HOW TO ADD A DO NOT CLAIM IN SSIS

Ranae Eichstadt from Scott County is your starting pitcher!

In SSIS go to Person Search Icon

Enter Client’s First & Last Name – Right Click on the Client from Search Results – Select View Cnty Detail

• Click on side triangle Supplemental Healthcare Eligibility

• Click on Do Not Claim Determination

• Click on Lightning Bolt drop down

• Select New Do Not Claim Determination

The Do Not Claim Determination will pop up – select the following information from drop downs

• Claim Category – select MH-TCM
• Start Date – Enter date PMAP insurance started
• Plan – select client’s PMAP insurance type
• Click on the Save Icon

DO NOT CLAIM REPORT FOR PMAP BILLING IN SSIS

Ranae Eichstadt from Scott County is your starting pitcher!

Our County policy is the Case Managers have until the 10^th of the following month to enter their time from the month before. I will pull my PMAP report after the 10^th of the following month, if workers don’t have their time entered by the deadline the worker will need to e-mail me with the client’s name, date of service & insurance so I can back bill

Go to Tools – General Reports

Select Healthcare Eligibility – Do Not Claim Detail

From the Setup Tab –

• From Date Range select the following
• Period – Custom
• From – First day of Month To – Last day of Month

Report on & Include in Report should be auto checked

Select

• Claim Category – MH-TCM
• Do Not Claim Reason – I leave blank
• Plan – Select the Insurance Plan you want from report
• Click Search

A Preview Tab will pop up with all the clients that have a Do Not Claim with the Insurance Plan you selected

Print or Save from Icons below the Preview Tab, click on the Setup tab & change to the next Insurance Plan you want to view.

The Do Not Claim report will show every client that has a DNC entered from SSIS for that PMAP insurance even if the client doesn’t have time entered for that month. You will need to sort through all the pages to find your billable claims. I highlight the Client’s Name, PMI, billable ICD-10 CM, Date of Service (Make sure the Status says Completed & not Attempted to be billable). I also write the Modifier(s), and the billing rate at the top of the page before I start billing in MN E Connect

HE-674.00

BILLING PMAP MH-TCM IN MN E CONNECT

Ranae Eichstadt from Scott County is your starting pitcher!

Reviewing time that workers have entered on the Do Not Claim Report from SSIS you will bill the client’s PMAP insurance

Once you are logged into MN E Connect with the PMAP insurance you are going to bill, you should be in EDI Transactions

• Click on Add CMS 1500
• Select Primary

• Click on frfrom section 2 to search for an established client or if you know it’s a new client click New (See how to enter a new client later in instructions) next to the magnifying glass

• If it’s an established client type the first few letters of the client’s first name
• Tab
• Type first few letters of client’s last name
• Enter
• Click on the pointing hand to select client

You will now be in the Add CMS 1500 Primary EDI Transaction & the client’s information should be displayed on this page

**Click on section 11.d Is there Another Health Benefit Plan

• Click No

• Tab or click to section 21 Diagnosis or Nature of Illness or Injury
• Enter client’s diagnosis (make sure it’s a billable ICD-10-CM

• Tab or click to sections 24 to enter several pieces of information

Above are several examples of information that could be entered in section 24. For Dates of Service you will need to enter the full date of service (example 06/01/2021)

• Enter the date of service in From box
• Tab (To) date of service should auto fill
• You will need to click on the to select Place of Service
• Tab or click on HCPCS to enter T2023
• Tab to click enter Modifiers – Adult-HE, Adult Phone-HE U4, or Child-HE HA
• Tab to Diagnosis Pointer – Type A
• Tab to Charges and enter what your county charges for MH-TCM (we enter the State rate)
• Tab or click to Rendering Provider click on click on the to select your NPI#

Note – You can add several different Dates of Service if you need to back bill the same client on rows below

• Tab or click to section 31 Signature of Physician or Supplier Credentials click on the click on the to select your NPI#
• Click Submit
• It may take a few minutes for your claim to get submitted. Once submitted the claim will pop up to the top of the page & give you a message “Claim has been successfully submitted”

If you need to add a new client – From the Add CMS 1500 Primary EDI Transaction

• Click - New

You will need to enter several pieces of information for this client. You can get this information usually from the client’s PMAP insurance website. You need to enter information in any section that has * in order to process claim.

• In section 1a Insured’s ID# - I copy the client’s insurance ID from insurance website by Ctrl C to copy & Ctrl V to paste in MN E Connect (right click mouse is disabled)
• Section 2 Last Name, First Name
• Section 3 Birth Date & Sex
• Section 5 Address, City, State, & Zip Code
• Section 6 Click Self (when you select this several pieces of information will auto fill
• Click to section 11c click Select insurance plan by clicking

Continue as previously discussed by clicking in section ** 11d

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I track the PMAP clients that I’ve billed on an Excel Spreadsheet with the following information

• Client’s Name
• Insurance Company (Payer’s Name)
• Total billed
• Submit Date
• Paid Amount
• Paid Date
• Notes

I track for the entire year on this spreadsheet but have separate tabs for each month

The last tab the is titled Client’s SCMIDS is information I need for my Journal Entry I have to send to Accounting once we get paid

HOW TO CHECK FOR REJECTED CLAIMS IN MN E CONNECT

Ranae Eichstadt from Scott County is your starting pitcher!

After you have billed you PMAP insurance from MN E Connect you will want to check for rejected claims. You should wait at least 2 days before checking for rejected claims as it takes that amount of time for claims to get rejected

From the EDI Transaction Menu

• Click on Search EDI Transaction
• Click on drop down in Date Type – select Import Date
• Click on drop down in Select Last – select 10 days
• Click on drop down in Claim Status- select Rejected by Payer
• Click Search

If you receive a message in red “No matching records found for your selection” then there are no rejected claims for that claim status, if you have any rejected claims the client’s EOB will show up

To view the rejected EOB click on View

The rejected EOB will appear, the reason it was rejected will show on the top page of the form

The above is an example of a rejected claim because the Principle diagnosis isn’t a billable diagnosis.

A few other examples may be:

• Subscriber: Entity not eligible for benefits for submitted dates of service (Client didn’t have insurance coverage for this company for this date of service)
• Rejected: Procedure code for services rendered (Didn’t enter HCPCS code)

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You may want to check other Claim Status for rejected claims also, click on drop down to check: Rejected by HealthEC, Duplicate, and Incomplete Remittance to see if there are other types of rejected claims