EDS Provider Electronic Solutions - Connecticut Medical Assistance
Contents
1. topic HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 22 ELIGIBILITY VERIFICATION INSTRUCTIONS 270 Eligibility Request t Header 1 Header 2 Service Information Receiver Name Provider mi Provider ID Code Qualifier v Taxonomy Code Provider Code v Last Org Name First Name Subscriber Name Client ID Card Issue Date 00 00 0000 Client SSN W Client DOB 00 00 0000 Account tt Last Name First Name MI Hi Edit All WW WW Help From DOS 00 00 0000 To DOS 0070070000 OK Close HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 23 ELIGIBILITY VERIFICATION INSTRUCTIONS 270 271 DATA REOUIREMENTS Data Information Connecticut Medical Related Data Assistance Requirements Valid combinations of Client ID amp SSN ConnPACE client client data for eligibility Client ID amp DOB eligibility will only request SSN amp DOB accept Client ID amp SSN Client ID amp DOB Card Issue Date If used data should be Segment Field DTP02 entered in Loop 2100C should be D8 date Segment Field DTP03 expressed in format CCYYMMDD Client ID If used data should be Oualifier should be entered in Loop 2100C MP Member Segment Field NM108 Identification Number Client SSN If used data should be Segment Field REFO1 entered in Loop 2100C should be SY Social Segment Field REF02 Security Number Client DOB If used data should be Segment Field DMGO1 ent2. 17 ELIGIBILITY VERIFICATION INSTRUCTIONS When you are ready to retrieve your responses you will need to download the eligibility response for the entire batch of clients To do this 1 On the HPE Provider Electronic Solutions main toolbar select the Communication drop down menu 2 Then select Submission You will see the following screen See the following page Submission Method Web Server Select All Deselect All Select All Deselect All i Files To Receive 270 Eligibility Request 271 Eligibility Response s Submit 276 Claim Status Reguest 277 Claim Status Response s 837 Dental 999 Acknowledgement s 837 Institutional Inpatient 837 Institutional Nursing Home 837 Institutional Outpatient 837 Professional 3 On the same batch submission screen you would need to click on the 271 Eligibility Response s for the Verification Response under Files To Receive 4 Then click on Submit When receiving the batch response the actual time will vary according to the size of your batch Interactive Eligibility Inquiries are available on the Connecticut Medical Assistance Secure Web portal This method of requesting eligibility will allow you to receive immediate results on individual client eligibility inquiries 1 Log into the www ctdssmap com secure Web site 2 Click on the Eligibility tab on the main menu HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 18 3 ELIGIBILITY VERIFICATION INSTRUCTIONS
3. Date Used only in response when SSN is found but does not Match That the DOB does not match for the Patient on the Database 72 Invalid Missing Used in response when Invalid ID invalid Subscriber Insured DOB ID 73 Invalid Missing Subscriber Insured Name 74 Invalid Missing Subscriber Insured Gender Code 75 Subscriber Insured Not Found 76 Duplicate Used in response when Multiple IDs found Subscriber Insured ID Number 77 Subscriber Found Patient not Found 78 Subscriber Insured Not in Group Plan Identified HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 28 ELIGIBILITY VERIFICATION INSTRUCTIONS ELIGIBLITY FOLLOW UP ACTION CODES Follow up Description Usage if specified Action Code C Please Correct and Resubmit Used when AAAO3 is other than an N Resubmission not Allowed R Resubmission Allowed Used only when AAAO3 is 42 S Do not Resubmit Inquiry Please Wait 30 Days and Resubmit Initiated to a Third Party lt si Please Wait 10 Days and Resubmit Do not Resubmit We will hold your Request and Respond Again Shortly HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 29
