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PC-ACE Pro32 User`s Manual

1. If there is a problem with processing your request form such as an invalid Submitter ID or information in a required field is missing an error page will display Click Back to Download Request Page to correct and resubmit the form 4 After you have successfully submitted the form a File Download dialog box will display Click Save to save the software file to your computer 5 Download complete will display when the download is complete Click the Open Folder button 6 The file is a compressed zip file Double click on the PCACEPro32 zip file to unzip the file When complete you may need to refresh your file folder to see the unzipped Pro32setup exe file 7 Double click on the file name Pro32setup exe The Wise Installation Wizard will initialize and guide you through the installation process outlined in the Installation Instructions J Welcome Installation Instructions i Welcome to PC ACE Pro32 Claims Processing p System Setup program This program will install 1 The Welcome screen Figure 2 1 displays to remind FO Hee rence Edi e you to close all programs you may have running on benet per ll an your computer If you have not alr eady done SO we Click Cancel to quit Setup and close any programs you have recommen d that you close any open programs at this running Click Next to continue with the Setup program r R WARNING This program is protected by copyright law and time If you are r
2. Permits entry of one or more claim level adjustments as reported by the payer Adjustments are defined by a specific Group code and Reason code combination Enter these codes manually or select them from the available lookup lists Each claim level adjustment must specify a non zero Amount value and may also specify an optional Units value COB MOA Amounts Permits entry of various general claim level COB amount values as well as amount values defined specifically for Medicare Outpatient Adjudication MOA use Enter or select the Code which defines the amount type to be reported and enter the corresponding Amount value Medicare Outpatient Adjudication MOA Remarks Codes Permits entry of up to 5 remarks codes for Medicare Outpatient Adjudication MOA use These optional codes may be entered manually or selected from the available lookup list Claim Adjudication Date Permits entry of the date on which the payer adjudicated the claim This date is typically required at either the claim or line level The line level COB data is entered on the MSP COB sub tab of the Billing Line Items tab Figure 6 11 The purpose and use of the various field groups on this sub tab are as follows Service Line Adjudication SVD Information Permits entry of one or more Service Line Adjudication SVD lines as reported by the payer for the current service line The P S field identifies the p
3. Associate the new provider with the selected provider View Update button or double click on the record Select the desired option and click the OK button ta continue men Figure 4 6 New Provider Options Window Institutional Provider Information 4 The Institutional Provider Figure 4 7 General Info Extended Info or Professional Provider Figure 4 8 Name JONES MEMORIAL NPI OOOOH Information window will display Address PALMERS ST Tax ID Type 00 E Complete the fields Tax SubID 001 City St Zip ANYWHERETOWN TX 74123 Taxonomy 99000066 Phone 214 555 1212 Fax Country Site Contact INDIANA JONES Provider ID No 6660000004 LOB MCA a Include In Lookups Y Payer ID Tag Remarks Provider Associations Select Provider ID Provider Name Professional Provider Information General Info Extended Info Note Professional field requirements will vary bas ed on the Provider Type Provider Type Group Practice Individual in Group Solo Practice chosen radio buttons at top of Group Name MASTERS CLINIC Group Label 22222222 window Part B Set up Group LastFisuM Mm s Add 234 ANYSTREET LN Tax ID T POOH E Practices before adding Individuals in ys iL a G SUITE 450 UPIN POND City St Zip DALLAS TX 78123 Specialty 010 TypeOig Fhone 972 555 1212 Fax 972 555 1213 Taxonomy 60006000 Contact AUGUSTA MASTERS Accept Assign
4. Auth IDE Num Reference Number Type Treatment Authorization Period Rev Code E45 thru EEE HCPCS Save Cancel Figure 5 10 Institutional Claim Form Extended Payer Tab 15 After completing all of the data entry on the claim form click the Save button or press ALTJ IS to save and exit the claim Note clicking the Cancel button will abandon all changes made to the claim When you click the Save button PC ACE Pro32 begins an Edit Validation process One or more of the following edits may be required a Atleast one of the payers specified on a claim must have the same LOB line of business as the claim itself b If no edit validation errors occur the claim is saved with a clean CLN status c If one or more edit validation errors occur the Edit Validation Errors List form will display indicating fatal and non fatal errors You may correct the errors or save the claim with errors Note If a fatal error exists in the LOB PCN or TOB field you must correct the error before you will be allowed to save the claim i To save a claim that contains only non fatal errors click the Save With Errors button These claims are saved with a has errors ERR status ii To save a claim that contains fatal errors click the Save With Fatal button Such claims are assigned the has fatal errors ERF status Claims with an ERF status are not eligible for preparation into an electronic EMC file 16 If edit validation err
5. Include edit error details in process error report Claim preparation generates a transmission ready Electronic Media Claims EMC file EMC files contain submission details for one or more processed claims Only claims in the to be transmitted CL location that have an electronic E media setting are eligible for preparation When a claim is prepared Page 30 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 5 Institutional Claims Processing into an EMC file it is automatically moved to the transmitted TR location which prevents the claim from being inadvertently retransmitted Note Before preparing claims for the first time you will need to set up your Submitter Reference File This file contains important data that will be used to build the EMC file To generate an EMC file 1 Select the Prepare Claims option from the Institutional Claim Prepare For Transmission E Institutional Claims Menu The Institutional Claim UEM Prepare For Transmission window will display aw Figure 5 13 Payer 2 Specify from the drop down list if you want only a a QE single line of business LOB to be considered or select lt lt All gt gt to include claims for any line of Output Format Submission Status Include Error Claims business If you specify an LOB NSF f Production C Yes a Choose a single Payer or lt lt All Payers for fe ANS I 83 C Test No LOB s gt gt to include claims for all payers P
6. PC ACE Pro32 User s Manual For ANSI X12N 837 v4010A1 E CPT codes descriptors and other data only are copyright 1999 Pa m etto G B A z American Medical Association or such other date of publication of CPT All Rights Reserved Applicable FARS DFARS apply PARTNERS IN EXCELLENCE AY 8 ga pply A CMS Contracted Intermediary and Carrier June 2008 PC ACE Pro32 User s Manual TABLE OF CONTENTS SECTION 1 INTRODUCTION Minimum System Requirements cccccccccsssseseeeceeeeceeaeeeseeeeceeeeeenaas Technical SUPPOl n SECTION 2 ACCESSING amp INSTALLING PC ACE PRO32 Accessing PC ACE Pro32 from a CD ROM eerrrrrrnrrrrrrvvnnvvnnnnnnrrsrrrnnns Accessing PC ACE Pro32 from the Palmetto GBA Web Site Instal tation ENG C 0 EE EEE ENER SECTION 3 GETTING STARTED Logging Into the PC ACE Pro32 Claims Processing System EE LE RE Adding or Modifying a User sss Building Your Reference Files rrrnnrrrnnnnnnnnnrrnvnvrnnnnnnnrnrrrnnnvnnnnnnnnnnssnnnn Getting Help In PC ACE PEQO2 siones isis bi venens Pte Some oem en Logging Out of PC ACE Pro32 ssrrrrnnnrrronnnnnnrrnnnnnnessnnnnnvnnnnnnnsssnnnnnnnnnnne SECTION 4 REFERENCE FILE MAINTENANCE Payer ete he nee vvs Adding or Updating a Payer Record rrrrornnnrrrrrrnnrorrrrrrrrrnnnnnvvvrnnnnnnnnn Deleting an Existing Payer Record rrrrnnnnnnnnnrnnnn
7. 2007 03 01 2007 E B 99213 F E 95 00 1 0 ELT JT 2 0303 2007 jo 3 03 2007 T E 38213 M 1 35 00 1 0 ETENE l g Iiii LIB fi EMNE 2 1L 11 jf eg sp FTP FIT FT TITT gg sp p ITLI FRP HET TIITTT a A Total Charge 190 00 Recalculate 23 Amount Paid 0 00 30 Balance Due 190 00 Save Cancel Figure 6 17 Line Item Details Tab Approved Amount 90 00 per line item Allowed Amount 75 00 per line item Deductible Amount 75 00 per line item Amount Paid by Payor SVD 0 Line Level Adjustments CAS 1 Patient Responsibility 75 00 Deductible 2 Contractual Obligation 20 00 Co Insurance Amount G Adjudication Payment Date 03 30 2007 ie oe Professional Claim Form Patient Info amp General Insured Information Billing Line Items Ext Patient General Ext Pat Gen 2 Ext Payer Insured Line Item Details Extended Details Line 1 Ext Details 2 Line 1 MSP COB Line 1 Common Line MSP Amounts Additional Line level Adjudication COB Information ANS1 837 Use Only B Approved L 30 00 E Service Line Adjudication SYD Information C SVD P S Proc Qual Code Modifiers 1 thru 4 Paid Amount Paid Units B U Line Allowed 75 00 Ds 1 P ac 8013 0 00 1 000 Deductible 75 00 Co Insurance 0 00 7 os Primary Paid DD a m m m mm a OTAF
8. Claim Level COB Reporting Remittance data that is not specific to a particular service line is reported at the claim level The claim form provides claim level COB fields for both the primary and secondary Palmetto GBA June 2008 Page 25 Section 5 Institutional Claims Processing PC ACE Pro32 User s Manual payers These fields are located on the COB Info Primary Figure 6 10 and COB Info Secondary sub tabs of the Extended Payer Insured tab Line Level COB Reporting Remittance data specific to a particular service line is reported at the line level The claim form provides a set of line level COB fields for each service line These fields are located on the MSP COB sub tab of the Billing Line Items tab Figure 6 11 This sub tab tracks the currently selected service line in the same manner as the other extended line item sub tabs The current service line is identified in the sub tab caption e g Line 4 The claim level COB data is entered on the COB Info Primary and COB Info Secondary sub tabs of the Extended Payer Insured tab The purpose and use of the various field groups on these sub tabs are as follows Common Payer MSP Information This field group exists primarily to provide a bridge between the MSP COB reporting standards defined in the older NSF format and those defined in the ANSI X12 implementation Only the amount Paid by primary payer amount Allowed by primary payer
9. Click the FL56 button and the Form Locator 56 popup window will display b Type in the related information Press to start a new line if needed c When you have completed your entry press to close the pop up window d Follow the same steps with each Form Locator button on the Payer Information tab to complete the field entries for this portion of the claim form 8 When you have completed all of the fields on the Payer Information tab click on the Diagnosis Procedure tab to display that section of the claim entry form Figure 5 6 Institutional Claim Form Patient Info amp Codes Billing Line Items Payer Info Diagnosis Frocedure Extended General Ext General 21 Extended Paper DHPC Principal Diag Other Diagnosis Codes 1 17 1 OO ee eee OOO 1L TOO OO O 3 Nb O External Cause of Injury Codes 1 3 PPS DAG Principal Proc Code Date Other Procedure Codes D ates 1 5 COB H H CRE L E I g EEE BEEN o 8B P 1 dg o Supporting Provider Information Admitting Diagnosis Patient s Reason For Visit Codes 1 3 Remarks Type Last Org Mame First Mame MI Suffix Provider IDs Types arr Save Cancel Figure 5 6 Institutional Claim Form Diagnosis Procedure Tab 9 Enter data into blank fields 10 Enter a Y in the COB field if you have COB related information Note Entering a Y in this field will generate two new sub tabs to the Extended Payer tab COB In
10. Working aged beneficiary I Zero Payment Indicator Z Payment amount was zero J Adjudication Indicator 05 Entire amount to deductible Professional Claim Form Common Payer MSP Information m Additional Adjustment COB Amounts MOA Information amp N51 83 Only Allowed 0 00 Claim Level Adjustments CAS COB MOA Amounts Paid 0 00 Num Group Reason Amount Units Num Code Amount H Insurance Type 1 2 y p zl l zl DisallowedCost 00 II I 2 Disallowed Other 000 _ m Q 3 D pL Deductible j__ 000 Medicare Outpatient Adjudication MOA Remarks Codes Co Insurance 0 00 o na OTAF 0 00 1 Zero Payment Ind Zz Claim Adjudication Date 7 J AdjudicationInd 05 Figure 6 20 COB Info Primary Tab Page 42 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 6 Professional Claims Processing SINGLE LINE CLAIM WITH OTAF AMOUNT Claim Example A Claim Amount 70 00 Professional Claim Form Patient Info amp General Insured Information Billing Line Items Est Patient General Ext Pat Gen 21 Ext Payer Insured Line Item Details Extended Details Line 1 Ext Details Z Line 1 MSP COB Line 1 Claim Diagnosis Codes 1 I 24a Service Dates 46 24c 24d Zu aes ede 24r 24g LM From Thru PS TS Proc Diagnosis Charges Units EPFPEMLEB
11. existing payers 2 Highlight the desired record from the list click the Delete button and confirm the deletion Provider Institutional and Professional Reference File The Provider Inst and Provider Prof tabs of the Reference File Maintenance window provide access to maintain the provider information referenced on claims Setup of the provider reference file s is required to process claims All providers referenced on claims must be represented in the reference file s ADDING OR UPDATING A PROVIDER l Click the Refer ence File i Reference File Maintenance Maintenance button on the PC ACE fle view Reports Pro32 main menu The Reference Patient Payer Provider Inst Provider Prof Codes Misc File Maintenance window will Tag Fed Tax ID MCA JONES MEMORIAL display SotBy 0 LOB Provider Name Provider ID C Tag List Filter Options Show all providers no filter applied Show only providers associated with selected provider C Filter list to include Provider IDs starting with Filter list to include Provider Names starting with New View Update Delete Close Figure 4 4 Institutional Part A Provider Tab 2 Click on either the Provider Inst Felene a Melptenenge e e Fie view Reports tab for Part A providers Figure 4 4 P id P f tab for Part E Patient Payer Provider Inst Provider Prof Codes Misc or Provider Prof tab for Par iders Fi 4 5 O h of Tag providers ri
12. f Save Cancel Figure 6 22 MSP COB Line 1 Tab Palmetto GBA Page 43 June 2008 Section 6 Professional Claims Processing 2A FARR COB MOA Allowed Amount 60 00 Amount Paid 40 00 Insurance Type Working age beneficiary Amounts Zero Payment Indicator N Payment amount was greater than zero Adjudication Indicator 06 Charges exceed allowance 1 Primary Paid Amount D 40 00 2 Allowed Amount AAE 50 00 O Adjudication Date 02 28 07 Professional Claim Form D og Common Payer MSP Information Allowed 60 00 Paid 4000 Insurance Type 2 Disallowed Cost 0 00 Disallowed Other 0 00 Deductible 0 00 oo OTAF 0 00 Zero Payment Ind IN Co Insurance Additional Adjustment COB Amounts MOA Information ANS1 837 Only Claim Level Adjustments CAS Amount COB MOA Amounts Num Group Reason Units Num Code Amount Fr mH Ir e Cy Ta gt me 350 3 2 p EE ET T L m Medicare Outpatient Adjudication MOA Remarks Codes ee eee eee 0 Claim Adjudication Date 02 28 2007 AdiudicationInd foe Figure 6 23 COB Info Primary Tab SINGLE LINE CLAIM WITH DEDUCTIBLE AND OTAF AMOUNTS Claim Example A Claim Amount 90 00 Professional Claim Form Patient Info amp General Insured Information Billing Line Items Est Patient General Ext Pat Gen 21 Ext Payer Insured Line Item Details Extended Details Line 1 Ext Deta
13. resides in the pre transmitted CL location and has a clean CLN status or optionally a non fatal errors ERR status 3 After each eligible claim is printed you will be prompted to move the claim to the transmitted TR location When multiple paper claims are eligible for submission you may use the Yes To All No To All buttons to move not move all eligible paper claims to the transmitted TR location after printing Adobe Acrobat Reader version 4 0 is required for this function Note Since paper claims will never be prepared into an EMC file this prompt provides the only available mechanism for moving these claims out of the pre transmitted CL location Automated Claims Processing The Process Claims feature allows you to run front end edits on claims being submitted To process claims 1 Select the Process Claims option from the Automated Claim Processing Institutional Claims Menu The Automated Claim Process Claims Matching leave blank for all claims Processing window will display Figure 5 12 LOE TOR E EE 2 If you want to process only specified claims Reprocess claims with errors complete the top portion of the window Place a check in the box next to the options in the lower portion of the window if desired 3 Click the Process button Process Close Figure 5 12 Automated Claim Processing Window Preparing Claims for Electronic Transmission Present claims with errors for immediate editing
14. the Insurance Type OTAF Obligated To Accept In Full Amount if applicable Zero Payment Ind and Claim Adjudication Date fields are actually needed to process MSP COB claims in PC ACE Pro32 Claim Level Adjustments CAS Permits entry of one or more claim level adjustments as reported by the payer Adjustments are defined by a specific Group code and Reason code combination Enter these codes manually or select them from the available lookup lists Each claim level adjustment must specify a non zero Amount value and may also specify an optional Units value COB MOA Amounts Permits entry of various general claim level COB amount values as well as amount values defined specifically for Medicare Outpatient Adjudication MOA use Enter or select the Code which defines the amount type to be reported and enter the corresponding Amount value Medicare Outpatient Adjudication MOA Remarks Codes Permits entry of up to 5 remarks codes for Medicare Outpatient Adjudication MOA use These optional codes may be entered manually or selected from the available lookup list Claim Adjudication Date Permits entry of the date on which the payer adjudicated the claim This date is typically required at either the claim or line level The line level COB data is entered on the MSP COB sub tab of the Billing Line Items tab Figure 6 11 The purpose and use of the various field groups
