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Claims Processing System User Manual May 2010

1. Inquiry Submission Master Record Claims Processing rian added nert eik Request Date 03 30 2010 Units 1 Log Off HP Member ID 447345136 HP ARIZONA HEALTH PLAN RA Piscaer Name WONG FLORIE Sex F DOB 02 17 2003 Provider ID 327760 j Name MEXAL Place of Service 11 OFFICE z 11 OFFICE 0 OTHER LOCATIONS Provider Claim 99 OTHER UNLISTED FACILITY OUTPATIENT HOSPITAL Authorization x DUTPATIENT HOSPITAL 4 PATIENT S HOME Date Received PSYCH FACILITY PARTIAL HOSP 56 PSYCH RESIDENTIAL TRMT CENTER 55 RESIDENTIAL SUBST ABUSE TRMT C RESIDENTIAL TREATMENT CENTER 72 RURAL HEALTH CLINIC d Aiaanacic radar atinwa Outcome le niannncic lado d Addl f nf PCG Claim Processing System May 2010 Page 32 _ jg PUBLIC Il CONSULTING Ill GROUP Arizona Health Care Cost Containment System Outcome code should always be 4 for Other EETZETZCUEDCTIITTITUONNMEMC sln xd File Edit View Favorites Tools Help ar Qa O x B TA JO search p Favorites t2 E LJ M Address g https tpawebt pcgus com eznet ClaimRequest asp NodeId LEVEL4 1 Home Providers doi E Member Eligibility Claim Submission Entry Authorizations Claims Company ID AZTPA ARIZONA TPA z Inquiry Submission Master Record Claims Processing Submitter Services Request Date 03 30 2010 Units Log O
2. 20100330151828607698 20100330151828640699 20100330151828670700 20100330151828700701 20100330151828733702 Batch 202 Error Details 10 Of 13 Claims Found Submitter PAROQ0002 Batch 202 Member Name Sex SSN Dob FLORIE WONG F 764 28 7642 02 17 2003 Claim Date INVALID DOB DETAILS FOR MEMBER 03 30 2010 INVALID DOB DETAILS FOR MEMBER 03 30 2010 INVALID DOB DETAILS FOR MEMBER 03 30 2010 INVALID DOB DETAILS FOR MEMBER 03 30 2010 INVALID DOB DETAILS FOR MEMBER 03 30 2010 INVALID DOB DETAILS FOR MEMBER 03 30 2010 INVALID DOB DETAILS FOR MEMBER 03 30 2010 INVALID DOB DETAILS FOR MEMBER 03 30 2010 INVALID DOB DETAILS FOR MEMBER 03 30 2010 INVALID DOB DETAILS FOR MEMBER 03 30 2010 Claims with errors 10 First Page 12 LL sue XT Provider LOCHRIDGE LOCHRIDGE LOCHRIDGE LOCHRIDGE LOCHRIDGE LOCHRIDGE LOCHRIDGE LOCHRIDGE LOCHRIDGE LOCHRIDGE 315 39 315 39 315 39 315 39 315 39 315 39 315 31 315 39 315 39 315 39 Lines 20 Billed Total 50 00 50 00 50 00 50 00 50 00 50 00 50 00 50 00 50 00 50 00 500 00 v PCG Claim Processing System May 2010 Page 23 _ ig PUBLIC m Jl CONSULTING GROUP Arizona Health Care Cost Containment System Batch Queue Submissions Windows Internet Explorer Go File Edit View Favorites Tools Help pdf F E search Ss 7 PDF wd Batch Queue Submissions ht
3. Member Eligibility piai Submissions Ente Authorizations Sane Company ID AZTPA ARIZONA TPA nquiry Submission Master Record Claims Processing esie d Lois Request Date 03 30 2010 Units og Off HP Member Ip 547345136 HP ARIZONA HEALTH PLAN EE Name WONG FLORIE Sex F DOB 02 17 2003 Provider ID 327760 Name MEXAL Place of Service None Selected Outcome 1 HOME z Provider Claim sc Authorization d Date Received 03 30 2010 You are now ready to enter the claims information for this Member and Provider selected Place of Service is a dropdown feature allowing you to select the appropriate POS for your claim The only POS allowable for school based billing are 03 School OR 99 Other Unlisted Facility If a service is provided in an alternate approved setting please select the relevant place of service Additional information will need to be submitted separately to support alternate place of service such as the student s IEP You can quickly access your POS by typing in the first few characters such as oth for other Z Claim Submission Microsoft Internet Explorer File Edit View Favorites Tools Help gt JA Qm O 9 d sr Teme OO SE B Address e https tpawebt pcgus com eznet ClaimRequest asp NodeId LEVEL4 1 Go Links e X Home Providers F EGER Member Eligibility Claim Submission Entry Authorizations Claims Company ID AZTPA ARIZONA TPA z
4. N dh b Page Tools x Home Providers Member Eligibility Provider Search Result eee Provider Name Specialty Group Phone Fax_ City State Company Claims MEXAL 060 Description ARIZONA COMMUNITY DEV CORP LA PALOMA 6028675135 PHOENIX AZ attaztpa ezcap AZTPA Claims Processing Submitter Services MEXAL SANDRA K ARIZONA COMMUNITY DEV CORP LA PALOMA 6028675135 PHOENIX AZ attaztpa ezcap AZTPA Last Page 1 Site Disclaimer Administration 2007 MZI Healthcare All Rights Reserved System Availability transaction execution and response times may vary due to volume system performance and other factors Technology provided by MZI Healthcare All Rights reserved Int xDic E This Site Best Viewed with zu Done CEEE POP Mkoan 100 4 https tpawebt pcgus com eznet SearchResults asp Action Query amp Map Provider XMLMAP xml amp XSL Pro Windows Internet Explorer Go hi SANDRAS 20K amp Prvno 6331088Cc a x ue Search er File Edit View Favorites Tools Help pdf y E search 735 Tv w d https j tpawebt pcgus com eznet SearchResults as https tpawebt pcgus comjeznet SearchResults asp Action2Query amp Map Provider XMLMAP xml amp XSL ProviderDetail xsl amp PCP MEXAL fh amp dh b Page Tools bt Home g Providers Provider Details Member Eligibility Claims Processing Provider ID 633108 Company ID AZTPA rs
5. batch select the Re Process button and click on the Submit Updates button Since the rest of the claims in the batch have already passed the edits and been forwarded to AHCCCS as clean claims PCG suggests the users select Process to only submit the corrected claims This will repeat the claim review process and submit those corrections for adjudication PCG Claim Processing System May 2010 Page 24 m PUBLIC CONSULTING GROUP Arizona Health Care Cost Containment System SECTION V SINGLE CLAIM SUBMISSION Single Claims Submissions is a secondary option provided to the LEA s and Billers to support submissions while implementing the 837 file creation and continued testing This feature allows the user to enter data at a single claim submissions level and included editing and correction features during the entry To access the Single Claims Submission feature select Claims in the left menu The menu bar will expand then click submissions d PCG Claims Processing Web Portal Microsoft Internet Explorer File Edit View Favorites Tools Help Q O 92 1 vem O O S EA L Address https tpawebt pcgus com eznet default asp Welcome PARADISE Member Eligibility Authorizations Claims Inguiry Submission Claims Processing Submitter Services VERSION 5 3 References Log Off Site Disclaimer Administration Presented By PUBLIC I CONSULTING fl GROUP This page has been vi
6. Providers Member Eligibility Authorizations ENS ccessfully uploaded file 1001141078 txt File Size 182109 Claims Processing Submitter Services References Log Off Site Disclaimer Administration 2007 MZI Healthcare All Rights Reserved System Availability transaction execution and response times may vary due to volume system performance and other factors Technology provided by MZI Healthcare All Rights reserved This Site Best Viewed with PCG Claim Processing System May 2010 Page 13 __ W PUBLIC I CONSULTING GROUP Arizona Health Care Cost Containment System To validate that the file was uploaded correctly select the 997 download option on the left menu then view or print the confirmation At this point the system is running its initial edit to ensure the file is in the proper 837 file format If the upload is unsuccessful the 997 report will detail the errors for correction The batch can be uploaded again once errors have been fixed An example of a 997 report that displays a failed batch is as follows 997 Report Windows Internet Explorer E lgi xi Ge gt https tpawebt pcaus com eznet 997Report_detail asp id 837P hf ts x Live Search 2 B File Edt View Favorites Tools Help pdf We BP G97 Report z EB search Ss Tex a A EZ4NET ie 997 Report Webpage Dialog xi rit File Information Batch information File 131257_1011933312_
