DDE PROFFESSIONAL CLAIMS

Transcription

1 DDE PROFFESSIONAL CLAIMS SUBMISSION MANUAL

2 Purpose: The EDI Portal application will enable Providers to bill and adjust claims electronically. To access the EDI Portal, logon to and enter your logon name and password. Logon Name Enter the log on name you selected during New Trading Partner Registration. Password Enter the password.

3 Scroll to Submit by Form, click on Claim.

4 Select Health Care Claim Professional to load the professional form.

5 Begin: Click this button once you have completed reading the instructions.

6 Submitter Organization Name: Enter the Organization Name. Contact Name: Enter the person billing the claims. Billing Provider Enter a check in the box if organization name is same as the Submitter. This automatically enters the name in the Organization Name field. Provider KY Medicaid ID: Enter the 8-digit KY Medicaid ID number. Taxonomy Code: This is an optional field. (not currently used) Pay-to Provider Enter a check in the box if organization name is same as the Billing Provider. This automatically enters the name in the Organization Name field. Group Number: Enter 8-digit KY Medicaid ID number is applicable. Taxonomy Code: This is an optional field (not currently used) Commit these entries: Click this button to save the information entered on this form and advance to the next page. Note: Providers with a group or clinic number would use Pay-to Provider information.

7 Recipient Patient KY Medicaid ID: Enter the 10-digit KY Medicaid Recipient number. First Name: Enter the recipient s first name. Last Name: Enter the recipient s last name. Date of Birth: This is an optional field (not required by KY Medicaid). Gender: This is an optional field (not required by KY Medicaid). Commit these entries: Click this button to save the information entered on this form and advance to the next page.

8 Claim Professional Patient Account Number: The first 20 digits (alpha-numeric) will appear on the remittance advice as the invoice number. This is an optional field. Prior Authorization Number: Enter the prior authorization number, if applicable Facility Type Code: Click on the drop down box and select the appropriate value. For a listing of values, refer to the KY Medicaid Billing Instructions. Adjustment Indicator: Click on the drop down box and select 7 for a claim adjustment or 8 for a claim credit. Other Insurance: Click on the drop down box and select yes or no. Payer Paid Amount: Enter the dollar amount other insurance paid, if applicable. Original TCN: Enter the original TCN of the claim due an adjustment or claim credit. Related Causes Data Click the drop down box and select the appropriate code, if applicable. Diagnosis Data Enter the appropriate ICD-9-CM diagnosis code.

9 Referring Provider Organization Name: Enter the Organization name or the Physician name. KY Medicaid ID: Enter the 8-digit KY Medicaid provider ID. Taxonomy Code: This is an optional field. (not currently used) Rendering Provider Organization Name: Enter the Organization name or the Physician name. KY Medicaid ID: Enter the 8-digit KY Medicaid provider ID. Taxonomy Code: This is an optional field. (not currently used) Transportation Claims Only Destination Code: Click on drop down box for the appropriate two-digit destination code. Time of Pickup: (hh-mm) Click the drop down box for appropriate time of pickup. Location of Pickup: Click the drop down box for appropriate code. School Claims Only School ID: Enter the school ID number. Used by Preventive Health Services providers only. Commit These Entries: Click this button to save the information entered on this form and advance to the next page. Note: In order to file an adjustment or claim credit each line must be keyed as in the original claim. For an adjustment correct or change the information needed to reflect the adjustment. Should you have questions please call the EDI Department at EDS (800)

10 Service Line From Date: Enter the From Date of service (MM-DD-YYYY). To Date: Enter the to date of service (MM-DD-YYYY). Place of Service Code: Enter the appropriate place of service (reference KY Medicaid Billing Instructions). Product/Service Qualifier: Click the drop down box and select HCPCS (NDC is for Primary Care or Rural Health Provider only). Procedure Code: Enter the appropriate 5-digit procedure code. Modifier: Enter the appropriate 2 digit modifier is applicable. Diagnosis Code Pointers: Enter 1, 2, 3, or 4, when referencing the specific diagnosis for which the recipient is being treated. Charges: Enter the usual and customary charge for the service being provided to the recipient. Quantity: Enter the appropriate unit(s) or day(s) of services. EPSDT: Enter if applicable Emergency: Enter if applicable Family Planning: Enter if applicable

11 Notes: : Enter up to 27 characters as follows Position 1-3 Employee Id Provider Type 21 only Position 4 Number of Students Provider Type 21 only Position 5-6 Tooth number Provider Types 31 and 35 only Position 7-8 EPSDT referral code 1 Provider Types 20, 31, 35, 40, 50, 52, 70, 77 Position 9-10 EPSDT referral code 2 Provider Types 20, 31, 35, 40, 50, 52, 70, 77 Position EPSDT referral code 3 Provider Types 20, 31, 35, 40, 50, 52, 70, 77 Position Vaccine code 1 Provider Types 20, 31, 35, 40 Position Vaccine code 2 Provider Types 20, 31, 35, 40 Position Vaccine code 3 Provider Types 20, 31, 35, 40 Position 19 Local Modifiers All Provider Types Position Community Mental Health Employee Id Provider Type 30 Note: The total claim charge amount is automatically calculated as service lines are added. To use the Notes field: Click into the note field box, using the space bar on your computer keypad to determine the position by spacing.

12 Add: Click to add the service line.

13 Submit: Click button to submit the claim. Print: Click this button to print the page. Enter Another Claim: Click this button to enter another claim. Finished Entering Claims: Click this button if all claims have been entered.