15. 5500 al Disallowed Cost 000 2 m mmn z 2 i E xj Disallowed Other 000 3 re 3 34 v Deductible 0 00 Medicare Outpatient Adjudication MOA Remarks Codes Co Insurance 0 00 m OTAF 0 00 K Zero Payment Ind jz N Claim Adjudication Date 01 23122007 AdjudicationInd foe Figure 6 26 COB Info Primary Tab The Professional Claim List The Professional Claim List Figure 6 12 provides versatile access to create list vai 7 PEN Patemtlast Bi Provider Type Entered 5 modify print and otherwise PCH Patient Last Bill Provider ntere maintain claims To access the Claim List form 1 Select the List Claims option from the Profes sional Claims Menu il Professional Claim List File Filter Actions Reports 2 Choose one of the Sort By options radio buttons mj shown just below list SortBy Patient Name PCN C EntyDate C Service Date Claim List Filter Options 3 If you want to filter the Location CL to be transmitted Status cc All LOB lt lt Als v claim list select the desired filters from the Clear Filters Advanced Filter Options Checked claim count O Claim List Filter Options drop down lists view Delet Close Figure 6 27 Professional Claim List Window Page 46 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 6 Professional Claims Processing CLAIM ACTIONS To perform an action
16. Actions menu on the Claim List toolbar you can also right click over a selected claim to view a pop up menu Available claim actions are described in the table on the following page An X in the M column indicates that the action menu option can be performed on multiple claims Menu Option M Description of Action 7 or New button EK An View and or modify the selected claim or View Update button Copy Selected Claim The Institutional Claim Entry form will display containing details of the or Copy button highlighted claim Some fields are cleared automatically in the new claim Delete Selected Claim X Deleted claims are assigned DEL status or Delete button Note DEL status claims can be recovered undeleted Purge Selected Claim X Claims in the pre transmitted CL location with a DEL status will be purged from the system Note Purged claims cannot be recovered Reactivate Selected X Move selected claim s from the previously transmitted TR or paid Claim PD location into the pre transmitted CL location The reactivated claim will be assigned the unprocessed UNP status Hold Selected Claim X Changes the status of the selected claim to hold HLD Held claims are not considered for future claim activities such as automated claim processing or claim preparation Print Selected Claim X Claims may be printed using either a plain paper image overlay technique or the traditional pre print
17. Billing Line Items Ext Details 2 Sub Tab section of the claim entry form Figure 6 8 Professional Claim Form Patient Info amp General Insured Information Biling Line Items Ext Patient General Ext Pat Gen 2 Ext Payer Insured Patient Legal Representative Information Miscellaneous Patient amp General Information Name LF gn Date of Death Lt Functional Status Code Address Accident State Hour Special Pragram Indicator Fn Accident Diagnosis Medical Rec Ma Citp StZip Responsibility Ind IDE Number County Phoe L3 FL 10d DocInd Typ Sent 22 Homebound Ind E Doc ACH Facility Information Care Plan Prov Form Loc 31 Name Date Care Assumed 2 EPSDT Referal Address Date Care Relinquished 4 4 Submission Reason Cade Patient Residence Type Delay Reason Code City S tip meam Referring Physician State Pregnancy Indicator IDs Type Date Last Seen Fac Type Retum Ta Work Date Error List Save With Fatal Save Cancel Figure 6 8 Professional Claim Form Extended Patient General Tab Palmetto GBA Page 35 June 2008 Section 6 Professional Claims Processing PC ACE Pro32 User s Manual 11 Enter data into blank fields When you have completed entering information into the Extended Patient General tab click on the Extended Payer Insured tab to display that section of the claim entry form Figure 6 9 Professional Claim Form Patient Info amp Genera
18. Claim Form will display Figure 6 3 Professional Claim Form Patient Info amp General Insured Information Biling Line Items Ext Patent General Ext Pat Gen 21 Eat Paper Insured LOB MCB Billing Provider 26 Patient Control Ma B Pat Status Death 12 Legal 2 Patient Last Mame First M ame MI Gen 3 Birthdate Ge MS ES 55 Ind SOF Rep 1 3 ee ee ove ENS NE M MN 5 Patient Address 1 Patient Address 2 Patient City State Patient zip Country Patient Phone 10 Patient Condition Related To AOIL R l Date Other Ins 14 Date Ind of Current 15 First Date 16 UTW Disability D ates amp Type E mployment i Accident E E EAN E Ker E pee mE to 7 sd 17 Referring Phys Name Last Org First MI Suffix 17a Refering Phys IDs Tvypes 18 Hospitalization Dates 20 Outside Lab Chgs EE FP Y PIIeK p 13 Reserved For Local Use 22 Medicaid Resubmission Code amp Ref No 25 Fed Tax ID S85N EIM B Ar Provider Accepts Assignment B 33a PIN No 31 ProviderSOF Date 7 Facility Dental COB Frequency 33b GRF No Save Cancel Figure 6 3 Professional Claim Form Patient Info amp General Tab 2 Begin entering patient and general data using your cursor or the key to move through the fields Note Many fields on this and subsequent tabs will fill automatically as other fields are completed with information pulled from the reference files For example when you enter a Patien
19. Figure 9 2 System Utilities Window server and client systems In the event a full restore is required you would first restore from a full system backup to rebuild the system s directory hierarchy and restore all program and support files The most recent PC ACE Pro32 backup could then be restored to recover your databases and configuration settings The following sections describe the steps to backup validate and restore Backup To perform a backup of the PC ACE Pro32 database files and configuration settings 1 From the Systems Utilities window click the Backup Restore tab and the Backup sub tab see Figure 9 2 2 Complete the following information a Enter type or click the button to browse the destination drive or folder to which the file will be written You can choose your floppy or writeable CD ROM drive or a hard disk drive local or remote Note Disk spanning is supported for backups to diskette You will be prompted to insert blank diskettes as needed b Specify whether or not to include certain infrequently changed database files in the backup To ensure minimal problems in the event that a database restoration is required we recommend leaving this option checked for all backups c Specify whether or not to include the claim archive database files in the backup Refer to Section 15 Archiving Claims for more information on the archive feature d Specify whether or not to include all archived EMC
20. Line Adjustment CAS amp Miscellaneous Fu for SVD 1 above Disallow Cost Procedure Code Description Line Level Adjustments CAS Num Group Reason Amount Units Disallow Other U PR i 7500 1000 a co 2 2000 1 000 G ream Dat 03 30 2007 3 ey h Save Cancel Figure 6 18 MSP COB Line 1 Tab Palmetto GBA Page 41 June 2008 Section 6 Professional Claims Processing PC ACE Pro32 User s Manual Professional Claim Form Patient Info amp General Insured Information Biling Line Items Ext Patient General Ext Pat Gen 2 Ext Payer Insured Line Item Details Extended Details Line 2 Ext Details 2 Line 2 MSP COB Line 2 Additional Line level Adjudication COB Information amp NS1I 837 Use Only 30 00 E Service Line Adjudication SYD Information 75 00 SVD P S Proc Qual Code Modifiers 1 thru 4 Paid Amount Paid Units B U Line Deductible 7500 Bee pec je 1 gj jp pop S Co Insurance EK m m m m m p En Primary Paid 000 i m _ _ m m mE gol OTAF 0 00 Line Adjustment CAS amp Miscellaneous CE for SYD 1 above Line Level Adjustments CAS Disallow Cost 000 Procedure Code Description Num Group Reason Amount Units Disallow Other 000 PR mn 70 700 aj co f2 20 00 1 000 G ad Papmen Date 03 30 2007 3 vi Save Cancel Figure 6 19 MSP COB Line 2 Tab H Insurance Type Code
21. PC ACE Pro32 User s Manual Section 4 Reference File Maintenance 8 The Preferences window will display Figure 4 26 If you are using the HCPCS Reference file click once on Use Charge Master reference file for Professional procedure code lookups Preferences General Claim List Claim Import Printing Data Comm Misc General Preferences Automatically tab at maximum field length during data entry Tab key jumps between controls with edit errars when displayed Enable flashing notification method for controls with edit errors Warn an close when deferred claims tasks are scheduled Show descriptive Field hints on claim and reference file forme Present claims with errors for immediate editing during process runs 9 Click the OK button Interpret Enter ker as save request on claim entry and other editable forms Automatically display E dit Validation Error List when saving a claim that contains errors Automatically prompt for selection of non unique Payer Provider and Physician IDs Automatically focus on Patient PCN field for new Institutional hand keyed claims Automatically focus an Patient PCM field for new Professional hand keyed claims Auto populate zero service line Units value to I during Professional claim entry Skip over line item Service Thru Date field during Institutional claim entry Use the PhysiciansUPIN reference file for Professional purchased services lookups Include only Revenue Codes with non zero charge
22. Participating a Group ID No 696600 LOB MCB Signature Ind Y Date 03 15 1994 Payer ID Tag Provider Roles Billing v IN Remarks Provider Associations Select Provider Group Name Figure 4 8 Professional Provider Window Page 10 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 4 Reference File Maintenance 5 After you have completed your additions changes click the Save button located on the bottom right of the window The system will perform an edit validation on the entered information If you have not completed or incorrectly completed one or more required fields the Edit Validation Errors List will display Figure 4 9 This form lists all fatal and non fatal errors that occurred Fatal errors indicated by a red X must be corrected before the system will allow you to save the information Edit Validation Errors List Medicare ID Pos 1 2 Must Be Numeric non zero Tax ID Must Be 9 Position Numeric a Double click on a listed error to go to that location in the Provider Information form and make the necessary corrections fields with errors will be flashing red b If there are no fatal errors that must be corrected now those marked with a red X Diei exe le error to jump to the corresponding fel you may close the Edit Validation Errors 7X Indicates that error must be corrected before saving List and then click the Save With Errors Figure 4 9 Edit Validation Errors L
23. Patient General Ext Pat Gen 2 Ext Payer Insured Primary Payer Insured Secondary Payer Insured Tertiary Payer Insured COB Info Primary COB Info Secondary Common Payer MSP Information Additional Adjustment COB Amounts MOA Information amp NSI 837 Only Allowed 131 34 Claim Level Adjustments CAS COB MOA Amounts Paid 0 00 Num Group Reason Amount Units Num Code Amount CO 42 20 70 1 000 _4 D 10507 _4 E Insurance Type 12 A Ex EL zl Disallowed Cost PR 3 5 00 1 000 F2 15 00 Disallowed Other 3 ve x 3 bh p Deductible Medicare Outpatient Adjudication MOA Remarks Codes Co Insurance mA Gen OTAF Zero Payment Ind E Claim Adjudication Date fi 0 31 2006 Adjudication Ind Figure 6 16 COB Info Primary Tab Page 40 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 6 Professional Claims Processing MULTI LINE CLAIM WITH DEDUCTIBLE AMOUNT Claim Example A Claim Amount 190 00 Professional Claim Form Patient Info amp General Insured Information Billing Line Items Est Patient General Ext Pat Gen 21 Ext Payer Insured Line Item Details Extended Details Line 1 Ext Details Z Line 1 MSP COB Line 1 Claim Diagnosis Codes 1 25000 J E E 5 B i B CF 24a Service Dates 24b 24c 24d 24d aes ede 24r 24g LM From Thru PS TS Proc 1 Diagnosis Charges Units EPFPEMLEB AT Rendering Phys 1 oso
24. Professional Claims Processing PC ACE Pro32 User s Manual To print all or a subset of claims currently eligible for paper submission 1 Select Reports from the Claim List toolbar 2 Choose Print Claims for Paper Submission A claim is eligible for paper submission if it has a media setting of paper P resides in the pre transmitted CL location and has a clean CLN status or optionally a non fatal errors ERR status 3 After each eligible claim is printed you will be prompted to move the claim to the transmitted TR location When multiple paper claims are eligible for submission you may use the Yes To All No To All buttons to move not move all eligible paper claims to the transmitted TR location after printing Adobe Acrobat Reader version 4 0 is required for this function Note Since paper claims will never be prepared into an EMC file this prompt provides the only available mechanism for moving these claims out of the pre transmitted CL location Preparing Claims for Electronic Transmission Claim preparation generates a transmission ready Electronic Media Claims EMC file EMC files contain submission details for one or more processed claims Only claims in the to be transmitted CL location that have an electronic E media setting are eligible for preparation When a claim is prepared into an EMC file it is automatically moved to the transmitted TR location which prevents the claim from being inadvertently ret
25. Under the Professional list click on the Charges Master button The Charges Master Setup window will display Figure 4 24 Determine if you plan to add or modify a code a To add a new code click the New button b To update an existing code highlight the code and click the View Update button or double click on the code The Charges Master Information window Figure 4 25 will display Enter a valid HCPCS code or right click in the Code field to select a code from the master HCPCS code reference file Enter change the desired Charges value After you have completed your additions changes click the OK button located on the bottom right of the window fox it Charges Master Setup List Filter Options f Show all codes no filter applied Filter list to include codes starting with Filter list to include descriptions starting with up to first 5 characters C Filter list to include descriptions containing Mer vew edste Dette Figure 4 24 Charges Master Setup Window Close Charges Master Information LOB ETE Paper ID blank all payers Code Description Charges 0 00 men Figure 4 25 Charges Master Information Window Close your Reference File Maintenance tab which will return you to the PC ACE Pro32 Claims Processing System toolbar From menu options at the top of the toolbar click File and then Preferences Page 20 Palmetto GBA June 2008
26. a variable list values selected from reference files lookup To access the lookup list move your cursor over the field and right click to display a pop up menu You can also click in the field and press F2 Select the appropriate value from the list and it will automatically be entered in the claim form field If you inadvertently make a change to a field you can press ESC which will un do the change and restore the field s original value Fly over hints provide a brief description of a field s purpose They become visible when the mouse cursor pauses over the field Page 32 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 6 Professional Claims Processing When the focus leaves a particular field for example when you press the key or click on a new field an edit validation is performed on the field losing the focus Edits performed at this time are referred to as field level edits If a field level edit error occurs an audible tone will sound and the error message will display in the lower left corner of the claim form In addition the focus will remain on the field with the error so that you can correct the problem if desired If you choose not to correct the data at this time simply press again to move to the next field Entering Professional Claim Data To enter Professional claims into the PC ACE Pro32 system 1 Select Enter Claims from the Professional Claims Menu The Professional
27. button Confirm your intention to prepare all eligible claims by clicking OK on the displayed confirmation Running totals of the count and dollar value of all prepared claims will be displayed on the Claims Prepare For Transmission form You will be notified when the claim preparation operation completes 5 You can click the View Results and or View Errors buttons to view reports of the successfully prepared claims and rejected claims respectively These reports can be printed from the report previewer if desired 6 When you have completed your review of the claim preparation reports click the Close button on the Claim Prepare For Transmission form Page 52 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 7 Data Communications SECTION 7 DATA COMMUNICATIONS Before you are ready to transmit you must have already entered one or more claims and prepared these claims into an EMC file suitable for transmission Claim files are located on the same drive on which the software is installed see Installation Instructions in Section 2 step 2 and can be found under winpcace filename The filename for the Professional claim file is bstrans dat The filename for the Institutional claim file is betrans dat SC Part A NC Part A SC Part B OH WV Part B amp Railroad Claim Submissions To transmit your claim file exit PC ACE Pro32 Go to your communication software to send the file to GPNet Refer to the GPNet Communication
28. button Confirm your intention to prepare all eligible claims by clicking OK on the displayed confirmation Running totals of the count and dollar value of all prepared claims will be displayed on the Claims Prepare For Transmission form You will be notified when the claim preparation operation completes 5 Youcanclick View Results and or View Errors to view reports of the successfully prepared claims and rejected claims respectively These reports can be printed from the report previewer if desired Page 48 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 6 Professional Claims Processing 6 When you have completed your review of the claim preparation reports click the Close button on the Claim Prepare For Transmission form Roster Billing The PC ACE Pro32 Roster Billing List form provides a versatile interface from which the user can create list modify print and otherwise maintain Professional roster billings Click the Professional Claims Processing button on the PC ACE Pro32 Main Toolbar to open the corresponding Claims Menu form Then select the Maintain Roster Billings item from the Professional Claims Menu form s main Roster menu to open the Roster Billing List form ADDING A NEW ROSTER BILLING L New Professional roster billings Professional Billing Form Patient Info amp General Extended Roster Info ins be added to PC ACE Pro32 Payer ID Provider ID No Service Date POS Type HCPCS Refe
