EDI Claims Link for Windows® User`s Manual
Contents
1. May 2007 ValueOptions Inc Version 3 1 11 Adding a Patient to the Patient Database EDI Claims Link for Windows User s Manual 1 From the Main Screen click Tools and then click Patient Data Maintenance or click Add Patient under the EDI Claims Link Tasks to go directly to the Patient Maintenance Screen Step 3 EDI Claims Link 3 Batch Browse go File Edit View H Institution E EA 837 Professiot Window Help Reference Data Maintenance Patient Data Maintenance Provider Data Maintenance Submitter Data Maintenance View Application Event Log Options Add Batch Add Claim Add Patient Add Provider Batches 837i Institutional Batch 1 Batches 6837p Professional Batch 1 Professional Batch 2 Generated Claim Files 210303191534 bet 8397p 2 If you clicked Patient Maintenance located under Tools The Patient List screen displays Click Add Patient located under the Patient List screen or click ADD Patient located under the EDI Claims Link Tasks pane EDI Claims Link 3 Table Maintenance gS File Edit View Tools Window Help Patients Providers Submitters Reference Data Patient Last Add Patient Johnson Man Schmo May 2007 ValueOptions Inc Patient First 2 14 1980 32171986 3111970 al Patient DOB EDI Claims Link Tasks Tasks Add Batch Add Claim Add Patient Add Provider Batches 837i Institutional Batch2. 1 Click on Add Batch link on the Task Pane on the right side of the window The Add Batch Window displays L EDI Claims Link 3 Batch Browse E File Edt 837 Institutional 837 Professional Batches EDI Claims Link Tasks E 237 Professional Tasks Add Batch Add Claim Add Patient Enter information pertaining to this batch and then click OK when you are Add Provider finished First select the form type of the batch vou are adding Form Type 837 Professional T Next enter a name for the batch you are adding Batch Name 2 Form Type Select whether you are creating an Instituitonal or Professional batch 3 Type an identifying name for the batch The Batch Name can be a combination of alpha and numeric characters and should be something that provides easy identification of the batch A batch consists of any number of claims for any number of providers 4 Click OK May 2007 ValueOptions Inc Version 3 1 17 EDI Claims Link for Windows User s Manual The Batch Name is now displayed on the left side of the Batch Browse Window and under the appropriate claim type on the right side EDI Claims Link 3 Batch Browse go File Edit View Tools Window Help H A 837 Institutional 837 Professional Batches EDI Claims Link Tasks saa O32803HCFA H Professional Batch 1 Add Batch H Professional Batch 2 Add Claim Batch Name Create gt Add Patient 032
3. AS15154 ted 9537p May 2007 ValueOptions Inc Version 3 1 EDI Claims Link for Windows User s Manual About the EDI Claims Link for Windows Application The EDI Claims Link for Windows ECLW application uses a series of screens or windows with boxes or fields in which data is entered The fields may be required must have data entered in it optional can have data entered in it or protected only displays data Note The general rule for entering claims is to enter the same information you included on the paper forms that ensured claims payment by Va lueOptions New and current providers should consult the ValueOptions Provider Manual for specific claims submission instructions and or contact your local ValueOptions Service Center o Help Icon appears by any missing information or incorrect entry To view the message hover the cursor over the icon The lt TAB gt key is used to move from field to field Pressing the lt SHIFT gt and lt TAB gt keys at the same time moves the cursor back to the previous field Many of the fields have drop down reference boxes Clicking on the arrow at the end of the field displays a list of valid entries Selecting the appropriate choice by highlighting it places the text in the field Clicking the down arrow adjacent to the date field displays a Calendar to assist in selecting the appropriate date You can also type the date in Sun Mon Tue Wed Thu Fri Sl the date field
4. Enter your Submitter Information to begin using EDI Claims Link JG Fro vid er May 2007 ValueOptions Inc Version 3 1 EDI Claims Link for Windows User s Manual Identifying and Adding the Submitter A submitter is the individual or billing agent assigned by the Service Provider to prepare and submit claims on their behalf Note Visit www valueoptions com providers htm for instructions on obtaining Submitter ID s from ValueOptions 1 From the Main Screen click Tools and then click Submitter Data Maintenance EDI Claims Link 3 Table Maintenance go File Edit View reece Window Help qe 3 Reference Data Maintenance EDI Claims Link Tasks a Patient Data Maintenance er Name Tasks Patients i Providers F Provider Data Maintenance Add Batch bp Pe ae ees ee ee M ai aoe Add Claim A Reer Submitter Data Maintenance pes atlent View Application Event Log Add Provider Options Batches 837i Institutional Batch 1 Batches 837p Professional Balls 1 Professional Batch 2 Generated Claim Files 200303191534 bt 6837p 2 The Submitter List screen displays Click Add Submitter EDI Claims Link 3 Table Maintenance gl File Edit View Tools Window Help Yoo e ey EDI Claims Link Tasks Patients Submitter ID Submitter Name Tasks i Prowiders Add Submitter Ei Add Batch 2 Ra Add Claim Reference Data E ca Add Patient A Add Provider Batches 8371
