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PC-ACE user guide section 1
Last Modified: 6/24/2024
Location: FL, PR, USVI
Business: Part A, Part B
Once PC-ACE has been installed, the payer information, submitter information and the Provider Information within the Reference File must be set up prior to using the PC-ACE software program.
Once you have downloaded your software, you will you need to complete the necessary setup screens before submitting any claims.
This guide will only review the fields that are required to be completed.
To access the setup screens, you must first log into the software by completing the following steps:
• Start PC-ACE. Double click on the icon located on your desktop.
• Click on the Reference File Maintenance icon (yellow folder picture).
• At this point the user will be asked to Sign On. Type “SYSADMIN” for both the User ID and the Password.
• The F2 function key will access the lookup list for a field, place the cursor in the field and press F2 (or right-click the mouse). When an item from the list is selected, its value is automatically entered in the field.
• To identify which fields contain a lookup list, hold the Alt key and press F2.
• Clicking Save on any screen will show all fields that are required.
• Press the Esc key to disable the flashing notification.
This is for the electronic billing submitter information that was provided in your EDI PC-ACE Approval letter.
Only one submitter ID per contract can be set up in the PC-ACE software program. If you have more than one submitter ID per contract, either install PC-ACE on separate computers or enroll for one submitter ID and link all your providers to that submitter ID.
• Click on the Codes/ Misc tab in Reference File Maintenance and then click on “SUBMITTER.”
• Choose the appropriate Claim Type. “Institutional” is for Part A claims and “Professional” is for Part B claims.
• For Part B, click View/Update
• For Part A, click Copy
• Complete the General tab fields including the E-mail field. Type your submitter ID in the “ID” field. The submitter ID was provided to you in the PC-ACE Approval Letter. Complete the remaining information. Leave the Employer Identification Number (EIN) and country fields blank.
This is for the billing and / or rendering provider information.
The Group ID / No. or Provider ID / No. should be completed with your Provider Transaction Access Number (PTAN).
• Click on the Provider (Inst) or (Prof) tab in Reference File Maintenance and then click on New.
Institutional providers should complete the General tab with the information specific to your facility then click Save.
Professional providers need to choose the appropriate option(s) below before completing the setup.
Dental providers should setup using the professional options.
Enter a group practice (professional only)
• Click on Group Practice in the Provider Type.
• Complete the General Info tabs with the following fields specific to the group.
• Group Name
• Group Street Address, City, State and Zip (9-digit zip)
• Group ID (which can be the Medicare PTAN)
• LOB (MCA for Part A or MCB for Part B)
• Payer ID (Right Click for options)
• Tag leave blank
• Group Label (which can be the Medicare PTAN)
• NPI and Tax ID of the Group
• Tax ID/Type (Right click in Type for options)
• Accept Assignment
• A=Assigned
• B=Assigned Accepted on Clinical Lab Services Only
• C=Not Assigned
• Participating Y or N
• Signature Ind
• Yes
• No
For a Group Practice, you must also enter at least one Individual (rendering) provider on the Provider Set up screens.
Enter an individual within the group practice (professional only)
This is also known as the rendering physician.
• Click on New again and click on Inherit name / address information from the selected provider.
• Click on Individual in Group in the Provider Type.
• Group information will be prepopulated. Complete the screen with additional information specific to the rendering provider as follows:
• Individual’s Name
• LOB (MCA for Part A or MCB for Part B)
• Payer ID (Right Click for options)
• Tag leave blank
• Group Label (which can be the Medicare PTAN)
• NPI (Remember to change the National Provider Identifier [NPI] to the rendering provider’s NPI)
• Repeat if adding more than one rendering provider.
• Click on Close when finished.
Enter a solo practice or institution
• Click on New.
• Click on Solo Practice in the Provider Type (Professional only)
• Complete the General Info with the following fields:
• Organization or Individual (Last, First, MI) Name
• Street Address, City, State and Zip (9-digit zip)
• Provider ID (which can be the Medicare PTAN)
• LOB (right click for options)
• Payer ID (Right Click for options)
• Tag leave blank
• NPI and Tax ID or SSN of the provider/organization
• Accept Assignment
• A=Assigned
• B=Assigned Accepted on Clinical Lab Services Only
• C=Not Assigned
• Signature Ind
• Yes
• No
• Click on Save.
• Repeat if adding more than one provider.