29. image of the blank claim form resulting in a complete claim image that can be printed on plain paper The image overlay method requires the use of Adobe Acrobat Reader version 4 0 or higher This free software can be downloaded from the Adobe Web site www adobe com A new default Form Version selector has been added to the Printing Preferences screen to allow selection of the default claim version The available form versions for Institutional claims are the Traditional CMS 1450 UB 92 and enhanced CMS 1450 UB 04 Format Simply choose the claim version you plan to use most often when printing claims A corresponding Form version selector has been added to the Claim Print Options form to allow override of this default form version each time claims are printed To print a claim or selection of claims 1 From the PC ACE Pro32 main menu click either the Institutional Claims or Professional Claims Menu button to open the corresponding Claims Menu 2 Click List Claims on the Claims Menu to display the Claim List form 3 Youcan print a single claim or a selection of claims a To print a single claim highlight the desired claim Select Actions from the Claim List toolbar and choose Print Selected Claim or right click to access a pop up menu b To print more than one claim place a check in the left column next to the desired claims Select Actions from the Claim List toolbar and choose Print All Checked Claims Multiple claims a
30. list of existing payers if any Using the radio buttons just below the list you can sort the list by Payer ID Payer Description Payer LOB or Payer State LL Reference File Maintenance File view Reports Patient Payer Provider Inst Provider Prot Codes Misc SotBy PayerID PayerDescription Paper LOB Payer State List Filter Options f Show all payers no filter applied Filter list to include Payer IDs starting with Filter list to include Payer Hames starting with Figure 4 2 Reference File Maintenance Payer Tab Palmetto GBA Page 7 June 2008 Section 4 Reference File Maintenance PC ACE Pro32 User s Manual 3 Determine if you plan to add a new record or modify an existing record a To add anew Payer record click the New button You can also highlight an existing Payer and click the Copy button to create a new record using information from an existing record b To update an existing Payer record highlight the record and click the View Update button or double click on the record 4 The Payer Information window Figure 4 3 will display Complete each of the following fields the table below has values for each of these fields Payer ID LOB Full Description and Flags The other fields should remain empty Payer Information E Paver ID LOB Receiver ID ISA08 Override E d d d eee Full Description p Address amp Contact Information Flags Addr
31. on the COB Info Primary Figure 6 10 and COB Info Secondary sub tabs of the Extended Payer Insured tab Line Level COB Reporting Remittance data specific to a particular service line is reported at the line level The claim form provides a set of line level COB fields for each service line These fields are located on the MSP COB sub tab of the Billing Line Items tab Figure 6 11 This sub tab tracks the currently selected service line in the same manner as the other extended line item sub tabs The current service line is identified in the sub tab caption e g Line 4 Page 36 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 6 Professional Claims Processing The claim level COB data is entered on the COB Info Primary and COB Info Secondary sub tabs of the Extended Payer Insured tab The purpose and use of the various field groups on these sub tabs are as follows Common Payer MSP Information This field group exists primarily to provide a bridge between the MSP COB reporting standards defined in the older NSF format and those defined in the ANSI X12 implementation Only the amount Paid by primary payer amount Allowed by primary payer the Insurance Type OTAF Obligated To Accept In Full Amount if applicable Zero Payment Ind and Claim Adjudication Date fields are actually needed to process MSP COB claims in PC ACE Pro32 Claim Level Adjustments CAS
32. sub tab for that attachment Bur ME will display Figure 6 6 Note To Purpose of Stretcher EMT Paramedic Name Last First MI view a drop down list of attachment options right click in the AT field on the Line Item Details sub tab Error List Save With Fatal Save Cancel Figure 6 6 Billing Line Items Ambulance Attachment Sub Tab 9 When billing a National Drug Code NDC go to the Billing Line Items Professional Claim Form Patient Info amp General Insured Information Billing Line Items Ext Patient General Ext Pat Gen 2 Ext Payer Insured tab and the Line Item Details sub tab Line Item Details Extended Details Line 1 Ext Details 2 Line 1 Ambulance Line level Miscellaneous Information and enter XXXXX In the Proc field National Drug Code Ref No Type 24d Select the Ext Details 2 sub National Drug Unit Price 000 Ref No Type tab Figure 6 7 while on the claim oo om i Prescription No Facility Name line Enter NDC infor mation under Drug Discount Amount 000 Facility Address FO Line level Miscellaneous Information Drio eye oan o Fac CiS 00 DME Length of Need Days 0 Fac IDs Types fo gt Type 10 When you have completed all of the DME PuchasePice _000 sub tabs including all additional sg e attachments of the Billing Line Items tab click on the Extended Error List Save With Fatal Save Cancel Patient General tab to display that VP Figure 6 7
33. the window and confirm the reactivation when prompted 4 You will be notified when the reactivation operation has successfully completed The EMC file is now ready for retransmission Click the Close button to close the form Palmetto GBA Page 61 June 2008 Section 14 Archiving PC ACE Pro32 User s Manual SECTION 14 ARCHIVING Transmitted claims in PC ACE Pro32 can be optionally moved off line to any number of user defined claim archives Claim archiving provides the following advantages Archiving claims reduces the size and optimizes the performance of the current claims database Archiving claims eliminates claims that are no longer needed from the current claims database making it easier to locate and work with the other current claims Archiving claims promotes organized storage of older claims without requiring that they be purged Claim archives can be maintained by transmit date line of business submission payer or other preferred criteria Claim archive databases look and act much like the current database With a few minor exceptions the same actions available for transmitted claims in the current database are also available for archived claims For example archived claims can be viewed and printed just like claims in the current database The payment history of archived claims can be viewed as well To create a new claim archive or open an existing claim archive 1 From the PC ACE Pro32 main menu click
34. 2 Click the Codes Misc tab im HCPCS Codes 3 Under the Shared list click the HCPCS List includes Globalcodes Local codes button The HCPCS Codes window will as display Figure 4 18 4 Choose Global Codes or Local Codes from the radio buttons at the top of the window 5 Determine if you plan to add or modify List Filter Options a code fe Show all codes na filter applied C Filter list to include codes starting with C Filter list to include descriptions starting with up to first 5 characters Filter list ta include descriptions containing b To update an existing code highlight the code and click the View Update New Belte button or double click on the code Figure 4 18 HCPCS Codes Window a To add a new code click the New button 6 The HCPCS Code Information window HCPCS Code Information Figure 4 19 will display Complete the fields Code Description Enter the effective date range using a 4 digit year 00100 ANESTH SALIVARYGLAND format Effective Date Range 0170171998 thu 2 2 7 After you have completed your additions changes OF Cancel click the OK button located on the bottom right of EM the window Figure 4 19 HCPCS Code Information Window Page 16 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 4 Reference File Maintenance DELETING AN EXISTING HCPCS CODE To delete an existing code l uu a E c Click the Reference File
35. AT Rendering Phys ra par p emt TiT Th gt Og gt I L ITIT TII LE L ITIITL EO ILCI M LL LE sp FTP FIT FE E JITTT I gg hi TT PPT FEE TTTTTTR al A 28 Total Charge 700 0 00 Recalculate 28 Amount Paid 0 00 30 Balance Due 70 00 Save Cancel Figure 6 21 Line Item Details Tab Approved Amount 60 00 Allowed Amount 50 00 Primary Paid Amount 40 00 OTAF Amount 70 00 Note Only submit OTAF amount if reported on Primary Remittance Notice Line Level Adjustments CAS 1 Contractual Obligations 30 00 Amount Paid by Primary SVD 40 00 Adj Payment Date 02 28 07 oP eo LO Professional Claim Form Patient Info amp General Insured Information Biling Line Items Ext Patient General Ext Pat Gen 2 Ext Payer Insured Line Item Details Extended Details Line 1 Ext Details 2 Line 1 MSP COB Line 1 Common Line MSP Amounts Additional Line level Adjudication COB Information amp N51 83 Use Only Service Line Adjudication SYD Information SYD P S Proc Qual Code Modifiers 1 thru 4 Paid Amount Paid Unis B U Line pf eo a ZTTTTTTTTT ETT TITTTT T T Line Adjustment CAS amp Miscellaneous Fu for SVD 1 above Deductible Co Insurance Disallow Cost i Procedure Code Description Line Level Adjustments CAS Num Group Reason Amount Units Disallow Other PR D 3000 1000 ES L1 H AdvPaymert Date 02 28 2007 3f 1
36. Copy Close Figure 4 15 Submitter Setup Window 6 The Institutional or the Professional Submitter Information window will display Institutional Submitter Information a Institutional Submitter General Prepare ANSI Info ANSI Info 2 Information Figure 4 16 i Complete all fields on the General tab except EIN ii No updates required on the iss General Prepare ANSI Info ANSI Info 2 Mee p Submitter Intchg ID Qual Acknowledgment Requested a iii On the ANSI Info tab enter Receiver Intchg ID Qual E ZZ in the Submitter Authorization Info Intchg ID Qual field and IE enter 28 in Receiver Intchg ID Qual field The Acknowledgement a Additional Submitter EDI Contact Information Number amp Type Requested field must contain 1 iv No updates required on the ANSI Info 2 tab b Professional Submitter pe _ Information Figure 4 17 Figure 4 16 Institutional Submitter Setup Window Page 14 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 4 Reference File Maintenance i Complete all fields on the General tab Professional Submitter Information General Prepare ANSI Info ANSI Info 2 ii On the Prepare tab change the EMC Output Format field to A and change the ANSI Version 837 to Al Include Ens n Es LEES Lied FL LA ed meee General Prepare ANSI Info ANSI Info 2 Mame S ubmiss
37. FYING A USER To add a new user or modify an existing user 1 Select Security from the PC ACE 2 To add a new user click the New button on the bottom of Pro32 Toolbar and choose the window To modify an existing user highlight the Add Update User The Security desired user from the Security List and click View Update List form Figure 3 1 will display The User Security Update window will display Figure 3 2 Security List User Security Update User ID User ID Password User Name SYSADMIN SYSTEM ADMINISTRATOR User Permissions Institutional Claim Activities View Institutional Claims Enter Institutional Claims Modify Institutional Claims I Delete Institutional Claims Import Institutional Claims Process Institutional Claims Prepare Institutional Claims Archive Institutional Claims Professional Claim Activities h v New View Update Delete Close en _View Update __ Delte oe Check All Clear Al ESEN Figure 3 1 Security List Window Figure 3 2 User Security Update Window 3 Complete or make desired changes to the User ID Password and Name fields 4 Assign or change User Permissions such as entering viewing and deleting claims Check the box next to the permission to allow access to the activity Use the Check All and Clear All buttons to quickly check or uncheck all permission checkboxes 5 Click OK to save the new modified user record Note When ch
38. Form UB 92 and Professional Claim Form CMS 1500 will not display properly at lower screen resolutions Technical Support Palmetto GBA technical support is available by calling the Electronic Data Interchange EDI Technology Support Center toll free at 1 866 749 4301 Monday through Friday from 8 00 a m until 5 00 p m ET Ohio and West Virginia Part B providers should call the EDI Technical Support Team at 1 866 308 5438 Palmetto GBA Page 1 June 2008 Section 3 Getting Started PC ACE Pro32 User s Manual SECTION 2 ACCESSING amp INSTALLING PC ACE PRO32 Note PC ACE Pro32 will NOT be supported if it is installed in a network environment The following step by step instructions will walk you through accessing and installing PC ACE Pro32 to your personal computer Accessing PC ACE Pro32 from a CD ROM 1 Close all Windows based programs and if you are installing from a CD insert the CD in your CD drive Click Start lower left corner of your screen and then Run 2 The Run dialog box will open Use the Browse option to select your CD drive or the folder into which you saved the downloaded program file highlight the setup exe file and click Open 3 The setup file will now be listed in the Open field of the Run dialog box Click OK 4 The PC ACE Pro 32 Claims Processing System will begin installing 5 The Welcome screen will display Figure 2 1 6 Continue with the steps in the Installation Instructions sec
39. General 21 Extended Paper Facility Information Claim Supplemental Information FWE Mum Type Trans Attachment Control Number Description ID Type HET s Mame Address City State Claim Notes NTE File Information 3 E po Num T Marati Zip County z C Pacii Type T ype arrative Tax ID Type a ef ba Miscellaneous General Information Delay Reason Code Accident State Figure 5 9 Institutional Claim Form Extended Patient General Tab 13 Complete the additional patient and general claim level fields as needed 14 Enter data into any required authorization fields This tab also includes fields for MSP and other secondary claims where COB information is required Figure 5 10 Palmetto GBA Page 27 June 2008 Section 5 Institutional Claims Processing PC ACE Pro32 User s Manual Institutional Claim Form Patient Info amp Codes Billing Line Items Payer Info Diagnosis Procedure Extended General Ext General 2 Extended Payer Primary Payer Secondary Payer Tertiary Payer gt Payer Address amp Miscellaneous Insured Address amp Miscellaneous Address Address City Stip 8E City St Zip cues Lo a _o SER o En E Country iz Birthdate ET Sex il Patient ID Paper Source Code Claim Office Number Paper Indicator Contractor ID Extended Authorization IDE Information 34 Record Provider SOF i Provider Accepts Assign ICN DCN Type
40. Insured Information Gilly Line Inert Et PatertGenstdl Ext Pat Gen 2 Ext Pasteriuned Poa PapeiAnsueed Secondary PayerdAreaed Teshary Papereria COB Indo Pressey CE Indo Encor Line liem Cheieds Exierededi Detads Lie 1 Ext Delai 2e 1 MSP COB Ure T Ambala Diiin Payer MiP bahai Additonal uiuent COD Amount i MOA ndoenater ABIIT riy Common Line MSP Amount Additional Line leneel Buche ation CODE Minformation ANHAN Ure Denke Abowd fun Chien Lewel Adpuztmentt LAS COD MOA Amounts Approved i Service Line Adudication SYD Information Paid ma 7 md doed Tid ri Kl 99 P5 Pecued Co Magnet Fadamount Padune B ULIM T C C eR I FT zm 231 eer I TF OTT af wj or aff l rr T LK Marke ane Dd pom Aue shor ACTA Remake Cocke 0 00 r nun Line Adaobi C5 amp Mocelsnecur Adgde anon Into Larsen Lend Forti rede fL Procedure Code Deepon Hum lip Resco ra Claes Auction Date F mm Eno List Save With Fall i Ema List Save Wilh Faal Figure 6 10 COB Info Primary Sub Tab Figure 6 11 MSP COB Sub Tab Two distinct levels of Coordination of Benefits reporting are supported Claim Level COB Reporting Remittance data that is not specific to a particular service line is reported at the claim level The claim form provides claim level COB fields for both the primary and secondary payers These fields are located
41. Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display Click the Codes Misc tab Under Shared click the HCPCS button The HCPCS Code window will display Choose Global Codes or Local Codes from the radio buttons at the top of the window Highlight the desired code from the list click the Delete button and confirm the deletion Physician UPIN Reference File Codes Misc Shared Note This reference file does not apply to Institutional Claims The Physician UPIN Setup form provides access to maintain the optional UPIN or Physicians reference file The list of physicians and associated UPIN and address information is made available via lookups to speed the claims entry process The Physician UPIN Setup can be sorted by Name or UPIN ADDING OR UPDATING A PHYSICIAN UPIN RECORD l Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display iii Physician UPIN Setup Slee 2 Click the Codes Mise tab 3 Under the Shared list click the Physician button The Physician UPIN window will display Figure 4 20 4 Determine if you plan to add or modify a record Sot By 0 Mame Last First MI 6 Physician ID List Filter Options a To add a new record click f Show all physicians no filter applied the New button Filter list to include Physician IDs starting with b To update an existing record Filter list to inclu
42. VENUE CODE CHARGES MASTER SPECIALTY MODIFIERS ICDS PHYSICIAN FACILITY MISC ANSI Figure 4 14 Reference File Maintenance Codes Misc Tab Page 13 Section 4 Reference File Maintenance PC ACE Pro32 User s Manual Submitter Reference File Codes Misc Shared Submitter information in PC ACE Pro32 is maintained from the Submitter Setup form for Institutional Part A and Professional CMS 1500 Part B claim types Information from the Submitter Reference File is required during preparation of Electronic Media Claims EMC files At least one default submitter record LOB lt lt All gt gt must be available before claims can be prepared Additional LOB specific submitter records may also be created if required ADDING OR UPDATING A SUBMITTER RECORD 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu for the Reference File Maintenance window 2 Click the Codes Misc tab el Submitter Setu 3 Under the Shared list click the Submitter button The Submitter Setup window will display Figure 4 15 Claim Type 6 Institutional Professional Submitter ID EIN Submitter Name ALL gt gt lt lt ABCDM3ABCD SUBMITTER NAME 4 Choose the appropriate Claim Type Institutional for Part A claims and Professional for Part B claims 5 Please do not update the default Submitter record Select New to configure your v Submitter information Hew Miew Update