4. ELECTRONIC SOLUTIONS USER S MANUAL 13 ELIGIBILITY VERIFICATION INSTRUCTIONS Remarks Optional HEADER TWO SCREEN Header 1 Header 2 Service N From DOS 04701 2013 Format A To DOS 04 01 2013 Trace Assigning Additional ID Trace Transaction Reference 5861 HEADER TWO INFORMATION DESCRIPTION FROM DOS TO DOS TRACE ASSIGNING ADDITIONAL ID TRACE TRANSACTION REFERENCE R REQUIRED A ALPHA O OPTIONAL N NUMERIC FIELD REQUIRED LENGTH OPTIONAL CONDITIONAL 8 R 8 R 30 O 3 SYSTEM GENERATED C CONDITIONAL X ALPHANUMERIC HEADER TWO ENTRY INSTRUCTIONS From DOS ALPHA NUMERIC N N X Enter the requested beginning date of service of the insured s eligibility This can be a future date but cannot exceed the last day of the current month If not keyed present date will be autofilled HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 14 ELIGIBILITY VERIFICATION INSTRUCTIONS Remarks Reguired Format MM DD CCYY To DOS Enter the requested ending date of service of the insured s eligibility This can be a future date but cannot exceed the last day of the current month If not keyed the value from From DOS field will be populated Remarks Required Format MM DD CCY Y Trace Assigning Additional ID An additional ID used by the submitter for identification of the Eligibility Remarks Optional Format XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX Trace Transac
5. To edit an existing entry select the entry and then enter your changes The command buttons for Delete Undo All Find Print and Close work as titled Note The Select Command button is not visible on the List window unless it has been invoked by double clicking an autoplug field from a claim screen Once a List entry has been either added or edited the Select button must be clicked in order for the data to populate the claim screen with the selected List entry HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 3 ELIGIBILITY VERIFICATION INSTRUCTIONS BILLING PROVIDER SCREEN Billing Provider Provider ID Provider ID Code Qualifier xx x v s Taxonomy Code Entity Type Qualifier v Last Org Name First Name SSN Tax ID SSN Tax ID Qualifier v Undo n Provider Address Line 1 Line 2 s City State Zip _ Find Print Provider ID Taxonomy Last Org Name Type Qualifier Close The Provider list requires you to collect information about service providers which is then automatically entered into forms These can be individual providers or organizations Use this list to enter all billing provider and Medicare rendering Medical Assistance Provider number All fields are required except Provider Address Line 2 and First Name when the Entity Type Qualifier is a 2 Facility BILLING PROVIDER ENTRY INSTRUCTIONS Provider ID Enter the National Provider Identifier NPI or the Connecti
6. and contains the provider s name or the first letter of the provider s first name as enrolled in the Connecticut Medical Assistance programs Required when the Entity Type Qualifier is a 1 There are no spaces allowed in this field Example THOMPSON or TH Remarks Required Format AAAAAAAAAAAAAAAAAAAAAAAAA or A Client ID Enter the insured s 9 digit Connecticut Medical Assistance Program s identification number or select the client s Connecticut Medical Assistance Program s identification number from the drop down list if the list is created NOTE The client list is not a required list for eligibility verification However if you use the Provider Electronic Solutions software to verify eligibility for Medicaid clients creating the list will save time and reduce the chance of keying errors Remarks Optional Format NNNNNNNNN Card Issue Date HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 12 ELIGIBILITY VERIFICATION INSTRUCTIONS Enter the card issue date as shown on the clients Medical Identification card this field is not applicable for ConnPACE clients This field will be auto plugged if you select the client s Connecticut Medical Assistance Program s identification number from the drop down list Remarks Optional Format MM DD CCYY Client SSN Enter the client s social security number This field will be auto plugged if you select the client s Connecticut Medical Assistance Program s identific
7. entered a request for one client press the Save button 3 Then press the Add button and you will see a new request screen 4 Enter information for the next client and repeat as often as needed to enter requests for all clients After completing and saving all your requests you are now ready to submit a batch To do this HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 16 ELIGIBILITY VERIFICATION INSTRUCTIONS 1 First close the eligibility window 2 Onthe HPE Provider Electronic Solutions main toolbar select the Communication drop down menu 3 Then select Submission You will see the following screen See the following page ouas O Submission Method Web Server Select All Deselect All Select All Deselect All Files To Send Files To Receive 270 Eligibility Request 271 Eligibility Response s Submit 276 Claim Status Request 277 Claim Status Response s 837 Dental 999 Acknowledgement s 837 Institutional Inpatient 837 Institutional Nursing Home 837 Institutional Outpatient 837 Professional 4 Under Files To Send select 270 Eligibility Request 5 Then click on the Submit button Once you receive the message Submission Successful the batch is processing the actual processing time will vary according to the size of your batch and the number of other batches submitted Once this is completed you may close the screen HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL
