Presentation on theme: "Presented by The HIPAA Helpdesk Department Payer Path."— Presentation transcript:
Presented by The HIPAA Helpdesk Department Payer Path
Call or to directly reach all provider help desks including Provider Relations, Provider Enrollment, the HIPAA/EMC help desk and TPL. For all contact, Claims, and Correspondence Addresses information go to the following link on the New Mexico Medicaid Web Portal: https://nmmedicaid.acs- inc.com/nm/general/loadstatic.do?page=ContactUs.htm https://nmmedicaid.acs- inc.com/nm/general/loadstatic.do?page=ContactUs.htm Contact Xerox
Payerpath Registration If you have not registered with Payerpath, You can access the Payerpath registration form at gistrationformAddDelete.pdf When you have completed the user registration form, Please fax to (505) Attention: HIPAA Help Desk or to 3
Payerpath and Electronic Claims Submission Assistance The HIPAA Help Desk supports the Payerpath claims application product, technical support for the New Mexico provider community. (Note) No billing training will be provided. For PayerpathSupport: the HIPAA Help Desk at or you may call (Toll Free) or
Before Logging on to PayerPath, please turn your Pop-up Blockers off or disable them 5
6 Payerpath Home Page To access the Payerpath home page through Microsoft Internet Explorer (preferred browser), the web address is Select the Client Login link in the top right hand corner of the page above the Payerpath road sign to enter the Payerpath system.
Payerpath Login When you access Payerpath for the first time, you will be requested to change your password, as the one provided to you when you registered is only a temporary password. You must select a “Strong Password” in order to obtain access. When you first login into Payerpath, use the Customer Name, User Name, and Password provided to you when you registered.
8 What is a “Strong Password”? A “strong password” contains each of the following: between 6-20 characters upper case letter lower case letter numeric value symbol (*, Some examples of strong passwords are: Xyz123! Passwords expire every 60 days and can be changed at any time. If you forget your password, select the link Forget Your Password? at the Payerpath Login screen. This link will allow you to request a new password by entering your Customer Name, User Name, and address. A new password will be ed to you. You will then be prompted to change and confirm a new password.
9 When issues arise or other “news” occurs, you will receive a message. To view messages, you may either: 1.Go to the Maintenance link in the Tool Bar at the top of the screen and select View Messages, or 2.Obtain access directly on the underlined link You have # NEW MESSAGES. Messages
10 Required Fields Documents HELPFUL TIP! BEFORE entering claims, print out and read the following documents that are applicable to your agency. The information provided within these documents is essential to entering your claims correctly into Payerpath. NM 837 Professional Required Fields NM 837 Institutional Required Fields NM 837 Dental Required Fields -Go to “Help” -Choose Document Library -Download the appropriate document for your claim form NM Medicaid Institutional
11 The Document Library will be opened in a pop-up window. Open the required fields document that is consistent with your billing (837P, 837I, or 837D) in order to aid in determining valid values for required fields.
Payerpath Tips! Setting Defaults To avoid having to enter the same data information in the electronic fields, click on the MAINTENANCE tab, Edit Claim Defaults, then locate the fields that you want to have constant values. 12 Select Edit Claim Defaults under the Maintenance dropdown.
Defaults (cont.) 14 Enter information that will remain constant on every claim. Click save defaults button
15 Claims Billing (New Claim) To create new claims or rebill, click on “Claims” then “View Claims”.
16 Claims Billing (cont.) Leave the default of “ALL” unless performing advanced functions. Claim Status Definitions All - All claim statuses. Failed (F) - Claims that did not meet payer-specific edit criteria. Warning (W) - Claims flagged for manual review via a custom or Code Check edit requested by the user. Held (H) - Claims placed on hold by the user. Passed (P) - Clean claims ready to be sent to the Payer. Marked for Send (S) - Claims marked as ready to send to the payer. In Process to Payer(A) - Claims sent to payer, not yet been archived to a transmitted status. Unless your organization uses multiple claims types leave all defaults and select “DISPLAY LIST”
17 Claims Billing (cont.) To enter a new claim, click on New.
18 Claims Billing (cont.) HAVE YOU PRINTED AND READ THE FOLLOWING FORM YET? NM 837 Professional Required Fields NM 837 Institutional Required Fields NM 837 Dental Required Fields BEFORE entering claims, return to the Home page (Tools and then Home) under Help and print out and read the above noted documents, as applicable to your agency, as the information provided within these documents is essential to entering claims correctly into Payerpath.
19 Claims Billing (cont.) The claim form will be displayed with required fields displayed in solid red. All required fields must be completed. Errors are highlighted in red in the Navigation tool bar. To view all of the outstanding errors in the claim, left click the mouse on the down arrow of in the Error box. Correct the highlighted fields and select the Save and Run Edits link on the Navigation tool bar to save the corrections. You must select Save and Run Edits every 5 minutes or so to prevent session time-out. When all errors are corrected, the tool bar should read No Edit Errors in the Errors space in the Navigation tool bar.
