Ability PC-ACE Medicare Institutional Manual
PC-ACE MedicareInstitutional ManualPage 1 of 51Revised July 24, 2021
ContentsPC-ACE . 6Note:If you are on a network system, please consult your Systems Administrator before attempting to load PC-ACE 6Instructions for Downloading and Installing PC-ACE . 6Instructions for CD-ROM . 6Instructions for Downloading and Installing PC-ACE for existing users . 6Sign On: . 8Main Toolbar Menu: . 9PROVIDER INSTITUTIONAL –. 12Provider Address . 12CODES/MISC – . 13Shared Column . 13NOTE: . 13PUERTO RICO U.S. VIRGIN ISLANDS. 13Payer ID for Puerto Rico/U.S. Virgin Islands is 09201. 13Submitter – Continued. 141)Obtain your current password . 152)Create your new password . 163)Update your password . 16Institutional Column . 18INSTITUTIONAL CLAIMS MENU . 19Institutional Claim Form . 19Function Keys . 22Institutional Claim List . 23REACTIVATING TRANSMITTED CLAIMS . 24Processing Claims/Automated Claim Processing. 25Preparing Claims/Institutional Claim Prepare for Transmission . 26Import Claims . 27Print File . 27Pre-built File . 28Electronic Media . 28Maintain . 28Payment made by Primary Payer . 31PAYER INFORMATION . 32 Line of Business (LOB) – (COM) . 32PATIENT INFORMATION . 33General Information . 33PATIENT INFORMATION . 33Page 2 of 51Revised July 24, 2021
Primary Insured (Inst) . 33PATIENT INFORMATION . 34Secondary Insured . 34No Claim Payment Made By Primary Payer . 39Info . 39Patient & Codes . 39Billing Line Items . 41We do not promote use of this function because it is not fully automated. . 43ANSI – 835 Electronic Remittances. 44Launch the Institutional ETRA . 44Select ANSI File . 45Translate/Import ETRA . 47Export Data – Not supported Print/View Reports. 47SYSTEM UTILITIES . 48Backup/Restore and File Maintenance . 48Backup – . 48 CD Rom restores– You must copy your PCACEPBK.zip file onto your hard drive before restoring data. . 48Email . 50TIPS . 51Password Reset . 51Communications Hardware/Software . 51999 Initial Acknowledgment . 51277CA – Claim Acknowledgements . 51Receiving Update Notification. 51Steps to Manually Enter Claim . 51Importing Claims . 51IntroductionSection IFirst Coast Service Options, Inc. (First Coast) is pleased to offer PC-ACE software.PC-ACE was designed for easy submission of your Medicare claims. Special care has been taken to ensure that PCACE looks and feels like other popular Windows programs. This means that you can concentrate on your billing and thefeatures offered by PC-ACE rather than worrying about how to navigate the program.The new Windows 10 operating system was released on June 29, 2015. Ability has completed comprehensive testing ofPC-ACE in the new Windows 10 environment and no compatibility issues have been discovered.Page 3 of 51Revised July 24, 2021
Advantages for submitting electronic claims Claims are received the same day they are transmitted, eliminating the 3-4 day mail delay 999 – Initial Acknowledgment and 277CA – Claim Acknowledgment reports are available the same day oftransmission Improves your cash flow – Clean claims process in 14 days in lieu of 29 days for paper claimsPage 4 of 51Revised July 24, 2021
Eliminates costs associated with submitting paper claims – forms, stationery, envelopes and postageAllows your staff to key the claims, bypassing various claims entry departmentsFeatures that PC-ACE will offer Patient Information DatabaseClaims submission (Medicare A)Optional claim import from existing systemsDetailed claim import & edit validation error reporting Remittance translation 277CA - Medicare Claim Acknowledgement available within 2 hours or sooner.Comprehensive real-time claims editing minimizes rejected claimsField-level edit validation provides immediate user feedbackAutomatic code validation (HCPCS, Modifiers, ICD-9, ICD-10) Context-sensitive pop-up selection list speeds claim entry and promotes accuracyPrints CMS-1450 (UB04) forms on plain paper or pre-printed forms Maintains claim historyProvides manual posting of paymentsIntegrate Backup/Validate/Restore and File Maintenance functions Familiar Windows “look and feel”Ongoing maintenance, updates and enhancementsAvailable on CD Rom/Web-SiteTechnical support via phone or emailOptional communications capabilitiesPage 5 of 51Revised July 24, 2021
Getting StartedSection IIPC-ACEDownload and Installation Instructions for PC-ACENote: If you are on a network system, please consult your Systems Administrator before attempting to loadPC-ACEWe would like to take this opportunity to thank you for choosing PC-ACE software.Instructions for Downloading and Installing PC-ACEFollow the steps below to download the files necessary to install the PC-ACE program. You will download from thehttps://medicare.fcso.com web site.1. Either type https://medicare.fcso.com in your internet browser or select your Ctrl key on the site name.o If requested, select your location, line of business, and customize2. Select EDI3. Select PC-ACE.4. Select “Current version (Release Number) –full download for new users-month/year”5. Unless you have turned the option off, you will be prompted with “Would you like to open this file or save it to yourcomputer?” Select Save 6. You will be prompted to designate a location to save the file to (normally C:\ is selected). (Note the file name andlocation, ex. C:\ 123456.zip.)o The download box may automatically close when the download is complete. If not, close the box when thedownload is complete.7. Locate the file from the location you previously designated and double click on it.8. This will invoke the Extraction Wizard Designate a location to extract the files to (normally C :\), then follow theremaining prompts. When the extraction is complete, select the setup.exe file to install the PC-ACEprogram.