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PC-ACE Release 2.7 User`s Manual

1. ABILITY PC ACE Pro32 User Guide ABILITY PC ACE Pro32 CLAIMS PROCESSING SYSTEM User Guide Release 2 7 July 2015 Copyright and Trademark Copyright Copyright 2015 ABILITY Network Inc All Rights Reserved All text images and graphics and other materials in this document are subject to copyright and other intellectual property rights of ABILITY Network Inc These materials many not be reproduced distributed modified or republished without the express written permission of ABILITY Network Inc Trademark The marks appearing in this document including but not limited to ABILITY Network ABILITY ABILITY logo and all ABILITY services are trademarks and or registered trademarks of ABILITY Network Inc All other brands product names or services are trademarks or registered trademarks of their respective holders Table of Contents Introducing PC ACE Pro32 1 Getting started with PC ACE Pro32 3 PC ACE Pro32 Setup Procedures 7 Setup of Medicare Part A Systems Setup of Institutional All Payer Systems Setup of Professional Systems Main Toolbar amp Forms 27 The PC ACE Pro32 Main Toolbar Institutional amp Professional Claims Menus Claim List Form Features The Institutional Claim Form The Professional Claim Form Eligibility Benefit Request List Form Features The Eligibility Benefit Request Form The Service Type Eligibility Benefit Request Form Roster Billing List Form Features The Professional Roste
2. Note Use the TE Telephone and FX Facsimile contact types only if an alternate phone fax number is needed The primary phone and or fax number should always be entered in the fields provided on the General tab ANSI Info 2 specifies optional data element override values to be used exclusively during the preparation of transmission files in ANSI 837 format Leave these override fields empty for default ANSI 837 processing You should change these values only under instructions from your distributor The currently defined ANSI 837 override fields include e Interchange Sender ID ISA06 specifies the Interchange Sender ID override value This value populates element ISA06 of the Interchange Control Header ISA segment in the ANSI 837 format EMC file e Interchange Receiver ID ISA08 specifies the Interchange Receiver ID override value This value populates element ISA08 of the Interchange Control Header ISA segment in the ANSI 837 format EMC file e Application Sender s Code GS02 specifies the Application Sender s Code override value This value populates element GS02 of the Functional Group Header GS segment in the ANSI 837 format EMC file e Application Receiver s Code GS03 specifies the Application Receiver s Code override value This value populates element GSO3 of the Functional Group Header GS segment in the ANSI 837 format EMC file e Submitter Primary Identifier NM109 1000A specifies the Subm
3. Within the various help topic windows you will encounter several informational icons positioned in the left margin These are used to convey additional information that may be of special interest Getting started with PC ACE Pro32 x Tip This informational icon is used to pass along tips that improve the usability of the application Note This informational icon is used to present special notes relating to the current help topic These may indicate a requirement or restriction of the application In some cases they are simply general interest items amp Attention This informational icon is used to bring attention to an important issue relating to the current topic Often these instructions must be taken to ensure optimum operation of an application feature Where Do I Go From Here You will need to perform a few setup tasks before using PC ACE Pro32 to process claims Proceed to the appropriate setup section below based on the type of claims you will be processing e Medicare Part A clients proceed to the Setup of Medicare Part A Systems section e Institutional All Payer clients proceed to the Setup of Institutional All Payer Systems section e Professional clients proceed to the Setup of Professional Systems section These sections present detailed instructions on how to set up your PC ACE Pro32 system PC ACE Pro32 Setup Procedures Setup of Medicare Part A Systems This section describes the setup procedures require
4. A number of productivity enhancing features are available during plan data entry e Fixed List Lookups The Plan of Care form supports fixed list lookups on many of the plan s fields Fixed list lookups apply to fields whose list of valid values can be determined in advance For example the patient s sex field typically has 3 possible values M male F female and U unknown USAGE Access the lookup list for a field by positioning the cursor on the field and pressing the F2 function key or right clicking the mouse When an item from the list is selected its value is automatically entered in the Plan of Care form field hS Tip Type lt ALT gt F2 press the F2 key while holding the ALT key down to identify all fields that support a lookup list Press the ESC key to disable the flashing notification e Variable List Lookups The Plan of Care form supports variable list lookups on a number of the plan s fields Variable list lookups apply primarily to fields whose values are selected from reference files Some variable list lookups use other plan field values 73 PC ACE Pro32 User s Manual to filter the presented list For example treatment code lookups present only those codes applicable to the specified discipline In addition variable list lookups often retrieve data used to fill in other Plan of Care form fields For example selection of a Patient PCN from the variable list lookup completes numerous patient
5. code and Reason code combination Enter these codes manually or select them from the available lookup lists Each claim level adjustment must specify a non zero Amount value and may also specify an optional Units value e COB MOA Amounts Permits entry of various general claim level COB amount values as well as amount values defined specifically for Medicare Outpatient Adjudication MOA use Enter or select the Code which defines the amount type to be reported and enter the corresponding Amount value e Medicare Outpatient Adjudication MOA Remarks Codes Permits entry of up to 5 remarks codes for Medicare Outpatient Adjudication MOA use These optional codes may be entered manually or selected from the available lookup list e Claim Adjudication Date Permits entry of the date on which the payer adjudicated the claim This date is typically required at either the claim or line level e Common Payer MSP Information Contains miscellaneous COB related fields which are either defined in the ANSI X12 implementation or are needed to support COB editing 48 Main Toolbar amp Forms The line level COB data is entered on the MSP COB sub tab of the Billing Line Items tab The purpose and use of the various field groups on this sub tab are as follows Service Line Adjudication SVD Information Permits entry of one or more Service Line Adjudication SVD lines as reported by the payer for the current service line
6. you can generate claims for this roster billing using either of the following techniques e When a new Professional roster billing is created from the New Roster Billing menu item and saved error free you will be prompted to proceed automatically to the claim generation step e Claims for existing Professional roster billings can be generated from the Roster Billing List Form To be eligible for generation a roster billing must reside in the to be generated RL location and have a clean CLN or has errors ERR status Select the desired roster billing record and click the Generate button or choose the Generate Selected Roster action to initiate the claim generation process You will be prompted to confirm your intent to generate claims for this roster billing As the operation proceeds running totals of the count and dollar value of all generated claims will be displayed on the Roster Claim Generation form You will be notified when the claim generation operation completes If desired click the View Results or View Rejects buttons to view 150 Common Reference File Procedures reports of the successfully generated claims or rejected claims respectively These reports can be printed from the report previewer if desired If any claim rejects occur during the generation process the entire process will be reversed Review the rejects report correct the offense and run the roster billing generation process again Suc
7. 163 provider inheritance and association Professional 166 provider setup and maintenance 163 166 setting up Institutional providers 163 setting up Professional providers 166 Provider Specialty File Maintenance 194 Provider Taxonomy Codes File Maintenance 195 purging archived transmission files 98 purging claim activity logs 98 Reactivating previously transmitted claims 119 Recovering from an interrupted claim prepare run 214 Reference File Maintenance Form 76 reference file setup and maintenance171 177 179 180 182 183 184 185 186 189 190 191 192 194 195 Charges Master 192 220 Condition Occurrence Span Value Codes amp Assignments Data Communications Facility HCPCS Codes HCPCS Modifiers amp Assignments ICD9 Codes Physician UPIN Place of Service POS Codes amp Assignments Provider Specialty Provider Taxonomy Codes Revenue Codes amp Assignments submitter Type of Bill TOB Type of Service TOS Codes amp Assignments Rehab 700 701 medical attachment report printing preferences restoring from a PC ACE Pro32 backup retransmitting an EMC file Revenue Codes File Maintenance Reversing the most recent claim import run reviewing a claim s status request response history Reviewing the claim activity logs Roster Billing Form Professional Roster Billing List Form Features saving and canceling claims Institutional saving and canceling claims Professional saving and canceling Plans of Care saving and cancellin
8. Click the Print button to print the plan s without previewing them Plan of Care previewing employs the Adobe Acrobat Reader Use the Acrobat Reader s print option to print a previewed plan When you have previewed and optionally printed the plan close the Acrobat Reader program This will signal PC ACE Pro32 that you are ready to continue E Attention You will not be able to resume activities in PC ACE Pro32 until the Acrobat Reader program has been exited Simply closing the plan document within the reader is not enough to signal PC ACE Pro32 to continue 5 If you have selected multiple plans they will be printed in sequence based on the current Plan of Care List form s Sort By selection A progress form will display details about the plan currently being printed Click the Cancel button on this progress form to cancel the printing session following the plan currently being printed A Few Technical Notes Here is some additional technical information that you need to know about printing Plans of Care in PC ACE Pro32 155 PC ACE Pro32 User s Manual 156 One or more Home Health Plan of Care Addendum CMS 487 forms will be printed automatically if needed to handle overflow from both the Home Health Certification And Plan of Care CMS 485 and Medical Update And Patient Information CMS 486 forms Home Health Plan of Care printing will be available only if the Adobe Acrobat Reader Version 4 0 or later is properly i
9. Next Serial No specifies the next Serial Number to be assigned during the prepare process This value is automatically updated each time claims are prepared Next File Seq Institutional only specifies the next File Sequence Number to be assigned during the prepare process This value is automatically updated each time claims are prepared Force Separate Prepare specifies whether or not claims for the LOB and or Payer ID combination specified on this Submitter record are to be prepared separately from all other claims Use this option to insure that restricted groups of claims are not inadvertently included in prepare runs containing claims outside of the restricted group This advanced feature should typically be used only when instructed to do so by your distributor The Force Separate Prepare option may not be available on all installations and will not override any permanent prepare restrictions defined by the distributor ANSI Info specifies flags and data element values to be used exclusively during the preparation of transmission files in ANSI 837 format The currently defined ANSI information fields include Submitter Interchange ID Qualifier specifies the system method of code structure used to designate the Submitter ID in all electronic interchanges This qualifier populates element ISA05 of the Interchange Control Header ISA segment in the ANSI 837 format EMC file The distributor will provide this qualifier if requ
10. Once the packing operation has started it must continue to completion We recommend packing claim archives only when no other users are accessing PC ACE Pro32 hS Tip If you close the Claim List form without first closing an open claim archive the archive is closed automatically and you will receive the pack prompt described above Note If claims have been archived you will receive a notification when the archive is closed concerning packing the current claims database The system administrator should pack the current claims database periodically to keep the database size minimized and to maintain optimum system performance Refer to the Packing and Common Reference File Procedures reindexing the databases topic for information on packing the Institutional and or Professional current claims database 137 PC ACE Pro32 User s Manual Adding a new eligibility benefit request New patient eligibility benefit requests can be added to PC ACE Pro32 from the Eligibility Benefit Request List form The operation of this list form is identical for Institutional and Professional request types Perform the following steps to access the Eligibility Benefit Request List form and open a new eligibility benefit request 1 Click either the Institutional Claims Processing or Professional Claims Processing button on the PC ACE Pro32 Main Toolbar to display the respective Claims Menu form 2 From the Institutional or Professional Claim
11. Press the F8 key while positioned on any field on a line to automatically advance the cursor to the first field of the next line skipping over any remaining fields on the current line 45 PC ACE Pro32 User s Manual e Jump To Narrative Press the lt ALT gt N key combination while positioned on any field on a line to automatically position on the Narrative field Enter the desired narrative text and press the lt TABs gt key to return to the original line field e Line Item Totals Recalculation The Billing Line Items tab provides a Recalculate button located near the bottom of the tab adjacent to the totals fields Click this button to recalculate and update the Total Charge and Balance Due fields from the current claim line item charges values and the Amount Paid field value NOTE This button may not be available on some installations e Payer Insured Features The following payer and or insured information productivity features are available e Quick Payer Access Press the lt ALTs gt I key combination while positioned anywhere on the Patient Info amp General tab to move immediately to the primary payer s Payer ID field Press the lt ALT gt O key combination to move immediately to the secondary payer s Payer ID field e Clear Payer Feature The Insured Information tab provides a Clear Payer button for each of the 3 claim payers Click this button to clear all payer insured and employer fields fo
12. Save With Fatal button to save a roster billing that contains fatal errors Such roster billings are assigned the has fatal errors ERF status Claims cannot be generated from a roster billing with an ERF status If edit validation errors occur several Save attempts may be required to correct and save a clean roster billing At any time click the Errors List button to review the remaining edit validation errors Miscellaneous Roster Billing Form Topics The following comments cover any miscellaneous features of the Professional Roster Billing Form e Displaying Audit information Click the picture button in the upper right corner of the form to display audit information for this roster billing This audit information includes the date the roster billing was created the last modification date and the User ID of the user that modified the roster billing last Common Roster Billing Activities The following hyperlinks provide additional instruction on several common roster billing activities e Refer to the Adding a new roster billing topic for more information on adding roster billings e Refer to the Listing modifying and maintaining roster billings topic for tips on maintaining roster billings from the Roster Billing List form 70 Main Toolbar amp Forms Home Health Plan of Care List Form Features The PC ACE Pro32 Home Health Plan of Care List form provides a versatile interface from which the user can create
13. These navigation keys are recognized only when the list is the active control i e has the focus Reference File Reports Common reference file reports are accessible from the Reference File Maintenance form s main Reports menu Currently available reports include Patient List previews and or prints a summary report of all or a selection of patient records The Patient List Report Filter Criteria form will be displayed to allow the user to restrict the patient records to be included in the report Enter any desired report filter criteria and preview or print the report as desired Related Topics The following hyperlinks provide additional information related to this topic Refer to the Adding and maintaining patients Adding and maintaining payers Adding and maintaining providers Institutional Adding and maintaining providers 79 PC ACE Pro32 User s Manual Professional and Codes amp Miscellaneous Reference Files Overview topics for additional information on these core PC ACE Pro32 s reference files e Refer to the Claim amp Reference File Edit Validation topic for a discussion of the edit validation process 80 Main Toolbar amp Forms Claim amp Reference File Edit Validation The term edit is commonly used in claims processing to describe a specific rule imposed on a claim field or combination of claim fields The plural term edits refers to the collection of individual rules imposed on
14. When you have finished adding Provider records you should have one record for each applicable line of business LOB for each provider entity When all desired Provider records have been added click the Close button on the Reference File Maintenance form to return to the PC ACE Pro32 Main Toolbar Patient Reference File Setup This section describes the process of setting up the Patient reference file Setup of the Patient reference file is optional If you choose to setup patients the complete patient list will be accessible during claim entry using the variable list lookup feature When a patient is selected from the lookup list during claim entry all applicable patient information will be automatically loaded into the appropriate claim form fields Complete the following steps as needed bS Tip You may want to refer to the Adding and maintaining patients topic for more information on entering Patient records If you do make sure and return to this topic to continue the setup steps 1 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form Select the Patient tab to display a list of all existing Patient records 2 If you have just installed PC ACE Pro32 the Patient list should be empty If so skip to the next step If the list is not empty any existing Patient records are likely there as samples only Once you have confirmed that this is the case delete a
15. alignment headaches often associated with printing onto pre printed claim forms Use this printing method to print claims for archiving or distribution Note The image overlay printing method requires that the free Adobe Acrobat Reader Version 4 0 or later be installed on your system This reader is available for download from Adobe www adobe com When the Acrobat Reader is properly installed PC ACE Pro32 will automatically detect and configure the path to the ACRORD32 EXE program The steps involved in printing a claim or selection of claims are the same regardless of the selected printing method 1 From the PC ACE Pro32 Main Toolbar click either the Institutional Claims Processing or Professional Claims Processing button to open the appropriate Claims Menu form 2 Click the List Claims button on the Claims Menu form to display the appropriate Claim List form All claim printing is performed from the claim list 3 To print a single claim simply select the desired claim from the list and select the Print Selected Claim item from the Claim List form s main Actions menu or convenient right click popup menu The Claim Print Options form will be displayed hS Tip To print a selection of claims simply check the desired claims and select the Print All Checked Claims item from the Claim List form s main Actions menu Refer to the Claim List Form Features topic for more information on multiple claim selection
16. fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the claim edit validation process and the Edit Validation Errors List form If edit errors exist you will have the option to correct the errors or save the request with errors Click the Save With Errors button to save a request that contains only non fatal errors Such requests are assigned the has errors ERR status Click the Save With Fatal button to save a request that contains fatal errors Such requests are assigned the has fatal errors ERF status Requests with an ERF status will not be eligible for preparation If edit validation errors occur several Save attempts may be required to correct and save a clean eligibility benefit request At any time click the Errors List button to review the remaining edit validation errors Miscellaneous Eligibility Benefit Request Form Topics The following comments cover miscellaneous features of the Eligibility Benefit Request Form e Displaying Audit information Click the picture button in the upper right corner of the Patient Subscriber Info tab to display audit information for this eligibility benefit request This audit information includes the date the request was created the last modification date and the User ID of the user that modified the request last Common Eligibility Benefit Request Activities The following hyperlinks provide additio
17. flagging fatal errors with a red X graphic Double click on any of the listed errors to jump directly to the offending field on the claim form Claims with fatal errors can be saved unless the fatal errors exist on one of the claim s key fields Key fields include LOB PCN and TOB for Institutional claims and LOB and PCN for Professional claims Click the Save With Errors button to save a claim that contains only non fatal errors Such claims are assigned the has errors ERR status Click the Save With Fatal button to save a claim that contains fatal errors Such claims are assigned the has fatal errors ERF status Claims with an ERF status will not be eligible for preparation into an electronic EMC file Fatal edit errors on reference file records must be corrected before the user can save the record If edit validation errors are reported several Save attempts may be required to correct and save a clean claim At any time click the Errors List button to review the remaining claim edit validation errors Remember that file level edit errors are only re checked when the claim is saved Therefore these edit errors will remain in the list even though the problem may have already been corrected The next claim save attempt will clear any corrected file level edit validation errors from the list AS Tip When the Edit Validation Errors List form closes all claim fields reporting edit validation errors will begin flashin
18. list modify print and otherwise maintain Plans of Care Click the Institutional Claims Processing button on the PC ACE Pro32 Main Toolbar to open the Institutional Claims Menu form Then select the Attachments and Maintain HH Plans of Care menu items on the Institutional Claims Menu form to open the Plan of Care List form You may reposition and resize this form if desired The list can be easily sorted and filtered to display only the plans of interest Sorting Plans of Care The plan list may be sorted by Patient Control Number PCN Patient Name Entry Date and Start of Care SOC Date Simply select the desired sort order from the available Sort By radio buttons Filtering Plans of Care The Plan of Care List may be filtered to display a select subset of plans using the Advanced Filter Options accessible from the Filter main menu item These advanced options permit filtering on the plan s patient PCN patient name provider as well as a selection of date fields When multiple filter criteria are specified only those plans that meet all filter criteria will be displayed A convenient Clear Filters item is also available from the Filter main menu to quickly remove any existing filter criteria Plan of Care Actions The Plan of Care List form may also be used to perform specific actions on any individual plan or a group of selected plans To perform an action on an individual plan simply select the plan from the list and
19. mapcntlu win and should be located in the server s winpcace impub92 directory 3 Setup all required PrintLink Matching Description strings in the Payer reference file These strings are used to match payer descriptions from claims in the intermediate delimited file to specific Payer reference file records Refer to the Adding and maintaining payers topic for details on setting up your PrintLink Matching Description strings 4 Each time you want to import claims copy the new intermediate delimited file generated by your upstream system into the server s winpcace impub92 directory The file must be named plink out Electronic Media Claims EMC Format import claims from a file in Electronic Media Claims EMC format If using this claim import method complete the following steps 1 Confirm that your upstream system is capable of producing a supported version Electronic Media Claims EMC format file Contact your distributor for the list of supported EMC file versions 2 Each time you want to import claims copy the new EMC file generated by your upstream system into the server s winpcace impub92 directory The file must have a dat file extension e g EMC192 DAT Claim Prepare amp Transmit Considerations This section describes setup considerations that should be reviewed before you attempt to prepare and transmit claims using PC ACE Pro32 12 Note Your distributor may have already performed some or all
20. of this setup for you Consult your distributor s installation instructions or contact the distributor if it is unclear how to proceed Setup default Institutional submitter information in the PC ACE Pro32 Submitter reference file Information from this reference file is required during preparation of Electronic Media Claims EMC files Consult your distributor s installation instructions or contact the distributor for assistance in setting up this critical reference file hS Tip Refer to the Submitter File Maintenance topic for more information on setting up the default Submitter record If required by your distributor setup default Institutional data communications parameters in the PC ACE Pro32 Data Communications reference file This reference file contains the Institutional data communications parameters exported to the bcdatcom dat file prior to the PC ACE Pro32 Setup Procedures launch of any external data communications program e g file transmission These parameters are used by the third party data communications program to control the file transmission etc hS Tip Refer to the Data Communications File Maintenance topic for more information on setting up the default Data Communications record This completes the required setup steps to ready PC ACE Pro32 for Medicare Part A Only claims processing PC ACE Pro32 User s Manual Setup of Institutional All Payer Systems This section describes the setup procedures
21. topic for more information on entering Patient records If you do make sure and return to this topic to continue the setup steps 1 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form Select the Patient tab to display a list of all existing Patient records 2 If you have just installed PC ACE Pro32 the Patient list should be empty If so skip to the next step If the list is not empty any existing Patient records are likely there as samples only Once you have confirmed that this is the case delete all sample Patient records To delete a Patient record select the desired record in the list click the Delete button and confirm the deletion 3 Click the New button to display the Patient Information form Enter the patient information taking advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse hS Tip Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator The Patient reference file contains general patient information as well as optional primary secondary and tertiary insured details Enter as much information as you have available for the patient 4 Click the Save button to save the new Patient record An edit validation process will be perform
22. 4 The Claim Print Options form allows the user to override default preferences for things like destination printer printing method pre printed forms versus image overlay claim form version and miscellaneous options Click the Preview button to preview the claim s before printing available with image overlay method only Click the Print button to print the claim s without previewing them Claim previewing for claims printed using the image overlay method employs the Adobe Acrobat Reader Use the Acrobat Reader s print option to print a previewed claim When you have previewed and optionally printed the claim close the Acrobat Reader program This will signal PC ACE Pro32 that you are ready to continue 128 Common Reference File Procedures E Attention You will not be able to resume activities in PC ACE Pro32 until the Acrobat Reader program has been exited Simply closing the claim document within the reader is not enough to signal PC ACE Pro32 to continue If you have selected multiple claims they will be printed in sequence based on the current Claim List form s Sort By selection A progress form will display details about the claim currently being printed Click the Cancel button on this progress form to cancel the printing session following the claim currently being printed A Few Technical Notes Here is some additional technical information that you need to know about printing claims in PC ACE Pro32 The ima
23. Acrobat Reader is properly installed PC ACE Pro32 will automatically detect and configure this path The Adobe Acrobat Reader is available for download from Adobe http www adobe com Refer to the Printing claims topic for more information on printing claim forms and attachments 99 Common Claim Activities Adding a new claim New claims can be added to PC ACE Pro32 using any of these techniques e Import the claims from a print file or other supported source See the Importing claims topic for more details e Click the Enter Claims button on the Claims Menu form Institutional or Professional to enter claims manually The system will automatically create and display new empty claims in succession until a claim is cancelled Use this technique to enter multiple claims in a single session e Click the New button on the Claim List form Institutional or Professional to enter a single claim manually The new claim will automatically be selected in the list when it is saved Claims are manually entered on the Institutional Claim Form or Professional Claim Form The data fields are typically entered in the order presented from left to right and top to bottom on each tab of the claim form Edit validation errors may be encountered during this entry process if the data entered violates any of the predefined edits for the specific claim type Correct any such edit errors and click the Save button to save the claim Claims cont
24. Assignments Information form provides the following assignment detail fields e LOB specifies the Line of Business LOB for which this assignment applies If the lt lt All LOBs gt gt option is selected then this assignment will apply to all LOBs e TOB specifies the Type of Bill TOB for which this assignment applies If this field is left blank then this assignment will apply to all TOBs Only the first 2 characters of the TOB are required hS Tip Two special TOB values are available to make it easier to define Revenue Code Assignments applicable to inpatient or outpatient claims Enter IP in the TOB field to indicate that the assignment applies to all inpatient TOBs Alternatively enter OP in this field to indicate that the assignment applies to all outpatient TOBs The inpatient outpatient designations for all TOBs are defined in the Type of Bill TOB Maintenance File Revenue Code Assignments that use these special inpatient outpatient designators will automatically adapt to changes in the Type of Bill Maintenance File e Control Settings includes control flags which describe the assignment as follows e Valid Determines the validity of the revenue code for claims having the specified LOB TOB combination Default Valid M When checked the revenue code is valid for claims having the specified LOB TOB combination When unchecked the revenue code is not valid for claims having the specified LOB TOB
25. Attachments and New HH Plan of Care menu items on the Institutional Claims Menu form e Click the New button on the Home Health Plan of Care List form This form can be accessed by selecting the Attachments and Maintain HH Plans of Care menu items on the Institutional Claims Menu form or by clicking the Plan of Care button on the Patient tab of the Reference File Maintenance form When creating the new Plan of Care from the patient listing the Patient Control Number PCN and pertinent patient information for the currently selected patient will be completed automatically Plans of Care are entered on the Home Health Plan of Care Form The data fields are typically entered in the order presented from left to right and top to bottom on each tab of the Plan of Care form Edit validation errors may be encountered during this entry process if the data entered violates any of the predefined Plan of Care edits Correct any such edit errors and click the Save button to save the Plan of Care Plans of Care containing unresolved edit errors may be saved if desired by clicking either the Save With Errors button visible if only non fatal errors exist or Save With Fatal button visible if any fatal errors exist Only one of these buttons will be visible at any given time If neither button is visible then fatal errors exist on one or more key Plan of Care fields These key fatal edit errors must be corrected before the Plan of Care can
26. Claims are rarely rejected during import into PC ACE Pro32 The most common reason for rejecting a claim is that the claim is a duplicate of an existing unprocessed UNP claim in the to be transmitted CL location This can sometimes occur if the same file is inadvertently re imported into the system If desired click the View Results and or View Rejects buttons to view the accepted and rejected claim reports respectively These reports can be printed from the report previewer if desired AS Tip Refer to the Printing Preferences topic for information on configuring claim import reports to be printed automatically or to a specific printer When you have completed your review of the claim import reports click the Close button on the Claim Import form You may now proceed to process the imported claims automatically or work the claims one by one from the Claim List form Common Reference File Procedures Optional Import Preprocessor Feature Additional claim import flexibility is available with PC ACE Pro32 s optional import preprocessor feature A user developed executable program or a DOS batch file with associated PIF file can be configured for execution prior to standard claim import processing The PC ACE Pro32 import sequence will launch this preprocessor automatically and wait for completion before continuing with standard import processing The preprocessor might simply copy a print image file from one directory to anot
27. Form topic for more discussion of these common filter options Effective Date Range The Effective Date Range dates are compared to the claim s date of service range during the claim edit validation process If the effective date range for an ICD code falls outside the claim s service date range an edit validation error will be reported If the effective date range is left blank the ICD code is valid for all dates of service If the start date is completed but the end date is left blank the ICD code is valid for all dates of service from and including the start date forward If the start date is left blank but the end date is completed the ICD code is valid for all dates of service up to and including the end date POA Exempt The POA Exempt field is a Y N indicator displayed for diagnosis codes only It s purpose is to identify the diagnosis code as exempt from Present On Admission POA reporting requirements if applicable The POA exempt status of standard diagnosis codes is maintained by the software manufacturer This field is accessible to the user only to respond in situations where the POA exempt status might need to be changed during an interim period prior to the next scheduled product update Enter a Y in this field for diagnosis codes which are exempt from POA reporting Enter a N or leave the field empty for non exempt diagnosis codes ICD 10 General Equivalence Mapping GEM Lookup Feature The General Equivalence M
28. LOB should be created and these related provider records should be associated with each other The inherit and associate options can be a real timesaver when setting up providers that support multiple lines of business In this scenario select an existing provider in the list click the New button and choose the inherit and associate options You will see that the top portion of the Provider Information form will be completed automatically Simply tab through or overwrite the Provider ID No field may be the same or different enter a unique line of business identifier in the LOB field and click the Save button When you have finished adding Provider records you should have one record for each applicable line of business LOB for each provider entity When all desired Provider records have been added click the Close button on the Reference File Maintenance form to return to the PC ACE Pro32 Main Toolbar Patient Reference File Setup This section describes the process of setting up the Patient reference file Setup of the Patient reference file is optional If you choose to setup patients the complete patient list will be accessible during claim entry using the variable list lookup feature When a patient is selected from the lookup list during claim entry all applicable patient information will be automatically loaded into the appropriate claim form fields Complete the following steps as needed PC ACE Pro32 User s Ma
29. Maintaining Claim Status Response Files Claim Acknowledgment Files and Post Reports Archived ANSI 277 claim status response files ANSI 277CA claim acknowledgment files and claim status response post reports can be viewed and or printed from the Claim Status Response amp Acknowledgment Log form To view the currently archived ANSI 277 and ANSI 277CA files select the Maintain and Claim Status Response amp Acknowledgment Log menu items on either the Institutional or Professional Claims Menu form The following operations are available e To view and or print an archived ANSI 277 response file or ANSI 277CA claim acknowledgment file report select the desired record and click the View Response Report or View Ack Report button respectively or double click the desired record The report may be printed from the preview form if desired e To view and or print the post report for an archived ANSI 277 response file select the desired record and click the View Post Report button The report may be printed from the preview form if desired e To delete an archived ANSI 277 or ANSI 277CA file and its associated post report select the desired record click the Delete button and confirm the deletion Note By default archived ANSI 277 claim status response and ANSI 277CA claim acknowledgment files will be automatically purged after a certain number of days Refer to the PC ACE Pro32 Miscellaneous preferences topic for details on ho
30. Medicare and Medicaid claims then two Payer records must be added both with Payer ID 12345 one with LOB MCB and the other with LOB MCD 3 Click the Save button to save the new Payer record An edit validation process will be performed to check for problems with the payer information When prompted correct any missing or invalid field values if present and re save as needed The new Payer record should now be visible in the Payer list Note If you plan on using the PrintLink feature of PC ACE Pro32 to import claims from print image files then you will also need to add PrintLink Matching Description strings to this Payer record The Claim Import Considerations section later in this topic will lead you through this process 4 Repeat the relevant steps to create additional Payer records as needed This may include records for the same payer and different LOBs or records for additional payers 5 When all desired Payer records have been added click the Close button on the Reference File Maintenance form to return to the PC ACE Pro32 Main Toolbar Provider Reference File Setup This section describes the process of setting up the Professional Provider reference file This file contains information about the valid providers in your system All providers for whom you will be billing Professional claims must exist in the Professional Provider reference file The Professional Provider reference file is organized such
31. PC ACE Pro32 claim import routines The map control file is always named mapcntlu win and should be located in the server s winpcace impub92 directory 4 Setup all required PrintLink Matching Description strings in the Payer reference file These strings are used to match payer descriptions from claims in the print file to specific Payer reference file records Refer to the Adding and maintaining payers topic for details on setting up your PrintLink Matching Description strings PC ACE Pro32 User s Manual Each time you want to import claims copy the new print image file generated by your upstream system into the server s winpcace impub92 directory The first line of the map file provided by your distributor dictates what the print image file must be named typically ub92 prt Intermediate Delimited Format imports claims from a file in intermediate delimited format If using this claim import method complete the following steps 1 Work with your distributor to develop the programs necessary to produce a file in intermediate delimited format from your upstream system Your distributor should have detailed specifications of this internal file format Verify that the generated files meet these specifications 2 Confirm the existence of the required map control file This file provides a control interface between the intermediate delimited file and the PC ACE Pro32 claim import routines The map control file is always named
32. The P S field identifies the payer primary secondary reporting this line adjudication notice The procedure code and modifier fields identify the specific procedure being adjusted The practice of procedure code bundling and unbundling utilizes these fields to provide specific information regarding how the payer has grouped the procedures for payment The Paid Amount indicates the amount the payer has paid on this procedure The Paid Units value permits reporting of payments for less than the originally billed units Finally the B U Line field identifies the service line on the original claim to which this SVD line applies This reference identifier should be included on the remittance and is primarily used in scenarios where procedure code bundling unbundling has occurred Line Adjustment CAS amp Miscellaneous Adjudication Info Permits entry of several additional Service Line Adjudication SVD fields for the current SVD line The fields in this control group track the currently selected SVD line The control group s caption indicates the current SVD line e g for SVD 1 above e Line Level Adjustments CAS Permits entry of one or more line level adjustments as reported by the payer for the current Service Line Adjudication SVD line Adjustments are defined by a specific Group code and Reason code combination Enter these codes manually or select them from the available lookup lists Each line level adjustment m
33. Type fields are populated with the standard Provider ID No Type fields from the selected Provider record e Default Tax ID Type to generic code Fl instead of 24 EIN or 34 SSN This option controls the source for the value assigned to the Information Receiver Primary ID Type field during lookups from the Provider reference file This option is only available when the Federal Tax ID has been selected to populate the Information Receiver Primary ID field i When checked the Information Receiver Primary ID Type field is forced to the generic Tax ID type code FI When unchecked the Information Receiver Primary ID Type field is populated with the ANSI X12 qualifier corresponding to the Federal Tax ID Type value from the selected Provider record Valid qualifier values are 24 EIN and 34 SSN e Give preference to non person Organization name on Information Receiver lookups This option controls the preferred source for the value assigned to the Information Receiver Name fields during lookups from the Provider reference file M When checked the Information Receiver Name fields are populated with the non person Organization field from the selected Provider record if available If no organization is specified on the selected Provider record then the proper i e person name fields are used instead When unchecked the Information Receiver Name fields are populated with the proper i e person name fields fr
34. a Y in the COB field to make these COB related fields available for use The COB field is located in the upper right quadrant of the Diagnosis Procedure tab Two distinct levels of Coordination of Benefits reporting are supported e Claim Level COB Reporting Remittance data which is not specific to a particular service line is reported at the claim level The claim form provides claim level COB fields for both the primary and secondary payers These fields are located on the COB Info Primary and COB Info Secondary sub tabs of the Extended Payer tab e Line Level COB Reporting Remittance data specific to a particular service line is reported at the line level The claim form provides a set of line level COB fields for each service line These fields are located on the MSP COB sub tab of the Billing Line Items tab This sub tab tracks the currently selected service line in the same manner as the 38 Main Toolbar amp Forms other extended line item sub tabs The current service line is identified in the MSP COB sub tab caption e g MSP COB Line 4 The decision to report COB information at the claim versus line level is made by the payer and communicated to the provider via a remittance The remittance may be in electronic ANSI 835 or paper format and typically serves as the source for all COB data to be entered into the claim form s COB fields Tip There s no need to re enter claims for submission to
35. a specific claim field or on the entire claim Sequentially applying all applicable edits on a claim field or all claim fields is referred to as the edit validation process The set of rules edits to be imposed on a claim s fields varies with the type of claim and is typically defined by the distributor PC ACE Pro32 provides a powerful and flexible system for defining maintaining and validating claim edits In addition edits are available for validating Institutional Home Health Plans of Care Professional roster billings as well as records in the Patient Payer Provider and Submitter reference files This discussion will focus on the claim editing process however the same concepts and procedures apply to plan of care roster billing patient payer provider and submitter editing unless specified otherwise Field Level vs File Level Edits Edits in PC ACE Pro32 are defined at the time they are created as one of two possible types e Field Level During claim entry when the focus leaves a claim form field either by pressing the TAB key or clicking on a new field an edit validation process is performed on the field losing the focus Edits performed at this time are referred to as field level edits If a field level edit validation error is detected you can either correct the problem at that time or leave it for later e File Level Edits that are validated only when an attempt is made to save the claim are referred to as f
36. appropriate on Professional claim forms The standard Professional form layout implies that double spacing is to be used by default M When checked all Professional claims containing more than 6 line items will be printed with the line items single spaced This technique accommodates up to 11 line items per claim form page When unchecked all Professional claims will be printed using the standard pre printed form line item spacing 6 line items per page Print claim attachments by default Professional only specifies whether Professional claim attachments should be printed by default This default setting can be overridden when a claim is printed if desired M When checked any existing claim attachments for the selected claim s will be printed by default I When unchecked no claim attachments for the selected claim s will be printed by default Print all claim attachments at the end of multiple claim print run when appropriate specifies whether claim attachments should be printed as a group at the end of a multiple claim print session M When checked claim attachments will be printed as a group following the printing of all selected claims when using the pre printed form method You will be prompted to load stock paper in the printer prior to claim attachment printing 95 PC ACE Pro32 User s Manual When unchecked claim attachments for each claim will always be printed immediately following the associated clai
37. appropriate to accommodate the additional ICD 10 codes from the combination For professional claims each service line s Diagnosis Pointer field will also be adjusted automatically to insure that it continues to reference the original diagnosis codes 183 PC ACE Pro32 User s Manual Physician UPIN File Maintenance The Physician Setup form provides an interface to maintain the optional Physician UPIN reference file The list of physicians and associated ID UPIN address and miscellaneous information is made available via lookups to speed the claim entry process The following maintenance operations can be performed e To add anew Physician record click the New button and enter the new physician information e To view or modify an existing Physician record select the desired record from the list and click the View Update button or double click the desired record e To delete a Physician record select the desired record from the list click the Delete button and confirm the deletion AS Tip A convenient Sort By feature quickly sorts the Physician s list by Name or Physician ID The Physician Setup form also provides several List Filter Options that can be helpful in locating specific physician records Refer to the Reference File Maintenance Form topic for more discussion of these common filter options 184 Common Reference File Procedures Type of Bill TOB File Maintenance The Type of Bill TOB Codes for
38. be named plink out Electronic Media Claims EMC Format import claims from a file in Electronic Media Claims EMC format If using this claim import method complete the following steps 1 Confirm that your upstream system is capable of producing a supported version Electronic Media Claims EMC format file Contact your distributor for the list of supported EMC file versions 2 Each time you want to import claims copy the new EMC file generated by your upstream system into the server s winpcace impub92 directory The file must have a dat file extension e g EMC192 DAT Claim Prepare amp Transmit Considerations This section describes setup considerations that should be reviewed before you attempt to prepare and transmit claims using PC ACE Pro32 1 Note Your distributor may have already performed some or all of this setup for you Consult your distributor s installation instructions or contact the distributor if it is unclear how to proceed Setup default Institutional submitter information in the PC ACE Pro32 Submitter reference file Information from this reference file is required during preparation of Electronic Media Claims EMC files Consult your distributor s installation instructions or contact the distributor for assistance in setting up this critical reference file AS Tip Refer to the Submitter File Maintenance topic for more information on setting up the default Submitter record If requir
39. billing e Extended Roster Info includes any supplemental common fields that may be required in certain situations Click the appropriate tab or simply press the PAGE UP and PAGE DOWN keys to move between these major roster billing form sections Entering Roster Billing Data Click on any field to activate it for data entry or press the TAB key to move from field to field in a predefined sequence generally left to right and top to bottom Use the UP ARROW and DOWN ARROW keys to move up and down through the roster billing form fields respectively A number of productivity enhancing features are available during roster billing data entry e Fixed List Lookups The roster billing form supports fixed list lookups on many of its fields Fixed list lookups apply to fields whose list of valid values can be determined in advance For example Patient Sex typically has 3 possible values M male F female and U unknown USAGE Access the lookup list for a field by positioning the cursor on the field and pressing the F2 function key or right clicking the mouse When an item from the list is selected its value is automatically entered in the roster billing form field hS Tip Type lt ALT gt F2 press the F2 key while holding the ALT key down to identify all fields that support a lookup list Press the ESC key to disable the flashing notification e Variable List Lookups The roster billing form support
40. by clicking the left mouse button once while the mouse pointer is positioned over the list row s left most column A checkmark will be visible in the left most column for all currently checked claims in the list Choose the Reactivate All Checked Claims item from the form s main Actions menu Confirm the reactivation of all checked claims when prompted AS Tip To automatically check all claims included in a previous transmission file select the Check All Claims From Selected Transmission item from the form s main Filter menu The Institutional or Professional Claim Transmission Log form will display a list of recent transmission files with the most recent automatically selected Select the desired transmission file entry and click the Select button Upon return to the Claim List form the program will automatically check all claims included in the selected transmission You may then simply choose the Reactivate All Checked Claims item from the form s main Actions menu to reactivate these checked claims Refer to the Claim List Form Features topic for more information Refer to the Claim List Form Features topic for more information on using the Institutional and Professional Claim List forms Reactivating an Entire EMC File for Retransmission PC ACE Pro32 archives all prepared EMC files for a duration determined by a Miscellaneous Preferences setting Until an EMC file is purged from the archive it is available for rea
41. by right clicking the mouse over the selected roster billing record Available roster billing actions include e Creating New Rosier Billings Click the New button or choose the Create New Roster action to create a new roster billing See the Adding a new roster billing topic for more details e Viewing Modifying Roster Billings Click the View Update button or choose the View Update Selected Roster action to view and or modify the selected roster billing See the Professional Roster Billing Form topic for details on using this roster billing entry form hS Tip The View Update action is the default roster billing action In addition to the techniques described above this action can also be invoked by double clicking on the desired roster billing record or by selecting the desired record and pressing the ENTER key 66 Main Toolbar amp Forms Deleting Roster Billings Click the Delete button or choose the Delete Selected Roster action to delete the selected roster billing Deleted roster billings are assigned a DEL status and can be recovered i e un deleted if needed See the Purging Roster Billings action description below for instructions on permanently removing roster billings from the PC ACE Pro32 database Copying Rosier Billings Click the Copy button or choose the Copy Selected Roster action to copy the selected roster billing The roster billing entry form will be displayed contain
42. captions for external data communication programs Miscellaneous Preferences includes settings to configure and control several maintenance options and other miscellaneous features Click on the links above for a description of the available preference options in each category Note Preference settings are workstation specific In a multi user installation each client workstation may set these preferences to best suit their work flow and data entry style 85 PC ACE Pro32 User s Manual General Preferences PC ACE Pro32 preference settings are organized on a tabbed dialog accessible from the PC ACE Pro32 Main Toolbar s main File menu The General Preferences tab settings control a number of claim entry options as well as other basic aspects of PC ACE Pro32 operation A description of each available option is included below 86 Automatically tab at maximum field length during data entry This option applies to data entry in the Institutional Claim Form Professional Claim Form and a number of other editable forms M When checked an automatic tab will occur when the field has been completely filled For example entering a single character in a one character field will automatically position the cursor on the next field in the tab sequence When unchecked the user must physically tab to the next field regardless of the contents of the current field Tab key jumps between controls with edit errors when displayed T
43. claim print method Importing claims 218 163 166 169 185 177 177 97 81 57 51 145 104 35 43 101 57 138 73 68 149 157 191 81 152 179 180 73 71 177 101 152 149 138 157 182 128 104 Installing PC ACE Pro32 Institutional Claim Form Institutional Eligibility Benefit Request Form Institutional Medical Attachment List Form Features Intermediate Format File claim import method Introducing PC ACE Pro32 launching data communications functions Launching the ANSI 835 Electronic Remittance Module Listing and modifying claims Listing and modifying eligibility benefit requests Listing and modifying Plans of Care Listing and modifying roster billings Logging in for the first time main toolbar maintaining reference files maintaining various code reference files Medical Attachments Institutional Miscellaneous Functions Adding or modifying a system user Launching the ANSI 835 Electronic Remittance Module Packing and re indexing the databases Performing system backups restores Scheduling unattended claim activities Sending support mail to your distributor miscellaneous preferences On line help optimizing your claims databases Packing and re indexing the databases patient setup and maintenance payer setup and maintenance PC ACE Pro32 Features PC ACE Pro32 Main Toolbar PC ACE Pro32 Setup Procedures Setup of Institutional All Payer Systems Setup of Medicare Part A Systems Setup of Pr
44. click the desired action button along the lower edge of the form The complete list of plan actions can be accessed from the Plan of Care List form s main Actions menu or from the convenient pop up menu accessed by right clicking the mouse over the selected plan Available plan actions include e Creating New Plans of Care Click the New button or choose the Create New Plan of Care action to create a new plan See the Adding a new Home Health Plan of Care topic for more details e Viewing Modifying Plans of Care Click the View Update button or choose the View Update Selected Plan of Care action to view and or modify the selected plan See the Home Health Plan of Care Form topic for details on using the PC ACE Pro32 Plan of Care entry form AS Tip The View Update action is the default plan action In addition to the techniques described above this action can also be invoked by double clicking on the desired plan record or by selecting the desired record and pressing the ENTER key X Tip Holding down the SHIFT key while invoking the View Update action on an eligible plan will force an automatic save attempt on the plan This is a shortcut technique equivalent to invoking the View Update action and subsequently clicking the Save button on the plan entry form Eligible plans are those with a status of unprocessed UNP has errors ERR or has fatal errors ERF e Copying Plans of Care Click the Copy b
45. click the up or down arrow to reposition the field in the list e The Width and Heading fields specify the column width and heading caption for the currently selected field in the Selected Fields listbox The default width and heading are usually acceptable but the user may change these if desired The width values are in approximate character increments Note This customization feature may not be available in all installations If the Claim List Preferences tab is visible then the feature is supported 90 System Preferences Claim Import Preferences PC ACE Pro32 preference settings are organized on a tabbed dialog accessible from the PC ACE Pro32 Main Toolbar s main File menu The Claim Import Preferences tab allows the user to select the processing method used to import claim files from an up stream system or other external source These preferences can be defined independently for Institutional and Professional claim types If your installation is licensed for both Institutional and Professional claim activities then you will need to select the appropriate claim type from the Institutional Claim Import or Professional Claim Import radio buttons near the top of this tab If your installation is licensed for only one claim type then this selection option will not be visible e Claim Import Processing Method specifies the preferred claim import method The following claim import methods are available Import cl
46. e Archiving claims reduces the size and optimizes the performance of the current claims database e Archiving claims eliminates claims that are no longer of interest from the current claims database making it easier to locate and work with the current claims e Archiving promotes organized storage of older claims without requiring that they be purged Claim archives can be maintained by transmit date line of business submission payer or other preferred criteria Claim archive databases look and act much like the current database With a few minor exceptions the same actions that can be taken on transmitted claims in the current database can also be taken on archived claims For example archived claims can be viewed and printed just like claims in the current database The payment history of archived claims can be viewed as well AS Tip To greatly reduce the time required to perform claim archiving activities on networked installations it is strongly recommended that such activities be initiated from the server s console It is also recommended though not required that no other users be accessing PC ACE Pro32 during claim archiving activities Note Access to various features of the PC ACE Pro32 claim archiving system is controlled by user permissions For example a user may be able to archive and unarchive claims but not have permission to create new claim archives If any or all of the claim archiving features described in thi
47. entry or press the TAB key to move from field to field in a predefined sequence generally left to right and top to bottom Use the UP ARROW and DOWN ARROW keys to move up and down through the claim form fields respectively A number of productivity enhancing features are available during claim data entry e Fixed List Lookups The claim entry form supports fixed list lookups on many of the claim s fields Fixed list lookups apply to fields whose list of valid values can be determined in advance For example Patient Sex typically has 3 possible values M male F female and U unknown USAGE Access the lookup list for a field by positioning the cursor on the field and pressing the F2 function key or right clicking the mouse When an item from the list is selected its value is automatically entered in the claim form field AS Tip Type lt ALT gt F2 press the F2 key while holding the ALT key down to identify all fields that support a lookup list Press the ESC key to disable the flashing notification e Variable List Lookups The claim entry form supports variable list lookups on a number of the claim s fields Variable list lookups apply primarily to fields whose values 43 PC ACE Pro32 User s Manual 44 are selected from reference files Most variable list lookups use other claim field values the specified claim LOB for example to filter the presented list For example provider lookups attem
48. expect to find remittance files in the following directory e Place Institutional remittance files in the server s winpcace etraub92 ansi835 directory e Place Professional remittance files in the server s winpcace etra1500 ansi835 directory e To launch an ANSI 835 program click the ANSI 835 Functions button on the PC ACE Pro32 Main Toolbar Click the desired button to launch either the Institutional ETRA or Professional ETRA1500 electronic remittance program Note The second level launch buttons may not be presented if only a single ANSI 835 Electronic Remittance module is configured for your installation Refer to the separate ANSI 835 Electronic Remittance ETRA module manuals for information about the capabilities and operation of these programs amp Attention The ANSI 835 Electronic Remittance modules are not available on all systems If either or both of these launch buttons are disabled then the corresponding ANSI 835 module is not available 205 PC ACE Pro32 User s Manual Performing system backups restores PC ACE Pro32 provides complete database backup validation and restore facilities to protect your valuable system data All claims reference files and system configuration settings can be backed up to either removable media diskettes writeable CDROM or a standard Windows directory local or remote In the event a catastrophic system failure results in the loss or compromise of PC ACE Pro32 data
49. fatal errors ERF Deleting Requests Click the Delete button or choose the Delete Selected Request action to delete the selected eligibility benefit request E Attention Deleted eligibility benefit requests are permanently removed from PC ACE Pro32 they cannot be recovered Copying Requests Click the Copy button or choose the Copy Selected Request action to copy the selected eligibility benefit request The eligibility benefit request entry form will be displayed containing the details of the newly copied request Holding Requests Choose the Hold Selected Request action to change the status of the selected eligibility benefit request to held HLD Held requests are not eligible for preparation Releasing Requests Choose the Release Selected Request action to release a previously held eligibility benefit request In addition to releasing the request this action also sets the status of the selected request to unprocessed UNP Reactivating Requests Choose the Reactivate Selected Request action to reactivate the selected eligibility benefit request This action will move the previously submitted request from the submitted TR location into the to be submitted EL location The reactivated request will be assigned the unprocessed UNP status Viewing Responses Choose the View Response for Selected Request action to view the ANSI 271 eligibility benefit response information for the selec