8. 7 837 Institutional Inpatient 08 26 2010 H ClientID SSN Last Name First Name From DOS Status HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 21 ELIGIBILITY VERIFICATION INSTRUCTIONS 5 Batch Resubmission T WM L ZS Resubmission Ext Batch Description Datesent Timesent a 212749 270 Eligibility Request 11 10 2010 13 48 212289 270 Eligibility Request 11 05 2010 14 45 211745 837 Professional 11 01 2010 20 45 210074 270 Eligibility Request 10 12 2010 20 50 209790 270 Eligibility Request 10 07 2010 205680 837 Professional 09 02 2010 205435 270 Eligibility Request 08 30 2010 Last Name First Name From DOS To change the DOS on all R status eligibility requests simultaneously use the following steps 1 Click on the Eligibility Forms icon 2 Click on the Edit All button see screen print on the following page 3 Enter the new From DOS and To DOS and click on the OKT button Only those requests in a Ready status will be edited The application will locate all of the requests that need to be changed and will ask you if you want to proceed after verifying the number of requests that are going to be changed Once you select Yes the changes are final and cannot be undone by the Undo All Command Button Once this is accomplished you are now ready to submit your new batch request To do this just follow the instructions on pages 14 15 of this manual under the Batch
9. Enter enough client data to satisfy at least one of the valid search criteria Client ID SSN Client ID Birth Date Birth Date SSN Full Name SSN Full Name Birth Date 4 Click Search VIEWING YOUR RESPONSE To view your batch response you need to close the batch submission screen On the HPE Provider Electronic Solutions toolbar select the Communication menu and then select View Response The Find button can be very helpful when locating specific client information on the Eligibility Response Screen The Find feature is case sensitive In other words the text you enter as your selection criteria must match exactly the text that is on the Response Screen in terms of upper and lower case letters To find specific text L 2 Click on the Find option from the Response Screen In the Find What box enter the text you are searching for Click OK to activate search Once the search has completed you will be referred to the line that matched your selection criteria If you wish to continue looking for other lines that match the criteria simply click on Find Next from the Response Screen and the search will continue looking for the next occurrence HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 19 ELIGIBILITY VERIFICATION INSTRUCTIONS HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 20 ELIGIBILITY VERIFICATION INSTRUCTIONS EDIT ALL FEATURE The Edit All command button
10. HPE Provider Electronic Solutions Submission Instructions O Hewlett Packard Enterprise Provider Electronic Solutions Eligibility Verification Instructions Batch Eligibility Inguiry and Response ELIGIBILITY VERIFICATION INSTRUCTIONS TABLE OF CONTENTS BILLING PROVIDER SCREEN 2 sacs E st ase i eae AS ah Resets st Mohd asus 4 BILLING PROVIDER ENTRY INSTRUCTIONS imiimimiteeeeeeeeeteeneeeteeeneenneoneeenenneeeneeeneeeeneneeeneeeeeeneeenee 4 TAXONOMY SCREEN mere suet se aree Eep thok beea TEE CaP a EEEE TE AEE kE EEEE aS Ep SEREEN EEEE EESSI ERDER 6 TAXONOMY BILLING INSTRU CTIONS Er e kaduda Zoe a e k e NE iey 6 CLIENT SCREEN e rae aree E E E ET eE te EE E E E EEEE Ea EE En 7 CLIENT ENTRY INSTRUCTIONS oneer eea ea e Ee EE sebib EEE TEE EEEE ES 7 INQUIRY ENTRY INSTRUCTIONS Soenen oi deste e E E E E te aes 8 HEADER ONE SCREEN enner taaa send epee s A e EEDE EE a EAE EE ESEE SE 9 HEADER ONEVENTRY INSTRUCTIONS anien naaier iee o E E T E E E E 11 HEADER TWO SCREEN nriran mee r ENEE E ke 14 HEADER TWO ENTRY INSTRUCTION A 14 SUBMITTING BATCH ELIGIRBILITYVRROUERSTIR 16 VIEWING YOUR RESPONSE 245 15 tt pituiiivks ohoslesislpb pt teps at t nkisnilalas ha stugiioilip pabad s n KESE e SRS as s enda she S enesti ok 19 EDIT ALL MR 21 210 271 DATA REOUITREMENTS eg gen deeg deene ss tenes CES Sege kuhu pe ks Mod putes etc 24 ELIGIBILITY RESPONSE VALUES gees 25 ELIGIBILITY REJECT REASON CODES agen naa a E onni sor
