Louisiana Medicaid Management Information System (LMMIS)
Contents
1. B erm v Your Trace E Hotecfequs ed fiekds are m red Submit I Required fields are denoted in red on the web screen All required data fields must contain valid entries before processing continues The following table designates which fields are required Field Name Search Type Provider Last Name Provider ID Recipient ID Claim Charge Amount Required Data Validation Use the dropdown box to select General Search or ICN Search Maximum length 13 characters alohanumeric This field is automatically populated based on the provider log in authentication information 7 numeric This field is automatically populated based on the provider log in authentication information 13 digits numeric Numeric with 2 decimal places Date Revised 07 12 2010 eCSI Application User Manual Field Name Required Data Validation Dates of Service Type in dates of service or click on popup calendar and select calendar options If only a beginning date of service is entered the ending date of service will auto populate with the same date of service Your Trace The provider s unique code to link a transaction to a recipient The eCSI application validates selected fields to ensure that data is entered in an acceptable format and range criterion Many data fields require information to be entered in a specific format If the data entered is not in the proper for2. Chane Account info Prowiders Logout Help toll free 4 877 598 3754 E ProviderLogout Medicaid Claims Status Inquiry Web Application New Medicasd te mation Navigation Menu HIPAA Bros nition Centel eMEVS Mainienu Help His Billing instructions amp New Medicasd bled nation IMPORTANT DO HOT use the RACK browser butten pleats use the navigation nena Far Technical Support please contact 877 98 8753 Far Eligibility verification Support please choose the eMEVS Navigation Menu Option above or call 000 776 8323 or 223 HIP AS Billing Imetructionna E 7T15 7T38T to access RETS ENEE For ther Types of Assistance please contact Unisys Provider Relations at BOD 473 2765 ar 225 924 5040 iompanion Cgldea HIPAA into mation Cemer Dr ougtslet Tra Materiale Clear Sereen Search Type JOHN Search sl Ahde Medic sid lrovider Web Beeommi Boegistratieon bain yet ona D eulgdet Support rising bn eet ration Provider Update Hermgiacep Archie a ges Pharmacy Pres riling ICH Ld om Humpe providers YourTrace 0 0 Current Hegwaslettes Ac BA Hef ull Murder s Bote Required fields are n ied Submit FAG 3 3 2 Data Fields Required fields are denoted in red on the web screen All required data fields must contain valid entries before processing continues The following table designates which fields are required Field Name Required Data Validation Search Type Yes Use the dropdown box to
3. in a numeric field then a message is returned identifying the error All data must be entered in the correct format before processing continues The following is an example of an error message eCSI Error Message Medicaid Claims Status Inquiry Web Application Navigation Menu Search Response Printfriendly eMEVS Nam Menu Help IMPORTANT DO HOT use the BACK browser button please use the navigation menu For Technical Support please contact 877 598 8753 For Eligibility verification Support please choose the eMEWS Navigation Menu Option above or call 800 776 6323 or 225 216 7387 to access REYS For Other Types of Assistance please contact Unisys Provider Relations at BOO 473 2783 or 225 924 5040 Search Type General HEET Provider Last Name UNKNOWN Recipient ID adteactacd Claim Charge Amount Dates of Service iz Your Trace 4 Hote Required fields are in red Date Revised 07 12 2010 eCSI Application User Manual 3 1 3 Informational Messages During eCSI web screens processing the user is kept aware of the processing status through the use of informational messages If an informational message Is received the user does not have to initiate a corrective action The message is for informational purposes solely and the processing continues The following is an example of an informational message that is executed when the server is down and the user needs to try again later Medicaid Claims Status I
