACE Pro32 uses the claim import report preference settings to define the default reporting options for the roster billing generation process Refer to the Printing Preferences topic for information on configuring claim import and roster billing generation reports to be printed automatically or to a specific printer Related Topics The following hyperlinks provide additional information related to this topic b gt Refer to the Roster Billing List Form Features topic for details on using the HCFA 1500 Roster Billing List form b Refer to the HCFA 1500 Roster Billing Form topic for more information on
214. imply moves the selected claim s from the transmitted TR location to the to be transmitted CL location and sets the status to unprocessed UNP The reactivated claim can then be processed and if no fatal edit validation errors are present becomes eligible for inclusion into the next EMC file prepared Claim reactivation is performed from the UB92 or HCFA 1500 Claim List form 1 Filter the claim list to include only transmitted only TR claims 2 Ifa single claim is to be reactivated simply select the claim record in the list and choose the Reactivate Selected Claim item from the form s main Actions menu Confirm the reactivation when prompted The claim should disappear from the list since it is no longer in the transmitted TR location You should now find the unprocessed Status UNP claim in the to be transmitted CL location 3 To reactivate several claims at one time simply check the desired claims A claim in the list is checked by clicking the left mouse button once while the mouse pointer is positioned over the list row s left most column A checkmark will be visible in the left most column for all currently checked claims in the list Choose the Reactivate All Checked Claims item from the form s main Actions menu Confirm the reactivation of all checked claims when prompted hS To automatically check all claims included in a previous transmission file select the Check All Claims From
215. ims and selected reference files M When checked the appropriate variable list lookup will be automatically initiated whenever the hand keyed ID UPIN cannot be uniquely resolved in the corresponding reference file The lookup list will automatically position itself on the 95 2 Od O ko 96 first of several records with the specified ID UPIN The user may then select the desired record from the list When unchecked the variable list lookup will not be initiated and the non unique ID UPIN value will be left unresolved In most cases this will result in a subsequent edit validation error To correct this the user should manually initiate a variable list lookup operation and select the desired unique record Right click the mouse or press the F2 key while positioned on the offending ID UPIN field to manually initiate the lookup operation Automatically focus on Patient PCN field for new UB92 hand keyed claims Determines whether or not the cursor focus should be forced directly to the Patient PCN field when the user manually creates a new UB92 claim Enable this patient centered configuration option for installations that make extensive use of the Patient reference file Upon patient selection the claim s LOB field and primary provider field optional will be populated automatically from information on file in the patient record i When checked the cursor focus will be forced to the Patient PCN field when a
216. in either the Setup of Medicare Part A Systems Setup of UB92 All Payer Systems or Setup of HCFA 1500 Systems topic hS Check with your distributor before performing these once only setup steps Some distributors build this setup into the program installation procedure 2 Generate the EMC format file containing the claims to be imported 3 Copy the EMC format file to be imported into the server s claim import directory The file must have a dat file extension e g EMC192 DAT The claim import directory is named winpcace impub92 for UB92 claim import operations and winpcace imp1500 for HCFA 1500 claim import operations Once these preparation steps are complete you are ready to import the claims into PC ACE Pro32 Importing the Claims Once the preparation steps are complete importing claims into PC ACE Pro32 is quick and simple The following steps outline the claim import process 1 2 From the PC ACE Pro32 Main Toolbar click either the UB92 Claims Processing or HCFA 1500 Claims Processing button to open the desired Claims Menu form Click the Import Claims button on the Claims Menu form to open the UB92 or HCFA 1500 Claim Import form The forms caption should reflect the chosen claim import method If you are using the PrintLink claim import method and you have multiple map files in the server s claim import directory you will see a drop down list labeled Select PrintLink 111 Map File
217. in this topic will lead you through this process 4 Repeat the relevant steps to create additional Payer records as needed This may include records for the same payer and different LOBs or records for additional payers 5 When all desired Payer records have been added click the Close button on the Reference File Maintenance form to return to the PC ACE Pro32 Main Toolbar Provider Reference File Setup This section describes the process of setting up the HCFA 1500 Provider reference file This file contains information about the valid providers in your system All providers for whom you will be billing HCFA 1500 claims must exist in the HCFA 1500 Provider reference file The HCFA 1500 Provider reference file is organized such that each record describes a valid provider fora single line of business LOB This organization allows for greater flexibility in specifying Provider IDs and support information Tax ID address etc that can vary across multiple LOBs for a single provider Complete the following steps as needed The HCFA 1500 provider structure defines 3 distinct provider types 1 Provider Groups 2 Individual Providers Within A Group and 3 Solo Providers HCFA 1500 claims require a billing provider that can be either a group or solo provider but not an individual within a group The HCFA 1500 claim entry provider lookups and claim editing process will enforce this requirement You will be required to assign one
218. ing descriptions Setup of the Payer reference file is mandatory although it may be setup in advance by your distributor All payers referenced on claims must exist in the Payer reference file with the exception of the special dump payer Payer ID 99999 The Payer tab provides a convenient Sort By selection that quickly sorts the Payer list by Payer ID Payer Description Payer LOB or Payer State Operations available include e To add a new payer record click the New button and enter the new payer record information Refer to the Adding and maintaining payers topic for additional information on payer and PrintLink matching description requirements e To view or modify an existing payer record select the desired record from the list and click the View Update button or double click the desired record e To create a new payer record that is similar to an existing record select the desired payer record click the Copy button and change only the desired fields This feature makes it easy to create multiple payer records for the same payer to support more than one line of business LOB e To delete an existing payer record select the desired record from the list click the Delete button and confirm the deletion e Click the PrintLink Matching Descriptions button while viewing a Payer s details to view edit the PrintLink matching strings for the selected payer Refer to the Adding and maintaining payers topic for
219. ing modifying and maintaining roster billiNS ceeeeeeeeeeeeeeeeeeees Adding a new Home Health Plan of Care ccceeeeeeeneeeeeeeeneeeeeeaaeeeeeeaa Listing modifying and maintaining Plans of Care a e Printing Home Health Plans of Care ceeeeeeceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeees Adding a new UB92 Medical Attachment ceceeceeeeeeeeneeeeeeaneeeeeeea Listing modifying and maintaining UB92 Medical Attachments Preparing UB92 Medical Attachments for transmission 0 008 Common Reference File Procedures 155 Adding and maintaining patients cccceeeeeeeneeeeeeeeeeeeeeeaaeeeeeeaaeeeeeeaa Adding and maintaining payers c cececceeeeeeeeaeeeeeeaaeeeeeeaaeeeeeeaaeeeeeead Adding and maintaining providers UB9Q2 ceceeeneeeeeeeaeeeeeeeaneeeeeeee Adding and maintaining providers HCFA 1500 cceeeeeeeeeeeeeeeees Maintaining Codes amp Miscellaneous Reference Files 0ee Codes amp Miscellaneous Reference Files Overview ecseeeeeee Submitter File Maintenance 2 cececceeeeceeeeeceeeeeeeeesaeeeeaeeeeseees Data Communications File Maintenance 22 c cceeeeeeeeeeeeeeeees HCPCS Codes File Maintenance 2 cecceeeeeeeeeeeeeceeeeeaeeeeeeees HCPCS Modifiers File Maintenance ccceeeeeeeeeeeeneeeeeeeeeeees ICD9 Codes File Maintenance 2
220. ing payers topic for details on setting up your PrintLink Matching Description strings Each time you want to import claims copy the new print image file generated by your upstream system into the server s winpcace impub92 directory The first line of the map file provided by your distributor dictates what the print image file must be named typically ub92 prt Intermediate Delimited Format imports claims from a file in intermediate delimited format If using this claim import method complete the following steps 1 gt Work with your distributor to develop the programs necessary to produce a file in intermediate delimited format from your upstream system Your distributor should have detailed specifications of this internal file format Verify that the generated files meet these specifications Confirm the existence of the required map control file This file provides a control interface between the intermediate delimited file and the PC ACE Pro32 claim import routines The map control file is always named mapentlu win and should be located in the server s winpcace impub92 directory Setup all required PrintLink Matching Description strings in the Payer reference file These strings are used to match payer descriptions from claims in the intermediate delimited file to specific Payer reference file records Refer to the Adding and maintaining payers topic for details on setting up your PrintLink Matching Descripti
221. inished reviewing and possibly unarchiving claims in the claim archive select the View Current Claims item from the main File menu to toggle back to the current claims Select the Close Claim Archive item from the main File menu to close the open claim archive You will be prompted to pack the claim archive before closing Click the Yes button to pack and close the archive the No button to close the archive without packing or the Cancel button to leave the archive open E Packing a claim archive database minimizes the disk space requirements and enhances performance It is recommended that claim archive databases be packed periodically especially after groups of claims have been unarchived or purged from the archive The packing process can be lengthy for large databases Once the packing operation has started it must continue to completion We recommend packing claim archives only when no other users are accessing PC ACE Pro32 AS If you close the Claim List form without first closing an open claim archive the archive is closed automatically and you will receive the pack prompt described above If claims have been archived you will receive a notification when the archive is closed concerning packing the current claims database The system administrator should pack the current claims database periodically to keep the database size minimized and to maintain optimum system performance Refer to the Packing and reind
222. inter 99 100 t og Include error details on process error report specifies whether detailed edit validation error descriptions are to be included in the processing error report by default This default value can be overridden for each processing run if desired M When checked the processing error report will include edit validation error descriptions for each claim by default When unchecked the processing claim report will not include edit validation error descriptions Maximum number of process errors reported per claim specifies the maximum number of processing edit validation errors to be reported per claim The default value of 5 errors per claim helps to limit the size of the processing error report Increase this value substantially if you prefer that all errors be included in the report Prepare settings on this tab control the printing of claim prepare reports These include A Kosa O Kosa Automatically print claim prepare reports on completion specifies whether claim prepare reports will be printed automatically M When checked the claim prepare reports automatically print after the claim prepare run has completed I When unchecked the claim prepare reports will not print automatically You will still have the option to print the reports manually Print claim prepare error report even when no errors exist specifies whether empty claim prepare error reports will be printed automatically This opt
223. ion t Assignments defines the list of valid TOS codes for each line of business LOB These assignments will also determine which TOS codes will be included in the TOS lookup list presented during claim entry The TOS assignment maintenance options include e Select LOB filters the assignment list to include only assignments for a specific line of business LOB When a specific LOB is selected it will be used as the default LOB for new TOS code assignments e To add anew TOS code assignment record click the New button on the Assignments tab Select the desired LOB and TOS code from the drop down lists e To delete a TOS code assignment record select the desired record click the Delete button and confirm the deletion Effective Date Range The Effective Date Range dates are compared to the associated claim line s service date range during the claim edit validation process If the effective date range for a Type of Service TOS code falls outside the line s service date range an edit validation error will be reported If the effective date range is left blank the TOS code is valid for all dates of service If the start date is completed but the end date is left blank the TOS code is valid for all dates of service from and including the start date forward If the start date is left blank but the end date is completed the TOS code is valid for all dates of service up to and including the end date 186 Facilit
224. ion Since this record exists in our example it would serve as the source for the data communications parameters written to the control file If instead the last EMC file was prepared for LOB MCA and any other Payer ID or all payers then the Data Communications reference file record for LOB MCA and Payer unspecified would be used Finally if the last EMC file was build with no filter selections or with and LOB selection of anything other than MCA then the default Data Communication reference file record LOB and Payer would be used Related Topics The following hyperlinks provide additional information related to this topic b gt Refer to the Preparing claims for transmission topic for more information on preparing electronic claim files b Refer to the Transmitting electronic claim files topic for a typical example of how the data communications launch facility can be used b Refer to the Data Communication Preferences topic for information on configuring the Data Communication Options form launch buttons 174 HCPCS Codes File Maintenance The HCPCS Codes form provides an interface to maintain the HCPCS codes used in PC ACE Pro32 Separate database files are used to maintain global versus local HCPCS codes Global HCPCS codes are maintained and updated by your distributor Changes to global HCPCS codes should be rare and should always be performed under a distributor s supervision Local HCPC
225. ion is only enabled if you have chosen to print claim prepare reports automatically M When checked the claim prepare error report automatically prints even if all claims were successfully prepared When unchecked the claim prepare error report will not automatically print if it is empty Prepare Report Printer specifies the claim prepare reports printer Claim Form settings on this tab control printing of UB92 and HCFA 1500 claim forms and claim attachments These include O Og Default Printer specifies the default claim form printer This default selection may be overridden when the claim form is printed Default Method specifies the default claim form printing method This method may be overridden when the claim form is printed The available printing methods include Pre printed Forms specifies the traditional printing method requiring pre printed HCFA 1450 1500 claim forms Image Overlay specifies an advanced overlay technique in which both the claim form graphics and claim data are printed on stock paper This method requires the Adobe Acrobat Reader and will only be enabled if this reader is properly installed on the client workstation Refer to the Printing claims topic for more information on this advanced printing technique Pre printed Claim Form Options specifies page positioning adjustment settings for printing claims using the pre printed forms method These settings allow the user to adjust the
226. ires users to enter a valid User ID and Password to log in User activity permissions are not enforced at this security level Once a user logs in all system functions are allowed lt 7 k9 Password not required User ID for Audit only requires users to enter only a valid User ID to log in This minimum security level uses the User ID for audit purposes only Access to the Security Options form requires a master System Administrator password Related Topics The following hyperlinks provide additional information related to this topic gt Refer to the Adding or modifying a system user topic for more information on user maintenance 91 System Preferences 92 Preferences Overview Many of the features in PC ACE Pro32 are customizable These preference settings are organized on a tabbed dialog accessible from the PC ACE Pro32 Main Toolbar s main File menu The major tabs on this dialog include Ke General Preferences includes settings to control general claim entry and other basic aspects of the program s behavior o oe Claim List Preferences permits customization of the UB92 and HCFA 1500 Claim List forms including column field selection order width and headings Claim Import Preferences permits selection of the UB92 and HCFA 1500 claim import processing method as well as specification of an optional import preprocessor Printing Preferences includes UB92 and HCFA 1500 report a
227. is technique also frees you to jump around between on line help topics without losing your place in the migration procedure To print the topic just click the Print button at the top of this on line Help screen Submitter amp Payer Auto Creation and Patient Reference File Migration This section describes the steps required to migrate your current DOS MEDA Submitter information Payer information and Patient reference file optional into the PC ACE Pro32 system The default PC ACE Pro32 Submitter reference file record and a single Payer reference file record will be auto created from submitter payer information in the DOS MEDA Submitter file SUBMIT DAT The claims data from your DOS system will be migrated in a later step after the necessary UB92 Provider record s have been setup To perform the submitter payer and patient data migration complete the following steps 1 Close PC ACE Pro32 before beginning this migration process 2 From the Windows Start menu select the PC ACE Pro32 Migration Utility item in the MedLink Technologies PC ACE Pro32 programs folder This will start the migration utility and display its main form 3 If the Select System Type radio button is visible select the Medicare A system type If this selection is not visible the Medicare A system type selection has already been made for you 4 Select the drive containing the PCACE directory from which you intend to migrate the DOS MEDA system da
228. isabled in the General Preference settings This form lists all the edit validation errors that have occurred flagging fatal errors with a red X graphic Double click on any of the listed errors to jump directly to the offending field on the claim form Claims with fatal errors can be saved unless the fatal errors exist on one of the claim s key fields Key fields include LOB PCN and TOB for UB92 claims and LOB and PCN for HCFA 1500 claims Click the Save With Errors button to save a claim that contains only non fatal errors Such claims are assigned the has errors ERR status Click the Save With Fatal button to save a claim that contains fatal errors Such claims are assigned the has fatal errors ERF status Claims with an ERF status will not be eligible for preparation into an electronic EMC file Fatal edit errors on reference file records must be corrected before the user can save the record If edit validation errors are reported several Save attempts may be required to correct and save a clean claim At any time click the Errors List button to review the remaining claim edit validation errors Remember that file level edit errors are only re cchecked when the claim is saved Therefore these edit errors will remain in the list even though the problem may have already been corrected The next claim save attempt will clear any corrected file level edit validation errors from the list AS When the Edit Validati
229. ividual in group provider record perform a lookup in the Group Label field and select the group in which this individual provider will be a member Complete entry of the remaining provider fields as desired 5 Click the Save button to save the new HCFA 1500 Provider record An edit validation process will be performed to check for problems with the provider information When prompted correct any missing or invalid field values if present and re save as needed The new Provider record should now be visible in the Provider list 22 6 Repeat the last few steps to add each additional HCFA 1500 Provider record Now each time you click the New button you will be prompted to select whether you want a completely new provider all fields blank to start with or whether you would like to inherit the name address information from the currently selected provider If you choose the inherit option you will also have the option to associate the new provider record with the selected provider record Provider records should be associated when they represent the same entity For example if a solo provider supports multiple lines of business one solo provider record for each LOB should be created and these related provider records should be associated with each other The inherit and associate options can be a real timesaver when setting up providers that support multiple lines of business In this scenario select an existing provider i
230. l local fields defined by the distributor The available control flags are defined as follows e Source indicates the national payment source code for this payer e Edit ind claim editing indicator assigned by the receiver to determine the adjudication program HCFA 1500 use only e Media specifies whether the payer receives claims electronically or on paper The media flag of a claim s submission payer will determine whether the claim is eligible for preparation into an EMC file or whether it must be submitted on paper e Card setting used to govern payer specific requirements e g claim office requirements Consult your distributor concerning the correct card setting for new payers e Address indicates whether the payer address is a required for this payer e Usage indicates whether the payer record is restricted for UB92 use only HCFA 1500 use only or unrestricted use This feature permits Payers for shared LOBs such as Commercial COM to optionally have distinct settings and PrintLink matching strings for UB92 versus HCFA 1500 use If the specified Payer LOB is valid for only one of these claim types then the Usage value will be forced to the appropriate setting by the program 158 hS A number of fields on the Payer Information tab support data entry via fixed list or variable list lookups These lookup lists are accessed by right clicking the mouse over the field or pressing the F2 key while focused on the
231. l relevant status request details for one or more previously transmitted claims Upon receipt of the ANSI276 file the claims processor will generate a corresponding ANSI 277 claim status response file containing status information for the requested claims This ANSI 277 response file can be processed by PC ACE Pro32 and the user will be able to view the status information returned for each claim represented in the original ANSF276 claim status request file Only claims that have been added to the status request queue will be included in the ANSI 276 claim status request file See the Claim List Form Features topic for details on how to build the status request queue Before preparing claims into a status request file for the first time you may need to setup your Submitter reference file This file contains important data that will be used to build the ANSI 276 file Separate submitter details exist for UB92 and HCFA 1500 claim types Since some distributors pre configure the Submitter reference file you should check with them before making any changes Refer to the Submitter File Maintenance topic for more information on configuring this important reference fle To prepare a claim status request file in PC AC Pro32 follow these steps 1 Add one or more transmitted claims to the status request queue using the Request Selected Claim Status or Request All Checked Claims Status action in the UB92 or HCFA 1500 Claim List form 2 From
232. laims K3 SR Status Response Indicator This indicator will display an R on claims where status has been requested but where a response has not yet been received An A value indicates that status response information is available for this claim An empty SR column indicates that no claim status request response history is available for the claim Status Date Status Response Date Specifies the date of the most recent status request or posted status response for the claim This date column will be empty if no claim status request response history is available for the claim These columns should be visible by default at the far right of the UB92 and HCFA 1500 Claim List forms whenever the TR PD or TR PD claim location is selected You may need to maximize the window or scroll the list horizontally to bring these columns into view If these columns are not present you will need to add the associated fields to the current claim list column configuration in the Claim List Preferences form Select the Preferences item from the PC ACE Pro32 main toolbar s File menu to display the Preferences form Select the Claim List tab choose either the UB92 Claim List or HCFA 1500 Claim List radio button if available and then select the Transmitted TR nested tab Move the Status Response Ind and Status Response Date fields from the available fields list to the selected fields list Reorder the new fields in the sel
233. le if payer 12345 will receive both Medicare and Medicaid claims then two Payer records must be added both with Payer ID 12345 one with LOB MCA and the other with LOB MCD Since this is a Medicare Part A Only system it is conceivable that you will only be required to setup one Payer record This record would contain the Payer ID of your Medicare Part A payer and an LOB of MCA You may decide to add additional Payer records for other lines of business if you want to include these on the claim s secondary and tertiary payer lines 3 Click the Save button to save the new Payer record An edit validation process will be performed to check for problems with the payer information When prompted correct any missing or invalid field values if present and re save as needed The new Payer record should now be visible in the Payer list If you plan on using the PrintLink feature of PC ACE Pro32 to import claims from print image files then you will also need to add PrintLink Matching Description strings to this Payer record The Claim Import Considerations section later in this topic will lead you through this process 4 Repeat the relevant steps to create additional Payer records as needed This may include records for the same payer and different LOBs or records for additional payers 5 When all desired Payer records have been added click the Close button on the Reference File Maintenance form to return to the
