DDE for Dental Claims Submission

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "DDE for Dental Claims Submission"

Transcription

1 DDE for Dental Claims Submission

2 Purpose: The Health PAS-Online application will enable Dental Providers to bill and adjust claims electronically. To access Health PAS- Online, logon to and enter your logon name and password. Logon Name Enter the logon name you selected during New Trading Partner Registration. Password Enter the password.

3 Scroll to the 6 th option, Submit by Form, and click on Claim.

4 Select the 3 rd link, Health Care Claim Dental to load the dental claim form. Please Wait while the Form Loads.

5 Begin: click this button once you have completed reading the instructions.

6 Submitter Organization Name: Enter the Dental Provider name. Contact Name: Enter the person billing the claims. Billing Provider Enter a check in the box if organization name is same as the Submitter. This automatically enters the name in the Organization Name field. Provider KY Medicaid ID: Enter the 8-digit KY Medicaid ID number. Taxonomy Code: This is an optional field (not currently used). Commit These Entries: Click button to save the information entered on this form and advance to the next page.

7 Recipient Patient KY Medicaid ID: Enter the 10-digit KY Medicaid Recipient number. First Name: Enter the recipient s first name. Last Name: Enter the recipient s last name. Date of Birth: This is an optional field (not required by KY Medicaid) Gender: This is an optional field (not required by KY Medicaid) Commit These Entries: Click button to save the information entered on this form and advance to the next page.

8 Claim Patient Account Number: The first 20 digits (alpha-numeric) will appear on the remittance advice as the invoice number. This is an optional field. Facility Type Code: Click the drop down box and select the appropriate value. For a listing of values, refer to the KY Medicaid Billing Instructions. Prior Authorization Number: Enter the prior authorization number, if applicable. Adjustment Indicator: Click on the drop down box and select 7 for a claim adjustment or 8 for a claim credit. Other Insurance: Click the drop down box and select yes or no. Payer Paid Amount: Enter the dollar amount other insurance paid, if applicable. Original TCN: Enter the original TCN of the claim due an adjustment or claim credit. Special Program Code: Click on the drop down box and select the appropriate code, if applicable. Related Cause Code: Click the drop down box and select the appropriate code, if applicable. Auto Accident: Click the drop down box and select the appropriate state, if applicable. Date of accident: Enter, if applicable. Commit These Entries: Click this button to save the information entered on this form and advance to the next page.

9 Note: In order to file an adjustment or claim credit each line must be keyed as in the original claim. For an adjustment correct or change the information needed to reflect the adjustment. Should you have questions please call the EDI Department at Unisys (800) Service Line Date: Enter the Date of Service Oral Cavity: Click the drop down box and select the appropriate cavity. See Appendix A for a crosswalk of local values to HIPAA standard values. Tooth Number: Click the drop down box and select the appropriate tooth number. Surface: Click the drop down box and select the appropriate surfaces Procedure Code: Enter the appropriate procedure code Facility Type Code: Click the drop down box and select the appropriate facility type code. Charges: Enter the total charge amount. Procedure Count: Enter the procedure count (1) Add: Click to add the service line. Commit These Entries: Click button to save the information entered on this form and advance to the next page.

10 Submit: Click button to submit the claim.

11 Print: Click this button to print the page. Enter Another Claim: Click this button to enter another claim. Finished Entering Claims: Click this button if all claims have been entered.

12 DDE Value Appendix A Crosswalk KY Description prior to 10/16/03 KY Value Lower Left Lower Left Quadrant LL 30 Upper Left Upper Left Quadrant UL 20 Lower Right Upper Right Lower Right Quadrant Upper Right Quadrant LR 40 UR 10 Maxillary Area Upper Arch UA 01 Mandibular Area Lower Arch LA 02 X12 Value

ND HEALTH ENTERPRISE MMIS PHASE III TRAINING SUBMITTING DENTAL CLAIMS ONLINE JANUARY 2016

ND HEALTH ENTERPRISE MMIS PHASE III TRAINING SUBMITTING DENTAL CLAIMS ONLINE JANUARY 2016 ND HEALTH ENTERPRISE MMIS PHASE III TRAINING SUBMITTING DENTAL CLAIMS ONLINE JANUARY 2016 1 Today we will learn how to create, save and submit Dental claims using ND Health Enterprise MMIS. Learning Objectives:

More information

Examples of a Suffix are: Jr. or Sr. 5. Optionally, enter the Beneficiary s Suffix. Beneficiary Information. 6. Enter the Beneficiary s Date of Birth

Examples of a Suffix are: Jr. or Sr. 5. Optionally, enter the Beneficiary s Suffix. Beneficiary Information. 6. Enter the Beneficiary s Date of Birth Submit Dental Claims Online (Direct Data Entry) Quick Reference Business Rules o Fields marked with an asterisk (*) are required and must be completed for the Claim to be submitted successfully. o DDE

More information

2012 ADA Dental Claim Form Instructions

2012 ADA Dental Claim Form Instructions 2012 ADA Dental Claim Form Instructions June 9, 2015 Date (mm/dd/yyyy) Description of Changes Impact 02/11/2014 Initial version 07/16/2014 Updated instructions for fields 29a and 32 06/09/2015 Clarified