11. Tax ID Qualifier Select the appropriate code from the drop down box that identifies what value is being submitted in the SSN Tax ID field Provider Address Line 1 Enter the street address that is on file with CT Medicaid of the provider being referenced The address is required for providers clients and policyholders Line 2 Enter additional address information of the provider being referenced such as suite or apartment number if applicable City Enter the city of the provider being referenced The address is required for providers clients and policyholders State Enter the state of the address of the provider being referenced The address is required for providers clients and policyholders Zip Code Enter the 9 digit zip code of the provider being referenced The address is required for providers clients and policyholders HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 5 ELIGIBILITY VERIFICATION INSTRUCTIONS TAXONOMY SCREEN s Taxonomy Taxonomy Code Add Description Delete Undo All l Find Taxonomy Code Description Print Ss Close The Taxonomy list allows you to list the taxonomy code which is then automatically entered into the Provider List All fields are reguired TAXONOMY BILLING INSTRUCTIONS Taxonomy Code An alphanumeric code that consists of a combination of the provider type classification area of specialization and education training require
12. allows you to resubmit an eligibility batch with new From and Thru dates of service without having to re key repeated batch requests This will be especially helpful for providers who need to check eligibility on the same group of clients on a regular basis This is done by performing the following steps 1 Click on Communication on tool bar 2 Click on Resubmission see screen print on the following page 3 Place the cursor on the row in the list of batches that corresponds to the batch you wish to copy and select it by left clicking with the mouse A list of the forms that were sent in that batch will appear in the bottom half of the window By default all of the forms are already selected 4 If you wish to copy the entire batch simply click on the Copy button 5 If you wish to copy some of the forms then click on the forms one by one to select or de select the individual forms 6 Click on the Copy button when you have completed your selections This option will create a new copy of each of the forms They will appear in an R Ready status at the bottom of your new eligibility request 5 Batch Resubmission L ZS Resubmission Ext Batch Description Datesent Timesent 211745 837 Professional 11 01 2010 210074 270 Eligibility Request 10 12 2010 270 Eligibility Request 10 07 2010 205680 837 Professional 09 02 2010 205435 270 Eligibility Request 08 30 2010 205433 837 Professional 08 30 2010 20528
13. ation number from the drop down list Remarks Optional Format NNNNNNNNN Client DOB The patient s Date of Birth The field is in the format MM DD CCYY Remarks Optional Format NNNNNNNN Account Enter the patient account number This field will be auto plugged if you select the client s Connecticut Medical Assistance Program s identification number from the drop down list Remarks Optional Format XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX Last Name Enter the client s last name or the first two characters of the client s last name There are no special characters apostrophes spaces etc allowed in this field This field will be auto plugged if you select the client s Connecticut Medical Assistance Program s identification number from the drop down list Example THOMPSON or TH Remarks Optional Format AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA or AA First Name Enter the client s first name or the first character of the client s first name This field will be auto plugged if you select the client s Connecticut Medical Assistance Program s identification number from the drop down list Example JOHN or J Remarks Optional Format AAAAAAAAAAAAAAAAAAAAAAAAA or AA MI Enter the first character of the client s middle name This field will be auto plugged if you select the client s Connecticut Medical Assistance Program s identification number from the drop down list Example OR HPE PROVIDER
