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User Manual For Professional Providers

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1. Click on the guestion mark to pull up a help window Tip This page provides a user with the ability to key in other insurance information per line item Professional eClaims User Manual Rev March 2007 Page 16 ot 29 Primary Payer Payment Information Line Level at BlueCross BlueShield About Us Contact Us Careers Help VAY of Alabama ae Search Home gt Providers gt ProviderAccess gt eClaims You are signed in as 510234 Primary Payer Payment Information Line Level gt ProviderAccess Menu gt Claims Administration Contract XAA1 234567389 Date of Birth 01 28 1972 Patient Name JANE DOE Required fields are denoted by an asterisk C Payer ok Line 2 Insurance ok Claim Info ok a Facility Type rocedures Services or Supplies F eae eee lam Line Info ok From To mmddyy Code POS S iagnosis Code Pointens dicstor arges n Mi Primary Payer MR crrteres Modifies Line 1 ok 10312006 11 1 75 00 1 10312006 Enter the payment information for LINE 2 from the Primary payer Primary Payer Name ABC INSURANCE Primary Payer Contract Number ABC123456789 Line Level Adjustments Line 2 Payment Details Num Group Reason Amount allowed Amount 75 00 1 PR gt 3 gt 75 00 Paid Amount 150 00 lt z z Payment Date fi1012006 3 we H gt Ee Eke m ma D m o m m
2. fos2o0s TEE fos2o08 Nex gt You may key up to 10 lines items on this screen After completion click the Next button If there are no errors the claim will be accepted and you will be forwarded to the Claims Administration screen If you have more than 10 line items you must add a new claim to enter the additional line items Professional eClaims User Manual Rev March 2007 Page 14 of 29 Line Level Information Click here if you do not have line level payment information ER BlueCross BlueShield Abougpls Contact Us Careers Help a XY onan 7 Home gt Providers gt ProviderAccess gt eClaims You are signed in as 510136 Primary Payer Payment Information Line Level b ProviderAccess Menu gt Claims Administration Contract XAA1 23456789 Date of Birth 01 28 1972 Mitient Name JANE DOE Required fields are denoted by an asterisk Click here ifyou do not have line level payment information Payer ok Insurance ok ine 1 Claim Info ok Procedures Services or Supplies Dates of Service Facility Type ig mergency z N R E Line Info ok From To mmddyy Code POS KM nese eee Reina n nn Primary Payer CPT HCPCS Modifiers Line amp 1 inc 10312006 14 2 No 100 00 1 o 10312006 Daysor Anesth Charges units Minutes Enter the payment info
3. G mam mn mn mm a gt CE Each line item is pre populated in the top portion of this page This option makes it easy for the user to key secondary information on this claim Professional eClaims User Manual Rev March 2007 Page 17 of 29 Submit your completed claim Claims Administration at BlueCross BlueShield About Us Contact Us Careers Help VAY of Alabama E Search Home gt Providers gt ProviderAccess gt eClaims You are signed in as 51012346 Claims Administration New Claim Submit All Pending Claims Incomplete and Pending Claims Date Created Claim Type Contract Number ee Patient Name Claim Amount mmm 10 59 00 professional 400123456789 12345678 DOE JANE 17500 Pending Edit Submit Delete m 10 28 33 Professional 00123456789 12345678 DOE JANE 17500 Pending Edit Submit Delete Submitted and Processed Claims Select all submitted claims or processed claims by date Submitted Claims gt Go Date Crested Claim Type Contract Number Patient Account Patient Name Claim amount Status Action Number 10 25 2006 02 08 39 Professional HAA123456789 Accomt Number DOE JOHN 30 00 Submitted Mew 1019 2006 09 91 12 Professional PPA123456789 Accout Number DOE JANE 200 00 Submitted view Tip The Claims Administration screen shows all claims that are in a pending status and all claims that have been
4. PC while accessing ProviderAccess 4 To select a field using a mouse e Movethe mouse pointer to the information to be selected e Depress or click the left mouse button once e The item is selected if the information you choose is highlighted by color shading 5 To select a field without using a mouse e Use the Tab key to move the cursor to the item you would like to select e The item is selected if the information you choose is highlighted by color shading 6 To select a button choose one of the following e Move the mouse pointer to the button and depress the left mouse button once or e Press the Tab key until the dotted line appears around the word and then press the Enter button Professional eClaims User Manual Rev March 2007 Page 2 of 29 Easy Steps to ProviderAccess www bcbsal com Click on Tam a Provider on the Blue Cross and Blue Shield of Alabama home page BlueCross BlueShield About Us Careers Contact Us Help WAY g of Alabama Q SEARCH SEARCH CustomerAccess Plans amp Services Health amp Wellness Pharmacy Find a Doctor repiny CustomerAccess Even You Learn more about Blue Cross Forgot your ID SPECIAL OPEN ENROLLMENT Hurry limited time only Register for qa New Fraudulent E Mail Alert CustomerAccess to use these secure services Looking for Insurance View claims status gt ieee s x Hi ele Check benefits summary i Order new
