Users Manual Winasap 2003 Version 1.0 As of September 15, 2003 · 2016-07-26 · WINASAP 2003 Users...

U s e r s M a n u a l

W i n a s a p 2 0 0 3

V e r s i o n 1 . 0

A s o f S e p t e m b e r 1 5 , 2 0 0 3

WINASAP 2003 Users Manual

Nursing Facility

As of September 2003 1

Table of Contents

Welcome to WINASAP2003..………………………… 2 Loading WINASAP2003..……………………………. 3 Payer Screen..…………………………………………. 10 Trading Partner..……………………………………… 11 Host Phone Number…..………………………………. 13 Provider Reference File.……………………………… 13 Patient Reference File………………………………… 16 Revenue Code Reference File...……………………… 18 Diagnosis Reference File……………………………… 19 Create a Nursing Home Template…………………… 20 Build a Nursing Home Claim………………………… 24

Change Claim Information…………………………… 25

Sending Claims………………………………………… 26

Receiving A Response File …………………………… 28

Reports…….….………………………………………… 29 Extraordinary Care Instructions.….………………………………………… 32 Extraordinary Care Forms…………………………… 33


Nursing Facility


Welcome to WINASAP2003 Nursing Facility Billing! Let’s begin! What is WINASAP2003? Windows Accelerated Submission And Processing 2003 What is required to use WINASAP2003? Windows 98 Second Edition, Windows NT, Windows 2000 (Service Pack 3) or Windows XP operating system Pentium processor CD-ROM drive 25 Megabytes of free disk space 128 Megabytes of RAM Monitor resolution of 800 x 600 pixels Hayes compatible 9600 baud asynchronous modem Telephone connectivity Where can I obtain WINASAP2003? There are two options: You can call ACS EDI Gateway at 1-800-672-4959 and request a CD be sent to you, or download it off the ACS EDI Website. www.acs-gcro.com

http://www.acs-gcro.com/


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If you choose to Upload WINASAP2003 from a CD, insert the CD into your CD-ROM. Skip to page 5 of this packet. If you choose to download WINASAP2003 from ASC EDI Gateway. You will click on the “boxed icon”

Click “Save”


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Click “Save” You will then close this program and go to your desktop. You will find a WINASAP2003 Icon. Double click on the WINASAP2003 Icon.

Click “Continue”


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This is a progress screen, please wait.

Click “Next”


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Click “Yes”

You will type you Name. If you are self-employed, you will type your name again. If you work for an organization (example, a Hospital or Facility) type the organizations name. Click “Next”


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Click “Next”

Click “Next”


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This is a progress screen, please wait.

Still processing, please wait.


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Click on the box in front of “Yes, Launch the program file” Then Click “Finish”. Then go to your desktop and Double Click on the “WINASAP2003” Icon.

Leave the User ID as “ADMIN”. Tab to Password and type “asap”. Then Click “OK”


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Click “OK”

Click “File” then Click “Open Payer”


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You must complete the following criteria:

Select Payer: Use the down box to the far right. Go to the bottom and Click “Wyoming Medicaid” Click “OK”

Click “File” then Click “Trading Partner”


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Trading Partner Identification: Primary Identification: You will enter your 5 or 6 digit Trading Partner ID number assigned to you by ACS EDI Gateway. This information is listed on the Logon Sheet sent to you from the EDI Support Unit. Secondary Identification: You will re-enter your 5 or 6 digit Trading Partner ID number assigned to you by ACS EDI Gateway. This information is listed on the Logon Sheet sent to you from the EDI Support Unit. Trading Partner Name: Entity Type: Most Nursing Facility Providers should use “non-person” You will enter your Organization Name Contact Information: Contact Name: Enter your Name Telephone Number: Enter your phone number Fax Number: Enter your fax number (optional) Email: Enter your email address (optional)


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WINASAP2003 Communications: Host Telephone Number: This phone number is listed on the Logon Information sheet from ACS EDI Gateway. User Id Number: Enter your User ID# exactly as it appears on your Logon Form. User Name: Enter your User Name exactly as it appears on your Logon Form. Click “Save”

Congratulations, You are now ready to build your Reference Screens! Step 1. Click “Reference” Click “Provider”


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Click “Add”


Provider ID #: Enter your 9-digit EqualityCare provider number Provider Name: Entity Type: Enter “Non-Person” Organization Name: Enter the name of the facility


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Contact Information: Enter a your name, your phone number, fax number and email (optional) Provider Address: Enter your address, city, state and Click “Secondary Identification” at the top of the screen.