43. aining backup to be restored mn lw Restore system and user configuration settings In addition to database files Start Restore Figure 9 4 Backup Restore Tab Restore Sub Tab terminate automatically following a restore operation The restored database files and configuration settings will be available the next time the program is opened Page 56 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 10 Sending an E Mail SECTION 10 SENDING AN E MAIL In addition to calling the Palmetto GBA Technology Support Center toll free at 1 866 749 4301 or 1 866 308 5438 for Ohio amp West Virginia Part B providers you can also initiate technical support e mail for general software related issues only directly from the PC ACE Pro32 system To send an e mail I Click the Send E Mail button on the PC ACE Pro32 main menu 2 PC ACE Pro32 will launch your default e mail program 3 Ensure that the e mail is correctly addressed a For SC Part A NC Part A SC Part B and Railroad inquiries use the following e mail address medicare edi palmettogba com b For Ohio and West Virginia Part B inquiries use the following e mail address ohwvmedb email amp palmettogba com Be sure to include EDI in your subject Palmetto GBA Page 57 June 2008 Section 11 Claim Activity Log PC ACE Pro32 User s Manual SECTION 11 CLAIM ACTIVITY LOG The Claim Activity Log files provide details of all claim import
44. amounts in lookups Enable service line Total Changes auto calculations during Institutional claim entry Iw v rJ r4 v v E Iv Iv E E w a Iv Figure 4 26 Preferences Window DELETING AN EXISTING CHARGES MASTER CODE To delete an existing code 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display 2 Click the Codes Misc tab 3 Under Professional click the Charges Master button The central field of the Charges Master Setup window will display a list of existing codes 4 Highlight the desired code from the list click the Delete button and confirm the deletion Palmetto GBA Page 21 June 2008 Section 5 Institutional Claims Processing PC ACE Pro32 User s Manual SECTION 5 INSTITUTIONAL PART A CLAIMS PROCESSING Once your reference files have been established you can begin claims processing The Institutional Claims Processing option Ele view Security Help on the PC ACE Pro32 main menu button highlighted in Figure 5 1 gives you access to the Institutional Claims Menu Figure 5 2 m PC ACE Pro32 Claims Processing System Seles From the Institutional Claims Menu the following operations are available Import Claims from a print file Note Claim importing is not supported Refer to on line help for information Enter Claims manually List Claims to maintain existing claims from a comprehensive li
45. and run the roster billing generation process again Successfully generated roster billings will be moved automatically to the generated GR location AUTOMATED CLAIMS PROCESSING The Process Claims feature allows you to run front end edits on Roster Billing claims being submitted To process claims Automated Claim Processing 1 Select the Process Claims option from the Professional Claims Menu The Automated Claim Process Claims Matching leave blank for all claims Processing window will display Figure 6 17 LOB Provider 2 If you want to process only specified claims Reprocess claims with errors complete the top portion of the window Place a check in the box next to the options in the lower portion of the window if desired 3 Click the Process button Process Close Figure 6 32 Automated Claim Processing Window Present claims with errors for immediate editing Include edit error details in process eror report PREPARING CLAIMS FOR ELECTRONIC TRANSMISSION Claim preparation generates a transmission ready Electronic Media Claims EMC file EMC files contain submission details for one or more processed claims Only claims in the to be generated GL location that have an electronic E media setting are eligible for preparation When a claim is prepared into an EMC file it is automatically moved to the transmitted GR location which prevents the claim from being inadvertently retransmitted Not
46. anges are made to a user profile the changes go into effect the next time that user logs on Palmetto GBA Page 5 June 2008 Section 3 Getting Started PC ACE Pro32 User s Manual Building Your Reference Files PC ACE Pro32 is an integrated system that automatically pulls information from various databases within the system to assist users in the completion of claims information Therefore It is very important that reference file information be entered into the system before entering claims If you do not create the reference file information before entering your claim vital information necessary for processing and payment may be missing from the claim Please refer to Section 4 Reference File Maintenance for information on how to enter this data Getting Help In PC ACE Pro32 PC ACE Pro32 has a number of helpful features that will assist you while entering information and using the system You can access specific and general PC ACE Pro32 Help from anywhere in the system Fly Over Hints While entering data into the various Reference Files and Claim Forms you can view helpful fly over hints for most entry fields Simply hold your mouse cursor still over a field and a small pop up will display with a description of the data to be entered into that particular field Fixed or Variable List Lookups A number of fields in the Reference Files and Claim Forms support data entry using fixed list or variable list look
47. ary Paid 000 E OTAF 5500 Disallow Cost 0 00 Disallow Other 0 00 Palmetto GBA June 2008 Additional Line level Adjudication COB Information amp NSI 837 Use Only Service Line Adjudication SYD Information SYD P S Proc Qual Code Modifiers 1 thru 4 Paid Amount Paid Units B LI Line 1 ppop spm a ETT ey ees ETT ey ee le Line Adjustment CAS amp Miscellaneous Adjudicgtax Info for SYD 1 above G Line Level Adjustments LAS Num Group Reason Amount Units PR fi 5500 1000 co a 3500 1 000 H aareaymen Dae 01 31 2007 3 EFE ni Procedure Code Description Save Cancel Figure 6 25 MSP COB Line 1 Tab Page 45 Section 6 Professional Claims Processing PC ACE Pro32 User s Manual I Allowed Amount 55 00 J Insurance Type Working age beneficiary K Zero Payment Indicator Z Payment amount was zero L Adjudication Indicator 06 Charges exceeded allowance M COB MOA 1 Patient Responsibility F2 55 00 N Adjudication Date 01 31 2007 Professional Claim Form Patient Info amp General Insured Information Billing Line Items Ext Patient General Ext Pat Gen 2 Ext Payer Insured Common Payer MSP Information Additional Adjustment COB Amounts MOA Information ANS1 837 Only Allowed 5500 Claim Level Adjustments CAS COB MOA Amounts Pas 000 Num Group Reason Amount Units Num Code Amount Insurance Type 2 1 m mm as l O F2
48. ayer primary secondary reporting this line adjudication notice The procedure code and modifier fields identify the specific procedure being adjusted The practice of procedure code bundling and unbundling utilizes these fields to provide specific information regarding how the payer has grouped the procedures for payment The Paid Amount indicates the amount the payer has paid on this procedure The Paid Units value permits reporting of payments for less than the originally billed units Finally the B U Line field identifies the service line on the original claim to which this SVD line applies This reference identifier should be included on the remittance and is primarily used in scenarios where procedure code bundling unbundling has occurred Line Adjustment CAS amp Miscellaneous Adjudication Info Permits entry of several additional Service Line Adjudication SVD fields for the current SVD line The fields in this control group track the currently selected SVD line The control group s caption indicates the current SVD line e g for SVD I above Line Level Adjustments CAS Permits entry of one or more line level adjustments as reported by the payer for the current Service Line Adjudication SVD line Adjustments are defined by a specific Group code and Reason code combination Enter these codes manually or select them from the available lookup lists Each line level adjustment m
49. bmission payer the payer to which the claim is to be submitted If you view the claim after saving you will see a checkmark adjacent to the submission payer line on the Payer tab It is possible that multiple payers on a claim will have an LOB that matches the claim s LOB In this case you will be prompted to select which of these payers is to be designated as the submission payer If no edit validation errors occur the claim is saved with a clean CLN status If one or more edit validation errors occur the Edit Validation Errors List form will display indicating fatal and non fatal errors You may correct the errors or save the claim with errors Note If a fatal error exists in the LOB PCN or TOB field you must correct the error before being allowed to save the claim i To save a claim that contains only non fatal errors click the Save With Errors button These claims are saved with a has errors ERR status ii To save a claim that contains fatal errors click the Save With Fatal button Such claims are assigned the has fatal errors ERF status Claims with an ERF status are not eligible for preparation into an electronic EMC file 14 If edit validation errors occur several Save attempts may be required to correct and save a clean claim At any time you can click the Errors List button to review remaining edit validation errors Medicare Secondary Payer Claim Examples LINE LEVEL ADJUSTMENTS Claim Example A Claim Amou
50. cally re sequenced by Revenue Code when a claim is saved 5 When you have completed line item entries click the Recalculate button located near the bottom of the tab adjacent to the Totals field This will recalculate and update the Total Charges and Total Non Covered Charges fields from the current claim line item charges values 6 When you have finished with the information on this tab click on the Payer Information tab to display that section of the claim entry form Figure 5 5 Institutional Claim Form Patient Info amp Codes Biling Line Items Payer Info Diagnosis Procedure Extended General Ext General 21 Extended Payer Sub Paver ID Payer Name Provider Ha AO ADE Prior Payments Amount Due O GE Du iB 000 000 Clear Payer Do M i re e Clear Payer TT I 4 P 1 liil i L 4 Clear Payer Due From Patient gt gt 000 000 P Rel Insured s Last Name First Mame MI Suffs Insured s ID Group Mame Group Mumber Authorization Code Type ESC Employer Mame Employer Address mu Save Cancel Figure 5 5 Institutional Claim Form Payer Information Tab Page 24 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 5 Institutional Claims Processing 7 Begin entering payer data Fields that require free form text are shown on the tab as Form Locator buttons e g FL56 To enter information into these fields a
51. ctivating Transmitted Claims eese 60 Reactivating an Entire EMC File for Retransmission ccccccccccsssseseececeeeeeeaeesseeeeeeeeeeaaas 60 SECTION 14 ARCHIVING 62 Cor dieu CS REE m 63 Page ii Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 1 Introduction SECTION 1 INTRODUCTION PC ACE Pro32 is a complete self contained electronic processing system for healthcare claims submission and management It can be used in a stand alone configuration or in conjunction with your existing claims management system The system has been designed to work exclusively with the Microsoft Windows operating system The PC ACE Pro32 program is available either on a CD or as a download from our Web site www PalmettoGB A com See the next page for information on accessing downloading and installing the software Minimum System Requirements Pentium 133 MHz processor Pentium II 350 for larger claim volume 64 MB system memory 128 MB recommended CD ROM drive recommended for server installation SVGA monitor resolution 800 x 600 Windows 95 98 2000 Me XP or NT 4 0 operating system 9 gt oe 9 Adobe Acrobat Reader Version 4 0 or later for overlaid claim printing This free software can be downloaded from the Adobe Web site www adobe com When the Windows Large Fonts display setting is enabled the screen resolution must be 1024 x 768 or higher The Institutional Claim
52. d rrrrnrnnnrnnnnnnrrrnrnnnnnvvvrvnnnnnnnnnrn Deleting an Existing Facility Record rrrornnnnnnrrrnnnorrrrnnvnnnvrvnnnnrnnnnnnnnen Charges Master Reference File Codes Misc Professional Adding or Modifying a Charges Master Code sss Deleting an Existing Charges Master Code sssss SECTION 5 INSTITUTIONAL PART A CLAIMS PROCESSING Using the Institutional Claim Form eeeeeeeeeeeeeeeeeen Palmetto GBA June 2008 Table of Contents Table of Contents PC ACE Pro32 User s Manual Entenae Institutional Claim Data ociieccs cesasacsiesiedesociesastancexenensctsausenseiaceateatananremnessedsedaerecuadeasen 23 DiS MS GEO ti EAS EEE EE 29 GET COINS EEE ENE 29 Gerd CM CSS SEEREN 30 MTT 30 Preparing Claims for Electronic Transmisslon r rrrrrrvvvrrnnnnnrnrrrnnnvvrnnnnnsnnssrnnnnnnnnessssnnnssnnnne 30 SECTION 6 PROFESSIONAL CMS 1500 PART B CLAIMS PROCESSING 32 Using the Professional Claim Form esses nennen nenne nnn nnne eene a2 Fe Professional Claim DEC p 33 Medicare Secondary Payer Claim Examples sees 38 Line Level Adjustments rrrnnnnnrnnnnrnrnnnnnnrrrvnnnnnnnnnnnnnnnnnnssrsnnnnnnnrvrnnnnnnnnnnnnssnnnnsssnnnnnsnnrsnnnnnnnnnnnn 38 Clam Level l Adjustments sexsinmnrvessusvranirarmnireninnsiannduuebnanbomniunaduunbsusiuenbaiedeeseessasvesesnreamenssa
53. d Last Name Is Required Double click error to jump to the corresponding field gt Indicates that error must be corrected before saving Figure 4 13 Edit Validation Errors List errors will be flashing red b Ifthere are no fatal errors that must be corrected now those marked with a red X you may close the Edit Validation Errors List and then click the Save With Errors button on the Patient Information form DELETING AN EXISTING PATIENT RECORD To delete an existing record 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display with the default tab Patient displayed The central field will display a list of existing patients 2 Highlight the desired record from the list click the Delete button and confirm the deletion Codes Misc The Codes Misc tab Figure 4 14 of the Reference File Maintenance form provides access to many of the core PC ACE Pro32 reference files The reference file buttons are grouped under Shared files used by both Institutional and Professional Institutional only and Professional only Many of the reference files require setup before use while others are optional Palmetto GBA June 2008 LU Reference File Maintenance File wiew Reports Patient Paver Provider Inst Provider Prof LCodes Misc shared DATA COMM HCPCS Institutional Professional TOB POS CONADCC PAAL TOs RE
54. de Physician Names starting with highlight the record and click the View Update button or eit eon eae Ome rete Figure 4 20 Physician UPIN Setup Window Palmetto GBA Page 17 June 2008 Section 4 Reference File Maintenance PC ACE Pro32 User s Manual The Physician UPIN Information window Figure i 4 21 will display Complete the fields Physician Information Physician ID Type After you have completed your additions changes NB click the OK button located on the bottom right of sr ERE fe Gee the window E TE Address DELETING AN EXISTING PHYSICIAN UPIN RECORD City State Zip Phone To delete an existing record EEE l Click the Reference File Maintenance button on Federal Tax ID Type NPI the PC ACE Pro32 main menu The Reference I File Maintenance window will display 5 Cancel Click the Codes Misc tab Lance Under Shared click the UPIN button The central Figure 4 21 Physician UPIN Info field of the Physician UPIN Setup window will display a list of existing records Highlight the desired record from the list click the Delete button and confirm the deletion Facility Reference File Codes Misc Professional The Facility Setup form provides access to maintain the optional Facility Reference file You may enter Facility records for each frequently referenced facility if desired The facility reference file is available as a lookup list from the Extended Patient Genera
55. djudication Date 7 Figure 6 14 COB Info Primary Tab Page 39 Section 6 Professional Claims Processing PC ACE Pro32 User s Manual CLAIM LEVEL ADJUSTMENTS Claim Example A Claim Amount 140 77 Professional Claim Form Patient Info amp General Insured Information Billing Line Items Est Patient General Ext Pat Gen 21 Ext Payer Insured Line Item Details Extended Details Line 4 Ext Details 2 Line 4 MSP COB Line 4 Claim Diagnosis Codes 1 7948 z 2724 3 5990 4 fam 5 E gt 24a Service Dates 24b 24e 24d 24d ae ede 24r 24g LM From Thru PS TS Proc 1 Diagnosis Charges Units EPFPEMLEB AT Rendering Phys Meme Fromm rr mmc Ler se TT I T L ILLL LLL L L ILILL c gt L fit Plt LL IIIITL to tit JT L L ITIIIL LT L Og ET Pl FTT EL HII 28 Total Charge i 140 77 Recalculate 29 Amount Paid 0 00 30 Balance Due 14077 Save Cancel Figure 6 15 Line Item Details Tab B Allowed Amount 131 34 C Line Item Adjustments CAS 1 Contractual Obligations 20 70 2 Patient Responsibility 15 00 Co Pay D COB MOA Amounts 1 Payor Paid Amount D 105 07 2 Patient Responsibility Amount F2 15 00 E Insurance Type Working age beneficiary F Adjudication Date 10 31 06 Professional Claim Form Patient Info amp General Insured Information Billing Line Items Ext
56. e 2 Select File from Claim List toolbar and then choose View Archived Claims The claims in the open claim archive will display 3 Select File from Claim List toolbar and then choose View Current Claims to toggle back to the current claims 4 Only transmitted and paid claims can be archived Therefore under Claim List Filter Options at the bottom of the window choose TR transmitted only or TR PD transmitted paid from the Location field Page 62 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 14 Archiving 10 11 To archive a A single claim highlight the desired claim b Several claims place a check in the left column next to each desired claim Select Actions from the Claim List toolbar and choose a Archive Selected Claim for a single claim b Archive All Checked Claims for more than one claim The claim s will disappear from the current claim list To view the claims you just archived toggle back to the claim archive by selecting File from the Claim List toolbar and choosing View Archived Claims When you are finished reviewing the claim archive select File from the Claim List toolbar and choose View Current Claims Select File from the Claim List toolbar and choose Close Claim Archive to close the open claim archive You will be prompted to pack the claim archive before closing We recommend packing a claim archive database occasionally as it minimizes the disk space requir