5. Submitted Claims gt Go 10 25 2006 02 09 39 Professional XAA123456789 Account Number DOE JOHN 50 00 Submitted View 1013 2006 09 91 12 Professional PPA123456789 Account Number DOE JANE 200 00 Submitted View Tip The Claims Administration screen shows all claims that are in a pending status and all claims that have been submitted or processed The claim that you just entered should now appear in the Incomplete and Pending Claims list along with the total claim amount You may now choose to edit submit or delete the claim After the batch is received by Blue Cross and Blue Shield of Alabama the claim will appear in the Submitted and Processed Claims list Note Claims located in the Incomplete and Pending Claims list have not yet been received by Blue Cross and Blue Shield of Alabama for processing Professional eClaims User Manual Rev March 2007 Page 24 of 29 Tip Please Audit Report Retrieval An audit report is generated by Blue Cross that confirms the receipt of your electronic claims This report specifies whether the submitted claims were accepted for processing or rejected due to an error Normally if we receive your claims before approximately 3 30 p m an audit report will be available the following business day If we receive your claims after approximately 3 30 p m your audit report should be available after two business days From the ProviderAccess
6. page use your mouse to click on the Audit Report link a BlueCross BlueShield About Us Contact Us Careers Help UA labar i o verdana MA Home gt Providers gt ProviderAccess You are signed in as 51017545 ProviderAccess Menu k ProviderAccess User Manuals k Provider Publications Please select the e Practice Management application you would like to perform from the list below To perform additional transactions please return to this page to select your next function Patient Information see page 3 to Eligibility and Benefits access this page r Summary Plan Description Wi Patient Medical Information Claim Information t Claim Entry WvebClaims b Audit Reports E r Audit Reports Error Descriptions r Claim Status Payment Information r Professional Online Remittance Report r Professional Refund Balance Actrity Report r Professional Claim Refiling Information Report r Payment History r Refund Billing Invoices Fee Schedules r DME Fee Schedule Fee Schedule Indnmdual Code Pei A L ee eed eee Fe ted AD IMPORTANT NOTE Audit Reports are now available electronically for 60 business days An Audit Report should be retrieved for every date of claims submission Professional eClaims User Manual Rev March 2007 Page 25 of 29 To view Audit Reports enter your Submitter ID Click Submit to continue ma BlueCross BlueShield About Us Contact Us Careers Help BEY of A
7. the Next key If the information is not correct select the ProviderAccess link and re key your information If the information is still incorrect contact your EDI Services Representative for assistance Professional eClaims User Manual Rev March 2007 Page 12 of 29 Claim Information pa BlueCross BlueShield About Us Contact Us Careers Help VAY of Alabama Saas Home gt Providers gt ProviderAccess gt eClaims You are signed in as 510234 Claim Information gt ProviderAccess Menu gt Claims Administration Contract XAA1 23456789 Date of Birth 01 28 1975 Patient Name JANE DOE Payer ok SS Insurance ok Is Patient s condition employment related Date of current Illness Injury or Pregnancy Claim Info inc If Patient has had same or similar illness give first date Dates Patient unable to work in current occupation Last Name of Referring Physician or Other From Source To HE UPIN of Referring Physician Hospitalization dates related to current services Prior authorization number From To Accept Assignment Yes gt Corrected Claim Original Claim Number Next Review this screen and answer any questions that are valid for this claim Once complete click the Next button to save your information and to advance to the next step Professional eClaims User Manual Rev March 2007 Page 13 of 29 Line Item Infor
8. 10 28 59 10 28 53 Professional 40123456789 12345678 DOE JANE 17500 Pending Edit Submit Delete Submitted and Processed Claims Select all submitted claims or processed claims by date Submitted Claims gt Go Professional PPA123456789 Account Number DOE JANE 200 00 eClaims allows a user to select a date to view submitted or processed claim files Professional eClaims User Manual Rev March 2007 Page 19 of 29 Required fields are Verify that all information is correct denoted by an asterisk Member Information st BlueCross BlueShield About Us Contact Us Careers Help US of Alabama E Search Home gt Providers gt ProviderAccess gt eClaims You are signed in as 5101346 Member Information gt ProviderAccess Menu gt Claims Administration Required fields are denoted by an asterisk C Contract Number kaa123456789 gt First Name ae Middle Initial o Last Name Doe Date of Birth 01281972 Gender Female gt Choose the correct Last date of service for this claim 10312006 Claim Type Professional Anesthesia Home Health claim type aie This claim is being submitted as Primary Secondary Next Choose the type of claim that is submitted Primary or Secondary Payer Information Verify that all information is correct Select the Patient Relationship to Insured field and choose the o
