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Provider Web Portal Quick Guide: Submitting a Professional Claim

Last updated: 1/10/2024
 
  1. Login to Provider Web Portal.
  2. Select Claims in the header.
    Claims tab in header
  3. Select Submit Claim Prof.
    Submit claim professional link

  4. Select the "Claim Type" (Professional, Professional Crossover) then enter the information needed for the claim on the Submit Professional Claim: Step 1 page and click "Continue".

    To enter Medicare information, select a claim type of Professional Crossover. 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" in the Service Details section and inserts that NPI into the "Billing Provider ID" field during Submit Claim: Step 3.
    Professional Crossover Medicare information will be entered on Submit Professional Claim: Step 3 page.

    NOTE: Rendering provider will be entered on the detail line.

    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 Professional Claims with TPL and with Medicare (Crossover).

    Professional claim step one

  5. Enter the "Diagnosis Type" and "Diagnosis Code" information on the Submit Professional Claim: Step 2 page under "Diagnosis Codes", click "Add", and then click "Continue".Diagnosis code step two
  6. On the Submit Professional Claim: Step 3 page under "Service Details", enter the service detail information and click "Add". If applicable, upload any supporting documents under "Attachments" by clicking the "+" symbol. Once finished, click "Submit".
    service detail screen shot
    service detail screen shot part 2

  7. Review the information entered on the Confirm Professional Claim, then 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.

    Confirm Professional Claim

  8. The claim status and Claim ID will be displayed on the Submit Professional Claim: Confirmation page. This will also appear on the RA.
    claim status and ID

     

  9. (Optional) If the date of service (DOS) are past 365 days, enter the previous ICN in the field “Previous Claim ICN.”

    Professional Rebill

  10. Note: A "Suspended" claim status in the Provider Web Portal means that the claim requires manual review by Gainwell Technologies claims staff before a final disposition (status) can be assigned.

    Suspended claims only show up once on the Remittance Advice (RA). The claim won't appear again on the RA until the claim either denies or pays. Once the claim is finalized, it will be reported on the RA and the 835. Suspended claims are not reported on the 835, only on the RA.

Need More Help?

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