5. Institutional Batch 1 May 2007 ValueOptions Inc Version 3 1 EDI Claims Link for Windows User s Manual 3 The Submitter Maintenance Screen displays Submitter Maintenance Submitter ID 123456789 Password rrF Confirm Password a Submitter Hame Doe Jane Contact Smith cara Phone 757 459 5200 4 Type the Submitter ID issued by Va lueOptions This Submitter ID is obtained by sending in the application found on the provider web page If you have questions about obtaining an identification number please call the EDI Helpdesk at the number listed in the Whom to Call for Help Information section of this manual 5 Type the Submitter s password and then type it again in the Confirm Password field 6 Enter the submitter name 7 Assign a contact person and enter his her name 8 Enter the contact person s telephone number 9 Click OK The name of the Submitter displays in the Submitter List window ED Clann Link J Table Maintenance is Ble Edi Her Jools kirdi Hap EDI Chains Link Tasks Sbmttar Ib Suibmitber hemn Tasks MM add patch add aim Admiccion Source B Add Patient Admission Typs a Odd Prenner Ea Csai ations aim Fing nior Hatches aani K Tam Fruer rsttubonal Beech J a nn Pachty Tps Har Codes May 2007 ValueOptions Inc Version 3 1 EDI Claims Link for Windows User s Manual Adding a Provider to the Provider Database 1 From
6. Version 3 1 EDI Claims Link for Windows User s Manual 3 The Provider Maintenance Screen displays Provider Maintenance Provider Detak Record ype BillingPap to Provider Name Last or Orgi Provider Name First Wl ohm Address 1201 Healthcare Wap 0 City State Zip Norfolk Wa l 23502 Contact Hame lane Contact 0 Phone 757 555 1234 0 Fax 757 555 4321 ldentification Numbers Provider ID Social Security Humber 555123456 HFI 9876543210 ValueUptions Practice Ag54321 l Location Yerndor H eit R754 State License ir Medicaid P Faciliy Identifier pe Taxonomy Code Sy Taxonomy Code Required Demographics 4 Record type Select the type of provider record you are creating Most will be Billing Pay To but depending on how you submit your claims you may also need to create Rendering Provider Records as well 5 Type the Provider last name or the Organization name 6 Enter the Provider s first name and middle initial 7 Enter the Provider s street address 8 Type the Provider s City State and Zip Code 9 Type the name of the office contact person 10 Type the Provider s office phone number 11 Enter the Provider s fax phone number Identification Numbers 12 Select the type of Provider ID number used Employer Identification Number or the Provider s security Social Number from the drop down menu in the Provider ID box Type the appropriate ID number in the unlabele
7. 032103HCFA o hag Smith Group i Total Amount 760 00 Professional Batch 2 Provider ID city Smith Group 23456756 1111 2 From the File menu select Create EDI Claim File or click the Generate Claims File link located at the top of the window SEDI Claims Link 3 Batch Br EDI Claims Link 3 Batch Browse aG File Edit View Tools Wind Ee pE fat Wen Teese Onder here New Batch Ctrl Shil a Hd 937 Institutional Batch 032103HCFA 837p 837 Professional Create EDI Claim Fie 2032 103HCFA Mew Claim Ctrl Shil Claims 2 Service Lines T view EDI Claim File r Smith Group Total Amount 260 00 Fe Professional Batch 1 Reopen Batch i a see Professional Batch 2 Provider ID Print Batch Smith Group 123456756 Close Import Data Export Data Exit May 2007 ValueOptions Inc Version 3 1 _29 EDI Claims Link for Windows User s Manual The Create EDI Claim File dialog box displays Batch Claim File Wizard File Information Select a file name and a usage indicator for this batch claims file When you are finished click the Next gt button below Select a file name for the claims file that will be generated A name has been suggested for the file but you may modify the name as you desire IE ED Claims Link 3 200303311452 tt all Select the usage of this file whether it will be submitted for Production or Test use Production 3 The path where the claims
8. 4 oe 7 E l F E T Loo E Procedure Codes 17 17800 5 l 17 17800 Frincipal ga iaae r zi o mem 7 uN F a a s a a c se ae ae ano a Bill Details gl z al al 10 Type of Facility Y Attending Physician Admission Bill Classifications Name Last Date Frequency First Ml W Hour MFI Provider ID Type Claim Submitter s Identifier 2007041 107204 a a Source Claim Taxonomy State License Attachment Informaton O Medicaid ID Discharge Hour ka Attachment Type Patent Status Fan E Admitting Diaanosis Neale a Control Number External Cause of Injury Original Ref The following minimum information is required Statement covers dates The entire date range for this claim covering every service line Diagnosis Codes The Principal Code is required the rest are as needed for the claim Bill Details Select the Type of Facility Bill Classification and Frequency for this particular claim May 2007 ValueOptions Inc Version 3 1 26 EDI Claims Link for Windows User s Manual Click on the Claim Details tab 837 Institutional Claim Patient John ee Save ab Close Provider Patient Claim Claim Details Claim Details Revenue Code Procedure Mod 1 Mod2 Moda Mod4 Fate Service From Service To Units Charges Non Covered 7142006 31 2006 This is where you will e