7. Search Clear ciose Numb Services Procedu https tpawebt pcgus com eznet ProvCodeSearch asp Company AZTPA8SearchType REFPROVID amp S MB Internet Modifier 1 None Selected Modifier 2 None Selected Modifier 3 None Selected Modifier 4 None Selected Qty MH Diag Ref n E Rats Cerne Cunas nzz3n omin Tima Ceca Cune I A DAO 2 40 00 x TT T iBlBmewe p M n j start ego gt MetaFrame Present pce ven ig Inbox Microsoft A Training Manual C J i claims Processing 5 JE Claim Submissio Documentt Micros eio WV 10 56 PM SEIE RIE 4 E Provider Search Web Page Dialog Click Search and select your provider by clicking the Provider hyperlink Provider List ai Provider Name Specialty Group Term Date Company MEXAL 327760 060 Description ARIZONA COMMUNITY DEY CORP LA PALOMA 4 9 2008 AZTPA Last Page First Prev Next Last Back to Search i https tpawebt pcgus com eznet ProvCodeSearch asp Company AZTPA amp SearchType REFPROVID amp S Internet PCG Claim Processing System May 2010 Page 31 _ mM PUBLIC Il CONSULTING GROUP Arizona Health Care Cost Containment System File Edit View Favorites Tools Help Q O 2 Dl gt sirem Address e https tpawebt pcgus com eznet ClaimRequest asp ModeId LEVEL4 1 J g Go Links
8. Arizona Health Care Cost Containment System Log Off Site Disclaimer Administration Company ID lt C gt lt P gt SCHEMA_HEADER MEML amp i x Live Search ajxi 2 AZTPA Member Name Member ID IE hs Page G Tools Eligibility Member Information A47945136 Address City St Zip Member Information WONG FLORIE Sex F DOB 02 17 2003 Age 7 1123 yrs Health Plan Benefits Termed ARIZONA HEALTH PLAN Benefit Category N A Co Pay N A Category N A Relation to Sub Co Pay N A Member Benefit Information SELF PCP Name Specialty Benefit Plan TPA Benefits Effective Phone Additional Benefit Search 06 02 2003 PCP Effective 6 2 2003 Co Insurance N A Primary Care Provider Information Co Insurance N A Provider ID 2007 MZI Healthcare All Rights Reserved System Availability transaction execution and response times may vary due to volume system Fax performance and other factors PCP Termination E E EST eres s X 4 The next screen will display the member name sex date of birth age and member ID number It will also show the effective date of the coverage and the relationship to the subscriber PCG Claim Processing System May 2010 Page 11 m PUBLIC CONSULTING GROUP SECTION lil UPLOADING A BATCH Arizona Hea
9. Procedure Bi 20100222134130280796 Processing Complete A67460393 AALIYAH ABRAMSON F Mrd de MEXAL 315 8 409 49 je A ie I rem Date IP rocedure Billed aE lo 02 17 2009 92508 25 23 02 11 2009 97530 29 11 02 04 2009 97530 58 22 02 25 2009 97530 29 11 02 18 2009 97530 29 11 02 04 2009 97530 29 11 02 26 2009 92508 25 23 02 18 2009 97530 29 11 02 19 2009 92508 25 23 02 11 2009 97530 29 11 won TT T Rhein PCG Claim Processing System May 2010 PUBLIC CONSULTING GROUP Posted Claims https tpawebt pcgus com eznet Arizona Health Care Cost Containment System SearchResults asp Action Query amp Map EZcap BatchPostedDetail ml Windows Internet Explorer g9 Fie Edit View Favorites pdf 2 Home Providers Member Eligibility Authorizations Claims Claims Processing Access Batches Report Batches Submitter Services References Log Off Site Disclaimer Administration Done w d https tpawebt pcgus com eznet _SearchResults as Tools Help z Eg search 05 Tox EZ CAP Claim 20100222T0300202 Processing Errors https tpawebt pcgus com eznet Batch Posted Claims Detail List Submitter PAROO0002 Batch 192 Member A352532015 M MAJESTIC GALLAGHER F Date Proced rocedure Billed 03 02 2009 55125 4 06 02 04 2009 55125 4 06 02 1 1 2009 55125 4 06 02 09 2009 55125 s X 02 10 2009 55125 02 18 2
10. a successfully uploaded batch select the Access Batches option in the Claim Processing tab Batch Claims Search Windows Internet Explorer https tpawebt pcgus com eznet EZcap File Edit view Favorites Tools Help on the left menu of the home page Batches can be searched by user name batch ID or batch status If no search criteria are entered all batches will be shown Click on the Search button P BatchClaimsSearch asp NodeId LEVELS 0 z amp search Ss PoF w a Batch Claims Search Home Providers Member Eligibility Authorizations Claims d B s x Live Search fp A Page C Toos Batch Claims Search Claims Processing Access Batches Report Batches Submitter Services References Log Off Site Disclaimer Administration Enter your search criteria below Any combination may be selected User Ip Submitter ID P4R000002 Batch Ip Batch Status Search Clear ormance and other factors 2007 MZI Healthcare All Rights Reserved System Availability transaction execution and response times may vary due to volume system pe Technology provided by MZI Healthcare All Rights reserved x B This Site Best Viewed with Explorer EEE Bde amp 7 in the previous screen The Batch Queue Submissions page which will display all batches that match the search criteria entered PCG Claim Processing System May 2010 Page 15 PUBL
11. biller and self biller has completed the testing process and the live environment is ready PCG will provide that information to each valid system user PCG Claim Processing System May 2010 Page 5 w d Login Home Providers Member Eligibility Authorizations Claims Claims Processing Submitter Services References Log Off Site Disclaimer Administration S Login Windows Internet Explorer Go e https tpawebt pcgus com eznet login asp File Edit View Favorites Tools Help Jf z E search 034 Z por m PUBLIC CONSULTING IM M MI GROUP Arizona Health Care Cost Containment System v amp l x ue Search og e h Lp Page O Toos To request a new User Id or changes to an existing Id please contact New Accounts Setup User 1D Enter your User ID Password Enter your Password Clear Form Forgot My Password 2007 MZI Healthcare All Rights Reserved System Availability transaction execution and response times may vary due to volume system performance and other factors Technology provided by MZI Healthcare All Rights reserved This Site Best Viewed vith IE OEE E SQ tocal intranet Enter the user id and password and click Login to access the system home page 2 PCG Claims Processing Web Portal Windows Internet Explorer Go e https Jtpawebt pcgus com eznet default asp xajex ei pd O dE semen Tte Ho
12. itake a L RMTS Lj My Documents i Claims Processi as Microsoft Excel c3 Microsoft Powe v QeVE 5 53PM 5 Select the Browse option and upload the file from the location it is stored on the user s system The extension of the file must end in txt do not include quotes After selecting the file click the Submit File to Upload button If successful a File Upload Successful message will appear at which point either upload another file or proceed to the claim processing screen PCG Claim Processing System May 2010 Page 12 __ w PUBLIC m Il CONSULTING GROUP Arizona Health Care Cost Containment System File Upload Page Windows Internet Explorer gt iS 2 e https tpawebt pcqus com eznet authediupload dl Providers Member Eligibility Authorizations Claims Claims Processing Submitter Services Eligibility Inquiry Enrollment Status Claim Inquiry Institutional Claims Professional Claims 837 upload 837 download EZ Link Claim Upld 997 download Remittances 835 Auth Referrals References Log Off Site Disclaimer Administration 2007 MZI Healthcare All Rights Reserved System Availability transaction execution and response times may vary due to volume system performance and other factors Technology provided by MZI Healthcare All Rights reserved This Site Best Viewed vith File Upload Successful Windows Internet Explorer Home
