User Manual - eMedNY.org
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1. HOSPITAL EXPENSE REPORT Facility Name Facility Address MIS TEST Month Year December 2013 October 2013 August 2013 February 2013 January 2013 December 2012 August 2012 June 2012 March 2012 February 2012 ebrua August 2011 F ry 2011 15 Metrotech Brooklyn NY 11201 Total Hospital Expense Reimbursement imt Figure 18 Hospital Expense Report PTAR User Manual 16 The View PDF button displays the complete set of individual hospital expense claims for a selected month The reports are PDFs showing each individual expense incurred in a given month Hospital Expense Reimbursements for June 2013 Back to Previous Page Automatic Zoom men voe Goen ot ep GED PUBLIC TRANSPORTATION AUTOMATED REIMBURSEMENT HOSPITAL EXPENSE REIMBURSEMENTS FOR JUNE 2013 Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 Print Date 12 12 2013 amp NO Name CIN Medical Ecoort Age Dicsbiliy Round Trip CarfareAmt Payment Mode Looation Name Bervloe Date AooPte a Ride NIA 05 032013 NO Nos No Yess Metrocard MIS TEST2 2 N A 05022013 NO Ne Na Yess Metrocard MIS TEST2 i NIA 05022013 NO Nc Na Yes 8 Metrocard Mis TEST 2 TOTAL NO OF CLAIMS 3 Total Amount 15 00 Cach Dicpencec 0 00 Page tori Figure 19 Hospital Expense Report Detail View Instructions 1 Click the View PDF button for a month to view its individual hospital expense claims The2. 2 3 4 D H 8 The Issuance Details report has many options for viewing issued claims for a selected period All claims AII claims for a specific facility All claims for a specific location All claims issued by a specific user or a user role Data Entry Cashier Supervisor Facility Administrator e Any combination of facility location and user or user role One thing to keep in mind is that because the output is a PDF reports can be stored for offline use It may be worthwhile to create a folder structure on a drive or utilize a document repository to hold a set of reports that are produced on a regular schedule PTAR User Manual 18 Instructions 1 Set the Start Date and the End Date using their respective calendar controls The maximum range is 31 days Select the group from the Group drop down or use the ALL default Select the location from the Location drop down or use the ALL default Select the user or role from the Issued By drop down or use the ALL default Click Submit to generate the report based on the selected parameters The report PDF displays NP ui PTAR User Manual 19 Issuance Summary Report The Issuance Summary report lists a summary of the claims issued on either a by date or by group basis for a period of up to 31 days The claims may be viewed as a complete summary of every claim for the period or a summary of the claims broken down by one or more of the Group Location and Issued by PTA
3. particular date or combined e g Incomplete claims on a particular date CIN Medical Service Date TS Request Type Medicaid Managed Care v Filter Clear Filter By Figure 15 View Reimbursement Filter By Fields A 14 claim listing VIEW REIMBURSEMENT HISTORY MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 December 2013 Denied Claims CIN Medical Service Date 8 Request Type Incomplete Claims Filter By Displaying 1 to 14 of 14 records Total Cash Amount 10 00 Total Metrocard Amount 20 00 12 07 2013 02 17 PM Nepoznato 12 07 2013 EE SEE em hc Jess su beren AE Administrator stach a N wed ET EE EE Toral Amount SSES HESE Code Legend AMT Invalid Amount CNF Client Not Found In WMS CP Coverage Period Not Valid FMT Invalid CIN Format MC Enrolled In Managed Care CONYC CIN Outside New York City HE Hospital Expense Figure 16 View Reimbursement Claims Detail Listing Unfiltered PTAR User Manual 14 can be filtered to a three claim listing In this case Medical Service Date is the filter VIEW REIMBURSEMENT HISTORY Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 December 2013 Denied Claims pce CIN Medical Service Date 2 2003 S Request Type Incomplete Claims Fitter Clear Displaying 1 to 3 of 3 records Total Cash Amount 5 00 Total Metro
4. 25 PTAR User Manual iii Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 15 Figure 16 Figure 17 Figure 18 Figure 19 Add New Request Batch Mode Entry Batch Mode Entry Successful Submission Change Facility ISI SUI ET p File Upload Spreadsheet Template 7 File Upload Template Field Formats and Values nennen ener nnn nnns enne nnns 7 Sample Entry in File Upload Template 7 Mark Service Month as Complete EERS ree pa etse tete pn an Ed Ea Ee a KO en Ge GR EERS vae Fe e ER GEE Ee ERE E RATER ERE ee 9 Mark Service Month As Complete Summary View Pending Claims ccccccccsssscecsssceeeesssseceesaeeeeessaeees 9 View Reimbursement HistOry sassaresi i aaiae aiaiai iia 11 View Reimbursement History Single Summary View Denied Claims uses esse ee es ee ee ee ee ee Re ee Re ee ee 12 View Reimbursement History Showing Multiple Summary Views 13 View Reimbursement History Detail View Issued Claims View Reimbursement Filter By Fields sse View Reimbursement Claims Detail Listing Unfiltered View Reimbursement Claims Detail Listing Filtered by Medical Service Date 15 Hospital Expense Report enero en em tne Ee sra e Yun ox EEN Fea va hee EAR EENS 16 Hospital Expense Report Detail View cccccccccccssssssssecececeesese
