MDofficeManager. User Manual Claims Processing

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1 Global Information Systems, Inc MDofficeManager User Manual Claims Processing 1. Electronic Claims Processing 2. Electronic Force to Paper Claims 3. Paper Claims 4. Secondary Claims 5. Statement Processing

Claim Processing Electronic Electronic Claim Processing CP Begin by clicking on the # to create a new Claim Processing ID Process Type: Proof, this will check the claims for errors but not process

2 Claim Processing Electronic Electronic Claim Processing CP Begin by clicking on the # to create a new Claim Processing ID Process Type: Proof, this will check the claims for errors but not process them. Always process the claims first in the Proof mode Claim Format: Electronic Proc Center: Click on the ellipsis and select a claim processing center Acct Start Date: Leave blank Acct End Date: Leave blank Posted Charges: Needs to be checked Unposted: Needs to be checked Claim Process: Yes Process Claim Types: Leave blank for ALL Process Charges: Leave blank for ALL, to re-process an individual charge ID, enter the ID in this field Billing Providers: Leave blank for ALL, to process claims for an individual provider, enter the provider ID in this field Insurance Companies: Leave blank for ALL, to process charges for a specific insurance company, enter the insurance ID in this field Insurance Groups: Leave blank for ALL To process the claims, click on Process Please note, by selecting a Claim Type, Charge ID, Billing Provider, Insurance Company, or Insurance Group only the information specified will process and produce a claim. 01/2009 1

Errors will have a red exclamation point and the error message will appear in the Error Message field.

3 Electronic Claim Processing Once electronic claims are processed, the Claim Details Tab will come up. The Claim Detail Tab lists the claims that will process and any errors that may be in the batch. Errors will have a red exclamation point and the error message will appear in the Error Message field. From this screen you are able to go directly to the Charge ID and make any corrections. After looking over the batch, go back to the General Tab. Change the Process Type from Proof to Final Click on Process at the bottom of the screen To transfer the file to the Claim Processing Center folder, click Yes 01/2009 2

4 Electronic Claim Processing Click OK This creates an ANSI 837 file on the MDOM server. This file has to be retrieved to your local computer for further upload to clearinghouse/medicare, etc. 01/2009 3

5 Claim File Retrieval and Upload Electronic Claim Processing FTP Go to your desktop and double click the FileZilla FTP software. Connect to the server as shown below. 01/2009 4

6 Electronic Claim Processing You will be connected to the claims folder on the server on the right hand side of the screen. On the left hand side, select the MDOM claims folder of your local computer. Drag and drop the ANSI 837 file to your local PC. You can now upload this file to the clearing house or Medicare, etc. for further processing. 01/2009 5

Claim Processing Electronic Force to Paper Claim Processing CP Begin by clicking on the # symbol to create a new Claim Processing ID Process Type: Proof, this will check the claims for errors but not

7 Claim Processing Electronic Force to Paper Claim Processing CP Begin by clicking on the # symbol to create a new Claim Processing ID Process Type: Proof, this will check the claims for errors but not process them Claim Form: Electronic-Force to Paper Proc Center: OAX - Office Ally Paper Form: New CMS1500 (08/05) Acct Start Date: Leave blank Acct End Date: Leave blank Posted Charges: Needs to be checked Unposted: Needs to be checked Claim Process: Yes Process Claim Types: Leave blank for ALL Process Charges: Leave blank for ALL, to re-process an individual charge ID, enter the ID in this field Billing Providers: Leave blank for ALL, to process claims for an individual provider, enter the provider ID in this field Insurance Companies: Leave blank for ALL, to process charges for a specific insurance company, enter the insurance ID in this field Insurance Groups: Leave blank for ALL To process claims, click on Process 01/2009 1

8 Electronic Force to Paper Claim Processing Once your claims are processed, the Claim Details Tab will open. The Claim Details Tab lists the claims that will process and any errors that may be in the batch. Errors will have a red exclamation point and the error message will appear in the Error Message field. From this screen you are able to go directly to the Charge ID and make any corrections. After looking over the batch, go back to the General Tab. Change the Process Type from Proof to Final Click on Process at the bottom of the screen Click Yes 01/2009 2

9 Electronic Force to Paper Claim Processing The Print Preview screen will come up. Make sure you have CMS 1500 claim forms in your printer. Click on the Print button 01/2009 3

Claim Processing Paper Paper Claim Processing CP Begin by clicking on the # to create a new Claim Processing ID Process Type: Proof, this will check the claims for errors but not process them Claim