234. leased and reactivated from the list Refer to the UB92 Medical Attachment List Form Features topic for complete details on the features and operation of the powerful UB92 Medical Attachment List form Viewing amp Modifying UB92 Medical Attachments Viewing and or modifying existing medical attachments from the UB92 Medical Attachment List form can be performed with these general steps 1 Use the UB92 Medical Attachment List form s sorting and advanced filtering capabilities to locate the medical attachment of interest in the list 2 Select the desired medical attachment in the list and click the View Update button to display the medical attachment details Alternatively just double click the desired medical attachment record in the list 3 Make all desired changes to the medical attachment Refer to the UB92 Medical Attachment Forms topic for details on the many productivity enhancing features available on this powerful form 4 When all changes have been made click the Save button to save the medical attachment record and close the form Review and correct any edit validation errors as needed Alternatively click the Cancel or Close button to cancel any pending medical attachment changes Actions On Multiple UB92 Medical Attachments Many of the actions available in the UB92 Medical Attachment List form are applicable to both single selected medical attachments as well as groups of checked medical attachments T
235. lect the C drive then the migration utility will expect to find the files BSPAYER IDX the DOS payer database and BSPAT IDX the DOS patient database in the directory C BSACE For each of these expected files found in this directory the corresponding checkbox in the Select the databases to migrate radio group will be enabled 5 Click the Migrate the payer reference file checkbox If you desire to migrate your DOS patient data click the Migrate the patient reference file checkbox as well Finally click the Migrate button to proceed You will be prompted to choose whether to replace the existing Payer and Patient reference file contents with the migrated data or to merge the migrated data with the Payer Patient reference file data already in PC ACE Pro32 The Patient and Payer reference files in PC ACE Pro32 are shared between UB92 and HCFA 1500 claims processing activities See the Migrating Dual Systems UB92 and HCFA 1500 topic for more information on migrating dual use systems 20 You should choose the Replace existing data options unless your system is already in use for UB92 claims processing The migration utility will proceed to dump the contents of your payer and patient databases into temporary files that will then be imported into the PC ACE Pro32 Payer and Patient reference files respectively All PrintLink matching strings defined in the DOS HCFA 1500 All Payer system will also be migrated and
236. licable to both single selected plans as well as groups of checked plans This powerful multi selection capability makes operating on groups of plans a snap Simply use the Plan of Care List form s advanced filtering options to narrow the plan list contents down until it contains only the desired plans Then select the Check All Plans of Care action from the main or popup menu to instantly mark i e Check all the plans of interest A number of actions are available from the main or popup menu to operate on the entire group of plans in a single session Refer to the Home Health Plan of Care List Form Features topic for complete details on selecting and acting on multiple plans at once Related Topics The following hyperlinks provide additional information related to this topic b Refer to the Home Health Plan of Care List Form Features topic for details on using the Plan of Care List form b gt Refer to the Home Health Plan of Care Form topic for more information on using the Plan of Care entry form 147 b gt Refer to the Claim amp Reference File Edit Validation topic for more information about the edit validation process and associated forms 148 Printing Home Health Plans of Care Home Health Plans of Care are printed in PC ACE Pro32 using an advanced image overlay technique This advanced method automatically overlays the plan field values onto a graphical image of the blank Plan of Care HCFA 485 486 487 form
237. lick the View Update button or double click the desired record e To delete a revenue code assignment record select the desired record click the Delete button and confirm the deletion e To copy all revenue code assignments records from another revenue code click the Copy button and enter the revenue code from which the assignment records are to be copied This feature makes it easy to duplicate assignment record sets from one revenue code to another 182 The Revenue Code Assignments Information form provides the following assignment detail fields K3 gt G o o LOB specifies the Line of Business LOB for which this assignment applies If the lt lt All LOBs gt gt option is selected then this assignment will apply to all LOBs TOB specifies the Type of Bill TOB for which this assignment applies If this field is left blank then this assignment will apply to all TOBs Only the first 2 characters of the TOB are required X Two special TOB values are available to make it easier to define Revenue Code Assignments applicable to inpatient or outpatient claims Enter IP in the TOB field to indicate that the assignment applies to all inpatient TOBs Alternatively enter OP in this field to indicate that the assignment applies to all outpatient TOBs The inpatient outpatient designations for all TOBs are defined in the Type of Bill TOB Maintenance File Revenue Code Assig
238. likely that your system does not have its default mailer properly configured 203 Troubleshooting 204 Reviewing the claim activity logs The Claim Activity Log files provide details of all claim import process prepare and transmission activities The logs also record any abnormal activities that may occur in the course of operation Separate log files are maintained for UB92 and HCFA 1500 claim activities The logs can be useful when researching past claim processing activity or reviewing the outcome of scheduled claim activities To view a claim activity log file select the View and Claim Activity Log items from the UB92 or HCFA 1500 Claims Menu form s main menu The applicable log file will be opened in the Windows Wordpad program Activities are logged chronologically with the most recent entries at the end of the file AS Be sure and close Wordpad when you are finished reviewing the log To purge a claim activity log file select the Maintain and Purge Claim Activity Log items from the UB92 or HCFA 1500 Claims Menu form s main menu This action simply deletes the appropriate Claim Activity Log file The next claim import process prepare or transmission will start a new log file Since the number of days for which entries are maintained in this log can be set in the PC ACE Pro32 preferences this function will rarely be used Related Topics The following hyperlinks provide additional information related to this topi
239. line e Field Duplication Press the F4 key while positioned on a specific field on a line to copy the value of that single field from the previous line into the current line e Line Deletion Press the F7 key while positioned on any field on a line to delete the line You will be prompted to confirm the deletion Alternatively enter the value DEL that s an asterisk plus DEL plus another asterisk without the double quotes into the HCPCS field on a claim line to delete the line Claim lines are automatically re sequenced by Revenue Code when a claim is saved As such there is no need to provide line rearrangement capabilities e Advance To Next Line Press the F8 key while positioned on any field on a line to automatically advance the cursor to the first field of the next line skipping over any remaining fields on the current line e Line Item Totals Recalculation The Billing Line Items tab provides a Recalculate button located near the bottom of the tab adjacent to the totals fields Click this button to 59 recalculate and update the Total Charges and Total Non Covered Charges fields from the current claim line item charges values NOTE This button may not be available on some installations e Clear Payer Feature The Payer Information tab provides a Clear Payer button for each of the 3 claim payers Click this button to clear all payer provider insured and employer fields for the associated payer
240. list click the Delete button and confirm the deletion E Claims are linked to provider records by an internal control number Deleting a provider record will irrevocably break any such links that may exist to claims in the system The Provider Deletion Confirmation form outlines alternatives to deletion and provides a convenient utility to determine how many claims reference the provider record to be deleted K Codes Misc provides access to the core PC ACE Pro32 codes and miscellaneous reference files Refer to the Codes amp Miscellaneous Reference Files Overview topic for additional information on each of these reference files Common Reference File Form Features A number of productivity enhancing features are available while entering reference file information e Fixed List Lookups Fixed list lookups are available on many of the fields on these forms Fixed list lookups apply to fields whose list of valid values can be determined in advance For example Patient Sex typically has 3 possible values M male F female and U unknown 85 USAGE Access the lookup list for a field by positioning the cursor on the field and pressing the F2 function key or right clicking the mouse When an item from the list is selected its value is automatically entered in the form field hS Type lt ALT gt F2 press the F2 key while holding the ALT key down to identify all fields that support a lookup list Press t
241. lling List form s main Actions menu or from the convenient pop up menu accessed by right clicking the mouse over the selected roster billing record Available roster billing actions include e Creating New Roster Billings Click the New button or choose the Create New Roster action to create a new roster billing See the Adding a new roster billing topic for more details e Viewing Modifying Roster Billings Click the View Update button or choose the View Update Selected Roster action to view and or modify the selected roster billing See the HCFA 1500 Roster Billing Form topic for details on using this roster billing entry form AS The View Update action is the default roster billing action In addition to the techniques described above this action can also be invoked by double clicking on the desired roster billing record or by selecting the desired record and pressing the ENTER key 67 68 Deleting Roster Billings Click the Delete button or choose the Delete Selected Roster action to delete the selected roster billing Deleted roster billings are assigned a DEL status and can be recovered i e un deleted if needed See the Purging Roster Billings action description below for instructions on permanently removing roster billings from the PC ACE Pro32 database Copying Roster Billings Click the Copy button or choose the Copy Selected Roster action to copy the selected roster billing
242. lling form 4 When all changes have been made click the Save button to save the roster billing record and close the form Review and correct any edit validation errors as needed Alternatively click the Cancel or Close button to cancel any pending roster billing changes Generating Roster Billing Claims A roster billing defines both the common and patient specific details required to create the corresponding set of claims Once you are satisfied with the roster billing contents and no fatal edit validation errors exist you can generate claims for this roster billing using either of the following techniques When anew HCFA 1500 roster billing is created from the New Roster Billing menu item and saved error free you will be prompted to proceed automatically to the claim generation step t Claims for existing HCFA 1500 roster billings can be generated from the Roster Billing List Form To be eligible for generation a roster billing must reside in the to be generated RL location and have a clean CLN or has errors ERR status Select the desired roster billing record and click the Generate button or choose the Generate Selected Roster action to initiate the claim generation process You will be prompted to confirm your intent to generate claims for this roster billing As the operation proceeds running totals of the count and dollar value of all generated claims will be displayed on the Roster Cla
243. ltiple database files by holding down the CTRL key while clicking the desired list items Click the Select All button to select all database files 3 Click the Pack button or Reindex button to perform the desired operation on all selected database files Certain database files tables should normally be worked with as a group For example there are 5 separate database files that make up the UB92 claims database The Select Group drop down list provides a convenient means of selecting all associated files in one of several 201 commonly used groups Use this selection technique instead of selecting database files individually from the list Related Topics The following hyperlinks provide additional information related to this topic b gt Refer to the Archiving and unarchiving claims topic for information on the PC ACE Pro32 claim archiving feature and its potential to enhance system performance 202 Sending support mail to your distributor Technical support e mail can be initiated directly from the PC ACE Pro32 system Click the Send E Mail button on the PC ACE Pro32 Main Toolbar to command your default e mail program to open a new message addressed to your distributor This feature may not be available on some systems If the support mail feature is disabled the Send E Mail button will not be present on the PC ACE Pro32 Main Toolbar If the button is available but does not open an e mail message window it is
244. lues may be entered with or without the century for convenience PC ACE Pro32 uses a user definable century pivot year to automatically derive the century when omitted To insure accuracy birthdate fields require that a full 4 digit year be entered e Descriptive Field Hints Most claim form fields have field hints that provide a brief description of the field s purpose These hints are often called fly over hints since they become visible when the mouse pointer moves over the specified field without actually selecting the field This feature can be disabled in the general preferences settings if desired e Line Item Scrolling The Billing Line Items tab displays 10 claim lines at a time For claims that contain more than 10 line items the user may scroll through the claim line items one line at a time or one page i e 10 lines at a time using the buttons provided along the right edge of this tab AS You can also use the up down arrow keys to move from line to line scrolling when appropriate Type lt ALT gt lt PAGE UP gt press the Page Up key while holding the ALT key down or lt ALT gt lt PAGE DOWN gt to scroll up down through all claim line items one page at a time e Line Item Features The following productivity features are available on the Billing Line Items tab e Line Duplication Press the F5 key while positioned on any field on a line to copy the values in all fields of the previous line into the current
245. m UB92 or HCFA 1500 cc ceeeeeeeeeeeeeeeeeeeeeeaeeeeeeeaeeeeeeaaaeeeeeaaeeeeeeaaeeeees 51 Codes amp Miscellaneous Reference Files OVErvieW cecceeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeaeeeseneaes 167 Common Claim Activities 106 107 109 113 114 117 120 122 124 126 128 131 133 136 138 140 142 14 Adding a New Clalins 22 7b ek droiens sorter Ssce state time tie ione eet betrcateuedtaatinntsaghate ouaeben diva teae ta geten 106 Adding a new Home Health Plan of Care cccceceeceeeeeeeeeeeeeeeeeeeeeeeaeeeeeeaaeeeeesaaaeeeesaaeeeees 145 Adding a New roster DINAG osoro eien sees ct dota RN teats latent get ERR ea Eaa R 142 Adding a new UB92 Medical Attachment ccceecceeeeeeceeeeeeeceeeeeeeaaeeeeeeaaaeeeeeaaeeeeeeaaeeeees 150 Archiving CIAIMNS penarnirconi deiat es EEE AAAA A ATE AAE RAAE ERREEN AEREA 140 IMPOrtiING CIAS renr ar E N A ER eel EAE N 109 110 Listing and modifying ClAIMS suosi an E RE EO ANNE i 107 Listing and modifying Plans of Care seii ersariiris neinar aan E e EAEE EACE EANA EE ri 146 Listing and modifying roster WINGS secere R AEREE 143 Listing and modifying UB92 Medical Attachment 0 ececccseeeeeenneeeeeeeeeeeeeeaaeeeeeeaaeeeeeeaa 151 Posting claim payments HCFA 1500 ceccseeeeeeeneeeeeeaeeeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaneeeeaaaeeees 138 Posting claim payments UBI Janena A AAE AAN AEA AEA 136 Preparing claim status request files for transmission
246. m payers has a LOB that matches the claim LOB then this payer is automatically designated as the submission payer the payer to which the claim is to be submitted If you view the claim after saving you will see a checkmark adjacent to the submission payer line on the Payer Information tab It is possible that multiple payers on a claim will have a LOB that matches the claim s LOB In this case you will be prompted to select which of these payers is to be designated as the submission payer e Edit Validation During the claim save process an edit validation process is performed on all fields on the claim This process includes re evaluating all field level edits as defined above In addition all claim file level edits are evaluated File level edits are evaluated only when the claim is saved and are typically those edits that require multiple data elements from the claim in order to be evaluated If no edit validation errors occur the claim is saved with a clean CLN status If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List form unless disabled in the Preference settings This form lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the 65 Claim amp Reference File Edit Validation topic for a more complete discussion of the claim edit validation process and the Edit Validation Errors List f
247. main archived until manually deleted Refer to the Viewing and maintaining claim status response files topic for more information on maintaining the response file archive If this preference option is disabled support for the ANSI 276 277 claim status request response feature is not available on your installation Purge claim activity log after NN days specifies whether the UB92 and HCFA 1500 claim activity logs will be automatically maintained by the system If automatic maintenance is enabled specifies the number of days that log entries are to be retained M When checked the claim activity logs will be maintained to include only entries for the specified number of days I When unchecked the claim activity logs will grow indefinitely until it they are purged manually Refer to the Reviewing the claim activity logs topic for more information on the viewing and purging the claim activity logs K Adobe Acrobat Reader specifies the complete path for the Adobe Acrobat Reader program ACRORD32 EXE required for printing claims using the image overlay method When the Acrobat Reader is properly installed PC ACE Pro32 will automatically detect and configure this path The Adobe Acrobat Reader is available for download from Adobe http Awww adobe com Refer to the Printing claims topic for more information on printing claim forms and attachments 105 Common Claim Activities 106 Adding a new claim New claims can
248. matic processing Leave this field empty to include claims for any line of business e TOB UB92 only specifies a single type of bill TOB to be considered Only claims with this TOB first 2 characters only will be eligible for automatic processing Leave this field empty to include claims for all bill types e Provider specifies one or more Provider IDs to be considered Only claims for the specified provider s will be eligible for automatic processing Leave this field empty to include claims for all providers If multiple Provi der ID values are specified claims for any of the specified providers will be included Separate multiple Provider ID values with a semi colon For UB92 claim processing the specified Provider ID value s will be compared to the claim s Provider ID field for the submission payer For HCFA 1500 claim processing the specified Provider ID value s will be compared to the claim s billing Provider ID e Reprocess claims with errors specifies whether or not claims in the to be transmitted CL location that currently have a has errors ERR or a has fatal errors ERF status are eligible for automatic processing If this option is unchecked only unprocessed claims UNP will be considered eligible AS Reprocessing claims with errors might be helpful for example after a change is made to the edit validation rules It is feasible that a group of claims all failed the same ill conceived edit validatio
249. ment files will be automatically purged after a certain number of days Refer to the PC ACE Pro32 Miscellaneous preferences topic for details on how to change the archive period or disable automatic purging altogether if desired e To refresh the list of archived ANSI997 files click the Refresh button The staging directory will be re scanned for the presence of new ANSI 997 files If new files are present in the staging directory they will be checked for proper format and automatically archived The displayed list will then be rebuilt to reflect the current archive contents Using the Acknowledgment Reports A detailed discussion of the ANSI 997 transmission acknowledgment file format is beyond the scope of this document Interpretation questions should be directed to your intermediary s support department The key fields present in the archive list display and on the individual acknowledgment reports are as follows e Acknowledgment Creation Date Time Specifies the date and time that the ANSI997 transmission acknowledgment file was created This date time permits ANSI997 files to be ordered chronologically and provides a general timeframe for locating the associated ANSI 837 4010 claim transmission file e Serial No Specifies the starting serial number assigned during preparation of the ANSI 837 4010 claim transmission file The serial number can be compared against the Serial No column in the Claim Transmission Log to ident
250. ments for the selected claim s will be printed by default When unchecked no claim attachments for the selected claim s will be printed by default Print all claim attachments at the end of multiple claim print run when appropriate specifies whether claim attachments should be printed as a group at the end of a multiple claim print session 101 i When checked claim attachments will be printed as a group following the printing of all selected claims when using the pre printed form method You will be prompted to load stock paper in the printer prior to claim attachment printing When unchecked claim attachments for each claim will always be printed immediately following the associated claim X Checking this option will typically result in the most reasonable approach to printing claim attachments The system will print attachments immediately following the associated claim form unless the pre printed forms method is being used Related Topics The following hyperlinks provide additional information related to this topic gt Refer to the Printing claims topic for more information on the pre printed versus image overlay techniques 102 Data Communication Preferences PC ACE Pro32 preference settings are organized on a tabbed dialog accessible from the PC ACE Pro32 Main Toolbar s main File menu The Data Communication Preferences tab includes settings to control the PC ACE Pro32 data communications interface PC
251. ments may be posted to a selected claim from the Claim List form Refer to the Claim List Form Features topic for complete details on the features and operation of the powerful Claim List form Viewing amp Modifying Claims Viewing and or modifying existing claims from the Claim List form can be performed with these general steps 1 Use the Claim List form s powerful sorting and filtering capabilities to locate the claim of interest in the list 2 Select the desired claim in the list and click the View Update button to display the claim details in the appropriate claim form Alternatively just double click the desired claim record in the list 3 Make all desired changes to the claim Refer to the UB92 Claim Form or HCFA 1500 Claim Form topics for details on the many productivity enhancing features available on these powerful claim forms 4 When all changes have been made click the Save button to save the claim record and close the form Review and correct any edit validation errors as needed Alternatively click the Cancel or Close button to cancel any pending claim changes Actions On Multiple Claims Many of the claim actions available in the Claim List form are applicable to both single selected claims as well as groups of checked claims This powerful multi selection capability makes operating on groups of claims a snap Simply use the Claim List form s advanced filtering options to narrow the claim list contents
252. more details Ke Provider UB92 provides access to maintain the providers to be referenced on UB92 claims Setup of the UB92 Provider reference file is required to process UB92 claims All providers referenced on UB92 claims must be represented in this reference file The UB92 Provider tab provides a convenient Sort By selection that quickly sorts the Provider list by LOB Provider Name Provider ID and Tag Operations available include e To add a new UB92 provider record click the New button and enter the new provider information If providers already exist in this reference file you will have the option to create a completely new provider record or inherit and associate the new provider record with the provider record currently selected in the list Select the 84 desired creation options and click the OK button to continue Refer to the Adding and maintaining providers UB92 topic for a discussion of these creation options and their applicability e To view or modify an existing provider record select the desired record from the list and click the View Update button or double click the desired record e To delete an existing provider record select the desired record from the list click the Delete button and confirm the deletion E Claims are linked to provider records by an internal control number Deleting a provider record will irrevocably break any such links that may exist to claims in the sy
253. mpleted 5 Complete the post transmit procedures provided by your distributor if any Related Topics The following hyperlinks provide additional information related to this topic gt Refer to the Reactivating previously transmitted claims topic to learn how a previously transmitted EMC file can be reactivated for re transmission b Refer to the Viewing and maintaining transmission acknowledgment files topic for information on how to archive view print and maintain ANSI 997 transmission acknowledgment files b gt Refer to the Data Communications File Maintenance topic for information on configuring data communications parameters and the Data Communications Control File 121 b gt Refer to the Data Communication Preferences topic for information on configuring the Data Communication Options form launch buttons 122 Viewing and maintaining transmission acknowledgment files Intermediaries or clearinghouses receiving ANSI 837 4010 format EMC files will acknowledge receipt by sending an ANSI 997 transmission acknowledgment file back to the submitter PC ACE Pro32 provides a facility by which users can archive these ANSI 997 transmission acknowledgment files for subsequent review and or printing This topic describes how to stage your ANSI 997 files so that they are automatically archived by PC ACE Pro32 as well as the functions available for viewing printing maintaining and using the archived acknowledgment files