13. 009 55125 T 02 12 2009 55125 4 06 01 29 2009 55125 __128 se 02 17 2009 55125 lo 01 26 2009 s 5125 lo 02 24 2009 s 5125 h E 02 23 2009 55125 4 06 02 26 2009 55125 4 06 06 03 03 2009 ss 125 03 05 2009 Provider https tpawebt pequs comfeznet _SearchResults asp Action Query amp Map EZcap_BatchPostedDetail xml amp XSL EZcap_BatchPostedDetail xsl amp Query lt C gt lt P gt SCHEMAS B Y aal lint 4 06 s5 125 i 03 04 2009 gs 125 02 25 2009 55125 ss Fa 02 25 2009 H0031 50 00 02 02 2009 92508 25 23 _SearchResults asp Action Query amp Map EZcap_BatchError_List xnml amp X Windows Internet Explorer Bi o x Juve search e m amp 5 dmh b Page O Tools k Received 02 22 2010 Processed 02 22 2010 Diagnosis Billed o 315 8 8 349 23 zl CEEE E Do Brocante 100 gt 7 File Edit View Favorites pdf gt ee p di f https tpawebt pcqus com eznet _SearchResults as Home Providers Member Eligibility Authorizations Claims Claims Processing Access Batches Report Batches Submitter Services References Log Off Site Disclaimer Administration e https Jtpawebt pcgus com eznet SearchResults asp ActionzQuery amp Map Ezcap BatchError List xml amp XSL EZcap BatchError List xsl amp Page 1 amp Query C P gt 5CHEM Batch 202 Error Details 10 Of 13 Claims Found Submitter PAR000002 Ba
14. 0908191044 txt dh b Page Cj Toos Submitted Date 26 Febuary 2010 Batches Included 1 Aes n No of Functional Group 1 Batches Received 1 Member Eligibility File Status Rejected Batches Accepted 0 Authorizations Claims T ien Acknowledgement Information Date Mee Claims Processing el L i Submitter Services Toc egment Code gt Segment Error Code gt Uy Ee E Eligibility Inquiry ae Number gt Number gt ieee in file Error test Element Position a gt Error a Enrollment Status Claim Inquiry 12345 12345 gt Rejected Institutional Claims 0169 gt Reiected Professional Claims because ue 2r Mare 837 upload 837 doweinad Segments in Error EZ Link Claim Upld 858 tH i 997 download Em N3 gt 7652 egment Has Data Element Errors Remittances 835 ES m Auth Referrals 1 2 Mandatory References B 1 data element Log Off missing Site Disclaimer Administration N3 gt 7655 3 gt Mandatory segment Ew FERNER TA Legend e system m Functinal Group FG W Transaction Set TS m Data Segment DS m Data Element DE tps tpawebt pcgus com eznet 997Report asp str997Filename 997 PARODOD02 20100226131312796 0908191044 txt je Local intranet 4 SSL wa e FT E E Beatae 100 7 PCG Claim Processing System May 2010 Page 14 __ W PUBLIC m Il CONSULTING il GROUP SECTION IV PROCESSING A BATCH Arizona Health Care Cost Containment System To process
15. 89 00 DILSAVER 179418 AZTPA 2 34 994 00 JACKSON 181037 AZTPA 1 2 34 00 FORTNEY 184124 AZTPA 3 22 646 00 KNAUER 187033 AZTPA 4 27 512 00 KRUSE 194857 AZTPA 9 45 1 208 00 BURDETTE 204626 AZTPA 1 17 544 00 FORBES 233020 AZTPA 1 18 306 00 HOMMEL 244398 AZTPA 7 43 1 133 00 GLEASON 256712 AZTPA 5 26 561 00 ESTEBO 257017 AZTPA 4 1 081 00 Batch Detail https tpawebt pcgus com eznet SearchResults asp Action Query amp Map EZcap BatchDetail ml amp X5SL E Windows Internet Explorer Fe Edit View Favorites Tools Help pdf gt E search 3s 5 Di d JE 5 x C Y amp x flive Search ng e https Jtpawebt pcgus com eznet SearchResults asp ActionzQuery amp Map EZcap BatchDetail xml amp XSL EZcap BatchDetail xsl amp Query C lt P gt SCHEMAS BATCHES BAT ff gt d b Page v Qi Tools Home Providers Batch Detail List Received 02 22 2010 Member Eligibility 573 Claims Received for Processing Processed 02 22 2010 Authorizations Claims Submitter PAROO0002 Batch 192 Claims Processing Access Batches Report Batches EDI Claim Status Member Provider Diagnosis Billed Submitter Services See ee ee eee cece enn n enna e SS aa References Log Off Site Disclaimer Administration 20100222134129970795 Processing Complete ainai ABDELKARIM ABDELHALIM 620501 HABGOOD 315 39 100 92 Detai an i Li ne I Itei uu 25 s Date
16. IC GROUP Batch Queue Submissions Windows Internet Explorer pdf CONSULTING File Edit View Favorites Tools Help w ae Batch Queue Submissions Home Providers Member Eligibility Authorizations Claims https tpawebt pcgus com eznet EZCAP_BatchQueue asp Action Query amp Map ezcap_batchclaims_search xml amp xSL ezcap_BatchQueue xsl amp BID RPage 1 z ER search Ss Ter Claims Processing Access Batches Report Batches Submitter Services Site Disclaimer Administration Process Re Process Delete Submitter Batch Date Dm mnm Uploaded PAR000002 190 20100222 Batch Queue Submissions Database Name OloOo o 0 O EZCAP PARO00002 192 20100222 PAROO00002 197 20100226 Status EZCAP PARO00002 198 20100302 EZCAP Total Claims Processing Complete with errors EZCAP PAROO0002 199 20100302 Processing Complete with errors Processing with processing errors and posted claims clean claims that have been forwarded to AHCCCS for The edits include Ej total number of claims in the batch and for batches that have been processed the number of claims For batches that have never been processed there will be a check box under the Process heading To Member first and last name Member ID submit a batch to be processed the user will select this box and click on Submit Updates The system Member DOB Provider ID NPI TIN and associated vendor Provider first
17. IDGE 315 39 2 50 00 Vendor IN E 260815824 f KINGMAN LINTFIED SCHOOL DISTRICT z edd gIUUS3U 5755400579 INVALID DOB DETAILS FOR MEMBER O ZOTO LOCHRIDGE 2 50 00 20100330151828670700 INVALID DOB DETAILS FOR MEMBER 03 30 2010 LOCHRIDGE 315 39 2 50 00 20100330151828700701 INVALID DOB DETAILS FOR MEMBER 03 30 2010 LOCHRIDGE 315 39 2 50 00 20100330151828733702 INVALID DOB DETAILS FOR MEMBER 03 30 2010 LOCHRIDGE 315 39 2 50 00 Claims with errors 10 20 500 00 First Page 12 i CEEE SQ tocat intranet amp 109 7 To correct the error listed click on the binoculars on the highlighted line s to search the data available In the example listed above the DOB is not valid By clicking on the binoculars the member eligibility search screen will be displayed PCG Claim Processing System May 2010 Page 20 Ww PUBLIC ol hi View p die f https jtpawebt Arizona Health Care Cost Containment System https tpawebt pcqus com eznet _SearchResults asp Action Query amp Map EZcap BatchError List Hml amp X Windows Internet Explorer e https tpawebt pcgus com eznet SearchResults asp Action Query amp Map EZcap_BatchError_List xml amp XSL EZcap_BatchError_List xsl amp Page 1 amp Query d el Member Search Webpage Dialog X Il E Member Eligibility Search i Enter your search criteria below Any combination may be used Last Name cATAP First Name FLORIE Date of Birth Gender Home Providers Member E