5. LEE 2 Approve REQUESES m 3 eu gen ETE EE 3 Batch Mode oe D ER N OE ET EG d INSTRUCTIONS SG ES eo ois SE bat din way EE I GE GE Ee EG Ge GE Ge ntes Gr Se N Ge 5 Change oe in AA oreet OR EE EE ER EE NE OE N EE 6 File YE Cc 7 e Cu ten Le EE 8 Mark Service Monthas Complete eege eret ergo tite E ei ed ee eee dese RR VIR Ene Le eR ee ede ey 9 View Reimbursement History senecon e Ere DERE toe EE 11 enn deed Le EE 15 REC PADIS i me 16 Hospital Expense Report se es ee EG Oe GE EE ee R Se ge Dee Se Dek GER ee ee BEG eie 16 enn Een Le EE 17 Issuance Details Report eee De pere ertet tene e ey tae O eee uade ot ense Ge EE 18 eu dees ve 19 Issuance Summary Report E 20 ene gien Le EE 21 Managed Care Ines EE OE RO EE N ER RR EE 22 INSTRUCTIONS cr 23 Cashier S CIEN EP 24 Usage 25 INSTRUCTIONS 4 25 otii tron teen Ge bee ee ee tain epe i AE Ce i RE OR TR rre RH epe een 25 104 M N IE EE EE EE N ER EE N EE ER EE N EE 26 Update User RE RE N AE EE EE AE EN 26 enn dees KERR EE EN 26 PTAR User Manual i Role Specific Contents REIMBURSEMENT GRA VE c N 1 Batch Mode Enty M sts een RE EE N N EE EE N 4 Fil W pla EE 7 View Reimbursement Histo
6. Pendingissuance 090 LI am weu November 2013 2 155 00 15 85 00 103 80 00 346 1 990 00 October 2013 170 00 0 0 00 6 30 00 28 140 00 Note Service Month can not be mark as complete until all Pending Requests are processed and approved Before Closing the Service Month please make sure all claims for the Service Month are entered in PTAR Figure 10 Mark Service Month As Complete Summary View Pending Claims PTAR User Manual The Mark Service Month as Complete function requires all pending claims to be processed as issued or denied before a month can be closed As well care should be taken before using Mark Service Month as Complete to ensure that all claims have been entered because once a month is closed those claims cannot be processed For months that have no pending claims clicking the Service Month field performs the function and marks that month as complete PTAR User Manual 10 View Reimbursement History View Reimbursement History presents a month by month summary of the reimbursement claims for a facility Two parameters control the report e Calendar year e Last x months where x 12 9 6 or 3 months Changing either of the parameters automatically refreshes the page with the selected information For each month two sets of information are presented Processing and Claims The status information is a combination of facility administrator and DOH proces
7. paper b Ifselecting Activate Signature Pad the client must sign the request using the electronic signature pad The page refreshes and displays the successful submission message The request is now pending approval by a supervisor or the facility administrator Click Add Another Request to create a new request for the selected facility or Select new Location to create request for a different facility PTAR User Manual Approve Requests Approve Requests provides supervisor and facility administrators with the ability to approve or deny reimbursement requests The requests may be approved individually or multiple groups There is also the ability to filter separate the requests into various types A list of the months containing outstanding requests is displayed under each facility A supervisor or facility administrator clicks on a month to view and process the individual claims The detailed breakdown for a month shows one or more pages of individual requests For each request has the following fields Client name Reimbursement Type CIN DOB Service Date Disability Access a Ride Roundtrip Carfare Escort Age age is either lt 65 or gt 65 and is only applicable when Escort Y Submitter Name Request Date Above the grid is a breakdown of the individual requests types and the number of requests for each type In addition the display may be limited to displaying a single type of request by selecting a type from the F
8. 1 Select the location from the location grid 2 Foreach batch entry fill out all fields The Escort field under Payment Mode is ignored if Escort Required is set to No Note Selecting the Service Date for the first batch entry defaults all entries to that date However the date may be overridden for each succeeding batch entry 3 Click Save to submit the batch entries The Request Submitted Successfully page displays 4 Click Select New Location to submit batch entries for a different location or Add New Request to submit a new set of batch entries for the same location PTAR User Manual Change Facility Change Facility sets the target facility for functions and reports The selection is made from a list of the available facilities Please Select a Facility MIS TEST Test Without Cluster Figure 4 Change Facility PTAR User Manual File Upload File Upload allows multiple requests to be submitted for a selected location by uploading them in a spreadsheet Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 Please Select a File to Upload Template Browse No file selected Upload Fed Figure 5 File Upload The system supplies a downloadable template for the submission that can be populated and uploaded or users may create one from scratch as long as it matches the column layout of the template and is in xls format The template has seven
