2What is PC-ACE Pro32?Free software (when downloaded from the internet)IME and EDISS supportedHIPAA compliantThere is only a cost if the software is not downloaded from the website.
3Why use PC-Ace? Faster claims processing No IME keying errors No scanning issuesUser friendlyIt’s free when downloaded from the internet
4How to get PC-ACE Access paperwork at Download and fill out formsNoridian Administrative Services, LLC (NAS) EDI Enrollment Form837P Professional Claim, or 837I Institutional Claim, or 837D Dental ClaimSoftware Licensing Agreement (SLA)Forms must be signed by the provider.Fax enrollment forms to
5How to get PC-ACE Download the software at Access installation and billing instructions at
6The Role of EDISSEDISS (Electronic Data Interchange Support Services) is the vendor for IMEEDISS processes electronic billing applications, sets up accounts with user names and passwordsEDISS troubleshoots the software
7The Role of IMEOutreach staff at IME can train providers on the software, help providers build files and give instructions on how to install and billOutreach staff can train providers either face-to-face or through a phone call
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10Once PC-ACE Pro32 is installed, the icon on the desktop will look like the one below. Double-click on the icon to open.
11PC-ACE Pro32 Toolbar This is the program’s main toolbar This is the main menu of the program. The reference file maintenance tab should only need to be set up once unless new patients are admitted or a provider is added or information is changed.
12Reference File Maintenance This is where the provider and patient files will be built. Looks like a file folder
13You will be asked to enter a User ID and Password when opening the Reference File Maintenance Screen. Enter ‘sysadmin’ for both.Providers may change their user ID and password.
14Setting Up Your Provider Files This is where you will build your files for provider information and patient files. This is done so that when you are building actual claims, much of the information will default into the required fields, meaning less work for the provider.
15From the Reference File Maintenance Screen, Click on ‘Codes/Misc’
18Click ‘Professional Option’ We will build our Professional Provider files first. Click the “Professional” option. Talk about who would use professional forms: Waivers, physician, dental, Case Management, Chiropractor.
20On the Professional Submitted Information screen, complete the required information then click ‘save’.Required information:Vendor Trading Partner ID that was sent to provider by EDISSTax ID (EIN)NameAddressPhoneFaxContact Name.
21From the Reference File Maintenance Screen, click on Provider (Prof) From the Reference File Maintenance Screen, click on Provider (Prof). Then click ‘new’.
22On the New Provider Options screen, choose the appropriate option. Note: If you have numerous individuals in a group, ‘Inherit name/address information’ would be the option to choose to avoid re-keying each time a new individual in a group is set up.
23On the Professional Provider Information screen, click the appropriate option. Note: Most providers will choose ‘solo’.
24On the Professional Provider Information screen, complete the required fields, then click on the ‘Extended Info’ tab.Required fieldsProvider TypeOrganization nameNameAddress- NOTE: The zip code MUST match the zip code that was used to verify with the NPI numberProvider ID/Type- NPI number. If atypical provider, use ‘X00’ in front of 7-digit legacyLOB- enter MCDPayer ID- right-click in box and choose choose “Medicaid for Iowa” from the list and the field will populate.NPI- Enter NPI. If atypical, enter “EXEMPT” in the fieldTax ID/Type: Enter Tax ID, then enter ‘E’ for EIN or ‘S’ For SSNTaxonomy/Type: Enter taxonomy code, the right-click on the small box beside it and enter “BI” for billingAccept assignment, Signature Ind, Date, Billing, Rendering required. Right-click in field to choose appropriate option.
25Professional Provider Information (extended info) Enter ‘XX’ for provider ID/No Type. The XX is for ‘NPI’NOTE: For Dental Providers ONLY- Enter Y in the Dental Provider field.
26Professional Provider Information (Local Fields) Enter Submitter ID given to you by EDISS, then click ‘save’.Note: The Submitter ID from EDISS should be entered here.
27Setting up Institutional Provider Files Nursing facilities
28From the Reference File Maintenance Screen, Click on ‘Codes/Misc’ and then on ‘Submitter’.
29Click the ‘Institutional’ Option and then click ‘View/Update’.
30On the Institutional Submitter Information screen, complete the required information, then click ‘save’.Required fields:Submitter IDTax IDNameAddressPhoneContact Name
31From the Reference File Maintenance Screen, click on the Provider (Inst) tab then click ‘New’.