50. field for the claim s billing provider will control whether or not the edits prompt for entry of POA information during claim entry Saving amp Canceling Claims After completing data entry on the claim form click the Save button or type lt ALT gt S to save and exit the claim Alternatively click the Cancel button to abandon any changes and exit the claim When an attempt is made to save a claim the following occurs e Submission Payer Determination At least one of the payers specified on a claim must have the same LOB line of business as the claim itself You will not be allowed to save a claim unless this condition is met If only one of the claim payers has a LOB that matches the claim LOB then this payer is automatically designated as the submission payer the payer to which the claim is to be submitted If you view the claim after saving you will see a checkmark adjacent to the submission payer line on the Payer Information tab It is possible that multiple payers on a claim will have an LOB that matches the claim s LOB In this case you will be prompted to select which of these payers is to be designated as the submission payer e Edit Validation During the claim save process an edit validation process is performed on all fields on the claim This process includes re evaluating all field level edits as defined above In addition all claim file level edits are evaluated File level edits are evaluated only when
51. fields are defined as follows e Provider ID No or Group ID No for group providers The provider group identifier to be used on claims for the line of business specified in the LOB field e LOB Specifies the line of business applicable to this provider record e Payer ID An optional field that if specified identifies this provider record as payer specific to the payer identified by this Payer ID The Provider Type selection and LOB field value are used to filter the list of providers presented to the user during claim entry lookup operations Only provider records with an LOB value matching the claim s LOB will be available for selection Claim billing provider lookup lists will include only group and solo providers while rendering provider lookup lists will include only individual in group providers If required this provider record s associations may be maintained from this form using the Select adds a new association and None deletes all associations buttons adjacent to the Provider Associations listbox AS Tip When setting up provider records for a group and its members always create the Group Practice provider record s first Associated group provider records must be created for each line of business LOB in which the group or any of its members will participate Once the group provider records are in place create Individual in Group provider records for each group member Associated
52. file The Provider tab provides a convenient Sort By selection that quickly sorts the Provider list by LOB Provider Name Provider ID or Tag Operations available include e To add anew provider record click the New button and enter the new provider s information If providers already exist in this reference file you will have the option to create a completely new provider record or to inherit and associate the new provider record with the provider record currently selected in the list Select the desired creation options and click the OK button to continue See the discussion below for more information on provider inheritance and association e To view or modify an existing provider record select the desired record from the list and click the View Update button or double click the desired record e To delete an existing provider record select the desired record from the list click the Delete button and confirm the deletion amp Attention Claims are linked to provider records by an internal control number Deleting a provider record will irrevocably break any such links that may exist to claims in the system The Provider Deletion Confirmation form will be displayed when you attempt to delete a provider record This form outlines alternatives to deletion and provides a convenient utility to determine how many claims reference the provider record to be deleted Consider clearing the Include In Lookups option o
53. file you should check with them before making any changes Refer to the Submitter File Maintenance topic for more information on configuring this important reference file To prepare claims in PC ACE Pro32 follow these simple steps 3 From the PC ACE Pro32 Main Toolbar click either the Institutional Claims Processing or Professional Claims Processing button to open the desired Claims Menu form 4 From the Claims Menu form click the Prepare Claims button to open the Claim Prepare For Transmission form This form provides the following preparation options e Claim Filter Parameters claims must meet all specified filter criteria to be considered for preparation e LOB specifies a single line of business LOB to be considered Only claims with this LOB will be eligible for preparation Select the lt lt All gt gt item to include claims for any line of business Note The Submitter reference file supports LOB specific setup information if desired Selecting a specific LOB for preparation will trigger the use of the matching LOB specific submitter information if any Refer to the Submitter File Maintenance topic for more information on this advanced feature e Payer specifies a single Payer to be considered Only claims being submitted to the selected payer will be eligible for preparation Select the lt lt All Payers for LOB s gt gt item to include claims for all payers Note This selection is only enabl
54. for example if the Information Source i e payer specified on the request is no longer present in the Payer reference file Rejected eligibility benefit requests must be re processed and corrected before they can be successfully prepared When you have completed your review of the eligibility benefit request preparation reports click the Close button on the Eligibility Benefit Request Prepare form The prepared ANSI 270 eligibility benefit request file is located in the server s winpcace directory The file is named bcreq270 dat for Institutional requests and bsreq270 dat for Professional requests You may now proceed to transmit the ANSI 270 eligibility benefit request file to your claims processor using their prescribed file transmission procedure Related Topics The following hyperlinks provide additional information related to this topic Refer to the Adding a new eligibility benefit request topic for more information on creating patient eligibility benefit requests 143 PC ACE Pro32 User s Manual 144 Refer to the Viewing and maintaining eligibility benefit response files topic for information on viewing and maintaining the ANSI 271 eligibility benefit response files that will be returned by your claims processor Refer to the Viewing the eligibility benefit response for a specific request topic for information on viewing the eligibility benefit response returned for a specific request Refer to the Submitter
55. group member provider records must then be created for each line of business LOB in which the member will participate Refer to the Setup of Professional Systems topic for a suggested approach to initial setup of the provider reference file hS Tip A number of fields on the Professional Provider Information form support data entry via fixed list or variable list lookups These lookup lists are accessed by right clicking the mouse over the field or pressing the F2 key while focused on the field Type lt ALT gt F2 press the F2 key while holding the ALT key down to identify all fields that support a lookup list Press the ESC key to disable the flashing notification Helpful fly over hints are also available for many fields Saving amp Canceling Provider Updates 167 PC ACE Pro32 User s Manual After completing data entry on the Professional Provider Information form click the Save button or type lt ALT gt S to save and exit the form Alternatively click the Cancel button to abandon any changes and exit the form During the provider save operation an edit validation process is performed on all provider record fields If no edit validation errors occur the provider record is saved without further user intervention If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List screen This screen lists all the edit validation errors that have occurred indicating whic
56. imp1500 directory 3 Setup all required PrintLink Matching Description strings in the Payer reference file These strings are used to match payer descriptions from claims in the intermediate delimited file to specific Payer reference file records Refer to the Adding and maintaining payers topic for details on setting up your PrintLink Matching Description strings 4 Each time you want to import claims copy the new intermediate delimited file generated by your upstream system into the server s winpcace imp1500 directory The file must be named plink out Electronic Media Claims EMC Format import claims from a file in Electronic Media Claims EMC format If using this claim import method complete the following steps 1 Confirm that your upstream system is capable of producing a supported version Electronic Media Claims EMC format file Contact your distributor for the list of supported EMC file versions 2 Each time you want to import claims copy the new EMC file generated by your upstream system into the server s winpcace imp1500 directory The file must have a dat file extension e g EMC320 DAT Claim Prepare amp Transmit Considerations This section describes setup considerations that should be reviewed before you attempt to prepare and transmit claims using PC ACE Pro32 1 Note Your distributor may have already performed some or all of this setup for you Consult your distributor s installation
57. impub92 directory The first line of the map file provided by your distributor dictates what the print image file must be named typically ub92 prt Intermediate Delimited Format imports claims from a file in intermediate delimited format If using this claim import method complete the following steps 1 Work with your distributor to develop the programs necessary to produce a file in intermediate delimited format from your upstream system Your distributor should have detailed specifications of this internal file format Verify that the generated files meet these specifications 2 Confirm the existence of the required map control file This file provides a control interface between the intermediate delimited file and the PC ACE Pro32 claim import routines The map control file is always named mapentlu win and should be located in the server s winpcace impub92 directory PC ACE Pro32 Setup Procedures 3 Setup all required PrintLink Matching Description strings in the Payer reference file These strings are used to match payer descriptions from claims in the intermediate delimited file to specific Payer reference file records Refer to the Adding and maintaining payers topic for details on setting up your PrintLink Matching Description strings 4 Each time you want to import claims copy the new intermediate delimited file generated by your upstream system into the server s winpcace impub92 directory The file must
58. in the processing error report by default This default value can be overridden for each processing run if desired M When checked the processing error report will include edit validation error descriptions for each claim by default M When unchecked the processing claim report will not include edit validation error descriptions Maximum number of process errors reported per claim specifies the maximum number of processing edit validation errors to be reported per claim The default value of 5 errors per claim helps to limit the size of the processing error report Increase this value substantially if you prefer that all errors be included in the report e Prepare settings on this tab control the printing of claim prepare reports These include Automatically print claim prepare reports on completion specifies whether claim prepare reports will be printed automatically i When checked the claim prepare reports automatically print after the claim prepare run has completed I When unchecked the claim prepare reports will not print automatically You will still have the option to print the reports manually Print claim prepare error report even when no errors exist specifies whether empty claim prepare error reports will be printed automatically This option is only enabled if you have chosen to print claim prepare reports automatically M When checked the claim prepare error report automatically prints even if all claims were
59. instructions or contact the distributor if it is unclear how to proceed Setup default Professional submitter information in the PC ACE Pro32 Submitter reference file Information from this reference file is required during preparation of Electronic Media Claims EMC files Consult your distributor s installation instructions or contact the distributor for assistance in setting up this critical reference file hS Tip Refer to the Submitter File Maintenance topic for more information on setting up the default Submitter record If required by your distributor setup default Professional data communications parameters in the PC ACE Pro32 Data Communications reference file This reference file contains the Professional data communications parameters exported to the bsdatcom dat 25 PC ACE Pro32 User s Manual file prior to the launch of any external data communications program e g file transmission These parameters are used by the third party data communications program to control the file transmission etc hS Tip Refer to the Data Communications File Maintenance topic for more information on setting up the default Data Communications record This completes the required setup steps to ready PC ACE Pro32 for Professional All Payer claims processing 26 Main Toolbar amp Forms The PC ACE Pro32 Main Toolbar All PC ACE Pro32 functions are available from the main toolbar action buttons and menu This toolbar consumes only a
60. is not visible then your system does not support paper claim processing and all claims must be submitted electronically Requesting Claim Status Choose the Request Selected Claim Status action to add the selected claim to the claim status request queue Status requests can only be made for claims in the transmitted TR and paid PD locations Any number of claims can be queued using this action item Once all desired claims have been queued refer to the Preparing claim status request files for transmission topic for instructions on preparing the ANSI 276 claim status response file Note Support for the ANSI 276 277 claim status request response feature may be disabled by the distributor If the Request Selected Claim Status action item is not visible then your system does not support the claim status request response feature Show Selected Claim Status History Choose the Show Selected Claim Status History action to view and maintain the claim status request response history for the selected claim This action is available for claims in the transmitted TR and paid PD locations only Refer to the Viewing and maintaining the claim status request response history topic for more information on how to use the Claim Status Request Response History form Note Support for the ANSI 276 277 claim status request response feature may be disabled by the distributor If the Show Selected Claim Status History action item
61. is not visible then your system does not support the claim status request response feature Refreshing the Claim List Choose the Refresh Claim List action or press the F5 function key to refresh the current Claim List form contents This action can be useful in a multi user installation to be sure that the claim list properly reflects claim additions and or modifications made by other users 31 PC ACE Pro32 User s Manual Note You will notice that only applicable actions are enabled for use in the main Actions menu or pop up menu For example it makes no sense to reactivate a claim that has yet to be transmitted so this action will be disabled for claims in the CL location Actions on Multiple Claims Some actions can be performed on multiple claims at once Multiple claim selection is accomplished by checking the claim of interest and subsequently performing one of the All Checked Claims actions To check a claim click the left mouse button over the checkbox in the first column of the desired list row Alternatively all claims in the current list can be checked using the Check All Claims item from the list s pop up menu Use the flexible Claim List form filter techniques to display only the subset of claims to be printed deleted held etc Then simply check all claims and perform the desired action on all checked claims at once hS Tip Use the Check All Claims From Selected Transmission filter option to
62. it possible for users to view and print just the portion of the ANSI 271 response report that pertains to a single eligibility benefit request Note The patient eligibility benefit request response capability may not be available on all installations If the Maintain Eligibility Benefit Requests item is not visible on the Maintain menu when performing the steps described in this topic then this capability is not available on your installation Responses for individual eligibility benefit requests can be accessed from the Eligibility Benefit Request List Form Perform the following steps to access the request list form and view these response reports 1 Click either the Institutional Claims Processing or Professional Claims Processing button on the PC ACE Pro32 Main Toolbar to display the respective Claims Menu form 2 From the Institutional or Professional Claims Menu form select the Maintain and Maintain Eligibility Benefit Requests menu items to open the respective Eligibility Benefit Request List form 3 In the Eligibility Request List Filter Options control group click the Location filter dropdown list and select the TR submitted location entry Response reports will only be available for eligibility benefit requests that have already been submitted transmitted Tip The Eligibility Benefit Request List Form displays a Reply column at the far left when the TR submitted location filter is selected T
63. lt TAB gt key to return to the original line field 37 PC ACE Pro32 User s Manual e Line Item Totals Recalculation The Billing Line Items tab provides a Recalculate button located near the bottom of the tab adjacent to the totals fields Click this button to recalculate and update the Total Charges and Total Non Covered Charges fields from the current claim line item charges values NOTE This button may not be available on some installations e Payer Insured Features The following payer and or insured information productivity features are available e Quick Payer Access Press the lt ALT gt I key combination while positioned anywhere on the Patient Info amp Codes tab to move immediately to the primary payer s Payer ID field Press the lt ALT gt O key combination to move immediately to the secondary payer s Payer ID field e Clear Payer Feature The Payer Information tab provides a Clear Payer button for each of the 3 claim payers Click this button to clear all payer provider insured and employer fields for the associated payer e Coordination of Benefits COB Support The claim form includes fields to allow entry of Coordination of Benefits COB data at both the claim and line levels when appropriate Enter a Y in the COB field to make these COB related fields available for use The COB field is located in the upper right quadrant of the Diagnosis Procedure tab See the section entitled C
64. naming convention may be overridden in the Submitter reference file Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Submitter File Maintenance topic for details on configuring the Submitter reference file e Refer to the Transmitting electronic claim files topic for more information on transmitting the prepared EMC file e Refer to the Reactivating previously transmitted claims topic to learn how transmitted claims can be selectively reactivated for re transmission e Refer to the Recovering from an interrupted claim prepare run topic to see how PC ACE Pro32 can recover from an interruption in the preparation process 114 Common Reference File Procedures Transmitting electronic claim files PC ACE Pro32 interfaces seamlessly with third party communications packages to transmit Electronic Media Claims EMC files This approach assures maximum flexibility for the distributor and eliminates any PC ACE Pro32 dependencies A convenient launch facility makes it easy for the user to initiate file transmissions and other data communications functions terminal emulation sessions for example PC ACE Pro32 may be configured to launch any required data communications functions without exiting the program Before you are ready to transmit you must have already entered or imported and processed one or more claims and prepared these claims into an EMC file suitable for t
65. omitted To insure accuracy birthdate fields require that a full 4 digit year be entered e Descriptive Field Hints Most Plan of Care form fields have field hints that provide a brief description of the field s purpose These hints are often called fly over hints since they become visible when the mouse pointer moves over the specified field without actually selecting the field This feature can be disabled in the general preferences settings if desired e Line Item Scrolling A variable number of Service Treatment lines on the Medical Update 486 1 tab and Expanded Narrative lines on the Miscellaneous tab may be entered on a Plan of Care form This form displays two Service Treatment lines and three Expanded Narrative lines at a time For plans that contain additional line items the user may scroll through the line items one line at a time or one page at a time using the buttons provided along the right edge of the respective tabs hS Tip You can also use the up down arrow keys to move from line to line scrolling when appropriate Type lt ALT gt lt PAGE UP gt press the Page Up key while holding the ALT key down or lt ALT gt lt PAGE DOWN gt to scroll up down through all line items one page at a time e Line Item Deletion Press the F7 key while positioned on any field of a Service Treatment line or Expanded Narrative line to delete the line You will be prompted to confirm the deletion When the focus l
66. or type lt ALT gt S to save and exit the form Alternatively click the Cancel button to abandon any changes and exit the form During the patient save operation an edit validation process is performed on all patient record fields If no edit validation errors occur the patient record is saved without further user intervention If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List form This form lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the reference file edit validation process and the Edit Validation Errors List form If any fatal edit errors exist you must correct them before the patient record can be saved If only non fatal edit errors exist you will have the option to correct the errors or save the patient record with errors Click the Save With Errors button to save a patient record that contains only non fatal errors If edit validation errors occur several Save attempts may be required to correct and save a clean patient record Common vs Separate Insured Information NOTE This discussion applies only if your system is licensed for both Institutional and Professional claim activities If you are licensed for only a single claim type the form controls described in this section will not even be v
67. provides a convenient utility to determine how many claims reference the provider record to be deleted Consider clearing the Include In Lookups option on the Professional Provider Information form as an alternative to deleting the provider AS Tip The Provider Prof tab of the Reference File Maintenance form provides several list filter options that can be helpful in locating specific providers Refer to the Reference File Maintenance Form topic for a discussion of these common filter options Entering Professional Provider Information The Professional Provider Information form provides access to all Professional provider fields These fields are grouped logically on the following tabs e General Info includes fields for the provider type name address contact identification Provider or Group ID No LOB Payer ID Group Label tax number and other miscellaneous information e Extended Info includes fields for any additional extended provider information e g the pay to provider name and address if different e Local Fields includes up to six additional local provider fields to be defined by the distributor This tab will only be visible if the distributor has defined one or more of these local fields Contact your distributor for completion details Click the appropriate tab or simply press the PAGE UP and PAGE DOWN keys to move between tabs The Professional provider structure defines 3 distinct provider
68. response files are to be automatically purged by the system If automatic purging is enabled specifies the number of days the response files are to be retained M When checked all ANSI 271 eligibility benefit response files older than the specified number of days will be automatically purged from the response file archive System Preferences M When unchecked all ANSI 271 eligibility benefit response files will remain archived until manually deleted Refer to the Viewing and maintaining eligibility benefit response files topic for more information on maintaining the response file archive Note If this preference option is disabled support for the ANSI 270 271 eligibility benefit request response feature is not available on your installation Purge claim activity log after NN days specifies whether the Institutional and Professional claim activity logs will be automatically maintained by the system If automatic maintenance is enabled specifies the number of days that log entries are to be retained M When checked the claim activity logs will be maintained to include only entries for the specified number of days When unchecked the claim activity logs will grow indefinitely until it they are purged manually Refer to the Reviewing the claim activity logs topic for more information on the viewing and purging the claim activity logs Limit initial claim list display of transmitted paid claims to most recent NN months
69. secondary payers if the original claim was processed through PC ACE Pro32 Simply use the Institutional Claim List form to locate the original claim in the TR transmitted location select the Copy action to create the new secondary claim and enter the LOB applicable to the secondary payer Finally enter a Y in the COB field on the Diagnosis Procedure tab to activate the COB related fields You will then have a duplicate of the original claim ready to add the primary payer s COB information The claim level COB data is entered on the COB Info Primary and COB Info Secondary sub tabs of the Extended Payer tab The purpose and use of the various field groups on these sub tabs are as follows Claim Level Adjustments CAS Permits entry of one or more claim level adjustments as reported by the payer Adjustments are defined by a specific Group code and Reason code combination Enter these codes manually or select them from the available lookup lists Each claim level adjustment must specify a non zero Amount value and may also specify an optional Units value COB MOA Amounts Permits entry of various general claim level COB amount values as well as amount values defined specifically for Medicare Inpatient Adjudication MIA and Medicare Outpatient Adjudication MOA use Enter or select the Code which defines the amount type to be reported and enter the corresponding Amount value Medicare Inpatient Adjudicat
70. successfully prepared I When unchecked the claim prepare error report will not automatically print if it is empty Prepare Report Printer specifies the claim prepare reports printer Report claims for each LOB Payer on a separate page controls the page break method used for claim prepare reports i When checked the claim prepare reports will break to a new page prior to printing the first claim for each unique LOB Payer combination Enable this option to insure that prepared claims for each LOB Payer combination are printed on separate pages I When unchecked the claim prepare reports will be printed in a continuous fashion with no forced page breaks 93 PC ACE Pro32 User s Manual 94 Claim Form settings on this tab control printing of Institutional and Professional claim forms and claim attachments These include Default Printer specifies the default claim form printer This default selection may be overridden when the claim form is printed Default Method specifies the default claim form printing method This method may be overridden when the claim form is printed The available printing methods include Pre printed Forms specifies the traditional printing method requiring pre printed CMS 1450 1500 claim forms Image Overlay specifies an advanced overlay technique in which both the claim form graphics and claim data are printed on stock paper This method requires the Adobe Acrobat Reader and wi
71. that requires POA information simply enter the diagnosis code followed by a single SPACE character to serve as a separator and then one of the valid POA indicator values It is not necessary to count spaces between the diagnosis code and the POA indicator The indicator character will be automatically repositioned to the 8th position of the diagnosis code field when the focus moves to another screen control When selecting diagnosis codes from a lookup list the cursor will automatically position itself at the end of the diagnosis code value to make it easy to append the POA indicator when appropriate Simply enter a single SPACE character followed by the POA indicator value Present On Admission POA information should be entered only on claims involving inpatient admissions to general acute care hospitals or other facilities that are subject to a law or regulation e g Deficit Reduction Act of 2005 mandating collection of this information Claim edits exist to enforce Medicare POA reporting requirements These edits are driven off the Requires POA Reporting field on the Extended Info tab of the Institutional Provider Information form located in the Reference File Maintenance module This Requires POA Reporting field should be set to Y for providers that are required to submit POA information 40 Main Toolbar amp Forms Leave this field empty or set to N for providers that are exempt from POA reporting The value entered in this
72. the Preparing claim status request files for transmission topic for information on creating ANSI 276 claim status request files to send to your claims processor e Refer to the Viewing and maintaining claim status response and acknowledgment files topic for information on viewing and maintaining the ANSI 277 claim status response files that will be returned by your claims processor 127 PC ACE Pro32 User s Manual Printing claims Claims can be printed in PC ACE Pro32 using either the traditional pre printed forms method or an advanced image overlay technique These 2 approaches are described below along with suggestions on when each method might be appropriate e Pre Printed Forms Method This traditional method prints just the actual claim field values at positions on the page that should line up with pre printed CMS 1450 Institutional or Professional claim forms Use this printing method when you require claims to be printed on the actual red pre printed claim forms Most optical character recognition OCR equipment used to scan paper claims requires that these red forms be used This method also provides the quickest means to get a claim printout for hardcopy review e Image Overlay Method This advanced method automatically overlays the claim field values onto a graphical image of the blank claim form resulting in a complete claim image that can be printed on stock paper The image overlay technique eliminates all the paper
73. the claim is saved and are typically those edits that require multiple data elements from the claim in order to be evaluated If no edit validation errors occur the claim is saved with a clean CLN status If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List form unless disabled in the Preference settings This form lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the claim edit validation process and the Edit Validation Errors List form If edit errors exist you will usually have the option to correct the errors or save the claim with errors If a fatal error exists on the LOB PCN or TOB field however you must correct the error before saving the claim Click the Save With Errors button to save a claim that contains only non fatal errors Such claims are assigned the has errors ERR status Click the Save With Fatal button to save a claim that contains fatal errors Such claims are assigned the has fatal errors ERF status Claims with an ERF status will not be eligible for preparation into an electronic EMC file If edit validation errors occur several Save attempts may be required to correct and save a clean claim At any time click the Errors List button to review the remaining edit valida
74. this occurs the revenue code is considered valid and the remaining control setting flags will assume their default values during edit validation processing Note Revenue Code Assignment records that include a specific TOB value take precedence over records with the special IP inpatient and OP outpatient TOB values This evaluation sequence makes it possible to define an inpatient outpatient group assignment that is valid for most TOBs in the group Separate assignment records with specific TOB values can be created as needed to handle exceptions to the group rule By understanding this matching process it is possible to build a revenue code assignment details set that can be as open or as specific as required 189 PC ACE Pro32 User s Manual Place of Service POS File Maintenance The Place of Service POS Codes form provides an interface to maintain the Place of Service POS codes and assignments POS codes apply exclusively to Professional claims The POS codes are pre loaded and should not require frequent additions or modifications The Place of Service POS form includes two tabs e Descriptions displays a list of Place of Service POS codes and their descriptions Maintenance operations available are e To adda POS code click the New button and enter the new POS code information Enter the effective date range using a 4 digit year format e To view or modify an existing POS record select the desired record
75. to right and top to bottom Use the UP ARROW and DOWN ARROW keys to move up and down through the eligibility benefit request form fields respectively A number of productivity enhancing features are available during eligibility benefit request data entry e Fixed List Lookups The eligibility benefit request entry form supports fixed list lookups on many of the request s fields Fixed list lookups apply to fields whose list of valid values can be determined in advance For example the Patient Sex field has only two possible values M male and F female USAGE Access the lookup list for a field by positioning the cursor on the field and pressing the F2 function key or right clicking the mouse When an item from the list is selected its value is automatically entered in the request form field AS Tip Type lt ALT gt F2 press the F2 key while holding the ALT key down to identify all fields that support a lookup list Press the ESC key to disable the flashing notification e Variable List Lookups The eligibility benefit request entry form supports variable list lookups on a number of the request s fields Variable list lookups apply primarily to fields whose values are selected from reference files Most variable list lookups use other eligibility benefit request field values the specified request LOB for example to filter the presented list For example provider lookups attempt to present only those provide
76. types 166 Common Reference File Procedures e Group Practice Identifies the provider record as representing a group practice for billing purposes When creating group provider records the user must assign a unique Group Label to identify the group It is assumed that a group provider will be assigned members see Individual in Group provider type below e Individual in Group Identifies the provider record as representing an individual provider that is a member of one of the existing group providers see Group Practice provider type above When creating individual in group provider records the user can select the desired Group Label from a lookup list of applicable group providers Claims may not be billed directly to individual in group providers rather these providers are specified as rendering providers on Professional claims e Solo Practice Identifies the provider record as representing a solo practice provider Solo practice providers are not associated with any provider group and will bill claims directly Professional claims require a billing provider that can be either a group or solo provider but not an individual in group The Professional claim entry provider lookup and claim editing process will enforce this requirement Provider records are uniquely defined by the Provider ID No Provider ID and LOB Line of Business fields and optionally by the Payer ID field as well These critical
77. will remain archived until manually deleted Refer to the Viewing and maintaining transmission acknowledgment files topic for more information on maintaining the acknowledgment file archive Note If this preference option is disabled support for ANSI 997 999 transmission acknowledgment files is not available on your installation Purge archived ANSI 277 claim status response or ack files after NN days specifies whether archived Institutional and Professional ANSI 277 claim status response and claim acknowledgment files are to be automatically purged by the system If automatic purging is enabled specifies the number of days the response files are to be retained i When checked all ANSI 277 claim status response and claim acknowledgment files older than the specified number of days will be automatically purged from the response file archive M When unchecked all ANSI 277 claim status response and claim acknowledgment files will remain archived until manually deleted Refer to the Viewing and maintaining claim status response and acknowledgment files topic for more information on maintaining the response file archive Note If this preference option is disabled support for the ANSI 276 277 claim status request response feature is not available on your installation Purge archived ANSI 271 eligibility benefit response files after NN days specifies whether archived Institutional and Professional ANSI 271 eligibility benefit
78. with When selected the list is filtered to include only those records whose PCN ID code name or description starts with the pattern entered in the adjacent filter control The filter is dynamically re applied as characters are added to or deleted from the pattern Main Toolbar amp Forms hS Tip This filter option is invoked automatically if the user types one or more alphanumeric characters while the focus is on the list which it is by default when the form is opened This behavior permits the user to easily filter the list if the first few characters of the code or description are known The user may then use the standard list navigation keys to move around in the filtered list Once the desired record is selected the user may press the ENTER key to view update or select in a lookup context the highlighted record These features are designed to increase operator efficiency by minimizing the need to use the mouse Filter list to include descriptions containing When selected the list is filtered to include only those records whose description field value contains the pattern entered in the adjacent filter control Click the Apply button or press the ENTER key after entering the search string to perform the filter operation Show only providers associated with selected provider When selected filters the list to include only those provider records associated with the currently selected provider record Th
79. 0 diagnosis codes procedure codes and descriptions Physician UPIN File Maintenance maintain the Physician UPIN file Provider Taxonomy Code File Maintenance MISC ANSI maintain provider taxonomy codes and classification specialization descriptions Claim Adjustment Reason Codes File Maintenance MISC ANSI maintain claim adjustment reason codes and descriptions Remittance Remark Codes File Maintenance MISC ANSI maintain remittance remark codes and descriptions Eligibility Request Service Type Codes File Maintenance MISC ANSI maintain eligibility oenefit request service type codes and descriptions Claim Status Response Codes File Maintenance MISC ANSI maintain claim status response codes and descriptions The following reference file topics apply exclusively to Institutional claims Type of Bill TOB File Maintenance maintain TOB assignments and related information Condition Occurrence Span Value Codes File Maintenance maintain condition occurrence span and value codes descriptions and assignments Revenue Codes File Maintenance maintain revenue codes descriptions assignments and related information The remaining reference file topics apply exclusively to Professional claims Place of Service POS File Maintenance maintain POS codes descriptions and assignments Facility File Maintenance maintain facility information Charges Master File Maintenance maintain charge master procedure code
80. 132 Common Reference File Procedures Posting claim payments Professional PC ACE Pro32 maintains an optional Professional claim payments database for organizations that wish to track payment data in the system Any number of payments may be posted against a transmitted Professional claim The payment history for a claim can be accessed from either the Professional Claim List form or the The Professional Claim Form as follows 1 2 Click the Professional Claims Processing button from the PC ACE Pro32 Main Toolbar to display the Professional Claims Menu form Click the List Claims button on the Professional Claims Menu form to display the Professional Claim List form By default the list will display claims in the to be transmitted CL location On the Professional Claim List form select either the transmitted only TR paid only PD or transmitted paid TR PD claims location to display claims eligible for payment Note Claims are assigned to the transmitted TR location as soon as they are prepared into an EMC file for transmission When the first payment is posted to a transmitted claim the claim is moved to the paid PD location where it will remain indefinitely Payments may be posted to claims in either the transmitted TR or paid PD locations but not to claims in the to be transmitted CL location hS Tip If you plan on posting payments to more than one claim we recommend that
81. 217 PC ACE Pro32 User s Manual Adding and maintaining providers Institutional Adding and maintaining providers Professional Maintaining Codes amp Miscellaneous Reference Files Condition Occurrence Span Value Codes File Maintenance Data Communications Control File Data Communications File Maintenance Data Communications preferences edits explained Eligibility Benefit Request Form Eligibility Benefit Request List Form Features eligibility benefit response files EMC File claim import method entering claim data Institutional entering claim data Professional entering claims entering eligibility benefit request data entering eligibility benefit requests entering Plan of Care data entering roster billing data Professional entering roster billings ESRD medical attachment Facility File Maintenance features list field level and file level edits Forms 485 486 Home Health Plan of Care Getting started with PC ACE Pro32 HCPCS Codes File Maintenance HCPCS Modifiers File Maintenance Help System How To Use Home Health Plan of Care Form Home Health Plan of Care List Form Features host phone and login setup how to complete a claim how to complete a Home health Plan of Care how to complete a roster billing how to complete an eligibility benefit request how to complete an Institutional Medical Attachment how to get started How to use the on line help system ICD9 Codes File Maintenance image overlay
82. 7 specifies the Interchange Receiver ID and ID Qualifier override values These values populate elements ISA08 and ISA07 of the Interchange Control Header ISA segment in the ANSI 270 format EMC file respectively e Application Sender s Code GS02 specifies the Application Sender s Code override value This value populates element GSO2 of the Functional Group Header GS segment in the ANSI 270 format EMC file e Application Receiver s Code GS03 specifies the Application Receiver s Code override value This value populates element GSO3 of the Functional Group Header GS segment in the ANSI 270 format EMC file ANSI Info 4 specifies optional data element override values to be used exclusively during the preparation of claim status request files in ANSI 276 format This tab will only be available if the ANSI 276 277 Claim Status Request Response feature is enabled on your installation Leave these override fields empty for default ANSI 276 processing You should change these values only under instructions from your distributor The currently defined ANSI 276 override fields include e Intchg Sender ID Qual ISA06 05 specifies the Interchange Sender ID and ID Qualifier override values These values populate elements ISAO6 and ISA05 of the Interchange Control Header ISA segment in the ANSI 276 format EMC file respectively e Intchg Receiver ID Qual ISA08 07 specifies the Interchange Receiver ID and ID Qualifier override va
83. 997 ack1500 For single user installations these directories will reside on the local drive letter to which PC ACE Pro32 was originally installed For multi user networked installations these directories will reside on the shared network drive letter to which PC ACE Pro32 was originally installed E Attention Care must be taken to copy Institutional acknowledgment files to the Institutional staging directory and Professional acknowledgment files to the Professional staging directory In addition if your contractor assigns the same filename to all ANSI 997 999 files you will need to make sure that the most recently staged acknowledgment file has been archived before copying a newer acknowledgment file into the staging directory hS Tip Installations that use data communications scripts to retrieve the ANSI 997 999 acknowledgment files may also automatically copy them to the appropriate staging directory Your distributor should be able to confirm whether or not automatic ANSI 997 999 file staging will be performed on your installation Viewing Printing amp Maintaining Acknowledgment Files Archived ANSI 997 999 transmission acknowledgment files can be viewed and or printed from the Acknowledgment File Log form To view the currently archived ANSI 997 999 files select the Maintain and Acknowledgment File Log menu items on either the Institutional or Professional Claims Menu form The following operations are available 117 PC A
84. ACE Pro32 server and client optional modules The final paragraph of this Getting Started section will direct you to the relevant setup tasks required to get you operational with PC ACE Pro32 Minimum System Requirements e SVGA monitor resolution 800 x 600 e Windows 8 Windows 7 or Vista operating system e Adobe Acrobat Reader Version 4 0 or later for overlaid claim printing Note When the Windows Large Fonts display setting is enabled the screen resolution must be 1024 x 768 or higher The Institutional Claim Form and Professional Claim Form will not display properly at lower screen resolutions PC ACE Pro32 Server Installation Perform these steps to install the PC ACE Pro32 server or single user install 1 If you are downloading PC ACE Pro32 save the installation program SETUP EXE to a temporary folder on your computer for example the Windows desktop Double click the SETUP EXE icon to begin the PC ACE Pro32 installation process For compact disk media the installation program should execute automatically when you insert the disk into your CDROM drive If the Windows auto detect feature is disabled you may need to start the installation program manually To do so type D setup in the Run dialog accessible from the Windows Start menu substituting the drive letter of your CDROM drive for the D in this example 2 Follow the on screen wizard steps to complete the server installation You will be prompted to sel
85. Automatic code validation diagnosis procedure etc e Detailed claim import amp edit validation error reporting e Context sensitive pop up selection lists speed claim entry and promote accuracy e Prints Institutional and Professional claims on plain paper or pre printed forms e Maintains claim payment history e Unattended scheduling of claims activities e Integrated backup restore and file maintenance functions e Familiar Microsoft Windows look and feel e Comprehensive on line help system e Technical support through direct customer service line and Internet web site e Ongoing maintenance updates and enhancements Thank you for choosing PC ACE Pro32 as the electronic claims processing system for your facility or organization It is our commitment to provide you with a quality product and outstanding support We will strive to constantly improve and enhance PC ACE Pro32 to serve the ever changing needs of the healthcare community well into the 21 century Getting started with PC ACE Pro32 The PC ACE Pro32 Claims Processing System was designed from the ground up for the Windows environment Special care has been taken to ensure that PC ACE Pro32 looks and feels like other popular Windows programs This means that you can concentrate on PC ACE Pro32 s features rather than worrying about how to navigate the program This section describes the recommended minimum system requirements for PC ACE Pro32 Follow the steps to install the PC
86. CE Pro32 User s Manual To view and or print an archived ANSI 997 999 file select the desired record and click the View Report button or double click the desired record The report may be printed from the preview form if desired To delete an archived ANSI 997 999 file select the desired record click the Delete button and confirm the deletion Note By default archived ANSI 997 999 transmission acknowledgment files will be automatically purged after a certain number of days Refer to the PC ACE Pro32 Miscellaneous preferences topic for details on how to change the archive period or disable automatic purging altogether if desired To refresh the list of archived ANSI 997 999 files click the Refresh button The staging directory will be re scanned for the presence of new ANSI 997 999 files If new files are present in the staging directory they will be checked for proper format and automatically archived The displayed list will then be rebuilt to reflect the current archive contents Using the Acknowledgment Reports A detailed discussion of the ANSI 997 999 transmission acknowledgment file format is beyond the scope of this document Interpretation questions should be directed to your contractor s support department The key fields present in the archive list display and on the individual acknowledgment reports are as follows Acknowledgment Creation Date Time Specifies the date and time that the ANSI 997 999 transmiss
87. E Pro32 require exclusive system access No other users may be running the program while claims are being prepared This exclusivity restriction is imposed intentionally in order to help guarantee the integrity of the prepare operation Even with this protection however it is still possible that an abnormal system and or network failure could result in an interruption of the prepare operation prior to successful completion If this were to happen it becomes important to recover from the interruption in such a way that maintains the integrity of the claims being prepared When the user clicks the Prepare button and confirms the request PC ACE Pro32 saves detailed information about the claims to be prepared before the actual prepare work begins If the prepare process is subsequently interrupted this saved information can be accessed to restore all affected claims to their state prior to initiation of the prepare operation The next time PC ACE Pro32 is executed following the system interruption the program will automatically recognize that a prepare operation was in progress when the interruption occurred Claim Prepare Recovery Options The distributor determines the level of user interaction required to recover from an interrupted claim prepare run There are two possible scenarios e Silent recovery No user interaction is required PC ACE Pro32 automatically detects that a prepare run was interrupted restores the affected claims to their
88. EMC file was build with no filter selections or with and LOB selection of anything other than MCA then the default Data Communication reference file record LOB and Payer would be used Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Preparing claims for transmission topic for more information on preparing electronic claim files e Refer to the Transmitting electronic claim files topic for a typical example of how the data communications launch facility can be used e Refer to the Data Communication Preferences topic for information on configuring the Data Communication Options form launch buttons 178 Common Reference File Procedures HCPCS Codes File Maintenance The HCPCS Codes form provides an interface to maintain the HCPCS codes used in PC ACE Pro32 Separate database files are used to maintain global versus local HCPCS codes Global HCPCS codes are maintained and updated by your distributor Changes to global HCPCS codes should be rare and should always be performed under a distributor s supervision Local HCPCS codes if any can be maintained by the distributor or user and include any additional HCPCS codes valid in your area but not included in the global list Select the Global codes or Local codes radio button to display the desired list Then perform one of the following functions e To add anew HCPCS code click the New button a
89. File Maintenance topic for details on configuring the Submitter reference file Common Reference File Procedures Viewing and maintaining eligibility benefit response files Claims processors receiving ANSI 270 format patient eligibility benefit request files generated by PC ACE Pro32 will retrieve the requested eligibility benefit information from their system and respond by sending an ANSI 271 eligibility benefit response file back to the submitter PC ACE Pro82 provides a facility by which users can archive these ANSI 271 eligibility benefit response files for subsequent review and or printing In addition to simply viewing the entire response file PC ACE Pro32 will automatically process this file and post the responses directly to the original Institutional or Professional eligibility benefit request This topic describes how to stage your ANSI 271 files so that they are automatically archived and processed by PC ACE Pro32 as well as the functions available for viewing printing maintaining and using the archived eligibility benefit response reports Note The patient eligibility benefit request response capability may not be available on all installations If the Eligibility Benefit Response Log item is not visible on the Maintain menu when performing the steps described in this topic then this capability is not available on your installation Staging Eligibility Benefit Response Files For Automatic Archiving At program startup
90. Held claims are not considered for future claim activities such as automated claim processing or claim preparation Releasing Claims Choose the Release Selected Claim action to release a previously held claim In addition to releasing the claim this action also sets the status of the selected claim to unprocessed UNP Printing Claims Choose the Print Selected Claim action to print the selected claim Claims may be printed using either a plain paper image overlay technique or the traditional pre printed forms method See the Printing claims topics for more details Posting Claim Payments Choose the Show Selected Claim Payments action to post view or modify payments for the selected claim Claim posting may also be performed from the appropriate claim entry form See the Posting claim payments Institutional and Posting claim payments Professional topics for more details Purging Claims Choose the Purge Selected Claim action to purge the selected claim Claims in the to be transmitted CL location must be deleted before being purged amp Attention Purged claims are permanently deleted from PC ACE Pro32 they cannot be recovered Main Toolbar amp Forms Reactivating Claims Choose the Reactivate Selected Claim action to reactivate the selected claim This action will move the previously transmitted claim from the transmitted TR or paid PD location into the to be transmitted CL locatio
91. Info amp Codes includes fields for general claim and patient information Also includes the Condition Occurrence Span and Value code fields e Billing Line Items includes all claim line item fields extended line item fields line level provider fields and line level MSP COB fields This major tab contains a number of second level tabs to accommodate the additional line level fields e Payer Info includes payer provider insured and employer fields for the primary secondary and tertiary payers e Diagnosis Procedure includes fields for diagnosis codes procedure codes and dates claim level provider information and a few miscellaneous data elements e Diag Proc 2 includes fields for additional diagnosis codes procedure codes and dates and claim level provider information e Extended General includes additional patient and general claim level fields e Ext General 2 includes additional Condition Occurrence Occurrence Span and Value code fields and most reserved CMS 1450 form locator fields e Extended Payer includes less frequently used payer insured and authorization fields for the primary secondary and tertiary payers Also includes fields for Medicare Secondary Payer MSP and other secondary claims where Coordination of Benefits COB information is required This major tab consists of a number of second level tabs that provide access to this extended information in a logical and efficient manner C
92. NTER key AS Tip Holding down the SHIFT key while invoking the View Update action on an eligible claim will force an automatic save attempt on the claim This is a shortcut technique equivalent to invoking the View Update action and subsequently clicking the Save button on the claim entry form It minimizes the keystrokes required to work claims from the Claim List form Eligible claims are those in the to be transmitted CL location with a status of either unprocessed UNP has errors ERR or has fatal errors ERF Deleting Claims Click the Delete button or choose the Delete Selected Claim action to delete the selected claim Deleted claims are assigned a DEL status and can be recovered i e un deleted if needed See the Purging Claims action description below for instructions on permanently removing claims from the PC ACE Pro32 database Copying Claims Click the Copy button or choose the Copy Selected Claim action to copy the selected claim When copying a single claim the claim entry form will be displayed containing the details of the newly copied claim The claim copy function may be used to create a duplicate of a previously transmitted claim for repeat billing in a subsequent period or for submission of a Coordination of Benefits COB claim to the secondary or tertiary payer Holding Claims Choose the Hold Selected Claim action to change the status of the selected claim to hold HLD
93. On the HCPCS Modifier Assignment form select or change the LOB and select a valid modifier from the drop down list Specify the claim type s for which this LOB modifier assignment is to be considered valid The validity selections are defined as follows e Valid for Inst claims specifies whether the modifier is valid for use on Institutional claims for the specified LOB M When checked the modifier will be considered valid for use on Institutional claims for the specified LOB This modifier will be included in claim entry lookup lists for the specified LOB The validity of this modifier may also be checked during the claim edit validation process When unchecked the modifier will not be considered valid for use on Institutional claims for the specified LOB e Valid for Prof claims specifies whether the modifier is valid for use on Professional claims for the specified LOB M When checked the modifier will be considered valid for use on Professional claims for the specified LOB This modifier will be included in claim entry lookup lists for the specified LOB The validity of this modifier may also be checked during the claim edit validation process L When unchecked the modifier will not be considered valid for use on Professional claims for the specified LOB To view or modify an existing HCPCS modifier assignment select the desired modifier from the list and click the View Update button or double click the desired HCPCS m
94. Overview 169 Common Claim Activities101 102 104 108 109 112 115 117 119 121 123 126 128 131 133 135 138 140 14 Adding a new claim 101 Adding a new eligibility benefit request 138 Adding a new Home Health Plan of Care 152 Adding a new Institutional Medical Attachment 157 Adding a new roster billing 149 Archiving claims 135 Importing claims 104 Listing and modifying claims 102 Listing and modifying eligibility benefit requests 140 Listing and modifying Plans of Care 153 Listing and modifying roster billings 150 Posting claim payments Institutional 131 Posting claim payments Professional 133 Preparing claim status request files for transmission 121 Preparing claims for transmission 112 Preparing eligibility benefit request files for transmission 142 Printing claims 128 Printing Home Health Plans of Care 155 Processing claims automatically 109 Reactivating previously transmitted claims 119 Reversing the most recent claim import run 108 Transmitting electronic claim files 115 Unarchiving claims 135 Viewing ANSI 271 eligibility benefit response files 145 Viewing ANSI 277 claim status response and acknowledgment files 123 Viewing ANSI 997 transmission acknowledgment files 117 Viewing the eligibility benefit response for a specific request 147 Viewing the status request response history for a claim 126 Common Reference File Procedures 157 160 163 166 169 Adding and maintaining patients 157 Adding and maintaining payers 160
95. PC ACE Pro32 the Provider list should be empty If so skip to the next step If the list is not empty contact your distributor to confirm that the existing Provider records can be safely deleted To delete a Provider record select the desired record in the list and click the Delete button Click the OK button on the Provider Deletion Confirmation form to confirm the deletion request Make sure the list is empty before continuing with the next step 3 Click the New button to display the Institutional Provider Information form Enter the first provider s information taking advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse PC ACE Pro32 User s Manual AS Tip Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator 4 Enter the provider s name and address information Enter the Provider ID in the Provider ID No field and the line of business in the LOB field The Payer ID field is only needed if you want to restrict assignment of this provider to a specific payer Normally the Payer ID field will be left blank You can also leave the Tag field blank Complete entry of the remaining provider fields as desired 5 Click the Save button to save the new Provider record An edit validation process will be performed to check for pr
96. PC ACE Pro32 automatically scans separate Institutional and Professional staging directories looking for new ANSI 271 eligibility benefit response files to be archived If any ANSI 271 files are present in the staging directories they are checked for proper format and archived automatically In addition the individual responses are automatically posted to the original eligibility benefit requests This automatic archive post process is also performed when the Eligibility Benefit Response Log form is opened or when the user manually refreshes the Eligibility Benefit Response Log list See next section for details On most PC ACE Pro32 installations the user will be required to manually copy the ANSI 271 files received from the claims processor into the appropriate staging directory The Institutional and Professional staging directories are Institutional winpcace ansi271 eligub92 Professional winpcace ansi271 elig1500 For single user installations these directories will reside on the local drive letter to which PC ACE Pro32 was originally installed For multi user networked installations these directories will reside on the shared network drive letter to which PC ACE Pro32 was originally installed E Attention Care must be taken to copy Institutional eligibility benefit response files to the Institutional staging directory and Professional eligibility benefit response files to the Professional staging directory In addition if your cla
97. Professional claims e Reference File Activities specifies user permission to view and update reference files e Miscellaneous Activities specifies user permission to access data communications and system utilities schedule claim activities perform database maintenance and system restores e Security Maintenance Activities specifies user permission to add and modify system users and their permission settings Tip Check the checkbox next to the permission to allow access to the activity Click the Check All and Clear All buttons to quickly check or un check all user permission checkboxes amp Attention Grant Security Maintenance Activities permissions only to users who need access to add delete users and set user permissions To modify the password name or permissions for an existing user select the user from the Security List and click the View Update button or double click the selection To delete a user select the user from the Security List click the Delete button and confirm the deletion S Attention If changes are made to a user profile the change will not go into effect until the next time that user logs into system The Logout Current User option available from the main Security menu provides a convenient way to log out the current user without exiting the system Note As shipped PC ACE Pro32 is configured with a single default user with full system access rights The default user s Use
98. S 485 form fields e g patient status selections diagnosis and treatment orders goals rehab narrative and physician information e Medical Update 486 1 includes all non narrative fields from the CMS 486 form This tab also provides line item entry of all service treatment information per discipline including actual projected visits frequency duration and applicable treatment codes e Medical Update 486 2 includes all remaining CMS 486 narrative fields e Miscellaneous includes any miscellaneous fields which are not specifically assigned to an CMS 485 486 form location but which may be required in certain situations This tab also provides line entry of any expanded narrative information to be associated with a specified form location hS Tip The two Medical Update tabs will be visible only if the Include Medical Update Form 486 checkbox on the Plan of Care 485 1 tab is checked This feature allows the user to optionally include the Medical Update CMS 486 data with the Plan of Care Click the appropriate tab or simply press the PAGE UP and PAGE DOWN keys to move between these major Plan of Care form sections Entering Plan of Care Data Click on any field to activate it for data entry or press the TAB key to move from field to field in a predefined sequence generally left to right and top to bottom Use the UP ARROW and DOWN ARROW keys to move up and down through the plan form fields respectively
99. Service Type eligibility oenefit requests e Provider Selection List This list box holds the providers that will be available for selection on the simplified Service Type Eligibility Benefit Request Form Users should add commonly used providers to this list in order to streamline the process of creating new Service Type eligibility oenefit requests Click the Add button to choose a provider from the Institutional or Professional Provider reference file and add this provider to the selection list Select an existing provider in the list and click the Remove button to 55 PC ACE Pro32 User s Manual 56 remove this provider from the selection list Use the Up Arrow and Down Arrow picture buttons to rearrange the order of providers in the selection list The first provider in the selection list for a given LOB and Payer ID combination will become the default provider when creating new Service Type eligibility benefit requests for that payer Note In addition to the providers listed in the Provider Selection List users will also be allowed to select from the complete Institutional or Professional Provider reference files when creating new Service Type eligibility oenefit requests The provider dropdown list on the Service Type Eligibility Benefit Request Form will include a special lt lt Select From Provider Reference File gt gt item to initiate this Provider file selection process Main Toolbar amp Forms The Eligibilit
