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ELECTRONIC CLAIMS MANAGEMENT ENGINE (ECME) Version 1.0 ELECTRONIC CLAIMS MANAGEMENT ENGINE (ECME) Version 1.0 USER MANUAL December 2020 Department of Veterans Affairs Office of Information and Technology (OIT) Product Development Revision History Date Description (Patch # if applicable) Project Manager Technical Writer 12/2020 Updated for BPS*1*27 MCCF EDI TAS MCCF EDI TAS Updated Potential Secondary Rx Claims Report ePharmacy ePharmacy Screen Display Development TeamDevelopment Team Updated Title Page date and footers 04/2020 Updated for BPS*1*26 REDACTED REDACTED Updated section 5.6 Add/View Comments Updated Title Page date and footers 1/2019 Updated for BPS*1*24 REDACTED REDACTED Change label on Claim Log, Modify Change View (CV), Enhance Claim Reports 08/2018 Updated for BPS*1*23 REDACTED REDACTED Update Title page date, footer date Modification filter questions CV Change View action, Rx Activity Log to add Date of Service to ECME Log, Resubmit with Edits action, Process Secondary/TRICARE Rx to ECME option, Payable Claims Report, Rejected Claims Report, Reversal Claims Report, Claims Submitted Not Yet Released Report, Recent Transactions Report, Closed Claims Report, View ePharmacy Rx Report Option 11/2017 Updated for BPS*1*22 REDACTED REDACTED Update Title page date, modification to Change View action; change auto-reverse parameter and auto-reversal bulletin; add Facility ID Qualifier and Reconciliation ID to Claim Log and Claim Response Inquiry; add new action PR Print Reports to VER View ePharmacy Rx. 05/2017 Updated for BPS*1*21 REDACTED REDACTED 08/2016 Updated for BPS*1*20 REDACTED REDACTED 06/2016 Updated Title Page to current OI&T standards. REDACTED REDACTED Updated for BPS*1*19 to reflect customer requested revisions throughout screenshots including numerous changes throughout to update for inclusion of the Close Claim functionality and the new Non-Billable Status Report (NBS) 10/2015 Updated for BPS*1*18 REDACTED REDACTED 11/2013 Updated for BPS*1*15 (made numerous minor REDACTED FirstView Team changes throughout; fixed defective page breaks) 02/2012 Updated for BPS*1*11 REDACTED REDACTED 10/2011 Updated for BPS*1*10 REDACTED REDACTED 06/2011 Updated for BPS*1*10 and consistency REDACTED REDACTED 12/2010 Reviewed and updated revisions; inserted TRICARE REDACTED REDACTED disclaimer 10/2010 Updated for accuracy changes per CBO REDACTED REDACTED 08/2010 Updated for BPS*1*8 and Addendum REDACTED REDACTED April 2006 Electronic Claims Management Engine V. 1.0 ii Revised December 2020 User Manual 10/2009 Updated for patch BPS*1.0*8 ePharmacy COB REDACTED REDACTED Support 04/2009 Updated for patch BPS*1.0*7 REDACTED REDACTED 02/2007 Updated for patch BPS*1.0*2 REDACTED REDACTED 08/2006 Updated for interim patch BPS*1.0*3 REDACTED REDACTED 04/2006 Initial release of the ECME User Manual. REDACTED REDACTED April 2006 Electronic Claims Management Engine V. 1.0 iii Revised December 2020 User Manual (This page included for two-sided copying.) April 2006 Electronic Claims Management Engine V. 1.0 iv Revised December 2020 User Manual Contents 1 INTRODUCTION ...................................................................................................................................... 1 2 ORIENTATION ........................................................................................................................................ 3 2.1 WORKING WITH THE ECME USER MANUAL ................................................................................................... 3 2.2 OBTAINING ONLINE HELP ........................................................................................................................... 4 2.3 FINDING RELATED MANUALS ....................................................................................................................... 5 3 ECME MENU STRUCTURES..................................................................................................................... 7 3.1 THE COMPLETE ECME MENU STRUCTURE ..................................................................................................... 9 3.2 ECME USER SCREEN ............................................................................................................................... 11 3.3 ECME PHARMACY COB MENU STRUCTURE ................................................................................................ 11 3.4 PHARMACY ECME MANAGER MENU STRUCTURE ......................................................................................... 11 3.5 PHARMACY ELECTRONIC CLAIMS REPORTS MENU STRUCTURE ......................................................................... 12 4 ACCESSING THE ECME MAIN MENU .................................................................................................... 13 5 ACCESSING THE ECME USER SCREEN ................................................................................................... 15 5.1 CHANGE VIEW ........................................................................................................................................ 22 5.2 SORT LIST .............................................................................................................................................. 31 5.3 REVERSE PAYABLE CLAIM .......................................................................................................................... 34 5.4 RESUBMIT CLAIM .................................................................................................................................... 37 5.5 CLOSE CLAIM .......................................................................................................................................... 40 5.5.1 Variations to the Close claim process. ........................................................................................ 43 5.5.2 Special Notes regarding secondary claims .................................................................................. 45 5.6 ADD/VIEW COMMENTS ............................................................................................................................ 45 5.7 FURTHER RESEARCH SCREEN...................................................................................................................... 47 5.7.1 Insurance Details ......................................................................................................................... 48 5.7.2 View Eligibility ............................................................................................................................. 49 5.7.3 View Prescription ........................................................................................................................ 50 5.7.4 Add/View Comments .................................................................................................................. 53 5.7.5 Claims Tracking ........................................................................................................................... 53 5.7.6 Third Party Inquiry ...................................................................................................................... 55 5.7.7 On Hold Copay Listing ................................................................................................................. 56 5.7.8 Release Copay ............................................................................................................................. 57 5.7.9 IB (Integrated Billing) Events Report ........................................................................................... 59 5.7.10 Group Plan Menu ...................................................................................................................... 63 5.7.11 Eligibility Inquiry Option ............................................................................................................ 64 5.8 PRINT CLAIM LOG (HIDDEN ACTION) ........................................................................................................... 66 5.09 SEND TO WORKLIST ............................................................................................................................... 69 5.10 REOPEN CLOSED CLAIMS (HIDDEN ACTION) ................................................................................................ 72 5.11 RESUBMIT WITH EDITS (HIDDEN ACTION) ................................................................................................... 74 5.12 OPECC REJECT INFORMATION (HIDDEN ACTION) ........................................................................................ 79 5.13 RESUBMIT CLAIM WITHOUT REVERSAL (HIDDEN ACTION) ............................................................................. 80 5.14 OPEN/CLOSE NON BILLABLE ENTRY (HIDDEN ACTION) ................................................................................. 82 5.15 DISPLAY UPDATE (HIDDEN ACTION) ........................................................................................................... 83 5.16 EXIT (FROM ECME USER SCREEN) ........................................................................................................... 85 6. ACCESSING THE ECME PHARMACY COB MENU ................................................................................... 86 April 2006 Electronic Claims Management Engine V. 1.0 v Revised December 2020 User Manual 6.1 POTENTIAL SECONDARY RX CLAIMS REPORT ................................................................................................. 86 6.2 POTENTIAL CLAIMS REPORT FOR DUAL ELIGIBLE ...........................................................................................
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