MEDICARE BILLING GUIDE

Requirements: All field users, case managers and clinical administrators can post information and instructions and make changes to this form if they have a HHC Ultra user’s account and have access to these sections.

Medicare Billing Page can be accessed by hovering the mouse to “Batch” button on the menu bar and clicking on “Batch Billing”.

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Once clicked, the user will be directed to the Batch Billing Page where the claim can be generated and reconciled and files received from Olympus Cloud/Ability can be checked.

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*Please take note that this is only applicable for agencies that have Olympus Cloud/Ability with DSL.

Navigating the Medicare Billing Module

The Medicare Billing page is your central hub for generating, submitting, and reconciling claims. To access this page, hover over the Batch button in the main menu bar and select Batch Billing.

Note: This functionality is designed for agencies using Olympus Cloud/Ability with DSL.

Step 1: Draft Claim

1.1 From the menu on the left, select the right Type of Bill to generate, add the necessary features, then click “Search”.

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Once done, the list of patient /claims will show up at the bottom as search results.

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1.2 Select the claim/s that need/s to be generated and click on the “Generate” button.

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Step 2: Batch Claims

2.1 To Batch the claim/s that were generated, select on the claim/claims first then, type in the BATCH NAME of the claim/claims. Afterwards, click on the “Batch Claims” button.

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There are extra features that are included in Step 2:

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Visit Compliance - directs the user to the Scheduled Visits Compliance Review page.

Set Adjustment Codes - clicking on the ripped paper-like icon under the claim type column will direct the user to the UB04 Adjustment Panel where the TOB and the Condition Codes of the claim can be updated.

Amount - clicking on the amount will open up the claim's UB04 Laser Format.

Visit Compliance

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Set Adjustment Codes

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UB04 Laser Format

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Step 3: Submit Claims

3.1 Select the Batch that needs to be submitted to Ability. If the agency has Olympus Cloud/Ability with DSL, click “Submit Electronically”. Otherwise, click “Move to Step 4”.

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Once the link under the Batch ID/Name column is clicked, the details of the claims inside the batch will show at the bottom under Batch Claims Detail Information.

If a claim inside the batch needs to be corrected, “Unbatch link” is available. This is located on the last column of the claim details and will move the claim back to STEP 1.

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Download 837 File - allows the user to download the 837 file of a claim that is for electronic submission.

Proof List and Print All Claims - prints the claim/s.

Name of the Patient - directs the user to the patient’s summary page if clicked.

Amount -opens the UB04 Laser Format.

Step 4: Submitted Batches

4.1 This is the page where the user can see all the Batch/es that were submitted with the status indicated on the leftmost side of the claim details.

The user may use the filter option by specifying the search type, patient last name and date range when the batch was submitted.

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In this page, the claim can be flagged as rejected if it was rejected or needs to corrected. Inside a batch, several claims can be processed, if there is only one claim to be corrected, make sure to check the box for that particular claim.

How to Check if the Submitted Claims are Accepted or Rejected?

If an agency has Olympus Cloud/Ability with DSL, the system will show the files that indicate that Medicare received the claims that were submitted through the TRN RESPONSE FILE, ACKNOWLEDGEMENT (999), CLAIMS ACKNOWLEDGEMENT (277CA) and PAYMENT ADVISE (835).

To check these files, click “Batch Receive Files” to select the Intermediary that the agency is associated with. To check the details of the file, click on “View”.

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Sample Acknowledgement (999)

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Sample Claims Acknowledgement (227CA)

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Sample Payment Advice (835)

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Clicking the “Save” button post the Payment Advice (835).

On the other hand, if the agency doesn’t have Olympus Cloud/Ability this file can be accessed through their Ability Subscription. They need to access the website: myability.abilitynetwork.com.

How to post the Payment Advice or Reconcile RA?

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This page is used if an agency doesn’t have Ability with DSL or they need to reconcile the Payment Advice (835) manually. Step by step instruction will be shown on the next page.

Clicking “Add New Remittance Advice” will be direct the user to where the information of the claim must be entered. Make sure to click on the “Save” button once done.

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If the biller or the user has the electronic file for claim submission, he/she can click “Import Electronic Remittance Advice (ERA)” and the page will load the data from Ability: myability.abilitynetwork.com.

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Once the Payment Advice (835) is reconciled, it will reflect on the Patient Billing Ledger. To access the said page, click or go to the specific patient and click the “Billing” tab on the upper right.

Sample Billing Ledger

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Sample Ledger (Click the claim ID)

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In this ledger, the Billing Activity of the patient’s claim is shown. The user can manually add a new Ledger Entry by filling out the necessary fields and clicking on Save.

A copy of the invoice can also be printed by clicking on “Print to PDF” button.

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Version Control #: DSLC2025-1.0

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