9. 56789 Patient Relationship to Insured Professional eClaims User Manual Rev March 2007 Page 11 of 29 INSURED PATIENT INFORMATION ie BlueCross BlueShield About Us Contact Us Careers Help si NY oadama MA iome gt Providers gt ProviderAccess gt eClaims You are signed in as 5102346 nsured Patient Information gt ProviderAccess Menu gt Claims Administration Contract AA1 23456789 Date of Birth 01 28 1975 Patient Name Required fields are denoted by an asterisk C insured Information Name Last Doe First Jane Middle Address Street fi 23 Park Place City Anywhere State ALABAMA gt Zip 35004 Other Date of Birth o 251972 Gender Female Patient Information Name Last Doe First Jane Middle Address Street fi 23 Park Place City Anywhere State ALABAMA gt Zip 35004 Other Date of Birth o 251972 Gender Female gt Patient s Account Number Release of Information Code Do you have on file a signed statement by the patient authorizing the release of medical billing information for this Yes claim Yes Next Tip Don t forget to add your Patient Account Number Verify the Insured Patient Information on this page to make sure all questions are answered and pre populate fields are accurate If the information is correct press
10. BlueCross BlueShield About Us Contact Us Careers Help m mm p Home gt Providers gt ProviderAccess You are signed in as 5102346 ProviderAccess Menu gt ProviderAccess User Manuals b Provider Publications Please select the e Practice Management application you would like to perform from the list below To perform additional transactions please return to this page to select your next function Patient Information gt Eligibility and Benefits gt Summary Plan Description gt B Patient Medical Information Claim Information gt Claim Entry eChims Eo gt Audit Reports gt Audit Reports Error Descriptions gt Claim Status Payment Information gt Professional Online Remittance Report gt Professional Refund Balance Activity Report gt Professional Claim Refiling Information Report gt Payment History gt Refund Billing Invoices Fee Schedules gt DME Fee Schedule gt Fee Schedule Individual Code gt Blue Advantage Fee Schedule Guidelines and Policies gt Blue Advantage Medical Policies gt Disease Management gt Fragmented Coding Edits gt Medical Policies gt CURP Manual Primary Care Network PCN gt PCN Cost Profile gt Review Referral t Submit Referral Professional eClaims User Manual Rev March 2007 Page 4 of 29 Provider Submitter Identification Please contact our web desk at 205 220 6899 if a Submitter Verify the Plan Code and the Provider Number is corr
11. Click submit to view this report on this screen You will also have the ability to print this report Tr BlueCross BlueShield About Us Contact Us Careers Help UAY of Alabama Search earch Home gt Providers gt Provider Access gt Audit Reports Select Date b ProwidernSccess Whenu FP Select Diferent Provider This application allows you to view your Audit Report for specific dates Choose a Date and then click Submit Submitter ID WEB ZASE Prowder Number ALL Date Movember 3 2006 rs Audit Report Format POF HTML p To view the Audit Report as a Portable Document Format PDF file you will need Adobe Acrobat Reader free software that lets you Click on view and print POF files lf you do not already have this software installed on your computer you may install it by selecting the Adobe Get ce Get Acrobat Reader box below Acrobat m 29 Reader To view the Audit Report as HTML no additional software is required Hote that when printing your audit reports the PDF format should be utilized Printing in HTML format is not recommended About Us Career Contact Us Fraud amp Abuse HIPAA Privacy Notice Privacy Statement Legal Disclaimer This site and all contents are Copyright 2006 Blue Cross and Blue Shield of Alabama an Independent Licensee of the Blue Cros and Blue Shield Association Audit Reports are available for retrieval 60 days after the submission of a cla
12. ES W P 07 15 03 07 15 03 106 00 CLAIM NBR 5611970085 35353785 CONT MED REC PAT CNTL PATIENT NAME FROM DOS THRU DOS CLAIM CHARGES XAA416545352 RAY L D 07 15 03 07 15 03 106 00 CLAIM NBR 5611970083 35353715 K Done internet se arrows to view the next page Rejected claim immediately follows the Accepted Claims totals This section contains a list of all claims that were rejected Each of these claims will have an associated error number and message explaining why it was rejected Note Remember that errored claims have not been accepted by Blue Cross and Blue Shield of Alabama and we keep no further record of them these claims should be corrected and resubmitted as new claims Professional eClaims User Manual Rev March 2007 Page 29 of 29
