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PC-ACE user guide section 2
Last Modified: 6/24/2024
Location: FL, PR, USVI
Business: Part A, Part B
Note: Medicare secondary claim instructions are in the next section of this user guide.
Enter a charge master reference file
Enter procedure code
Once the configuration has been completed, claims can be entered into PC-ACE.
• Click on the Institutional (Part A) or Professional (Part B) Claims Processing icon.
• If you have not already signed onto PC-ACE, you will be asked to do so at this point. Type “SYSADMIN” as the User ID and the Password.
• Click on the Enter Claims icon.
• Navigate between sections - Use the “Page Up” and “Page Down” keys to navigate between major sections of the Professional Claim Form (i.e., Patient Information and General, Insured Information, Billing Line Items, etc.)
• Navigate in second level tabs - Use the “Shift” key while holding down the “Page Up” or “Page Down” key to navigate on the second level tabs (i.e., Line Item Details, Extended Details (Line 1), etc.)
• Navigate from field to field - When entering claim data, click on any field or use the “TAB” key to move left-to-right, or top-to-bottom (i.e., Billing Line Item screen – to move from field to field.) Use the “Up Arrow” and “Down Arrow” keys to move up and down through the fields.
Enter a Medicare primary claim The following instructions are for entering a claim with Medicare as the primary payer.
• Complete the fields as required on the Institutional or Professional claim form. The F2 lookup help feature is available on many fields and provides information specific to that field. Another help feature is available by right-clicking on the field. Refer to Section 1, PC-ACE Configuration for details on these help features.
Required fields for Professional Claim Form
• Patient Info & General - LOB, Billing Provider, Patient Control No, Employment,
• Accident, Outside Lab.
• Insured Information - Payer ID, Payer Name, Insured’s ID P. Rel, Insured’s Last Name/Org Name, Birthday, Sex, Sig, AOB, Insured’s Address 1, Insured’s City, State, Zip.
Note: Information pulled from patient database when patient selected on Patient Info & General Tab, if patient was previously entered in the Reference file Maintenance/Patient database.
• Billing Line Items - Diagnosis Codes (at least one), Service From/Thru Dates, Charges, PS, Proc, Diagnosis Pointer, Charges, Units, Rendering Phys. (unless billing as a Solo Provider), Total Charge.
Required fields for Institutional Claim Form
• Patient Info & General - LOB (MCA will auto populate), Patient Control No. (right click to select from Patient database, Type of Bill, Statement Covers Period.
• Billing Line Items - Rev. Cd., HCPC, From Date, Units/Days, Total Charges.
• Payor Info - Payer ID, Payer Name, Provider Number, ROI, AOB P. Rel, Insured’s Last Name/Org Name, Insured’s First Name Insured’s ID. Note: Information pulled from Patient database when patient selected on Patient Info & General Tab, if patient was previously entered in the Reference file Maintenance/Patient database. If more than one provider exists for the LOB, the user will need to select the provider.
• Diagnosis/Procedure - Principal Diag., Attending Physician
Required fields for dental claim form • Patient info & general - LOB, billing provider, patient control no, employment, dental field.
• Accident, outside lab.
• Insured information - Payer ID, payer name, insured’s ID P. rel., insured’s last name/org name, birthday, sex, sig, AOB, insured’s address 1, insured’s city, state, zip.
If the patient was previously entered in the reference file maintenance/patient database, this information will pull from the patient database when the patient is selected on the patient info & general tab.
• Billing line items - Diagnosis codes (at least one), service from/thru dates, charges, PS, dental codes (HCPCS), diagnosis pointer, charges, units, rendering phys. (unless billing as a solo provider), total charge. Depending on service complete the tooth number and tooth service may be required on the dental attachment.
Billing Line Items Shortcuts
• Delete contents - Use the “ESC” key to cancel contents of a field on most claim form fields.
• Repeat/copy all values - Use “F5” key to copy the value of all fields on the previous line, except the date of service, to the current line.
