PTAR User Manual
Contents
1. 7 View os AMM TOS 11 REPORTS FELG ERE eem 25 PTAR User Manual ii FACILITY ADMINISTRATOR REIMBURSEMENT Add New et E I RENN 3 Pr 4 A AA em 6 MN 7 M rk Service Month as Re ue 9 View Reimbursement History E 11 REPORTS Hospital Expense Repol EE 16 Kne KR vr 18 FEN Re 20 MENN 22 Usace que DO ron MERE 25 PTAR User Manual iii Figures Fieure E ivo o NeW Request rata 1 Figure 2 Batch Mode EE 4 Figure 3 Batch Mode Entry Successful Submission esse eee eee ee eee eee 5 Figure aT eg lt 6 Fe o E 7 Figure 6 File Upload Spreadsheet Template ria aries 7 Figure 7 File Upload Template Field Formats and Values sees 7 Figure 8 Sample Entry in File Upload Template r re 7 Figure 9 Mark Service Month as Complete sse eee ee eee eee 9 Figure 10 Mark Service Month As Complete Summary View Pending Claims sss sss sse eee ee eee eee 9 Figure 11 View Reimbursement History sse eee eee eee eee 11 Figure 12 View Reimbursement History Single Summary View Denied Claims esee 12 Figure 13 View Reimbursement History Showing Multiple Summary Views esse eee eee eee ee eee ee eee ee eee 13 Figure 14 View Reimbursement History Detail View Issued Claims eee 13 Figure 15 View Reimbursement Filter By Fields sese eee 14 Figure 16 View Reimbursement Claims Detail Listing Unftered sss sese 14 Figure 17 View Reimbursement Claims Detail Listing Filtered by Medical Service Date 15 Figure 18 Hospital Expense Repor2. lt i n 3 y 0 A PIA Public Transportation Automated Reimbursement System User Manual Complete Contents RETMBURSEMENT scc tii das 1 AMIN 4 T e E E EA E E A EEEE ET I INSTRUCTIONS X OA 2 PRP UO E T PPP OO A 3 NINA 3 be A o E 4 INSTRUCTIONS Gr 5 A AAA T NE A 6 IICA D 7 INSTRUCTIONS stops 8 Mark Service Month as ern 9 View Reimbursement OP AMA 11 INSTRUCTIONS areia A E E A E OE EE OE E E A A AA 15 REFOR b ia E EET bestest 16 Hospital Expense EE EE ER 16 NR ING 17 DR NN 18 SCENE ON E E A 19 Issuance Summary A E O A 20 INSTRUCTIONS sp ls 21 IV Vain eel Care VOICE HT 22 I ICH ELO ELO S MT A O TET 23 SES E 24 UE e d 25 INSTRUCTIONS Gre 25 SH MN 26 Update User E EE 26 INSTRUCTIONS Jr 26 PTAR User Manual i Role Specific Contents REIMBURSEMENT UN E I Batc Mode cire NE Em 4 E PIG AG RR t EE 7 View Reimbursement TNA usaste cosita 11 CASHIER REIMBURSEMENT LEs Te Ee S e e E EE EE E A EE E E E I Bac Mode T CT 4 AI A 7 View Reimbursement Ee e 11 REPORTS GST dit EE ee 24 SUPERVISOR REIMBURSEMENT RS Te WT 01 800 038005002080 nota ted dep EopRoo 3 co coce RO deat e NUM REPRE ERE UC EISE IS CR SES MDRSAE I PRD OVS Se QUO AP A A A 3 Batch Mode vr 4 TEUD c
3. 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 IMVOICE Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 Managed Care Invoice for June 2010 Total Managed Care Denials Metro Plus Metropolitan Health Plus 1 za Deeg NY State Catholic Health Plan Fidelis 2 s90 m Plan Name Total Amount Invoice 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 vi for more details El MIS Group 1 Total Managed Care Denials Total Amount Invoice Plan Name Health First PHSP Inc Health Plus PHSP 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
4. 2011 E 3 January 2011 December 2010 JEJEJEJE 3 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 Peres Deparimen of sezhh R A KE PUBLIC TRANSPORTATION AUTOMATED REIMBURSEMENT HOSPITAL EXPENSE REIMBURSEMENTS FOR JUNE 2013 Facility Hama Facility Address MI amp TEST 15 Metrotech Brooklyn NY 11201 8 NO Mama CIM Medical Serving Data Ernuri Age Dibca blll y I Appess a Ride 1 HIA D01203 MO Noa Mo 2 NA 6032045 No Ha i No NA 603 2045 HO Ha No TOTAL HO OF CLAIMS Total Amount Cash Dicpancad o Round Trip i Carfara Amt Automatic Zoom YER I Yesi amp YESI amp 15 00 Payment Mode Metrocard Metrocard Metrocard Print Data 12 22 2018 Lonsm lamn Harms MIE TEST 2 MIE TEST 2 MIE TEST 2 Page 1 of 1 Figure 19 Hospital Expense Report Detail View Instructions 1 Click the View PDF button for a month to view its individual hospital expense claims The 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 cla
5. a sheet of paper b If selecting 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 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 1s 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 A ge 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 Filter By d