9. HSP Metro Plus Metropolitan Health Plus NY State Catholic Health Plan Fidelis Figure 23 Managed Care Invoice Group Report PTAR User Manual 22 The View PDF function for each provider generates the invoice for the managed care claims INVOICE FOR MANAGED CARE REQUESTS FOR OCTOBER 2010 Facility Name MIS TEST Print Date 12 10 2013 Facility Address 15 Metrotech Brooklyn NY 11201 15 Metrotech Brooklyn NY 11201 PLAN NAME HealthPlus an Amerigroup Company S NO Name CIN DOB Medica Disability Escort Age Round Trip Carfare Location Name Signature Service Date Access a Amt Ride 1 PACIENT PASYAN 2232145A mmiddlyyyy 10052010 YesiYes YES 65 Yes 4 50 M MIS TEST 2 2 ENKONI NEZ ZZ54321A mmiddlyyyy 10 18 2010 Yes No NO Yes 2 20 M MISTEST2 Hen Erb mis 3 PATIENS NOEN ZZ12345A mm ddiyyyy 10202010 Yes No NO Yes 225M MSTEST2 Nora fina Total Request for HealthPlus an Amerigroup Company 3 Total Amount 8 95 Number of cards 8220 x 1 220 Number of cards 4 50 x 1 450 Number of cards 225 x 1 225 Total Metrocards Amount 3 835 TOTAL NO OF REQUEST S 3 Grand Total 8 95 Figure 24 Managed Care Invoice Instructions 1 Select the month from the Managed Care Invoice grid 2 Select the report type 3 Click View Details The facility or group report displays 4 Fora group report click the icon to the left of the group to display its managed care providers fo
10. NY 11201 Group Name MIS Group 1 Location Name MIS TEST 2 Location Address 15 Metrotech New York NY 10001 Click Activate Signature Pad To Accept Client Signature OR Click Manual Issuance Client Information Client CIN ZZ12345X Client s Sex Female Client Name ANHYSBYS CLEIFION Client DOB MM DD YYYY Age XX Disbursement Information Medical Service Date 12 12 2013 Payment Details Comments Transportation covered by BLUE CHOICE BLUE CHOICE OPTIO Provider ID 00477023 Access a Ride No Escort Required No Trip Round Trip Back Manual Issuance Activate Signature Pad Figure 1 Add New Request PTAR User Manual 1 Instructions l 2 3 Cl Six tA Select facility Swipe the client s card or type the CIN Click the Next button The travel entry fields display with the client s information at the top and a system message indicating the paying provider Select the appropriate values for the travel Note that a row for Escort displays under Payment Details when selecting Yes for Escort Required Click Continue The travel details listing displays Verify the information is correct Click Back to change any incorrect entries Click Manual Issuance or Activate Signature Pad to acknowledge the information a If selecting Manual Issuance a comment must be entered and the signature collected by having the client physically sign a sheet of
11. Public Transportation Automated Reimbursement System User Manual Version 2014 01 April 2014 HIPAA Security and Privacy The Health Insurance Portability and Accountability Act of 1996 HIPAA is a federal law that protects health insurance coverage for workers and their families when they change or lose employment It includes the Privacy Rule enacted April 14 2003 that established regulations for the use and disclosure of Protected Health Information PHI the Security Rule enacted April 25 2005 that addressed electronic PHI e PHI and established the requirements to protect the confidentiality integrity and availability of PHI created maintained and transmitted in electronic format and Health Information Technology for Economic and Clinical Health Act of 2009 HITECH that strengthened the HIPAA regulations HIPAA is intended to e Provide better access to health insurance e Limit fraud and abuse e Reduce the administrative costs of providing health care e Standardize the content and format of electronic health care transactions and promote their use e Ensure privacy and security of paper PHI and e PHI Under HIPAA users are to e Utilize unique user IDs and passwords for each login e Only share PHI with co workers who have a need to know and the appropriate access e Discuss PHI in private areas not in public areas or in telephone conversations that can be easily overheard by others e Keep and protect writ
12. R user or role parameters The report has three sections two of which are the same for the by date and by group options e Report Parameters Date range group location and issued by e Issuance Summary summary of the issued claims The third section varies based on the By Dates or By Group option e By Dates claims broken down by the issuance summary types ISSUANCE SUMMARY REPORT Print Date 12 10 2013 MIS TEST 15 MetrotechBrooklyn NY 11201 Start Date 11 20 2013 End Date 12 01 2013 Group Name ALL Location Name ALL Issued By ALL Report Type Totals By Date ISSUANCE SUMMARY Metrocard Total Amount Cash Total Amount Total Amount Total Medicaid Fee For Service Issuances 1 5 00 0 0 00 5 00 Total Hospital Expense Issuances 8 40 00 0 0 00 40 00 Total 9 45 00 0 1 0 00 45 00 DATE 11 20 2013 Group Name MIS Group 1 Location Name MIS LOCATION 1 Total Medicaid Fee For Service Issuances Number of Cards 35 00 x 5 00 Total Metrocards Amount 5 00 Totals 5 00 Total Hospital Expense Issuances Number of Cards 935 00 x 10 00 2 2 Total Metrocards Amount 2 10 00 2 Totals 10 00 Total For Location MIS LOCATION 1 Metrocard Amount 15 00 Cash Amount 0 00 Total s 3 Location Name MIS TEST 2 Total Hospital Expense Issuances Number of Cards 35 00 x 4 20 00 Total Metrocards Amount 4 20 00 Totals 4 20 00 Total For Location MIS TEST 2 Metroca
