General Claim Information

When New Claim is selected from the left-hand menu, the page you initially see is the General Claim Information tab, part of the overall claim entry process. This tab is the same regardless of claim type. This tab contains the patient related information for the claim being entered. This includes the Patient Control Number An identifier used in provider's billing which uniquely identifies a patient visit. specific to this claim and the Client ID A unique 8-digit Medicaid assigned recipient identifier serving to permanently identify data pertaining to an individual. Format: AANNNNNA, where A is alphabetic and N is numeric., which provides the Patient's personal information.

If you are an a-typical provider (billing with a MMIS ID) please enter your three digit locator code in the location code field. This field will only appear if an a-typical provider is billing.

Submission Reason: Indicates if the claim is an Original, Replacement, or Void claim. This field will default to Original for all new claims, however you may select Void or Replace. Selecting the Edit Claim button, will change the claim reason to Original and allow the claim to be edited and resent. If a value other than Original is selected, the Claim Original Reference Number must be entered. Selecting Void or Replace and entering the Transaction Control Number will allow you to void or replace a claim which was not submitted via ePACES but is currently in the eMedNY system for adjudication processing or has been purged from the ePACES system. If a claim is still in the ePACES system and needs to be voided or replaced, it is recommended to do so with the appropriate button from within the claim, as this will remove the need to re-enter all the required information, the system will automatically make a copy of the original claim and then you may proceed with the necessary modifications.

NPI Number: The NPI or MMIS ID of the provider in the upper right hand corner of the screen is pre-populated in this field based upon the provider information selected from the drop down menu.

Patient Control Number: You must enter a value in this field for every claim, regardless of Submission Reason. The value entered may be no longer than 20 alphanumeric characters and should be unique for each individual claim. Individual Patient Control Numbers are usually assigned to each visit a client makes to a provider. This may also be referred to as the Patient Account Number in the provider's billing system.

Location Information: The address the service was rendered (including the zip+4) should be entered here.

Client ID: This is the 8-digit alphanumeric Medicaid assigned ID for the patient. Based on the value entered here, ePACES will retrieve the patient information from the database and display it for confirmation that the correct value was entered.

Once the required data elements are entered and you click Go, the Client Information grouping will be populated with the client's most recent personal information (Name, Address, Date of Birth The birth date of the individual, e.g. 04/15/1995. , and Gender). Entering a new Date of Birth or Gender for a client will only update those elements on the claim itself. Assuming this is the correct client, you are now able to continue with the entry of the claim. If the client returned is not correct, edit the Client ID and click Go.

Type of Claim: This field alone determines the type of claim that is going to be generated and what data elements will be requested and required on the subsequent pages. The predefined values available to you are: Dental, Professional, Professional Real Time and Institutional. You may either choose from the drop-down list or type the first character to highlight the type in the list and hit the Enter key to select.

To begin entering the new claim, choose the claim type and click Next. When this page is viewed following the initial entry of data, the Claim Submission Reason, Patient Control Number, Client ID, and Claim Type may not be modified. The Original Claim Reference Number may only be maintained on Replacement and Void claims.