6. 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 4 Click VIEW for a claim type to view the individual claims for that type 5 Optionally use one or more of the fields in the Filter By section to limit the claims shown 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 HOSPITAL EXPENSE REPORT Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 Total Hospital Expense Month Year Reimbursement Total Amount December 2013 5 00 545 0 560 October 2010 Figure 18 Hospital Expense Report November 2013 October 2013 August 2013 June 2013 May 2013 April 2013 March 2013 February 2013 3 January 2013 December 2012 August 2012 July 2012 June 2012 March 2012 February 2012 EEE EEE IST ISSUES UE STE SEE EE EGE EEIEIEE January 2012 August 2011 June 2011 May 2011 March 2011 February
7. 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 Select the location from the location grid Click Browse The Choose File to Upload dialog displays Navigate to the location containing the populated template Select the 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 ad dt 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 December 2013 186 930 00 November 2013 164 2 155 00 15 85 00 103 80 00 34 x October 2013 5i 875 00 14 105 00 23 130 00 121 640 00 August 2013 83 590 00 83 82 50 130 00 June 2013 165 00 49 65 00 14 70 00 May 2013 13 370 85 2 5 91 133 35 AT 235 00
8. April 2013 440 00 1 310 00 49 122 50 46 307 50 March 2013 333 1 625 00 2 15 00 1385 217 1 225 00 February 2013 8 3 712 10 11 563 00 275 884 10 518 2 765 00 January 2002 85 425 00 0 0 00 15 75 00 TO 350 00 January 2001 E 170 00 0 0 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 MARK SERVICE MONTA AS COMPLETE Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 Amount December 2013 GE 930 00 34 40 00 151 885 00 Pending Facility Approval 870 00 VIEW Pending Batch Processing 15 00 VIEW Pending Issuance o vew November 2013 2 155 00 15 85 00 103 50 00 346 51 990 00 October 2013 3 170 00 0 0 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 su
9. New Location Add New Request Figure 3 Batch Mode Entry Successful Submission Instructions 1 Select the location from the location grid 2 For each 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 5 Change Facility Change Facility sets the target facility for functions and reports The selection is made from a list of the available facilities CHANGE FACILITY Please Select a Facility 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 Metratech Brooklyn NY 11201 Please Select a File to Upload Template J Browse Mo file selected Upload Fis 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 o
10. OH Batch Mode is not included in the Total Claims and Total Claims Amount 41 72 50 121 640 00 86 430 00 0 0 00 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 Display Last 3 Months AA 1390 MEW O HE Figure 13 View Reimbursement History Showing Multiple Summary Views Clicking VIEW for a claim type displays the detail view of its individual claims VIEW RETMBURSEMENT HISTORY Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 November 2013 Issued Claims CIN Medical Service Date 58 Request Type Medicaid Managed Care Displaying 1 to 2 of 2 records Total Cash Amount 10 00 Total Metrocard Amount 5 00 MEDICAL EN i i i a IE NAME DESCRIPTION CIN jpop SERVICE GCARFARE MENT ESCORT SUBMITTER NPUTDATE LOCATION gt MODE AGE NAME E oS DATE MIS PATSIENDI 12 02 2013 TUNDMATU ZZ12345X N A 111112013 5 00 Metrocard NO N A 12 07 PM PATSIENDI su Code Legend Invalid Amount CNF Client Mot Found In WMS Coverage Period Not Valid FMT Invalid CIN Format Enrolled In Managed Care CONYC CIN Outside New York City Hospital Expense Figure 14 View Reimbursement History D
