Welcome to the Institutional Web Billing for Fee-For-Service Providers course.
Table of Contents
Verifying Recipient Eligibility
Submitting a Claim
Searching for a Claim
Viewing Claim Summary Information
Resubmitting a Claim
Adjusting a Claim
Copying a Claim
Voiding a Claim
This course provides you with the knowledge and skill to submit and manage claims using the new Medicaid Information Technology System (MITS) portal.
This is a self-paced course that you can complete at your own speed.
Before taking this course, you must complete the following courses:
By the end of this course you should be able to:
Note: Each topic is listed in the table of contents.
You can click here to return to the Table of Contents, or you can continue through this course in the order presented.
The Ohio Medicaid Information Technology System (MITS) portal (Web portal) allows you to submit fee-for-service (FFS) claims for reimbursement, correct denied claims for resubmission, adjust or void paid claims, or copy a claim to create a new claim.
The Web portal also gives you the ability to submit supporting documents and information electronically.
The biggest advantage of the Web portal is that it makes it easier for you to submit claims, track claims, and perform claim adjustments.
Review the following information to learn more about the advantages of Web billing:
Institutional Web billing assists many provider types including, but not limited to:
Review the following key terms as they apply to institutional Web billing:
A request for payment of health care services to a Medicaid recipient.
A code used to identify a condition relating to the institutional claim that may affect payer processing.
A numeric code that documents the recipient’s medical condition, symptom, or complaint as determined by the provider, and is the basis for rendering service(s). The diagnosis coding structure uses the International Classification of Disease – Ninth Revision, Clinical Modification (ICD-9-CM).
Internal Control Number
An Internal Control Number (ICN) is a unique, 13-digit identification number assigned to every claim in order to distinguish it from all other claims received by the system. The ICN is composed of multiple components that identify critical information about the claim.
A means by which the reporting provider can indicate that a service or procedure performed has been modified by some specific circumstance, but the service has not changed in its definition or code. Modifiers can be found in the Current Procedural Terminology (CPT) book.
A code that identifies a significant event relating to this bill that may affect payer processing.
Other Payer provides cost containment of the Medicaid program through the identification of services for which other insurance should be the primary payer. This includes, but is not limited to, private health insurance, any applicable Medicare coverage, worker's compensation, and accident-related liability insurance.
The amount received from third parties on claims sent to Medicaid should be indicated. Medicaid deducts the Other Payer amount from the payable amount, which is calculated based on reimbursement rules.
A code that indicates the status of the patient as of the ending service date for the period covered by the institutional claim.
Prior Authorization (PA) is requested by a provider in order to render specified services to a designated recipient. The authorization is given prior to the services being performed.
Note: PAs may be approved after the service is delivered.
A CPT or Healthcare Common Procedure Coding System (HCPCS) code is a five-digit code that uniquely identifies a service or procedure for a professional service from physicians, nurses, chiropractors, and so on. Procedure codes are used on all institutional claims to describe services performed.
A code that identifies a specific accommodation, ancillary service, or billing calculation.
Type of Bill
A code that indicates the specific type of facility and billing sequence.
The panel set for an institutional claim includes Institutional Claim, Condition, ICD-9 Procedure, Occurrence/Span, Value, Diagnosis, Other Payer, Other Payer Amounts and Adjustment Reason Codes, Detail, NDC, Other Payer - Detail, Other Payer Amounts and Adjustment Reason Codes – Detail, Attachments, Supporting Data for Delayed Submission / Resubmission, Claim Status Information, and EOB Information panels. Use these panels to create a new claim or manage an existing one.
The following images display the Institutional Provider panels you can view in MITS.
The image below shows the Institutional Claim panel. This panel displays basic billing and service information for a claim, such as the Medicaid billing number, date of birth, patient account number, release of information, and place of service. When initially accessed, this panel displays the provider's identifying information. You enter the remaining information when you submit a claim.
The image below displays the Condition and ICD-9 Procedure panels.
The image below displays the Occurrence/Span, Value, and Diagnosis panels.
The image below displays the Other Payer panel and the Other Payer Amounts and Adjustment Reason Codes panel.
The image below displays the Detail and NDC panels.
The image below displays the Other Payer - Detail panel and the Other Payer Amounts and Adjustment Reason Codes - Detail panel.
Note: You can access these panels provided there is data on the Other Payer panel.
The image below displays the Attachments panel.
The Attachments panel enables you to submit attachments for the claim. The attachments include supplemental information about the services provided to a specific individual in support of a claim evaluation before it is paid. When submitting attachments, you would click the addbutton to specify the type of document and type of transmission. Follow the instructions on the panel to submit either paper or electronic documents. After you submit a claim, additional buttons appear so you can upload an attachment or print a cover sheet.
The image below displays the Supporting Data for Delayed Submission/Resubmission, Claim Status Information, and EOB Information panels.