13. ation MIS LOCATION 1 Metrocard Amount 15 00 Cash Amount 0 00 Total s 3 Location Name MIS TEST 2 Total Hospital Expense Issuances Number of Cards 235 00 x 8 30 00 Total Metrocards Amount 6 30 00 Total 6 30 00 Total For Location MIS TEST 2 Metrocard Amount 30 00 Cash Amount 0 00 Total s 6 Total for Group MIS Group 1 Metrocard Amount 45 00 Cash Amount 0 00 Totals 9 Figure 21 Issuance Summary Report by Group The Issuance Summary report has many options for viewing issued claims for a selected period All claims AII claims for a specific facility AII claims for a specific location All claims issued by a specific user or a user role Data Entry Cashier Supervisor Facility Administrator Any combination of facility location and user or user role One thing to keep in mind is that because the output is a PDF reports can be stored for offline use It may be worthwhile to create a folder structure on a drive or utilize a document repository to hold a set of reports that are produced on a regular schedule Instructions 1 ON d bs Set the Start Date and the End Date using their respective calendar controls The maximum range is 31 days Select the group from the Group drop down or use the ALL default Select the location from the Location drop down or use the ALL default Select the user or role from the Issued By drop down or use the ALL default Select the By Date or By Group o
14. card Amount 0 00 Administrator 12 03 2013 Facility 06 23 PM MIS LOCATION 1 Total Amount Code Legend AMT Invalid Amount CNF Client Not Found In WMS CP Coverage Period Not Valid FMT Invalid CIN Format MC Enrolled In Managed Care CONYC CIN Outside New York City HE Hospital Expense Figure 17 View Reimbursement Claims Detail Listing Filtered by Medical Service Date Instructions 1 Select the calendar year from the Year drop down The Reimbursement History grid updates to the selected year 2 Select the number of months to display The grid updates to display the selected number of months 3 Click the applicable claims amount field for a month to display the claims by type summary This may be repeated for different months simultaneously Click VIEW for a claim type to view the individual claims for that type Optionally use one or more of the fields in the Filter By section to limit the claims shown Uus PTAR User Manual 15 REPORTS Hospital Expense Report The Hospital Expense report provides summary and detail views of hospital expense claims for a facility The initial summary view displays the total number and dollar amount of claims for every month on record The view stretches over multiple pages beginning with the most recent month The two summary two fields e Total Hospital Expense Reimbursement e Total Amount present the number of the claims and total amount for each month
15. cards e The date of service may be any date rather the current date The requests are arranged in a 25 row grid with each row having fields for e CIN e Service Date e Escort Required e Access a Ride e Round Trip e Payment Mode o Client o Escort BATCH MODE ENTRY Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 Group Name MIS Group 1 Location Name MIS LOCATION 1 Location Address 15 Metrotech Brooklyn NY 11201 KIN ENE NEE IE EIN NEE ee 1 F8 ocve9No CYes9No 9YesC No Metiocara x Metrocard v 2 OP ovaeew Yes No Yes No Kees Metrocard e 3 FS genge OYes No 9 Yes No CH Mebocard an d OP Cep be OYe9No Yes No Kegel Metocard z s TS Yes No Yes No 9 Yes No Metrocard 7 Metrocard v 6 FE OVes No Yes9 No 9 Yes No Metrocar 7 Metrocard v 7 Tes No eg Ne 9 Yes No EN Metrocard 8 TTT geg No Yes No 9 Yes No Metrocard v Metrocard v 9 F8 oOve amp No OvYe9 No 9YesONo Weess Metrocard v 10 P ER Yes No Yes9 No yes No Metrocard Metrocard Yes No Yes No 9 Yes No Metrocard Metrocard 12 OR Yes No Yes No Yes No Metrocard Metrocard v 13 F8 ocvaeNo OCYe9No 9YesONo Meroen AT 14 88 ove9No OYe No 9YeONo Metrocaro 7 Metrocard 15 BE Yes No Yes No 9YesO No Metrocard 7 Metrocard v 16 m Yes No Yes No YesO No Bescht Metrocard iz 17 8 oveseN V
16. columns that match the seven parameters entered when using the Add New Request or Batch Mode Entry functions A B c D E F G 1 Service Date Medicaid CIN Escort Y N Access A Ride Y N RoundTrip Y N Pay Client C M Pay Escort C M 2 3 4 Figure 6 File Upload Spreadsheet Template Each row in the template is one reimbursement and every entry must be a specific format or value Column Format or value Service Date MM DD YYY Y mm dd yyyy Medicaid CIN XXXXXXXX Escort Y N Y or N Yes or No Access A Ride Y N Y or N Yes or No RoundTrip Y N Y or N Yes or No Pay Client C M C or M Cash or Metrocard Pay Escort C M C or M Cash or Metrocard Must always be specified Figure 7 File Upload Template Field Formats and Values For example a claim on November 18 2013 for CIN ZZ12345X with no escort Access a Ride a roundtrip and a Metrocard for the client would be entered as A B G D E E G 1 Service Date MM DD YYYY Medicaid CIN Escort Y N Access A Ride Y N RoundTrip Y N Pay Client C M Pay Escort C M 2 11 18 2013 ZZ12345X N Y Y c Figure 8 Sample Entry in File Upload Template NOTE Even though there is no escort Escort cell 2 N the Pay Escort cell must contain a value PTAR User Manual Instructions First time usage including template download 1 Select the location from the location grid 2 Click the Template link to download the File Upload spread