100. a print image file If using this claim import method complete the following steps 1 Have your distributor perform a one time PrintLink mapping procedure on a sample print image file that you have supplied This mapping process defines the template used to extract and interpret fields from your print image file Since all upstream systems print claims in a slightly different format this mapping process is required to build your custom template 2 Obtain the resulting map file from your distributor This file is typically named ub92 map but can be any valid filename with a map extension The map file must be placed in the server s winpcace impub92 directory 3 Confirm the existence of the required map control file This file provides a control interface between the output of the PrintLink translator and the PC ACE Pro32 claim import routines The map control file is always named mapcntlu win and should be located in the server s winpcace impub92 directory 4 Setup all required PrintLink Matching Description strings in the Payer reference file These strings are used to match payer descriptions from claims in the print file to specific Payer reference file records Refer to the Adding and maintaining payers topic for details on setting up your PrintLink Matching Description strings 5 Each time you want to import claims copy the new print image file generated by your upstream system into the server s winpcace
101. abs The appropriate payer insured information will be brought forward into the Institutional or Professional claim during the patient lookup process The decision as to whether common or separate payer insured information is required can be made separately for the primary secondary and tertiary Insured tabs Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Reference File Maintenance Form topic for a discussion of the common reference file form features and filter options 158 Common Reference File Procedures e Refer to the Claim amp Reference File Edit Validation topic for a discussion of the edit validation process 159 PC ACE Pro32 User s Manual Adding and maintaining payers The Payer tab of the Reference File Maintenance form provides access to maintain system payer information Setup of the Payer reference file is mandatory although it may be setup in advance by your distributor Payers are accessible during claim entry using the variable list lookup feature When a payer is selected from the lookup list during claim entry all applicable payer information will be automatically loaded into the appropriate claim form fields Payers are uniquely defined by their Payer ID Line of Business LOB and an optional Usage flag see below All payers referenced on claims must exist in the Payer reference file with the exception of the special dump payer P
102. ach transmitted claim Requests are added to this history log as the final step of the ANSI 276 claim status request prepare operation Responses are recorded in the history log during automatic posting of the ANSI 277 claim status response files returned from the contractor or clearinghouse PC ACE Pro32 provides a facility by which users can view print and maintain this claim request response history This topic describes how to access and use this advanced capability Refer to the Related Topics links at the end of this topic for more information on how to request claim status and process the returned status response files Note Support for ANSI 276 277 claim status request response files may not be available on all installations If the Purge archived ANSI 277 claim status response or ack files after NN days option is disabled grayed out on the PC ACE Pro32 Miscellaneous preferences form then this capability is not available on your installation Determining Status Request Response Availability The Institutional and Professional Claim List forms include the following columns for use in determining the availability of status request response history for transmitted claims e SR Status Response Indicator This indicator will display an R on claims where status has been requested but where a response has not yet been received An A value indicates that status response information is available for this claim An empty SR colu
103. acknowledgment files Note Certain capabilities may not be available on your installations Only those capabilities supported by your distributor will be visible in these menus 28 Main Toolbar amp Forms Claim List Form Features The PC ACE Pro32 Claim List form provides a versatile interface from which the user can create list modify print and otherwise maintain claims Click either the Institutional Claims Processing button or Professional Claims Processing button on the PC ACE Pro32 Main Toolbar to open the corresponding Claims Menu form Then click the List Claims button on the Claims Menu form to open the desired Claim List form You may reposition and resize this form if desired The list can be easily sorted and filtered to display only the claims of interest The Institutional and Professional Claim List forms are virtually identical All procedures described in this section pertain to both claim types unless otherwise specified Sorting Claims The claim list may be sorted by Patient Name Patient Control Number PCN Entry Date Service Date and Transmit Date Simply select the desired sort order from the available Sort By radio buttons Filtering Claims The claim list may be filtered to display a select subset of claims by manipulating the Claim List Filter Options drop down lists Basic filter options include e Location filters the claim list to include only claims in the to be transmitted CL transmit
104. ackup request Validate validates an existing backup file The backup archive s integrity is confirmed and the archive details date of backup etc are presented to the user No data will be restored during the validation process so it is always safe and advisable to validate an archive before attempting a subsequent restore operation The following controls and options apply to the validate operation e Source Drive or Folder specifies the drive or Windows folder directory from which the backup archive file will be read This path may point to a removable media device diskettes writeable CDROM or to a standard Windows directory on a hard disk drive local or remote Disk spanning is supported for backup archives on diskette The user will be prompted to insert specific diskettes from the backup archive as needed hS Tip When validating backup archives that span multiple diskettes insert the last diskette in the set first The system will prompt for the first and subsequent diskettes as the validation proceeds Once the desired source drive folder path has been specified click the Start Validate button to proceed You will be presented with details of the validated backup archive on completion Restore restores the PC ACE Pro32 database files and configuration settings optional from an existing backup file The Restore tab will be visible only to users with the appropriate permissions The following controls and opti
105. additional information related to this topic e Refer to the Setup of Professional Systems topic for a suggested approach to initial setup of the provider reference file e Refer to the Reference File Maintenance Form topic for a discussion of the common reference file form features and filter options e Refer to the Claim amp Reference File Edit Validation topic for a discussion of the edit validation process 168 Common Reference File Procedures Maintaining Codes amp Miscellaneous Reference Files Codes amp Miscellaneous Reference Files Overview The Codes Misc tab of the Reference File Maintenance form provides access to many of the core PC ACE Pro32 reference files Most of these files will be pre loaded and ready for use when PC ACE Pro32 is installed Others are optional and will require setup before use The buttons on this tab are grouped as Shared Institutional and Professional Institutional only and Professional only The following reference file topics apply to both Institutional and Professional claims Submitter File Maintenance maintain submitter identification and related information Data Communications File Maintenance maintain data communications parameters HCPCS Codes File Maintenance maintain HCPCS procedure codes and descriptions HCPCS Modifiers File Maintenance maintain HCPCS procedure code modifiers descriptions and assignments ICD Codes File Maintenance maintain ICD 9 and ICD 1
106. aims from print file using standard PrintLink mapping technique Import claims from a print image file using our advanced PrintLink mapping technique This is the default claim import method in most installations Import claims directly from pre built file in intermediate delimited format Import claims directly from a pre built file in intermediate delimited format This method bypasses the PrintLink translation step for facilities that can produce the intermediate format file directly from an upstream system Import claims from file in Electronic Media Claims EMC format Import claims directly from a file in Electronic Media Claims EMC format This method may be used in facilities where the upstream system can generate a reliable EMC output file e Claim Import Preprocessor specifies an optional external preprocessor program to be called prior to claim import processing This preprocessor may be an executable program or a DOS batch file with associated PIF file The PC ACE Pro32 import code will launch this preprocessor automatically and wait for completion before continuing with import processing Claims preprocessing can be performed with any of the 3 claim import methods Note Your distributor may have already configured these claim import settings The distributor can determine which settings if any a user can modify Therefore some or all of the controls may be disabled S Attention You should modify these claim i
107. ain Reports menu Print Claim Detail Report Select this item to print a detailed report of either all listed or all checked claims If one or more claims in the list are checked then only the checked claims will be included in the report If no claims are checked then the report will include all listed claims The previewed report may be printed if desired by clicking the printer button at the top of the report preview form To print a detailed report on a specific subset of claims first use the Claim List form s filter capabilities to display only the claims of interest If even more specific identification is required then simply check only those claims that are to be included in the report Print Claims for Paper Submission Select this item to print all or a subset of claims currently eligible for paper submission A claim is eligible for paper submission if it has a media setting of paper P resides in the to be transmitted CL location and has a clean CLN status or optionally a non fatal errors ERR status When printing claims for paper submission you will have the option to print all eligible claims or just eligible claims for a selected payer You will also choose whether or not to include eligible claims with a status of non fatal errors ERR After each eligible claim is printed you will be prompted to automatically move the claim to the transmitted TR location Since paper claims will never b
108. aining unresolved edit errors may be saved if desired by clicking either the Save With Errors button visible if only non fatal errors exist or Save With Fatal button visible if any fatal errors exist Only one of these buttons will be visible at any given time If neither button is visible then fatal errors exist on one or more key claim fields These fatal edit errors must be corrected before the claim can be saved Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Institutional amp Professional Claims Menus topic for more information about the Claims Menu form e Refer to the Claim List Form Features topic for details on using the Claim List form e Refer to the Institutional Claim Form and Professional Claim Form topics for more information on using the Institutional and Professional claim forms e Refer to the Claim amp Reference File Edit Validation topic for more information about the edit validation process and associated forms 101 PC ACE Pro32 User s Manual Listing modifying and maintaining claims Claims in PC ACE Pro32 are listed modified and otherwise maintained from the Institutional amp Professional Claim List forms The Claim List form operation is identical for Institutional and Professional claim types To access the Claim List form 1 Click either the Institutional Claims Processing or Professional Claims Processing button on t
109. ally archived and posted as appropriate by PC ACE Pro32 as well as the functions available for viewing printing maintaining and using the archived claim status response files and post reports Note Support for ANSI 276 277 claim status request response files may not be available on all installations If the Purge archived ANSI 277 claim status response or ack files after NN days option is disabled grayed out on the PC ACE Pro32 Miscellaneous preferences form then this capability is not available on your installation Staging Claim Status Response Files and Claim Acknowledgment Files For Automatic Archiving At program startup PC ACE Pro32 automatically scans separate Institutional and Professional staging directories looking for new ANSI 277 claim status response and ANSI 277CA claim acknowledgment files to be archived If any ANSI 277 or ANSI 277CA files are present in the staging directories they are checked for proper format and archived automatically In addition the individual responses in ANSI 277 files are automatically posted to the appropriate claims This automatic archive post process is also performed when the Claim Status Response amp Acknowledgment Log form is opened or when the user manually refreshes the Claim Status Response amp Acknowledgment Log list see next section for details On most PC ACE Pro32 installations the user will be required to manually copy the ANSI 277 and ANSI 277CA files received from th
110. ally submitted on separate forms know as attachments PC ACE Pro32 has extended this attachment metaphor into the world of electronic claims submission The Professional Claim Form supports most of the commonly used attachment types Claim attachments can be triggered activated for a claim s line item in one of 2 ways e Automatically Triggered Attachments Since the procedure HCPCS code on a claim s line item describes the type of service provided it is logical that this same procedure code would dictate which attachment is required if any for the line Using automatically triggered attachments certain procedure codes are pre defined to trigger specific attachment types Automatically triggered claim attachments fall into one of 2 categories line level attachments and claim level attachments Line level attachments are defined separately for each service line item on the claim that triggers the attachment If the procedure codes for 3 line items all trigger a certain line level attachment then the user will be required to enter a separate set of attachment data for each of the 3 lines Claim level attachments on the other hand are defined only once for the entire claim regardless of how many service line items have triggered the attachment The Professional Claim Form supports both types of automatically triggered attachments 46 Main Toolbar amp Forms Note The decisions regarding which procedure codes should automatica
111. an existing Remittance Remark code record select the desired record and click the View Update button or double click the desired record e To delete a Remittance Remark code record select the desired record from the list click the Delete button and confirm the deletion AS Tip When the Remittance Remark Code description is too long to be displayed in the list the description is truncated and the phrase right click for full text is displayed To view the complete code description simply right click on the desired record The full description text will be presented in a read only window X Tip The Remittance Remark Codes form provides several List Filter Options that can be helpful in locating specific codes Refer to the Reference File Maintenance Form topic for more discussion of these common filter options 198 Miscellaneous Functions Eligibility Request Service Type Codes File Maintenance The Eligibility Request Service Type Codes form provides an interface to maintain the Eligibility Request Service Type codes These service type codes are used on ANSI 270 eligibility oenefit requests to indicate the service for which benefit information is being requested They are pre loaded and should require minimal maintenance Maintenance operations available include e To add an Eligibility Request Service Type code click the New button and enter the new code information e To view or modify an existing Eligibility Request Se
112. and click the View Update button or double click the desired record e To delete a POS record select the desired record from the list click the Delete button and confirm the deletion e Assignments defines the list of valid Place of Service POS codes for each line of business LOB These assignments will also determine which POS codes will be included in the POS lookup list presented during claim entry The POS assignment maintenance options include e Select LOB filters the assignment list to include only assignments for a specific line of business When a specific LOB is selected it will be used as the default LOB for new POS code assignments e To add anew POS code assignment record click the New button on the Assignments tab Select the default LOB and POS code from the drop down lists e To delete a POS code assignment record select the desired record click the Delete button and confirm the deletion Effective Date Range The Effective Date Range dates are compared to the associated claim line s service date range during the claim edit validation process If the effective date range for a Place of Service POS code falls outside the line s service date range an edit validation error will be reported If the effective date range is left blank the POS code is valid for all dates of service If the start date is completed but the end date is left blank the POS code is valid for all dates of service from and inc
113. ansmission Click the Close button to close the form Note Archived EMC files and associated reports may be manually deleted from the EMC file archive by selecting the row describing the file to be deleted and clicking the Delete button Confirm the deletion when prompted Common Reference File Procedures Preparing claim status request files for transmission Claim status request file preparation in PC ACE Pro32 refers to the act of generating an ANSI 276 claim status request file suitable for transmission to your claims processor This file will contain all relevant status request details for one or more previously transmitted claims Upon receipt of the ANSI 276 file the claims processor will generate a corresponding ANSI 277 claim status response file containing status information for the requested claims This ANSI 277 response file can be processed by PC ACE Pro32 and the user will be able to view the status information returned for each claim represented in the original ANSI 276 claim status request file Only claims that have been added to the status request queue will be included in the ANSI 276 claim status request file See the Claim List Form Features topic for details on how to build the status request queue Note Before preparing claims into a status request file for the first time you may need to setup your Submitter reference file This file contains important data that will be used to build the ANSI 276 file S
114. apping GEM files published by CMS provide crosswalks from ICD 9 diagnosis and procedure codes to their ICD 10 equivalent codes PC ACE Pro32 makes these powerful crosswalks available to users through an advanced lookup feature available on the claim roster bill and eligibility oenefit request forms The advanced GEM crosswalk lookup feature may not be available in all installations Look for the GEM button and the Select ICD 10 GEM Equivalent Code s menu described below to determine if this feature is available in your installation When the user initiates a lookup by pressing the F2 key or by right clicking the mouse while positioned on an ICD diagnosis or procedure code field the program determines if the context 182 Common Reference File Procedures is appropriate for enabling the GEM crosswalk feature For example the GEM crosswalk feature will be enabled when the selected ICD field currently contains an ICD 9 code either hand keyed or imported into the field In this scenario the selection list will position automatically to the current ICD 9 code value To identify the equivalent ICD 10 code s for the selected ICD 9 code simply click the GEM button or right click the mouse on the highlighted list entry and select the Select ICD 10 GEM Equivalent Code s item from the popup menu Either method will display the ICD 10 General Equivalence Mapping Selection list pre populated with the ICD 9 code s equivalent ICD 10 cod
115. approximate countdown timer To insure success of the scheduled claim activity the user should refrain from using the system until the scheduled activity has completed When you see this notification form click the OK button and return to the PC ACE Pro32 Main Toolbar Once the scheduled activity is initiated the status bar along the lower edge of the PC ACE Pro32 Main Toolbar will display messages describing the progress of the scheduled activity The status bar will be blanked when the scheduled activity completes You may then review the claim activity log to see the outcome of the scheduled claim activity if desired Once the scheduled activity has completed you may resume normal use of PC ACE Pro32 S Attention PC ACE Pro32 must be running for scheduled activities to execute If desired minimize the PC ACE Pro32 Main Toolbar on your desktop after scheduling claim activities 204 Miscellaneous Functions Launching the ANSI 835 Electronic Remittance Module The optional ANSI 835 Electronic Remittance modules provide tools for processing the electronic remittance files returned from your claims processor Electronic remittance data can be viewed printed and or exported using these tools Exported remittance data can for example be used to automatically post payments to an upstream claims management system Separate ANSI 835 modules exist for use with Institutional and Professional claims e The ANSI 835 Electronic Remittance modules
116. are Part B MCB and Blue Shield BS patients two separate provider records must be added However since these 2 records really represent the same provider they should be associated with each other The Provider tab of the Reference File Maintenance form provides a convenient inheritance option that makes creation of associated provider records a snap Simply click the New button and create the first John D Solo provider record from scratch start with all fields blank assign the MCB line of business complete all applicable fields on the Professional Provider Information form and save the provider record Then select the newly created provider record in the provider list and click the New button again When prompted select the Inherit name address information from the selected provider option Also check the Associate the new provider with the selected provider checkbox and click the OK button A duplicate of the selected provider will be created and displayed Enter BS in the LOB field and save the new provider record These provider records are now associated with each other to reflect that they represent the same entity Repeat this inherit and associate process to create additional John D Solo provider records for other LOBs if desired Associations are used during the claim preparation process to identify the various lines of business applicable to a specific provider Related Topics The following hyperlinks provide
117. ata in the table changes these indexes must be updated to accurately reflect the current table contents Indexes are normally maintained automatically by the PC ACE Pro32 database engine If an index gets out of date as the result of some unexpected system or network malfunction it may become necessary to manually reindex the associated table Database reindexing is typically the responsibility of your system administrator File maintenance operations like packing and reindexing require appropriate user permission You will be notified if your user is not authorized to perform these functions In addition these functions require exclusive system access AS Tip To greatly reduce the time required to perform claim archiving activities on networked installations it is strongly recommended that such activities be initiated from the server s console To pack or reindex a table s 1 Click the System Utilities button on the PC ACE Pro32 Main Toolbar to display the System Utilities form Select the File Maintenance tab 2 Select one or more tables from the Database Files list hS Tip Select multiple database files by holding down the CTRL key while clicking the desired list items Click the Select All button to select all database files 209 PC ACE Pro32 User s Manual 3 Click the Pack button or Reindex button to perform the desired operation on all selected database files Certain database files tables should normal
118. atively click the Cancel button to abandon any changes and exit the roster billing When an attempt is made to save a roster billing an edit validation process is performed on all fields on the form This process includes re evaluating all field level edits as defined above In addition all file level edits are evaluated File level edits are evaluated only when the roster billing is saved and are typically those edits that require multiple data elements from the roster billing in order to be evaluated If no edit validation errors occur the roster billing is saved with a clean CLN status If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List form This form lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the edit validation process and the Edit Validation Errors List form If edit errors exist you will usually have the option to correct the errors or save the roster billing with errors If a fatal error exists on the Payer ID Provider ID No Service Date or Type field however you must correct the error before saving the roster billing Click the Save With Errors button to save a roster billing that contains only non fatal errors Such roster billings are assigned the has errors ERR status Click the
119. ayer ID 99999 The Payer tab provides a convenient Sort By selection that quickly sorts the payer list by Payer ID Payer Description Payer LOB or Payer State Operations available include e To add anew payer record click the New button and enter the new payer information e To view or modify an existing payer record select the desired record and click the View Update button or double click the desired record e To create a new payer record that is similar to an existing record select the desired payer record click the Copy button and change only the desired fields This feature makes it easy to create multiple payer records for the same payer to support more than one line of business LOB e To delete an existing payer record select the desired record click the Delete button and confirm the deletion AS Tip The Payer Information form provides several List Filter Options that can be helpful in locating specific payers Refer to the Reference File Maintenance Form topic for more discussion of these common filter options Entering Payer Information The Payer Information form provides access to a payer s identification fields Payer ID LOB and Description address information control flags and optional local fields defined by the distributor The available control flags are defined as follows e Source indicates the national payment source code for this payer e Media specifies whether the payer
120. ayer list Note If you plan on using the PrintLink feature of PC ACE Pro32 to import claims from print image files then you will also need to add PrintLink Matching Description strings to this Payer record The Claim Import Considerations section later in this topic will lead you through this process 4 Repeat the relevant steps to create additional Payer records as needed This may include records for the same payer and different LOBs or records for additional payers 5 When all desired Payer records have been added click the Close button on the Reference File Maintenance form to return to the PC ACE Pro32 Main Toolbar Provider Reference File Setup This section describes the process of setting up the Institutional Provider reference file This file contains information about the valid providers in your system All providers for whom you will be billing Medicare Part A claims must exist in the Institutional Provider reference file The Institutional Provider reference file is organized such that each record describes a valid provider for a single line of business LOB This organization allows for greater flexibility in specifying Provider IDs and support information Tax ID address etc that can vary across multiple LOBs for a single provider Complete the following steps as needed hS Tip You may want to refer to the Adding and maintaining providers Institutional topic for more information on entering Institutional Prov
121. base files a complete database restore operation can be performed from the most recent backup E Attention These backup facilities are designed to protect just the PC ACE Pro32 databases and configuration information The program executable files and other support files are not included in the backup archive It is strongly recommended that you supplement these backups with a comprehensive backup schedule for your server and client systems In the event a full restore is required you would first restore from a full system backup to rebuild the system s directory hierarchy and restore all program and support files The most recent PC ACE Pro32 backup could then be restored to recover your databases and configuration settings You will be prompted to perform a backup each time you exit the PC ACE Pro32 program unless your distributor has disabled this prompt feature You may also perform a backup from the Backup Restore tab of the System Utilities form This form can be accessed by clicking the System Utilities button from the PC ACE Pro32 Main Toolbar The following sections describe the backup validate and restore options and operation e Backup performs a backup of the PC ACE Pro32 database files and configuration settings All files to be included are compressed into a single archive and written to the specified destination drive or directory The following controls and options apply to the backup operation e Destination Drive or Fol
122. be done by the third party data communications program or script e g re dial restart on dropped line etc 4 Click the Close button on the Data Communications Options form when the file transmission has completed 5 Complete the post transmit procedures provided by your distributor if any Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Reactivating previously transmitted claims topic to learn how a previously transmitted EMC file can be reactivated for re transmission e Refer to the Viewing and maintaining transmission acknowledgment files topic for information on how to archive view print and maintain ANSI 997 999 transmission acknowledgment files e Refer to the Data Communications File Maintenance topic for information on configuring data communications parameters and the Data Communications Control File e Refer to the Data Communication Preferences topic for information on configuring the Data Communication Options form launch buttons 115 PC ACE Pro32 User s Manual 116 Common Reference File Procedures Viewing and maintaining transmission acknowledgment files Contractors or clearinghouses receiving ANSI 837 format EMC files will acknowledge receipt by sending an ANSI 997 999 transmission acknowledgment file back to the submitter PC ACE Pro32 provides a facility by which users can archive these ANSI 997 999 transmission acknowledgment
123. be saved Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Institutional amp Professional Claims Menus topic for more information about the Institutional Claims Menu form e Refer to the Home Health Plan of Care List Form Features topic for details on using the Home Health Plan of Care List form e Refer to the Home Health Plan of Care Form topic for more information on using the Plan of Care entry form e Refer to the Claim amp Reference File Edit Validation topic for more information about the edit validation process and associated forms 152 Common Reference File Procedures Listing modifying and maintaining Plans of Care Home Health Plans of Care in PC ACE Pro32 are listed modified and otherwise maintained from the Home Health Plan of Care List form To access the Plan of Care List form 1 Click the Institutional Claims Processing button on the PC ACE Pro32 Main Toolbar to display the Institutional Claims Menu form 2 From the Institutional Claims Menu form select the Attachments and Maintain HH Plans of Care menu items to open the Home Health Plan of Care List form Most actions to be performed on a Plan of Care may be executed from the Plan of Care List form Plans of Care can be created viewed modified copied deleted and printed from the list Refer to the Home Health Plan of Care List Form Features topic for complete details on the
124. bmitter reference file supports LOB specific setup information if desired Selecting a specific LOB for preparation will trigger the use of the matching LOB specific submitter information if any Refer to the Submitter File Maintenance topic for more information on this advanced feature e Payer specifies a single Payer to be considered Only requests being submitted to the selected payer will be eligible for preparation Select the lt lt All Payers for LOB s gt gt item to include requests for all payers Note This selection is only enabled when a specific LOB has been selected for preparation 142 3 Common Reference File Procedures Note The Submitter reference file supports Payer specific setup information if desired Selecting a specific LOB and Payer for preparation will trigger the use of the matching LOB Payer specific submitter information if any Refer to the Submitter File Maintenance topic for more information on this advanced feature e Prepare Options options that control the eligibility benefit request preparation operation e Submission Status specifies whether the ANSI 270 file should be designated as a production or test submission The initial state of this option is determined by a Submitter reference file setting e Include Error Requests specifies whether eligibility benefit requests with non fatal errors Status ERR are to be eligible for preparation When checked all reque
125. by the billing office rather than the entire HCPCS code universe Using a Charges Master file will reduce the size of the HCPCS code lookup lists during claim entry thus promoting accuracy and enhancing productivity In addition a dollar amount may be assigned to each Charges Master entry This value is automatically brought forward to the claim line item Charges field when a valid Charges Master code is entered or looked up during claim entry Maintenance operations available include e To add anew Charges Master code click the New button and optionally select a specific line of business LOB from the dropdown list if the charge is specific to claims for a particular LOB Enter an optional Payer ID value if the charge is specific to claims billed to a particular payer See the discussion of LOB Payer specific Charges Master records below for more information Enter a valid HCPCS Code Alternatively the Payer ID and HCPCS Code values can be selected from a lookup list by pressing the F2 key or right clicking the mouse while positioned on the respective control Enter the desired Charges value and click the OK button to save the new record e To view or modify an existing Charges Master record select the desired record and click the View Update button or double click the desired record Only the description and charge amount fields may be modified e To delete a Charges Master record select the desired record from the list cli
126. cally purged after a certain number of days Refer to the PC ACE Pro32 Miscellaneous preferences topic for details on how to change the archive period or disable automatic purging altogether if desired E Attention Once an archived ANSI 271 response file has been manually deleted or automatically purged the individual responses for the eligibility benefit requests represented in this file will no longer be available Be sure to set the ANSI 271 archive period such that eligibility benefit response files remain available long enough to meet your needs e To refresh the list of archived ANSI 271 files click the Refresh button The staging directory will be re scanned for the presence of new ANSI 271 files If new files are present in the staging directory they will be checked for proper format and automatically archived and posted The displayed list will then be rebuilt to reflect the current archive contents AS Tip You can also right click the mouse on the desired ANSI 271 archive record to access all available actions Using the Eligibility Benefit Response Reports The ANSI 271 eligibility benefit response information is presented by PC ACE Pro32 in a human readable report format The report presents general identification information along with the eligibility benefit inquiry details returned by the claims processor for all requests Since the responses can be viewed for individual eligibility benefit requests from the Eligibility Be
127. cantly speed the process of entering eligibility benefit requests The data fields on the simplified Service Type Eligibility Benefit Request Form should be completed in top to bottom order Edit validation errors may be encountered during this entry process if the data entered violates any of the predefined edits for the specific request type Correct any such edit errors and click the Save button to save the request Requests containing unresolved edit errors may be saved if desired by clicking either the Save With Errors button visible if only non fatal errors exist or Save With Fatal button visible if any fatal errors exist Only one of these buttons will be visible at any given time Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Institutional amp Professional Claims Menus topic for more information about the Claims Menu form e Refer to the Eligibility Benefit Request List Form Features topic for details on using the Eligibility Benefit Request List form e Refer to the Eligibility Benefit Request Form topic for more information on using the eligibility benefit request form e Refer to the Service Type Eligibility Benefit Request Form topic for more information on using the simplified Service Type eligibility benefit request form if available on your installation 138 Common Reference File Procedures Refer to the Claim amp Reference File Edit Va
128. ce Type is being defaulted to the Payer code PR M When checked the Information Source Primary Identification Type will be defaulted to the NAIC code NI during Information Source lookups from the Payer reference file I When unchecked the Information Source Primary Identification Type will be defaulted to the Payer Identification code PI during Information Source lookups from the Payer reference file e Default Information Receiver Type to Provider Qualifier 1P This option controls the default value assigned to the Information Receiver Type field for new requests i When checked the Information Receiver Type is defaulted to the Provider code 1P Most distributors expect a provider to be identified in the Information Receiver fields Setting this field to 1P enables Information Receiver lookups from the Provider reference file I When unchecked the Information Receiver Type field is left empty and must be entered by the user or selected from the right click popup menu e Load Information Receiver Primary ID with Federal Tax ID on Provider lookups This option controls the source for the value assigned to the Information Receiver Primary ID Type fields during lookups from the Provider reference file M When checked the Information Receiver Primary ID Type fields are populated with the Federal Tax ID Type fields from the selected Provider record I When unchecked the Information Receiver Primary ID
129. cellaneous Preferences PC ACE Pro32 preference settings are organized on a tabbed dialog accessible from the PC ACE Pro32 Main Toolbar s main File menu The Miscellaneous Preferences tab includes the following maintenance and configuration settings 98 Purge archived EMC transmission files after NN days specifies whether archived Institutional and Professional EMC transmission files are to be automatically purged by the system If automatic purging is enabled specifies the number of days EMC files are to be retained M When checked all EMC transmission files older than the specified number of days will be automatically purged from the transmission file archive M When unchecked all EMC transmission files will remain archived until manually deleted Refer to the Reactivating previously transmitted claims topic for more information on maintaining the transmission file archive Purge archived ANSI 997 acknowledgment files after NN days specifies whether archived Institutional and Professional ANSI 997 999 transmission acknowledgment files are to be automatically purged by the system If automatic purging is enabled specifies the number of days the acknowledgment files are to be retained M When checked all ANSI 997 999 transmission acknowledgment files older than the specified number of days will be automatically purged from the acknowledgment file archive M When unchecked all ANSI 997 999 transmission acknowledgment files
130. cent to the submission payer line on the Payer Information tab It is possible that multiple payers on a claim will have a LOB that matches the claim s LOB In this case you will be prompted to select which of these payers is to be designated as the submission payer Edit Validation During the claim save process an edit validation process is performed on all fields on the claim This process includes re evaluating all field level edits as defined above In addition all claim file level edits are evaluated File level edits are evaluated only when the claim is saved and are typically those edits that require multiple data elements from the claim in order to be evaluated If no edit validation errors occur the claim is saved with a clean CLN status If however one or more edit validation 49 PC ACE Pro32 User s Manual errors occur you will be presented with the Edit Validation Errors List form unless disabled in the Preference settings This form lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the claim edit validation process and the Edit Validation Errors List form If edit errors exist you will usually have the option to correct the errors or save the claim with errors If a fatal error exists on the LOB or PCN field however you must correct the error befor
131. cessfully generated roster billings will be moved automatically to the generated GR location hS Tip The claim billing report for any previously generated roster billing may be previewed and or printed by selecting the desired roster billing record in the Roster Billing List Form and choosing the View Selected Roster Report action Note PC ACE Pro32 uses the claim import report preference settings to define the default reporting options for the roster billing generation process Refer to the Printing Preferences topic for information on configuring claim import and roster billing generation reports to be printed automatically or to a specific printer Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Roster Billing List Form Features topic for details on using the Professional Roster Billing List form e Refer to the Professional Roster Billing Form topic for more information on using the Professional Roster Billing form e Refer to the Claim amp Reference File Edit Validation topic for more information about the edit validation process and associated forms e Refer to the on line help Common Claim Activities folder for hyperlinks to other claim related topics of interest 151 PC ACE Pro32 User s Manual Adding a new Home Health Plan of Care New Home Health Plans of Care can be added to PC ACE Pro32 using either of these techniques e Select the
132. ch steps you need to perform contact your distributor for assistance hS Tip You may want to print this help topic and refer to the printed version as you perform these setup steps You can check off the steps as they are completed This technique also frees you to jump around between on line help topics without losing your place in the setup procedure To print the topic just click the Print button at the top of this on line Help screen Payer Reference File Setup This section describes the process of setting up the Payer reference file This file contains information about the valid payers in your system All payers to be specified on your Professional claims must exist in the Payer reference file with the exception of a special dump payer Complete the following steps as needed AS Tip You may want to refer to the Adding and maintaining payers topic for more information on entering Payer records If you do make sure and return to this topic to continue the setup steps 1 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form Select the Payer tab to display a list of all existing Payer records E Attention One or more Payer records may already exist in the system if your distributor has already setup this reference file for you Consult the distributor s installation notes or contact your distributor for assistance before continuing this Payer setup
133. checked the background of the fields with edit validation errors will be statically displayed in the appropriate error color Warn on close when deferred claims tasks are scheduled Scheduled claim import processing and transmission activities can only be initiated when PC ACE Pro32 is running M When checked the user will be warned when exiting PC ACE Pro32 if claims activities are currently scheduled The user will have the option to leave the program running if desired When unchecked no warnings will be issued when exiting PC ACE Pro32 Scheduled claims activities will not be performed while the program is down Show descriptive field hints on claim and reference file forms The Institutional Claim Form Professional Claim Form and a number of other editable forms support hint or fly over popup windows for each field This hint provides a brief description of the data required in the associated field System Preferences M When checked the hint popup window will be displayed for a few seconds whenever the mouse pointer moves over a supported field When unchecked the field hints feature is disabled Present claims with errors for immediate editing during process runs During automated claim processing runs the user may choose to review and or correct claims with edit validation errors as they are encountered This option controls the default setting for this interactive claim processing mode M When check
134. chive database files in the backup Refer to the Archiving and unarchiving claims topic for more information on the PC ACE Pro32 claim archive feature 206 Miscellaneous Functions e Options Button Include archived ANSI response files in backup specifies whether or not to include all archived ANSI 271 ANSI 277 ANSI 277CA and ANSI 997 999 files in the backup e Options Button Include archived ANSI 835 remittance files in backup specifies whether or not to include the ANSI 835 remittance file archive and related configuration files in the backup This option will be disabled if the ANSI 835 Electronic Remittance Processors are not available on your installation e Options Button Include archived Report Manager response report files in backup specifies whether or not to include the response reports archived by the optional PC ACE Pro32 Report Manager program in the backup This option will be disabled if the Report Manager is not available on your installation Once the desired destination and options have been specified click the Start Backup button to proceed You will be notified upon successful backup completion Note Exclusive system access is required to perform backups in PC ACE Pro32 If this program is in use on another client workstation you will be notified when the Start Backup button is clicked You can either instruct the other users to exit PC ACE Pro32 and then continue the backup or simply cancel the b
135. ck the Delete button and confirm the deletion LOB Payer Specific Charges Master Records The Charges Master reference file allows you to create multiple records for the same HCPCS code each applicable to a specific line of business LOB and optionally to a specific payer within that line of business This feature is useful if your standard charge for a procedure varies depending on the claim s LOB or depending on the payer within that LOB In addition a default record for each HCPCS code may be added using the special lt lt All gt gt pseudo LOB option During Professional claim entry the HCPCS code lookup lists will include only the most specific record s available for each HCPCS code For example suppose three Charges Master records have been added for HCPCS code 00100 as follows Code 00100 LOB lt lt ALL gt gt Payer ID left blank Code 00100 LOB COM Payer ID left blank Code 00100 LOB COM Payer ID 12345 The HCPCS code lookup list presented during entry of a commercial claim LOB COM would include only the LOB specific COM records for code 00100 i e the last 2 records The same lookup operation performed during entry of claims for all other LOBs would include only the non LOB specific lt lt All gt gt record for code 00100 When an HCPCS code is entered manually in the Professional Claim Form as opposed to performing a lookup operation the program will atte
136. combination The remaining Control Setting flags will be ignored e Required Flags determine which claim line fields are required for lines containing this revenue code on claims having the specified LOB TOB The claim line Units Rate HCPCS and Remarks fields are represented by these flags Default Not Required M When checked the corresponding field is required for claim lines containing this revenue code on claims having the specified LOB TOB combination When unchecked the corresponding field is not required for claim lines containing this revenue code on claims having the specified LOB TOB combination e Is Accommodation determines whether or not the revenue code represents an accommodation for claims having the specified LOB TOB combination Default Not An Accommodation i When checked the revenue code represents an accommodation for claims having the specified LOB TOB combination I When unchecked the revenue code does not represent an accommodation for claims having the specified LOB TOB combination Evaluating Revenue Code Assignments During the claim edit validation process revenue code assignment records are considered in order from most specific to least specific i e from bottom to top as they appear on the Revenue Code Assignments form As soon as an acceptable match is found the search ends and edit validation decisions are made based on control settings for the matching assignme
137. ctions menu All checked claims will disappear from the current claims list Refer to the Claim List Form Features topic for more information on using this form s powerful multi selection feature Select the View Archived Claims item from the Claim List form s main File menu to once again view the claims in the open claim archive You should see the claims you just archived If you desire you can unarchive the same claims by selecting single or checking multiple the desired claim s and choosing either the Unarchive Selected Claim or Unarchive All Checked Claims item from the Claim List form s main Actions menu When you are finished reviewing and possibly unarchiving claims in the claim archive select the View Current Claims item from the main File menu to toggle back to the current claims Select the Close Claim Archive item from the main File menu to close the open claim archive You will be prompted to pack the claim archive before closing Click the Yes button to pack and close the archive the No button to close the archive without packing or the Cancel button to leave the archive open E Attention Packing a claim archive database minimizes the disk space requirements and enhances performance It is recommended that claim archive databases be packed periodically especially after groups of claims have been unarchived or purged from the archive The packing process can be lengthy for large databases
138. ctivation and subsequent retransmission Retransmission of an EMC file might be required for example if the receiver has determined that a previously sent file was somehow corrupted during transmission 119 PC ACE Pro32 User s Manual Reactivation of an EMC file consists of restoring the selected file from the archive to its original prepared filename in the server s winpcace directory After reactivation the EMC file and other associated system settings exist just as they did when the file was originally prepared for transmission EMC file reactivation is performed from the Claim Transmission Log form 1 2 120 From the PC ACE Pro32 Main Toolbar click either the Institutional Claims Processing or Professional Claims Processing button to display the appropriate Claims Menu form Select the Transmission Log item from the Claims Menu form s main Maintain menu This action will display the Claim Transmission Log form which lists details for all archived EMC files in chronological order You may resize the form to see any additional list columns if desired Select the row describing the EMC file to be reactivated Click the View Details and or View Errors buttons to preview the original prepare reports if desired Click the Reactivate button and confirm the reactivation operation when prompted You will be notified when the reactivation operation has successfully completed The EMC file is now ready for retr
139. d click the View Update button or double click the desired record e To copy an existing submitter record select the record to be copied from the list and click the Copy button This copy feature provides a convenient means of creating new LOB Payer specific submitter records Enter the desired LOB and or Payer ID and make any other required changes to the copied fields e To delete a submitter record select the desired record from the list click Delete button and confirm the deletion Entering Submitter Information The Submitter Information form contains three tabs e General specifies the LOB line of business Payer ID submitter name address and IDs e Prepare specifies flags used to control the claim preparation process as well as information to be placed directly in the EMC transmission file The currently defined prepare control fields include e Include Error Claims specifies whether claims with non fatal errors will be included in the electronic transmission file by default This default setting may be overridden when the claims are prepared e Submission Status specifies if the electronic transmission file will be flagged as a Production or a Test file by default This default setting may be overridden when the claims are prepared e EMC Output Format specifies the default electronic file format Only the ANSI 837 format is currently supported e ANSI Version 837 institutional only specifies
140. d Topics The following hyperlinks provide additional information related to this topic e Refer to the Institutional amp Professional Claims Menus topic for more information about the Claims Menu form e Refer to the Roster Billing List Form Features topic for details on using the Professional Roster Billing List form e Refer to the Professional Roster Billing Form topic for more information on using the Professional Roster Billing form e Refer to the Claim amp Reference File Edit Validation topic for more information about the edit validation process and associated forms 149 PC ACE Pro32 User s Manual Listing modifying and maintaining roster billings Professional roster billings in PC ACE Pro32 are listed modified generated printed and otherwise maintained from the Professional Roster Billing List Form To access this form 1 Click the Professional Claims Processing button on the PC ACE Pro32 Main Toolbar to display the Professional Claims Menu form 2 From the Professional Claims Menu form select the Maintain Roster Billings item from the main Roster menu to open the Professional Roster Billing List Form All actions to be performed on a roster billing may be executed from the Roster Billing List form Roster billings can be created viewed modified copied deleted undeleted and purged from the list In addition claims may be generated for a selected roster billing and the resulting roster billing r
141. d click the OK button A duplicate of the selected provider will be created and displayed Enter BC in the LOB field and save the new provider record These provider records are now associated with each other to reflect that they represent the same entity Repeat this inherit and associate process to create additional Jones Memorial Hospital provider records for other LOBs if desired Associations are used during the claim preparation process to identify the various lines of business applicable to a specific provider Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Setup of Medicare Part A Systems or Setup of Institutional All Payer Systems topic for a suggested approach to initial setup of the provider reference file e Refer to the Reference File Maintenance Form topic for a discussion of the common reference file form features and filter options e Refer to the Claim amp Reference File Edit Validation topic for a discussion of the edit validation process 165 PC ACE Pro32 User s Manual Adding and maintaining providers Professional The Provider Prof tab of the Reference File Maintenance form provides access to maintain the providers to be referenced on Professional claims NOTE If you are licensed for Professional claim activities only then this tab will be labeled simply Provider Setup of the Professional Provider reference file is mandatory if
142. d to prepare your PC ACE Pro32 system for Medicare Part A Only claims processing Topics to be covered include setting up the Payer Provider and Patient optional reference files A section on claim import considerations is included for users who will be importing claims from an upstream claims management system Finally a section covering considerations for claims preparation and transmission should be reviewed E Attention Your distributor may have already completed some of the setup steps described in this section Supplement this setup topic with any installation notes provided by your distributor If you are in doubt about exactly which steps you need to perform contact your distributor for assistance AS Tip You may want to print this help topic and refer to the printed version as you perform these setup steps You can check off the steps as they are completed This technique also frees you to jump around between on line help topics without losing your place in the setup procedure To print the topic just click the Print button at the top of this on line Help screen Payer Reference File Setup This section describes the process of setting up the Payer reference file This file contains information about the valid payers in your system All payers to be specified on your Medicare Part A claims must exist in the Payer reference file with the exception of a special dump payer Complete the following steps as needed hS Tip You
143. der specifies the drive or Windows folder directory to which the backup archive file will be written This path may point to a removable media device diskettes writeable CDROM or to a standard Windows directory on a hard disk drive local or remote Disk spanning is supported for backups to diskette The user will be prompted to insert blank diskettes as needed AS Tip If you are unable to perform the backup directly to your writeable CDROM drive for any reason simply set the destination to a hard drive folder and then copy the resulting PCACEPBK ZIP file to the CD using whatever technique you normally use for saving files to the CDROM drive e Include infrequently changed database files specifies whether or not to include certain infrequently changed database files in the backup The optional files include only reference file databases that are generally static for long periods of time Examples include the HCPCS Codes and Edit Validation database files The backup archive will be somewhat smaller if these optional files are omitted AS Tip To ensure minimal problems in the event a database restore is required we recommend leaving this option checked for all backups e Options Button Include archived claim transmission EMC files in backup specifies whether or not to include all archived EMC files in the backup e Options Button Include claim archive database files in backup specifies whether or not to include the claim ar
144. des tab to display audit information for this claim This audit information includes the date the claim was created the last modification date and the User ID of the user that modified the claim last Common Claim Activities The following hyperlinks provide additional instruction on several common claim activities 42 Refer to the Adding a new claim topic for more information on adding claims Refer to the Listing modifying and maintaining claims topic for tips on maintaining claims from the Institutional Claim List form Refer to the Printing claims topic to learn about printing claims Refer to the Posting claim payments Institutional topic to learn about Institutional claim payment posting Main Toolbar amp Forms The Professional Claim Form The Professional Claim Form provides access to all data elements of an Professional claim New claims are entered and existing claims are viewed and or modified from this form The Professional Claim Form has been designed to provide a data entry flow resembling that of the printed Professional claim form whenever possible Claim fields are grouped logically on six major tabs e Patient Info amp General includes fields for general claim and patient information e Insured Information includes payer insured and employer fields for the primary secondary and tertiary payers e Billing Line Items includes the claim diagnosis codes as well as all claim line item field
145. directory names in double quotes to ensure proper launch interpretation e Button Caption specifies the desired button caption text hS Tip Use a single amp character in the button caption to define a windows shortcut key Place the amp character immediately before the desired shortcut character Once a valid program script path and button caption are defined on any of these tabs the corresponding launch button will be enabled on the Data Communications Options form Note Your distributor may have already configured these data communication launch paths and captions The distributor can determine which data communications settings if any a user can modify Therefore some of the tabs controls may be disabled or even hidden S Attention You should modify these data communications settings only under the supervision of your distributor or a technical support specialist Incorrectly configuring these options will render the data communications feature non functional Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Transmitting electronic claim files topic for more information on a typical application of the PC ACE Pro32 data communications launch capabilities e Refer to the Data Communications File Maintenance topic for information on configuring data communications parameters and the Data Communications Control File 97 PC ACE Pro32 User s Manual Mis
146. display a list of all existing user accounts 2 To add a new user account click the New button on the Security List form and assign the user a User ID Password and Name Assign permissions to this user and click the OK button to save the new user record 10 PC ACE Pro32 Setup Procedures hS Tip Check the checkbox next to the permission to allow access to the activity Click the Check All and Clear All buttons to quickly check or un check all user permission checkboxes 3 Repeat the previous step to create additional user accounts Note If changes are made to a user profile the changes will not go into effect until the next time that user logs into system Select the Logout Current User item on the main Security menu to manually log out without exiting the system S Attention You should change the default user s password as soon as possible if you are concerned about controlling user access at your facility Claim Import Considerations This section describes setup considerations that should be reviewed only if you intend to import claims into PC ACE Pro32 from an upstream system If you will not be importing claims skip this section entirely Three methods are available for importing claims Print Image PrintLink Intermediate Delimited Format and Electronic Media Claims EMC Format Note Getting setup to import claims into PC ACE Pro32 typically involves coordination with your distributor If you are in
147. dy Test Match feature that allows the user to quickly identify which payer will be matched to a given print file payer description To use the test match feature select the Show all strings radio button select either the Institutional or Professional radio button if visible and click the Test Match button Enter the payer description as it would appear on the printed claim and click the OK button If a match is found the matching string record will be highlighted in the list You will be notified if no match is found Related Topics The following hyperlinks provide additional information related to this topic 161 PC ACE Pro32 User s Manual Refer to the Reference File Maintenance Form topic for a discussion of the common reference file form features and filter options Refer to the Claim amp Reference File Edit Validation topic for a discussion of the edit validation process 162 Common Reference File Procedures Adding and maintaining providers Institutional The Provider Inst tab of the Reference File Maintenance form provides access to maintain the providers to be referenced on Institutional claims NOTE If you are licensed for Institutional claim activities only then this tab will be labeled simply Provider Setup of the Institutional Provider reference file is mandatory if you intend to process Institutional claims All providers referenced on Institutional claims must be represented in this reference
148. e Automatically display Edit Validation Error List when saving a claim that contains errors Determines whether the Edit Validation Errors List form is displayed automatically when a claim containing edit validation errors is saved This setting controls the display of this errors list when a claim is saved manually e g clicking the Save button on the Institutional Claim Form or Professional Claim Form or when an implied save operation is performed during an interactive claim processing run M When checked the Edit Validation Errors List will be displayed automatically during a claim save operation if the claim contains edit validation errors The user may jump directly to the offending field for any listed edit validation error M When unchecked the Edit Validation Errors List will not be displayed automatically If the claim contains one or more edit validation errors focus will be directed to the field representing the first listed error The user may view the Edit Validation Errors List form if desired by clicking the Error List button on the claim entry form Automatically prompt for selection of non unique Payer Provider and Physician IDs Determines whether or not a variable list lookup operation will be initiated automatically when the user enters a non unique Payer ID Provider ID or Physician ID UPIN while hand keying data into claims and selected reference files M When checked the appropriate variable list lo
149. e This feature can be disabled in the general preferences settings if desired Cancel Field Changes If a change is inadvertently made to the contents of a field press the ESC key to cancel this change and restore the field s value to what it was when the field received the focus This feature is available for most claim form fields Date Completion Date values may be entered with or without the century for convenience PC ACE Pro32 uses a user definable century pivot year to automatically derive the century when omitted To insure accuracy birthdate fields require that a full 4 digit year be entered Main Toolbar amp Forms Descriptive Field Hints Most claim form fields have field hints that provide a brief description of the field s purpose These hints are often called fly over hints since they become visible when the mouse pointer moves over the specified field without actually selecting the field This feature can be disabled in the general preferences settings if desired Line Item Scrolling The Billing Line Items tab displays 6 claim lines at a time For claims that contain more than 6 line items the user may scroll through the claim line items one line at a time or one page i e 6 lines at a time using the buttons provided along the right edge of this tab bS Tip You can also use the up down arrow keys to move from line to line scrolling when appropriate Type lt ALT gt lt PAGE UP gt press the Page Up ke