This activity contains questions to assess your understanding of key concepts in this topic.
Each question is followed by the correct answer. Review the topic if your score is below your standards.
Question: Which of the following are advantages of Web billing?
A. Processing speed and accuracy are far superior to paper claims
B. Risk of lost claims and human error is minimal
C. Discovery of data entry errors is possible before claim submission
D. Expense of processing claims is lower
E. All of the above
Answer: E. All of the above
Question: Which panel displays detail line item information about the Medicaid service(s) for which the provider is billing, including procedure code, date of service, and amount charged for service?
A. Other Payer
Answer: B. Detail
Question: Which panel displays payer line item information for third-party liability or Medicare crossover information?
Answer: A. Other Payer
Question: Which panel displays control numbers for any documents submitted electronically for the claim?
C. Other Payer
Answer: B. Attachments
Question: You can use the claim panels only to submit a claim for reimbursement.
Answer: B. False
In this topic you learned the advantages of Web billing and previewed the panel set for a claim.
Among the many useful features of the Web portal, one feature is the ability to verify a person's eligibility for Medicaid.
This topic explains how to use the portal to verify recipient eligibility.
Before you submit a claim, particularly for a new patient, you should verify that the person is eligible for Medicaid.
Verifying eligibility helps you avoid having your submitted claims returned as denied. Because verifying eligibility is faster than submitting a claim, this results in a net savings of time for you.
Use one of the following combinations to search for eligibility:
Date of Service (DOS)
Medicaid Billing Number OR
Social Security Number
Tip: You can also include a procedure code in your search criteria to obtain more detailed information.
Follow these steps from the Web portal main menu to verify a recipient's eligibility for Medicaid:
Click Eligibility Search.
Type the search criteria in the corresponding fields.
Valid search criteria:
If you want to see service limitation information, type a procedure code in theProcedure Code field.
Type the date(s) of service in the From DOS and To DOS fields.
Verify that the recipient information matches the person for whom you want information.
If it does, scroll down until you find the eligibility information you need.
If it does not, go back to step 2 and search again.
The following image shows that you have successfully completed this task when the recipient's name appears in the Recipient Information panel.
The screen illustrations and instructions below provide a demonstration to reinforce the procedures learned in this course.
This demonstration illustrates how to verify eligibility for a recipient.
In this topic you learned:
A primary feature of the Web portal is the ability to submit a claim for reimbursement. This topic explains how to use the portal to submit a claim.
Submitting a claim through the Web portal speeds up the reimbursement process, especially when you submit a claim successfully. A major advantage of using the portal is that you receiveimmediate feedback on your submission; however, payments are still made on a weekly basis.
If you submit a claim unsuccessfully, you receive an immediate Not Submitted yet status response and must resolve any errors.
You have one year to submit a claim to Medicaid for reimbursement.
The following requirements apply to submitting a claim:
Follow these steps from the Web portal main menu to submit an institutional claim:
Type the Medicaid Billing Number and Date of Birth in the header, and then click outside those fields to populate the first and last name.
Type or specify data in all required fields on the header panel.
Note: Required fields are designated by an asterisk (*).
Complete the claim by following these steps:
Perform the following from the Diagnosis panel:
Third-party liability or Medicare crossover information
Perform the following from the Other Payer panel:
Detail about a service
Perform the following from the Detail panel:
Paid amounts and dates for other payers (carrier codes)
Perform the following:
Prescribed drug information
Attach supporting documents
Perform the following from the Attachmentspanel:
If the claim status is "Not Submitted yet," click each error message to correct the field in error.
You have successfully completed this task when the claim status displays Paid, Denied, orSuspended.
This demonstration illustrates how to submit an institutional claim.
The Claim Search feature allows you to search for all claims associated with your provider ID, including claims submitted through the Web portal, EDI, or on paper.
The following examples represent some of the most common claim searches:
This topic explains how to use the portal to search for claims.
In the Web portal, you have the ability to expand or refine your search criteria. The expansion or refinement helps you find claims quickly, which minimizes the time you spend weeding through unnecessary claims.
Note: You can search for up to three years of historical claims data.
To display all claims associated with your provider ID, you need not specify any search criteria.
To refine or expand your search, specify any or a combination of the following:
Note: When combining search criteria, MITS may require additional information.
ICN/TCN: allows full or partial numbers
Medicaid Billing Number
Rendering Provider ID
Date of Service
Follow these steps from the Web portal main menu to search for a claim:
Type, specify, or search for criteria.
You have successfully completed this task when the desired claims appear in the Search panel.
This demonstration illustrates how to search for claims using a basic search and an advanced search.
Note: The search process is the same for professional, institutional, and dental claims.
A handy feature of the Web portal is the ability to view claim activity summary information. This topic shows you how to accomplish this simple task.
The claim activity summary includes information such as:
You can view the claim activity summary at any time.