13. ID cards Order forms and materials Research health and wellness topics BE HEALTHY WEB SITE Get a variety of health information on Blue Cross Health Care Provider or health web site Facility Go to BeHealthy com Find a hospital doctor dentist or other medical professional Pharmacy Find a pharmacy near you I am an Employer Resources for employers to maintain their group s benefits I am a Provider Resources for those who provide health care for patients Enter your Provider Clinic ID and Password then click Sign In aD BlueCross BlueShield About Us Contact Us Careers Help e ME Home gt Providers gt ProviderAccess Provider Sign In provideracce your secure link to Blue Cross Provider Clinic ID Bi 012345 Welcome to ProviderAccess your secure sign in for all Blue Cross and Blue Shield of Alabama e Practice Management and InfoSolutions transactions Use this single secure sign in page for access to Claim Payment Information and Patient Account Information Primary Care Physicians will also use Password this sign in for access to Primary Care Network transactions gt Be sure to check the ProviderAccess User Manuals if you have any questions Sign nj Register for online access Forget your password Professional eClaims User Manual Rev March 2007 Page 3 of 29 Click on the words Claims Entry eClaims N
14. Number e Patient Name Claim Amourt 1115 2006 02 25 15 Professional 20123456789 12345678 DOE JANE Pending Edit Submit Delete Delete 1115 2006 01 36 44 Professional 40123456789 12345678 DOE JANE 175 00 Pending Edit Submit Delete Submitted and Processed Claims Select all submitted claims or processed claims by date Submitted Claims gt Go Date Crested Claim Type Contract Number ee Patient Name Claim Amount 10 25 2008 02 03 33 02 09 33 Professional KARL25456789 50 00 Submitted Me Me 10 19 2006 09 31 12 Professional PPAL 15454 769 Account Number DOF JOHN 200 00 Submitted View Tip The Claims Administration screen shows all claims that are in a pending status and all claims that have been submitted or processed The claim that you just entered should now appear in the Incomplete and Pending Claims list along with the total claim amount You may now choose to edit submit or delete the claim After the batch is received by Blue Cross and Blue Shield of Alabama the claim will appear in the Submitted and Processed Claims list Note Claims located in the Incomplete and Pending Claims list have not yet been received by Blue Cross and Blue Shield of Alabama for processing Professional eClaims User Manual Rev March 2007 Page 10 of 29 Secondary Claims Member Information Required fields are denoted by an asterisk Choose
15. ProviderAccess www bcbsal com User Manual For Professional Providers eClaims And Audit Report Retrieval BlueCross BlueShield of Alabama Professional eClaims User Manual Rev March 2007 Page of 29 CONTACT NAMES AND NUMBERS l For connectivity or communication problems call or e mail the Corporate Support Center at 205 220 6134 6 00 a m 5 30 p m SupportCenter bcbsal org 2 For other questions or problems e System Status is available as a streamer on the website www bcbsal com e Contact your Electronic Data Interchange EDI Services Representative at 205 220 6899 HARDWARE REQUIREMENTS Minimum Browser Requirements Netscape or Internet Explorer 4 0 or higher Minimum Hardware Requirements for best results Screen Resolution 640 x 480 Internet connection with at least 28 800 bps HELPFUL HINTS l If you leave the PC for a long period of time the application will time out You will need to close and restart your browser or if you have previously bookmarked your ProviderAccess sign in page you may use your Favorites or Bookmark to access the Sign In page directly If you were keying a claim any information not previously saved will be lost 2 Use the tab key not the Enter key when navigating through a screen however don t forget to select the Next button to save your data prior to leaving the screen 3 Do not use the back button on your
16. an JANE DOE 4 e 2 73393 3 3349 7 7 7 0 10312006 hil jossa hil No ion fi Delete TED OOO OC 10312006 hzl 39212 el No gt Ea Delete f0312006 TL IL I nin e L No E m e COO K L z l No gt HER Delete HW KE L e E gt L L Now Belete E KE EE EE me nm Noel Delete H KE KE EE L C Ek rf eal fel 7 LL nim ae Z Hil No gt O Delete CEO i zi L Nos _ Delete E KE KE EE L E gt nm Now Delete H KE KE EE L Next Professional eClaims User Manual Rev March 2007 Page 23 of 29 Submit your claim Claims Administration VAY of Alabama MER E Home gt Providers gt ProviderAccess gt eClaims You are signed in as 510234 Claims Administration New Claim Submit All Pending Claims pincomplete and Pending Claims Date Crested Claim Type Contract Number ee Patient Name Claim Amour 12 26 28 Professional XAA123456789 123456789 DOE JANE 175 00 Pending Edit Submit Delete 11 20 2008 10 59 00 professional 23456789 12345878 DOE JANE 175 00 Pending Edit Submit Delete m Submitted and Processed Claims Select all submitted claims or processed claims by date
17. ate of Birth 01 25 1972 You are signed in as 510234 gt ProviderAccess Menu gt Claims Administration Patient Name Payer inc Primary Payer BCBS gt Payer Name BCBS of Alabama Patient Relationship to Insured Member ID f HICN KAAT 23456789 Professional eClaims User Manual Rev March 2007 Page 6 of 29 Insured Patient Information Verify that all information returned on this screen 1s correct ie BlueCross BlueShield About Us Contact Us Careers Help ME a Home gt Providers gt ProviderAccess gt eClaims You are signed in as 510134 Insured Patient Information gt ProviderAccess Menu gt Claims Administration Contract XAA1 23456789 Date of Birth 01 28 1975 Patient Name Required fields are denoted by an asterisk C Insured Information Payer ok Insurance inc Name Last Doe First Jane Middle Address Street 1 23 Park Place City Anywherw State ALABAMA gt Zip 35004 Click on the 5 Other previous Date of Birth 01251972 Gender Female gt Section Heading to move Patient Information backward or to fone correct any Last Doe First Jane Middle information Address Street fi 23 Park Place City Anywhere State ALABAMA gt Zip 35004 b A Other Date of Birth 01251972 Gender Female TS Patient s Account Number Release of Information Code Do y
