Using PES Billing Professional Services Arkansas Medicaid © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.

Agenda Claim forms Third Party Liability Eligibility 5010 Changes Transmitting data

© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Claim forms

4 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Primary Care Physician (PCP) Arkansas Medicaid operates as a Primary Care Case Management Program. Most beneficiaries are required to have a PCP, and most services require PCP referral. Beneficiaries that are not required to enroll with a PCP include:  Beneficiaries with Medicare coverage  Residents of an Intermediate Care Facility for the Mentally Retarded  Residents of Long Term Care facilities  Beneficiaries on spend down aid categories  Retroactive eligible beneficiaries

5 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Header 1 Header 1 contains 2 main pieces of information: Who is getting paid? –This is who is billing for services that will be paid by Arkansas Medicaid Who are we billing services for? –This is who actually received the services that is an Arkansas Medicaid beneficiary

6 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.

7 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Provider ID This is the provider who will be paid for this claim. When submitting claims electronically, ALWAYS USE YOUR NPI

8 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Beneficiary ID Account # - We recommend using the patient’s last name unless using a vendor for electronic posting. Use the Last Name, First Name, and DOB that Arkansas Medicaid has on file for this beneficiary. SSN not Required

9 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Omit Attachment Section

10 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.

11 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Header 2 Header 2 relates to diagnosis codes, auths, etc. Diagnosis Codes –Do not enter the decimal in the DX code. Example: if DX is ; enter Referring Provider –If a PCP referral is required, PCP info must be entered Facility Provider ID –Where was the patient located for these services?

12 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Prior Auth: Only if required (one PA per Claim) Hospital Admit Date: Facility admit date (required if POS is 21, 22, or 23) Date Last Seen/Onset of Current Illness (not required)

13 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Referring Provider or Facility

14 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.

15 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Header 3 Header 3 relates to the services that are provided Related Causes –If services were provided due to accident; workers comp, auto accident, etc. Special Program Code –Indicates if an EPSDT screening was performed EPSDT Referral –Indicates if an EPSDT Referral was given –Referral Status Therapy Service –See section of the OT, PT, and speech manual

16 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Header 3 (cont) School District –School’s LEA Code TPL stands for Third Party Liability –This is for patients who have commercial insurance coverage Crossover –This is for patients who have Medicare or a Medicare Replacement Plan coverage NET –Non Emergency Transportation

© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Third Party Liability

18 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. TPL Indicator If beneficiary has commercial insurance change the TPL indicator to “Y”. This will add another tab at the top to enter the commercial insurance payment information.

19 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.

20 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. TPL Information Claim Filing Indicator Code ALWAYS USE COMMERCIAL INSURANCE (CI) Paid Amount and Denial Date If the claim was paid on by commercial insurance, then enter that amount here If the claim was TOTALLY denied, then enter the date from EOB here Policy Holder Information This information can be found on eligibility strip that ran for the patient

21 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. How to Read TPL Information E L I G I B I L I T Y I N F O R M A T I O N ELIGIBILITY/BENEFIT:1 ACTIVE COVERAGE PLAN DESCRIPTION:01ARKIDS 1ST ELIGIBILITY PERIOD:01/01/ /01/2010 COUNTY:731 WHITE ELIGIBILITY/BENEFIT:R TPL INSURANCE TYPE:C1 COMMERCIAL TPL MEMBER #:xxxxxxxxxx TPL POLICY #: TPL GROUP #: PLAN NAME:ACME INSURANCE ELIGIBILITY PERIOD:01/01/2010 – 07/01/2010 COVERAGE 1:FULL COVERAGE LAST/ORG NAME:ACME INSURANCE COMPANY CODE:ABC ADDRESS LINE 1:P.O. BOX 1000 CITY:LITTLE ROCK STATE:AR ZIP:72201 (continued next) Shows coverage TPL information Aid category Dates of eligibility County of residence Type of TPL Member number Policy number Group number Plan name Type of coverage Dates of coverage Name of insurer Company code Address

22 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. To get the additional information you will need to check the supplemental eligibility information for the beneficiary. The supplemental eligibility information can be obtained through the Medicaid website or PES.

© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Eligibility

24 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Supplemental Eligibility website PES software

25 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice SUPPLEMENTAL ELIGIBILITY BATCH RESPONSE BENEFICIARY ID:XXXXXXXXXX PLAN CODE:01 PLAN DESCRIPTION 1:ARKIDS 1ST ELIGIBILITY BEGIN DATE:1/01/2005 ELIGIBILITY END DATE:7/01/2005 COUNTY CODE:731 COUNTY:WHITE TPL SEGMENT COUNT1 TPL COMPANY CODED02 TPL SUBSCRIBER NAMEJOHN DOE Beneficiary ID for this eligibility segment…up to 4 segments returned Plan code and description Dates of eligibility in this aid category Number of TPL segments TPL carrier code Name of policy holder

26 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Arkansas Medicaid does not return the Policy Holder’s DOB, Gender, Address, or Relationship to the Beneficiary through the eligibility response. You will need to obtain this information from the patient.

