Open up Internet Explorer, Version 7 or above. Go to:

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1 Open up Internet Explorer, Version 7 or above. Go to: HMSA e-claim System: Call HMSA EDI Helpdesk at on Oahu or 1 (800) from the Neighbor Islands. Enter your HHIN User ID and Password. Click on the HMSA e-claims located at the top of the HHIN Home Page Connecting to HMSA e-claims screen will appear. You will be taken to the main page of the HMSA e-claim System (also known as My Portal). Entering a Claim Click Generate DDE Claim under Data Management. Select the following values in the 4 drop-down fields: CMS-1500, Primary, Your office name, and HMSA. Click on the Next button right below the last field entry. Click on My Portal located at the upper left hand corner to get back to the main page. The options buttons at the top of the CMS-1500 claim form are also located at the bottom of the screen. Reset will erase what you have entered. Use the Cancel when you do not want to enter a claim this will take you to the Manage DDE Claims screen. The last two buttons will be discussed below. The Claim Number and DCN fields are pre-filled with a system-assigned claim number. Also, the Claim option to the right is the default do NOT change it to Encounter for your claim. Use scroll bar on the right side of your screen to efficiently move vertically on the form. Use the mouse wheel when you are entering service lines and need to move vertically in Box 24 on the CMS-1500 or Box 42 on the UB04 form. When moving between fields in the CMS-1500 or UB04 form, use the TAB key or the mouse. Pressing the ENTER key will bring up a warning message shown to the right. Do not enter asterisks (*), equal signs (=), pound signs (#), caret symbols (^), hyphens (-), apostrophes ('), underscores (_), periods (.) or percentages (%). (For example, tax ID, diagnosis code, address, phone number, etc.). Nonalphanumeric characters may cause problems when the claim is sent to HMSA. * Fields with a red asterisks are required. * Fields with an S or Select indicate that you can search for a value in a table (ex: diagnosis, CPT, modifier). No blank spaces at end of a data field. This will cause a HIPAA rejection at the HMSA EDI front-end system. HIPAA guidelines affect how and what you enter in an electronic claim. These rules do not apply to a paper claim. To avoid rejections at the HMSA EDI front-end system: Enter NPI or Secondary Provider Identifier (State License and UPIN Numbers). At least one identifier is required in an e-claim. Box 17 Referring Provider and 32 Service Facility on the CMS-1500; and Box 82 Service Facility, 76 Attending, 77 Operating, 78 Other Operating, 79A Referring, 79B Rendering Providers and 82 Service Facility on the UB04 form. Search the NPI Registry at: 1

2 New e-claim User CMS-1500 Setup - Setting up Boxes 31, 33, and 36 Box 31: Name of Physician or Supplier If the name and NPI of the provider who renders the service is the same as the Billing Provider in Box 33, do not enter the information in box 31. If the provider rendering the service and NPI are not the same as in Box 33 and 33A, click on Select in Box 31 and click Yes when asked Do you want to add a new physician? A 9-digit zip code is required. Exclude special characters (hyphens). Select Yes from the Default dropdown, and then click Add to save the information. The rendering provider information will now appear every time you access the CMS-1500 form. Box 32: Name and Address of Facility Where Services Were Rendered If services were rendered outside the home or office, click on Save/Look up Facility Info. Select No in the Default dropdown if this location will not be relevant for most claims. Click on the option button next to the facility just entered. Enter the NPI in Box 32A. If services are rendered in the office for the next claim and Submit and Add Another is used for the prior claim (with Box 32 populated), delete each field in Box 32 for the next claim. Box 33: Physicians Supplier s Billing Name and information To save billing physician information in box 33, click Save/Look up Provider Info, then click Yes when asked, Do you want to add a new Billing? If your practice has a group name, it should be entered in the Last Name field. Do not use the first and middle name in that case. Select Yes from the Default dropdown, and then click Add to save the information. The billing provider information will now appear every time you access the CMS-1500 form. Enter the street address only in Box 33 no PO Box. PO Box goes in Box 36. Box 36: Pay to Provider Address The Pay To Provider Address is only required when the address where the payment goes is different from the Billing Physician s address in Box 33 (eg: a PO Box). If the address is the same, do not complete Box 36. 2

3 1.Adding a patient who is also the insured member A. Box 1: Use BL for HMSA PPO & HMO plans and Blue Cross/Blue Shield plans (Blue Card), MC for the HMSA QUEST plan; or FI for the BCBS Federal Employees Health Benefits Plan. B. Box 1A: Click on the Save/Look up Member Info to search for or add subscriber and patient information. Do NOT enter the insured and patient information directly into the CMS-1500 claim form. C. Select Add Insured from the Member Search box. ***The Insured Member box to the right must be completed to save your subscriber and patient information for this claim and for future use. D. Complete the Insured Member: Enter the Subscriber ID. The format of HMSA Plan is 13- characters; Quest is 10-numeric characters; BCBS Federal Employees Health Benefits Plan is 9-characters; BlueCard plans use the exact number as shown on the card. Enter the Address, City, State, and valid Zip Code. Select Sex and enter Date of Birth. The phone number, insured s policy group or FECA number, and employer/school name are not required. Enter HMSA in the Insurance Plan Name or Program Name box. Click Add. E. You will then see the following: Click on the option button for the insured. F. A message box will appear: Click Yes the patient is also the insured member. The data entered in the Insured Member screen is now populated into the CMS-1500 form. 3

