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Professional Web Billing for Fee-for-Service Providers
Welcome to the Professional Web Billing for Fee-For-Service Providers course.
Professional Web Billing for Fee-for-Service Providers

Welcome

OVERVIEW

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.

PREREQUISITES

Before taking this course, you must complete the following courses:

  • MITS Overview for Providers
  • Navigating the MITS Web Portal
  • Web Portal Fundamentals

OBJECTIVE(S)

By the end of this course you should be able to:

  • Identify advantages of Web billing
  • Verify recipient eligibility
  • Submit a claim
  • Search for a claim
  • View claim summary information
  • Resubmit a claim
  • Adjust a claim
  • Copy a claim
  • Void a claim

Note: Each topic is listed in the table of contents.

Billing Overview

INTRODUCTION

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.

ADVANTAGES

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:

  • Web billing offers speed and accuracy far superior to a paper claim. Submitting claims electronically typically results in faster claims processing and payments. By eliminating paper claims, you can save money on claim forms, office supplies, printing, postage, the time it takes to complete a claim, document management, and document storage.
     
  • When submitting a claim via the Internet, the system performs data entry edits and informs you when data is missing BEFORE you actually submit a claim, as shown in the image below. After you submit a claim, the claim goes from your computer into MITS -- requiring less human intervention and eliminating many of the steps required to process paper claims. Electronic submission also significantly lowers the risk of losing claims and the risk of human error.


    MITS Claim panel displaying data entry edits.
  • Another advantage for Web billing is that MITS processes claims in real time, which means that once you submit a claim, you receive an immediate online adjudication response. The response notifies you that the claim has been paid, denied, or suspended, as shown in the image below. You no longer need to wait to receive a Remittance Advice (RA) to determine the status of the claim. Payment will occur on the regular schedule.

    Claim Status Information panel displaying claim status and EOB information.
  • Web billing is usually recommended for providers who submit fewer than 50 claims per day. Providers who submit a large volume of claims (more than 50 claims per day) may opt to use Electronic Data Interchange (EDI) rather than Web billing.

PROVIDERS

Professional Web billing assists many provider types including, but not limited to:

  • Doctors of Medicine
  • Ophthalmologists
  • Optometrists
  • Registered Nurses
  • ODJFS Waiver Providers

KEY TERMS

Review the following key terms as they apply to professional Web billing:

Term

Definition

Claim

A request for payment of health care services to a Medicaid recipient.

Diagnosis Code

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.

  • The first two characters represent the region code that identifies the source (paper, electronic, claim adjustments, and so on) of the claim submission.
  • The ICN also represents the date the claim was received in the year and Julian date portion of the field. This facilitates control reporting of claims for the receipt date, as well as other downstream processing, such as edit disposition.

Modifier

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.

Other Payer

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.

Place of Service Codes

A two-digit code that specifies the setting in which services were rendered. The Centers for Medicare and Medicaid Services (CMS) maintains place of service (POS) codes. A list of these codes can be found in the CPT book.

Prior Authorization

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.

Procedure Code

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 professional claims to describe services performed.

PANELS

The panel set for a professional claim includes Professional Claim, Other Payer, Other Payer Amounts and Adjustment Reason Codes, Other Payer - Detail, Other Payer Amounts and Adjustment Reason Codes – Detail, Diagnosis, Detail, NDC, Attachments, Supporting Data for Delayed Submission / Resubmission, and Claim Status Information panels.

The following images display the Professional Provider panels you can view in MITS.

The image below shows the Professional Claim panel. This panel displays basic billing and service information for a claim, such as Medicaid billing number, date of birth, patient account number, Medicare assignment, and release of information. When initially accessed, this panel displays only the provider's identifying information. You enter the remaining information when you submit a claim.

Professional Claim panel with Provider ID field highlighted.

The image below displays the Other Payer and Other Payer Amounts and Adjustment Reason Codes panels.

