04/24/2019

AdminisTEP Billing & Training Manual

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Table of Contents

Chapter 1: INTRODUCTION ....................................................................................................... 3

About AdminisTEP ................................................................................................................... 3

Enrolling in AdminisTEP .......................................................................................................... 4

Sign Up in AdminisTEP ............................................................................................................ 5

Accessing AdminisTEP ............................................................................................................. 6

Chapter 2: DASHBOARD ............................................................................................................ 7

AdminisTEP Dashboard ........................................................................................................... 7

Chapter 3: DATA MANAGEMENT - Sending and Receiving Claim/Files ............................... 8

File Upload .............................................................................................................................. 8

File Download ....................................................................................................................... 12

Generate DDE (Direct Data Entry) Claim .............................................................................. 14

Professional Form Billing (CMS-1500) .................................................................................. 15

Saving Subscriber/Member Information (Save/Look-Up Member Info) .................... 16

Saving Provider Information (Save/Look-Up Provider Info) ....................................... 20

Institutional Form Billing (UB-04) ......................................................................................... 23

* SECONDARY DDE Billing (CMS-1500) ................................................................................. 24

* SECONDARY DDE Billing (UB-04) ........................................................................................ 26

Manage DDE Claims - Claim Correction ................................................................................ 28

Chapter 4: INQUIRIES - Search and view individual transactions online ............................. 30

View Claims - (claim level detail) .......................................................................................... 30

View Claim Rejects ................................................................................................................ 32

Submitted Claim File Detail - (file level detail) ...................................................................... 34

Remittance ............................................................................................................................ 36

Received Remittance File Detail - (file level detail) .................................................... 36

Received Remittance Txn Detail - (check level detail) ................................................ 38

Chapter 5: REPORTS ................................................................................................................. 40

Reports .................................................................................................................................. 40

Chapter 6: MAINTENANCE - Manage Users & Passwords ................................................... 41

Maintenance ......................................................................................................................... 41

Chapter 7: SUPPORT ................................................................................................................. 42

Report a Problem .................................................................................................................. 42

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Chapter 1: INTRODUCTION

About AdminisTEP To help streamline claims submissions, inquiries and reimbursement processes, AdminisTEP offers its provider clients a new online system that can be accessed via any standard Web browser. AdminisTEP makes it easy for providers to securely submit claims, access detailed reports and manage reimbursements. Most importantly, the use of AdminisTEP is FREE for providers. Following log in, AdminisTEP users have menu options to manage their data, reporting, inquiry and maintenance needs. These options can be customized based on the user needs and roles. From anywhere within AdminisTEP, users are only a click or two away from the task they need. Please be advised that AdminisTEP works best with Internet Explorer (IE). Using a different browser other than IE can affect claim data or certain boxes not to appear or populate correctly. AdminisTEP benefits include:

• Free to providers (No monthly, set up or connection fees)

• Web-based no software required

• Connect directly to Payers

• Online claim submission and claim status

• Easily edit rejected claims

• Translate non-electronic formats (i.e., paper-based claims) into electronic format (DDE)

• Receive and view remittance (835)

• Access pre-formatted and custom reports

• And many more…

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Enrolling in AdminisTEP

To enroll, please go to www.administep.com and click on “Sign Up” at the bottom of the page. See below.

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Sign Up in AdminisTEP

Please fill out our AdminisTEP Provider Sign Up form and click on “Submit” when complete. An email notification will be sent to one of our Provider Enrollment Specialist who will contact you to get set up.

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Accessing AdminisTEP

Go to http://www.administep.com/ to login. On the top right corner click on the lock icon to key in your login credentials then click on Login.

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Chapter 2: DASHBOARD

AdminisTEP Dashboard Following login, My Portal gives you options to manage your data, reporting, and inquiry needs as well as a dashboard that allows easy access to your ”Daily/weekly/Monthly” billing activity directly from the main page.

The dashboard displays the following information: - Submitted Claim File Status:

Claim files submitted within the last 30 days. The date range can be changed by clicking on the calendar icon.