150. e Multiple plan selection is accomplished by checking the plans of interest and subsequently performing one of the All Checked Plans of Care actions To check a plan click the left mouse button over the checkbox in the first column of the desired list row Alternatively all plans in the current list can be checked using the Check All Plans of Care item from the list s pop up menu Use the form s flexible advanced filter techniques to display only the subset of plans to be printed deleted etc Then simply check all plans and perform the desired action on all checked plans at once 72 Main Toolbar amp Forms The Home Health Plan of Care Form The Home Health Plan of Care Form provides access to all data elements of a Home Health Plan of Care New plans are entered and existing plans are viewed and or modified from this form The Home Health Plan of Care Form has been designed to provide a data entry flow resembling that of the printed Home Health Certification And Plan of Care CMS 485 and Medical Update And Patient Information CMS 486 forms Plan fields are grouped logically on five major tabs e Plan of Care 485 1 includes most of the CMS 485 form s general plan and patient information fields as well as all diagnosis and procedure codes dates Patient medication information the DME and supplies listing and the safety measures narratives are also included on this tab e Plan of Care 485 2 includes all remaining CM
151. e saving the claim Click the Save With Errors button to save a claim that contains only non fatal errors Such claims are assigned the has errors ERR status Click the Save With Fatal button to save a claim that contains fatal errors Such claims are assigned the has fatal errors ERF status Claims with an ERF status will not be eligible for preparation into an electronic EMC file If edit validation errors occur several Save attempts may be required to correct and save a clean claim At any time click the Errors List button to review the remaining edit validation errors Miscellaneous Claim Form Topics The following comments cover a few miscellaneous features of the Professional Claim Form ICD 10 General Equivalence Mapping GEM Lookup Feature Some installations support an advanced lookup feature which greatly simplifies the task of cross walking ICD 9 diagnosis codes to their ICD 10 equivalents during claim entry Refer to the ICD Codes File Maintenance topic for details Optional Local Fields Your distributor may have configured additional local fields at the claim payer and or line item levels Local fields are typically defined to provide data elements that are needed by the distributor but are not included in the Professional specification If such local fields are defined at the claim level you will see an additional Local Fields tab on the claim form If local fields are defined at the payer and line
152. e contractor into the appropriate staging directory The Institutional and Professional staging directories are Institutional winpcace ansi277 statub92 Professional winpcace ansi277 stat1500 For single user installations these directories will reside on the local drive letter to which PC ACE Pro32 was originally installed For multi user networked installations these directories will reside on the shared network drive letter to which PC ACE Pro32 was originally installed E Attention Care must be taken to copy Institutional claim status response and claim acknowledgment files to the Institutional staging directory and Professional claim status response and claim acknowledgment files to the Professional staging directory In addition if your contractor assigns the same filename to all ANSI 277 and or ANSI 277CA files you will need to make sure that the most recently staged claim status response or claim acknowledgment file has been archived before copying a newer response or claim acknowledgment file into the staging directory 123 PC ACE Pro32 User s Manual AS Tip Installations that use data communications scripts to retrieve the ANSI 277 claim status response files and ANSI 277CA claim acknowledgment files may also automatically copy them to the appropriate staging directory Your distributor should be able to confirm whether or not automatic ANSI 277 file staging will be performed on your installation Viewing Printing amp
153. e edits that require multiple data elements from the request in order to be evaluated If no edit validation errors occur the request is saved with a clean CLN status If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List form unless disabled in the Preference settings This form lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the claim edit validation process and the Edit Validation Errors List form If edit errors exist you will have the option to correct the errors or save the request with errors Click the Save With Errors button to save a request that contains only non fatal errors Such requests are assigned the has errors ERR status Click the Save With Fatal button to save a request that contains fatal errors Such requests are assigned the has fatal errors ERF status Requests with an ERF status will not be eligible for preparation If edit validation errors occur several Save attempts may be required to correct and save a clean service type eligibility benefit request At any time click the Errors List button to review the remaining edit validation errors Common Service Type Eligibility Benefit Request Activities The following hyperlinks provide additional instruction on several common
154. e modifiers and their assignments 179 PC ACE Pro32 User s Manual HCPCS Modifiers File Maintenance The HCPCS Modifiers form provides an interface to maintain the HCPCS modifiers and their assignments HCPCS modifiers and assignments are pre loaded and should require minimal maintenance The HCPCS Modifiers form includes two tabs 180 Descriptions displays a list of HCPCS modifiers and their descriptions Maintenance operations available include To add a modifier click the New button and enter the new modifier information Enter the effective date range using a 4 digit year format To view or modify an existing HCPCS modifier select the desired modifier from the list and click the View Update button or double click the desired HCPCS modifier in the list To delete a HCPCS modifier select the desired modifier from the list click the Delete button and confirm the deletion Assignments defines the list of valid modifiers for each line of business LOB These assignments will also determine which modifiers will be included in the modifier lookup lists presented during claim entry The modifier assignment maintenance options include Select LOB filters the assignment list to include only assignments for a specific line of business When a specific LOB is selected it will be used as the default LOB for new HCPCS modifier assignments To add a new modifier assignment click the New button on the Assignments tab
155. e prepared into an EMC file this prompt provides the only available mechanism for moving these claims out of the to be transmitted CL location When multiple paper claims are eligible for submission you may use the convenient Yes To All No To All button to move not move all eligible paper claims to the transmitted TR location after printing 33 PC ACE Pro32 User s Manual hS Tip When printing claims for paper submission you will also have the option to print these same claims on behalf of their alternate non submission payers This feature can be useful if you also need to submit paper claims to the secondary or tertiary payers for example Refer to the Printing claims topic for more details on the alternate payer printing feature Note Support for paper claims may be disabled by the distributor If the Print Claims for Paper Submission menu item is not visible then your system does not support paper claim processing and all claims must be submitted electronically 34 Main Toolbar amp Forms The Institutional Claim Form The Institutional Claim Form provides access to all data elements of an Institutional claim New claims are entered and existing claims are viewed and or modified from this form The Institutional Claim Form has been designed to provide a data entry flow resembling that of the printed Institutional CMS 1450 claim form Claim fields are grouped logically on these major tabs e Patient
156. e print filename must not contain parenthesis or space characters Use the underscore _ character instead of the space character when naming the print file e Intermediate Delimited Format importing claims using the intermediate delimited format method requires the following preparation 1 Perform all required once only preparation steps for importing claims using the intermediate delimited format method Complete these steps as part of the initial PC ACE Pro32 system setup described in either the Setup of Medicare Part A Systems Setup of Institutional All Payer Systems or Setup of Professional Systems topic In summary this once only setup consists of e Confirming that the correct map control file has been placed in the server s claim import directory x Tip Check with your distributor before performing these once only setup steps Some distributors build this setup into the program installation procedure Generate the intermediate format file containing the claims to be imported Copy the intermediate format file to be imported into the server s claim import directory The intermediate format file must be named plink out The claim import directory is named winpcace impub92 for Institutional claim import operations and winpcace imp1500 for Professional claim import operations e Electronic Media Claims EMC Format importing claims using the EMC format method requires the following preparation 1 P
157. e s There are two equivalence mapping selection types e Single Code Mappings Lists individual ICD 10 codes which are each considered appropriate equivalents for the specified ICD 9 code based on the billing situation Only one code from this section may be checked Some ICD 9 codes do not have any equivalent ICD 10 codes defined in the GEM crosswalk If the selected ICD 9 code has no equivalent ICD 10 code s the selection list will display the message No equivalent ICD 10 code available e Combination Code Mappings Lists equivalent mapping Scenarios each of which will include two or more ICD 10 code Choice Lists Combination code mappings are used in situations where multiple ICD 10 codes are required in combination to adequately replace the specified ICD 9 code Decide first which Scenario is appropriate then check exactly one code from each Choice List in that scenario Once the ICD 10 code s selection has been made click the Select button to close the selection list and replace the ICD 9 code with the selected ICD 10 code s Alternatively click the Cancel button to close the selection list without modifying the selected ICD 9 code If a selection from the Combination Code Mappings section has been made the program will replace the ICD 9 code with the first ICD 10 code in the combination and then insert the remaining combination codes immediately after the first code Existing ICD codes will be shifted as
158. e situations in which ambiguous status responses returned by the contractor will not be posted to the original claim In these situations you will be referred back to the original claim status response file and this report 124 Common Reference File Procedures for additional information Contact your contractor s support department for assistance in understanding the ANSI 277 report nomenclature and claim status code interpretation Using the Claim Status Response Post Reports The ANSI 277 claim status response post report presents the claim by claim results of the automatic response posting operation A response posting will fail for either of the following reasons e The claim for which status was requested no longer exists The claim has been purged archived or reactivated from the TR transmitted only or PD paid only location e Multiple claim status responses have been returned by the contractor for the same unique claim trace number This typically indicates that the contractor could not uniquely identify the claim of interest based on the identifying information included in the ANSI 276 claim status request file Multiple responses may be returned at the discretion of the contractor PC ACE Pro32 will not post any of the ambiguous responses directly to the claim but will instead post an attention notification which directs the user back to the original archived claim status response file report The user must review t
159. e updated record is saved If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List form This form lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the Edit Validation Errors List form If any fatal edit errors exist you must correct them before the record can be saved If only non fatal edit errors exist you will have the option to correct the errors or save the record with errors Click the Save With Errors button to save a record that contains only non fatal errors Descriptive Field Hints Most reference file fields have field hints that provide a brief description of the field s purpose These hints are often called fly over hints since they become visible when the mouse pointer moves over the specified field without actually selecting the field This feature can be disabled in the general preference settings if desired Common Reference File Filter Options Many of the reference file forms provide a common set of List Filter Options that can be helpful in locating a specific record in the list These common filter options are defined as follows 78 Show all no filter applied When selected any existing filter is removed and all records in the list are displayed Filter list to include starting
160. eader is available for download from Adobe www adobe com When the Acrobat Reader is properly installed PC ACE Pro32 will automatically detect and configure the path to the ACRORD32 EXE program The steps involved in printing a Plan of Care or a selection of plans are as follows 1 From the PC ACE Pro32 Main Toolbar click the Institutional Claims Processing button to open the Institutional Claims Menu form 2 Select the Attachments and Maintain HH Plans of Care menu items to display the Home Health Plan of Care List form All plan printing is performed from the Plan of Care list 3 To print a single Plan of Care simply select the desired plan from the list and select the Print Selected Plan of Care item from the Plan of Care List form s main Actions menu or convenient right click popup menu The Home Health Plan of Care Print Options form will be displayed hS Tip To print a selection of plans simply check the desired plans and select the Print All Checked Plans of Care item from the Plan of Care List form s main Actions menu Refer to the Home Health Plan of Care List Form Features topic for more information on multiple plan selection 4 The Home Health Plan of Care Print Options form allows the user to override the default destination printer and to select the desired Plan of Care forms i e CMS 485 only CMS 486 only or both if available Click the Preview button to preview the plan s before printing
161. eaves a Plan of Care form field either by pressing the TAB key or clicking on a new field an edit validation process is performed on the field losing the focus Edits performed at this time are referred to as field level edits If a field level edit validation error occurs you will receive an audible response and the edit validation error message will be displayed in the lower left corner of the plan form In addition the focus will remain on the field so that you can correct the problem if desired If you choose not to correct the data at this time simply press the TAB key again to move to the next field Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the plan edit validation process 74 Main Toolbar amp Forms Saving amp Canceling Plans of Care After completing data entry on the Plan of Care form click the Save button or type lt ALT gt S to save and exit the plan Alternatively click the Cancel button to abandon any changes and exit the plan When an attempt is made to save a plan an edit validation process is performed on all fields on the plan This process includes re evaluating all field level edits as defined above In addition all plan file level edits are evaluated File level edits are evaluated only when the plan is saved and are typically those edits that require multiple data elements from the plan in order to be evaluated If no edit validation error
162. ect a destination drive For best performance select a drive local to your machine If multi user operation is required select a drive accessible by all workstations on the network that will require PC ACE Pro32 access The PC ACE Pro32 files will be installed to the WINPCACE directory on the selected drive Desktop icons will be created for PC ACE Pro32 and the current README file Note If you performed this server installation to a remote hard drive you can improve program execution speed on this workstation by also performing the client installation below This will install a copy of the PC ACE Pro32 main program and support files to your local hard drive If you performed the server installation to a local hard drive you should skip the client installation for this workstation You will still be required to perform the client installation for any additional workstations that require PC ACE Pro32 access PC ACE Pro32 Client Installation If multi user operation is required perform this client installation procedure from each workstation that requires PC ACE Pro32 access Perform these steps to install the PC ACE Pro32 client PC ACE Pro32 User s Manual 1 Confirm that the workstation has network access via a mapped drive letter to the hard drive volume containing the PC ACE Pro32 server installation directory WINPCACE You must have access to this remote drive volume before proceeding with the PC ACE Pro32 client installation 2 U
163. ed claims with edit validation errors will be presented for review and or correction as soon as they are encountered in the automated claim processing run I When unchecked all claims in the automated processing run will be processed without user intervention Claims with edit validation errors can be worked from the Claim List form after the automated processing run completes Note The user may override this default setting when initiating an automated claim processing run Use Charge Master reference file for Professional procedure code lookups Controls the data source for procedure code lookups in the Professional Claim Form M When checked the optional Charges Master reference file will serve as the source for claim line procedure code lookups I When unchecked the master HCPCS Codes reference file will serve as the source for claim line procedure code lookups Interpret Enter key as save request on claim entry and other editable forms Controls the action taken when the ENTER key is pressed on the claim entry and other editable forms e g Patient Payer Provider and Submitter Information forms i When checked pressing the ENTER key during data entry on an applicable form will invoke a save request Thus pressing the ENTER key is equivalent to clicking the Save button I When unchecked pressing the ENTER key during data entry on an applicable form will simply tab to the next field in the form s tab sequenc
164. ed at this security level Once a user logs in all system functions are allowed e Password not required User ID for Audit only requires users to enter only a valid User ID to log in This minimum security level uses the User ID for audit purposes only Note Access to the Security Options form requires a master System Administrator password Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Adding or modifying a system user topic for more information on user maintenance 84 System Preferences Preferences Overview Many of the features in PC ACE Pro32 are customizable These preference settings are organized on a tabbed dialog accessible from the PC ACE Pro32 Main Toolbar s main File menu The major tabs on this dialog include General Preferences includes settings to control general claim entry and other basic aspects of the program s behavior Claim List Preferences permits customization of the Institutional and Professional Claim List forms including column field selection order width and headings Claim Import Preferences permits selection of the Institutional and Professional claim import processing method as well as specification of an optional import preprocessor Printing Preferences includes Institutional and Professional report and claim printing options Data Communication Preferences allows assignment of launch file paths and button
165. ed by your distributor setup default Institutional data communications parameters in the PC ACE Pro32 Data Communications reference file This reference file contains the Institutional data communications parameters exported to the bcdatcom dat file prior to the launch of any external data communications program e g file transmission These parameters are used by the third party data communications program to control the file transmission etc hS Tip Refer to the Data Communications File Maintenance topic for more information on setting up the default Data Communications record This completes the required setup steps to ready PC ACE Pro32 for Institutional All Payer claims processing PC ACE Pro32 User s Manual Setup of Professional Systems This section describes the setup procedures required to prepare your PC ACE Pro32 system for Professional All Payer claims processing Topics to be covered include setting up the Payer Provider and Patient optional reference files A section on claim import considerations is included for users who will be importing claims from an upstream claims management system Finally a section covering considerations for claims preparation and transmission should be reviewed E Attention Your distributor may have already completed some of the setup steps described in this section Supplement this setup topic with any installation notes provided by your distributor If you are in doubt about exactly whi
166. ed to check for problems with the patient information When prompted correct any missing or invalid field values if present and re save as needed The new Patient record should now be visible in the Patient list 5 Repeat the relevant steps to create additional Patient records as needed 6 When all desired Patient records have been added click the Close button on the Reference File Maintenance form to return to the PC ACE Pro32 Main Toolbar User Account Setup PC ACE Pro32 requires that a valid login and optional password be entered by anyone desiring access to the system The system administrator must set up a user account for each person that will use PC ACE Pro32 The user account specifies the user s login password values and defines which activities the user has permission to perform As shipped PC ACE Pro82 is configured with a single default user with full system access rights The default user s User ID is SYSADMIN and password is SYSADMIN as well Complete the following steps to add additional user accounts hS Tip You may want to refer to the Adding or modifying a system user topic for more information on adding and maintaining users If you do make sure and return to this topic to continue the setup steps 1 Select the main Security menu from the PC ACE Pro32 Main Toolbar and choose the Add Update User item The Security List form will display a list of all existing user accounts 2 To add a new user accoun
167. ed when a specific LOB has been selected for preparation Note The Submitter reference file supports Payer specific setup information if desired Selecting a specific LOB and Payer for preparation will trigger the use of the matching LOB Payer specific submitter information if any Refer to the Submitter File Maintenance topic for more information on this advanced feature e Provider specifies one or more Providers to be considered Only claims for the selected provider s will be eligible for preparation Select the lt lt All Providers for Payer s gt gt item to include claims for all providers For Institutional claim preparation the provider to be compared is the one associated with the claim s submission payer For Professional claim preparation the provider to be compared is the claim s billing provider Note This selection is only enabled when a specific LOB and Payer have been selected for preparation 5 Common Reference File Procedures Note Choose the lt lt Selected Providers for Payer gt gt item in the drop down list to specify multiple Provider IDs Enter any number of Provider IDs separated by semicolons on the Multiple Provider Selection form If multiple providers are specified claims for any of the specified providers will be included For your convenience the system remembers the last multiple provider filter string specified e Prepare Options options that control the claim preparat
168. eing submitted and is necessary to enforce prepare break rules and to permit more specific editing of the Information Source Receiver fields e Information Receiver The Information Receiver refers to the entity which is requesting and will receive the eligibility benefit information This role is typically performed by the provider however the ANSI 270 transaction also allows for several other entity types The Information Receiver Type field specifies the intended entity type which is assumed to be 1P Provider when left empty Press the lt F2 gt key or right click the mouse while positioned on the Information Receiver ID or Organization field to select a provider from the Institutional or Professional Provider reference file All applicable information on file for the selected provider will be used to populate the corresponding 59 PC ACE Pro32 User s Manual eligibility benefit request fields This lookup feature is only available when the Information Receiver Type field is set to 1P or is left empty e Inquiry Service Lines Each eligibility benefit request must include one or more Eligibility Benefit Inquiry service lines The simplest inquiry service line consists of Service Type 30 general health care coverage inquiry with the remaining service line entries left empty Inquiries can also be made for specific procedure HCPCS codes and can include a number of extended service line data elements if desired The Inf
169. elds Variable list lookups apply primarily to fields whose values are selected from reference files or other dynamically changing sources Some variable list lookups use other service type eligibility benefit request field values to filter the presented list For example provider lookups present only those provider records applicable to the payer specified for the request It is therefore necessary to select a valid payer before selecting the desired provider To access the Payer Provider and Eligibility Type variable list lookups click the down arrow button adjacent to the respective combo box e Automatic Field Tabs When entering data in a field an automatic tab will occur when the field has been completely filled For example entering a single character in a one character field will automatically position the cursor on the next field in the tab sequence This feature can be disabled in the general preferences settings if desired e Cancel Field Changes If a change is inadvertently made to the contents of a field press the ESC key to cancel this change and restore the field s value to what it was when the field received the focus This feature is available for most service type eligibility benefit request form fields e Date Completion Date values may be entered with or without the century for convenience PC ACE Pro32 uses a user definable century pivot year to automatically 62 Main Toolbar amp Forms derive the century whe
170. elete button and confirm the deletion Entering Data Communications Information The Data Communication Information Form contains three tabs e General specifies the LOB optional Payer ID and a description of this data communications record e Host Info specifies up to 3 distributor defined data communications variables as well as several Host Phone fields The distributor receiving your electronic claims transmission will define the communications variable names and content requirements e Local specifies up to six additional data communications fields to be defined by the distributor This tab will only be visible if the distributor has defined one or more of these local fields Contact your distributor for completion details amp Attention You should add and or modify data communications information only under the supervision of your distributor or an authorized technical support specialist Incorrectly configuring data communications records will result in EMC file transmission problems LOB amp Payer Specific Data Communications Records In addition to the default record the Data Communications Setup form allows you to create data communications records that are specific to a particular line of business LOB or a specific LOB Payer combination This feature provides flexibility in cases where the claims for specific LOBs and or payers must be transmitted to different locations For example you might use this feature if y
171. eparate submitter details exist for Institutional and Professional claim types Since some distributors pre configure the Submitter reference file you should check with them before making any changes Refer to the Submitter File Maintenance topic for more information on configuring this important reference file To prepare a claim status request file in PC ACE Pro32 follow these steps 1 Add one or more transmitted claims to the status request queue using the Request Selected Claim Status or Request All Checked Claims Status action in the Institutional or Professional Claim List form 2 From the PC ACE Pro32 Main Toolbar click either the Institutional Claims Processing or Professional Claims Processing button to open the desired Claims Menu form 3 From the Claims Menu form select the Prepare Claim Status Request File option from the form s Maintain menu This will display the Claim Status Request File Prepare form which provides the following preparation options e Claim Filter Parameters queued claims must meet all specified filter criteria to be considered for preparation e LOB specifies a single line of business LOB to be considered Only queued claims with this LOB will be eligible for preparation Select the lt lt All gt gt item to include queued claims for any line of business Note The Submitter reference file supports LOB specific setup information if desired Selecting a specific LOB for pr
172. eparation will trigger the use of the matching LOB specific submitter information if any Refer to the Submitter File Maintenance topic for more information on this advanced feature e Payer specifies a single Payer to be considered Only queued claims for the selected payer will be eligible for preparation Select the lt lt All Payers for LOB s gt gt item to include queued claims for all payers Note This selection is only enabled when a specific LOB has been selected for preparation Note The Submitter reference file supports Payer specific setup information if desired Selecting a specific LOB and Payer for preparation will trigger the use of the matching LOB Payer specific submitter information if any Refer 121 PC ACE Pro32 User s Manual Rel The 122 to the Submitter File Maintenance topic for more information on this advanced feature e Prepare Options options that control the claim status request preparation operation e Submission Status specifies whether the claim status request file should be designated as a production or test submission The initial state of this option is determined by a Submitter reference file setting Specify the desired filter parameters if any When ready click the Prepare Status Request button and confirm your intention to prepare the claim status request file Progress information will be displayed as the prepare operation proceeds You will be notified when t
173. eport may be printed from this list Refer to the Roster Billing List Form Features topic for complete details on the features and operation of the powerful Roster Billing List form Viewing amp Modifying Roster Billings Viewing and or modifying existing roster billings from the Professional Roster Billing List form can be performed with these general steps 1 Use the Roster Billing List form s sorting and filtering capabilities to locate the roster billing of interest in the list 2 Select the desired roster billing in the list and click the View Update button to display the roster billing details in the appropriate roster billing form Alternatively just double click the desired roster billing record in the list 3 Make all desired changes to the roster billing Refer to the Professional Roster Billing Form topic for details on the many productivity enhancing features available on the powerful roster billing form 4 When all changes have been made click the Save button to save the roster billing record and close the form Review and correct any edit validation errors as needed Alternatively click the Cancel or Close button to cancel any pending roster billing changes Generating Roster Billing Claims A roster billing defines both the common and patient specific details required to create the corresponding set of claims Once you are satisfied with the roster billing contents and no fatal edit validation errors exist
174. er ID 12345 is to be built then the information in this MCA 12345 specific reference file record will be used Submission headers for claims with LOB MCA and Payer IDs other than 12345 as well as claims for all other LOBs will use the default Submitter reference file record Note If desired the Intermediary value may be specified on LOB specific and or Payer specific submitter records This feature is useful to control custom prepare and claim printing rules defined by a particular distributor If the Intermediary value is left blank default value on an LOB specific and or Payer specific submitter record then the value specified on the next least specific submitter record will be used The Intermediary value on the default submitter record serves as the last resort value The Intermediary values should be modified only when directed to do so by your distributor Related Topics The following hyperlinks provide additional information related to this topic 175 PC ACE Pro32 User s Manual e Refer to the Preparing claims for transmission topic for more information on preparing electronic claim files e Refer to the Reference File Maintenance Form topic for a discussion of the common reference file form features and filter options e Refer to the Claim amp Reference File Edit Validation topic for a discussion of the edit validation process 176 Common Reference File Procedures Data Communications Fi
175. er for hyperlinks to other claim related topics of interest 103 PC ACE Pro32 User s Manual Importing claims Claims are introduced into PC ACE Pro32 by either entering them manually or by importing them from an external source The claim import method is ideal for facilities that maintain their claims in an upstream claims management system Using our versatile claim import capabilities these claims can be quickly and accurately loaded into the PC ACE Pro32 database for subsequent processing preparation and transmission Three external claim import sources are supported e Print Image PrintLink Using PC ACE Pro32 s advanced PrintLink mapping technique claims can be imported from print image files produced by your upstream system This is the default claim import method in most installations e Intermediate Delimited Format Claims can be imported directly from a pre built file in intermediate delimited format This internal delimited ASCII format is the same as that produced by the PrintLink translator in the print image import technique This claim import method provides a more versatile solution for facilities that can produce the intermediate format file directly from an upstream system e Electronic Media Claims EMC Format Claims can be imported directly from a file in Electronic Media Claims EMC format This method may be used in facilities where the upstream system can generate a reliable EMC output file PC ACE P
176. erform all required once only preparation steps for importing claims using the EMC format method Complete these steps as part of the initial PC ACE Pro32 system setup described in either the Setup of Medicare Part A Systems Setup of Institutional All Payer Systems or Setup of Professional Systems topic bS Tip Check with your distributor before performing these once only setup steps Some distributors build this setup into the program installation procedure Generate the EMC format file containing the claims to be imported 105 PC ACE Pro32 User s Manual 3 Copy the EMC format file to be imported into the server s claim import directory The file must have a dat file extension e g EMC192 DAT The claim import directory is named winpcace impub92 for Institutional claim import operations and winpcace imp1500 for Professional claim import operations Note Windows long filenames are supported for the EMC Format claim import method Once these preparation steps are complete you are ready to import the claims into PC ACE Pro32 Importing the Claims Once the preparation steps are complete importing claims into PC ACE Pro32 is quick and simple The following steps outline the claim import process 1 2 106 From the PC ACE Pro32 Main Toolbar click either the Institutional Claims Processing or Professional Claims Processing button to open the desired Claims Menu form Click the Import Claim
177. es Provider Taxonomy Codes File Maintenance The Provider Taxonomy Codes form provides an interface to maintain the Provider Taxonomy codes Provider Taxonomy codes may be required for submission of EMC files in ANSI 837 format The Provider Taxonomy code is a field on the Institutional and Professional Provider Information forms These codes are pre loaded and should require minimal maintenance Maintenance operations available include e To add a Provider Taxonomy code click the New button and enter the new code information e To view or modify an existing Provider Taxonomy code record select the desired record and click the View Update button or double click the desired record e To delete a Provider Taxonomy code record select the desired record from the list click the Delete button and confirm the deletion bS Tip The Provider Taxonomy Codes form provides several List Filter Options that can be helpful in locating specific codes Refer to the Reference File Maintenance Form topic for more discussion of these common filter options Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Adding and maintaining providers Institutional topic for a discussion of Institutional provider maintenance e Refer to the Adding and maintaining providers Professional topic for a discussion of Professional provider maintenance 195 Claim Adjustment Reason Codes File Maintena
178. es provider lookup operations during Professional claim entry i When checked all line level Purchased Services provider lookups are performed from the Physician reference file M When unchecked all line level Purchased Services provider lookups are performed from the Facility reference file Include only Revenue Codes with non zero charge amounts in lookups Determines which Revenue Codes will be included in the lookup list during Institutional claim entry Consider enabling this option if most claims are to be hand keyed and the Revenue Code charge amounts for most of the codes to be billed have been setup in advance M When checked revenue code lookups will include only those Revenue Codes for which a non zero charge amount has been setup I When unchecked revenue code lookups will include all valid Revenue Codes regardless of whether or not a charge amount has been setup Enable service line Total Charges auto calculations during Institutional claim entry Controls whether or not the Institutional claim s service line Total Charges field will be automatically recalculated when appropriate in response to changes in the Rate and or Units field values M When checked the service line Total Charges field will be automatically recalculated when appropriate in response to changes in the Rate and or Units field values I When unchecked changes to other fields on the service line will not impact the Total Charges f
179. est Form for such detailed inquiries Entering Service Type Eligibility Benefit Request Data Click on any field to activate it for data entry or press the TAB key to move from field to field in a predefined sequence generally left to right and top to bottom Drop down combo box controls permit selection from a list of available items All other edit controls allow key entry of the desired field s information A number of productivity enhancing features are available during service type eligibility benefit request data entry e Fixed List Lookups The service type eligibility benefit request entry form supports fixed list lookups on several of the request s fields Fixed list lookups apply to fields whose list of valid values can be determined in advance For example the Gender fields have only two possible values M male and F female USAGE Access the lookup list for a field by positioning the cursor on the field and pressing the F2 function key or right clicking the mouse When an item from the list is selected its value is automatically entered in the request form field AS Tip Type lt ALT gt F2 press the F2 key while holding the ALT key down to identify all fields that support a lookup list Press the ESC key to disable the flashing notification e Variable List Lookups The service type eligibility benefit request entry form supports variable list lookups on the Payer Provider and Eligibility Type fi
180. every claim The map file has now been corrected and the original print file is to be re imported The same claim file was inadvertently imported more than once Follow the steps below to reverse the most recent claim import run 108 From the PC ACE Pro32 Main Toolbar click either the Institutional Claims Processing or Professional Claims Processing button to open the desired Claims Menu form From the Claims Menu form select the main menu Maintain and Reverse Claim Import items to display the Claim Import Reversal Utility form Select the Reverse most recent claim import operation radio button and click the Continue button to proceed The Claim Import Reversal Confirmation form will be displayed containing a list of all claims imported in the most recent run Note If the Reverse most recent claim import operation radio button is disabled the system cannot determine the specific details of the most recent claim run Also notice the Delete all unprocessed claims for date range radio button which provides an alternate technique for selectively deleting unprocessed claims by date range Click the Check All Claims button to mark all claims from the previous claim import run for deletion Click the Delete Checked Claims button to perform the deletion E Attention Claims can only be reversed if they remain unprocessed i e their claim status UNP Once a claim has been processed or materially changed it
181. f description of the field s purpose These hints are often called fly over hints since they become visible when the mouse pointer moves over the specified field without actually selecting the field This feature can be disabled in the general preferences settings if desired Line Item Scrolling The Billing Line Items tab displays 8 claim lines at a time For claims that contain more than 8 line items the user may scroll through the claim line items one line at a time or one page i e 8 lines at a time using the buttons provided along the right edge of this tab hS Tip You can also use the up down arrow keys to move from line to line scrolling when appropriate Type lt ALT gt lt PAGE UP gt press the Page Up key while holding the ALT key down or lt ALT gt lt PAGE DOWN gt to scroll up down through all claim line items one page at a time Line Item Features The following productivity features are available on the Billing Line Items tab e Current Line Tracking The Billing Line Items tab contains a number of second level tabs The first second level tab Line Item Details displays the basic line item fields available on the hard copy Institutional claim form The remaining second level tabs are linked to the currently selected line on the Line Item Details tab As the cursor moves from one line to another on the Line Item Details tab the remaining second level tabs will track the new current line This technique prov
182. features and operation of the powerful Plan of Care List form Viewing amp Modifying Plans of Care Viewing and or modifying existing plans from the Plan of Care List form can be performed with these general steps 1 Use the Plan of Care List form s sorting and advanced filtering capabilities to locate the plan of interest in the list 2 Select the desired plan in the list and click the View Update button to display the plan details Alternatively just double click the desired plan record in the list 3 Make all desired changes to the Plan of Care Refer to the Home Health Plan of Care Form topic for details on the many productivity enhancing features available on this powerful form 4 When all changes have been made click the Save button to save the Plan of Care record and close the form Review and correct any edit validation errors as needed Alternatively click the Cancel or Close button to cancel any pending plan changes Actions On Multiple Plans of Care Many of the actions available in the Plan of Care List form are applicable to both single selected plans as well as groups of checked plans This powerful multi selection capability makes operating on groups of plans a snap Simply use the Plan of Care List form s advanced filtering options to narrow the plan list contents down until it contains only the desired plans Then select the Check All Plans of Care action from the main or popup menu to instantly mar
183. ferences section of the Eligibility Benefit Request List Form Features help topic for more information on this feature e Provider Selection Click the down arrow button adjacent to the Provider combo box to select the provider requesting this eligibility benefit information The drop down list will include the preferred providers previously configured on the Eligibility Benefit Request Preferences form See the Eligibility Benefit Request Preferences section of the Eligibility Benefit Request List Form Features help topic for information on setting up preferred providers 63 PC ACE Pro32 User s Manual Note The drop down Provider selection list will only include providers applicable to the selected payer A valid payer must therefore be selected before selecting the provider This selection list will also include the special lt lt Select From Provider Reference File gt gt item Choosing this item allows the user to select a provider from the Institutional or Professional Provider reference file Again the selection list will be filtered to display only those providers applicable to the selected payer e Eligibility Type Selection Click the down arrow button adjacent to the Eligibility Type combo box to select the desired eligibility Service Type code The list will default to 30 Health Benefit Plan Coverage which is the most commonly requested code e Patient s Relationship To Subscriber Enter the ANSI X12 qua
184. files for subsequent review and or printing This topic describes how to stage your ANSI 997 999 files so that they are automatically archived by PC ACE Pro32 as well as the functions available for viewing printing maintaining and using the archived acknowledgment files Note Support for ANSI 997 999 transmission acknowledgment files may not be available on all installations If the Purge archived ANSI 997 acknowledgment files after NN days option is disabled grayed out on the PC ACE Pro32 Miscellaneous preferences form then this capability is not available on your installation Staging Acknowledgment Files For Automatic Archiving At program startup PC ACE Pro32 automatically scans separate Institutional and Professional staging directories looking for new ANSI 997 999 transmission acknowledgment files to be archived If new ANSI 997 999 files are present in the staging directories they are checked for proper format and archived automatically This automatic archiving process is also performed when the Acknowledgment File Log form is opened or when the user manually refreshes the Acknowledgment File list see next section for details On most PC ACE Pro32 installations the user will be required to manually copy the ANSI 997 999 files received from the contractor into the appropriate staging directory The Institutional and Professional staging directories are Institutional winpcace ansi997 ackub92 Professional winpcace ansi
185. g By default the normal tab sequence is overridden and will now jump between these error fields This special tab feature is intended to speed up the process of correcting multiple edit validation errors and can be disabled in the general preferences settings if desired Press the ESC key to stop the error fields from flashing and to restore the normal tab sequence Note The Errors List button is not available on the Patient Payer Provider and Submitter reference file information forms 82 Main Toolbar amp Forms Security amp User Maintenance The Security amp User Maintenance features accessible from the main Security menu allow a System Administrator to add and delete system users and to maintain security access permissions for these users Select the Add Update User item from the main Security menu to display the current system user list To add a user click the New button Each user must be assigned a User ID Password and Name During the user creation process it is important to set the user s access permissions to allow complete or selective access to activities within the system The user permissions are grouped as follows e Institutional Claim Activities specifies user permission to view enter modify delete import process prepare and archive Institutional claims e Professional Claim Activities specifies user permission to view enter modify delete import process prepare and archive
186. g roster billings Professional Scheduled Activity Notification Scheduling unattended claim activities Security amp User Maintenance Sending support mail to your distributor Setup Procedures Setup of Institutional All Payer Systems Setup of Medicare Part A Systems Setup of Professional Systems Submitter File Maintenance submitter information system requirements system level security setting toolbar Transmission acknowledgment files Index 185 177 191 179 180 182 183 189 194 195 186 171 184 190 157 92 206 119 186 108 126 213 68 66 35 43 73 68 202 202 83 211 7 14 20 14 20 171 171 83 27 117 221 PC ACE Pro32 User s Manual transmission file archive Transmitting electronic claim files Troubleshooting Recovering from an interrupted claim prepare run Reviewing the claim activity logs Type of Bill TOB File Maintenance Type of Service TOS File Maintenance unarchiving claims user permissions using claim archives using the Eligibility Benefit Request form using the Institutional claim form using the Plan of Care form using the Professional claim form using the Professional roster billing form validating a PC ACE Pro32 backup Viewing and maintaining claim status response and acknowledgment files Viewing and maintaining eligibility benefit response files Viewing and maintaining the claim status request response history Viewing and maintaining transmission acknowledgment files Viewing the e
187. g user access at your facility How To Use This Help System This on line help system provides instant access to helpful information from anywhere in the PC ACE Pro32 system Features of the on line help system include e Context Sensitive Access Just press the F1 key from anywhere in PC ACE Pro32 to display help information relevant to your current location in the program For example hitting F1 while entering an Institutional claim will display the Institutional Claim Form topic e Help System Contents The Contents tab of the PC ACE Pro32 help system presents all help topics in a nested table of contents format Just double click on a topic entry to display the topic or double click on a folder entry to reveal the next level of topics and folders e Help System Index The Index tab of the PC ACE Pro32 help system lists all available index entries and allows the user to easily jump to the first index entry that matches a user entered search string Just double click on an index entry to display the corresponding topic e Help System Search The Search tab labeled Find on older Help systems of the PC ACE Pro32 help system permits the user to perform a free form text search of all topics in the entire help system Simply enter the search word or phrase and the topics that include this search string will be automatically listed Again just double click an entry in the search results list to open the corresponding topic
188. ge overlay printing method option will be enabled only if the Adobe Acrobat Reader Version 4 0 or later is properly installed on the system You must exit PC ACE Pro32 before installing the Acrobat Reader A properly installed reader will be detected automatically the next time PC ACE Pro32 is started If necessary you can manually configure the Acrobat Reader executable file ACRORD32 EXE path from the Misc tab of the PC ACE Pro32 Preferences form X Tip The Adobe Acrobat Reader has its own preference settings that will let you choose the initial document magnification level and get rid of the splash screen that is shown by default every time the reader is started Claim printing default values for destination printer printing method pre printed forms versus image overlay pre printed position and point size adjustments claim form version and numerous miscellaneous options can be set from the Printing tab of the PC ACE Pro32 Preferences form Claim printing defaults are set independently for Institutional and Professional claim printing if you are licensed for both claim types These default settings will be used during claim print operations unless overridden at print time from the Claim Print Options form Using the Payer Options selections claims may be printed on behalf of the their alternate payers if desired An alternate payer is any payer specified on the claim other than the submission payer For example if a Medicare pa
189. gibility benefit response for a specific request Adding a new roster billing Listing modifying and maintaining roster billings Adding a new Home Health Plan of Care Listing modifying and maintaining Plans of Care Printing Home Health Plans of Care Common Reference File Procedures Adding and maintaining patients Adding and maintaining payers Adding and maintaining providers Institutional Adding and maintaining providers Professional Maintaining Codes amp Miscellaneous Reference Files Codes amp Miscellaneous Reference Files Overview Submitter File Maintenance Data Communications File Maintenance HCPCS Codes File Maintenance HCPCS Modifiers File Maintenance ICD Codes File Maintenance Physician UPIN File Maintenance Type of Bill TOB File Maintenance Condition Occurrence Span Value Codes File Maintenance Revenue Codes File Maintenance Place of Service POS File Maintenance Facility File Maintenance Charges Master File Maintenance Provider Specialty File Maintenance Provider Taxonomy Codes File Maintenance Claim Adjustment Reason Codes File Maintenance Remittance Remark Codes File Maintenance Eligibility Request Service Type Codes File Maintenance 119 121 123 126 128 131 133 135 138 140 142 145 147 149 150 152 153 155 157 157 160 163 166 169 169 171 177 179 180 182 184 185 186 187 190 191 192 194 195 197 198 199 Table of Contents Claim Status Response Codes File Maintenance 200 Miscellane
190. h ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the reference file edit validation process and the Edit Validation Errors List screen If any fatal edit errors exist you must correct them before the provider record can be saved lf only non fatal edit errors exist you will have the option to correct the errors or save the provider record with errors Click the Save With Errors button to save a provider record that contains only non fatal errors If edit validation errors occur several Save attempts may be required to correct and save a clean provider record Provider Inheritance and Associations PC ACE Pro32 requires that each Professional provider record be defined for a single line of business LOB As such if a provider supports multiple LOBs then separate records for each are required This hierarchy results in greatly enhanced flexibility by allowing the user to define unique IDs and support information addresses etc on a per LOB basis If necessary provider records may even be defined such that the information is unique to a single payer within the LOB by completing the Payer ID field on the Professional Provider Information form In order to link provider records that represent the same entity PC ACE Pro32 has introduced the concept of provider associations For example if John D Solo is a Professional solo provider for Medic
191. h payer record These matching strings are used exclusively to map print file Payer Descriptions to PC ACE Pro32 Payer records during the PrintLink claim import process Each PrintLink matching string must adhere to one of these 3 formats e String ends with a tilde character A match is found if the string appears anywhere in the claim s payer description field e String ends with a vertical bar character A match is found only if the string appears at the start of the claim s payer description field The payer description may contain additional trailing characters not included in the matching string e String ends with an alphanumeric character A match is found only if the string and the payer description field are identical The 2 strings must be the same length and contain exactly the same characters in the same order Note All PrintLink matching string comparisons are case insensitive Click the PrintLink Matching Descriptions button while viewing a payer s details to view edit the PrintLink matching strings for the selected payer Click the New Edit and Delete buttons to add modify and delete matching strings for the selected payer record respectively In addition to maintaining the selected payer s matching strings the user also has the option to view all currently defined matching string for all payers in the order that they will be searched during the claim import process This form also provides a han
192. he PC ACE Pro32 Main Toolbar to display the respective Claims Menu form 2 From the Institutional or Professional Claims Menu form click the List Claims button to open the respective Claim List form Most actions to be performed on a claim may be executed from the Claim List form Claims can be created viewed modified copied deleted undeleted purged reactivated held released printed and archived unarchived from the list In addition payments may be posted to a selected claim from the Claim List form Refer to the Claim List Form Features topic for complete details on the features and operation of the powerful Claim List form Viewing amp Modifying Claims Viewing and or modifying existing claims from the Claim List form can be performed with these general steps 1 Use the Claim List form s powerful sorting and filtering capabilities to locate the claim of interest in the list 2 Select the desired claim in the list and click the View Update button to display the claim details in the appropriate claim form Alternatively just double click the desired claim record in the list 3 Make all desired changes to the claim Refer to the Institutional Claim Form or Professional Claim Form topics for details on the many productivity enhancing features available on these powerful claim forms 4 When all changes have been made click the Save button to save the claim record and close the form Review and correct any edit validat
193. he claim status file prepare operation completes If desired click the View Results and or View Errors buttons to view reports of the successfully prepared claim status requests and any failed requests respectively These reports can be printed from the report previewer if desired Note Claims will rarely be rejected during the claim status request prepare operation A claim will be rejected for example if the submission payer specified on the claim is no longer present in the Payer reference file Since the claim has already been transmitted and cannot be modified you will not be able to request claim status for these rejected claims When you have completed your review of the claim status request preparation reports click the Close button on the Claim Status Request File Prepare form The prepared ANSI 276 claim status request file is located in the server s winpcace directory The file is named bcreq276 dat for Institutional claims and bsreq276 dat for Professional claims You may now proceed to transmit the ANSI 276 claim status request file to your claims processor using their prescribed file transmission procedure ated Topics following hyperlinks provide additional information related to this topic Refer to the Claim List Form Features topic for more information on adding claims to the status request queues Institutional and Professional Refer to the Viewing and maintaining claim status response and acknow
194. her Alternatively it might perform a complex data translation operation to generate the supported claim import file Claims preprocessing can be performed with any of the 3 claim import methods described above See the Claim Import Preferences topic for information on configuring a claim import preprocessor Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Claim Import Preferences topic to select the desired claim import method and configure the optional preprocessor e Refer to the Processing claims automatically topic to learn how the imported claims can be processed automatically e Refer to the Printing Preferences topic for information on claim import report options automatic printing printer selection etc 107 PC ACE Pro32 User s Manual Reversing the most recent claim import run On occasion it may become desirable to reverse the most recent claim import operation In other words to remove the imported claims from the database as if they had never been imported in the first place Possible scenarios that might give rise to this requirement include A partially corrupted print file resulted in an incomplete claim import run The print file has been repaired and it is desirable to perform the import again from the beginning The PrintLink map file had a minor mapping error that resulted in the truncation of the first character of a specific data field on
195. her the information displayed in the Additional Eligibility Benefit Information fields will track the new current inquiry line Notice that the Additional Eligibility Benefit Information control group caption always reports the current inquiry line for reference e Line Duplication Press the F5 key while positioned on any field on an inquiry line to copy the values in all fields of the previous line into the current line e Field Duplication Press the F4 key while positioned on a specific field on an inquiry line to copy the value of that single field from the previous line into the current line e Line Deletion Press the F7 key while positioned on any field on an inquiry line to delete the line You will be prompted to confirm the deletion e Advance To Next Line Press the F8 key while positioned on any field on an inquiry line to automatically advance the cursor to the first field of the next line skipping over any remaining fields on the current line When the focus leaves a request form field either by pressing the TAB key or clicking ona new field an edit validation process is performed on the field losing the focus Edits performed at this time are referred to as field level edits If a field level edit validation error occurs you will receive an audible response and the edit validation error message will be displayed in the 58 Main Toolbar amp Forms lower left corner of the eligibility benefit request for
196. his column will contain the value Yes for eligibility benefit requests that have responses available 4 Select the desired eligibility benefit request from the list Then select the View Response For Selected Request item from the Eligibility Benefit List Form s main Actions menu or from the convenient right click popup menu to preview the response report for this request The report may be printed from the preview form if desired Note The View Response For Selected Request item will be grayed if no response has been posted for the selected eligibility benefit request amp Attention Eligibility benefit responses will be available for individual requests until the original archived ANSI 271 response file is manually deleted or automatically purged from the system The user will be notified when an attempt is made to view a response which is no longer available Be sure to set the ANSI 271 archive period such that eligibility benefit response files remain available long enough to meet your needs The archive period can be adjusted from the PC ACE Pro32 Miscellaneous preferences form Using the Eligibility Benefit Response Reports The ANSI 271 eligibility benefit response information is presented by PC ACE Pro32 in a human readable report format The report presents general identification information along with the eligibility benefit inquiry details returned by the claims processor for the selected 147 PC ACE Pro32 User s Man
197. his file by checking the Use Charges Master reference file for Professional procedure code lookups option in the PC ACE Pro32 General Preferences tab hS Tip The Charges Master form provides several List Filter Options that can be helpful in locating specific codes Refer to the Reference File Maintenance Form topic for more discussion of these common filter options 193 PC ACE Pro32 User s Manual Provider Specialty File Maintenance The Provider Specialties form provides an interface to maintain the Provider Specialty codes Provider Specialty codes apply exclusively to Professional providers The Provider Specialty is a required field on the Professional Provider Information form These codes are pre loaded and should require minimal maintenance Maintenance operations available include e To add a Provider Specialty code click the New button and enter the new code information e To view or modify an existing Provider Specialty record select the desired record and click the View Update button or double click the desired record e To delete a Provider Specialty record select the desired record from the list click the Delete button and confirm the deletion Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Adding and maintaining providers Professional topic for a discussion of Professional provider maintenance 194 Common Reference File Procedur
198. his option applies to data entry in the Institutional Claim Form Professional Claim Form and a number of other editable forms When edit validation errors are encountered during a save operation the fields with errors will display in color and optionally flash to help the user locate them This option will be in effect while these fields are displayed in this manner M When checked the tab sequence will be altered to include only those fields with errors i e those fields that are displayed in color allowing the user to rapidly locate and correct the edit validation errors M When unchecked the normal tab sequence remains in effect at all times hS Tip If this feature is enabled press the ESC key to deactivate the special notification error mode and return to normal tab operation Enable flashing notification method for controls with edit errors This option applies to the Institutional Claim Form Professional Claim Form and a number of other editable forms When edit validation errors are encountered during a save operation the fields with errors will display in color and optionally flash to help the user locate them This option controls whether or not the background of these fields will alternate flash between the error color and the standard field color M When checked the background of the fields with edit validation errors will alternate flash between their standard color and the appropriate error color M When un
