Transcript Document

Payer Path
Presented by
The HIPAA Helpdesk Department
Contact Xerox
Call 505-246-0710 or 800-299-7304 - to directly reach all provider help desks
including Provider Relations, Provider Enrollment, the HIPAA/EMC help desk
and TPL.
For all contact, Claims, and Correspondence Addresses information go to the
following link on the New Mexico Medicaid Web Portal:
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https://nmmedicaid.acsinc.com/nm/general/loadstatic.do?page=ContactUs.htm
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Email: [email protected]
Payerpath Registration
If you have not registered with Payerpath,
You can access the Payerpath registration form at
http://www.hsd.state.nm.us/mad/pdf_files/HIPAA/PPRe
gistrationformAddDelete.pdf
When you have completed the user registration form,
Please fax to (505) 246-8485 - Attention: HIPAA Help Desk
or email to
[email protected]
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Payerpath and Electronic Claims
Submission Assistance
The HIPAA Help Desk supports
the Payerpath claims application product, technical support
for the New Mexico provider community. (Note)
No billing training will be provided.
For PayerpathSupport:
Email the HIPAA Help Desk at
[email protected]
or you may call
1-800-299-7304 (Toll Free) or 505-246-0710
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Before Logging on to PayerPath, please turn your Pop-up
Blockers off or disable them
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Payerpath Home Page
To access the Payerpath home page through Microsoft Internet Explorer
(preferred browser), the web address is http://www.Payerpath.com.
Select the Client Login link in the top right hand corner of the page
above the Payerpath road sign to enter the Payerpath system.
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Payerpath Login
When you first login
into Payerpath, use
the Customer Name,
User Name, and
Password provided to
you when you
registered.
When you access Payerpath for the first time, you will be requested to
change your password, as the one provided to you when you registered is
only a temporary password. You must select a “Strong Password” in order
to obtain access.
What is a “Strong Password”?
A “strong password” contains each of the following:
between 6-20 characters
upper case letter
lower case letter
numeric value
symbol (*, #, @)
Some examples of strong passwords are:
Pp@456
John@1969
P@yerpath1
Xyz123!
Passwords expire every 60 days and can be changed at any time.
If you forget your password, select the link Forget Your Password? at the Payerpath Login screen.
This link will allow you to request a new password by entering your Customer Name, User Name, and
e-mail address. A new password will be e-mailed to you.
You will then be prompted to change and confirm a new password.
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Messages
When issues arise or other “news” occurs, you will receive a message.
To view messages, you may either:
1.
2.
Go to the Maintenance link in the Tool Bar at the top of the screen and select View
Messages, or
Obtain access directly on the underlined link You have # NEW MESSAGES.
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Required Fields Documents
HELPFUL TIP!
BEFORE entering claims, print out and read the following documents that are applicable to your agency. The
information provided within these documents is essential to entering your claims correctly into Payerpath.
NM 837 Professional Required Fields
NM 837 Institutional Required Fields
NM 837 Dental Required Fields
-Go to “Help”
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The Document Library will
be opened in a pop-up
window.
Open the required fields
document that is
consistent with your billing
(837P, 837I, or 837D) in
order to aid in determining
valid values for required
fields.
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Payerpath Tips!
Setting Defaults

To avoid having to enter the same data information in the electronic fields, click on the MAINTENANCE tab, Edit
Claim Defaults, then locate the fields that you want to have constant values.
Select Edit
Claim
Defaults
under the
Maintenance
dropdown.
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Setting Defaults (cont.)
Click
select
button
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Defaults (cont.)
Enter information that
will remain constant
on every claim.
Click save
defaults button
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Claims Billing (New Claim)
To create new
claims or
rebill, click on
“Claims” then
“View Claims”.
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Claims Billing (cont.)
Leave the default of “ALL”
unless performing advanced
functions.
Claim Status Definitions
Unless your
organization
uses multiple
claims types
leave all
defaults and
select “DISPLAY
LIST”
All - All claim statuses.