• Repeat/copy specific values - Use “F4” to copy a specific field from a previous line to a current line.
• Move line to line - Use the up/down arrow keys to move from line to line or press “Page Up” or “Page Down” while holding the “ALT” key to scroll one page at a time.
• Delete line – Use "F7" to delete an entire line.
• When all the information has been completed, click on Save. If errors exist on the claim, the Edit Validation Errors List window will appear. Double-click the error to jump to the error on the claim form.
• Make the corrections and click on Save or Error List to view any additional errors. The Save with Errors option is only available for claims that do not have fatal errors. Fatal errors are indicated on the Errors List with a red X. The Save with Fatal option is available when there are fatal errors.
• Upon saving your claim, you will be returned to the Institutional or Professional Claims Entry screen. Here you may enter additional claims or click Cancel then Yes to go back to the Claims Menu screen.
• Repeat the first four steps to enter additional claims as needed. Click on Close when finished.
Note: Additional modifier fields are available on the Extended Details (Line X) tab of the Billing Line Items. "X" is equal to the line of service that is highlighted on the Line Items Detail tab. Additional diagnosis fields are available on the Ext. Pat/Gen (2) tab.
Medicare Part B and HIPAA legislation require that certain claim types contain information in addition to basic claim information. Some of these claim types are addressed below.
Ambulance Claims – Special Requirements:
• Key "Y" in the Facility Info? field at the bottom of the Patient Info & General tab of the Professional Claim Form.
• Use the Facility Name/Address/City/State/ZIP fields to enter the address where the patient was picked up (the origin of the transport). The Facility fields are located on the Extended Patient/General tab.
• Note: The software will require the Facility Name. You can use "Patient Home" or "Transport Origin", etc., in this field.
• The Ambulance Attachment fields must be completed on the Billing Line Items screen. Only enter the attachment indicator on the first line of service. Do not enter it on every detail.
Note: The Ambulance tab is programmed to automatically appear when ambulance service procedure codes are entered. If the tab is not triggered, go to the AT field on the first line item and type "1".
Complete the following Required fields on the Ambulance tab. Press <F2> or right click while your cursor is positioned in the field for a list of valid values:
• Type of Transport Field
• Transport To/For Field
• At least one of the Yes/No fields regarding the situation are required.
• Miles Field – Type the number of miles the patient was transported. If you are billing a separate charge for mileage, this should match the number of units on the line item for that charge. If no transport made, type "0" (zero).
• Enter any additional information in the Narrative field on the Extended Details 3 (Line 1) tab. This is not required.
Prior Authorization Numbers
• Access the Ext. Payer/Insured Tab
• Click on Primary Payer/Insured Tab
• Right Click and choose G1 in the small box under Payer/Insured Reference IDS or just key "G1" in that box.
• Enter the Prior authorization number in the large box on the left under Payer/Insured Reference IDS.
Chiropractic Claims – Special Requirements:
The Chiropractic Attachment fields must be completed on the Billing Line Items screen.
Note: The chiropractic tab is programmed to automatically appear when a spinal manipulation procedure code is entered. If the tab is not triggered, go to the AT field on the first line item and type "4".
Complete the following Required fields on the Chiropractic tab:
• Initial Treatment Date Field – (Always Required)
• Enter the date the treatment for this ‘episode’.
• Date of Last X-Ray Field – (Optional)
• Enter the date of the patient’s last X-ray.
• X-Rays on file at Site Field (Y/N) – (Optional)
• Type "Y" if you have the X-rays on file at your office. "N" indicates the X-rays are not on file.
• Nature of Condition Field – (Optional)
• Press <F2> or right click while your cursor is positioned in the field to obtain a list of valid code values.
• Acute Manifestation Date Field – (Always Situational)
• Enter the date of acute manifestation, if applicable.
Enter Referring (Ordering) Physician name and NPI in the Referring Physician Name and Referring Physician ID fields on the Patient Info & General screen IF the claim contains charges for X-rays.