  1. The Other Payer panel displays payer line item information for other payers (third-party liability or Medicare crossover). Payer line item information includes policy holder information, the paid amount, and insurance carrier code. When initially accessed, this panel displays only minimal information.
  2. The Other Payer Amounts and Adjustment Reason Codes panel enables you to set Claims Adjustment Segment (CAS) group codes, change the payment amount, and assign an adjustment reason code. You would click the Other Payer Amounts and Adjustment Reason Codes link to view this panel and enter Other Payer information.

Other Payer panel and Other Payer Amounts and Adjustment Reason Codes panel.

The image below displays the Other Payer - Detail and Other Payer Amounts and Adjustment Reason Codes – Detail panels.

  1. The Other Payer - Detail panel displays carrier code and payment information for the selected Detail line item. You would click the Other Payer - Detail link to view this panel and add paid amounts and dates to carrier code records for each Detail line item.
  2. The Other Payer Amounts and Adjustment Reason Codes – Detail panel displays CAS and adjustment reason code (ARC) information for the selected Other Payer Detail line item. You would click the Other Payer Amounts and Adjustment Reason Codes – Detaillink to view this panel and add CAS and adjustment reason code information for the selected Detail line item.

    Note: You can access these panels provided there is data on the Other Payer panel.

Other Payer-Detail, Other Payer Amounts and Adjustment Reason Codes-Detail.

The image below displays the Diagnosis and Detail panels.

  1. The Diagnosis panel displays diagnostic information. Diagnostic information includes sequence, diagnosis code, and a description. The sequence represents the order of the diagnosis as it appears on a claim. When initially accessed, this panel displays no information. When submitting a claim, you would click Add to create a new line item for each diagnosis.
  2. The Detail panel displays detail line item information about the professional claim, including rendering provider, procedure code, date of service, and charges.

Item 1 shows the Diagnosis panel. Item 2 shows the Detail panel.

The image below displays the NDC and Other Payer Detail panels.

  1. The NDC panel allows you to add prescribed drug information related to the claim. You may have up to 25 NDC items per detail line item.
  2. The Other Payer Detail panel allows you to add paid amounts and dates to carrier code records for the other payer selected on the Other Payer panel.

Item one shows NDC panel. Item two shows Other Payer Detail panel.

The image below displays the Attachments panel.

The Attachments panel displays attachments submitted 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. 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.

Note: When submitting attachments, you would click Add to specify the type of document and type of transmission, and you would repeat this step for each additional attachment.

Attachments panel

The image below displays the Supporting Data for Delayed Submission / Resubmission andClaim Status Information panels.

  1. The Supporting Data for Delayed Submission / Resubmission panel enables you to enter a previous ICN or TCN (transaction control number). You can resubmit a suspended or denied claim after making changes, and then MITS assigns the resubmission its own ICN.
  2. The Claim Status Information panel displays claim status, paid date, and paid amount. Upon submission, this panel also displays an explanation of benefits (EOB), which includes related adjustment reason codes (ARCs) and descriptions.
  3. Depending on the status of the claim, different buttons appear at the bottom of the panels to allow further processing if needed. For example, in the image below, the status of this claim is PAID, so the canceladjustvoid, and copy claim buttons appear. 

Note: Information displays on this read-only panel about the status of a claim. Initially, it indicates the status is not submitted yet. After you submit a claim, the status is updated to Paid, Suspended or Denied.

Supporting Data for Delayed Submission/Resubmission, Claim Status.

CHECK YOUR UNDERSTANDING

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. Attachments
B. Detail
C. Other Payer
D. Diagnosis

Answer: B. Detail

Question: Which panel displays payer line item information for third-party liability or Medicare crossover information?

A. Detail
B. Other Payer
C. Attachments
D. Diagnosis

Answer: B. Other Payer

Question: Which panel displays control numbers for any documents submitted electronically for the claim?

A. Attachments
B. Detail
C. Other Payer
D. Diagnosis

Answer: A. Attachments

Question: You can use the claim panels only to submit a claim for reimbursement.

A. True
B. False

Answer: B. False

SUMMARY

In this topic you learned the advantages of Web billing and previewed the panel set for a claim.

Verifying Recipient Eligibility

OVERVIEW

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.    

RELEVANCE

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.