• Click on Close when finished.
An organization that has no rendering providers would be added as a solo practice. (I.e. Ambulatory Surgical Center, Ambulance, Pharmacies)
State / Payer ID / LOB Key
JN Part A
State |
Payer ID |
LOB |
FL |
09101 |
MCA |
PR |
09201 |
MCA |
VI |
09201 |
MCA |
JN Part B
State |
Payer ID |
LOB |
FL |
09102 |
MCB |
PR |
09202 |
MCB |
VI |
09302 |
MCB |
All payers referenced on claims must exist in the Payer reference file. In PC-ACE, all payers under our jurisdiction (listed above) are already uniquely defined by their payer ID and LOB. No additional payer information needs to be entered except for primary insurances when Medicare is the secondary payer. Please note that nothing should be entered in the Receiver ID and ISA08 Override fields.
To enter an insurance that is primary to Medicare, complete the following steps:
• Click on the Reference File Maintenance icon.
• Click the New button.
• Complete the fields with information specific to each payer. The Payer ID in this screen will be the primary insurance company’s identification number. Click on Save.
• Repeat as needed.
Enter secondary payer information
First Coast automatically crosses over claims to secondary payers based on the relationship between First Coast and the other payers. Automatic crossover companies do NOT need to be entered.
• In the Payer tab, click on New. Complete the fields with information specific to each payer.
• Payer ID.
• Full Description. Name of the insurance company.
• Address including City, State and full nine-digit Zip Code
• Source (right click for options)
• Click on Save. Repeat as needed.
Patient information entered in this file will be available to automatically load applicable patient information into the appropriate claim form when entering claims via the Look Up feature (F2).
• Enter the patient’s name exactly as it is shown on their Medicare card.
Entering patient information is not necessary if you are importing claims through the Claim Import function. The patient information will be imported with the claim file. Proceed to “Section 4 – Claim Import Process”. Otherwise, proceed with the following instructions.
• Click on the Patient tab in Reference File Maintenance.
• Click on New to display the Patient Information form.
• Enter the patient information in all applicable tabs – General Information, Extended Info, Primary Insured (select Institutional or Professional tab) and Secondary Insured as follows:
General information tab
• Patient’s name (enter name exactly as it is shown on their Medicare card)
• Patient Control Number (patient account number-office tracking number assigned by providers office)
• Patient’s address
• Country leave blank
• Gender
• Date of Birth
• Signature on File (First box is for Institutional claims and second box is for Professional claims)
• Release of Info
• ROI Date
Primary insured
• Payer ID (right click to select)
• Rel (always choose self for Medicare Primary)
• Insured ID (for Medicare key in the Medicare Beneficiary Identifier)
If Medicare is not primary, complete the Insured ID field with the appropriate patient’s ID number for the other primary insurance and the relationship (Rel field) should be who owns the insurance (i.e. self, spouse, parent, etc.) You will need to complete the payer ID screen for the primary payer prior to completing the primary insured tab.
• Patient or subscriber’s address
• Date of Birth
• Signature on File
• Release of Info
• ROI Date
Secondary insured
Click the Radio button and choose separate Inst and Prof before completing the next tabs.
• Payer ID (right click to select)
• Rel (the relationship of the owner of the secondary insurance)
• Insured ID (ID for the secondary insurance)
• Patient or subscriber’s address
• Date of Birth
• Signature on File
• Release of Info
• ROI Date
• Click on Save. If prompted, correct any missing or invalid field values and re-save the data. The new patient record should now be visible in the Patient list.
• Repeat for each patient. Click on Close when finished.
This is for the referring, ordering, attending, or supervising physician information. Enter the billing and / or rendering provider in the Provider Information screen.
• Click on the Codes / Misc tab in Reference File Maintenance and then click on Physician.
• Click on New.
• Complete the fields with information specific to the physician. Only the Physicians name and NPI are required. The Physician ID and Address information may be left blank. Enter the physician’s NPI number in the NPI field. Click on Save.
• Repeat these steps for each physician. Click on Close when finished.
This screen is for entering the Facility, other than office, where the service was rendered.
• Click on the Codes / Misc tab in Reference File Maintenance and then click on Facility.
• Click on New.
• Complete the fields with the name and address of the Facility. A nine-digit postal zip code is required. Choose the appropriate Facility type.
• Click on Save.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