18. PoRFE EE EE x Ei B TL A start O MetaFrame Present C PCG VPN iv Inbox Microsoft Training Manual C i Claims Processing 5 amp Claim Submissio Document Micros yy W VE 11 22 PM At this point you should select your date from and to and total billed charge amount In this example we utilized 03 01 10 as our POS Place of Service and 120 00 for totaled billed You must select ADD to bring your selections into the claim Services Requested Procedure Code d Service Type Prof Modifier 1 None Selected Modifier 2 None Selected Modifier 3 None Selected X Modifier 4 None Selected Qty i Diag Ref i se d Date Service From 03 30 2010 Time Service From 1030 for 10 30 AM Date Service To geal Time Service To 520 for 3 20 PM Billed Charge Add Sue Sew Pe OR OR LORS X Pref 9213 Ir r R 03 01 2010 os 01 2010 imo POP B ep Internet A start 3 metaFrame Present C PCG VPN Inbox Microsoft Training Manual C b Claims Processing 5 Claim Submissio Documentt Micros Ye VE 11 29PM Please note this step should be repeated for each additional service line Submit the claim for processing by selecting the SUBMIT REQUEST button PCG Claim Processing System May 2010 Page 34
19. _ jy PUBLIC m Il CONSULIING GROUP Arizona Health Care Cost Containment System AHCCCS School Based Claiming Claim Processing System Training Guide May 2010 PCG Claim Processing System May 2010 Page 1 all m PUBLIC CONSULIING GROUP Table of Contents Introduction Section General Claim Edits Section II Accessing the System s Section Il Viewing Member and Provider Data Section III Uploading a Batch Section IV Processing a Batch Section V Single Claim Submission PCG Claim Processing System May 2010 Page 2 Arizona Health Care Cost Containment System _ fy PUBLIC m Il CONSULIING GROUP Arizona Health Care Cost Containment System INTRODUCTION The PCG Claim Processing System is designed to allow LEAs and billers the capability of submitting claims in the HIPAA compliant 837 file format It will utilize a secure web based portal that will provide easy access for users and updated functionality including features such as online claim correction and access to provider and member enrollment information The LEA to PCG claims submission process will be comprised of the following steps e LEA Biller creates 837 file e 837 file is uploaded into the claim system via the secure web portal e File is checked to ensure it conforms to the 837 file format specifications e 837 files that fail the format specifications are not loaded into the processing system and a 997 report is provided to show
20. and last name will then begin to perform an edit on all the claims in the batch to check the validity of the claim data Validity of ICD 9 and CPT4 codes Date span check comparing the claim header and the claims detail information PCG Claim Processing System May 2010 Page 16 Posted Errors Claims Count 8 1 7 573 149 424 P de Aca gam 577 142 435 gren hoor aa 112 43 69 EZCAP m 180 43 137 Submit Updates Last Page 1 Done P POP H Local intranet 100 7 This screen will display the user the Submitter Batch number the date the file was uploaded the status of the batch Never Processed Processing Complete with Errors and Processing Complete as well as the adjudication Arizona Health Care Cost Containment System n Be e x Live Search fi E od csp Page C Tools Processing oun __ W PUBLIC I CONSULTING GROUP Arizona Health Care Cost Containment System After processing is complete the user can immediately see how many clean claims were forwarded to AHCCCS for adjudication and how many claims were determined to have errors To view more detail the user can click on the Submitter Batch Number link which will display the Summary Detail screen https tpawebt pcgus com eznet _SearchResults asp Action Query amp Map EZcap_batchclaim xml amp XSL EZ Windows Internet Explorer File Edit View Favorites Tools Help pdf d EQ search Ss por w ab
21. any 1p All Companies x References Log Off Last Name Wong Site Disclaimer 5 ee oo Administration First Name Fore Member 1p Health Plan None Selected x Clear Sort by Member Name xl 2007 MZI Healthcare All Rights Reserved System Availability transaction execution and response times may vary due to volume system performance and other factors Technology provided by MZI Healthcare All Rights reserved This Site Best Viewed with AeZe Z FT T T FT Bde A 7 In the Company ID field select AZTPA the member information can be searched by last name first name Member ID or Health Plan Once entered click on the Search button for results PCG Claim Processing System May 2010 Page 9 __ W PUBLIC m Il CONSULTING GROUP Arizona Health Care Cost Containment System https tpawebt pcgus com eznet SearchResults asp Action Query amp Map Member Search XMLMAP xml amp X5S Windows Internet Explorer https tpawebt pcgus com eznet SearchResults asp Action Query amp Map Member Search XMLMAP xml amp XxSL member search xsl amp Page 1 v B 1 X Live Search File Edit View Favorites Tools Help pdf 7 E search 4 por w d https j tpawebt pcgus com eznet SearchResults as m amp 5 dh v b Page Tools ui Home Providers Member Eligibility Eligibility Member Search Results Authorizations re Member Member Name S Birth Date Health Plan Name Health Pia
22. ar with the Batch Error Edit entry which will highlight the problem field in red https tpawebt pcaus com eznet SearchResults asp Action Queryt amp Map EZcap BatchError LisbanltzX Windows Internet Explorer File Edit View Favorites Tools pdf lt C gt lt P gt SCHEMA v Ie x Live Search e https tpawebt pcgus com eznet SearchResults asp Action Query amp Map EZcap_BatchError_List xml amp XSL EZcap_BatchError_List xsl amp Page 1 amp Query Batch Claim Error Edit Windows Internet Explorer Batch Error Edit Batch ID 202 Claim ID 20100330151828467694 em dh v sie Page Tools S A cose Save Changes OO INVALID DOB DETAILS FOR MEMBER Providers RE ee SS SSS yee s Informati onFromClaim Member Eliaibility E EIE inal Member From Cla i Authorizations Provider s Name 866000474 LOCHRIDGE HEIDI Claims Member s Name CATAP FLORIE Claims Processing ee Mess ades Date of Birth 02 18 2003 Report Batches Gender F Submitter Services Address Provider Diag Lines Billed Total pp ati 2340 N 31ST PL Site Disclaimer STUDENTVILLE AZ 12345 LOCHRIDGE 315 39 2 50 00 Administration epee ee rae ay A LOCHRIDGE 315 39 2 50 00 Payer Responsibility IP LOCHRIDGE 315 39 2 50 00 PH Code P Authorization d LOCHRIDGE 315 39 2 50 00 i LOCHRIDGE 315 39 2 50 00 Provider ID 627995 d 866000474 LOCHRIDGE HEIDI LOCHR
23. ates the general edits that are performed on submitted claims The list is not exhaustive and does not include standard X12 edits for a valid HIPAA X12 transaction sets however it does provide guidance as to the desired quality of the claims upon submission All services must be submitted within 6 months of the data of service Transportation services will suspend until a supporting non transportation service has been paid Health Aide services must have a place of service of 03 all other services must use either 03 or 99 whichever is appropriate for the rendered service Health Aide services cannot exceed 8 units per day and must be reported in the same claim The member student must be eligible on the date of service The member student must be at least 3 but not more than 22 years of age at the time of service for all services except Speech and Occupational Therapy For Speech and Occupational Therapy the range must be between 3 and 21 The service must have been provided during a valid school or AHCCCS agreed upon day The rendering provider must be eligible on the date of service The provider must be licensed to render the service provided The procedure code and or modifier must be valid codes Third Party Coverage must not exist for the rendered services with the exception of Transportation Health Aide and Nursing services The diagnosis code must be a valid ICD9 code Dates of services must be valid dates and when sending a s