17. e No 9 Yes No Lr IT 18 TT EC Yes No OYes9No 9 Yes No Metrocard 7 Metrocard v 19 Ces g No Yes9 No Yes No Metrocard v Metrocard v 20 Be Yes No OYes No 9 Yes No Metrocard Metrocard v n F8 ocve No OYe9No 9YesONo Wees Sec 22 OF weg No Yes9 No Yes No Metrocard Metrocard 2 F8 ovee9No OYe9No 9YesONo eescht Metrocard TE Ove No OVYes No YesO No Metocard v Mekcca v 25 TTT oveseN Yes9 No 9 Yes No Bees aboca lin Back Save Figure 2 Batch Mode Entry PTAR User Manual The system processes only rows that contain a CIN In those rows all fields must be filled to be valid Note that the Escort field under Payment Mode is ignored if the Escort Required value is No After submission the function displays the submitted request The user may continue using the function by either selecting a new facility or adding a new batch mode entry BATCH MODE ENTRY Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 Group Name MIS Group 1 Location Name MIS LOCATION 1 Location Address 15 Metrotech Brooklyn NY 11201 Request s Submitted Successfully Escort EE Access A Ride Round Trip Client Payment Mode Escort Payment Mode 11 25 2013 ZZ54321X 12 02 2013 Metrocard Cash Z254321X Select New Location Add New Request Figure 3 Batch Mode Entry Successful Submission Instructions
18. ecember 2013 930 00 1 5 00 151 885 00 November 2013 2 155 00 15 85 00 See 80 00 346 1 990 00 October 2013 875 00 14 105 00 23 130 00 121 640 00 August 2013 590 00 14 77 50 83 82 50 86 430 00 June 2013 165 00 6 30 00 49 65 00 14 70 00 May 2013 370 85 91 133 35 47 235 00 April 2013 440 00 49 122 50 46 307 50 March 2013 1 625 00 V 114 385 00 217 1 225 00 February 2013 3 712 10 i 275 884 10 518 2 765 00 January 2002 425 00 0 0 00 15 75 00 70 350 00 January 2001 170 00 0 0 00 6 30 00 28 140 00 Note Service Month can not be mark as complete until all Pending Requests are processed and approved Before Closing the Service Month please make sure all claims for the Service Month are entered in PTAR Figure 9 Mark Service Month as Complete The Mark Service Month as Complete grid displays seven fields Service Month Total Claims Total Claims Amount Issued Claims Amount Denied Claims Amount Pending Claims Amount The three claims amount fields are click thrus that lead to summary and detailed listings of their respective claim types The type of claim summary is indicated by the shading under its name Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 930 00 34 40 00 151 885 00 GE EE Pending Facility Approval 148 swo wem Pending Batch Processing 3 sso vw
19. eecececseseseeseseesescsesneeeseeeesceeseeaeseseesssesssaeaeees 17 Figure 20 Issuance Summary Report by Date 20 Figure 21 Issuance Summary Report by Group 21 Figure 22 Managed Care Invoice Facility Report 22 Figure 23 Managed Care Invoice Group Report 22 Figure 24 Managed Care INVOICE sese nn nnns enne RA ee sess enne taa ee sess esse Ee assai sees ee rasa asas enean ad 23 Figure 25 Figure 26 Usage efa EE Update User Settings PTAR User Manual iv REIMBURSEMENT Add New Request Add New Request creates a new reimbursement request for an individual client of a facility The function is a multi step process that begins with swiping or entering a client s ID The system uses the ID to determine the client s eligibility and the provider who will pay the claim After entering the relevant information for a claim escort one way roundtrip the client electronically signs the claim and it is submitted for approval by either a supervisor or the facility administrator The following information is specified CIN Date Access A Ride request Escort One way or roundtrip Cash or Metrocard payment specified for both if client had an escort The date is always set to the current date and cannot be changed Requests for dates other than the current date must be submitted through either Batch Mode Entry or File Upload ADD NEW REQUEST Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn
20. et the Start Date and the End Date using their respective calendar controls The maximum range is 31 days Select the group from the Group drop down or use the ALL default Select the location from the Location drop down or use the ALL default Select the user or role from the Staff drop down or use the ALL default Select Issued Denied or Pending from the Request Claims drop down Click Submit to generate the report based on the selected parameters The report PDF displays PTAR User Manual 25 SETTINGS Update User Settings Update User Settings contains personal and security information for users It is the initial page that all users encounter in order to create a permanent password and set up the three required security questions The information may be updated at any time UPDATE USER SETTINGS Please complete all fields denoted by the red asterisk Please leave password field blank if you don t want to change password Password must meet the following minimum New Password LILLTILII requirements Be at least 8 characters in length and contain at least one each of the following English uppercase letter A through Z English lowercase letter a through z Email Address emailaddress emailaddress com Number 0 through 9 Special Character amp Confirm Password First Name Ukendt Middle Initial Last Name Bruger Security Question1 Select X Security Answer1 Security Question2 Se