14. cut Medical Assistance Program billing provider number with two leading zeros if the provider is a Non Covered Entity NCE An NCE is a Medicaid service provider who is not included in the National Provider Identifier requirement Provider ID Code Qualifier Enter the code which identifies the type of Provider ID submitted with the eligibility form Taxonomy Code An alphanumeric code that consists of a combination of the provider type classification area of specialization and education training requirements Only numeric characters 0 9 and alphabetic characters A Z are accepted Lower case letters are automatically converted to upper case Note The health care provider taxonomy code list is available on the Washington Publishing Company web site http www wpc edi com Entity Type Qualifier Select the appropriate value to indicate if you are an individual performer or corporation Last Org Name HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 4 ELIGIBILITY VERIFICATION INSTRUCTIONS Enter the last name of an individual provider or the business name of a group or facility when the Entity Type Qualifier is a 2 First Name Enter the first name of the provider when they are an individual Required when the Entity Type Qualifier is a 1 This field will not be available when the Facility Type Qualifier is a 2 SSN Tax ID Enter the Social Security Number or Tax Identification number of the party being referenced SSN
15. d social security number e Client identification number and date of birth e Social security number and date of birth not valid for ConnPACE HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 9 ELIGIBILITY VERIFICATION INSTRUCTIONS HEADER ONE INFORMATION DESCRIPTION PROVIDER ID PROVIDER ID CODE OUALIFIER TAXONOMY CODE PROVIDER CODE LAST ORG NAME FIRST NAME CLIENT ID CARD ISSUE DATE CLIENT SSN CLIENT DOB ACCOUNT LAST NAME FIRST NAME MI R REOUIRED A ALPHA FIELD LENGTH 9 2 THIS FIELD 2 THIS FIELD THIS FIELD 16 8 9 8 38 35 25 1 O OPTIONAL N NUMERIC REQUIRED OPTIONAL CONDITIONAL R R AUTOFILLS R AUTOFILLS AUTOFILLS O O OO00000 C CONDITIONAL X ALPHANUMERIC ALPHA NUMERIC gt gt PX2Z22Z2ZP PP Z KZ HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 10 ELIGIBILITY VERIFICATION INSTRUCTIONS HEADER ONE ENTRY INSTRUCTIONS Special Note All entered information will default to capital letters Eligibility Field Definition A Alpha N Numeric X Alphanumeric Provider ID Enter your NPI or Connecticut Medical Assistance Program s Provider Number with two leading zeros Remarks Required Format NNNNNNNNN Provider ID Code Qualifier Select the appropriate code from the drop down list that identifies the type of Provider ID submitted with the Eligibility form Code Description SV Service provider number XX HCFA national plan ID d
16. ed in response when of Birth DID is valid but no DOB no SSN 2 if SSN is valid but no DOB 3 Invalid ID invalid DOB 60 Date of Birth follows Used only in response to information that is in Date s of service or should be in the Subscriber Name loop 2100C 61 Date of Death Used only in response to information that is in Precedes Date s of or should be in the Subscriber Name loop HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 27 ELIGIBILITY VERIFICATION INSTRUCTIONS Reject Description Usage If specified Reason Code Service 2100C 62 Date of Service not Used in response when cannot validate within Allowable eligibility for dates older than 1 year or Future Inquiry Period date 63 Date of Service in Used only in response to information that is in Future or should be in the Subscriber Name loop 2100C 64 Invalid Missing Used only in response to information that is in Patient ID or should be in the Subscriber Name loop 2100C 65 Invalid Missing Patient Name 66 Invalid Missing Used only in response to information that is in Patient Gender Code or should be in the Subscriber Name loop 2100C 67 Patient not Found Used only in response to information that is in or should be in the Subscriber Name loop 2100C 68 Duplicate Patient ID Used only in response to information that is in Number or should be in the Subscriber Name loop 2100C 71 Patient Birth