57. e Before preparing claims for the first time you will need to set up your Submitter Reference File This file contains important data that will be used to build the EMC file To generate an EMC file Select the Prepare Claims option from the Professional Claim Prepare For Transmission E Professional Claims Menu The Professional MTT Prepare For Transmission window will display ie ERE Figure 6 18 Payer 2 Specify from the drop down list if you want only a single line of business LOB to be considered or select lt lt All gt gt to include claims for any line of Output Format Submission Status Include Error Claims business If you specify an LOB C NSF Production 7 Yes a Choose a single Payer or lt lt All Payers for fe ANSES C Test f No LOB s gt gt to include claims for all payers Prepare Claims Cancel b Choose one or more Providers or lt lt All Providers for Payer s gt gt to include claims Figure 6 33 Professional Claim Prepare for Transmission for all providers 3 Specify whether a You want ANSI 837 EMC file output format b The EMC file should be designated as a production or test submission c Claims with non fatal errors ERR are to be eligible for preparation When unchecked only processed claims will be eligible for preparation Palmetto GBA Page 51 June 2008 Section 6 Professional Claims Processing PC ACE Pro32 User s Manual 4 Click the Prepare Claims
58. e Read Me File window Figure 2 4 will display Read the information be sure to use the scrollbar on the right of the screen to scroll down and read all of the text and click Next to continue 7 The Installation Complete window displays indicating that PC ACE Pro32 has been successfully installed Click Finish to close the window 8 The installation process automatically places a PC ACE Pro32 shortcut icon Figure 2 5 on your desktop which can be used to open the program Page 4 PC ACE Pro32 User s Manual Password Thiz installation is password protected Please enter the installation password into the Field below Password Press the OF button to continue Press Cancel to abort the installation cancel Figure 2 3 Password Dialog Box 73 Read Me File Thank you for installing MedLink Technologies PC ACE A Pro32 Claims Processing System 3 Y ou have just completed the PC ACE Pro32 server installation amp single PC amp CE Pro32 client has also been installed on this system Additional PC ACE Pro32 clients can be installed at each individual workstation by executing the CLIENT32 EXE program from the server s WINPCACE directory This client installation will create a local WINPCACE directory and configure the workstation for shared database access 4 default user SYSADMIN with password SYSADMIN can be used to evaluate PC ACE Pro32 From the PC ACE Pro32 main Security menu use
59. e current Service Line Adjudication SVD line Adjustments are defined by a specific Group code and Reason code combination Enter these codes manually or select Page 26 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 5 Institutional Claims Processing them from the available lookup lists Each line level adjustment must specify a non zero Amount value and may also specify an optional Units value Common Line MSP Information This field group exists primarily to provide a bridge between the MSP COB reporting standards defined in the older NSF format and those defined in the ANSI X12 implementation Only the Approved and OTAF Obligated To Accept In Full amount fields are actually needed to process COB claims in the newer ANSI X12 format All remaining fields in this group can be reported using equivalent values in the SVD or CAS field groups For backward compatibility PC ACE Pro32 will continue to recognize and report values in these obsolete fields whenever it is practical to do so 11 Enter a Y in the ANSI 837 HH CR6 Attachment field if required for claim submission 12 When you have completed entering information into the Diagnosis Procedure tab click on the Extended Patient General tab to display that section of the claim entry form Figure 5 9 Institutional Claim Form Patient Info amp Codes Billing Line Items Paver Info Diagnosis Frocedure Extended General Ext
60. e unprocessed UNP claim in the to be transmitted CL location 7 From the to be transmitted CL location highlight the unprocessed UNP claim and click Save This step will change the claim status from UPN to CL allowing claims to be prepared to a new file Reactivating an Entire EMC File for Retransmission Until an EMC file is purged from the archive it is available for reactivation and subsequent retransmission Retransmission of an EMC file might be required for example if a previously sent file was somehow corrupted during transmission Reactivation of an EMC file consists of restoring the selected file from the archive to its original prepared filename in the server s WINPCACE directory After reactivation the EMC file and other associated system settings exist just as they did when the file was originally prepared for transmission Page 60 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 13 Reactivating Previously Transmitted Claims To reactivate an EMC file 1 From the PC ACE Pro32 main menu click the Institutional Claims Processing or the Professional Claims Processing button The Institutional or Professional Claims Menu will display 2 Select Maintain from the Claims Menu toolbar and then choose Transmission Log The Claim Transmission Log form will display which lists chronologically all archived EMC files 3 Highlight the EMC file to be reactivated Click the Reactivate button on the bottom of
61. eady to continue the installation click ie international treaties N ext Unauthorized reproduction or distribution of this program or any portion of it may result in severe civil and criminal penalties and will be prosecuted to the maximum extent possible under law 2 The Drive Selection window will display Figure 22 2 Drive Selection requesting that you choose the drive to which you want Setup will install PC amp CE Pro32 Claims Processing System to to install PC ACE Pro32 The default is set on the C the drive specified below drive If you want to choose a different drive click the let red down arrow to the right of the Select Destination Drive Um pn mE pa E Pro32 Claims Processing stem by clicking Lancel to exit Setup field scroll through the list and highlight the desired xc i drive Click Next to continue Select Destination Drive l c system Cancel Figure 2 2 Drive Selection Window 3 Onthe Start Installation window click Next to continue Palmetto GBA Page 3 June 2008 Section 3 Getting Started 4 The Password dialog box Figure 2 3 will display In the Password field enter the installation password medicare This password is case sensitive so be sure to use all lower case letters 5 PC ACE Pro32 Setup begins copying the program files to your computer A status of the copy process is shown on the Installing window 6 When the file copying is complete th
62. ed form method Adobe Acrobat Reader version 4 0 is required for this function Palmetto GBA Page 29 June 2008 Section 5 Institutional Claims Processing PC ACE Pro32 User s Manual Menu Option M Description of Action gt 10 0 lE locations to the open claim archive database pu Allows you to post view or modify payments for the selected claim Payments set Selected Claim X Designates the selected claim for either electronic or paper submission Media Only claims with a media setting of electronic E will be eligible for preparation into an EMC file Claims with a media setting of paper P can be printed and submitted in hardcopy form When a paper claim is printed you will be given the option to move the claim from the pre transmitted CL location to the transmitted TR location CLAIM LIST REPORTS PC ACE Pro32 gives you the ability to view several reports and a number of special print functions To view a detailed report of the currently listed claims 1 Select Reports from the Claim List toolbar 2 Choose Print Claim Detail Report The previewed report may be printed if desired by clicking the printer button at the top of the report preview form To print all or a subset of claims currently eligible for paper submission 1 Select Reports from the Claim List toolbar 2 Choose Print Claims for Paper Submission A claim is eligible for paper submission if it has a media setting of paper P
63. eed to be resubmitted in a future EMC file the claim must first be reactivated Reactivation moves the selected claim s from the transmitted TR location to the to be transmitted CL location and resets the claim status to unprocessed UNP The reactivated claim can then be processed and if no fatal edit validation errors are present it will be included in the next EMC file prepared Note Only claims in the transmitted TR location may be reactivated Once a payment has been made on a claim it moves to the paid PD location and is no longer eligible for reactivation To reactive one or more claims 1 Click on the Institutional Claims Processing or Professional Claims Processing button on the PC ACE Pro32 main menu to display the corresponding Claims Menu 2 From the Claims Menu choose List Claims The Claim List will display 3 Under Claim List Filter Options at the bottom of the window choose TR transmitted only from the Location field 4 To reactivate a single claim highlight that claim record in the list b Several claims place a check in the left column next to each desired claim 5 Select Actions from the Claim List toolbar and choose a Reactivate Selected Claim for a single claim b Reactivate All Checked Claims for more than one claim 6 Confirm the reactivation when prompted The claim s should disappear from the list since it is no longer in the transmitted TR location You should now find th
64. eeded c When you have completed your entry press to close the popup window d Follow the same steps with each Form Locator button on the tab to complete the field entries for this portion of the claim form Palmetto GBA Page 23 June 2008 Section 5 Institutional Claims Processing PC ACE Pro32 User s Manual 4 When you have completed entering information into the Patient Info and Codes tab click on the Billing Line Items tab to display that section of the claim entry form Figure 5 4 Institutional Claim Form Patient Info amp Codes Biling Line Items Payer Information Diagnosis Procedure Extended Patient General Extended Payer Line Item Details Extended Details Line 1 42 44 44 Modifiers dd 45 Service Date 46 4r 48 Rev Cd HCPCS 1 2 3 4 Rate From Date Thru Date Unitz Days Total Charges Man Cov Charges r T Ftitittt_______C_ LL L L 1 111 1 i i E In 1 J 1 fi i i il l I Recalculate Totals 0 00 0 00 uu fog ie fr Figure 5 4 Institutional Claim Form Billing Line Items Tabs To enter a new line you can enter data into each field of the line or to facilitate your entry you can a Duplicate all the fields from the previous line by pressing F5 b Duplicate a single field from the previous line by clicking in the selected field and pressing F4 c Delete an entire line by pressing F7 Note Claim lines are automati
65. ements and enhances performance Note The packing process can be lengthy for large databases Once the packing operation has started it must continue to completion Click the Yes button to pack and close the archive the No button to close the archive without packing or the Cancel button to leave the archive open Note If you close the Claim List form without first closing an open claim archive the archive is closed automatically and you will receive the pack prompt Unarchiving Claims To unarchive claims 1 Open the claim archive see steps above 2 Highlight single or check multiple the desired claim s 3 Select Actions from the Claim List toolbar and choose a Unarchive Selected Claim for a single claim b Unarchive All Checked Claims for more than one claim Palmetto GBA Page 63 June 2008
66. ent Info amp General Insured Information Billing Line Items Ext Patent General Ext Pat Gen 2 Eat Paper Insured Line Item Details Extended Details Line 1 Ext Details 2 Line 1 Claim Diagnosis Codes 1 2 3f 4f s Bf Ff 8 24a Service Dates 24b 24c 24d 24d Maodifiers 24e 24r 24q LM From Thru PS TS Proc 1 2 Diagnosis Charges Units EPFPEMCB AT Rendering Physician B i i JJ mm uw J 7 pFTITIT A a fL rire 2 1 11 1 NENNE HS 1L 11 1 jf II g i iii SL PL i111 111 GE T gg J2S L 11717 P1 _f__f j Js 28 Tatal Charge 0 00 Recalculate 29 Amount Paid 0 00 30 Balance Due Figure 6 5 Billing Line Items Tab Line Item Details Sub Tab 5 The Billing Line Items tab contains a number of sub tabs The first sub tab Line Item Details displays the claim diagnosis codes as well as the basic line item fields available on the hard copy Professional CMS 1500 claim form The remaining sub tabs are linked to the currently selected line on the Line Items Details tab As you move from one line to another on the Line Items Details tab the remaining sub tabs will track the new current line Note that the Extended Details tab caption will change based on the current line highlighted 1 e Ext Details Line 1 Ext Details Line2 etc To enter a new line you can enter data into each field of the line or to facilitate your entry yo
67. eral tab Figure 6 14 Enter aoe NM Tax ID Type patient specific information for any number of patients in the Seve Concel lower section of this tab Enter supplemental information on the Extended Roster Info tab Figure 6 15 if required Figure 6 30 Prof Roster Billing Form Extended Roster Info Tab LISTING MODIFYING AND MAINTAINING ROSTER BILLINGS Professional roster billings in PC ACE Pro32 are listed modified generated printed and otherwise maintained from the Professional Roster Billing List Form To access this form Palmetto GBA Page 49 June 2008 Section 6 Professional Claims Processing PC ACE Pro32 User s Manual a Click the Professional Claims Processing button on the PC ACE Pro32 Main Toolbar to display the Professional Claims Menu form b From the Professional Claims Menu form select the Maintain Roster Billings item from the main Roster menu to open the Professional Roster Billing List Form 2 Allactions to be performed on a roster billing may be executed from the Roster Billing List form Roster billings can be created viewed modified copied deleted undeleted and purged from the list In addition claims may be generated for a selected roster billing and the resulting roster billing report may be printed from this list ill Professional Roster Billing List 3 Viewing and or modifying existing roster billings from the Professional Roster Billin
68. ess Source mm a Edit Ind an City State Zip Media gn m Card gn Contact Name Rae E Phone Ext Usage gn i gd Save Cancel Figure 4 3 Payer Information Window 2p Payer ID LOB ISA08 Override 5 After you have completed your additions changes click the Save button located on the bottom right of the window The system will perform an edit validation on the entered information If you have not completed or incorrectly completed one or more required fields the Edit Validation Errors List will display This form lists all fatal and non fatal errors that occurred Fatal errors indicated by a red X must be corrected before the system will allow you to save the information a Double click on a listed error to go to that location in the Payer Information form and make the necessary corrections fields with errors will be flashing red b If there are no fatal errors that must be corrected now those marked with a red X you may close the Edit Validation Errors List and then click the Save With Errors button on the Payer Information form Page 8 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 4 Reference File Maintenance DELETING AN EXISTING PAYER RECORD To delete an existing record 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display Click on the Payer tab The central field will display a list of
69. files in the backup 3 Click the Start Backup button The system will notify you when the backup is successfully completed Palmetto GBA Page 55 June 2008 Section 9 System Utilities Validate PC ACE Pro32 User s Manual No data is restored during the validation process so it is safe and advisable to validate an archive before attempting a restore operation To validate an existing backup file 1 From the System Utilities window click the Backup Restore tab and the Validate sub tab Figure 9 3 2 Specify the drive or folder where the backup file is located 3 Click the Start Validate button Note When validating backup archives that span multiple diskettes insert the last diskette in the set first The system will prompt for the first and subsequent diskettes as the validation proceeds 4 The system will confirm details of the backup archive s integrity and display archive details date of backup etc Restore System Utilities Backup Validate Restore This utility validates a previously made PC ACE Proda database and configuration setting backup archive file Specify the source drive e g 4 47 ar hard disk folder path containing the backup and click the Start Validate button Mote This process simply confirms that the backup archive has the expected format and that all files contained within the archive are readable Ma data will be restored during this validation process So
70. fo Primary and COB Info Secondary Figure 5 7 and one new sub tab to the Billing Line Items tab MSP COB Figure 5 8 This information is required on all Medicare claims where Medicare is not the primary payer Institutional Claim Form Patent inio amp Codes Dil Line Inemt Payerinto Disgnom Procedue Extended General Ext General 2 Extended Faye Institutional Claim Form Potent Info amp Coder Ding Line nena Paser indo DingnosaProtedure Extended General Ext Genera 2 Extended Fuge Presa Payor Secondary Paget Tosen Pay COR Inde Peary COR trie Secondary Pmp Pager Secondary Faget Tertiary Faye CIE Indo Primary COB indo ecendanyi Claro Adinani COR Anoura MIA BA intonation AR 514817 Ork Claro Adinani DDD Aemeosands HAA HIA intonation AR 51H17 Dnk Cham Level Acute 5 7 HRA KODA Ameunti Cham Level Acute 5 COO MEA P HO Airani Hum Code Aina Feide rpari Arlen M UA Panaka Boxer Medicare Dutpabert Adjadicabon BOA Fiemarkz Coder Cia ication Chante tt Ema List Save With Fal Figure 5 7 COB Info Primary Sub Tab Hum Code Jori Milne Trygd fucose M UA Aaaa Boxer ff gd 13 Bg Medicae Outpatient Adudcabon MD Menn Codes Cum ipaka Dae 7 7 Ener Lie Sam With Fad Save Cancel Figure 5 8 MSP COB Sub Tab Two distinct levels of Coordination of Benefits reporting are supported