24. ations Claims Inquiry a A LEA ARIZONA TP MEM Submission Master Record Claim Submission Entry Claims Processing Submitter Services Request Date 03 30 2010 References eee Log Off Site Disclaimer HP Member ID 547345136 d HP ARIZONA HEALTH PLAN Administration Name WONG FLORIE Sex F DOB 02 17 2003 Provider 1D j Name PCG Claim Processing System May 2010 Page 30 __ W PUBLIC Il CONSULTING GROUP Arizona Health Care Cost Containment System To begin the selection of provider will need to enter in your provider information In this case we will enter in the provider number 327760 but if you do not know the provider ID you can click the feature and this will open a searchable field with the same flow as the member search E Claim Submission Microsoft Internet Explorer File Edt View Favorites Tools Help Q O 2 5 eres eic a LJ Address https tpawebt pcgus com eznet ClaimRequest asp NodeId LEVEL4 1 Home Providers i Zl Provider Search Web Page Dial al xi Member Eligibility E Provider Searc it ain s p A1 xl Authorizations Claims nik E Provider Directory Search Inquiry Submission Master R Enter your search criteria below Any combination may be selected Claims Processing Submitter Services References Last Name on eism First Name Administration Provider ID 27e o Specialty None Selected z Zip
25. e https tpawebt pcgus com eznet _SearchResults as https tpawebt pcgus com eznet _SearchResults asp Action Query amp Map EZcap_batchclaim xml amp xSL EZcap_Batchview xsl amp Query lt C gt lt P gt BATCHQUEUE BATCH ATTR Y ri 4 X Live Search A D deh Pag Gj Toos Home Providers Member Eligibility Work With Batch Queue Authorizations Claims Claims Processing Access Batches Report Batches Submitter Services References Log Off Site Disclaimer Administration Summary Detail Batch Source 134116 668046750 0908181043 txt i 02 22 2010 Provider Count 02 22 2010 Member Count 2 22 2010 Detail Count Submitter ID PAR000002 Total Claims Status Processing Complete with errors Total Charges 130 365 32 Claims With Errors 149 30 500 24 Internal Batch ID 192 424 99 865 08 Manual Dt Entered for Recvd Dt 156 Override Date Received Post Errors Available Reports Batch Summary Batch by Provider Summary Batch Detail ion and response times may vary due to volume system d Processing Errors brs Techno Rights reserved w icrosoft w This Site Best Viewed with Explorer ME u c t ET TIR esl ae eos seem 0 ee The summary screen will display basic information on the batch including the date submitted and last processed the status number and dollar amount of claims posted and
26. e of service Request Date 03 30 2010 Company ID AZTPA ARIZONA TPA z HP MemberID amp Hp Name Sex DOB Provider m o 4 Name Place of Service None Selected z as Outcome 1 HOME z Provider Claim aooo Authorization aooo 4 Date Received 03 30 2010 Diagnosis Code d Add Only 4 diagnosis codes allowed umber Code Units fi ription Requested Desription OOO Procedure Code O t Service Type Prof z Modifier 1 None Selected z 1 T start 9 MetaFrame Present Pcs ven i Inbox Microsoft 4 Training Manual C Claims Processing 5 Claim Submissio Documenti micros jet WV 10 14PM Please note the Request Date will default to the date of entry E T TT Bm 5 PCG Claim Processing System May 2010 Page 26 _ W PUBLIC Il CONSULTING GROUP Arizona Health Care Cost Containment System The bottom half of the data entry form will encompass the procedure code modifier units beginning date of service ending date of service and total charge amount Z Claim Submission Microsoft Internet Explorer E 5 8 xj File Edit View Favorites Tools Help T Q O xl ig Dl Ds vemm O zB 78 Address e https tpawebt pcgus com eznet ClaimRequest asp NodeId LEVEL4 1 Go Links e Services Requested Procedure Code f Service Type Prof z Modifier 1 None Selected Modi
27. e visit 73 Claim Submission Microsoft Internet Explorer File Edit View Favorites Tools Help O O i 2 6 Os dre O12 3 EB LEE Address e https tpawebt pcgus com eznet ClaimRequest asp ModeId LEVEL4 1 x go Links e T Log ott HP Member ID 545 2 p HP ARIZONA HEASETH PLAN Site Disclaimer Name WONG FLORIE Sex F DOB 02 17 2003 Administration Provider 10 3277560 Name MEXAL Place of Service 11 OFFICE a Dutcome 1 HOME Provider Claim I Authorization d Date Received 03 30 2010 Diagnosis Diagnosis Code d Only 4 diagnosis codes allowed cription HOUSING ECONO CIRCUM NOS PCG Claim Processing System May 2010 Page 33 __ m PUBLIC I CONSULTING GROUP Arizona Health Care Cost Containment System Service Requested in this example if 99213 searchable field by selecting the binoculars Service Type should always remain as Prof Professional our units selected is 1 represents one service and the diag ref should remain as 1 Services Requested Procedure Code 99213 8 amp Service Type Prof z Modifier 1 None Selected e Modifier 2 None Selected X Modifier 3 None Selected 2 Modifier 4 None Selected Qty Diag Ref I Date Service From o3 01 2010 Time Service From 1030 for 10 30 AM Date Service To EHE 2010 Time Service To 1520 for 3 20 PM Billed Charge fono 00 Adol FP EFPP
28. er to the correct one listed in the system click on the member ID field and the claim detail is automatically updated with the new information Please make sure to confirm this is the correct member by validating against other LEA information before making any updates to the claim Click on the Save Changes button and the update is complete PCG Claim Processing System May 2010 Page 22 PUBLIC al I GROUP CONSULTING Arizona Health Care Cost Containment System To confirm that this claim has been updated the system changes the color of the error description from red to green once the page has been refreshed https tpawebt pcgus com eznet SearchResults asp Action Query amp Map EZcap BatchError List ml amp X Windows Internet Explorer C P SCHEMA Y amp ty x flive Search 8 x i e e https tpawebt pcgus com eznet SearchResults asp Action Query amp Map EZcap_BatchError_List xml amp XSL EZcap_BatchError_List xsl amp Page 1 amp Query File Edit View Favorites Tools Help pdf j E search Tx P di f https f tpawebt pegus com eznet SearchResults as Home Providers Member Eliaibility Authorizations Claims Claims Processing Access Batches Report Batches Submitter Services References Log Off Site Disclaimer Administration EDI Claim 20100330151828450693 20100330151828467694 20100330151828500695 20100330151828530696 20100330151828577697
29. ff HP MemberID i47345130 A np ARIZONA HEALTH PLAN Be ER Name WONG FLORIE Sex F DOB 02 17 2003 Provider 10 37760 dh Name MEXAL Place of Service 11 OFFICE x Outcome i Provider Claim kex iti SOSC C S Authorization e d Date Received 03 30 2010 The Provider Claim is an optional field If you utilize an internal patient number and would like this to appear on your RA Remittance Advice you can utilize this field to log the identifier Diagnosis Codes are entered into the Diagnosis Code field and can be searched similar to the Member and Provider search features T Claim Submission Microsoft Internet Explorer File Edit View Favorites Tools Help gt Back E2 2 Es if 2 Search gy Favorites A Ca i m Lal rel Address https ffEpawebe poqus comyseznet ClaimRequest asp hodeId LEVEL4 1 Log ctr AP FienbermID piWn eae HP GE a a H Site Disclaimer Name VVIOONG FLORIE Sex F DOB 02 17 2003 Administration CURIE i Provider Ip 327750 Ph Name MEAL Place of Service 11 OFFICE Ee Outcome 1 HOME 1 Provider Claim az Authorization th Date Received 0 sfso0 2o01 Diagnosis Diagnosis Code 60 9 dH c Add Oniy F diagnosis codes affowed umb ex Code escrip etree Once you have entered the diagnosis code you must select the ADD button to move the code into the claim Repeat this step for each diagnosis code supporting th
