Institutional Web Portal Tutorial. Revised 5/11/17

Transcription

1 Institutional Web Portal Tutorial Revised 5/11/17 1

2 Contents INSTITUTIONAL CLAIMS... 3 PROVIDER INFORMATION... 7 SUBSCRIBER/CLIENT INFORMATION... 7 CLAIM INFORMATION... 8 BASIC LINE ITEM INFORMATION EDITING OR DELETING A LINE ITEM ENTERING A NATIONAL DRUG CODE (NDC) SUBMITTING AN ATTACHMENT TO A CLAIM SUBMITTED THROUGH THE WEB PORTAL MEDICARE SECONDARY/CROSSOVER TPL (OTHER THAN MEDICARE) ADJUSTING A CLAIM

3 INSTITUTIONAL CLAIMS Navigate to and select Provider Select Provider Portal from the left hand navigation bar. 3

4 Enter your User ID and Password. Click on Log In Note: If you have not yet registered for the Web Portal, you must do this first. Reference the Registration Tutorial or contact EDI Services at for assistance. 4

5 Select Claims. Select Create Institutional Template Name the template 5

6 o If making a template for each client, it is recommended that you name the template after each client i.e. Jane Smith. o If making a template for a code, it is recommended that you name the template after the code i.e or Office Visit. Note: When creating a template only fill out those selections that are not going to change from claim to claim such as NPI and taxonomy. Note: If using this tutorial to create a claim to submit, make a selection at each information. and fill out the necessary additional Note: There are red + signs before certain areas that allow additional information to be entered. Selecting the red + sign will expand the area. Only expand and enter information that is required, as entering invalid/incorrect information can cause a claim to reject. The below information will instruct you in which areas are required to be completed. 6

7 PROVIDER INFORMATION Are you resubmitting this claim? o Select Yes to submit a claim adjustment o Select No if creating a template or submitting an original claim. BILLING/PAY-TO PROVIDER o Provider ID dropbox - Select the Billing/Pay-To Provider s NPI Note: Select the Provider ID if you do not bill with an NPI. If the provider information you need is not in this drop down list, contact the EDI Call Center at , option 3 o Select the red + sign for Additional Billing Provider Information and enter the Billing/Pay-To Provider s taxonomy code in the Taxonomy Code box Note: Entering any additional information in this section may cause your claim to reject. SUBSCRIBER/CLIENT INFORMATION Recipient ID box - Enter the Wyoming Medicaid Client ID 7

8 CLAIM INFORMATION Patient Account No. box - Enter the patient account number Place of Service/Type of Bill dropdown Select the appropriate type of bill Frequency Type Code dropdown Select the appropriate 3 rd digit for the type of bill Statement Dates boxes Enter the statement dates Complete additional fields as needed Note: Admission type is where the claim can be indicated as an emergency, urgent, elective, newborn, trauma center, or unknown. Total Claim Charge box Enter the total claim charge Provider Signature on File Select Yes Medicare Assignment Code dropdown Select A:Assigned Benefits Assignment Certification Select Yes Release of Information Code dropdown Select Y:Provider Has Signed Release 8

9 Entery any condition, occurrence, or value codes if necessary Enter Prior Authorization information if necessary \ Ender diagnosis codes along with Present on Admission indicators as needed Note: Do not enter the periods in the diagnosis codes. 9

10 Does this claim have backup documentation? o Select Yes if the claim has backup documentation i.e. invoice, op notes, etc. a. Select BM: By Mail if sending the backup documentation by mail i. If BM: By Mail is selected, enter the most appropriate selection in the Type Attachment dropdown box b. Select EL: Electronic Attachment Only if sending the backup documentation electronically o Select No if the claim does not have backup documentation BASIC LINE ITEM INFORMATION Revenue Code box Enter revenue code Procedure Code box Enter procedure code if necessary o Modifiers boxes Enter modifiers if necessary Service Date/First Date of Service & Last Date of Service boxes Enter dates of service Service Units box Enter number of units Total Line Charges box Enter the total line Charges Once all necessary boxes have been completed, select the Add Service Line Item button 10

