LA Professional Billing Input

LA Professional Input Billing is a program that allows the user to claim records that can be filed with Medicaid for reimbursement.

• Before starting LA Professional Input Billing for the first time: Be sure to obtain the ability to download monthly Medicaid eligibility files from the DHH VPN. Click the following link for directions on this procedure: DHH VPN Access Directions.

I. Getting Started

1. In the JCampus navigation menu, go to Required Reporting, then click LA Professional Input Billing. A setup box will appear.
2. Year: Select the correct year to work with. Use the drop down arrow to select a different year.
3. District: Current District number will display here. No need to change anything here.
4. School: Select the school, or schools, by clicking in the cell and then place a check mark in the box corresponding to the schools needed.
   • Selecting "700" will select all sites.
5. Billing Group: The last "Billing Group" is entered initially. Click to move to another billing group.
   • To change the "Billing Group" click in the cell, then place a check mark in the box corresponding to the billing group needed.
   • NOTE: After creating a "Transmit" file, the program automatically creates the next billing group.
6. Click the Ok button to begin.

II. Initial Items to Complete/Review Before Beginning to Create Claim Records

The information is loaded on each student but can be changed if necessary for an individual. Click on the Action button in the upper right of the screen. Click on the item to edit/review each.

A. Set Default Submit/Receive Values

Defaults the information for the district for submitting and receiving Medicaid. Click Action, then Default Submit/Receive Values, then go through each of the following:

1. Submitter Information (1): Enter Organization Name, Submitter ID#, Contact Name, Contact Phone, Contact Email, and Contact Fax.
2. Submitter Information (2): Enter Organization Name as LOUISIANA MEDICAID and Receiver Code as LA-DHH-MEDICAID
3. Submitter Information (3): Enter Provider ID# (7-digit #), NPI# (10-digit #), Employer ID# (Tax #), Address Line 1, Address Line 2, City, State, Zip Code, V/H Site Code (001)
4. Click Save and Close

B. Set Default Claim Info

Use to set defaults with the claim information for the parish. Click Action, then Default Claim Info for each below:

1. Claim Information: Enter Facility Code, Provider Signature on File, Provider Accept Assignment Code, Assignment of Benefits Indicator, Release of Information, Parent Signature Source Code, Special Program Code, Was an EPSDT referral given to the patient, and EPSDT Condition Indicator.
2. Service Information: Enter Product/Service ID Qualifier, Unit of Basis for Measurement Code, EPSDT involvement.

C. Add Eligibility

Use to identify a single student as Medicaid eligible.

1. Select the Click Action, then Add Eligibility.
2. Click the Student Id field. A list of students will appear. Browse, then click on the student.
3. Set the Eligibility Year by clicking on the desired year.
4. Set the Eligibility Month by click on the desired month.
5. Enter the Medicaid Number in the field.
6. Click the Save Eligibility button.
7. Important: To save additional months of eligibility in a fast manner, don't close the screen after clicking Save Eligibility. Change the Eligibility Month, then click the Save Eligibility button again. Repeat for each month needed.
8. Click the yellow "x" in the upper right when done adding eligibility month(s) to the student.

D. Import Eligibility

Each month, a Medicaid Eligibility file is downloaded from DHH, via VPN. If not done so yet, a set of directions for obtaining access to the DHH VPN may be accessed by clicking here: Link to directions page here.

1. Click Action, then Import Eligibility.
2. Click to set the Eligibility Year.
3. Click to set the Eligibility Month
4. Click to browse to the location of the Medicaid file, then click OK to import.
5. A processing window appears indicating that the program is gathering data.
6. After the import process is completed, you will see a list of those that are not found in Student Master database. Medicaid Eligibility Import Errors will be displayed with errors – most of these will be where SSN is not in the database. You can research these by printing and investigating on LAMedicaid.com, if necessary.

