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Claims are introduced into PC-ACE by either entering them manually or by importing them from an external source. The claim import method is ideal for facilities that maintain their claims in an upstream claims management system.
Roster billing is available for Part B providers that bill for influenza, pneumonia, COVID-19, hepatitis B, and Monoclonal Antibody (mAb) infusion vaccines.
Prepare new claim for transmission
Click the Institutional or Professional Claims Processing icon from the PC-ACE Main Toolbar.
Select MCB from the LOB dropdown.
Use these self-service tools and forms related to EDI and SPOT.
Providers may utilize this tool attest to their relationship with a third-party entity for conducting 270/271 eligibility request transactions and response.
Learn how PWK, the paperwork segment of the X12N version 5010, allows providers to submit medical documentation with their initial claim.
Steps to import a file into PC-ACE in the Electronic Medica Claims (EMC) format.
Backup approvers may complete these instructions AFTER their organization's designated approver has received an approval communication from the SPOT Help Desk and created their organization in IDM.
The PC-ACE professional training module provides instructions necessary to set up and use the PC-ACE software.
The following information outlines procedures related to getting started along with additional electronic features available to EDI providers.