17. efault Remarks Reguired Format AA Taxonomy Code This field will be auto plugged once you enter your NPI provider number and contains an alphanumeric code that consists of a combination of the provider type classification area of specialization and education training reguirements Note The health care provider taxonomy code list is available on the Washington Publishing Company web site http www wpc edi com Remarks Optional required if NPI Format NNNANNNNNA Provider Code HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 11 ELIGIBILITY VERIFICATION INSTRUCTIONS Select the appropriate code from the drop down list that identifies the type of provider Code Description Code Description AD Admitting Pl Pharmacist AT Attending P2 Pharmacy BI Billing PC Primary Care Physician CO Consulting PE Performing CV Covering R Rural Health Clinic H Hospital RF Referring HH Home Health Care SB Submitting LA Laboratory SK Skilled Nursing Facility OT Other Physician SU Supervising Remarks Required Format AA Last Org Name This field will be auto plugged once you enter your provider number and contains the provider s name or the first two letters of the provider s last name as enrolled in the Connecticut Medical Assistance Programs Example THOMPSON or TH Remarks Required Format AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA or AA First Name This field will be auto plugged once you enter your provider number
18. ent Client SSN Enter the client s social security number Last Name Enter the last name of the client who received services First Name Enter the first name of the client who received services HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 7 ELIGIBILITY VERIFICATION INSTRUCTIONS MI Enter the middle initial of the client who received services Client DOB Enter the date the client was born Gender Select the appropriate value from the drop down list to enter the clients gender Code Description F Female M Male U Unknown Subscriber Address Line 1 Enter the street address of the party being referenced The address is required for providers clients and policyholders Line 2 Enter additional address information of the party being referenced such as suite or apartment number if applicable City Enter the city of the party being referenced The address is required for providers clients and policyholders State Enter the state of the address of the party being referenced The address is required for providers clients and policyholders Zip Enter the zip code of the party being referenced The address is required for providers clients and policyholders INQUIRY ENTRY INSTRUCTIONS Use the following instructions to complete the inquiry screens When data entry is complete click SAVE The saved inquiry will appear in the list below the data entry screen If the data hits edits a message
19. ered in Loop 2100C should be D8 date Segment Field DMG02 expressed in format CCYYMMDD BHT02 Must contain the value 13 Reguest EQO1 Default is 30 and may Requests that use type codes send up to 15 total service additional EQ02 segment at the detail level will be processed HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 24 ELIGIBILITY VERIFICATION INSTRUCTIONS ELIGIBILITY RESPONSE VALUES Eligibility or Service Type Code Insurance Type Plan Benefit EB03 Code Coverage Information EB04 Description EB01 EB05 1 Active MC Medicaid Benefit plan Coverage List of STC OT Other 1 Medical Care 2 Surgical 4 Diagnostic X Ray 5 Diagnostic Lab 6 Radiation Therapy 7 Anesthesia 8 Surgical Assistance 12 Durable Medical Equipment Purchase 13 Ambulatory Service Center Facility 18 Durable Medical Equipment Rental 20 Second Surgical Opinion 33 Chiropractic 35 Dental Care 40 Oral Surgery 42 Home Health Care 45 Hospice 47 Hospital 48 Hospital Inpatient 50 Hospital Outpatient 51 Hospital Emergency Accident 52 Hospital Emergency Medical 53 Hospital Ambulatory Surgical 54 Long Term Care 56 Medically Related Trans 62 MRI CAT Scan 65 Newborn Care 68 Well Baby Care 73 Diagnostic Medical 75 Prosthetic Device 76 Dialysis 78 Chemotherapy 80 Immunizations 81 Routine Physical 82 Family Planning 86 Emergency Services 88 Pharmacy 93 Podiatr
20. he lists are available from the data entry section as a drop down list where you can select previously entered data to speed the data entry process and help ensure accuracy of the form There are three lists that you are reguired to complete prior to entering an eligibility transaction Because this software uses the HIPAA compliant transaction format there is certain information which is required for each eligibility transaction To assist you making sure that all required information is included and save time entering your information some of the lists are required These lists are e Billing Provider e Taxonomy If these lists are not completed prior to keying your transaction the list will open in the transaction form The Client List may be used but is not required for eligibility requests If used other data from this list will auto plug into the eligibility form once the client id has been selected Some of the lists contain preloaded information that is available for auto plugging as soon as you install Provider Electronic Solutions You may choose to enter data in any of the lists soon after you set up Provider Electronic Solutions to take advantage of the auto plug feature To create or edit a list select List from the Main Menu and then select the appropriate item Working with Lists From the Lists option on the menu bar select the list you want to work with Perform one of the following To add a new entry select Add