More information

Direct Data Entry of a Dental Claim

Direct Data Entry of a Dental Claim Operational instructional series: Direct Data Entry of a Dental Claim Presented by the Provider Relations Team Office of the Chief Medical Officer Washington Medicaid 10-14-2011 1 How to submit a Direct

More information

POLICY HOLDER/SUBSCRIBER INFORMATION

POLICY HOLDER/SUBSCRIBER INFORMATION Dental Claim Form Instructions Claim Field Identification 1. Type of Transaction Statement of Actual Services EPSDT/Title XIX Request for Predetermination 2. Predetermination/ Prior Authorization Code

More information

Dental Billing Instructions

Dental Billing Instructions Dental Billing Instructions DIVISION OF MEDICAL ASSISTANCE PROGRAMS Billing instructions for Provider Web Portal and ADA 2012 dental claim formats for Oregon Medicaid providers April 2014 Contents Introduction...

More information

2012 American Dental Association Claim Form Completion Instructions

2012 American Dental Association Claim Form Completion Instructions 01 American Dental Association Claim Form Completion Instructions COMPLETING THE ADA CLAIM FORM The following instructions explain how to complete the ADA Claim Form and whether a field is Required, Required

More information

How to do a Resubmit of a paper claim using ProviderOne

How to do a Resubmit of a paper claim using ProviderOne How to do a Resubmit of a paper claim using ProviderOne Changing the NPI or taxonomy code on the line level of a CMS- 1500 Professional claim format Why is this information on the line level? This issue

More information

Electronic Claims Submission. The Future of Dental Claims

Electronic Claims Submission. The Future of Dental Claims Electronic Claims Submission The Future of Dental Claims 1 Table of Contents Introduction 2 Why Submit Electronically 3 Getting Started 4 Technical Requirements 4 Submitting Electronic Claims 5 Special

More information

Real Time Responses... 153 Real Time Claim Status Response Details... 154 Claim Level Information... 154 Service Line Information...

Real Time Responses... 153 Real Time Claim Status Response Details... 154 Claim Level Information... 154 Service Line Information... epaces Help Table Of Contents What is epaces?... 1 System Requirements... 2 Key Features... 2 What's New in epaces... 3 June 2014... 3 ICD-10... 3 June 2013... 3 Eligibility Requests... 3 Eligibility

More information

Providers must attach a copy of the payer s EOB with the UnitedHealthcare Community Plan dental claim (2012 ADA form).

Providers must attach a copy of the payer s EOB with the UnitedHealthcare Community Plan dental claim (2012 ADA form). UnitedHealthcare Community Plan (formerly APIPA) Medicaid Dental Claims and Billing Process Effective Dates of Service October 01, 2015 or after AHCCCS Provider Identification Number and NPI Number All

More information

The following provider types should bill using the Dental claim form:

The following provider types should bill using the Dental claim form: Section: 4.0 Dental Claim Form This section explains the procedures for obtaining reimbursement for dental services submitted to Medicaid. Mississippi Medicaid accepts both electronic and paper dental

More information

Medicaid Management Information Systems

Medicaid Management Information Systems Medicaid Management Information Systems Maine Integrated Health Management Solution Health PAS Online: Dental Claim Submission and Claim Status User Guide Date of Publication: 09/02/2015 Document Number:

More information

EDI Support Services

EDI Support Services EDI Support Services Iowa Medicaid Web Portal The web portal uses the Internet to transport transactions for the Iowa Medicaid line of business only. The web portal provides access to submit and receive

More information

ND Health Enterprise MMIS ADA-Dental Claim Form Instructions

ND Health Enterprise MMIS ADA-Dental Claim Form Instructions October 2015 ND Health Enterprise MMIS ADA-Dental Claim Form Instructions These instructions address the North Dakota Health Enterprise MMIS paper claim requirements. You must be an enrolled ND Medicaid

More information

WV TPA Trading Partner Account Getting Started

WV TPA Trading Partner Account Getting Started WV TPA Trading Partner Account Getting Started User Guide Date of Publication: 11/22/2013 Document Version: 1.0 Privacy Rules Page 1 of 17 The Health Insurance Portability and Accountability Act of 1996

More information

AP Vendor Portal - Instructions

AP Vendor Portal - Instructions AP Vendor Portal - Instructions Manual Genuine Parts Company Welcomes you to The AP Vendor Portal - Instructions 1 P a g e TABLE OF CONTENTS AP Vendor Portal - Instructions Manual LOGGING IN... PAGE 3

More information

ADA Dental Claim Form (2012 American Dental Association) Completion Instructions Page 1 of 17

ADA Dental Claim Form (2012 American Dental Association) Completion Instructions Page 1 of 17 Page 1 of 17 Introduction The ADA Dental Claim Form has been revised to incorporate key changes to the HIPAA standard electronic dental claim transaction. This version of the form, front and reverse sides,

More information

TexMedConnect Acute Care Manual

TexMedConnect Acute Care Manual TexMedConnect Acute Care Manual v2015_0811 Contents 1.0 Overview.......................................... 1 2.0 TexMedConnect Internet Requirements.......................... 2 3.0 Getting Support......................................

