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Welcome The Claim Adjustment Webinar will begin shortly ...

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Welcome The Claim Adjustment Webinar will begin shortly ...

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    1. Welcome! The Claim Adjustment Webinar will begin shortly. While you are waiting, please check your audio settings 1 You can dial in using a telephone. Long-distance charges may apply.

    2. 2

    3. Webinar Tips Attendee Control Panel Asking Questions 3

    4. Attendee Control Panel Hiding the Control Panel Toggle Auto-Hide On/Off Use this panel to: Set your sound preferences Ask Questions and view answers Your microphone should always be muted Do not use the hand raising icon We are not monitoring this feature 4

    5. Asking Questions You may ask questions anytime during the Webinar Click the Questions option in the Webinar toolbar Type in question Click Send Selected questions will be answered during the Webinar time permitting Questions will be reviewed for inclusion in future communications from DSHS 5

    6. Operational webinar series: PROVIDERONE CLAIM ADJUSTMENT/void PROCESS Copy of this presentation located at http://hrsa.dshs.wa.gov/providerone/Webinars/ClaimAdjustmentWebinar.ppt Links to all resources located throughout the presentation

    7. After this webinar you will be able to Know when to adjust vs. voiding a claim Learn the time period allowed to resubmit, modify, and adjust a claim in ProviderOne Know how to read the new TCN number Understand the two methods of submitting an adjustment Electronic Paper Adjust a claim originally sent in the old Legacy Payment System 7

    8. Know when to adjust vs. voiding a claim Adjust/Replace a paid claim when: A billing error was made The claim contained multiple surgical procedure codes The claim was over paid (could also be a void) Void a paid claim when: The claim was billed incorrectly The claim was over paid Denied claims simply need to be rebilled. You can not adjust a denied claim 8

    9. Time Limits for claims in ProviderOne Professional, Dental, and Institutional claims can be resubmitted, modified, or adjusted for a period of 24 months from the DOS Pharmacy claims can be resubmitted, modified, or adjusted for a period of 15 months from the DOS. Please refer to numbered memorandum 09-24 for specific information. http://hrsa.dshs.wa.gov/download/Memos/2009Memos/09-24.pdf 9

    10. How to read the new TCN Claim number Claims submitted in ProviderOne will contain 18 numbers each having a specific meaning Claims from old Legacy Payment System which are adjusted/resubmitted/voided in ProviderOne will contain 21 numbers A: Claim Medium Indicator B: Type of claim C: Batch Date D: Adjustment Indicator E: Claim Sequence Number F: Line Number 10

    11. How to do Electronic Adjustments/Voids 11 Log into ProviderOne using one of the following profiles: EXT Claims Submitter EXT Claims Submitter/Eligibility Checker EXT Super User From the Provider Portal choose the option Claim Adjustment/Void

    12. How to do Electronic Adjustments/Voids (cont.) 12 Enter the required search information and click submit

    13. How to do Electronic Adjustments/Voids (cont.) 13 Results are displayed

    14. How to do Electronic Adjustments/Voids (cont.) 14

    15. How to do Electronic Adjustments/Voids (cont.) 15

    16. Filling out the paper paid claim adjustment form DSHS has discontinued the old paper adjustment claim form. The ProviderOne adjustment claim form is your regular claim form with minor additions. CMS-1500 2006 ADA Dental Claim Form UB-04 Form

    17. Filling out the paper paid claim adjustment form CMS 1500 CMS-1500: In field 22 enter The qualifier 7 and the Transaction Control Number (TCN) to adjust a paid claim The qualifier 8 and the TCN to void a paid claim Example 7-300629600000340000 (replace/adjust) TCN is also referred to as the claim number.

    18. Filling out the paper paid claim adjustment form 2006 ADA ADA Dental claim form in the remarks field 35 enter: The qualifier 7-TCN to adjust a paid claim The qualifier 8-TCN to void a paid claim Example 7-300629600000340000(replace/adjust)

    19. Filling out the paper paid claim adjustment form UB-04 UB-04 Claim Form The qualifier 7 to adjust a paid claim added to the end of the type of bill in form locator 4 The qualifier 8 to void a paid claim added to the end of the type of bill in form locator 4 Original TCN entered in form locator 64 Example 7-300629600000340000(replace/adjust)

    20. Adjust a claim originally sent in the old Legacy Payment System Claims from the old Legacy Payment System can be adjusted/resubmitted/voided in ProviderOne Enter 9 at beginning of claim number from old system Add three zeros (0) to the end of claim number from old system Example Old ICN claim number 00914562815002500 (17 digits) New format in ProviderOne 900914562815002500000 (21 digits)

    21. Reference guides Information about how to fill out each standard paper claim form for use as an adjustment/void can be found: In our new ProviderOne Billing and Resource Guide http://hrsa.dshs.wa.gov/download/ProviderOne_Billing_and_Resource_Guide.html Very specific claim information may be found in each program specific billing instructions located at web site http://hrsa.dshs.wa.gov/Download/BI.html 21

    22. Ending the webinar To close the webinar Click the X button in the control panel 22

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