199. his report manually to determine which one of the multiple responses is applicable if any The ANSI 277 claim status response post report will display an explanatory error message for each response that could not be posted Using the Claim Acknowledgment Reports The ANSI 277CA claim acknowledgment file is presented by PC ACE Pro32 in a human readable report format The report presents general identification information along with the acceptance or rejection status codes returned by the contractor for each claim Contact your contractor s support department for assistance in understanding the ANSI 277CA report nomenclature and accept reject status code interpretation Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Claim List Form Features topic for more information on adding claims to the status request queues Institutional and Professional e Refer to the Preparing claim status request files for transmission topic for information on creating ANSI 276 claim status request files to send to your claims processor e Refer to the Viewing and maintaining the claim status request response history topic for information on viewing and maintaining status request response history for transmitted claims 125 PC ACE Pro32 User s Manual Viewing and maintaining the claim status request response history PC ACE Pro32 keeps a history of claim status requests and responses for e
200. ht margin of the control It is not necessary to enter any manual carriage returns in a narrative field If however a hard carriage return is desired simply press the ENTER key and resume typing on the next line of the narrative control e Displaying Audit information Click the picture button in the upper right corner of the Plan of Care 485 1 tab to display audit information for this plan This audit information includes the date the plan record was created the last modification date and the User ID of the user that modified the plan last Common Plan of Care Activities The following hyperlinks provide additional instruction on several common plan activities e Refer to the Adding a new Home Health Plan of Care topic for more information on adding plans e Refer to the Listing modifying and maintaining Plans of Care topic for tips on maintaining plans from the Home Health Plan of Care List form e Refer to the Printing Home Health Plans of Care topic to learn about printing plans 75 PC ACE Pro32 User s Manual Reference File Maintenance Form The Reference File Maintenance form provides an interface to access all PC ACE Pro32 reference files Click the Reference File Maintenance button on the PC ACE Pro32 Main Toolbar to open the Reference File Maintenance form The form consists of up to 5 major tabs Patient Payer Provider Inst Provider Prof and Codes Misc If you are licensed for only Institu
201. ider ID NPI for the claim s Billing Rendering and Referring Providers Print with Payer Description Payer Source Code Payer ID specifies whether to include the Payer Source Code and or Payer ID values when printing the Payer Description The selected values are printed to the left of the Payer Description M When checked the Payer Source Code or Payer ID will be printed to the left of the Payer Description When unchecked the Payer Source Code or Payer ID will not be printed with the Payer Description Print decimal point on all dollar amount fields specifies whether to print the decimal point on all currency fields When printing forms it is often desirable to omit the decimal point i When checked the decimal point will be printed on all currency fields I When unchecked the decimal point will not be printed on currency fields System Preferences Print the signature block date by default Institutional UB92 form only specifies whether the Institutional claim form signature block date is to be printed automatically by default This default setting can be overridden when a claim is printed M When checked the current system date will be printed automatically by default in the claim form signature block An alternate date or no date at all may be specified instead when a claim is printed I When unchecked the claim form signature block date will be left blank by default Print today s date as line 23 creatio
202. ider identifier to be used on claims for the line of business specified in the LOB field e LOB Specifies the line of business applicable to this provider record e Payer ID An optional field that if specified identifies this provider record as payer specific to the payer identified by this Payer ID The LOB field value is used to filter the list of providers presented to the user during claim entry lookup operations Only provider records with an LOB value matching the LOB of the selected claim payer line will be available for selection If required this provider record s associations may be maintained from this form using the Select adds a new association and None deletes all associations buttons adjacent to the Provider Associations listbox x Tip A number of fields on the Institutional Provider Information form support data entry via fixed list or variable list lookups These lookup lists are accessed by right clicking the mouse over the field or pressing the F2 key while focused on the field Type lt ALT gt F2 press the F2 key while holding the ALT key down to identify all fields that support a lookup list Press the ESC key to disable the flashing notification Helpful fly over hints are also available for many fields Saving amp Canceling Provider Updates After completing data entry on the Institutional Provider Information form click the Save button or type lt ALT gt S to save and e
203. ider is setup on the Patient record or if only one Provider record is available Note If secondary and or tertiary payer insured information is present on the selected Patient record the program will prompt the user to choose which of these payers is applicable to this eligibility benefit request Only the information from the selected payer insured set will be used to populate the corresponding request fields e Information Source The Information Source refers to the entity serving as the source of the eligibility benefit information This role is typically performed by the payer e g Medicare commercial insurance etc however the ANSI 270 transaction also allows for several entity types other than payer The Information Source Type field specifies the intended entity type which is assumed to be PR Payer when left empty Press the lt F2 gt key or right click the mouse while positioned on the Information Source ID or Organization field to select a payer from the Payer reference file All applicable information on file for the selected payer will be used to populate the corresponding eligibility benefit request fields This lookup feature is only available when the Information Source Type field is set to PR or is left empty Note The eligibility benefit request also requires that a line of business LOB be specified This represents the line of business for the Information Source payer to whom the inquiry is b
204. ider records If you do make sure and return to this topic to continue the setup steps 1 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form Select the Provider tab to display a list of all existing Provider records 2 If you have just installed PC ACE Pro32 the Provider list should be empty If so skip to the next step PC ACE Pro32 Setup Procedures S Attention Some distributors include sample provider records for illustration purposes You can choose to either modify these existing records to add any missing information or delete them and build your Provider reference file from scratch If the list is not empty consult your distributor s installation instructions or contact the distributor to confirm that the existing Provider records can be safely deleted To delete a Provider record select the desired record in the list and click the Delete button Click the OK button on the Provider Deletion Confirmation form to confirm the deletion request Make sure the list is empty before continuing with the next step Click the New button to display the Institutional Provider Information form Enter the first provider s information taking advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse hS Tip Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual i
205. ides an efficient method of providing access to a large number of data elements on a potentially large number of claim lines Notice that the Extended Details and Ext Details 2 tab captions always report the current line for reference e Line Duplication Press the F5 key while positioned on any field on a line to copy the values in all fields of the previous line into the current line e Field Duplication Press the F4 key while positioned on a specific field on a line to copy the value of that single field from the previous line into the current line e Line Deletion Press the F7 key while positioned on any field on a line to delete the line You will be prompted to confirm the deletion Alternatively enter the value DEL that s an asterisk plus DEL plus another asterisk without the double quotes into the HCPCS field on a claim line to delete the line Note Claim lines are automatically re sequenced by Revenue Code when a claim is saved As such there is no need to provide line rearrangement capabilities e Advance To Next Line Press the F8 key while positioned on any field on a line to automatically advance the cursor to the first field of the next line skipping over any remaining fields on the current line e Jump To Narrative Press the lt ALT gt N key combination while positioned on any field on a line to automatically position on the 84 Remarks field Enter the desired narrative text and press the
206. ield value Use Windows Notepad instead of built in previewer to view response reports Controls whether the various ANSI response reports ANSI 271 ANSI 277 ANSI 277CA and ANSI 997 999 are to be displayed using the built in previewer or Windows Notepad i When checked the response reports will be displayed using Windows Notepad M When unchecked the response reports will be displayed using the built in previewer Prompt to include only rejected claims in the Claim Ackkowledgment 277CA reports Controls whether or not to prompt the user to include either all claims or only rejected claims when printing Claim Acknowledgment ANSI 277CA reports i When checked prompts the user with the choice to include only rejected claims in the report When unchecked includes all claims in the report without prompting the user 89 PC ACE Pro32 User s Manual Claim List Preferences PC ACE Pro32 preference settings are organized on a tabbed dialog accessible from the PC ACE Pro32 Main Toolbar s main File menu The Claim List Preferences tab allows the user to customize the Institutional amp Professional Claim List form column configurations Columns are configured separately for the Institutional Claim List form and Professional Claim List form In addition unique column configurations exist for each of the primary claim locations to be transmitted CL transmitted TR and paid history PD If your installation is
207. ient information such as information on the patient s legal representative Professional use only the primary Provider ID Institutional use only and the Billing and Rendering Provider IDs Professional use only e Primary Insured provides access to the payer insured and employer information for the primary Institutional and or Professional payer s If your system is licensed for both Institutional and Professional claim activities then you will have the option to enter separate Institutional and Professional insured information See the Common vs Separate Insured Information section below for details e Secondary Insured provides access to insured information for the secondary Institutional and or Professional payer s See the Primary Insured information bullet above for details e Tertiary Insured provides access to insured information for the tertiary Institutional and or Professional payer s See the Primary Insured information bullet above for details Tip A number of fields on the Patient Insured Information tabs support data entry via fixed list or variable list lookups These lookup lists are accessed by right clicking the 157 PC ACE Pro32 User s Manual mouse over the field or pressing the F2 key while focused on the field Helpful fly over hints are also available for many fields Saving amp Canceling Patient Updates After completing data entry on the Patient Information form click the Save button
208. ile level edits File level edits are typically those that require multiple data elements from the claim in order to be evaluated For example looking for duplicate procedure codes on all lines of a claim is a task that can only be performed correctly when all lines have been entered As such this type of duplicate check is the ideal candidate for a file level edit Note All field level edits for the entire claim are re evaluated when an attempt is made to save the claim This is necessary to catch those field level edit errors that were never corrected and to catch any new edit errors that may have been introduced by other changes on the claim Fatal vs Non Fatal Edits Edits in PC ACE Pro32 are defined at the time they are created as either fatal or non fatal e Fatal Edits Fatal edits describe rules that should never be broken For example a claim has no useful meaning until at least one valid payer has been specified Therefore a fatal edit exists to ensure that a valid payer has been specified Claims with fatal errors can be saved unless the fatal errors exist on one of the claim s key fields Key fields include LOB PCN and TOB for Institutional claims and LOB and PCN for Professional claims Claims saved with fatal errors will not be eligible for preparation into an electronic EMC file All fatal errors in reference file records must be corrected before the user can save the record There are relatively few fa
209. ility Benefit Request List form are applicable to both single selected requests as well as groups of checked requests This powerful multi selection capability makes operating on groups of requests a snap Simply use the Eligibility Benefit Request List form s advanced filtering options to narrow the eligibility benefit request list contents down until it contains only the desired requests Then select the Check All Requests action from the main or popup menu to instantly mark i e check all the requests of interest A number of actions are available from the main or popup menu to operate on the entire group of requests in a single session Refer to the Eligibility Benefit 140 Common Reference File Procedures Request List Form Features topic for complete details on selecting and acting on multiple eligibility benefit requests at once Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Eligibility Benefit Request List Form Features topic for details on using the Eligibility Benefit Request List form e Refer to the Eligibility Benefit Request Form topic for more information on using the Institutional and Professional eligibility benefit request forms e Refer to the Claim amp Reference File Edit Validation topic for more information about the edit validation process and associated forms e Refer to the on line help Common Claim Activities folder for hyperlinks t
210. ims processor assigns the same filename to all ANSI 271 files you will need to make sure that the most recently staged eligibility benefit response file has been archived before copying a newer response file into the staging directory hS Tip Installations that use data communications scripts to retrieve the ANSI 271 eligibility benefit response files may also automatically copy them to the appropriate staging directory Your distributor should be able to confirm whether or not automatic ANSI 271 file staging will be performed on your installation Viewing Printing amp Maintaining Eligibility Benefit Response Files 145 PC ACE Pro32 User s Manual Archived ANSI 271 eligibility benefit response files can be viewed and or printed from the Eligibility Benefit Response Log form To view a list of the currently archived ANSI 271 files select the Maintain and Eligibility Benefit Response Log menu items on either the Institutional or Professional Claims Menu form The following operations are available e To view and or print an archived ANSI 271 response file report select the desired record and click the View Response Report button or double click the desired record The report may be printed from the preview form if desired e To delete an archived ANSI 271 file select the desired record click the Delete button and confirm the deletion Note By default archived ANSI 271 eligibility benefit response files will be automati
211. ing rather than the has errors ERR status that you might expect This is done to avoid inadvertently including these claims in a subsequent prepare run since ERR status claims can optionally be included in the prepare When you eventually work these claims you can decide on an individual Common Reference File Procedures basis whether the claim should be corrected transmitted with the non fatal error s or held pending further evaluation 111 PC ACE Pro32 User s Manual Preparing claims for transmission Claim preparation in PC ACE Pro32 refers to the act of generating an Electronic Media Claims EMC file suitable for transmission to your claims processor This EMC file will contain all relevant submission details for one or more processed claims Only claims in the to be transmitted CL location with an electronic E media setting are eligible for preparation When a claim is prepared into an EMC file it is automatically moved to the transmitted TR location Residence in the transmitted TR location reflects its transmitted state and also prevents the claim from being inadvertently retransmitted Note Before preparing claims for the first time you may need to setup your Submitter reference file This file contains important data that will be used to build the EMC file Separate submitter details exist for Institutional and Professional claim types Since some distributors pre configure the Submitter reference
212. ing the details of the newly copied roster billing The Service Date field is cleared automatically in the new roster billing This roster billing copy function is often used to duplicate a previous roster billing greatly simplifying the process of billing for periodic immunizations on a relatively consistent set of patients Generating Roster Billing Claims Click the Generate button or choose the Generate Selected Roster action to automatically generate claims for the selected roster billing Upon completion of the claim generation process you may view the roster billing report if desired A successfully generated roster billing is automatically moved to the generated GR location Refer to the Listing modifying and maintaining roster billings topic for more information on this claim generation process Note PC ACE Pro32 uses the claim import report preference settings to define the default reporting options for the roster billing generation process Refer to the Printing Preferences topic for information on configuring claim import and roster billing generation reports to be printed automatically or to a specific printer Viewing Roster Billing Reports Choose the View Selected Roster Report action to preview the report for a previously generated roster billing The report may be printed from the preview screen if desired Purging Roster Billings Choose the Purge Selected Roster action to purge the selected roste
213. inimum and their performance optimized e Indexes may become out of date due to an abnormal system or network problem that interferes with the PC ACE Pro32 database engine s self maintenance tasks In these scenarios and others that occur less frequently database tables s may require manual packing and or reindexing e Database Packing As records are deleted from PC ACE Pro32 database tables the file disk space consumed by these deleted records is not automatically recovered Over time this unrecovered space can result in a table that consumes more disk space that it really needs In addition the unnecessarily large table can have an impact on database performance When a database table is packed this unrecovered space is eliminated resulting in a table that is as small as possible and optimum performance is restored As an example of when packing would be recommended consider the claim archiving process One of the primary motivations behind claim archiving is to keep the current claims database tables as small and as fast as possible by moving older claims to off line storage However once a group of claims have been archived the current claims database tables must be packed in order to fully realize the size and performance benefits Database packing is typically the responsibility of your system administrator e Database Reindexing Database indexes facilitate optimized access to the information in a database table As d
214. ion If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List form This form lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the reference file edit validation process and the Edit Validation Errors List form If any fatal edit errors exist you must correct them before the payer record can be saved If only non fatal edit errors exist you will have the option to correct the errors or save the payer record with errors Click the Save With Errors button to save a payer record that contains only non fatal errors If edit validation errors occur several Save attempts may be required to correct and save a clean payer record PrintLink Matching Descriptions PrintLink refers to a unique process by which claims can be imported into PC ACE Pro32 from print image files generated by the user s upstream system Since the Payer ID field for a claim s primary secondary and tertiary payers is not available on the printed claim form PC ACE Pro82 uses a novel matching technique to map the Payer Description field which is available on the printed claim to the correct payer record in PC ACE Pro32 s Payer reference file During the one time Payer reference file setup process one or more matching strings should be defined for eac
215. ion MIA Remarks Codes Permits entry of up to 5 remarks codes for Medicare Inpatient Adjudication MIA use These optional codes may be entered manually or selected from the available lookup list Medicare Outpatient Adjudication MOA Remarks Codes Permits entry of up to 5 remarks codes for Medicare Outpatient Adjudication MOA use These optional codes may be entered manually or selected from the available lookup list Claim Adjudication Date Permits entry of the date on which the payer adjudicated the claim This date is typically required at either the claim or line level The line level COB data is entered on the MSP COB sub tab of the Billing Line Items tab The purpose and use of the various field groups on this sub tab are as follows Service Line Adjudication SVD Information Permits entry of one or more Service Line Adjudication SVD lines as reported by the payer for the current service line The P S field identifies the payer primary secondary reporting this line adjudication notice The revenue code reflects that of the service line being adjusted The procedure code and modifier fields identify the specific procedure being adjusted The practice of procedure code bundling and unbundling utilizes these fields to provide specific information regarding how the payer has grouped the procedures for payment The Paid Amount indicates the amount the payer has paid on this procedure The Paid Units value permi
216. ion Occurrence Span Value Codes form includes two tabs e Descriptions displays a list of Condition Occurrence Span Value codes and descriptions Maintenance operations available include e Type filters the Condition Occurrence Span Value code list to include only those codes of the specified type e To add a Condition Occurrence Span Value code click the New button and enter the new code information e To view or modify an existing Condition Occurrence Span Value code record select the desired record and click the View Update button or double click the desired record e To delete a Condition Occurrence Span Value Code record select the desired record from the list click the Delete button and confirm the deletion e Codes TOB displays a list of valid code assignments for specific Line of Business LOB code type and Type of Bill TOB combinations Code assignments for a specific code type Condition Occurrence Span or Value are made for each applicable LOB TOB combination These assignments are used to filter the code lookup lists during Institutional claim entry and to define the acceptable list of codes during the claim edit validation process To display the current list of valid code assignments for a specific LOB TOB combination select the desired LOB Type and TOB After a selection is made the maintenance operations available will include e To add a Condition Occurrence Span Value code assignment record f
217. ion acknowledgment file was created This date time permits ANSI 997 999 files to be ordered chronologically and provides a general timeframe for locating the associated ANSI 837 claim transmission file Serial No Specifies the starting serial number assigned during preparation of the ANSI 837 claim transmission file The serial number can be compared against the Serial No column in the Claim Transmission Log to identify the specific EMC file associated with this acknowledgment file To view the Claim Transmission Log form select the Maintain and Transmission Log menu items on either the Institutional or Professional Claims Menu form Status Displays a status code indicating whether or not the ANSI 837 transmission file was accepted or rejected Additional identification information is included in the acknowledgment report to aid in researching transmission errors Contact your contractor s support department for assistance in understanding the ANSI 997 999 report nomenclature 118 Common Reference File Procedures Reactivating previously transmitted claims In some situations it may become necessary to reactivate one or more previously transmitted claims for retransmission PC ACE Pro32 provides two techniques for reactivating claims e Individual claims in the transmitted TR location may be reactivated for inclusion in a subsequent EMC file e Anentire EMC file may be reactivated for retransmission This section
218. ion errors as needed Alternatively click the Cancel or Close button to cancel any pending claim changes Actions On Multiple Claims Many of the claim actions available in the Claim List form are applicable to both single selected claims as well as groups of checked claims This powerful multi selection capability makes operating on groups of claims a snap Simply use the Claim List form s advanced filtering options to narrow the claim list contents down until it contains only the desired claims Then select the Check All Claims action from the main or popup menu to instantly mark i e check all the claims of interest A number of actions are available from the main or popup menu to operate on the entire group of claims in a single session Refer to the Claim List Form Features topic for complete details on selecting and acting on multiple claims at once Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Claim List Form Features topic for details on using the Claim List form e Refer to the Institutional Claim Form and Professional Claim Form topics for more information on using the Institutional and Professional claim forms 102 Common Reference File Procedures Refer to the Claim amp Reference File Edit Validation topic for more information about the edit validation process and associated forms Refer to the on line help Common Claim Activities fold
219. ion operation Note These options may not be available on some systems e Submission Status specifies whether the EMC file should be designated as a production or test submission The initial state of this option is determined by a Submitter reference file setting e Include Error Claims specifies whether claims with non fatal errors Status ERR are to be eligible for preparation When checked all claims in the to be transmitted CL location with a status or either CLN clean or ERR contains non fatal errors will be eligible for preparation When unchecked only clean claims will be eligible for preparation The initial state of this option is determined by a Submitter reference file setting E Attention The default settings for these control options are typically configured by your distributor We recommend overriding these option settings only under the instruction of your distributor or an authorized technical support specialist The distributor may restrict which of these prepare options you are permitted to override Specify the desired filter parameters if any and preparation options When ready click the Prepare Claims button and confirm your intention to prepare all eligible claims As the preparation operation proceeds running totals of the count and dollar value of all prepared claims will be displayed on the Claim Prepare For Transmission form You will be notified when the claim preparation operation c
220. ional Payer records as needed This may include records for the same payer and different LOBs or records for additional payers 5 When all desired Payer records have been added click the Close button on the Reference File Maintenance form to return to the PC ACE Pro32 Main Toolbar Provider Reference File Setup This section describes the process of setting up the Institutional Provider reference file This file contains information about the valid providers in your system All providers for whom you will be billing Institutional claims must exist in the Institutional Provider reference file The Institutional Provider reference file is organized such that each record describes a valid provider for a single line of business LOB This organization allows for greater flexibility in specifying Provider IDs and support information Tax ID address etc that can vary across multiple LOBs for a single provider Complete the following steps as needed hS Tip You may want to refer to the Adding and maintaining providers Institutional topic for more information on entering Institutional Provider records If you do make sure and return to this topic to continue the setup steps 1 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form Select the Provider Inst or just Provider tab to display a list of all existing Provider records 2 If you have just installed
221. ior makes it possible to request alternate payer printing for multiple checked claims without regard for whether or not the alternate payers are actually present on all the claims Claim attachments can be optionally printed when present by checking the Print claim attachments if present option on the Claim Print Options form Claim attachments should always be printed on stock paper If you are printing your claims using the pre printed forms method onto actual CMS 1450 1500 red forms then you will want to print all attachments at the end of the print run Doing this will give you the opportunity to change the printer paper prior to printing the attachments Make sure the Print all claim attachments at the end of multiple claim print run when appropriate option on the Printing tab of the PC ACE Pro32 Preferences form is checked Common Reference File Procedures Posting claim payments Institutional PC ACE Pro32 maintains an optional Institutional claim payments database for organizations that wish to track payment data in the system Any number of payments may be posted against a transmitted Institutional claim The payment history for a claim can be accessed from either the Institutional Claim List form or the Institutional Claim Form as follows 1 2 Click the Institutional Claims Processing button from the PC ACE Pro32 Main Toolbar to display the Institutional Claims Menu form Click the List Claims button on the In
222. ip You may want to refer to the Adding and maintaining payers topic for more information on entering Payer records If you do make sure and return to this topic to continue the setup steps 1 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form Select the Payer tab to display a list of all existing Payer records E Attention One or more Payer records may already exist in the system if your distributor has already setup this reference file for you Consult the distributor s installation notes or contact your distributor for assistance before continuing this Payer setup procedure 2 Click the New button to display the Payer Information form Enter the new payer s information taking advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse hS Tip Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator The Payer ID LOB and Usage fields together serve as the identification key for this Payer record A specific Payer ID LOB combination may exist for a maximum of two Payer records If two such Payer records are defined then their Usage settings must not overlap Valid Usage settings include U Institutional use only H Professional use only a
223. ired Receiver Interchange ID Qualifier specifies the system method of code structure used to designate the Receiver ID in all electronic interchanges This qualifier populates element ISA07 of the Interchange Control Header ISA segment in the ANSI 837 format EMC file The distributor will provide this qualifier if required Authorization Info specifies optional Interchange Sender Authorization or identification information This value populates element ISA02 of the Interchange Control Header ISA segment in the ANSI 837 format EMC file Security Info specifies optional Interchange Sender Security information This value populates element ISA04 of the Interchange Control Header ISA segment in the ANSI 837 format EMC file Acknowledgment Requested specifies whether or not an interchange acknowledgment TA1 is requested This value populates element ISA14 of the Common Reference File Procedures Interchange Control Header ISA segment in the ANSI 837 format EMC file You should change this value only under instructions from your distributor e Additional EDI Submitter Contact Information specifies up to three 3 additional EDI communication numbers for the person in the submitter organization who deals with data transmission issues Each number has a corresponding type field to identify the number s purpose This information populates the Submitter EDI Contact Information PER segment in the ANSI 837 format EMC file
224. is no longer eligible for reversal If any claims in the selected deletion list are no longer eligible for reversal you will receive a notification message for each such claim These ineligible claims must be located and deleted manually from the Claim List form When the reversal operation completes the Claim Import Reversal Confirmation form will close automatically Common Reference File Procedures Processing claims automatically Claim processing in PC ACE Pro32 refers to the application of a specific set of edit validation rules to the claim A processed claim is pronounced as either clean contains non fatal errors or contains fatal errors This claim is assigned a status code of CLN ERR or ERF respectively to indicate the state of the processed claim In addition to processing or working claims one by one from the Claim List form PC ACE Pro32 also provides an automatic processing function that can sequentially process all or a filtered selection of unprocessed claims in the to be transmitted CL location Automatic claim processing is an ideal way to quickly work a batch of imported claims Once automatic processing has completed the user can focus attention only on the claims with errors greatly improving user productivity To process claims automatically follow these simple steps 1 From the PC ACE Pro32 Main Toolbar click either the Institutional Claims Processing or Professional Claims Proces
225. is filter option is only available with the Institutional and Professional provider lists Refer to the Adding and maintaining providers Institutional and Adding and maintaining providers Professional topics for a discussion of provider associations Common Reference File Sort amp Selection Features Most reference file forms support a common set of sort and selection features that can be helpful in locating a specific record in the list These features are designed to increase operator efficiency by minimizing the need to use the mouse especially when accessing lookup lists during manual claim entry These common features include Quick Sort Order Toggle In addition to the standard Sort By selection controls most reference file forms also recornize the F3 function key as a way to quickly toggle between the most commonly desired sorting selections Typically the F3 key can be used to toggle between the ID or Code sort order and the Name or Description sort order List Navigation Keys Most reference file forms recognize all common list navigation keys These include the up down arrow keys moves up down one record page up down keys moves up down one page and home end keys moves to the first last record In addition the lt TAB gt key can be used to move down through the currently visible records and the lt SHIFT gt lt TAB gt key combination can be used to move up through the visible records Note
226. isible in your system The Patient reference file is shared between Institutional and Professional claim activities In terms of general patient information this shared approach is satisfactory However it is quite possible that the payer insured information will need to be different when an Institutional claim is billed for a patient versus when a Professional claim is billed for the same patient For example an Institutional Medicare claim requires that the submission payer have an MCA line of business LOB while a Professional Medicare claim requires a submission payer LOB of MCB In order to deal with this need for separate Institutional and Professional payer insured information sets the Patient Information form provides the Insured Information Options selection group This selection group exists on each of the Insured tabs and controls whether common or separate payer insured information is required The available selections include e Common Inst amp Prof When selected instructs the system to maintain a single set of payer insured information The same payer insured information will be brought forward into both Institutional and Professional claims during the patient lookup process e Separate Inst amp Prof When selected instructs the system to maintain separate payer insured information sets for Institutional and Professional use The single Insured tab will be replaced by separate Inst and Prof Insured t
227. ist may be sorted by Service Date Provider Roster Type and Entry Date Simply select the desired sort order from the available Sort By radio buttons Filtering Roster Billings The roster billing list may be filtered to display a select subset of roster billings by manipulating the Roster Billing List Filter Options drop down lists Basic filter options include e Location filters the roster billing list to include only roster billings in the to be generated RL or generated GR locations e Status filters the roster billing list to include only roster billings assigned a specific status The possible status codes are clean ready CLN deleted DEL has fatal errors ERF and has errors ERR Note Note that selecting a status of DEL is the only way to view deleted roster billings which can be recovered until they are purged from the system When multiple filter criteria are specified only those roster billings that meet all filter criteria will be displayed Roster Billing Actions The Roster Billing List form may also be used to perform specific actions on any individual roster billing To perform an action on a roster billing simply select the roster billing from the list and click the desired action button along the lower edge of the form The complete list of roster billing actions can be accessed from the Roster Billing List form s main Actions menu or from the convenient pop up menu accessed
228. istributor does not provide PrintLink support ask that they refer you directly to the software manufacturer for assistance PrintLink functionality may be licensed and supported as an add on to your base PC ACE Pro32 system hS Tip You may want to refer to the Importing claims topic for a discussion of these claim import methods If you do make sure and return to this topic to continue the setup steps Review only the setup considerations applicable to the claim import method you intend to use e Print Image PrintLink imports claims from a print image file If using this claim import method complete the following steps 1 Have your distributor perform a one time PrintLink mapping procedure on a sample print image file that you have supplied This mapping process defines the template used to extract and interpret fields from your print image file Since all upstream systems print claims in a slightly different format this mapping process is required to build your custom template 2 Obtain the resulting map file from your distributor This file is typically named h1500 map but can be any valid filename with a map extension The map file must be placed in the server s winpcace imp1500 directory 3 Confirm the existence of the required map control file This file provides a control interface between the output of the PrintLink translator and the PC ACE Pro32 claim import routines The map control file is always named ma
229. item levels you will see similar Local Fields second level tabs on the Extended Payer Insured tab and Billing Line Items tab respectively Displaying Audit information Click the picture button in the upper right corner of the Patient Info amp General tab to display audit information for this claim This audit information includes the date the claim was created the last modification date and the User ID of the user that modified the claim last Common Claim Activities The following hyperlinks provide additional instruction on several common claim activities 50 Refer to the Adding a new claim topic for more information on adding claims Refer to the Listing modifying and maintaining claims topic for tips on maintaining claims from the Professional Claim List form Refer to the Printing claims topic to learn about printing claims Refer to the Posting claim payments Professional topic to learn about Professional claim payment posting Main Toolbar amp Forms Eligibility Benefit Request List Form Features The PC ACE Pro32 Eligibility Benefit Request List form provides a versatile interface from which the user can create list modify and otherwise maintain patient eligibility benefit requests Click either the Institutional Claims Processing button or Professional Claims Processing button on the PC ACE Pro32 Main Toolbar to open the corresponding Claims Menu form Then click the Maintain Eligibility Benefit Req
230. itter Primary Identifier override value This value populates element NM109 of the Submitter Name NM1 segment in the Submitter Name 1000A loop in the ANSI 837 format EMC file e Receiver Name NM103 1000B specifies the Receiver Name override value This value populates element NM103 of the Receiver Name NM1 segment in the Receiver Name 1000B loop in the ANSI 837 format EMC file e Receiver Primary Identifier NM109 1000B specifies the Receiver Primary Identifier override value This value populates element NM109 of the Receiver Name NM1 segment in the Receiver Name 1000B loop in the ANSI 837 format EMC file ANSI Info 3 specifies optional data element override values to be used exclusively during the preparation of patient eligibility oenefit request files in ANSI 270 format This tab will only be available if the ANSI 270 271 Eligibility Benefit Request Response feature is enabled on your installation Leave these override fields empty for default ANSI 270 processing You should change these values only under instructions from your distributor The currently defined ANSI 270 override fields include e Intchg Sender ID Qual ISA06 05 specifies the Interchange Sender ID and ID Qualifier override values These values populate elements ISAO6 and ISA05 of the 173 PC ACE Pro32 User s Manual 174 Interchange Control Header ISA segment in the ANSI 270 format EMC file respectively e Intchg Receiver ID Qual ISA08 0
231. ity to determine how many claims reference the provider record to be deleted Provider Prof provides access to maintain the providers to be referenced on Professional claims Setup of the Professional Provider reference file is required to process Professional claims All providers referenced on Professional claims must be represented in this reference file The Professional Provider form provides a convenient Sort By selection that quickly sorts the Provider list by LOB Type Provider Group Name Provider ID Group Label and Tag Operations available include To add a new Professional provider record click the New button and enter the new provider information If providers already exist in this reference file you will have the option to create a completely new provider record or inherit and associate the new provider record with the provider record currently selected in the list Select the desired creation options and click the OK button to continue Refer to the Adding and maintaining providers Professional topic for a discussion of these creation options and their applicability To view or modify an existing provider record select the desired record from the list and click the View Update button or double click the desired record To delete an existing provider record select the desired record from the list click the Delete button and confirm the deletion E Attention Claims are linked to provider reco
232. ivities but not both then you will see only a single set of 3 tabs A common set of 3 scheduling options are presented on each of the tabs e No claim scheduling when selected no claim import processing or transmission activity is currently scheduled e Manually initiate deferred claim one time execution when selected the scheduler will initiate a one time claim import processing or transmission activity at the next occurrence of the specified start time e Automatically initiate deferred claim each day when selected the scheduler will initiate a claim import processing or transmission activity daily at the specified start time In addition to selecting the desired scheduling option each scheduled activity type requires some specific configuration e Claim Import Scheduling To schedule an unattended claim import operation click the desired Institutional or Professional Claim Import tab select either the one time or daily scheduling option and enter the desired Start Time Specify the following import specific scheduling options e Import claims only instructs the scheduler to perform the claim import operation only See the Import and process claims option description below for an alternate approach e Import and process claims instructs the scheduler to perform the claim import operation followed immediately by a claim processing operation on all unprocessed claims in the system This option
233. k i e check all the plans of interest A number of actions are available from the main or popup menu to operate on the entire group of plans in a single session Refer to the Home Health Plan of Care List Form Features topic for complete details on selecting and acting on multiple plans at once Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Home Health Plan of Care List Form Features topic for details on using the Plan of Care List form e Refer to the Home Health Plan of Care Form topic for more information on using the Plan of Care entry form e Refer to the Claim amp Reference File Edit Validation topic for more information about the edit validation process and associated forms 153 PC ACE Pro32 User s Manual 154 Common Reference File Procedures Printing Home Health Plans of Care Home Health Plans of Care are printed in PC ACE Pro32 using an advanced image overlay technique This advanced method automatically overlays the plan field values onto a graphical image of the blank Plan of Care CMS 485 486 487 form resulting in a complete plan image that can be printed on stock paper The image overlay technique eliminates all the paper alignment headaches often associated with printing onto pre printed forms Note Home Health Plan of Care printing requires that the free Adobe Acrobat Reader Version 4 0 or later be installed on your system This r
234. kups Variable list lookups are available on many of the fields on these forms Variable list lookups apply primarily to fields whose values are selected from other reference files Such lookups often retrieve data used to fill in other form fields For example if you use the variable list lookup feature to select a Payer ID on the Primary Insured tab of the Patient Information form the Payer Description and Payer LOB will be retrieved as well Access variable list lookups using the same method described above for fixed list lookups Automatic Field Tabs When entering data in a field an automatic tab will occur when the field has been completely filled For example entering a single character in a one character field will automatically position the cursor on the next field in the tab sequence This feature can be disabled in the General Preferences settings if desired Cancel Field Changes If a change is inadvertently made to the contents of a field press the ESC key to cancel this change and restore the field s value to what it was when the field received the focus This feature is available for most fields on any of the reference file information forms Edit Validation Edit validation rules apply to patient payer provider and submitter reference file records When a new or modified patient payer provider or submitter record is saved an edit validation process is performed on all fields If no edit validation errors occur th
235. l and Professional claim activities The menu s action buttons provide access to the most commonly used claim activities sh Pa Import claims from a print file PrintLink or alternate source Enter claims manually Maintain existing claims from a comprehensive list Process imported or reactivated claims automatically Prepare claims into an EMC file for transmission The form s View menu provides access to the most recent claim import claim status request and eligibility benefit request reports as well as the claim activity log The Attachments menu Institutional only includes options to create and maintain Home Health Plans of Care Form No CMS 485 CMS 486 The Roster menu Professional only includes options to create and maintain professional roster bills In addition a few handy claim activity maintenance functions are available from the Maintain menu These include the ability to reverse the most recent claim import run to review and reactivate previously prepared EMC files for re transmission to review and maintain ANSI 997 999 transmission acknowledgment files to launch the PC ACE Pro32 Report Manager to add and maintain patient eligibility benefit requests to prepare an ANSI 270 eligibility benefit request file for transmission to view and maintain ANSI 271 eligibility benefit response files to prepare an ANSI 276 claim status request file and to review and maintain ANSI 277 claim status response and claim
236. lds to allow entry of Coordination of Benefits COB information at the claim and or line level Claims submitted to secondary or tertiary payers may be required to report the payment remittance data returned by prior payers Medicare Secondary Payer MSP claims for example must include specific COB information obtained from the primary payer in order to insure prompt processing by Medicare 47 PC ACE Pro32 User s Manual Note Since Coordination of Benefits information is not required on all claims the screen tabs containing COB related fields are hidden by default Enter a Y in the COB field to make these COB related fields available for use The COB field is located along the lower edge of the Patient Info amp General tab Two distinct levels of Coordination of Benefits reporting are supported e Claim Level COB Reporting Remittance data which is not specific to a particular service line is reported at the claim level The claim form provides claim level COB fields for both the primary and secondary payers These fields are located on the COB Info Primary and COB Info Secondary sub tabs of the Extended Payer Insured tab e Line Level COB Reporting Remittance data specific to a particular service line is reported at the line level The claim form provides a set of line level COB fields for each service line These fields are located on the MSP COB sub tab of the Billing Line Items tab This sub tab tracks the c
237. le Maintenance Data communications information in PC ACE Pro32 is maintained from the Data Communications Setup form for both Institutional and Professional claim types This reference file defines the data communication parameter values to be made available to an external data communications program If your installation is licensed for both Institutional and Professional claim activities you must first select the appropriate claim type from the Institutional or Professional radio buttons near the top of this tab If you are licensed for only one of these claim types this selection will not be available The Data Communications Setup form provides the following maintenance options e To add anew data communications record click the New button and enter the desired information on the Data Communication Information form e To view or modify an existing data communications record select the desired record from the list and click the View Update button or double click the desired record e To copy an existing data communications record select the desired record from the list and click the Copy button The copy feature provides a convenient means of creating new LOB specific or LOB Payer specific data communications records Enter the desired LOB and optional Payer ID and make any other required changes to the copied fields e To delete an existing data communications record select the desired record from the list click the D
238. ledgment files topic for information on viewing and maintaining the ANSI 277 claim status response and claim acknowledgment files that will be returned by your claims processor Refer to the Viewing and maintaining the claim status request response history topic for information on viewing and maintaining status request response history for transmitted claims Refer to the Submitter File Maintenance topic for details on configuring the Submitter reference file Common Reference File Procedures Viewing and maintaining claim status response and acknowledgment files Contractors or clearinghouses receiving ANSI 276 format claim status request files generated by PC ACE Pro32 will retrieve the requested status information from their adjudication system and respond by sending an ANSI 277 claim status response file back to the submitter Contractors or clearinghouses will also send ANSI 277CA claim acknowledgment files in response to receipt of ANSI 837 claim transmission files PC ACE Pro32 provides a facility by which users can archive these ANSI 277 claim status response files and ANSI 277CA claim acknowledgment files for subsequent review and or printing In addition to simply viewing the response file PC ACE Pro32 will automatically process this file and post the claim status responses directly to the appropriate Institutional or Professional claims This topic describes how to stage your ANSI 277 and ANSI 277CA files so that they are automatic
239. level Amount Paid field at the top of the form will display a running total of the Amount Paid values entered for all claim lines When all desired payment fields have been entered click the OK button to save the payment record e To modify an existing payment record select the desired record click the View Update button or double click the selected record and modify the payment field values as required Click the OK button to save the modified payment record 133 PC ACE Pro32 User s Manual Note The Date Paid value for an existing claim payment record cannot be modified To change the payment date you must delete the existing payment record and add a new one with the correct date e To delete a payment record select the desired record click the Delete button and confirm the deletion 6 The Claim Payment History form maintains running totals of all claim payments posted to the selected claim When you have completed the payment posting activities for this claim click the Close button to return to the previous form The Professional Claim List form will reflect the most recent payment date and total amount paid in the Paid Date and Paid Amount columns respectively 134 Common Reference File Procedures Archiving and unarchiving claims Transmitted claims in PC ACE Pro32 can be optionally moved off line to any number of user defined claim archives Claim archiving provides the following advantages
240. licensed for both Institutional and Professional claim activities then you will need to select the appropriate claim type from the Institutional Claim List or Professional Claim List radio buttons near the top of this tab If your installation is licensed for only one claim type then this selection option will not be visible Select the second level tab for the desired primary claim location CL TR or PD The various controls on this tab will be populated with the current column configuration for the selected location The remaining controls on this tab include e The Available Fields listbox contains the names of all fields that are available for selection e The Selected Fields listbox contains the names of all fields that are currently configured for the selected claim type and claim location The order in which the Selected Fields are listed represents the order in which they will be displayed on the Claim List form from left to right e The gt and lt buttons located between the listboxes move fields to from the Selected Fields list respectively To add a field to the current column configuration just select the field from the Available Fields listbox and click the gt button To remove a field select the desired field in the Selected Fields listbox and click the lt button e The Up Down Arrow buttons allow the user to order the fields in the Selected Fields listbox as desired Simply select a field and
241. lick the appropriate tab or simply press the PAGE UP and PAGE DOWN keys to move between these major claim form sections Entering Claim Data Click on any field to activate it for data entry or press the TAB key to move from field to field in a predefined sequence generally left to right and top to bottom Use the UP ARROW and DOWN ARROW keys to move up and down through the claim form fields respectively A number of productivity enhancing features are available during claim data entry e Fixed List Lookups The claim entry form supports fixed list lookups on many of the claim s fields Fixed list lookups apply to fields whose list of valid values can be determined in advance For example Patient Sex typically has 3 possible values M male F female and U unknown USAGE Access the lookup list for a field by positioning the cursor on the field and pressing the F2 function key or right clicking the mouse When an item from the list is selected its value is automatically entered in the claim form field hS Tip Type lt ALT gt F2 press the F2 key while holding the ALT key down to identify all fields that support a lookup list Press the ESC key to disable the flashing notification e Variable List Lookups The claim entry form supports variable list lookups on a number of the claim s fields Variable list lookups apply primarily to fields whose values are selected from reference files Most variable
242. lidation topic for more information about the edit validation process and associated forms Refer to the on line help Common Claim Activities folder for hyperlinks to other eligibility benefit request topics of interest 139 PC ACE Pro32 User s Manual Listing modifying and maintaining eligibility benefit requests Patient eligibility benefit requests in PC ACE Pro32 are listed modified and otherwise maintained from the Eligibility Benefit Request List Form The operation of this list form is identical for Institutional and Professional request types To access the Eligibility Benefit Request List form 1 Click either the Institutional Claims Processing or Professional Claims Processing button on the PC ACE Pro32 Main Toolbar to display the respective Claims Menu form 2 From the Institutional or Professional Claims Menu form select the Maintain and Maintain Eligibility Benefit Requests menu items to open the respective Eligibility Benefit Request List form Most actions to be performed on an eligibility benefit request may be executed from the Eligibility Benefit Request List form Requests can be created viewed modified copied deleted reactivated and held released from the list In addition archived eligibility benefit responses for individual requests can be viewed and printed from the request list form Refer to the Eligibility Benefit Request List Form Features topic for complete details on the features and opera
243. lifier which describes the patient s relationship to the subscriber in the Relationship field Alternatively you may press the lt F2 gt key or right click the mouse while positioned on this field to select from a list of valid qualifiers When the 18 Self relationship qualifier is entered the Patient Information control group will be disabled Since by definition the patient and subscriber are the same person in this scenario it is only necessary to enter the personal information once in the Subscriber Information fields All other relationship codes will permit entry of both the subscriber and patient information although it may not be necessary to enter both in order to perform a successful eligibility oenefit inquiry Saving amp Canceling Service Type Eligibility Benefit Requests After completing data entry on the service type eligibility benefit request form click the Save button or type lt ALT gt S to save and exit the request Alternatively click the Cancel button to abandon any changes and exit the request When an attempt is made to save a request the following occurs e Edit Validation During the request save process an edit validation process is performed on all fields on the request This process includes re evaluating all field level edits as defined above In addition all request file level edits are evaluated File level edits are evaluated only when the request is saved and are typically thos
244. ligibility benefit response for a specific request Welcome what is an edit 222 218 119 115 214 214 213 184 190 135 83 135 57 35 73 43 68 206 123 145 126 117 147 81
245. ligibility information is being requested AS Tip You may encounter situations where you need to enter a value for one of the ANSI 270 data elements that isn t represented on this simplified Service Type Eligibility Benefit Request Form When this situation arises consider creating the request with this simplified form and then modifying the resulting request to add the additional data element This two step process may still be quicker that entering the entire request on the complete Eligibility Benefit Request Form Fields that are required by the ANSI 270 specifications are enforced by edits on the Service Type Eligibility Benefit Request Form Here are a few important details concerning the use of this simplified request form e Payer Selection Click the down arrow button adjacent to the Payer combo box to select the payer to whom this eligibility benefit request will be submitted The drop down list will include the preferred payers previously configured on the Eligibility Benefit Request Preferences form See the Eligibility Benefit Request Preferences section of the Eligibility Benefit Request List Form Features help topic for information on setting up preferred payers Note The drop down Payer selection list may also include the special lt lt Select From Payer Reference File gt gt item Choosing this item allows the user to select a payer from the complete Payer reference file See the Eligibility Benefit Request Pre
246. list and variable list lookups These lookup lists are accessed by right clicking the mouse over the field or pressing the F2 key while focused on the field Common Reference File Procedures S Attention You should add and or modify submitter information only under the supervision of your distributor or an authorized technical support specialist Incorrectly configuring submitter records will result in EMC file incompatibilities Saving amp Canceling Submitter Updates After completing data entry on the Submitter Information form click the Save button or type lt ALT gt S to save and exit the form Alternatively click the Cancel button to abandon any changes and exit the form During the submitter save operation an edit validation process is performed on all submitter record fields If no edit validation errors occur the submitter record is saved without further user intervention If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List form This form lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the reference file edit validation process and the Edit Validation Errors List form If any fatal edit errors exist you must correct them before the submitter record can be saved If only non fatal edit errors exist
247. list lookups use other claim field values 35 PC ACE Pro32 User s Manual 36 the specified claim LOB for example to filter the presented list For example provider lookups attempt to present only those provider records applicable to the claim being entered In addition variable list lookups often retrieve data used to fill in other claim form fields For example selection of a Patient from the variable list lookup completes numerous patient related fields on the claim Access variable list lookups using the same method described above for fixed list lookups Recurring Field Sets Field sets consist of two or more logically related fields For example most ANSI X12 reference identifiers include an identification number a type code qualifier and in some situation a payer identifier as well It is often a requirement to support a variable number of occurrences of a particular field set The claim entry form provides an intelligent combo i e dropdown control to allow entry and maintenance of such recurring field sets To identify a recurring field set look for the 5 selector which will be positioned adjacent to the rightmost field in the set The recurring field set and associated selector function in the following manner e As the user tabs normally away from the last field in the set the focus will automatically return to the first field in the set and the next data occurrence will be displayed Only when all occurrences ha
248. ll only be enabled if this reader is properly installed on the client workstation Refer to the Printing claims topic for more information on this advanced printing technique Pre printed Claim Form Options specifies page positioning adjustment settings for printing claims using the pre printed forms method These settings allow the user to adjust the top and left margins in 1 100 inch increments as well as the character font point size Default Form Version specifies the default claim form version This selection may be overridden when the claim form is printed The available claim form versions include e Traditional CMS 1450 UB92 Format the standard Institutional claim form for many years This format will become obsolete when the National Provider ID NPI rollout is complete e Enhanced CMS 1450 UB 04 Format the enhanced Institutional UB 04 claim form capable of reporting the National Provider ID NPI for the claim s Billing Provider and Attending Operating and Other Physicians Increases the number of Condition Occurrence Occurrence Span and Value codes that can be reported and adds several miscellaneous fields e Traditional CMS 1500 Format the standard Professional claim form for many years This format will become obsolete when the National Provider ID NPI rollout is complete e Enhanced CMS 1500 Format Aug 2005 the enhanced Professional claim form capable of reporting the National Prov
249. ll sample Patient records To delete a Patient record select the desired record in the list click the Delete button and confirm the deletion 16 PC ACE Pro32 Setup Procedures 3 Click the New button to display the Patient Information form Enter the patient information taking advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse hS Tip Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator The Patient reference file contains general patient information as well as optional primary secondary and tertiary insured details Enter as much information as you have available for the patient 4 Click the Save button to save the new Patient record An edit validation process will be performed to check for problems with the patient information When prompted correct any missing or invalid field values if present and re save as needed The new Patient record should now be visible in the Patient list 5 Repeat the relevant steps to create additional Patient records as needed 6 When all desired Patient records have been added click the Close button on the Reference File Maintenance form to return to the PC ACE Pro32 Main Toolbar User Account Setup PC ACE Pro32 requires that a valid login and optional password be entered by an