21. ments Only numeric characters 0 9 and alphabetic characters A Z are accepted Lower case letters are automatically converted to upper case Note The health care provider taxonomy code list is available on the Washington Publishing Company web site http www wpc edi com Description Enter the description of the code listed HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 6 ELIGIBILITY VERIFICATION INSTRUCTIONS CLIENT SCREEN D Client Client ID ID Qualifier MI Issue Date 0070070000 Account ALL Client SSN Delete Last Name First Name E HI Client DOB 00 00 0000 Gender sl uc m Subscriber Address liet Line2 e Fra Ciy Statel Zip ES Print Client ID Last Name First Name wat Close The Client list reguires you to collect detailed information about your clients which is then automatically entered into forms All ofthe fields are reguired except Account number middle initial issue date and Subscriber Address Line 2 CLIENT ENTRY INSTRUCTIONS Client ID Enter the Client identification number assigned by the Connecticut Medical Assistance Program ID Oualifier This field has been preloaded with the information which identifies the type of client This field will be by passed Issue Date Enter the issue date found on the patient s Medical Assistance Program Identification Card Account Enter the unigue number assigned by your facility to identify a cli
22. nse Payor type X Health Care Facility Not used for this response type Not used for this response type Hospice LTC 26 HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL ELIGIBILITY VERIFICATION INSTRUCTIONS ELIGIBILITY REJECT REASON CODES Reject Description Usage If specified Reason Code 15 Required application Used when Valid DOB no ID no SSN data missing 42 Unable to respond at Code used in batch environment where an current time information source returns all requests for the 270 in the 271 and identifies Unable to respond at current time for each individual request within the transaction that they were unable to process for reasons other than data content 43 Invalid Missing Used only in response to information that is in Provider or should be in the Subscriber Name loop Identification 2100B 45 Invalid Missing Provider Specialty 47 Invalid Missing Provider State 48 Invalid Missing Referring Provider Identification 49 Provider is not a Primary Care Physician 51 Provider not on file Used only in response to information that is in or should be in the Subscriber Name loop 2100B 52 Service Dates not within Provider Plan Enrollment 56 Inappropriate Date 57 Invalid Missing Used only in response to information that is in Date s of Service or should be in the Subscriber Name loop 2100C 58 Invalid Missing Date Us
23. t E E nen eten NENNEN onne a 27 ELIGIBLITY FOLLOW UP ACTION CODES ena 29 HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 1 ELIGIBILITY VERIFICATION INSTRUCTIONS INTRODUCTION Now that you have installed and become familiar with the functionality of the Hewlett Packard Enterprise PROVIDER ELECTRONIC SOLUTIONS software you are ready to verify client eligibility for the Connecticut Medical Assistance Program Eligibility reguest may be submitted by using either the interactive or batch function An explanation of each can be found on page 16 The following instructions detail requirements and general information for each section of the eligibility reguests for the Connecticut Medical Assistance Program In the following sections each request entry field is defined with the appropriate requirements Edits have been built into the software to assist you in entering correct eligibility information The following pages contain Screen Samples for ELIGIBILITY VERIFICATION requests and instructions for submitting requests to verify a client s eligibility in the Connecticut Medical Assistance Program HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 2 ELIGIBILITY VERIFICATION INSTRUCTIONS Provider Electronic Solutions contains reference lists of information that you commonly use when you enter and edit forms For example you can enter lists of common diagnosis codes procedure codes type of bill and admission source and type All of t