30. fier 2 None Selected Modifier 3 None Selected Modifier 4 None Selected Qty fi Diag Ref fi p Date Service From 03 30 2010 Time Service From 1030 for 10 30 AM Date Service To 03 30 2010 Time Service To 1520 for 3 20 PM Billed Charge o Add ype Ivice dl 4 i i te m Code f rom m To Ivice Service ervice Claim Notes Submit Request Clear Form Fields marked with are required fields 2007 MZI Healthcare All Rights Reserved System Availability transaction execution and response times may vary due to volume system erformance and other factors Technology provided by MZI Healthcare All Rights reserved id v EPOD dB ig nenet Pam EGO f MetaFrame Present C3 PCG ER i A Training Manual C i Claims Processing 5 4 Claim Submissio Fi Document Micros lt WV 10 19PM PCG Claim Processing System May 2010 Page 27 _ W PUBLIC Il CONSULTING GROUP Arizona Health Care Cost Containment System To begin the data entry of a particular claim you will need to enter in your member information If you have the proper Member ID you can data enter the ID into the HP Member ID field If you do not have the correct HP Member ID you can click the feature and this will open a searchable field zl Claim Submission Microsoft Internet Explorer File Edt View Favorites Tools Help Ges O ix 2 t9 rs OS a lg Address https tpawebt pcg
31. ligibility Authorizations Claims Claims Processing Access Batches Report Batches Submitter Services References Log Off Site Disclaimer Administration lt c gt lt P gt scHema m 4 X live Search ar dh v b Page Tools Subscriber ssn Patient 1p Member ID 2273451 36 Health Plan None Selected z Search Clear Close CONSULTING GROUP Provider tps tpawebt pcgus com eznet MemberCodeSearchErr asp Company AZTPARS 20100330151828700701 Diag Lines Billed Total OCHRIDGE 315 39 2 50 00 OCHRIDGE 315 39 2 50 00 OCHRIDGE 315 39 2 50 00 OCHRIDGE 315 39 2 50 00 OCHRIDGE 315 39 2 50 00 OCHRIDGE 315 39 2 50 00 OCHRIDGE 315 31 2 50 00 eee mdi uhr pir ESS ocuRince 315 39 2 50 00 INVALID DOB DETAILS FOR MEMBER iia LOGIESE SI A WR 20100330151828733702 INVALID DOB DETAILS FOR MEMBER 03 30 2010 LOCHRIDGE 315 39 2 Claims with errors 10 First Page 322 D P Sd Local intranet 100 7 In this example the DOB for Florie Wong is incorrect By clearing the DOB and searching for any members with the last name Wong the system returns the following results 50 00 20 500 00 ml PCG Claim Processing System May 2010 Page 21 W PUBLIC m Il CONSULTING GROUP Arizona Health Care Cost Containment System https tpawebt pcaus com eznet SearchResults asp Action tQuerytMap EZcap BatchError List Hml amp X Windows Inter
32. lth Care Cost Containment System Once the 837 file is created by the LEA or biller it can be uploaded directly into the web portal The user will select the Submitter Services option on the left hand side of the home page then select down window gt File Upload Successful Windows Internet Explorer hd e ey e https fezazweb pcgus com eznet ediuploadfile dll File Edit view Favorites Tools Help pdf Professional Claims then 837 File Upload Users will then select AZTPA from the companies drop E E search 01 7T por wa du File Upload Successful Y Home Providers Member Eligibility Authorizations Claims lalejx ar CP gt E dh Phe Ton Try another file Upload Attempt Claims Processing File Upload Successful Access Batches Report Batches Submitter Services Eligibility Inquiry Enrollment Status Claim Inquiry Institutional Claims Professional Claims 837 upload 837 download Ez Link Claim Upld 997 download Remittances 835 Auth Referrals References Log Off Site Disclaimer Administration ormance and other factors 2007 MZI Healthcare All Rights Reserved System Availability transaction execution and response times may vary due to volume system p Technology provided by MZI Healthcare All Rights reserved This Site Best Viewed with 1 P POP Local intranet Rio 7 d start eosudmo I Inbox Microso amp File Upload Su dE How do
33. me Providers Member Eligibility Authorizations Claims Claims Processing Submitter Services References Log Off Site Disclaimer Administration WE BP SPC Claims Processing Web Portal f B p dh ip Page gt ee Welcome PARADISE EZ NET VERSION 5 3 Presented By PUBLIC n CONSULTING fi GROUP This page has been visited 65 times 2007 MZI Healthcare All Rights Reserved System Availability transaction execution and response times may vary due to volume system performance and other factors Technology provided by MZI Healthcare All Rights reserved This Site Best Viewed vith EME PCG Claim Processing System May 2010 Page 6 CONSULTING GROUP Arizona Health Care Cost Containment System I PUBLIC SECTION II VIEWING MEMBER AND PROVIDER DATA The system provides the functionality of viewing the member and provider data that is uploaded from the AHCCCS system To view the provider data click on the Provider menu option on the left side menu of the home page Provider Search Windows Internet Explorer G X e https Jtpawebt pcgus com eznet ProviderSearch asp ModeId LEVEL 1 Y 4 X Live Search File Edit View Favorites Tools Help pdf gt E search 094 Ter we od Provider Search Be DECIDE Home Providers Member Eligibility Authorizations Provider Directory Search Claims Enter your search criteria below Any combinations ma
34. n Option Plan Option From Date hru Date _ Date company ID ID Panne eles a47945 138 wong FLORIE FCs 7 2003 ARIZONA HEALTH PLAN mra e 2003 Submitter Services Last Page References 1 Log Off Site Disclaimer Administration 2007 MZI Healthcare All Rights Reserved System Availability transaction execution and response times may vary due to volume system performance and other factors Technology provided by MZI Healthcare All Rights reserved w Microsoft i w This Site Best Viewed with li Explorer n EENEEEEEHNIEGHEEEEMEISEERUS The system will provide a list of results that match the search criteria entered You have the ability to verify the member data by comparing Member name Gender and Date of Birth Once you have narrowed your search you may access an individual member eligibility table select the appropriate Member ID PCG Claim Processing System May 2010 Page 10 i PUBLIC CONSULTING GROUP File Edt View Favorites Tools Help pdf j E search 4 por https tpawebt pcgus com eznet SearchResults asp Action Query amp Map Member Detail X MLMAP xml amp X5 Windows Internet Explorer e https Jtpawebt pcgus comj eznet SearchResults asp Action2Query amp Map Member Detail XMLMAP xml amp XSL Member Detail xsl amp Query P de e https tpawebt pcgus com eznet SearchResults as Home Providers Member Eligibility Authorizations Claims Claims Processing
35. net Explorer g EE j je x Qc lt C gt lt P gt 5CHEMA Y r x Live Search J re En M 00000 77x WE Be Ghttps iftpanebt Eligibility Member Search Results I gt e me Page To Memb rt clk for det Member Name Gen Birth Date Health Plan Name Company ID SubSSN A EZIN 447945136 WONG FLORIE F 02717 2003 ARIZONA HEALTH PLAN AZTPA Home Last Page Providers BE e https tpawebt pegus comjeznet _SearchResults asp Action Query amp Map E2cap_BatchError _List xmlexSL EZcap_BatchError List xsl amp Page 1 amp Query First Prev Next Last Member Eligibility Authorizations Claims Claims Processing Access Batches Report Batches Submitter Services rovider Diag Lines Billed Total References Log Off Site Disclaimer OCHRIDGE 315 39 2 50 00 Administration OCHRIDGE 315 39 2 50 00 OCHRIDGE 315 39 2 50 00 OCHRIDGE 315 39 2 50 00 OCHRIDGE 315 39 2 50 00 Back to Search OCHRIDGE 315 39 2 50 00 OCHRIDGE 315 31 2 50 00 https tpawebt pcgus com eznet Memberc ORSON tO SHIP PNET OIE amp J Local intranet CEA OCURIBGE aie a5 5 50 00 20100330151828700701 INVALID DOB DETAILS FOR MEMBER 03 30 2010 LOCHRIDGE 315 39 2 50 00 20100330151828733702 INVALID DOB DETAILS FOR MEMBER 03 30 2010 LOCHRIDGE 315 39 2 50 00 Claims with errors 10 20 500 00 First Page 12 zi SL II a The member is listed in the AHCCCS system with a DOB of 2 17 2003 To update the memb