9. Patients Providers gt Submitters Reference Data Admission Source Admission Type Attachment Report Type Attachment Transmission Coda Bill Classifications Qaim Filing Indicator Condition Hour Codes Insurance Type Medicare Assignment Codes Occurence Decurence Span Fatient Signature Source Fatient Status Place of Service Provider ID Type Relalivriship Release of Information Sex Specialties Taxonomy Codes States Add Value Clinic Referral Court Law Enforcement Emergency Room HMO Referal Infomation Unavailable Transfer from a Hospital Transfer from a SNF Transfer from another Health Care Facil tem Value EDI Claims Link Tasks Tasks Add Batch Add Claim Add Patient Add Provider Batches 837i Institutional Batch 1 Batches 837p Professional Batch 1 Professional Batch 2 Generated Claim Files 200303191534 bt 83 7p 3 Enter the appropriate item description and item value Refer to the HIPAA Companion Guide for help with this information Reference Maintenance 4 Click OK The new value displays in the Reference Value Window EDI Claims Link 3 Table Maintenance go File Edit View Tools Window Help Me l 1 p Patients Providers Submitters H Reference Data i Admission Source Admission Type Attachment Report Type Attachment Transmission Code Bill Classifications Claim Filing Indicator Condition Hour Codes Add V
10. Version 3 1 EDI Claims Link for Windows User s Manual 3 The Patient Maintenance Screen displays Patient Maintenance Patient Detak Name Last First Mi E Fatient ID e E Address o Date of Birth 1711800 7 See a O Primary Subscriber Secondary Subscriber Tertiary Subecnber Subscriber i Patient Patent Relationshix Subscriber ID Group Mame Name Last First Ml ge Group Number areas ss Paver Name Valued pions Inc _ lt SS Paver ID FHC tAftliates City State Zip o CO Release of Information Assignment of Benefits Date of Birth 1 171800 i Sex Patient Signature Source Claim Filing Indicator 4 Enter the patient s demographics and Patient ID number Note The Date of Birth field must be in MMDDCCYY format e g 01 01 2000 5 If the patient is also the subscriber or primary insured click the box next to Subscriber is Patient This wil prefill most of the lower section 6 Type the Subscriber s ID Number 7 Enter Group Number if needed by the appropriate carrier requirements 8 The Payer Name and Payer ID should be pre entered Do not change these values 9 Select the appropriate answer from the drop down box for the Release of Information 10 Select the appropriate answer from the drop down box for the Assignment of Benefits if necessary to change to YES 11 Select the appropriate statement from the drop down box for the Patient Sig
11. for Windows User s Manual How to Print a Claim Once you have created a claim you can print a copy of the claim for your records Note You can also print claims that you previously entered Refer to Reviewing and Editing Previously Entered Claims for details on displaying these claims 1 With the appropriate claim displayed on the screen click the printer icon 2 The claim displays in a printable format Click on File then Print to send the claim to the appropriate printer a 63 7 Professional Claim Microsoft Internet Explorer provided by ValueOptions Inc Seles ay Cs tec gt x 2 fi Search 5 2 Favorites GP media G4 62 te Ky J3 Address C Program Files ValueOptions EDI Claims Link 3 837p Claim him E co Links Customize Links Free Hotmail Search E Skins Web z 837 Professional Claim Provider Name First Last MI Provider John Q Contact Name Jane Contact Address 1201 Healthcare Way Phone 757 555 1234 City State Zip Norfolk VA 23502 Fax 757 555 4321 Specialty Psychiatric Mental Health Child amp Family Provider ID 555123456 Provider ID Type Social Security Number VO Provider 555123456 chil tale RDE 555123456001 Location Vendor Medicaid Pa tient Name First Last MI Patient John Q Patient ID Address 2211 Eastside Dr Date of Birth 3 13 1959 Sex Male City State Zip Norfolk VA 23502 Account 12345789 E Done May 2007 Value
12. or discrepancies with the data you have entered the icon will appear May 2007 ValueOptions Inc Version 3 1 24 EDI Claims Link for Windows User s Manual Click the Close button The claim is saved and assigned a sequential number that is displayed in the Batch Browse Window The Add Claim Wizard displays to add another claim click Add Another Claim and repeat the above steps If not click Finish Add Claim Wizard Finished You have successfully added a claim to EDI Claims Link 1 Your claim has been successfully added to the system If you have more claims to add click the Add Another Claim button to restart this wizard otherwise click the Finish button to return to ED Claims Link IMPORTANT The instructions above contain the minimal information necessary for verification and acceptance of the claim into the Va ueOptions Claims Processing systems It does not imply nor guarantee payment of the claim Information on required data elements for a particular contract can be found in the Claims Submission Manual May 2007 ValueOptions Inc Version 3 1 25 EDI Claims Link for Windows User s Manual If you are creating an Institutional Claim 837i batch Click on the Claim Tab 837 Institutional Claim ALEMAN TIMOTHY SEE fou es Save ab Close Provider Fatient m Details Statement Covers r Diagnosis Codes From q7 171800 r To q7 171800 Principal 1 2 a
