Provider Web Portal Quick Guide: Submitting an Institutional Claim

Last updated: 09/02/2020
 
  1. Login to Provider Web Portal.
  2. Select Claims in the header.
    Claims tab in header
  3. Select Submit Claim Inst.
    submit claims institutional link
  4. Select the "Claim Type" (Inpatient, Crossover Inpatient, Outpatient, Crossover Outpatient or Long-Term Care). Next, enter the information needed for the claim on the Submit Institutional Claim: Step 1 page and click "Continue".

    The Long-Term Care claim type should only be utilized for Nursing Facility charges.

    The Billing Provider ID will be used for claims payment. If the Billing Provider ID is a National Provider Identifier (NPI), the Web Portal automatically selects the NPI that is effective on the from date of the "Covered Dates" in the Claim Information section and inserts that NPI into the "Billing Provider ID" field during Submit Claim: Step 3.

    Completion of the Service Facility Provider ID field, previously the Institutional Provider ID, is conditional. If a provider has the same provider type for multiple enrolled, service locations, the provider should use the unique NPI in the Billing Provider ID field. The provider may use the unique NPI in the Service Facility ID field if they choose. If the NPI for the billing provider is different than the location that the service was rendered, the Service Facility ID field must be completed.

    To enter Medicare information, select a claim type of Crossover Outpatient or Crossover Inpatient. Crossover Inpatient Medicare information will be entered on the Submit Institutional Claim: Step 1 page. Crossover Outpatient Medicare information will be entered on Submit Institutional Claim: Step 3 page.

    fields on institutional claim submission form

    NOTE: Check the "Include Other Insurance" box to indicate a commercial (Non- Medicare) Third-Party Liability (TPL) coverage. Please refer to the Submitting a Claim with Other Insurance or Medicare Crossover Information Quick Guide on the Quick Guides web page for more information on submitting Institutional Claims with TPL , Medicare (Crossover) and Part B Only.

  5. Enter the "Diagnosis Type" and "Diagnosis Code" information on the Submit Institutional Claim: Step 2 page under "Diagnosis Codes" and click "Add".
    diagnosis code and type screenshot



     
  6. If applicable, enter the "Diagnosis Type" and "Diagnosis Code" information on the Submit Institutional Claim: Step 2 page under "External Cause of Injury Diagnosis Codes" and click "Add".
    adding a diagnosis code
  7. If applicable, enter the "Diagnosis Type" and "Diagnosis Code" information on the Submit Institutional Claim: Step 2 page under "Patient Reason for Visit Diagnosis Codes" and click "Add".
    patient reason for diagnosis code
  8. If applicable, enter the "Condition Code" information on the Submit Institutional Claim: Step 2 page under "Condition Codes" and click "Add".

    Condition and occurrence codes can be found in the following UB-04 billing manuals: Dialysis Billing Manual, FQHC and RHC Billing Manual, Home Health Billing Manual, Hospice Care Billing Manual, Inpatient/Outpatient Billing Manual, Nursing Facility Billing Manual and the Private Duty Nurse Billing Manual.

    add condition code
  9. If applicable, enter the "Occurrence Code" and "From and To Date information on the Submit Institutional Claim: Step 2 page under "Occurrence Codes" and click "Add".
    occurrence codes
  10. If applicable, enter the value code and amount information on the Submit Institutional Claim: Step 2 page under "Value Codes" and click "Add".
    value codes
  11. If applicable, enter the "Surgical Procedure Type", "Surgical Procedure Code" and "Date" information on the Submit Institutional Claim: Step 2 page under "Surgical Procedures" click "Add". Click "Continue" when finished.
    surgical procedure information page
  12. Enter the service detail information and, if applicable, upload supporting attachments on the Submit Institutional Claim: Step 3 page under "Service Details" and "Attachments". Once finished, click "Submit".
    service detail information screen
  13. Confirm Institutional Claim information that was entered. If correct, click "Confirm".

    If changes need to be made, navigate back to the appropriate section using the "Back to Step X" buttons at the bottom of the page. Do not use the web browser's "back" button as it can cause errors on the claim.

    confirming institutional claim information
  14. The claim status and Claim ID will be displayed on the Submit Inpatient Claim: Confirmation page. This will also appear on the RA.
    claim confirmation screen

Need More Help?

Please visit the Quick Guides web page to find all the Provider Web Portal Quick Guides.