More information

National Billing Provider Setup

National Billing Provider Setup National Billing Provider Setup Setting Up Billing Module Create Funding Source A Funding Source is a person or entity paying the Claims or Invoices for one or more individuals. Funding sources are used

More information

Emdeon ERA Provider Information Form *This form is to ensure accuracy in updating the appropriate account

Emdeon ERA Provider Information Form *This form is to ensure accuracy in updating the appropriate account PAYER ID: SUBMITTER ID: Emdeon ERA Provider Information Form *This form is to ensure accuracy in updating the appropriate account 1 Provider Organization Practice/ Facility Name Provider Name Tax ID Client

More information

NEW YORK STATE MEDICAID PROGRAM DENTAL BILLING GUIDELINES

NEW YORK STATE MEDICAID PROGRAM DENTAL BILLING GUIDELINES NEW YORK STATE MEDICAID PROGRAM DENTAL BILLING GUIDELINES TABLE OF CONTENTS Section I Purpose Statement...3 Section II Claims Submission... 4 Electronic Claims... 5 Paper Claims... 9 Claim Form A-eMedNY-000201...

More information

CHAPTER 7 (E) DENTAL PROGRAM CLAIMS FILING CHAPTER CONTENTS

CHAPTER 7 (E) DENTAL PROGRAM CLAIMS FILING CHAPTER CONTENTS CHAPTER 7 (E) DENTAL PROGRAM CHAPTER CONTENTS 7.0 CLAIMS SUBMISSION AND PROCESSING...1 7.1 ELECTRONIC MEDIA CLAIMS (EMC) FILING...1 7.2 CLAIMS DOCUMENTATION...2 7.3 THIRD PARTY LIABILITY (TPL)...2 7.4

More information

How to Add or Change a Billing Agent and Other Claim Submission Options in NCTracks

How to Add or Change a Billing Agent and Other Claim Submission Options in NCTracks How to Add or Change a Billing Agent and Other Claim Submission Options in NCTracks Overview This user guide provides step-by-step instructions for adding or changing a billing agent or making other claim

More information

QUICK START GUIDE EDI Claims Link for Windows version 3.5

QUICK START GUIDE EDI Claims Link for Windows version 3.5 QUICK START GUIDE EDI Claims Link for Windows version 3.5 System Requirements - Operating system: Windows XP or later - Computer/Processor: Pentium 2, 233 MHz or greater - Memory: 64MB Ram - Minimum Screen

More information

2011 Provider Workshops. EDI Presents

2011 Provider Workshops. EDI Presents 2011 Provider Workshops EDI Presents 1 Electronic Transaction Exchange The electronic format you exchange with BCBSLA today is referred to as: ANSI 4010A1, HIPAA 4010A1 or 4010 Changes have been made and

More information

Minnesota Health Care Programs (MHCP) MN ITS Interactive User Guide http://mn-its.dhs.state.mn.us. Using MN ITS Interactive. Entering an Online Claim

Minnesota Health Care Programs (MHCP) MN ITS Interactive User Guide http://mn-its.dhs.state.mn.us. Using MN ITS Interactive. Entering an Online Claim Minnesota Health Care Programs (MHCP) MN ITS Interactive User Guide http://mn-its.dhs.state.mn.us Objective Performed by Background Claim Form Completing a MN ITS Interactive Professional (837P) claim

More information

ADA 2006 Paper Claim Form Changes and Requirements

ADA 2006 Paper Claim Form Changes and Requirements INDIANA HEALTH COVERAGE PROGRAMS P R O V I D E R B U L L E T I N B T 2 0 0 7 0 5 F E B R U A R Y 1 3, 2 0 0 7 To: All Dental Providers Subject: Overview The Indiana Health Coverage Program (IHCP) will

More information

SD MEDX South Dakota Medical Electronic Data Exchange SD Department of Social Services

SD MEDX South Dakota Medical Electronic Data Exchange SD Department of Social Services GENERAL INFORMATION Q. Is SD MEDX specifically for medical claims and prior authorizations or what will a dental provider use SD MEDX for? A. Delta Dental is still contracted with Medical Services for

More information

GETTING STARTED WITH EDISS AND TOTAL ONBOARDING (TOB)

GETTING STARTED WITH EDISS AND TOTAL ONBOARDING (TOB) GETTING STARTED WITH EDISS AND TOTAL ONBOARDING (TOB) Table of Contents What is an electronic transaction?...2 What forms will be required for EDISS registration now that TOB is effective for most lines

More information

Electronic Data Interchange (EDI) Registration for Oregon Medicaid

Electronic Data Interchange (EDI) Registration for Oregon Medicaid Electronic Data Interchange (EDI) Registration for Oregon Medicaid Learn how to complete the following forms: Oregon MMIS Trading Partner Agreement ( 2080) Exhibit A Application for Authorization ( 2081)

More information

Preview of the Attestation System for the Medicare Electronic Health Record (EHR) Incentive Program