250. llowing the user to define unique IDs and support information addresses etc on a per LOB basis If necessary provider records may even be defined such that the information is unique to a single payer within the LOB by completing the Payer ID field on the Institutional Provider Information form In order to link provider records that represent the same entity PC ACE Pro32 has introduced the concept of provider associations For example if Jones Memorial Hospital is an Institutional provider for Medicare Part A MCA and Blue Cross BC patients two separate provider records must be added However since these 2 records really represent the same provider they should be associated with each other The Provider tab of the Reference File Maintenance form provides a convenient inheritance option that makes creation of associated provider records a snap Simply click the New button and create the first Jones Memorial Hospital provider record from scratch start with all fields blank assign the MCA 164 Common Reference File Procedures line of business complete all applicable fields on the Institutional Provider Information form and save the provider record Then select the newly created provider record in the provider list and click the New button again When prompted select the Inherit name address information from the selected provider option Also check the Associate the new provider with the selected provider checkbox an
251. lly trigger which attachments are typically made by the distributor or whoever makes your claim submission rules PC ACE Pro32 supports an external attachment trigger control file to provide flexibility in this area On program startup PC ACE Pro32 reads the trigger control file and uses this information to present the appropriate attachment at the appropriate time e Manually Triggered Attachments To provide maximum flexibility PC ACE Pro32 also allows the user to manually trigger a specific claim attachment on any claim line item Simply enter the appropriate attachment trigger code in the desired claim line item s AT control For convenience you may press the F2 key or right click the mouse while focused on the AT control to display a popup selection menu All manually triggered attachments are line level by definition hS Tip The special Cancel automatic attachment manual trigger code is available to override cancel any automatically triggered claim line item attachment This override is useful in exception situations where it is desirable not to send a typically required claim attachment Note The manual attachment trigger feature may not be available in all installations If the claim line item s AT control is disabled and will not allow entry of the attachment trigger code then this feature is unavailable Attachments are displayed on second level tabs on the Billing Line Items tab These attachment tabs are show
252. lookup list during claim entry all applicable patient information will be automatically loaded into the appropriate claim form fields The Patient tab provides a convenient Sort By selection that quickly sorts the patient list by Patient PCN or Patient Name Operations available include e To add anew patient record click the New button and enter the new patient information e To view or modify an existing patient record select the desired record and click the View Update button or double click the desired record e To delete an existing patient record select the desired record click the Delete button and confirm the deletion e To display a list of the Home Health Plans of Care POCs on file for an existing patient record select the desired record and click the Plan of Care button See the Listing modifying and maintaining Plans of Care topic for more information hS Tip The Patient Information form provides several List Filter Options that can be helpful in locating specific patients Refer to the Reference File Maintenance Form topic for more discussion of these common filter options Entering Patient Information The Patient Information form provides access to a patient s details on the following information tabs e General Information provides access to general patient information such as the patient s name address birthdate and various status flags e Extended Info provides access to extended pat
253. lso leave the Tag field blank Enter a unique Group Label for the first group provider record defined for each group When adding an individual in group provider record perform a lookup in the Group Label field and select the group in which this individual provider will be a member Complete entry of the remaining provider fields as desired 5 Click the Save button to save the new Provider record An edit validation process will be performed to check for problems with the provider information When prompted correct any missing or invalid field values if present and re save as needed The new Provider record should now be visible in the Provider list 6 Repeat the last few steps to add each additional Professional Provider record Now each time you click the New button you will be prompted to select whether you want a completely new provider all fields blank to start with or whether you would like to inherit the name address information from the currently selected provider If you choose the inherit option you will also have the option to associate the new provider record with the selected provider record Provider records should be associated when they represent the same entity For example if a solo provider supports multiple lines of business one solo provider record for each LOB should be created and these related provider records should be associated with each other The inherit and associate options can be a
254. luding the start date forward If the start date is left blank but the end date is completed the POS code is valid for all dates of service up to and including the end date 190 Common Reference File Procedures Facility File Maintenance The Facility Setup form provides an interface to maintain the optional Facility reference file The Facility file applies exclusively to Professional claims The user may enter Facility records for each frequently referenced facility if desired The Facility reference file is available as a lookup list from the Extended Patient General tab on the Professional Claim Form Maintenance operations available include e To add a Facility click the New button and enter the new facility information e To view or modify an existing Facility record select the desired record click the View Update button or double click the desired record e To delete a Facility record select the desired record click the Delete button and confirm the deletion hS Tip A convenient Sort By feature quickly sorts the Facility list by Facility Name or Facility ID 191 PC ACE Pro32 User s Manual Charges Master File Maintenance The Charges Master form provides an interface to maintain the Charges Master reference file Charges Master codes apply exclusively to Professional claims If you choose to use this optional reference file it should be setup to include only those procedure codes that are to be used
255. lues These values populate elements ISA08 and ISA07 of the Interchange Control Header ISA segment in the ANSI 276 format EMC file respectively e Application Sender s Code GS02 specifies the Application Sender s Code override value This value populates element GS02 of the Functional Group Header GS segment in the ANSI 276 format EMC file e Application Receiver s Code GS03 specifies the Application Receiver s Code override value This value populates element GSO3 of the Functional Group Header GS segment in the ANSI 276 format EMC file e Payer ID Qual NM109 08 2100A specifies the Payer Primary Identifier and ID Qualifier override values These values populate elements NM109 and NM108 of the Payer Name NM1 segment in the Payer Name 2100A loop in the ANSI 276 format EMC file respectively e Info Revr ID Qual NM109 08 2100B specifies the Information Receiver Primary Identifier and ID Qualifier override values These values populate elements NM109 and NM108 of the Information Receiver Name NM1 segment in the Information Receiver Name 2100B loop in the ANSI 276 format EMC file respectively Local fields specifies up to six additional submitter fields to be defined by the distributor This tab will only be visible if the distributor has defined one or more of these local fields Contact your distributor for completion details Tip A number of fields on the Submitter Information form support data entry via fixed
256. ly be worked with as a group For example there are 5 separate database files that make up the Institutional claims database The Select Group drop down list provides a convenient means of selecting all associated files in one of several commonly used groups Use this selection technique instead of selecting database files individually from the list Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Archiving and unarchiving claims topic for information on the PC ACE Pro32 claim archiving feature and its potential to enhance system performance 210 Miscellaneous Functions Sending support mail to your distributor Technical support e mail can be initiated directly from the PC ACE Pro32 system Click the Send E Mail button on the PC ACE Pro32 Main Toolbar to command your default e mail program to open a new message addressed to your distributor Note This feature may not be available on some systems If the support mail feature is disabled the Send E Mail button will not be present on the PC ACE Pro32 Main Toolbar If the button is available but does not open an e mail message window it is likely that your system does not have its default mailer properly configured 211 Troubleshooting Reviewing the claim activity logs The Claim Activity Log files provide details of all claim import process prepare and transmission activities The logs also record any abn
257. m hS Tip Checking this option will typically result in the most reasonable approach to printing claim attachments The system will print attachments immediately following the associated claim form unless the pre printed forms method is being used Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Printing claims topic for more information on the pre printed versus image overlay techniques 96 System Preferences Data Communication Preferences PC ACE Pro32 preference settings are organized on a tabbed dialog accessible from the PC ACE Pro32 Main Toolbar s main File menu The Data Communication Preferences tab includes settings to control the PC ACE Pro32 data communications interface PC ACE Pro32 can be configured to launch external data communications programs or scripts to perform electronic claim file transfers or other data communication related operations The identical Option tabs correspond to each of the available launch buttons on the Data Communications Options form The controls on each tab include e Option N Program specifies the complete path and filename of the program or batch file with corresponding Windows PIF file to be launched hS Tip Use the convenient browse button adjacent to this control to easily locate and retrieve the full path of the desired program or batch file Enclose paths that contain spaces i e Windows long file and
258. m In addition the focus will remain on the field so that you can correct the problem if desired If you choose not to correct the data at this time simply press the TAB key again to move to the next field Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the edit validation process Key Concepts Regarding Eligibility Benefit Requests The design of the ANSI 270 Health Care Eligibility Benefit Inquiry transaction allows the requestor to enter as little or as much information as desired to ensure a match by the source organization who will be processing the request Fields that are required by the ANSI 270 specifications are enforced by edits on the Eligibility Benefit Request Form The process of entering an eligibility benefit request can be greatly streamlined by effective use of the available variable list lookups e Patient Lookup Press the lt F2 gt key or right click the mouse while positioned on the Patient PCN or Patient Last First Name fields to select a patient from the Patient reference file All applicable information on file for the selected patient will be used to populate the corresponding eligibility benefit request fields This will include the Patient General Information fields the Subscriber General Information fields if Insured info is setup on the Patient record the Information Source fields uses the Insured Payer info and the Information Receiver fields if the Prov
259. m provides an interface to maintain the Type of Bill TOB codes used in PC ACE Pro32 TOB codes apply exclusively to Institutional claims The TOB codes are pre loaded and should not require frequent additions or modifications The following maintenance operations can be performed e Select LOB filters the list to include only valid TOBs for a specific line of business When a specific LOB is selected it will be used as the default LOB for new TOB code assignments e To add anew TOB record click the New button and enter the new TOB information On the Type of Bill TOB Information form select or change the LOB in the drop down list and enter a valid TOB first 2 positions only Identify the TOB assignment as either Inpatient or Outpatient by selecting the appropriate Patient Category radio button e To delete a TOB record select the desired record from the list click the Delete button and confirm the deletion Note To modify an existing TOB record you must delete the existing record and add a new record with the correct information 185 PC ACE Pro32 User s Manual Condition Occurrence Span Value Codes File Maintenance The Condition Occurrence Span Value Codes form provides an interface to maintain the condition occurrence span value codes and assignments This reference file applies exclusively to Institutional claims These codes are pre loaded and should not require frequent additions or modifications The Condit
260. m user Adobe Acrobat Reader path setup alternate payer printing Ambulance medical attachment ANSI 267 277 claim status request response history ANSI 271 file review and maintenance ANSI 277 file review and maintenance ANSI 835 Electronic Remittance Module ANSI 997 file review and maintenance archiving claims archiving transmission files attachments printing audit tracking automatic report printing backing up your PC ACE Pro32 databases building the ANSI 270 eligibility benefit request file building the ANSI 276 claim status request file building the electronic claims file Charges Master File Maintenance Claim amp Reference File Edit Validation Claim Archive Feature claim attachments printing Claim Form Institutional Claim Form Professional claim import in PC ACE Pro32 claim import preferences Claim List Form configuration 216 117 29 213 101 138 152 157 149 157 160 163 166 201 98 128 157 126 145 123 205 117 135 119 128 83 92 206 142 121 112 192 81 135 128 35 43 104 91 90 Index Claim List Form Features 29 claim payments 131 133 posting to Institutional claims 131 posting to Professional claims 133 claim printing preferences 92 claim status request response history 126 claim status response and acknowledgment files 123 claims activity logs viewing and purging 213 Claims Menu Form Institutional or Professional 28 Codes amp Miscellaneous Reference Files
261. may want to refer to the Adding and maintaining payers topic for more information on entering Payer records If you do make sure and return to this topic to continue the setup steps 1 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form Select the Payer tab to display a list of all existing Payer records E Attention One or more Payer records may already exist in the system if your distributor has already setup this reference file for you Consult the distributor s installation notes or contact your distributor for assistance before continuing this Payer setup procedure 2 Click the New button to display the Payer Information form Enter the new payer s information taking advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse hS Tip Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator The Payer ID LOB and Usage fields together serve as the identification key for this Payer record A specific Payer ID LOB combination may exist for a maximum of two Payer records If two such Payer records are defined then their Usage settings must PC ACE Pro32 User s Manual not overlap Valid Usage settings include U Institutional use only H Pr
262. mn indicates that no claim status request response history is available for the claim e Status Date Status Response Date Specifies the date of the most recent status request or posted status response for the claim This date column will be empty if no claim status request response history is available for the claim Note These columns should be visible by default at the far right of the Institutional and Professional Claim List forms whenever the TR PD or TR PD claim location is selected You may need to maximize the window or scroll the list horizontally to bring these columns into view If these columns are not present you will need to add the associated fields to the current claim list column configuration in the Claim List Preferences form Select the Preferences item from the PC ACE Pro32 main toolbar s File menu to display the Preferences form Select the Claim List tab choose either the Institutional Claim List or Professional Claim List radio button if available and then select the Transmitted TR nested tab Move the Status Response Ind and Status Response Date fields from the available fields list to the selected fields list Reorder the new fields in the selected fields list as desired Select the Paid History PD tab and repeat this configuration process Save the preference setting changes This configuration process must be performed separately for the Institutional Claim List form and the Profes
263. mport settings only under the supervision of your distributor or a technical support specialist Incorrectly configuring these options will render the claim import feature non functional Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Importing claims topic for a detailed description of the claim import methods and optional preprocessor 91 PC ACE Pro32 User s Manual Printing Preferences PC ACE Pro32 preference settings are organized on a tabbed dialog accessible from the PC ACE Pro32 Main Toolbar s main File menu The Printing Preference tab allows the user to specify options to control the printing of Institutional and Professional claim activity reports claim forms and claim attachments If your installation is licensed for both Institutional and Professional claim activities first select the appropriate claim type from the Institutional Printing Options or Professional Printing Options radio buttons near the top of this tab If your installation is licensed for only one claim type then this selection option will not be visible The printing options are organized in a series of nested tabs as follows e Import settings on this tab control the printing of claim import reports These include e Automatically print claim import reports on completion specifies whether claim import reports will be printed automatically i When checked the claim import report
264. mpt to locate the most specific record match based on the claim s line of business and payer s For example if the HCPCS code 00100 is entered manually on a commercial claim LOB COM for Payer ID 12345 the program will automatically use the charge amount associated with the matching payer specific record i e the third record above If the commercial claim is being billed to any other payer however the program will instead use the charge amount from the non payer specific record i e the second record above Finally if the HCPCS code 00100 is entered manually on a non commercial claim the program will use the charge amount from the default i e first 192 Common Reference File Procedures Charges Master record If the appropriate Charges Master record cannot be automatically determined with complete certainty then the user will be prompted to select the desired record If your installation does not require LOB specific and or LOB Payer specific charge amounts then simply setup all Charges Master records using the lt lt All gt gt pseudo line of business and leave the Payer ID field empty Note By default procedure code lookups performed during Professional claim entry access the master HCPCS reference file To use the Charges Master file instead you must first create records in this reference file for all desired procedure codes along with their standard Charges amounts Second enable lookups to t
265. n The reactivated claim will be assigned the unprocessed UNP status See the Reactivating previously transmitted claims topic for more details Archiving Claims Choose the Archive Selected Claim action to move the selected claim from the current claim database to the open claim archive database Only claims in the transmitted TR and paid PD locations are eligible for archiving Refer to the Archiving and unarchiving claims topic for more information on the PC ACE Pro32 claim archiving feature Unarchiving Claims Choose the Unarchive Selected Claim action while viewing the claims in an open claim archive to move the selected claim from the archive database to the current claim database Refer to the Archiving and unarchiving claims topic for more information on the PC ACE Pro32 claim archiving feature Setting Claim Media Choose the Set Selected Claim Media action to designate the selected claim for either electronic or paper submission Only claims with a media setting of electronic E will be eligible for preparation into an EMC file Claims with a media setting of paper P can be printed and submitted in hardcopy form When a paper claim is printed you will be given the option to move the claim from the to be transmitted CL location to the transmitted TR location automatically Note Support for paper claims may be disabled by the distributor If the Set Selected Claim Media action item
266. n The next time you execute PC ACE Pro32 you will be presented with this same prepare recovery options form If the first or second option is selected the user will be required to log in using the same User ID and password that was in effect when the prepare interruption occurred Upon successful login the prepare recovery process will either be performed or skipped based on the user s selection Once the recovery process has completed successfully we suggest that you review the affected claims using the Claims List form to insure that everything looks like it did before the 214 Troubleshooting prepare operation was initiated You may then run the prepare operation again to prepare the eligible claims Note Claim prepare recovery requires exclusive system access Since the prepare operation itself requires exclusivity this should never become an issue In any event you will be notified if exclusive system access cannot be granted 215 PC ACE Pro32 User s Manual Index acknowledgment files actions on multiple claims at once activity logs viewing and purging adding a new claim Adding a new eligibility benefit request adding a new Home Health Plan of Care Adding a new Institutional Medical Attachment Adding a new roster billing Adding and maintaining patients Adding and maintaining payers Adding and maintaining providers Institutional Adding and maintaining providers Professional Adding or modifying a syste
267. n bill type and numerous other criteria When multiple filter criteria are specified only those claims that meet all filter criteria will be displayed Note You may observe that the Transmit Date is being populated automatically even when you ve cleared the advanced filter settings This is normal when the Claim List form is configured to limit the initial display of transmitted paid claims Refer to the PC ACE Pro32 Miscellaneous preferences topic for a description of this feature and to review the current settings e Check Uncheck All Claims Permits the user to check or uncheck all claims currently displayed in the claim list presumably in anticipation of some action to be 32 Main Toolbar amp Forms performed on this block of claims See the Actions on Multiple Claims section above for more information Check All Claims From Selected Transmission Provides an easy way to check all claims included in a previous transmission file The Institutional or Professional Claim Transmission Log form will display a list of recent transmission files with the most recent automatically selected Select the desired transmission file entry and click the Select button Upon return to the Claim List form the program will automatically check all claims included in the selected transmission This feature is especially useful in situations where all claims from a previous transmission need to be reactivated modified and the
268. n date Institutional UB 04 form only specifies whether to print the current date by default in the Creation Date field on the Institutional claim form s 23rd service line This default setting can be overridden when a claim is printed M When checked the current system date will be printed automatically by default in the Creation Date field An alternate date may be specified instead when a claim is printed M When unchecked the standard method for determining the Creation Date will be used by default The prepare date will be printed for transmitted claims The entry date will be printed for claims pending transmission Override the provider signature block date by default Professional only specifies whether to print the provider signature on file date from the Professional Claim Form or to instead allow the user to override the signature block date by default This default setting can be overridden when a claim is printed M When checked the provider signature on file date on the Professional Claim Form will be ignored by default during claim printing An alternate date or no date at all may be specified instead when a claim is printed I When unchecked the provider signature on file date on the Professional Claim Form will be printed by default to the claim form signature block Print line items using single spacing when appropriate Professional only specifies whether single spacing of line items is to be used when
269. n omitted To insure accuracy birthdate fields require that a full 4 digit year be entered When the focus leaves a request form field either by pressing the TAB key or clicking ona new field an edit validation process is performed on the field losing the focus Edits performed at this time are referred to as field level edits If a field level edit validation error occurs you will receive an audible response and the edit validation error message will be displayed in the lower left corner of the eligibility benefit request form In addition the focus will remain on the field so that you can correct the problem if desired If you choose not to correct the data at this time simply press the TAB key again to move to the next field Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the edit validation process Additional Service Type Eligibility Benefit Request Form Information The design of the ANSI 270 Health Care Eligibility Benefit Inquiry transaction allows the requestor to enter as little or as much information as desired to ensure a match by the source organization who will be processing the request The simplified Service Type Eligibility Benefit Request Form targets only general eligibility oenefit requests These simple service type requests typically include only the subscriber and or patient name the Subscriber Member ID and a code specifying the service type for which general e
270. n or hidden dynamically based on the currently selected service line and the attachment type line level or claim level If the procedure code on the current line automatically triggers a particular attachment or if an attachment is manually triggered then the corresponding attachment tab will be shown Since claim level attachments exist only once for the entire claim the associated attachment tabs are visible regardless of the current line position Claim level attachments are identified by a C designator on the attachment tab s caption The following attachment productivity features are also available e CLIA and Mammography Certification Numbers When a CLIA or Mammography attachment is triggered the corresponding certification number is retrieved from the claim s billing solo or rendering group provider reference file record if available These certification numbers can be setup in advance in the Professional Provider reference file thus freeing the user from remembering and entering these numbers on each claim attachment e Attachment Field Duplication Press the F5 key while positioned on any line level attachment field to copy all attachment field values from the closest previous line with the same attachment type into the current line s attachment fields This feature minimizes the need to type line level attachment data multiple times on a single claim Coordination of Benefits The Professional Claim Form includes fie
271. n re prepared into a new transmission file After selecting the desired transmission file entry the user would simply choose the Reactivate All Checked Claims item from the form s main Actions menu to complete the reactivation process Refer to the Reactivating previously transmitted claims topic for more information on reactivating previously transmitted claims Check All Queued Claims For Status Request This is simply a convenience feature that will check all claims that are currently queued for inclusion in the next ANSI 276 claim status request file It can be used as a reminder of which claims have already been added to the queue See the Preparing claim status request files for transmission topic for information on how to use the ANSI 276 277 claim status request response feature Clear Claim Status Request Queue Clears the ANSI 276 claim status request queue See the Preparing claim status request files for transmission topic for information on how to use the ANSI 276 277 claim status request response feature Note Support for the ANSI 276 277 claim status request response feature may be disabled by the distributor If the Check All Queued Claims For Status Request and Check Claim Status Request Queue action items are not visible then your system does not support the claim status request response feature Claim List Reports Several reports and special print functions are accessible from the Claim List form s m
272. n the Institutional Provider Information form as an alternative to deleting the provider hS Tip The Provider Inst tab of the Reference File Maintenance form provides several list filter options that can be helpful in locating specific providers Refer to the Reference File Maintenance Form topic for a discussion of these common filter options Entering Institutional Provider Information The Institutional Provider Information form provides access to all Institutional provider fields These fields are grouped logically on the following tabs e General Info includes fields for the provider name address contact and identification information ID LOB Payer ID and tax number e Extended Info includes fields for any additional extended provider information e g the pay to provider name and address if different e Local Fields includes up to six additional local provider fields to be defined by the distributor This tab will only be visible if the distributor has defined one or more of these local fields Contact your distributor for completion details Click the appropriate tab or simply press the PAGE UP and PAGE DOWN keys to move between tabs Provider records are uniquely defined by the Provider ID No Provider ID and LOB Line of Business fields and optionally by the Payer ID field as well These critical fields are defined as follows 163 PC ACE Pro32 User s Manual e Provider ID No The prov
273. n to save the new Patient record An edit validation process will be performed to check for problems with the patient information When prompted correct any missing or invalid field values if present and re save as needed The new Patient record should now be visible in the Patient list 5 Repeat the relevant steps to create additional Patient records as needed 6 When all desired Patient records have been added click the Close button on the Reference File Maintenance form to return to the PC ACE Pro32 Main Toolbar User Account Setup PC ACE Pro32 requires that a valid login and optional password be entered by anyone desiring access to the system The system administrator must set up a user account for each person that will use PC ACE Pro32 The user account specifies the user s login password values and defines which activities the user has permission to perform As shipped PC ACE Pro32 is configured with a single default user with full system access rights The default user s User ID is SYSADMIN and password is SYSADMIN as well Complete the following steps to add additional user accounts AS Tip You may want to refer to the Adding or modifying a system user topic for more information on adding and maintaining users If you do make sure and return to this topic to continue the setup steps 1 Select the main Security menu from the PC ACE Pro32 Main Toolbar and choose the Add Update User item The Security List form will
274. nal Claim Form or Professional Claim Form when processing claims in interactive mode Click this button to cancel the currently displayed claim and abort the automatic processing run The current claim and all remaining eligible claims will remain unprocessed If desired click the View Results and or View Errors buttons to view reports of the clean claims and claims with errors respectively These reports can be printed from the report previewer if desired Note If you checked the Include edit error details in process error report processing option the claims with errors report will include the specific edit validation errors reported for each claim up to 5 per claim maximum by default If this option was not checked the claim reference will be reported without any supporting edit validation error details hS Tip Refer to the Printing Preferences topic for information on configuring claim processing reports to be printed automatically or to a specific printer You can also set the maximum number of edit validation errors to be listed per claim When you have completed your review of the claim processing reports click the Close button on the Automated Claim Processing form You may now proceed to work the remaining unprocessed claims and claims with errors one by one from the Claim List form amp Attention Claims containing non fatal errors will be assigned a status of unprocessed 110 UNP during automatic process
275. nal instruction on several common eligibility benefit request activities 60 Main Toolbar amp Forms Refer to the Adding a new eligibility benefit request topic for more information on adding eligibility benefit requests Refer to the Listing modifying and maintaining eligibility benefit requests topic for tips on maintaining eligibility benefit requests from the Eligibility Benefit Request List form Refer to the Preparing eligibility benefit request files for transmission topic to learn about preparing eligibility benefit requests into an ANSI 270 format file for transmission Refer to the Viewing and maintaining eligibility benefit response files topic to learn about handling ANSI 271 response files returned from the Information Source Payer 61 PC ACE Pro32 User s Manual The Service Type Eligibility Benefit Request Form The Service Type Eligibility Benefit Request Form provides a simple user interface for creating new service type patient eligibility oenefit requests This form provides access to only the most commonly used data elements defined in the ANSI 270 Health Care Eligibility Benefit Inquiry transaction Service type requests are used for general eligibility inquiries and must include one of the valid eligibility Service Type codes Note The Service Type Eligibility Benefit Request Form cannot be used to make eligibility inquiries for specific procedure codes Use the complete Eligibility Benefit Requ
276. nce The Claim Adjustment Reason Codes form provides an interface to maintain the Claim Adjustment Reason codes These reason codes are used on Coordination of Benefits COB claims to report prior payer information They are pre loaded and should require minimal maintenance Maintenance operations available include e To add a Claim Adjustment Reason code click the New button and enter the new code information e To view or modify an existing Claim Adjustment Reason code record select the desired record and click the View Update button or double click the desired record e To delete a Claim Adjustment Reason code record select the desired record from the list click the Delete button and confirm the deletion AS Tip The Claim Adjustment Reason Codes form provides several List Filter Options that can be helpful in locating specific codes Refer to the Reference File Maintenance Form topic for more discussion of these common filter options 197 PC ACE Pro32 User s Manual Remittance Remark Codes File Maintenance The Remittance Remark Codes form provides an interface to maintain the Remittance Remark codes These remark codes are used on Coordination of Benefits COB claims to report prior payer information They are pre loaded and should require minimal maintenance Maintenance operations available include e To adda Remittance Remark Reason code click the New button and enter the new code information e To view or modify
277. nce file with the exception of the special dump payer Payer ID 99999 The Payer tab provides a convenient Sort By selection that quickly sorts the Payer list by Payer ID Payer Description Payer LOB or Payer State Operations available include e To add anew payer record click the New button and enter the new payer record information Refer to the Adding and maintaining payers topic for additional information on payer and PrintLink matching description requirements e To view or modify an existing payer record select the desired record from the list and click the View Update button or double click the desired record e To create a new payer record that is similar to an existing record select the desired payer record click the Copy button and change only the desired fields This feature makes it easy to create multiple payer records for the same payer to support more than one line of business LOB e To delete an existing payer record select the desired record from the list click the Delete button and confirm the deletion e Click the PrintLink Matching Descriptions button while viewing a Payer s details to view edit the PrintLink matching strings for the selected payer Refer to the Adding and maintaining payers topic for more details Provider Inst provides access to maintain the providers to be referenced on Institutional claims Setup of the Institutional Provider reference file is required to proce
278. ncel this change and restore the field s value to what it was when the field received the focus This feature is available for most eligibility benefit request form fields e Date Completion Date values may be entered with or without the century for convenience PC ACE Pro32 uses a user definable century pivot year to automatically derive the century when omitted To insure accuracy birthdate fields require that a full 4 digit year be entered e Inquiry Line Item Scrolling The Eligibility Benefit Inquiry tab displays 4 inquiry lines at a time For requests that contain more than 4 line items the user may scroll through the inquiry line items one line at a time or one page i e 4 lines at a time using the buttons provided along the right edge of this tab hS Tip You can also use the up down arrow keys to move from line to line scrolling when appropriate Type lt ALT gt lt PAGE UP gt press the Page Up key while holding the ALT key down or lt ALT gt lt PAGE DOWN gt to scroll up down through all inquiry line items one page at a time e Inquiry Line Item Features The following line item productivity features are available on the Eligibility Benefit Inquiry tab e Current Line Tracking The Eligibility Benefit Inquiry tab contains the Additional Eligibility Benefit Information control group This control group is linked to the currently selected inquiry line on this tab As the cursor moves from one inquiry line to anot
279. nd B or blank unrestricted use The only valid situation where two Payer 14 PC ACE Pro32 Setup Procedures records with the same Payer ID LOB combination may exist is when one of the records specifies a Usage value of U Institutional use only and the other record specifies a Usage value of H Professional use only This feature permits Payers for shared LOBs such as Commercial COM to optionally have distinct settings and PrintLink matching strings for Institutional versus Professional use An individual Payer record must be setup for each line of business LOB handled by that payer For example if payer 12345 will receive both Medicare and Medicaid claims then two Payer records must be added both with Payer ID 12345 one with LOB MCA and the other with LOB MCD 3 Click the Save button to save the new Payer record An edit validation process will be performed to check for problems with the payer information When prompted correct any missing or invalid field values if present and re save as needed The new Payer record should now be visible in the Payer list Note If you plan on using the PrintLink feature of PC ACE Pro32 to import claims from print image files then you will also need to add PrintLink Matching Description strings to this Payer record The Claim Import Considerations section later in this topic will lead you through this process 4 Repeat the relevant steps to create addit
280. nd enter the new HCPCS code information Enter the effective date range using a 4 digit year format e To view or modify an existing HCPCS code select the desired code from the list and click the View Update button or double click on the desired code e To delete an existing HCPCS code select the desired code from the list click the Delete button and confirm the deletion AS Tip The HCPCS Codes form provides several List Filter Options that can be helpful in locating specific codes Refer to the Reference File Maintenance Form topic for more discussion of these common filter options Effective Date Range The Effective Date Range dates are compared to the claim s date of service range during the claim edit validation process If the effective date range for a HCPCS code falls outside the claim s service date range an edit validation error will be reported If the effective date range is left blank the HCPCS code is valid for all dates of service If the start date is completed but the end date is left blank the HCPCS is valid for all dates of service from and including the start date forward If the start date is left blank but the end date is completed the HCPCS code is valid for all dates of service up to and including the end date Related Topics The following hyperlinks provide additional information related to this topic e Refer to the HCPCS Modifiers File Maintenance topic for information on maintaining HCPCS cod
281. ndication of all fields that support lookups Press the ESC key to turn off the flashing indicator Enter the provider s name and address information Enter the Provider ID in the Provider ID No field and the line of business in the LOB field probably MCA The Payer ID field is only needed if you want to restrict assignment of this provider to a specific payer Normally the Payer ID field will be left blank You can also leave the Tag field blank Complete entry of the remaining provider fields as desired Click the Save button to save the new Provider record An edit validation process will be performed to check for problems with the provider information When prompted correct any missing or invalid field values if present and re save as needed The new Provider record should now be visible in the Provider list Repeat the last few steps to add each additional Provider record Now each time you click the New button you will be prompted to select whether you want a completely new provider all fields blank to start with or whether you would like to inherit the name address information from the currently selected provider If you choose the inherit option you will also have the option to associate the new provider record with the selected provider record Provider records should be associated when they represent the same entity For example if a provider supports multiple lines of business one provider record for each
282. nefit Request List Form this report is typically used as a secondary reference source There may be situations in which a response returned by the claims processor cannot be posted to the original eligibility benefit request In these situations you can refer back to this complete ANSI 271 eligibility benefit response report for the missing information Contact your claims processor s support department for assistance in understanding the ANSI 271 report nomenclature and eligibility benefit code interpretation Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Eligibility Benefit Request List Form Features topic for more information on adding and maintaining eligibility benefit requests e Refer to the Preparing eligibility benefit request files for transmission topic for information on creating ANSI 270 eligibility benefit request files to send to your claims processor e Refer to the Viewing the eligibility benefit response for a specific request topic for information on viewing the eligibility benefit response returned for a specific request 146 Common Reference File Procedures Viewing the eligibility benefit response for a specific request When PC ACE Pro32 archives an ANSI 271 eligibility benefit response file certain access information is posted back to each individual eligibility benefit request represented in the response file This stored access information makes
283. nefit request See the Adding a new eligibility benefit request topic for more details Note The Create New Request Service Type action may not be available on all installations When this action is unavailable all new requests should be initiated by clicking the New button or selecting the Create New Request action Viewing Modifying Requests Click the View Update button or choose the View Update Selected Request action to view and or modify the selected eligibility benefit request See the Eligibility Benefit Request Form topic for details on using the PC ACE Pro22 eligibility benefit request entry form hS Tip The View Update action is the default eligibility benefit request action In addition to the techniques described above this action can also be invoked by double clicking on the desired request record or by selecting the desired record and pressing the ENTER key hS Tip Holding down the SHIFT key while invoking the View Update action on an eligible eligibility benefit request will force an automatic save attempt on the request This is a shortcut technique equivalent to invoking the View Update action and subsequently clicking the Save button on the request entry form It minimizes the keystrokes required to work requests from the Eligibility Benefit Request List form Eligible requests are those in the to be submitted EL location with a status of either unprocessed UNP has errors ERR or has
284. ng Provider records 2 If you have just installed PC ACE Pro32 the Provider list should be empty If so skip to the next step If the list is not empty contact your distributor to confirm that the existing Provider records can be safely deleted To delete a Provider record select the desired record in the list and click the Delete button Click the OK button on the Provider Deletion 21 PC ACE Pro32 User s Manual Confirmation form to confirm the deletion request You must delete all Indiv type Provider records before deleting Solo and Group type Provider records Make sure the list is empty before continuing with the next step 3 Click the New button to display the Professional Provider Information form Enter the first provider s information taking advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse hS Tip Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator 4 Select the desired Provider Type and enter the provider s name address and contact information Enter the Provider ID in the Provider ID No field and the line of business in the LOB field The Payer ID field is only needed if you want to restrict assignment of this provider to a specific payer Normally the Payer ID field will be left blank You can a
285. nly preparation steps for importing claims using the PrintLink method Complete these steps as part of the initial PC ACE Pro32 system setup described in either the Setup of Medicare Part A Systems Setup of Institutional All Payer Systems or Setup of Professional Systems topic In summary this once only setup consists of 104 2 Common Reference File Procedures e Performing PrintLink mapping on a sample print file to generate the corresponding map file Copying the map file to the server s claim import directory e Confirming that the correct map control file has been placed in the server s claim import directory AS Tip Check with your distributor before performing these once only setup steps Some distributors build this setup into the program installation procedure Copy the print file to be imported into the server s claim import directory The print file must be named as defined in the corresponding print map file The claim import directory is named winpcace impub92 for Institutional claim import operations and winpcace imp1500 for Professional claim import operations gt Attention Windows long filenames are partially supported for the PrintLink import method map and print files The map filename may contain space characters periods underscores and most other characters permitted in long filenames under Windows However the parenthesis characters and are not allowed in the map filename Th
286. nstalled on the system You must exit PC ACE Pro32 before installing the Acrobat Reader A properly installed reader will be detected automatically the next time PC ACE Pro32 is started If necessary you can manually configure the Acrobat Reader executable file ACRORD32 EXE path from the Misc tab of the PC ACE Pro32 Preferences form hS Tip The Adobe Acrobat Reader has its own preference settings that will let you choose the initial document magnification level and get rid of the splash screen that is shown by default every time the reader is started The default destination printer for Institutional Claims printing is also used as the Plan of Care default destination printer This default can be set from the Printing tab of the PC ACE Pro32 Preferences form This default destination printer setting will be used during Plan of Care print operations unless overridden at print time from the Home Health Plan of Care Print Options form Common Reference File Procedures Common Reference File Procedures Adding and maintaining patients The Patient tab of the Reference File Maintenance form provides an interface to add and maintain patient information including the patient s primary secondary and tertiary insured details Setup of the Patient reference file is optional If you choose to setup patients the complete patient list will be accessible during claim entry using the variable list lookup feature When a patient is selected from the
287. nt record if any For example if the following 3 detail assignment records exist for revenue code 0022 LOB lt lt ALL gt gt TOB lt lt ALL gt gt LOB lt lt ALL gt gt TOB 11 188 Common Reference File Procedures LOB MCA TOB 11 Case 1 Medicare claim LOB MCA with a TOB 112 claim lines with a revenue code of 0022 would use control settings from the third record above during edit validation since both the LOB and TOB are an exact match Case 2 Commercial claim LOB COM with a TOB 112 claim lines with a revenue code of 0022 would use control settings from the second record above during edit validation since the TOB matches and the LOB of lt lt ALL gt gt matches any claim LOB The third record was rejected because of the LOB mismatch MCA versus COM Case 3 Medicare claim LOB MCA with a TOB 122 claim lines with a revenue code of 0022 would use control settings from the first record above during edit validation since the TOB of lt lt ALL gt gt matches any claim TOB and the LOB of lt lt ALL gt gt matches any claim LOB The third and second records were rejected because of the TOB mismatch 12 versus 1 J In our example the first record was a catch all record since it matched all LOBs and TOBs If that assignment record were not present then Case 3 above MCA 122 would not have matched any of the detail assignment records When
288. nt value and may also specify an optional Units value bS Tip Fixed list or variable list lookups are available on many of the COB related fields to improve user efficiency In addition the standard line duplication F5 field duplication F4 and line deletion F7 functions are available on all COB related scrolling arrays As an additional convenience pressing the F5 key while positioned on the first Service Line Adjudication SVD line will populate the SVD fields with their equivalent values from the original service line Present On Admission POA Indicators PC ACE Pro32 uses the 8th position of the Principal Diagnosis Code Other Diagnosis Codes and External Cause of Injury E Code fields to hold the Present On Admission POA indicators These indicators are required on certain inpatient claims and are displayed in the right justified shaded area of these diagnosis code fields Valid POA indicator values are Y Yes Present at the time of inpatient admission N No Not present at the time of inpatient admission U Unknown The documentation is insufficient to determine if the condition was present at the time of inpatient admission W Clinically Undetermined The provider is unable to clinically determine whether the condition was present at the time of inpatient admission or not 1 Unreported Not used Exempt from POA reporting This code is the equivalent code of a blank on the UB 04 When hand keying a claim
289. nual AS Tip You may want to refer to the Adding and maintaining patients topic for more information on entering Patient records If you do make sure and return to this topic to continue the setup steps 1 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form Select the Patient tab to display a list of all existing Patient records 2 If you have just installed PC ACE Pro32 the Patient list should be empty If so skip to the next step If the list is not empty any existing Patient records are likely there as samples only Once you have confirmed that this is the case delete all sample Patient records To delete a Patient record select the desired record in the list click the Delete button and confirm the deletion 3 Click the New button to display the Patient Information form Enter the patient information taking advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse hS Tip Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator The Patient reference file contains general patient information as well as optional primary secondary and tertiary insured details Enter as much information as you have available for the patient 4 Click the Save butto
290. o other eligibility benefit request topics of interest 141 PC ACE Pro32 User s Manual Preparing eligibility benefit request files for transmission Patient eligibility benefit request file preparation in PC ACE Pro32 refers to the act of generating an ANSI 270 eligibility benefit request file suitable for transmission to your claims processor This file will contain all relevant details for one or more eligibility benefit requests Upon receipt of the ANSI 270 file the claims processor will generate a corresponding ANSI 271 eligibility benefit response file containing the requested eligibility oenefit information This ANSI 271 response file can be processed by PC ACE Pro32 and the user will be able to view the eligibility oenefit information returned for each request represented in the original ANSI 270 eligibility benefit request file Only eligibility benefit requests in the to be submitted EL location are eligible for preparation When a request is prepared into an ANSI 270 eligibility benefit request file it is automatically moved to the submitted TR location Residence in the submitted TR location reflects its transmitted state and also prevents the request from being inadvertently retransmitted Note The patient eligibility benefit request response capability may not be available on all installations If the Prepare Eligibility Benefit Request File item is not visible on the Maintain menu when performing the s
291. o printing the first claim for each unique LOB Payer combination Enable this option to insure that imported claims for each LOB Payer combination are printed on separate pages When unchecked the claim import reports will be printed in a continuous fashion with no forced page breaks e Process settings on this tab control the printing of claim processing reports These include e Automatically print claim process reports on completion specifies whether claim processing reports will be printed automatically 92 System Preferences M When checked the claim processing reports automatically print after the claim processing operation has completed When unchecked the claim processing reports will not print automatically You will still have the option to print the reports manually Print claim process error report even when no errors exist specifies whether empty processing error reports will be printed automatically This option is only enabled if you have chosen to print claim processing reports automatically i When checked the claim processing error report automatically prints even if all processed claims were clean M When unchecked the claim processing error report will not automatically print if it is empty Process Report Printer specifies the claim processing reports printer Include error details on process error report specifies whether detailed edit validation error descriptions are to be included
292. oblems with the provider information When prompted correct any missing or invalid field values if present and re save as needed The new Provider record should now be visible in the Provider list 6 Repeat the last few steps to add each additional Provider record Now each time you click the New button you will be prompted to select whether you want a completely new provider all fields blank to start with or whether you would like to inherit the name address information from the currently selected provider If you choose the inherit option you will also have the option to associate the new provider record with the selected provider record Provider records should be associated when they represent the same entity For example if a provider supports multiple lines of business one provider record for each LOB should be created and these related provider records should be associated with each other The inherit and associate options can be a real timesaver when setting up providers that support multiple lines of business In this scenario select an existing provider in the list click the New button and choose the inherit and associate options You will see that the top portion of the Provider Information form will be completed automatically Simply tab through or overwrite the Provider ID No field may be the same or different enter a unique line of business identifier in the LOB field and click the Save button 7
293. occur when the field has been completely filled For example entering a single character in a one character field will automatically position the cursor on the next field in the tab sequence This feature can be disabled in the general preferences settings if desired Intelligent Groups Tabs The Institutional claim form contains a number of field groups Examples of such groups include Condition Occurrence Span Value Diagnosis and Procedure codes Fields in these groups are always completed sequentially Therefore when a field in one of these groups is left empty it can be assumed that data entry in the group is complete When the TAB key is pressed the remaining fields in that group will be skipped and the cursor will be positioned on the first field in the tab sequence beyond the group fields Main Toolbar amp Forms Cancel Field Changes If a change is inadvertently made to the contents of a field press the ESC key to cancel this change and restore the field s value to what it was when the field received the focus This feature is available for most claim form fields Date Completion Date values may be entered with or without the century for convenience PC ACE Pro32 uses a user definable century pivot year to automatically derive the century when omitted To insure accuracy birthdate fields require that a full 4 digit year be entered Descriptive Field Hints Most claim form fields have field hints that provide a brie
294. ode form displays the current list of revenue codes their descriptions and an indication of whether or not revenue code assignment details exist for this code Maintenance operations available include e To add a revenue code click the New button and enter the new revenue code information Enter the effective date range using a 4 digit year format e To view or modify an existing revenue code record select the desired record from the list and click the View Update button or double click the desired record e To delete a revenue code record select the desired record from the list click the Delete button and confirm the deletion e To view revenue code assignment details select the desired record from the list and click the TOB Detail button See the Revenue Code Assignments discussion later in this topic for more information hS Tip The Revenue Codes form provides several List Filter Options that can be helpful in locating specific codes Refer to the Reference File Maintenance Form topic for more discussion of these common filter options Effective Date Range The Effective Date Range dates are compared to the claim s date of service range during the claim edit validation process If the effective date range for a revenue code falls outside the claim s service date range an edit validation error will be reported If the effective date range is left blank the revenue code is valid for all dates of service If the start da
295. odifier Only the Valid flags may be modified To delete a HCPCS modifier assignment select the desired modifier assignment from the list click the Delete button and confirm the deletion Common Reference File Procedures Related Topics The following hyperlinks provide additional information related to this topic e Refer to the HCPCS Codes File Maintenance topic for information on maintaining HCPCS codes 181 PC ACE Pro32 User s Manual ICD Codes File Maintenance The ICD Codes form provides an interface to maintain the ICD 9 and ICD 10 diagnosis and procedure codes used in PC ACE Pro32 These codes are pre loaded and should not require frequent additions or modifications Select the desired radio button to display either the Diagnosis codes list or the Procedure codes list The following maintenance options are available e To add anew ICD 9 or ICD 10 code click the New button and enter the new code s information Enter the effective date range using a 4 digit year format e To view or modify an existing ICD 9 or ID 10 code select the desired code from the list and click the View Update button or double click the selected ICD code e To delete an ICD 9 or ICD 10 code select the desired code from the list click the Delete button and confirm the deletion bS Tip The ICD Codes form provides several List Filter Options that can be helpful in locating specific codes Refer to the Reference File Maintenance
296. ofessional use only and B or blank unrestricted use The only valid situation where two Payer records with the same Payer ID LOB combination may exist is when one of the records specifies a Usage value of U Institutional use only and the other record specifies a Usage value of H Professional use only This feature permits Payers for shared LOBs such as Commercial COM to optionally have distinct settings and PrintLink matching strings for Institutional versus Professional use An individual Payer record must be setup for each line of business LOB handled by that payer For example if payer 12345 will receive both Medicare and Medicaid claims then two Payer records must be added both with Payer ID 12345 one with LOB MCA and the other with LOB MCD Note Since this is a Medicare Part A Only system it is conceivable that you will only be required to setup one Payer record This record would contain the Payer ID of your Medicare Part A payer and an LOB of MCA You may decide to add additional Payer records for other lines of business if you want to include these on the claim s secondary and tertiary payer lines 3 Click the Save button to save the new Payer record An edit validation process will be performed to check for problems with the payer information When prompted correct any missing or invalid field values if present and re save as needed The new Payer record should now be visible in the P
297. ofessional Systems performance suggestion packing claims databases Performing system backups restores permissions user Physician UPIN File Maintenance Place of Service POS File Maintenance Plan of Care 485 486 Form Index 35 57 76 104 115 205 102 140 153 150 3 27 76 169 157 201 202 205 206 209 211 201 205 209 206 202 211 98 3 209 209 157 160 27 7 14 20 14 20 209 206 83 183 189 73 219 PC ACE Pro32 User s Manual Posting claim payments Institutional 131 Posting claim payments Professional 133 preferences 85 86 90 91 92 97 98 Claim Import 91 Claim List Form 90 Data Communications 97 General 86 Miscellaneous 98 Overview 85 Printing 92 prepare run interruption recovery 214 Preparing claim status request files for transmission 121 Preparing claims for transmission 112 Preparing eligibility benefit request files for transmission 142 pre printed form claim print method 128 printer selection claims amp reports 92 printing claims 128 printing claim attachments 128 printing claims on pre printed forms 128 printing claims on stock paper 128 Printing Home Health Plans of Care 155 Printing preferences 92 PrintLink claim import method 104 PrintLink matching strings 160 Processing claims automatically 109 Profesional Eligibility Benefit Request Form 57 Professional Claim Form 43 Professional Roster Billing Form 68 provider inheritance and association Institutional
298. okup will be automatically initiated whenever the hand keyed ID UPIN cannot be uniquely resolved in the 87 PC ACE Pro32 User s Manual 88 corresponding reference file The lookup list will automatically position itself on the first of several records with the specified ID UPIN The user may then select the desired record from the list M When unchecked the variable list lookup will not be initiated and the non unique ID UPIN value will be left unresolved In most cases this will result in a subsequent edit validation error To correct this the user should manually initiate a variable list lookup operation and select the desired unique record Right click the mouse or press the F2 key while positioned on the offending ID UPIN field to manually initiate the lookup operation Automatically focus on Patient PCN field for new Institutional hand keyed claims Determines whether or not the cursor focus should be forced directly to the Patient PCN field when the user manually creates a new Institutional claim Enable this patient centered configuration option for installations that make extensive use of the Patient reference file Upon patient selection the claim s LOB field and primary provider field optional will be populated automatically from information on file in the patient record i When checked the cursor focus will be forced to the Patient PCN field when a new Institutional claim is created Upon patient selecti
299. olumn of the desired list row Alternatively all requests in the current list can be checked using the Check All Requests item from the list s pop up menu Use the flexible Eligibility Benefit Request List form filter techniques to display only the subset of requests to be deleted held reactivated etc Then simply check all eligibility benefit requests and perform the desired action on all checked requests at once Eligibility Benefit Request List Filter Menu Several eligibility benefit request list filtering and related functions are accessible from the Eligibility Benefit Request List form s main Filter menu e Clear Filters Clears any existing filter criteria and refreshes the eligibility benefit request list to display all requests in the selected location e Advanced Filter Options Opens the Advanced Eligibility Request List Filter Criteria form to permit filtering on the request s patient payer entry date range submission date range and numerous other criteria When multiple filter criteria are specified only those requests that meet all filter criteria will be displayed e Check Uncheck All Requests Permits the user to check or uncheck all eligibility benefit requests currently displayed in the request list presumably in anticipation of some action to be performed on this block of requests See the Actions on Multiple Eligibility Benefit Requests section above for more information Eligibility Benefi