11. S t 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 Qutside 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 1s the filter VIEW RETMBURSEMENT HISTORY Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 December 2013 Denied Claims CIN Medical Service Date 12 3 2013 Request Type Incomplete Claims Filter By Displaying 1 to 3 of 3 records Total Cash Amount 5 00 Total Metrocard Amount 0 00 MEDICAL E NAME DESCRIPTION CIN DOB SERVICE CARrARE PAYMENT ESCORT SUBMITTER NPUTDATE LOCATION EIE MODE AGE NAME idisse 2212345X MMOD YY 12 3 2013 Cash NO N S SC MIS TEST 2 MIS PATSIENDI j 1 zem 3 Lo CATIDN Administrator MENO 3 gt AE Code Legend Invalid Amount CHF Client Not Found In WMS Coverage Period Not Valid FMT Invalid CIN Format Enrolled In Managed Care CONYC CIN Outside New York City 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
12. ate 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 CIN Service Date Escort Required Access a Ride Round Trip Payment Mode o Client o Escort Facility Mame MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 Group Name MIS Group 1 MIS LOCATION 1 15 Metrotech Brooklyn NY 11201 Location Name Location Address JE 1 8 Yeko OYesBNo Yes No Metrocard Metrocard 2 TT Ovesen OYesNo BYesONo Metrocard Metrocard 3 Yes No Yes No Yes No Metrocard jan Metrocard an 4 8S8 yYes No Yes No Yes No EIT TET 5 798 Ove No Yes No WYes No Reeg Mekocerd ian 6 78 Yes No OYes No 9 Yes No Metrocard lang Metrocard iac 7 T8 Yes l No Yes 9 No 9 Yes No Metrocard Metrocard 8 Oves No Yes No 9 Yes No ALT ia 3 Yes No OYas No 9 Yes C No Metrocard Metrocard 10 TT oveSNo Cve9 No WYesO No Metrocard Metrocard 1 FS Yes No Yes No vos Ne Gesell Metrocard 12 TE Yes No OYes9 No Yes No Metrocard v Metrocard 13 i TS Yes No 2 Yes 2 No 2 Yes No Metrocard Metrocard gt 14 ZE yYes No COYe 9 No BYesONo Metrocard Metrocard 15 9 OYes No Yes 9 No 9 Yes No Metrocard Metrocard 16 8 Oe No Yes 8 Na 9 Yes No EDU Metrocar
13. ation 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 Ye md 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 PTAR 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 cla
14. d an 17 F8 Oyvesn yag Ma 9 Yes No a atl Meca n 18 Fs Yes No COYes No Yes No Metrocard Metrocard 19 R Gve n CYesWNo yes Ne Metrocard Metrocard 2 F8 Ovesen raag Na Yes No Mairocani jg mU 21 FW OY ONO Crespo 9 YesC No Metrocard a Metrocard y 22 Yes No Yes No Yes No Metrocard Metrocard 23 ZS yYes No CYes No Yes No Metrocard 7 Metrocard gt 24 8 GyYes No Yes No WYes No Metrocard yr Metrocard v 25 7H Oves CYes9 No 9 Yes No Metrocard i LL BATCH HODE ENTRY 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 T he 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 LETT sare A Ride Round Trip Client Payment Mode Escort Payment Mode 2212345X 11 25 2013 Yes Metrocard NA on ve mw me eo ah peer cer Fe sm ps Select
15. d care provider a 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 Select Location 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 Select a Group Select a Location Select a Staff Select a Request Claims Select a Request Type 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 All claims for a specific location All claims for a staff member Any combination of group location and staff Instructions l E E Es 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 Staff drop down or use the ALL default Select Issued Denied or Pending from the Request Cla
16. er of Cards 235 00 x 510 00 Total Metrocards Amount 10 00 Totals 2 10 00 Total For Location MIS TEST 2 Metrocard Amount 10 00 Cash Amount 0 00 Totals 2 Total for Group MIS Group 1 Merocard Amount 10 00 Cash Amount 0 00 Totalfs 2 Total For Date 11 21 2013 Metrocard Amount 10 00 Cash Amount 0 00 Total s 2 Figure 20 Issuance Summary Report by Date PTAR User Manual 20 e By Group summary of the 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 Group ISSUANCE SUMMARY Metrocard Total Amount Cash Total Amount Total Medicaid Fee For Service issuances 1 5 00 D 0 00 Total Hospital Expense Issuances 40 00 0 0 00 Total 9 45 00 0 0 00 Group Name MIS Group 1 Location Name MIS LOCATION 1 Total Hospital Expense Issuances Number of Cards 235 00 x 510 00 Total Metrocards Amount 510 00 Total 10 00 Total Medicaid Fee For Service Ilssuances Number of Cards 235 00 x 1 55 00 Total Metrocards Amount 1 55 00 Total 1 5 00 Total For Location MIS LOCATION 1 Metrocard Amount 45 00 Cash Amount 0 00 Total s 3 Location Name MIS TEST 2 Total Hospital Expense Issuances Number of Cards 35 00 x 30 00 Total Metrocards Amount 8 30 00 Total B 30 00 Total For L
