Quick Reference Guide for Part B Providers

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Minimum System Requirements...3

Online Help Feature ...3

Getting Started Using PC-ACE PRO 32 ...4

Submitter Setup ...4

Referring Physician Setup ...6

Facility Setup...7

Charges Master Setup (Optional) ...8

Medicare Solo Provider Setup ...10

Group Record Setup for Medicare...12

Individual Group Member Record Setup for Medicare...14

Claims Entry ...16

Prepare Claims Function...21

List Claim Features ...23

Reactivating Previously Transmitted Claims and Reactivation of Individual Claims...24

How to Backup PC-ACE Pro32 Claims Processing System ...26

Additional Features ...28

Tips and Hints ...30

Coordination of Benefits ...30

Medicare Secondary Payer ...32

Claim-Level Entry...36

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Minimum System Requirements

 Super video graphics array (SVGA) monitor resolution (800 x 600)

 Windows Vista, XP, or NT 4.0 operating system

 Adobe Acrobat Reader Version 4.0 or later (for overlaid claim printing)

Note: When the Windows ‘large fonts’ display setting is enabled, the screen resolution must be 1024 x 768 or higher. The CMS-1500 claim form will not display properly at lower screen resolutions.

Online Help Feature

The PC-ACE Pro32 program has an online help feature that can be accessed from the PC-ACE Pro32 Claims Processing System main menu.

1. Select Help, then select Help Topics (Figure 1).

Figure 1

2. Select the Index tab (Figure 2)

a. To search for a particular word, type a few letters of the word.

b. Select the index entry and select Display. That portion of the topic will appear. The information can be printed or read.

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Getting Started Using PC-ACE PRO 32

1. From the main menu of PC-ACE Pro32 Claims Processing System, select the PC-ACE Pro32 icon (Figure 3).

Figure 3

2. Select the Reference File Maintenance folder (yellow folder) (Figure 4).

Figure 4

3. Enter “SYSADMIN” in the User ID and Password fields in the Sign On box and select OK (Figure 5).

Figure 5

Submitter Setup

1. Select the tab marked Codes/Misc (Figure 6). 2. Select SUBMITTER.

Figure 6 3. Select the Professional button (Figure 7).

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Figure 7

General Tab

5. Enter submitter number (e.g., NYBXXXX) in the ID field (Figure 8). 6. Enter name and address of submitter.

7. Enter phone number and contact. 8. Select Save.

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Referring Physician Setup

Referring physician National Provider Identifier (NPI) record should be created for all doctors ordering diagnostic tests and consultations.

1. Select SUBMITTER on the Provider (Prof) tab (Figure 9).

Figure 9

2. Select New (found on bottom left of screen) (Figure 10).

Figure 10

3. Enter physician’s last name, first name, and middle initial (Figure 11). 4. Enter physician’s NPI number.

5. Select Save.

Figure 11

6. Select Close to exit Physician Information box (Figure 12).

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Facility Setup

A facility record must be created for all places of service other than home and office. If a modifier QU is utilized for a health professional shortage area (HPSA) location or if there is a second provider location within the same pricing jurisdiction, a facility record will need to be created.

1. Select FACILITY (Figure 13).

Figure 13 Select New (Figure 14).

Figure 14 2. Enter in the following fields: (Figure 15)

 Facility Name

 Address

 City/St/Zip

 NPI number for facility (only needed for purchased services and laboratory) 3. Select Save.

Figure 15

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Charges Master Setup (Optional)

To have charges automatically populate in charge field the charges master must be set up. 1. Select CHARGES MASTER (Figure 17).

Figure 17 2. Select New (Figure 18).

Figure 18

Charges Master Information

3. Fill in the following: (Figure 19)

 Enter procedure code in Code field. Description will automatically populate after entering

procedure code.

 Enter money amount in Charges field.