10 Claim Processing Paper Paper Claim Processing CP Begin by clicking on the # to create a new Claim Processing ID Process Type: Proof, this will check the claims for errors but not process them Claim Form: Paper Proc Center: Leave blank Paper Form: New CMS1500 (08/05) Acct Start Date: Leave blank Acct End Date: Leave blank Posted Charges: Needs to be checked Unposted: Needs to be checked Claim Process: Yes Process Claim Types: Leave blank for ALL Process Charges: Leave blank for ALL, to re-process an individual charge ID, enter the ID in this field Billing Providers: Leave blank for ALL, to process claims for an individual provider, enter the provider ID in this field Insurance Companies: Leave blank for ALL, to process charges for a specific insurance company, enter the insurance ID in this field Insurance Groups: Leave blank for ALL To process claims, click on Process 01/2009 1

Paper Claim Processing Once your claims are processed, the Claim Details Tab will open. The Claim Details Tab lists the claims that will process and any errors that may be in the batch.

11 Paper Claim Processing Once your claims are processed, the Claim Details Tab will open. The Claim Details Tab lists the claims that will process and any errors that may be in the batch. Errors will have a red exclamation point and the error message will appear in the Error Message field. From this screen you are able to go directly to the Charge ID and make any corrections. After looking over the batch, go back to the General Tab Change the Process Type from Proof to Final Click on Process at the bottom of the screen Click on Yes 01/2009 2

12 Paper Claim Processing The Print Preview screen will come up. Make sure you have CMS 1500 claim forms in your printer. Click on the Print button 01/2009 3

Claim Processing Secondary Claim Processing CP Begin by clicking on the # symbol to create a new Claim Processing ID Process Type: Proof, this will check the claims for errors but not process them

13 Claim Processing Secondary Claim Processing CP Begin by clicking on the # symbol to create a new Claim Processing ID Process Type: Proof, this will check the claims for errors but not process them Claim Form: Electronic Proc Center: OAX - Office Ally Paper Form: Leave blank Acct Start Date: Leave blank Acct End Date: Leave blank Posted Charges: Needs to be checked Unposted: Needs to be checked Claim Process: On Hold w/payment From Primary Process Claim Types: Leave blank for ALL Process Charges: Leave blank for ALL, to re-process an individual charge ID, enter the ID in this field Billing Providers: Leave blank for ALL, to process claims for an individual provider, enter the provider ID in this field Insurance Companies: Leave blank for ALL, to process charges for a specific insurance company, enter the insurance ID in this field Insurance Groups: Leave blank for ALL To process claims, click on Process 01/2009 1

Secondary Claim Processing Once electronic claims are processed, the Claim Details Tab will come up. The Claim Detail Tab lists the claims that will process and any errors that may be in the batch.

14 Secondary Claim Processing Once electronic claims are processed, the Claim Details Tab will come up. The Claim Detail Tab lists the claims that will process and any errors that may be in the batch. Errors will have a red exclamation point and the error message will appear in the Error Message field. From this screen you are able to go directly to the Charge ID and make any corrections. After looking over the batch, go back to the General Tab. Change the Process Type from Proof to Final Click on Process at the bottom of the screen To transfer the file to the Claim Processing Center folder, click Yes Click OK Minimize the MDofficeManager program and get to your Windows Desktop. The batch file will be saved on the MDOM server. Retrieve the file as you would for an electronic claims batch shown earlier. 01/2009 2

Statement Generation STATEMENT GENERATION (ST) ID: Description: Click on # to generate an ID. A name of the batch or single statement to be generated. This will not be displayed in the statement.

15 Statement Generation STATEMENT GENERATION (ST) ID: Description: Click on # to generate an ID. A name of the batch or single statement to be generated. This will not be displayed in the statement. Process Type:Proof Process in proof mode to review the statements before printing. Final Process in final mode once you are ready to print statements. Report Format: Statements can be printed either on a plain paper, pre-printed paper or electronic. Select the format you want the statements to be printed in. Aging Field: Select the appropriate aging field. Cutoff Date: The date at which you want to cut off statement processing. Other filters such as Name range, days since last statement, minimum balance etc can be selected. Responsible Parties (Leave blank for all): To process a single statement select the responsible party name or leave blank for all. Global Statement Message: Type in a message that you want it to appear on all the statements. 01/2009 1

You can view the statement details, balance etc and also exclude the statement

16 Statement Generation Once the statements are processed, the statement details tab will come up. You can view the statement details, balance etc and also exclude the statement from printing by checking the exclude box. Click preview to view statements. After reviewing the statement, process in final mode to print them. 01/2009 2

ELECTRONIC REMITTANCE ADVICE

ELECTRONIC REMITTANCE ADVICE INFORMATION ABOUT ERAS (ELECTRONIC REMITTANCE ADVICE) FILES Did you recently receive a check without a paper EOB? If so, the insurance company is sending you an Electronic