Preview of the Attestation System for the Medicare Electronic Health Record (EHR) Incentive Program Preview of the Attestation System for the Medicare Electronic Health Record (EHR) Incentive Program The Medicare EHR Incentive Program provides incentive payments to eligible professionals, eligible hospitals

More information

LOUISIANA MEDICAID PROGRAM ISSUED: 03/15/12 REPLACED: CHAPTER 16: DENTAL SERVICES SECTION 16.1: PROVIDER REQUIREMENTS PAGE(S) 7 PROVIDER REQUIREMENTS

LOUISIANA MEDICAID PROGRAM ISSUED: 03/15/12 REPLACED: CHAPTER 16: DENTAL SERVICES SECTION 16.1: PROVIDER REQUIREMENTS PAGE(S) 7 PROVIDER REQUIREMENTS PROVIDER REQUIREMENTS A dentist must enroll as a Louisiana Medicaid dental provider to receive reimbursement for covered dental services performed on eligible Medicaid recipients. Providers must be licensed

More information

Xerox EDI Direct Electronic Claims Acquisition Services WINASAP5010 Quick Reference Guide BrickStreet Mutual Insurance

Xerox EDI Direct Electronic Claims Acquisition Services WINASAP5010 Quick Reference Guide BrickStreet Mutual Insurance Xerox EDI Direct Electronic Claims Acquisition Services WINASAP5010 Quick Reference Guide BrickStreet Mutual Insurance This document was developed for the BrickStreet Mutual Insurance provider community.

More information

Colorado Medical Assistance Program Web Portal Dental Claims User Guide

Colorado Medical Assistance Program Web Portal Dental Claims User Guide Colorado Medical Assistance Program Web Portal Dental Claims User Guide The Dental Claim Lookup screen (Figure 1) is the main screen from which to manage Dental claims. It consists of different sections

More information

ESS Internet Report Access System (IRAS) Applicant Tracking System (ATS) Instructions 4-12

ESS Internet Report Access System (IRAS) Applicant Tracking System (ATS) Instructions 4-12 Logon ESS Internet Report Access System (IRAS) Applicant Tracking System (ATS) Instructions 4-12 1. Go to https://iras.essclientservices.com 2. Enter your Username (which is your email address.) 3. Enter

More information

Wordware Family Website Instructions

Wordware Family Website Instructions Registering on the Family Website Wordware Family Website Instructions Important: You must fully complete registration in one session in order to guarantee that there are no problems with activating your

More information

Open up Internet Explorer, Version 7 or above. Go to: https://hhin.hmsa.com

Open up Internet Explorer, Version 7 or above. Go to: https://hhin.hmsa.com Open up Internet Explorer, Version 7 or above. Go to: https://hhin.hmsa.com HMSA e-claim System: Call HMSA EDI Helpdesk at 948-6355 on Oahu or 1 (800) 377-4672 from the Neighbor Islands. Enter your HHIN

More information

Security Frequently Asked Questions And General Information

Security Frequently Asked Questions And General Information Security Frequently Asked Questions And General Information Here are several things to keep in mind, along with some frequently asked questions with their answers. Terminology Domain = 7-digit security

More information

How to Register for an Event Using Cheer America s New Online Registration System

How to Register for an Event Using Cheer America s New Online Registration System Step 1: Go to our website (www.cachampionships.com). Click on the Registration Button. Step 2: On the Registration Page, click on the blue button Click HERE to REGISTER. Step 3: Welcome to our Registration

More information

National Uniform Claim Committee. 1500 Health Insurance Claim Form Reference Instruction Manual for Form Version 02/12. June 2013. Version 1.

National Uniform Claim Committee. 1500 Health Insurance Claim Form Reference Instruction Manual for Form Version 02/12. June 2013. Version 1. National Uniform Claim Committee 1500 Health Insurance Claim Form Reference Instruction Manual for Form Version 02/12 June 2013 06/13 06/13 Disclaimer and Notices 2013 American Medical Association This

More information

Louisiana Medicaid Management Information Systems (LA MMIS) User Manual for the Medicaid Eligibility Verification System (MEVS) Web Application

Louisiana Medicaid Management Information Systems (LA MMIS) User Manual for the Medicaid Eligibility Verification System (MEVS) Web Application Unisys Global Industries Louisiana Medicaid Management Information Systems (LA MMIS) User Manual for the Medicaid Eligibility Verification System (MEVS) Web Application 17 June 2003 Initial Release Version

More information

Illinois Mental Health Collaborative Provider Guide to Using Direct Claim Submission

Illinois Mental Health Collaborative Provider Guide to Using Direct Claim Submission Illinois Mental Health Collaborative Provider Guide to Using Direct Claim Submission www.illinoismentalhealthcollaborative.com Direct Claim Submission allows the provider/submitter to enter claims directly

More information

Easy Dental 11. Release Guide. (For Easy Dental 11.2, Easy Dental 11 Productivity Pack 1, and Easy Dental 11) www.easydental.