254. mported into PC ACE Pro32 from print image files generated by the user s upstream system Since the Payer ID field for a claim s primary secondary and tertiary payers is not available on the printed claim form PC ACE Pro32 uses a novel matching technique to map the Payer Description field which is available on the printed claim to the correct payer record in PC ACE Pro32 s Payer reference file During the one time Payer reference file setup process one or more matching strings should be defined for each payer record These matching strings are used exclusively to map print file Payer Descriptions to PC ACE Pro32 Payer records during the PrintLink claim import process Each PrintLink matching string must adhere to one of these 3 formats e String ends with a tilde character A match is found if the string appears anywhere in the claim s payer description field e String ends with a vertical bar character A match is found only if the string appears at the start of the claim s payer description field The payer description may contain additional trailing characters not included in the matching string e String ends with an alphanumeric character A match is found only if the string and the payer description field are identical The 2 strings must be the same length and contain exactly the same characters in the same order All PrintLink matching string comparisons are case insensitive Click the PrintLink Matching De
255. n locating specific codes Refer to the Reference File Maintenance Form topic for more discussion of these common filter options Effective Date Range The Effective Date Range dates are compared to the claim s date of service range during the claim edit validation process If the effective date range for a revenue code falls outside the claim s service date range an edit validation error will be reported If the effective date range is left blank the revenue code is valid for all dates of service If the start date is completed but the end date is left blank the revenue code is valid for all dates of service from and including the start date forward If the start date is left blank but the end date is completed the revenue code is valid for all dates of service up to and including the end date Revenue Code Assignments The Revenue Code Assignments form provides an interface to maintain optional assignment details for a specific revenue code If no details exist for a specific revenue code then the code will be considered valid for all LOBs and the various flags described below will assume their default values Maintenance operations available on the Revenue Code Assignments form include e To add a new revenue code assignment record click the New button and enter the desired information on the Revenue Code Assignment Information form e To view or modify an existing revenue code assignment record select the desired record and c
256. n selector to TR transmitted only or PD paid only you can list claims migrated from the DOS UB92 All Payer tracking and history databases respectively If desired repeat the review process for claims in these locations When finished with your claims review click the Close button on the UB92 Claim List form Select the Close item from the UB92 Claims Menu form s main File menu to return to the PC ACE Pro32 Main Toolbar Completing the Setup Process Additional steps will be required to complete the PC ACE Pro32 setup and get the system ready to process your claims Proceed at this time to the Setup of UB92 All Payer Systems topic and review the steps outlined there Make additional changes if needed to the migrated reference file records and complete any other applicable setup tasks that were not addressed in this migration procedure 19 Migrating HCFA 1500 Systems A goal of PC ACE Pro32 is to provide users with a smooth transition from their existing DOS HCFA 1500 All Payer systems The PC ACE Pro32 Migration Utility permits you to easily migrate your current DOS HCFA 1500 All Payer patient optional and payer reference file data as well as your existing claims into the PC ACE Pro32 system Once you have performed this migration procedure you will be directed to proceed to the appropriate topic to complete any additional setup tasks required E Your distributor may choose to supplement or replace these migration p
257. n taking advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse hS Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator 4 Enter the provider s name and address information Enter the Medicare Provider ID in the Provider ID No field and MCA in the LOB field The Payer ID field is only needed if you want to restrict assignment of this provider to a specific payer Normally the Payer ID field will be left blank You can also leave the Tag field blank Complete entry of the remaining provider fields as desired 5 Click the Save button to save the new UB92 Provider record An edit validation process will be performed to check for problems with the provider information When prompted correct any missing or invalid field values if present and re save as needed The new Provider record should now be visible in the Provider list 12 6 If desired repeat the last few steps to add each additional UB92 Provider record Now each time you click the New button you will be prompted to select whether you want a completely new provider all fields blank to start with or whether you would like to inherit the name address information from the currently selected provider If you choose the inherit option you will also have the option
258. n rule which has subsequently been reviewed and changed b Processing Options options that control the automatic processing operation e Present claims with errors for immediate editing instructs the automatic processing engine to pause each time a claim with errors is processed and to present the claim for immediate consideration in the UB92 Claim Form or HCFA 1500 Claim Form This is referred to as interactive processing mode When the user closes the claim form the automatic processing run will resume with the next claim in the sequence e Include edit error details in process error report instructs the automatic processing engine to include the specific edit validation error descriptions in the 115 compiled error report Check this option when plan to research the specific edit validation errors for each claim from this hardcopy report hS If you rarely refer to the specific edit validation error descriptions in the error report you can significantly speed up automatic processing by leaving this option unchecked This allows the edit engine to stop processing a claim on the first detected error since it is only important to know that the claim has errors not specifically which errors 3 Specify the desired filter parameters if any and processing options When ready click the Process button and confirm your intention to process the claims Each eligible claim will be processed in sequence As the processing operation
259. n the list click the New button and choose the inherit and associate options You will see that the top portion of the Provider Information form will be completed automatically Simply tab through or overwrite the Provider ID No field may be the same or different enter a unique line of business identifier in the LOB field and click the Save button 7 When you have finished adding HCFA 1500 Provider records you should have one record for each applicable line of business LOB for each solo group or individual in group provider entity When all desired Provider records have been added click the Close button on the Reference File Maintenance form to return to the PC ACE Pro32 Main Toolbar 8 Select the Exit item from the main File menu to exit PC ACE Pro32 Cancel the system backup request when prompted Claims Migration This section describes the steps required to migrate your current DOS HCFA 1500 All Payer claims entry tracking and history into the PC ACE Pro32 system To migrate your claims complete the following steps E It is critical that setup of the Payer and HCFA 1500 Provider reference files has been completed prior to migrating your claims The key payers and providers referenced on these claims must be present in these reference files to insure a smooth migration In practice it may be necessary to review and re migrate the claims multiple times correcting problems in the Payer and HCFA 15
260. n the mouse pointer moves over the specified field without 69 actually selecting the field This feature can be disabled in the general preferences settings if desired e Line Item Scrolling The lower section of the roster billing form displays 5 patient billing lines at a time For roster billings that contain more than 5 patients the user may scroll through the patient billing lines one line at a time or one page i e 5 lines at a time using the buttons provided along the right edge of this tab AS You can also use the up down arrow keys to move from line to line scrolling when appropriate Type lt ALT gt lt PAGE UP gt press the Page Up key while holding the ALT key down or lt ALT gt lt PAGE DOWN gt to scroll up down through all roster billing lines one page at a time e Billing Line Field Duplication Pressing the F4 key while positioned on a specific roster billing line field will copy the value of that single field from the previous line into the current line hS Pressing the F4 key while positioned on the Address Line 1 field will copy all address fields from the previous line into the current line e Automatic Patient Control Number Generation optional The roster billing form supports automatic generation of the Patient Control Number field The decision to enable automatic PCN generation is typically made by the distributor When this feature is disabled the PCN field must be entered manually o
261. nd claim printing options Data Communication Preferences allows assignment of launch file paths and button captions for external data communication programs Miscellaneous Preferences includes settings to configure and control several maintenance options and other miscellaneous features Click on the links above for a description of the available preference options in each category Preference settings are workstation specific In a multi user installation each client workstation may set these preferences to best suit their work flow and data entry style 93 General Preferences PC ACE Pro32 preference settings are organized on a tabbed dialog accessible from the PC ACE Pro32 Main Toolbar s main File menu The General Preferences tab settings control a number of claim entry options as well as other basic aspects of PC ACE Pro32 operation A description of each available option is included below K og A e d 7 94 Automatically tab at maximum field length during data entry This option applies to data entry in the UB92 Claim Form HCFA 1500 Claim Form and a number of other editable forms lM When checked an automatic tab will occur when the field has been completely filled For example entering a single character in a one character field will automatically position the cursor on the next field in the tab sequence When unchecked the user must physically tab to the next field regardl
262. nd click the desired action button along the lower edge of the form The complete list of claim actions can be accessed from the Claim List form s main Actions menu or from the convenient pop up menu accessed by right clicking the mouse over the selected claim Available claim actions include e Creating New Claims Click the New button or choose the Create New Claim action to create a new claim See the Adding a new claim topic for more details e Viewing Modifying Claims Click the View Update button or choose the View Update Selected Claim action to view and or modify the selected claim See 53 54 the UB92 Claim Form or HCFA 1500 Claim Form topics for details on using the PC ACE Pro82 claim entry forms hS The View Update action is the default claim action In addition to the techniques described above this action can also be invoked by double clicking on the desired claim record or by selecting the desired record and pressing the ENTER key bS Holding down the SHIFT key while invoking the View Update action on an eligible claim will force an automatic save attempt on the claim This is a shortcut technique equivalent to invoking the View Update action and subsequently clicking the Save button on the claim entry form It minimizes the keystrokes required to work claims from the Claim List form Eligible claims are those in the to be transmitted CL location with a status of either unprocessed UNP
263. ng advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse AS Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator Select the desired Provider Type and enter the provider s name address and contact information Enter the Provider ID in the Provider ID No field and the line of business in the LOB field The Payer ID field is only needed if you want to restrict assignment of this provider to a specific payer Normally the Payer ID field will be left blank You can also leave the Tag field blank Enter a unique Group Label for the first group provider record defined for each group When adding an individual in group provider record perform a lookup in the Group Label field and select the group in which this individual provider will be a member Complete entry of the remaining provider fields as desired Click the Save button to save the new Provider record An edit validation process will be performed to check for problems with the provider information When prompted correct any missing or invalid field values if present and re save as needed The new Provider record should now be visible in the Provider list Repeat the last few steps to add each additional HCFA 1500 Provider record Now each time you click the New button
264. nic EMC file All fatal errors in reference file records must be corrected before the user can save the record There are relatively few fatal edits defined in PC ACE Pro32 e Non Fatal Edits Non fatal edits describe rules that should probably not be broken however PC ACE Pro32 will look the other way if they are Claims containing only non fatal edit errors can be saved and even prepared into an EMC file if desired It is up to the user to decide when a non fatal edit validation error can be ignored 88 Handling Edit Validation Errors Field level edit validation errors are reported as the focus leaves the offending field during claim entry If such an error occurs you will receive an audible response and the edit validation error message will be displayed in the lower left corner of the claim form In addition the focus will remain on the field so that you can correct the problem if desired If you choose not to correct the data at this time you can simply press the TAB key again to move to the next field When an attempt is made to save the claim an edit validation process is performed on all claim fields This process includes re evaluating all field level edits In addition all claim file level edits are evaluated If no edit validation errors occur the claim is saved with a clean CLN status If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List form unless d
265. nment maintenance options include Select LOB filters the assignment list to include only assignments for a specific line of business When a specific LOB is selected it will be used as the default LOB for new HCPCS modifier assignments To add a new modifier assignment click the New button on the Assignments tab On the HCPCS Modifier Assignment form select or change the LOB and select a valid modifier from the drop down list Specify the claim type s for which this LOB modifier assignment is to be considered valid The validity selections are defined as follows O Valid for UB92 claims specifies whether the modifier is valid for use on UB92 claims for the specified LOB M When checked the modifier will be considered valid for use on UB92 claims for the specified LOB This modifier will be included in claim entry lookup lists for the specified LOB The validity of this modifier may also be checked during the claim edit validation process When unchecked the modifier will not be considered valid for use on UB92 claims for the specified LOB Valid for 1500 claims specifies whether the modifier is valid for use on HCFA 1500 claims for the specified LOB M When checked the modifier will be considered valid for use on HCFA 1500 claims for the specified LOB This modifier will be included in claim entry lookup lists for the specified LOB The validity of this modifier may also be checked during the claim e
266. nments that use these special inpatient outpatient designators will automatically adapt to changes in the Type of Bill Maintenance File Control Settings includes control flags which describe the assignment as follows Valid Determines the validity of the revenue code for claims having the specified LOB TOB combination Default Valid M When checked the revenue code is valid for claims havi ng the specified LOB TOB combination When unchecked the revenue code is not valid for claims having the specified LOB TOB combination The remaining Control Setting flags will be ignored Required Flags determine which claim line fields are required for lines containing this revenue code on claims having the specified LOB TOB The claim line Units Rate HCPCS and Remarks fields are represented by these flags Default Not Required lM When checked the corresponding field is required for claim lines containing this revenue code on claims having the specified LOB TOB combination I When unchecked the corresponding field is not required for claim lines containing this revenue code on claims having the specified LOB TOB combination Is Accommodation determines whether or not the revenue code represents an accommodation for claims having the specified LOB TOB combination Default Not An Accommodation i When checked the revenue code represents an accommodation for claims having the specified LOB TOB combination
267. nored This behavior makes it possible to request alternate payer printing for multiple checked claims without regard for whether or not the alternate payers are actually present on all the claims Claim attachments can be optionally printed when present by checking the Print claim attachments if present option on the Claim Print Options form Claim attachments 135 136 should always be printed on stock paper If you are printing your claims using the pre printed forms method onto actual HCFA 1450 1500 red forms then you will want to print all attachments at the end of the print run Doing this will give you the opportunity to change the printer paper prior to printing the attachments Make sure the Print all claim attachments at the end of multiple claim print run when appropriate option on the Printing tab of the PC ACE Pro32 Preferences form is checked Posting claim payments UB92 PC ACE Pro32 maintains an optional UB92 claim payments database for organizations that wish to track payment data in the system Any number of payments may be posted against a transmitted UB 92 claim The payment history for a claim can be accessed from either the UB92 Claim List form or the UB92 Claim Form as follows 1 6 Click the UB92 Claims Processing button from the PC ACE Pro32 Main Toolbar to display the UB92 Claims Menu form Click the List Claims button on the UB92 Claims Menu form to display the UB92 Claim List form By d
268. ns on the network that will require PC ACE Pro32 access The PC ACE Pro32 files will be installed to the WINPCACE directory on the selected drive Desktop icons will be created for PC ACE Pro32 and the current README file Note If you performed this server installation to a remote hard drive you can improve program execution speed on this workstation by also performing the client installation below This will install a copy of the PC ACE Pro32 main program and support files to your local hard drive If you performed the server installation to a local hard drive you should skip the client installation for this workstation You will still be required to perform the client installation for any additional workstations that require PC ACE Pro32 access PC ACE Pro32 Client Installation If multi user operation is required perform this client installation procedure from each workstation that requires PC ACE Pro32 access Perform these steps to install the PC ACE Pro 32 client 1 Confirm that the workstation has network access via a mapped drive letter to the hard drive volume containing the PC ACE Pro32 server installation directory WINPCACE You must have access to this remote drive volume before proceeding with the PC ACE Pro32 client installation 2 Using the Windows Explorer locate the client installation program CLIENT32 EXE in the WINPCACE directory on the server Execute this program directly from the remote drive volume do not copy
269. ntact information If any changes are made click the Save button to save the updated Payer record An edit validation process will be performed to check for problems with the payer information When prompted correct any missing or invalid field values and re save as needed hS While viewing a Payer reference file record you may also click the PrintLink Matching Descriptions button to view the PrintLink matching strings migrated for the selected payer This only applies if you have been importing claims from print image files into the DOS HCFA 1500 All Payer system Select the Patient tab to review the migrated patient records if any Double click a record to view the migrated details for that patient Confirm that the Patient record appears complete and correct Click the Close button to close the Patient Information form Repeat this review process for a few patients in the list When finished with your review of the Patient and Payer reference files click the Close button to close the Reference File Maintenance form and return to the PC ACE Pro32 Main Toolbar Setting Up HCFA 1500 Provider Records 21 This section describes how to set up your HCFA 1500 Provider reference file This reference file is organized such that each record describes a valid provider for a single line of business LOB This organization allows for greater flexibility in specifying provider IDs and support information Tax ID address etc which can va
270. ntains the HCFA 1500 data communications parameters exported to the bsdatcom dat file prior to the launch of any external data communications program e g file transmission These parameters are used by the third party data communications program to control the file transmission etc hS Refer to the Data Communications File Maintenance topic for more information on setting up the default Data Communications record This completes the required setup steps to ready PC ACE Pro32 for HCFA 1500 All Payer claims processing 49 Main Toolbar amp Forms 50 The PC ACE Pro32 Main Toolbar All PC ACE Pro32 functions are available from the main toolbar action buttons and menu This toolbar consumes only a small amount of your valuable desktop space and can be set to dock automatically to any desktop corner or float if desired The toolbar action buttons provide quick access to Import enter modify process and prepare UB92 claims and attachments aes fi t l Import enter modify process and prepare HCFA 1500 claims Z2 Maintain all supporting reference files patient payer provider etc Launch your claim submission and related data communication software Schedule delayed and daily recurring claim activities Launch the ANS 835 Electronic Remittance program Da Perform system backup restore and other maintenance functions Send support mail to your distributor may not be available The main File
271. numerous patient related fields on the claim Access variable list lookups using the same method described above for fixed list lookups Automatic Field Tabs When entering data in a field an automatic tab will occur when the field has been completely filled For example entering a single character in a one character field will automatically position the cursor on the next field in the tab sequence This feature can be disabled in the general preferences settings if desired Cancel Field Changes If a change is inadvertently made to the contents of a field press the ESC key to cancel this change and restore the field s value to what it was when the field received the focus This feature is available for most claim form fields Date Completion Date values may be entered with or without the century for convenience PC ACE Pro32 uses a user definable century pivot year to automatically derive the century when omitted To insure accuracy birthdate fields require that a full 4 digit year be entered Descriptive Field Hints Most claim form fields have field hints that provide a brief description of the field s purpose These hints are often called fly over hints since they become visible when the mouse pointer moves over the specified field without actually selecting the field This feature can be disabled in the general preferences settings if desired Line Item Scrolling The Billing Line Items tab displays 6 claim lines at a time
272. o such Payer records are defined then their Usage settings must not overlap Valid Usage settings include U UB92 use only H HCFA 1500 use 43 only and B or blank unrestricted use The only valid situation where two Payer records with the same Payer ID LOB combination may exist is when one of the records specifies a Usage value of U UB92 use only and the other record specifies a Usage value of H HCFA 1500 use only This feature permits Payers for shared LOBs such as Commercial COM to optionally have distinct settings and PrintLink matching strings for UB92 versus HCFA 1500 use An individual Payer record must be setup for each line of business LOB handled by that payer For example if payer 12345 will receive both Medicare and Medicaid claims then two Payer records must be added both with Payer ID 12345 one with LOB MCB and the other with LOB MCD 3 Click the Save button to save the new Payer record An edit validation process will be performed to check for problems with the payer information When prompted correct any missing or invalid field values if present and re save as needed The new Payer record should now be visible in the Payer list If you plan on using the PrintLink feature of PC ACE Pro32 to import claims from print image files then you will also need to add PrintLink Matching Description strings to this Payer record The Claim Import Considerations section later
273. o32 Main Toolbar click either the UB92 Claims Processing or HCFA 1500 Claims Processing button to open the desired Claims Menu form 2 From the Claims Menu form click the Prepare Claims button to open the Claim Prepare For Transmission form This form provides the following preparation options gt Claim Filter Parameters claims must meet all specified filter criteria to be considered for preparation e LOB specifies a single line of business LOB to be considered Only claims with this LOB will be eligible for preparation Select the lt lt All gt gt item to include claims for any line of business The Submitter reference file supports LOB specific setup information if desired Selecting a specific LOB for preparation will trigger the use of the matching LOB specific submitter information if any Refer to the Submitter File Maintenance topic for more information on this advanced feature e Payer specifies a single Payer to be considered Only claims being submitted to the selected payer will be eligible for preparation Select the lt lt All Payers for LOB s gt gt item to include claims for all payers Note This selection is only enabled when a specific LOB has been selected for preparation The Submitter reference file supports Payer specific setup information if desired Selecting a specific LOB and Payer for preparation will trigger the use of the matching LOB Payer specific submitter information
