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PC-ACE user guide section 6
Last Modified: 1/4/2024
Location: FL, PR, USVI
Business: Part A, Part B
The PC-ACE List Claim form provides a versatile interface from which the user can create, list, modify, print, and otherwise maintain claims.
1. Click the Institutional or Professional Claims Processing icon from the PC-ACE Main Toolbar.
2. Click on List Claims to display the Institutional or Professional Claim List form.
The Institutional and Professional Claim Lists contains a list of all claims that were entered or imported into PC-ACE and not yet prepared in a claim file. It is imperative to review this list in detail to ensure all claims are in the proper status before preparing the claim file.
3. Review the list of claims. Ensure all claims that are to be submitted are in either the “CLN” or “ERR” status. Claims in the “ERR” status contain informational errors but may still be prepared for submission. The status code descriptions are as follows:
• CLN – clean/ready
• DEL – deleted
• ERF – has fatal errors
• ERR – has errors
• HLD – held
• UNP – unprocessed
If claims were previously saved with errors and/or are not to be included in the file for submission, they will need to be moved to the hold “HLD” status.
Claims in a "UNP" status must be opened and saved to be included in the transmission. For anyone with a large number of claims in a "UNP," return to the Institutional or Professional Claims Menu, click "Process Claims" and follow the prompts
4. The list of claims can be sorted or filtered to assist with the review of specific claims. Filtering by the status "DEL" is the only way to view deleted claims. Claims in this status can be recovered until they are purged from the system. When multiple filter criteria are specified, only those claims that meet all filter criteria will be displayed. When using the Advanced Filter Options, remember to click on “Clear Filter” when done to restore the Claim List to its previous sort option.
5. It may be necessary to perform actions on certain claims. The action menu can be accessed by clicking on the word Actions from the toolbar, by right clicking on a claim from the list, or by clicking on the shortcut buttons at the bottom of the Claim List screen. Some actions can be performed on multiple claims at once. To select multiple claims, check the box in the first column of each claim or right click and select Check All Claims.
The actions available include:
• Refresh the Claim List – refreshes the current Claim List form contents.
• Create New Claim – opens a blank “Institutional/Professional Claim Form” to manually enter a claim.
• View/Modify Claims – opens the “Institutional/Professional Claim Form” for the selected claim.
• Copy Claims – creates a copy of a selected claim and opens the “Institutional/Professional Claim Form” for the newly copied claim.
• Delete Claims – places selected claims in the "DEL" status.
• Purge Claims – purges selected claims in a “TR” or “PD” location. This will physically remove the claim from the system - they cannot be recovered. Claims that are in the "CL” location must be deleted before being purged.
• Reactivate Selected Claims – moves previously transmitted claims from the "TR" location into the "CL” location. Claims will show in a “UNP” status until processed.
• Reactivate All Checked Claims – moves all claims checked, from the ‘TR” location back to the “CL” location. Claims will show in a “UNP” status until processed.
• Release Claims – releases claims from the “HLD” status to the “UNP” status.
• Print Claims – prints selected claims.
• Hold Claims – changes the status of selected claims to “HLD”.
6. Print Claim Detail Report (optional). Click on the word Reports from the Institutional/Professional Claim List toolbar and select Print Claim Detail Report. This will open the report preview. To print, click on the printer icon.
7. Click on Close when finished reviewing the list of claims. Claims will be automatically removed from this list when prepared in a claim file.
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.
