Provider Web Portal

1. 1 Provider Web Portal Institutional (UB-04) Web billing Department of Human Services

2. 2 Web portal basics This tutorial is specifically for those providers who submit on the Institutional (UB-04) claim form. The Web portal processes claims real-time so you will know the status of the claim as soon as you submit it. Providers will be able to view claims on the Web portal no matter how the claim is submitted (paper, electronic data interchange, or Web). Providers can: View submitted claims for status and accuracy. Submit new claims. Correct and resubmit denied claims. Adjust, void or copy paid claims. Forms: Professional (CMS-1500) Dental (ADA) Institutional (UB-04) Consistency across forms: Many of the sections are the same on each form. Some sections differ in required and optional information. All required fields are marked with an asterisk (*). Many items feature a Search hyperlink that allows the provider to search for the appropriate item. Once an inactive field is activated, the field becomes required. Forms: Professional (CMS-1500) Dental (ADA) Institutional (UB-04) Consistency across forms: Many of the sections are the same on each form. Some sections differ in required and optional information. All required fields are marked with an asterisk (*). Many items feature a Search hyperlink that allows the provider to search for the appropriate item. Once an inactive field is activated, the field becomes required.

3. 3 Web portal billing

4. 4 Submitting Institutional claims From the main menu select �Claims.� Select �Institutional� from the drop-down menu.

5. Institutional claim example. Six sections display. Institutional Claim TPL Medicare Information Detail Hard-Copy Attachments Claim Status Information Six additional sections do not display. Sections that differ from those already covered will be explained in the slides to follow. Institutional claim example. Six sections display. Institutional Claim TPL Medicare Information Detail Hard-Copy Attachments Claim Status Information Six additional sections do not display. Sections that differ from those already covered will be explained in the slides to follow.

6. 6 Institutional claim � section 1 Enter the required information and as much information as possible. The left side includes billing information. The right side includes service information. The Institutional Claim section is the main screen to access data entry sections for an institutional claim. Billing Information and Service Information items differ from professional and dental claim forms. The Institutional Claim section is the main screen to access data entry sections for an institutional claim. Billing Information and Service Information items differ from professional and dental claim forms.

7. 7 Additional sections

8. 8 Institutional sections A navigation menu allows access to additional sections that do not appear on the main page. Additional sections are: Diagnosis Condition Payer Procedure Occurrence/Span Value Click on the item to navigate a section.

9. 9 Additional � Diagnosis section Allows entry of up to ten diagnoses. Click �add� to activate the diagnosis section for each diagnosis to be entered. Enter the Diagnosis (to find a diagnosis code, use the Search feature). Enter the Sequence (diagnosis code pointer) number. Allows entry of one or multiple diagnoses. Click add to activate the diagnosis section for each diagnosis to be entered. Once the fields are activated, they become required. Enter diagnosis code. If Search is used, click the diagnosis from the line item results. Allows entry of one or multiple diagnoses. Click add to activate the diagnosis section for each diagnosis to be entered. Once the fields are activated, they become required. Enter diagnosis code. If Search is used, click the diagnosis from the line item results.

10. 10 Additional - Condition section Allows entry of one or multiple conditions (i.e., disabled beneficiary, private room medically necessary). Click �add� to activate the condition section for each condition to be entered. The Condition section allows entry of one or multiple conditions. Click add to activate the section for each condition to be entered. Enter condition code. If Search is used, click the condition from the line item results. The Condition section allows entry of one or multiple conditions. Click add to activate the section for each condition to be entered. Enter condition code. If Search is used, click the condition from the line item results.

11. 11 Additional � Payer section Allows entry of the names of the payer organizations being billed (A. Medicare, B. Other, C. Medicaid). Payers are to be entered in order of primary, secondary, and tertiary. Click �add� to activate the payer section for each payer to be entered. This section allows the user to enter the names of the payer organizations being billed. Payers are to be entered in order of primary, secondary, and tertiary. Click the add button to activate the Payer panel for each payer to be entered. This section allows the user to enter the names of the payer organizations being billed. Payers are to be entered in order of primary, secondary, and tertiary. Click the add button to activate the Payer panel for each payer to be entered.

12. 12 Additional � Procedure section Allows entry of the 4-digit principal procedure code. The procedure code is used to describe the procedure performed for definitive treatment rather than for diagnostic or exploratory purposes. Click �add� to activate the procedure section for each procedure to be entered. This screen allows you to enter the 4-digit principal procedure code. The procedure code is used to describe the procedure performed for definitive treatment rather than for diagnostic or exploratory purposes. Click add to activate the Procedure section. This screen allows you to enter the 4-digit principal procedure code. The procedure code is used to describe the procedure performed for definitive treatment rather than for diagnostic or exploratory purposes. Click add to activate the Procedure section.

13. 13 Additional � Occurrence/Span section Allows entry of the occurrence code (auto accident, employment related accident) relating to the billing period. Click �add� to activate the Occurrence/Span section. Required fields are: Sequence Occurrence code From date This screen allows you to enter the occurrence code and associated beginning and end dates used to define specific events relating to the billing period. Click add to activate the Occurrence/Span section. This screen allows you to enter the occurrence code and associated beginning and end dates used to define specific events relating to the billing period. Click add to activate the Occurrence/Span section.

14. 14 Additional � Value section Allows entry of the value code and related dollar or unit amounts to identify data of a monetary nature (most common semi-private rate). Click �add� to activate the Value section. Enter the Value (to find a value code, use the Search feature). This screen allows entry of the value code and related dollar or unit amounts to identify data of a monetary nature. Click add to activate the Value section. This screen allows entry of the value code and related dollar or unit amounts to identify data of a monetary nature. Click add to activate the Value section.