REQUIREMENTS

Use one of the following combinations to search for eligibility:

You need:

AND Either:

AND this:

Date of Service (DOS)

Medicaid Billing Number OR

Social Security Number

 Birth date

Tip: You can also include a procedure code in your search criteria to obtain more detailed information.

HOW TO

Follow these steps from the Web portal main menu to verify a recipient's eligibility for Medicaid:

Step

Action

1

Click Eligibility Search.

2

Type the search criteria in the corresponding fields.

Valid search criteria:

  • Medicaid Billing Number and birth date

OR

  • Social Security Number and birth date

3

If you want to see service limitation information, type a procedure code in theProcedure Code field.

4

Type the date(s) of service in the From DOS and To DOS fields.

5

Click search.

6

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.

SUCCESS

The following image shows that you have successfully completed this task when the recipient's name appears in the Recipient Information panel.

Notes:

  • Additional detail panels appear below the Recipient Information panel to provide more detail about the recipient.
  • Do NOT attempt to file a claim for a recipient who is not eligible for Medicaid.

Eligibility Verification Request panel with Recipient Information highlighted.

DEMONSTRATION

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.

  1. For this demonstration, you would click the Eligibility Search submenu option from the Eligibility menu to begin your search.

    MITS home page with Eligibility menu and Eligibility Search submenu highlighted.
     
  2. The Eligibility Verification Request panel appears. You would then type the Medicaid Billing Number for the recipient for which you are searching. 

    Eligibility Verification Request panel. Medicaid Billing Number highlighted.
     
  3. You would type the recipient's birth date in the Birth Date field.

    Eligibility Verification Request panel with Birth Date field highlighted.
     
  4. You would type the From Date of Service in the From DOS field.

    Eligibility Verification Request panel with From DOS field highlighted.
     
  5. You would type the To Date of Service in the To DOS field.

    Eligibility Verification Request panel with To DOS field highlighted.
     
  6. Finally, you would click the search button to view your search results.

    Eligibility Verification Request panel with search button highlighted.

SUMMARY

In this topic you learned:

  • How to verify recipient eligibility for Medicaid
  • The benefits of verifying eligibility before submitting claims
  • The data requirements for an eligibility search
  • The on-screen indicator of a successful search

Submitting a Claim

OVERVIEW

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.          

RELEVANCE

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.

REQUIREMENTS

You have one year to submit a claim to Medicaid for reimbursement.

The following requirements apply to submitting a claim:

  • Use a valid user ID and password for the portal.
  • Sign in and act on behalf of the CORRECT provider.
  • Have all pertinent recipient and claim information on hand so you can easily and quickly enter the data on the claim.
  • Verify recipient eligibility BEFORE submitting a claim.
  • Exhaust ALL other insurance possibilities BEFORE billing Medicaid. For example, if a recipient has Blue Cross Blue Shield and Medicare, bill Medicare last.

HOW TO

Follow these steps from the Web portal main menu to submit a professional claim:

Step

Action

1

Click Claims.

2

Click Professional.

3

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.

4

Type or specify data in all required fields on the header panel.

Note: Required fields are designated by an asterisk (*).

5

Complete the claim by following these steps:

TO add:

THEN:

Diagnostic information

Perform the following from the Diagnosis panel:

  1. Select the appropriate sequence in theSequence drop-down field.

  2. Type or search for the appropriate diagnosis in the Diagnosis Code field.

  3. For multiple diagnoses, click Add and repeat steps a - b.

Third-party liability or Medicare crossover information

Perform the following from the Other Payer panel:

  1. Click Add.

  2. Type or search for required fields.

  3. Type or search for optional fields.

  4. To add adjusted amounts and reason codes:

    1. Select the applicable payer.
    2. Click the Other Payer Amounts and Adjustment Reason Codes link.
    3. Click Add.
    4. Type or specify required fields.
  1. For additional payers, repeat steps a - c.