4. Select OK.

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6. Select Close to exit from the Reference File Maintenance box (Figure 21). Figure 21

To activate the Charges Master list do the following:

1. From the PC-ACE Pro32 Claims Processing System main menu, select File (Figure 22).

Figure 22 2. Select Preferences (Figure 23).

Figure 23

3. Under the General tab, select Use Charge Master Reference files for Professional procedure code lookups (Figure 24).

4. Select OK.

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Medicare Solo Provider Setup

To set up an individual provider number electronically, set up must be in a ten-digit format for the NPI. Note: Instructions for group provider and individual group members set up are on pages 12–14. 1. From the PC-ACE Pro32 Claims Processing System main menu select Reference File Maintenance

(yellow folder) (Figure 25).

Figure 25 2. Select Provider (Prof) tab (Figure 26).

Figure 26 3. Select New.

4. Enter the following information: (Figure 27)

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Field Name Information

Provider Type Select Solo Practice button.

Last/First/MI Enter practitioner’s name.

Address Enter practitioner’s address.

City/St/Zip Enter practitioner’s city, state, and ZIP Code.

Phone Enter office phone number.

Contact Enter contact name for office.

Provider ID/No. Use the ten-digit NPI number.

LOB (line of business) Press <F2> key to show list, then select MCB.

Payer ID Press <F2> key to show list, then select the appropriate payer ID.

NPI Enter ten-digit NPI number.

Tax ID Enter Social Security Number (SSN) or Employer Identification Number (EIN)

as appropriate.

Type Enter “S” for SSN or “E” for EIN.

Specialty Press <F2> key to show list, then select the appropriate specialty.

Type Org Press <F2> key to show list, then select the appropriate Org.

Accept Assign? Press <F2> key to show list, then select the appropriate assign code.

Participating? Press <F2> key to show list, then select Y or N.

Signature Ind Press <F2> key to show list, then select Y or N.

Signature Date Enter date electronic data interchange (EDI) agreement was signed for

electronic billing. 5. Select the Extended Info tab (Figure 28).

6. Enter Clinical Laboratory Improvement Act (CLIA) number, if appropriate. 7. Enter “XX” in the Group ID/No. field.

8. Select Save.

Figure 28

9. Select Close to exit the Reference File Maintenance box (Figure 29).

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Group Record Setup for Medicare

1. Select Reference File Maintenance (yellow folder) from the PC-ACE Pro32 Claims Processing System main menu (Figure 30).

Figure 30 2. Select the Provider (Prof) tab (Figure 31).

3. Select New.

Figure 31

4. New Provider Options box appears with Create a completely new provider (all fields blank) button selected (Figure 32).

5. Select OK.

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Figure 33

Field Name Action

Provider Type Select Group Practice button.

Group Name Enter group name.

Address Enter group service location.

City/St/Zip Enter group city, state, and ZIP Code.

Phone Enter office phone number.

Fax Optional field

Contact Enter office contact name.

Group ID/No. Enter ten-digit group NPI number.

LOB Press <F2> key to show list, then and select MCB.

Payer ID Press <F2> key to show list, then select the appropriate payer ID.

Group Label Enter abbreviation to link group to individual records.

Note: The group label is very important. A user-assigned identifier that is used to link the group and individuals within the group (e.g., “AMD” for American Medical Doctors) group label is assigned by the provider.

NPI Enter the group NPI number.

Tax ID/Type Enter tax identification number and “E” for tax ID.

Specialty Press <F2> key to show list, then select appropriate specialty.

Type Org Press <F2> key to show list, then select appropriate Org

Accept Assign? Press <F2> key to show list, then select appropriate assign code.

Participating? Press <F2> key to show list, then select Y or N

Signature Ind Press <F2> key to show list, then select Y or N

Signature Date Enter date EDI agreement was signed for electronic billing.

7. Select the Extended Info tab (Figure 34).

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Figure 34

Individual Group Member Record Setup for Medicare

1. Highlight group record and select New (Figure 35).

2. Select the Inherit name/address information from the selected provider button. 3. Select OK.

Figure 35

4. Change Group Practice to ‘Individual in Group’ (Figure 36)

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Provider Type Select Individual in Group button.