32On the New Provider Options screen, select the appropriate choice and click ‘OK’. Inherit name/address is a good choice when having to enter numerous individual providers.
33From the Institutional Provider Information screen, complete the required information under General Info.Required information:NameAddressPhoneFaxContact NameProvider ID/No- NPILOB- enter MCDPayer ID- right-click and choose ‘Medicaid for Iowa- IANPITax ID/Type- enter tax id and ‘E’ in small box to the right for EIN and ‘S’ for SSNTaxonomy/Type- enter taxonomy code, and enter ‘BI’ for billing in small box to the right.
34On the Extended Info tab, enter ‘XX’ in the Provider ID/No Type field. XX is for NPI
35From the Local Fields tab, enter the Submitter ID number sent by EDISS, then click ‘Save’. Submitter ID comes from EDISS
36Setting up the Patient Files This is where you build patient information so that you don’t have to enter all of the information on every claim. By doing this step, it allows most of the information to auto-populate on the claims screens.
37From the main Reference File Maintenance screen, click on the ‘patient’ tab as shown below, then click ‘new’.
38On the General Information tab, complete the required information. NamePatient Control Number (most people use Medicaid ID), but they can use an internal account number for the patient up to 20 charactersAddress (can use office address)Active Patient is already checkedSexDate of BirthSignature on file right-click in box and choose Y, and then P in the box to the right of itRelease of Info right-click in box and choose appropriate option (A is usually the appropriate option)ROI Date (have providers use 01/01/2001).
39On the Primary Insured tab, complete the required information and click ‘save’. Then click ‘close’ in the bottom right corner.Required info:Payer ID – right click in the field and choose Medicaid for Iowa- the number will populate the fieldPayer Name (Choose Medicaid for Iowa-IA)LOB (Choose MCD)Rel- enter 18 for ‘self’, and this will automatically populate much of the information on the pageFields that need to still be filled in are:Insured ID- enter the patient’s State IDAssignment of Benefits- Enter ‘Y’If billing BOTH Institutional and Professional claims, go to the Insured Information Options box in the top right corner of this tab and choose ‘Common Inst & Prof’.
40Creating Professional Claims Waiver and Targeted Case Management This is where you will build Waiver and Targeted Case Management claims.
42On the Patient Info & General tab, complete the required fields On the Patient Info & General tab, complete the required fields. Do not click ‘save’ when completed.Required:LOB (MCD)Billing Provider right-click to choose appropriate billing provider to populate the field. This will automaticallly populate Fed Tax ID, SSN/EIN, Accepts Assignment, Provider SOF, Date, and Box 33a PIN No.Patient Control Number- right-click to view patient list. Choose appropriate patient and field will populate.At this point, most of the following fields should automatically populate:NameBirthdateSexSOFLegal RepAddressROI, ROI dateOther InsuranceThe only fields that will not automatically populate arePatient condition related to- Right click to choose ‘Yes’, ‘no’, or ‘unknown’ for Employment AND Accident.
43On the Insured Information tab, the required fields should automatically populate. The required fields should already be populated:Payer IDPayer NameInsured’s IDP. RelInsured’s NameBirthdateSexSigAOBAddress
44On the Billing Line Items tab, complete the required information, then click ‘save’. Diagnosis code- Waiver providers and TCM will use V0001. Do not use decimal point when entering diagnosis codes.Service from and through dates required- Waiver and TCM will bill for the full monthPS (Place of Service)- Most Waiver and TCM providers can choose ’99’ for ‘other’ place of serviceProcedure code- right click in field to see a list of procedure codes. It will have 5 digits.Diagnosis indicator- Place a 1 in this field to relate the line item to to the diagnosis code you entered aboveCharges- enter TOTAL charges for the entire month. Ex: rate per unit is $10 and 5 units are performed, you would enter $50 in this fieldUnits- enter total number of units that were provided during the month of service.Click ‘recalculate’ toward the bottom of the page.NOTE- when you click save, a box entitled ‘Edit Validation Errors List’ may appear. This means required fields have been left blank or there is invalid information. If there are no errors, the claim will be saved as a clean claim waiting to be transmitted.Once a claim has been saved and errors have been corrected, a blank claim form will pop up for the provider to begin a new claim.