36. pan the from date must be equal to or less than the to date All typical providers must submit their National Provider ID Per unit transportation services cannot exceed 2 units per day PCG Claim Processing System May 2010 Page 4 m PUBLIC CONSULTING GROUP SECTION I ACCESSING THE SYSTEM S Arizona Health Care Cost Containment System https tpaweb pcgus com eznet PCG Claims Processing Web Portal Windows Internet Explorer To access and login to the claim processing system go to the following link e https Jtpawebt pcgus com eznet File Edit View Favorites Tools Help pdf EJ search 74 T por WE die SPC Claims Processing Web Portal Home Providers Member Eliaibility Authorizations Rey x Live Search 2 Claims Processing Submitter Services A dh v c Page Tools Site Disclaimer Administration EZ NET VERSION 5 3 Presented By PUBLIC zl CONSULTING fi GROUP Agree performance and other factors 2007 MZI Healthcare All Rights Reserved System Availability transaction execution and response times may vary due to volume system Technology provided by MZI Healthcare All Rights reserved This Site Best Viewed vith Z YT Njwenee 8m 77 Select on the Agree button to access the login screen Please note that this URL is NOT the live production environment and will only be used for testing purposes Once each
37. rvices Reque Procedure Cod P5i tbawebt pcgus com eznet MemberCodeSearch asp Company AZTPABSV atta 8B Internet Modifier 1 None Selected Modifier 2 None Selected Modifier 3 None Selected z Modifier 4 None Selected Qty fi Diag Ref fi Rats Cnunirn Euer Inz73nz nin H CPieee Camuirn Cuns I LADDAD 2 40 00 ARAN zi TT T Bex start EGO gt g MetaFrame Present L PCG ven A Training Manual c E claims Processing 5 4 Claim Submissio 1 Document Micros PCG Claim Processing System May 2010 __ W PUBLIC I CONSULTING GROUP Arizona Health Care Cost Containment System Once the member search field populates you will have the ability to select the member by clicking the member hyperlink E Member Search Web Page Dialog Eligibility Member Search Results Member Member Name Gender Birth Date Health Plan Name Company ID 847945136 WONG FLORIE F 02 17 2003 ARIZONA HEALTH PLAN AZTPA Last Page First Prev Next Last Back to Search https tpawebt pegus com eznet MemberCodeSearch asp Company AZTPA amp SY atta 4B Internet You selection will auto populate the HP Member field Z Claim Submission Microsoft Internet Explorer File Edit View Favorites Tools Help Om O Fd Ol laa teem OG a ER LI Address e https tpawebt pcgus com eznet ClaimRequest asp NodeId LEVEL4 1 Home Providers Member Eligibility Authoriz
38. s eise Name MEXAL SANDRA K Class Log Off Practice Group ARIZONA COMMUNITY DEV CORP LA PALOMA Group ID 043617951 Zt d Street 15002 N 32ND ST Specialty Street 2 City State Zip PHOENIX AZ 85032 Contract Effective 3 10 2008 Phone 6028675135 Contract Term Fax Contact JIM DICELLO Health Plan Affiliations Office Locations 2007 MZI Healthcare All Rights Reserved System Availability transaction execution and response times may vary due to volume system performance and other factors Technology provided by MZI Healthcare All Rights reserved D A Inter Ej Enn This Site Best Viewed with l Doe a EEEE Po oaint Roo 7 The provider detail screen will display the provider ID group ID and contract effective and termination dates PCG Claim Processing System May 2010 Page 8 m PUBLIC I CONSULTING GROUP zl Arizona Health Care Cost Containment System To look up member eligibility information click on the Member Eligibility option on the left side of the screen S Eligibility Inquiry Windows Internet Explorer i laj x Gc v e https Jtpawebt pcgus com eznet EligibilitySearch asp NodeId LEVEL2 hd Rey x flive Search ng pdf Ege 4 T VE dw Elgibility Inquiry D D Page e Gi Tools Home Providers Member Eligibility Pn Ope a A TR TAS ART TION Enter your search criteria below Any combination may be used Claims Processing Submitter Services Comp
39. sited 65 times 2007 MZI Healthcare All Rights Reserved System Availability transaction execution and response times may vary due to volume system erformance and other factors Technology provided by MZI Healthcare All Rights reserved This Site Best Viewed with sj https tpawebt pcqus comfeznet ClaimRequest asp Nodeld LEVEL4_ 1 j mi Ii Ici iB Internet start e o s http nicholasacad 1 PCG VPN i Inbox Microsoft a Training Manual 27 Claims Processing 5 ex PCG Claims Proce Document1 Micros v Ww V 10 02 PM PCG Claim Processing System May 2010 Page 25 il PUBLIC CONSULTING GROUP and outcome code File Z Claim Submission Microsoft Internet Explorer Home Providers Member Eligibility Authorizations Claims Inquiry Arizona Health Care Cost Containment System Q O A ose vemm eic 2E J https tpawebt pcgus com eznet ClaimRequest asp NodeId LEVEL4 1 Submission Claims Processing Log Off Once you have selected submissions on the menu bar you will be directed to the data entry module Submitter Services References The first half the data entry form will default to the master record In this screen select the patient Edit View Favorites Tools Help Address Site Disclaimer Master Record Administration student provider qualified Medical provider or LEA for transportation claims POS plac
40. tch 202 EDI Claim 20100330151828450693 20100330151828467694 20100330151828500695 20100330151828530696 20100330151828577697 20100330151828607698 20100330151828640699 20100330151828670700 20100330151828700701 20100330151828733702 Member Name Sex SSN Dob Claim Date FLORIE WONG F 764 28 7642 02 17 2003 03 30 2010 INVALID DOB DETAILS FOR MEMBER INVALID DOB DETAILS FOR MEMBER INVALID DOB DETAILS FOR MEMBER INVALID DOB DETAILS FOR MEMBER INVALID DOB DETAILS FOR MEMBER INVALID DOB DETAILS FOR MEMBER INVALID DOB DETAILS FOR MEMBER INVALID DOB DETAILS FOR MEMBER INVALID DOB DETAILS FOR MEMBER INVALID DOB DETAILS FOR MEMBER Claims with errors PCG Claim Processing System May 2010 03 30 2010 03 30 2010 03 30 2010 03 30 2010 03 30 2010 03 30 2010 03 30 2010 03 30 2010 03 30 2010 10 First Page 2 Provider LOCHRIDGE LOCHRIDGE LOCHRIDGE LOCHRIDGE LOCHRIDGE LOCHRIDGE LOCHRIDGE LOCHRIDGE LOCHRIDGE LOCHRIDGE Diag 315 39 315 39 315 39 315 39 315 39 315 39 315 31 315 39 315 39 315 39 I amlelx s e A A dosage Gi Tools s Lines Billed Total 50 00 50 00 50 00 50 00 50 00 50 00 50 00 50 00 50 00 50 00 __ Wm PUBLIC Il CONSULTING GROUP Arizona Health Care Cost Containment System To see the detail of a claim error click on the description of the error A smaller screen will appe