(Some computers will require you to “RUN” the program).9. Enter the installation password under Technical Information, previously provided on the PC-ACE approvalletter.10. After reading the Welcome screen, select Next 11. Select destination drive.12. Select Next 13. Select Next to Start Installation14. When installation is complete, a Readme file will appear. After reading the Readme file, select Next 15. Select Finish Instructions for CD-ROMThe installation program will execute automatically when you insert the CD into your CD ROM drive if your auto-detectfeature is enabled. If the windows auto-detect feature is disabled, you may need to start the installation programmanually. To do so, type “D:\setup” in the”Run” dialog (accessible from the Windows Start menu), substituting thedrive letter of your CD ROM drive (“D” was used in this example). Enter the installation password under TechnicalInformation, previously provided on the PC-ACE approval letter. To access the Help function after installation, pressthe "F1" key from anywhere in PC-ACE to display help information relevant to your current location in the program.Refer to Section VI for separate Data Communication instructions.Instructions for Downloading and Installing PC-ACE for existing usersPrior to installing an update, we strongly suggest you create a backup of the current version. Instructions forcreating a backup are available at the end of this section. The PC-ACE software must be closed prior to installing theupdate. Once you begin the installation of an update, it is important that you do NOT interrupt the update process.1. Either type https://medicare.fcso.com in your internet browser or select your Ctrl key on the site name.2. Select EDI.3. Select PC-ACE Software.Page 6 of 51Revised July 24, 2021
4. Select PC-ACE current version update download month/year.5. Select Save.6. Designate a location to download to (normally C:\ or Desktop is selected). Note the file name (example: 18620.zip)and location if needed for future reference.7. Select Save and the download will begin.8. When the download is complete, select Open.9. The WinZip program (or the program you use to un-zip files) will appear containing the file pcaceup.exe. If necessary,select Extract, noting the location the file is extracted to (normally C:\), and then select Extract.10. When the extraction is complete, close the WinZip window (or the program you used to un-zip the file) and open thelocation the file was extracted to.11. Open the pcaceup.exe file.12. The installation password is located under Technical Information, previously provided on the PC-ACEapprovalletter.13. If you receive an error message indicating that the password is not valid for the version you have installed, pleasecontact Medicare EDI PC-ACE Software Support using the contact information at the end of this document.14. After reading the Welcome screen, select Next .15. Select destination drive then Next.16. Select Next to activate the Installation Wizard.17. To begin installation, select OK.18. You will be prompted with the following reminder: “Did you backup your PC-ACE databases before running thisupdate? If not, it is strongly recommended that you cancel the update and perform a PC-ACE backup in order tosafeguard your valuable information. Do you want to proceed with the update at this time? Yes/No”. We do NOTrecommend continuing with the installation if a backup has not been created. (Refer to “Create a Backup” below).19. When the “Welcome” screen appears, you will be given the option to continue with the installation.20. The installation process typically takes approximately 1 minute to complete but times vary based on the amount ofinformation in your databases and the number of databases changes in a specific release. When the update iscompleted, you will receive a Readme File screen to review. After selecting “Next” you will be prompted with a secondBackup Reminder.21. Select “OK”. For your protection, we strongly recommend you create a backup after the program is installed, andbackup on a regular basis. You will then receive an “Update Complete” screen; select Finish and you’ll be returned toyour desktop.22. To confirm that the installation was successful; double click on the PC-ACE Icon to access the PC- ACE ClaimsProcessing System Main Toolbar. From the Main Toolbar, select “Help” then “About PC- ACE. Confirm the currentversion is installed. Select OK to close this window. If the version is other than the currentversion, contact Medicare EDIPC-ACE Software Support for additional assistance.23. Create a backup – From the Main Toolbar, select System Utilities, Backup/Restore, and Backup. Indicate thedestination drive you want your backup to be stored to and select Start Backup. Failure to create and maintain a backupwill prevent you from being able to restore data in the event you need to uninstall and reinstall the PC- ACE program.Page 7 of 51Revised July 24, 2021
