1 Training Module 2 Building Reference Files PC-ACE Pro32

Palmetto GBA – October Objectives PC-ACE Pro32 provides the ability to enter and store frequently used information in reference files to allow for quick and easy claim entry. After completing this training module, you should be able to:  Enter information into the following Reference Files.  Patient  Payer  Provider  Submitter  Optional Files

Palmetto GBA – October Disclaimer The information provided in this presentation was current as of 10/14/2011. Any changes or new information superceding the information in this presentation are provided in articles with publication dates after 10/14/2011 posted on our Web site at: Palmetto GBA strongly encourages you to check the Web site for updates that may have occurred after the publication date of this module.

Palmetto GBA – October Software Shortcuts  Hold your cursor still over a field and a small pop-up will display information on that field.  Right-click or press F2 to bring up a list or reference file  Press F5 to duplicate all the fields from the previous line  Press F4 to duplicate a single field from the previous line  Press F7 to delete an entire line Software shortcuts help provide a quick and easier method of navigating and using computer programs. Listed here are shortcuts to be used with PC ACE Pro 32:

Palmetto GBA – October How to bring up Reference Files Click on the yellow file folder (third icon) to bring up the Reference Files. A Sign On Screen will appear. Type the following as your default User ID and Password: SYSADMIN Important: Change the default user’s password as soon as possible if you are concerned about user access at your facility.

Palmetto GBA – October Patient Reference File The Patient Reference File saves time and keystrokes by storing information specific to a patient. From the Reference File Maintenance screen, click on the Patient tab and then click on New.

Palmetto GBA – October Patient Reference File When you click on New, the Patient Information screen is displayed. This screen has several tabs. Initially, the General Information tab will be displayed. This tab contains basic Patient information. The next tab is the Extended Info tab. This tab contains fields for Patient’s Legal Representative. These fields are for 4010 Professional Claims. Following that is the Primary Insured tabs. For Institutional and Professional. These tabs contain information about the Primary Payer and the Insured for that payer. Then there are the Secondary and Tertiary Insured. These tabs contain information about the Secondary and Tertiary Payers and Insured.

Palmetto GBA – October Patient Reference File On the General Information tab, complete the highlighted fields. Right click in the following fields to choose from valid selections: Sex Signature on File Release of Info Signature on File has two fields: the first is for Institutional; the second is for Professional. ROI Date is the date the patient signed the Release of Info. Contact the Provider for needed information

Palmetto GBA – October Patient Reference File Two of the tabs on this screen are titled, Primary Insured (Inst) and Primary Insured (Prof). Select the appropriate tab depending on whether you are billing Institutional or Professional claims. The screens for these options differ slightly.

Palmetto GBA – October Patient Reference File Right click on the Payer ID field Select the Plan Payer for this Patient. The Payer fields will be automatically populated. Right click on the Rel field Select the relationship of the Patient to the Insured for this Payer. For Medicare claims the code should be 18. The Insured fields will be automatically populated. Insured ID – Enter the patient’s Health Insurance Claim Number (HICN) Right click on the Assign of Benefits and Release of Info fields and select the appropriate values. Contact the Provider for needed information Click on Save

Palmetto GBA – October Patient Reference File Encounter claims are sent to Medicare with Medicare as the Secondary Payer. The Secondary Insured tab is used to provide information on the Encounter Medicare Payer

Palmetto GBA – October Patient Reference File Under the Insured Information Options, click on the Separate Inst & Prof button Click on either the Secondary Insured (Inst) or Secondary Insured (Prof) tab. Fill in the fields the same as was done in the Primary Insured tabs.

Palmetto GBA – October Payer Reference File Most Palmetto Payer IDs are pre-loaded into PC-ACE Pro32.  For Encounter Medicare Payers, enter the payer information for the Institutional and Professional payers.  For Plan Payers, enter the payer information and indicate the Plan can be used for both Institutional and Professional payers.  For Durable Medical Equipment Payers, enter the payer information.

