Real Time Professional Claims

Real Time Professional Claims differ from batch Professional Claims in that you will receive an immediate claim status response for each claim entered. The process of entering a Real Time Professional Claim is simplified by the user-friendly tab layout of the pages, grouping data elements to be entered into logical sets.

The tabs of information are as follows:

General Claim Information: The General Claim Information tab is identical for all Claim Types. It contains client specific information for the claim, and once data has been entered, is view only as the client personal information may not be modified.

Professional Claim Information: This tab is specific to Professional Claims. Just over half the data elements included on this page are unique to Professional Claims.

Provider Information: All information pertaining to the Rendering, Referring, Primary Care, or Supervising Provider is entered on this tab.

Diagnosis: Diagnosis codes are entered here to allow charges to be properly assigned. Multiple diagnosis codes may be entered.

Other Payers: The Other Payer tab allows for the entry of payers and the related subscriber information who, in addition to NY Medicaid, are responsible for the payment of the claim being entered.

Service Line(s): May be entered to provide detailed information regarding the services rendered and associated with this claim.