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PC-ACE Pro32 User`s Manual

1. T pr an ii EE Figure 45 Professional CMS 1500 Part B Provider Tab Pies GBA Pags i Geiober 2075 3 Determine if you plan to add or modify a record a To add a new Provider record click the New button The New Provider Options window will display Figure 4 6 Choose one of the options and click OK Ag avoryren Me eso ie bani ane and aenar anae aaas nieh Ai 10 7778 cape cde erect Sect deed open rici tution econ eum pac OS ee ES LET Er ee EEUU ee IER aa oe Ene BREE eer Sea me PESE aes soa FEE Pent tti t Note Professional field requirements will vary based on the Provider Type chosen radio buttons at top of window Part B Set up Group Practices before adding Individuals Group Afer you have completed your additions changes click the Save button located on the bottom right ofthe window The system will perform an edit validation on the entered information If you have not completed or incorrectly completed one or more required fields the Edit Validation Errors List will display Figure 4 9 This form lists all fatal and non fat
2. s HN n 6 meena _ mee ore SE FT rer E E ows Fg lg ne tena Are ST 9 When billing a National Drug Code NDC go to the Billing Line Items tab and the Line Item Details sub tab and enter in the Proc field 24d Select Ext Details 2 sub tab Figure 6 7 while on the claim line Enter NDC information under Line level Miscellaneous Information Pashia ore reenter Penn Cobain iri fere er mite m pret Wm O CE emm Tim E pue LI zm Em L H pee a Figure 67 Bling Line tems Ext Details 2 Sub Tab 10 When you have completed all of the sub tabs including all additional attachments of the Billing Line tems tab click on the Extended Patient General tab to display that section of the claim entry form Figure 6 8 iS PEACE Pros2 User s Manuals Section 6 Professional Claims Processing ED ames pese T tm M femen Moe Figure 68 Proessoral Claim Form Extended PatientGeneral Tab 11 E
3. Tit ESSE eA elope se cre tst ee il E Fee spirant niger jen ne nl Suites Figure 4 BackupRestore Tab Restore Sub Tab Specify the drive or folder where the backup file is located Place a check next to Restore system and user configuration settings Click the Start Restore button Note When restoring backup archives that span multiple diskettes insert the last diskette n the set first The system will prompt for the first and subsequent diskettes as the restoration proceeds 5 You will be notified when the restore operation completes 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 opened Paimetis GBA SECTION 10 SENDING AN EMAIL In addition to calling the Palmetto GBA Provider Contact Center toll free at 888 355 9165 RRB or 855 696 0705 Part A Part B HHH you can also initiate technical support email for general software related issues only directly from the PC ACE Pro32 system To send an email 1 Click the Send EMail button on the PC ACE Pro32 main menu 2 PC ACE Pro32 will launch your default email program 3 Ensure that the email is correctly addressed a For Part A Part B HHH and Railroad inquiries use the following email address medicare edi palmettogba com b For Ohio and
4. a metet rr T cer T f ei TI L HHL Figure 5 5 Institutional Chim Form Payer formation Tab 7 Begin entering payer data Fields that require free form text are shown on the tab as Form Locator buttons e g FLS6 To enter information into these fields a Click the FLS6 button and the Form Locator 56 popup window will display b inthe related information Press ENTER to start a new line if needed c When you have completed your entry press AB to close the pop up window 4 Follow the same steps with each Form Locator button on the Payer Information tab to complete the field entries for this portion of the claim form S When you have completed all of the fields on the Payer Information tab click on the Diagnosis Procedure tab to display that section of the claim entry form Figure 5 6 Prem eate buen oP Cee ee tun eget a x ise 7 m pp ee a I e m u n ET Figure 58 Institutional Claim Form DiagnosisProcedure Tab 9 Enter data into blank fields 10 Entera Y in the COB field if you have COB related information Note Entering a Y in this field will generate two new sub tabs to the Extended Payer tab COB Inf
5. epe rar pm roo Tee Pas cop nt Info amp Codes Tab Figure 3 Institutional Claim Form Begin entering patient and code data using your cursor or the AE key to move through the fields Note Many fields on this and subsequent tabs will fill automatically as other fields are completed with information pulled from the reference fles For example when you enter a Patient Control Number the patient s name address ete will automatically fill the appropriate fields If any of the automatically entered information is incorrect it cannot be changed from this tab You must exit the Claim Form and make the necessary change s directly to the proper reference file GBA Pags 25 Geiber 18 Section 5 Institutional Claims Processing 3 Fields that require free form text are shown on the tab as Form Locator buttons FLI To enter information into these fields Click the FLI button and the Form Locator 1 popup window will display b in the relevant information Press ENTER to start a new line if needed c When you have completed your entry press FAB to close the popup window 4 Follow the same steps with each Form Locator button on the tab to complete the field entries for this portion of the claim form 4 When y
6. AS nso EMC Oup Form Qual Mer Peonio Anite Sene pe Tse Ct ont du Jm rrr GBA 18 PC ACE Pro32 User s Manual Section 4 Reference File Maintenance i Complete all fields on the General tab ii On the Prepare Tab enter N in the Include Error Claims field Enter P in Submission Status field Enter A in the EMC Output Format field The ANSI Version 837 Prof is prefilled with 00501041 All other fields on this tab should be left as defaulted On the ANSI Info tab enter 27 in the Submitter Intche ID Qual and the Receiver Intchg ID Qual fields The Acknowledgement Requested field must contain 1 iv No updates required on the ANSI Info 2 tab 7 After you have completed your additions changes click the Save button located on the bottom right of the window S During the submitter save operation an edit validation process is performed on all submitter record files If no edit validation errors occur the submitter record is saved If one or more edit validation errors occur the Edit Validation Errors List will display This form lists all fatal and non fatal errors that occurred any fatal errors exist you must correct them before the submitter record can be saved IF only non fatal errors exist you can either correct the errors or save the submitter record with errors Click on Save with
7. Full Description and Flags The other fields should remain empty iam fe mm fates Cota aman Figure 43 Payer information Window Railroad Teave blank South PARA HEH TIGOT MCA Teave Blank Nor Carolina Par A TISUT MCA Teave Blank Virginia Par A TIOO3 MCA Teave Bari West Virgina T1003 MCA Teave Bari South Pan E 71202 MCB Teave Blank Nor Carolina Part B 71802 MCB Teave Blank Virginia Par E T1302 MCB Teave Bari West Virgina Pan E T1402 MCB Teave Blank Afer you have completed your additions changes click the Save button located on the bottom right ofthe window The system will perform an edit validation on the entered information If you have not completed or incorrectly completed one or more required fields the Edit Validation Errors List will display This form lists all fatal and non fatal errors that occurred Fatal errors indicated by a red X must be corrected before the system will allow you to save the information a Double click on a listed error to go to that location in the Payer Information form and make the necessary corrections fields with errors will be lashing red there are no fatal errors that must be corrected now those marked with red X you may close the Edit Validation Errors List and then click the Save With Errors button on the Payer Information form Pa
8. Select the appropriate value from the list and it will automatically be entered the claim form field Ifyou inadvertently make a change toa field you can press ESE which will undo the change and restore the field s original value Fly over hints provide a brief description ofa field s purpose They become visible when the mouse cursor pauses over the field When the focus leaves a particular field for example when you press the FAB key or click on a new field an edit validation is performed on the field losing the focus Edits performed at this time referred to as field level edits If a field level adit error occurs an audible tone will sound and the error message will display in the lower left comer of the claim form In addition the focus will remain on the field with the error so that you can correct the problem if desired If you choose not to correct the data at this time simply press FAB again to move to the next field Entering Institutional Claim Data To enter Institutional claims to the PC ACE Pro32 system 1 Select Enter Claims from the Institutional Claims Menu The Institutional Claim Form will display Figure 5 3 atest Pom rece m treet Par n2 Pacman 7 Pit ses Tats a aaj mmm m m TE deum deum
9. Reference File Maintenance for information on how to enter this data Getting Help In PC ACE Pro32 PC ACE P1032 has a number of helpful features that will assist you while entering information and using the system You can access specific and general PC ACE Pro32 Help from anywhere in the system Fly Over Hints While entering data into the various Reference Files and Claim Forms you can view helpful y over hints for most entry fields Simply hold your mouse cursor still over field and a small pop up will display with a description of the data to be entered into that particular field 4 Fixed or Variable List Lookups A number of fields in the Reference Files and Claim Forms support data entry using fixed lst or variable list lookups If you know the options for a particular field you can type in the selection or you can access the lookup list by right clicking the mouse over the field or click in the field and press F Once the list is visible you use your mouse to highlight and then click on your choice and it will be entered into the field Context Sensitive Access Press E from anywhere in PC ACE Pro32 to display help information relevant to your current location in the program Conventional Access Select Help on the PC ACE Pro32 toolbar and choose Help Topics From the Help Topics window choose one of the following tabs Contents Presents all help topics in a nested table of contents format Index Al
10. click on the record The Facility Information window Figure 4 23 will display Complete the fields ZIP Codes require full digits Palmetto GBA Manual Section 4 Reference File Maintenance a TE mese meme Figure 423 Facility Infomation Window 6 Afer you have completed your additionsichanges click the Save button located on the bottom right of the window DELETING AN EXISTING FACILITY RECORD To delete an existing record 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display 2 Click the Codes Mise tab 3 Under Professional click the Facility button The central field of the Facility Setup window will display a list of existing records 4 Highlight the desired record from the list click the Delete button and confirm the deletion Charges Master Reference File Codes Misc Professional The optional Charges Master Setup form provides access to maintain the Charges Master reference file If you choose to use this optional reference file it should be set up to include only those procedure codes that are to be used by the billing office rather than the entire HCPCS code universe Using a Charges Master reference file will reduce the size of the HCPCS code lookup lists during claim entry which promotes accuracy and enhances productivity A dollar amount may also be assign
11. filesin the backup 3 Click the Start Backup button The system will notify you when the backup is successfully completed Val No data is restored during the validation process so it is safe and advisable to validate an archive before attempting a restore operation To validate an existing backup file 1 From the System Utilities window click the Backup Restore tab and the Validate sub tab Figure late po INUENITUR E c ER ance bie reto orsi Mad El seriis Figure 3 BachupiRestore Tab Validate Sub Tab Specify tbe drive or folder where the backup file is located 3 Click the Start Validate button Note 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 4 The system will confirm details of the backup archive s integrity and display archive details date of backup ete Restore Important Note The restore operation will overwrite your current database files with older data from the specified backup To restore database files and configuration settings from a backup file 1 From the System Utilities window click the Backup Restore tab and the Restore sub tab Figure 94 Austin HE Pa is agin LT I Am