15. 15 TPL � section 2 If a third party payer was billed, enter that information in this section. Click �add� to activate. Enter as much information as necessary. If a third-party did not make a payment or made a partial payment, the appropriate HIPAA Adjustment Reason Codes (ARC) must be entered. Allows entry of TPL information. Click add to activate. If a third-party or other insurance did not make a payment or made a partial payment, the appropriate HIPAA ARC code must be entered. Do not enter recipient liability on the claim. Allows entry of TPL information. Click add to activate. If a third-party or other insurance did not make a payment or made a partial payment, the appropriate HIPAA ARC code must be entered. Do not enter recipient liability on the claim.

16. 16 Medicare information � section 3 This section is completed when the client has Medicare. This section is Medicare information applicable to Medicare/Medicaid crossover claims. If you are not billing a crossover claim, skip this section. Enter the total amount paid by Medicare for the entire claim. This is 1 of 2 screens that must be completed to bill for crossover claims; the Medicare items in the Detail section must also be completed. This section is Medicare information applicable to Medicare/Medicaid crossover claims. If you are not billing a crossover claim, skip this section. Enter the total amount paid by Medicare for the entire claim. This is 1 of 2 screens that must be completed to bill for crossover claims; the Medicare items in the Detail section must also be completed.

17. 17 Detail � section 4 Allows entry of up to 999 detail lines. Click �add� to activate the section for each service you are billing. Enter all required information. Allows entry of multiple detail lines (up to 999). Click add to activate the Detail section for each detail line item. Enter required information. Allows entry of multiple detail lines (up to 999). Click add to activate the Detail section for each detail line item. Enter required information.

18. 18 Hard-copy attachments � section 5 If you need to submit attachments with your claim, click �add� and complete as much information as possible. Examples include, sterilization or hysterectomy consent forms, op reports, medical records, etc. This section is optional, and contains a link to detailed instructions on how to submit supplemental documentation. Information about hard-copy attachments submitted with the claim can be entered. This section is optional, and contains a link to detailed instructions on how to submit supplemental documentation. Information about hard-copy attachments submitted with the claim can be entered.

19. 19 Claim status information � section 6 Claim status information displays at the bottom of all claims. No data displays before the claim has been submitted. Click �submit.� Before the claim has been submitted no data displays. The section will read �Not Submitted Yet.� Click submit. Before the claim has been submitted no data displays. The section will read �Not Submitted Yet.� Click submit.

20. Institutional claim, completed example. The claim is now available for status inquiry. Paid claims can be adjusted, voided or copied. Suspended claims can only be viewed. No action is available. Denied claims can be updated or corrected and then resubmitted. Institutional claim, completed example. The claim is now available for status inquiry. Paid claims can be adjusted, voided or copied. Suspended claims can only be viewed. No action is available. Denied claims can be updated or corrected and then resubmitted.

21. 21 Claim status information � section 7 Once the claim is submitted, this section indicates whether a claim is paid, suspended or denied. This section only indicates the allowed amount. To find out the actual amount DHS paid for the claim, you will need to perform a claim search. If applicable, click on �coversheet for supporting documentation.� Displays at the bottom of all claims. A button to obtain a coversheet is in this section. Once the claim is submitted, this section indicates whether a claim is paid, suspended or denied. Displays at the bottom of all claims. A button to obtain a coversheet is in this section. Once the claim is submitted, this section indicates whether a claim is paid, suspended or denied.

23. 23 EOB information The EOB (explanation of benefits) information section appears once the claim is submitted. This section populates with explanations specific to the claim.

24. 24 Claim actions Once you submit a claim, the following buttons are available at the bottom of the claim: --Paid claims: Adjust, copy, and void --Denied claims: Re-submit

25. 25 Paid claim � Adjust The adjust button allows modification of information within the claim, and then resubmits the claim to DHS. Modify and update data as necessary. Click on �adjust.� The adjust button allows modification of information within the claim, and then resubmits the claim to DHS. Modify and update data as necessary. Select the most appropriate HIPAA ARC code. Click on adjust. The claim, with adjustments, is ready for status inquiry. The adjust button allows modification of information within the claim, and then resubmits the claim to DHS. Modify and update data as necessary. Select the most appropriate HIPAA ARC code. Click on adjust. The claim, with adjustments, is ready for status inquiry.

26. 26 Paid claim � Void The void button cancels the entire claim. Click on �void.� Any amount previously paid by DHS will be recouped. You will not receive a warning! The void button cancels an entire claim that was previously submitted. Click on void. A message appears advising the void was successful. The void button cancels an entire claim that was previously submitted. Click on void. A message appears advising the void was successful.

27. 27 Paid claim � Copy claim The copy claim button makes an exact duplicate of an existing claim. Once copied, claims data can be updated, and the claim can be submitted as a new claim. Click �copy claim.� Update information as needed. Click �submit.� The copy claim button makes an exact duplicate of the existing claim. Once copied, claims data can be updated, and the claim can be submitted as a new claim. Click copy claim. Update information as needed. Click on submit.The copy claim button makes an exact duplicate of the existing claim. Once copied, claims data can be updated, and the claim can be submitted as a new claim. Click copy claim. Update information as needed. Click on submit.

28. 28 Denied claim � Re-submit The re-submit button allows modification of information within the claim, and then resubmits the claim to DHS. Enter new data in appropriate fields. Click �re-submit.� The re-submit button allows modification of information within the claim, and then resubmits the claim to DHS. Enter new data in appropriate fields. Click re-submit. The new re-submitted claim is ready for status inquiry. The re-submit button allows modification of information within the claim, and then resubmits the claim to DHS. Enter new data in appropriate fields. Click re-submit. The new re-submitted claim is ready for status inquiry.

29. 29 Thank you!