21. ilter By drop down Requests can be individually selected using the checkboxes next to each request or all requests can be selected using the Check all function Clicking either Approve or Dispaaprove displays the Confirm action page that dispalys only the selected claim s with either the Approve Requests or Disapprove Requests button After selecting the action the display updates with a success message and presents the option to return to approvals by location or by month Instructions 1 Select month under the appropriate facility The individual requests for the month display 2 Select one or more of the displayed requests or use the By Filter function to limit the displayed requests 3 Click Approve Requests or Disapprove Requests The confirm action page displays with only the selected requests and the applicable Approve Disapprove button 4 Click the Approve or Disapprove button to confirm the action The action page updates with the action success message and displays the Go Back to Pending Approvals by Month and Locations button 5 Click the appropriate button to continue processing requests PTAR User Manual 3 Batch Mode Entry Batch Mode Entry provides the ability to enter up to 25 reimbursement requests in a single submission for a selected facility It is essentially the same as doing a series of individual Add New Requests with two major differences e All CINs must manually entered There is no ability to swipe
22. lams TotalAmount Detals Disapproved Claims 1 soo VEW k Incomplete Claims 1 300 vew Client Ineligible PS Ew 121 640 00 Total Claims Amount Denied Claims Amount Pending Claims Amount Online 10 40 00 2 10 00 8 30 00 0 0 00 180 00 17 107 50 41 72 50 Legend Pending Processing By DOH Batch Mode is not included in the Total Claims and Total Claims Amount Figure 12 View Reimbursement History Single Summary View Denied Claims PTAR User Manual 12 Multiple months can display summaries including showing different claim types VIEW REIMBURSEMENT HISTORY Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 Please selecta Year 2010 7 Display Last 3 e Months DOH Medicaid Approved Date N A DOH Finance Processed Date N A Voucher No Total Claims Total Claims Amount Issued Claims Amount Denied Claims Amount 170 85 36 166 35 ClaimType TotalAmount Details Client ineligible Jo o 111 31 X 450 9 MEW ccce pec een je ee VIE GER DOH Medicaid Approved Date 05 21 2012 DOH Finance Processed Date 08 23 2012 Voucher No N A Type Total Claims Total Claims Amount Issued Claims Amount_ Denied Claims Amount Pending Claims Amount DOH Medicaid Approved Date 08 02 2011 DOH Finance Processed Date 10 27 2011 Voucher No N A ype otal Claims otal Claims A
23. lect X Security Answer2 Security Question3 Select Security Answer3 Submit Figure 26 Update User Settings Instructions Update password 1 Enter the updated password in New Password The password must conform to the minimum requirements listed on the page 2 Enter the updated password in Confirm Password 3 Click Submit Update security question s 1 Select a new security question from the applicable drop down 2 Enter the answer in the corresponding Security Answer field 3 Click Submit PTAR User Manual 26
24. mount Issued Claims Amount laims Amount ing Claims Amount Online 29 89 70 20 64 95 9 2475 0 0 00 egend Pending Processing By DOH Batch Mode is not included in the Total Claims and Total Claims Amount Figure 13 View Reimbursement History Showing Multiple Summary Views Clicking VIEW for a claim type displays the detail view of its individual claims VIEW REIMBURSEMENT HISTORY Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 November 2013 Issued Claims CIN Medical Service Date 9 Request Type Medicaid Managed Care cer Filter By Displaying 1 to 2 of 2 records Total Cash Amount 10 00 Total Metrocard Amount 5 00 Print MEDICAL SERVICE DATE PAYMENT ESCORT SUBMITTER DESCRIPTION NAME INPUTDATE LOCATION GE ZZ12345X 41 1 2013 RE EE ta T ENE kel od om fev UE E potalAmutt LI eso II Code Legend AMT Invalid Amount CNF Client Not Found In WMS cP Coverage Period Not Valid FMT Invalid CIN Format MC Enrolled In Managed Care CONYC CIN Outside New York City HE Hospital Expense Figure 14 View Reimbursement History Detail View Issued Claims PTAR User Manual For large individual claim listings the Filter By fields CIN Medical Service Date and Request Type can limit the number of displayed claims The filters can be specified individually e g all claims on a