17. etail View Issued Claims PTAR User Manual 13 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 particular date or combined e g Incomplete claims on a particular date CIN Medical Service Date 8 Request Type Medicaid Managed Care Figure 15 View Reimbursement Filter By Fields A 14 claim listing VIEW RETMBURSEMENT HISTORY Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 December 2013 Denied Claims CIN Medical Service Date 8 Request Type Incomplete Claims Displaying 1 to 14 of 14 records Total Cash Amount 10 00 Total Metrocard Amount 20 00 DESCRIPTION DO R R x R INPUTDATE LOCATION 12 03 2013 ANHYSBYS Nepoznato 12 07 2013 PATSIENDI SEN Nepoznato 12 07 2013 rom ez NEZ 12 7 2013 sem 00 nan NO NIA UC 3 lus eer a sal z e fer or A a fig ae ke er fe I CIE ex E Fe O O M ee o MIS PATSIENDI arian O PACIENT Administrator 12 03 2013 PASYAN 24532154 MMIDO YYY 12 3 2013 50 00 Metrocard NO N A Faclly 08 23 PM SE Administrator 12 12 2013 22452214 umore 12 12 2013 0 00 uerocae no rA ees MIS TEST 2 Administrator 1212 2013 PATIENS NOEN 7745123X MWDODD Y YYY 1211212013 55 00 Metrocard HO N A Facilly 04 18 PM ES Total Amount L 1 IS I
18. f the template and is in xls format The template has seven columns that match the seven parameters entered when using the Add New Request or Batch Mode Entry functions A B C D E L 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 1s one reimbursement and every entry must be a specific format or value Y or N Yes or No 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 F 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 2212345X N Y Y A E 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 spreadsheet 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
19. 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 40 2013 Facility Address 15 Metrotech Brooklyn MY 11201 15 Metrotech Brooklyn NY 11201 PLAN NAME HealthPlus an Amerigroup Company 5 NO Name CIN DOB Medical Disability Escort Age Round Trip Carfare Location Name Signature Service Date a Amt Ride 1 PACIENT PASYAN 77232145 mmiddiyyyy 10052010 Yes Yes YES 85 Yes 5450M Metroc MIS TEST 2 2 ENKONI NEZ ZZ54321A mmiddyyyy 10182010 Yes No NO Yes 2 20 M Metroc MISTEST2 Hen Fb mi 3 PATIENS NOEN 2Z712345A mmiddiyyyy 10202010 Yes No NO Yes 2 25 M Metroc MIS TEST 2 Nora Malin Total Request for HealthPlus an Amerigroup Company 3 Total Amount Number of cards 220 x 1 Humber of cards 450 x 1 Number of cards 225 x 1 Total Metrocards Amount 3 TOTAL MO OF REQUEST S 3 Grand Total 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 for a facility report the providers are immediately displayed Click the View PDF button to view the invoice for the selected managed care provider Print or save the PDF in preparation for sending to the manage
20. im 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 Print Date 124 2011 Facility Mame MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 Start Daba 1121 124 2011 Grp Hama MIS Group 1 N MIS LOCATION 2 issued by ALL ISSUAMCE SUMMARY Total Naic ald Fads for Servica Total Managed Care Rummen Total Out of County nuances Total Hospital Expense Iagances Total DATE 01 03 2011 Group Name MIS Group 1 Location Mame MIS LOCATION 2 Medica Di H TOIT UD g10x2011 Medicaid Fese or zensice 480350 0101011 i Yes ga klede Feehan Terrie weiss aan NO Moi U Af inty Hex Pe anyi BANDET l f NY Sus Carole Heath PLEGET iniz 61032011 Mai E GIN im County Guide NTC ii DLC Mo M CIN In County Dubra NYC BAYI 7 DUC K f N Y Hospital Experg di VK et i eo NE al HORN Brod 1200 LU Tot For Location MIS LOCATION 2 127 00 The Issuance Details report has many options for viewing issued claims for a selected period All claims All 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 combin