Getting StartedSection IISign On:As shipped, PC-ACE is configured with a single default user with full system access rights. The default User IDandPassword are "SYSADMIN". If you are logging into PC-ACE for the first time, you will see the PC- ACE screen pop up.Select an icon on the toolbar. Use this default login.Default Sign OnIf you are concerned about controlling user access, you should add/update you and your staff’s user information. Fromthe main toolbar, select Security and then Add/Update User. Select New, then select Check All, or check the desiredpermissions for that User. After checking the permissions, select OK to update your Security List for that user. Repeatthese steps to add additional Users. You must close the program to activate any changes to the Security setup.Default Security ListUser PermissionsUpdate Security ListPage 8 of 51Revised July 24, 2021
Getting StartedSection IIMain Toolbar Menu:MenuIconsMain Tool BarPC-ACE functions are available from the main toolbar, icons and menu.The MainToolbar Menu (File, View, Security, and Help) provides quick access to:1. File – Preferences dialog used to customize PC-ACE to your particular installation and style.2. View – Main Form allows you to choose where you would like to position your toolbar on your desktop.3. Security – Add/Update User, and Logout Current User.4. Help – On-Line help system, Password Reset Link, HIPAA Compliance Information, Privacy Policy and the"About" box (containing the PC-ACE program version number and important copyrightinformation).The Main Toolbar Icons provide quick access to:1. Institutional Claims Processing – Import, Enter, Modify, Process, Prepare Institutional claims, and Transmissionlog.2. Professional Claims Processing – Not used by Medicare A.3. Reference File Maintenance – Maintains all supporting reference files 4.5.6.7.8.Patient database Payer database Provider Institutional database Provider Professional database – Not used by Medicare A Codes/Miscellaneous databasesData Communication Functions – Contact your connectivity vendor in regards to using this option. Yourconnectivity vendor may not use this option. Please contact your connectivity vendor in regards to submitting andretrieving claim information.Claims Activity Scheduling – Schedule delayed and daily recurring claim activities.ANSI-835 Functions – Launch the ANSI-835 Electronic Remittance program.System Utilities – Perform system backup/restore and other maintenance functions.Send Email – Send support mail to medicareedi@fcso.com for assistance with use of the program for Medicareinquires.Page 9 of 51Revised July 24, 2021
Reference File MaintenanceSection IIISample of Adding a New User to the Security ListReference File MaintenanceThe Reference File Maintenance Icon allows access to various pre-built databases and databases that requirecustomization prior to entering, preparing and transmitting claims.Reference File MaintenancePATIENT - The "Patient" tab allows you to add and maintain patient information, including the patient's primary andsecondary insured details. The setup of the Patient’s information is optional. If you choose not to setup the patientdatabase, or if you Import your claims, the patient information will not be accessible during claim entry. If you choose tosetup patients, the complete patient list will be accessible during claim entry using the variable-list lookup feature. When apatient is selected from the lookup list during claim entry, all applicable patient information will auto populate to theappropriate claim form fields. The Patient tab provides a convenient "Sort By" selection that quickly sorts the patient list by"Patient PCN" or "Patient Name" (use F1 function key for more information).Revised July 24, 2021Page 10of
Reference File MaintenanceSection IIIThe two tabs that are required to be completed are the General Information and the Primary Insured (Inst). Refer tosample database data for field entry, some fields support lookup lists that can be accessed by right-clicking the mouseover the field or pressing the “F2” key while on the field. If the patient has a secondary payer then the Secondary Insuredtab should be completed. When entering Secondary Insured information select Insured Information Options (Separate Inst& Prof) radial button to separate the tabs into Secondary Insured (Inst) and Secondary Insured (Prof) tabs. Then,complete the Secondary Insured (Inst) tab.The information you entered in the Patient information tab will be populate into the claim form when the patient’s controlnumber is typed or selected.See Payer Note belowPatient – General InformationPatient - Primary InsuredNote: When updating patient demographic information on the General Information tab, you will also need to update it onthe Primary and Secondary Insured information tabsPAYER – Provides access to maintain system payer information and PrintLink matching descriptions. A pre-built Payerfile is provided, but may not contain all the payers your office utilizes. All payers referenced on claims must exist in thePayer reference file. The Payer tab provides a convenient "Sort By" selection that quickly sorts the Payer list by "PayerID", "Payer Description", "Payer LOB" or "Payer State". Once customized in the database, it will retain the information forfuture use. The Florida Payer ID file has been customized for you as indicated below.NOTE:FLORIDAPayer ID for Florida is 09101.Puerto Rico/U.S. Virgin IslandsPayer ID for Puerto Rico/U.S. VirginIslands is 09201.MCA Payer FilePage 11 ofRevised July 24, 2021