274. oaded and should require minimal maintenance Maintenance operations available include e To add a Provider Taxonomy code click the New button and enter the new code information e To view or modify an existing Provider Taxonomy code record select the desired record and click the View Update button or double click the desired record e To delete a Provider Taxonomy code record select the desired record from the list click the Delete button and confirm the deletion hS The Provider Taxonomy Codes form provides several List Filter Options that can be helpful in locating specific codes Refer to the Reference File Maintenance Form topic for more discussion of these common filter options Related Topics The following hyperlinks provide additional information related to this topic gt Refer to the Adding and maintaining providers HCFA 1500 topic for a discussion of HCFA 1500 provider maintenance 191 Miscellaneous Functions 192 Adding or modifying a system user PC ACE Pro32 requires that a valid login and optional password be entered by anyone desiring access to the system The system administrator must set up a user account for each person that will use PC ACE Pro32 The user account specifies the user s login password values and defines which activities the user has permission to perform To add a new user or modify an existing user select the main Security menu from the PC ACE Pro32 Main Toolbar and choose
275. ocably break any such links that may exist to claims in the system The Provider Deletion Confirmation form will be displayed when you attempt to delete a provider record This form outlines alternatives to deletion and provides a convenient utility to determine how many claims reference the provider record to be deleted Consider clearing the Include In Lookups option on the UB92 Provider Information form as an alternative to deleting the provider hS The Provider UB92 tab of the Reference File Maintenance form provides several list filter options that can be helpful in locating specific providers Refer to the Reference File Maintenance Form topic for a discussion of these common filter options Entering UB92 Provider Information The UB92 Provider Information form provides access to all UB92 provider fields These fields are grouped logically on the following tabs e General Info includes fields for the provider name address contact and identification information ID LOB Payer ID and tax number e Extended Info includes fields for any additional extended provider information e g the pay to provider name and address if different e Local Fields includes up to six additional local provider fields to be defined by the distributor This tab will only be visible if the distributor has defined one or more of these local fields Contact your distributor for completion details Click the appropriate tab or simply pre
276. ocess is performed on all fields If no edit validation errors occur the updated record is saved If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List form This form lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the Edit Validation Errors List form If any fatal edit errors exist you must correct them before the record can be saved If only non fatal edit errors exist you will have the option to correct the errors or save the record with errors Click the Save With Errors button to save a record that contains only non fatal errors Descriptive Field Hints Most reference file fields have field hints that provide a brief description of the field s purpose These hints are often called fly over hints since they become visible when the mouse pointer moves over the specified field without actually selecting the field This feature can be disabled in the general preference settings if desired Common Reference File Filter Options Many of the reference file forms provide a common set of List Filter Options that can be helpful in locating a specific record in the list These common filter options are defined as follows 86 Show all no filter applied When selected any existing filter is removed and all
277. odes procedure codes and descriptions UPIN Physician File Maintenance maintain the UPIN Physician file The following reference file topics apply exclusively to UB92 claims K 9 A Ksa Type of Bill TOB File Maintenance maintain TOB assignments and related information Condition Occurrence Span Value Codes File Maintenance maintain condition occurrence span and value codes descriptions and assignments Revenue Codes File Maintenance maintain revenue codes descriptions assignments and related information The remaining reference file topics apply exclusively to HCFA 1500 claims Place of Service POS File Maintenance maintain POS codes descriptions and assignments Type of Service TOS File Maintenance maintain TOS codes descriptions and assignments Facility File Maintenance maintain facility information Charges Master File Maintenance maintain charge master procedure codes descriptions and charge amounts Provider Specialty File Maintenance maintain provider specialty codes and descriptions Provider Taxonomy Code File Maintenance maintain provider taxonomy codes and classification specialization descriptions Follow any of the hyperlinks above for more information about the purpose and maintenance of these core reference files 168 Submitter File Maintenance Submitter Information in PC ACE Pro32 is maintained from the Submitter Setup form for both UB92 and HCFA 1500
278. of Care topic for more details e Viewing Modifying Plans of Care Click the View Update button or choose the View Update Selected Plan of Care action to view and or modify the selected plan See the Home Health Plan of Care Form topic for details on using the PC ACE Pro32 Plan of Care entry form AS The View Update action is the default plan action In addition to the techniques described above this action can also be invoked by double clicking on the desired plan record or by selecting the desired record and pressing the ENTER key AS Holding down the SHIFT key while invoking the View Update action on an eligible plan will force an automatic save attempt on the plan This is a shortcut technique equivalent to invoking the View Update action and subsequently clicking the Save button on the plan entry form Eligible plans are those with a status of unprocessed UNP has errors ERR or has fatal errors ERF e Copying Plans of Care Click the Copy button or choose the Copy Selected Plan of Care action to copy the selected plan If the plan being copied includes a Medical 72 Update HCFA 486 section you will be given the option to include or omit this data on the new plan The Plan of Care entry form will be displayed containing the details of the newly copied plan Make modifications as required and save the new plan e Deleting Plans of Care Click the Delete button or choose the Delete Selected
279. of the 3 provider types to each provider you add during this setup procedure AS If it is not clear which type is appropriate in each instance you may want to refer to the Adding and maintaining providers HCFA 1500 topic for a more complete description of the various provider types If you do make sure and return to this topic to continue the setup steps If you are sill unsure contact your distributor for assistance To setup the HCFA 1500 Provider reference file complete the following steps 1 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form Select the Provider 1500 or just Provider tab to display a list of all existing Provider records 2 If you have just installed PC ACE Pro32 the Provider list should be empty If so skip to the next step If the list is not empty contact your distributor to confirm that the existing 44 Provider records can be safely deleted To delete a Provider record select the desired record in the list and click the Delete button Click the OK button on the Provider Deletion Confirmation form to confirm the deletion request You must delete all Indiv type Provider records before deleting Solo and Group type Provider records Make sure the list is empty before continuing with the next step Click the New button to display the HCFA 1500 Provider Information form Enter the first provider s information taki
280. ompared to the associated claim line s service date range during the claim edit validation process If the effective date range for a Place of Service POS code falls outside the line s service date range an edit validation error will be reported If the effective date range is left blank the POS code is valid for all dates of service If the start date is completed but the end date is left blank the POS code is valid for all dates of service from and including the start date forward If the start date is left blank but the end date is completed the POS code is valid for all dates of service up to and including the end date 185 Type of Service TOS File Maintenance The Type of Service TOS Codes form provides an interface to maintain the TOS codes and assignments TOS codes apply exclusively to HCFA 1500 claims TOS codes are pre loaded and should require minimal maintenance The Type of Service TOS form includes two tabs Ke w Descriptions displays a list of TOS codes and their descriptions Maintenance operations available are e To adda TOS code click the New button and enter the new TOS code information Enter the effective date range using a 4 digit year format e To view or modify an existing TOS record select the desired record and click the View Update button or double click the desired record e To delete a TOS record select the desired record from the list click the Delete button and confirm the delet
281. on e Insured Information includes payer insured and employer fields for the primary secondary and tertiary payers e Billing Line Items includes the claim diagnosis codes as well as all claim line item fields extended line item fields and claim attachment fields This major tab contains a number of second level tabs to accommodate the extended line item and attachment fields e Extended Patient General includes patient legal representative fields facility information fields and numerous general claim fields that are not present on the hard copy HCFA 1500 claim form e Extended Payer Insured includes less frequently used payer insured and employer fields for the primary secondary and tertiary payers Also includes fields for Medicare Secondary Payer claims This major tab consists of a number of second level tabs that provide access to this extended information in a logical and efficient manner Click the appropriate tab or simply press the PAGE UP and PAGE DOWN keys to move between these major claim form sections Holding down the SHIFT key while pressing the PAGE UP and PAGE DOWN keys will cycle between second level tabs where applicable Entering Claim Data Click on any field to activate it for data entry or press the TAB key to move from field to field in a predefined sequence generally left to right and top to bottom Use the UP ARROW and DOWN ARROW keys to move up and down through the claim form
282. on Errors List form closes all claim fields reporting edit validation errors will begin flashing By default the normal tab sequence is overridden and will now jump between these error fields This special tab feature is intended to speed up the process of correcting multiple edit validation errors and can be disabled in the general preferences settings if desired Press the ESC key to stop the error fields from flashing and to restore the normal tab sequence The Errors List button is not available on the Patient Payer Provider and Submitter reference file information forms 89 Security amp User Maintenance The Security amp User Maintenance features accessible from the main Security menu allow a System Administrator to add and delete system users and to maintain security access permissions for these users Select the Add Update User item from the main Security menu to display the current system user list The Security List form can be sorted by User ID or User Name to assist in locating a specific user To add a user click the New button Each user must be assigned a User ID Password and Name During the user creation process it is important to set the user s access permissions to allow complete or selective access to activities within the system The user permissions are grouped as follows UB92 Claim Activities specifies user permission to view enter modify delete import process prepare and ar
283. on of claim fields The plural term edits refers to the collection of individual rules imposed on a specific claim field or on the entire claim Sequentially applying all applicable edits on a claim field or all claim fields is referred to as the edit validation process The set of rules edits to be imposed on a claim s fields varies with the type of claim and is typically defined by the distributor PC ACE Pro32 provides a powerful and flexible system for defining maintaining and validating claim edits In addition edits are available for validating UB92 Home Health Plans of Care standalone UB92 Medical Attachments HCFA 1500 roster billings as well as records in the Patient Payer Provider and Submitter reference files This discussion will focus on the claim editing process however the same concepts and procedures apply to plan of care standalone medical attachment roster billing patient payer provider and submitter editing unless specified otherwise Field Level vs File Level Edits Edits in PC ACE Pro32 are defined at the time they are created as one of two possible types e Field Level During claim entry when the focus leaves a claim form field either by pressing the TAB key or clicking on a new field an edit validation process is performed on the field losing the focus Edits performed at this time are referred to as field level edits If a field level edit validation error is detected you can either correct t
284. on process has completed click the Close button to exit the PC ACE Pro32 Migration Utility Reviewing the Migrated Patient and Payer Data This section describes the process of reviewing the migrated Patient and Payer reference file data for correctness and completeness Suggestions concerning where and when to supplement the migrated data will be made when appropriate Complete the following steps amp It is important to thoroughly review the migrated Patient and Payer reference file data To insure a smooth transition from the DOS MEDA system any required modifications or additions to this migrated data should be made prior to migrating your claims data or using PC ACE Pro32 for daily claims processing activities Execute PC ACE Pro32 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form When prompted to login you may enter the default user s User ID SYSADMIN and password SYSADMIN as well Select the Payer tab and review the auto created Medicare payer record Double click the record to see the details for this payer If desired enter the missing address and contact information If any changes are made click the Save button to save the updated Payer record An edit validation process will be performed to check for problems with the payer information When prompted correct any missing or invalid field values and re save as needed AS While viewin
285. on strings Each time you want to import claims copy the new intermediate delimited file generated by your upstream system into the server s winpcace impub92 directory The file must be named plink out Electronic Media Claims EMC Format import claims from a file in Electronic Media Claims EMC format If using this claim import method complete the following steps 1 2 Confirm that your upstream system is capable of producing a supported version Electronic Media Claims EMC format file Contact your distributor for the list of supported EMC file versions Each time you want to import claims copy the new EMC file generated by your upstream system into the server s winpcace impub92 directory The file must have a dat file extension e g EMC192 DAT Claim Prepare amp Transmit Considerations This section describes setup considerations that should be reviewed before you attempt to prepare and transmit claims using PC ACE Pro32 Your distributor may have already performed some or all of this setup for you Consult your distributor s installation instructions or contact the distributor if it is unclear how to proceed 34 1 Setup default UB92 submitter information in the PC ACE Pro32 Submitter reference file Information from this reference file is required during preparation of Electronic Media Claims EMC files Consult your distributor s installation instructions or contact the distributor f
286. on while viewing the claims in an open claim archive to move the selected claim from the archive database to the current claim database Refer to the Archiving and unarchivi ng claims topic for more information on the PC ACE Pro32 claim archiving feature e Setting Claim Media Choose the Set Selected Claim Media action to designate the selected claim for either electronic or paper submission Only claims with a media setting of electronic E will be eligible for preparation into an EMC file Claims with a media setting of paper P can be printed and submitted in hardcopy form When a paper claim is printed you will be given the option to move the claim from the to be transmitted CL location to the transmitted TR location automatically Support for paper claims may be disabled by the distributor If the Set Selected Claim Media action item is not visible then your system does not support paper claim processing and all claims must be submitted electronically e Requesting Claim Status Choose the Request Selected Claim Status action to add the selected claim to the claim status request queue Status requests can only be made for claims in the transmitted TR and paid PD locations Any number of claims can be queued using this action item Once all desired claims have been queued refer to the Preparing claim status request files for transmission topic for instructions on preparing the ANSI 276 claim status
287. only the roster billings of interest Sorting Roster Billings The roster billing list may be sorted by Service Date Provider Roster Type and Entry Date Simply select the desired sort order from the available Sort By radio buttons Filtering Roster Billings The roster billing list may be filtered to display a select subset of roster billings by manipulating the Roster Billing List Filter Options drop down lists Basic filter options include e Location filters the roster billing list to include only roster billings in the to be generated RL or generated GR locations e Status filters the roster billing list to include only roster billings assigned a specific status The possible status codes are clean ready CLN deleted DEL has fatal errors ERF and has errors ERR Note that selecting a status of DEL is the only way to view deleted roster billings which can be recovered until they are purged from the system When multiple filter criteria are specified only those roster billings that meet all filter criteria will be displayed Roster Billing Actions The Roster Billing List form may also be used to perform specific actions on any individual roster billing To perform an action on a roster billing simply select the roster billing from the list and click the desired action button along the lower edge of the form The complete list of roster billing actions can be accessed from the Roster Bi
288. ons are highly customizable Many of the UB92 and HCFA 1500 claim data elements may be included or excluded from the list The display order column width and column headings of each selected field may also be customized See the Claim List Preferences topic for a description of the list customization process NOTE Some distributors may disable this customization feature Claim List Filter Menu Several claim list filtering and related functions are accessible from the Claim List form s main Filter menu e Clear Filters Clears any existing filter criteria and refreshes the claim list to display all claims in the selected location e Advanced Filter Options Opens the Advanced Claim List Filter Criteria for to permit filtering on the claim s patient payer provider date ranges batch information bill type and numerous other criteria When multiple filter criteria are specified only those claims that meet all filter criteria will be displayed e Check Uncheck All Claims Permits the user to check or uncheck all claims currently displayed in the claim list presumably in anticipation of some action to be performed on this block of claims See the Actions on Multiple Claims section above for more information e Check All Claims From Selected Transmission Provides an easy way to check all claims included in a previous transmission file The UB92 or HCFA 1500 Claim Transmission Log form will display a list of
289. ons will be visible at any given time If neither button is visible then fatal errors exist on one or more key roster billing fields These fatal edit errors must be corrected before the roster billing can be saved When a new HCFA 1500 roster billing is created from the New Roster Billing menu item and saved error free you will be prompted to proceed automatically to the claim generation step If you choose not to generate the claims at this time or if the roster billing was saved with errors you may generate the claims at a later time from the Roster Billing List Form Related Topics The following hyperlinks provide additional information related to this topic b gt Refer to the UB92 amp HCFA 1500 Claims Menus topic for more information about the Claims Menu form b gt Refer to the Roster Billing List Form Features topic for details on using the HCFA 1500 Roster Billing List form b gt Refer to the HCFA 1500 Roster Billing Form topic for more information on using the HCFA 1500 Roster Billing form b gt Refer to the Claim amp Reference File Edit Validation topic for more information about the edit validation process and associated forms 143 Listing modifying and maintaining roster billings HCFA 1500 roster billings in PC ACE Pro32 are listed modified generated printed and otherwise maintained from the HCFA 1500 Roster Billing List Form To access this form 1 Click the HCFA 1500 Claims Processing
290. or assistance in setting up this critical reference file hS Refer to the Submitter File Maintenance topic for more information on setting up the default Submitter record 2 If required by your distributor setup default UB92 data communications parameters in the PC ACE Pro32 Data Communications reference file This reference file contains the UB92 data communications parameters exported to the bcdatcom dat file prior to the launch of any external data communications program e g file transmission These parameters are used by the third party data communications program to control the file transmission etc AS Refer to the Data Communications File Maintenance topic for more information on setting up the default Data Communications record This completes the required setup steps to ready PC ACE Pro32 for Medicare Part A Only claims processing 35 Setup of UB92 All Payer Systems This section describes the setup procedures required to prepare your PC ACE Pro32 system for UB92 All Payer claims processing Topics to be covered include setting up the Payer Provider and Patient optional reference files A section on claim import considerations is included for users who will be importing claims from an upstream claims management system Finally a section covering considerations for claims preparation and transmission should be reviewed E Your distributor may have already completed some of the setup steps described in this section
291. or preparation will trigger the 127 use of the matching LOB Payer specific submitter information if any Refer to the Submitter File Maintenance topic for more information on this advanced feature Specify the desired filter parameters if any When ready click the Prepare Status Request button and confirm your intention to prepare the claim status request file Progress information will be displayed as the prepare operation proceeds You will be notified when the claim status file prepare operation completes If desired click the View Results and or View Errors buttons to vi ew reports of the successfully prepared claim status requests and any failed requests respectively These reports can be printed from the report previewer if desired Claims will rarely be rejected during the claim status request prepare operation A claim will be rejected for example if the submission payer specified on the claim is no longer present in the Payer reference file Since the claim has already been transmitted and cannot be modified you will not be able to request claim status for these rejected claims When you have completed your review of the claim status request preparation reports click the Close button on the Claim Status Request File Prepare form The prepared ANSI276 claim status request file is located in the server s winpcace directory The file is named bcreq276 dat for UB92 claims and bsreq276 dat for HCFA 1500
292. orce a requery of the list s contents 4 Select the desired claim from the list and perform either of the following to access the claim s payment history e Select the Show Selected Claim Payments item from the HCFA 1500 Claim List form s main Actions menu or from the convenient right click popup menu e Click the View button or double click the selected record to display the claim in the HCFA 1500 Claim Form Click the Show Payment History button to access the payment history for this claim 5 The Claim Payment History form lists all existing payments made to the selected claim if any Perform the desired payment related tasks from this list including e To post a new payment click the New button and enter the payment date on the Claim Payment Details form The Date Paid field is defaulted to the current system date and can be changed if desired Payment data for HCFA 1500 claims must be entered on a per line item basis Click the Amount Paid cell for the line item to be paid click twice for edit mode enter the payment amount and press the ENTER or TAB key to accept the entry Complete some or all of the optional payment record fields and line item cells if desired The claim level Amount Paid field at the top of the form will display a running total of the Amount Paid values entered for all claim lines When all desired payment fields have been entered click the OK button to save the payment record e
293. ore options and operation Backup performs a backup of the PC ACE Pro32 database files and configuration settings All files to be included are compressed into a single archive and written to the specified destination drive or directory The following controls and options apply to the backup operation e Destination Drive or Folder specifies the drive or Windows folder directory to which the backup archive file will be written This path may point to a removable media device diskettes writeable CDROM or to a standard Windows directory on a hard disk drive local or remote Disk spanning is supported for backups to diskette The user will be prompted to insert blank diskettes as needed e Include infrequently changed database files specifies whether or not to include certain infrequently changed database files in the backup The optional files include only reference file databases that are generally static for long periods of time Examples include the HCPCS Codes and Edit Validation database files The backup archive will be somewhat smaller if these optional files are omitted X To ensure minimal problems in the event a database restore is required we recommend leaving this option checked for all backups e Include claim archive database files specifies whether or not to include the claim archive database files in the backup Refer to the Archiving and unarchiving claims topic for more information on the PC ACE Pro32 claim
