Use this screen to create your Medicaid claims.
The screen is divided into three sections. The following is the order in which you would use it:
2nd Panel: Use this to select the billing date and criteria for payers.
1st Panel: After selecting the patient billing criteria, this panel will show you all patients that were active during the billing dates/payer(s) you selected.
3rd Panel: This area allows you to select the type of charges for the claim. It will gather the charges to print summary or detailed reports before creating the claim. It is also where you will generate the claim.
Select Patients for Claim and Review for Errors
1. Click the Billing button from the Main Menu.
2. Click the All Other Billing item at the top of the screen.
3. In the middle of the screen under Select Patients for Billing, set the From and thru billing dates.
4. You can either chose billing format, or you can specify a certain program/payer. Perform one of these actions:NC MCO Payers: If you have only one PCSNPI, then all the MCO claims can be created at the same time by selecting payers 840,860,870,880,890 (and if you have children billed as 99509:HA, then add payers 841,861,871,881,891). If you have different NPI numbers for each program, then create separate files for each NPI.
- Enter program number (Recommended)
- Enter payer number (Recommended)
OR
- Select the billing format (you can click the View List button to see the list of formats and select one)
OR
- Pull up the patient's name or chart number from the bottom, middle screen to pull individual patients.
5. Click on the Select Patients as Specified Above button. The list of patients will appear in the first panel. This will add any patient that was active during the time frame you have selected - even if they do not have any charges keyed for that time.
6. Dates These Charges Were Keyed: This will default with the From date the same as the billing From date and the Thru date as today. Modify these dates only if you want to capture charges that were keyed during a select time frame. This helps to select late entry charges when a week or month has already been billed. Include Modified Charges = When checked it will include any charges that were added or modified during your Keyed date range. When it is not checked it will only include charges added during the time frame.
7. Click the Prepare Charges for Billing button on the right side of the screen.
8. **Note: If there are any errors, a list of the errors will preview first.
- You may print the list of errors.
- You may view details or summary of the errors.
- You may correct the errors and then return to billing.
- Click the Hide button to hide the errors.
9. To remove patients not ready to be billed (which includes any that came up on the error screen after step 6):
- In the first panel, click on the Chart Number of any patient you do not want to include in billing.
- The chart number will move to the bottom of the second panel.
- If you change your mind, you can click the chart number second panel, and it will move back to the first panel, which is the list of patients for billing.
10. If you remove patients, you will need to click the Prepare Charges for Billing button again.
Review Charges Before Creating Claim
11. Click the View Billing button. A new screen will pop up.
12. Click the View Details button and the details by day and unit and amount will appear.
13. Click the View Summary button and a summary of the total quantity, hours, and amount will appear.
14. Click the Print button to print either the detailed or summary view.
15. Click the Hide button to hide the screen.
Create the Claim
16. Click the Create HIPAA Tx button in the lower right. A new screen will come up with the HIPAA transactions. You can view and/or print the summary or detailed view.
17. Click the Hide button to hide the screen.
18. (Optional if sending paper claims) Click the Print UB04 Form.
19. (Optional if sending paper claims) Click on Print All Claims in This Batch.
Who are you sending the claim to and how to send?
NC Tracks uploading claim direct through NC Tracks Portal: Use this step if you are not setup to transmit using SFTP through NC Tracks. Upload the Claim to NC Tracks NC MCO Portal: If you do not want to use Barnestorms's Change Healthcare service to send claims, you can use each MCO portal to transmit electronic claim files for MCOs: Amerihealth, Carolina Complete, United Healthcare, Wellcare. Barnestorm does not have instructions for uploading the claims on each MCO portal: those instructions are included in the billing guide for the MCO, or you can call the MCO for assistance.
Transmit the Claim to Medicaid (Other States)
If you are not transmitting for NC Medicaid, your process will stop at Step 18 (in Barnestorm). You will then log in to the system your state/agency uses to send files to Medicaid, and follow their upload procedures. If you do not know which folder to "browse to," pull up that payer in Barnestorm. Go to Codes>Program Related Codes>Payer Codes. Pull up that payer and select the Electronic Claims Setup button. The file path/Transmit Folder will be listed at the bottom. You will need to find that folder and claim file you created, and upload that file to Medicaid.