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Electronic Claims Management Version 1.0 Engine User Manual Electronic Claims Management Engine (ECME) Version 1.0 User Manual May 2021 Department of Veterans Affairs Office of Information and Technology (OIT) Revision History Description (Patch # if Date Project Manager Technical Writer applicable) 05/2021 Updated for BPS*1*28 MCCF EDI TAS MCCF EDI TAS Updated Title Page date and ePharmacy ePharmacy footers Development Development Added Section 6.3.3 SC Team Team Prescriptions for Active Duty Prescriptions Added Section 8.1.11 Duplicate Claims Report 12/2020 Updated for BPS*1*27 MCCF EDI TAS MCCF EDI TAS Updated Potential Secondary Rx ePharmacy ePharmacy Claims Report Screen Display Development Development Updated Title Page date and Team Team 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 Electronic Claims Management Engine V. 1.0 User Manual ii May 2021 Description (Patch # if Date Project Manager Technical Writer applicable) 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 REDACTED REDACTED OI&T standards. 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 REDACTED FirstView Team numerous minor 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 REDACTED REDACTED consistency 12/2010 Reviewed and updated REDACTED REDACTED revisions; inserted TRICARE disclaimer 10/2010 Updated for accuracy changes REDACTED REDACTED per CBO 08/2010 Updated for BPS*1*8 and REDACTED REDACTED Addendum 10/2009 Updated for patch BPS*1.0*8 REDACTED REDACTED ePharmacy COB Support 04/2009 Updated for patch BPS*1.0*7 REDACTED REDACTED 02/2007 Updated for patch BPS*1.0*2 REDACTED REDACTED Electronic Claims Management Engine V. 1.0 User Manual iii May 2021 Description (Patch # if Date Project Manager Technical Writer applicable) 08/2006 Updated for interim patch REDACTED REDACTED BPS*1.0*3 04/2006 Initial release of the ECME User REDACTED REDACTED Manual. Electronic Claims Management Engine V. 1.0 User Manual iv May 2021 Table of Contents 1 Introduction .................................................................................. 1 2 Orientation .................................................................................... 2 2.1 Working with the ECME User Manual ............................................... 2 2.2 Obtaining Online Help ....................................................................... 3 2.3 Finding Related Manuals ................................................................... 4 3 ECME Menu Structures ............................................................... 4 3.1 The Complete ECME Menu Structure ............................................... 5 3.2 ECME User Screen ............................................................................ 6 3.3 ECME Pharmacy COB Menu Structure ............................................ 6 3.4 Pharmacy ECME Manager Menu Structure ...................................... 7 3.5 Pharmacy Electronic Claims Reports Menu Structure.................... 7 4 Accessing the ECME Main Menu ............................................... 8 5 Accessing the ECME User Screen............................................. 8 5.1 Change View .................................................................................... 13 5.2 Sort List ............................................................................................ 19 5.3 Reverse Payable Claim.................................................................... 20 5.4 Resubmit Claim................................................................................ 22 5.5 Close Claim ...................................................................................... 25 5.5.1 Variations to the Close Claim Process ....................................... 28 5.5.2 Special Notes Regarding Secondary Claims .............................. 30 5.6 Add / View Comments ..................................................................... 30 5.7 Further Research Screen ................................................................ 32 5.7.1 Insurance Details ....................................................................... 33 5.7.2 View Eligibility ............................................................................ 34 5.7.3 View Prescription ....................................................................... 35 5.7.4 Add / View Comments ............................................................... 37 5.7.5 Claims Tracking ......................................................................... 37 5.7.6 Third Party Inquiry ..................................................................... 38 5.7.7 On Hold Copay Listing ............................................................... 39 5.7.8 Release Copay .......................................................................... 40 5.7.9 IB (Integrated Billing) Events Report .......................................... 41 5.7.10 Group Plan Menu ....................................................................... 44 5.7.11 Eligibility Inquiry Option.............................................................. 44 5.8 Print Claim Log (Hidden Action) ..................................................... 46 5.9 Send to Worklist .............................................................................. 49 5.10 Reopen Closed Claims (Hidden Action) ......................................... 51 5.11 Resubmit with Edits (Hidden Action) ............................................. 52 5.12 OPECC Reject Information (Hidden Action) .................................. 57 5.13 Resubmit Claim Without Reversal (Hidden Action) ...................... 58 Electronic Claims Management Engine V. 1.0 User Manual v May 2021 5.14 Open / Close Non-Billable Entry (Hidden Action) .......................... 59 5.15 Display Update (Hidden Action) ..................................................... 60 5.16 Exit (From ECME User Screen) ....................................................... 61 6 Accessing the ECME Pharmacy COB Menu ........................... 61 6.1 Potential Secondary Rx Claims Report .......................................... 61 6.2 Potential Claims Report for Dual Eligible....................................... 63 6.3 Process Secondary / TRICARE Rx to ECME .................................. 64 6.3.1 Submitting Secondary Claims .................................................... 65 6.3.2 Submitting Primary Claims for TRICARE and Dual Eligibility Patients ..................................................................................... 66 6.3.3 SC Prescriptions for Active Duty Patients .................................. 67 7 Accessing the Pharmacy ECME Manager Menu .................... 68 7.1 ECME Transaction Maintenance Options ...................................... 69 7.1.1 View / Unstrand Submissions Not Completed ............................ 69 7.1.2 REOPEN a CLOSED ECME Claim ............................................ 71 7.2 Pharmacy ECME Setup Menu ......................................................... 72 7.2.1 Edit Basic ECME Parameters .................................................... 73 7.2.2 Edit ECME Pharmacy Data ........................................................ 74 7.2.3 Register Pharmacy with Austin Information Technology Center . 76 7.3 Statistics Screen .............................................................................. 78 7.3.1 Update Continuously ................................................................. 80 7.3.2 Display Update .......................................................................... 81 7.3.3 Zero (Clear) Statistics ................................................................ 81 7.3.4 Exiting the Statistics Screen ...................................................... 82 8 Accessing the Pharmacy Electronic Claims Reports ........... 83 8.1 Claim Results and Status ................................................................ 83 8.1.1 Payable Claims Report .............................................................. 85 8.1.2 Rejected Claims Report ............................................................. 89 8.1.3 CMOP / ECME Activity Report ................................................... 94 8.1.4 Reversal Claims Report ............................................................
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