4. select General Search or ICN Search Provider Last Name Yes Maximum length 13 characters alohanumeric This field is automatically populated based on the provider log in authentication information Provider ID or NPI Yes 7 or 10 digits numeric This field is automatically populated based on the provider log in authentication information Date Revised 07 12 2010 eCSI Application User Manual Field Name Required Data Validation ICN 13 digits numeric Your Trace No The provider s unique code to link a am transaction to a recipient Search Type Yes Use the dropdown box to select General Search or ICN Search 3 4 Response Screen When all required fields of the inquiry page have been entered and the Submit button is selected the message is sent to the eCSI system The application returns a response providing information about a claim once a match has been established using the search criteria All original search data that has been entered on the inquiry page will be displayed on the response screen Related data is grouped together by subject matter An ICN Search uniquely identifies a claim thus the response is an exact match For inquiries by ICN it is possible to return status information about the claim history starting with the ICN that is input Adjustments will appear if the original claim was paid For example if the original claim were adjusted twice and the original ICN is input there
5. special or consequential damages Exercise caution to ensure the use of this information and or software material complies with the laws rules and regulations of the jurisdictions with the respect to which it is used The information contained herein is subject to change without notice upon DHH approval Revisions may be issued to advise of such changes and or additions Molina Medicaid Solutions is a registered trademark of Molina Healthcare Inc Copyright 2010 Molina Medicaid Solutions All rights reserved Date Revised 07 12 2010 i eCSI Application User Manual PROJECT INFORMATION Document Title Louisiana Medicaid Management Information System LMMIS XXX Application User Manual Technical Communications Group Molina Medicaid Solutions LMMIS QA Revision History 6 01 04 Section 1 0 2 0 3 0 Attachment A and Attachment B Section 3 1 3 Section 3 4 1 Section 3 4 2 B B Vazquez lt 6 29 04 B Vazquez and Attachment B 9 13 04 Sections 2 0 and 3 0 Replaced all screens 11 29 04 Sections 3 2 2 Data Fields and Section 3 4 Response Screens 01 10 05 Replaced all screens containing PHI Information 02 04 05 Replaced screens on pages 5 7 10 and 12 Blacked out the provider last name in the screens on pages 5 10 and 12 Blacked out the date of birth on the Response Screen on page 14 Section 3 2 2 and 3 3 2 Removed Org Name from Table Section 3 1 3 Added last line to first paragr
6. 29 DEPARTMENT OF T HEALTH aid MOLINA Medicaid Solutions AND HOSPITALS Medicaid Louisiana Medicaid Management Information System LMMIS Electronic Claims Status Inquiry eCSl Application User Manual Date Created 06 01 2004 Date Revised 07 12 2010 Prepared By Technical Communications Group eCSI Application User Manual Molina Medicaid Solutions and the Louisiana Department of Health and Hospitals Proprietary Data Notice The information contained in this document is proprietary to Molina Medicaid Solutions and the Louisiana Department of Health and Hospitals The information in this document shall not be reproduced shown or disclosed outside Molina Medicaid Solutions or Louisiana DHH BHSF without written permission Information contained in this document is highly sensitive and of a competitive nature NO WARRANTIES OF ANY NATURE ARE EXTENDED BY THIS DOCUMENT Any product and related material disclosed herein are only furnished pursuant and subject to the terms and conditions of a duly executed license or agreement to purchase services or equipment The only warranties made by Molina Medicaid Solutions if any with respect to the products programs or services described in this document are set forth in such license or agreement Molina Medicaid Solutions cannot accept any financial or other responsibility that may be the result of your use of the information in this document including but not limited to direct indirect