45Creating Professional Claims CMS 1500 This is where Remedial, physician, Dental, Chiropractic, etc claims will be built
47On the Patient Info & Codes tab, complete the required information. Enter ‘MCD’ in LOB field. When this is done, most of the required information will populate automatically.Required information that needs to be manually entered:Patient condition related to- right click to choose appropriate option for Both Employment AND Accident fieldsReferring Physician Name/ID/Type (Box 17 and 17a)- conditional. If patient is a MediPASS member and has an authorization from the MediPASS physician, enter the 10 digit NPI MediPASS authorization number. If the patient is lock-in and has an authorization from the Lock-in physician, enter the NPI number of that physician. In the box underneath ‘Type’ enter ‘XX’ for NPI.For chiropractors ONLY- Box 14, Date/Ind of Current is required- Enter date of onset of treatment. Also right click in the small box next to the date and select ‘1’ for Date of first symptoms of illness.Also for chiropractors ONLY- Box 15, First Date, is required- enter date of the current x-ray.IMPORTANT for Dentists- put a ‘Y’ in the Dental? Field at the bottom of this screen
48On the Insured Information tab, All required information should automatically populate. Payer IDPayer NameInsured’s IDP. RelNameBirthdateSexSigAOBAddress
49On the Billing Line Items tab, complete the required information and click ‘save’. Required fields to be filled out manually:Diagnosis code- right-click in the field and choose appropriate dx codeService datesPS- Place of Service- enter place of service code or right click in the field to see a listProcedure code- enter code or right click in the field to see a listModifiers- conditionalDiagnosis indicator- requiredCharges- enter total chargesUnitsRendering Physician- conditional- this field is only used for group providers. The individual physician’s provider number would be entered here if part of a group.Hit Recalculate to bring charges down.Hit save- if there is missing or invalid information entered, it will instruct you to correct the errors. Save again. If the claim is correct, a blank form will pop up for the provider to build the next claim.
50Creating Institutional Claims Nursing Facility This is where Nursing Facility claims will be built
52On the Patient Info & Codes screen, complete the required information On the Patient Info & Codes screen, complete the required information. Do not click save when completed.In LOB, enter MCDRight-click in the Patient Control Number field and highlight the patient that you want to bill for. Click ‘select’.This should auto populate the patient information.Other required fields:Statement Covers Period: enter the first date through the last date of the month.Covered daysNon-covered daysAdmission DateAdmission hour- enter as a two-digit code. Goes from If not sure, can enter 08 for 8am.Type- enter 9Source- enter 9Status- 30 for ‘still a patient’, 01 for ‘general discharge’ or 20 for ‘expired’Do not click save
53On the Billing Line Items tab, complete the required information On the Billing Line Items tab, complete the required information. Do not click save when completed.Required:Revenue code for nursing facilityRate per unit/dayService date- enter from and through dateUnits- number of units/daysTotal charges should populateClick recalculate at the bottom.
54On the Payer Info tab, the information should already be populated. This should be auto-populated
55On the Diagnosis/Procedure tab, complete the required information. Principal diagnosis code. Right click and choose the appropriate diagnosis, or if you know the diagnosis, type it in the field. Do NOT use decimal points.Supporting Provider Information in the bottom right corner- right click in the first field under Last/Org Name and select and option.
56On the Extended Payer tab, complete the required information, then click ‘save’. All of the information should be auto populated EXCEPT:Reference Number/Type in the bottom left corner- enter I, and in the small box to the right of it enter IMS. Remember to do this on every claim.Click Save. If there is any invalid information or required information missing, a box will pop up telling you which fields to correct.
57Preparing Claims for Transmission Click either INST or PROF, depending on which clam type you will be transmitting.
59‘LOB’ drop-down box should say ‘All’. Click on ‘Prepare Claims’. The LOB (Level Of Business) field should say <<All>>. Make sure ‘Production’ is checked in the Submission Status Box and that ‘No’ is checked in the Include Error Claims? Box. Click Prepare Claims.
61Transmission Detail Report This report shows you a list of claims that have been prepared to transmit. It is NOT a list of claims that have been transmitted.
62Contact EDISS to send a test submission claims batch Contact EDISS to send a test submission claims batch. You will need to have 10 sample claims set up to test. Once this has been completed successfully, you will be moved to ‘Production’ status. You will then be able to start submitting claims for payment.