300. om the selected Provider record if available If no 54 Main Toolbar amp Forms proper name is specified on the selected Provider record then the value in the Organization field is used instead Simplified Service Type Request Form Preferences Select the Service Type tab to view and or modify Service Type Eligibility Benefit Request Form preferences Note The simplified Service Type Eligibility Benefit Request Form may not be available on all installations If you do not see the Service Type preferences tab then this feature is unavailable e Use the simplified Service Type request form by default for new eligibility benefit requests This option controls which of the two available eligibility oenefit request forms to display when the user clicks the New button on the Eligibility Benefit Request List Form M When checked the simplified Service Type Eligibility Benefit Request Form will be displayed when the user clicks the New button on the Eligibility Benefit Request List Form I When unchecked the complete Eligibility Benefit Request Form will be displayed when the user clicks the New button on the Eligibility Benefit Request List Form AS Tip New eligibility benefit requests may be added using either request form by selecting the desired Create New Request item from the Eligibility Benefit Request List form s main Actions menu e Payer Selection List This list box holds the payers that will be a
301. ompletes amp Attention Claim preparation requires exclusive system access When you attempt to prepare claims you will be notified if exclusive system access cannot be granted i e other users are running PC ACE Pro32 When this occurs you should instruct all users to exit the program before proceeding If desired click the View Results and or View Errors buttons to view reports of the successfully prepare claims and rejected claims respectively These reports can be printed from the report previewer if desired Note Claims will rarely be rejected during the prepare operation A claim will be rejected for example if the submission payer specified on the claim is no longer present in the Payer reference file Rejected claims must be re processed and corrected before they can be successfully prepared hS Tip Refer to the Printing Preferences topic for information on configuring claim preparation reports to be printed automatically or to a specific printer When you have completed your review of the claim preparation reports click the Close button on the Claim Prepare For Transmission form You may now proceed to transmit the EMC file generated during this claim preparation session 113 PC ACE Pro32 User s Manual Note The prepared EMC file is located in the server s winpcace directory The file is named bctrans dat for Institutional claims and bstrans dat for Professional claims by default This default
302. on or just double click the new list entry The new claim archive will be opened and you will be returned to the Claim List form 135 PC ACE Pro32 User s Manual 10 11 12 136 AS Tip Claim archive names must adhere to your server s directory naming convention If Windows long file directory names are permitted then you can give the archive a descriptive name Otherwise you may be limited to 8 characters Archive names can contain only alphabetic characters numeric characters underscore _ characters and spaces You will receive an error message if the chosen archive name is unacceptable Once you re back to the Claim List form select the View Archived Claims item from the form s main File menu to view the claims in the open claim archive Select the View Current Claims item from the main File menu to toggle back to the current claims Only transmitted and paid claims can be archived so choose either the transmitted only TR paid only PD or transmitted paid TR PD item from the Location drop down list To archive a single claim select the desired claim from the list and choose the Archive Selected Claim item from the Claim List form s main Actions menu or the convenient right click popup menu The selected claim will disappear from the current claims list To archive multiple claims at once simply check the desired claims and select the Archive All Checked Claims item from main A
303. on the claim s LOB will be assigned automatically from the primary payer s LOB specified on the patient record The provider associated with the claim s primary payer will also be populated automatically if it has been specified on the patient record When unchecked the cursor focus will be positioned normally on the LOB field The user is expected to enter or select the desired LOB for the new claim Automatically focus on Patient PCN field for new Professional hand keyed claims Determines whether or not the cursor focus should be forced directly to the Patient PCN field when the user manually creates a new Professional claim Enable this patient centered configuration option for installations that make extensive use of the Patient reference file Upon patient selection the claim s LOB field and billing rendering provider fields optional will be populated automatically from information on file in the patient record i When checked the cursor focus will be forced to the Patient PCN field when a new Professional claim is created Upon patient selection the claim s LOB will be assigned automatically from the primary payer s LOB specified on the patient record The claim s billing provider and rendering provider will also be populated automatically if they have been specified on the patient record M When unchecked the cursor focus will be positioned normally on the LOB field The user is expected to enter or select the de
304. ons apply to the restore operation e Source Drive or Folder specifies the drive or Windows folder directory from which the backup archive file will be read This path may point to a removable media device diskettes writeable CDROM or to a standard Windows directory on a hard disk drive local or remote Disk spanning is supported for backup archives on diskette The user will be prompted to insert specific diskettes from the backup archive as needed X Tip When restoring backup archives that span multiple diskettes insert the last diskette in the set first The system will prompt for the first and subsequent diskettes as the restoration proceeds e Restore system and user configuration settings specifies whether or not to restore the system and user configuration settings that were included in the backup 207 PC ACE Pro32 User s Manual 208 archive These settings define system user preference settings for example Unless otherwise instructed by a technical support specialist this option should always be checked Once the desired source drive folder path and option settings have been specified click the Start Restore button to proceed amp Attention The restore operation will overwrite your current database files with older data from the specified backup You should perform this operation only under the supervision of authorized technical support personnel You will be notified when the restore operation complete
305. oordination of Benefits later in this topic for details on this advanced capability When the focus leaves a claim form field either by pressing the TAB key or clicking ona new field an edit validation process is performed on the field losing the focus Edits performed at this time are referred to as field level edits If a field level edit validation error occurs you will receive an audible response and the edit validation error message will be displayed in the lower left corner of the claim form In addition the focus will remain on the field so that you can correct the problem if desired If you choose not to correct the data at this time simply press the TAB key again to move to the next field Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the claim edit validation process Coordination of Benefits The Institutional Claim Form includes fields to allow entry of Coordination of Benefits COB information at the claim and or line level Claims submitted to secondary or tertiary payers may be required to report the payment remittance data returned by prior payers Medicare Secondary Payer MSP claims for example must include specific COB information obtained from the primary payer in order to insure prompt processing by Medicare Note Since Coordination of Benefits information is not required on all claims the screen tabs containing COB related fields are hidden by default Enter
306. or the selected LOB Type TOB combination click the New button and select the new code from the drop down list e To delete a code assignment record for the selected LOB Type TOB combination select the desired record from the list click the Delete button and confirm the deletion e To delete all code assignment records for the selected LOB Type TOB combination click the Delete All button and confirm the deletion e To copy an existing set of code assignment records from a specified source LOB Type TOB combination into the assignment list for the currently specified LOB Type TOB combination select the desired destination LOB Type TOB and click the Copy button Select the code assignments set from which to copy on the Code Assignments Copy Source form click the Copy button and confirm the copy request If required you may then add delete code assignment records to from the newly created list Note The TOB drop down list on the Codes TOB tab will include only valid TOBs for the selected LOB Refer to the Type of Bill TOB File Maintenance topic for information on maintaining the list of valid TOBs for each line of business 186 Common Reference File Procedures Revenue Codes File Maintenance The Revenue Codes form provides an interface to maintain the revenue codes used in PC ACE Pro32 Revenue codes apply exclusively to Institutional claims They are pre loaded and should require minimal maintenance The Revenue C
307. ormal activities that may occur in the course of operation Separate log files are maintained for Institutional and Professional claim activities The logs can be useful when researching past claim processing activity or reviewing the outcome of scheduled claim activities e To view a claim activity log file select the View and Claim Activity Log items from the Institutional or Professional Claims Menu form s main menu The applicable log file will be opened in the Windows Wordpad program Activities are logged chronologically with the most recent entries at the end of the file AS Tip Be sure and close Wordpad when you are finished reviewing the log e To purge a claim activity log file select the Maintain and Purge Claim Activity Log items from the Institutional or Professional Claims Menu form s main menu This action simply deletes the appropriate Claim Activity Log file The next claim import process prepare or transmission will start a new log file Since the number of days for which entries are maintained in this log can be set in the PC ACE Pro32 preferences this function will rarely be used Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Miscellaneous Preferences topic for more information on the claim activity log auto purge feature 213 PC ACE Pro32 User s Manual Recovering from an interrupted claim prepare run Claim prepare operations in PC AC
308. ormation Source will provide eligibility benefit response information consistent with the level of detail requested if available hS Tip Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator Saving amp Canceling Eligibility Benefit Requests After completing data entry on the eligibility benefit request form click the Save button or type lt ALT gt S to save and exit the request Alternatively click the Cancel button to abandon any changes and exit the request When an attempt is made to save a request the following occurs e Edit Validation During the request save process an edit validation process is performed on all fields on the request This process includes re evaluating all field level edits as defined above In addition all request file level edits are evaluated File level edits are evaluated only when the request is saved and are typically those edits that require multiple data elements from the request in order to be evaluated If no edit validation errors occur the request is saved with a clean CLN status If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List form unless disabled in the Preference settings This form lists all the edit validation errors that have occurred indicating which ones are
309. ou are required to prepare and submit your Medicare MCA MCB claims to a different physical location than claims for other LOBs Read the Data Communications Control File section below to see how these specific data communications records are used 177 PC ACE Pro32 User s Manual The Data Communications Control File Transmission of the electronic claim files generated by PC ACE Pro32 will be performed by a third party communications package The Data Communications Options form provides launch buttons by which users can initiate claims transmission terminal emulation sessions or any other data communication function defined by your distributor Each time any of these data communications launch buttons are clicked PC ACE Pro32 automatically creates a Data Communications Control File containing applicable parameters from the Data Communications reference file This control file will be located in the server s winpcace directory and will be named bcdatcom dat for Institutional claim activities and bsdatcom dat for Professional claim activities Note Actually both the Institutional and Professional Data Communications Control Files are created each time any of the launch buttons are clicked This approach relieves PC ACE Pro32 from needing to know whether a certain launch button is configured as an Institutional activity a Professional activity or an activity common to both claim types If your system is licensed for a single claim
310. ous Functions 201 Adding or modifying a system user 201 Scheduling unattended claim activities 202 Launching the ANSI 835 Electronic Remittance Module 205 Performing system backups restores 206 Packing and reindexing the databases 209 Sending support mail to your distributor 211 Troubleshooting213 Reviewing the claim activity logs 213 Recovering from an interrupted claim prepare run 214 Index 216 Introducing PC ACE Pro32 Welcome to the PC ACE Pro32 Claims Processing System the system of choice for electronic healthcare claims submission and management PC ACE Pro32 is a complete self contained electronic claims processing system It can be used in a stand alone configuration or in conjunction with your existing claims management system Designed exclusively for Microsoft Windows PC ACE Pro32 is the latest generation of the PC ACE family of electronic claims processing systems that have been successfully serving the healthcare community for decades Key Features PC ACE Pro32 is a comprehensive claims management system Some of the more prominent features include e Combined Medicare Part A Institutional All Payer and Professional claims system e Electronic submission of claims in ANSI 837 format e Flexible claim import from existing systems e Remittance translation export to existing systems e Comprehensive real time claims editing minimizes rejected claims e Field level edit validation provides immediate user feedback e
311. ove the list s responsiveness in some situations To display transmitted paid claims older than the current transmit date window simply click the Advanced Filter Options button and enter the desired Transmit Date range Claim Actions The Claim List form may also be used to perform specific actions on any individual claim or a group of selected claims To perform an action on an individual claim simply select the claim from the list and click the desired action button along the lower edge of the form The 29 PC ACE Pro32 User s Manual complete list of claim actions can be accessed from the Claim List form s main Actions menu or from the convenient pop up menu accessed by right clicking the mouse over the selected claim Available claim actions include 30 Creating New Claims Click the New button or choose the Create New Claim action to create a new claim See the Adding a new claim topic for more details Viewing Modifying Claims Click the View Update button or choose the View Update Selected Claim action to view and or modify the selected claim See the Institutional Claim Form or Professional Claim Form topics for details on using the PC ACE Pro32 claim entry forms hS Tip The View Update action is the default claim action In addition to the techniques described above this action can also be invoked by double clicking on the desired claim record or by selecting the desired record and pressing the E
312. pcntlh win and should be located in the server s winpcace imp1500 directory 4 Setup all required PrintLink Matching Description strings in the Payer reference file These strings are used to match payer descriptions from claims in the print file to specific Payer reference file records Refer to the Adding and maintaining payers topic for details on setting up your PrintLink Matching Description strings 24 PC ACE Pro32 Setup Procedures 5 Each time you want to import claims copy the new print image file generated by your upstream system into the server s winpcace imp1500 directory The first line of the map file provided by your distributor dictates what the print image file must be named typically h1500 prt Intermediate Delimited Format imports claims from a file in intermediate delimited format If using this claim import method complete the following steps 1 Work with your distributor to develop the programs necessary to produce a file in intermediate delimited format from your upstream system Your distributor should have detailed specifications of this internal file format Verify that the generated files meet these specifications 2 Confirm the existence of the required map control file This file provides a control interface between the intermediate delimited file and the PC ACE Pro32 claim import routines The map control file is always named mapcntlh win and should be located in the server s winpcace
313. pre prepare state and simply notifies the user that this recovery process has taken place e Verbose recovery Upon detecting that a prepare operation has been interrupted the user is presented with the Claim Prepare Recovery Options form This form notifies the user that a prepare run was interrupted and provides specific details of the prepare operation in progress including time date EMC filename EMC file format and the prepare filter and option settings specified by the user when the prepare run was initiated In the verbose recovery mode the user has 3 options represented by buttons on the recovery options form e Perform Recovery Performs the prepare recovery process without further prompting All affected claims will be restored to their pre prepare state This is the recommended course of action unless a technical support specialist has instructed you otherwise e Skip Recovery Skips the recovery process and leaves the affected claims in an undetermined state You will be warned that some affected claims may be flagged as transmitted and may need to be reactivated Skipping the recovery process should only be done under the instruction of a technical support specialist e Cancel Cancels the prepare recovery process and exits the program Selecting this option is the equivalent of saying have no idea what to do Consult with your system administrator or a technical support specialist for the suggested course of actio
314. procedure 2 Click the New button to display the Payer Information form Enter the new payer s information taking advantage of the built in lookups where possible by pressing the F2 key or right clicking the mouse hS Tip Type lt ALT gt F2 press the F2 function key while holding down the ALT key to provide a visual indication of all fields that support lookups Press the ESC key to turn off the flashing indicator The Payer ID LOB and Usage fields together serve as the identification key for this Payer record A specific Payer ID LOB combination may exist for a maximum of two Payer records If two such Payer records are defined then their Usage settings must not overlap Valid Usage settings include U Institutional use only H Professional use only and B or blank unrestricted use The only valid situation where two Payer 20 PC ACE Pro32 Setup Procedures records with the same Payer ID LOB combination may exist is when one of the records specifies a Usage value of U Institutional use only and the other record specifies a Usage value of H Professional use only This feature permits Payers for shared LOBs such as Commercial COM to optionally have distinct settings and PrintLink matching strings for Institutional versus Professional use An individual Payer record must be setup for each line of business LOB handled by that payer For example if payer 12345 will receive both
315. provides a smooth transition from the claim import operation to the claim processing operation and relieves the user from the need to schedule the claim processing run separately Note Selecting the Import and process claims option will disable the 3 scheduling options on the Claim Process tab since claim processing is now chained to the claim import operation e Import Map Print File Selection select check one or more PrintLink map files to be imported at the scheduled time Each valid PrintLink map file present in the pre defined claim import directory will be represented in this selection list 202 Miscellaneous Functions Note This selection list will be visible only if PC ACE Pro32 is configured to use the standard PrintLink claim import method Refer to the Claim Import Preferences topic for more information on claim import configuration Once all scheduling options are completed click the Initiate Deferred Claim Import button to complete the scheduling task If all scheduling tasks have been completed click the OK button to close the form and return to the PC ACE Pro32 Main Toolbar Claim Process Scheduling To schedule an unattended claim processing operation click the desired Institutional or Professional Claim Process tab select either the one time or daily scheduling option and enter the desired Start Time Specify the following process specific scheduling options e Include claims with error
316. pt to present only those provider records applicable to the claim being entered In addition variable list lookups often retrieve data used to fill in other claim form fields For example selection of a Patient from the variable list lookup completes numerous patient related fields on the claim Access variable list lookups using the same method described above for fixed list lookups Recurring Field Sets Field sets consist of two or more logically related fields For example most ANSI X12 reference identifiers include an identification number a type code qualifier and in some situation a payer identifier as well It is often a requirement to support a variable number of occurrences of a particular field set The claim entry form provides an intelligent combo i e dropdown control to allow entry and maintenance of such recurring field sets To identify a recurring field set look for the selector which will be positioned adjacent to the rightmost field in the set The recurring field set and associated selector function in the following manner e As the user tabs normally away from the last field in the set the focus will automatically return to the first field in the set and the next data occurrence will be displayed Only when all occurrences have been displayed will the focus move to the next field on the claim entry form This behavior permits the user to view all occurrences without using the mouse and also provides an opportuni
317. quickly identify i e check all claims that were included in a specific transmission file This filter option can be especially useful if for example it becomes necessary to reactivate all claims from a recent transmission file A warning will be displayed if one or more of the claims from the selected transmission file are no longer present in the claim list This filter option can be accessed from the Claim List form s main Filter menu and will be available only when viewing claims in the transmitted TR and transmitted paid TR PD locations Claim List Field Customization The Claim List form field definitions are highly customizable Many of the Institutional and Professional claim data elements may be included or excluded from the list The display order column width and column headings of each selected field may also be customized See the Claim List Preferences topic for a description of the list customization process NOTE Some distributors may disable this customization feature Claim List Filter Menu Several claim list filtering and related functions are accessible from the Claim List form s main Filter menu e Clear Filters Clears any existing filter criteria and refreshes the claim list to display all claims in the selected location e Advanced Filter Options Opens the Advanced Claim List Filter Criteria for to permit filtering on the claim s patient payer provider date ranges batch informatio
318. r records applicable to the request being entered In addition variable list lookups often retrieve data used to fill in other request form fields For example selection of a Patient from the variable list lookup completes numerous patient related and subscriber related fields on the request Access variable list lookups using the same method described above for fixed list lookups 57 PC ACE Pro32 User s Manual e Automatic Field Tabs When entering data in a field an automatic tab will occur when the field has been completely filled For example entering a single character in a one character field will automatically position the cursor on the next field in the tab sequence This feature can be disabled in the general preferences settings if desired e Intelligent Groups Tabs The eligibility benefit request entry form contains one or more field groups The Diagnosis amp Facility Type Codes control array on the Eligibility Benefit Inquiry tab is an example of such a group Fields in these groups are always completed sequentially Therefore when a field in one of these groups is left empty it can be assumed that data entry in the group is complete When the TAB key is pressed the remaining fields in that group will be skipped and the cursor will be positioned on the first field in the tab sequence beyond the group fields e Cancel Field Changes If a change is inadvertently made to the contents of a field press the ESC key to ca
319. r Billing Form Home Health Plan of Care List Form Features The Home Health Plan of Care Form Reference File Maintenance Form Claim amp Reference File Edit Validation Security amp User Maintenance System Preferences 85 Preferences Overview General Preferences Claim List Preferences Claim Import Preferences Printing Preferences Data Communication Preferences Miscellaneous Preferences Common Claim Activities 101 Adding a new claim Listing modifying and maintaining claims Importing claims Reversing the most recent claim import run Processing claims automatically Preparing claims for transmission Transmitting electronic claim files Viewing and maintaining transmission acknowledgment files 14 20 27 28 29 35 43 51 57 62 66 68 71 73 76 81 83 85 86 90 91 92 97 98 101 102 104 108 109 112 115 117 Table of Contents Reactivating previously transmitted claims Preparing claim status request files for transmission Viewing and maintaining claim status response and acknowledgment files Viewing and maintaining the claim status request response history Printing claims Posting claim payments Institutional Posting claim payments Professional Archiving and unarchiving claims Adding a new eligibility benefit request Listing modifying and maintaining eligibility benefit requests Preparing eligibility benefit request files for transmission Viewing and maintaining eligibility benefit response files Viewing the eli
320. r ID is SYSADMIN and password is SYSADMIN as well If you are logging into PC ACE Pro32 for the first time use this default login unless instructed otherwise by your distributor If the default login does not work review the installation guidelines provided by your distributor Distributors often pre configure the security system according to their own internal specifications If you still have difficulties logging into the system contact your distributor for assistance 83 PC ACE Pro32 User s Manual IMPORTANT You should change the default user s password as soon as possible if you are concerned about controlling user access at your facility Audit Tracking E An integrated audit tracking feature tracks modifications to user claim and reference files records You will see these audit buttons throughout PC ACE Pro32 Click the button to display the date the record was added the date the record was last changed and the User ID responsible for the last change System Security Level The Set Security Options on the main Security menu provides access to PC ACE Pro32 s security level setting Three security levels are available e Full password protection requires users to enter a valid User ID and Password to log in User activity permissions are enforced at this security level e Password required no function checking requires users to enter a valid User ID and Password to log in User activity permissions are not enforc
321. r billing Roster billings in the to be generated RL location must be deleted before being purged S Attention Purged roster billings are permanently deleted from PC ACE Pro32 they cannot be recovered Refreshing the Roster Billing List Choose the Refresh Roster List action to refresh the current Roster Billing List form contents This action can be useful in a multi user installation to be sure that the roster billing list properly reflects additions and or modifications made by other users Note You will notice that only applicable actions are enabled for use in the main Actions menu or pop up menu For example it makes no sense to view the roster report of a roster billing that has yet to be generated so this action will be disabled for roster billings in the RL location 67 PC ACE Pro32 User s Manual The Professional Roster Billing Form The Professional Roster Billing Form provides access to all data elements of a Professional roster billing New roster billings are entered and existing roster billings are viewed and or modified from this form The form consists of the following major tabs e Patient Info amp General includes general roster patient and insured information fields The upper section of this tab presents those fields that will be common to all claims generated from the roster billing The lower section of the form presents those fields that are unique to each claim generated from the roster
322. r the associated payer e Coordination of Benefits COB Support The claim form includes fields to allow entry of Coordination of Benefits COB data at both the claim and line levels when appropriate Enter a Y in the COB field to make these COB related fields available for use The COB field is located along the lower edge of the Patient Info amp General tab See the section entitled Coordination of Benefits later in this topic for details on this advanced capability When the focus leaves a claim form field either by pressing the TAB key or clicking ona new field an edit validation process is performed on the field losing the focus Edits performed at this time are referred to as field level edits If a field level edit validation error occurs you will receive an audible response and the edit validation error message will be displayed in the lower left corner of the claim form In addition the focus will remain on the field so that you can correct the problem if desired If you choose not to correct the data at this time simply press the TAB key again to move to the next field Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the claim edit validation process Claim Attachments Claims submitted for certain types of professional services require supporting data that is not included on the basic Professional claim In the world of paper claims this supporting data is usu
323. ransmission Let s assume your system has been configured to launch a data communications program that will transmit the prepared EMC file to your claims processor You can initiate this file transmission with the following steps 1 Complete the pre transmit procedures provided by your distributor if any 2 From the PC ACE Pro32 Main Toolbar click the Data Communications Functions button to open the Data Communications Options form Each pre configured data communications function will be represented by one of the available launch buttons hS Tip Only the pre configured launch buttons will be enabled These available buttons may be presented on up to 3 distributor defined tabs If all buttons are disabled then your system has not been setup for any data communications functions Refer to the Data Communication Preferences topic for information on configuring these launch buttons 3 For this example let s assume the first button is labeled Transmit Claims and is pre configured to launch the EMC file transmission program Your button labels and functions may be different but the launch procedure is basically the same Simply click the Transmit Claims button to initiate the transmission process Note PC ACE Pro32 only initiates or launches the third party file transmission program It does not monitor the transmission program s progress nor is it informed of the transmission s completion status All exception handling must
324. rds by an internal control number Deleting a provider record will irrevocably break any such links that may exist to claims in the system The Provider Deletion Confirmation form outlines alternatives to deletion and provides a convenient utility to determine how many claims reference the provider record to be deleted Codes Misc provides access to the core PC ACE Pro32 codes and miscellaneous reference files Refer to the Codes amp Miscellaneous Reference Files Overview topic for additional information on each of these reference files Common Reference File Form Features A number of productivity enhancing features are available while entering reference file information Fixed List Lookups Fixed list lookups are available on many of the fields on these forms Fixed list lookups apply to fields whose list of valid values can be determined in 77 PC ACE Pro32 User s Manual advance For example Patient Sex typically has 3 possible values M male F female and U unknown USAGE Access the lookup list for a field by positioning the cursor on the field and pressing the F2 function key or right clicking the mouse When an item from the list is selected its value is automatically entered in the form field hS Tip Type lt ALT gt F2 press the F2 key while holding the ALT key down to identify all fields that support a lookup list Press the ESC key to disable the flashing notification Variable List Loo
325. real timesaver when setting up providers that support multiple lines of business In this scenario select an existing provider in the list click the New button and choose the inherit and associate options You will see that the top portion of the Provider Information form will be completed automatically Simply tab through or overwrite the Provider ID No field may be the same or different enter a unique line of business identifier in the LOB field and click the Save button 7 When you have finished adding Professional Provider records you should have one record for each applicable line of business LOB for each solo group or individual in group provider entity When all desired Provider records have been added click the Close button on the Reference File Maintenance form to return to the PC ACE Pro32 Main Toolbar Patient Reference File Setup This section describes the process of setting up the Patient reference file Setup of the Patient reference file is optional If you choose to setup patients the complete patient list will be accessible during claim entry using the variable list lookup feature When a patient is selected from the lookup list during claim entry all applicable patient information will be automatically loaded into the appropriate claim form fields Complete the following steps as needed 22 PC ACE Pro32 Setup Procedures AS Tip You may want to refer to the Adding and maintaining patients
326. receives claims electronically or on paper The media flag of a claim s submission payer will determine whether the claim is eligible for preparation into an EMC file or whether it must be submitted on paper e Usage indicates whether the payer record is restricted for Institutional use only Professional use only or unrestricted use This feature permits Payers for shared LOBs such as Commercial COM to optionally have distinct settings and PrintLink matching strings for Institutional versus Professional use If the specified Payer LOB is valid for only one of these claim types then the Usage value will be forced to the appropriate setting by the program hS Tip A number of fields on the Payer Information tab support data entry via fixed list or variable list lookups These lookup lists are accessed by right clicking the mouse over the field or pressing the F2 key while focused on the field Helpful fly over hints are also available for many fields Saving amp Canceling Payer Updates After completing data entry on the Payer Information form click the Save button or type lt ALT gt S to save and exit the form Alternatively click the Cancel button to abandon any 160 Common Reference File Procedures changes and exit the form During the payer save operation an edit validation process is performed on all payer record fields If no edit validation errors occur the payer record is saved without further user intervent
327. related fields on the plan Access variable list lookups using the same method described above for fixed list lookups e Automatic Field Tabs When entering data in a field an automatic tab will occur when the field has been completely filled For example entering a single character in a one character field will automatically position the cursor on the next field in the tab sequence This feature can be disabled in the general preferences settings if desired e Intelligent Groups Tabs The Plan of Care form contains a number of field groups Examples of such groups include Other Diagnosis Functional Limitations and Mental Status codes Fields in these groups are always completed sequentially Therefore when a field in one of these groups is left empty it can be assumed that data entry in the group is complete When the TAB key is pressed the remaining fields in that group will be skipped and the cursor will be positioned on the first field in the tab sequence beyond the group fields e Cancel Field Changes If a change is inadvertently made to the contents of a field press the ESC key to cancel this change and restore the field s value to what it was when the field received the focus This feature is available for most Plan of Care form fields e Date Completion Date values may be entered with or without the century for convenience PC ACE Pro32 uses a user definable century pivot year to automatically derive the century when
328. required to prepare your PC ACE Pro32 system for Institutional All Payer claims processing Topics to be covered include setting up the Payer Provider and Patient optional reference files A section on claim import considerations is included for users who will be importing claims from an upstream claims management system Finally a section covering considerations for claims preparation and transmission should be reviewed E Attention Your distributor may have already completed some of the setup steps described in this section Supplement this setup topic with any installation notes provided by your distributor If you are in doubt about exactly which steps you need to perform contact your distributor for assistance hS Tip You may want to print this help topic and refer to the printed version as you perform these setup steps You can check off the steps as they are completed This technique also frees you to jump around between on line help topics without losing your place in the setup procedure To print the topic just click the Print button at the top of this on line Help screen Payer Reference File Setup This section describes the process of setting up the Payer reference file This file contains information about the valid payers in your system All payers to be specified on your Institutional claims must exist in the Payer reference file with the exception of a special dump payer Complete the following steps as needed AS T
329. ro32 currently supports UB92 Version 5 0 UB92 Version 6 0 and ANSI 837 file formats for Institutional claims Professional claim import formats include NSF 1 04 thru NSF 3 01 and ANSI 837 E Attention Support for the listed import formats varies among PC ACE Pro32 distributors Check with your software distributor first if you intend to import claims into the product Fee based support from ABILITY Network Inc may also be available for import formats which are not being supported by your software distributor Refer to the Claim Import Preferences topic to select the desired claim import method and configure the optional preprocessor described later in this topic S Attention You should modify these claim import settings only under the supervision of your distributor or a technical support specialist Incorrectly configuring these options will render the claim import feature non functional Getting Ready To Import Claims Some preparation is required before claims can be imported into PC ACE Pro32 Certain preparation steps need only be performed once while others must be performed each time a new set of claims is to be imported The preparation steps required for each claim import method are listed below You need only be concerned with the preparation steps for your selected claim import method e Print Image PrintLink importing claims using the PrintLink method requires the following preparation 1 Perform all required once o
330. rvice Type code record select the desired record and click the View Update button or double click the desired record e To delete an Eligibility Request Service Type code record select the desired record from the list click the Delete button and confirm the deletion AS Tip The Eligibility Request Service Type Codes form provides several List Filter Options that can be helpful in locating specific codes Refer to the Reference File Maintenance Form topic for more discussion of these common filter options 199 PC ACE Pro32 User s Manual Claim Status Response Codes File Maintenance The Claim Status Response Codes form provides an interface to maintain the Claim Status Response codes Three groups of response codes are defined category codes status codes and entity codes Select the desired List includes radio button to display the desired group Claim Status Response codes are reported on ANSI 277 claim status response transactions They are pre loaded and should require minimal maintenance Maintenance operations available include e To adda Claim Status Response code select the desired List includes group click the New button and enter the new code information e To view or modify an existing Claim Status Response code record select the desired List includes group select the desired record in this group and click the View Update button or double click the desired record e Todelete a Claim Status Respon
331. s When checked instructs the scheduler to process all claims that have been previously saved with errors fatal or non fatal in addition to all unprocessed claims When left unchecked only unprocessed claims will be included in the processing run e Process LOB Selection select check one or more lines of business LOB to be considered during the claim processing operation Only claims with the specified LOBs will be processed Select the special lt lt PROCESS ALL LOBS gt gt item to process claims for all LOBs Once all scheduling options are completed click the Initiate Deferred Claim Processing button to complete the scheduling task If all scheduling tasks have been completed click the OK button to close the form and return to the PC ACE Pro32 Main Toolbar Note If the Import and process claims option is checked on the Claim Import scheduling tab then the scheduler will initiate claim processing immediately upon completion of the claim import operation The claim process schedule will be reported as controlled by claim import settings Claim Transmission Scheduling To schedule an unattended claim transmission or other data communication operation click the desired Institutional or Professional Claim Transmit tab select either the one time or daily scheduling option and enter the desired Start Time Specify the following transmit specific scheduling options e Data Comm Claim Transmission Function
332. s descriptions and charge amounts Provider Specialty File Maintenance maintain provider specialty codes and descriptions 169 PC ACE Pro32 User s Manual Follow any of the hyperlinks above for more information about the purpose and maintenance of these core reference files 170 Common Reference File Procedures Submitter File Maintenance Submitter Information in PC ACE Pro32 is maintained from the Submitter Setup form for both Institutional and Professional claim types Information from the Submitter reference file is required during preparation of Electronic Media Claims EMC files As such at least one default submitter record LOB lt lt ALL gt gt Payer ID lt lt ALL gt gt must be created before claims can be prepared Additional LOB Payer specific submitter records may also be created if required see discussion later in this topic for more details If your installation is licensed for both Institutional and Professional claim activities you must first select the appropriate claim type from the Institutional or Professional radio buttons near the top of this tab If you are licensed for only one of these claim types this selection will not be available The maintenance options available on this form include e To add anew submitter record click the New button and enter the required submitter information e To view or modify an existing submitter record select the desired record from the list an
333. s PC ACE Pro32 will terminate automatically following a restore operation The restored database files and configuration settings will be available the next time the program is executed Note Exclusive system access is required to perform a restore operation in PC ACE Pro32 If this program is in use on another client workstation you will be notified when the Start Restore button is clicked You can either instruct the other users to exit PC ACE Pro32 and then continue the restore operation or simply cancel the restore request Miscellaneous Functions Packing and reindexing the databases PC ACE Pro32 uses proven database technology that is for the most part self maintaining Database files or tables contain the data records that define a claim patient provider etc Most tables are equipped with indexes that organize the records in the table for optimal access As records are added to modified or deleted from a database table the PC ACE Pro32 database engine performs all necessary housekeeping For example all indexes are maintained to reflect the current set of records after one or more records has been added modified or deleted Having said this there are certain situations when the system administrator may be required to perform manual database maintenance operations The most common scenarios include e Frequently updated tables claim tables for example may require periodic maintenance to keep their size at a m
334. s button on the Claims Menu form to open the Institutional or Professional Claim Import form The form s caption should reflect the chosen claim import method If you are using the PrintLink claim import method and you have multiple map files in the server s claim import directory you will see a drop down list labeled Select PrintLink Map File Select the map print file to be imported from this list If you are using the PrintLink claim import method but only one map file is defined this drop down list will not be visible If you are using the Intermediate Delimited Format claim import method the system assumes that the file to be imported has already been placed in the claim import directory This file must be named plink out If you are using the Electronic Media Claims EMC File claim import method and you have multiple EMC files in the server s claim import directory with dat extensions you will see a drop down list labeled Select EMC File Select the EMC file to be imported from this list If you are using the EMC File claim import method but only one EMC file is present in the claim import directory this drop down list will not be visible Click the Import button to initiate the claim import operation As the import proceeds running totals of the count and dollar value of all imported and rejected claims are displayed on the Claim Import form You will be notified when the claim import operation completes Note
335. s extended line item fields claim attachment fields and line level MSP COB fields This major tab contains a number of second level tabs to accommodate the many line level fields e Ext Patient General includes patient legal representative fields facility information fields and numerous general claim fields that are not present on the hard copy Professional claim form e Ext Pat Gen 2 includes additional claim level information not present on the hard copy Professional claim form Additional diagnosis codes and claim level supporting providers are located on this tab Most of the fields on this tab populate data elements defined only for the ANSI 837 EMC format e Ext Payer Insured includes payer level reference identifiers as well as less frequently used payer and insured fields for the primary secondary and tertiary payers Also includes fields for Medicare Secondary Payer MSP and other secondary claims where Coordination of Benefits COB information is required This major tab consists of a number of second level tabs that provide access to this extended information in a logical and efficient manner Click the appropriate tab or simply press the PAGE UP and PAGE DOWN keys to move between these major claim form sections Holding down the SHIFT key while pressing the PAGE UP and PAGE DOWN keys will cycle between second level tabs where applicable Entering Claim Data Click on any field to activate it for data
336. s Menu form select the Maintain and Maintain Eligibility Benefit Requests menu items to open the respective Eligibility Benefit Request List form 3 Click the New button on the request list form to open either the complete Eligibility Benefit Request Form or the simplified Service Type Eligibility Benefit Request Form depending on preference settings and begin entering information on the new eligibility benefit request You may also open either request form from the Eligibility Benefit List Form s main Actions menu Note The patient eligibility benefit request response capability may not be available on all installations If the Maintain Eligibility Benefit Requests item is not visible on the Maintain menu then this capability is not available on your installation In addition the simplified Service Type Eligibility Benefit Request Form may not be available on all installations Requests are manually entered on the respective Eligibility Benefit Request Form or simplified Service Type Eligibility Benefit Request Form Refer to the associated Help topic for information on entering eligibility benefit requests The data fields on the complete Eligibility Benefit Request Form are typically entered in the order presented from left to right and top to bottom on each tab of the request form The fields that are most commonly used are concentrated on the leftmost tabs Lookups available on key fields e g Patient PCN can signifi
337. s are clean ready CLN has fatal errors ERF has errors ERR held HLD and unprocessed UNP e LOB filters the eligibility benefit request list to include only requests for a specific line of business In addition to these basic filter options the Eligibility Benefit Request List form also provides a number of Advanced Filter Options These advanced options permit filtering on the request s patient payer entry date range submission date range and numerous other criteria When multiple filter criteria are specified only those requests that meet all filter criteria will be displayed Eligibility Benefit Request Actions The Eligibility Benefit Request List form may also be used to perform specific actions on any individual request or a group of selected requests To perform an action on an individual request simply select the request from the list and click the desired action button along the lower edge of the form The complete list of request actions can be accessed from the Eligibility Benefit Request List form s main Actions menu or from the convenient pop up menu accessed by right clicking the mouse over the selected request Available eligibility benefit request actions include 51 PC ACE Pro32 User s Manual 52 Creating New Requests Click the New button or choose the Create New Request Create New Request Service Type or Create New Request Complete action to create a new eligibility be
338. s automatically print after the claim import operation has completed I When unchecked the claim import reports will not print automatically You will still have the option to print the reports manually e Print claim import rejection report even when all claims accepted specifies whether empty claim import rejection reports will be printed automatically This option is only enabled if you have chosen to print claim import reports automatically M When checked the claim import rejection report automatically prints even if there are no rejected claims When unchecked the import claim rejection report will not automatically print if it is empty e Import Report Printer specifies the claim import reports printer e Sort and subtotal claim import report by LOB and Payer ID controls the sort order and subtotaling method used for claim import reports i When checked the claim import report will be presorted by LOB and Payer ID and the resulting report will be subtotaled by LOB Payer and by Provider ID within each LOB Payer group When unchecked claims will be be listed in the order they appear in the imported file and no subtotaling will be performed e Report claims for each LOB Payer on a separate page controls the page break method used for claim import reports This option is only available when sorting the import report in LOB Payer order M When checked the claim import reports will break to a new page prior t
339. s general claim identification information along with the claim level status response codes and payment details returned by the contractor Reference information is also available to locate the original claim status response file should it be needed e Attention Indicates that a response was available for this claim however could not be posted for some specific reason Additional information directs the user to the original claim status response report The most common cause for this attention condition is an ambiguous claim status response This occurs when the response file contains more than one response referencing the same unique claim trace number The following operations are available on the Claim Status Request Response History form e To view status response details or attention information select the desired record and click the View button or double click the desired record e To delete a request response entry select the desired record click the Delete button and confirm the deletion e To view and or print the complete status request response history for this claim click the Print History button The report may be printed from the preview form if desired Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Claim List Form Features topic for more information on adding claims to the status request queues Institutional and Professional e Refer to
340. s occur the plan is saved with a clean CLN status If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List form This form lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the plan edit validation process and the Edit Validation Errors List form If edit errors exist you will usually have the option to correct the errors or save the plan with errors If a fatal error exists on the PCN field however you must correct the error before saving the plan Click the Save With Errors button to save a plan that contains only non fatal errors Such plans are assigned the has errors ERR status Click the Save With Fatal button to save a plan that contains fatal errors Such plans are assigned the has fatal errors ERF status If edit validation errors occur several Save attempts may be required to correct and save a clean plan At any time click the Errors List button to review the remaining edit validation errors Miscellaneous Plan of Care Form Topics The following comments cover a few miscellaneous features of the Home Health Plan of Care Form e Entering Free Form Narrative Data The free form narrative fields on the Plan of Care form will automatically wrap to the next line as typing proceeds beyond the rig
341. s topic are unavailable then you either do not have the required archive permissions or your distributor does not support the claim archiving function All claim archive functions are performed from the familiar Institutional or Professional Claim List form To archive and unarchive claims follow these general steps 1 From the PC ACE Pro32 Main Toolbar click either the Institutional Claims Processing button or Professional Claims Processing button to display the corresponding Claims Menu form 2 Click the List Claims button on the Claims Menu form to display the Institutional or Professional Claim List form By default the list will display claims in the to be transmitted CL location 3 From the Claim List form s main File menu select the Open Claim Archive item to display the Open Claim Archive form This form will display a list of all existing claim archives if any 4 To open an existing claim archive select the desired archive from the list and click the Open button or just double click the list entry The claim archive will be opened and you will be returned to the Claim List form Skip over the next step 5 To create a new archive if you have archive maintenance permission click the New button and enter a descriptive name for the new archive The empty archive will be created and the corresponding entry will be added to the selection list Select the new archive from the list and click the Open butt
342. s variable list lookups on a number of its fields Variable list lookups apply primarily to fields whose values are selected from reference files Many of the variable list lookups use other roster billing field values to filter the presented list For example the provider lookup presents only those provider records applicable to the roster billing being entered In addition variable list lookups often retrieve data used to fill in other roster billing form fields For example selection of a Patient from the variable list lookup completes numerous patient related fields on the roster billing form Access variable list lookups using the same method described above for fixed list lookups e Automatic Field Tabs When entering data in a field an automatic tab will occur when the field has been completely filled For example entering a single character in a one character field will automatically position the cursor on the next field in the tab sequence This feature can be disabled in the general preferences settings if desired e Cancel Field Changes If a change is inadvertently made to the contents of a field press the ESC key to cancel this change and restore the field s value to what it was when the field received the focus This feature is available for most roster billing form fields e Date Completion Date values may be entered with or without the century for convenience PC ACE Pro32 uses a user definable century pivot year to automa
343. se record select the desired List includes group select the desired record from the list click the Delete button and confirm the deletion 200 Miscellaneous Functions Miscellaneous Functions Adding or modifying a system user PC ACE Pro32 requires that a valid login and optional password be entered by anyone desiring access to the system The system administrator must set up a user account for each person that will use PC ACE Pro32 The user account specifies the user s login password values and defines which activities the user has permission to perform To add a new user or modify an existing user select the main Security menu from the PC ACE Pro32 Main Toolbar and choose the Add Update User item Only users with User Add Modify privileges can perform these maintenance functions which include e To add anew user click the New button on the Security List form and assign the user a User ID Password and Name Assign permissions to this user and save the new user record e To modify an existing user select the desired user from the Security List form and click the View Update button or double click the user record Modify the Password User Name and User Permissions fields as desired When all changes have been made save the modified user record hS Tip Check the checkbox next to the permission to allow access to the activity Click the Check All and Clear All buttons to quickly check or un check all user permis
344. ser logs into system Select the Logout Current User item on the main Security menu to manually log out without exiting the system S Attention You should change the default user s password as soon as possible if you are concerned about controlling user access at your facility PC ACE Pro32 User s Manual Claim Import Considerations This section describes setup considerations that should be reviewed only if you intend to import claims into PC ACE Pro32 from an upstream system If you will not be importing claims skip this section entirely Three methods are available for importing claims Print Image PrintLink Intermediate Delimited Format and Electronic Media Claims EMC Format Note Getting setup to import claims into PC ACE Pro32 typically involves coordination with your distributor If you are interested in importing claims using the PrintLink print image method but your distributor does not provide PrintLink support ask that they refer you directly to the software manufacturer for assistance PrintLink functionality may be licensed and supported as an add on to your base PC ACE Pro32 system AS Tip You may want to refer to the Importing claims topic for a discussion of these claim import methods If you do make sure and return to this topic to continue the setup steps Review only the setup considerations applicable to the claim import method you intend to use 18 Print Image PrintLink imports claims from
345. service type eligibility benefit request activities e Refer to the Adding a new eligibility benefit request topic for more information on adding eligibility benefit requests 64 Main Toolbar amp Forms Refer to the Listing modifying and maintaining eligibility benefit requests topic for tips on maintaining eligibility benefit requests from the Eligibility Benefit Request List form Refer to the Preparing eligibility benefit request files for transmission topic to learn about preparing eligibility benefit requests into an ANSI 270 format file for transmission Refer to the Viewing and maintaining eligibility benefit response files topic to learn about handling ANSI 271 response files returned from the Information Source Payer 65 PC ACE Pro32 User s Manual Roster Billing List Form Features The PC ACE Pro32 Rosier Billing List form provides a versatile interface from which the user can create list modify print and otherwise maintain Professional roster billings Click the Professional Claims Processing button on the PC ACE Pro32 Main Toolbar to open the corresponding Claims Menu form Then select the Maintain Roster Billings item from the Professional Claims Menu form s main Roster menu to open the Roster Billing List form You may reposition and resize this form if desired The list can be easily sorted and filtered to display only the roster billings of interest Sorting Roster Billings The roster billing l
346. sing button to open the desired Claims Menu form 2 From the Claims Menu form click the Process Claims button to open the Automated Claim Processing form This form provides the following processing options e Claim Filter Parameters claims must meet all specified filter criteria to be considered for automatic processing e LOB specifies a single line of business LOB to be considered Only claims with this LOB will be eligible for automatic processing Leave this field empty to include claims for any line of business e TOB Institutional only specifies a single type of bill TOB to be considered Only claims with this TOB first 2 characters only will be eligible for automatic processing Leave this field empty to include claims for all bill types e Provider specifies one or more Provider IDs to be considered Only claims for the specified provider s will be eligible for automatic processing Leave this field empty to include claims for all providers If multiple Provider ID values are specified claims for any of the specified providers will be included Separate multiple Provider ID values with a semi colon For Institutional claim processing the specified Provider ID value s will be compared to the claim s Provider ID field for the submission payer For Professional claim processing the specified Provider ID value s will be compared to the claim s billing Provider ID e Reprocess claims with errors specifies whe
347. sing the Windows Explorer locate the client installation program CLIENT32 EXE in the WINPCACE directory on the server Execute this program directly from the remote drive volume do not copy CLIENT32 EXE to your local system 3 Follow the on screen wizard steps to complete the client installation You will be prompted to select a local destination drive The PC ACE Pro32 program and client support files will be installed to the WINPCACE directory on the selected local drive In addition a PC ACE Pro32 shortcut icon will be created and placed on your Windows desktop Logging In The First Time Users are required to log into PC ACE Pro32 before performing any system activities The login process involves entering a User ID and optional Password As shipped PC ACE Pro32 is configured with a single default user with full system access rights The default user s User ID is SYSADMIN and password is SYSADMIN as well If you are logging into PC ACE Pro82 for the first time use this default login unless instructed otherwise by your distributor If the default login does not work review the installation guidelines provided by your distributor Distributors often pre configure the security system according to their own internal specifications If you still have difficulties logging into the system contact your distributor for assistance IMPORTANT You should change the default user s password as soon as possible if you are concerned about controllin
348. sion checkboxes amp Attention If changes are made to a user profile the changes will not go into effect until the next time that user logs into system Select the Logout Current User item available from the main Security menu to manually log out without exiting the system Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Security amp User Maintenance topic for more information about the PC ACE Pro32 security implementation and the User Security Update form 201 PC ACE Pro32 User s Manual Scheduling unattended claim activities Claim import processing and transmission activities may be scheduled for unattended operation if desired This feature can be used to enhance productivity by automatically performing time consuming tasks that night otherwise require an operator to be present Tasks may be scheduled for either one time deferred execution or daily recurring execution at a specified time by clicking the Claim Activity Scheduling button on the PC ACE Pro32 Main Toolbar Note This claim activity scheduling feature may not be available in all installations You will be notified when you attempt to enter the scheduling module if the distributor has disabled this feature The Claim Activity Scheduling form consists of 3 tabs each for Institutional and Professional claim activity scheduling If you are licensed for only Institutional or Professional claim act