- Claim Reject Inventory (not reviewed):

Claims rejected and not reviewed by the end user. The end user can remove each claim from “not reviewed” status by simply toggling the claim to a “reviewed” status and vice versa. See page ## to learn how to change each claim’s review status

- Claim Processing Status:

Claims that have been received by AdminisTEP and are in queue for processing. If a yellow warning or red alert appear after a few days, please contact AdminisTEP support at: 888-751-3271 for more assistance.

Clicking on “My Portal” in the upper left corner will bring you back to the main page every single time.

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Chapter 3: DATA MANAGEMENT - Sending and Receiving Claim/Files

File Upload Please contact AdminisTEP at 888-751-3271 X3141 if you are interested and to see if you’re software supports this option. AdminisTEP accepts only 837 I/P file formats. To upload batch files into AdminisTEP, click on “File Upload” under [DATA MANAGEMENT].

Click the icon to upload a file(s).

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Then click on “Add”

Locate the desired file on your computer then click on “Open”.

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Once you located the file to upload select “Upload” as shown below.

Files that have been successfully uploaded will display as shown below.

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If a file was uploaded accidentally, you can delete it by right clicking on the file name and selecting “Delete” from the dropdown. You can also rename by clicking on “Rename”.

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File Download To download files from AdminisTEP, click on “File Download” under [DATA MANAGEMENT]. Files that can be downloaded from AdminisTEP are 997’s, 277CA’s and 835’s. Please contact AdminisTEP at 888-751-3271 X3141 for more information.

If files are available for download they will be displayed as shown below.

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To download a file(s), right click on the file and select “Download” or “Download As Zip” from the dropdown if downloading more than one.

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Generate DDE (Direct Data Entry) Claim Generate DDE Claim allows providers to manually bill to most Payers directly by keying their claim information via one our standard template forms (CMS-1500 or UB-04). From the AdminisTEP Main Page, select “Generate DDE Claim” under [Data Management]. - Go to page 15 for CMS-1500 billing instructions

- Go to page 23 for UB-04 billing instructions Please contact AdminisTEP at 888-751-3271 X3141 for more information on which Payers you can bill to.

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Professional Form Billing (CMS-1500) If billing on the CMS-1500 form, please select (CMS-1500) from the “Claim Type” dropdown and complete the rest of the dropdown selections. Click “Next” when finished.

• Claim Type = (CMS-1500) / (UB-04)

• Payer Resp = Primary / Secondary / Tertiary

• Sender Trading Partner = Provider sending the claim

• Received Trading Partner = Payer receiving the claim.

Following will be a blank template of the CMS-1500 form. Please complete ALL fields that have a * asterisk next to each box.

Please be sure to avoid entering special characters like asterisk (*), equal sign (=), pound sign (#), caret symbol (^), apostrophe ('), underscore (_), period (.), or percentage (%) in any of the fields.

* Fields where red asterisks appear are required or mandatory. See icon above. * Fields with “S” indicate that you can search for a value in a table. * When moving between fields, use the Tab key or the mouse. Pressing the ENTER key may cancel entry and you will need to re-enter the claim.

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Saving Subscriber/Member Information (Save/Look-Up Member Info)

Functionality has been added to the CMS-1500 & UB-04 form to save Subscriber/Member and Provider information. Once it is provided one time it is saved in our system for future use. This saves time in filling out Subscriber/Member or Provider information every time you access the form. Please review the below steps to learn how this information needs to be saved. Click on the “Save/Look up – Member Info” link in box 1a to add Subscriber/Member information.

Adding an Insured who is ALSO the “Patient” Select “Add Insured” from the [Member Search] box. See below

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In the Insured Member box below, complete all the demographic fields. If there is no “insured’s Policy Group”, please leave blank. No hyphens, apostrophes or dashes. Once you complete this screen, click on “Add”.

Please note that this is the screen we need filled out in order for AdminisTEP to save your Subscriber information into our database for future use. *You only have to fill this one time for each of your clients/patients. Once you added all your clients in the “Insured Member” screen above you will now be able to search for them in the “Member Search” screen below.

You can search by Subscriber ID, Last Name, and First Name or by clicking “Search”. Once a member is

found, select it by clicking on the radio button “ ” shown below.

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A message box like the one below will appear. Please select the appropriate box.