13. put that batch off for later or start a new batch You can build a batch all at once or over the course of a week or month then submit the batch whenever you are ready The basic steps required to enter a claim in the EDI Claims Link for Windows application are outlined in the graphic below More detailed information for each step can be found on the following pages of this manual Creating and naming a professional or instiutional batch Creating a claim Selecting the correct provider and member for the specific claim Entering the claim details Save the claim Starting the next claim if needed Generating the 837 claim file Institutional or Professional batch If you usually submit paper claims on the HCFA 1500 form you will create a Professional batch If you usually submit paper claims on the UB92 form you will create an Institutional batch Professional and Institutional claims cannot be together in the same batches If your practice has to submit both types the claims must be separate batches based on type A batch may contain claims for multiple providers and multiple patients What is an 837 file The HIPAA 837 file is the industry standard format for electronic claims submission Since institutional and professional batch need to be separate we may refer to an 837i or 837p file May 2007 ValueOptions Inc Version 3 1 16 EDI Claims Link for Windows User s Manual Adding a Claims Batch
14. to the Batch Name on the Batch Browse Window changes from an open brief case to a closed brief case indicating that an EDI claim file has been generated for this batch If a file has been created for a batch and you want to access that batch to adjust information you need to reopen the batch make your changes and create a new batch file May 2007 ValueOptions Inc Version 3 1 31 2 EDI Claims Link for Windows User s Manual Reviewing and Editing Previously Entered Claims Highlight the Batch Name on the left side of the Batch Browse Window or double click the batch name in the Batch window on the right hand side Batch Manualdisplay 837p Reopen Batch Claims 1 Provider Count 1 Service Lines 1 File Created Date 08 01 2006 12 25 Total Amount 100 00 ProviderID City State o O Add Provider Provider John 555123456 Norfolk YA If you just need to review and read a claim you can double click on the provider name and the patient name If you need to make any changes to any claims click on the link that now says Reopen Batch This link will change to Generate Claim File Don t click again on Generate Claim File yet You can now go into the batch make the appropriate changes to existing claims add new claims or delete existing claims You can then generate a new claim file as described in the preceding section May 2007 ValueOptions Inc Version 3 1 39 EDI Claims Link
15. 32803HCFA May 2007 ValueOptions Inc Version 3 1 19 EDI Claims Link for Windows User s Manual 3 Select the correct form type and select an existing batch name or add a new batch name and click Next 4 The Add Claim Wizard continues select an existing provider and patient from the drop down boxes then click Next Add Claim Wizard Claim Infonmaton fo Enter information relating to the provider and patient that this claim X applies to Once you are finished click the Next button Select the provider that this claim applies to Hf the provider is not included in the list click the Add button and enter the information required to add this provider Provider John Select the patient that this claim is for f the patient is not included in the list click the Add button and enter the information required to add this patient Patient John May 2007 ValueOptions Inc Version 3 1 _ 20 EDI Claims Link for Windows User s Manual 5 The Claim Entry window displays the Provider information It is automatically populated with information contained in the Provider database Verify all information is accurate If it is not you can close the claim without saving go to the Provider Maintenance section and correct the provider record Then start the Add Claim procedure again amp EDI Claims Link 3 837 Professional Claim Patient John EE File Edit View Tools Window Help S gave a
16. 803HCFA Sidi 3 28 2003 sel it hs hod Professional Batch 1 Open 3 26 2003 Professionad Batch 2 mienen 3 11 2003 Babda Institutional Batch 1 Batches 837p 0327803HCFA Professional Batch 1 Professional Batch 2 Generated Claim Files 200303191534 bt 83 7p May 2007 ValueOptions Inc Version 3 1 _18 EDI Claims Link for Windows User s Manual 1 Highlight the Batch Name on the left side of the Batch Browse Window EDI Claims Link 3 Batch Browse gol File Edit View Tools Window BSE H A 37 Institutional Batch 032803HCFA 837p Generate Claim File EDI Claims Link Tasks zal 837 Professional 3 pees Be Provider Count 1 Tasks SE 032803HCFA ee ai ai F Provider John SET mae n Ej Add Batch H Professional Batch 1 z l Add Claim w Professional Batch 2 Provi Provider ID__ City Add Patient Tiaka E Add Provider Batches 837i Institutional Batch 1 2 Click on File then New Claim on the menu bar at the top of the window or click the Add Claim link on the Task Pane on the right side of the window The Add Claim Wizard displays Add Claim Wizard Batch Infonmabon Enter information about the batch you are adding this claim to Once you are finished entering information click the Next button First select the form type of the claim you are adding Form ype amp 37 Professicnal Next either select an existing batch to add this clain to or enter a new name 0
17. 837 Institutional 837 Institutional Batches EDI Claims Link Tasks ieee a 1 Open Batches 1 Open Claims Tasks a Paneer Sent Batches g Sent Claims Kid Bdr Add Claim Add Patient Add Batch Add Provider Institutional Batch 1 Generated Claim Files 210303191534 bt 8397p If your screen is missing any of the fields shown above click on the View menu at the top and make sure there is a checkmark next to both Batch Browse and Task Pane The left side of the Batch Browse Window is the Treeview showing the hierarchy of claims and batches The two form types Institutional and Professional are the top level batches for each form are on the next level and providers are the third level within the hierarchy Individual claims are listed under each provider Selecting an item by clicking on it in the Treeview opens it and displays all the items under it in the Listview on the right side of the window Double clicking a claim item in the Listview opens the Claim Entry window Expanding an item clicking on the sign in front of it or double clicking it in the Treeview lists all items under it in the Treeview section May 2007 ValueOptions Inc Version 3 1 _15 EDI Claims Link for Windows User s Manual Getting started with creating a batch and adding a claim One great feature is the ability to go back and forth between open batches You can start one batch now create a few claims then