Last/First/MI Enter name of provider.

Provider ID/No. Remove provider number, and enter ten-digit NPI number of individual.

LOB Press <F2> key to show list, then select MCB.

Payer ID Press <F2> key to show list, then select appropriate payer ID.

Group Label Enter label used for group setup.

NPI Remove the group NPI, and enter the individual NPI number.

Specialty Press <F2> key to show list, then select the appropriate specialty ID.

Select the Extended Info tab (Figure 37).

5. Enter CLIA No./Mammography No. if appropriate. 6. Enter “XX” for the NPI in the Group ID/No Type field. 7. Select Save.

8. Select Close to exit the Reference File Maintenance.

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Claims Entry

1. Select the PROF icon from the PC-ACE Pro32 Claims Processing System main menu (Figure 38).

Figure 38

2. Enter “SYSADMIN” in Sign On box, if it appears (Figure 39). 3. Select OK.

Figure 39 4. Select Enter Claims (Figure 40).

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Field Name Information

LOB Press <F2> key to show list, then select MCB.

Billing Provider Press <F2> key to show list, then select the appropriate provider.

Patient Control No. Press <F2> key to show list, if patient has been added previously in the Patient Selection select the patient.

If the patient is not in the Patient Selection select New (Figure 42).

Figure 42 6. Enter in the following fields: (Figure 43)

Figure 43

Last Name/First Name/MI Enter patient’s name.

Patient Control No (PCN) Enter patient’s last name, space, first name. Or if preferred use a numbering system.

Address Enter patient’s address.

City/State/Zip Enter city, state, and ZIP Code.

Phone Optional

Sex Enter “M” for male or “F”for female.

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7. Note: Do not select Save.

8. Select the Primary Insured (Prof) tab (Figure 44).

Figure 44 9. Enter the following information: (Figure 44)

Payer ID Press <F2> key to show list, then select the appropriate payer.

Rel (relationship to insured) Enter “18” for self. Enter “01” for spouse. Enter “19” for child.

Insured ID Enter Medicare Health Insurance Number or subscriber number.

Assignment of Benefits Enter “Y” for yes or “N” for no.

10. Select Save.

11. The Professional Claim Form box will appear (Figure 45).

12. In box 10 enter “N” for condition related to employment and “N” for condition related to an accident. 13. In box 20 enter “N” for outside lab charges not included in claim or “Y” for outside lab charges

included in claim.

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Figure 45

15. When the Facility Setup box appears press the <F2> key for the facility information (Figure 46). 16. Select the facility.

Note: Additional facilities may be added by selecting New, then adding the facility data, and then selecting Save.

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17. Select Billing Line Items tab (Figure 47).

Figure 47

Claim Diagnosis Codes Enter up to four diagnosis codes.

Service Dates Enter dates of service.

PS (place of service) Press the <F2> key to show list, then select the appropriate value.

TS (type of service) Leave field blank.

Proc (procedure code) Enter procedure code.

Modifiers If necessary, press the <F2> key to show list for appropriate values, then select

modifier.

Diagnosis Enter values 1–4.

Charges Enter charge. Note: When entering a charge that includes cents, a decimal

point is required (e.g., $12.01, $25.24).

Units Only enter field if more than one unit.

Rendering Phys. If billing in a group, press the <F2> key to show list of rendering providers of service.

19. Select Recalculate (Figure 47). 20. Select Save.

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Prepare Claims Function

Medicare claims must be prepared and transmitted using communication software before another batch can be prepared. Failure to follow these instructions will overwrite the previous claim file. When ready to prepare claims for transmission, do the following:

1. Select PROF from PC-ACE Pro32 Claims Processing System main menu (Figure 48).

Figure 48

2. Select Prepare Claims (Figure 49).

Figure 49

3. The Professional Claims Prepare For Transmission box appears (Figure 50). 4. Select Prepare Claims.

Figure 50

5. The Confirm box appears and says, “Ready to prepare selected Professional claims for transmission?” (Figure 51).

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7. The Information box appears and says, “The claim operation has completed successfully.” (Figure 52). 8. Select OK.