12. b The EMC file should be designated as a production or test submission c Claims with non fatal errors ERR are to be eligible for preparation When unchecked only processed claims will be eligible for preparation ck the Prepare Claims button Confirm your intention to prepare all eligible claims by clicking on the displayed confirmation Running totals of the count and dollar value ofall prepared claims will be displayed on the Claims Prepare For Transmission form You will be notified when the claim preparation operation completes 5 You can click the View Results and or View Errors buttons to view reports of the successfully prepared claims and rejected claims respectively These reports can be printed from the report previewer if desired 6 When you have completed your review of the claim preparation reports click the Close button on the Claim Prepare For Transmission form GBA Wage it Geisber 18 Section 7 Data Communications SECTION 7 DATA COMMUNICATIONS Before you are ready to transmit you must have already entered one or more claims and prepared these claims into an EMC file suitable for transmission Claim files ate located on the same drive on which the software is installed see Installation Instructions Section 2 step 2 and can be found under winpcace filename The filename for the Professional claim file is bstrans dat The filename for the Institutional claim file is betrans dat Part
13. A Part B HHH amp Railroad Claim Submissions To transmit your claim file exit PC ACE Pro32 Go to your communication software to send the file to GPNet Refer to the GPNet Communications Manual for information on GPNet and sending receiving data You may download a copy of the GPNet Communications Manual by visiting the Palmetto GBA website at www PalmettoGBA convEDI Select EDI from the link of Self Service Tools amp Top links Select your line of business and Software amp Manuals to locate the GPNet Communications Manual Page iz 18 SECTION 8 EXITING PRO32 To exit the PC ACE Pro32 Claims Processing System Close any data entry windows by saving or canceling as needed To close the Institutional Professional Claims Menu select File from the toolbar and then choose Exit you can also type or click on the x in the upper right corner of the screen To exit PC ACE Pro32 select File on the PC ACE Pro32 toolbar and then choose Exit you can also type AETH or click on the x in the upper sight corner of the sereen Note Every time you exit the program you will be prompted to perform a backup Figure 8 1 For more information on performing backups see Section 9 System Utilities adi jae pm ech ie PCAC Pecans A n ho ke ck te led tor DesyienDive a For Instone abi ee lb xp seat E
14. Claims option from the Institutional Claims Menu The Institutional Claim Prepare For Transmission window will display Figure 5 13 MEE px Figure 513 Institutional Claim Prepare for Transmission Specify from the drop down list if you want only a single line of business LOB to be considered or select lt All gt gt to include claims for any line of business If you specify an LOB a Choose single Payer or eAII Payers for LOB s gt gt to include claims for all payers b Choose one or more Providers or lt lt All Providers for Payer sj to include claims for all providers 3 Specify whether You want ANSI 837 EMC file output format b The EMC file should be designated as a production or test submission c Claims with non fatal errors ERR are to be eligible for preparation When unchecked only processed claims will be eligible for preparation 4 Click the Prepare Claims button Confirm your intention to prepare all eligible claims by clicking on the displayed confirmation Running totals ofthe count and dollar value ofall prepared claims will be displayed on the Claims Prepare For Transmission form You will be notified when the claim preparation operation completes 5 You can click the View Results and or View Errors buttons to view reports of the successfully prepared claims and rejected claims respectively These reports can be printed from the report prev
15. Errors to save a submitter record with non fatal errors Several Save attempts may be required to correct and save a clean submitter record DELETING AN EXISTING SUBMITTER RECORD delete an existing record 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display 2 Click the Codes Mise tab 3 Under the Shared list click the Submitter button The central field ofthe Submitter Setup window will display list of existing submitters 4 Highlight the desired record from the list click the Delete button and confirm the deletion Data Communications Reference File Codes Misc Shared Note This reference is not used HCPCS Reference File Codes Misc Shared Note This reference does not apply to Institutional Claims The HCPCS Codes form provides access to maintain the HCPCS codes used in the PC ACE Pro32 software Separate database files are used to maintain global and local HCPCS codes You can add and maintain global and local HCPCS Select the Global codes or Local codes radio button to display the desired list You can list all codes by clicking the top option under List Filter Options You can also filer the HCPCS code list to include codes starting with particular value descriptions starting with particular value or descriptions containing particular value Some HCPCS Codes are preloaded into Palmetto Pro32 Softwar
16. SAVE button located on the bottom right of the window DELETING AN EXISTING PHYSICIAN RECORD To delete an existing record 1 Clickthe Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display Click the Codes Mise tab 3 Under Shared click the Physician button The central field ofthe Physician Setup window will display list of existing records 4 Highlight the desired record from the list click the Delete button and confirm the deletion Facility Reference le Codes Misc Professional The Facility Setup form provides access to maintain the optional Facility Reference file You may enter Facility records for each frequently referenced facility if desired The facility reference file is available as lookup list from the Extended Patient General Tab on the Professional Claim Form ADDING OR MODIFYING A FACILITY RECORD 1 Clickthe Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display Click the Codes Mise tab 3 Under the Professional list click the Facility button The Facility Setup window will display Figure 42 dus E fete scr veste dee Figure 122 Faciity Setup Window 4 Determine if you plan to add or modify a record a add a new record click the New button b To update an existing record highlight the record and click the View Update button or double
17. The central field will display a list of existing patients Highlight the desired record from the list click the Delete button and confirm the deletion Codes Misc The Codes Mise tab Figure 4 14 ofthe Reference File Maintenance form provides access to many of the core PC ACE Pro32 reference files The reference file buttons are grouped under Shared files used by both Institutional and Professional Institutional only and Professional only Paimetis GBA Fal ron owt Pir Cue ur ee ndi Fur pem messer er rum em p Figure 41 Reference File Maintenance Codesise Tab Many ofthe reference files require setup before use while others are optional Submitter Reference File Codes Misc Shared Submitter information in PC ACE Pro32 is maintained from the Submitter Setup form for Institutional Part A and Professional CMS 1500 Part B claim types Information from the Submitter Reference File is required during preparation of Electronic Media Claims EMC files At east one default submitter record LOB lt lt All gt gt must be available before claims be prepared Additional LOB specifie submitter records may also be created if required ADDING OR UPDATING A SUBMITTER RECORD 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu for the Reference File Maintenance window 2 Click the Codes Mise tab 3 Under the Shared list click the Submitter bu
18. West Virginia Part B inquiries use the following email address ohwymedb email palmettogba com Be sure to include EDI in your subject GBA Section 11 Claim Activity Log SECTION 11 CLAIM ACTIVITY LOG The Claim Activity Log files provide details of all claim import process prepare and transmission activities The log files also record any abnormal activities that may occur in the course of operation Separate log files are maintained for Institutional and Professional claim activities The log files can be useful when researching past claim processing activity or reviewing the outcome of scheduled claim activities view a claim activity log file 1 Open either the Institutional or the Professional Claims Menu 2 Select View from the Claims Menu toolbar and then choose Claim Activity Log E Windows WordPad will launch and open the applicable log file Activities are logged chronologically with the most recent entries at the end of the file 4 When you are finished reviewing the log close the WordPad program Paimetis GBA diis PC ACE Pro32 User s Manual Section 12 Claim Printing SECTION 12 CLAIM PRINTING Claims can be printed in PC ACE Pro32 using either the traditional CMS 1450 UB 92 or enhanced CMS 1450 UB 04 Format The enhanced pre printed forms method or an advanced image overlay technique are also supported The pre printed forms method prints just the actual cl
19. and those defined in the ANSI XI2 implementation Only the Approved and OTAF Obligated To Accept In Full amount fields are actually needed to process COB claims in the newer ANSI X12 format All remaining fields in this group can be reported using equivalent values in the SVD or CAS field groups For backward compatibility PC ACE Pro32 will continue to recognize and report values in these obsolete fields whenever it is practical to do so 13 After completing all of the data entry on the claim form click the Save button or press RETE to save and exit the claim Note clicking the Cancel button will abandon all changes made to the claim When you click the Save button PC ACE Pro32 begins an Edit Validation process One or of the following edits may be required a Atleast 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 that 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 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
20. are cleared automatically in the new claim Datta Cui or Delete button Deleted claims are assigned DEL status Note DEL status claims can be recovered undeleted Purge Claim Claims in the pre iransmitted CL location with a DEL status will be purged from the system Note Purged claims cannot be recovered Paimetis GBA Option M esie Selected X Move selected claims rom the previously transmitted TR or pax PD location into the pre transmitted CL location The reactivated claim will be assigned the unprocessed UNP status Waid Claim X Changes the status of the selected claim to hold HLD Held claims are not considered for future claim activities such as automated claim processing or claim preparation Pant Seacied Gaim X Claims may be printed using either a plain paper image overlay technique or the traditional pre printed form method Adobe Acrobat Reader version 4 0 is required for this function Archive Claims X Moves the selected claim from the transmitted TR and paid PD locations to the open claim archive database Show Selected Gaim Allows you to pos view or modify payments forthe selected claim Payments Ser Selected Claim X Designates the selected claim for ether electronic or paper submission Media Only claims with a media setting of electronic E will be eligible for pr
21. button file folder Figure 41 PCACE Pro32 Claims Processing Toolbar Payer Reference File The Payer tab of the Reference File Maintenance form provides access to maintain payer information Setup of the payer reference file is required to process claims Palmetto GBA Medicare Payer IDs are now preloaded in the software ADDING OR UPDATING A PAYER RECORD 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display Click on the Payer tab to display the Payer information Figure 4 2 The central field will display a list of existing payers if any Using the radio buttons just below the list you can sort the list by Payer ID Payer Description Payer LOB or Payer State S PII Eu e Ei gre 42 Reference Payer Tab 3 Determine if you plan to add new record or modify an existing record a To adda new Payer recond click the New button You can also highlight an existing Payer and click the Copy button to create a new record using information from an existing record b To update an existing Payer record highlight the record and click the View Update button or double click on the recon 4 The Payer Information window Figure 4 3 will display Complete each of the following fields the table below has values for each of these fields Payer ID LOB
22. chaim evel 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 Outpatient Adjudication MOA use Enter or select the Code which defines the amount type to e reported and enter the corresponding Amount value 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 Figure 6 11 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 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 r