18. EDI Claims Link for Windows User s Manual N VALUEOPTIONS utting People First EDI Claims Link for Windowse Version 3 1 User s Manual May 2007 May 2007 ValueOptions Inc Version 3 1 _l EDI Claims Link for Windows User s Manual TABLE OF CONTENTS Overview EDI Claims Link for Windows Application 4 About the EDI Claims Link for Windows Application 5 How to log into EDI Claims Link for Windows 6 Identifying and Adding the Submitter T Adding a Provider to the Provider Database 9 Adding a Patient to the Patient Database 12 The Batch Browse Window 15 Getting started with creating a batch and adding a claim 16 Adding a claims batch Selecting a provider and patient 17 If you are creating a Professional 837p batch 23 oe If you are creating an Institutional 837i batch 26 Generating and Sending an 837 EDI Claim File 29 Reviewing and Editing Previously Entered Claims 32 How to print a claim 33 APPENDIX Adding a Reference to the Reference Database 34 How to use a Dial Up Connection for 837 file submission 36 Help and Information Contact 37 May 2007 ValueOptions Inc Version 3 1 EDI Claims Link for Windows User s Manual The information in this document is furnished for informational use only Changes are periodically made to the information in this book these changes will be incorporated in new editions of this publication ValueOptions may make improvements and or changes in the product an
19. Options Inc Version 3 1 mee EDI Claims Link for Windows User s Manual APPENDIX Adding a Reference to the Reference Database Reference data from the Reference Databases appear throughout the application The item description and values are defined in the HIPAA Companion Guide You may add delete or update item descriptions and values for any of the reference databases Warning lf you add or change an item description or value and make it a non compliant HIPAA value one not listed in the HIPAA Companion Guide or a value that ValueOptions does not accept any claim with the non compliant value may not process correctly 1 From the Main Screen click Tools and then click Reference Data Maintenance EDI Claims Link 3 Batch Browse Window Help Reference Data Maintenance ih EDI Claims Link Tasks Institution cg Patient Data Maintenance Tasks 837 Professio Provider Data Maintenance Add Batch Submitter Data Maintenance Add Claim Add Patient View Application Event Log cia SA n Add Provider Diti 3 11 2003 Batches 8371 Institutional Batch 1 Generated Claim Files 200303191534 bet 837p May 2007 ValueOptions Inc Version 3 1 _ 34 EDI Claims Link for Windows User s Manual 2 The Reference List screen displays Click the appropriate Reference Data then click Add Value Hl EDI Claims Link 3 Table Maintenance gi File Edit View Tools Window Help Ha
20. alue Clinic Referral Court Law Enforcement Emergency Room HMO Referral Information Unavailable Physician Referral Transfer from a Hospital Transfer from a SNF Transfer fram another Health Care Facil May 2007 ValueOptions Inc ter Value 35 Seis ox EDI Claims Link Tasks Tasks fel Add Batch Add Claim Add Patient Add Provider Batches 837i Institutional Batch 1 Version 3 1 EDI Claims Link for Windows User s Manual How to use a Dial Up Connection for 837 file submission If you do not have access to the Internet you may need to use a modem to transmit your claims Many versions come with HyperTerminal which ccn be used for dialup connection If you have other connectivity software please refer to the manual for that software for configuration instructions The toll free dial in number is 888 685 2595 1 Generate an 837 as described in preceding sections of this manual 2 Connect to the Va ueOptions BBS with your dial in software 3 Upon connection to the BBS enter your user name Submitter ID and password when prompted 4 You ll see a Check for Mail prompt Press lt ENTER gt to bypass or type R to read the message 5 At the Main Menu type E E Upload an EDI File to upload your EDI file 6 Select the Type of Claim 837p or 8371 7 Enter the Number of Claims 8 Enter the Total Dollar Amount including decimal point Verify your entries and Type Y i
21. b Close Provider Patient Claim Claim Details Billing Provider D etak Hame Last or Oral RENEE Name First MIL John E Address 1201 Healthcare Yay City State Zir Norfolk WA 23502 Contact Hame Jane Contact Phone 757 555 1234 Fax 757 R55 4321 Identification Numbers Provider ID Social Security Number 5551 23456 MPI 9876543210 Valuel ptions 87654 Yalue ptione Practice Besan Provider H Jo7bo4 Location Yendor H Abata Medicaid May 2007 ValueOptions Inc Version 3 1 2 EDI Claims Link for Windows User s Manual Click on the Patient tab to review that information is accurate as well If it is not you can close the claim without saving go to the Patient Maintenance section and correct the provider record Then start the Add Claim procedure again 837 Professional Claim Patient John Save a Close Patent D etak Hame Last First Hil Patient Joha E Patient ID 123456789 0 Address 1212 Suburb Steet Date of Birth 2071960 Sex Mae City State Zim Anywhere Aw 38983 Primary Subscriber Secondary Subscriber Tertiary Subscriber Subscriber it Patient y Patient Relationship Subscriber ID Group Name Name Last First Ml a Group Number Address 1212 Suburb Street Payer Hame ValueQ ptions Inc S Payer ID FHC Affiliates City State Zip Anywhere va Fn Release of Informatio Appropriate Release of I