294. orm If edit errors exist you will usually have the option to correct the errors or save the claim with errors lf a fatal error exists on the LOB or PCN field however you must correct the error before saving the claim Click the Save With Errors button to save a claim that contains only non fatal errors Such claims are assigned the has errors ERR status Click the Save With Fatal button to save a claim that contains fatal errors Such claims are assigned the has fatal errors ERF status Claims with an ERF status will not be eligible for preparation into an electronic EMC file If edit validation errors occur several Save attempts may be required to correct and save a clean claim At any time click the Errors List button to review the remaining edit validation errors Miscellaneous Claim Form Topics The following comments cover a few miscellaneous features of the HCFA 1500 Claim Form Optional Local Fields Your distributor may have configured additional local fields at the claim payer and or line item levels Local fields are typically defined to provide data elements that are needed by the distributor but are not included in the HCFA 1500 specification If such local fields are defined at the claim level you will see an additional Local Fields tab on the claim form If local fields are defined at the payer and line item levels you will see similar Local Fields second level tabs on the Extended Payer Insured
295. orm select the View Archived Claims item from the form s main File menu to view the claims in the open claim archive Select the View Current Claims item from the main File menu to toggle back to the current claims Only transmitted and paid claims can be archived so choose either the transmitted only TR paid only PD or transmitted paid TR PD item from the Location drop down list To archive a single claim select the desired claim from the list and choose the Archive Selected Claim item from the Claim List form s main Actions menu or the convenient right click popup menu The selected claim will disappear from the current claims list To archive multiple claims at once simply check the desired claims and select the Archive All Checked Claims item from main Actions menu All checked claims will disappear from the current claims list Refer to the Claim List Form Features topic for more information on using this form s powerful multi selection feature Select the View Archived Claims item from the Claim List form s main File menu to once again view the claims in the open claim archive You should see the claims you just archived If you desire you can unarchive the same claims by selecting single or checking multiple the desired claim s and choosing either the Unarchive Selected Claim or Unarchive All Checked Claims item from the Claim List form s main Actions menu When you are f
296. our distributor If you are in doubt about exactly which steps you need to perform contact your distributor for assistance hS You may want to print this help topic and refer to the printed version as you perform these setup steps You can check off the steps as they are completed This technique also frees you to jump around between on line help topics without losing your place in the setup procedure To print the topic just click the Print button at the top of this on line Help screen Payer Reference File Setup This section describes the process of setting up the Payer reference file This file contains information about the valid payers in your system All payers to be specified on your Medicare Part A claims must exist in the Payer reference file with the exception of a special dump payer Complete the following steps as needed hS You may want to refer to the Adding and maintaining payers topic for more information on entering Payer records If you do make sure and return to this topic to continue the setup steps 1 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form Select the Payer tab to display a list of all existing Payer records E One or more Payer records may already exist in the system if you have migrated to PC ACE Pro32 from the DOS version of PC ACE or if your distributor has already setup this reference file for you Consult the dis
297. our installation is licensed for only one claim type then this selection option will not be visible Select the second level tab for the desired primary claim location CL TR or PD The various controls on this tab will be populated with the current column configuration for the selected location The remaining controls on this tab include K The Available Fields listbox contains the names of all fields that are available for selection c K d The Selected Fields listbox contains the names of all fields that are currently configured for the selected claim type and claim location The order in which the Selected Fields are listed represents the order in which they will be displayed on the Claim List form from left to right 2 wow The gt and lt buttons located between the listboxes move fields to from the Selected Fields list respectively To add a field to the current column configuration just select the field from the Available Fields listbox and click the gt button To remove a field select the desired field in the Selected Fields listbox and click the lt button 7 ko The Up Down Arrow buttons allow the user to order the fields in the Selected Fields listbox as desired Simply select a field and click the up or down arrow to reposition the field in the list 7 ko 7 ko The Width and Heading fields specify the column width and heading caption for the currently selecte
298. ovider Deletion Confirmation form will be displayed when you attempt to delete a provider record This form outlines alternatives to deletion and provides a convenient utility to determine how many claims reference the provider record to be deleted Consider clearing the Include In Lookups option on the HCFA 1500 Provider Information form as an alternative to deleting the provider hS The Provider 1500 tab of the Reference File Maintenance form provides several list filter options that can be helpful in locating specific providers Refer to the Reference File Maintenance Form topic for a discussion of these common filter options Entering HCFA 1500 Provider Information The HCFA 1500 Provider Information form provides access to all HCFA 1500 provider fields These fields are grouped logically on the following tabs e General Info includes fields for the provider type name address contact identification Provider or Group ID No LOB Payer ID Group Label tax number and other miscellaneous information e Extended Info includes fields for any additional extended provider information e g the pay to provider name and address if different e Local Fields includes up to six additional local provider fields to be defined by the distributor This tab will only be visible if the distributor has defined one or more of these local fields Contact your distributor for completion details Click the appropriate tab or simply
299. ovider records are in place create Individual in Group provider records for each group member Associated group member provider records must then be created for each line of business LOB in which the member will participate Refer to the Setup of HCFA 1500 Systems topic for a suggested approach to initial setup of the provider reference file X A number of fields on the HCFA 1500 Provider Information form support data entry via fixed list or variable list lookups These lookup lists are accessed by right clicking the mouse over the field or pressing the F2 key while focused on the field Type lt ALT gt F2 press the F2 key while holding the ALT key down to identify all fields that support a lookup list Press the ESC key to disable the flashing notification Helpful fly over hints are also available for many fields Saving amp Canceling Provider Updates 165 After completing data entry on the HCFA 1500 Provider Information form click the Save button or type lt ALT gt S to save and exit the form Alternatively click the Cancel button to abandon any changes and exit the form During the provider save operation an edit validation process is performed on all provider record fields If no edit validation errors occur the provider record is saved without further user intervention If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List screen This screen lists all
300. owever one or more edit validation errors occur you will be presented with the Edit Validation Errors List form This form lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the reference file edit validation process and the Edit Validation Errors List form If any fatal edit errors exist you must correct them before the submitter record can be saved If only non fatal edit errors exist you will have the option to correct the errors or save the submitter record with errors Click the Save With Errors button to save a submitter record that contains only non fatal errors If edit validation errors occur several Save attempts may be required to correct and save a clean submitter record LOB Payer Specific Submitter Records In addition to the default submitter record the Submitter Setup form allows you to create submitter records that are specific to a particular line of business LOB a particular Payer ID or a combination of LOB and Payer ID This feature provides flexibility in cases where the submitter information to be included in the EMC file varies depending on the LOB and or Payer ID For example you might use this feature if you are required to prepare and submit your Medicare MCA MCB claims to a different claims processor than claims for other LOBs Likewise you might
301. phical image of the blank claim form resulting in a complete claim image that can be printed on stock paper The image overlay technique eliminates all the paper alignment headaches often associated with printing onto pre printed claim forms Use this printing method to print claims for archiving or distribution The image overlay printing method requires that the free Adobe Acrobat Reader Version 4 0 or later be installed on your system This reader is available for download from Adobe www adobe com When the Acrobat Reader is properly installed PC ACE Pro32 will automatically detect and configure the path to the ACRORD32 EXE program The steps involved in printing a claim or selection of claims are the same regardless of the selected printing method 1 2 3 134 From the PC ACE Pro32 Main Toolbar click either the UB92 Claims Processing or HCFA 1500 Claims Processing button to open the appropriate Claims Menu form Click the List Claims button on the Claims Menu form to display the appropriate Claim List form All claim printing is performed from the claim list To print a single claim simply select the desired claim from the list and select the Print Selected Claim item from the Claim List form s main Actions menu or convenient right click popup menu The Claim Print Options form will be displayed AS To print a selection of claims simply check the desired claims and select the Print All Checked Claims
302. pic just click the Print button at the top of this on line Help screen Patient and Payer Reference File Migration This section describes the steps required to migrate your current DOS UB92 All Payer Patient optional and Payer reference file data into the PC ACE Pro32 system The claims data from your DOS system will be migrated in a later step after the necessary UB92 Provider records have been setup To perform the patient and payer data migration complete the following steps 1 Close PC ACE Pro32 before beginning this migration process 2 From the Windows Start menu select the PC ACE Pro32 Migration Utility item in the MedLink Technologies PC ACE Pro32 programs folder This will start the migration utility and display its main form 3 Select the UB92 All Payer system type 4 Select the drive containing the BCACE directory from which you intend to migrate the UB92 All Payer system data For example if you select the C drive then the migration utility will expect to find the files BCPAYER IDX the DOS payer database and BCPAT IDX the DOS patient database in the directory C BCACE For each of these expected files found in this directory the corresponding checkbox in the Select the databases to migrate radio group will be enabled 5 Click the Migrate the payer reference file checkbox If you desire to migrate your DOS patient data click the Migrate the patient reference file checkbox as well Finall
303. pically h1500 prt Intermediate Delimited Format imports claims from a file in intermediate delimited format If using this claim import method complete the following steps 1 Ke Work with your distributor to develop the programs necessary to produce a file in intermediate delimited format from your upstream system Your distributor should have detailed specifications of this internal file format Verify that the generated files meet these specifications Confirm the existence of the required map control file This file provides a control interface between the intermediate delimited file and the PC ACE Pro32 claim import routines The map control file is always named mapecntlh win and should be located in the server s winpcace imp1500 directory Setup all required PrintLink Matching Description strings in the Payer reference file These strings are used to match payer descriptions from claims in the intermediate delimited file to specific Payer reference file records Refer to the Adding and maintaining payers topic for details on setting up your PrintLink Matching Description strings Each time you want to import claims copy the new intermediate delimited file generated by your upstream system into the server s winpcace imp1500 directory The file must be named plink out Electronic Media Claims EMC Format import claims from a file in Electronic Media Claims EMC format If using this claim import
304. port for the ANSI 276 277 claim status request response feature may be disabled by the distributor If the Check All Queued Claims For Status Request and Check Claim Status Request Queue action items are not visible then your system does not support the claim status request response feature Claim List Reports Several reports and special print functions are accessible from the Claim List form s main Reports menu Print Claim Detail Report Select this item to print a detailed report of either all listed or all checked claims If one or more claims in the list are checked then only the checked claims will be included in the report If no claims are checked then the report will include all listed claims The previewed report may be printed if desired by clicking the printer button at the top of the report preview form To print a detailed report on a specific subset of claims first use the Claim List form s filter capabilities to display only the claims of interest If even more specific identification is required then simply check only those claims that are to be included in the report Print Claims for Paper Submission Select this item to print all or a subset of claims currently eligible for paper submission A claim is eligible for paper submission if it has a media setting of paper P resides in the to be transmitted CL location and has a clean CLN status or optionally a non fatal errors ERR statu
305. print image files into the DOS UB92 All Payer system 3 Select the Patient tab to review the migrated patient records if any Double click a record to view the migrated details for that patient Confirm that the Patient record appears complete and correct Click the Close button to close the Patient Information form Repeat this review process for a few patients in the list 4 When finished with your review of the Patient and Payer reference files click the Close button to close the Reference File Maintenance form and return to the PC ACE Pro32 Main Toolbar Setting Up UB92 Provider Records This section describes how to set up your UB92 Provider reference file This reference file is organized such that each record describes a valid provi der for a single line of business LOB 16 This organization allows for greater flexibility in specifying provider IDs and support information Tax ID address etc which can vary across multiple LOBs for a single provider At least one record must be added for each provider on behalf of whom claims are to be billed If desired an additional record can be added for each line of business in which the provider participates To setup the UB92 Provider reference file complete the following steps S It is important to correctly setup the UB92 Provider reference file before continuing with this migration process In order for claims to migrate cleanly into PC ACE Pro32 the key providers reference
306. proceeds running totals of the count and dollar value of all clean claims and claims with errors are displayed on the Automated Claim Processing form You will be notified when the claim processing operation completes If you are processing claims in interactive mode automatic processing will be temporarily paused each time a claim containing errors is processed The claim will be automatically displayed in either the UB92 Claim Form or HCFA 1500 Claim Form with the Edit Validation Errors List form open to display the claim s edit validation errors unless disabled in the Preference settings You can either work the claim until it is clean save the claim with errors or cancel the claim to leave it unprocessed Once you have closed the claim form the automatic processing run will continue with the next eligible claim in the sequence hS A convenient Cancel Run button will be available on the UB92 Claim Form or HCFA 1500 Claim Form when processing claims in interactive mode Click this button to cancel the currently displayed claim and abort the automatic processing run The current claim and all remaining eligible claims will remain unprocessed 4 If desired click the View Results and or View Errors buttons to view reports of the clean claims and claims with errors respectively These reports can be printed from the report previewer if desired If you checked the Include edit error details in process error report proce
307. ps need only be performed once while others must be performed each time a new set of claims is to be imported The preparation steps required for each claim import method are listed below You need only be concerned with the preparation steps for your selected claim import method e Print Image PrintLink importing claims using the PrintLink method requires the following preparation 1 Perform all required onceonly preparation steps for importing claims using the PrintLink method Complete these steps as part of the initial PC ACE Pro32 system setup described in either the Setup of Medicare Part A Systems Setup of UB92 All Payer Systems or Setup of HCFA 1500 Systems topic In summary this once only setup consists of b Performing PrintLink mapping on a sample print file to generate the corresponding map file Copying the map file to the server s claim import directory gt Confirming that the correct map control file has been placed in the server s claim import directory hS Check with your distributor before performing these once only setup steps Some distributors build this setup into the program installation procedure 110 2 Copy the print file to be imported into the server s claim import directory The print file must be named as defined in the corresponding print map file The claim import directory is named winpcace impub92 for UB92 claim import operations and winpcace imp1500 for HCFA 1500 claim impor
308. r looked up from the Patient reference file via the F2 shortcut key When the focus leaves a roster billing form field either by pressing the TAB key or clicking on a new field an edit validation process is performed on the field losing the focus Edits performed at this time are referred to as field level edits If a field level edit validation error occurs you will receive an audible response and the edit validation error message will be displayed in the lower left corner of the roster billing form In addition the focus will remain on the field so that you can correct the problem if desired If you choose not to correct the data at this time simply press the TAB key again to move to the next field Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the roster billing edit validation process Saving amp Canceling Roster Billings After completing data entry on the roster billing form click the Save button or type lt ALT gt S to save and exit the roster billing Alternatively click the Cancel button to abandon any changes and exit the roster billing When an attempt is made to save a roster billing an edit validation process is performed on all fields on the form This process includes re evaluating all field level edits as defined above In addition all file level edits are evaluated File level edits are evaluated only when the roster billing is saved and are typicall
309. ransmitted so this action will be disabled for claims in the CL location Actions on Multiple Claims 55 Some actions can be performed on multiple claims at once Multiple claim selection is accomplished by checking the claim of interest and subsequently performing one of the All Checked Claims actions To check a claim click the left mouse button over the checkbox in the first column of the desired list row Alternatively all claims in the current list can be checked using the Check All Claims item from the list s pop up menu Use the flexible Claim List form filter techniques to display only the subset of claims to be printed deleted held etc Then simply check all claims and perform the desired action on all checked claims at once X Use the Check All Claims From Selected Transmission filter option to quickly identify i e check all claims that were included in a specific transmission file This filter option can be especially useful if for example it becomes necessary to reactivate all claims from a recent transmission file A warning will be displayed if one or more of the claims from the selected transmission file are no longer present in the claim list This filter option can be accessed from the Claim List form s main Filter menu and will be available only when viewing claims in the transmitted TR and transmitted paid TR PD locations Claim List Field Customization The Claim List form field definiti
310. re recovery process and exits the program Selecting this option is the equivalent of saying have no idea what to do Consult with your system administrator or a technical support specialist for the suggested course of action The next time you execute PC ACE Pro32 you will be presented with this same prepare recovery options form If the first or second option is selected the user will be required to log in using the same User ID and password that was in effect when the prepare interruption occurred Upon successful login the prepare recovery process will either be performed or skipped based on the user s selection Once the recovery process has completed successfully we suggest that you review the affected claims using the Claims List form to insure that everything looks like it did before the 206 prepare operation was initiated You may then run the prepare operation again to prepare the eligible claims If the original prepare operation included UB92 standalone medical attachments e g Rehab Ambulance ESRD then these attachments will be recovered along with the claims In this scenario the term claims as it is used in this topic can be interpreted as claims and attachments Claim prepare recovery requires exclusive system access Since the prepare operation itself requires exclusivity this should never become an issue In any event you will be notified if exclusive system access cannot be granted 207 Index
311. rectly from pre built file in intermediate delimited format Import claims directly from a pre built file in intermediate delimited format This method bypasses the PrintLink translation step for facilities that can produce the intermediate format file directly from an upstream system te Import claims from file in Electronic Media Claims EMC format Import claims directly from a file in Electronic Media Claims EMC format This method may be used in facilities where the upstream system can generate a reliable EMC output file t d Claim Import Preprocessor specifies an optional external preprocessor program to be called prior to claim import processing This preprocessor may be an executable program or a DOS batch file with associated PIF file The PC ACE Pro32 import code will launch this preprocessor automatically and wait for completion before continuing with import processing Claims preprocessing can be performed with any of the 3 claim import methods Your distributor may have already configured these claim import settings The distributor can determine which settings if any a user can modify Therefore some or all of the controls may be disabled amp You should modify these claim import settings only under the supervision of your distributor or a technical support specialist Incorrectly configuring these options will render the claim import feature non functional Related Topics The following hyperlinks provide
312. resulting in a complete plan image that can be printed on stock paper The image overlay technique eliminates all the paper alignment headaches often associated with printing onto pre printed forms Home Health Plan of Care printing requires that the free Adobe Acrobat Reader Version 4 0 or later be installed on your system This reader is available for download from Adobe www adobe com When the Acrobat Reader is properly installed PC ACE Pro32 will automatically detect and configure the path to the ACRORD32 EXE program The steps involved in printing a Plan of Care or a selection of plans are as follows 1 From the PC ACE Pro32 Main Toolbar click the UB92 Claims Processing button to open the UB92 Claims Menu form 2 Select the Attachments and Maintain HH Plans of Care menu items to display the Home Health Plan of Care List form All plan printing is performed from the Plan of Care list 3 To print a single Plan of Care simply select the desired plan from the list and select the Print Selected Plan of Care item from the Plan of Care List form s main Actions menu or convenient right click popup menu The Home Health Plan of Care Print Options form will be displayed AS To print a selection of plans simply check the desired plans and select the Print All Checked Plans of Care item from the Plan of Care List form s main Actions menu Refer to the Home Health Plan of Care List Form Features topic for more info
313. rmation cannot be modified from this list Refer to the Listing modifying and maintaining Plans of Care topic for details on how plans can be added or updated Displaying Audit information Click the picture button in the upper right corner of the Patient Info amp Codes tab to display audit information for this claim This audit information includes the date the claim was created the last modification date and the User ID of the user that modified the claim last Common Claim Activities The following hyperlinks provide additional instruction on several common claim activities b b b b Refer to the Adding a new claim topic for more information on adding claims Refer to the Listing modifying and maintaining claims topic for tips on maintaining claims from the UB92 Claim List form Refer to the Printing claims topic to learn about printing claims Refer to the Posting claim payments UB92 topic to learn about UB92 claim payment posting 61 The HCFA 1500 Claim Form The HCFA 1500 Claim Form provides access to all data elements of an HCFA 1500 claim New claims are entered and existing claims are viewed and or modified from this form The HCFA 1500 Claim Form has been designed to provide a data entry flow resembling that of the printed HCFA 1500 claim form whenever possible Claim fields are grouped logically on five major tabs e Patient Info amp General includes fields for general claim and patient informati
