Step 1

Select a claim type: Professional Claim or Institutional Claim; then click Next.

Step 2

Under Member Information, in the Member ID box, type the Member ID for the claim.  Click Lookup Member ID, if you do not know the ID.

Step 3

Under Rendering Provider Information, in the Provider ID box, type the provider ID of the provider who rendered the services. Click Lookup Provider ID if you do not know the ID.

Step 4

Under Pay to Provider Information, in the Vendor ID box, type the ID of the provider who should receive payment; then click Submit.

Step 5

The claim information screen is displayed. To successfully create the claim, you need to enter all of the required information and enter each claim line separately.
 

Aside from the claim detail lines, the following fields are required:

• Rendering Provider Medicaid ID
• Pay To Provider Medicaid ID
• Claim Place of Service
• Claim Frequency Type Code
• Principal Diagnosis Code 1
• Patient Account Number
• Medicare Assignment Code

Step 6

To add a line to the claim, enter the appropriate fields in the Service Line section and click the Add Detail Line button. You must have one detail line to submit the claim.  All fields in this section are required to add the line to the claim.

Step 7

Click Submit.