71. g List form Figure 6 16 can be performed with these steps File Actions a Usethe Roster Billing List form s sorting and filtering capabilities to locate the roster billing of interest b Select the desired roster billing in the list and click the erg ee eet eee EE a Ut By te Service Late rovider ype ntry Date View Update button to REN EON oster Billing List Filter Options display the roster billing Location AL to be generated Status B All gt gt v details in the appropriate roster billing form New Close Alternatively just double click the desired roster billing record in the list iiil Figure 6 31 Professional Roster Billing List c Make all desired changes to the roster billing Refer to the Professional Roster Billing Form topic for details on the many productivity enhancing features available on the roster billing form d When all changes have been made click the Save button to save the roster billing record and close the form Review and correct any edit validation errors as needed Alternatively click the Cancel or Close button to cancel any pending roster billing changes GENERATING ROSTER BILLING CLAIMS 1 A roster billing defines both the common and patient specific details required to create the corresponding set of claims Once you are satisfied with the roster billing contents and no fatal edit validation errors exist you can generate claims for this ros
72. gure 4 5 Un eacn o Group MASTERS CLINIC 22222222 these tabs the central field will MCB Indiv ALLEN PAUL 22222222 A T MCB Solo SOLO JOHN D display a list of existing providers if MCB Indiv PETERSON JILL A 22222222 any Use the radio buttons just below the list to sort by the options provided SotBy LOB Type Provider Group Name ProviderID Group Label Tag List Filter Options Show all providers no filter applied Show only providers associated with selected provider Filter list to include Provider IDs starting with C Filter list to include Provider Names starting with New View Update Delete Close Figure 4 5 Professional CMS 1500 Part B Provider Tab Palmetto GBA Page 9 June 2008 Section 4 Reference File Maintenance PC ACE Pro32 User s Manual 3 Determine if you plan to add or modify a record New Provider Options a To add a new Provider record click the New s a convenience the new provider may inherit the basic name and button The New Provider Options window address information from the currently selected provider This facilitates B the creation of provider records which differ only in the specification of will display Figure 4 6 Choose one of the ID LOB and Payer ID fields options and click OK b To update an existing Provider record C Inherit name address information from the selected provider highlight the record and click the
73. igure 8 1 System Backup Prompt Page 54 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 9 System Utilities SECTION 9 SYSTEM UTILITIES To reach the System Utilities click the i PC ACE Pro32 Claims Processing System E O fX System Utilities button from the PC ACE Pro32 main menu Figure 9 1 File wiew Security Help The System Utilities window Figure 9 2 will display You can perform complete database backup validation and restore functions from PC ACE Pro32 System Utilities All claims reference files and system configuration settings can be backed up to either removable media diskette writeable CDROM or a standard Windows Backup Validate Restore directory local Or remote In the event that a This utility performs a backup of the PC ACE Pro32 databases and configuration catastrophic system failure results in the loss Wee qaid drive e g AN or hard disk folder path and click or compromise of PC ACE Pro32 data a ee complete database restore operation can be E performed from the most recent backup Iw Include infrequently changed database files backup will be larger Backup is designed to protect just the PC ACE Pro32 databases and configuration information The program executable files ptions Start Backup and other support files are not included in the backup archive It is strongly recommended that you supplement these backups with a comprehensive backup schedule for your
74. ility Setup window will display a list of existing records 4 Highlight the desired record from the list click the Delete button and confirm the deletion Charges Master Reference File Codes Misc Professional The optional Charges Master Setup form provides access to maintain the Charges Master reference file If you choose to use this optional reference file it should be set up to include only those procedure codes that are to be used by the billing office rather than the entire HCPCS code universe Using a Charges Master reference file will reduce the size of the HCPCS code lookup lists during claim entry which promotes accuracy and enhances productivity A dollar amount may also be assigned to each entry This value is automatically brought forward to the claim line item Charges field when a valid Charges Master code is entered during claim entry You can list all Charges Master codes by clicking the top option under List Filter Options You can also filter the Charges Master code list to include codes starting with a particular value descriptions starting with particular value or descriptions containing particular value Palmetto GBA Page 19 June 2008 Section 4 Reference File Maintenance PC ACE Pro32 User s Manual ADDING OR MODIFYING A CHARGES MASTER CODE l Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display Click the Codes Misc tab
75. ils 2 Line 1 MSPYCOB Line 1 Claim Diagnosis Codes 1 TT J OG M 0 NJ E WW LN 24a Service Dates From Thru 24b 240 PS TS 2dd 24d Modifiers 24e 24t 24g Prac 1 2 Diagnosis Charges Units EPFPEMCE AT Rendering Phys PC ACE Pro32 User s Manual veas fonr Bee FR so TITT S EREN EEEN E E LLLI L LIIBTITD 27 iiiI jf jf fj jf sg en g LrF 111 jf 1 en sp Pp ilili J FE E TIITT og 2 1 1 eg en EE A Tota Charge ____ 90 00 Recalculate 29 Amount Paid 0 00 30 Balance Due 90 00 Save Cancel Page 44 Figure 6 24 Line Item Details Tab Palmetto GBA June 2008 PC ACE Pro32 User s Manual Approved Amount 55 00 Allowed Amount 55 00 Deductible Amount 55 00 a mJrmuost Section 6 Professional Claims Processing OTAF Amount 55 00 Note Only submit OTAF amounts if reported on Primary Remittance Amount Paid by Primary SVD 0 00 Line Level Adjustments CAS 1 Contractual Obligations 35 00 2 Patient Responsibility 55 00 H Adj Payment Date 01 31 07 Professional Claim Form Patient Info amp General Insured Information Billing Line Items Ext Patient General Ext Pat Gen 2 Ext Payer Insured Line Item Details Extended Details Line 1 Ext Details 2 Line 1 MSP COB Line 1 Common Line MSP Amounts B Jappoved EE 9 Allowed 55 00 D Deductible 55 00 Co Insurance 0 00 Prim
76. io Address Submitter Intehg ID Qual Acknowledgment Requested E Recerver Intchg ID Qual am Authonzation Info mE Security Info EE On the ANSI Info tab enter ZZ in the Submitter Intchg ID Qual field and enter 27 in the Receiver Intchg ID Qual field The Acknowledgement Requested field must contain 1 E ii City Phone Contact Additional Submitter EDI Contact Information Number amp Type Save Cancel Figure 4 17 Professional Submitter Setup Window iv No updates required on the ANSI Info 2 tab After you have completed your additions changes click the Save button located on the bottom right of the window During the submitter save operation an edit validation process is performed on all submitter record files If no edit validation errors occur the submitter record is saved If one or more edit validation errors occur the Edit Validation Errors List will display This form lists all fatal and non fatal errors that occurred If any fatal errors exist you must correct them before the submitter record can be saved If only non fatal errors exist you can either correct the errors or save the submitter record with errors Click on Save with Errors to save a submitter record with non fatal errors Several Save attempts may be required to correct and save a clean submitter record DELETING AN EXISTING SUBMITTER RECORD To delete an existing rec
77. ist button on the Provider Information form DELETING AN EXISTING PROVIDER RECORD Important Note Claims are linked to provider records by an internal control number Deleting a provider record will irrevocably break any such links that may exist in claims in the system To delete an existing record 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display Provider Deletion Confirmation 2 Click on either the Provider Inst tab or Provider Prof tab On each of these Claims are linked to provider records by an internal control number Deleting this s provider will irrevocably break these links on all claims that reference this provider tabs the central field will display a list of Click the Check Usage button for a count of affected claims existing providers Consider the following options before deleting the provider record Option 1 IF the provider 18 not referenced on any claims iE may be safely deleted 3 Highlight the desired record from the list Option 2 IF the provider is referenced en one or more claims consider modifying th ider inf ti ther than deleting it altogether Refrain f difuing th and click the Delete button The Provider Ir P LB ae B lc i E MA MEITA PiE SAT Deletion Confirmation will display Option 3 If the provider is na longer in use set the Include In Lookups flag to N The provider will remain an fi
78. l Insured Information Billing Line Items Ext Patent General Ext Pat Gen 2 Est Paper Insured Payer Address amp Miscellaneous Insured Miscellaneous Address Insurance Type Supplemental Ins Ind Ins Location Ident Medicaid ID City StZip 4 Card Eit Tm Date thu 7 7 ayer Source 09 PPO HMO Ind li tir t fof Spouse Retire Claim E dit Ind Prior Auth Ma AT pe lai itl TRICARE Sponsor y linn anes fr per E Grade E Sum Add Ref No Type Addl Ref No Type Employer Information Patient ID Address City StZip mm Employer ID Error List Save With Fatal Save Cancel Figure 6 9 Professional Claim Form Extended Payer Insured Tab 12 To enter MSP claims you must first enter Y in the COB field from Patient Info amp General tab see Figure 6 3 For examples of completed MSP data screens see the next section Medicare Secondary Payer Claim Examples Note This will generate two new sub tabs to the Extended Payer Insured tab On the COB Info Primary and COB Info Secondary sub tabs Figure 6 10 complete the fields under Common Payer MSP Information if Medicare is tertiary Also note the generated MSP COB sub tab on the Billing Line Items tab Figure 6 11 A Professional Claim Form Professional Claim Form Patent Info amp Gensel Inqured Information Diria Line Irene Ext PaseraGencial Ext Pat Gen z Ext Payerineued Patent niot Gensel
79. l Tab on the Professional Claim Form ADDING OR MODIFYING A FACILITY RECORD 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display isi Facility Setup 2 Click the Codes Misc tab aes a 3 Under the Professional list click the Facility button The Facility Setup window will display Figure 4 22 4 Determine if you plan to add or modify a record a To add a new record click the New Sort By C FaciityName Facility ID button New b To update an existing record Figure 4 22 Facility Setup Window highlight the record and click the View Update button or double click on the record Page 18 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 4 Reference File Maintenance 5 The Facility Information window Figure 4 23 will slusen Facility OT poe Facility Name display Complete the fields Address 6 After you have completed your additions changes click the Save button located on the bottom right City Stip N of the window Facility Type TalD Twe ENP DELETING AN EXISTING FACILITY RECORD Cancel To delete an existing record Figure 4 23 Facility Information Window 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display 2 Click the Codes Misc tab 3 Under Professional click the Facility button The central field of the Fac
80. le but will na longer be available from the claim Figure 4 10 and outline alternatives l Do vou still want to delete the selected provider record 4 If you determine that you still want to delete the selected provider click OK Check Usage Figure 4 10 Provider Deletion Confirmation Dialog Box Patient Reference File The Patient Reference File maintains all necessary general patient information as well as primary secondary and tertiary insured details Patient information that has been entered in the Patient Reference File is available for lookup during claim entry Note To assist you in completing field entries accurately fly over hints display when you stop your mouse cursor over a field Palmetto GBA Page 11 June 2008 Section 4 Reference File Maintenance PC ACE Pro32 User s Manual ADDING OR UPDATING A PATIENT RECORD 1 Click the Reference File Maintenance si Reference File Maintenance le View Reports button on the PC ACE Pro32 main menu gt Patient Payer Provider Inst Provider Prof Codes Misc The Reference File Maintenance window pp RR RR will display Figure 4 11 OOOO Q 0713 1958 MCA MCB 2 Click on the Patient tab the reference file will always open on the previously displayed tab The central field will display a list of existing patients if any FET List Filter Options Using the radio buttons just below the list en a you can sort the lis
81. ms entry PC ACE Pro32 automatically fills fields on the Claims Entry screens based on information previously entered into the various Reference Files For example when you enter a Patient Control Number PCN on the Professional Claim Form all fields related to that PCN e g patient s name address telephone etc will automatically be filled with data from the Patient Reference File For this reason it is very important that you update all Reference Files before creating claims Be sure to complete the Reference Files in the following order Payer Reference File 2 Provider Reference File 3 busentcPshsrescebils Bi PC ACE Pro32 Claims Processing System Me ld 4 Submitter Reference File File View Security Help To begin editing the reference files sign on and from the PC ACE Pro32 Claims Processing toolbar Figure 4 1 click on the Reference File Maintenance Reference File button file folder Figure 4 1 PC ACE Pro32 Claims Processing Toolbar Payer Reference File The Payer tab of the Reference File Maintenance form provides access to maintain payer information Setup of the payer reference file is required to process claims ADDING OR UPDATING A PAYER RECORD 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display 2 Click on the Payer tab to display the Payer information Figure 4 2 The central field will display a
82. nnnnrrrrnrnnnnnvvvrnnnnnnnnen Provider Institutional and Professional Reference File Adding or Updating a Provider ccccccceeecccceceeeeeeeceeeeeeaaaeeeeeeeseeees Deleting an Existing Provider Record rrrrrnnnnnnrnnnnrrrnnnvnvvvvvrnnnnnnnnnnnnen PRAKT de Sess Roh tandesttne ven S Adding or Updating a Patient Record rrrrrrnnnrrrrnnnrrrrrnnnnvrvvrrnnnnnnnnnnnnnn Deleting an Existing Patient Record rrrrrnnnnnnrrnnnnrrrnnnnnvnvnnnvrvrnnnnnnnner Sou c AU REE EE Submitter Reference File Codes Misc Shared Adding or Updating a Submitter Record rrrrrnnnnnnrnvnnvnnnvvrnnnnnnnnnnnnnnn Deleting an Existing Submitter Record rrrnnnnnrrnnnnrrrnnnvnvnrvvnvvvrnnnnnnnnen Data Communications Reference File Codes Misc Shared HCPCS Reference File Codes Misc Shared Adding or Updating a HCPCS Code eese Deleting an Existing HCPCS Code rrrrrrrrrrrnnnnnnnnrrrrnrrrrrrrrnnnnnvvvrnnnnnnnne Physician UPIN Reference File Codes Misc Shared Adding or Updating a Physician UPIN Record Deleting an Existing Physician UPIN Record Facility Reference File Codes Misc Professional Adding or Modifying a Facility Recor
83. nt 140 77 Professional Claim Form Patient Info amp General Insured Information Billing Line Items Ext Patient General Ext Pat Gen 21 Est Payer Insured Line Item Details Extended Details Line 1 Ext Details 2 Line 1 MSP COB Line 1 Claim Diagnosis Codes 1 PELS B 12724 3 5990 4 4011 5 B i i 24a Service Dates 24b 24c 24d 24d Madfiers 24e adf 24g LM From Thru PS TS Proc 1 2 Diagnosis Charges Units EPFPEMCB AT Rendering Phys i ma er fir fascia Tf arr so PPP PI T L es 42 T L EE T III III it iit L Og OE JO ITT m A 28 Total Charge 140 77 Recalculate 23 Amount Paid 000 30 Balance Due 140 77 Save Cancel Figure 6 12 Line Item Details Tab Page 38 Palmetto GBA June 2008 PC ACE Pro32 User s Manual B Allowed Amount 131 34 C Line Level Adjustments CAS Section 6 Professional Claims Processing 1 Charges exceed our fee schedule or maximum allowed amount 20 70 2 Patient Responsibility 15 00 Co Pay z E Adjudication Date 03 05 07 Professional Claim Form Amount Paid by Primary SVD 105 07 Patient Info amp General Insured Information Biling Line Items Ext Patient General Ext Pat Gen 2 Ext Payer Insured Line Item Details Extended Details Line 1 Ext Details 2 Line 1 MSP COB Line 1 Common Line MSP Amounts Approved 000 B Allowed jt 31 34 Ded
84. on one or more claims 1 Highlight the single selected claim or choose multiple claims by clicking in the left hand column to place a checkmark next to each selected claim 2 Perform the desired action Primary actions have conveniently placed buttons located at the bottom of the form Additional actions can be chosen by selecting the Actions menu on the Claim List toolbar you can also right click over a selected claim to view a pop up menu Available claim actions are described in the following table An X in the M column indicates that the action menu option can be performed on multiple claims Menu Option M Description of Action a aae or New button E730 lini diccns er or View Update button pe The Professional Claim Entry form will display containing details of the or Copy button highlighted claim Some fields are cleared automatically in the new claim Delete Selected Claim X Deleted claims are assigned DEL status or Delete button Note DEL status claims can be recovered undeleted Purge Selected Claim X Claims in the pre transmitted CL location with a DEL status will be purged from the system Note Purged claims cannot be recovered Move selected claim s from the previously transmitted TR or paid PD location into the pre transmitted CL location The reactivated claim will be assigned the unprocessed UNP status Changes the status of the selected claim to hold HLD Held claims are n
