Entering Claims

Providers and third-party Billing Services can enter Institutional, Professional, Dental batch and Professional Real Time claims for processing by eMedNY. When you start entering a claim, you will be prompted to select the type of claim A claim may be one of the following: Professional, Institutional, or Dental. The type of claim will drive the fields displayed and required when entering claims. Companion Guides, Trading Partner Agreements, On-Line Help, and Provider Relations training will guide the user in selecting the correct claim type.. Batch claims will not be available for processing by eMedNY until the claims have been batched using the Build Claim Batch pages and transmitted with the Submit Claim Batch pages. Professional Real Time claims are submitted one at a time and are available for viewing within moments using the Real Time Response page.

If your facility is set up to enter claim transactions for multiple Providers, be sure the Provider Name and ID displayed above the left-hand menu is correct. In the event of a Physician Group, claims must be entered under the individual provider and the Group will be entered on the Claim information tab.

Warning: ePACES provides individuals the ability to create and submit transactions to eMedNY over the Internet using their browser.  Collecting multiple transactions created in ePACES, and submitting these as batches is also supported.  However, automated programmatic scripting of the ePACES online access and entry process to eMedNY is expressly forbidden, and will result in your user ID being revoked.

Scripting is a process of storing transactions in a computer file and programming the computer to enter them in rapid succession expecting online responses.  This can create serious performance problems in ePACES and unnecessarily inconvenience other users of the product.

If you need information about automated interfaces to eMedNY, please visit our website: www.emedny.org , and select NYHIPAADESK.  If you cannot locate the answer to your question(s), call the eMedNY Call Center at 800-343-9000.

Navigating the Claim Entry Pages

When the New Claim link is initially selected from the left-hand menu, you will be required to enter the Patient Control Number An identifier used in provider's billing which uniquely identifies a patient visit., Location Code if Billing provider has MMIS ID, address (plus Zip+4) if Billing Provider has National Provider ID and 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.. These items are required for all claims regardless of type. The Client ID is used to retrieve the patient information from the database and pre-populate certain parts of the claim. Following the validation of the Client Information, you must select the Claim Type (Institutional, Professional, Real Time Professional, or Dental), this will drive the contents of the subsequent pages.

The next page that is displayed will have multiple tabs across the top of the page, of which the number and names of will depend on the claim type selected on the prior page. You may enter information on these tabs in the order they are presented or click on the individual tab to enter information in an order that works for you. However, you may not move from one tab to another without entering all required fields on that tab. At the bottom of each tab are Previous and Next buttons, clicking these will bring you to the prior or following tab respectively. To clear all data entered or changed on the claim since the last time it was saved, you may Cancel these changes. Note that the claim information is saved automatically as you navigate through the pages.

Some data fields will provide you with a listing of possible options from which to choose. These are available through either drop-down list boxes ( ) or a separate pop-up listing () of values and descriptions. In either case, simply enter or select the value and the field will be populated accordingly.

Once all the necessary and/or available information is filled in on all tabs, you may click Finish at the bottom of any tab. If all data entered passes validation, a message confirming the completion of the claim will be displayed along with a button to enter another new claim. If the claim just completed was a Real Time Professional claim, a Real Time Claim Confirmation message is displayed and you are prompted to submit the claim for processing. However, if any data entered does not pass the validation process, a table containing the field in error along with the tab on which the error is located is displayed. If errors exist you may elect to return to the claim and make the necessary changes or continue on to enter another new claim and return to this claim at a later time, in which case you may wish to print out this page for reference.

If at any time during the entry process you decide not to complete the entry of a batch claim, you may either Save As Draft or Delete the claim. Saving the claim as a draft will not initiate the validation process which is done upon finishing a claim.

If you click more than once on a different tab to get off the page ( before allowing the page to load ) OR if you are entering a claim, click back on the browser to leave a tab and then try to save it you may receive this message: " The information on this claim has been updated while you were viewing the claim. Leave this tab and return to it to view any updated information. Your changes have not been made to this claim.". You must refresh the page or go to find claims to continue working on that claim.

To review the Claim Entry process, click here ....