DDE for Dental Claims Submission

Size: px

Start display at page:

Download "DDE for Dental Claims Submission"

Stewart Newman
8 years ago
Views:

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 1 Today we will learn how to create, save and submit Dental claims using ND Health Enterprise MMIS. Learning Objectives: