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Waiver Web Portal

Tutorial Revised 5/11/17

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Contents WAIVER CLAIMS ...................................................................................................................................................................... 3

PROVIDER INFORMATION ................................................................................................................................................... 8

SUBSCRIBER/CLIENT INFORMATION ................................................................................................................................... 9

CLAIM INFORMATION ....................................................................................................................................................... 10

BASIC LINE ITEM INFORMATION ....................................................................................................................................... 11

EDITING OR DELETING A LINE ITEM .................................................................................................................................. 12

CREATING A CLAIM FROM A TEMPLATE ........................................................................................................................... 13

ADJUSTING/VOIDING A CLAIM ......................................................................................................................................... 15

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WAIVER CLAIMS

Navigate to http://wymedicaid.acs-inc.com and select Provider

Select Provider Portal from the left hand navigation bar.

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Enter your User ID and Password.

Note: If you have not yet registered for the Web Portal, you must do this first. Reference the Registration Tutorial or

contact EDI Services at 800.672.4959 for assistance.

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Select Claims.

Select Create Professional Template

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Name the template

o If making a template for each client, it is recommended that you name the template after each client –

i.e. Jane Smith.

o If making a template for a code, it is recommended that you name the template after the code – i.e.

99212 or Office Visit.

Note: When creating a template only fill out those selections that are not going to change from claim to claim such as

NPI and taxonomy.

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NOTE: If using this tutorial to create a claim to submit, make a selection at each and fill out the necessary additional

information.

Note: There are red + signs before certain areas that allow additional information to be entered. Selecting the red + sign

will expand the area. Only expand and enter information that is required, as entering invalid/incorrect information can

cause a claim to reject. The below information will instruct you in which areas are required to be completed.

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PROVIDER INFORMATION

Are you resubmitting this claim?

o Select Yes to submit a claim adjustment

o Select No if creating a template or submitting an original claim.

BILLING/PAY-TO PROVIDER

o Provider ID dropbox - Select the Billing/Pay-To Provider’s NPI

a. If you are a Waiver Provider, not enrolled with an NPI number, use the drop down box to choose

your Wyoming Medicaid Provider Number.

o If you have more than one provider number, select the red + sign for Additional Billing Provider

Information and enter the Billing/Pay-To Provider’s taxonomy code in the Taxonomy Code box (Please

contact Provider Relations 1-800-251-1268 if you are unsure about which provider number or taxonomy

code to use.)

Note: Entering any additional information in this section may cause your claim to reject.

Is the Billing Provider or Pay-To Provider also the Rendering Provider?

o Select Yes if the Billing Provider is also the Rendering Provider (For most Waiver Providers, the billing

provider will be the same as the rendering provider).

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o Select No if the Billing Provider is different from the Rendering Provider

a. Provider ID box – Enter the Rendering Provider’s NPI or provider number if the rendering is not

enrolled with an NPI number.

SUBSCRIBER/CLIENT INFORMATION

Is this service the result of a referral?

o Select No - this claim is not the result of a referral

Recipient ID box - Enter the Wyoming Medicaid Client ID

Does the subscriber have insurance other than Medicaid?

o Select No - the client does not have insurance other than Medicaid. Waiver Services are not required to

be billed to a primary insurance. This will always be no, even if the client does in fact have a primary

insurance.

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CLAIM INFORMATION

Select the red + sign for Prior Authorization

o Prior Authorization number box – Enter the prior authorization number (If creating a template, you may

chose to leave this blank since the PA number may change between billing claims)

Is this claim accident related?

o Select No - the claim is not accident related

Does this claim have backup documentation?

o Select No - the claim does not have backup documentation

Patient Account No. box – Enter the patient account number if you have one established for this client.

Select the red + sign for Additional Claim Data.

o Place of Service – Select the appropriate place of service from the list

o Provider Signature on File – Select Yes

o Medicare Assignment Code – Select C: Not Assigned

o Benefits Assignment Certification – Select Yes

o Release of Information Code – Select Y:Provider Has Signed Release

o Patient Signature Source Code – Select P: Signature generated by provider; patient not present for

services

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BASIC LINE ITEM INFORMATION

Enter Service From To dates (DO NOT span bill separate months on one line. Example: For billing for services

that were performed January 1 through February 5, bill line one with dates 1/1/17 through 1/31/17. For line 2,

you can bill for 2/1/17 through 2/5/17. Billing 1/1/17 through 2/5/17 on one line will cause your claim to be

denied.)

Place of Service dropdown – Select the appropriate place of service

Procedure Code/Modifiers – Enter the procedure code and any appropriate modifiers (Refer to your prior

authorization approval letter for procedure codes and modifiers).

Submitted Charges box – Enter the submitted charges

Diagnosis Pointers – drop down box – Choose the appropriate pointers

Units – Enter the number of units

Select the Add Service Line Item button

Repeat this process for any additional services

Click on Save Template

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EDITING OR DELETING A LINE ITEM

To edit a line item

o Select the number next to the line item that needs edited

The information will repopulate under the Basic Service Line Items section

o Make any necessary changes

o Select the Update Service Line Item button

To delete a line item

o Select the Delete link for the line item that needs deleted

o National Drug Unit Count box – Enter the unit count

o Unit Code dropdown – Select the unit code

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CREATING A CLAIM FROM A TEMPLATE

Click on Claims

Click on Create Claim From Template

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Enter the name of your template, click Search

o If you do not remember the name of the template, click on search and all of your saved templates will

appear.

Click on the template you wish to use

Change any information that may need to be updated (i.e. PA number, dates of services)

To verify claim

o Click on verify claim. Any possible errors detected on the claim will appear at the top of the page in red.

This function may not detect all errors, and some errors may not affect processing of the claim. Errors

found in verify will NOT prevent you from submitting your claim.

To Submit claim

o Click on Submit Claim

To Save claim

o Click on Save Claim

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ADJUSTING/VOIDING A CLAIM

Are you resubmitting this claim?

o Select Yes to submit a claim adjustment

o Resubmission Type Code box – Select the appropriate action

o ICN to Credit/Adjust box – Enter the ICN/TCN from the claim to be adjusted

Note: If 7:Replacement is selected from the Resubmission Type Code box, this will void the original claim and submit a

clean new claim. This should only be used when the originally paid claim needs voided or the originally paid claim’s paid

date is past the six month timely filing adjustment limit.

Enter the corrected claim according to the instructions within this manual for submitting a claim.