7. 924 5040 Warning Unauthorized use of this site or the information i Em Clear Screen Rid by ine Louisa Search Type General Search E Department of Health and Hospitals Provider Name DHH EXEC MGMT Provider ID 1209996 Recipient ID 1 13 Digit Number Claim Charge Amount 1 im Dates of Service CO B thru B mmiddiyyyy Your Trace 1 Note Required fields are in red _ Submit Date Revised 07 12 2010 eCSI Application User Manual 3 0 USING THE eCSI APPLICATION This section of the User Manual presents information on navigating through the application general search inquiry ICN search inquiry and the response transaction Providers are able to inquire on the status of a claim by performing a general search or an ICN specific search These two different search methods are provided in a pull down menu in the Search Type field eCSI Search Type Methods ESTEE e e STEIER sl ue Lia Seite Phong TH AIM Garey Pero 1 thes Gua Louis ENT aci p Poen nts Muri for Lecta Suppor cod nf ecc tar eM 2683 e A c u Ce Loos WP et nai Do wol uo fe TALE Drum Lafen idee see Te Fea a os eee Pte Mu O4 e 1 mo Tasten for Terura Support please contact 077 4P1711 sg Dn n d GE P oh NI fiw va rm Mere Cow e Sum er wi ARC 3 o D PPAR forms eng Comm SPOT AR per v eut oF er coe 690 H 225 For ther ty Vere ae PID TIRY 1o ect tS ead Oo Perens A for Gthar lyon of Ancitance pieste contact Use
8. CPi bec fees rei ee ra meme C nt Fr sche Ce Bimi AiE N h Ce Biere Foren Haler Elame Tete ce a cer Cham Sabor haere E giua Clos fe ses Rp al Cd ue Fe a Ck mm Pan or dm gain Wages a Esmit awe c Check Binh atid Eiere Dare Check bri Gee Geis ind ee vi op Pr oe he Ce Preece Code Boi diera i KS Gebel ud Pundel batter PR Typ Claims later atit irri Asii Chai abus Fa HER d Co mpi d Cie ue Fin Chim Esasemnt dom ere Pern Metis Beenie cu sec Rus Trein Page Gate bach n LEN Dee Bate of service Wr nhan Coke Pyme ea Code bied Hie jet ECH We A TTEN TETE ER Tape Zeg g s E xm Pie ee cere be pres Fux een pai HPA Jag np Coe 1T een seu eg oe En r m HFAA Ag Boon Gone dis Potties Origins Sores SS po aor Ae rad eel oes Be ial ro TARSAT Hr Ce eu H Ac re 3 SC RODOICER OE Eva eei eria Tht lar Mine fete etes emnes id AA Foi En Commen ARR auer Jona mi errors Fart As no d DOO Y TEPE P A SO Hau 08 AENSART CZE i rg Sete ee ae FiA A ed re PI enu Pi Par Pred rl du ey Bee Com PS erii mad par crine ind HFAA Jud Ern Ge T For mera Sebmded recite xam Cee ence mds BP A A Jud Ben Cos d EL Cr tir Rn nd eres id A2 a cr ZO OO OC ITAR Em AFAA Fe u DS ae 25217 VUE GSE HET TE HE Errare a Or LS e ET iey IE s EET uei ge Date Revised 07 12 2010 12 eCSI Application User Manual The following is an example of an ICN Search Response Screen Thi
9. PneizedRe vised Adiuckostion nfonmalion has been changed Claims Statues Clar ific ation PPA Sd zn Cade 117 Chain require zignelure on iks ndicalor HPO A8 Fieri Coda 465 Entis Original Signaler Original Charge Annount 4200 Claim Payrreenit Sarna Du Payment Meth Remittance or Check Hunni Statue Effectme Date E342 3 2 O0 Chesck or EFT Date Dade if ees vice TON 2 2 063 thi 1 Procedure Code 988212 Prin che Coste Blo lifes ICH fae Medical Record Hurnbwer DOO D D D 00000 0 DIOOIOICIC D DI Bill Type Traresesction nun on CPL 203 ar L I AXE CT Erg L8 Me dioad Louesane Medicakd Date Revised 07 12 2010 eCSI Application User Manual 3 4 2 Data Fields The Electronic Claim Status Inquiry application returns a response providing the following information about a claim Field Name Data Validation Search Criteria Search Type Denotes whether search mechanism was General or ICN ICN If ICN search methodology was entered denotes the ICN number Provider Information Name Provides the name of the servicing provider Provider ID or NPI Denotes the ID number for the servicing provider If the user logs in using NPI instead of Louisiana Medicaid Provider ID then NPI is displayed Telephone Provides the area code and telephone number for the servicing provider Sex Provides the sex of the subscriber Claim Information Claim Status Denotes whether a claim has been paid denied or pended Provides