23. designated as the submission payer b Ino edit validation errors occur the claim is saved with a clean CLN status Ione or more edit validation errors occur the Edit Validation Errors List form will display indicating fatal and non fatal errors You may correct the errors or save the claim with errors Note Ifa fatal error exists in the LOB PCN or field you must correct the error before being allowed to save the claim 1 To save a claim that contains only non fatal errors click the Save With Errors button These claims are saved with a has errors ERR status i save a claim that contains fatal errors click the Save With Fatal button Such claims are assigned the has fatal erors ERF status Claims with an ERF status are not eligible for preparation into an electronic EMC file 14 If edit validation errors occur several Save attempts may be required to correct and save a clean claim At any time you can click the Errors List button to review remaining edit validation errors PC ACE Pro32 User s Manual Section 6 Professional Claims Processing Medicare Secondary Payer Claim Examples LINE LEVEL ADJUSTMENTS Claim Example A Claim Amount 185 00 ee Jered rete En ume leere tumore e ater cawan ore Lic Rc sp kw ae E sf a T a a EXE 3 SEE E TFT I
24. one of the Sort By options radio buttons below list If you want to filter the claim list select the desired filters from the Claim List Filter Options drop down lists Paimetis GBA Pags SU 18 CHA ED x swear oni n onem Figure 511 Institutional Claim List Window CLAM ACTIONS To perform an action on one more claims 1 Highlight the single selected claim or choose multiple claims by clicking in the left hand column to place a checkmark next to each selected claim Perform the desired action Primary actions have conveniently placed buttons located atthe bottom of the form Additional actions can be chosen by selecting the Actions menu on the Claim List toolbar you can also right click over a selected claim to view a pop up menu Available claim actions are described in the table on the following page An X in the M column indicates that the action menu option can be performed on multiple claims Menu Option tion Create New clam Access blank Institutional Claim Entry oF New button View Selected View andlor modify the selected claim or ViewlUpdate bution Copy Selected Gian The Institutional Claim Entry Form will display containing details of the r Copy button highlighted claim Some fields are cleared automatically in the new claim Delete Selected Cim X Deleted c
25. to move the claim from the pre transmitted CL location to the transmitted TR location CLAIM List REPORTS PC ACE Pro32 gives you the ability to view several reports and a number of special print functions To view a detailed report of the currently listed claims 1 Select Reports from the Claim List toolbar 2 Choose Print Claim Detail Report The previewed report may be printed if desired by clicking the printer button at the top of the report preview form To print all or a subset of claims currently eligible for paper submission 1 Select Reports from the Claim List toolbar 2 Choose Print Claims for Paper Submission A claim is eligible for paper submission if it has a media setting of paper resides in the pre transmitted CL location and has a clean CLN status or optionally a non fatal errors ERR status 3 After each eligible claim is printed you will be prompted to move the claim to the transmitted TR location When multiple paper claims are eligible for submission you may use the Yes To To All buttons to move not move all eligible paper claims to the transmitted TR location after printing Adobe Acrobat Reader version 4 0 is required for this function Note Since paper claims will never be prepared into an EMC file this prompt provides the only available mechanism for moving these claims out of the pre transmitted CL location Automated Claims Processing The Proce
26. will display in the lower left comer ofthe claim form In addition the focus will remain on the field with the error so that you can correct the problem if desired If you choose not to correct the data at this time simply press FAB again to move to the next field Entering Professional Claim Data enter Professional claims into the PC ACE Pro32 system 1 Select Enter Claims from the Professional Claims Menu The Professional Claim Form will display Figure 6 3 Tomer eit tins Fe Punt IEEE aro atento _ FF d RE e Rene N RON DE po _ mis Der Pant Pree T LT 10 foment DU BOI Dam Dei IS EUMD ui qe wm al OLI T DEI a Rm Re Ene T T TT T Tox _ iral 1 paisa Sram m spese BA rem m Rem Figure 3 Professional Claim Form Patient info amp Genera Tab 2 Begin entering patient and general data using your cursor or the EAE key to move through the fields Note Many fields on this and subsequent tabs will fill automatically as other fields are completed with information pulled from the reference files For example when you enter a Patient Control Number the patiens name address ete will automatically fill the appropriate fields If any of the automatically entered information is incorrect it cannot be chang
27. with the new claim archive open in the window To archive a claim 1 Open claim archive into the Claim List form see steps above Select File from Claim List toolbar and then choose View Archived Claims The claims in the open claim archive will display 3 Select File from Claim List toolbar and then choose View Current Claims to toggle back to the current claims Palmetto GBA Pags 6r 2075 PC ACE Pro32 User s Manual Section 14 Archiving 4 Only transmitted and paid claims can be archived Therefore under Claim List Filter Options at the bottom of the window choose TR transmitted only or TR PD transmitted paid from the Location fied 5 Toarchive a A single claim highlight the desired claim b Several claims place a check in the let column next to each desired claim 6 Select Actions from the Claim List toolbar and choose Archive Selected Claim for a single claim b Archive All Checked Claims for more than one claim 7 The claim s will disappear from the current claim list 8 To view the claims you just archived toggle back to the claim archive by selecting File from the Claim List toolbar and choosing View Archived Claims 9 When you are finished reviewing the claim archive select File from the Claim List toolbar and choose View Current Claims 10 Select File from the Claim List toolbar and choose Close archive im Archive to close the open claim 11 You will be prompted
28. 999nnnnn 999 999 where nnnnn represents a sequential number Download a File b Referto the GPNet Communications Manual 3 Place the downloaded file in the appropriate folder CAWINPCACE Ansi997 Ack1500 for Professional 999 reports bs CAWINPCACE Ansi997 Ackub92 for Institutional 999 reports 4 Open PC ACE Pro32 Ifyou wish to view the files in the Pro32 Previewer no change is necessary default If instead you wish to open the file ina modifiable Notepad file you must make this preference change before continuing Click File from the main menu Select Preferences Figure 15 1 and then check Use Windows Notepad instead of built in previewer to view response reports CI X 4 cus ies mos aet ces Ae Hb mtn ig dir T Toth rs nen lia ertt Fate vacabat Women dre cate cha 1 Shon estat or dam tenerlo M rot erpiar pee atra Hats eines dn Rc neu Ses P dona aeta aot c dm A cle a e etis min Fe ens e dt n Fonte ca mami PEN ila mona chap detent tc ea are AS eur diy En seen il hag s ciere Sara zi int ok E Figure 41 Preferences Window 6 From your PC ACE Pro32 toolbar Figure 15 2 click on the Inst or the Prof button Paimetis GBA Figure 152 PC ACE Pro32 Toolbar 7 In the Institutional or Professional Claims Menu Figure 15 3 click on Maintain and choose Ackno
29. B HHH amp Railroad Claim Submissions 52 SECTION 8 EXITING PC ACE PRO32 53 SECTION 9 SYSTEM UTILITIES 54 Backup 54 Validate 55 Restore 55 SECTION 10 SENDING AN EMAIL 57 SECTION 11 CLAIM ACTIVITY LOG 58 SECTION 12 CLAIM PRINTING 59 SECTION 13 REACTIVATING PREVIOUSLY TRANSMITTED CLAIMS 60 Individually Reactivating Transmitted Claims 60 Reactivating an Entire EMC File for Retransmission 60 SECTION 14 ARCHIVING 62 Unarchiving Claims 6 SECTION 15 USING PC ACE PRO32 TO TRANSLATE 999 AND277CAREPORTS 64 Translating the 999 Report 64 Translating the 277CA Report 66 PC ACE Pro32 User s Manual Section 1 Introduction SECTION 1 INTRODUCTION PC ACE Pro32 is a complete self contained electronic processing system for healthcare claims submission and management It can be used in a stand alone configuration or in conjunction with your existing claims management system The system has been designed to work exclusively with the Microsoft Windows operating system The PC ACE Pro32 program is available either on a CD or as a download from our website www PalmetioGBA com medicare See the next page for information on accessing downloading and installing the software Minimum System Requirements SVGA monitor resolution 800 x 600 4 Windows 8 Windows 7 or Vista operating system Adobe Acrobat Reader Version 4 0 or later for overlaid claim printing This free software can be downloaded from the Adobe web
30. Figure t1 System Backup Prompt Ifyou do not want to perform the backup at this time press Cancel and PC ACE Pro32 will close PC ACE 2 SECTION 9 SYSTEM UTILITIES To reach the System Utilities click the System Utilities button from the PC ACE Pro32 main menu Figure 9 1 Vion Heb Jallalla Ersten ites Figure 31 PCACE Pro32 Claims Processing Nenu The System Utilities window Figure 9 2 will display You can perform complete database backup validation and restore functions from PC ACE Pro32 System Utilities All claims reference fles and system configuration settings can be backed up to either removable media diskette writeable CDROM or a standard Windows directory local or remote In the event that a catastrophic system failure results in the loss or compromise of PC ACE Pro32 data a complete database restore operation can be performed from the most recent backup teorie tere Thay pre lane PACE Pate darter tin E vede chats le hu dica sedere lessen Figure 92 System Window Backup is 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 schedu
31. Physician Reference File Codes Misc Shared 19 Adding or Updating a Physician Record 19 Deleting an Existing Physician Record 20 Facility Reference File Codes Misc Professional 20 Adding or Modifying a Facility Record 20 Deleting an Existing Facility Record 21 Charges Master Reference File Codes Misc Professional 21 Adding or Modifying a Charges Master Code 21 Deleting an Existing Charges Master Code 23 SECTION 5 INSTITUTIONAL PART A CLAIMS PROCESSING 24 Using the Institutional Claim Form 24 Entering Institutional Claim Data 25 The Institutional Claim List 30 Lr EE Wai 18 PC ACE Pro32 User s Manual Table of Contents Claim Actions Claim List Reports 32 Automated Claims Processing 32 Preparing Claims for Electronic Transmission SECTION 6 PROFESSIONAL CMS 1800 PART B CLAIMS PROCESSING Using the Professional Claim Form 34 Entering Professional Claim Data 35 Medicare Secondary Payer Claim Examples a Line Level Adjustments 41 Claim Level Adjustments 43 The Professional Claim List 45 Claim Actions 45 Claim List Reports 46 Preparing Claims for Electronic Transmission 46 Roster Billing 47 Adding a new roster billing 47 Listing Modifying and Maintaining Roster Billings 48 Generating Roster Billing Claims 49 Automated Claims Processing 50 Preparing Claims for Electronic Transmission 50 SECTION 7 DATA COMMUNICATIONS 52 Part A Part
32. Pro32 Figure 25 PCACE Pro32 Startup leon 02 Section 3 Getting Started SECTION 3 GETTING STARTED Logging Into the Pro32 Claims Processing System Users are required to log into PC ACE Pro32 before performing any system activities The login process involves entering a User ID and Password Your PC ACE Pro32 software has been configured with a single default user the system administrator who has foll system access rights The default User ID is SYSADMIN and the password is SYSADMIN as well If you are logging into PC ACE Pro32 for the first time you should use this default login Important You should change the default user s password as soon as possible if you are concerned about controlling user access at your facility System Users PC ACE Pro32 requires that a valid login and password be entered by anyone accessing 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 the activities that the user has permission to perform Only users with User Add Modify privileges can perform these maintenance functions which include adding new user and modifying information on an existing user ADDING OR MODIFYING A USER add new user or modify an existing user 1 Select Security from the PC ACE P1032 Toolbar and choose Add Update User The Sec
