PC-ACE Pro32 User Guide
[Pages:228]User Guide
ABILITY Network Inc
ABILITY | PC-ACE Pro32TM
CLAIMS PROCESSING SYSTEM
User Guide
Release 2.7 | July, 2015
Copyright and Trademark
Copyright
Copyright 2015 ABILITY Network Inc. All Rights Reserved. All text, images, and graphics, and other materials in this document are subject to copyright and other intellectual property rights of ABILITY Network Inc. These materials many not be reproduced, distributed, modified, or republished without the express written permission of ABILITY Network Inc.
Trademark
The marks appearing in this document including, but not limited to ABILITY Network(ABILITY), ABILITY logo, and all ABILITY services are trademarks and/or registered trademarks of ABILITY Network Inc. All other brands, product names, or services are trademarks or registered trademarks of their respective holders.
Table of Contents
Introducing PC-ACE Pro32 1
Getting started with PC-ACE Pro32 3
PC-ACE Pro32 Setup Procedures
7
Setup of Medicare Part A Systems
7
Setup of Institutional All-Payer Systems
14
Setup of Professional Systems
20
Main Toolbar & Forms 27
The PC-ACE Pro32 Main Toolbar
27
Institutional & Professional Claims Menus
28
Claim List Form Features
29
The Institutional Claim Form
35
The Professional Claim Form
43
Eligibility Benefit Request List Form Features
51
The Eligibility Benefit Request Form
57
The Service Type Eligibility Benefit Request Form
62
Roster Billing List Form Features
66
The Professional Roster Billing Form
68
Home Health Plan of Care List Form Features
71
The Home Health Plan of Care Form
73
Reference File Maintenance Form
76
Claim & Reference File Edit Validation
81
Security & User Maintenance
83
System Preferences 85
Preferences Overview
85
General Preferences
86
Claim List Preferences
90
Claim Import Preferences
91
Printing Preferences
92
Data Communication Preferences
97
Miscellaneous Preferences
98
Common Claim Activities
101
Adding a new claim
101
Listing, modifying and maintaining claims
102
Importing claims
104
Reversing the most recent claim import run
108
Processing claims automatically
109
Preparing claims for transmission
112
Transmitting electronic claim files
115
Viewing and maintaining transmission acknowledgment files
117
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Reactivating previously transmitted claims
119
Preparing claim status request files for transmission
121
Viewing and maintaining claim status response and acknowledgment files
123
Viewing and maintaining the claim status request/response history
126
Printing claims
128
Posting claim payments (Institutional)
131
Posting claim payments (Professional)
133
Archiving and unarchiving claims
135
Adding a new eligibility benefit request
138
Listing, modifying and maintaining eligibility benefit requests
140
Preparing eligibility benefit request files for transmission
142
Viewing and maintaining eligibility benefit response files
145
Viewing the eligibility benefit response for a specific request
147
Adding a new roster billing
149
Listing, modifying and maintaining roster billings
150
Adding a new Home Health Plan of Care
152
Listing, modifying and maintaining Plans of Care
153
Printing Home Health Plans of Care
155
Common Reference File Procedures
157
Adding and maintaining patients
157
Adding and maintaining payers
160
Adding and maintaining providers (Institutional)
163
Adding and maintaining providers (Professional)
166
Maintaining Codes & Miscellaneous Reference Files
169
Codes & Miscellaneous Reference Files Overview
169
Submitter File Maintenance
171
Data Communications File Maintenance
177
HCPCS Codes File Maintenance
179
HCPCS Modifiers File Maintenance
180
ICD Codes File Maintenance
182
Physician (UPIN) File Maintenance
184
Type of Bill (TOB) File Maintenance
185
Condition/Occurrence/Span/Value Codes File Maintenance
186
Revenue Codes File Maintenance
187
Place of Service (POS) File Maintenance
190
Facility File Maintenance
191
Charges Master File Maintenance
192
Provider Specialty File Maintenance
194
Provider Taxonomy Codes File Maintenance
195
Claim Adjustment Reason Codes File Maintenance
197
Remittance Remark Codes File Maintenance
198
Eligibility Request Service Type Codes File Maintenance
199
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Claim Status Response Codes File Maintenance
Miscellaneous Functions
201
Adding or modifying a system user
Scheduling unattended claim activities
Launching the ANSI-835 Electronic Remittance Module
Performing system backups/restores
Packing and reindexing the databases
Sending support mail to your distributor
Troubleshooting 213
Reviewing the claim activity logs
Recovering from an interrupted claim prepare run
Index 216
Table of Contents
200
201 202 205 206 209 211
213 214
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Introducing PC-ACE Pro32
Welcome to the PC-ACE Pro32 Claims Processing System - the system of choice for electronic healthcare claims submission and management. PC-ACE Pro32 is a complete, selfcontained electronic claims processing system. It can be used in a stand-alone configuration or in conjunction with your existing claims management system. Designed exclusively for Microsoft Windows, PC-ACE Pro32 is the latest generation of the PC-ACE family of electronic claims processing systems that have been successfully serving the healthcare community for decades.
Key Features
PC-ACE Pro32 is a comprehensive claims management system. Some of the more prominent features include:
? Combined Medicare Part A, Institutional All-Payer and Professional claims system ? Electronic submission of claims in ANSI-837 format ? Flexible claim import from existing systems ? Remittance translation/export to existing systems ? Comprehensive real-time claims editing minimizes rejected claims ? Field-level edit validation provides immediate user feedback ? Automatic code validation (diagnosis, procedure, etc.) ? Detailed claim import & edit validation error reporting ? Context-sensitive pop-up selection lists speed claim entry and promote accuracy ? Prints Institutional and Professional claims on plain paper or pre-printed forms ? Maintains claim payment history ? Unattended scheduling of claims activities ? Integrated backup, restore and file maintenance functions ? Familiar Microsoft Windows "look and feel" ? Comprehensive on-line help system ? Technical support through direct customer service line and Internet web site ? Ongoing maintenance, updates and enhancements
Thank you for choosing PC-ACE Pro32 as the electronic claims processing system for your facility or organization. It is our commitment to provide you with a quality product and outstanding support. We will strive to constantly improve and enhance PC-ACE Pro32 to serve the ever-changing needs of the healthcare community well into the 21st century.
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