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How to Enter Medicaid Claims in the PortalLog In: to top bar and hover over “Claims”Click on “Submit Claims Prof”Double check “Provider Information” and be sure it matches your information. This should be your business NPI number here. This is who is getting paid by Medicaid. The “Member ID” is the child’s information. This is the Medicaid Number.Enter in the Medicaid number and press “tab”. This should auto-populate the child’s information, including last name, first name and DOB.Move down to Claim InformationYou always need a Patient Number. I like to do the child’s initials, followed by the year they were born. You can choose something that is unique to you.Once that is entered always answer “No” for Transport CertificationFrom there, enter “Yes” for if the provider has a signature on file. This is your consent to treat. You can use the IFSP if you are comfortable with that, but remember, your name is not on there unless you were at the initial IFSP development meeting. So, it is up to you if you want to create an informed consent sheet of your own.After you have filled in those three areas, you hit “Continue”.On the next page you need to add your ICD 10 treatment codes (the diagnosis code(s) that you are using to justify your treatment) and any medical ICD 10 codes you have received from the physician (e.g., codes for autism or Down Syndrome). Treatment codes always come first. Type in the ICD 10 code and hit “add”. Then you can add additional codes as needed. Try to think about medical codes that impact treatment when entering in medical codes. You don’t want to have 20 codes in this section. Once you get your codes entered, hit “continue”. Be sure to remember to hit “add” after each code.The “From Date” and “To Date” are your dates of service. That date should be the same in both spots. The “Place of Service” is the number “12” which means “home”. Regardless of where you see the child it is always number “12”. Procedure code is your CPT Code. This is your treatment code. Modifiers are your profession: “GO” is OT, “GP” is PT, and “GN” is SLP. This goes in the first box. Your second box is the modifier “TL” indicating this is an Early Intervention service. If the visit is via telehealth, GT is the modifier that goes in the 3rd box.The Diagnosis Pointers are indicators of which ICD 10 diagnosis you are using for the claim. If you only entered one ICD 10 then you will click on the first pointer to drop down the number “1” (see above). If there are additional ICD 10 diagnoses that impact your treatment you can list up to 4 from the previous page, depending on how many you entered in. I included a blank screen shot so you can see the whole page.The “Charge Amount” is the amount typically that you charge for a session (not what Medicaid reimburses). For PT/OT, this is the amount you charge per unit times the number of units (Medicaid does not do the math for you). For SLP this is the amount for the session since the SLP CPT code is an untimed encounter code. The Units will be however many units you are billing for that particular code. SLPs, this will always be “1”. PT/OT this can vary by how many different CPT codes you use, but cannot exceed 5 units for a given Date of Service (DOS).You want to check the box next to “Family Plan Services” indicating this is IFSP services.The Rendering Provider is you…not your business but your NPI number as a therapist. The ID Type is “NPI”.The Referring Provider is the physician if you have a script. If you don’t have a script then you are also the Referring Provider. The taxonomy should auto-populate, remember ID Type is NPI number.Don’t forget to hit “add”.After you have added the information, the system will take you back to “From Date” where you can add additional visits. Once you have added all your visits for that child, you will hit “submit”. Once you have hit “Submit” you can view the entry one last time prior to hitting “Confirm”. If everything looks correct, hit “Confirm”.In an ideal world you will see this on the next screen:Congratulations!!! ................
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