Reference File MaintenanceSection IIIPROVIDER INSTITUTIONAL –Provides access to maintain the providers referenced on Institutional claims. Setup of the Institutional Provider databasemust be completed before you enter a claim. All providers referenced on Institutional claims must be represented in thisreference file. The following Institutional Provider Information screen is an example of the information that is required forthis database.Provider AddressWith ANSI 5010, the billing provider address must contain a 9-digit zip code and an actual street address. Any variationsof the following examples with cause your claim to reject: Post Office, PO Box, Lock Box, etc. If a post office box isnecessary for your office, it can be added to the “Pay to Provider” field in the Provider Information/Extended Info tab.Following are examples of Institutional Provider Information screens.NOTE:FLORIDAPayer ID for Florida is 09101.Puerto Rico/U.S. Virgin IslandsPayer ID for Puerto Rico/U.S. Virgin Islands is 09201Page 12 ofRevised July 24, 2021
Reference File MaintenanceSection IIICODES/MISC –Provides access to the core PC-ACE codes and miscellaneous reference files. The Shared section contains databasesthat are shared by both Institutional and Professional providers. The Institutional section applies to InstitutionalUB04claims.The following provides more detailed information about each database within the Codes/Misc tab.Shared ColumnSubmitter - Submitter Information in PC-ACE is maintained from the Submitter Setup database for your Institutionalclaims. Information from the Submitter reference file is required during preparation of Electronic Media Claims(EMC) files.Refer to the following examples for entering your Submitter information.Blank fields should remain blank. The Prepare, ANSI Info and ANSI Info (2) tabs have already been customized for you;therefore no changes are needed on these tabs.Sample SubmitterNOTE:SelectNewFLORIDAPayer ID for Florida is 09101.PUERTO RICO U.S. VIRGIN ISLANDSPayer ID for Puerto Rico/U.S. Virgin Islands is 09201Page 13 ofRevised July 24, 2021
Reference File MaintenanceSection IIISubmitter – ContinuedSample SubmitterPage 14 ofJuly 24, 2021July 26, 2021Revised July 24, 2021
Reference File MaintenanceSection IIIData Comm – To help maintain the confidentiality of Medicare beneficiary information and other protected healthinformation (PHI), the Centers for Medicare and Medicaid Services (CMS) requires a Mailbox ID and a Password toaccess the Electronic Data Interchange (EDI) mailbox. The Data Communications information in PC-ACE containsinformation, which is used to validate your access to the EDI Gateway (the system you are transmitting your claims to).The program defaults to the Claim Type “Institutional”. Select “View/Update” to update your information. On the Host Infotab, enter your Mailbox ID and Password, which was provided with your approval letter. See the following sample. View/Update EDI GATEWAY Choose Host Info tab Enter your Mailbox ID and Password, as indicated on your critical data letter. These are case sensitive.Password Reset: Mailbox passwords will expire every 60 days.To ensure your transmissions are not interrupted follow all 3 of the following steps:1) Obtain your current passwordWhen changing passwords, you will be required to know your current Mailbox ID and Password. To get thisinformation from the PC-ACE Main toolbar, select:a) Reference File Maintenanceb) Codes/Miscc) Data Commd) Claim Type – select Institutional (Medicare A)e) View/Updatef) Host InfoPage 15 ofRevised July 24, 2021
Reference File MaintenanceSection III2) Create your new passwordFrom the PC-ACE Main Toolbar select: Help and Password Reset. The First Coast webpage will prompt you to select alocation and line of business. Once you’ve selected customized you will automatically be brought to the EDI Gatewaypassword change screen. Enter all requested information then select Submit . You will be provided with a passwordverification screen. Ensure the password you changed to is accepted.Password Criteria Be sure to make note of your new password; it will never be displayed. Passwords must be alphanumeric and uppercase only. Passwords are exactly 8 characters long. New passwords must differ from old passwords by at least 4 characters. Passwords may not match your mailbox or the word "password". Passwords may not be repeated within 10 updates. Your password expires every 60 days.3) Update your passwordWithin PC-ACE - Before transmitting your next file, you must update the Password field on the Data CommunicationsInformation screen with the new password you created using the instructions above. From the Main Toolbar se
PC-ACE was designed for easy submission of your Medicare claims. Special care has been taken to ensure that PC- ACE looks and feels like other popular Windows programs. This means that you can concentrate on your billing and the features offered by PC-ACE rather than worrying about how to navigate the program.
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