With the advent of HIPAA and the desire to advance electronic claiming within our provider community, New York Medicaid made available the HIPAA compliant electronic Provider Assisted Claim Entry System (ePACES) web based application. ePACES, developed by CSC, will allow Medicaid providers to request and receive HIPAA-compliant Claims (Professional, Institutional, and Dental), Eligibility, Claim Inquiry, Service Authorization, and Dispensing Validation System (DVS) transactions. The application is simple to grasp and is an incentive for our paper submitters to switch to an electric format.
Submit HIPAA Compliant Transactions to New York Medicaid (Free of Charge) via ePACES
ePACES is faster and more efficient than submitting paper claims. The program performs basic editing on claims as they are entered, thereby reducing invalid data and denials and any associated rebilling efforts.
Claim Status via ePACES
Providers can utilize ePACES to view the status of claims submitted regardless of the submission method. This means that providers can check on the status of claims (and the associated payment amount) for claims submitted via ePACES or any other method (electronic or paper). A great advantage of ePACES is the speedy availability of claim status. For claims submitted via ePACES (batch method), the status of the claim(s) is available usually on the same day the claim was submitted.
Besides claim status requests, ePACES performs the following transaction types:
- Claims (Professional, Institutional and Dental)
- Eligibility Requests including Service Authorizations
- Prior Approval Requests, including Dispensing Validation System (DVS) requests
For Professional providers (Physicians, Nurses, Nurse practitioners and DME, etc.) claims can be submitted in “real-time”. Real time means that the status of the claim and any associated payment amount will be available to the provider within seconds. Please note that to take advantage of real-time submissions; the claim must not contain more that 4 lines (procedures).
To enroll in ePACES, providers will need the following:
- Computer with internet access
- Valid email address
- Internet browser (Explorer v.4.01, Netscape v. 4.7 or higher)
- Internet access via a broadband connection (AOL Broadband, Road Runner, DSL connection, etc.) or a dial-up connection at 56Kbps for optimal performance
- Operating systems: Microsoft Windows, Macintosh, or Linux
- NYS Medicaid Provider ID Number
- Electronic/Paper Submitter Identification Number
ETIN Applications and instructions are available at www.emedny.org, click on Provider Enrollment Forms in the Featured Links section of the home page. The ETIN application is located in the left-hand column.
Some providers may experience slow ePACES response times, this is most likely due to the provider’s system configurations. The majority of providers using ePACES do not experience slow response times.
Providers should contact the eMedNY Call Center at 1-800-343-9000 for more information on ePACES enrollment. Training for ePACES is available from CSC Regional Representatives. Quick reference documents are available in this section of the website to guide providers through ePACES usage.
One of the primary premises behind the development of ePACES was that it must be “provider friendly” and appeal to smaller providers. We did not wish to pursue development of an application that would scare smaller providers away. ePACES does not disappoint. Since ePACES runs in the browser environment instead of the operating system environment, providers are not constrained in their choice of operating system; they can run Microsoft, Macintosh, or Linux. Providers do not need to install any custom software, and the provider will always be accessing the most updated version of the software because the application will reside on CSC’s server.
Due to the sensitive and private information being served by the application, certain processes have been implemented. Access to the ePACES system will be restricted and only users who have been created by CSC or the ePACES system administrator at the Provider site will be allowed in. ePACES will use form-based authentication where user submits the userid and password to the server using a login screen. The user submitted data is compared with the information in the authentication database; anonymous and unknown users will not be allowed to go anywhere beyond the login screen.
The ePACES application uses role-based security, which means that different users may have access to different sets of functions within the application based on their ePACES profile. The associations between users, functions and data are never direct. Function, and thereby data items, are first logically grouped and then these groups are assigned to a role. In turn, roles are assigned to users. Functional groups will often define functionally common to specific user roles. For example, one user group may only enter claims while another may strictly process eligibility inquiries. In addition to role-based security, ePACES will restrict the access based on HIPAA transactions. Users will be able to access only the data associated with their Provider Identification Number. The ePACES application will give providers the ability to remotely administer their users’ security and manage their users.
Built with the end-user in mind, the ePACES application has user-friendly navigation, data entry fields and pop-up boxes that encourage both speed and accuracy, and comprehensive on-line help documentation. Persistent navigational menus where the items are logically divided into functional groupings allow the user to quickly and easily move about the system. Entering claim information is made quick and simple with the addition of context-specific pop-up boxes which when used will display code values specific to the field in question, lessening the opportunity for incorrect codes being entered when the user is unsure of the actual value. Certain data integrity and simple field validation is done as the user enters the claim to ensure the highest possible percentage of claims are valid upon completion.
Each function and page within the ePACES application is supported in the on-line help documentation, which is easily accessed via the link at the top of each page. The help system will open in a separate window to allow the user to reference the help text while still looking at the page in question. The content available in the on-line help is broken down into main topics with individual pages within each topic. The user will be brought to the main page of content relating to the page from which the Help tool was accessed, however the user may also navigate to any page within the help system from that point to find the information which best helps them.