Easy Dental 11. Release Guide. (For Easy Dental 11.2, Easy Dental 11 Productivity Pack 1, and Easy Dental 11) www.easydental. Easy Dental 11 Release Guide (For Easy Dental 11.2, Easy Dental 11 Productivity Pack 1, and Easy Dental 11) www.easydental.com 1-800-824-6375 PUBLICATION DATE October 2013 COPYRIGHT 1987 2013 Henry Schein,

More information

Patient Portal. Accessing the Patient Portal. How to Begin: Enter first and last name, date of birth and create a user name and password.

Patient Portal. Accessing the Patient Portal. How to Begin: Enter first and last name, date of birth and create a user name and password. Patient Portal How to Begin: If you provided an email address when you registered as a patient, you can expect an email after your discharge that will be sent directly from CPSI, our Electronic Health

More information

ValueOptions Provider Guide to using Direct Claim Submission

ValueOptions Provider Guide to using Direct Claim Submission ValueOptions Provider Guide to using Direct Claim Submission www.valueoptions.com Table of Contents Introduction 1 Submitting a New Claim 3 Searching for Claims 9 Changing or Re-processing a claim 13 Submitting

More information

Medicaid Claim Status Guide for Internet Access. State of Nebraska Health and Human Services Finance and Support

Medicaid Claim Status Guide for Internet Access. State of Nebraska Health and Human Services Finance and Support Medicaid Claim Status Guide for Internet Access State of Nebraska Health and Human Services Finance and Support Revised November 26, 2014 Table of Contents MEDICAID CLAIM STATUS APPLICATION... 3 ACCESSING

More information

Agenda Pre-Application Checklist Introduction to IMPACT and Key Terms Application Process Starting an Application The Business Process Wizard (BPW)

Agenda Pre-Application Checklist Introduction to IMPACT and Key Terms Application Process Starting an Application The Business Process Wizard (BPW) Billing Agent Agenda Pre-Application Checklist Introduction to IMPACT and Key Terms Application Process Starting an Application The Business Process Wizard (BPW) Completing the Application using the BPW

More information

Online Services through My Direct Care www.mydirectcare.com

Online Services through My Direct Care www.mydirectcare.com Online Services through My Direct Care www.mydirectcare.com WEB PORTAL Employers and Employees associated with Consumer Direct have access to online services available through a secure website www.mydirectcare.com.

More information

306 276-277 HEALTH CARE CLAIM STATUS REQUEST AND RESPONSE

306 276-277 HEALTH CARE CLAIM STATUS REQUEST AND RESPONSE Handbook for Electronic Processing Chapter 300 Requirements for Electronic Processing 306 276-277 HEALTH CARE CLAIM STATUS REQUEST AND RESPONSE 306.1 GENERAL INFORMATION Introduction This chapter contains

More information

Electronic Transaction Manual for Arkansas Blue Cross and Blue Shield FEDERAL EMPLOYEE PROGRAM (FEP) Dental Claims

Electronic Transaction Manual for Arkansas Blue Cross and Blue Shield FEDERAL EMPLOYEE PROGRAM (FEP) Dental Claims Electronic Transaction Manual for Arkansas Blue Cross and Blue Shield FEDERAL EMPLOYEE PROGRAM (FEP) Dental Claims HIPAA Transaction Companion Document Guide Refers to the X12N Implementation Guide: 005010X224A2:

More information

GDP11 Student Registration Guide

GDP11 Student Registration Guide GDP11 Student Registration Guide Getting Started with GDP11 What You Will Need URL/Web Site Address for GDP Online You will access GDP11 at a URL (Web address) that is specific to your school. This URL

More information

MITS WEB PORTAL BILLING GUIDE FOR DENTAL CLAIMS

MITS WEB PORTAL BILLING GUIDE FOR DENTAL CLAIMS MITS WEB PORTAL BILLING GUIDE FOR DENTAL CLAIMS Revised 2011.12.21 Fields marked with an asterisk (*) require an entry. Information entered into a field must be "recorded" before the system can use it.

More information

Getting Started Guide: Transaction Download for QuickBooks 2009-2011 Windows. Information You ll Need to Get Started

Getting Started Guide: Transaction Download for QuickBooks 2009-2011 Windows. Information You ll Need to Get Started Getting Started Guide: Transaction Download for QuickBooks 2009-2011 Windows Refer to the Getting Started Guide for instructions on using QuickBooks online account services; to save time, improve accuracy,

More information

ADA Claim Form Version 2012 Completion Aid for Dentists

ADA Claim Form Version 2012 Completion Aid for Dentists Prior Authorization/Benefit Limit Exception Request Purpose of the document Document format The purpose of this document is to provide a block-by-block reference guide to assist the following provider

More information

Insurance claims through ClaimConnect (Dentxchange.com) using your Data Team Program.

Insurance claims through ClaimConnect (Dentxchange.com) using your Data Team Program. Insurance claims through ClaimConnect (Dentxchange.com) using your Data Team Program. 1) Set Data Team DDS to interface with ClaimConnect: Under Settings > Business Description > Site Code > Set Site Code

More information

FMH Benefit Services, Inc.