Please remember to enter any Demonstration Project information that may apply to your situation.
Physical Therapy – Special Requirements:
Include the Supervising Provider information on the Extended Details (Line 1) tab.
The Physical Therapy Tab fields must be completed on the Billing Line Items screen.
The Physical Therapy Tab is programmed to automatically appear when the provider’s taxonomy indicates Physical/Occupational Therapist and a PT/OT procedure code is used. If the tab does not appear, go to the AT field on the first line item and type "7".
Complete the following Required fields on the Physical Therapy tab:
• Attending/Supervising Physician ID Field – (Required)
• Press <F2> or right click while your cursor is in this field to obtain a list of provider records in your Physician Reference file. Select the appropriate record and click Select.
• Date Last Seen Field – (Required)
• Enter the date the patient was last seen by the Attending/Supervising Physician.
• Treatment Plan on File Field – (Optional)
Press <F2> or right click while your cursor is positioned in the field to obtain a list of valid code values.
Podiatry Claims – Special Requirements:
Include the Supervising Provider information on the Extended Details (Line 1) tab.
The Podiatry Tab fields must be completed on the Billing Line Items screen.
The Podiatry tab is programmed to automatically appear when the provider’s taxonomy indicates Podiatrist and a routine foot care procedure code is used. If the tab does not appear, go to the AT field on the first line item and type "3". Only enter the attachment indicator on the first line of service. Do not enter it on every detail.
Complete the following Required fields on the Podiatry tab:
• Date Last Seen Field – Required. Enter the date the patient was last seen by the supervising physician.
• Supervising Provider ID - Required
Press <F2> or right click while your cursor is in this field to obtain a list of provider records in your Physician Reference File. Select the appropriate record and click Select.
Enter a charge master reference file When billing for Professional claims only, there is a feature available called the Charge Master Reference File. This allows the user to establish a database with procedure codes and their corresponding charges. Follow the steps below to use the Charge Master Reference File.
• On the PC-ACE toolbar, click on File, then Preferences.
• Enter a checkmark in front of Use Charge Master Reference file for Professional procedure code lookups and click OK.
• Open the Reference File Maintenance folder, click on the Codes/Misc tab, and then click the Charges Master button. Click New to enter procedure codes and corresponding charges.
• When a claim is entered, right click on 24d/Proc field in the Billing Line Items tab. This will access the Charges Master Setup window so the appropriate code may be selected. Note: only procedure codes will appear if Charges Master is turned on.
Global procedure codes are maintained and updated quarterly by the software distributor. The below instructions are only necessary if a procedure code is not present on the provided procedure code listing.
• Right click on the Codes/Misc tab in Reference File Maintenance and then click on HCPCS.
• Click on New.
• Complete the fields with information specific to the procedure code being added. The thru date field can be left blank. Click on OK.
• Repeat for each code to add. Click on Close when finished.
Global Modifiers are maintained and updated quarterly by the software distributor. The below instructions are only necessary if a modifier is not present on the provided modifier listing.
• Right click on the Codes/Misc tab in Reference File Maintenance and then click on Modifiers.
• Click on New.
• Complete the fields with information specific to the modifier. The thru date field can be left blank. Click on OK.
• Click the Assignments tab. Click on New.
• Choose the correct Line of Business (LOB) from the dropdown.
• Choose the modifier entered in Step 3 from the dropdown.
• Click on OK.
• Repeat for each modifier. Click on Close when finished.
Entering ICD-10 (diagnosis) code
Global diagnosis codes are maintained and updated quarterly by the software distributor. The below instructions are only necessary if a diagnosis code is not present on the provided diagnosis code listing.
• Right click on the Codes/Misc tab in Reference File Maintenance and then click on ICD.
• Click on New.
• Complete the fields with information specific to the ICD-10 (diagnosis) code being added. The thru date field can be left blank. Click on Save.
• Repeat for each ICD-10 (diagnosis) code. Click on Close when finished.
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