Identification Type: This is the Employers tax id number Identification: This is probably your Facility’s Tax id Number Click “Save”


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Your Provider information has been saved. Next you will click “Cancel” “Reference” “Patient” “Add” and then you are ready to enter the patients information.


Patient Identification: Enter the 10-digit Patient EqualityCare Id # Enter the patient’s social security number You must create a Patient Account # Patient Name and Demographic Information: Enter the patient’s Last Name, First Name, Middle initial (optional) Enter the patient’s Date of Birth Enter the patient’s Sex


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Patient Address Information: Enter the patient’s address, city, state and zip code Enter the patient’s Telephone # (optional) Next you will click “Insured’s Data” at the top of the screen.


Patient Relationship to Insured: Use the drop down box and choose the appropriate category. We will use “Self” as an example. Entity Type: Use the drop down box and choose the appropriate category. We will use “Person” as an example. Payer Information: Payer Responsibility Sequence Code: Use the drop down box and choose the appropriate category. We will use “Primary” as an example. Click “Save” You will follow the above steps for all of your clients


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Your Patient information has been saved. Next you will Click “Cancel” “Reference” “Revenue Code” “Add” and then you are ready to enter the Revenue code information.


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Revenue Code Data: Revenue Code: Enter your 4-digit Revenue code Revenue Code Description: Enter a description of the revenue code Revenue Code: Enter the charge amount per day Click “Save” If you have additional Revenue codes click “Add” and complete the above instructions until all the revenue codes you want to have in the reference file are added. Additional Revenue Codes: Revenue Code 0100 -Room and Board Revenue Code 0180 -Leave of absents, General Class Revenue Code 0181 -Leave of absents, Reserved Revenue Code 0182 -Leave of absents , Patient Convenience Revenue Code 0183 -Leave of absents, Therapeutic Leave Revenue Code 0184 -Leave of absents, IFC/MR any Reason Revenue Code 0185 -Leave of absents, Hospitalization Revenue Code 0189 -Leave of absents, Other Reason NOTE: Revenue code 101 – All Inclusive Room and Board, should be used for Extraordinary Care. Please read the criteria and requirements for Extraordinary Care on page 33 of this manual.


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Your Revenue code information has been saved. Click “Cancel” “Reference” “Diagnosis Code” “Add” and then you are ready to enter the diagnosis information.

Diagnosis Code Data: Diagnosis Code: Enter your 3-5-digit diagnosis code Diagnosis Code Description: Enter a description of the diagnosis code Click “Save”


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If you have additional diagnosis codes Click “Add” and complete the above instructions until all the diagnosis codes you want to have in the reference file are added.

Your Diagnosis code information has been saved. Click “Cancel”

Step 2. Lets build your Templates! You are now ready to create your Nursing Facility Template WINASAP2003 claim. Click “Claims” and “Nursing Facility” and “Nursing Facility Template”


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Click “Add”


Bill Date: DO NOT ENTER DATE Claim Status: The status will be “Template” Patient Information: Patient Id# (you can use the drop down button and choose the patient id number) the fields will be automatically filled in. Provider Information: Billing Provider ID: Enter your 9-digit Wyoming EqualityCare Provider number (You can use the drop down button and choose the provider number)