25. ption Click Submit to generate the report based on the selected parameters The report PDF displays PTAR User Manual 21 Managed Care Invoice Managed Care Invoice is a combination report and invoice producer for claims involving managed care providers The claims may be viewed on a facility or group basis The invoices are PDFs that can be printed and sent to providers The report presents the number of claims and amount totals for each month having managed care claims Selecting a month and the report type displays a summary of the claims based on the report type facility or group The facility report type lists the claims and total amounts for each associated managed care provider MANAGED CARE INVOICE Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 Managed Care Invoice for June 2010 Total Managed Plan Name Care Denials Total Amount Invoice Health First PHSP Inc Figure 22 Managed Care Invoice Facility Report The group report type lists the groups that have associated managed care providers Click the plus icon to the left displays the managed care providers At that point the report types converge MANAGED CARE INVOICE Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 Managed Care Invoice for June 2010 Click for more details El MIS Group 1 Total Managed Plan Name Care Denials Health First PHSP Inc Health Plus P
26. r a facility report the providers are immediately displayed 5 Click the View PDF button to view the invoice for the selected managed care provider 6 Print or save the PDF in preparation for sending to the managed care provider PTAR User Manual 23 Cashier s Issuance CASHIER ISSUANCE REPORT Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 No Reimbursement Issued Select a Date Range Start Date S End Date S Select Location bal Ca Se PTAR User Manual 24 Usage Report The Usage report lists the individual Issued Denied or Pending claims for a period of up to 31 days The claims may be viewed as a complete listing of every claim for the period or broken down by one or more of the Group Location and Staff PTAR user or role parameters USAGE REPORT Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 Select a Date Range Start Date T End Date 2 Select a Group ALL M Select a Location ALL Select a Staff ALL Y Select a Request Claims Select Y Select a Request Type ALL bi Submit Clear Figure 25 Usage Report The Usage report has many options for viewing issued claims for a selected period All claims All claims for a specific group AII claims for a specific location All claims for a staff member Any combination of group location and staff Instructions 1 E LN P ab S
27. rd Amount 20 00 Cash Amount 0 00 Total s 4 Total for Group MIS Group 1 Metrocard Amount 35 00 Cash Amount 0 00 Total s 7 Total For Date 11 20 2013 Metrocard Amount 35 00 Cash Amount 0 00 Total s 7 DATE 11 21 2013 Group Name MIS Group 1 Location Name MIS TEST 2 Total Hospital Expense Issuances Number of Cards 235 00 x 10 00 Total Metrocards Amount 10 00 Totals 2 10 00 Total For Location MIS TEST 2 Metrocard Amount 10 00 Cash Amount 0 00 Total s 2 Total for Group MIS Group 1 Metrocard Amount 10 00 Cash Amount 0 00 Toral s 2 Total For Date 11 21 2013 Metrocard Amount 10 00 Cash Amount 0 00 Total s 2 5 2 5 2 Figure 20 Issuance Summary Report by Date PTAR User Manual 20 By Group summary of the types ISSUANCE SUMMARY REPORT Print Date 1240 2013 MIS TEST 15 MetrotechBrooklyn NY 11201 Start Date 11 20 2013 End Date 12 01 2013 Group Name ALL Location Name ALL Issued By ALL Report Type Totals By Group ISSUANCE SUMMARY Total Medicaid Fee For Service Issuances Total Hospital Expense Issuances Total Group Name MIS Group 1 Location Name MIS LOCATION 1 Total Hospital Expense Issuances Number of Cards 235 00 x 10 00 Total Metrocards Amount 10 00 Total 10 00 Total Medicaid Fee For Service Issuances Number of Cards 235 00 x 5 00 Total Metrocards Amount 5 00 Total 5 00 Total For Loc
28. report PDF displays 2 Print and or save the PDF PTAR User Manual 17 Issuance Details Report The Issuance Details report lists the individual claims issued for a period of up to 31 days The claims may be viewed as a complete listing of every claim for the period or broken down by one or more of the Group Location and Issued by PTAR user or role parameters The report has three sections e Report Parameters Date range group location and issued by e Issuance Summary summary of the issued claims e Date detailed listing by date of the individual claims ISSUANCE DETAILS REPORT Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 Start Date wie 1242011 Growp Name MIS Group 1 MIS LOCATION 2 sed by ALL ISSUANCE SUMMARY Total Medicald f es for Service Total Managed Care issuances Total Out ot County issuances Total Hospital Expense issuances Total DATE 01 03 2011 Group Name MIS Group 1 Location Name MIS LOCATION 2 Medical No Name pos CN Service Date Access Cartare Reimbursement Type 1 1027 1960 01032011 Medicaid Feetor Service 91950 01632011 Me3ica Fee tor cervce Mees EET Aen Meath Pan 6 4 1961 01032011 i 25 NY State Cer Meath Pun Fe 1212 1999 01032011 CIN In County Outside NYC 122 1995 01632011 CIN In County Outside NYC 530 1967 01632011 MOED Expense seen 010y2011 HOEDE Expense 200 18 00 Total For Location MIS LOCATION 2 Requests 27 00 EE ELE SII