33. S PALMETTO GBA A CELERIAN GROUP COMPANY A CMS Medicare Administrative Contractor PC ACE Pro32 User s Manual For ANSI X12N 837 v5010A1 Prof For ANSI X12N 837 v5010A2 Inst October 2015 PC ACE Pro32 User s Manual TABLE OF CONTENTS Table of Contents SECTION 1 INTRODUCTION 1 Minimum System Requirements 1 Technical Support 1 SECTION 2 ACCESSING amp INSTALLING PC ACE PRO32 2 Accessing PC ACE Pro32 from the Palmetto GBA Website Installation Instructions 3 SECTION 3 GETTING STARTED 5 Logging Into the PC ACE Pro32 Claims Processing System E System Users 5 Adding or Modifying a User 5 Building Your Reference Files 6 Getting Help In PC ACE Pro32 6 Logging Out of PC ACE Pro32 6 SECTION 4 REFERENCE FILE MAINTEN 8 Payer Reference File 8 Adding or Updating a Payer Record 8 Deleting an Existing Payer Record 10 Provider Institutional and Professional Reference File 10 Adding or Updating a Provider 10 Deleting an Existing Provider Record 12 Patient Reference File 12 Adding or Updating a Patient Record B Deleting an Existing Patient Record 14 Codes Mise 14 Submitter Reference File Codes Mise Shared 15 Adding or Updating a Submitter Record 15 Deleting an Existing Submitter Record 17 Data Communications Reference File Codes Misc Shared 17 HCPCS Reference File Codes Misc Shared 17 Adding or Updating a HCPCS Code 17 Deleting an Existing HCPCS Code 18
34. Senco Thu Dale Id lam erty TT Uco the Pyar eee far Piolessional cur chasad samico okue T oriy Revene Code wih ront sage lookups IF Erste sanke Ine tel Crag accidere ding isla lim erty Figure 426 Preferences Window 9 Click the OK button DELETING AN EXISTING CHARGES MASTER CODE To delete an existing code 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display 2 Click the Codes Mise tab 3 Under Professional click the Charges Master button The window will display list of existing codes tral field of the Charges Master Setup 4 Highlight the desired code from the list click the Delete button and confirm the deletion PC ACE Pro32 User s Manual Section 5 Institutional Claims Processing SECTION 5 INSTITUTIONAL PART A CLAIMS PROCESSING Once your reference files have been established you can begin claims processing The Institutional Claims Processing option on the PC ACE Pro32 main menu button highlighted in Figure 5 1 gives you access to the Institutional Claims Menu Figure 5 2 Vien Heb E S D Figure 1 PCACE Pro32 Claims Processing Nenu le allchnents Harb Figure 52 Institutional Claims Menu From the Institutional Claims Menu the following operations are available Imp
35. TT es a 3 or EE Figure 12 Lire Rem Details Tab B Line Level Adjustments CAS Patient Responsibility 50 00 Deductible Amount Paid by Primary SVD 0 00 13 09 TTT E aa re aa igri pases rie on me E a es ci O JBE m e ee 222 tne ier Paimetis GBA Page dt Geiober 18 PC ACE Pro32 User s Manual Section 6 Professional Claims Processing Eme a EE MLLLS E D n nil ae E ee EE oer ae or EIE Figure 6199 MSPICOB Line 2 Tab E Zero Payment Indicator N Payment was greater than zero F Amounts 1 Payor Paid Amount D 100 00 2 Patient Allowed Amount Owed EAF 65 00 sees nen a tenda a annette E yr e me mun es ET Figure MSPICOB Line 1 Tab Faimes sx PC ACE Pro32 User s Manual 99 Insurance Type 12 Working age beneficiary Section 6 Professional Claims Processing Pr rte SP er Pere CBI mp OB o Beet olen T Led lt Figure 615 Primary Payern
36. ady Electronic Media Claims EMC file EMC files contain submission details for one or more processed claims Only claims in the to be generated GL location that have 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 GR location which prevents the claim from being inadvertently retransmitted Note Before preparing claims for the fist time you will need to set up your Submitter Reference File This file contains important data that will be used to build the EMC file To generate an EMC file 1 Select the Prepare Claims option from the Professional Claims Menu The Professional Prepare For Transmission window will dila Figure 6 25 retest awn prepare Fe WEBKD O EH SERES ruere routine Den Figure 625 Profesional Ciaim Prepare for Transmission Paimetis GBA Section 6 Professional Claims Processing 2 Specify from the drop down list if you want only a single line of business LOB to be considered or select lt All gt gt to include claims for any line of business If you specify an LOB a Choose single Payer or eAII Payers for LOB s gt gt to include claims for all payers b Choose one or more Providers or lt lt All Providers for Payer s gt gt to include claims for all providers 3 Specify whether You want ANSI 837 EMC file output format
37. aim field values at positions on the page that should line up with pre printed CMS 1450 Institutional UB92 or CMS 1500 Professional claim forms or enhanced CMS 1450 UB 04 for both Institutional and Professional The image overlay 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 plain paper The image overlay method requires the use of Adobe Acrobat Reader version 4 0 or higher This five software can be downloaded from the Adobe website www adobe com new default Form Version selector has been added to the Printing Preferences screen to allow selection of the default claim version The available form versions for Institutional claims are the Traditional CMS 1450 8 92 and enhanced CMS 1450 UB 04 Format Simply choose the claim version you plan to use most often when printing claims A corresponding Form version selector has been added to the Claim Print Options form to allow override of this default form version each time claims are printed To print a claim or selection of claims 1 From the PC ACE Pro32 main menu click either the Institutional Claims or Professional Claims Menu button to open the corresponding Claims Menu 2 Click List Claims on the Claims Menu to display the Claim List form 3 You can print single claim or a selection of claims a To print a single claim highlight the desired claim S
38. al errors that occurred Fatal errors indicated by a red X must be corrected before the system will allow you to save the information Palmetto GBA PC ACE Pro32 K LOB Ie gt welid eons Provider 09000000609 K D Marte Postion unen Teo Coda 6000000000 ny Figure 49 Edt Validation Errors Lit 2 Double click on a listed error to go to that location in the Provider Information form and make the necessary corrections fields with errors will be flashing red b Ifthere are no fatal errors that must be corrected now those marked with a red X you may close the Edit Validation Errors List and then click the Save With Errors button on the Provider Information form DELETING AN EXISTING PROVIDER RECORD Important Note Claims are linked to provider records by an internal control number Deleting a provider record will irrevocably break any such links that may exist in claims in the system delete an existing record 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display 2 Click on either the Provider Inst tab or Provider Prof tab On each of these tabs the central field will display list of existing providers 3 Highlight the desired record from the list and click the Delete button The Provider Deletion Confirmation will display Figure 4 10 and outline alternat
39. de claims for all payers b Choose one or more Providers or lt lt All Providers for Payer sj to include claims for all providers 3 Specify whether You want ANSI 837 EMC file output format b The EMC file should be designated as a production or test submission c Claims with non fatal errors ERR are to be eligible for preparation When unchecked only processed claims will be eligible for preparation 4 Click the Prepare Claims button Confirm your intention to prepare all eligible claims by clicking on the displayed confirmation Running totals of the count and dollar value ofall prepared claims will be displayed on the Claims Prepare For Transmission form You will be notified when the claim preparation operation completes You can click View Results and or View Errors to view reports of the successfully prepared claims and rejected claims respectively These reports can be printed from the report previewer if desired 6 When you have completed your review of the claim preparation reports click the Close button on the Claim Prepare For Transmission form The PC ACE Pro32 Roster 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 Pro
40. e ADDING OR UPDATING A HCPCS CODE 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display 2 Click the Codes Mise tab Palmetto GBA Page iT 18 T bp chs 3 9 ss eas zl Figure 18 HCPCS Codes Window 4 Choose Global Codes or Local Codes from the radio buttons at the top of the window Determine if you plan to add or modify a code a To add a new code click the New button b To update an existing code highlight the code and click the View Update button or double click on the code 6 The HCPCS Code Information window Figure 4 19 will display Complete the fields Enter the effective date range using a 4 digit year format Dein mr mam ras 7 After you have completed your additions changes click the OK button located on the bottom right of the window DELETING AN EXISTING HCPCS CODE delete an existing code 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display Click the Codes Mise tab Under Shared click the HCPCS button The HCPCS Code window will display Choose Global Codes or Local Codes from the radio buttons at the top of he window Hi
41. e Claim List form Gerne cribs Sena Dini le De Loater CL termed E Stake J aar oe SSE EE TT Dos Figure 6 19 Professional Claim List Window 1 Select the List 2 Choose one of the Sort By options radio buttons shown just below list Claims option from the Professional Claims Menu 3 Ifyou want to filter the claim list select the desired filters from the Claim List Filter Options drop down lists CLAIM ACTIONS perform an action on one or more claims 1 Highlight the single selected claim or choose multiple claims by clicking in the left hand column to place a checkmark next to each selected claim 2 Perform the desired action Primary actions have conveniently placed buttons located at the bottom of the form Additional actions can be chosen by selecting the Actions menu on the Claim List toolbar you can also right click over a selected claim to view a pop up menu Available claim actions are described in the following table An X in the M column indicates thatthe action menu option can be performed on multiple claims Menu Option Description of Action Access a blank Professional Claim Entry form View Ciim View andlor modify the selected claim or ViewlUpdate bution Copy Selected Clam The Professional Claim Entry form will display containing details ofthe button highlighted claim Some fields
42. e Extended Payer Insured tab The purpose and use of the various field groups on these sub tabs are as follows Common Payer MSP Information This field group exists primarily to provide a bridge between the MSP COB reporting standards defined in the older NSF format and those defined in the ANSI X12 implementation Only the amount Paid by primary payer amount Allowed by primary payer the Insurance Type OTAF Obligated To Accept In Full Amount if applicable Zero Payment Ind and Claim Adjudication Date fields are actually needed to process MSP COB claims in PC ACE Pro32 Chim 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 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 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 manua
43. ed Tabs click on the right arrow at the right of the tabs to Tab See the Primary Insured Tab above for details After you have completed your additionslchanges click the Save button located on the bottom right ofthe window The system will perform an edit validation on the entered information If you have not completed or incorrectly completed one or more required fields the Edit Validation Errors List will display Figure 4 13 This form lists all fatal and non fatal errors that occurred Fatal errors indicated by a red X must be corrected before the system will allow you to save the information DX FerentLoe ret Ferre nendPirer Payer D let On Fi Nerius Or Rested Uno aman Payer Namee Paqurea Fomor Foyer Faro icu ob acu eee eee Figure 12 Edi Validation Errors List Double click on a listed error to go to that location in the Patient Information form and make the necessary corrections fields with errors will be lashing red b Ifthere are no fatal errors that must be corrected now those marked with a red X you may close the Edit Validation Errors List and then click the Save With Errors button on the Patient Information form DELETING AN EXISTING PATIENT RECORD delete an existing record Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display with the default tab Patient displayed
44. ed from this tab You must exit the Claim Form and make the necessary change s directly to the proper reference file 3 When you have completed entering information into the Patient Info and General tab lick on the Insured Information tab to display that section of the claim entry form Figure 6 4 Paimetis GBA Pags 3s Section 6 Professional Claims Processing a a i 8 1 T sare a T f GES TES Figure 64 Professional Claim Form Insured Information Tab 4 Enter data into blank fields When you have completed the fields on this tab click on the Billing Line Items tab to display that section of the claim entry form Figure 6 5 iene eee betae BE dis GE dia IIT a rrr rrr ks rT 3 a ana FERES Figure 65 Biling Line toms Tab Line lem Details Sub Tab The Billing Line tems tab contains a number of sub tabs The first sub tab Line Details displays the claim diagnosis codes as well as the basic line item fields available on the hard copy Professional CMS 1500 claim form The remaining sub tabs are l