10. any corrective action that is needed Claims Status Explains in further detail the status of the claim Clarification Original Charge Provides the original charge amount submitted by the Amount provider Claim Payment Provides the amount paid by the payer Amount Payment Method Denotes how the payment was made The alternatives are Automated Clearing House ACH Financial Institution Option Federal Reserve Funds Wire Transfer or non payment data Remittance or The Remittance or Check number Check Number Date Revised 07 12 2010 eCSI Application User Manual Procedure Code Provides the procedure code modifier s if Modifier s applicable ICN 13 digit numeric Internal Control Number Medical Record An internal number assigned by the provider Number Bill Type Code designation that is returned if the claim was associated with a UB92 claim Timestamp The date and time that the eCSI response was generated Date Revised 07 12 2010 eCSI Application User Manual 4 0 APPENDIX A INTERNET EXPLORER WEB BROWSER SET UP Prior to initial use of the eCSI Web User Screens the web browser setup must be implemented This will ensure that the latest change information is displayed to the user Using a Web Browser compatible with Internet Explorer v4 0 or higher Select the Tools menu selection Select the Internet Options selection At the General Tab page under the Temporary Internet Files section sele
11. aph regarding error message 0005 Restored document from 2005 pdf original and updated screen shots that contain left hand menu bar updated Section 2 0 05 05 06 Added Approval names and titles 08 08 08 Removed Approval page updated 2 0 and 5 0 for NPI 08 14 08 Reformatted pp 5 6 of 2 0 updated 3 1 1 3 1 2 3 2 2 and 5 0 in accordance with changes requested by PCT B Vazquez B Vazquez B Vazquez B Vazquez 03 18 05 B Vazquez 04 27 06 H Eyster Kearney S Triggs R Sheehan R Sheehan S Triggs R Sheehan R Sheehan 12 02 08 The application displays NPI if user logs in using 2278 R Sheehan NPI if user logs in using LA Medicaid ID LA Medicaid ID is displayed Following sections updated 2 0 Item 6 3 2 2 3 3 2 3 4 1 second screenshot 3 4 2 12 17 08 Formatted per approved user manual template n a R Sheehan and streamlined application access information Replaced Appendix B with a link in 1 0 Date Revised 07 12 2010 i eCSI Application User Manual 07 12 10 Logos updated Unisys gt Molina R Sheehan Date Revised 07 12 2010 Iii eCSI Application User Manual TABLE OF CONTENTS LO OVERVIEW E 1 EE ed ME 1 2 0 ACCESSING THE APPLICA HON eseu sees eseu seess 2 3 0 USING THE ECSI APPLICATION esee 4 3 1 Navigating Through the Application 4 3 1 1 SCLC Re e E d 3 1 2 Su
12. bmission Error E e TE 5 3 1 3 Informational Messages 1 eere eire reise seen nana a nans a anna a ana RE En 7 2 2 QOeheral Search SCreeN EE 7 24 2 1 Secreen Samples EE 8 222 ER A EE 8 23 9 ICN RE e E d atre a uses Venu n ui U tacui aS uE sa VE na urn UU ND VE RE NEU RR NEMUS 9 3 31 Sleen SAMDIOS met m 10 9 0 2 Data Field 900 07 2202020 220058 0202020 2200028 12005020 2000028 12020200 006 020 Teen 10 3 4 En e E E 11 44 1 Screen Samples EE 12 242 Dala Fields uicti eb t Fk p Ee aues exa pra EN ER VR Rd S 15 4 0 APPENDIX A INTERNET EXPLORER WEB BROWSER SET UP 17 Date Revised 07 12 2010 IV eCSI Application User Manual 1 0 OVERVIEW 1 1 Objectives The Electronic Claims Status Inquiry eCSI Web Application provides a secure web based tool for providers to inquire on the status of a claim within the adjudication process This application is accessible to all providers who have a computer with Internet access using a recent version of either Netscape Navigator or Internet Explorer browser software Providers must establish a valid online account with Louisiana Medicaid complete with a valid login ID and password in order to access the web based application The eCSl application enables providers to inquire on the status of claims i e paid denied voided etc using the HIPAA compliant Transaction Set 276 277 It is a real time application that processes in accordance wi
13. ct the Settings button At the Settings page select the Every visit to the page radio button oelect the OK button on the Settings page oelect the OK button on the Internet Options page Date Revised 07 12 2010