The claim activity summary lets you view "at a glance" the status of your claim payments for the current month or for the past 12 months, along with information about claims that have been suspended or denied.
Follow these steps from the Web portal main menu to view claim activity summary information:
Scroll down to view the available information.
Note: The claim activity summary information appears automatically each time you log in.
When the following image displays, you have successfully completed this task.
This demonstration illustrates how to view the claim activity summary information.
Note: This process is the same for professional, institutional, and dental claims.
After you submit a claim, it passes through the adjudication process. You can then view the claim from the Search panel, and depending on the status of the claim, you can perform multiple actions.
This topic shows you how to perform the easy task of resubmitting a previously denied claim.
Having the ability to resubmit claims online means you have more control over your success rate for claims processing correctly.
Though this task is easy to learn and perform, it is an important task because denied claims result in you not being paid for services you have already rendered.
Before you can resubmit a claim, it must have been previously submitted and returned with aDenied status.
Note: Resubmit a claim after you address the reasons it was denied.
Follow these steps from the Web portal main menu to resubmit a claim:
Using any desired search method, display the denied claim.
Scroll to the bottom of the page and examine the text in the EOB Informationpanel to determine the reason(s) the claim was denied.
Modify the claim data to address the EOB information.
If the date of service is more than one year in the past, you must type the previously denied ICN in the Supporting Data for Delayed Submission / Resubmission panel.
Note: The re-submit button does not appear unless the claim is in a Denied status.
You have successfully completed this task when a new ICN is assigned to the resubmitted claim.
This demonstration illustrates how to search for a previously denied claim, update the claim data, and then resubmit the claim.
Note: The images below show data for a dental claim, but the resubmit process is the same for professional, institutional, and dental claims.
After you submit a claim, it goes through an immediate adjudication process. After adjudication, you can view the claim from the Search panel. Depending on the status of the claim, you may perform multiple actions.
This topic explains how to use the Web portal to adjust a paid claim.
When you make adjustments on a paid claim, you must report the differences between the claim charges (billed amount) and the claim paid amount.
Note: Failure to make the appropriate adjustments could subject you to fines and potential imprisonment.
The following examples represent typical reasons for adjusting a claim:
The following are the requirements for adjusting a claim.
Note: You may not modify the recipient ID or provider ID.
The following guidelines or rules apply to claim adjustments:
Follow these steps from the Web portal main menu to adjust a claim:
Using any desired search method, display the paid claim.
Adjust the claim data as necessary.
You have successfully completed this task when the claim appears with the modified information in a Paid status.
This demonstration illustrates how to adjust a claim.
Note: The images below display data for a dental claim, but the adjustment process is the same for professional, institutional, and dental claims.
Submitted claims pass through an adjudication process. You can then view the claims from the Search panel, and depending on their status, you can take multiple actions.
This topic explains how to copy a previously paid claim.
Copying claims, while easy to do, is a very useful feature of MITS. For example, it is likely that you render the same service to multiple patients each day. You can save considerable time and effort by first copying a claim and then modifying only the patient information.
The claim you copy FROM must have been previously submitted and returned with a Paidstatus.
Follow these steps from the Web portal main menu to copy a claim:
Using any desired search method, display the paid claim you want to copy FROM.
Verify the claim you selected is the one desired.
Click copy claim.
Note: The copy claim button does not appear unless the claim is in a Paid status.
You have successfully completed this task when you see the status of the claim change to "Not Submitted yet."
Change the claim information to reflect the accurate recipient and any other unique information, and then submit the claim as usual. You can repeat the copy process as many times as desired.
This demonstration illustrates how to search for an existing, paid claim and then copy it.
Note: The images below display data for a dental claim, but the copy process is the same for professional, institutional, and dental claims.
After claims pass through the adjudication process, you can view them from the Search panel. Depending on their status, you can then take one of several actions.
This lesson explains how to void a previously paid claim.
Voiding a claim is very easy to do and is similar to copying a claim. The ability to void a claim permits you to fix certain mistakes, such as billing the wrong recipient. Because you cannot change the recipient information on a paid claim, you must void the incorrect claim and submit a new claim.
The claim you want to void must have been previously submitted and returned with a Paidstatus.
Follow these steps from the Web portal main menu to void a claim:
Using any desired search method, display the paid claim you want to void.
You have successfully completed this task when the claim status for the ICN you voided changes to Denied.
Create a new claim with the corrected information and submit it in the usual way.
This demonstration illustrates how to search for an existing, paid claim and then void it.
Note: The images below display data for a dental claim, but the void process is the same for professional, institutional, and dental claims.
Congratulations on completing this course!
In this course you learned how to:
This is the end of the course.
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Solutions to Reduce the MITS Web Portal Timing Out
HIPAA 5010 Implementation
Answer Keys: Problems while submitting claims in MITS