45. ed to each entry This value is automatically brought forward to the claim line item Charges field when a valid Charges Master code is entered during claim entry You can list all Charges Master codes by clicking the top option under List Filter Options You can also filter the Charges Master code list to include codes starting with a particular value descriptions starting with particular value or descriptions containing particular value ADDING OR MODIFYING A CHARGES MASTER CODE 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display Click the Codes Mise tab 3 Under the Professional list click on the Charges Master button The Charges Master Setup window will display Figure 4 24 Palmetto GBA Geiber 2075 PC ACE Pro32 User s Manual Section 4 Reference File Maintenance mE o gt lae tere B Sioued odes im Fae maha sates Cerere pn sey toto C Pituin Figure 424 Charges Master Setup Window 4 Determine if you plan to add or modify a code a Toadda new code click the New button b To update an existing code highlight the code and click the View Update button or double click the code 5 The Charges Master Information window Figure 4 25 will display Enter a valid HCPCS code or right click in the Code field to select a code from the master HCPCS code reference file Enter change the desired Charg
46. egarding how the GBA Page di payer has grouped the procedures for payment The Paid Amount indicates the amount the payer thas 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 rack the currently selected SVD line The control group s caption indicates the current SVD line e g for SVD 1 above 4 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 Amount value and may also specify an optional Units value Common Line MSP Information This field group exists primarily to provide a bridge between the MSP COB reporting standards defined in the older NSF format
47. elect Actions from the Claim List toolbar and choose Print Selected Claim or right click to access a pop up menu b To print more than one claim place a check in the left column next to the desired claims Select Actions from the Claim List toolbar and choose Print All Checked Claims Multiple claims are printed in sequence based on the current Claim List form s Sort By selection 4 The Claim Print Options form will display 5 Determine if you will use the pre printed forms method or the image overlay method To use the pre printed forms method ensure that you have loaded pre printed forms into your printer and then click the Print button b To use the image overlay method i Click the Preview button The Acrobat Reader program will automatically be launched with the claim displayed ii From the Acrobat Reader toolbar select File and then Print to print the previewed claim When finished close Acrobat Reader You will not be able to resume activities in PC ACE Pro32 until the Acrobat Reader program has been closed Simply closing the claim document within the reader is not enough to signal PC ACE Pro32 to continue Palmetto GBA Bago PC ACE Pro32 User s Manual Section 13 Reactivating Previously Transmitted Claims SECTION 13 REACTIVATING PREVIOUSLY TRANSMITTED CLAIMS some situations it may become necessary to reactivate one or more previously transmitted claims for retransmission PC ACE Pr
48. eparation into an EMC file Claims with a media setting of paper P can printed and submitted in hardcopy form When a paper claim is printed you will be given the option to move the claim from the pre transmitted CL location to the transmitted TR location CLAIM List REPORTS PC ACE Pro32 gives you the ability to view several reports and a number of special print functions To view a detailed report of the currently listed claims 1 Select Reports from the Claim List toolbar 2 Choose Print Claim Detail Report The previewed report may be printed if desired by clicking the printer button at the top of the report preview form To print all or a subset of claims currently eligible for paper submission 1 Select Reports from the Claim List toolbar Choose Print Claims for Paper Submission A claim is eligible for paper submission if it has a media setting of paper P resides in the pre transmitted CL location and has a clean CLN status optionally a non fatal errors ERR status 3 After each eligible claim is printed you will be prompted to move the claim to the transmitted TR location When multiple paper claims are eligible for submission you may use the Yes To To All buttons to move not move all eligible paper claims to the transmitted TR location after printing Adobe Acrobat Reader version 4 0 is required for this function Note Since paper claims will never be prepa
49. er 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 reports of the successfully generated claims or rejected claims respectively These reports can be printed from the report previewer Paimetis GBA Pags di Pro32 if desired If any claim rejects occur during generation process the entire process will be reversed Review the rejects report correct the offense and run the roster billing generation process again Successfully generated roster billings will be moved automatically to the generated GR location AUTOMATED CLAIMS PROCESSING The Process Claims feature allows you to run front end edits on Roster Billing claims being submitted process claims 1 Select the Process Claims option from the Professional Claims Menu The Automated Cl Processing window will display Figure 6 24 lsh leave Hark far cas ue I Fenena ciam wh eroi Persians wh ral ned dir I ide nat arar nsec erate Be Figure 24 Automated Claim Processing Window 2 Ifyou want to process only specified claims complete the top portion of the window Place a check in the box next to the options in the lower portion of the window if desired 3 Click the Process button PREPARING CLAIMS FOR ELECTRONIC TRANSMISSION Claim preparation generates a transmission re
50. es value I A os aio Wank a nami moe ou Figure 425 Charges Master Information Window 6 After you have completed your additionsichanges click the OK button located on the bottom right of the window 7 Close your Reference File Maintenance tab which will return you to the PC ACE Pro32 Claims Processing System toolbar From menu options at the top of the toolbar click File and then Preferences 8 The Preferences window will display Figure 4 26 Ifyou are using the HCPCS Reference file click once on Use Charge Master reference file for Professional procedure code lookups GBA Page 18 Clim L t Cain rai Ping Dala Carm Sor Paene amp oraica tab at maine ld brah dina cra IF Enable lashing neiesten mel do wh Wer ence wher dere clans tasks we ches Sten decile eid hn on and reference eoe T ath oni for cta duina poses ure Wasa leere ie Peet procede code GRGE TF pel Erte pa ev troc on com enig che chee T Aor del Ed Vann Ero Lit hen corn scm har ent aret eosin cfvonuniue Parr Psion and Phan D gt T locus Part FEN fid nea stata clane Psonic laci or FEN kd ia halk eyed elaine zero seret ire nts veke lo 1 ding cam niy Sia over ine
51. fessional Claims Menu form s main Roster menu to open the Roster Billing List form ADDING A NEW ROSTER BILLING 1 New Professional roster billings can be added to PC ACE Pro32 using either of these techniques a Select the New Roster Billing item from the Professional Claims Menu form s main Roster menu The system will automatically create and display an empty roster billing form GBA tl b Click the New button on the Roster Billing List Form The system will automatically create and display an empty roster billing form Figures 6 21 and 6 22 The new roster billing will automatically be selected in the list when it is saved Phor Ts 2 Pfeil ross anal earl Profesional Roster ling Form The fields are typically entered in the order presented from left to right and top to bottom Enter the ering information nie op section of de Pen nto amp General gue rer fiam number i pens in the lowe to of his u supplemental muon on the Extended Roster Ia gure 629 rege LISTING MODIFYING AND MAINTAINING ROSTER BILLINGS 1 Professional roster billings in PC ACE Pro32 listed modified generated printed and otherwise maintained from the Professional Roster Billing List Form To access his form Click the Professional Claims Processing button on the PC ACE Pro32 Main Toolbar
52. ghlight ihe desired code from the list click the Delete button and confirm the deletion Paimetis GBA PC ACE Pro32 User s Manual Section 4 Reference File Maintenance Physician Reference File Codes Misc Shared Note This reference does not apply to Institutional Claims The Physician Setup form provides access to maintain the optional Physicians reference file The list of physicians and associated and address information is made available via lookups to speed the Claims entry process The Physician Setup can be sorted by Name or Physician ID ADDING OR UPDATING PHYSICIAN RECORD 1 Clickthe Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display 2 Click the Codes Mise tab 3 Under the Shared list click the Physician bution The Physician window will display Figure 4 20 Poi p 4 Determine if you plan to add or modify a record a To add a new record lick the New button b To update an existing record highlight the record and click the View Update button or double click on the record 5 The Physician Information window Figure 4 21 will display Complete the fields a Lo EE Fain Type Paimetis GBA Page d 6 After you have completed your additions changes click the
53. gure 15 11 or open in Notepad Figure 15 12 see step 5 information Source 10 9002 TRATLRLAZER HEALTH CHTERPRESES otmCO oenonzotiososocon ty EER eater SE ex id re E in the meslth cara Elain Atinoelesgenent Figure 1512 Notepad a Click on the Print button in the Report Preview if you wish to print a paper copy of the Functional Acknowledgment ANSI 277CA Report b Click on the Close button in the Report Preview if you wish to close the window c Click on the Delete button in the ANSL 277CA Acknowledgment File Log window if you wish to delete the selected Functional Acknowledgment ANSI 277CA File from PC ACE Pro32 GBA
54. he Claim List toolbar and choose a Reactivate Selected Claim for a single claim b Reactivate All Checked Claims for more than one claim 6 Confirm the reactivation when prompted The claims should disappear from the list since it is no longer in the transmitted TR location You should now find the unprocessed UNP claim in the to be transmitted CL location 7 From the to be transmitted CL location highlight the unprocessed UNP claim and click Save This step will change the claim status from UPN to CL allowing claims to be prepared to a new file is purged from the archive it is available for reactivation and subsequent retransmission Retransmission of an EMC file might be required for example if a previously sent file was somehow corrupted during transmission 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 file and other associated system settings exist just as they did when the file was originally prepared for transmission To reactivate an EMC file Pags to 2075 1 From the PC ACE Pro32 main menu click the Institutional Claims Processing or the Professional Claims Processing button The Institutional or Professional Claims Menu will display Select Maintain from the Claims Menu toolbar and then choose Transmission Log The Claim Tra
55. ield if required for claim submission 12 When you have completed entering information into the Diagnosis Procedure tab click on the Extended Patient General tab to display that section of the claim entry form Figure 5 9 etes 2 z e em EE mes EE T3 Males Glin mater Cn oe IE roma tin ie e E E Asi meses IEEE Figure 3 institutional Claim Form Extended PatientGeneral Tab 13 Complete the additional patient and general claim level fields as needed 14 Enter data into any required authorization fields This tab also includes fields for MSP and other secondary claims where COB information is required Figure 5 10 Palmetto GBA Page di 2075 PC ACE Pro32 User s Manual Section 5 Institutional Claims Processing Dep premere prre T P nie T I e LL EEE E mr aor 1 ow n eo OOOO me O ES Figure 10 Institutional Claim Form Extended Payer Tab 15 After completing all of the data entry on the claim form click the Save button or press to save and exit the claim Note clicking the Caneel button will abandon all changes made to the claim When you click the Save button PC ACE Pro32 begin
56. iewer if desired 6 When you have completed your review of the claim preparation reports click the Close button on the Claim Prepare For Transmission form GBA Page di 18 PC ACE Pro32 User s Manual Section 6 Professional Claims Processing SECTION 6 PROFESSIONAL CMS 1500 PART B CLAIMS PROCESSING Once your reference files have been established you can begin claims processing The Professional Claims Processing option on the Pro32 main menu button highlighted in Figure 6 1 gives you access to the Professional Claims Menu Figure 6 2 E care ez ct Processing Sse ion Heb Chins Figure PCACE Pro32 Claims Processing Mana Figure 2 Professional Claims Menu From the Professional Claims Menu the following operations are available Import Claims fiom a print file Note Claim importing is not supported Refer to on line help for information Enter Claims manually List Claims to maintain existing claims from a comprehensive list ims imported or reactivated automatically Prepare Claims into an EMC file for transmission Process Using the Professional Claim Form The Professional Claim Form has been designed to provide a data entry flow resembling that ofthe printed Professional CMS 1500 claim form The following information will help you as you complete the claim form To move between