11 EDITING OR DELETING A LINE ITEM To edit a line item o Select the number next to the line item that needs edited The information will repopulate under the Service Line Items section o Make any necessary changes o Select the Update Service Line Item button To delete a line item o Select the Delete link for the line item that needs deleted ENTERING A NATIONAL DRUG CODE (NDC) Select the Other Svc Info link for the service line which needs an NDC Select the red + sign next to DRUG IDENTIFICATION o National Drug Code box Enter the NDC o National Drug Unit Count box Enter the unit count o Unit Code dropdown Select the unit code SUBMITTING AN ATTACHMENT TO A CLAIM SUBMITTED THROUGH THE WEB PORTAL Does this claim have backup documentation? o Select Yes if the claim has backup documentation i.e. invoice, op notes, etc. 11

12 Once the claim is keyed, select the Verify Claim button. This will help identify any errors that exist with the claim. Once any errors are corrected if there are any, select the Submit Claim button. 12

13 MEDICARE SECONDARY/CROSSOVER Select the red + sign next to Other Payer Information o Payer/Insurance Organization Name box Enter Medicare Select the red + sign next to Additional Other Payer Information o Adjudication Date box Enter the date that Medicare adjudicated Select the red + sign next to COB Monetary Amounts o COB Payer Paid Amount box Enter the amount that Medicare paid Select the red + sign next to Other Subscriber Information Select the red + sign next to Additional Other Subscriber Information o Claim Filing Code dropdown Select MA:Medicare Part A o Payer Responsibility Sequence Number Code dropdown Select P:Primary 13

14 Note: The Wyoming Medicaid Web Portal was only built to allow one additional insurance besides Medicaid. If the client has more than one additional insurance, please submit the claim on paper as an appeal stating why it cannot be billed through the Wyoming Medicaid Web Portal along with all necessary paperwork to process the claim. Select the red + sign next to Other Insurance Coverage o Benefits Assignment Certification Select Yes o Release of Information Code dropdown Select Y:Provider Has Signed Release From the top of the claim, select the tab that says Other Claim Info Under Coordination of Benefits, select the red + sign next to Claim level Adjustments o Claim Adjustment Group Code dropdown - Select PR: Patient Responsibility o Reason Code box - Enter the reason code a. 1 Deductible b. 2 Coinsurance c. 122 Psych Deductible o Amount box Enter the amount Select Basic Claim Form button to return to the Basic Claim Info page. Note: When verifying a claim, if the error code 265 The recipient has TPL on file and no TPL amount is indicated on the claim posts and the above information has been entered, please submit the claim. 14

15 TPL (OTHER THAN MEDICARE) Select the red + sign next to Other Payer Information o Payer/Insurance Organization Name Enter name of other insurance Select the red + sign next to COB Monetary Amounts o COB Payer Paid Amount Enter the amount that Medicare paid Select the red + sign next to Other Subscriber Information Select the red + sign next to Additional Other Subscriber Information o Claim Filing Code dropdown Select CI:Commercial Insurance o Payer Responsibility Sequence Number Code dropdown Select P:Primary Note: The Wyoming Medicaid Web Portal was only built to allow one additional insurance besides Medicaid. If the client has more than one additional insurance, please submit the claim on paper as an appeal stating why it cannot be billed through the Wyoming Medicaid Web Portal along with all necessary paperwork to process the claim. Select the red + sign next to Other Insurance Coverage o Benefits Assignment Certification Select Yes o Release of Information Code dropdown Select Y:Provider Has Signed Release Note: When verifying a claim, if the error code 265 The recipient has TPL on file and no TPL amount is indicated on the claim posts and the above information has been entered, please submit the claim. 15

16 ADJUSTING A CLAIM Are you resubmitting this claim? o Select Yes to submit a claim adjustment o Resubmission Type Code box Select 6:Adjustment o ICN to Credit/Adjust box Enter the ICN/TCN from the claim to be adjusted Note: If 7:Replacement is selected from the Resubmission Type Code box, this will void the original claim and submit a clean new claim. This should only be used when the originally paid claim needs voided or the originally paid claim s paid date is past the six month timely filing adjustment limit. 16