24. tion Reference Verification number to be used by the information receiver if there is a need to follow up on the transaction This number is system generated Remarks System Generated Format NNNNN SERVICE SCREEN Header 1 Header 2 Service Service Type Code EME v Service Type Code Dt Add Dtl Delete D SERVICE ENTRY INSTRUCTIONS Service Type Code Use the drop down feature to select the service type code for the program you wish to inguire about the insured s eligibility The default code is 30 for Health Benefit Plan Coverage HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 15 ELIGIBILITY VERIFICATION INSTRUCTIONS Remarks Reguired Format XX Add Dtl To check an additional program about the insured s eligibility click the add Dtl button then select the Service type code of the program s Delete Dtl To remove Service types codes highlight the line of the Service type code to be removed and press the Delete Dtl button Note at least one Service Type Codes must be submitted SUBMITTING BATCH ELIGIBILITY REQUESTS BATCH This method of requesting eligibility will allow you to submit multiple requests at once This batch eligibility request can be used when you have multiple clients to submit at the same time This is done by 1 Entering the required information into the Eligibility screens for each client the same as with the interactive request 2 When you have
25. window will appear with error messages Click SELECT to move to the highlighted error and correct the data Once all error messages have been resolved you can save the inquiry Newly saved inquiries are in Status R Ready Status R inquiries can be edited and saved multiple times prior to submission Be sure to click ADD before beginning to enter the data for each new inquiry Note The Select Command button is not visible on the List window unless it has been invoked by double clicking an autoplug field from a claim screen Once a List entry has been either added or edited the Select button must be clicked in order for the data to populate the claim screen with the selected List entry HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 8 ELIGIBILITY VERIFICATION INSTRUCTIONS HEADER ONE SCREEN Header 1 Header 2 Service Information Receiver Name Taxonomy Code 261 OFO400x Provider Code r Last Org Name CHARTEROAKHLTH First Name Subscriber Name Client ID Card Issue Date 0070070000 Client SSN Client DOB 0070070000 Account t Last Name First Name MI Coverage for all clients in the state eligibility system can be verified using the Provider Electronic Solution software NOTE The client name plus two valid identifiers for the client are required to request eligibility When completing an eligibility request you will need to use one of the following three combinations e Client identification number an
26. y 98 Professional Physician Visit Office 99 Professional Physician Visit Inpatient AO Professional Physician Visit Outpatient A3 Professional Physician Visit Home A6 Psychotherapy A7 Psychiatric Inpatient A8 Psychiatric Outpatient AD Occupational Therapy HPE PROVIDER ELECTRONIC SOLUTIONS USER S MANUAL 25 ELIGIBILITY VERIFICATION INSTRUCTIONS Eligibility or Service Type Code Insurance Type Plan Benefit EB03 Code Coverage Information EB04 Description EB01 EB05 AE Physical Medicine AF Speech Therapy AG Skilled Nursing Care AI Substance Abuse AL Vision Optometry BG Cardiac Rehabilitation BH Pediatric DM Durable Medical Equipment MH Mental Health PT Physical Therapy RT Residential Psych Therapy UC Urgent Care 6 Inactive See list of STC Not used for this Not used for response type this response type A Coinsurance See list of STC Not used for this Benefit plan response type B Copay See list of STC Not used for this Benefit plan response type C Deductible See List of STC Not used for this Benefit plan response type G Stop Loss See list of STC Not used for this Benefit plan response type N Service Not used for this response type Not used for this Inmate Restricted to the response type Pharmacy Following Physician Provider R Other or Not used for this response type Not used for this Not used for Additional response type this respo
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