22. batch files are stored is defaulted by using the File Name Link We recommend keeping the default path and filename but you can change it if you like 4 Usage Leave this at Production if even you are doing a test batch If you are unsure if your account is in test or production mode please contact the EDI Helpdesk 5 Click Next The Batch Claim File Wizard will calculate the values in the batch The following screen will appear We highly recommend writing down the complete File Name Total of claims and Total Amount You will need this information when visiting the EDI Website Batch Claim File Wizard Finished a Your batch claims file has been successtully generated 3 A batch claims tile has been generated using the options you selected in this wizard File Name C Program Files ValueOptrons ED Claims Link 3400303311452 bet Total Claims 1 Total Amount 700 00 The file that was generated can be submitted to ValueOptons for electronic processing If you would like to submit this file follow these steps 1 Visit the www valueoptions com website 2 Follow the link marked For Providers 3 Sign in with your ValueOptions Submitter ID and Password ae Ce May 2007 ValueOptions Inc Version 3 1 _ 30 EDI Claims Link for Windows User s Manual The EDI Claims Link file is created You can either click on Finish or click the link to be taken to the ValueOptions website Note The symbol next
23. d box next to the right of Provider ID 13 Enter your National Provider ID NPI number into the NPI field 14 Optional Enter the ValueOptions assigned Vendor number into the labeled field May 2007 ValueOptions Inc Version 3 1 10 EDI Claims Link for Windows User s Manual 15 Optional Type the Providers Va ueOptions assigned number in the ValueOptions Provider field 16 Optional Type the Provider s Medicaid number if applicable 17 Type the Taxonomy Code if applicable 18 Click OK The name of the Provider displays in the Provider List window Note Contact your Provider Relations representative if you have questions regarding the appropriate information for these fields EDI Claims Link 3 Table Maintenance gS File Edit View Tools Window Help Ta m Mk EDI Claims Link Tasks Patients Provider First Provider ID City Tasks Providers Add Prowider isa Add Batch Submitters A Place 14 5151511 Some City Add Claim Reference Data Provider 555123456 Nofolk tS age The Happy Place 14 1414555 Happy Town i Add Patient Add Provider Batches 837i Institutional Batch 1 HINT If you have to create multiple provider records you can put additional notes in the last name field to help you identify the different records Examples Record 1 Lastname Smith Metropolos Record 2 Lastname Smith Gotham This way you will be able to see the details for the provider as you build the claim
24. d or program described in this publication at any time without notice 2003 2006 2007 ValueOptions Inc 240 Corporate Blvd Norfolk VA 23502 All Rights Reserved Printed in the USA DISCLAIMER The names of persons appearing in the examples used in this documentation are intentionally fictional Help and Information Contact If you have any questions about the EDI Claims Link for Windows application please contact ValueOptions EDI Helpdesk PO Box 1287 Latham NY 12110 Phone 888 247 9311 Hours 8 00 AM to 6 00 PM Eastern Time Monday through Friday Fax 866 698 6032 Email address e supportServices valueoptions com Not available during the following observed Holidays New Years Day Memorial Day Independence Day Labor Day Thanksgiving Day The Day After Thanksgiving and Christmas Day May 2007 ValueOptions Inc Version 3 1 EDI Claims Link for Windows User s Manual Overview EDI Claims Link for Windows The EDI Electronic Data Interchange Claims Link for Windows application provides a method for providers or their designated representatives to submit HIPAA Health Insurance Portability and Accountability Act of 1996 compliant electronic claims to ValueOptions Inc ValueOptions Electronic claims submission provides a value added service to the providers by reducing submission costs It also helps reduce the turn around time for the payment of claims by ensuring that all data critical to the claim
25. f correct 9 Type the file name not the entire path that you saved 10 Select A Z Modem 11 Press lt ENTER gt to begin the upload Modem handshake will occur 12 On your dial up software locate the command or menu item that allows you to send a file 13 Browse to select your file or type in the entire path where the file resides 14 Click Send or OK on your software 15 You will receive a tracking number and a message that the file has been successfully uploaded May 2007 ValueOptions Inc Version 3 1 36 EDI Claims Link for Windows User s Manual Help and Information Contact If you have any questions about the EDI Claims Link for Windows application please contact ValueOptions EDI Helpdesk PO Box 1287 Latham NY 12110 Phone 888 247 9311 Hours 8 00 AM to 6 00 PM Eastern Time Monday through Friday Fax 866 698 6032 Email address e supportServices valueoptions com Not available during the following observed Holidays New Years Day Memorial Day Independence Day Labor Day Thanksgiving Day The Day After Thanksgiving and Christmas Day May 2007 ValueOptions Inc Version 3 1 37
