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Institutional Web Portal

Tutorial Revised 5/11/17

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Contents INSTITUTIONAL CLAIMS .......................................................................................................................................................... 3

PROVIDER INFORMATION ................................................................................................................................................... 7

SUBSCRIBER/CLIENT INFORMATION ................................................................................................................................... 7

CLAIM INFORMATION ......................................................................................................................................................... 8

BASIC LINE ITEM INFORMATION ....................................................................................................................................... 10

EDITING OR DELETING A LINE ITEM .................................................................................................................................. 11

ENTERING A NATIONAL DRUG CODE (NDC) ...................................................................................................................... 11

SUBMITTING AN ATTACHMENT TO A CLAIM SUBMITTED THROUGH THE WEB PORTAL ................................................ 11

MEDICARE SECONDARY/CROSSOVER ............................................................................................................................... 13

TPL (OTHER THAN MEDICARE) .......................................................................................................................................... 15

ADJUSTING A CLAIM ......................................................................................................................................................... 16

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INSTITUTIONAL CLAIMS

Navigate to http://wymedicaid.acs-inc.com and select Provider

Select Provider Portal from the left hand navigation bar.

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Enter your User ID and Password.

Click on Log In

Note: If you have not yet registered for the Web Portal, you must do this first. Reference the Registration Tutorial or

contact EDI Services at 800.672.4959 for assistance.

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Select Claims.

Select Create Institutional Template

Name the template

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o If making a template for each client, it is recommended that you name the template after each client –

i.e. Jane Smith.

o If making a template for a code, it is recommended that you name the template after the code – i.e.

99212 or Office Visit.

Note: When creating a template only fill out those selections that are not going to change from claim to claim such as

NPI and taxonomy.

Note: If using this tutorial to create a claim to submit, make a selection at each and fill out the necessary additional

information.

Note: There are red + signs before certain areas that allow additional information to be entered. Selecting the red + sign

will expand the area. Only expand and enter information that is required, as entering invalid/incorrect information can

cause a claim to reject. The below information will instruct you in which areas are required to be completed.

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PROVIDER INFORMATION

Are you resubmitting this claim?

o Select Yes to submit a claim adjustment

o Select No if creating a template or submitting an original claim.

BILLING/PAY-TO PROVIDER

o Provider ID dropbox - Select the Billing/Pay-To Provider’s NPI

Note: Select the Provider ID if you do not bill with an NPI. If the provider information you need is not in this drop down

list, contact the EDI Call Center at 800-672-4959, option 3

o Select the red + sign for Additional Billing Provider Information and enter the Billing/Pay-To Provider’s

taxonomy code in the Taxonomy Code box

Note: Entering any additional information in this section may cause your claim to reject.

SUBSCRIBER/CLIENT INFORMATION

Recipient ID box - Enter the Wyoming Medicaid Client ID

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CLAIM INFORMATION

Patient Account No. box - Enter the patient account number

Place of Service/Type of Bill dropdown – Select the appropriate type of bill

Frequency Type Code dropdown – Select the appropriate 3rd digit for the type of bill

Statement Dates boxes – Enter the statement dates

Complete additional fields as needed

Note: Admission type is where the claim can be indicated as an emergency, urgent, elective, newborn, trauma center, or

unknown.

Total Claim Charge box – Enter the total claim charge

Provider Signature on File – Select Yes

Medicare Assignment Code dropdown – Select A:Assigned

Benefits Assignment Certification – Select Yes

Release of Information Code dropdown – Select Y:Provider Has Signed Release

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Entery any condition, occurrence, or value codes if necessary

Enter Prior Authorization information if necessary

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Ender diagnosis codes along with Present on Admission indicators as needed

Note: Do not enter the periods in the diagnosis codes.

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Does this claim have backup documentation?

o Select Yes if the claim has backup documentation i.e. invoice, op notes, etc.

a. Select BM: By Mail if sending the backup documentation by mail

i. If BM: By Mail is selected, enter the most appropriate selection in the Type Attachment

dropdown box

b. Select EL: Electronic Attachment Only if sending the backup documentation electronically

o Select No if the claim does not have backup documentation

BASIC LINE ITEM INFORMATION

Revenue Code box – Enter revenue code

Procedure Code box – Enter procedure code if necessary

o Modifiers boxes – Enter modifiers if necessary

Service Date/First Date of Service & Last Date of Service boxes – Enter dates of service

