Manitoba (includes test submission details)

Mary Jane -

Clinics located in Manitoba can only submit medical claims to Manitoba Health electronically. This is used by Doctors, Chiropractors, and Optometrists only.

You must be registered with Manitoba Health. Upon registration they will send you a package with a clinic #, clinic name, a fob that provides you with a # you will use to log into the Manitoba Health portal and they send you a package with details on what is required on 15 test claims. 

After you submit the 15 test claims, the claims will be approved or MB will provide you with feedback on changes that need to be made to the claims. You will have to resubmit them until the claims are all approved. You are then able to go ahead and do your regular submissions.

There is some system set up before you can start creating claims as detailed below.

You are able to access a "Rejected Claim Code List" by going to http://www.gov.mb.ca/health/claims/docs/eob.pdf

Manitoba Health Care Numbers

Enter your Manitoba Health Care Numbers into the system before creating or submitting claims.

  1. Go to Settings>General>System.
  2. You will be on the Accounting tab. Scroll down to the "Clinics Health Care Numbers" section. Enter the Clinic #, Clinic Username, Clinic User # then Save.

NOTE: The clinic # and the Clinic User # are the same.

 

Manitoba health testing process

  1. You are going to set up 15 separate test claims you can use real or fake patient profiles if you don't have any patients as yet.
  2. Information that must be added in patient profile and claim:
  • Patient: Name, Address
  • Health Care # (add a fake health care #) Phin # (add a fake phin #)
  • Clinic name must appear on the claim.
  • Comments: must be filled in when creating each test claim.
  • Tariffs: enter the correct tariff for the service. (chiro billing do not use products & services you use Tariffs only).
  • ICD codes: enter correct ICD codes for the service you are billing.
  1. Create a test claim by going to the Billing tab, beside the Quick Invoice link select the down arrow and select New Claim, Insurance the Type is set to CLAIM.
  2. Create the submission file on a CD by going to Accounting>Appointment Claims. Select the Search criteria as "New". (Let Customer Support know when the test claims are ready to get assistance with this).

Manitoba Chiro billing (Do not create test claims using the Chiro Bill link on the schedule for this process).

  1. Create an appointment on the schedule.
  2. If a patient or their insurance is paying all or a portion of the appointment you will add the item to the Products & Services section. When completing the appointment the patient/insurance portion will automatically generate.
  3. When the appointment is complete, from the appointment options select "Complete and Chiro"NOTE: (ONLY MANITOBA USES COMPLETE AND CHIRO ALL OTHER PROVINCES SELECT CLAIM)
  4. Select Create invoice. A Popup claim will open.
  5. The system automatically generates a claim for the tariff billed to Manitoba Health and an Invoice for the patient or insurance portion.

Viewing New Claims

  1. Go to Accounting>Appointment Claims.
  2. Set the Search Status field to "New" then search.
  3. All the new claims you have created that have not been billed will appear on the list.

How to create a claim

There are two areas where you can create a claim.

  1. From the Home page>Billing tab you can create a manual Claim. Click the down arrow beside the Quick Invoice button located in the top right corner of the page.
  2. From a patient’s appointment on the schedule.
  3. How to create a manual Claim
  4. From the Home page select the Billing tab. Click the down arrow beside the Quick Invoice button and select New Claim.  The New Claim screen will pop up.
  5. The Invoice Date will default to the current day’s date. To change the invoice date (THIS IS NOT THE APPOINTMENT DATE), use the arrow keys and click on the calendar icon to open it and select an invoice date.
  6. On the left side of the screen you will see Patient Name field. Type the patient's name or date of birth on the patient line and select the patient from the drop down list.
  7. To add a new patient press the down arrow at the end of the Patient Name field and select New. The Quick Patient creation input box will open.
  8. Note: Manitoba Health requires the information for the fields with an asterisk.
  9. Adjust the date for a back dated appointment, and finally press the Add button to add the tariff to the claim.
  10. From the Appointment Details section, If your clinic has only one practitioner, the practitioner’s name will default.
  11. If your clinic has more than one practitioner, select the correct Practitioner by typing in the name on the practitioner line. (If the clinic only has one practitioner they can be set as a default to reduce the steps. This setting is within Administrator profiles only on their General page, Default Practitioner field.)
  12. Tariff Section: Enter the start and end date. (Time start and end time relates to tariffs related to after hours claims).
  13. Enter the Tariff. Hotlinks for frequently used tariffs can be set up by going to Accounting>Module Settings>Enter the Tariffs. You can also set up a default ICD Code in this section. Save. The Tariff will populate the cost of the appointment and move the details to the left side of the page under the Appointment Details section.
  14. Enter the ICD Code.
  15. When all the details are entered for the claim select "Save".
  16. Create a Claim from a patients appointment on the schedule

Click the patients appointment block on the schedule and select Claim Appoinment. The patient’s information will populate to the claim form.

The process is the same as manual claim.