Select “Yes” when the Insured is also the patient, and the data originally entered in the “Insured Member” screen will now populate into the CMS-1500 form.

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Adding a dependent of the “Insured Member”

Click on “No” to the message “Is the Patient the Insured”? Click on “Yes” to “Do you want to add a new Patient Member?”

Enter the new Patient/Member here and then click on “Add”.

Following will be the saved records for both the subscriber and the patient.

Click on the radio button (highlighted by the orange arrow above) for the patient and the dependent’s data will then populate in box 2/5 and the insured in box 4/7.

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Saving Provider Information (Save/Look-Up Provider Info) To save Provider Information, click on the “Select” OR “Save/Look up – Provider Info” link in box 31, 32 and 33.

Box 31: Rendering Provider Information This box in not mandatory and is only required when the rendering physician/doctor is different than the billing provider/facility in box 33. If the provider rendering the service is different from that in Box 33, click on “Select” in Box 31 and on the next screen, click on “Yes” for “[Do you want to add a new Physician].”

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Complete the rendering provider information, select “Yes” from the [Default] dropdown and then click “Add” to save the information. The provider information will now appear every time you access the CMS-1500 form in box 31.

Box 32: Name of Service Facility Facility where services were rendered. If address is different than box 33, follow box 33 instructions on how to auto-save this information.

Box 33: Billing Provider/Facility

To save Billing Provider information on box 33 click on “Save/Look up Provider Info” then click on “Yes” for [Do you want to add a new Billing].

Complete the fields below. Exclude special characters and blanks.

1. If your practice has a group name, enter entire group name in the last name field 2. Enter the street address on box 33 only. PO Boxes are NOT allowed. 3. A 9-digit ZIP code is required. Exclude hyphens

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Select “Yes” from the [Default] dropdown and then click “Add” to save the information. The Billing provider information will now appear every time you access the CMS-1500 form in box 33.

Box 36: Pay-to Provider: The Pay-to Provider Address in box 36 is only required when it is different from the Billing Provider address in Box 33. If the address is the same, do not fill out box 36.

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Institutional Form Billing (UB-04)

If billing on the UB-04 form, please refer to page 14, select the appropriate form from the [Claim Type] dropdown and follow the rest of the steps.

• Box 1: Complete/Review the Billing Provider information.

• Box 2: Is the Pay-to Provider Information. The Pay-to Provider Address is only required when it is different from the Billing Provider address in box 1. If not required, do not enter.

• Go to box 60 to look up or add new insured member and patient information. Refer to page 16 for instructions on what steps to take after you click on “Save/Look Up “Member info”.

Please complete entire form as you would a paper claim then select “Submit” when finished. Please be sure not to enter Asterick (*), equal sign (=), pound sign (#), caret symbol (^), hyphen (-), apostrophe ('), underscore (_), period (.), or percentage (%) in any of the fields.

* Fields with a red asterisks are required or mandatory. See icon below * Fields with “S” indicate that you can search for a value in a table. * When moving between fields, use the Tab key or the mouse. Pressing the ENTER key may cancel entry and you will need to re-enter the claim.

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* SECONDARY DDE Billing (CMS-1500) The AdminisTEP system supports Secondary insurance billing via our Professional CMS-1500 and Institutional UB-04 form template. Follow the steps below to submit a Professional CMS-1500 Secondary claim. Please be advised that in order for the Secondary claim to be filed successfully in AdminisTEP the Primary claim should have already been submitted and you have the Primary EOB on-hand. ===================================================================================== When billing SECONDARY 1500 claims, please follow steps 1-4 first then proceed with steps 5-13.

1. Login to AdminisTEP 2. Click on “Generate DDE Claim” under Data Management 3. Fill in the below selections (Make sure you select “Secondary” on Payer Resp:) 4. Click on “Next”

5. Fill out the CMS-1500 Claim with information to send to (Secondary Payor). Please refer to page

14 on how to “Generate DDE Claim” 6. Select “Yes” in Box 11d (is there another health benefit plan) 7. Fill out box 9 (Primary Ins. Information) 8. Once you have filled out the CMS-1500 form completely, click on SUBMIT Since you selected that there is another health benefit plan the system will direct you to our COB screen below.

