Clinitrak EDI Medi-Cal Eligibility Training

Transcription

1 Clinitrak EDI Medi-Cal Eligibility Training Introduction Clinitrak allows users to submit electronic Medi-Cal Eligibility Checking batches to the California State Medi-Cal site using Electronic Data Interface (EDI). Medi-Cal requires each software vendor to pass a testing certification process to ensure that correct electronic claims are submitted before going into Production. Clinitrak has been certified with Medi-Cal for EDI Eligibility Checking using the ASC x /271 standard. Clinitrak Medi-Cal Eligibility Checking Interface 1

2 Clinitrak Medi-Cal Eligibility Checking Creating Medi-Cal Eligibility Checking Batches 1. From the MAIN MENU click on CLAIMS PROCESSING. 2. Select EDI Medi-Cal Eligibility Check. 3. Select the Reporting Unit, Client and Funding Source(s). 4. Select the Service Date. 5. Click on Update View. This will display all clients based on the filters selected. 6. Click on the check-box at the far right of the screen to confirm that the user wishes to create a client to be included in the Eligibility Checking batch. Clicking the x at the top of the column will automatically prepare all clients for checking. Note: Please do not create batches with more than 99 clients. Medi-Cal will not accept these batches. 7. Click on the Create Batch button. 2

3 Sending EDI Medi-Cal Eligibility Batches to Medi-Cal To send EDI Medi-Cal Eligibility batches to Medi-Cal, the 270 batch must be downloaded from Clinitrak to your local desktop, then sent from your desktop to the Medi-Cal web site. Here s how to do that. Note: Whenever you create batches (clicking on the Create Batch button) in the Clinitrak Medi- Cal EDI Billing, a file is created with the following name agency_reportingunit_yyyymmdd_nnnnnnnnn.txt where yyyymmdd is the date when the batch was created and nnnnnnnnn is the internal batch number. You will need to send all files for the day they were created. Establishing a Secure Connection with the Clinitrak Servers Clinitrak uses the Sonicwall Global VPN Client to establish a secure connection with the Clinitrak servers. Before transferring any files between your desktop computer and the Clinitrak servers, you must make sure this connection is active. The following procedure will active the Sonicwall secure connection: 1. Start the SonicWALL Global VPN Client from your Programs list. 2. Double click on the entry labeled Clinitrak. 3. Enter the Username and Password given to you by Clinivate. 3

4 4. Wait for the status to change to Connected. Downloading EDI Medi-Cal Eligibility Batches from Clinitrak 1. Using Secure Transport (icon located in your startup tray in the bottom right-hand corner of your screen), Connect from Clinitrak to your Agency for Sending Medi-Cal. 2. Select the batch or batches you want to send to Medi-Cal. 3. Click on the Download arrow. 4

5 4. Click on the Now button when the Schedule dialog box pops up. The files should be transferred to your C:\Clinitrak_EDI\DMH\Agency\to folder. 5. Close the Secure Transport application. Uploading EDI Medi-Cal Eligibility Batches to Medi-Cal 1. Using your Internet Explorer, go to 2. Log into the Medi-Cal site by clicking on the Transactions>>Login link. 3. Enter your User ID and Password and click on the Submit button. 4. Click on Batch Internet Eligibility in the Elig tab. 5. Click on Upload 270 File. 6. Click on the Browse button to navigate to the C:\Clinitrak_EDI\DMH\Agency\to folder and click on the EDI Medi-Cal Eligibility batch that you just created. 7. Click on the Upload File button to upload the EDI Medi-Cal Eligibility batch file to the Medi-Cal web site. Make note of the Volser number that corresponds to the batch just uploaded. This is the unique identifier for tracking EDI Medi-Cal Eligibility batches with Medi-Cal. 8. Repeat steps 5 7 if you have other batches to upload. 5

6 Receiving EDI Medi-Cal Eligibility Responses from Medi-Cal To receive EDI Medi-Cal Eligibility responses from Medi-Cal, the 271 response must be downloaded from Medi-Cal to your local desktop, then sent from your desktop to the Clinitrak web site. Here s how to do that. Downloading EDI Medi-Cal Eligibility Responses from Medi-Cal 1. Using your Internet Explorer, go to 2. Log into the Medi-Cal site by clicking on the Transactions>>Login link. 3. Enter your User ID and Password and click on the Submit button. 4. Click on Batch Internet Eligibility in the Elig tab. 5. Click on Inquiry/Download 271 File. 6. Identify the Volser number of the batch for which you want to receive a response. If the Status column has a Rejected in it, you will need to contact Clinivate Support at x14 to troubleshoot the problem. 7. If the 271 Response column has a Download link in it, click on it to download the 271 file. 8. Click on the Save button to navigate to the C:\Clinitrak_EDI\DMH\Agency\from folder, then click on the Save button. The 271 response file will be downloaded in Zip format, so you will need to extract the files so that they get placed in the C:\Clinitrak_EDI\DMH\Agency\from folder. 6

7 Uploading EDI Medi-Cal Eligibility Responses to Clinitrak 1. Using Secure Transport (icon located in your startup tray in the bottom right-hand corner of your screen), connect from your Agency to Clinitrak for Receiving Medi-Cal. 2. Navigate to your desktop computer s C:\Clinitrak_EDI\DMH\Agency\from folder and find the files that you extracted. They should have a.edi file extension. 3. Select the file or files you want to send to Clinitrak. 4. Click on the Upload arrow. 5. Click on the Now button when the Schedule dialog box pops up. The files should be transferred from your C:\Clinitrak_EDI\DMH\Agency\from folder to the Clinitrak response folder. The responses should be processed shortly and the result will show up in Clinitrak. 6. Close the Secure Transport application. 7

8 Reviewing EDI Medi-Cal Eligibility Responses 1. From the MAIN MENU click on CLIENT DATA>>Create/Update Files. 2. Select a Client to view. This will take you to the Client s virtual chart. 3. Select Funding Source. 4. Review the Medi-Cal Eligibility Check History section of the screen. This summarizes the entire history of the Client s Medi-Cal Eligibility checks. The Status column describes the state of the Medi-Cal eligibility check. The Share of Cost column will contain a non-zero value if the Client has Share of Cost. 8