Palmetto GBA – October Payer Reference File If you need to add a payer, click on the Payer tab from the Reference File Maintenance screen and then click on New.

Palmetto GBA – October Payer Reference File Complete the highlighted fields: Payer ID Line of Business* Full Description Source* Media* Usage* *right click in field and make a selection Click on Save. Full Description Field ValuePayer IDLOBSourceMediaUsage Medicate Part A80881MCAMAEU Medicare Part B80882MCBMBEH Durable Medical Equipment80887MCBMBEH (Plan Name)(Plan ID)(Plan LOB)16EB The DME and Encounter Medicare Payers need to be entered into the Payer Information File through this screen. Plan Payers can also be added through this screen.

Palmetto GBA – October Provider Reference File The Provider Reference File contains information on Billing and Rendering Providers. There are two separate Provider Reference Files: Provider (Inst) for Institutional or Part A claims Provider (Prof) for Professional or Part B claims Select the Provider Tab that applies to your facility or practice.

Palmetto GBA – October Provider Reference File On the Provider (Inst) or Provider (Prof) tab, click on New. On the New Provider Options screen there is a choice to create a new empty record; or to inherit information from a selected provider. Make a choice and click on OK.

Palmetto GBA – October Institutional Provider Information Complete the highlighted fields. Right click in the following fields to choose from valid selections: LOB (MCA) Tax ID/Type Payer ID* * If you want to associate this Provider with a specific Payer. Enter the NPI in the Provider ID/No field. Enter optional Tax Sub ID and Taxonomy/Type if needed. Click on the Extended Info tab.

Palmetto GBA – October Institutional Provider Information Right click on the following fields to choose from valid selections: Provider ID/No Type – select XX for NPI Provider Accepts Assign – select A or C (Contact Provider for setting) Provider SOF (signature on file) – select Y or N (Contact Provider for setting) Click on Save.

Palmetto GBA – October Professional Provider Information Determine Provider Type Step 1: Determine the Provider Type If the Medicare PTAN (Provider Transaction Access Number) is linked to others and there are members, use Group Practice If the Medicare PTAN is linked to others and belong to a group, use Individual in Group If the Medicare PTAN is not linked to any other PTAN and there are no members, use Solo Practice

Palmetto GBA – October Professional Provider Information Group Practice Select Group Practice as Provider Type. Enter Group Name, Address, and Contact Enter Medicare PTAN in Group ID/No field. Enter a unique label in the Group Label field. Enter NPI Right click in the following fields to choose from valid selections: LOB (MCB) Tax ID/Type Click on Save. Specialty Accept Assign? Participating? Signature Ind/Date Contact Provider for information

Palmetto GBA – October For Group Practices, add the individual providers which make up the group. PC- ACE Pro32 allows you to save a few steps in these cases. Highlight the Group Practice on the Provider (Prof) screen and then click on New. On the New Provider Options window, select Inherit name/address information from the selected provider and then click on OK. Professional Provider Information Individual in Practice

Palmetto GBA – October The items shown in green will auto fill with information from your Group Practice Provider and may need to be altered with the Individual Provider’s information. Enter the Provider’s Name Enter the Provider’s Medicare PTAN in the Provider ID/No field. Right click in the following fields to choose from valid selections: LOB (MCB) Group Label Enter the Provider’s NPI Enter the Provider’s Tax ID/Type if different from the group. Click on Save. AUTO FILLED Professional Provider Information Individual in Practice

Palmetto GBA – October Professional Provider Information Solo Practice Select Solo Practice as Provider Type and complete the highlighted fields. Enter Provider’s Name, Address, and Contact Enter the Medicare PTAN in Provider ID/No field Enter Provider’s NPI Right click in the following fields to choose from valid selections: LOB (MCB) Tax ID/Type Click on Save Specialty Accept Assign? Participating? Signature Ind/Date Contact Provider for needed information

Palmetto GBA – October Submitter Reference File The Submitter Reference file contains information on the submitter of the electronic claims file. Click on the Codes/Misc tab from the Reference File Maintenance screen. Under Shared, click the Submitter button.