314. rmation on multiple plan selection 4 The Home Health Plan of Care Print Options form allows the user to override the default destination printer and to select the desired Plan of Care forms i e HCFA 485 only HCFA 486 only or both if available Click the Preview button to preview the plan s before printing Click the Print button to print the plan s without previewing them Plan of Care previewing employs the Adobe Acrobat Reader Use the Acrobat Reader s print option to print a previewed plan When you have previewed and optionally printed the plan close the Acrobat Reader program This will signal PC ACE Pro32 that you are ready to continue E You will not be able to resume activities in PC ACE Pro32 until the Acrobat Reader program has been exited Simply closing the plan document within the reader is not enough to signal PC ACE Pro32 to continue 5 If you have selected multiple plans they will be printed in sequence based on the current Plan of Care List form s Sort By selection A progress form will display details about the plan currently being printed Click the Cancel button on this progress form to cancel the printing session following the plan currently being printed A Few Technical Notes 149 Here is some additional technical information that you need to know about printing Plans of Care in PC ACE Pro32 One or more Home Health Plan of Care Addendum HCFA 487 forms will be printed automatically if n
315. rocedures Refer to any installation notes provided by your distributor before continuing If you are in doubt about whether or not you need to perform these steps contact your distributor for assistance hS You may want to print this help topic and refer to the printed version as you perform these migration steps You can check off the steps as they are completed This technique also frees you to jump around between on line help topics without losing your place in the migration procedure To print the topic just click the Print button at the top of this on line Help screen Patient and Payer Reference File Migration This section describes the steps required to migrate your current DOS HCFA 1500 All Payer Patient optional and Payer reference file data into the PC ACE Pro32 system The claims data from your DOS system will be migrated in a later step after the necessary HCFA 1500 Provider records have been setup To perform the patient and payer data migration complete the following steps 1 Close PC ACE Pro32 before beginning this migration process 2 From the Windows Start menu select the PC ACE Pro32 Migration Utility item in the MedLink Technologies PC ACE Pro32 programs folder This will start the migration utility and display its main form 3 Select the HCFA 1500 system type 4 Select the drive containing the BSACE directory from which you intend to migrate the HCFA 1500 All Payer system data For example if you se
316. rocess One of the primary motivations behind claim archiving is to keep the current claims database tables as small and as fast as possible by moving older claims to off line storage However once a group of claims have been archived the current claims database tables must be packed in order to fully realize the size and performance benefits Database packing is typically the responsibility of your system administrator K Database Reindexing Database indexes facilitate optimized access to the information in a database table As data in the table changes these indexes must be updated to accurately reflect the current table contents Indexes are normally maintained automatically by the PC ACE Pro32 database engine If an index gets out of date as the result of some unexpected system or network malfunction it may become necessary to manually reindex the associated table Database reindexing is typically the responsibility of your system administrator File maintenance operations like packing and reindexing require appropriate user permission You will be notified if your user is not authorized to perform these functions In addition these functions require exclusive system access To pack or reindex a table s 1 Click the System Utilities button on the PC ACE Pro32 Main Toolbar to display the System Utilities form Select the File Maintenance tab 2 Select one or more tables from the Database Files list AS Select mu
317. rs occur several Save attempts may be required to correct and save a clean patient record Common vs Separate Insured Information NOTE This discussion applies only if your system is licensed for both UB92 and HCFA 1500 claim activities If you are licensed for only a single claim type the form controls described in this section will not even be visible in your system The Patient reference file is shared between UB92 and HCFA 1500 claim activities In terms of general patient information this shared approach is satisfactory However it is quite possible that the payer insured information will need to be different when a UB92 claim is billed for a patient versus when a HCFA 1500 claim is billed for the same patient For example a UB92 Medicare claim requires that the submission payer have an MCA line of business LOB while a HCFA 1500 Medicare claim requires a submission payer LOB of MCB In order to deal with this need for separate UB92 and HCFA 1500 payer insured information sets the Patient Information form provides the Insured Information Options selection group This selection group exists on each of the Insured tabs and controls whether common or separate payer insured information is required The available selections include e Common UB92 amp 1500 When selected instructs the system to maintain a single set of payer insured information The same payer insured information will be brought forward into both U
318. ry across multiple LOBs for a single provider At least one record must be added for each provider on behalf of whom claims are to be billed If desired an additional record can be added for each line of business in which the provider participates The HCFA 1500 provider structure defines 3 distinct provider types 1 Provider Groups 2 Individual Providers Within A Group and 3 Solo Providers HCFA 1500 claims require a billing provider that can be either a group or solo provider but not an individual within a group The HCFA 1500 claim entry provider lookups and claim editing process will enforce this requirement You will be required to assign one of the 3 provider types to each provider you add during this setup procedure If it is not clear which type is appropriate in each instance refer to the Adding and maintaining providers HCFA 1500 topic for a more complete description of the various provider types If you are sill unsure contact your distributor for assistance E It is important to correctly setup the HCFA 1500 Provider reference file before continuing with this migration process In order for claims to migrate cleanly into PC ACE Pro32 the key providers referenced on these claims must be present in the HCFA 1500 Provider reference file To setup the HCFA 1500 Provider reference file complete the following steps 1 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display th
319. s When printing claims for paper submission you will have the option to print all eligible claims or just eligible claims for a selected payer You will also choose whether or not to include eligible claims with a status of non fatal errors ERR After each eligible claim is printed you will be prompted to automatically move the claim to the transmitted TR location Since paper claims will never be prepared into an EMC file this prompt provides the only available mechanism for moving these claims out of the to be transmitted CL location When multiple paper claims are eligible for submission you may use the convenient Yes To All No To All button to move not move all eligible paper claims to the transmitted TR location after printing hS When printing claims for paper submission you will also have the option to print these same claims on behalf of their alternate non submission payers This feature can be useful if you also need to submit paper claims to the secondary or tertiary payers for example Refer to the Printing claims topic for more details on the alternate payer printing feature Support for paper claims may be disabled by the distributor If the Print Claims for Paper Submission menu item is not visible then your system does not support paper claim processing and all claims must be submitted electronically 57 The UB92 Claim Form The UB92 Claim Form provides access to all data elements of a U
320. s e Pentium 133 MHz processor Pentium II 350 for larger claim volume e 64 MB system memory e CD ROM drive recommended for server installation e SVGA monitor resolution 800 x 600 e Windows 95 98 2000 Me XP or NT 4 0 operating system e Adobe Acrobat Reader Version 4 0 or later for overlaid claim printing Note When the Windows Large Fonts display setting is enabled the screen resolution must be 1024 x 768 or higher The UB92 Claim Form and HCFA 1500 Claim Form will not display properly at lower screen resolutions PC ACE Pro32 Server Installation Perform these steps to install the PC ACE Pro 32 server or single user install 1 If you received PC ACE Pro32 on floppy disks simply insert Disk 1 and type A setup in the Run dialog accessible from the Windows Start menu 2 For compact disk media the installation program will execute automatically when you insert the disk into your CDROM drive If the Windows auto detect feature is disabled you may need to start the installation program manually To do so type D setup in the Run dialog accessible from the Windows Start menu substituting the drive letter of your CDROM drive for the D in this example 3 Follow the on screen wizard steps to complete the server installation You will be prompted to select a destination drive For best performance select a drive local to your machine If multi user operation is required select a drive accessible by all workstatio
321. s drop down lists Basic filter options include e Location filters the claim list to include only claims in the to be transmitted CL transmitted TR or paid PD locations An additional transmitted paid TR PD selection is available to display both transmitted and paid claims This selection may provide a more comprehensive view of the claims during payment posting for example e Status filters the claim list to include only claims assigned a specific status The possible status codes are clean ready CLN deleted DEL has fatal errors ERF has errors ERR held HLD and unprocessed UNP Note that selecting a status of DEL is the only way to view deleted claims which can be recovered until they are purged from the system e LOB filters the claim list to include only claims for a specific line of business In addition to these basic filter options the Claim List form also provides a number of Advanced Filter Options These advanced options permit filtering on the claim s patient payer provider date ranges batch information bill type and numerous other criteria When multiple filter criteria are specified only those claims that meet all filter criteria will be displayed Claim Actions The Claim List form may also be used to perform specific actions on any individual claim or a group of selected claims To perform an action on an individual claim simply select the claim from the list a
322. s Response Log menu items on either the UB92 or HCFA 1500 Claims Menu form The following operations are available e To view and or print an archived ANSI277 response file report select the desired record and click the View Response Report button or double click the desired record The report may be printed from the preview form if desired e To view and or print the post report for an archived ANSI277 response file select the desired record and click the View Post Report button The report may be printed from the preview form if desired e To delete an archived ANSI 277 file and its associated post report select the desired record click the Delete button and confirm the deletion By default archived ANSI277 claim status response files will be automatically purged after a certain number of days Refer to the PC ACE Pro32 Miscellaneous preferences topic for details on how to change the archive period or disable automatic purging altogether if desired Individual claim status responses which have been posted to claims will remain on file even after the original archived response file has been manually deleted or automatically purged e To refresh the list of archived ANSI277 files click the Refresh button The staging directory will be re scanned for the presence of new ANSI 277 files If new files are present in the staging directory they will be checked for proper format and automatically archived and posted The display
323. s informational icon is used to pass along tips that improve the usability of the application This informational icon is used to present special notes relating to the current help topic These may indicate a requirement or restriction of the application In some cases they are simply general interest items E This informational icon is used to bring attention to an important issue relating to the current topic Often these instructions must be taken to ensure optimum operation of an application feature Where Do I Go From Here f you are currently using the DOS version of MedLink Technologies PC ACE product you have the option to migrate most of your existing data into PC ACE Pro32 Proceed to the Current DOS PC ACE Users Read This First topic where you will be directed through the migration process If you are new to the PC ACE family of products skip the migration topic and proceed directly to the appropriate setup procedure b gt Medicare Part A clients proceed to the Setup of Medicare Part A Systems section gt UB92 All Payer clients proceed to the Setup of UB92 All Payer Systems section b HCFA 1500 clients proceed to the Setup of HCFA 1500 Systems section These sections present detailed instructions on how to set up your PC ACE Pro32 system Migrating from a DOS PC ACE System Migrating Medicare Part A Systems A goal of PC ACE Pro32 is to provide users with a smooth transition from their existing DOS Medicare Part A ME
324. s to from the newly created list The TOB drop down list on the Codes TOB tab will include only valid TOBs for the selected LOB Refer to the Type of Bill TOB File Maintenance topic for information on maintaining the list of valid TOBs for each line of business 181 Revenue Codes File Maintenance The Revenue Codes form provides an interface to maintain the revenue codes used in PC ACE Pro32 Revenue codes apply exclusively to UB92 claims They are pre loaded and should require minimal maintenance The Revenue Code form displays the current list of revenue codes their descriptions and an indication of whether or not revenue code assignment details exist for this code Maintenance operations available include e To add a revenue code click the New button and enter the new revenue code information Enter the effective date range using a 4 digit year format e To view or modify an existing revenue code record select the desired record from the list and click the View Update button or double click the desired record e To delete a revenue code record select the desired record from the list click the Delete button and confirm the deletion e To view revenue code assignment details select the desired record from the list and click the TOB Detail button See the Revenue Code Assignments discussion later in this topic for more information hS The Revenue Codes form provides several List Filter Options that can be helpful i
325. scriptions button while viewing a payer s details to view edit the PrintLink matching strings for the selected payer Click the New Edit and Delete buttons to add modify and delete matching strings for the selected payer record respectively In addition to maintaining the selected payer s matching strings the user also has the option to view all currently defined matching string for all payers in the order that they will be searched during the claim import process 159 This form also provides a handy Test Match feature that allows the user to quickly identify which payer will be matched to a given print file payer description To use the test match feature select the Show all strings radio button select either the UB92 or HCFA 1500 radio button if visible and click the Test Match button Enter the payer description as it would appear on the printed claim and click the OK button If a match is found the matching string record will be highlighted in the list You will be notified if no match is found Related Topics The following hyperlinks provide additional information related to this topic b Refer to the Reference File Maintenance Form topic for a discussion of the common reference file form features and filter options b Refer to the Claim amp Reference File Edit Validation topic for a discussion of the edit validation process 160 Adding and maintaining providers UB92 The Provider UB92 tab
326. se fatal edit errors must be corrected before the claim can be saved Related Topics The following hyperlinks provide additional information related to this topic gt Refer to the UB92 amp HCFA 1500 Claims Menus topic for more information about the Claims Menu form gt Refer to the Claim List Form Features topic for details on using the Claim List form b gt Refer to the UB92 Claim Form and HCFA 1500 Claim Form topics for more information on using the UB92 and HCFA 1500 claim forms b gt Refer to the Claim amp Reference File Edit Validation topic for more information about the edit validation process and associated forms 107 Listing modifying and maintaining claims Claims in PC ACE Pro32 are listed modified and otherwise maintained from the UB92 amp HCFA 1500 Claim List forms The Claim List form operation is identical for UB92 and HCFA 1500 claim types To access the Claim List form 1 Click either the UB92 Claims Processing or HCFA 1500 Claims Processing button on the PC ACE Pro32 Main Toolbar to display the respective Claims Menu form 2 From the UB92 or HCFA 1500 Claims Menu form click the List Claims button to open the respective Claim List form Most actions to be performed on a claim may be executed from the Claim List form Claims can be created viewed modified copied deleted undeleted purged reactivated held released printed and archived unarchived from the list In addition pay
327. section describes the process of reviewing the migrated claims for correctness and completeness Complete the following steps amp It is important to thoroughly review the migrated claims Pay close attention to any edit validation errors that would indicate incorrect or missing Payer and or HCFA 1500 Provider reference file records Since problems with these key reference files can impact a large number of claims is to your advantage to correct these problems at this point and re migrate the claims if necessary 1 Execute PC ACE Pro32 From the PC ACE Pro32 Main Toolbar click the HCFA 1500 Claims Processing button to display the HCFA 1500 Claims Menu form When prompted to login you may enter the default user s User ID SYSADMIN and password SYSADMIN as well 2 Click the List Claims button to open the HCFA 1500 Claim List form Resize and reposition this form as desired By default the list will contain all claims migrated from your DOS HCFA 1500 All Payer claims entry database Double click any record to view the migrated claim details If the Save button ower right is disabled make a superficial change to one of the claim s fields in order to enable this button e g overtype the same patient sex value Click the Save button to save the updated claim An edit validation process will be performed to check for problems with the claim information When prompted correct any missing or invalid field values and re save as need
328. sion Three external claim import sources are supported Print Image PrintLink Using PC ACE Pro32 s advanced PrintLink mapping technique claims can be imported from print image files produced by your upstream system This is the default claim import method in most installations 7 Intermediate Delimited Format Claims can be imported directly from a pre built file in intermediate delimited format This internal delimited ASCII format is the same as that produced by the PrintLink translator in the print image import technique This claim import method provides a more versatile solution for facilities that can produce the intermediate format file directly from an upstream system o Electronic Media Claims EMC Format Claims can be imported directly from a file in Electronic Media Claims EMC format This method may be used in facilities where the upstream system can generate a reliable EMC output file Refer to the Claim Import Preferences topic to select the desired claim import method and configure the optional preprocessor described later in this topic amp You should modify these claim import settings only under the supervision of your distributor or a technical support specialist Incorrectly configuring these options will render the claim import feature non functional Getting Ready To Import Claims Some preparation is required before claims can be imported into PC ACE Pro32 Certain preparation ste
329. ss the PAGE UP and PAGE DOWN keys to move between tabs Provider records are uniquely defined by the Provider ID No Provider ID and LOB Line of Business fields and optionally by the Payer ID field as well These critical fields are defined as follows 161 e Provider ID No The provider identifier to be used on claims for the line of business specified in the LOB field e LOB Specifies the line of business applicable to this provider record e Payer ID An optional field that if specified identifies this provider record as payer specific to the payer identified by this Payer ID The LOB field value is used to filter the list of providers presented to the user during claim entry lookup operations Only provider records with an LOB value matching the LOB of the selected claim payer line will be available for selection If required this provider record s associations may be maintained from this form using the Select adds a new association and None deletes all associations buttons adjacent to the Provider Associations listbox hS A number of fields on the UB92 Provider Information form support data entry via fixed list or variable list lookups These lookup lists are accessed by right clicking the mouse over the field or pressing the F2 key while focused on the field Type lt ALT gt F2 press the F2 key while holding the ALT key down to identify all fields that support a lookup list Press
330. ssing option the claims with errors report will include the specific edit validation errors reported for each claim up to 5 per claim maximum by default If this option was not checked the claim reference will be reported without any supporting edit validation error details X Refer to the Printing Preferences topic for information on configuring claim processing reports to be printed automatically or to a specific printer You can also set the maximum number of edit validation errors to be listed per claim 5 When you have completed your review of the claim processing reports click the Close button on the Automated Claim Processing form You may now proceed to work the remaining unprocessed claims and claims with errors one by one from the Claim List form E Claims containing non fatal errors will be assigned a status of unprocessed UNP during automatic processing rather than the has errors ERR status that you might expect This is done to avoid inadvertently including these claims in a subsequent prepare run since ERR status claims can optionally be included in the prepare When you eventually work these claims you can decide on an individual basis whether 116 the claim should be corrected transmitted with the non fatal error s or held pending further evaluation 117 Preparing claims for transmission Claim preparation in PC ACE Pro32 refers to the act of generating an Electronic Media Claims EMC file suit
331. st and click the New button again When prompted select the Inherit name address information from the selected provider option Also check the Associate the new provider with the selected provider checkbox and click the OK button A duplicate of the selected provider will be created and displayed Enter BC in the LOB field and save the new provider record These provider records are now associated with each other to reflect that they represent the same entity Repeat this inherit and associate process to create additional Jones Memorial Hospital provider records for other LOBs if desired Associations are used during the claim preparation process to identify the various lines of business applicable to a specific provider Related Topics The following hyperlinks provide additional information related to this topic b Refer to the Setup of Medicare Part A Systems or Setup of UB92 All Payer Systems topic for a suggested approach to initial setup of the provider reference file b Refer to the Reference File Maintenance Form topic for a discussion of the common reference file form features and filter options b gt Refer to the Claim amp Reference File Edit Validation topic for a discussion of the edit validation process 163 Adding and maintaining providers HCFA 1500 The Provider 1500 tab of the Reference File Maintenance form provides access to maintain the providers to be referenced on HCFA 1500 claims NOTE If
332. stem The Provider Deletion Confirmation form outlines alternatives to deletion and provides a convenient utility to determine how many claims reference the provider record to be deleted K Provider 1500 provides access to maintain the providers to be referenced on HCFA 1500 claims Setup of the HCFA 1500 Provider reference file is required to process HCFA 1500 claims All providers referenced on HCFA 1500 claims must be represented in this reference file The HCFA 1500 Provider form provides a convenient Sort By selection that quickly sorts the Provider list by LOB Type Provider Group Name Provider ID Group Label and Tag Operations available include e To add a new HCFA 1500 provider record click the New button and enter the new provider information If provi ders already exist in this reference file you will have the option to create a completely new provider record or inherit and associate the new provider record with the provider record currently selected in the list Select the desired creation options and click the OK button to continue Refer to the Adding and maintaining providers HCFA 1500 topic for a discussion of these creation options and their applicability e To view or modify an existing provider record select the desired record from the list and click the View Update button or double click the desired record e To delete an existing provider record select the desired record from the
333. ster billing data HCFA 1500 0 0 eeeceeeee cette ee eeeeeeeeeeeeeeeeeaaeeeeeaaaaeeeeaaeeeeeeaaaeeees 68 entering roster DINOS eei aina oc see Nese cs nite sc phe dees ok pees dada etek pak pee ck otek bates etek sy 142 entering UB92 Medical Attachment data cece eere nee ee etna ee eeee nae eeeeaaeeeeeeaaaeeees 79 ESRD medical attachment x c 0 fectcectee entice Sas A AE EPEAN AAA n AANER heehee tide 150 F Facility File Maint Mane uiai roia iea AA AEAEE EEEE AEE EA EA AAEE NEET 186 209 OAtUPES iSite tha wae TA ln tis ech tao Lesh ENA sp oti EPEE E EAE 3 field level and file level edits ieee cececeee cc eeee cece eee eeccee tees ecae eres aaaaeeeeaaaaeeeesaaaeeeeaaaaeeeeaaaa ees 87 Forms 485 486 Home Health Plan of Care cccseececeseeeeeeeaeeeeeeeaaeeeeeaaeeeeeeaaeeeeeaaaeeees 145 G Getting started with PC ACE Prod 2 ci eeeccce cece ce neeee tena eter ee cae eres nae eeeeaaaeeeeeaaaeeeeeaaaeeeeeaaeneess 5 H HCFA 1500 Claim FOP arr aar n aa codduasanendeadevaraudaras doaagadedduansud adie taeda 61 62 63 HCFA 1500 Roster Billing FO saiia etan renna iar oa rtea rii ea AETERNA ECEE AAEE ERNE EAA CEES 68 HCPCS Codes File Maintenance onsu ionenraea n a a A a a a a aN a 174 HCPCS Modifiers File Maintenance seesseeeneeeeeeeeennreserrieserrrreernrecennrieennteennteccnnreeenneeee 175 Help System How To USG arceau A aa aR cae ee ee a ARET eeseaaeeeeseaaeesessaaeeeessaaeees 5 Home Health