21. ims broken down by the issuance summary types ISSUANCE SUMMARY REPORT Print Date 12 10 2013 MIS TEST 15 MetrotechBrooklyn NY 11201 Start Date 1120 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 40 00 D 0 00 40 00 Total 9 45 00 0 0 00 45 00 DATE 11 20 2015 Group Name MIS Group 1 Location Name MIS LOCATION 1 Total Medicaid Fee For Service Ilssuances Number of Cards 35 00 x 35 00 Total Metrocards Amount 35 00 Totals 53 00 Total Hospital Expense Issuances Number of Cards 235 00 x 10 00 Total Metrocards Amount 10 00 Totals 10 00 Total For Location MIS LOCATION 1 Metrocard Amount 45 00 Cash Amount 0 00 Total s 3 Location Name MIS TEST 2 Total Hospital Expense issuances Number of Cards 235 00 x 520 DU Total Metracards Amount 4 20 00 Totals d 20 00 Total Far Location MIS TEST 2 Metrocard Amount 20 00 Cash Amount 0 00 Total s 4 Total for Group MIS Group 1 Mewvrocard Amount 35 00 Cash Amount 50 00 Toral 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 Numb
22. ims 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 1s 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 tidal n 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 amp emailaddress com Number 0 through 9 Special Character amp Confirm Password First Name Ukendt Middle Initial Last Name Bruger Security Question Select Security Answer Security Question Select Security Answer2 Security Question3 Select v Security Answer3 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
23. ocation MIS TEST 2 Metrocard Amount 30 00 Cash Amount 50 00 Total s 6 Total for Group MIS Group 1 Memrocard Amount 545 00 Cash Amount 50 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 All 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 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 Select the By Date or By Group option Click Submit to generate the report based on the selected parameters The report PDF displays p DS PTAR User Manual 21 Managed Care Invoice Managed Care Invoice is a combination report and invoice producer for claims involving managed care providers
24. re 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 1s a combination of facility administrator and DOH processing 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 Amo
25. rop 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 cards e The d
26. s l 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
27. t 16 Figure 19 Hospital Expense Report Detail View sees eee eee 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 heen e e 23 PUSS NNN 25 Figure 26 Update User E dn osaa E E E E E E E E 26 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 NY 11201 Group Name MIS Group 1 Location Name MIS TEST 2 Location Address 15 Metrotech Ne
28. unt Denied Claims Amount Pending Claims Amount VIEW RETMBURSEMENT HISTORY Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 Please select a Year 2013 Display Last 3 Months Online 160 915 00 Total Claims Total Claims Amount Online 464 2 155 00 875 00 14 105 00 3 130 121 640 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 Facility Name MIS TEST Facility Address 15 Metrotech Brooklyn NY 11201 Please select a Year 2013 Display Last 6 Months DOH Medicaid Approved Date DOH Finance Processed Date Online Disapproved Claims Client Ineligible 2 165 00 15 85 00 DOH Medicaid Approved Date DOH Finance Processed Date Total Claims Total Claims Amount Issued Claims Amount Online 15 745 00 14 105 00 DOH Medicaid Approved Date DOH Finance Processed Date Total Claims Amount Issued Claims Amount DOH Finance Processed Date Total Claims Amount Issued Claims Amount 500 00 14 577 50 DOH Finance Processed Date Total Claims Amount Issued Claims Amount 180 00 17 107 50 Legend Pending Processing By D
29. w York NY 10001 Click Activate Signature Pad To Accept Client Signature OR Click Manual Issuance Client Information Client CINF 7712345X Clients Sex Female Client Name ANHYSBYS CLEIFION Client DOB MM DD YYYY Age XX Disbursement Information Medical Service Date 12 12 2013 Recipient Amount Payment Mode Gent 500 Metrocard Comments Based on the information below client is entitled to receive 5 00 Client is Enrolled in Managed Care Transportation covered by BLUE CHOICE BLUE CHOICE OPTIO Provider ID 00477023 Access a Ride No Escort Required No Trip Round Trip Manual Issuance Activate Signature Pad Figure 1 Add New Request PTAR User Manual Instructions l P 3 S PTAR User Manual 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
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