Failed (F) - Claims that
did not meet payer-specific
edit criteria.
Warning (W) - Claims
flagged for manual review
via a custom or Code Check
edit requested by the user.
Held (H) - Claims placed on
hold by the user.
Passed (P) - Clean claims
ready to be sent to the
Payer.
Marked for Send (S) Claims marked as ready to
send to the payer.
In Process to Payer(A) Claims sent to payer, not
yet been archived to a
transmitted status.
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Claims Billing (cont.)
To enter a new
claim, click on
New.
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Claims Billing (cont.)
HAVE YOU PRINTED AND READ THE FOLLOWING FORM YET?
NM 837 Professional Required Fields
NM 837 Institutional Required Fields
NM 837 Dental Required Fields
BEFORE entering claims, return to the Home page (Tools and then Home)
under Help and print out and read the above noted documents, as applicable
to your agency, as the information provided within these documents is
essential to entering claims correctly into Payerpath.
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Claims Billing (cont.)
The claim form will be displayed with required fields displayed in solid red. All required fields must
be completed.
Errors are highlighted in red in the Navigation tool bar. To view all of the outstanding errors in the
claim, left click the mouse on the down arrow of in the Error box.
Correct the highlighted fields and select the Save and Run Edits link on the Navigation tool bar to
save the corrections. You must select Save and Run Edits every 5 minutes or so to prevent session
time-out.
When all errors are corrected, the tool bar should read No Edit Errors in the Errors space in the
Navigation tool bar.
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Claims Billing (cont.)
The Form Navigation tool bar contains the functions needed when editing claims. This tool bar can
be moved anywhere on the screen as you edit your claims by moving your mouse pointer over the top
blue field of the box, depress and hold the left mouse key down while moving the tool bar to the
desired location.
Save and Run Edits. This saves your changes and runs the edits again to determine if there
are new errors. NOTE: Make sure to tab out of the field you have corrected in order to commit
your changes before selecting Save and Run Edits and be sure to run Save and Run Edits
before moving to the electronic fields and back to form.
Previous Claim. Navigates back one claim in the list.
Electronic Fields. Displays the electronic fields.
New Claim. Brings up a blank claim form for key entry.
Back to List. Navigates back to the Claim List.
Next Claim. Navigates forward one claim in the list.
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Claims Billing 1500 HCFA Form
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July 6, 2015
NPI number is entered in Field 33, bottom of form, far right.
NPI
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Claims Billing 1500 HCFA Form (cont.)
A diagnosis code must be entered on claim
A diagnosis code must now be entered regardless of the date of service. When the diagnosis is entered, the
decimal point is NOT to be included. The diagnosis pointer must be completed to point the service procedure
code to the diagnosis code.
The placeholder diagnosis code (to be used until a more accurate diagnosis code can be provided) for DDW
providers is 799.9 which is entered as 7999 in box 21.
When there is just one diagnosis on the claim, each procedure code will have a diagnosis pointer of “1” meaning
that it’s the diagnosis “1” to which the service corresponds. (Do not try to enter the actual diagnosis code in the
pointer field because it only allows up to 2 digits).
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July 6, 2015
Claims Billing 1500 HCFA Form (cont.)
To input your taxonomy code click on Electronic Fields in the form
navigation box.
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Claims Billing 1500 HCFA Form (cont.)
Provider Taxonomy Codes
Rendering
Billing
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Claims Billing 1500 HCFA Form (cont.)
Update to Billing Addresses
Please be aware P.O. Boxes are no longer valid in the billing section of the claim.
Physical addresses must now be entered in this section of the form.. Another
change is the zip code must now be the 5 digit zip WITH the 4 digit suffix included
WITHOUT the hyphen (as shown below in box 33). If you don’t have a 4 digit
suffix, please enter four zeroes instead. (0000).
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July 6, 2015
Claims Billing 1500 HCFA Form (cont.)