29. ry eege gedd EENEG EENS eke Ee SR GR SR EEN 11 CASHIER REIMBURSEMENT Lonmavduitle 1 Batch Mode EMY T PEE 4 Fil W pla EE H View Reinibursement History eicere ettet eene cott enero nde ke See ee BEK shoe Fea aede eei ge ee ia 11 REPORTS Cashier ISSUANCE see c eee Die eec o re Dreier o ee ER Fel eoe tee agde eoe ee Gadd cre ee Che d eds 24 SUPERVISOR REIMBURSEMENT Add EE WEE 1 Approve E WEE 3 Batch Mode Entry ee RR HERE Regu Istae ii eser bert ees eode ipee va Pape OR EN 4 Fil Upload MEE EE EE N EE 7 View Reimbursement Historie 11 REPORTS Usage ei g et MEN 25 PTAR User Manual ii FACILITY ADMINISTRATOR REIMBURSEMENT Add New E 1 ADDrove WE 3 Batch Mlode BEntty i ee RE EE EE EE OE EE AR N 4 Change Kl 6 File Upload M C 7 Mark Service Month as Complete 5 x eet Eee DEER e EE ere HIS SEENEN 9 View Reimbursement History ceti reset oh Ere a eR Fo hosed HELFER ee sacvo engaugavbesnepavednsaneescens 11 REPORTS Hospital Expense Report issie ss HOM 16 Issuance Details AE RE EE EE N 18 Issuance Summary Report 20 Matiased Care Iuwetge eggeiegeg ef EO OE OE RE EE EE N EE OE RE See 22 MEEN REPOP A C eEteEe
30. sheet template The web browser prompts to open or save the template Steps 3 and 4 are performed offline in a spreadsheet application 3 After opening the template in a spreadsheet application enter the appropriate values for each claim in a separate row Refer to the table above for the proper field formats and values 4 Save the spreadsheet The remaining steps are performed online in the PTAR system 5 Click Browse The Choose File to Upload dialog displays 6 Navigate to the location containing the updated template 7 Select the template and click Open The dialog closes and the upload field displays the selected template 8 Click Upload File The file successfully accepted message displays Template populated and ready for upload 1 Select the location from the location grid 2 Click Browse The Choose File to Upload dialog displays 3 Navigate to the location containing the populated template 4 Selectthe template and click Open The dialog closes and the upload field displays the selected template 5 Click Upload File The file successfully accepted message displays PTAR User Manual Mark Service Month as Complete Mark Service Month as Complete ends the ability for new reimbursements claims to be added for a selected month It can be thought of as closing the books for that month MARK SERVICE MONTH AS COMPLETE Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 D
31. sing milestones Did the Facility Administrator close the Medical Service Month Date Closed DOH Medicaid Approved Date DOH Finance Processed Date Voucher No The claims information includes the claim submission type totals and summaries for issued denied and pending claims Type Total Claims Total Claims Amount Issued Claims Amount Denied Claims Amount Pending Claims Amount VIEW REIMBURSEMENT HISTORY MIS TEST 15 Metrotech Brooklyn NY 11201 Please selecta Year 2013 Display Last 3 Months DOH Finance Processed Date 915 00 28 25 00 151 885 00 DOH Medicaid Approved Date DOH Finance Processed Date Voucher No Online 464 2 155 00 15 85 00 103 80 00 346 1 990 00 DOH Medicaid Approved Date DOH Finance Processed Date Voucher No Online 158 875 00 14 105 00 23 130 00 121 0 00 Legend Pending Processing By DOH Batch Mode is not included in the Total Claims and Total Claims Amount Figure 11 View Reimbursement History PTAR User Manual 11 The three claims amount fields are click thrus that lead to summary and detailed listings of their respective claim types The type of claim summary is indicated by the shading under its name VIEW REIMBURSEMENT HISTORY MIS TEST 15 Metrotech Brooklyn NY 11201 Please select a Year 2013 v Display Last 6 Months DOH Finance Processed Date 930 00 1 5 00 18 40 00 151 885 00 Claim Type TetalNo ofC
32. ten and electronic health information from the eyes of others who do not need the information in order to perform their assigned jobs e Ensure that casual visitors cannot access areas in which clinical or billing information is kept Know when a person s PHI can be shared without the person s permission and when written or oral permission is required e Ensure that all policies and procedures for safeguarding the confidentiality of PHI or other sensitive material are followed e Investigate and report to the appropriate Compliance Officer or designee any incident where the acquisition access use or disclosure of PHI is in a manner not permitted or which compromises the security or privacy of PHI e Properly dispose of printed PHI and delete e PHI e Access PHI on company owned equipment in secure locations and not in public settings such as malls and libraries Users are responsible for the preservation privacy and security of data in their possession While using the application the user has access to data that contains PHI and must be guarded and disposed of appropriately if downloaded by the user As covered entities or vendors operating on behalf of a covered entity any inappropriate use or disclosure of PHI must be handled as prescribed in the federal regulations above Complete Contents REIMBURSEMENT m 1 Add New Request sa cti rect duree Er Rieti ede ce bo percepit s Pare Pe EE 1 e Cu gen
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