14. e Revised 07 12 2010 4 eCSI Application User Manual Louisiana i ad For Technical Support call Change Password Change Account Info Prowider Logout Kelp toll tree 1 877 588 8753 Frovicler Logout Medicaid Claims Status Inquiry Web Application Heu Medicaid Infarnation Navigation Menu IMPORTANT BO HOT use the BACE browser Irutton please use the navigation For Technical Support please contact 8771 599 6753 For Eligibility Verification Support please choose the MEWS Navigation Menu Option above or call 800 T 75 5323 or 225 216 7307 bs access REYS Far Other Types of Assistanca pleaza contact Linizyz Providar Relations at 473 2783 ar 225 924 5040 HIPAA information Center HIPAA Billing Instructions amp Search Type General Search lear Sereen Companion ande 4 Provider Traitins Materiale Provider Last Name EE RE Ahat Medicaid Provider Web Accoumt Provider Support E Recipient ff IT Ire peter Claim Charge Amount sd isa Date at Service E3 sm BS emmmer Your Trace s Hote Required fields are in red Submit e Select the Search link to perform a Claims Status Inquiry search by ICN or General Method e Select the Response link to view the claims status response screen e Select the Print Friendly link to view a print friendly version of the response screen e Select the eMEVS link to access the electronic Medicaid Eligibility Verification oystem e Select the Main Me
15. mat a message and an example of the required format are displayed Processing continues after all data on the page is entered in the correct format Character fields accept alphabetic numeric and special character data Character fields are NOT case sensitive for alphabetic characters Numeric fields accept only numeric values Monetary amounts must be a number with 2 decimal places No dollar signs and positive negative signs are accepted 3 3 ICN Search Screen The eCSI ICN Search methodology is discussed in this subsection This search methodology can uniquely identify a claim within the system by matching the ICN eCSI automatically populates the Provider Last Name and Provider ID fields based on the authentication process that occurs when a provider logs into the application The provider is required to enter the ICN only Required fields are denoted in red on the web screen When an ICN search inquiry is initiated the eCSI application checks the database against the following match criteria e Provider Billing or Servicing e ICN The eCSI application returns all claims where there is a match on provider and ICN If the provider has entered incorrect information in a field eCSI will echo back the correct data Date Revised 07 12 2010 eCSI Application User Manual 3 3 1 Screen Samples The following is an example of an ICN Search Home Screen eCSI Search by ICN Cours ficaid aem For Technical Support call Clanen Footed
16. nquiry Web Application Navigation Menu Search Response PrintFriendly eMEVS Main Mem Help IMPORTANT DO NOT use the BACK browser button please use the navigation menu For Technical Support please contact 877 598 8753 For Eligibility Verification Support please choose the eMEWS Navigation Menu Option above or call 800 776 6323 or 225 216 7387 to access REVS For Other Types of Assistance please contact Unisys Provider Relations at 800 473 2783 or 225 924 5040 Error Message 0005 Unable to Respond within required time limits 3 2 General Search Screen The eCSI General Search methodology is discussed in this subsection This search methodology can return multiple claims that meet the parameters supplied by the provider when the inquiry does not uniquely identify a claim within the system The provider may enter unique identifying elements to obtain an exact match The system automatically populates the Provider Last Name and Provider ID fields based on the authentication process that occurs when a provider logs into the application The provider is required to enter the Recipient ID number only however there are other search elements available for inquiry purposes Required fields are denoted in red on the web screen When a General Search inquiry is initiated the eCSI application always checks the database against the following match criteria e Provider Billing or Servicing e Recipient ID eCSl returns all claim
