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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