20 The Form Navigation tool bar contains the functions needed when editing claims. This tool bar can be moved anywhere on the screen as you edit your claims by moving your mouse pointer over the top blue field of the box, depress and hold the left mouse key down while moving the tool bar to the desired location. Save and Run Edits. This saves your changes and runs the edits again to determine if there are new errors. NOTE: Make sure to tab out of the field you have corrected in order to commit your changes before selecting Save and Run Edits and be sure to run Save and Run Edits before moving to the electronic fields and back to form. Previous Claim. Navigates back one claim in the list. Electronic Fields. Displays the electronic fields. New Claim. Brings up a blank claim form for key entry. Back to List. Navigates back to the Claim List. Next Claim. Navigates forward one claim in the list. Claims Billing (cont.)
May 3, Claims Billing 1500 HCFA Form
NPI number is entered in Field 33, bottom of form, far right. 22 NPI
A diagnosis code must be entered on claim May 3, A diagnosis code must now be entered regardless of the date of service. When the diagnosis is entered, the decimal point is NOT to be included. The diagnosis pointer must be completed to point the service procedure code to the diagnosis code. The placeholder diagnosis code (to be used until a more accurate diagnosis code can be provided) for DDW providers is which is entered as 7999 in box 21. When there is just one diagnosis on the claim, each procedure code will have a diagnosis pointer of “1” meaning that it’s the diagnosis “1” to which the service corresponds. (Do not try to enter the actual diagnosis code in the pointer field because it only allows up to 2 digits). Claims Billing 1500 HCFA Form (cont.)
To input your taxonomy code click on Electronic Fields in the form navigation box. 24 Claims Billing 1500 HCFA Form (cont.)
Claims Billing 1500 HCFA Form (cont.) Update to Billing Addresses May 3, Please be aware P.O. Boxes are no longer valid in the billing section of the claim. Physical addresses must now be entered in this section of the form.. Another change is the zip code must now be the 5 digit zip WITH the 4 digit suffix included WITHOUT the hyphen (as shown below in box 33). If you don’t have a 4 digit suffix, please enter four zeroes instead. (0000).
Claims Billing 1500 HCFA Form (cont.) May 3,
Claims Billing 1500 HCFA Form ( cont. ) May 3, You will receive message (Patient signature source – Invalid Code.) This field will be seen in the Electronic Fields. To see and correct the error, click on Electronic Fields in the Navigation Box as seen below.
Patient Signature Source Update (cont.) Change the Patient Signature Source to either a “P” or leave blank, then Save and Run Edits in the Form Navigation box. May 3, Gipson section of Enter a “P” or Leave Blank.
Claims Billing UB92 Form May 3,
Claims Billing UB92 Form (cont.) May 3,
May 3, Claims Billing UB92 Form (cont.) NPI
Claims Billing UB92 Form (cont.) May 3,
Institutional Claim Covered Days Update In order to get your claims to pass, the covered days now must be entered on the claim as such. The Value Code (box 39) for covered days is ‘80’ and the Value Code for non-covered days is ‘81’. So, if the submitter needs to enter 10 covered days on the claim, they need to add a Value Code of ‘80’ with ’10.0’ days. It will show up in monetary value but its ok. Just remember it will equate to the total amount of days covered. May 3,
May 3, Claims Billing ADA 2002 Form
May 3, Claims Billing ADA 2002 Form (cont.)
May 3, Claims Billing ADA 2002 Form (cont.)
May 3, Claims Billing ADA 2002 Form (cont.) Box 50 should always be blank
May 3, Claims Billing ADA 2002 Form (cont.) Dentist License Number Qualifier should always be left blank.
40 Claims Billing Claims in a Failed status will need to be edited and corrected prior to sending, as Payerpath will not send any claims in this status. View claims to be edited by selecting V for View in the far right column of the claims list. To view the history of a claim click on the “H”.
41 Once you have the claim(s) in a Passed status you must mark them for send. To display all the claims that have been corrected and are now ready to send, at the Claim List, select Passed within the Show box in the upper right corner. NOTE: Payerpath will only send those claims that have progressed to the Passed status and have been changed to Mark for Send. You may select the claims in three ways. 1.Select all the claims in the list. Go to the Tools link in the Tool Bar at the top right of the screen and click on Select/Unselect List. 2.Select claims displayed on current page. Go to the Tools link in the Tool Bar and click on Select/Unselect Page. 3.Select only certain claims to Rebill. Click on the box to the left of the applicable claims to display a checkmark in the box. To send the claims selected, go to the Tools link in the Tool Bar at the top right of the screen and click on Send Selected or Send All to send the claims. The screen will refresh to automatically display the claims with an S status and you may print the list of sent claims.