17. nu link to discontinue current processing at any page and return to the Provider Applications Area Main Menu e Select the Help link to obtain field specific help information e Select the Clear Screen link to clear a page and reset the page data fields to their default values There is a selection processing button that appears in the lower right hand corner of the web Screen e Select the Submit button to process the data entered on a screen 3 1 2 Submission Error Messages The eCSI application provides logical user friendly error messages during the submitting process to inform the user that an error has occurred and corrective action is needed When an error is detected a user is informed via a message box that an error has occurred The error message identifies the corrective action needed to fix the error If a required field is blank when the user selects the Submit button an error message dialog box is displayed indicating that the required field s is blank Most text fields require a certain number of characters to be entered If fewer than the required number of characters is entered a message will inform the Date Revised 07 12 2010 eCSI Application User Manual user that a minimum number of characters must be entered This sequence continues until the user has entered the appropriate information in all required fields If data entered in a specific field is in an incorrect format i e alohabetic instead of numeric data
18. of an ICN Search Response Screen where the original claim and an adjustment are displayed eCSI ICN Search Response Screen Adjustment Medicaid Claims Status Inquiry Web Application ix Navigation Menu Search Responsa Print Eriendiy eMEVS Mein Min Hein IMPORTANT DO HOT use thee HACE ber Caer Dutton phase use the nagigatin mee nin For Technical Support please contact 6775 538 8753 For Eligibility warlfication Support please choose the gMEYS Navigation Menu Opton above or call BD TT amp 6323 or 225 Phe TRA tn mormecce AES For Other Types of Assistance please contact Unisys Provider Relations at B00 473 2783 or 225 974 5040 Search Criteria Search Type KN Search ICH Provider Information Hamr Provider IL Telephone Subscriber lnfarmation Haan ember 10 Hunter Date of Birth Sx Claims Information Claim Status Find z e diPevy mert The clamine has been pesci Chine Status Clarification HIPAG Adi Ran Code 177 Cln requires gignure on dis indic Nor HIP E A been Code 4565 Erie z Original Signature Original Charge Aemmognt 42 00 Claim Paynem frneurnt 30 13 Payment Method Automated Clearing House EUCH Remittance or Check Humber EI Status Effective Date 120059 200g Cheek or EFT Date i Dais of cervice 1090 2 2003 thr 1022003 Procedure Code 99212 Procedure Code Modifier s KH Medical Rer ord WBurnber CRCMC D LC CHCHCRORT D in DL DI Ball Type Claims Information Clair Status
19. r fe 3e uonr at 6 473 270 cc C2275 924 3040 Caramanh unde s repr rem Pro Search Typa Gervetat Search Lal Virun ei WS freut eur L ori Herra Creo 0 MEN Ste M ien What Chee a freche Supper UM a Po teh Heme Irre Ames biz Ines Sm Wess IW Raijaa 1 if Ose Change Apgetgt Qe tt se ven Date of Saric Mute Your Trace Fu d Le 8 7 Puchequeed iets ue i rec wan De A provider is able to utilize the billing provider number or the servicing provider number whichever the provider used to log into the application If a billing provider number is used eCSI returns all claims for that billing provider regardless of the servicing provider If a servicing provider number is used eCSI will returns only claims where that provider is the servicing provider 3 1 Navigating Through the Application This subsection provides information on navigating through the eCSI application 3 1 1 Screen Buttons The selection processing functions that appear on the eCSI web user screen pages assist the user in navigating through the application There are six navigational links that appear across the top of the web screen These links are disabled if the function is not available from a particular screen In addition the Clear Screen link appears in the middle of the screen If the user s mouse hovers i e remains stationary for a period of time over one of these links a message appears to identify the purpose of the link Dat