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July 6, 2015
Claims Billing 1500 HCFA Form (cont.)
You will receive message (Patient signature
source – Invalid Code.) This field will be
seen in the Electronic Fields. To see and
correct the error, click on Electronic Fields in
the Navigation Box as seen below.
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July 6, 2015
Patient Signature Source Update (cont.)
Change the Patient Signature Source to either a “P” or leave blank, then Save and Run Edits in the Form
Navigation box.
section of
Gipson
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July 6, 2015
Claims Billing UB92 Form
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July 6, 2015
Claims Billing UB92 Form (cont.)
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July 6, 2015
Claims Billing UB92 Form (cont.)
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July 6, 2015
Claims Billing UB92 Form (cont.)
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July 6, 2015
Institutional Claim Covered Days Update
In order to get your claims to pass, the covered days now must be entered on the claim as
such.
The Value Code (box 39) for covered days is ‘80’ and the Value Code for non-covered days
is ‘81’. So, if the submitter needs to enter 10 covered days on the claim, they need to add a
Value Code of ‘80’ with ’10.0’ days. It will show up in monetary value but its ok. Just
remember it will equate to the total amount of days covered.
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July 6, 2015
Claims Billing ADA 2002 Form
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July 6, 2015
Claims Billing ADA 2002 Form (cont.)
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July 6, 2015
Claims Billing ADA 2002 Form (cont.)
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July 6, 2015
Claims Billing ADA 2002 Form (cont.)
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July 6, 2015
Claims Billing ADA 2002 Form (cont.)
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July 6, 2015
Claims Billing
Claims in a Failed
status will need to
be edited and
corrected prior to
sending, as Payerpath
will not send any
claims in this
status.
View claims to be edited
by selecting V for View in
the far right column of
the claims list.
To view the
history of a
claim click on
the “H”.
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Once you have the claim(s) in a Passed status you must mark them for send.
 To display all the claims that have been corrected and are now ready to send, at the Claim List,
select Passed within the Show box in the upper right corner.
NOTE: Payerpath will only send those claims that have progressed to the Passed status and have been
changed to Mark for Send.
 You may select the claims in three ways.
1. Select all the claims in the list. Go to the Tools link in the Tool Bar at the top right of the
screen and click on Select/Unselect List.
2. Select claims displayed on current page. Go to the Tools link in the Tool Bar and click on
Select/Unselect Page.
3. Select only certain claims to Rebill. Click on the box to the left of the applicable claims to
display a checkmark in the box.
 To send the claims selected, go to the Tools link in the Tool Bar at the top right of the screen and
click on Send Selected or Send All to send the claims. The screen will refresh to automatically
display the claims with an S status and you may print the list of sent claims.
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Re-bill and Demographic Claims
To rebill a claim,
open the claim filter
by clicking on “View
Claims.”
There are two ways that you can rebill a claim after the claim has been initially entered into Payerpath
1.
The Rebill function is useful in performing follow-up with payers, or when billing for repeat service(s) when
only the Date(s) of Service (DOS) require changing. This is also helpful when all you need is to correct and
re-send claims that have been rejected by the payer by accessing the database of claims previously sent
through Payerpath.
2.
The Patient Demographics function allows you to create new claims for recurring patients and when the
services rendered differ from the last visit.
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Re-bill Claims (cont.)
Enter a date
span into the
Sent Date that
is no greater
than 3 months.
Choose
“Transmitted”
claims in the Claim
Status.
Click on DISPLAY
LIST to display the
Transmitted claims
within the date span
indicated.
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Re-bill Claims (cont.)
T = Transmitted Claim
View Transmitted Claims
online to make rebilling
decision.
Once the claim is open you have the option to rebill.
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Re-bill Claims (cont.)
You can select the claims to Rebill in one of the following ways.
1. Select all the claims in the list. Go to the Tools link in the Tool Bar at the top right
of the screen and click on Select/Unselect List.