57. imetis GBA Section 4 Reference File Maintenance DELETING AN EXISTING PAYER RECORD delete an existing record 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display Click on the Payer tab The central field will display a list of existing payers 2 Highlight the desired record from the list click the Delete button and confirm the deletion Provider Institutional and Professional Reference File The Provider Inst and Provider Prof tabs of the Reference File Maintenance window provide access to maintain the provider information referenced claims Setup of the provider reference file s is required to process claims providers referenced on claims must be represented in the reference file s ADDING OR UPDATING A PROVIDER 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display 2 Click on either the Provider Inst tab for Part A providers Figure 4 4 or Provider Prof tab for Part B providers Figure 4 5 On each of these tabs the central field will display a list of existing providers if any Use the radio buttons just below the list to sort by the options provided D o fest n tane CUR Cakes CUR a Cma rap Er Figure 44 institutional Part A Provider Tab o FP ei te Pel i
58. inked to the currently selected line the Line Items Details tab As you move from one line to another on the Line Items Details tab the remaining sub tabs will track the new current line Note that the Extended Details tab caption will change based on the current line highlighted 1 Ext Details Line 1 Ext Details Line2 etc To enter a new line you can enter data into each field of the line or to facilitate your entry you a Duplicate all the fields from the previous line by pressing E b Duplicate single field from the previous line by clicking inthe selected field and pressing Fa c Delete an entire line by pressing FJ When you have completed line item entries click the Reealculate button located near the bottom of the tab adjacent to the Totals field This will recalculate and update the Total Charges and the Balance Due fields from the current claim line item charges values and the Amount Paid field value Paimetis GBA 2075 Section 6 Professional Claims Processing Click on the Extended Details sub tabs and review the information in these fields Ifyou have entered a procedure code that requires a Professional CMS 1500 Attachment or CMN an additional sub tab for that attachment will display Figure 6 6 Note To view a drop down list of attachment options right click in the AT feld on the Line ltem Details sub tab metta tq certe verum tee etnies tame eva tte obese ede
59. istory of archived claims can be viewed as well crente a new claim archive or open an existing claim archive 1 From the PC ACE Pro32 main menu click the Institutional Claims Processing or Professional Claims Processing button to display the corresponding Claims Menu form Click the List Claims button on the Claims Menu to display the Claim List form By default the list will display claims in the to be transmitted CL location 3 From the Claim List form toolbar select File and then choose Open Claim Archive The Open Claim Archive form will display listing all existing claim archives if any 4 From the Open Claim Archive form you can open and create claim archives a To create a new archive click the New button and the Create New Claim Archive dialog box will display Figure 14 1 Enter a descriptive name for the new archive Archive names can contain only alphabetic and numeric characters the underscore _ character and spaces You will receive an error message if the chosen archive name is unacceptable Ertomaro lr naw acire tro x Figure 11 Create New Archive Dialog Click the OK button and the empty archive will be created and the corresponding entry will be added to the selection list b To open a claim archive highlight the desired archive and click the Open button or double click the new list entry You will be returned to the Claim List form
60. ives pu rarely ea te ts naga rere d EE nl ap terreat aide Cocina ae ea eta Up ihe prises rendono cy my gina esos ever d Opin 2 he tins net P Pilea a The param alaman drs se voto fom Eo Dosou coit Figure 410 Provider Deletion Confirmation Dialog Box 4 Ifyou determine that you still want to delete the selected provider click OK Patient Reference The Patient Reference File maintains all necessary general patient information as well as primary secondary and tertiary insured details Patient information that has been entered in the Patient Reference File is available for lookup during claim entry GBA Section 4 Reference File Maintenance Note To assist you in completing field entries accurately Ily over hints display mouse cursor aver field ADDING OR UPDATING PATIENT RECORD 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display Figure 4 11 dele p Farenheit rch Camerata wren Figure 411 Reference File Maintenance Form Patient Tab Click on the Patient tab the reference file will always open on the previously displayed tab The central field will display list of existing patients if any Using
61. laims are assigned DEL status Note DEL status claims can be recovered undeleted jed Gaim x Claims in the pre transmitted CL location with a DEL status wil Be purged from the system Note Purged claims cannot be recovered Selected X Move selected claim s from the previously transmitted TR or paid PD location into the pre transmitted CL location The reactivated claim will be assigned the unprocessed UNP status Fold Selected Gaim X Changes the satus of the selected claim to hold HLD Held claims are not considered for future claim activities such as automated claim processing or claim preparation Pant Selected Cam X Claims may be printed using either plain paper image overlay technique or the traditional pre printed form method Adobe Acrobat Reader version 4 0 is required for this function chive Clams X Moves the selected claims from the transmitted TR and paid PD locations to the open claim archive database Page Palmetto GBA Allows you to post view or modify payments for the selected claim Designates 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 be printed and submitted in hardcopy form When a paper claim is printed you will be given the option
62. le 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 The following sections describe the steps to backup validate and restore Backup To perform a backup ofthe PC ACE Pro32 database files and configuration settings 1 From the Systems Utilities window click the Backup Restore tab and the Backup sub tab see Figure 9 2 2 Complete the following information Palmetia GBA PC ACE Pro32 a Enter type or click the button to browse the destination drive or folder to which the file will be written You can choose your floppy or writeable CD ROM drive or a hard disk drive local or remote Note Disk spanning is supported for backups to diskette You will be prompted to insert blank diskettes as needed b Specify whether or not to include certain infrequently changed database files in the backup ensure minimal problems in the event that a database restoration is required we recommend leaving this option checked for all backups c Specify whether or not to include the claim archive database files in the backup Refer to Section 14 Archiving for more information on the archive feature d Specify whether or not to include all archived
63. lly or selected from the available lookup list Chim 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 Figure 6 11 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 procedure code Paimetis GBA Pags di 018 PC ACE Pro32 User s Manual Section 5 Institutional Claims Processing 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 thas 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
64. nd access the PC ACE Pro32 Software Download Request form at www PalmettoGBA com medicare a From the menu on the left of the page choose the appropriate line of business b Choose Software amp Manuals v From the list choose PC ACE Pro32 Software Download for your line of business d Read the instructions and then click on Download Form for PC Ace Pro 32 Complete all of the form fields completely and correctly Note Forms submitted with missing required information will not be processed Required fields are noted in the following table with an asterisk Form Field Name Instructions for Field Compie Submitter ID The ID that was issued by Palmetto GBA upon completion of your EDI application form This ID may be referred to as a Receiver ID Company Name The company name of the entity downloading the software Contact Name The name of the person downloading the software Mailing Address Line 1 First line of the company mailing address Mailing Address Line 2 econd line of the company mailing address City of the mailing address State or the mailing address ZIP code of the mailing address Phone number fo reach the contact name FAX number to reach the contact name The email address for user 3 Double check your information and then click Begin Download I there is problem with processing your request form such as an invalid Submitter ID or information in a required field is missing an err
65. nsmission Log form will display which lists chronologically all archived EMC files 3 Highlight the EMC file to be reactivated Click the Reaetivate button on the bottom of the window and confirm the reactivation when prompted 4 You will be notified when the reactivation operation has successfully completed The EMC file is now ready for retransmission Click the Close button to close the form Pies GBA PC ACE Pro32 User s Manual Section 14 Archiving SECTION 14 ARCHIVING 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 Archiving claims reduces the size and optimizes the performance of the current claims database Archiving claims eliminates claims that are no longer needed from the current claims database making it easier to locate and work with the other current claims Archiving claims 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 available for transmitted claims in the current database are also available for archived claims For example archived claims can be viewed and printed just like claims in the current database The payment h
66. nter data into blank fields When you have completed entering information into the Extended Patient Genera tab click on Extended Payer Insured tab to display that section of the claim entry form Figure 69 Pl al an nt rone 4 Psi Pui EP ze ee een X ee C gt D LS 0 Figure 69 Profesional Caim Form Extended Payernsured Tab 12 To enter MSP claims you must first enter Y in the COB field from Patient Info amp General tab see Figure 6 3 For examples of completed MSP data sereens see the next section Medicare Secondary Payer Claim Examples Note This will generate two new sub tabs to the Extended Payer Insured tab On the COB Info Primary and COB Info Secondary sub tabs Figure 6 10 complete the fields under Common Payer MSP Information if Medicare is tertiary Also note the generated MSP COB sub tab on the Billing Line Items tab Figure 6 11 Geiber 18 Section 6 Professional Claims Processing Figure amp 10 COB Info Primary Sub Tab Figure amp 11 MSPICOB Sub Tab Two distinct levels of Coordination of Benefits reporting are supported 4 Claim Level COB Reporting Remittance data that is not specific to particular service line is reported at the claim level The claim form provides claim level COB fields for both
67. o Primary and COB Info Secondary Figure 5 7 and one new sub tab to the Billing Line Items tab MSP COB Figure 5 8 This information is required on all Medicare claims where Medicare is not the primary payer GBA Pags 37 Section 5 Institutional Claims Processing SSS eee e Figure 5 7 COB Info Primary Sub Tab Figure 58 MSPICOB Sub Tab Two distinct levels of Coordination of Benefits reporting are supported Claim Level COB Reporting Remittance data that 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 Figure 6 10 and COB Info Secondary sub tabs of the Extended Payerlnsured tab Line Level COB Reporting Remittance data specific toa 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 Figure 6 11 This sub tab tracks the currently selected service line in the same manner as the other extended line item sub tabs The current service line is identified in the sub tab caption e g Line 4 The claim level COB data is entered on COB Info Primary and Info Secondary sub tabs of th