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9. Fill out everything that has a red Asterisk with Primary Insurance Information Refer to the Primary Insurance EOB for the following critical information:

- Payor Paid Amount - Payer Paid Date - Remaining Patient Liability

UNDER: Claim Level Adjustments… enter Remaining Patient Liability again with correct Reason Code. Example below.

Reason Code Amount

Patient Responsibility

01 "Deductible Amt" ?

02 "Coinsurance Amt" ?

03 "Co-payment Amt" ?

Contractual Obligation 45 ?

10. ALL amounts will need to balance and = to Total Claim Amount being billed to Secondary Ins. 11. Click Submit. 12. If there are no issues the claim will save successfully and give you a DCN number 13. Please monitor the status of the claim(s) in “View Claims” under INQUIRIES

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* SECONDARY DDE Billing (UB-04) The AdminisTEP system supports Secondary insurance billing via our Professional CMS-1500 and Institutional UB-04 form template. Follow the steps below to submit an Institutional UB-04 Secondary claim.

Please be advised that in order for the Secondary claim to be filed successfully in AdminisTEP the Primary claim should have already been submitted and you have the Primary EOB on-hand. ===================================================================================== When billing SECONDARY UB-04 claims, please follow steps 1-4 first then proceed with steps 5-17.

1. Login to AdminisTEP 2. Click on “Generate DDE Claim” under Data Management 3. Fill in the below selections (Make sure you select “Secondary” on Payer Resp:) 4. Click on “Next”

5. Fill out the UB-04 Claim with information to send to (Secondary Payor). Please refer to page 23 on how to “Generate DDE Claim”

6. Complete Box 50 (Secondary & Primary Payor Information) 7. Complete Box 58 (COB Info)

i. Box 58a would be the insured on the Secondary policy ii. Box 58b would be the insured on the Primary policy

8. Once you are done, Click on SUBMIT

Since there is another health benefit plan the system will direct you to our COB screen below.

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9. Fill out everything that has a red Asterisk with Primary Insurance Information

Refer to the Primary Insurance EOB for the following critical information:

- Payor Paid Amount - Payer Paid Date - Remaining Patient Liability

UNDER: Claim Level Adjustments… enter Remaining Patient Liability again with correct Reason Code. Example below.

Reason Code Amount

Patient Responsibility

01 "Deductible Amt" ?

02 "Coinsurance Amt" ?

03 "Co-payment Amt" ?

Contractual Obligation 45 ?

14. ALL amounts will need to balance and = to Total Claim Amount being billed to Secondary Ins. 15. Click Submit. 16. If there are no issues the claim will save successfully and give you a DCN number 17. Please monitor the status of the claims in “View Claims” under INQUIRIES

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Manage DDE Claims - Claim Correction AdminisTEP allows providers to correct DDE claims that have been rejected at the payer’s end and resubmit with a few simple keystrokes. This applies to recently submitted claims in “T-Txn-Loaded” status or “E-Rejected/Error” status. From the AdminisTEP Main Page, select “Manage DDE Claims” under [DATA MANAGEMENT].

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When you first access “Manage DDE Claims” click on . Any claims that have not yet been processed (T-Txn Loaded) and/or claims that have been rejected (E-Reject/Error) will display as shown below. Use % to perform wildcard searches.

• Claims with the (T-Txn Loaded) can still be edited by clicking on the DCN number assigned to each claim and clicking on “EDIT”. See above.

• Claims with a (E-Reject/Error) can be corrected by clicking on the DCN number assigned to each claim and clicking on “EDIT”. See above.

• “Report” will give you an option to save this information in Excel or PDF format.

Click on “Do Not Resubmit” ONLY when there are claims you Do NOT want us to process.

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Chapter 4: INQUIRIES - Search and view individual

transactions online

View Claims - (claim level detail) “View Claims” under INQUIRIES, allow AdminisTEP end users to manually search/view claims.

From the Main page select “View Claims” from the [Inquiries] section. This search allows you to search claims based on a variety of search criteria but the most commonly used are the following below or a combination between several. On a side note, you can use % to perform wildcard searches.

