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Welcome to the Oklahoma SoonerCare Program This introductory CD will walk you through the process of setting up your provider account on.

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Presentation on theme: "Welcome to the Oklahoma SoonerCare Program This introductory CD will walk you through the process of setting up your provider account on."— Presentation transcript:

1 Welcome to the Oklahoma SoonerCare Program This introductory CD will walk you through the process of setting up your provider account on our secure website and how to submit a professional claim through direct data entry.

2 Go to:

3 Log on ID is provider legacy number PIN information is listed on provider welcome letter

4 To access the claim forms, click on Claim Submission

5 The 1500 claim form, is called the Professional

6 To begin, enter the client ID and hit tab. If your service requires a referral, enter the NPI of the Referring physician Enter the primary diagnosis code with no decimal point. If additional diagnosis codes are needed, hit tab. Dates will populate as you fill out the claim lines of service

7 Continued Enter the amount paid, if the client had another insurance that paid primary to SoonerCare Enter Yes, if the client had another insurance that denied the claim. **attachment will be required. CLIA Number goes in this field, only when billing a procedure code that requires a CLIA number

8 This information will be populated with the detailed claim information below. Enter the From Date of Service. Hit tab and enter the To Date of Service Enter the Place of Service

9 Enter the appropriate procedure code Enter any appropriate Modifiers, if needed

10 Enter the appropriate Diagnosis cross reference number, 1 2 3 or 4 with no comma Enter the amount of units being billed for this procedure code Enter the Usual and Customary Charge for this procedure

11 When using NDC numbers type the quantity used in this field. When billing with J codes, you must include the 11-digit NDC number in this field. Choose from the drop down the Unit of measure for the NDC code used.

12 This field is used by A-typical providers only. These are providers who are not required to have an NPI number. If the rendering and billing provider are the same, place the cursor and the pointer in the rendering NPI field and double left click. The fields will populate for you. If the contract code field applies to you, choose from the drop down. All providers who have an NPI number must also include either their taxonomy number or the zip plus four.

13 Use these buttons to add additional lines of service or to remove extra lines. To remove lines, highlight the line in blue then click the remove button. When you have typed in all lines of service, click on the Submit button to process the claim. In a matter of seconds, you claim will process. You will see the claim status, an Internal Control Number (ICN) and the error codes.

14 After hitting submit, the claim will pay or deny. If the claim shows a paid status, then at least one line of the claim paid. To verify if all lines on the claim paid, review each line detail or review the claim under claim inquiry. If no lines on the claim pay, the system will tell you that the claim is denied. You must review the denials listed below to determine why the claim was denied. If you have miskeyed information into the claim, which has made the claim deny, you can simply change the information on the claim form and hit the Resubmit button. Denied Claim Paid Claim

15 Medical Center Hospital 100123456A Resolving Denials To review claims submitted under your provider number, click on the Claim Inquiry link.

16 012345678 2208000001234 To look up one claim, enter the ICN number. Other searches, such as, the client ID and dates will show all claims submitted for this provider, client and date of service. Various combinations of the search function will help narrow to more specific claims data. The website has six years of claims history. It is not recommended to hit the search button without enter detailed criteria. Once the claim/claims are found, click on the ICN to view the entire claim

17 2208000001234 If your claim is denied, it will list all the denials for each detail. For a more descriptive EOB remark code, click on the blue link. If the denial is something that can be corrected, scroll back up to the claim form, change the information and click on resubmit. The system will resubmit the claim.

18 If your claim requires a hard copy attachment, the website can be used to submit supporting documentation, TPL EOB, sterilization consent forms, proof of timely filing and other information pertinent to the processing of the claim. If your claim requires a hard copy attachment, click on the down arrows to access the additional fields needed to appropriately submit the attachment with the claim. If a claim requires an attachment: DO NOT click submit on the claim, until all fields on the hard copy attachment screen are entered.

19 Submitting the Attachment, cont. Enter an Attachment Control number: This should be a random number that will be used to tie the attachment to the claim. How do you want to send the attachment? What kind of documentation are you sending? E.g. OZ- Support Document for Claim Give a short description of the documentation being sent.

20 Submitting the Attachment, cont. Once the hard copy attachment information is entered, click on the “Show” link, to print out the HCA-13 form.

21 Oklahoma Health Care Authority Electronic Claim Paper Attachment Form Cover Sheet 100123456A Verify all information is correct and print.

22 Submitting the Attachment, cont. After the HCA-13 is printed, you can now click on the Submit button. NOTE: Claims that have a hard copy attachment will suspend until the attachment is married to the claim.

23 Thank you for supporting the SoonerCare program. For additional assistance please contact: OHCA Provider Services: 877-823-4529, Option 2 EDS Field Consultants: 800-522-0114, Option 1 or

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