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Pay-to-Provider ID: Re-enter your 9-digit Wyoming EqualityCare Provider number (You can use the drop down button and choose the provider number) Signature on file: Click “Yes” Claim Data: Admission: Date: Enter the original admission date HR: Enter “0” Min: Enter “0” Type: Enter “2” Src: Enter “9” Discharge: No Entry Statement Coverage Period: No entry (This Field will auto-fill) Medical Record: No entry Bill Type: Enter the three-digit code indicating the specific type of bill. The first two-digits will always begin with a 2 for Skilled Nursing, and a 1 for Inpatient. The third digit sequence is as follows: 1-Admit through discharge claim 2-Interim –1st claim 3-Interim – Continuing claim 4-Interim – Last claim 5-Late charges only Example: 213 would be used for a client that already resides in your facility. Click “Next Page”


Procedure Codes: No entry required Condition Codes: No entry required


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Diagnosis Codes: Principal Diagnosis Code: Enter the client’s diagnosis code Admitting Diagnosis Code: Enter the client’s diagnosis code (this can be the same as the Principal Diagnosis code) Additional Claim Codes: Medicare Assignment Code: This is probably “Not Assigned” Release of Information Code: This is probably “Appropriate Release of Information on file at Health Care Service Provider or at Utilization Review Organization” Claim Filing Indicator Code: Enter “Medicaid” Click “Next Page”

Claim Line Item: Service Date(s): No entry Revenue Code: Enter the Revenue Code 0100 -Room and Board Unit Code: Enter “Days” Unit Rate: Enter your Facility Rate Click “Save”


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You will complete one template for each client. Click “Add” After you have entered all Clients, Click “Cancel”

Click “Tools” “Build Nursing Facility Claims”


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Billing Type: Enter Monthly Billing Period: Enter the Month and Year Click “Build”

Make sure to verify: Accounts Checked, Accounts Deleted on the Billing Period, Claims Created, and Total Charges. Click “Cancel”


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To edit or change your claim, Click “Claims”, Click Nursing Facility Claim”

Highlight the claim line that needs to be corrected, Click “Change” You are now able to correct or change your claim. For example, you can change the revenue code(s), bill type, covered days.


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Step 3. Congratulations! You are now ready to send your Claims. Click “Tools” then Click “Send Claim File”

Click “Select by Claim Type” then Click “Send”


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Click “OK”

The transmission is in process, please wait.


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Your claims have been sent successfully. Click “Cancel” Within a few hours your response file will be accessible.

Remember to a couple of hours after submission before attempting to retrieve your response file. Click “Tools” then “Receive Response File”


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Click on “Receive” Once you retrieve your response, you will have verification that your claims were accepted.

Step 4. You are now ready to retrieve your claims reports. Click “Tools” then Click “Reports”


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Click the box in front of the report that you would like to view. Click “Run”

The following are examples of each report.


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Extraordinary Care

Extraordinary Care clients are clients who require skilled nursing facility extraordinary care. They have an MDS Activities of Daily Living Sum score of ten (10) or more and require special or clinically complex care as recognized under the Medicare RUG-III classification system. These conditions which have received prior authorization from the Department.

The extraordinary care resident’s cost and service requirements must clearly exceed supplies and services covered under a facility’s per diem rate. The extraordinary care fee will be paid in addition to the established EqualityCare per diem rate, but shall not exceed the actual cost. The cost of this resident’s care shall not be included in the annual cost reports.

The documentation must be forwarded to CFMC along with the required supporting documentation listed on the top of the Extraordinary Care Check List. Submission of documentation does not guarantee extraordinary care status or payment. The supporting documentation will be reviewed by CFMC, who will then issue a PA Number for the resident upon approval of Extraordinary Care Status. The claim must contain the appropriate PA number and revenue code in order for the claim to be paid at the extraordinary care level.

The Department of Health, Aging Division has the option of final approval for any PA and may change or alter criteria based on available funding.

Questions and Concerns Contacts:

Aging Division Lura Crawford, Long Term Care Program Manager

6101 Yellowstone, Rm 259B Cheyenne, WY 82002 1-307-777-5382 Phone 1-307-777-5340 Fax

CFMC/QIO Linda Meyers

P.O. Box 17300 Denver, CO 80217-0300

1-888-545-1710 ext: 3024 Phone 1-888-245-1928 Fax


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Nursing FacilityExtraordinary Care Criteria

Recipients who have an MDS Activities of Daily Living Sum score of ten (10) or more and require special care or clinically complex care as recognized under the Medicare RUG III

classification system for those conditions which have been prior authorized by the Department.