18. claim is assigned a claim number The claim number can be used to track the claim throughout processing This claim number confirms receipt of your claim but does not guarantee payment Printing Tip The Acrobat print function must be used to print the complete Audit Trail Report Click on the printer icon in the Acrobat Reader toolbar Select Different Provider Select Different Date ProviderAccess Sign Out Help BI Blin A g BODIE M 4 gt NA E S BE BER Bookmark selek e ONAN Ri TE ey L Provider ID ER BlueCross BlueShield 2 L Batch Message WAY of Alabama amp ame 1005279 i 1 151010716 2 1 151018248 im AUDIT REPORT g 51020851 a 151020852 07 16 2003 ht PROVIDER 051006279 OR DAVID S H BELL nCCEPTED CLAIMS 51035988 O Real VEIDAGATR E p ee CONT MED REC PAT CNTL PATIENT NAME FROM DOS THRU DOS CLAIM CHARGES 1 51080728 XAA424968934 AVERETTE G K 07 15 03 07 15 03 106 00 1 151084618 CLAIM NBR 5611970082 E C 51096168 35354168 li 51097664 CONT MED REC PAT CNTL PATIENT NAME FROM DOS THRU DOS O CLAIM CHARGES 1 151098575 EDU459669195 BOSARGE J R 07 15 03 07 15 03 06 0 151099854 CLAIM NBR 5611970081 51509854 io T E SPS E E E N SSN SE gi 51512728 CONT MED REC PAT CNTL PATIENT NAME FROM DOS THRU DOS CLAIM CHARGES XAA417789105 GRAV
19. e 5 of 29 Member Information Enter all information in required fields Required fields are denoted by an asterisk pa BlueCross BlueShield US of Alabama ct Us Careers Help E Seach Home gt Providers gt ProviderAccess gt eClaims Member Information Required fields are denoted by an asterisk You are signed in as 5101346 b ProviderAccess Menu gt Claims Administration Contract Number lt AA123455789 First Name JANE Middle Initial ns Last Name DOE Date of Birth 01251972 OO Gender Female gt Choose the Last date of service for this claim f 0312006 Claim Type This claim is being submitted as Primary Secondary Claim Type Professional Anesthesia Home Health Next Tip Choosing the correct claim type will allow the appropriate screen to appear i e Home Health Prescription Number NDC Code Anesthesia Days or Units Payer Information Choose the type of claim that is submitted Primary or Secondary Verify that all information is accurate Select the Patient Relationship to Insured field and choose the option that applies to your claim PA BlueCross BlueShield VAY of Alabama About Us Contact Us Careers Help Seach Home gt Providers gt ProviderAccess gt eClaims Payer Information Contract AA1 23456789 Required fields are denoted by an asterisk D
20. ect Enter your Submitter Billing ID Billing ID is needed ar BlueCross BlueShield About Us Contact Us Careers Help WAY of Alabama E Search Home gt Providers gt ProviderAccess gt eClaims You are signed in as 51017345 Provider Submitter Identification gt ProviderAccess Menu Identification Plan Code 51 0 Provider Number 12345 Submitter Billing ID WEE Submit N Kp r eClaims allows a user to Claims Administration Administration submit all pending claims by placing your mouse on the highlighted words and clicking the left mouse To create a new claim click the word New Claim amp Ji button ax BlueCross BlueShield About Us Contact Us Careers Help KEA J or iam a Home gt Providers gt ProviderAccess gt eClaims You are signed in as 51017345 Claims Administration TT New Claim and Pending Claims Submitted and Processed Claims Submit All Pending Claims Select all submitted claims or processed claims by date Submitted Claims gt Go Date Created Claim Type Contract Number Patient Account Patient Name Number 10 25 2006 02 09 39 a Professional KAA123456789 Account Number DOE JOHN 10 19 2008 09 31 12 Professional PPA123456799 Accout Number DOE JANE eClaims allows a user to select a date to view submitted or processed claim files Professional eClaims User Manual Rev March 2007 Pag
21. ims batch Note It is necessary to have the Acrobat Reader software installed on PAN Adobe SOLUTIONS PRODUCTS SUPPORT COMMUNITIES COMPANY DOWNLOADS STORE SEARCH your computer in order to view print the audit trail reports eleme N Adobe Reader for yau arslon of Adeka If you have trouble viewing the report Download the latest version of Adobe Reader Pind out how diskte Adobe or do not have the software installed on Step 4 of 2 a your computer download the free Ge ei a version of the Acrobat Reader software Select a Windows 2000 version a Adobe Reader for Symbian OS Adobe Reader for Pocket PC Adobe Reader for Palm OS What is Adobe PDF Clicking the download link will open a browser window taking you directly to the download page Follow the download instructions and install the software Once install return the Online Audit Trail Retrieval Page and repeat steps above continue Select the version of Windows that you are currently utilizing Professional eClaims User Manual Rev March 2007 Page 27 of 29 P Y Fa your ACCOUNI LOontact united gt tates e nanges Adobe SOLUTIONS PRODUCTS SUPPORT COMMUNITIES COMPANY DOWNLOADS STORE SEARCH Adobe Reader updates Get the latest updates available Adobe Reader lerin of Adobe Distribute Adobe Reader Download the latest version of Adobe Reader Find out how to distribute Adobe Reader software on an intranet Step 1 of 2 CD o