85. on this sub tab are as follows Service Line Adjudication SVD Information Permits entry of one or more Service Line Adjudication SVD lines as reported by the payer for the current service line The P S field identifies the payer primary secondary reporting this line adjudication notice The procedure code and modifier fields identify the specific procedure being adjusted The practice of procedure code bundling and unbundling utilizes these fields to provide specific information regarding how the payer has grouped the procedures for payment The Paid Amount indicates the amount the payer has paid on this procedure The Paid Units value permits reporting of payments for less than the originally billed units Finally the B U Line field identifies the service line on the original claim to which this SVD line applies This reference identifier should be included on the remittance and is primarily used in scenarios where procedure code bundling unbundling has occurred Line Adjustment CAS amp Miscellaneous Adjudication Info Permits entry of several additional Service Line Adjudication SVD fields for the current SVD line The fields in this control group track the currently selected SVD line The control group s caption indicates the current SVD line e g for SVD I above Line Level Adjustments CAS Permits entry of one or more line level adjustments as reported by the payer for th
86. ord 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display 2 Click the Codes Misc tab 3 Under the Shared list click the Submitter button The central field of the Submitter Setup window will display a list of existing submitters 4 Highlight the desired record from the list click the Delete button and confirm the deletion Palmetto GBA Page 15 June 2008 Section 4 Reference File Maintenance PC ACE Pro32 User s Manual Data Communications Reference File Codes Misc Shared Note This reference file is not used HCPCS Reference File Codes Misc Shared Note This reference file does not apply to Institutional Claims The HCPCS Codes form provides access to maintain the HCPCS codes used in the PC ACE Pro32 software Separate database files are used to maintain global and local HCPCS codes You can add and maintain global and local HCPCS Select the Global codes or Local codes radio button to display the desired list You can list all codes by clicking the top option under List Filter Options You can also filter the HCPCS code list to include codes starting with a particular value descriptions starting with particular value or descriptions containing particular value ADDING OR UPDATING A HCPCS CODE 1 Click the Reference File Maintenance button on the PC ACE Pro32 main menu The Reference File Maintenance window will display
87. ormation Tab primary Institutional Part A and or Professional 1500 Part B payer s If your system is set up for both Institutional and Professional claim activities then you will have the option to enter separate Institutional and Professional insured information d Secondary and Tertiary Insured Tabs click on the right arrow at the right of the tabs to view the Tertiary Tab See the Primary Insured Tab above for details 5 After you have completed your additions changes click the Save button located on the bottom right of the window The system will perform an edit validation on the entered information Page 12 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 4 Reference File Maintenance 6 If you have not completed or incorrectly completed one or more required fields the Edit Validation Errors List will display Figure 4 13 This form lists all fatal and non fatal errors that occurred Fatal errors indicated by a red X must be corrected before the system will allow you to save the information a Double click on a listed error to go to that location in the Patient Information form and make the necessary corrections fields with Edit Validation Errors List x Patient Last Name Is Required Invalid Primary Payer ID Not On File Not Unique Or Restricted Use Frimary Insured Last Name Is Required Invalid Alt Primary Payer ID Not On File Not Unique Or Restricted Use Alt Primary Insure
88. ors occur several Save attempts may be required to correct and save a clean claim At any time you can click the Errors List button to review remaining edit validation errors Page 28 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 5 Institutional Claims Processing The Institutional Claim List The Institutional Claim List Figure 5 11 provides versatile access to Bi Institutional Claim List File Filter Actions Reports irate ae RUNI Entered Serv Frc otherwise maintain claims To access the Claim List form 1 Select the List Claims option from the Institutional Claims Menu 2 Choose one of the Sort By options radio buttons below list sa Sot By Patient Mame 6 PCN Entry Date Service Date 3 If you want to filter the claim list Claim List Filter Options select the desired filters from the Location CL ta be transmitted Status ce All gt gt LOB e lt Al gt gt Claim List Filter Options drop ORT Esser down lists CLAIM ACTIONS hem oven Doe Figure 5 11 Institutional Claim List Window To perform an action on one or more claims 1 Highlight the single selected claim or choose multiple claims by clicking in the left hand column to place a checkmark next to each selected claim 2 Perform the desired action Primary actions have conveniently placed buttons located at the bottom of the form Additional actions can be chosen by selecting the
89. ot considered for future claim activities such as automated claim processing or claim preparation Print Selected Claim Claims may be printed using either a plain paper image overlay Reactivate Selected Claim Hold Selected Claim Moves the selected claim s from the transmitted TR and paid PD locations to the open claim archive database Allows you to post view or modify payments for the selected claim technique or the traditional pre printed form method Adobe Acrobat Archive Claims X Reader version 4 0 is required for this function Show Selected Claim Payments Media Only claims with a media setting of electronic E will be eligible for preparation into an EMC file Claims with a media setting of paper P can be printed and submitted in hardcopy form When a paper claim is printed you will be given the option to move the claim from the pre transmitted CL location to the transmitted TR location set Selected Claim Designates the selected claim for either electronic or paper submission CLAIM LIST REPORTS PC ACE Pro32 gives you the ability to view several reports and a number of special print functions To view a detailed report of the currently listed claims 1 Select Reports from the Claim List toolbar 2 Choose Print Claim Detail Report The previewed report may be printed if desired by clicking the printer button at the top of the report preview form Palmetto GBA Page 47 June 2008 Section 6
90. process prepare and transmission activities The log files also record any abnormal activities that may occur in the course of operation Separate log files are maintained for Institutional and Professional claim activities The log files can be useful when researching past claim processing activity or reviewing the outcome of scheduled claim activities To view a claim activity log file 1 Open either the Institutional or the Professional Claims Menu 2 Select View from the Claims Menu toolbar and then choose Claim Activity Log 3 Windows WordPad will launch and open the applicable log file Activities are logged chronologically with the most recent entries at the end of the file 4 When you are finished reviewing the log close the WordPad program Page 58 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 12 Claim Printing SECTION 12 CLAIM PRINTING Claims can be printed in PC ACE Pro32 using either the traditional CMS 1450 UB 92 or enhanced CMS 1450 UB 04 Format The enhanced pre printed forms method or an advanced image overlay technique are also supported The pre printed forms method prints just the actual claim field values at positions on the page that should line up with pre printed CMS 1450 Institutional UB92 or CMS 1500 Professional claim forms or enhanced CMS 1450 UB 04 for both Institutional and Professional The image overlay method automatically overlays the claim field values onto a graphical
91. r ID UPIN Vaccine Chg Admin Cho amp j using either of these techniques TI EI CFT Ent Im a S el e ct th e N ew Ro S ter Patient Control No Insured s ID Patient s Last Name First Name MI Sex Birthdate LN Address Line 1 Address Line 2 City State Zip Code Billing item from the 1 8 B U Professional Claims Menu B m ET 99 2 mH 0 B8 KEN form s main Roster menu TMTT831898 8 The system will automatically F J 555 ml smi il si un create and display an empty F ptt a roster billing form x fT gg 1 66 99 OE b Click the New button on the Roster Billing List Form E JR zi The system will automatically create and display an empty roster billing form Figure 6 14 The new roster billing will automatically be selected in the list when it is saved Professional Roster Billing Form Patient Info amp General Extended Roster Info Referring Physician Information Nme FM IS p 2 Professional roster billings are IONS manually entered on the gt amp Professional Roster Billing Cyrsvzp L Form The data fields are ir SS lait typically entered in the order EJ 0 jo presented from left to right and Facility Information top to bottom Enter the common iiid E roster billing information in the Address top section of the Patient Info amp Gen
92. ransmitted Note Before preparing claims for the first time you will need to set up your Submitter Reference File This file contains important data that will be used to build the EMC file To generate an EMC file Protessional Claim Prepare For Transmission E 1 Select the Prepare Claims option from the Include Claims Matching Professional Claims Menu The Professional BEES Prepare For Transmission window will display Payer e lt AllFaversforLoBis E Figure 6 13 BE lt lt A1 Providers tor Papers M 2 Specify from the drop down list if you want only a single line of business LOB to be considered or select lt lt All gt gt to include claims for any line of business If you specify an LOB a Choosea single Payer or lt lt All Payers for Prepare Claims Cancel LOB s gt gt to include claims for all payers Output Format Submission Status Include Error Claims MSF f Production Tes f AMSI E3 i Test fe Ma Figure 6 28 Professional Claim Prepare for Transmission b Choose one or more Providers or lt lt All 9 P Providers for Payer s gt gt to include claims for all providers 3 Specify whether a You want ANSI 837 EMC file output format b The EMC file should be designated as a production or test submission c Claims with non fatal errors ERR are to be eligible for preparation When unchecked only processed claims will be eligible for preparation 4 Click the Prepare Claims
93. re printed in sequence based on the current Claim List form s Sort By selection 4 The Claim Print Options form will display 5 Determine if you will use the pre printed forms method or the image overlay method a To use the pre printed forms method ensure that you have loaded pre printed forms into your printer and then click the Print button b To use the image overlay method i Click the Preview button The Acrobat Reader program will automatically be launched with the claim displayed ii From the Acrobat Reader toolbar select File and then Print to print the previewed claim i When finished close Acrobat Reader You will not be able to resume activities in PC ACE Pro32 until the Acrobat Reader program has been closed Simply closing the claim document within the reader is not enough to signal PC ACE Pro32 to continue Palmetto GBA Page 59 June 2008 Section 13 Reactivating Previously Transmitted Claims PC ACE Pro32 User s Manual SECTION 13 REACTIVATING PREVIOUSLY TRANSMITTED CLAIMS In some situations it may become necessary to reactivate one or more previously transmitted claims for retransmission PC ACE Pro32 provides two techniques for reactivating claims Individual claims in the transmitted TR location may be reactivated for inclusion in a subsequent EMC file An entire EMC file may be reactivated for retransmission Individually Reactivating Transmitted Claims If one or more transmitted claims n
94. repare Claims Cancel b Choose one or more Providers or lt lt All Providers for Payer s gt gt to include claims Figure 5 13 Institutional Claim Prepare for Transmission for all providers 3 Specify whether a You want ANSI 837 EMC file output format b The EMC file should be designated as a production or test submission c Claims with non fatal errors ERR are to be eligible for preparation When unchecked only processed claims will be eligible for preparation 4 Click the Prepare Claims button Confirm your intention to prepare all eligible claims by clicking OK on the displayed confirmation Running totals of the count and dollar value of all prepared claims will be displayed on the Claims Prepare For Transmission form You will be notified when the claim preparation operation completes 5 You can click the View Results and or View Errors buttons to view reports of the successfully prepared claims and rejected claims respectively These reports can be printed from the report previewer if desired 6 When you have completed your review of the claim preparation reports click the Close button on the Claim Prepare For Transmission form Palmetto GBA Page 31 June 2008 Section 6 Professional Claims Processing PC ACE Pro32 User s Manual SECTION 6 PROFESSIONAL CMS 1500 PART B CLAIMS PROCESSING inen PUN ree us nave poen a PC ACE Pro32 Claims Processing System MoR established you can begin claims proces
95. s Manual for information on GPNet and sending receiving data You may download a copy of the GPNet Communications Manual by visiting the Palmetto GBA Web site at www PalmettoGBA com Palmetto GBA Page 53 June 2008 Section 8 Exiting PC ACE Pro32PC ACE Pro32 User s Manual SECTION 8 EXITING PC ACE PRO32 To exit the PC ACE Pro32 Claims Processing System 1 Close any data entry windows by saving or canceling as needed 2 Toclose the Institutional Professional Claims Menu select File from the toolbar and then choose Exit you can also type ALT X or click on the X in the upper right corner of the screen 3 To exit PC ACE Pro32 select File on the PC ACE Pro32 toolbar and then choose Exit you can also type ALT X or click on the X in the upper right corner of the screen Note Every time you exit the program you will be promp ted to p erform a backup Figure Would you like to perfarm a backup of the PO ACE Pros databases and 8 1 For more information on performing configuration settings IF 20 specify a destination drive e g 6 47 or hard disk ne folder path and click the Start Backup button backups see Section 10 System Utilities HE a A CE d a Destination Drive or Folder Perform System Backup If you do not want to perform the backup at this time press Cancel and PC ACE Pro32 will close TU PLE Iw Include infrequently changed database files backup will be larger Options Start Backup F
96. seieasers 40 Multi Line Claim with Deductible Amount errrroonnnnnrnrrrrnnrrnnnnnnnnnrrrnnvnnnnnnnnnrrrnnnrnnnnnnennnnnnnnnnn 41 Single Line Claim with OTAF Amount reoorrrrrrrrrnnnnnnnnnnnnnnnnnnnnrnsrnnnnnnvrrnnnnnnnnnnnnnnsnnnnnsnnsnnnnnnnn 43 Single Line Claim with Deductible and OTAF Amounts essen 44 Hede ESS TO ENG IUE EEE 46 TAI ACTIONS EEE NE EE E E 47 Cam list ivo E rammes 47 Preparing Claims for Electronic Transmisslon rr rrrrrrvvvrrnnnnnnnrrrrnnnvrnnnnnsnnssrnnnnnnnnsssssssnnssnnnn 48 decis d T 49 Adding a new roster billing rrrrrrrrrrnnrrnnnnnrrnrrrnnnvnnnnnnnnrrrrrnnnrnnnnnsssnssnnnsnnsnnnnnnsssssnnnnsnnnnnnssssnnne 49 Listing Modifying and Maintaining Roster Billings eese 49 Generating Roster Billing Claims sueco dedere oc eoa Deo doe DR DOR aas 50 MOTTA ROS REN TRAD ER RESUME MEE o1 Preparing Claims for Electronic Transmission eeeeesssesseeeeeeeeeeeeen nnn 51 SECTION 7 DATA COMMUNICATIONS 53 SC Part A NC Part A SC Part B OH WV Part B amp Railroad Claim Submissions 53 SECTION 8 EXITING PC ACE PRO32 54 SECTION 9 SYSTEM UTILITIES 55 PN 55 VU 56 SE NE EE EE e Atte 56 SECTION 10 SENDING AN E MAIL 57 SECTION 11 CLAIM ACTIVITY LOG 58 SECTION 12 CLAIM PRINTING 59 SECTION 13 REACTIVATING PREVIOUSLY TRANSMITTED CLAIMS 60 Individually Rea
97. sing AE UNE The Professional Claims Processing option on the PC ACE Pro32 main menu button highlighted in Figure 6 1 gives you access to the Professional Claims Menu Figure 6 2 File View Security Help From the Professional Claims Menu the following operations are available Hl EET Import Claims from a print file Note Claim File View Roster Maintain importing is not supported Refer to on line help for information Enter Claims manually List Claims to maintain existing claims from a comprehensive list Process Claims imported or reactivated automatically Prepare Claims into an EMC file for transmission Process Claims Prepare Claims Figure 6 2 Professional Claims Menu Using the Professional Claim Form The Professional Claim Form has been designed to provide a data entry flow resembling that of the printer Professional CMS 1500 claim form The following information will help you as you complete the claim form To move between the five major claim form sections click on the associated tab or press the and keys To move through the claim form fields you can click on a field to activate it or you can press the key to move from field to field in a predefined sequence generally left to right and top to bottom Use the UP ARROW and DOWN ARROW keys to move up and down through the claim form fields Many fields will have either a fixed list established set of values or