334. t data in the system Any number of payments may be posted against a transmitted HCFA 1500 claim The payment history for a claim can be accessed from either the HCFA 1500 Claim List form or the The HCFA 1500 Claim Form as follows 1 Click the HCFA 1500 Claims Processing button from the PC ACE Pro32 Main Toolbar to display the HCFA 1500 Claims Menu form 2 Click the List Claims button on the HCFA 1500 Claims Menu form to display the HCFA 1500 Claim List form By default the list will display claims in the to be transmitted CL location 3 On the HCFA 1500 Claim List form select either the transmitted only TR paid only PD or transmitted paid TR PD claims location to display claims eligible for payment Claims are assigned to the transmitted TR location as soon as they are prepared into an EMC file for transmission When the first payment is posted to a transmitted claim the claim is moved to the paid PD location where it will remain indefinitely Payments may be posted to claims in either the transmitted TR or paid PD locations but not to claims in the to be transmitted CL location hS If you plan on posting payments to more than one claim we recommend that you select the combined transmitted paid TR PD claims location Updates to the claim list are more efficient to process from this location since claims being moved from the transmitted TR to paid PD status will not f
335. t operations Intermediate Delimited Format importing claims using the intermediate delimited format method requires the following preparation 1 Perform all required onceonly preparation steps for importing claims using the intermediate delimited format method Complete these steps as part of the initial PC ACE Pro32 system setup described in either the Setup of Medicare Part A Systems Setup of UB92 All Payer Systems or Setup of HCFA 1500 Systems topic In summary this once only setup consists of b Confirming that the correct map control file has been placed in the server s claim import directory aN Check with your distributor before performing these once only setup steps Some distributors build this setup into the program installation procedure 2 Generate the intermediate format file containing the claims to be imported 3 Copy the intermediate format file to be imported into the server s claim import directory The intermediate format file must be named plink out The claim import directory is named winpcace impub92 for UB92 claim import operations and winpcace imp1500 for HCFA 1500 claim import operations Electronic Media Claims EMC Format importing claims using the EMC format method requires the following preparation 1 Perform all required onceonly preparation steps for importing claims using the EMC format method Complete these steps as part of the initial PC ACE Pro32 system setup described
336. t set up a user account for each person that will use PC ACE Pro32 The user account specifies the user s login password values and defines which activities the user has permission to perform As shipped PC ACE Pro32 is configured with a single default user with full system access rights The default user s User ID is SYSADMIN and password is SYSADMIN as well Complete the following steps to add additional user accounts bS You may want to refer to the Adding or modifying a system user topic for more information on adding and maintaining users If you do make sure and return to this topic to continue the setup steps 46 1 Select the main Security menu from the PC ACE Pro32 Main Toolbar and choose the Add Update User item The Security List form will display a list of all existing user accounts 2 To add a new user account click the New button on the Security List form and assign the user a User ID Password and Name Assign permissions to this user and click the OK button to save the new user record X Check the checkbox next to the permission to allow access to the activity Click the Check All and Clear All buttons to quickly check or un check all user permission checkboxes 3 Repeat the previous step to create additional user accounts If changes are made to a user profile the changes will not go into effect until the next time that user logs into system Select the Logout Current User item on the main Se
337. t validation errors Miscellaneous Roster Billing Form Topics The following comments cover any miscellaneous features of the HCFA 1500 Roster Billing Form e Displaying Audit information Click the picture button in the upper right corner of the form to display audit information for this roster billing This audit information includes the date the roster billing was created the last modification date and the User ID of the user that modified the roster billing last Common Roster Billing Activities The following hyperlinks provide additional instruction on several common roster billing activities b gt Refer to the Adding a new roster billing topic for more information on adding roster billings b Refer to the Listing modifying and maintaining roster billings topic for tips on maintaining roster billings from the Roster Billing List form 71 Home Health Plan of Care List Form Features The PC ACE Pro32 Home Health Plan of Care List form provides a versatile interface from which the user can create list modify print and otherwise maintain Plans of Care Click the UB92 Claims Processing button on the PC ACE Pro32 Main Toolbar to open the UB92 Claims Menu form Then select the Attachments and Maintain HH Plans of Care menu items on the UB92 Claims Menu form to open the Plan of Care List form You may reposition and resize this form if desired The list can be easily sorted and filtered to display only the plans of interest
338. ta For example if you select the C drive then the migration utility will expect to find the files SUBMIT DAT the DOS Submitter file and PATIENT IDX the DOS patient database in the directory C PCACE For each of 10 these expected files found in this directory the corresponding checkbox in the Select the databases to migrate radio group will be enabled Click the Auto create the submitter and payer reference files checkbox If you desire to migrate your DOS patient data click the Migrate the patient and Plan of Care reference files checkbox as well The optional Plan of Care database file HHPOT IDX will be migrated if present along with the Patient reference file data Finally click the Migrate button to proceed If selected the migration utility will proceed to dump the contents of your patient and Plan of Care databases into temporary files that will then be imported into the PC ACE Pro32 Patient reference file and Plan of Care database respectively The default Submitter reference file record and a single Medicare Payer reference file record will also be created A single PrintLink matching string of MEDICARE will be assigned to the auto created payer record The migration utility will also copy the PCACEXMT BAT file all PrintLink MAP files and the ANSF835 ETRA Intermediary and Provider configuration files from the DOS MEDA system to their corresponding directories in PC ACE Pro32 When the migrati
339. tachment ssaki ernari r nka seeeeeeesaaeeeeeaaeeeeeeaaeeeeesaaeeeees 150 ANSI 267 277 claim status request response history ceeeceeeeeeeeeeeeeeeeeceeeeeeeaaeeeeeeaneneees 131 ANSI 277 file review and Maintenance cceeeeeeeeeeeeeeeceeeeeeeeeeeeeeeaaeeeeeesaeeeeeesaaeeeesaaeeees 128 ANSI 835 Electronic Remittance MOdule ccceceeeeeeeceeeeeeeeeeeeeeaeeeeeeeaaeeeeeeaaeeeeeeaaeeees 196 ANSI 997 file review and Maintenance ee ceee cece eee ee cece ener ee eeeeeeeaaeeeeeeaaeeeeesaaeeeeeeaaeeees 122 ALCHIVING CLAIMS ena aet aa eA Eea enat A tenn AAE LEIE AORTE EEA tee aaa debe sande 140 archiving tranSMiSSiOn fil S esparsa SEE ae EEA EIE e E aa AE 124 attachments PITIN aesan aae ra AAE REESE AA deta EA ARE EER RAAEN 133 audit racking coer oteti Ste Aa an A ETER TA eee NEA E ae AARATI ar REEERE AET 90 automatic report prining senini osiin A A A E iD n i a a a aeai 98 B backing up your PC ACE Pro32 databases ceceeeeceeeeeeeeeeeeeeee ee eeeeeeeeeeeeeeaaeeeseeeeeeeseeeees 197 building the ANSI 276 claim status request file cece cece ee eeee cece eeeeeeeeeeeeeeeeaeeeeeeaaeeeeeeaees 126 building the electronic claims file scine r enken r e a a a rea Re K e ERNS 117 C Charges Master File Maintenance cccceeeeeceeeeeee eee eeeeeeeeeeeeeeaeeeeeeeeeeeeeeeaaeeeeeeaeeeeeeeaaes 187 Claim amp Reference File Edit Validation 2 0 0 00 cecceeeeeeceeeeeeeeeeeeeeeeaeeeeeeaaaeeeeeaaee
340. tachments are identified by a C designator on the attachment tab s caption The following attachment productivity features are also available e CLIA and Mammography Certification Numbers When a CLIA or Mammography attachment is triggered the corresponding certification number is retrieved from the claim s billing solo or rendering group provider reference file record if available These certification numbers can be setup in advance in the HCFA 1500 Provider reference file thus freeing the user from remembering and entering these numbers on each claim attachment e Attachment Field Duplication Press the F5 key while positioned on any line level attachment field to copy all attachment field values from the closest previous line with the same attachment type into the current line s attachment fields This feature minimizes the need to type line level attachment data multiple times on a single claim Saving amp Canceling Claims After completing data entry on the claim form click the Save button or type lt ALT gt S to save and exit the claim Alternatively click the Cancel button to abandon any changes and exit the claim When an attempt is made to save a claim the following occurs e Submission Payer Determination At least one of the payers specified on a claim must have the same LOB line of business as the claim itself You will not be allowed to save a claim unless this condition is met If only one of the clai
341. tc Then simply check all plans and perform the desired action on all checked plans at once 73 The Home Health Plan of Care Form The Home Health Plan of Care Form provides access to all data elements of a Home Health Plan of Care New plans are entered and existing plans are viewed and or modified from this form The Home Health Plan of Care Form has been designed to provide a data entry flow resembling that of the printed Home Health Certification And Plan of Care HCFA 485 and Medical Update And Patient Information HCFA 486 forms Plan fields are grouped logically on five major tabs e Plan of Care 485 1 includes most of the HCFA 485 form s general plan and patient information fields as well as all diagnosis and procedure codes dates Patient medication information the DME and supplies listing and the safety measures narratives are also included on this tab e Plan of Care 485 2 includes all remaining HCFA 485 form fields e g patient status selections diagnosis and treatment orders goals rehab narrative and physician information e Medical Update 486 1 includes all non narrative fields from the HCFA 486 form This tab also provides line item entry of all service treatment information per discipline including actual projected visits frequency duration and applicable treatment codes e Medical Update 486 2 includes all remaining HCFA 486 narrative fields e Miscellaneous includes any miscellaneous fiel
342. ted claims topic for more information on maintaining the transmission file archive Purge archived ANSI 997 acknowledgment files after NN days specifies whether archived UB92 and HCFA 1500 ANSI 997 transmission acknowledgment files are to be automatically purged by the system If automatic purging is enabled specifies the number of days the acknowledgment files are to be retained M When checked all ANSF997 transmission acknowledgment files older than the specified number of days will be automatically purged from the acknowledgment file archive When unchecked all ANSF997 transmission acknowledgment files will remain archived until manually deleted Refer to the Viewing and maintaining transmission acknowledgment files topic for more information on maintaining the acknowledgment file archive If this preference option is disabled support for ANSI 997 transmission acknowledgment files is not available on your installation Purge archived ANSI 277 acknowledgment files after NN days specifies whether archived UB92 and HCFA 1500 ANSI 277 claim status response files are to be automatically purged by the system If automatic purging is enabled specifies the number of days the response files are to be retained i When checked all ANSF277 claim status response files older than the specified number of days will be automatically purged from the response file archive When unchecked all ANSF277 claim status response files will re
343. tered This option controls the default setting for this interactive claim processing mode lM When checked claims with edit validation errors will be presented for review and or correction as soon as they are encountered in the automated claim processing run When unchecked all claims in the automated processing run will be processed without user intervention Claims with edit validation errors can be worked from the Claim List form after the automated processing run completes The user may override this default setting when initiating an automated claim processing run Use Charge Master reference file for HCFA 1500 procedure code lookups Controls the data source for procedure code lookups in the HCFA 1500 Claim Form lM When checked the optional Charges Master reference file will serve as the source for claim line procedure code lookups L When unchecked the master HCPCS Codes reference file will serve as the source for claim line procedure code lookups Interpret Enter key as save request on claim entry and other editable forms Controls the action taken when the ENTER key is pressed on the claim entry and other editable forms e g Patient Payer Provider and Submitter Information forms lM When checked pressing the ENTER key during data entry on an applicable form will invoke a save request Thus pressing the ENTER key is equivalent to clicking the Save button M When unchecked pressing the ENTER key d
344. ternate flash between their standard color and the appropriate error color I When unchecked the background of the fields with edit validation errors will be statically displayed in the appropriate error color Warn on close when deferred claims tasks are scheduled Scheduled claim import processing and transmission activities can only be initiated when PC ACE Pro32 is running M When checked the user will be warned when exiting PC ACE Pro32 if claims activities are currently scheduled The user will have the option to leave the program running if desired When unchecked no warnings will be issued when exiting PC ACE Pro32 Scheduled claims activities will not be performed while the program is down Show descriptive field hints on claim and reference file forms The UB92 Claim Form HCFA 1500 Claim Form and a number of other editable forms support hint or fly over popup windows for each field This hint provides a brief description of the data required in the associated field o e o o K ko M When checked the hint popup window will be displayed for a few seconds whenever the mouse pointer moves over a supported field When unchecked the field hints feature is disabled Present claims with errors for immediate editing during process runs During automated claim processing runs the user may choose to review and or correct claims with edit validation errors as they are encoun
345. tes organized storage of older claims without requiring that they be purged Claim archives can be maintained by transmit date line of business submission payer or other preferred criteria Claim archive databases look and act much like the current database With a few minor exceptions the same actions that can be taken on transmitted claims in the current database can also be taken on archived claims For example archived claims can be viewed and printed just like claims in the current database The payment history of archived claims can be viewed as well Access to various features of the PC ACE Pro32 claim archiving system is controlled by user permissions For example a user may be able to archive and unarchive claims but not have permission to create new claim archives If any or all of the claim archiving features described in this topic are unavailable then you either do not have the required archive permissions or your distributor does not support the claim archiving function All claim archive functions are performed from the familiar UB92 or HCFA 1500 Claim List form To archive and unarchive claims follow these general steps 1 From the PC ACE Pro32 Main Toolbar click either the UB92 Claims Processing button or HCFA 1500 Claims Processing button to display the corresponding Claims Menu form 2 Click the List Claims button onthe Claims Menu form to display the UB92 or HCFA 1500 Claim List form By default t
346. the ESC key to disable the flashing notification Helpful fly over hints are also available for many fields Saving amp Canceling Provider Updates After completing data entry on the UB92 Provider Information form click the Save button or type lt ALT gt S to save and exit the form Alternatively click the Cancel button to abandon any changes and exit the form During the provider save operation an edit validation process is performed on all provider record fields If no edit validation errors occur the provider record is saved without further user intervention If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List screen This screen lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the reference file edit validation process and the Edit Validation Errors List screen If any fatal edit errors exist you must correct them before the provider record can be saved If only non fatal edit errors exist you will have the option to correct the errors or save the provider record with errors Click the Save With Errors button to save a provider record that contains only non fatal errors If edit validation errors occur several Save attempts may be required to correct and save a clean provider record Provider Inh
347. the Save button to save the new Provider record An edit validation process will be performed to check for problems with the provider information When prompted correct any missing or invalid field values if present and re save as needed The new Provider record should now be visible in the Provider list Repeat the last few steps to add each additional Provider record Now each time you click the New button you will be prompted to select whether you want a completely new provider all fields blank to start with or whether you would like to inherit the name address information from the currently selected provider If you choose the inherit option you will also have the option to associate the new provider record with the selected provider record Provider records should be associated when they represent the same entity For example if a provider supports multiple lines of business one provider record for each LOB should be created and these related provider records should be associated with each other The inherit and associate options can be a real timesaver when setting up providers that support multiple lines of business In this scenario select an existing provider in the list click the New button and choose the inherit and associate options You will see that the top portion of the Provider Information form will be completed automatically Simply tab through or overwrite the Provider ID No field may be the same or
348. the UB92 All Payer system type Select the drive containing the BCACE directory from which you intend to migrate the UB92 All Payer claims data For example if you select the C drive then the migration utility will expect to find the files BCENTRY IDX the DOS claims entry database BCTRACK IDX the DOS claims tracking database and BCHIST IDX the DOS claims history database in the directory C BCACE For each of these expected files found in this directory the corresponding checkbox in the Select the databases to migrate radio group will be enabled Click the Migrate the selected claims databases checkbox Also click the Entry Tracking and History checkboxes those that are enabled Finally click the Migrate button to proceed The migration utility will proceed to dump the contents of your claims databases into temporary files that will then be imported into the PC ACE Pro32 claims database When the migration process has completed click the Close button to exit the PC ACE Pro32 Migration Utility Reviewing the Migrated Claims This section describes the process of reviewing the migrated claims for correctness and completeness Complete the following steps amp It is important to thoroughly review the migrated claims Pay close attention to any edit 18 validation errors that would indicate incorrect or missing Payer and or UB92 Provider reference file records Since problems with these key referen
349. the EMC file should be designated as a production or test submission The initial state of this option is determined by a Submitter reference file setting Include Error Claims specifies whether claims with non fatal errors Status ERR are to be eligible for preparation When checked all claims in the to be transmitted CL location with a status or either CLN clean or ERR contains non fatal errors will be eligible for preparation When unchecked only clean claims will be eligible for preparation The initial state of this option is determined by a Submitter reference file setting E The default settings for these control options are typically configured by your distributor We recommend overriding these option settings only under the instruction of your distributor or an authorized technical support specialist The distributor may restrict which of these prepare options you are permitted to override Specify the desired filter parameters if any and preparation options When ready click the Prepare Claims button and confirm your intention to prepare all eligible claims As the preparation operation proceeds running totals of the count and dollar value of all prepared claims will be displayed on the Claim Prepare For Transmission form You will be notified when the claim preparation operation completes amp Claim preparation requires exclusive system access When you attempt to prepare claims you will be notifi
350. the PC ACE Pro32 Main Toolbar click either the UB92 Claims Processing or HCFA 1500 Claims Processing button to open the desired Claims Menu form 3 From the Claims Menu form select the Prepare Claim Status Request File option from the form s Maintain menu This will display the Claim Status Request File Prepare form which provides the following preparation options b Claim Filter Parameters queued claims must meet all specified filter criteria to be considered for preparation e LOB specifies a single line of business LOB to be considered Only queued claims with this LOB will be eligible for preparation Select the lt lt All gt gt item to include queued claims for any line of business The Submitter reference file supports LOB specific setup information if desired Selecting a specific LOB for preparation will trigger the use of the matching LOB specific submitter information if any Refer to the Submitter File Maintenance topic for more information on this advanced feature e Payer specifies a single Payer to be considered Only queued claims for the selected payer will be eligible for preparation Select the lt lt All Payers for LOB s gt gt item to include queued claims for all payers Note This selection is only enabled when a specific LOB has been selected for preparation The Submitter reference file supports Payer specific setup information if desired Selecting a specific LOB and Payer f
351. the Payer reference file with the exception of a special dump payer Complete the following steps as needed AS You may want to refer to the Adding and maintaining payers topic for more information on entering Payer records If you do make sure and return to this topic to continue the setup steps 1 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form Select the Payer tab to display a list of all existing Payer records E One or more Payer records may already exist in the system if you have migrated to PC ACE Pro32 from the DOS version of PC ACE or if your distributor has already setup this reference file for you Consult the distributor s installation notes or contact your distributor for assistance before continuing this Payer setup procedure 2 Click the New button to display the Payer Information form Enter the new payer s information taking advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse AS Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator The Payer ID LOB and Usage fields together serve as the identification key for this Payer record A specific Payer ID LOB combination may exist for a maximum of two Payer records If tw
352. the Plan of Care Plans of Care containing unresolved edit errors may be saved if desired by clicking either the Save With Errors button visible if only non fatal errors exist or Save With Fatal button visible if any fatal errors exist Only one of these buttons will be visible at any given time If neither button is visible then fatal errors exist on one or more key Plan of Care fields These key fatal edit errors must be corrected before the Plan of Care can be saved Related Topics The following hyperlinks provide additional information related to this topic gt Refer to the UB92 amp HCFA 1500 Claims Menus topic for more information about the UB92 Claims Menu form b Refer to the Home Health Plan of Care List Form Features topic for details on using the Home Health Plan of Care List form b gt Refer to the Home Health Plan of Care Form topic for more information on using the Plan of Care entry form gt Refer to the Claim amp Reference File Edit Validation topic for more information about the edit validation process and associated forms 146 Listing modifying and maintaining Plans of Care Home Health Plans of Care in PC ACE Pro32 are listed modified and otherwise maintained from the Home Health Plan of Care List form To access the Plan of Care List form 1 Click the UB92 Claims Processing button on the PC ACE Pro32 Main Toolbar to display the UB92 Claims Menu form 2 From the UB92 Claims Menu form
353. the Reference File Maintenance form The form consists of up to 5 major tabs Patient Payer Provider UB92 Provider 1500 and Codes Misc If you are licensed for only UB92 claims processing or only HCFA 1500 claims processing then you will see only 4 tabs and the provider tab will be labeled simply Provider You may reposition and resize this form if desired The following is a brief explanation of these major tabs including the operations available on each Patient provides access to maintain general patient information as well as primary secondary and tertiary insured details Setup of the Patient reference file is optional Patient information from this reference file is available for lookup during claim entry The Patient tab provides a convenient Sort By selection that quickly sorts the Patient list by Patient PCN or Patient Name Operations available include e To add a new patient record click the New button and enter the new patient record information Refer to the Adding and maintaining patients topic for more information e To view or modify an existing patient record select the desired record from the list and click the View Update button or double click the desired record e To delete an existing patient record select the desired record from the list click the Delete button and confirm the deletion A d Payer provides access to maintain system payer information and PrintLink match