22. labama amman Home gt Providers gt ProviderAccess gt Audit Reports Enter Submitter ID Number b ProviderAccess Menu Please enter a Submitter ID to view Audit Reports Submitter ID webxxccr About Us Careers Contact Us Fraud amp Abuse HIPAA Privacy Notice Privacy Statement Legal Disclaimer This site and all contents are Copyright 2006 Blue Cross and Blue Shield of Alabama an Independent Licensee of the Blue Cross and Blue Shield Association To view all audit reports for this submitter ID select ALL To view an audit report for an individual provider select the desired provider number Click submit when finished er BlueCross BlueShield About Us Contact Us Careers Help EY or Alabama gamma Home gt Providers gt ProviderAccess gt Audit Reports Select Provider Number b ProviderAccess Menu To view all audit reports for this Submitter ID select ALL To view an audit report for an individual provider select the desired provider number Provider Number ZANR About Us Careers Contact Us Fraud amp Abuse HIPAA Privacy Notice Privacy Statement Legal Disclaimer This site and all contents are Copyright 2006 Blue Cross and Blue Shield of Alabama an Independent Licensee of the Blue Cross and Blue Shield Association Professional eClaims User Manual Rev March 2007 Page 26 of 29 Click on the drop down date list and select your desired report date
23. mation BlueCross BlueShield of Alabama Home gt Providers gt ProviderAccess gt eClaims Line Item Information You can add up to 8 diagnoses per claim Also the diagnosis does not need a period between the third and fourth digit Use the diagnosis code pointer to indicate which diagnosis applies to your claim About Us Contact UW Careers Help You are fgned in as 510346 b ProviderAccess Menu gt Claims Administration Contract XAA1 23456789 Date of Birth 01 25 1972 Patient Name JANE Required fields are denoted by an asterisk C Diagnosis Codes fat least one required Payer ok 9 d Insurance ok 1 73330 2 73393 Claim Info ok 3 73349 7 Procedures Services or Supplies Dates of Service Facility Type From To mmddyy Code POST CPT HCPCS Modifiers Diagnosis Code Pointers th sd id 4 on Delete e T nm Tip Place Delete n your mouse over the Delete L E guestion mark on the screen Delete L B fora help window to Delete L L appear Help Delete L L Windows provide a Delete L L description of the chosen N Delete L field Delete L L ne m gi E E E E E E PITIT Delete L L
24. ne Middle Address Street fi 23 Park Place City Anywhere State ALABAMA Zip 35004 Other Date of Birth 01251972 Gender Female b Patient s Account Number fi 2345678 Release of Information Conde 1 Do you have on file a signed statement by the patient authorizing the release of medical billing information for this Yes claim Yes x Next Tip Don t forget to add your Patient Account Number Verify the Insured Patient Information on this page to make sure all questions are answered and pre populate fields are accurate If the information is correct press the Next key If the information is not correct select the ProviderAccess link and re key your information If the information is still incorrect contact your EDI Services Representative for assistance Professional eClaims User Manual Rev March 2007 Page 21 of 29 Claim Information pa BlueCross BlueShield About Us Contact Us Careers Help UN of Alabama orn Search Home gt Providers gt ProviderAccess gt eClaims You are signed in as 5101346 Claim Information gt ProviderAccess Menu gt Claims Administration Contract XAA1 23456789 Date of Birth 01 25 1972 Patient Name JANE DOE Payer ok Insurance ok Is Patient s condition employment related No Date of current Illness Injury or Pregnancy If Patient has had same or similar illness give first date Last Name of Refe
25. ou have on file a signed statement by the patient authorizing the release of medical billing information for this claim Yes Next Tip Don t forget to add the Patient Account Number Verify the Insured Patient Information on this page to make sure all questions are answered and pre populate fields are accurate If the information is correct press the Next key If the information is not correct select the ProviderAccess link and re key your information If the information is still incorrect contact your EDI Services Representative for assistance Professional eClaims User Manual Rev March 2007 Page 7 of 29 Claim Information This section contains the information related to the medical services rendered to the patient by the provider The field number corresponds to the box number on the CMS 1500 CL 4 form ar BlueCross BlueShield About Us Contact Us Careers Help US of Alabama e Search Home gt Providers gt ProviderAccess gt eClaims You are signed in as 5101234 Claim Information b ProviderAccess Menu b Claims Administration Contract AA1 23456789 Date of Birth 01 28 1975 Patient Name JANE DOE Payer ok Insurance ok Is Patient s condition employment related Date of current Illness Injury or Pregnancy Claim Info inc If Patient has had same or similar illness give first date Dates Patient unable to work in current occupation Last Name of Refer