Special Care/Clinically Complex:

Yes No

AND

Ventilator dependent (automatically qualify); and/or

Tracheostomy; and/or

Coma;

PLUS

Three (3) or more of the following:

Skin care could include

Stage 3 or 4 pressure ulcer

Turning every two hours

Foley/incontinence care could include

Urinary tract infections

Diarrhea/constipation

Bowel and Bladder training

Tube feedings/Aphasia could include

Dehydration

Weight loss

Aspiration pneumonia

Physical Therapy could include

Wound Care

Range of motion exercises

Special equipment used only by this resident that is clearly above and beyond what is covered in the per diem rate

1. Quadriplegia (ICD 9 344.00, 344.01, 344.02, 344.03, 344.04, and 344.09) with ADL Sum 10 +


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Yes No

AND

Ventilator Dependent (automatically qualify); and/or


Coma; and/or

Seizures; and/or

Disease process involving five (5) or more functional areas of visual, motor, sensory, cognitive, coordination and/or balance, and/or bowel and bladder

PLUS










Dehydration

Weight loss



Wound Care



2. Multiple Sclerosis (ICD-9 340) with ADL Sum 10 +

Special Care/Clinically Complex (Cont):


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Yes No

AND

Ventilator dependent (automatically qualify); and/or


Seizures; and/or

Spastic quadriplegia; and /or

Coma;

PLUS










Dehydration

Weight loss



Wound Care



3. Cerebral Palsy (ICD-9 343) with ADL Sum 10 +



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Yes No

4. Ventilator dependent recipient with MDS Activities of Daily Living Sum score of ten (10) or more and requires special care or clinically complex care as recognized under the Medicare RUG III classification system.

AND MAY INCLUDE


PLUS







Diarrhea /constipation



Dehydration

Weight loss



Wound Care



5. Morbid Obesity (ICD -9 278.01) with MDS Activities of Daily Living Sum score of ten (10) or more and requires special care or clinically complex care as recognized under the Medicare RUG III classification system.



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Extraordinary Recipients:

Recipients who have an MDS Activities of Daily Living Sum score of ten (10) or more and require special care or clinically complex care as recognized under the Medicare RUG III classification system for those conditions which have been prior authorized by the Department.

Required documentation: 1. PASRR Date: For CFMC use only 2. LT 101 less than 45 days Date received: 3. MDS assessment Approved: Denied: 4. History and Physical (<1 yr old) Certified Through: 5. Drug history Reviewed By: 6. Nursing Care Plan PCN: 7. Progress notes 8. Itemized cost 9. Doctors statement with Dx's and prognosis (includes expected length of treatment) Name: DOB:

Medicaid ID #: SS #: Admitting Facility Name: Contact person: Address: Phone: Discharging Facility Name: Contact person: Address: Phone: Requesting Date: Admit Date: Ventilator Dependent: ICD 9 Diagnosis Codes 1. (___.__) ________________________________ 7. (___.__) ___________________________________ 2. (___.__) ________________________________ 8. (___.__) ___________________________________ 3. (___.__) ________________________________ 9. (___.__) ___________________________________ 4. (___.__) ________________________________ 10. (___.__) ___________________________________ 5. (___.__) ________________________________ 11. (___.__) ___________________________________ 6. (___.__) ________________________________ 12. (___.__) ___________________________________ HCPCS Codes** 1. (_____) ___________________________________ 5. (_____) ___________________________________ 2. (_____) ___________________________________ 6. (_____) ___________________________________ 3. (_____) ___________________________________ 7. (_____) ___________________________________ 4. (_____) ___________________________________ 8. (_____) ___________________________________ ** Include DME providers name and address.


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Users Manual Winasap 2003 Version 1.0 As of September 15, 2003 · 2016-07-26 · WINASAP 2003 Users...

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