26. ld be completed as per the requirements of the claim May 2007 ValueOptions Inc Version 3 1 ee EDI Claims Link for Windows User s Manual Click on the Claim Details tab 837 Professional Claim Patient John ia amp Save Close Claim Details Service From Service To Place of Service Procedure Mod1 Mod2 Mod3 Mod4 Diag Diag2 Diag3 Charges Units EMG This is where you will enter the specific service line information just as you would on a paper claim Enter the Service From and Service To date for this line of service Each date of service should have its own service line Select the appropriate Place of Service code Procedure Code The correct procedure code for this line of service Optional Modifier codes Enter this only if required for this particular service Diagnosis codes Select the drop down number that corresponds to the correct diagnosis code previously entered on the Claim tab Charges Enter your total charge for this service line Use decimals no dollar sign ex 100 00 Units Enter the number of billing units being represented on this particular service line Optional EMG Select Y for this field if this was an emergency session You can now continue to enter more service lines or click on Save at the top of the window If all the information you have entered is accurate the Save button will change from color to greyed out Then click Close If there are any errors
27. nature Source if necessary to change to On File 12 Select the appropriate statement from the drop down box for the Claim Filing Indicator 13 If there are Secondary and Tertiary subscribers click on the appropriate tab at the top of the window and complete the required information on each tab Note Remember to complete any other fields that are required for the specific contract May 2007 ValueOptions Inc Version 3 1 _13 EDI Claims Link for Windows User s Manual 14 Click OK The name of the Patient displays in the Patient List window EDI Claims Link 3 Table Maintenance go File Edit View Tools Window Help To a EDI Claims Link Tasks Patients Patient Last Patient First Patient DOB Tasks Providers Add Patient Add Batch Submitters f 2 14 1980 P Add Claim Reference Data 3 21 1986 313 1959 i Add Patient 311 1370 Add Provider Batches 837i Institutional Batch 1 May 2007 ValueOptions Inc Version 3 1 14 EDI Claims Link for Windows User s Manual The Batch Browse Window The Batch Browse Window is the main work area within the EDI Claims Link for Windows application It is displayed when the application is opened From this window the type of claims batch being entered is selected an identifying name is assigned to the batch the provider is selected and the claim is entered EDI Claims Link 3 Batch Browse go File Edit View Tools Window Mel
28. nformation Assignment of Benefits Yes Date of Birth Sex Patient Signature Source Signed Form On File ka Claim Filing Indicator Other Federal Program Insurance Type Code May 2007 ValueOptions Inc Version 3 1 DD EDI Claims Link for Windows User s Manual If you are creating a Professional Claim 837p batch Click on the Claim tab 837 Professional Claim Patient John E Save ak Close Provider Patient Claim Claim Details Rendering Provider Hame Last First Ml fe ee ine Provider Accept Assignment Assigned MPI Doo riqinal Reference Number C Provider ID le Claim Submitter s Identifier 20060801122503 YalueU ptions as Medicaid ID SSS Diagnosis Codes Provider Taxonony Code q1 300 00 Z 3 4 Referring Provider Hame Last First MI z Attachment Information Attachment Type HPI Transmission Type Provider ID Control Humber Medicaid ID Dates Service Facility Location Disability Hospitaliz aton Name Last or Org From From Address To To City State ip HPI Provider ID Facility Identifier The following minimum information is required The Provider Accept Assignment field must be completed The Claim s Submitter s Identifier which should be pre populated At least 1 Diagnosis Code The rest of the data is optional or shou
29. nter the specific service line information just as you would on a paper claim Enter the appropriate claim details Revenue code Procedure code Optional Modifer Codes Rate Enter the rate you charge for the particular service that was provided Service From amp Service To The date ranges of this specific line of service Units Units Enter the number of billing units being represented on this particular service line Charges You will have to manually calculate this number Rate X Units Charges You can now continue to enter more service lines or click on Save at the top of the window If all the information you have entered is accurate the Save button will change from color to greyed out Then click Close If there are any errors or discrepancies with the data you have entered the icon will appear May 2007 ValueOptions Inc Version 3 1 MEy o an EDI Claims Link for Windows User s Manual Click the Close button The claim is saved and assigned a sequential number that is displayed in the Batch Browse Window The Add Claim Wizard displays to add another claim click Add Another Claim and repeat the above steps If not click Finish Add Claim Wizard Finished You have successfully added a claim to EDI Claims Link 1 Your claim has been successfully added to the system If you have more claims to add click the Add Another Claim button to restart this wizard otherwise click the Finish butt