20. r Technical Support cal Provider Applications Area toll free 8753 ia The application s listed below are for authorized use only Cli application n an application link to access the Provider Applications LAMEDICAID COM Fact Sheet Restricted Provider Applications Administrative Tools Administrative Tools PBM Submitter Contact Information Submitter Linked Provider Submitter Claims Denied All 9 Batch Eligibility Verification Zar Claim Status Inquin Prescriber Practices and Diabetes Management Admin Electronic Prior Authorization Provider Ownership Enrollment Medicaid Eligibility Verification System National Provider Identifier Immunization Pay For Performance P4P PACE 820 Report System Provider Locator Information Electronic Referral Authorization Pilot PA Requests for Case Managers Uncompensated Care Costs EDI Submission Application EDI Document Provider Appliostons Ares Note The list of applications shown here is comprehensive you may not see as many options on the Provider Applications page Date Revised 07 12 2010 eCSI Application User Manual 4 The Medicaid Claims Status Inquiry Web Application screen is displayed If you logged in using your NPI then your NPI is displayed For Technical Support call Change Password Change Account Info Provider Logout Help toll free 1 877 598 8753 Medicaid Claims Stat
21. s response is an exact match because the ICN Search uniquely identifies a claim eCSI ICN Search Response Screen Change Password Cher S rccamd lr Ernzer logan Help E Medicaid Claims Status Inquiry Web Application Navigation Menu Seah fespones Primi Fricmdi i Moie Monu Heip MP esr AT cr HMEST ee ite DUC ROI ieee LT fees g s 55 2 iles pt hn mh WT Ful d 53 For Technical Saippok please contact 677 525 57 Por Eligibility wmriFiraticm Support plassa chen the gREWS Hevigation Manu Caption abowe nr call BOR TTUE ESZ3 ar 225 zI1E T CHPT to errcegg BES For Stree Tapes of Gzcsctatsp Glesse Contact Unisys Provider Relations sr OB d 73 2743 or S25 924 5 idi Search Criteria Bean Type Tu 1 pc Provider infoarrmmatian Happ HPI Tieni pnriont aubecribesr lforieatian Hun Beri HER Huari er Date og Birth ET CH abris link nian Maint Stoarbuk Pine inae Pee ee Tha Che ee her bean pmid Cette Strie Cleric ation HFAA S Adj Pi Ceda O25 Cee har beer pmid Chrizgirial Charge Arman T Oo Qaim Pasar Aa ure a 43 BPoeratr zg Pele Pod ae Henua iA Fuamitence or Check Hamnbar t Statue ETc El mia Check ar EFT Cee Ceo 4 El urban o sarvim DERE 4 thr u Oe 1 Prace dure Code raiz Preece dure agas Foe fier eb m Bedice Raced Huber Bill Typa Trenton nun oi S00 e 82 EE CT DL oab er cepi Loir ieee Pe ec Date Revised 07 12 2010 eCSI Application User Manual The following is an example
22. s where there is a match on provider and recipient ID If the provider has entered incorrect information in a field the correct data echoes back Date Revised 07 12 2010 7 eCSI Application User Manual 3 2 1 Screen Samples The following is an example of a General Search Home Screen eCSI General Search See For Technical Support call toll free 1 377 598 8753 Provider Logout hew Medicaid information HIPAA Information Center HIPAA Billing instructions amp HIPAA Information Center HIPAA Information Center HIP AA Baling Inst uctions A Companion Guides About Me decd Provider Web Account Registi ation Instructions Provider Support Uden information Provider Update Renwttance Advice Index Pharmacy Preseribing Provide s Current keete and PA Recht Humbe s FAQ 3 2 2 Data Fields Change Password Change Account info Prowder Logout Help E Medicaid Claims Status Inquiry Web Application Navigation Menu RL Mam fiers Help EEN ap no deg the ke browser use the mavegeton menu uppo contact 07 j di b ty en tion Support p ease dn rep MEVS Menu Option above or call 800 776 6323 or 228 216 7387 to rare REV For Other Types of Acsista nlasse contact Unisys Provider Relations at 880 473 2783 or 225 924 5040 Search Type General Search v Clear Screen Provider Last Name Ried ID nes Recipient ID l 13 Dist Number Claim Charge Amount Le zs Dates of Service S thru