349. sional Claim List form Viewing Printing amp Maintaining Claim Status Request Response History The status request response history for any transmitted claim can be viewed and or printed from the Claim Status Request Response History form Access to this history log is available from the Institutional and Professional Claim List forms On either claim list select the TR PD 126 Common Reference File Procedures transmitted paid location to display all transmitted claims To access the history log select the claim record of interest in the list and choose the Show Selected Claim Status History item from the form s main Actions menu The Claim Status Request Response History form will display all available status requests and responses for this claim The Claim Status Request Response History form displays a summary of each request or response including the associated date time the Action or type and a few key status response data elements The possible Action types include e Request Records the date time a claim status history request was made on behalf of this claim This is actually the date time associated with the ANSI 276 claim status request file prepared by PC ACE Pro32 e Response Identifies a posted response for this claim A summary of the status response is displayed in the list s columns Additional details for this response are available for viewing if desired see below for instructions This include
350. sired LOB and Billing Provider for the new claim Auto populate zero service line Units value to 1 during Professional claim entry Enables or disables auto population of the service line Units value to one 1 during Professional claim entry This auto population will occur when the user exits the 24d Procedure Code field only if the Units value is currently zero i When checked the service line Units value will be initialized to 1 if currently zero when the service line s procedure code is entered IT When unchecked the service line Units value will not be initialized and must always be entered by the user if a non zero value is desired Skip over line item Service Thru Date field during Institutional claim entry Controls whether or not the Service Thru Date field on the Institutional claim service line is include in the forward tab sequence M When checked the service line Service Thru Date field will not be included in the forward tab sequence unless a date is already present in this field Hand key users System Preferences who are accustomed to a single line item service date field may prefer to skip the Service Thru Date field when entering claims M When unchecked the service line Service Thru Date field will be included in the forward tab sequence Use the Physician reference file for Professional purchased services lookups Controls the source reference file for line level Purchased Servic
351. small amount of your valuable desktop space and can be set to dock automatically to any desktop corner or float if desired The toolbar action buttons provide quick access to y B Import enter modify process and prepare Institutional claims E E Gil TOND Import enter modify process and prepare Professional claims S Ce Maintain all supporting reference files patient payer provider etc Launch your claim submission and related data communication software Schedule delayed and daily recurring claim activities Launch the ANSI 835 Electronic Remittance program Perform system backup restore and other maintenance functions E Send support mail to your distributor may not be available The main File menu provides access to the Preferences dialog used to customize PC ACE Pro32 to your particular installation and style The main Security menu provides access to the system s user maintenance and security features and also allows the current user to logout The main Help menu provides access to this on line help system the Online Software Update utility and the PC ACE Pro32 About box containing the PC ACE Pro32 program version number and important copyright information 27 PC ACE Pro32 User s Manual Institutional amp Professional Claims Menus Most claim activities in PC ACE Pro32 are initiated from one of 2 essentially identical claim activity menu forms one each for Institutiona
352. specifies the data communication function to be launched at the specified start time Select the desired function from the drop down list provided Note The scheduler is responsible only for launching the program or batch file associated with the selected claim transmission function It does not attempt to monitor the progress or completion status of this data communications operation If no items are available in the drop down list then no data communications programs have been configured for launch from PC ACE Pro32 Refer to the Data Communication Preferences topic for more information on configuring Data Communications program access Once all scheduling options are completed click the Initiate Deferred Claim Transmission button to complete the scheduling task If all scheduling tasks have been completed click the OK button to close the form and return to the PC ACE Pro32 Main Toolbar 203 PC ACE Pro32 User s Manual AS Tip Don t forget to click the Initiate Deferred Claim button after setting up for a scheduled claim activity You will see a notification message in red at the bottom of the tab when the activity is properly scheduled Scheduled Activity Notification Approximately 5 minutes prior to the start time of a scheduled claim activity the Scheduled Activity Notification form will be automatically displayed on the client workstation This notification form describes the scheduled activity type and displays an
353. specifies whether or not to limit the initial display of transmitted paid claims in the Institutional and Professional Claim List forms based on the claim s transmission date If this feature is enabled specifies the number of months of the most recent claims to be displayed by default M When checked only claims that have been transmitted i e prepared in the most recent number of months as specified will be displayed by default when viewing the transmitted paid claim list locations TR PD and TR PD When unchecked all transmitted paid claims in the database will be displayed by default when viewing the transmitted paid claim list locations TR PD and TR PD AS Tip To display transmitted paid claims older than the specified number of months simply click the Advanced Filter Options button on the Claim List form and enter the desired Transmit Date range Note Limiting the number of transmitted paid claims being displayed in the claim list improves the list s responsiveness Claim list performance improvements should be particularly noticable when accessing the TR PD and TR PD locations on networked installations with large active claims databases If this preference option is disabled support for this feature is not available on your installation Adobe Acrobat Reader specifies the complete path for the Adobe Acrobat Reader program ACRORD32 EXE required for printing claims using the image overlay method When the
354. ss Institutional claims All providers referenced on Institutional claims must be represented in this reference file The Institutional Provider tab provides a convenient Sort By selection that quickly sorts the Provider list by LOB Provider Name Provider ID and Tag Operations available include Main Toolbar amp Forms To add a new Institutional provider record click the New button and enter the new provider information If providers already exist in this reference file you will have the option to create a completely new provider record or inherit and associate the new provider record with the provider record currently selected in the list Select the desired creation options and click the OK button to continue Refer to the Adding and maintaining providers Institutional topic for a discussion of these creation options and their applicability To view or modify an existing provider record select the desired record from the list and click the View Update button or double click the desired record To delete an existing provider record select the desired record from the list click the Delete button and confirm the deletion amp Attention Claims are linked to provider records by an internal control number Deleting a provider record will irrevocably break any such links that may exist to claims in the system The Provider Deletion Confirmation form outlines alternatives to deletion and provides a convenient util
355. ster Billing Form The data fields are typically entered in the order presented from left to right and top to bottom Enter the common roster billing information in the top section of the Patient Info amp General tab Enter patient specific information for any number of patients in the lower section of this tab Enter supplemental information on the Extended Roster Info tab if required Edit validation errors may be encountered during this entry process if the data entered violates any of the predefined roster billing edits Correct any such edit errors and click the Save button to save the roster billing Roster billings containing unresolved edit errors may be saved if desired by clicking either the Save With Errors button visible if only non fatal errors exist or Save With Fatal button visible if any fatal errors exist Only one of these buttons will be visible at any given time If neither button is visible then fatal errors exist on one or more key roster billing fields These fatal edit errors must be corrected before the roster billing can be saved Note When a new Professional roster billing is created from the New Roster Billing menu item and saved error free you will be prompted to proceed automatically to the claim generation step If you choose not to generate the claims at this time or if the roster billing was saved with errors you may generate the claims at a later time from the Roster Billing List Form Relate
356. stitutional Claims Menu form to display the Institutional Claim List form By default the list will display claims in the to be transmitted CL location On the Institutional Claim List form select either the transmitted only TR paid only PD or transmitted paid TR PD claims location to display claims eligible for payment Note Claims are assigned to the transmitted TR location as soon as they are prepared into an EMC file for transmission When the first payment is posted to a transmitted claim the claim is moved to the paid PD location where it will remain indefinitely Payments may be posted to claims in either the transmitted TR or paid PD locations but not to claims in the to be transmitted CL location hS Tip If you plan on posting payments to more than one claim we recommend that you select the combined transmitted paid TR PD claims location Updates to the claim list are more efficient to process from this location since claims being moved from the transmitted TR to paid PD status will not force a requery of the list s contents Select the desired claim from the list and perform either of the following to access the claim s payment history e Select the Show Selected Claim Payments item from the Institutional Claim List form s main Actions menu or from the convenient right click popup menu e Click the View button or double click the selected record to displa
357. sts in the to be submitted EL location with a status or either CLN clean or ERR contains non fatal errors will be eligible for preparation When unchecked only clean requests will be eligible for preparation The initial state of this option is determined by a Submitter reference file setting E Attention The default settings for these control options are typically configured by your distributor We recommend overriding these option settings only under the instruction of your distributor or an authorized technical support specialist Specify the desired filter parameters if any and preparation options When ready click the Prepare Eligibility Request button and confirm your intention to prepare all eligible eligibility benefit requests Progress information will be displayed as the prepare operation proceeds You will be notified when the eligibility benefit request file prepare operation completes If desired click the View Results and or View Errors buttons to view reports of the successfully prepared eligibility benefit requests and rejected requests respectively These reports can be printed from the report preview form if desired The reports for the most recent eligibility benefit request prepare operation are also available from the View menu on the Institutional amp Professional Claims Menu forms Note Eligibility benefit requests will rarely be rejected during the prepare operation A request may be rejected
358. t click the New button on the Security List form and assign the user a User ID Password and Name Assign permissions to this user and click the OK button to save the new user record 23 PC ACE Pro32 User s Manual bS Tip Check the checkbox next to the permission to allow access to the activity Click the Check All and Clear All buttons to quickly check or un check all user permission checkboxes 3 Repeat the previous step to create additional user accounts Note If changes are made to a user profile the changes will not go into effect until the next time that user logs into system Select the Logout Current User item on the main Security menu to manually log out without exiting the system S Attention You should change the default user s password as soon as possible if you are concerned about controlling user access at your facility Claim Import Considerations This section describes setup considerations that should be reviewed only if you intend to import claims into PC ACE Pro32 from an upstream system If you will not be importing claims skip this section entirely Three methods are available for importing claims Print Image PrintLink Intermediate Delimited Format and Electronic Media Claims EMC Format Note Getting setup to import claims into PC ACE Pro32 typically involves coordination with your distributor If you are interested in importing claims using the PrintLink print image method but your d
359. t Request Preferences Certain aspects of the Eligibility Benefit Request Form operation are customizable The default behavior is typically determined by your software distributor so you should check with their support department before making changes to these settings The Eligibility Benefit Request Preferences are accessible from the Eligibility Benefit Request List form s main File menu Preferences item The following options are available for configuration General Eligibility Benefit Preferences Select the General tab to view and or modify general eligibility oenefit preferences e Default Information Source Type to Payer Code PR This option controls the default value assigned to the Information Source Type field for new requests M When checked the Information Source Type is defaulted to the Payer code PR Most distributors expect a payer to be identified in the Information Source fields 53 PC ACE Pro32 User s Manual Setting this field to PR enables Information Source lookups from the Payer reference file M When unchecked the Information Source Type field is left empty and must be entered by the user or selected from the right click popup menu e Default Information Source Primary Identification Type to NAIC Code NI This option controls the default value assigned to the Information Source Primary Identification Type field for new requests It is available only when the Information Sour
360. t information for the roster billing line items The other second level tab is linked to the currently selected billing line on the Patient Information tab As the cursor moves from one billing line to another on the Patient Information tab the other second level tab will track the new current billing line This technique provides an efficient method of providing access to additional data elements on a potentially large number of roster billing lines Notice that the Insured amp Misc Info tab caption always reports the current billing line for reference e Billing Line Field Duplication Pressing the F4 key while positioned on a specific roster billing line field will copy the value of that single field from the previous line into the current line hS Tip Pressing the F4 key while positioned on the Address Line 1 field will copy all address fields from the previous line into the current line e Line Deletion Press the F7 key or the lt ALT gt D key sequence while positioned on any field on a roster billing line to delete the line You will be prompted to confirm the deletion e Advance To Next Line Press the F8 key while positioned on any field on a roster billing line to automatically advance the cursor to the first field of the next line skipping over any remaining fields on the current line Automatic Patient Control Number Generation optional The roster billing form supports automatic generation of the Patient Con
361. tal edits defined in PC ACE Pro32 e Non Fatal Edits Non fatal edits describe rules that should probably not be broken however PC ACE Pro32 will look the other way if they are Claims containing only non fatal edit errors can be saved and even prepared into an EMC file if desired It is up to the user to decide when a non fatal edit validation error can be ignored Handling Edit Validation Errors 81 PC ACE Pro32 User s Manual Field level edit validation errors are reported as the focus leaves the offending field during claim entry If such an error occurs you will receive an audible response and the edit validation error message will be displayed in the lower left corner of the claim form In addition the focus will remain on the field so that you can correct the problem if desired If you choose not to correct the data at this time you can simply press the TAB key again to move to the next field When an attempt is made to save the claim an edit validation process is performed on all claim fields This process includes re evaluating all field level edits In addition all claim file level edits are evaluated If no edit validation errors occur the claim is saved with a clean CLN status If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List form unless disabled in the General Preference settings This form lists all the edit validation errors that have occurred
362. te is completed but the end date is left blank the revenue code is valid for all dates of service from and including the start date forward If the start date is left blank but the end date is completed the revenue code is valid for all dates of service up to and including the end date Revenue Code Assignments The Revenue Code Assignments form provides an interface to maintain optional assignment details for a specific revenue code If no details exist for a specific revenue code then the code will be considered valid for all LOBs and the various flags described below will assume their default values Maintenance operations available on the Revenue Code Assignments form include e To add anew revenue code assignment record click the New button and enter the desired information on the Revenue Code Assignment Information form e To view or modify an existing revenue code assignment record select the desired record and click the View Update button or double click the desired record e To delete a revenue code assignment record select the desired record click the Delete button and confirm the deletion e To copy all revenue code assignments records from another revenue code click the Copy button and enter the revenue code from which the assignment records are to be copied This feature makes it easy to duplicate assignment record sets from one revenue code to another 187 PC ACE Pro32 User s Manual The Revenue Code
363. ted TR or paid PD locations An additional transmitted paid TR PD selection is available to display both transmitted and paid claims This selection may provide a more comprehensive view of the claims during payment posting for example e Status filters the claim list to include only claims assigned a specific status The possible status codes are clean ready CLN deleted DEL has fatal errors ERF has errors ERR held HLD and unprocessed UNP Note Note that selecting a status of DEL is the only way to view deleted claims which can be recovered until they are purged from the system e LOB filters the claim list to include only claims for a specific line of business In addition to these basic filter options the Claim List form also provides a number of Advanced Filter Options These advanced options permit filtering on the claim s patient payer provider date ranges batch information bill tyoe and numerous other criteria When multiple filter criteria are specified only those claims that meet all filter criteria will be displayed Note The initial display of transmitted paid claims in the Claim List form may be optionally limited to only the most recently transmitted claims Refer to the PC ACE Pro32 Miscellaneous preferences topic for a description of this feature and to review the current settings Limiting the number of transmitted paid claims being displayed in the claim list can impr
364. ted eligibility benefit request Refer to the Viewing the eligibility benefit response for a specific request topic for additional information Note This action is available only when the Eligibility Benefit Request List is filtered to view requests in the submitted TR location The Reply column will Main Toolbar amp Forms contain the value Yes when a response has been received and posted for the selected eligibility benefit request e Refreshing the Request List Choose the Refresh Request List action or press the F5 function key to refresh the current Eligibility Benefit Request List form contents This action can be useful in a multi user installation to be sure that the request list properly reflects additions and or modifications made by other users Note You will notice that only applicable actions are enabled for use in the main Actions menu or pop up menu For example it makes no sense to reactivate an eligibility benefit request that has yet to be submitted so this action will be disabled for requests in the to be submitted EL location Actions on Multiple Eligibility Benefit Requests Some actions can be performed on multiple eligibility benefit requests at once Multiple request selection is accomplished by checking the request of interest and subsequently performing one of the All Checked Requests actions To check a request click the left mouse button over the checkbox in the first c
365. teps described in this topic then this capability is not available on your installation Note Before preparing eligibility benefit requests for the first time you may need to setup your Submitter reference file This file contains important data that will be used to build the ANSI 270 file Separate submitter details exist for Institutional and Professional request types Since some distributors pre configure the Submitter reference file you should check with them before making any changes Refer to the Submitter File Maintenance topic for more information on configuring this important reference file To prepare eligibility benefit requests in PC ACE Pro32 follow these simple steps 1 From the PC ACE Pro32 Main Toolbar click either the Institutional Claims Processing or Professional Claims Processing button to open the desired Claims Menu form 2 From the Claims Menu form select the Maintain and Prepare Eligibility Benefit Request File menu items to open the respective Eligibility Benefit Request Prepare form This form provides the following preparation options e Request Filter Parameters eligibility benefit requests must meet all specified filter criteria to be considered for preparation e LOB specifies a single line of business LOB to be considered Only requests with this LOB will be eligible for preparation Select the lt lt All gt gt item to include requests for any line of business Note The Su
366. terested in importing claims using the PrintLink print image method but your distributor does not provide PrintLink support ask that they refer you directly to the software manufacturer for assistance PrintLink functionality may be licensed and supported as an add on to your base PC ACE Pro32 system AS Tip You may want to refer to the Importing claims topic for a discussion of these claim import methods If you do make sure and return to this topic to continue the setup steps Review only the setup considerations applicable to the claim import method you intend to use e Print Image PrintLink imports claims from a print image file If using this claim import method complete the following steps 1 Have your distributor perform a one time PrintLink mapping procedure ona sample print image file that you have supplied This mapping process defines the template used to extract and interpret fields from your print image file Since all upstream systems print claims in a slightly different format this mapping process is required to build your custom template 2 Obtain the resulting map file from your distributor This file is typically named ub92 map but can be any valid filename with a map extension The map file must be placed in the server s winpcace impub92 directory 3 Confirm the existence of the required map control file This file provides a control interface between the output of the PrintLink translator and the
367. that each record describes a valid provider for a single line of business LOB This organization allows for greater flexibility in specifying Provider IDs and support information Tax ID address etc that can vary across multiple LOBs for a single provider Complete the following steps as needed The Professional provider structure defines 3 distinct provider types 1 Provider Groups 2 Individual Providers Within A Group and 3 Solo Providers Professional claims require a billing provider that can be either a group or solo provider but not an individual within a group The Professional claim entry provider lookups and claim editing process will enforce this requirement You will be required to assign one of the 3 provider types to each provider you add during this setup procedure hS Tip If it is not clear which type is appropriate in each instance you may want to refer to the Adding and maintaining providers Professional topic for a more complete description of the various provider types If you do make sure and return to this topic to continue the setup steps If you are sill unsure contact your distributor for assistance To setup the Professional Provider reference file complete the following steps 1 From the PC ACE Pro32 Main Toolbar click the Reference File Maintenance button to display the Reference File Maintenance form Select the Provider Prof or just Provider tab to display a list of all existi
368. the error report you can significantly speed up automatic processing by leaving this option unchecked This allows the edit engine to stop processing a claim on the first detected error since it is only important to know that the claim has errors not specifically which errors Specify the desired filter parameters if any and processing options When ready click the Process button and confirm your intention to process the claims Each eligible claim will be processed in sequence As the processing operation proceeds running totals of the count and dollar value of all clean claims and claims with errors are displayed on the Automated Claim Processing form You will be notified when the claim processing operation completes Note If you are processing claims in interactive mode automatic processing will be temporarily paused each time a claim containing errors is processed The claim will be automatically displayed in either the Institutional Claim Form or Professional Claim Form with the Edit Validation Errors List form open to display the claim s edit validation errors unless disabled in the Preference settings You can either work the claim until it is clean save the claim with errors or cancel the claim to leave it unprocessed Once you have closed the claim form the automatic processing run will continue with the next eligible claim in the sequence hS Tip A convenient Cancel Run button will be available on the Institutio
369. the desired version of the institutional ANSI 837 transmission file You should change this value only under instructions from your distributor e ANSI Ver 837 Prof professional only specifies the desired version of the professional ANSI 837 transmission file You should change this value only under instructions from your distributor 171 PC ACE Pro32 User s Manual 172 ANSI Ver 837 Dent professional only specifies the desired version of the dental ANSI 837 transmission file You should change this value only under instructions from your distributor ANSI Version 270 specifies the desired version of the ANSI 270 eligibility benefit request file if this feature is enabled on your installation You should change this value only under instructions from your distributor ANSI Version 276 specifies the desired version of the ANSI 276 claim status request file if this feature is enabled on your installation You should change this value only under instructions from your distributor EMC File specifies the desired EMC filename using the standard DOS 8 3 naming convention Leave this field blank to use the default EMC filename Vendor specifies an optional Vendor number required by some distributors Intermediary specifies the unique Intermediary distributor identification number of the organization processing your electronic claims This identifier is used to trigger distributor specific claim prepare rules
370. ther or not claims in the to be transmitted CL location that currently have a has errors ERR or a has fatal errors ERF status are eligible for automatic processing If this option is unchecked only unprocessed claims UNP will be considered eligible hS Tip Reprocessing claims with errors might be helpful for example after a change is made to the edit validation rules It is feasible that a group of claims all failed the same ill conceived edit validation rule which has subsequently been reviewed and changed e Processing Options options that control the automatic processing operation e Present claims with errors for immediate editing instructs the automatic processing engine to pause each time a claim with errors is processed and to present the claim for immediate consideration in the Institutional Claim Form or Professional Claim Form This is referred to as interactive processing mode When the user closes the claim form the automatic processing run will resume with the next claim in the sequence e Include edit error details in process error report instructs the automatic processing engine to include the specific edit validation error descriptions in the 109 PC ACE Pro32 User s Manual compiled error report Check this option when plan to research the specific edit validation errors for each claim from this hardcopy report AS Tip If you rarely refer to the specific edit validation error descriptions in
371. tically 68 Main Toolbar amp Forms derive the century when omitted To insure accuracy birthdate fields require that a full 4 digit year be entered Descriptive Field Hints Most roster billing form fields have field hints that provide a brief description of the field s purpose These hints are often called fly over hints since they become visible when the mouse pointer moves over the specified field without actually selecting the field This feature can be disabled in the general preferences settings if desired Line Item Scrolling The lower section of the Patient Info amp General tab displays 5 patient billing lines at a time For roster billings that contain more than 5 patients the user may scroll through the patient billing lines one line at a time or one page i e 5 lines at a time using the buttons provided along the right edge of this tab hS Tip You can also use the up down arrow keys to move from line to line scrolling when appropriate Type lt ALT gt lt PAGE UP gt press the Page Up key while holding the ALT key down or lt ALT gt lt PAGE DOWN gt to scroll up down through all roster billing lines one page at a time Billing Line Item Features The following productivity features are available for roster patient billing lines e Current Billing Line Tracking The Patient Info amp General tab contains two second level tabs The first second level tab Patient Information displays the patien
372. tion errors Miscellaneous Claim Form Topics The following comments cover a few miscellaneous features of the Institutional Claim Form e ICD 10 General Equivalence Mapping GEM Lookup Feature Some installations support an advanced lookup feature which greatly simplifies the task of cross walking ICD 9 diagnosis and procedure codes to their ICD 10 equivalents during claim entry Refer to the ICD Codes File Maintenance topic for details e Entering Form Locator Data In order to preserve space on the Institutional Claim Form most of the fields that permit free form text entry have been implemented as pop up windows These fields are activated by clicking the associated button e g the FL1 button at the top of the Patient Info amp Codes tab activates the Form Locator 1 popup 41 PC ACE Pro32 User s Manual window Simply enter the text in this pop up window pressing the ENTER key to start a new line if desired and press the TAB key to exit and close the window Viewing Home Health Plans of Care Type lt ALT gt H to display a list of Home Health Plans of Care Form No CMS 485 CMS 486 on file for the patient specified in the claim The plan information cannot be modified from this list Refer to the Listing modifying and maintaining Plans of Care topic for details on how plans can be added or updated Displaying Audit information Click the picture button in the upper right corner of the Patient Info amp Co
373. tion of the powerful Eligibility Benefit Request List form Note The patient eligibility benefit request response capability may not be available on all installations If the Maintain Eligibility Benefit Requests item is not visible on the Maintain menu then this capability is not available on your installation Viewing amp Modifying Eligibility Benefit Requests Viewing and or modifying existing eligibility benefit requests from the Eligibility Benefit Request List form can be performed with these general steps 1 Use the Eligibility Benefit Request List form s powerful sorting and filtering capabilities to locate the request of interest in the list 2 Select the desired eligibility benefit request in the list and click the View Update button to display the request details in the request form Alternatively just double click the desired request record in the list 3 Make all desired changes to the request Refer to the Eligibility Benefit Request Form topic for details on the many productivity enhancing features available on this powerful request form 4 When all changes have been made click the Save button to save the request record and close the form Review and correct any edit validation errors as needed Alternatively click the Cancel or Close button to cancel any pending request changes Actions On Multiple Eligibility Benefit Requests Many of the eligibility benefit request actions available in the Eligib
374. tional claims processing or only Professional claims processing then you will see only 4 tabs and the provider tab will be labeled simply Provider You may reposition and resize this form if desired The following is a brief explanation of these major tabs including the operations available on each 76 Patient provides access to maintain general patient information as well as primary secondary and tertiary insured details Setup of the Patient reference file is optional Patient information from this reference file is available for lookup during claim entry The Patient tab provides a convenient Sort By selection that quickly sorts the Patient list by Patient PCN or Patient Name Operations available include e To add anew patient record click the New button and enter the new patient record information Refer to the Adding and maintaining patients topic for more information e To view or modify an existing patient record select the desired record from the list and click the View Update button or double click the desired record e To delete an existing patient record select the desired record from the list click the Delete button and confirm the deletion Payer provides access to maintain system payer information and PrintLink matching descriptions Setup of the Payer reference file is mandatory although it may be setup in advance by your distributor All payers referenced on claims must exist in the Payer refere
375. trol Number field The decision to enable automatic PCN generation is typically made by the distributor When this feature is disabled the PCN field must be entered manually or looked up from the Patient reference file via the F2 shortcut key hS Tip Lookups from the Patient reference file may be performed even when automatic PCN generation is enabled In this scenario the lookup operation will retrieve all patient information except the PCN When the focus leaves a roster billing form field either by pressing the TAB key or clicking on anew field an edit validation process is performed on the field losing the focus Edits performed at this time are referred to as field level edits If a field level edit validation error occurs you will receive an audible response and the edit validation error message will be 69 PC ACE Pro32 User s Manual displayed in the lower left corner of the roster billing form In addition the focus will remain on the field so that you can correct the problem if desired If you choose not to correct the data at this time simply press the TAB key again to move to the next field Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the roster billing edit validation process Saving amp Canceling Roster Billings After completing data entry on the roster billing form click the Save button or type lt ALT gt S to save and exit the roster billing Altern
376. ts reporting of payments for less than the originally billed units Finally the B U Line field identifies the service line on the original claim to which this SVD line applies This reference identifier should be included on the remittance and is primarily used in scenarios where procedure code bundling unbundling has occurred Line Adjustment CAS amp Miscellaneous Adjudication Info Permits entry of several additional Service Line Adjudication SVD fields for the current SVD line The fields in 39 PC ACE Pro32 User s Manual this control group track the currently selected SVD line The control group s caption indicates the current SVD line e g for SVD 1 above e Procedure Code Description Permits entry of an optional description of the procedure code specified on this SVD line e Adj Payment Date Permits entry of the date on which the payer specified on this SVD line adjudicated this service e Remaining Amt Owed Permits entry of the optional remaining amount to be paid after adjudication by the other payer represented in this SVD line e Line Level Adjustments CAS Permits entry of one or more line level adjustments as reported by the payer for the current Service Line Adjudication SVD line Adjustments are defined by a specific Group code and Reason code combination Enter these codes manually or select them from the available lookup lists Each line level adjustment must specify a non zero Amou
377. ty to enter new data if desired e Click the selector graphic to open the dropdown list and display all existing data occurrences A vertical scrollbar will appear as needed to permit access to all occurrences Select an entry from the list or press the ESC key or click elsewhere on the form to close the dropdown list The data values corresponding to the selected entry will be displayed in the field set and are now available for editing as needed e To add anew occurrence to a field set either tab through all existing occurrences until an empty field set is displayed or simply select the Enter New item in the dropdown list e Press the F7 key while positioned on any field in the set to delete the selected occurrence You will be prompted to confirm the deletion e If the focus moves away from a recurring field set while an empty occurrence is displayed the field set will automatically display the data for the first occurrence if any rather than leave the screen fields blank e The edit validation process understands the recurring nature of these special field sets and will automatically reposition to the proper occurrence when displaying edit validation errors Automatic Field Tabs When entering data in a field an automatic tab will occur when the field has been completely filled For example entering a single character in a one character field will automatically position the cursor on the next field in the tab sequenc
378. type then only the appropriate control file will be created The Data Communications Control File can be read by the external data communications program to obtain the needed transmission parameters phone number password etc The layout of this control file is defined in a separate document and is available to distributors or facilities developing their own data communications scripts As explained earlier in this topic the Data Communications reference file supports multiple records defined for specific LOB and or LOB Payer combinations For example a Data Communications record can be defined for LOB MCA and Payer 00190 Another might be defined for LOB MCA and no Payer i e left empty The Data Communications Control File will be built using data from the record that most precisely describes the filter options used to prepare the current EMC file For example if the last EMC file was prepared to include only claims for LOB MCA and Payer ID 00190 then the Data Communications reference file will be searched for a record specific to this LOB Payer combination Since this record exists in our example it would serve as the source for the data communications parameters written to the control file If instead the last EMC file was prepared for LOB MCA and any other Payer ID or all payers then the Data Communications reference file record for LOB MCA and Payer unspecified would be used Finally if the last
379. ual request Contact your claims processor s support department for assistance in understanding the ANSI 271 report nomenclature and eligibility benefit code interpretation Related Topics The following hyperlinks provide additional information related to this topic e Refer to the Eligibility Benefit Request List Form Features topic for more information on adding and maintaining eligibility benefit requests e Refer to the Preparing eligibility benefit request files for transmission topic for information on creating ANSI 270 eligibility benefit request files to send to your claims processor e Refer to the Viewing and maintaining eligibility benefit response files topic for information on viewing and maintaining the ANSI 271 eligibility benefit response files returned by your claims processor 148 Common Reference File Procedures Adding a new roster billing New Professional roster billings can be added to PC ACE Pro32 using either of the following techniques e Select the New Rosier Billing item from the Professional Claims Menu form s main Roster menu The system will automatically create and display an empty roster billing form e Click the New button on the Roster Billing List Form The system will automatically create and display an empty roster billing form The new roster billing will automatically be selected in the list when it is saved Professional roster billings are manually entered on the Professional Ro
380. uests item on the Claims Menu form s Maintain menu to open the Eligibility Benefit Request List form You may reposition and resize this form if desired The list can be easily sorted and filtered to display only the requests of interest The Institutional and Professional Eligibility Benefit Request List forms are virtually identical All procedures described in this section pertain to both request types unless otherwise specified Note The patient eligibility benefit request response capability may not be available on all installations If the Maintain Eligibility Benefit Requests item is not visible on the Maintain menu then this capability is not available on your installation Sorting Eligibility Benefit Requests The eligibility benefit request list may be sorted by Patient Name Patient Control Number PCN Entry Date and Submit Date Simply select the desired sort order from the available Sort By radio buttons Filtering Eligibility Benefit Requests The eligibility benefit request list may be filtered to display a select subset of requests by manipulating the Eligibility Request List Filter Options drop down lists Basic filter options include e Location filters the eligibility benefit request list to include only requests in the to be submitted EL or transmitted TR locations e Status filters the eligibility benefit request list to include only requests assigned a specific status The possible status code
381. urrently selected service line in the same manner as the other extended line item sub tabs The current service line is identified in the MSP COB sub tab caption e g MSP COB Line 4 The decision to report COB information at the claim versus line level is made by the payer and communicated to the provider via a remittance The remittance may be in electronic ANSI 835 or paper format and typically serves as the source for all COB data to be entered into the claim form s COB fields hS Tip There s no need to re enter claims for submission to secondary payers if the original claim was processed through PC ACE Pro32 Simply use the Professional Claim List form to locate the original claim in the TR transmitted location select the Copy action to create the new secondary claim and enter the LOB and Billing Provider applicable to the secondary payer Finally enter a Y in the COB field on the Patient Info amp General tab to activate the COB related fields You will then have a duplicate of the original claim ready to add the primary payer s COB information The claim level COB data is entered on the COB Info Primary and COB Info Secondary sub tabs of the Extended Payer Insured tab The purpose and use of the various field groups on these sub tabs are as follows e Claim Level Adjustments CAS Permits entry of one or more claim level adjustments as reported by the payer Adjustments are defined by a specific Group
382. ust specify a non zero Amount value and may also specify an optional Units value Common Line MSP Information Contains miscellaneous line level COB related fields defined in the ANSI X12 implementation AS Tip Fixed list or variable list lookups are available on many of the COB related fields to improve user efficiency In addition the standard line duplication F5 field duplication F4 and line deletion F7 functions are available on all COB related scrolling arrays As an additional convenience pressing the F5 key while positioned on the first Service Line Adjudication SVD line will populate the SVD fields with their equivalent values from the original service line Saving amp Canceling Claims After completing data entry on the claim form click the Save button or type lt ALT gt S to save and exit the claim Alternatively click the Cancel button to abandon any changes and exit the claim When an attempt is made to save a claim the following occurs Submission Payer Determination At least one of the payers specified on a claim must have the same LOB line of business as the claim itself You will not be allowed to save a claim unless this condition is met If only one of the claim payers has a LOB that matches the claim LOB then this payer is automatically designated as the submission payer the payer to which the claim is to be submitted If you view the claim after saving you will see a checkmark adja
383. utton or choose the Copy Selected Plan of Care action to copy the selected plan If the plan being copied includes a Medical Update CMS 486 section you will be given the option to include or omit this data on 71 PC ACE Pro32 User s Manual the new plan The Plan of Care entry form will be displayed containing the details of the newly copied plan Make modifications as required and save the new plan e Deleting Plans of Care Click the Delete button or choose the Delete Selected Plan of Care action to delete the selected plan E Attention Deleted plans are permanently purged from PC ACE Pro32 they cannot be recovered e Printing Plans of Care Choose the Print Selected Plan of Care action to print the selected plan See the Printing Home Health Plans of Care topic for more details e Refreshing the Plan of Care List Choose the Refresh Plan of Care List action or press the F5 function key to refresh the current Plan of Care List form contents This action can be useful in a multi user installation to be sure that the list properly reflects plan additions and or modifications made by other users Note You will notice that only applicable actions are enabled for use in the main Actions menu or pop up menu For example the all checked actions will be enabled only when one or more plans in the list are checked Actions on Multiple Plans of Care Some actions can be performed on multiple plans at onc
384. vailable for selection on the simplified Service Type Eligibility Benefit Request Form If visible click the Add button to choose a payer from the Payer reference file and add this payer to the selection list Select an existing payer in the list and click the Remove button to remove this payer from the selection list Use the Up Arrow and Down Arrow picture buttons to rearrange the order of payers in the selection list The first payer in the selection list will be the default payer when creating new Service Type eligibility benefit requests Note PC ACE Pro32 distributors have the option to pre configure and restrict this default eligibility benefit payer selection list The Add Remove Up Arrow and Down Arrow buttons will not be visible when this restriction has been imposed by the distributor e Allow selection from Payer reference file This option controls whether or not users will be allowed to select payers other than those in the Payer Selection List when creating new Service Type eligibility benefit requests i When checked selection of alternate payers from the Payer reference file will be allowed The payer dropdown list on the Service Type Eligibility Benefit Request Form will include a special lt lt Select From Payer Reference File gt gt item to initiate the Payer file selection process M When unchecked only payers included in the Payer Selection List will be available for selection when creating new
385. ve been displayed will the focus move to the next field on the claim entry form This behavior permits the user to view all occurrences without using the mouse and also provides an opportunity to enter new data if desired e Click the selector graphic to open the dropdown list and display all existing data occurrences A vertical scrollbar will appear as needed to permit access to all occurrences Select an entry from the list or press the ESC key or click elsewhere on the form to close the dropdown list The data values corresponding to the selected entry will be displayed in the field set and are now available for editing as needed e To add anew occurrence to a field set either tab through all existing occurrences until an empty field set is displayed or simply select the Enter New item in the dropdown list e Press the F7 key while positioned on any field in the set to delete the selected occurrence You will be prompted to confirm the deletion e f the focus moves away from a recurring field set while an empty occurrence is displayed the field set will automatically display the data for the first occurrence if any rather than leave the screen fields blank e The edit validation process understands the recurring nature of these special field sets and will automatically reposition to the proper occurrence when displaying edit validation errors Automatic Field Tabs When entering data in a field an automatic tab will
386. vidual pointer value in the diagnosis pointer must be separated by a comma Examples of valid diagnosis pointers are 1234 6789 7 8 9 10 and 9 10 11 12 Use the values 10 11 and 12 notice trailing comma to specify only the tenth eleventh and twelfth diagnosis code respectively e Line Duplication Press the F5 key while positioned on any field on a line to copy the values in all fields of the previous line except the service date fields into the current line The service date fields in the current line are blanked and the cursor is then positioned on the first field of the current line e Field Duplication Press the F4 key while positioned on a specific field on a line to copy the value of that single field from the previous line into the current line bS Tip You can also use the F4 key to duplicate the service line Narrative text from the previous line into the current line This convenient feature eliminates the need to re type narrative text on consecutive service lines The Narrative field is located on the service line s Extended Details sub tab e Line Deletion Press the F7 key while positioned on any field on a line to delete the line You will be prompted to confirm the deletion Alternatively enter the value DEL that s an asterisk plus DEL plus another asterisk without the double quotes into the Procedure Code field 24d on a claim line to delete the line e Advance To Next Line
387. w to change the archive period or disable automatic purging altogether if desired Individual claim status responses which have been posted to claims will remain on file even after the original archived response file has been manually deleted or automatically purged e To refresh the list of archived ANSI 277 and ANSI 277CA files click the Refresh button The staging directory will be re scanned for the presence of new ANSI 277 or ANSI 277CA files If new files are present in the staging directory they will be checked for proper format and automatically archived and posted if appropriate The displayed list will then be rebuilt to reflect the current archive contents hS Tip Right click the mouse on the desired ANSI 277 or ANSI 277CA archive record to access all available actions For ANSI 277 files this popup menu provides several additional actions which allow the user to print post reports containing only the successfully posted responses or only responses that could not be posted Using the Claim Status Response Reports The ANSI 277 claim status response file is presented by PC ACE Pro32 in a human readable report format The report presents general identification information along with the claim level status response codes and payment details returned by the contractor for each claim Since the individual responses are posted directly to the applicable claims this report is typically used as a secondary reference source There may b
388. will describe the procedures required to perform both types of claim reactivation Reactivating Transmitted Claims Individually If one or more transmitted claims need to be resubmitted in a future EMC file these claims must first be reactivated Only claims in the transmitted TR location may be reactivated Once a payment has been made on a claim it will move to the paid PD location and is no longer eligible for reactivation This reactivation process simply moves the selected claim s from the transmitted TR location to the to be transmitted CL location and sets the status to unprocessed UNP The reactivated claim can then be processed and if no fatal edit validation errors are present becomes eligible for inclusion into the next EMC file prepared Claim reactivation is performed from the Institutional or Professional Claim List form 1 Filter the claim list to include only transmitted only TR claims 2 If a single claim is to be reactivated simply select the claim record in the list and choose the Reactivate Selected Claim item from the form s main Actions menu Confirm the reactivation when prompted The claim should disappear from the list since it is no longer in the transmitted TR location You should now find the unprocessed Status UNP claim in the to be transmitted CL location 3 To reactivate several claims at one time simply check the desired claims A claim in the list is checked
389. xit the form Alternatively click the Cancel button to abandon any changes and exit the form During the provider save operation an edit validation process is performed on all provider record fields If no edit validation errors occur the provider record is saved without further user intervention If however one or more edit validation errors occur you will be presented with the Edit Validation Errors List screen This screen lists all the edit validation errors that have occurred indicating which ones are fatal and which are non fatal Refer to the Claim amp Reference File Edit Validation topic for a more complete discussion of the reference file edit validation process and the Edit Validation Errors List screen If any fatal edit errors exist you must correct them before the provider record can be saved lf only non fatal edit errors exist you will have the option to correct the errors or save the provider record with errors Click the Save With Errors button to save a provider record that contains only non fatal errors If edit validation errors occur several Save attempts may be required to correct and save a clean provider record Provider Inheritance and Associations PC ACE Pro32 requires that each Institutional provider record be defined for a single line of business LOB As such if a provider supports multiple LOBs then separate records for each are required This hierarchy results in greatly enhanced flexibility by a
390. y Benefit Request Form The Eligibility Benefit Request Form provides access to all data elements defined in the ANSI 270 Health Care Eligibility Benefit Inquiry transaction New requests are entered and existing requests are viewed and or modified from this form Request fields are grouped logically on these major tabs e Patient Subscriber Info includes fields for patient and subscriber name address relationship and demographic information e Eligibility Benefit Inquiry includes fields describing the eligibility benefit information being requested from general coverage information to detailed coverage for specific diagnoses and procedures e Source Receiver Info includes fields defining the Information Source Payer typically and the Information Receiver Provider typically associated with this request e Patient Subscriber Extended includes less frequently used patient and subscriber fields e g additional identification numbers e Receiver Extended includes less frequently used Information Receiver fields such as additional identification numbers and the provider s Taxonomy code Click the appropriate tab or simply press the PAGE UP and PAGE DOWN keys to move between these major eligibility benefit request form sections Entering Eligibility Benefit Request Data Click on any field to activate it for data entry or press the TAB key to move from field to field in a predefined sequence generally left
391. y the claim in the Institutional Claim Form Click the Show Payment History button to access the payment history for this claim The Claim Payment History form lists all existing payments made to the selected claim if any Perform the desired payment related tasks from this list including e To post anew payment click the New button and enter the payment date and amount on the Claim Payment Details form The Date Paid field is defaulted to the current system date and can be changed if desired Complete some or all of the optional payment record fields if desired When all desired payment fields have been entered click the OK button to save the payment record e To modify an existing payment record select the desired record click the View Update button or double click the selected record and modify the payment field values as required Click the OK button to save the modified payment record e To delete a payment record select the desired record click the Delete button and confirm the deletion The Claim Payment History form maintains running totals of all claim payments posted to the selected claim When you have completed the payment posting activities for this claim click the Close button to return to the previous form The Institutional Claim List form will 131 PC ACE Pro32 User s Manual reflect the most recent payment date and total amount paid in the Paid Date and Paid Amount columns respectively
392. y while holding the ALT key down or lt ALT gt lt PAGE DOWN gt to scroll up down through all claim line items one page at a time Line Item Features The following productivity features are available on the Billing Line Items tab e Current Line Tracking The Billing Line Items tab contains a number of second level tabs The first second level tab Line Item Details displays the claim diagnosis codes as well as the basic line item fields available on the hard copy Professional claim form The remaining second level tabs are linked to the currently selected line on the Line Item Details tab As the cursor moves from one line to another on the Line Item Details tab the remaining second level tabs will track the new current line This technique provides an efficient method of providing access to a large number of data elements on a potentially large number of claim lines Notice that the Extended Details tab caption always reports the current line for reference e Diagnosis Pointer Field 24e Syntax The diagnosis pointer can point to as many as four of the twelve possible claim diagnosis codes For example a diagnosis pointer value of 1357 indicates that the service line references the first third fifth and seventh diagnosis codes No punctuation is necessary in the diagnosis pointer when pointing only to combinations of the first nine diagnosis codes However when pointing to the tenth eleventh or twelfth diagnosis codes each indi
393. yer is specified as primary ona Medicare claim then the primary payer will be designated as the submission payer In this scenario the secondary and tertiary payers are considered alternate payers Alternate Payers 1 and 2 are defined based on the claim s submission payer as follows Submission Primary Secondary Tertiary Alt Payer 1 Secondary Primary Primary Alt Payer 2 Tertiary Tertiary Secondary When a claim is printed for an alternate payer PC ACE Pro32 will attempt to populate the printed fields as though the selected alternate payer was the submission payer In general this means that the payer specific and provider specific information included on the printed claim will reflect the alternate Payer ID and LOB line of business For alternate payer printing to work most effectively all payers specified on the claim must be on file in the PC ACE Pro32 Payer reference file In addition provider records for the alternate claim payer LOBs must also be on file in the PC ACE Pro32 Institutional or Professional Provider reference file and must be associated with the submission provider record bS Tip This capability makes it easy to print secondary tertiary claims without requiring the creation of a separate claim for the alternate payer 129 PC ACE Pro32 User s Manual 130 hS Tip If a request is made to print an alternate payer that does not exist on the claim being printed the request will simply be ignored This behav
394. yone desiring access to the system The system administrator must set up a user account for each person that will use PC ACE Pro32 The user account specifies the user s login password values and defines which activities the user has permission to perform As shipped PC ACE Pro82 is configured with a single default user with full system access rights The default user s User ID is SYSADMIN and password is SYSADMIN as well Complete the following steps to add additional user accounts hS Tip You may want to refer to the Adding or modifying a system user topic for more information on adding and maintaining users If you do make sure and return to this topic to continue the setup steps 1 Select the main Security menu from the PC ACE Pro32 Main Toolbar and choose the Add Update User item The Security List form will display a list of all existing user accounts 2 To add a new user account click the New button on the Security List form and assign the user a User ID Password and Name Assign permissions to this user and click the OK button to save the new user record hS Tip Check the checkbox next to the permission to allow access to the activity Click the Check All and Clear All buttons to quickly check or un check all user permission checkboxes 3 Repeat the previous step to create additional user accounts Note If changes are made to a user profile the changes will not go into effect until the next time that u
395. you select the combined transmitted paid TR PD claims location Updates to the claim list are more efficient to process from this location since claims being moved from the transmitted TR to paid PD status will not force a requery of the list s contents Select the desired claim from the list and perform either of the following to access the claim s payment history e Select the Show Selected Claim Payments item from the Professional Claim List form s main Actions menu or from the convenient right click popup menu e Click the View button or double click the selected record to display the claim in the Professional Claim Form Click the Show Payment History button to access the payment history for this claim The Claim Payment History form lists all existing payments made to the selected claim if any Perform the desired payment related tasks from this list including e To post anew payment click the New button and enter the payment date on the Claim Payment Details form The Date Paid field is defaulted to the current system date and can be changed if desired Payment data for Professional claims must be entered on a per line item basis Click the Amount Paid cell for the line item to be paid click twice for edit mode enter the payment amount and press the ENTER or TAB key to accept the entry Complete some or all of the optional payment record fields and line item cells if desired The claim
396. you intend to process Professional claims All providers referenced on Professional claims must be represented in this reference file The Provider tab provides a convenient Sort By selection that quickly sorts the Provider list by LOB Type Provider Group Name Provider ID Group Label or Tag Operations available include e To add anew provider record click the New button and enter the new provider s information If providers already exist in this reference file you will have the option to create a completely new provider record or to inherit and associate the new provider record with the provider record currently selected in the list Select the desired creation options and click the OK button to continue See the discussion below for more information on provider inheritance and association e To view or modify an existing provider record select the desired record from the list and click the View Update button or double click the desired record e To delete an existing provider record select the desired record from the list click the Delete button and confirm the deletion amp Attention Claims are linked to provider records by an internal control number Deleting a provider record will irrevocably break any such links that may exist to claims in the system The Provider Deletion Confirmation form will be displayed when you attempt to delete a provider record This form outlines alternatives to deletion and
397. you will have the option to correct the errors or save the submitter record with errors Click the Save With Errors button to save a submitter record that contains only non fatal errors If edit validation errors occur several Save attempts may be required to correct and save a clean submitter record LOB Payer Specific Submitter Records In addition to the default submitter record the Submitter Setup form allows you to create submitter records that are specific to a particular line of business LOB a particular Payer ID or a combination of LOB and Payer ID This feature provides flexibility in cases where the submitter information to be included in the EMC file varies depending on the LOB and or Payer ID For example you might use this feature if you are required to prepare and submit your Medicare MCA MCB claims to a different claims processor than claims for other LOBs Likewise you might have a requirement to define unique submitter identification information Submitter ID address etc for a specific LOB and Payer ID combination When the prepare process generates a new submitter record the Submitter reference file is searched for the most specific match available For example assume that a Submitter reference file record for LOB MCA and Payer ID 12345 is defined in addition to the always present default record which has empty LOB and Payer ID values When the EMC file submission header for a batch of MCA claims for Pay

PC-ACE Release 2.7 User`s Manual

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