68. o32 provides two techniques for reactivating claims Individual claims in the transmitted TR location may be reactivated for inclusion in a subsequent EMC Anentire EMC file may be reactivated for retransmission Individually Reactivating Transmitted Claims If one or more transmitted claims need to be resubmitted in a future EMC file the claim must first be reactivated Reactivation moves the selected claims from the transmitted TR location to the to be transmitted CL location and resets the claim status to unprocessed UNP The reactivated claim can then be processed and if no fatal edit validation errors are present it will be included in the next EMC file prepared Note Only claims in the transmitted TR location may be reactivated Once a payment has been made on a claim it moves to the paid PD location and is no longer eligible for reactivation To reactive one or more claims 1 Click on the Institutional Claims Processing or Professional Claims Processing button on the PC ACE Pro32 main menu to display the corresponding Claims Menu From the Claims Menu choose List Claims The Claim List will display 3 Under Claim List Filter Options at the bottom of the window choose TR transmitted only from the Location field 4 To reactivate a single claim highlight that claim recond in the list b Several claims place a check in the left column next to each desired claim Select Actions from t
69. or page will display Click Back to Download Request Page to correct and resubmit the form 4 After you have successfully submitted the form a File Download dialog box will display Click Save to save the software file to your computer Download complete will display when the download is complete Click the Open Folder button 6 The file is a compressed zip file Double click on the PCACEPro32 zip file to unzip the file When complete you may need to refiesh your file folder to see the unzipped Pro32setup exe file 7 Double click on the file name Pro32setup exe The Wise Installation Wizard will initialize and guide you through the installation process outlined in the Installation Instructions Paimets GBA Section 2 Accessing 8 Installing PC ACE Pro32 Installation Instructions 1 The Password dialog box Figure 2 1 will display In the Password field enter the installation password medicare This password is case sensitive so be sure to use all lower case letters a Teter peer dct Pese Ihe lain pere rt e liber Pres tre DE buten to conus 3 Figure 1 Password Dialog Box The Welcome screen Figure 2 2 displays to remind you to close all programs you may have running your computer If you have not already done so we recommend that you close any open programs at this time If you are ready to continue the in
70. ort Claims from a print file Note Claim importing is not supported Refer to on line help for information Enter Claims manually List Claims to maintain existing claims from a comprehensive list Process Claims imported or reactivated automatically Prepare Claims into an EMC file for transmission Using the Institutional Claim Form The Institutional Claim Form has been designed to provide a data entry flow resembling that of the printer Institutional UB92 1450 claim form as well as the enhanced CMS 1450 UB 04 Institutional Professional claim form The following information will help you as you complete the claim form To move between the six major claim form sections click on the associated tabs or press the UF and PAGE DOWN keys GBA Page di 18 Section inetiutional Claims Processing To move through the claim form fields you can click on field to activate it or you can press the FAB key to move from field to field in a predefined sequence generally left to right and top to bottom Use the and keys to move up and down through the claim form fields Many fields will have either a fixed list established set of values variable list values selected from reference files lookup To access the lookup list move your cursor over the field and right click 1o display a pop up menu You can also click in the field and press
71. ou have completed entering information into the Patient Info and Codes tab click on the Billing Line Items tab to display that section of the claim entry form Figure 54 a Ponte Ca ua Pits get Do Ee Gre el tnt eterna rasta seem ae 1 aa AMET a die Tii Uses vaa nt T m oO ause vus Lem set Figure 4 Institutional Claim Form Biling Line Hons Tabs To enter a new line you can enter data into each field of the line or to facilitate your entry you can a Duplicate all the fields from the previous line by pressing E b Duplicate a single field from the previous line by clicking in the selected field and pressing Fa c Delete an entire line by pressing F7 Note Claim lines are automatically re sequenced by Revenue Code when a claim is saved 5 When you have completed line item entries click the Reealculate button located near the bottom of the tab adjacent to the Totals field This will recalculate and update the Total Charges and Total Non Covered Charges fields from the current claim line item charges values 6 When you have finished with the information on this tab click on the Payer Information tab to display that section of the claim entry form Figure 5 5 Geiber diis Section 5 Institutional Claims Processing Pe e nee 0 1
72. ownloaded file in the appropriate folder CAWINPCACE Ansi277 STATISO0 for Professional 277 reports bo CAWINPCACE Ansi277 STATUB9 for Institutional 277 reports PC ACE Pro32 User s Manual Section 15 Using PC ACE Pro32 to Translate Reports 4 Open PC ACE Pro32 5 Ifyou wish to view the files in the Pro32 Previewer no change is necessary default If instead you wish to open the file ina modifiable Notepad file you must make this preference change before continuing Click File from the main menu Select Preferences Figure 15 7 and then check Use Windows Notepad instead of built in previewer to view response reports INITIO Figure 157 Preferences Window 6 From your PC ACE Pro32 toolbar Figure 15 8 click on the Inst or the Prof button Figure 158 PC ACE Pros Toolbar 7 In the Institutional or Professional Claims Menu Figure 15 9 click on Maintain and choose Claim Status Response amp Acknowledgement Log Terens og arlroadgvert Fe Log EE Prepare Clai Figure 159 Professional or Institutional Claims Menu X Select the ANSI 277CA file you wish to review Figure 15 10 and click on the View Ack Report button nal Claim Status Response amp GAOL Grup se ESE EET E Figure 1510 Professional or sttutional Claim Status Response amp Acknowledgment Log 9 The report will display in the previewer Fi
73. phabetically lists available index entries Find Perform a free form text search of all topics Logging Out of PC ACE Pro32 You can log of PC ACE Pro32 without exiting to allow another user to log on and use the system To log out select Security from PC ACE Pro32 toolbar and choose Logout Current User To log back onto the system click on any button and the Sign On window wil your user ID and password and then click OK isplay Figure 3 3 Enter Figure 33 Sign On Window Section 4 Reference File Maintenance SECTION 4 REFERENCE FILE MAINTENANCE To streamline and improve the accuracy of claims entry PC ACE Pro32 automatically fills fields on the Claims Entry screens based on information previously entered into the various Reference Files For example when you enter a Patient Control Number PCN on the Professional Claim Form fields related to that PCN e g patient s name address telephone etc will automaticaly be filled with data from the Patient Reference File For this reason itis very important that you update all Reference Files before creating claims sure to complete the Reference Files in the following order 1 Payer Reference 2 Provider Reference File 3 Patient Reference File 4 Submitter Reference File To begin editing the reference files sign on and from the PC ACE Pro32 Claims Processing toolbar Figure 4 1 click on the Reference File
74. red into an EMC file this prompt provides the only available mechanism for moving these claims out ofthe pre transmitted CL location Preparing Claims for Electronic Transmission Claim preparation generates transmission ready Electronic Media Claims EMC file EMC files contain submission details for one or more processed claims Only claims in the to be transmitted CL location that have an electronic E media setting are eligible for preparation When a claim is prepared into an file it is automatically moved to the transmitted TR location which prevents the claim from being inadvertently retransmitted Note Before preparing claims for the first time you will need to set up your Submitter Reference File This fle contains important data that will be used to build the EMC file generate an EMC file Palmetto GBA 1 Select the Prepare Claims option from the Professional Claims Menu The Professional Prepare For Transmission window will display Figure 6 20 804 ree Cure acs 7 WEBKD rever Dee toed Figure 20 Professional Claim Prepare for Transmission Specify from the drop down list if you want only a single line of business LOB to be considered or select lt lt All gt gt to include claims for any line of business If you specify an LOB Choose single Payer or lt Payers for LOB s gt gt to inclu
75. s an Edit Validation process One or of the following edits may be required a Atleast one of the payers specified on a claim must have the same LOB line of business as the claim itself b If no edit validation errors occur the claim is saved with a clean CLN status c Hone or more edit validation errors occur the Edit Validation Errors List form will display indicating fatal and non fatal errors You may correct the errors or save the claim with errors Note Ifa fatal error exists in the LOB PCN or field you must correct the error before you will be allowed to save the claim i To save claim that contains only non fatal errors click the Save With Errors button These claims are saved with a has errors ERR status i To save a claim that contains fatal errors click the Save With Fatal button Such claims are assigned the has fatal erors ERF status Claims with an ERF status are not eligible for preparation into an electronic EMC file 16 If edit validation errors occur several Save attempts may be required to correct and save a clean claim At any time you can click the Errors List button to review remaining edit validation errors The Institutional Claim List The Institutional Claim List Figure 5 11 provides versatile access to create list modify print and otherwise maintain claims To access the Claim List form 1 Select the List Claims option from the Institutional Claims Menu 2 Choose
76. site www adobe com When the Windows Large Fonts display setting is enabled the screen resolution must be 1024 x 768 or higher The Enhanced Institutional Claim Form UB 04 and Professional Claim Form CMS 1500 will not display properly at lower screen resolutions Technical Support Palmetto GBA technical support is available by calling the Palmetto GBA Provider Contact Center at 888 355 9165 RRB or 855 696 0705 A Part B HHH VA amp WV Part A Palmetto GBA has subcontracted with National Government Services NGS to continue EDI support of the Virginia and West Virginia Part A workload for Palmetto GBA If you are using Pro32 software supplied by NGS please contact the NGS Help Desk at 1 877 273 4334 for Pro32 support If you are using Pro32 software supplied by Palmetto GBA please contact the Provider Contact Center at 888 355 9165 RRB or 855 696 0705 Part A Part B HHH GBA Paget diis Section SECTION 2 ACCESSING amp INSTALLING PC ACE PRO32 Note is installed in a network environment 1632 will NOT be supported i The following step by step instructions will walk you through accessing and installing PC ACE Pro32 to your personal computer Accessing PC ACE Pro32 from the Palmetto GBA Website To download the PC ACE Pro32 software you will need to complete the online Pro32 Software Download Request form 1 Open Internet Explorer a
77. ss Claims feature allows you to run front end edits on claims being submitted To process claims 1 Select the Process Claims option from the Institutional Claims Menu The Automated Claim Processing window will display Figure 5 12 Peces Cie aria jose Bani f alil 3 inj Provide ih ao Wee este dein poses ero ro Fem Figur 5 12 Automated Claim Processing Window 2 Ifyou want to process only specified claims complete the top portion of the window Place check in the box next to the options in the lower portion of the window if desired 3 Click the Process button Palmetto GBA PC ACE Pro32 User s Manual Section 5 Institutional Claims Processing Preparing Claims for Electronic Transmission Claim preparation generates a transmission ready Electronic Media Claims EMC file EMC files contain submission details for one or more processed claims Only claims in the to be transmitted CL location that have 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 which prevents the claim from being inadvertently retransmitted Note Before preparing claims for the fist time you will need to set up your Submitter Reference File This file contains important data that will be used to build the EMC file generate an EMC file 1 Select the Prepare