Service Units box – Enter number of units

Total Line Charges box – Enter the total line Charges

Once all necessary boxes have been completed, select the Add Service Line Item button

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EDITING OR DELETING A LINE ITEM

To edit a line item

o Select the number next to the line item that needs edited

The information will repopulate under the Service Line Items section

o Make any necessary changes

o Select the Update Service Line Item button

To delete a line item

o Select the Delete link for the line item that needs deleted

ENTERING A NATIONAL DRUG CODE (NDC) Select the Other Svc Info link for the service line which needs an NDC

Select the red + sign next to DRUG IDENTIFICATION

o National Drug Code box – Enter the NDC

o National Drug Unit Count box – Enter the unit count

o Unit Code dropdown – Select the unit code

SUBMITTING AN ATTACHMENT TO A CLAIM SUBMITTED THROUGH THE WEB PORTAL

Does this claim have backup documentation?

o Select Yes if the claim has backup documentation i.e. invoice, op notes, etc.

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Once the claim is keyed, select the Verify Claim button. This will help identify any errors that exist with the

claim.

Once any errors are corrected if there are any, select the Submit Claim button.

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MEDICARE SECONDARY/CROSSOVER

Select the red + sign next to Other Payer Information

o Payer/Insurance Organization Name box – Enter Medicare

Select the red + sign next to Additional Other Payer Information

o Adjudication Date box – Enter the date that Medicare adjudicated

Select the red + sign next to COB Monetary Amounts

o COB Payer Paid Amount box – Enter the amount that Medicare paid

Select the red + sign next to Other Subscriber Information

Select the red + sign next to Additional Other Subscriber Information

o Claim Filing Code dropdown – Select MA:Medicare Part A

o Payer Responsibility Sequence Number Code dropdown – Select P:Primary

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Note: The Wyoming Medicaid Web Portal was only built to allow one additional insurance besides Medicaid. If the

client has more than one additional insurance, please submit the claim on paper as an appeal stating why it cannot

be billed through the Wyoming Medicaid Web Portal along with all necessary paperwork to process the claim.

Select the red + sign next to Other Insurance Coverage

o Benefits Assignment Certification – Select Yes

o Release of Information Code dropdown – Select Y:Provider Has Signed Release

From the top of the claim, select the tab that says Other Claim Info

Under Coordination of Benefits, select the red + sign next to Claim level Adjustments

o Claim Adjustment Group Code dropdown - Select PR: Patient Responsibility

o Reason Code box - Enter the reason code

a. 1 – Deductible

b. 2 – Coinsurance

c. 122 – Psych Deductible

o Amount box – Enter the amount

Select Basic Claim Form button to return to the Basic Claim Info page.

Note: When verifying a claim, if the error code 265 “The recipient has TPL on file and no TPL amount is indicated on the

claim” posts and the above information has been entered, please submit the claim.

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TPL (OTHER THAN MEDICARE)

Select the red + sign next to Other Payer Information

o Payer/Insurance Organization Name – Enter name of other insurance

Select the red + sign next to COB Monetary Amounts

o COB Payer Paid Amount – Enter the amount that Medicare paid

Select the red + sign next to Other Subscriber Information

Select the red + sign next to Additional Other Subscriber Information

o Claim Filing Code dropdown – Select CI:Commercial Insurance

o Payer Responsibility Sequence Number Code dropdown – Select P:Primary

Note: The Wyoming Medicaid Web Portal was only built to allow one additional insurance besides Medicaid. If the client

has more than one additional insurance, please submit the claim on paper as an appeal stating why it cannot be billed

through the Wyoming Medicaid Web Portal along with all necessary paperwork to process the claim.

Select the red + sign next to Other Insurance Coverage

o Benefits Assignment Certification – Select Yes

o Release of Information Code dropdown – Select Y:Provider Has Signed Release

Note: When verifying a claim, if the error code 265 “The recipient has TPL on file and no TPL amount is indicated on the

claim” posts and the above information has been entered, please submit the claim.

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ADJUSTING A CLAIM

Are you resubmitting this claim?

o Select Yes to submit a claim adjustment

o Resubmission Type Code box – Select 6:Adjustment

o ICN to Credit/Adjust box – Enter the ICN/TCN from the claim to be adjusted

Note: If 7:Replacement is selected from the Resubmission Type Code box, this will void the original claim and submit a

clean new claim. This should only be used when the originally paid claim needs voided or the originally paid claim’s paid

date is past the six month timely filing adjustment limit.