Manitoba Health Submission Creation

  1. Log into Global Office and select the Accounting tab.
  2. Select the Generate Submission link.
  3. Click Create Submission.
  4. Press Print.
  5. The submission file has been created and is stored under the Documents tab.
  6. Click the Documents tab.  The file you just created will be at the top of the documents section.
  7. Click the blue icon to the left of the item and select Download.
  8. Select Save File and press OK.

Submission Upload - Manitoba Health Weblink Submission

  1. Go to the Manitoba Health portal and log in.
  2. Press space bar and Enter.
  3. Enter user ID then press tab.
  4. Enter password press Enter.
  5. Press enter again.
  6. Read messages on Red screen then press Enter.
  7. Read information on Last remittance and future remittance dates press Enter.
  8. At the command screen press U for Upload then press tab three times to get down to Name.
  9. Enter the file name (ex. mbc1509) press tab.
  10. Enter the extension (ex C70) press enter.

Day after submission

Manitoba Health weblink

Go to the Manitoba Health portal and log in.

  1. Press space bar and Enter.
  2. Enter user ID then press tab.
  3. Enter password press Enter.
  4. Press enter again.
  5. Read messages on Red screen then press Enter.
  6. Read information on Last remittance and future remittance dates press Enter.
  7. At the command screen press P1 to print the payment report.

Remittance Process

  1. Login into the SIS system (Manitoba Health portal).
  2. Type the letter D and press Tab.
  3. Make sure the Drive says C.
  4. Make sure the file name path says “Manitoba Health”.
  5. Press the Tab button to get to the file name and type in REM and the month and day (ex. REM1130).
  6. Press Tab to get to the Extension field and type in R and the year (ex. R10).
  7. Press Enter.
  8. The file has now been downloaded to your computer.

 Global Office Process

  1. Log into Global Office and click on the Accounting tab.
  2. Press the Parse Remittance button. NOTE: PLEASE PAY CAREFUL ATTENTION TO AND FOLLOW WARNINGS.
  3. In the window that opens press the Browse button.
  4. On the left side of the window that opens up, click on Desktop.
  5. On the right side of the screen scroll down until you find the Manitoba Health folder and click on the icon.
  6. Select the remittance file you just downloaded by clicking on it.
  7. Press the Open button.
  8. Press the Send File button.
  9. The Remittance is now being applied against your outstanding claims Printing Reports.

Printing Reports

  1. From the Accounting tab click the Reports button.
  2. Then select Remittances.
  3. In the pop up window ensure the Practitioner is selected and press the Create Button.

 Reject Claims & Codes

Rejection Process:

  1. Go to Accounting tab>Appointment claims.
  2. Set the Status: to Rejected
  3. Set your date range to ensure it covers the range the rejected claims would fall within and press Search.
  4. Click the blue icon to the left of the item you want to view and select Open Claim.
  5. Rejection codes and explanation will be found in the bottom right corner.
  6. Hover over the code to see why it was rejected.
  7. For most rejected claims they will be code 44 which is that the patient's demographics are incorrect. If this is the case click on the Edit Patient link beside their name and adjust winch ever field is incorrect. Then Save the changes.
  8. Now Press the Resubmit button in the bottom right corner of the screen
  9. When you've updated all the rejected claims go to the claims search page.
  10. When the next submission is sent these claims will automatically be resubmitted.
  11. If you are unsure as to why a claim has been rejected you can print the Query form for the claim by clicking on the Query form link in the left side of the claim screen below the patient demographics.

Delete a submission

  1. Go to Accounting>Claim Submissions.
  2. Only delete a file you have not submitted. Hover over the submission you want to delete and select delete. You can now start over.

Print Batching for WCB and MPI

  1. Go to Accounting>Create Batch Invoices.
  2. Fill in the details to create the batch in the pop up window.
  3. Confirm you want to create the Batch.
  4. Select the Print Options link to view the batch.
  5. Below are the options after creating the batch. Click the blue menu to the left of the item. Make your selection.
  6. Then select the Mark Batch as Printed. This indicates to you that you have sent the submission.
  7. You will be able to view the submission batch by changing the Search option Status field to Printed then click Search.
  8. You will see a list of print batches. Click the blue icon to the left of the item to view it.

 WCB

  1. The Practitioner requires a WCB #. The number is entered under the Practitioner profile under the Insurance tab.
  2. Set up insurance 3rd party companies. Go to Settings>Third Party Companies>New Third Party. Create the third party then Save.
  3. Set up insurance in the patients profile under the Insurance tab. Select New Insurance, Select WCB from the "Insurance" field drop down options.

MPIC - (Manitoba Public Insurance)

  1. Set up insurance 3rd party companies (same as above for WCB).
  2. Set up insurance in the patients profile under the Insurance tab (same as above for WCB).

How to complete and invoice a patients appointment for WCB and MPIC

  1. When the patient’s appointment is completed, click the patient’s appointment block on the schedule and select Complete and Invoice, select Check Out, then Close the invoice. This puts the invoice in the receivable status to send to WCB or MPIC.
  2. For a large volume clinic you can use the Batching Billing feature by going to Accounting>Print Batching>Create Batch Invoices.

 

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