General Claims Submission Training - idmedicaiduat.com

1 Idaho Department of Health & WelfareGeneral claim Submission TrainingIdaho Department of Health & WelfareOverview2 This session covers the steps to access online claim entry for the following: Professional, CMS-1500 Institutional, UB-04 Idaho Department of Health & WelfareNavigating the Secure Portal3 Idaho Department of Health & WelfareNavigating the Secure Portal4 Idaho Department of Health & WelfareClaim Submission5 There are three locations to submit a claim within the Care RosterNote: This presentation will focus on submitting a claim through claim Submission . For additional information on submitting a claim through the Patient Roster or Primary Care Roster, please refer to the Trading Partner Account (TPA) User Department of Health & WelfareView & Submit Claims6 Idaho Department of Health & WelfareCMS 1500 (Professional) ClaimIdaho Department of Health & WelfareClaim Submission | Professional8 Select your claim type: Professional, CMS 1500 Institutional, UB-04 Copy Last claim can be used after your first claim Submission for the member.

2 This feature allows you to use data from the most recent claim for the member ID entered. For more information on this feature, refer to the Trading Partner Account (TPA) User Department of Health & WelfareMember Search9 Note:Two pieces of information are required; MID and DOB are recommended. Idaho Department of Health & WelfareClaim Submission | Professional10 Idaho Department of Health & WelfareProfessional claim Information11 The participant information auto-fills based on the participant identified. Other fields include: Patient Account #:(required) The number assigned to the patient in your billing system. Medical Record #: (optional) As used by your office. Referring Provider: Required for certain provider types and specialties. Rendering Provider: (required) Choose from the drop-down. Service Location: Choose from the drop-down.

3 Condition Codes, Ordering Provider, and Supervising Provider: Requiredfor certain provider types and Department of Health & WelfareDiagnosis Codes12 Diagnosis codes are required on all claim types Use the correct ICD code set for the date of service (DOS):oDOS before October 1, 2015: Use the appropriate ICD-9 codeoDOS on or after October 1, 2015: Use the appropriate ICD-10 codeoOnly one ICD version may be used per claim ; if you attempt to submit a claim with both ICD-9 and ICD-10 codes, you will receive an error message. Idaho Department of Health & WelfareServices13 Fields marked with an asterisk (*) are required with the exception of minutes which is not required. An Auth#is required if the service requires a prior authorization. Only one Authis allowed per service line. If the service is for a drug product, click on the Enter NDC Codes checkbox.

4 Additional fields will appear for you to enter NDC (National Drug Code) Department of Health & WelfareCOB Information14 Click Enter COB Informationif this is a secondary claim . Your popup blocker must be off for this screen to Department of Health & WelfareAdditional Information15 Additional Information is for information about whether these services are related to any kind of accident. Once all the information has been completed on the claim form , select the Submitbutton at the bottom of the screen. You will receive a confirmation screen including the claim Department of Health & WelfareClaim Confirmation Page16 Idaho Department of Health & WelfareUB04 (Institutional) ClaimIdaho Department of Health & WelfareClaim Information | Institutional18 The participant information auto-fills based on the participant identified. Other fields include: Patient Account #:(required) The number assigned to the patient in your billing system.

5 Medical Record #: (optional) As used by your office. Referring Provider:(optional) Enter manually or use the search icon Service Location: Choose from the drop-down. Bill Type (required) Attending(required) Operating:(optional) Dependent on bill type or service codes. Covered Days, Non-Covered Days, Life-time Reserve, and Co-insured Days:(optional) Enter as Department of Health & WelfareAdmission Data19 Enter the closest hour to the admission/discharge time. Times should be entered using a 24-hour format. For example, 8:00 is entered as 08, and 7:00 is entered as 19 (12+7).Idaho Department of Health & WelfareDiagnosis Codes20 Select the radio button for the appropriate code version. Code: Diagnosis code to be entered Description: Populates automatically once the code is entered Type: Primary or secondary, fills automatically once the code is entered POA(Present on Admission): Use Y (Yes), N (No), or U (Unknown/Undetermined).

6 Idaho Department of Health & WelfareProcedure Codes21 For all procedure codes, the Code and the Date of Service should be entered. The Description and the Type will fill automatically. The first line entered will be the primary type. All following lines entered will be secondary. Idaho Department of Health & WelfareOther Codes22 Code: Diagnosis code to be entered Description: Will fill automatically once the code is entered Idaho Department of Health & WelfareService Codes23 Once all fields are completed, click the Submitbutton at the bottom of the page. You will then receive a confirmation including the claim Department of Health & WelfareClaim Confirmation Page24 Idaho Department of Health & WelfareReferences | claim Submission Tips25 Refer to the following sections of the Provider Handbook for more information on Claims Submission .

7 CMS 1500 Instructions UB04 Instructions General Billing Instructions Physician and Non-Physician Practitioners (for NDC information)The Provider Handbook is located at Department of Health & WelfareSplitting Claims26It may be necessary to split your Claims : A PA number changes in the middle of your DOS range The participant has an enrollment change The provider has a rate change A claimwith primary insurance that hascovered and non-covered services Services span from one month to the next month Services span from one year to the next yearNote: Thislist is not all Department of Health & WelfareClaim Adjudication27 Adjudicating the claim allows you to see some outstanding edits. If you choose not to adjudicate at this time, the claim will be picked up in the mass adjudication each evening. There are two locations to adjudicate a claim .

8 The claim confirmation screen right after finding the claim in View and Submit claim , select radio button in front of claim number and select the Department of Health & WelfareAdjudicate Button28 Idaho Department of Health & WelfareClaim Adjudication29 Once adjudicated, the Outstanding Edits screen will display any edits so you can address any outstanding issues. You can do this by selecting the Edit claim Department of Health & WelfareAdding Attachments30 There are two locations for uploading an the claim confirmation screen right after finding the claim in View and Submit claim , clicking on the radio button in front of the claim number and clicking the Add you submit your Claims via paper, vendor, clearinghouse, or portal, you can log into your Trading Partner Account (TPA) to attach a file. You can attach a file to any claim in open, pend or adjudicated Department of Health & WelfareAdding Attachments31 Idaho Department of Health & WelfareAdding Attachments32 Idaho Department of Health & WelfareProvider Relations Consultants33 Region 1 and the state of Washington1 (208) 559-4793 2 and the state of Montana1 (208) 991-7138 3 and the state of Oregon1 (208) 860-4682 4 and all other states 1 (208) 912-3970 5 and the state of Nevada1 (208) 484-6323 6 and the state of Utah1 (208) 870-3997 7 and the state of Wyoming1 (208) 991-7149 Department of Health & WelfareThank you for attending our General Claims Submission take a few minutes to complete the survey that will be emailed following this presentation.

9 This provides us with valuable information for future trainings.