23. th the Health Care Claim Status Request and Response 276 277 Implementation Guide ANSI X12N 276 277 004010X093 May 2000 The database for the application maintains two years of claim information based on the claim s date of receipt On a daily basis claim activity including new claims adjustments voids and pended claims is extracted and passed to the UNIX ORACLE Database and is processed as new activity Claim status inquiry and response processes are supported for all LMMIS claim types Providers can inquire on the status of a claim by executing a search via a generic general method or by specific ICN Date Revised 07 12 2010 eCSI Application User Manual 2 0 ACCESSING THE APPLICATION 1 Open your web browser and enter the URL for the Louisiana Medicaid main menu http www lamedicaid com 2 Login in to the Provider Applications area in accordance with the instructions located on the Provider Web Account Registration Instructions link at htto www lamedicaid com provweb1 Provweb_ Enroll website enrollment htm not already have a web account this guide will explain how you get a web account to access provider applications If you do already have an account the guide explains how to login to the provider application area 3 Once you login the Provider Applications Area screen is displayed Select the Claim Status Inquiry link LoS aia un Change Password Change Account info Provider Logow el Fo
24. us Inquiry Web Application Provider Logout Navigation Menu Search Response PrintFriendly eMEVS Main Menu Help Warning Unauthorized use of this site or the information IMPORTANT DO NOT use the BACK browser button plase use the navigation menu contained herein is prohibited by the Louisiana For Technical Support please contact 877 598 8753 Department of Health and For Eligibility Verification Support please choose the MEVS Navigation Menu Option above or call 800 776 6323 or 225 Hospitals 216 7387 to access REVS For Other Types of Assistance please contact UnisysfProvider Relations at 800 473 2783 or 225 924 5040 Search Type General Search J Lead Screen Recipient ID e 13 Digit Number Claim Charge Amount ix Dates of Service thru sd mm dd yyyy Your Trace O Note Required fields are in red _ Submit If you logged in using your Louisiana Medicaid ID then your Provider ID is displayed Navigation Menu For Technical Support call toll free 1 877 598 8753 Search Response PrintFriendly eMEVS Main Menu Help IMPORTANT DO NOT use the BACK browser button please use the navigatiogymenu For Technical Support please contact 877 598 8753 For Eligibility Verification Support please choose the eMEVS Navigationf ienu Option above or call 800 776 6323 or 225 216 7387 to access REVS For Other Types of Assistance please contact Unisys Provider RelatfMs at 800 473 2783 or 225
25. would be chronologically three ICNs associated with the claim the original and two adjustments The response will contain information regarding the ICN on the inquiry plus all subsequent adjustments If the provider does not supply unique identifying elements and initiates a General Search the response includes multiple claims that meet the parameters supplied by the provider Date Revised 07 12 2010 11 eCSI Application User Manual 3 4 1 Screen Samples The following is an example of a General Response Screen This response includes multiple claims because only the Recipient ID was entered for the inquiry eCSI General Response Screen Medicaid Claims Statut m in Viet Application kom ation fincas Seu th Hespeswsse ivi ei bein f er Phi FA CEH II ES HOI rege Cas TEAE ee es p kasd uibs Ein eq lmdas Fze zitit Ber Technical Jippi pleats conmtagk DT 73393 8735 Fer Elbsgibilz aiheina mapper t plasia chogais tha GHEE Ma igetian Fans Opes abtve sr cad eee TT amp B23z23 or Z275 Elm TEET te access AES Ber Cibert Types al Aesiebasm paa aaar leisy e harjas Balai isaga a CEA ae ai CFF ps4 RB Search Criteria ear ILI Esc Miri EI Ieper InFnaeadinm Kaien eag belo peri athe Baa ro Bieber Ob hion rnr Coe vii ath Emn Disia letenn ation Ski ig ee Cine Su bee ris ee Ow mun dd Cle qa Fils Hol Chim Pern ann Am mar E ema Medd ped Fami ama cu Check Barbar Seng Meihe bn heck a
Download Pdf Manuals
Related Search