354. the type of service provided it is logical that this same procedure code would dictate which attachment is required if any for the line Using automatically triggered attachments certain procedure codes are pre defined to trigger specific attachment types Automatically triggered claim attachments fall into one of 2 categories line level attachments and claim level attachments Line level attachments are defined separately for each service line item on the claim that triggers the attachment If the procedure codes for 3 line items all trigger a certain line level attachment then the user will be required to enter a separate set of attachment data for each of the 3 lines Claim level attachments on the other hand are defined only once for the entire claim regardless of how many service line items have triggered the attachment The HCFA 1500 Claim Form supports both types of automatically triggered attachments The decisions regarding which procedure codes should automatically trigger which attachments are typically made by the distributor or whoever makes your claim submission rules PC ACE Pro32 supports an external attachment trigger control file to provide flexibility in this area On program startup PC ACE Pro32 reads the trigger control file and uses this information to present the appropriate attachment at the appropriate time o d Manually Triggered Attachments To provide maximum flexibility PC ACE Pro32 also allows t
355. thods If you do make sure and return to this topic to continue the setup steps Review only the setup considerations applicable to the claim import method you intend to use K Print Image PrintLink imports claims from a print image file If using this claim import method complete the following steps 1 Have your distributor perform a one time PrintLink mapping procedure on a sample print image file that you have supplied This mapping process defines the template used to extract and interpret fields from your print image file Since all upstream systems print claims in a slightly different format this mapping process is required to build your custom template 33 Obtain the resulting map file from your distributor This file is typically named ub92 map but can be any valid filename with a map extension The map file must be placed in the server s winpcace impub92 directory Confirm the existence of the required map control file This file provides a control interface between the output of the PrintLink translator and the PC ACE Pro32 claim import routines The map control file is always named mapcentlu win and should be located in the server s winpcace impub92 directory Setup all required PrintLink Matching Description strings in the Payer reference file These strings are used to match payer descriptions from claims in the print file to specific Payer reference file records Refer to the Adding and maintain
356. ting claims on pre printed fOrMS osei a ae E aaa N a Aee EE 133 printing claims ON Stock PAPEL i coriiunsdiniierine diei cece ea eeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaeeeeeeeaeeeeeeeeees 133 Printing Home Health Plans of Care cccceeeecsseeeeeeaneeeeeeaeeeeeeeaaeeeeeeaaeeeeeeaaeeeeeeaaeeeeeaaeneees 148 Printing PreterenCOs s szee es caueeed pivataess dann E en Svan nchedtavests taaaeckudeeh eng puss eddpduavensstannecdetaenscee 98 PrintLink claim import Method 2 cccceec cece ceeeee ee eeeeeeeeaeeeeeeeeesaeeeeaeeeeeeeeesaeeeseeeesaees 110 111 PrintLink matching STINGS ics ciuedtee are indice log AE E AEA AAR EAE 157 158 Processing claims automatically zeroa ietan E ea EA AET AEE EEE n EAT 114 provider inheritance and association HCFA 1500 00 cceeeeceeeeeeeeeeeeeeeeeeeeeeeeeaeeeeeeaaeeeeeneees 163 provider inheritance and association UBQ2 ccececeeeeeeeeeeeeeee eee eeeeeeeeeeeeeeaaeeeeeeaaeeeeenaees 160 provider Setup ANd MAINTENANCE cece ee eeeeeeee ee eeeeeeceeeeeeeeeeeeeeeaeaeeeeeaaaeeeeeaaeeeeeeaaeeees 160 163 setting up HCFA 1500 providers 2 0 0 cece ceceeeeeee ee eeeeee cette eeeeeeeeeeseeeeeeeaaeeeeeeaaaeeeeeaaeeeeesaaaeees 163 setting up UB92 providers 220 5 eis dete ce te nen ele iene ete lent ae 160 211 Provider Specialty File Maintenance cccccseeeeeeaneeeeeeaeeeeeeeaaeeeeeaaeeeeeeaaeeeeeeaaeeeeesaaaneees 189 Provider Taxonomy Codes File Maintenance c
357. tion and restore facilities to protect your valuable system data All claims reference files and system configuration settings can be backed up to either removable media diskettes writeable CDROM or a standard Windows directory local or remote In the event a catastrophic system failure results in the loss or compromise of PC ACE Pro32 database files a complete database restore operation can be performed from the most recent backup E These backup facilities are designed to protect just the PC ACE Pro32 databases and configuration information The program executable fles and other support files are not included in the backup archive It is strongly recommended that you supplement these backups with a comprehensive backup schedule for your server and client systems In the event a full restore is required you would first restore from a full system backup to rebuild the system s directory hierarchy and restore all program and support files The most recent PC ACE Pro32 backup could then be restored to recover your databases and configuration settings You will be prompted to perform a backup each time you exit the PC ACE Pro32 program unless your distributor has disabled this prompt feature You may also perform a backup from the Backup Restore tab of the System Utilities form This form can be accessed by clicking the System Utilities button from the P C ACE Pro32 Main Toolbar The following sections describe the backup validate and rest
358. to associate the new provider record with the selected provider record Provider records should be associated when they represent the same entity For example if a provider supports multiple lines of business one provider record for each LOB should be created and these related provider records should be associated with each other The inherit and associate options can be a real timesaver when setting up providers that support multiple lines of business In this scenario select an existing provider in the list click the New button and choose the inherit and associate options You will see that the top portion of the Provider Information form will be completed automatically Simply tab through or overwrite the Provider ID No field may be the same or different enter a unique line of business identifier in the LOB field and click the Save button When you have finished adding UB92 Provider records you should have one record for each applicable line of business LOB for each provi der entity This could be as few as one record if you are billing Medicare claims for a single provider When all desired Provider records have been added click the Close button on the Reference File Maintenance form to return to the PC ACE Pro32 Main Toolbar Select the Exit item from the main File menu to exit PC ACE Pro32 Cancel the system backup request when prompted Claims Migration This section describes the steps required to mi
359. to ready PC ACE Pro32 for UB92 All Payer claims processing 42 Setup of HCFA 1500 Systems This section describes the setup procedures required to prepare your PC ACE Pro32 system for HCFA 1500 All Payer claims processing Topics to be covered include setting up the Payer Provider and Patient optional reference files A section on claim import considerations is included for users who will be importing claims from an upstream claims management system Finally a section covering considerations for claims preparation and transmission should be reviewed E Your distributor may have already completed some of the setup steps described in this section Supplement this setup topic with any installation notes provided by your distributor If you are in doubt about exactly which steps you need to perform contact your distributor for assistance hS You may want to print this help topic and refer to the printed version as you perform these setup steps You can check off the steps as they are completed This technique also frees you to jump around between on line help topics without losing your place in the setup procedure To print the topic just click the Print button at the top of this on line Help screen Payer Reference File Setup This section describes the process of setting up the Payer reference file This file contains information about the valid payers in your system All payers to be specified on your HCFA 1500 claims must exist in
360. top and left margins in 1 100 inch increments as well as the character font point size A lt Print with Payer Description Payer Source Code Payer ID specifies whether to include the Payer Source Code and or Payer ID values when printing the Payer Description The selected values are printed to the left of the Payer Description M When checked the Payer Source Code or Payer ID will be printed to the left of the Payer Description When unchecked the Payer Source Code or Payer ID will not be printed with the Payer Description Print decimal point on all dollar amount fields specifies whether to print the decimal point on all currency fields When printing forms it is often desirable to omit the decimal point i When checked the decimal point will be printed on all currency fields When unchecked the decimal point will not be printed on currency fields Print the signature block date by default UB92 only specifies whether the UB92 claim form signature block date is to be printed automatically by default This default setting can be overridden when a claim is printed lM When checked the current system date will be printed automatically by default in the claim form signature block An alternate date or no date at all may be specified instead when a claim is printed I When unchecked the claim form signature block date will be left blank by default Override the provider signature block date by default
361. transmission EMC file reactivation is performed from the Claim Transmission Log form 1 From the PC ACE Pro32 Main Toolbar click either the UB92 Claims Processing or HCFA 1500 Claims Processing button to display the appropriate Claims Menu form 2 Select the Transmission Log item from the Claims Menu form s main Maintain menu This action will display the Claim Transmission Log form which lists details for all archived EMC files in chronological order You may resize the form to see any additional list columns if desired 3 Select the row describing the EMC file to be reactivated Click the View Details and or View Errors buttons to preview the original prepare reports if desired 4 Click the Reactivate button and confirm the reactivation operation when prompted You will be notified when the reactivation operation has successfully completed The EMC file is now ready for retransmission Click the Close button to close the form Archived EMC files and associated reports may be manually deleted from the EMC file archive by selecting the row describing the file to be deleted and clicking the Delete button Confirm the deletion when prompted 126 Preparing claim status request files for transmission Claim status request file preparation in PC ACE Pro32 refers to the act of generating an ANSI 276 4010 claim status request file suitable for transmission to your claims processor This file will contain al
362. tributor s installation notes or contact your distributor for assistance before continuing this Payer setup procedure 2 Click the New button to display the Payer Information form Enter the new payer s information taking advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse hS Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator The Payer ID LOB and Usage fields together serve as the identification key for this Payer record A specific Payer ID LOB combination may exist for a maximum of two Payer records If two such Payer records are defined then their Usage settings must not overlap Valid Usage settings include U UB92 use only H HCFA 1500 use 29 only and B or blank unrestricted use The only valid situation where two Payer records with the same Payer ID LOB combination may exist is when one of the records specifies a Usage value of U UB92 use only and the other record specifies a Usage value of H HCFA 1500 use only This feature permits Payers for shared LOBs such as Commercial COM to optionally have distinct settings and PrintLink matching strings for UB92 versus HCFA 1500 use An individual Payer record must be setup for each line of business LOB handled by that payer For examp
363. ts To perform an action on an individual medical attachment simply select the medical attachment from the list and click the desired action button along the lower edge of the form The complete list of medical attachment actions can be accessed from the UB92 Medical Attachment List form s main Actions menu or from the convenient pop up menu accessed by right clicking the mouse over the selected medical attachment Available medical attachment actions include e Creating New Medical Attachments Click the New button or choose the Create New Attachment action to create a new medical attachment You will be prompted to select the desired medical attachment type See the Adding a new UB92 Medical Attachment topic for more details 77 e Viewing Modifying Medical Attachments Click the View Update button or choose the View Update Selected Attachment action to view and or modify the selected medical attachment See the UB92 Medical Attachment Forms topic for details on using the PC ACE Pro32 UB92 Medical Attachment entry forms AS The View Update action is the default medical attachment action In addition to the techniques described above this action can also be invoked by double clicking on the desired medical attachment record or by selecting the desired record and pressing the ENTER key X Holding down the SHIFT key while invoking the View Update action on an eligible medical attachment will force an automatic sav
364. uch groups include Other Diagnosis Functional Limitations and Mental Status codes Fields in these groups are always completed sequentially Therefore when a field in one of these groups is left empty it can be assumed that data entry in the group is complete When the TAB key is pressed the remaining fields in that group will be skipped and the cursor will be positioned on the first field in the tab sequence beyond the group fields Cancel Field Changes If a change is inadvertently made to the contents of a field press the ESC key to cancel this change and restore the field s value to what it was when the field received the focus This feature is available for most Plan of Care form fields Date Completion Date values may be entered with or without the century for convenience PC ACE Pro32 uses a user definable century pivot year to automatically derive the century when omitted To insure accuracy birthdate fields require that a full 4 digit year be entered Descriptive Field Hints Most Plan of Care form fields have field hints that provide a brief description of the field s purpose These hints are often called fly over hints since they become visible when the mouse pointer moves over the specified field without actually selecting the field This feature can be disabled in the general preferences settings if desired Line Item Scrolling A variable number of Service Treatment lines on the Medical Update 486 1 tab an
365. uring data entry on an applicable form will simply tab to the next field in the form s tab sequence Automatically display Edit Validation Error List when saving a claim that contains errors Determines whether the Edit Validation Errors List form is displayed automatically when a claim containing edit validation errors is saved This setting controls the display of this errors list when a claim is saved manually e g clicking the Save button on the UB92 Claim Form or HCFA 1500 Claim Form or when an implied save operation is performed during an interactive claim processing run i When checked the Edit Validation Errors List will be displayed automatically during a claim save operation if the claim contains edit validation errors The user may jump directly to the offending field for any listed edit validation error When unchecked the Edit Validation Errors List will not be displayed automatically If the claim contains one or more edit validation errors focus will be directed to the field representing the first listed error The user may view the Edit Validation Errors List form if desired by clicking the Error List button on the claim entry form Automatically prompt for selection of non unique Payer Provider and Physician IDs Determines whether or not a variable list lookup operation will be initiated automatically when the user enters a non unique Payer ID Provider ID or Physician UPIN while hand keying data into cla
366. using the HCFA 1500 Roster Billing form gt Refer to the Claim amp Reference File Edit Validation topic for more information about the edit validation process and associated forms b gt Refer to the on line help Common Claim Activities folder for hyperlinks to other claim related topics of interest 145 Adding a new Home Health Plan of Care New Home Health Plans of Care can be added to PC ACE Pro32 using either of these techniques Select the Attachments and New HH Plan of Care menu items on the UB92 Claims Menu form K ee Click the New button on the Home Health Plan of Care List form This form can be accessed by selecting the Attachments and Maintain HH Plans of Care menu items on the UB92 Claims Menu form or by clicking the Plan of Care button on the Patient tab of the Reference File Maintenance form When creating the new Plan of Care from the patient listing the Patient Control Number PCN and pertinent patient information for the currently selected patient will be completed automatically Plans of Care are entered on the Home Health Plan of Care Form The data fields are typically entered in the order presented from left to right and top to bottom on each tab of the Plan of Care form Edit validation errors may be encountered during this entry process if the data entered violates any of the predefined Plan of Care edits Correct any such edit errors and click the Save button to save
367. vider record An edit validation process will be performed to check for problems with the provider information When prompted correct any missing or invalid field values if present and re save as needed The new Provider record should now be visible in the Provider list Repeat the last few steps to add each additional UB92 Provider record Now each time you click the New button you will be prompted to select whether you want a completely new provider all fields blank to start with or whether you would like to inherit the name address information from the currently selected provider If you choose the inherit option you will also have the option to associate the new provider record with the selected provider record Provider records should be associated when they represent the same entity For example if a provider supports multiple lines of business one provider record for each LOB should be created and these related provider records should be associated with each other The inherit and associate options can be a real timesaver when setting up providers that support multiple lines of business In this scenario select an existing provider in the list click the New button and choose the inherit and associate options You will see that the top portion of the Provider Information form will be completed automatically Simply tab through or overwrite the Provider ID No field may be the same or different enter a unique line
368. y click the Migrate button to proceed You will be prompted to choose whether to replace the existing Payer and Patient reference file contents with the migrated data or to merge the migrated data with the Payer Patient reference file data already in PC ACE Pro32 The Patient and Payer reference files in PC ACE Pro32 are shared between UB92 and HCFA 1500 claims processing activities See the Migrating Dual Systems UB92 and HCFA 1500 topic for more information on migrating dual use systems 15 You should choose the Replace existing data options unless your system is already in use for HCFA 1500 claims processing The migration utility will proceed to dump the contents of your payer and patient databases into temporary files that will then be imported into the PC ACE Pro32 Payer and Patient reference files respectively All PrintLink matching strings defined in the DOS UB92 All Payer system will also be migrated and automatically assigned to the appropriate payer record The migration utility will also copy all PrintLink MAP files and the ANSF835 ETRA Intermediary and Provider configuration files from the DOS UB92 All Payer system to their corresponding directories in PC ACE Pro32 6 When the migration process has completed click the Close button to exit the PC ACE Pro32 Migration Utility Reviewing the Migrated Patient and Payer Data This section describes the process of reviewing the migrated Patient and Payer refer
369. y pressing the F2 key or right clicking the mouse 37 AS Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator Enter the provider s name and address information Enter the Provider ID in the Provider ID No field and the line of business in the LOB field The Payer ID field is only needed if you want to restrict assignment of this provider to a specific payer Normally the Payer ID field will be left blank You can also leave the Tag field blank Complete entry of the remaining provider fields as desired Click the Save button to save the new Provider record An edit validation process will be performed to check for problems with the provider information When prompted correct any missing or invalid field values if present and re save as needed The new Provider record should now be visible in the Provider list Repeat the last few steps to add each additional Provider record Now each time you click the New button you will be prompted to select whether you want a completely new provider all fields blank to start with or whether you would like to inherit the name address information from the currently selected provider If you choose the inherit option you will also have the option to associate the new provider record with the selected provider record Provider recor
370. y those edits that require multiple data elements from the roster billing in order to be evaluated If no edit validation errors occur the roster billing is saved with a clean CLN status If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List form This form lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the edit validation process and the Edit Validation Errors List form If edit errors exist you will usually have the option to correct the errors or save the roster billing with errors If a fatal error exists on the Payer ID Provider ID No Service Date or Type field however you must correct the error before saving the roster billing Click the Save With Errors button to save a roster billing that contains only non fatal errors Such roster billings are assigned the has errors ERR status Click the Save With Fatal button to save a roster billing that contains fatal errors Such roster billings are assigned the has fatal errors ERF status Claims cannot be generated from a roster billing with an ERF status If edit validation errors occur several Save attempts may 70 be required to correct and save a clean roster billing At any time click the Errors List button to review the remaining edi
371. y File Maintenance The Facility Setup form provides an interface to maintain the optional Facility reference file The Facility file applies exclusively to HCFA 1500 claims The user may enter Facility records for each frequently referenced facility if desired The Facility reference file is available as a lookup list from the Extended Patient General tab on the HCFA 1500 Claim Form Maintenance operations available include e To add a Facility click the New button and enter the new facility information e To view or modify an existing Facility record select the desired record click the View Update button or double click the desired record e To delete a Facility record select the desired record click the Delete button and confirm the deletion bS A convenient Sort By feature quickly sorts the Facility list by Facility Name or Facility ID 187 Charges Master File Maintenance The Charges Master form provides an interface to maintain the Charges Master reference file Charges Master codes apply exclusively to HCFA 1500 claims If you choose to use this optional reference file it should be setup to include only those procedure codes that are to be used by the billing office rather than the entire HCPCS code universe Using a Charges Master file will reduce the size of the HCPCS code lookup lists during claim entry thus promoting accuracy and enhancing productivity In addition a dollar amount may be assigned to each
372. y type requires some specific configuration e Claim Import Scheduling To schedule an unattended claim import operation click the desired UB92 or HCFA 1500 Claim Import tab select either the one time or daily scheduling option and enter the desired Start Time Specify the following import specific scheduling options Import claims only instructs the scheduler to perform the claim import operation only See the Import and process claims option description below for an alternate approach K9 Import and process claims instructs the scheduler to perform the claim import operation followed immediately by a claim processing operation on all unprocessed claims in the system This option provides a smooth transition from the claim import operation to the claim processing operation and relieves the user from the need to schedule the claim processing run separately Selecting the Import and process claims option will disable the 3 scheduling options on the Claim Process tab since claim processing is now chained to the claim import operation Import Map Print File Selection select check one or more PrintLink map files to be imported at the scheduled time Each valid PrintLink map file present in the pe defined claim import directory will be represented in this selection list 194 This selection list will be visible only if PC ACE Pro32 is configured to use the standard PrintLink claim import method R
373. you are licensed for HCFA 1500 claim activities only then this tab will be labeled simply Provider Setup of the HCFA 1500 Provider reference file is mandatory if you intend to process HCFA 1500 claims All providers referenced on HCFA 1500 claims must be represented in this reference file The Provider tab provides a convenient Sort By selection that quickly sorts the Provider list by LOB Type Provider Group Name Provider ID Group Label or Tag Operations available include e To add a new provider record click the New button and enter the new provider s information If providers already exist in this reference file you will have the option to create a completely new provider record or to inherit and associate the new provider record with the provider record currently selected in the list Select the desired creation options and click the OK button to continue See the discussion below for more information on provider inheritance and association e To view or modify an existing provider record select the desired record from the list and click the View Update button or double click the desired record e To delete an existing provider record select the desired record from the list click the Delete button and confirm the deletion E Claims are linked to provider records by an internal control number Deleting a provider record will irrevocably break any such links that may exist to claims in the system The Pr

PC-ACE Pro32 User`s Manual - Empire Blue Cross Blue Shield

Contents

Download Pdf Manuals

Related Search

Related Contents