1. Processed Date From / Processed Date To 2. Member Last Name / Member First Name 3. DCN Number 4. Member Number 5. Patient Account

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Following below are some examples of various claim statuses. T-Txn Loaded:

- Claim(s) have been loaded but awaiting processing.

X-Extracted to Payer:

- Claim(s) have been processed by AdminisTEP and sent to the Payer.

A-Accepted by Payer: - Claim(s) have been accepted/acknowledged at Payer’s end

(Please note: accepted claim status is driven off payer response reports we get from our payer clients and in some cases, we might not get these types of reports).

E-Reject/Error: - Payer has rejected this claim.

(Please go to “Manage DDE Claims” on page 24 for instructions on how to fix “Rejected” claims. Please note: Rejected claims can only be fixed online if submitted via DDE (Direct Data Entry).

M-Manual:

- Payer acknowledges receipt of claim, but it is being reviewed manually (Pending Status).

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View Claim Rejects

“View Claims Rejects” under [Inquiries] provides AdminisTEP end users with a complete history of ALL reject/error claims. You can also see the same information in “View Claims”. From the Main page select “View Claim Rejects” from the [Inquiries] section to view all claims with reject/error statuses. Please be advised that this will give you a history of ALL claims Rejections.

Update Review Status (Not Reviewed to Reviewed) In addition to seeing rejected claim detail, you can ALSO change the “Review Status” of the claims from “Not Reviewed” to “Reviewed” or vice versa. By changing and updating claims to “reviewed” status, the Dashboard will also update itself and provide only the claims still needing to be “Not Reviewed”. Use % to perform wildcard searches.

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To do this, click on the “DCN” claim number to view the detail of the claim.

Then select the “Toggle Reviewed” button under “Claim Info”.

The [Dashboard] will now be updated and only show remaining claims still under “not reviewed”.

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Submitted Claim File Detail - (file level detail)

Submitted Claim File Detail provides a search option to manually view a history of all files received and processed by AdminisTEP. Search for files based on the following criteria below.

Following below are file examples with various different file statuses.

File with NO errors below: Click on file name to view ALL claims.

Files with claim error(s) below: Click on file name to view ALL claims. Click on “Warn” to view individual rejected/error claims.

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Files with Compliance Error(s) below: Complete file failure: No claims were processed. For further information click on “Fail”.

Files with a File Error below: Complete file failure: No claims were processed. For further information click on “Fail”.

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Remittance Remittance under INQUIRIES provides AdminisTEP users with the ability to view Remittance information either by file or claim level.

• Received Remittance File Detail (file level detail)

• Received Remittance Txn Detail (check level detail)

Received Remittance File Detail - (file level detail)

From the Main page select “Received Remittance File Detail” under [Inquiries].

Search for files based on the following criteria below.

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Following below are examples of Received Remittance files.

Clicking on the Remittance file name above will provide more detail information as show below.

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Received Remittance Txn Detail - (check level detail)

From the Main page select “Received Remittance Txn Detail” under [Inquiries].

Search for files based on the following criteria below.

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Following below are examples of Remittance files.

Information down to the patient level and information on how much the Payer paid can be viewed by clicking on the check number...

Clicking on each patient control number will display line item information.

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Chapter 5: REPORTS

Reports Reporting tools within AdminisTEP display a variety of pre-formatted reports, enabling users to access the details they need to predict cash flow, reconcile problems and better manage their practices. Please ask your EDI contact person for more information on how to generate these reports.

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Chapter 6: MAINTENANCE - Manage Users & Passwords

Maintenance To change your password, click on “Change your Password” from the main screen under [Security Management].

Then follow below instructions.

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Chapter 7: SUPPORT

Report a Problem For any issues related to the functionality of AdminisTEP, please contact us via the following methods.

1. Report a problem via our portal (top right corner) 2. Call our Production Support Line at: 877-645-8620

OR 3. Email us at: administepprodsupport@administep.com

If reporting via the AdminisTEP portal click on “Report a Problem” from the main screen, then click on “Open Ticket”. See below.

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This AdminisTEP tutorial highlights a small subset of the transaction handling and reporting capabilities offered by the system. For more details, contact us at AdministepProviderEnrollment@administep.com or call 888-751-3271 X3141 for more information.