Detail about a service

Perform the following from the Detail panel:

  1. Type or search for required fields.

  2. Type or search for optional fields.

  3. For additional details, click Add and repeat steps a - b.

Paid amounts and dates for other payers (carrier codes)

Perform the following:

  1. Select the detail item on the Detail panel.

  2. Click the Other Payer-Detail link.

  3. Click Add.

  4. Type or search for required fields.

  5. Type or search for optional fields.

  6. For additional paid amounts and dates for other payers, repeat steps a-e.

Prescribed drug information

Perform the following from the Detail panel:

  1. Select the applicable service line item.

  2. Click the NDC link.

  3. Type or search for required fields.

  4. Type or search for optional fields.

  5. For additional prescribed drug information, click Add and repeat steps a-d.

Attach supporting documents

Perform the following from the Attachmentspanel:

  1. Click Add.

  2. Specify the type of document and transmission type.

  3. For additional attachments, repeat steps a - b.

6

Click Submit.

7

If the claim status is "Not Submitted yet," click each error message to correct the field in error.

SUCCESS

You have successfully completed this task when the claim status displays Paid, Denied, orSuspended.

DEMONSTRATION

The screen illustrations and instructions below provide a demonstration to reinforce the procedures learned in this course.

This demonstration illustrates how to submit a professional claim.

  1. For this demonstration, you would click the Claims menu option to begin.

    MITS home page with the Claims menu highlighted. 
  1. You would then click the Professional submenu option.

    MITS home page showing Claims menu with Professional submenu option highlighted.
  1. The Professional Claim panel appears. You would type the desired recipient identification in the Medicaid Billing Number field. 

    Professional Claim panel with the Medicaid Billing Number field highlighted.
  1. You would then type the specified recipient date of birth in the Date of Birth field. 

    Professional Claim panel with the Date of Birth field highlighted.
  1. You would type the specified patient account number in the Patient Account # field. 

    Professional Claim panel with the Patient Account # field highlighted.
  1. You would then click the add button on the Diagnosis panel to add a diagnosis. 

    Diagnosis panel with the add button highlighted.
  1. Next, you would type the specified diagnosis in the Diagnosis Code field. 

    Diagnosis panel with the Diagnosis Code field highlighted.
  1. You would then select the specified sequence number from the Sequence drop-down list.

    Diagnosis panel with the Sequence drop-down list highlighted.
  1. Next, on the Detail panel, you would type the specified from date of service in the From DOS field. 

    Detail panel with the From DOS field highlighted.
  1. You would type the specified units in the Units field. 

    Detail panel with the Units field highlighted.
  1. You would then type the specified charges in the Charges field. 

    Detail panel with the Charges field highlighted.
  1. Next, you would type the desired provider in the Rendering Provider field. 

    Detail panel with the Rendering Provider field highlighted.
  1. You would then type the desired place of service in the Place of Service field. 

    Detail panel with the Place of Service field highlighted.
  1. Next, you would type the specified procedure in the Procedure Code field. 

    Detail panel with the Procedure Code field highlighted.
  1. You would then select the specified pointer number from the Diagnosis Code Pointer drop-down list. 

    Detail panel with the Diagnosis Code Pointer drop-down list highlighted.
  1. Finally, you would click the submit button. 

    Professional Claim page with the submit button highlighted.

SUMMARY

In this topic you learned:

  • Why submitting a claim using the Web portal is important
  • How to submit a claim for reimbursement
  • The indicator of a successful submission

Searching for a Claim

OVERVIEW

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:

  • Search by Internal Control Number (ICN)
  • Search by recipient within a given period of time, such as within the last year
  • Search for all claims billed on a particular day, such as on the previous day or within the last 30 days

This topic explains how to use the portal to search for claims.

RELEVANCE

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.

REQUIREMENTS

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.

Search criteria options:

More options:

ICN/TCN: allows full or partial numbers

Claim Type

Medicaid Billing Number

Status

Rendering Provider ID

RA Date

Amount Billed

Date of Service

Prescription Number

From/Thru Date

HOW TO

Follow these steps from the Web portal main menu to search for a claim:

Step

Action

1

Click Claims.

2

Click Search.

3

Type, specify, or search for criteria.

Notes:

  • You can enter an ICN alone. If you do not enter an ICN, you must select a claim type or status, at a minimum.
  • When combining search criteria, MITS may require additional information.