III. Entering Claims

1. On the lower left, click the Claim Information tab.
2. Set the Date of Service, then in the Student field, select the student. The student’s name is entered into the field and the student’s Medicaid number appears to the right of the name.
3. Click in the Provider SSN field and find the provider’s name from the list. If the provider is not listed, check with Human Resources. Human Resources can add the person, then the provider will appear in the list. After selection, the section is populated with the provider’s information (SSN, Last Name, First Name, Middle Name and Suffix).
4. Click on the Reference Identification Code to select the proper code for the provider.
5. The Claim Submitter’s Identifier is populated by the program along with Total Claim Charges after this claim is saved.
6. The Facility Code through the EPSDT Condition Indicator fields are populated by the default settings indicated by Default Claim Info.
7. If anything needs to be adjusted, do so now. If complete and correct, select Health Care Diagnosis Code 1 through Health Care Diagnosis Code 4 if needed.
   • One code is required but more than one can be entered.
   • To find the Diagnosis Code, click on the column heading Value and then start typing in the Search box to find the code. #* If searching based on the description column, simply click in the search box to find any word in the Description.
8. The Date of Service and Product/Service ID Qualifier are already populated.
9. Select the Product/Service ID. The Product/Service Modifier is entered here and is used in different situations.
   • Examples:
     • If the Behavioral Health Product/Service ID is H0036, then a modifier of HN – bachelor’s degree or HO – master’s degree is used.
     • If more than one service is provided on the same day a modifier is needed – Speech Therapy and Occupational Therapy
10. Select the Health Care Diagnosis Code Reference Number which refers the claim info to which of the 4 diagnosis codes in the Claim Information is addressed in this claim.
11. Enter the Quantity according to the Unit of Basis for Measurement Code given in the default claim info.
12. Click the Save Service button.
13. The claim will be added to the New Services section (not yet transmitted) and the All Services section (not yet transmitted and previously transmitted claims)
14. Continue adding claims for the same student and then complete all other student claims for this billing group.
15. On the lower left, click the View All Claims tab to review all claim information for the group, including a total of charges for the billing group.

IV. Editing a Claim in a Billing Group

1. While on the Claim Information tab, enter any date in the Date of Service field. Next, click the Student field and select the student.
2. Scroll down to the New Services section of the screen. The services previously entered will be listed in rows.
3. Click on the row to be edited. This will populate the claim fields above.
4. Go to the field that needs changing, make the change and click the Save Service button.
5. A screen appears for (1) Update Existing, (2) New Service or (3) Cancel.
6. Select Update Existing to change the existing claim.

V. Creating a Transmit File

Upon completion of claims for this billing group, the next step is to create a transmit file.

1. Click the Action button in the upper right, then click Transmit.
2. On the Transmit screen, enter the Year, District, School (700 for all schools), and Billing Group.
3. Select New Transmit if this is the first time you are transmitting this group.
   • If you need to transmit this same group again at a later time, then select Re-Transmit.
4. After the transmit or re-transmit is complete a list of students with errors will be provided for you to correct and then process/transmit again.
5. The Transmit file is created and placed on the "JDrive". The "JDrive" space is accessed by clicking on the little cloud icon next to the user name in the top right. When clicked, the "JDrive" space of the user is opened.
   • Make sure to contact your Security Coordinator to give you R/W access to "JDrive".
6. The file is placed in a folder Medicaid, then Medicaid Billing.
7. Find the file and do a right click on it. Select Download. The file opens in a window.
8. Next right click anywhere on the file contents and select Save As. Select where you want to save the file on your computer.
9. In Windows, browse to the location of the download. Right click on the file and rename your file according to directions from Molina – H500XXX.phy

VI. Printing Billing Group Summary

The Print Billing Summary is used to print the billing group summary to compare or reference when the weekly remittance advice reports are downloaded from [1].

1. In the uppper right, click the Action button, then select Print Billing Summary.

Resources

LA Professional Billing Medicaid Guide: A quick guide on how to enter information for Louisiana Medicaid billing.

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JCampus / Required Reporting