electronic claims tracking - ect - · pdf fileyou have now completed electronic claims...

October 2007

Electronic Claims Tracking - ECT

© ENS Inc, an INGENIX company. 2

Introduction

You must have your assigned ENS User ID, Password and Organization IDDelivered to you on your ENS welcome letter via fax 3-4 days after enrolling for service with ENSOr, call Technical Support at 1-866-367-9778

What is Electronic Claims Tracking - ECTElectronic Claims Tracking (ECT) allows you to search for the status of a claim, view information about the claim and submit secondary claims

This lesson will show you how toFind the ENS Home Page and LoginSearch for an electronic claimView Claim Summary and Detail, Claim Adjustments, Line Adjustments and Provider detailsChange secondary IDs and NPI informationSubmit secondary claims

Read the instructions in the gray boxes in this lessonQuestions or problems can be reported to Technical Support at:

Email: [email protected] phone: 1-866-367-9778


Let’s Get Started

From a web browser,locate the ENS Main Home Page at: http:// www.enshealth.comHelpful hint: once you are at the ENS Home Page, save it as a favorite for future use

Click on “Client

Access”


Logging In

Enter your User ID, Password and

Organization ID


Access Electronic Claims Tracking (ECT)

To search for claims status or information, as well as to submit Secondary Claims, click on Electronic Claims Tracking (ECT)


Search Electronic Claims

Click on the tab Simple Search

1

Enter the ECT number, click on Add

2


Search Electronic Claims, cont.

Click on Run

3

For claim details or to submit a Secondary claim, click on Details

4

If you simply wish to see the high-level claim details, use the scroll bars on the current screen


Viewing Results

If you mouse over the ‘+’ symbol in those fields that are applicable, e.g., 17a, 24j, 31b, 32b, or 33b, you will see a list of all the Secondary IDs sent on the original claim. In this example, the claim rejected at ENS and therefore, a secondary claim cannot be submitted. The Create Secondary button will not be visible on a rejected claim.


Claim Adjustments

For adjustment details, click on the Claim Adjustment tab.

1

2

For adjustment details, click on the Claim Adjustment tab.

2

Claim Adjustment Reason Codes screen


Line Adjustments & Provider DetailsFor line adjustments, click on the Line Adjustment tab.

For provider details, click on the Provider Details tab.

Provider details screen


Secondary Claims

To submit a secondary claim, click on the Create Secondary Claim button from the claim details screen.


Secondary Claims

This Secondary Claim DDE screen must be populated with the secondary information.

In order to add or change the existing Provider Secondary ID numbers, click the ‘+’ symbol in the box that corresponds with the Provider ID in question. For example, if you wish to add a Secondary Provider in Box 24j, click on the ‘+’ in that box.


Secondary Claims, cont.

If an NPI number did not come in on the Original Claim, you can enter it in boxes 17, 24, 31,32 and 33. When finished, click OK.



The next step to submitting a secondary claim is to enter the claim level adjustments. Click on the Claim Level COB Tab to complete this next step.

Finally, the line level adjustments must be entered. To complete this final step, click on the Line Level COB tab



Select the reason for this adjustment, select the reason code from the drop-down list (if you need assistance with reason codes, click on the Reason Codes Description for a complete listing) and then enter in the adjustment Amount. You can also enter a Quantity if needed. Click on the OK button once you have populated the necessary fields.

You will need to have access to the Original EOB that you received back from the Primary Payer. Enter data in the Approved Amount, Service Line Paid Amount, Paid Units of Service and Line Adjudication Date. Once these fields have been populated, click on the Add Adjustment tab



You will be required to follow the previous steps for each Line Item. Click on the Submit Claim when this step has been completed.

In order for this claim to submit successfully, the following formula must be followed.

At the Claim Level:Payer Amount Paid (Claim Level COB) + All Adjustments (Line Level COB) = Total Claim

At the Line Level:Service Line Paid Amount (Line Level COB) + Line Adjustments = Original Claim Line Charges


Congratulations!

You have now completed Electronic Claims Tracking (ECT) self-service trainingQuestions or issues can be reported in one of two ways

Email Technical Support at [email protected], call at 1-866-367-9778

We appreciate your business!

electronic claims tracking - ect - · pdf fileyou have now completed electronic claims...

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