4

Click Search.

SUCCESS

You have successfully completed this task when the desired claims appear in the Search panel.

DEMONSTRATION

The screen illustrations and instructions below provide a demonstration to reinforce the procedures learned in this course.

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.

  1. For this demonstration, you would click the Claims menu option to begin a basic search.

    MITS home page with Claims menu option highlighted.
     
  2. Next, you would click the Search submenu option.

    MITS home page showing Claims menu with Search submenu option highlighted.
     
  3. The Claim Search panel appears. You would then select a status from the Status drop-down list.

    Claim Search panel with the Status field highlighted.
     
  4. You would select the Date Range filter option from the Date of Service drop-down list.

    Claim Search panel with Date of Service field highlighted.
     
  5. You would then type the desired from date in the first field in the From/Thru DOS field.

    Claim Search panel with the From/Thru DOS first field highlighted.
     
  6. You would then type the desired end date in the second field in the From/Thru DOS field.

    Claim Search panel with the From/Thru DOS second field highlighted.
     
  7. Finally, you would click the search button.

    Claim Search panel with search button highlighted.
     
  8. The Search Results panel appears below the Claim Search panel, listing claims that match your search criteria. 

    You could also conduct an advanced search. You would click the Claims menu option to begin.

    MITS screen with Claims menu option highlighted.
     
  9. You would then click the Search Detail submenu option.

    MITS screen with Claims menu and Search Detail submenu option highlighted.
     
  10. The Claim Search Detail panel appears. You would select the desired filter option from theClaim Type drop-down list. 

    Claim Search Detail panel with the Claim Type field highlighted.
     
  11. You would then select the desired filter option from the Status drop-down list. 

    Claim Search Detail panel with the Status field highlighted.
     
  12. You would then type the desired procedure code in the first field in the Procedure field.

    Claim Search Detail panel with the Procedure field highlighted.
     
  13. Finally, you would click the search button.

    Claim Search Detail panel with the search button highlighted.

SUMMARY

In this topic you learned:

  • The advantage of using the Search feature
  • The search criteria available to you
  • How to search for a claim

Viewing Claim Summary Information

OVERVIEW

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:

  • Number of claims paid in the current month
  • Amount paid in the current month
  • Number of claims paid in the last 12 months
  • Amount paid in the last 12 months
  • Amount of the most recent payment and more

You can view the claim activity summary at any time.

RELEVANCE

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.

HOW TO

Follow these steps from the Web portal main menu to view claim activity summary information:

Step

Action

1

Click Providers.

2

Scroll down to view the available information.

Note: The claim activity summary information appears automatically each time you log in.

SUCCESS

When the following image displays, you have successfully completed this task.

Claim Activity Summary panel showing provider information.

DEMONSTRATION

The screen illustrations and instructions below provide a demonstration to reinforce the procedures learned in this course.

This demonstration illustrates how to view the claim activity summary information.

  1. For this demonstration, you would click the Providers menu option to begin.

    MITS screen with Providers menu option highlighted.
     
  2. The Claim Activity Summary panel would display with your provider information at the top.The following image displays this information.

    MITS screen showing provider information and the Claim Activity Summary panel.

SUMMARY

In this topic you learned:

  • How to view claim activity summary information
  • The types of information available
  • The value of the information

Resubmitting a Claim

OVERVIEW

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.

RELEVANCE

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.

REQUIREMENTS

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.

HOW TO

Follow these steps from the Web portal main menu to resubmit a claim:

Step

Action

1

Using any desired search method, display the denied claim.

2

Scroll to the bottom of the page and examine the text in the EOB Informationpanel to determine the reason(s) the claim was denied.

3

Modify the claim data to address the EOB information.

4

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.

5

Click re-submit.

Note: The re-submit button does not appear unless the claim is in a Denied status.

SUCCESS

You have successfully completed this task when a new ICN is assigned to the resubmitted claim.

DEMONSTRATION

The screen illustrations and instructions below provide a demonstration to reinforce the procedures learned in this course.

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.