26. over the TEE u All con nia No sm i Delete question mark foar2006 Be na on the screen for 0 ae rT No N Delete a help window HAN KENE ER EE L to appear Help W J No Delete Windows provide a a ee a description eno nn of the chosen n E 7 EE No E beste field HE EE KE L x CO MaC ee Jf Itt L se nil No O Delete L Ee To me Date __ L nil ze a N A ele E KE KE L Nesi This section contains the information related to the medical services rendered to the patient by the provider The field number corresponds to the box number on the CMS 1500 CL 4 form You may key up to 10 line items on this screen After completion click the Next button If there are no errors the claim will be accepted and you will be forwarded to the Claims Administration screen Professional eClaims User Manual Rev March 2007 Page 9 of 29 If you have more than 10 line items you must add a new claim to enter the additional line items Edit Submit or Delete any pending claims Claims Administration Lats BlueCross BlueShield About Us Contact Us Careers Help VAY of Alabama _ Home gt Providers gt ProviderAccess gt eClaims You are signed in as 510136 Claims Administration New Claim Submit All Pending Claims incomplete and Pending Claims Date Crested Claim Type Contract
27. ption that applies to your claim Lar BlueCross BlueShield About Us Contact Us Careers Help VAY of Alabama Search Home gt Providers gt ProviderAccess gt eClaims You are signed in as 5101234 Payer Information gt ProviderAccess Menu gt Claims Administration Contract XAA1 23456789 Date of Birth 01 25 1972 Patient Name Required fields are denoted by an asterisk Payer inc Primary Payer BCBS Payer Name Member IDS HICN BCBS of Alabama KAA 23456789 Patient Relationship to Insured gt Patient Relationship to Insured Professional eClaims User Manual Rev March 2007 Page 20 of 29 Verify that all information returned on this page is accurate Insured Patient Information ar BlueCross BlueShield About Us Contact Us Careers Help YAV of Alabama MER E Home gt Providers gt ProviderAccess gt eClaims You are signed in as 5101234 Insured Patient Information a gt Claims Administration Contract XAA1 23456789 Date of Birth 01 25 1972 Patient Name Required fields are denoted by an asterisk C insured Information Payer ok nsur Name Last Doe First Jane Middle Address Street fi 23 Park Place City Anywhere State ALABAMA gt Zip 35004 Other Date of Birth 01251972 Gender Female Patient Information Name Last Doe First Ja
28. r other media or place an Includes Adobe Reader logo on Select your version of Windows your printed material Choose a different version A More info 2000 Adobe Reader Adobe Reader for Symbian OS Adobe Reader for Pocket PC Adobe Reader for Palm OS Whatis Adobe PDF Step 2of2 Adobe Reader 6 0 1 for Also download Windows 2000 M Adobe Yahoo Toolbar Learn more English Latest version Download information File size 16 4MB System requirements Update advisory It is recommended that version imleri gt ar 6 0 2 from within Adobe Click Download download CD Follow instructions By downloading software from the Adobe web site you agree to the terms of our license agreements including that you agree notto use Adobe Reader software with any other software plug in or enhancement which uses or relies on Adobe Reader when converting or transforming PDF files into other file formats Adobe Reader license agreement Adobe Photoshop Starter Edition license agreement Once you have selected Submit the next screen will show that your request is being processed Ba BlueCross BlueShield of Alabama AUDIT REPORT We are processing your request This may take several minutes depending on the size of the audit report Professional eClaims User Manual Rev March 2007 Page 28 of 29 The accepted portion of the audit report contains a list of all claims that were accepted for processing Each
29. ring Physician or Other From Source To EE UPIN of Referring Physician Hospitalization dates related to current services Prior authorization number From To Accept Assignment Yes Corrected Claim Original Claim Number Review this screen and answer any questions that are valid for this claim Once complete click the Next button to save your information and to advance to the next step Professional eClaims User Manual Rev March 2007 Page 8 of 29 You can add up to amp diagnoses per claim Also the diagnosis does not need a period between the third and fourth digit Use the diagnosis code pointer to indicate which diagnosis applies to your claim Line Item Information Aboy Contact Us Careers Help FD Seach pa BlueCross BlueShield US of Alabama Home gt Providers gt ProviderAccess gt eClaims You are signed in as Line Item Information b Provide cess Menu i Administration Contract XAA1 23456789 Date of Birth 01 25 1972 Patient Name JANE DOE l Required fields are denoted by an asterisk Diagnosis Codes at least one required Payer ok Insurance ok 1 73330 273393 3 73349 Claim Info ok Line Info inc 6 7 m n EE WF EE CPT HCPCS Modifiers FT m Ra SE Tip Place your TER m EE mouse