42 There are two ways that you can rebill a claim after the claim has been initially entered into Payerpath 1.The Rebill function is useful in performing follow-up with payers, or when billing for repeat service(s) when only the Date(s) of Service (DOS) require changing. This is also helpful when all you need is to correct and re-send claims that have been rejected by the payer by accessing the database of claims previously sent through Payerpath. 2.The Patient Demographics function allows you to create new claims for recurring patients and when the services rendered differ from the last visit. Re-bill and Demographic Claims To rebill a claim, open the claim filter by clicking on “View Claims.”
43 Choose “Transmitted” claims in the Claim Status. Re-bill Claims (cont.) Enter a date span into the Sent Date that is no greater than 3 months. Click on DISPLAY LIST to display the Transmitted claims within the date span indicated.
44 T = Transmitted Claim Re-bill Claims (cont.) Once the claim is open you have the option to rebill. View Transmitted Claims online to make rebilling decision.
45 Re-bill Claims (cont.) You can select the claims to Rebill in one of the following ways. 1.Select all the claims in the list. Go to the Tools link in the Tool Bar at the top right of the screen and click on Select/Unselect List. 2.Select claims displayed on current page. Go to the Tools link in the Tool Bar and click on Select/Unselect Page. 3.Select only certain claims to Rebill. Click on the box to the left of the applicable claims to display a checkmark in the box. To Rebill the claims selected, go to the Tools link in the tool bar and click on Rebill Claims.
46 The transmitted claim that is selected is copied and sits in a “Failed” status. Click on View on the far right the applicable claim, change the data as needed, and click on Save and Run Edits to save the modified claim. NOTE If you exit the Rebilled Claims List, the remaining claims, other than opening the claims to edit, will then appear on the Untransmitted Claims List in a Failed status. For example, if you went to Reports and then tried to come back, You would have to access the claims on the Untransmitted Claim List as they would have diverted to a Failed status. Re-bill Claims (cont.)
47 The Patient Demographics function allows you to create new claims for recurring patients when the services rendered differ from the last visit. Select Patient Demographics from the Claims menu. –Set parameters on the Patient Demographic filter –Patient Database will appear Demographic Claims
48 Demographic Claims (cont.) To bill Demographic Claims, you may select claims in one of the following ways. 1.Select all the claims in the list. Go to the Tools link in the Tool Bar at the top right of the screen and click on Select/Unselect List. 2.Select claims displayed on current page. Go to the Tools link in the Tool Bar and click on Select/Unselect Page. 3.Select only certain claims to Rebill. Click on the box to the left of the applicable claims to display a checkmark in the box. To bill the claims selected, go to the Tools link in the Tool Bar and click on Bill New.
49 In the event you would like to print information provided on a claim, View the desired claim and go to the Tools link in the tool bar at the top right of the screen and click on Print to print the claim’s field data on blank paper. If you want to print to a claim onto a form, you must print on a laser printer and use pre-printed laser forms. The parameters for printing vary and are dependant upon how your printer is programmed. To adjust the page setup parameters, open Internet Explorer and go to File on the browser Tool Bar and select Page Setup. Delete the contents of the Header and Footer, as they should be blank. Begin testing with all margins set at Also, when on the Adobe Acrobat print preview screen, make sure the Page Scaling box is set to None, so that it doesn’t automatically adjust the form to fit the page size. You may have to adjust the margins to accommodate your printer’s programming and perform a test print again. Print Claim Field Data and Claims
50 Individual claims or the Claim List can be printed from the Claim List page. The Claim List will print based on the status selected in the Show box (Failed, Passed, Marked for Send, Sent to Payer, or Held). Go to the Tools link in the tool bar at the top right of the screen and click on Print or Print All and select the print option for: Print List. Will print list of claims based on selected Claim Status (i.e. Failed, Passed, etc.) Print Forms. Will print all the claims from a selected Claim Status in HCFA, UB92 or ADA format, depending upon the payer type. Print Claim List and Claims
Payerpath Tips! When entering information on a claim, click out of the box before clicking on Save and Run Edits. When entering Service Lines, you do not have to enter the decimal point (.). To save time when first entering patients into Payerpath, establish a “Dummy Claim” that contains all the information that would remain the same for each patient (i.e. the Provider’s Federal Tax Identification Number, Billing Name and Address, etc.). 51
Payerpath Tips! When you have a new patient to add into Payerpath, click the View link on the Dummy Claim. Once the claim opens, click on the Tools link on the tool bar and click on the Copy link in the dropdown menu to create an exact duplicate of the claim. Enter the patient’s name onto the claim and immediately click on Save and Run Edits link on the Navigation tool bar to save the claim under that patient’s name. 52
Payerpath Tips! Claims Transmissions: Claims Marked for Send no later than 8:00 a.m. MT are picked up daily. Reminder: Do not forget to reconcile your weekly Remittance Advice. 53