Figure 52

9. The Claim Prepare For Transmission box appears (Figure 53). 10. Select View Results.

Figure 53

11. PC-ACE Pro32 Transmission Detail Report will appear. To print this report select the print icon (top of tool bar, to the left of Close). This report does not confirm the transmission of claims. The claim file must then be transmitted via the network service vendor (NSV) (Figure 54).

Figure 54

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List Claim Features

1. Select the PROF Processing icon from the PC-ACE Pro32 Claims Processing System main menu (Figure 65).

Figure 65

2. Select List Claims (Figure 66).

Figure 66

3. Enter the following information in the Claim List Filter Options box: (Figure 67)

Figure 67

 Location field– Select down arrow on right and select option to narrow search (Figure 68).

Figure 68

 Status field– Select down arrow on right, and select desired status (Figure 69).

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Reactivating Previously Transmitted Claims and Reactivation of

Individual Claims

To resubmit a transmitted claim, these claims must first be reactivated. Only claims in the transmitted (TR) location may be reactivated.

1. Select the PROF icon from the PC-ACE Pro32 Claims Processing System main menu (Figure 70).

Figure 70

2. Select List Claims (Figure 71).

Figure 71

3. Select Location (Figure 72). 4. Select CL (to be transmitted). 5. Select TR (transmitted only).

Figure 72

6. Check one claim or several claims to be reactivated. 7. Select Actions (Figure 73).

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Figure 73

9. The Confirm box appears (Figure 74). 10. Select OK to reactivate claim/claims.

Figure 74

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12. Reactivated claims will be listed with a status of “UNP”. These must be corrected before sending. 13. Double click the claim to open and make the necessary corrections (Figure 76).

14. Select Save.

Figure 76

15. The claim status will change to “CLN”. These claims are now ready to be prepared and transmitted.

How to Backup PC-ACE Pro32 Claims Processing System

Each time the program is exited the following message will appear: “Perform System Backup?” An external backup file of the program must be maintained in the event a fatal system crash occurs.

1. To do this, the backup may be placed on the desktop by selecting the Browse button and choosing the hard drive (system C) and desktop (Figure 77 and 78).

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2. This will put the backup file named PCACEPBK.ZIP on to the desktop (Figure 79).

Figure 79

3. From the desktop, save to a CD-ROM or flash drive. This external device must be maintained to assure the restore capabilities in the event of a fatal system crash.

4. Select My Computer on the desktop and drag the PCACEPK.ZIP file from the desktop to the CD-ROM and then burn it, or drag to the flash drive (Figure 80).

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Additional Features

Copying Claims

To bill claims that are identical (e.g., same patient, same procedures, etc) except for the dates of service, instead of creating a new claim each time, simply copy the previous claim, enter the correct dates of service, and save it.

1. In the Professional Claims Menu window, select List Claims.

2. In the Professional Claim List window, in the bottom left section of the screen, choose the Location of TR–transmitted only.

3. Put a check mark in the box in front of the claim(s) to be copied. 4. On the Actions Menu, select Copy All Checked Claims. 5. Select OK in the confirmation window.

Note: If only one claim is chosen to copy, the Professional Claim Form will be displayed instead of the Professional Claim List window. Change the dates of service and save the claim.

6. In the bottom section of the window, select the Location of CL–to be transmitted. The claims will be listed and have a status of UNP.

7. Double-click each claim in turn, enter new dates of service 8. Select Save.

Reactivating an Entire Batch of Claims

Changes cannot be made to a batch of claims that has been reactivated. This operation will restore the batch of claims so that it can be retransmitted. To make changes to already-transmitted claims, see the section titled Reactivating Claims.