41. the reason for failure within the specific format Claim files that pass the initial edit are loaded into the processing system e Once afile batch has been uploaded into the system and validated for syntactical errors the user must then Process the desired batch e The File is then checked for valid claim data valid AHCCCS member ID member DOB provider number etc e Clean claims are forwarded to AHCCCS for adjudication e Claims with errors are made available for review and correction e Claims that are corrected can be immediately reprocessed To gain access to the system users must apply for user names and passwords using the enrollment form provided by PCG For billers to have access to LEA specific claim data PCG must have a valid Biller Authorization form on file Users must then complete the PCG training course and complete the training certification form before they will be issued their user name and password LEAs using a biller can request view only access to the system and will be required to complete the training course and complete the training certification form as well Any questions or problems accessing the system or with claim data can be addressed to the PCG Helpdesk at 1 877 877 8011 or by contacting your assigned account manager PCG Claim Processing System May 2010 Page 3 PUBLIC m Il CONSULTING GROUP Arizona Health Care Cost Containment System SECTION I GENERAL CLAIM EDITS The list below indic
42. thorizations Claims Company ID AZTPA ARIZONA TPA z Inquiry Submission Master Record Claims Processing end A Request Date 03 30 2010 Units 1 Log Off HP Member ID amp HP EE B Member Search Web Page Dialog Enter your search criteria below Any combination may be used Last Name wong First Name ffl Member 1D Health Plan None Selected Search Clear Close Service Procedi Modifie Modifie Modifie Modifie Qty f Mata Cr xj LTT TTT TTT LE GNE OOB Ene are start e eo gt e MetaFrame Present L PCG YPN Training Manual C E Claims Processing 5 amp Claim Submissio en Document1 Micros ig W V2 10 34 PM Claim Submission Microsoft Internet Explorer f aj x File Edit View Favorites Tools Help ay Q O A Oph x m O 2 J0 amp 8 Address amp https tpawebt pcqus com eznet ClaimRequest asp Nodeld LEVEL4_1 ha Eo Links Home Providers mem 0 2 Member Search Web Page Dialog A Member Eligibility Authorizations Duc ciais Eligibility Member Search Results nquiry Submission Master Record Member Member Name Gender Birth Date Health Plan Name Company ID Claims Processing 547945136 WONG FLORIE IF n2 17 2003 ARIZONA HEALTH PLAN AZTPA Submitter Services References Last Page Log Off First Prev Next Last Site iv Administration Diagnosis Diagnosis Code umber lt 7 Back to Search Se
43. tps tpawebt pcgus com eznet EZCAP BatchQueue asp Action2Query amp Map ezcap batchclaims search xml amp xSL ezcap BatchQueue xsl amp BID amp Page 1 Y ri 47 x Live Search A A ab lP O Toos Home Providers Member Eligibility Authorizations Batch Queue Submissions Claims z Claims Processing Process Re Process Delete Submitter Batch Date Database Status Total Processing Posted Processing Uploaded Name Claims Errors Claims Count Access Batches Report Batches Submitter Services r PAR000002 19020100222 EZCAP g 1 7 o References with errors Log Off Vv T PAR000002 19220100222 EZCAP Editing Done 573 149 424 0 Site Disclaimer Processing Complete Administration m PAR000002 197 20100226 EZCAP sieg p 577 142 435 0 with errors n PAR000002 198 20100302 EZCAP Processing Complete 449 43 69 0 with errors n PAR000002 19920100302 EZCAP Processing Complete 480 43 137 0 with errors Submit Updates Last Page 1 ha Done P POP M Local intranet 4 100 7 After all errors are corrected the user can go back to the Access Batches screen and will have the option of processing or re processing the claim batch which will indicate that is has been corrected by changing the status to Editing Done To process ONLY the claims that have been corrected and updated select the Process button and click on the Submit Updates button To re process the ENTIRE
44. us com eznet ClaimRequest asp NodeId LEVEL4 1 Home Providers Member Eligibility n Claim Submission Entry Authorizations Company ID AZTPA ARIZONA TPA z Claims Inquiry Submission Master Record Claims Processing Submitter Services Request Date 03 010 Units References a mm BS Log Off HP Member ID amp np Site Disclaimer Administration 3 Member Search Web Page Dialog Last Name First Name Member 1p Health Plan None Selected z Search Clear Close Service Procedi Modifie Modifie Modifie Modifie Qty 1 Mats C E hitos itoawebt ocaus comleznet MemberCodeSearch aso Comoanv AZTPARSV atta AB Internet I T T By ap tnternet ds EGO MetaFrame Present PCG VPN lig A Training Manual c E Claims Processing 5 Claim Submissio Document Micros lt 99 W VE 10 33 Pm PCG Claim Processing System May 2010 Page 28 m PUBLIC CONSULTING GROUP Arizona Health Care Cost Containment System You can know search your patient by first and last name In this case we will enter Wong Florie and select the search feature Claim Submission Microsoft Internet Explorer File Edit View Favorites Tools Help Q O x 2 D P9 mm O S Ea Address https tpawebt pcgus com eznet ClaimRequest asp NodeId LEVEL4 1 PS Home Providers Member Eligibility a Au
45. with errors the number of providers in the batch and the number of members in the batch The batch can be viewed in different ways by using the drop down menu The following pages are screen shots and information on each of the Available Reports in the drop down menu PCG Claim Processing System May 2010 Page 17 m PUBLIC CONSULTING E M U eo oe NS sna nenten core con cate spe he amp 4 x Live Search ag e BD r page G Toos Home Providers Batch by Provider Summary report Received 02 22 2010 Member Eligibility 135 Providers Found in This Batch Processed 02 22 2010 Authorizations Claims Submitter PAR000002 Batch 192 Claims Processing Access Batches Rennt Batches Provider Claim Count Detail Count Billed Total Submitter Services References MATTSON 006692 AZTPA 2 43 415 00 Bi mn CALA 019136 AZTPA 2 54 844 00 MEL tasted CORDARO 022042 AZTPA 2 14 60 00 ANDERSEN 049131 AZTPA 3 5 290 00 CASTRONOVA 061922 AZTPA 2 44 795 00 FLORENTINE 089544 AZTPA 4 25 716 00 CECCARDI 122041 AZTPA 1 18 72 00 WALLS 122140 AZTPA 7 1i 610 00 WALLACE 122179 AZTPA 1 17 289 00 PILLINGER 122609 AZTPA 1 18 432 00 ADDINK 148512 AZTPA 1 49 520 00 HUFF 152525 AZTPA 1 17 373 00 PROUTY 157414 AZTPA 1 10 125 00 STANKOVIC 159221 AZTPA 9 63 1 369 00 SWETT 174590 AZTPA 1 9 237 00 FROST 176838 AZTPA 6 138 2 1
46. y be selected Claims Processing Submitter Services References Company ID Al Companies x Loa Off Site Disclaimer Provider ID nema tan Last Group Name Mexal First Name Specialty NONE SELECTED City zp Clear Sort by Provider Name 2007 MZI Healthcare All Rights Reserved System Availability transaction execution and response times may vary due to volume system performance and other factors Technology provided by MZI Healthcare All Rights reserved This Site Best Viewed vith mS wi SS III Ee In the company ID field choose AZTPA from the drop down menu To search for a provider enter the provider ID the last name first name specialty city or zip Once the information has been entered click on the search button The system will search based on the criteria entered and provide a list of all entries that match your selection criteria Next click on the provider last name to view the provider detail screen PCG Claim Processing System May 2010 Page 7 m PUBLIC CONSULTING il Ul GROUP Arizona Health Care Cost Containment System Provider Search Results Windows Internet Explorer l xj Go gt https tpawebt pcqus com eznet _SearchResults asp Action Query amp Map Provider_Search_XMLMAP xml amp XSL Provider_Search xsl amp Page 1 m a x ue Search p File Edit View Favorites Tools Help pdf E search 4 por w k Provider Search Results e

Claims Processing System User Manual May 2010

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