Page 31 - Claims Handbook

Claims Pend Processing Profile

Pend: 8W Queue Profile
Multiple Servicing Provider Affiliations Qualify
Pend Description One
Pend Category September 13, 1999
Date Implemented April 23, 2013
Date Updated/Revised Claims Examiner
Person(s) Responsible As defined below:
Processing Instructions

8W Queue is generated to ensure the appropriate servicing provider is selected.

ï‚· Open two Amisys Advance screens.

First
 Open Amisys and login.
 Click “Claims Processing” on Main Menu.
 Click “Medical Readjudication” under the “Readjudication” heading.

Second
 Open Amisys and login.
 Click “Provider” on Main Menu.
 Click “Provider Affiliation” under “Provider” heading.

ï‚· Determine if claim is Electronic or Manual and populate it.
Electronic
 Use EDI Viewer to view the claim when the claim contains the letter “E.” (e.g. 11265E030758)
 Open EDI Viewer and login.
 Enter claim number in blank field.
 Press Enter and claim image should populate.
Manual
 Use Macess when the claim contains the letter “M.” (e.g. 11263M001302 and
112970000010)
 Open Macess and login.
 Select “Open” from the toolbar.
 Select “Document” from the drop down menu.
 Put cursor in “Document ID” field.
 Enter claim number.
 Press Enter and claim image should populate.
 If no claim populates, wait two days for Scanning Department to upload the image; however, if
there is no image after those two days, inform management.

ï‚· Review the information on the Amisys readjudication screen and verify it matches the
information on the claim image.

ï‚· Correct the readjudication screen information if necessary and click ReAdjudicate or REset/Adj
to save changes.

ï‚· Verify that the Referring NPI # on claim is the same provider in Amisys.
Open an ecare screen
 Open Internet Explorer.
 Type www.ecare.com in the URL field and hit Enter.
 Click “NPI.”

1 SSA