  1. For this demonstration, you would click the Search submenu option on the Claims menu to begin.

    MITS home page with Search submenu option highlighted on the Claims menu.
     
  2. The Claim Search panel appears. You would type a claim number in the ICN/TCN field.

    Claim Search panel with ICN/TCN field highlighted.
     
  3. You would then click the search button.

    Claim Search panel with the search button highlighted.
     
  4. To resubmit a claim, you would first need to verify this claim is in a Denied status by viewing the Claim Status field. In this example, the claim status is Denied, and the EOBInformation panel indicates the service is not covered. You would need to modify the data so you can resubmit.


    Claim Status Information panel showing the claim status denied.
     
  5. In this example, you would need to change the procedure code. To change it, you wouldselect the line item on the Detail panel by clicking on the line item.


    Detail panel with line item highlighted.
     
  6. The details for the procedure you selected would appear on the panel. You would then type the updated information, such as a procedure code.


    Detail panel with Procedure Code field highlighted.
     
  7. You would then click the re-submit button.

    Claim panel with the re-submit button highlighted.
     
  8. After you click the re-submit button, the total charges and paid amounts display on the toppanel. The paid amount indicates the claim is in a paid status.

    Claim panel with total charges and paid amounts displayed.
     
  9. You would also confirm the status of the claim by viewing the Claim Status Information panel. In this example, the claim status is now Paid. The EOB information confirms the co-pay charges at the top of the panels.

    Claim Status Information panel with Claim Status displaying PAID.
     

SUMMARY

In this topic you learned:

  • How to resubmit a claim
  • Why resubmitting claims is important
  • The requirements for resubmitting a claim

Adjusting a Claim

OVERVIEW

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.

RELEVANCE

When you make adjustments on a paid claim, you must report the differences between the claim charges (billed amount) and the claim paid amount.

Warning: Failure to make the appropriate adjustments could subject you to fines and potential imprisonment.

The following examples represent typical reasons for adjusting a claim:

  • Add third-party liability (TPL) information, such as Medicare information
  • Modify the billing amount (negatively or positively)

REQUIREMENTS

The following are the requirements for adjusting a claim.

  • You can adjust a paid claim for the same recipient only.
  • You cannot adjust a denied claim.

Warning: You may not modify the recipient ID or provider ID.

GUIDELINES

The following guidelines or rules apply to claim adjustments:

  • You can adjust a paid claim at the detail level or claim level.
  • If you bill the wrong amount and are underpaid, you can adjust the paid claim.
  • If you bill the wrong amount and are overpaid, you must adjust the paid claim.

HOW TO

Follow these steps from the Web portal main menu to adjust a claim:

Step

Action

1

Using any desired search method, display the paid claim.

2

Adjust the claim data as necessary.

3

Click adjust.

SUCCESS

You have successfully completed this task when the claim appears with the modified information in a Paid status.

DEMONSTRATION

The screen illustrations and instructions below provide a demonstration to reinforce the procedures learned in this course.

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.

  1. For this demonstration, you would click the Search menu option on the Claims menu to begin.

    MITS home page with the Claims menu and Search menu option highlighted.
     
  2. The Claim Search panel appears. You would need to search for the paid claim to adjust itby typing the claim number in the ICN/TCN field.

    Claim Search panel with ICN/TCN field highlighted.
     
  3. You would then click the search button.

    Claim Search panel with search button highlighted.
     
  4. Next, the claim you need to adjust would display on the panels.

    Claim panel with claim information displayed.
     
  5. In this example, the charges for the procedure were entered incorrectly. To change the claim, you would need to select the line item on the Detail panel by clicking on the line item.

    Detail panel with claim line item highlighted.
     
  6. In this example, the charges are incorrect and need to be adjusted. You would type a new amount in the Charges field.

    Detail panel with Charges field highlighted.
     
  7. Finally, you would click the adjust button.

    Claim panel with adjust button highlighted.
     
  8. On the Claim Status Information panel, the Claim Status field would indicate that the claim is paid. On the Detail panel, the Charges field would show the new amount you typed.


    Claim Status Information panel showing claim in PAID status.
     