Palmetto GBA – October Submitter Setup Under Claim Type, click on either Institutional for Part A or Professional for Part B Submitter Set up. You will see an example submitter. The example submitter should not be changed. Click on New to add your submitter information.

Palmetto GBA – October Submitter Setup On the General tab, required fields are populated. LOB - Select MCA (Institutional) or MCB (Professional) Payer ID – Select the Payer this Submitter is associated with ID – Submitter ID Submitter’s Name and Address Submitter’s Contact and Phone Number

Palmetto GBA – October On the Prepare tab, complete the following fields: Include Error Claims – Y/N Submission Status – P = Production or T = Test EMC Output Format – A ANSI 837 Output ANSI Version (837) – Institutional – A2 – Professional – A1 ANSI Version (270) – Institutional – A1 – Professional – A1 ANSI Version (276) – Institutional – – Professional – EMC File – Alternate Drive, Directory, and Filename Vendor – Optional Vendor Nbr if required by distributor Intermediary – Intermediary ID Force Separate Prepare – Y/N Blank = N Submitter Setup

Palmetto GBA – October On the ANSI Info tab, enter the following: Submitter Intchg ID Qual – ZZ Receiver Intchg ID Qual – ZZ Authorization Info – Blank Security Info – Blank Acknowledgment Requested – 0 = No; 1 = Yes Additional Submitter Contact Info – Enter Contact Name – Select Contact Type Submitter Setup

Palmetto GBA – October On the ANSI Info (2) tab, enter the following: ISA06 – Submitter ID ISA08 – Payer ID GS02 – Submitter ID GS03 – Payer ID NM109/1000A – Submitter ID NM103/1000B – Payer Name NM109/1000B – Payer ID Submitter Setup

Palmetto GBA – October On the ANSI Info (3) tab, enter the following: ISA06/05 – Submitter ID/ZZ ISA08/07 – Payer ID/ZZ GS02 – Submitter ID GS03 – Payer ID Submitter Setup

Palmetto GBA – October On the ANSI Info (2) tab, enter the following: ISA06/05 – Submitter ID/ZZ ISA08/07 – Payer ID/ZZ GS02 – Submitter ID GS03 – Payer ID NM109/08/2100A – Payer ID/PI NM109/08/2100B – Submitter ID/46 Submitter Setup

Palmetto GBA – October Optional Reference Files The Physician Reference File stores information on Attending, Referring, Supervising, and Ordering Physicians. The Facility Reference File stores information on where the services were provided. This information is for places of service other than someone’s Home.

Palmetto GBA – October Physician Reference File Click on Physician Click on New

Palmetto GBA – October Physician Reference File Complete the highlighted fields. Enter Physician Name Enter Physician NPI Click on Save

Palmetto GBA – October Facility Reference File Click on Facility Click on New

Palmetto GBA – October Facility Reference File Complete the highlighted fields. Enter Facility Name and Address Enter Facility NPI Click on Save _____-____

Palmetto GBA – October  Module 1 – Introduction, Download and Installation  Module 2 – Building Reference Files  Module 3 Part A – Institutional Basic Claims  Module 3 Part B – Professional Basic Claims  Module 4 – Uploading EMC Files and Downloading Reports PC-ACE Pro32 Training Modules

Palmetto GBA – October Available in the Software and Manuals section of the Web site for your line of business: PC-ACE Pro32 User’s Guide PC-ACE Pro32 Reference Guide EDFS User Guide Join the Encounter Data mailing list for updates on PC- ACE Pro32 and other topics. Additional Resources

Palmetto GBA – October Contact Information PC-ACE Pro32 questions EDFS questions Encounter Claim questions Technical issues related to transmitting your claims Contact the CSSC Operations at: (877)

Palmetto GBA – October Thank you for completing PC-ACE Pro32 Training Module 2! Please return to the module links to launch additional PC-ACE Pro32 training modules.