1. In the Professional Claims Menu window, select the Maintain Menu

2. Select Transmission Log. The Professional Claims Transmission Log window will be displayed. 3. Select the batch of claims to reactivate. To see a summary of what is in the batch, highlight the line, then

select View Details.

4. Once the batch of claims is determined to reactivate, highlight the line and select the Reactivate button. 5. Read each window that pops up, then select OK in each.

6. Transmit this batch before selecting the Prepare Claims button.

Archiving Claims

Archiving claims in PC-ACE Pro32 improves performance and helps prevent database corruption. 1. Select the Prof button on the main toolbar.

2. Select the List Claims button. 3. Select the File Menu

4. Select Maintain Claim Archives

5. Select the New button and enter a name for the archive 6. Select OK.

7. Select the Close button.

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10. Select the Advanced Filter Options button near the bottom of the Professional Claim List window, and enter the filter criteria.

Example: If today’s date is March 13, 2009, to archive everything except the past three months, do the following:

 Check the box in front of “Invert filter logic…” at the bottom of the Advanced Claim List Filter

Criteria window.

 Enter “01/01/2009” in the first box in the Transmit Date: field, then enter “3/13/2009” in the second

box.

 Select OK.

 The Professional Claim List window appears and the only claims displayed are those that were

transmitted more than three months ago. These are the claims to be archived.

11. Select the Filter Menu and select check all claims. Each claim now has a checkmark in the box at the left of the line it is on.

12. Select the File Menu and select Open Claim Archive

13. Double-click the archive that was created in the steps above. An information window will pop up. Read the contents, then select OK.

14. Select the Actions Menu and select Archive All Checked Claims (near the bottom of the Actions menu.) Do not select Archive Selected Claim, as that will only archive the claim that is highlighted. 15. An information window will appear. Read the contents, then select OK.

16. The claims are no longer shown in the list. They are not gone, they have been stored in the archive. To see these claims, select the File menu, then select View Archived Claims.

Note: Do the following to view these claims again once PC-ACE Pro32 has been exited:  Open the claims list

 Select the File Menu and select Open Claim Archive.

 Double-click the archive to view, read the information in the pop-up information window, select

OK.

 Select the File Menu and select View Archived Claims.

 To see current claims, select the File Menu and select View Current Claims.

Transferring PC-ACE Pro32 to Another Computer

1. On the old computer, upgrade PC-ACE Pro32 to the current version.

2. On the new computer, install the full installation of the current version from our Web site. 3. On the old computer, open PC-ACE Pro32.

4. On the main toolbar, select the last button, which has a gear and a wrench on a French flag.

5. Sign in. The System Utilities window is displayed, the Backup/Restore tab should be selected and the Backup sub-tab displays the text “This utility performs a backup…”

6. Select the small button with three dots on it at the right end of the Destination Drive or Folder field. 7. In the Select Backup Destination Directory window, select the drop down arrow at the right end of the

Look in field, select Desktop at the very top of the list, then select the Open button. The System Utilities window will appear.

8. Select the Start Backup button and select OK in the Confirm window.

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10. In the System Utilities window, select the Validate sub tab, browse to the computer’s desktop as in the earlier steps, then select the Start Validate button

11. Select OK in the Confirm window.

12. When the validation is complete, the Information window will appear with the text “The validation operation has completed successfully:”

Note: If the text indicates that the validation failed, please contact the National Government Services EDI Help Desk.

13. Select OK in the Information window

14. Select the Close button in the System Utilities window.

15. The back up file on the computer’s desktop is named PCACEPBK.ZIP. Copy this file to the desktop of the new computer.

16. On the new computer, open PC-ACE Pro32

17. On the main toolbar, select the last button, which has a gear and a wrench on a French flag (as directed above).

18. Sign in. The System Utilities window will appear and the Backup/Restore tab should be selected and the Backup sub tab displays the text “This utility performs a backup…”

19. Select the Restore sub tab, browse the computer’s desktop, and select the Open button. Do not select the file, because the program knows the file name already.

