Web Portal Tutorial –
Waiver
Enter your user ID and password.
To Set up Templates:
When building a template, you will want to enter the information that will not change for each claim. You can think of this like pre-filling blanks on a paper form, prior to making copies of it. When you use the template to make the claim, these pre-filled areas will remain filled in and you will not have to enter this information again.
Note: There are red + signs before certain areas that allow additional information to be entered. Selecting the red + will expand the area. Only expand and enter information that is required, as entering invalid/incorrect information can cause a claim to reject. The below information will instruct you in which areas are required to be completed.
• Are you resubmitting this claim – always answer no
• Billing/Pay-To Provider – Select your pay-to provider ID from the drop down list. Remember to use your NPI if you are required to bill with an NPI. If the provider information you need is not in this drop down list, contact the ACS EDI Call Center at 800-672-4959, option 3
o Taxonomy Code – enter the pay-to provider’s taxonomy code o Do not enter any information below the taxonomy in this area
• Is the Billing Provider or Pay-To Provider also the Rendering Provider – Select Yes or No. If Yes is selected, continue. If No is selected, enter the NPI for the rendering provider, choose National Provider Identifier and select the red + before Additional Rendering (Performing) Provider Information and enter the taxonomy for the rendering provider.
Note: If this information will change with each claim, leave this section blank in the template
• Does the subscriber have insurance other than Medicaid – select No • Select the red + next to Prior Authorization
o Enter the Prior Authorization Number • Is the claim accident related – select No
• Does this claim have backup documentation – select No • Patient Account Number – Enter your unique identifier for this • Select the red + next to Additional Claim Data
o Place of Service – Select the appropriate place of service from the list o Provider Signature on File – Select Yes
o Medicare Assignment Code – No
o Benefits Assignment Certification – Select Yes
o Release of Information Code – Select Provider Has Signed Release
Line Item Information:
If you are building a template for a client whose procedures never change, you can pre-enter your procedure code information.
• Service Date From / To – Enter your dates of service • Place of Service – Select your place of service • Procedure Code – Enter your CPT or HCPCS code • Modifiers – Enter any appropriate modifiers
• Submitted Charges – Enter the total amount for this line item • Units – Enter the units for this line
• Select Add Service Line Item
This will move your line item to the Previously Entered Line Item Information area to prepare for submission.
Select Save Template when all information has been entered.
Creating a claim from a template
The template will open in a new claim, where you can enter or change any information that is missing or needs updated/changed.
To change line items:
Select the number at the beginning of the line that you wish to change. This will load the information back into the entry fields.
To delete a line item:
Select the word Delete to the right of the line item you wish to delete.
Once all changes and updates have been made to your claim, select the verify button at the bottom of the screen.
This will check your claim for any errors that can be identified before the claim is processed through our system. There may still be errors that cannot be determined until the claim is submitted and processed, but, this will catch many kinds of errors and allow you to fix them before submitting.
If you have questions regarding the errors, contact ACS EDI Help Desk at 800-672-4959, option 3 for assistance.
Select Save Claim
Select Return to Previous Page
Select Submit Claim