27 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.

28 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Crossover Indicator If beneficiary has Medicare change the Crossover indicator to “Y”. This will add another tab at the top to enter the Medicare payment information. If Medicare denied the claim it cannot be filed electronically.

29 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.

30 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Crossover This information is obtained from the Medicare EOB The Medicare ICN is the claim number assigned by Medicare –When entering this information, you must use a 13 digit/alpha claim number. If the Medicare ICN is not 13 digits/alpha characters, use zeros to make 13 digits/alpha characters long.

31 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.

32 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.

33 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Service 1 What DOS or range of DOS are we billing for? What Procedure Code for this DOS(s) are we billing for? What is the total units we provided for this Procedure Code on this DOS(s)? What is the total charge for all of these units (NOT FOR EACH UNIT) on this DOS(s) for this Procedure Code?

© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice Changes

35 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice Changes for PES The drug codes above are for a compound drug. Even though it is the same drug code, two different NDC numbers will be used so the drug code will have to be on two different service lines.

36 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice Changes for PES A drug code is listed on the Service tab 1. To enter the NDC number for the drug code being billed click the RX Indicator button on Service tab 2 and select Y for YES. The RX tab will appear.

37 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice Changes for PES A drug code is listed on Service line 2, so the NDC number for this line will be entered here. Providers will use the RX/Link # for the compound drug. The RX/Link # will indicate which NDC numbers on the claim need to be linked together for the compound drug

38 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice Changes for PES A drug code is listed on Service line 3, so the NDC number for this line will be entered here. Providers will use the RX/Link # for the compound drug. The RX/Link # will indicate which NDC numbers on the claim need to be linked together for the compound drug

39 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Do not enter the Place of Service on this tab Modifiers (only if required)

40 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Use the Copy Service button to easily enter multiple DOS or Procedure codes!

41 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice.

42 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Service 2 Were the services due to an Emergency, EPSDT, or Family Planning? Does the procedure code require an NDC number?

43 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. If procedure code requires an NDC # change the RX Indicator to “Y”. This will add an RX tab to enter the NDC #.

44 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. NDC must be 11 digits Click Save when all items have been entered.

45 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Your claim(s) is now ready to submit! Click Close to proceed to next step to submit claims

46 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. How to Submit Claims Once you are ready to submit your claim(s) for processing, click on the Communication Tab at the top of the main screen. This will open a drop down menu where you will now select Submission.

47 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Sending/Receiving Files to Send Do this step first Select the files you want to send and then click Submit. It is recommended to select all so you do not miss any files that you may need to send. Files to receive Select ALL files to receive and then click Submit.

48 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Claim Status Reports Once a claim has been submitted electronically, it takes about 3-4 minutes per claim to get a response. So if you submit 10 claims, you will need to wait approximately minutes to receive a response (Time may vary). When requesting to receive files, ALWAYS SELECT ALL! There are 2 main reports we want to look at. The Batch Response and 997s and the Rejected Response Report.

49 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Batch Response and 997s This report is basically a “Yes” or “No” answer to if your claim was successfully submitted for processing by Arkansas Medicaid. If the claim was accepted, you will see that an ICN number is assigned to your claim for tracking. If the claim was rejected, you will see that there is NOT an ICN number assigned to your claim.

50 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Rejected Response Report This report will go into detail of claims that were not accepted for processing. It will tell you how many errors were on your claim Where these errors are located (Header/Detail) Detail about the actual error such as invalid diagnosis (Did you use decimal point in diagnosis field?)

51 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. How to Fix Rejected Claims You may resubmit any rejected claim very easily. Find your claim that was rejected and select it with your mouse –You will receive an error that reads, “Record with status of F cannot be updated.” –Click “OK”

52 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Select the “Copy” button

53 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Corrected Claim By selecting “Copy”, this generates an exact duplicate of the claim previously submitted. Keep in mind that this function is also copying any error on your claim that was previously submitted also Find the error on your claim in the appropriate Header/TPL/Crossover/Service Tab Correct the error, save and then submit again!

54 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Build Lists When you are on the main screen when logged into PES, you can build a list for different beneficiaries, providers, revenue codes, diagnosis codes, etc. This will help make things faster by already having this information saved on your computer so that building claims becomes quicker

55 © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Additional Information Go to Click on Provider Click Free Software Click HP Enterprise Services Provider Electronic Solutions Scroll to the bottom; click on PES Handbook

© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Questions?

© Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Thank you