FMH Benefit Services, Inc. FMH Benefit Services, Inc. HIPAA Transaction Electronic Data Interchange (EDI) Implementation Guide For Health Care Providers Version Number: 2.0 Issued: October 28, 2003 FMH Benefit Services, Inc. a division

More information

PA PROMISe Provider Electronic Solutions Software User Manual

PA PROMISe Provider Electronic Solutions Software User Manual Project Workbook Provider Electronic Solutions software Documentation PA PROMISe User Manual PA PROMISe Provider Electronic Solutions Software User Manual PROVIDER ELECTRONIC SOLUTIONS SOFTWARE DOCUMENTATION

More information

Kansas Medical Assistance Program

Kansas Medical Assistance Program Kansas Medical Assistance Program Vertical Perspective Kansas Medical Assistance Program 2009 Spring Supplemental Billing Packet: Local Education Agency Professional Claims Introduction The Kansas Medical

More information

UHIN STANDARDS COMMITTEE Version 3.2 5010 Dental Claim Billing Standard J430

UHIN STANDARDS COMMITTEE Version 3.2 5010 Dental Claim Billing Standard J430 UHIN STANDARDS COMMITTEE Version 3.2 5010 Dental Claim Billing Standard J430 Purpose: The purpose of the Dental Billing Standard, is to clearly describe the standard use of each Item Number (for print

More information

EDI Claims Link for Windows Version 3.5. User s Manual. December 2011. EDI Claims Link for Windows User Manual

EDI Claims Link for Windows Version 3.5. User s Manual. December 2011. EDI Claims Link for Windows User Manual EDI Claims Link for Windows Version 3.5 User s Manual December 2011-1 - TABLE OF CONTENTS Overview EDI Claims Link for Windows Application 4 About the EDI Claims Link for Windows Application 6 How to log

More information

Health Professional Zone: Member validation and virtual quote. User manual and frequently asked questions

Health Professional Zone: Member validation and virtual quote. User manual and frequently asked questions Health Professional Zone: Member validation and virtual quote User manual and frequently asked questions About this guide We ve improved some of the online functionalities member validation and simulate

More information

Three weeks & counting: to ICD-10. Top Tips for Transitioning. Fall 2015. HP Fiscal Agent for the Arkansas Division of Medical Services

Three weeks & counting: to ICD-10. Top Tips for Transitioning. Fall 2015. HP Fiscal Agent for the Arkansas Division of Medical Services Three weeks & counting: Top Tips for Transitioning to ICD-10 Fall 2015 HP Fiscal Agent for the Arkansas Division of Medical Services Topics for Today Common problems/solutions during ICD-10 testing Helpful

More information

Claim Features Training

Claim Features Training Claim Features Training Molina Healthcare s Web Portal The Web Portal is secure and available 24 hours a day, seven days a week. Register for access to our Web Portal for selfservices, including: Submit

More information

Workers Compensation Claims Submitting Attachments

Workers Compensation Claims Submitting Attachments Workers Compensation Claims Submitting Attachments STEP 1 SUBMIT THE CLAIM To submit attachments for Workers Comp claims, users must first submit the Workers Comp claim through Office Ally. The claim must

More information

PA PROMISe Provider Internet User Manual

PA PROMISe Provider Internet User Manual PA PROMISe User Manual PA PROMISe Provider Internet User Manual SYSTEM DOCUMENTATION LIBRARY REFERENCE NUMBER: [00000164] SECTION: 4-5B LIBRARY REFERENCE NUMBER: [0000082] PROVIDER INTERNET USER MANUAL

More information

Free Medical Billing. Insurance Payment Posting: The following instructions will help guide you through Insurance Payment Posting Procedures.

Free Medical Billing. Insurance Payment Posting: The following instructions will help guide you through Insurance Payment Posting Procedures. : The following instructions will help guide you through Procedures. Click Windows Start Button Click Open Internet Browser Enter Https://www.FreeMedicalBilling.net Click Login to Your Account Enter Username:

More information

ValueOptions Provider Guide to using Single Claim Submission

ValueOptions Provider Guide to using Single Claim Submission ValueOptions Provider Guide to using Single Claim Submission www.valueoptions.com You may only use Single Claim Submission for outpatient claims. Inpatient claims may not be entered through Single Claim

More information

epaces Help Table Of Contents What is epaces?...1 System Requirements...1 Key Features...2 What's New in epaces...3 Logging Into epaces...4 Navigational Tips...5 Change Provider...8 Enter New Claims...9

More information

HMSA e-claims. Training Manual

HMSA e-claims. Training Manual HMSA e-claims Training Manual Table of Contents Chapter 1: INTRODUCTION... 2 About HMSA e-claim... 2 Accessing HMSA e-claim System... 3 Chapter 2: DASHBOARD... 4 HMSA e-claim Dashboard... 4 Generate Claim...