30. rmation for LINE 1 from the Primary payer Primary Payer Name ABC INSURANCE Primary Payer Contract Number ABC123456789 Line Level Adjustments Line 1 Payment Details Num Group Allowed Amount 60 00 1 PRE Paid Amount 0 00 PaymentDate 11032006 if ud end if Click on the question mark to pull up a help window Tip This page provides a user with the ability to key in other insurance information per line item Professional eClaims User Manual Rev March 2007 Page 15 of 29 Primary Payer Payment Information Claim Level Note This page is returned ONLY if you do not have line level payment information at BlueCross BlueShield About Us Contact Us Careers Help US of Alabama FY Search Home gt Providers gt ProviderAccess gt eClaims You are signed in as 510234 Primary Payer Payment Information Claim Level gt ProviderAccess Menu gt Claims Administration Contract XAA1 23456789 Date of Birth 01 28 1972 Patient Name JANE DOE Required fields are denoted by an asterisk C Payer ok daria ES Enter the claim level payment information from the Primary payer Primary Payer Name ABC INSURANCE nm Primary Payer Contract Number ABC123456789 Line Info ok dn Primary Payer Claim Level Adjustments Payment Details Num Group Total Charges Submitted Total Paid Amount Payment Date
31. rring Physician or Other Source Dates Patient unable to work in current occupation From To UPIN of Referring Physician Hospitalization dates related to current services Th pr From e ves Prior authorization number To Accept Assignment Yes v Corrected Claim No v Original Claim Number 999 1 23456 Next Review this screen and answer any questions that are valid for this claim Once complete click the Next button to save your information and to advance to the next step Professional eClaims User Manual Rev March 2007 Page 22 of 29 BlueCross BlueShield of Alabama Home gt Providers gt ProviderAccess gt eClaims Line Item Information Payer ok Insurance ok Claim Info ok Line Info ir Tip Place your mouse on the question mark for a help window to appear Help windows provide a description of the chosen field Required fields are denoted by an asterisk C Contract XAA1 23456789 Diagnosis Codes at least one required Line Item Info claim Date of Birth 01 28 1975 You can add up to amp diagnoses per claim Also the diagnosis does not need a period between the third and fourth digit Use the diagnosis code pointer to indicate which diagnosis applies to your About Us Con Us Careers Help E a are signed in as 510234 b ProviderAccess Menu gt Claims Administration Patient N
32. submitted or processed The claim that you just entered should now appear in the Incomplete and Pending Claims list along with the total claim amount You may now choose to edit submit or delete the claim After the batch is received by Blue Cross and Blue Shield of Alabama the claim will appear in the Submitted and Processed Claims list Note Claims located in the Incomplete and Pending Claims list have not yet been received by Blue Cross and Blue Shield of Alabama for processing Professional eClaims User Manual Rev March 2007 Page 18 of 29 eClaims allows a user to submit all pending claims by placing your mouse on Corrected Claims Claims Administration the highlighted words and clicking the left mouse To create a new claim click the word New Claim button A Date Created Claim Type Contract Number Patient Account Patient Name Number ei 0209 33 Professional XAA123456789 Accomt Number DOE JOHN 50 00 10 19 2006 09 31 12 About Us Contact Us M areers Help Pa BlueCross BlueShield ailemizi MR El You are signed i as 510234 Home gt Providers gt ProviderAccess gt eClaims Claims Administration New Claim Submit All Pending Claims Incomplete and Pending Claims Date Crested Claim Type Contract Number perine Patient Name Claim Amount a 10 59 00 Professional 00123456789 12345678 DOE JANE 175 00 Pending Edit Submit Delete 1120 2008
33. the option secondary to key a secondary claim ar BlueCross BlueShield About Us Contact Us Careers Help US of Alabama E Search Home gt Providers gt ProviderAccess gt eClaims You are signed in as 510234 Member Information gt ProviderAccess Menu b Claims Administration Required fields are denoted by an asterisk Contract Number kaa123456789 First Name ae Middle Initial eee O O Last Name Doe Date of Birth 028195 o Gender Female gt Last date of service for this claim fio312006 o Claim Type Professional Anesthesia Home Health This claim is being submitted as Primary Secondary Choosing the correct claim type will allow the appropriate screen to appear Next Choose the correct option for patient relationship to insured that applies to your claim Payer Information at BlueCross BlueShield About Us Contact Us Careers Help Li An ME Home gt Providers gt ProviderAccess gt eClaims You are signed in as 5101346 Payer Information gt ProviderAccess Menu gt Claims Administration Contract XAA1 23456789 Date of Birth 01 28 1975 Patient Name Required fields are denoted by an asterisk C Payer inc Primary Payer Commercial gt Payer Name Member ID HICN ABC INSURANCE ABCI 23456789 Secondary Payer BCBS gt Payer Name Member IDs HICN BCBS of Alabama KAAT 234

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