78. stallation click Next p TREE 655 EM Figure 22 Welcome Sereen 3 The Drive Selection window will display Figure 2 3 requesting that you choose the drive to which you want to install PC ACE Pro32 The default is set on the C drive If you want to choose a different drive click the down arrow to the right of the Select Destination Drive field scroll through the list and highlight the desired drive Click Next to continue E diis Section 2 Accessing 8 Installing PC ACE Pro32 E p a Figure 23 Drive Selection Window On the Start Installation window click Next to continue PC ACE Pro32 Setup begins copying the program files to your computer A status of the copy process is shown on the Installing window 6 When the file copying is complete the Read Me File window Figure 2 4 will display Read the information be sure to use the scrollbar on the right of the screen to scroll down and read all of the text and click Next to continue Figure 24 Read Me File Window D The Installation Complete window displays indicating that PC ACE Pro32 has been successfully installed Click Finish to close the window The installation process automatically places a PC ACE Pro32 shortcut icon Figure 2 5 on your desktop which can be used to open the program PCACE
79. sured Tab CLAIM LEVEL ADJUSTMENTS Claim Example Chim Amount 125 00 E enh ciae treten ORE 202 NES R T RED P EOS ES ETT T E p gj peni rel pen pe eni e n TIT S ey wo EEA EEA I E remi lie Ere E EE E Em Bi e es 3 E mens TIT Figure 6 16 Line tem Tab B Line kem Adjustments CAS 1 Contractual Obligations 25 00 2 Patient Responsibility 55000 Deductible Patient Responsibility 15 00 Co Pay C COBMOA Amounts 1 Payor Paid Amount D 35 00 2 Patient Amount Owed EAF 56500 Balas BBR Bagg nn PC ACE Pro32 User s Manual D Adjudication Date 03 09 mE ana Mate CDA Wen E i prie seen F LI I NC NN S ICE E zi Mr gem Em ar seems EST D Tp Figure 617 COB Into Primary Tab E Insurance Type Working age beneficiary renum E Figure 6 18 Primary Payernsured Tab 18 The Professional Claim List The Professional Claim List Figure 6 19 provides versatile access to create list modify print and otherwise maintain claims To access th
80. the five major claim form sections click on the associated tab or press the UF and PAGE DOWN keys Palmetto GBA Page 3i 18 o oc c nf Section Profenslanal Clans To move through the claim form fields you can lick on a field to activate it or you can press the FAB key to move from field to field in a predefined sequence generally left to right and top to bottom Use the and keys to move up and down through the claim form fields Many fields will have either fixed list established set of values or a variable list values selected fiom reference files lookup To access the lookup list move your cursor over the field and right click to display a pop up menu You can also click in the field and press Select the appropriate value from the list and it will automatically be entered in the claim form field Ifyou inadvertently make a change to field you can press ESE which will undo the change and restore the field s original value 4 Fly over hints provide a brief description ofa field s purpose They become visible when the mouse eursor pauses over the field 4 When the focus leaves a particular field for example when you press the FAB key or click on a new field an edit validation is performed on the field losing the focus Edits performed at this time are referred to as feld level edits If a field level edit error occurs an audible tone will sound and the error message
81. the primary and secondary payers These fields are located on the COB Info Primary Figure 6 10 and Info Secondary sub tabs of the Extended Payer lnsured tab Line Level COB Reporting Remittance data specific to 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 Figure 6 11 This sub tab tracks the currently selected service line in the same manner as the other extended line item sub tabs The current service line is identified in the sub tab caption e g Line 1 The claim level COB data is entered on the COB Info Primary Figure 6 10 and COB Info Secondary sub tabs of the Extended Payerinsured tab The purpose and use of the various field groups on these sub tabs are as follows Common Payer MSP Information Only the amount Paid by primary payer amount Allowed by primary payer the Insurance Type OTAF Obligated To Accept In Full Amount if applicable Zero Payment Ind and Claim Adjudication Date fields are actually needed to process MSP COB claims in PC ACE Pro32 4 Cliim 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
82. the radio buttons just below the list you can sort the list by Patient PCN or Patient Name 3 Determine if you plan to add a new record or modify an existing record To add a new Patient record click the New button b To update an existing Patient record highlight the record and click the View Update button or double click on the recond 4 The Patient Information window Figure 4 12 will display Complete the fields on each of the Patient Information tabs F r eres FF Seon Fe state mue ee cca deeem F p 8 FO ee LL e T mee m a mm 1 Ez Figure 412 Patient Information General Information Tab Page ii a General Information Tab Enter general patient information such as the patient s name address birth date and various status flags b Extended Info Tab Enter extended patient information such as information on the patient s legal representative Professional claim use only c Primary Insured Tab s Inst and or Prof Enter payer insured and employer information for the primary Institutional Part A and or Professional CM 1500 Part B payer s If your system is set up for both Institutional and Professional claim activities then you will have the option to enter separate Institutional and Professional insured information d Secondary and Tertiary Insur
83. tion errors as needed Alternatively click the Cancel or Close button to cancel any pending roster billing changes Cos Ca etn oan oe _ Figure 623 Professional Roster Biling List GENERATING ROSTER BILLING CLAIMS 1 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 you can generate claims for this roster billing using either of the following techniques a 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 b 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 2 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 Rost
84. to display the Professional Claims Menu form b From the Professional Claims Menu form select the Maintain Roster Billings item ftom the main Roster menu to open the Professional Roster Billing List Form 2 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 GBA Lilo nina Section f Professional Claims Processing In addition claims may be generated for a selected roster billing and the resulting roster billing report may be printed from this list 3 Viewing and or modifying existing roster billings from the Professional Roster Billing List form Figure 6 23 can be performed with these steps Use the Roster Billing List form s sorting and filtering capabilities to locate the roster billing of interest b 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 c 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 roster billing form d 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 valida
85. to pack the claim archive before closing We recommend packing a claim archive database occasionally as it minimizes the disk space requirements and enhances performance Note The packing process can be lengthy for large databases Once the packing operation has started it must continue to completion Click the Yes button to pack and close the archive the No button to close the archive without packing or the Cancel bution to leave the archive open Note 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 Unarchiving Claims To unarchive claims 1 Open the claim archive see steps above 2 Highlight single or check multiple the desired claim s Select Actions from the Claim List toolbar and choose Unarchive Selected Claim for a single claim b Unarchive All Checked Claims for more than one claim GBA Page l 18 SECTION 15 USING PRO32 TO TRANSLATE 999 AND 277CA REPORTS The 999 and 277CA reports will be uploaded to your GPNet Mailbox in raw data format PC ACE Pro32 software can translate these raw data files into a Previewer or into a modifiable Notepad file Translating the 999 Report 1 Check your GPNet Mailbox Referto the GPNet Communications Manual List Files In Mailbox 2 Retrieve the 999 report from your GPNet Mailbox a 999 Report filename format
86. tton The Submitter Setup window will display Figure 4 15 a on Gees Pend ree Figure 415 Submitter Setup Window 4 Choose the appropriate Claim Type Institutional for Part A claims and Professional for Part B claims Paimetis GBA Section 4 Reference File Maintenance 5 Please do not update the default Submitter record Select New to configure your Submitter information 6 The Institutional or the Professional Submitter Information window will display a Institutional Submitter Information Figure 4 16 ao TE RE pum M ney J tpn eget T Dien monroe T el a me FSS Figure 416 Institutional Submitter Setup Window i Complete all fields on the General except EIN ii On the Prepare Tab enter N in the Include Error Claims field Enter P in Submission Status field Enter A in the EMC Output Format field The ANSI Version 837 is prefilled with 00501042 All other fields on this tab should be left as defaulted On the ANSI Info tab enter 28 in the Submitter Intche ID Qu fields The Acknowledgement Requested field must contai iv No updates required on the ANSI Info 2 tab b Professional Submitter Information Figure 4 17 and Receiver Intehg ID Qual Pe st wo E smc EO
87. urity List form Figure 3 1 will display 4 Figure 31 Securty List Window To add a new user click the New button on the bottom of the window To modify an existing user highlight the desired user from the Security List and click View Update The User Security Update window will display Figure 3 2 eS ee RT Paimetis GBA Page Geiober diis PC ACE Pro32 User s Manual Section 3 Gotting Started 3 Complete or make desired changes to the User ID Password and Name fields 4 Assign or change User Permissions such as entering viewing and deleting claims Check the box next to the permission to allow access to the activity Use the Check All and Clear All buttons to quickly check or uncheck all permission checkboxes 5 Click OK to save the new modified user record Note When changes are made to a user profile the changes go into effect next time that user logs on Building Your Reference Files PC ACE Pro32 is an integrated system that automatically pulls information from various databases within the system to assist users in the completion of claims information Therefore It is very important that reference file information be entered into the system before entering claims you do not create the reference file information before entering your claim vital information necessary for processing and payment may be missing from the claim Please refer to Section 4
88. 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 this control group ack the currently selected SVD line The control group s caption indicates the current SVD line e g or SVD 1 above 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 Amount value and may also specify an optional Units value Common Line MSP Information This field group exists primarily to provide a bridge between the MSP COB reporting standards defined in the older NSF format and those defined in the ANSI 1X12 implementation Only the Approved and OTAF Obligated To Accept In Full amount fields are actually needed to process COB claims in the newer ANSI X12 format All remaining fields in this group can be reported using equivalent values in the SVD or CAS field groups For backward compatibility PC ACE Pro32 will continue to recognize and report values in these obsolete fields whenever it is practical to do so 11 Entera Y in the ANSI S37 HH CR6 Attachment f
89. wledgment File Log i Professional Claims Menu averse Ciam Inport Iranemeson Leg Prepare clam atu Request le am status gescerse s cimoaledgrent Log Activ os Figure 153 Professional or Institutional Claims Manu 8 Select the ANSI 999 file you wish to review Figure 15 4 and click on the View Report button Figure 154 1 url Acknowledgment Fl Log 9 The report will display in the previewer Figure 15 5 or open in Notepad Figure 15 6 see step 5 rofeesionl or Pies GBA PC ACE Pro32 User s Manual Section 15 Using PC ACE Pro32 to Translate Reports Figure 155 Previewer eared eth Figure 156 Notepad Click on the Print button in the Report Preview if you wish to print a paper copy of the Functional Acknowledgment ANSL997 Report Note page count b Click on the Close button in the Report Preview if you wish to close the window c Click on the Delete button in the ANSI 997 Acknowledgment File Log window if you wish to delete the selected Functional Acknowledgment ANSI 997 File from PC ACE Pro32 Translating the 277CA Report 1 Check your GPNet Mailbox a Referto the GPNet Communications Manual Lis Files In Mailbox 2 Retrieve the 277 report from your GPNet Mailbox 277 Report filename format RSPnnnnn RSP 277CA where nnnnn represents a sequential number b Referto the GPNet Communications Manual Download a File 3 Place the d

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