More information

State Grant Information Technology Application

State Grant Information Technology Application The makes grant information accessible to EPA Personnel, OMB, and State agencies. Grant pages contain general information as well as electronic copies of workplans and progress reports. The information

More information

Eligible Hospitals Meaningful Use Stage 1

Eligible Hospitals Meaningful Use Stage 1 South Dakota Medicaid EHR Incentive Payment Program Eligible Hospitals Meaningful Use Stage 1 User Guide 10/23/12 1 Eligible Hospitals Meaningful Use Stage 1 TABLE OF CONTENTS 1. Welcome Page: Account

More information

Provider Electronic Solutions Software User s Guide

Provider Electronic Solutions Software User s Guide Vermont Title XIX Provider Electronic Solutions Software User s Guide HP ENTERPRISE SERVICES 312 HURRICANE LANE, STE 101 PO BOX 888 WILLISTON VT 05495 Table of Contents 1 Introduction... 2 1.1 Provider

More information

Windows Accelerated Submission and Processing WINASAP 5010. Montana Medicaid, Healthy Montana Kids (HMK) and Mental Health Services Plan (MHSP)

Windows Accelerated Submission and Processing WINASAP 5010. Montana Medicaid, Healthy Montana Kids (HMK) and Mental Health Services Plan (MHSP) Windows Accelerated Submission and Processing WINASAP 5010 Montana Medicaid, Healthy Montana Kids (HMK) and Mental Health Services Plan (MHSP) October 2015 2015 Xerox Corporation. All rights reserved.

More information

Before submitting claims online you must complete the following form(s): Online Provider Services Account Request Form (www.valueoptions.

Before submitting claims online you must complete the following form(s): Online Provider Services Account Request Form (www.valueoptions. EDI RESOURCE DOCUMENT/ E-SUPPORT SERVICES PROVIDERCONNECT AND ELECTRONIC CLAIMS ValueOptions is committed to helping our providers manage administrative functions more efficiently and conveniently, and

More information

User Manual for Constituent Colleges(PIT) - Student

User Manual for Constituent Colleges(PIT) - Student User Manual for Constituent Colleges(PIT) - Student Step 1 Go to http://ptuaccounts.ac.in or http://ptu.ac.in Step 2 Take/Hover mouse on Registration/Online payment link Step 3 Click on Constituent Colleges

More information

MyCare Ohio Assisted Living Provider Orientation & Training

MyCare Ohio Assisted Living Provider Orientation & Training MyCare Ohio Assisted Living Provider Orientation & Training Opt IN Enrollees - Full duals with Buckeye Medicare and Medicaid benefits through Buckeye Medicare option to change plans monthly If member selects

More information

User Guide for Patients

User Guide for Patients User Guide for Patients Creating a My Health Online Account Before you can create a My Health Online account you must register for this service at your GP practice. Your practice will provide you with

More information

NEW YORK STATE MEDICAID PROGRAM CLINICAL SOCIAL WORKER BILLING GUIDELINES

NEW YORK STATE MEDICAID PROGRAM CLINICAL SOCIAL WORKER BILLING GUIDELINES NEW YORK STATE MEDICAID PROGRAM CLINICAL SOCIAL WORKER BILLING GUIDELINES TABLE OF CONTENTS Section I - Purpose Statement... 2 Section II Claims Submission... 3 Electronic Claims... 3 Paper Claims... 7

More information

Instruction Guide. People First Dependent Certification Process

Instruction Guide. People First Dependent Certification Process People First Dependent Certification Process Each time an employee logs into People First to make an enrollment selection during open enrollment or because of a qualified status change (QSC), he/she must

More information

WINASAP2003 Quick Reference Guide Version 5.16

WINASAP2003 Quick Reference Guide Version 5.16 ACS EDI Gateway, Inc. Electronic Claims Acquisition Services WINASAP2003 Quick Reference Guide Version 5.16 March 09, 2010 2324 Killearn Center Boulevard Tallahassee, FL 32309 Table of Contents 1 INTRODUCTION...

More information

EDI Insight Manual. Training Manual. Presented By

EDI Insight Manual. Training Manual. Presented By EDI Insight Manual Training Manual Presented By EDI Insight Manual 2 Step 1 Upload File: Select the file to transmit on the eceno claims transmission screen and click connect. Login to EDI Insight, when

More information

Getting Started Guide: Transaction Download for QuickBooks 2009-2011 Windows

Getting Started Guide: Transaction Download for QuickBooks 2009-2011 Windows Getting Started Guide: Transaction Download for QuickBooks 2009-2011 Windows Refer to the Getting Started Guide for instructions on using QuickBooks online account services; to save time, improve accuracy,

More information

RAILROAD MEDICARE PRE- ENROLLMENT INSTRUCTIONS MR018

RAILROAD MEDICARE PRE- ENROLLMENT INSTRUCTIONS MR018 RAILROAD MEDICARE PRE- ENROLLMENT INSTRUCTIONS MR018 TO COMPLETE THIS FORM YOU WILL NEED to use Internet Explorer to Open Links. Railroad Medicare Provider Number (PTAN) Billing NPI on file with Palmetto

More information

Please see detailed instructions on the entire Housing Online Process below!!