2. Select claims displayed on current page. Go to the Tools link in the Tool Bar and
click on Select/Unselect Page.
3. Select only certain claims to Rebill. Click on the box to the left of the applicable
claims to display a checkmark in the box.
To Rebill the claims selected, go to the Tools link in the tool bar and click on Rebill
Claims.
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Re-bill Claims (cont.)
The transmitted claim that is selected is copied and sits in a “Failed” status. Click on View on the far right the
applicable claim, change the data as needed, and click on Save and Run Edits to save the modified claim.
NOTE
If you exit the Rebilled Claims List,
the remaining claims, other than opening the claims to edit,
will then appear on
the Untransmitted Claims List in a Failed status.
For example, if you went to Reports and then tried to come back,
You would have to access the claims on
the Untransmitted Claim List as they would have diverted to a Failed status.
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Demographic Claims
The Patient Demographics function allows you to create new claims for recurring patients when the services
rendered differ from the last visit.
Select Patient Demographics from the Claims menu.
–
Set parameters on the Patient Demographic filter
–
Patient Database will appear
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Demographic Claims (cont.)
To bill Demographic Claims, you may select claims in one of the following
ways.
1. Select all the claims in the list. Go to the Tools link in the Tool Bar at the
top right of the screen and click on Select/Unselect List.
2. Select claims displayed on current page. Go to the Tools link in the Tool
Bar and click on Select/Unselect Page.
3. Select only certain claims to Rebill. Click on the box to the left of the
applicable claims to display a checkmark in the box.
To bill the claims selected, go to the Tools link in the Tool Bar and click on Bill
New.
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Print Claim Field Data and Claims
In the event you would like to print information provided on a claim, View the desired claim and go to the Tools link in the tool bar at
the top right of the screen and click on Print to print the claim’s field data on blank paper.
If you want to print to a claim onto a form, you must print on a laser printer and use pre-printed laser forms. The parameters for
printing vary and are dependant upon how your printer is programmed.
To adjust the page setup parameters, open Internet Explorer and go to File on the browser Tool Bar and select Page Setup.
 Delete the contents of the Header and Footer, as they should be blank.
 Begin testing with all margins set at 0.25. Also, when on the Adobe Acrobat print preview screen, make sure the Page
Scaling box is set to None, so that it doesn’t automatically adjust the form to fit the page size. You may have to adjust the
margins to accommodate your printer’s programming and perform a test print again.
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Print Claim List and Claims
Individual claims or the Claim List can be printed from the Claim List page. The Claim List will print based
on the status selected in the Show box (Failed, Passed, Marked for Send, Sent to Payer, or Held).
Go to the Tools link in the tool bar at the top right of the screen and click on Print or Print All and select
the print option for:
 Print List. Will print list of claims based on selected Claim Status (i.e. Failed, Passed, etc.)
 Print Forms. Will print all the claims from a selected Claim Status in HCFA, UB92 or ADA
format, depending upon the payer type.
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Payerpath Tips!
 When entering information on a claim, click out of the box before clicking
on Save and Run Edits.
 When entering Service Lines, you do not have to enter the decimal point
(.).
To save time when first entering patients into Payerpath, establish a
“Dummy Claim” that contains all the information that would remain the
same for each patient (i.e. the Provider’s Federal Tax Identification
Number, Billing Name and Address, etc.).
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Payerpath Tips!
•
When you have a new patient to add into Payerpath, click the View link
on the Dummy Claim.
•
Once the claim opens, click on the Tools link on the tool bar and click on
the Copy link in the dropdown menu to create an exact duplicate of the
claim.
•
Enter the patient’s name onto the claim and immediately click on Save
and Run Edits link on the Navigation tool bar to save the claim under
that patient’s name.
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Payerpath Tips!
 Claims Transmissions:
Claims Marked for Send no later than 8:00 a.m. MT are
picked up daily.
Reminder: Do not forget to reconcile your weekly
Remittance Advice.
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