98. st Process Claims imported or reactivated automatically Prepare Claims into an EMC file for transmission Process Claims Prepare Claims Figure 5 2 Institutional Claims Menu Using the Institutional Claim Form The Institutional Claim Form has been designed to provide a data entry flow resembling that of the printer Institutional UB92 HCFA 1450 claim form as well as the enhanced CMS 1450 UB 04 Institutional Professional claim form The following information will help you as you complete the claim form To move between the six major claim form sections click on the associated tabs or press the and keys To move through the claim form fields you can click on a field to activate it or you can press the key to move from field to field in a predefined sequence generally left to right and top to bottom Use the UP ARROW and DOWN ARROW keys to move up and down through the claim form fields Many fields will have either a fixed list established set of values or a variable list values selected from reference files lookup To access the lookup list move your cursor over the field and right click to display a pop up menu You can also click in the field and press F2 Select the appropriate value from the list and it will automatically be entered in the claim form field If you inadvertently make a change to a field you can press ESC which will un do the change and restore the field s original val
99. t Control Number the patient s name address etc will automatically fill the appropriate fields If any of the automatically entered information is incorrect it cannot be changed from this tab You must exit the Claim Form and make the necessary change s directly to the proper reference file Palmetto GBA Page 33 June 2008 Section 6 Professional Claims Processing PC ACE Pro32 User s Manual 3 When you have completed entering information into the Patient Info and General tab click on the Insured Information tab to display that section of the claim entry form Figure 6 4 Professional Claim Form Patient Info amp General Insured Information Billing Line Items Ext Patent General Ext Pat Gen 2 Eat Payer Insured b Sub Payer ID Payer Name Ingured s ID FP Rel Ingured s Last Name First M ame Birthdate i Insured s Address 1 Insured s Address 2 Insured z City State zip Ee Ei 31d 3 J J p KE EE h JJ 9 JS _ J ge EE m J rm Country Insured s Phone ESC Employer Name Group Name Group Number IL a Clear Payer a IL B Clear Payer mE IL E E a Clear Payer Figure 6 4 Professional Claim Form Insured Information Tab 4 Enter data into blank fields When you have completed the fields on this tab click on the Billing Line Items tab to display that section of the claim entry form Figure 6 5 Professional Claim Form Pati
100. t by Patient PCN Or Filter list to include Patient PENs starting with Patient Name Filter list to include Patient Names starting with New View Update Delete Plan of Care 3 Determine if you plan to add a new record or modify an existing record Figure 4 11 Reference File Maintenance Form Patient Tab a To add a new Patient record click the New button b To update an existing Patient record highlight the record and click the View Update button or double click on the record 4 The Patient Information window Figure KOE 4 12 will display Complete the fields on General Information Extended Info Primary Insured Inst Primary Insured Prof Secondary Insured each of the Patient Information tabs Last Name First Name MI Gen Patient Control No PCN ER a General Information Tab Enter Patient Address Patient Status general patient information such as E Active Patient i Discharge Status E the patient s name address birth IND Death ind date and various status flags City State Zip po f pb J _ HENG Marital Status Signature On File I E b Extended Info Tab Enter E ES i y Employment Status Release of Info i extended patient information such as NO DM information on the patient s legal Notes o representative Professional claim use only jr a Te ae ERR and or Prof Enter payer insured and employer information for the Figure 4 12 Patient Information General Inf
101. ter billing using either of the following techniques a Whena new Professional roster billing is created from the New Roster Billing menu item and saved error free you will be prompted to proceed automatically to the claim generation step b Claims for existing Professional roster billings can be generated from the Roster Billing List Form To be eligible for generation a roster billing must reside in the to be generated RL location and have a clean CLN or has errors ERR status Select the desired roster billing record and click the Generate button or choose the Generate Selected Roster action to initiate the claim generation process 2 You will be prompted to confirm your intent to generate claims for this roster billing As the operation proceeds running totals of the count and dollar value of all generated claims will be displayed on the Roster Claim Generation form You will be notified when the claim generation operation completes Page 50 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 6 Professional Claims Processing If desired click the View Results or View Rejects buttons to view reports of the successfully generated claims or rejected claims respectively These reports can be printed from the report previewer if desired If any claim rejects occur during the generation process the entire process will be reversed Review the rejects report correct the offense
102. the Add Update User option to add additional user accounts if desired This README TAT file can also be viewed by PL ACE Pro32 Figure 2 5 PC ACE Pro32 Startup Icon Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 3 Getting Started SECTION 3 GETTING STARTED Logging Into the PC ACE Pro32 Claims Processing System Users are required to log into PC ACE Pro32 before performing any system activities The login process involves entering a User ID and Password Your PC ACE Pro32 software has been configured with a single default user the system administrator who has full system access rights The default User ID is SYSADMIN and the password is SYSADMIN as well If you are logging into PC ACE Pro32 for the first time you should use this default login Important You should change the default user s password as soon as possible if you are concerned about controlling user access at your facility System Users PC ACE Pro32 requires that a valid login and password be entered by anyone accessing the system The system administrator must set up a user account for each person that will use PC ACE Pro32 The user account specifies the user s login password values and defines the activities that the user has permission to perform Only users with User Add Modify privileges can perform these maintenance functions which include adding a new user and modifying information on an existing user ADDING OR MODI
103. the Institutional Claims Processing or Professional Claims Processing button to display the corresponding Claims Menu form 2 Click the List Claims button on the Claims Menu to display the Claim List form By default the list will display claims in the to be transmitted CL location gt From the Claim List form toolbar select File and then choose Open Claim Archive The Open Claim Archive form will display listing all existing claim archives if any 4 From the Open Claim Archive form you can open and create claim archives a To create a new archive click the New button and the Create New Claim Archive dialog box will display Figure 14 1 Enter a descriptive name for the new Enter name for new archive no extension archive Archive names can contain only alphabetic Enter New Archive Name Here and numeric characters the underscore character and spaces You will receive an error message if the chosen archive name is unacceptable Click the OK button and the empty archive will be Figure 14 1 Create New Claim Archive Dialog created and the corresponding entry will be added to the selection list Create New Claim Archive b To open a claim archive highlight the desired archive and click the Open button or double click the new list entry You will be returned to the Claim List form with the new claim archive open in the window To archive a claim 1 Open a claim archive into the Claim List form see steps abov
104. tion Accessing PC ACE Pro32 from the Palmetto GBA Web Site Note This option is currently not available for Part B Ohio and West Virginia users To download the PC ACE Pro32 software you will need to complete the online PC ACE Pro32 Software Download Request form 1 Open Internet Explorer and access the PC ACE Pro32 Software Download Request form at www PalmettoGBA com a Using the Quick Links choose Electronic Data Interchange b Again from the Quick Links choose the appropriate line of business c From the menu on the left of the page choose Software amp Manuals d From the list choose PC ACE Pro32 Software for your line of business e Read the instructions and then click on Download Form for PC Ace Pro 32 2 Complete all of the form fields completely and correctly Note Forms submitted with missing required information will not be processed Required fields are noted in the following table with an asterisk application form This ID may be referred to as a Receiver ID Contact Name The name of the person downloading the software Mailing Address Line 1 First line of the company mailing address Phone number to reach the contact name Page 2 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 3 Getting Started Form Field Name Instructions for Field Completion FAX number to reach the contact name The e mail address for user 3 Double check your information and then click Begin Download
105. u can a Duplicate all the fields from the previous line by pressing F5 b Duplicate a single field from the previous line by clicking in the selected field and pressing F4 c Delete an entire line by pressing F8 Page 34 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 6 Professional Claims Processing 6 When you have completed line item entries click the Recalculate button located near the bottom of the tab adjacent to the Totals field This will recalculate and update the Total Charges and the Balance Due fields from the current claim line item charges values and the Amount Paid field value Professional Claim Form T Click on the Extended Details sub Patient Info amp General Insured Information Billing Line Items Ext Patient General Ext Pat Gen 2 Ext Payer Insured Line Item Details Extended Details Line 1 Ext Details 2 Line 1 Ambulance tabs and review the information in Origin Information s Type of Transport Services Available i these fields Transport To For Medically Necessary i Stretcher Patient Admitted E 8 If you have entered a procedure code Bed Confined Before Patient Discharged Destination Information m Bed Confined After Patient Admit 2nd Facility that requires a Professional CMS Unconscious Shock i EKG Order UPIN 1500 Attachment or CMN an Emergency Situation Patient Weight Purpose of Round Trip 1 Physical Restraints Miles additional
106. uctible 0 00 Co Insurance 000 Primary Paid 000 OTAF 000 Disallow Cost 000 Disallow Other 000 E adpamen Date 07052007 03 05 2007 3 ni Save Cancel Additional Line level Adjudication COB Information ANS1 837 Use Only Service Line Adjudication SVD Information SVD P S Proc Qual Code Modifiers 1 thru 4 Paid Amount Paid Units B U Line ac fase r f a M Line Adjustment CAS amp Miscellaneous C Info for SYD 1 above Code Description Line Level Adjustments LAS Num Group Reason Amount Units co faz 2070 1000 al PR 3 15 00 1 000 Figure 6 13 MSP COB Line 1 Tab F Insurance Type 12 Working age beneficiary G Zero Payment Indicator N Payment was greater than zero H COB MOA Amounts 1 Payor Paid Amount D 105 07 Professional Claim Form Common Payer MSP Information Palmetto GBA June 2008 Allowed 000 Paid 0 00 Insurance Type E 2 Disallowed Cost 0 00 Disallowed Other 0 00 Deductible 0 00 Co Insurance 0 00 OTAF 0 00 Zero Payment Ind IN Adjudication Ind Hi M Additional Adjustment COB Amounts MOA ENT ANSI 837 Only Claim Level Adjustments CAS COB MOA Amounts Num Group Reason Amount Units Num Code Amount 1f f L Im OP 10507 2 T EE EM 3 Lf vj 3 DJ vl Medicare Outpatient Adjudication MOA Remarks Codes i ffi 1 m Claim A
107. ue Page 22 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 5 Institutional Claims Processing Fly over hints provide a brief description of a field s purpose They become visible when the mouse cursor pauses over the field When the focus leaves a particular field for example when you press the key or click on a new field an edit validation is performed on the field losing the focus Edits performed at this time are referred to as field level edits If a field level edit error occurs an audible tone will sound and the error message will display in the lower left corner of the claim form In addition the focus will remain on the field with the error so that you can correct the problem if desired If you choose not to correct the data at this time simply press again to move to the next field Entering Institutional Claim Data To enter Institutional claims into the PC ACE Pro32 system 1 Select Enter Claims from the Institutional Claims Menu The Institutional Claim Form will display Figure 5 3 Institutional Claim Form Patient Into amp Codes Billing Line Items Payer Info Diagnosis Procedure Extended General Ext General 2 Extended Payer LOB MCA FL 1 FL 2 Patient Control Ma Type of Bill el Fatient Last Mame First Mame MI Suffis Fed Tax ID Statement E x Lov D N C D C4 D L A D Fo 5 P o Patient Address 1 Patient Address 2 Patient City State Patient zip Countr
108. ups If you know the options for a particular field you can type in the selection or you can access the lookup list by right clicking the mouse over the field or click in the field and press F2 Once the list is visible you can use your mouse to highlight and then click on your choice and it will be entered into the field Context Sensitive Access Press F1 from anywhere in PC ACE Pro32 to display help information relevant to your current location in the program Conventional Access Select Help on the PC ACE Pro32 toolbar and choose Help Topics From the Help Topics window choose one of the following tabs e Contents Presents all help topics in a nested table of contents format e Index Alphabetically lists all available index entries e Find Perform a free form text search of all topics Logging Out of PC ACE Pro32 You can log out of PC ACE Pro32 without exiting to allow another user to log on and use the system To log out select Security from the PC ACE Pro32 toolbar and choose Logout Current User To log back onto the system click on any button and the Sign On window will display Figure 3 3 Enter your user ID and password and then click OK User ID Sten On Password nen Figure 3 3 Sign On Window Page 6 Palmetto GBA June 2008 PC ACE Pro32 User s Manual Section 4 Reference File Maintenance SECTION 4 REFERENCE FILE MAINTENANCE To streamline and improve the accuracy of clai
109. urce Drive or Folder containing backup to be validated Start Validate Figure 9 3 Backup Restore Tab Validate Sub Tab Important Note The restore operation will overwrite your current database files with older data from the specified backup To restore database files and configuration settings from a backup file 1 From the System Utilities window click the Backup Restore tab and the Restore sub tab Figure 9 4 2 Specify the drive or folder where the backup file is located 3 Placea check next to Restore system and user configuration settings 4 Click the Start Restore button Note When restoring backup archives that span multiple diskettes insert the last diskette in the set first The system will prompt for the first and subsequent diskettes as the restoration proceeds 5 You will be notified when the restore operation completes PC ACE Pro32 will System Utilities Backup Validate Restore This utility performs a restore of the PE ACE Pros databases and configuration settings from previously made backup Specify the source drive e g 6 47 or hard dizk folder path containing the backup and click the Start Restore button Warning This restore operation will averwrite your curent databases with older data from the specified backup You should perform this operation under the supervision of authorized technical support personnel only Source Drive or Folder cont
110. ust specify a non zero Amount value and may also specify an optional Units value Common Line MSP Information This field group exists primarily to provide a bridge between the MSP COB reporting standards defined in the older NSF format and those defined in the ANSI X12 implementation Only the Approved and OTAF Obligated To Accept In Full amount fields are actually needed to process COB claims in the newer ANSI X12 format All remaining fields in this group can be reported using equivalent values in the SVD or CAS field groups For Palmetto GBA Page 37 June 2008 Section 6 Professional Claims Processing PC ACE Pro32 User s Manual backward compatibility PC ACE Pro32 will continue to recognize and report values in these obsolete fields whenever it is practical to do so 13 After completing all of the data entry on the claim form click the Save button or press ALT S to save and exit the claim Note clicking the Cancel button will abandon all changes made to the claim When you click the Save button PC ACE Pro32 begins an Edit Validation process One or more of the following edits may be required a At least one of the payers specified on a claim must have the same LOB line of business as the claim itself You will not be allowed to save a claim unless this condition is met If only one of the claim payers has a LOB that matches the claim LOB then that payer is automatically designated as the su
111. y Patient Phone B g gc Ne Birthdate Sex MS Admission HA Type SAC OHA Stat Medical Record No Condition Codes EE ter gee Fy tty Occurence Occurence Occurence Occurence Occurence Span Occurence ope ode Date Code Date Code Date Code Date Code rom Thru Code rom per 9 1 W 255 EE GET FENG EEE sen 2 5 3 27 GET 7 GF FE G FE KEN Value Value Value Value Value Value Code Amount Code Amount Code Amount Code Amount Code Amount Code Amount i i a g l L TI TT TTI TI TT Save Cancel Figure 5 3 Institutional Claim Form Patient Info amp Codes Tab 2 Begin entering patient and code data using your cursor or the key to move through the fields Note Many fields on this and subsequent tabs will fill automatically as other fields are completed with information pulled from the reference files For example when you enter a Patient Control Number the patient s name address etc will automatically fill the appropriate fields If any of the automatically entered information is incorrect it cannot be changed from this tab You must exit the Claim Form and make the necessary change s directly to the proper reference file 3 Fields that require free form text are shown on the tab as Form Locator buttons e g FL1 To enter information into these fields a Click the FL1 button and the Form Locator 1 popup window will display b Type in the relevant information Press to start a new line if n

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