  9. Next, you would scroll up to the top panel to verify that the total charges have been adjusted.

    Claim panel showing Total Charges have been adjusted.

SUMMARY

In this topic you learned:

  • How to adjust a paid claim
  • Why adjusting a claim is important
  • The requirements and guidelines for adjusting a claim

Copying a Claim

OVERVIEW

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.

RELEVANCE

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.

REQUIREMENTS

The claim you copy FROM must have been previously submitted and returned with a Paidstatus.

HOW TO

Follow these steps from the Web portal main menu to copy a claim:

Step

Action

1

Using any desired search method, display the paid claim you want to copy FROM.

2

Verify the claim you selected is the one desired.

3

Click copy claim.

Note: The copy claim button does not appear unless the claim is in a Paid status.

SUCCESS

You have successfully completed this task when you see the status of the claim change to "Not Submitted yet."

NEXT STEPS

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.

DEMONSTRATION

The screen illustrations and instructions below provide a demonstration to reinforce the procedures learned in this course.

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.

  1. For this demonstration, you would begin this task by searching for an existing claim that is similar to the new one you need to submit. You would click the Search submenu option on the Claims menu to begin.

    MITS home page with Claims menu and Search menu option highlighted.
     
  2. On the Claim Search panel, you would type a claim number in the ICN/TCN field.

    Claim Search panel with the ICN/TCN field highlighted.
     
  3. You would then click the search button. The existing paid claim you want to copy woulddisplay on the panels. 

    Claim Search panel with search button highlighted.
     
  4. Next, you would click the copy claim button. 
    Note: The copy claim functionality is only available for claims in Paid status.

    Claim panel showing Claim Status as Paid. The copy claim button is highlighted.
     
  5. After you copy an existing claim, the status would change to "Not Submitted yet". All datawould be copied from the original claim. The next step would be to modify the data to create a new claim and submit it for payment. 

    Claim panel showing Claim Status as Not Submitted yet.

SUMMARY

In this topic you learned:

  • How to copy a claim
  • Why copying claims is valuable to you
  • The requirements for copying a claim

Voiding a Claim

OVERVIEW

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.

RELEVANCE

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.

REQUIREMENTS

The claim you want to void must have been previously submitted and returned with a Paidstatus.

HOW TO

Follow these steps from the Web portal main menu to void a claim:

Step

Action

1

Using any desired search method, display the paid claim you want to void.

2

Verify the claim you selected is the one desired.

3

Click void.

Notes:

  • The void button does not appear unless the claim is in a Paid status.
  • You can void a paid claim at any time; there is no time limit.

SUCCESS

You have successfully completed this task when the claim status for the ICN you voided changes to Denied.

NEXT STEPS

Create a new claim with the corrected information and submit it in the usual way.

DEMONSTRATION

The screen illustrations and instructions below provide a demonstration to reinforce the procedures learned in this course.

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.

  1. For this demonstration, you would click the Search menu option on the Claims menu to begin.

    MITS home page with Claims menu and Search menu option highlighted.
     
  2. On the Claim Search panel, you would type a claim number in the ICN/TCN field.

    Claim Search panel with the ICN/TCN field highlighted.
     
  3. You would then click the search button.

    Claim Search panel with search button highlighted.
     
  4. The claim would display on the panels. You would then click the void button. 
    Note: Only claims that have previously been submitted and have a status of Paid can be voided.

    Claim panel with void button highlighted.
     
  5. After you click the void button, the top panel would display. You would verify the void is complete by viewing the Claim Status Information panel below. The claim status changes to Denied. 


    Claim Status Information panel with Claim Status field changed to DENIED status.

SUMMARY

In this topic you learned:

  • How to void a claim
  • How voiding claims can be useful to you
  • The requirements for voiding a claim

Conclusion

OBJECTIVES

Congratulations on completing this course!

In this course you learned how to:

  • Identify advantages of Web billing
  • Verify recipient eligibility
  • Submit a claim
  • Search for a claim
  • View claim summary information
  • Resubmit a claim
  • Adjust a claim
  • Copy a claim
  • Void a claim

This is the end of the course.