Please see detailed instructions on the entire Housing Online Process below!! 1 FAMU HOUSING ONLINE APPLICATION PROCESS FAMU Housing application process is online. This process will allow you to first, apply for housing online through your irattler account by selecting a term and

More information

SOUTH CAROLINA MEDICAID WEB-BASED CLAIMS SUBMISSION TOOL

SOUTH CAROLINA MEDICAID WEB-BASED CLAIMS SUBMISSION TOOL SOUTH CAROLINA MEDICAID WEB-BASED CLAIMS SUBMISSION TOOL User Guide Addendum CMS-500 October 28, 2003 Updated June 03, 203 CMS-500 CLAIMS ENTRY This document describes the correspondence between the South

More information

Workers Compensation Claims Submitting Attachments

Workers Compensation Claims Submitting Attachments Workers Compensation Claims Submitting Attachments STEP 1 SUBMIT THE CLAIM To submit attachments for Workers Comp claims, users must first submit the Workers Comp claim through Office Ally. The claim must

More information

877-646-5410 meipasshelp@csc.com

877-646-5410 meipasshelp@csc.com 877-646-5410 meipasshelp@csc.com emedny.org/meipass Table of Contents 1. Logging into MEIPASS 2. Eligibility 3. EHR Certification Number 4. Core Measures 5. Menu Measures 6. Clinical Quality Measures 7.

More information

Register Today! The registration guide attached below will lead you through the registration process.

Register Today! The registration guide attached below will lead you through the registration process. UnitedHealthcare Online All-Payer Gateway Solution Are you looking for a low-cost way to submit paper claims electronically? UnitedHealthcare is pleased to announce the UnitedHealthcare Online All-Payer

More information

QUICK START GUIDE EDI Claims Link for Windows version 3.1

QUICK START GUIDE EDI Claims Link for Windows version 3.1 QUICK START GUIDE EDI Claims Link for Windows version 3.1 System Requirements - Operating system: Windows 98 or later - Computer/Processor: Pentium 2, 233 MHz or greater - Memory: 64MB Ram - Initial application

More information

Quick Reference Training Guide for the Australia Post Mail Contract Online Tendering System

Quick Reference Training Guide for the Australia Post Mail Contract Online Tendering System How to register 1. After you have clicked on the internet link to reach the Registration page, choose Bidder from the drop down list. 2. Then click on the [Create] button. 3. Next, fill in your company

More information

****************************************** **************ATTENTION************** ******************************************

****************************************** **************ATTENTION************** ****************************************** 4/4/2006 Cover Page 1 PAYER ID: SKNJ0 SUBMITTER: 9902201 NEW JERSEY MEDICAID MEDICAL **************ATTENTION************** THIS PAYER EDI AGREEMENT MUST BE PROCESSED THROUGH EMDEON S PAYER ENROLLMENT DEPARTMENT.

More information

Standard Mutual Insurance Company

Standard Mutual Insurance Company Standard Mutual Insurance Company Documentation for Policyholder Access - Pay Online Policyholder Access - Pay Online July 26, 2013 Policyholder Access Page 0 Table of Contents Pay Online Policyholder

More information

Amerigroup Website User Guide for Providers: Provider Updates page 1

Amerigroup Website User Guide for Providers: Provider Updates page 1 Amerigroup Website User Guide for Providers: Provider Updates page 1 The tools for provider updates allow you to: Change and update o Basic information o Registration information o Practice information

More information

Submit Fee-for-Service Claims to Medical Assistance. Receive Timely and Accurate Payments for Covered Services

Submit Fee-for-Service Claims to Medical Assistance. Receive Timely and Accurate Payments for Covered Services Submit Fee-for-Service Claims to Medical Assistance Receive Timely and Accurate Payments for Covered Services This Chapter shows how to: Submit claims using any of the following methods: Direct data entry

More information

Users Guide to Internet Banking Self Service Enrollment

Users Guide to Internet Banking Self Service Enrollment Users Guide to Internet Banking Self Service Enrollment This document is a guide for customers who wish to use The Bank of Greene County s Self Service Enrollment Utility for Internet Banking The following

More information

Georgia Department of Revenue. georgia tax center. Quick Reference Guide

Georgia Department of Revenue. georgia tax center. Quick Reference Guide georgia tax center Quick Reference Guide 1 Table of Contents 1. Forgot Password or Username.. 3 2. Create a New GTC Profile.. 4 3. Register a New GA Business.. 5 4. Add Accounts to my GTC Profile. 6 5.

More information

EDI Enrollment Status Messages and Descriptions

EDI Enrollment Status Messages and Descriptions EDI Enrollment Status Messages and Descriptions APPROVALS Approved Claims Approved Remits Approved - Claims/Remits Approved Provider Approved DDE/PPTN Approved -New vendor Approved - Production Completed

More information

A Guide to the British Academy Electronic Submission System (e-gap2)

A Guide to the British Academy Electronic Submission System (e-gap2) INTERNAL USER GUIDE A Guide to the British Academy Electronic Submission System (e-gap2) A Quick Guide for Applicants applying for funding using the e-gap2 System The British Academy web page: http://www.britac.ac.uk/

More information

Eligible Professionals

Eligible Professionals South Dakota Medicaid EHR Incentive Payment Program Eligible Professionals User Guide South Dakota Medicaid EHR Incentive Payment Program Registration Steps for Eligible Professionals 1. Welcome Page:

More information