20. Continue with the restore, following the prompts. Once it is complete, PC-ACE Pro32 on the new computer is identical with what was on the old computer.

Tips and Hints

 Pressing the <F1> key while a PC-ACE window is open will display the online help for the active

window.

 A right-click in many fields will display a list of valid values for that field; select the value to insert.

 Pointing at a field with the mouse cursor will briefly display a description of what goes in that field.

 When entering certain procedure codes in the Billing Line Items window causes a new sub tab to

appear at the right end of the billing line items sub tabs (e.g., podiatry or chiropractic procedure codes that require more information.) The tab is line-item-specific, so if there are two lines, each with a code requiring more information, the tab will appear for each line, and must be filled out with each line. To make the tab visible for a line, select in any field on that line.

 When entering billing line items, to copy information from the field or line directly above a field or line,

select on the field or line to copy to, then press the <F4> key to copy the value directly above the field, or press the <F5> key to copy everything from the line above except the dates of service.

Coordination of Benefits

The Professional Claim Form includes fields to allow entry of coordination of benefits (COB) information at the claim or line adjustment level. Claims submitted to secondary payers may be required to report the payment remittance data returned by prior payers.

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Examples

Claim level: When there is only one line of service or on rare occasions when all the lines of service are the same except the date.

Line level: When there are multiple lines of service to be billed. Both instructions are enclosed.

The COB screens are hidden to minimize confusion.

1. To show the COB screens on the claims, enter a “Y” in the COB? field located at the bottom right of the Patient Info & General tab (Figure 81).

Figure 81

2. This will trigger the display of primary and secondary claim level COB Info sub tabs from the Extended Payer/Insured tab and line-level MSP/COB tabs on the Billing Line Items tab (Figure 82).

Figure 82

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Figure 83

Medicare Secondary Payer

Claim-Level Adjustment Entry

When entering a claim for MSP the EOB or remittance from the primary insurance carrier is needed in order to enter the information that is necessary on the screens. This information is necessary for Medicare to process the secondary claim.

To start the secondary claim, enter the primary payer and patient data (Figure 84).

Fiqure 84

Adding a Primary Payer

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Figure 86

4. Filled in the following fields: (Figure 87)

Figure 87

Payer ID Type the insurance ID (99999 can be used if the ID is not known).

LOB Press the <F2> key and pick appropriate code.

Full Description Type the name of the primary insurance company.

Source Click in the field, press the <F2> key and pick appropriate code.

Media Click in the field, press the <F2> key and pick appropriate code.

Usage Click in the field, press the <F2> key and pick appropriate code.

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Figure 88

7. Fill in the following required information for the patient: (Figure 89)

Figure 89

Last Name Enter the patient’s last name.

First Name Enter the patient’s first name.

Patient Control No (PCN) Enter the Patient account number assigned by the office.

Active Patient Press <F2> key and select appropriate code.

Sex Press <F2> key and select appropriate code.

DOB Enter patient’s date of birth.

Signature On File Press <F2> key and select appropriate code.

Release of Info Press <F2> key and select appropriate code.

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8. Select Primary Insured (Prof) tab, right click in the Payer ID and pick the primary insurance for this patient. Note: If the primary insurance does not appear on the list, follow the instructions above for entering it.

9. Fill in the following fields: (Figure 90)

Figure 90

Rel Press <F2> key and select appropriate code

Insured ID Enter the ID from the insurance card

Assign of Benefits Press <F2> key and select appropriate code

Note: Many of the fields will auto fill from data entered on the General Information tab. 10. Click on the Secondary Insured tab and choose Separate Inst & Prof (Figure 91).

Figure 91

11. The tab name will change to Secondary Insured (Prof).

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Figure 92

Rel Press <F2> key and select 18

Insured ID Enter the HICN from the Medicare card

Assign of Benefits Press <F2> key and select appropriate code

Note: Many of the fields will auto fill from data entered on the General Information tab.