30. on to return to ED Claims Link IMPORTANT The instructions above contain the minimal information necessary for verification and acceptance of the claim into the Va ueOptions Claims Processing systems It does not imply nor guarantee payment of the claim Information on required data elements for a particular contract can be found in the Claims Submission Manual May 2007 ValueOptions Inc Version 3 1 28 EDI Claims Link for Windows User s Manual Generating and Sending an 837 EDI Claim File When all claims have been entered in the EDI Claims Link for Windows application you can create a file to send to Va ueOptions You can transmit this file to Va ueOptions through the internet by accessing www valueoptions com and following the instructions on screen You can also transmit the file using a modem and any commercially available communications software Some Windows versions come with their own communications software called Hyper Terminal see the section addressing the set up and use of Hyper Terminal To generate the 837 file 1 Highlight the Batch Name on the left side of the Batch Browse Window or double click the batch name in the Batch window on the right hand side AB EDI Claims Link 3 Batch Browse Fien Loots window Help Batch 032103HCFA 837p Generate Claim File Claims 2 Provider Count 1 Service Lines 3 H A Professional Batch 1 H A 837 Institutional 837 Professional Ee
31. s The format for the date fields is MMDDCCYY a z4 z5 626 2r fo E win i ee ecg ge All date fields require that the century be typed in addition to the year J t0 ll l2 135 14 H i6 17 16 19 P 21 i e 2003 23 24 25 26 27 20 30 O31 1 z a 4 e JToday 03 70 7003 The Total Pane will display all totals for the Batches and Claims Batch 032103HC FA 837 p Generate Claim File Claims 2 Provider Count Service Lines 3 Total Amount 760 00 May 2007 ValueOptions Inc Version 3 1 EDI Claims Link for Windows User s Manual How to Log in to EDI Claims Link for Windows 1 Click the EDI Claims Link for Windows icon located on your desktop EDI Claims Link 2 The first time you access EDI Claims Link for Windows the Submitter Maintenance Screen displays with a welcome message Refer to Identifying and Adding the Submitter section for details The Submitter ID and Password you select must match the ID and password you have for the ValueOptions ProviderConnect website Submitter Maintenance Welcome to EDI Claims Link 3 Enter your ValueOptons Submitter Information to begin using EDI Claims Link This information will be used to log in the next time you launch this application JQProvider Peer ooo Confirm Password as 3 Once you have created your submitter ID the following screen displays when you click the EDI Claims Link for Windows icon EDI Claims Link 3 Login
32. s payment process is included and accurate Claims information is entered directly into the EDI Claims Link for Windows application database The software minimizes the number of keystrokes required to create electronic claims The user enters only those fields required to meet Va ueOptions claims processing systems requirements The EDI Claims Link for Windows application contains a flexible Table Maintenance function Provider information can be modified added or deleted at any time from the database In addition other code tables such as Occurrence Occurrence Span Relationship Type of Service Place of Service and Condition can be modified to meet any special requirements Using EDI Claims Link for Windows is a six step process 1 Install the software and install necessary patches 2 Identify who is submitting the claims 3 Create a database of the Providers for whom claims will be submitted 4 Create a database of individual clients for whom claims will be submitted 5 Enter individual claim information 6 Create a file for electronic transfer to Va ueOptions EDI Claims Link for Windows main window 237 Institutional Baiches EDI Claims Link Tasks Open Berisha 1 pe Clama Sert etches i Sart Clera eA behead Beach 1 z E 237 profesoral Tacks me Adc Beth o Add Clam i Add Potient_ P Add rrovider Add Baich inetlutional Batch 1 Batches 6370 Profssional Batch 1 Generated Clam Files
33. the Main Screen click Tools and then click Provider Data Maintenance or click Add Provider under the EDI Claims Link Tasks pane to go directly to the Provider Maintenance Screen Step 3 ED Claims Link 3 Batch Browse go File Edit View Beea Window Help E Ei 237 institutio Reference Data Maintenance F Institution Ea Patient Data Maintenance fal 837 Professio Provider Data Maintenance Submitter Data Maintenance View Application Event Log Options EDI Claims Link Tasks Open Claims i Tasks Sent Claims fed Add Batch Add Claim Add Provider Batches 837i Institutional Batch 1 Batches 837p Professional Batch 1 Professional Batch 2 Generated Claim Files 200303191534 bet 8397p 2 If you clicked Provider Maintenance located under Tools The Provider List screen displays Click Add Provider located under the Provider List screen or click Add Provider located under the EDI Claims Link Tasks pane on the right EDI Claims Link 3 Table Maintenance go File Edit View Tools Window Help Hoy Fatients Provider Last Providers Add Provider Submitters A Place Reference Data Provider The Happy Place May 2007 ValueOptions Inc Provider First EDI Claims Link Tasks Provider ID Cty Tasks Add Batch 14 5151511 Some City Add Claim 599123456 Nofolk 14 1414555 HappyTown c Add Patient Add Provider Batches 837i Institutional Batch 1
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