4 2. Adding a dependent of the Insured Member. If your patient is not the insured and instead, is a dependent of an insured member, use the following instructions. A. Follow instructions in step #1A to 1D (above this) to add the Insured Member. Click Yes to the question that appears Do you want to add a new Patient Member? B. Complete the Patient Member box: Select appropriate Sex. Enter Date of Birth. Select the appropriate relationship to the insured. The phone number is not required. Click Add. C. You will then see the following: Click on the option button for the patient. The dependent s data is populated in boxes 2, 3, 5 and 6; and the insured s data in boxes 7 and Patient is covered by a secondary plan (For example: secondary HMSA plan) A. If Box 11D is yes, also complete Box 9. Enter HMSA in the Insurance Plan Name or Program Name box. After completing the form and clicking on Submit, the Coordination of Benefits screen will be displayed: Enter for Payer ID Secondary for Payer Responsibility Yes for Release of Info Code C1 for Insurance Type Code CI for Claims Filing Indicator Code 4

5 CONTINUE ENTERING THE CLAIM Box 24A. Date of Service: Multi-service claim time-saver: After entering service line 1, begin entering service line 2 by entering the month. Use the Copy feature in box 24A. This will copy the day, year, and number of units to other line items in box 24G. Box 24F, $ Charge: When entering monetary amounts, notice that there are two separate blanks for dollars and cents. Do not use the decimal point, but rather enter the dollar amount first, then tab to enter the cents. Box 28, Total Charge: You can make sure that the charge amount in box 24F has been entered correctly by clicking the Calculate link and compare the total with the invoice/fee ticket. and Box 25: Federal Tax ID #: Enter your Tax ID And click on the option for EIN. Box 26: Patient Account Number is a required field in an e-claim. Complete the CMS-1500 and select Submit. Refer to Notes about CMS-1500 form below for information on Boxes 14, 17, and 19/22. After clicking on Submit, you will be in the Manage DDE Claims screen that shows the claim you just entered. Click on DCN number, which is the 4 th column from the left. Click on Printer Friendly to print the claim you just entered and follow the instructions listed on the right. Other options shown at the top of the page are: Click Do Not Resubmit for a claim you do not want the e-claim System to process (this option is shown in the red box, far left). Click on Edit to correct the claim you just entered (Status T-Txn Loaded) or claim already submitted and rejected (Status E-Error). 5

6 Notes about CMS-1500 form Box 14 Date of Current Illness/Injury/Pregnancy: Do not enter a date in Box 14 if this date is the same as the date of service in box 24A. Box 17 Name of Referring Physician: If a referring physician name is required for the type of claim you are submitting, enter the last and first name. Box 17B: At least one Referring Physician identifier is required in an e-claim. You can search the NPI Registry at: Boxes 22 (Medicaid Resubmission Code) and 19 (Reserved for Local Use): You can resubmit a corrected claim and void a previously submitted claim electronically. The following must be completed to avoid a duplicate claim denial: Box 22: Medicaid Resubmission Code. Select Code = 7 (Replacement) or 8 (Void). Box 22: The Original Ref. No. must contain Original HMSA Claim ID, which appeared on your HMSA Report To Provider (EOB) for the original claim submitted. Box 19: Enter the reason for claim resubmission or void. Box 24D Procedure Code/CPT: There can only be one S9999 tax line per electronic claim. Box 31, 32, 33 NPI number: Ensure that the correct NPI appears on the claim. Refer to the HIPAA guidelines about the NPI on Page 1. If your office adds or changes an NPI used in Box 31 or 33, call the HMSA EDI Helpdesk at This change must be reflected in your office setup. 6

7 CLAIM CORRECTION: for a claim just entered (Status T) or rejected by the edits in the e-claim or the HMSA EDI Systems (Status E) From My Portal, select Manage DDE Claims under Data Management. When you first access Manage DDE Claims, click to view all rejected and/or recently entered claims. A. Click Reject/Error to see a Claim Status Information box that will reveal the reason for the rejection. If more information is needed to correct the rejected claim, call the HMSA EDI Helpdesk at on Oahu or 1 (800) from the Neighbor Islands. B. Correct a claim with a Status Txn Loaded or Status E(Reject/Error) by clicking on the DCN number assigned to the claim and then clicking on Edit. C. If the information about the insured and/or patient is incorrect, click on Save/Look up Member Info in box 1a. Search by the Subscriber ID or the last name of the INSURED. D. If the information about the insured member is incorrect, click on Edit next to the Insured. Let s say that the format of the subscriber number is incorrect. Make the appropriate change (For example, add several zeroes after the initial alpha character of the HMSA plan, for a total of 13 characters) and click Update. If the patient is the insured, now click on the option button next to the Insured Member. The revision just made will now populate the CMS1500. Select Submit. E. If the information about the patient is incorrect, click Edit next to the patient. Let s say that the date of birth is incorrect. Make the appropriate change and click Update. If the patient is the dependent of the insured, click on the option button next to the Patient. The revision just made will now populate the CMS-1500 Select Submit. Doug, Dean, Guy and Keith are available to assist you. Let us know what office you are calling from and that you are using the HMSA e-claim System. Give us the name of the patient and date of service. Another option is the DCN number highlighted below. 7