Claim-Level Entry

1. When creating a claim level MSP claim, enter the appropriate information in the Patient Info & General tab and type “Y” in the COB? Field (Figure 93).

Figure 93

2. Select the Billing Line Items tab and enter the appropriate information. 3. Select Ext. Patient/Insured tab.

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Figure 94

5. Fill in the following fields: (Figure 95)

Figure 95

Allowed Fill in the total allowed amount which should be the same as the

balance due on the Billing Line Items tab.

Paid Fill in the total amount paid.

Insurance Type Press <F2> key for appropriate values.

Zero Payment Ind Press <F2> key for appropriate values.

Claim Level Adjustments (CAS) Take values from EOB or press <F2> key to select appropriate value.

COB/MOA Amounts Take values from EOB or press <F2> key to select appropriate value.

Claim Adjudication Date Enter date of remittance from the primary payer.

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Example

In this example, the information from the EOB is entered into the Common Payer MSP Information (the balance due in the billing line items must equal the claim amount from the EOB), then details are entered in the Claim Level Adjustments (CAS) section and COB/MOA Amounts section (Figure 96).

Figure 96

Claim Level Adjustments

Num 1 Code CO = Contractual Obligations.

Num 1 Reason 45 = Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement (use group codes or CO depending on liability.)

Num 1 Amount = Disallowed other from common payer MSP information Num 2 Code PR = Patient responsibility

Num 2 Reason 2 = Coinsurance amount

Num 2 Amount = Coinsurance from common payer MSP information

COB/MOA Amounts

Num 1 Code D = Payer paid amount

Num 1 Amount = Paid from common payer MSP information

NOTE: If more lines are required, click the down arrow.

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Edits Associated with MSP Claims

M384– INVALID VALUE 2300/CLM02

If there is a primary paid amount on the claim, the paid amount plus all line level and claim level adjustment amounts must equal the total claim charge.

M304– REQUIRED INFO MISSING 2320/AMT

If a claim level allowed amount and primary payer paid amount submitted on a claim, either the line level allowed amount or line level adjudication information is missing.

M312– INVALID MSP AMOUNTS 2320/AMT

If the payer being billed is the primary or secondary payer, the secondary or tertiary payer paid information cannot be submitted on the claim as the secondary or tertiary would not have paid on the claim yet.

M301– REQUIRED INFO MISSING 2400/SVD

The MSP claim approved amount has been submitted but the line level primary paid is missing.

Line-Level Entry

When entering a claim for MSP, enter the claim as a line-level adjustment entry. The EOB or remittance from the primary insurance carrier is needed in order to enter the information that is necessary on the screens. This information is necessary for Medicare to process the secondary claim.

1. Enter “Y” in the COB? field at the bottom of the Patient Info & General window (Figure 97).

Figure 97

2. Enter the billing information on each line of service

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Figure 98

4. Select the MSP/COB (Line 1) sub tab. 5. Fill in the following fields: (Figure 99)

Figure 99

Service Line Adjudication SVD Information

P/S Press F2 for appropriate values

PROC Press F2 for appropriate values

Qual/Code Procedure Code

Modifier Enter any modifiers (if necessary)

Paid Amount Enter amount paid

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Line Level Adjustment (CAS)

Group Press F2 for appropriate values

Reason Press F2 for appropriate values

Amount Amount of adjustment

Units Units

Adj/Payment Date Date of Remittance from the primary payer

Note: This information must be entered for each line of service.

The SVD paid amount and the line-level adjustment amount (CAS) must equal the submitted amount. 6. After entering the information for each line of service, the Ext Payer/Insured screen can be accessed. 7. Select the Info (Primary) tab.

8. Information has to be entered in the following fields:

Allowed Fill in the combined total allowed amount for all services.

Paid Fill in the combined total paid amount for all services.

Insurance Type Select <F2> key for appropriate values

Zero Payment Ind Select <F2> key for appropriate values