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Transportation Services

Web Portal Tutorial Revised 3/16/18

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Contents TRANSPORTATION SERVICES CLAIMS ..................................................................................................................................... 3

PROVIDER INFORMATION ................................................................................................................................................... 6

CLAIM INFORMATION ......................................................................................................................................................... 7

BASIC LINE ITEM INFORMATION ......................................................................................................................................... 8

EDITING OR DELETING A LINE ITEM .................................................................................................................................... 9

ADJUSTING/VOIDING A CLAIM ......................................................................................................................................... 10

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TRANSPORTATION SERVICES CLAIMS

Navigate to https://wymedicaid.portal.conduent.com/ and select Provider

Select Provider Portal from the left hand navigation bar.

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Enter your User ID and Password.

Note: If you have not yet registered for the Web Portal, you must do this first. Reference the Registration Tutorial or

contact EDI Services at 800.672.4959 for assistance.

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Select Claims.

Select Create Professional Claim

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PROVIDER INFORMATION

Are you resubmitting this claim?

o Select Yes to submit a claim adjustment

o Select No if creating a template or submitting an original claim.

BILLING/PAY-TO PROVIDER

o Provider ID dropbox - Select the Billing/Pay-To Provider number

Note: Entering any additional information in this section may cause your claim to reject.

Is the Billing Provider or Pay-To Provider also the Rendering Provider?

o Select Yes

Is this service the result of a referral?

o Select No

SUBSCRIBER/CLIENT INFORMATION

Recipient ID box - Enter the Wyoming Medicaid Client ID

Does the subscriber have insurance other than Medicaid?

o Select No

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CLAIM INFORMATION

Select the red + sign for Prior Authorization

o Prior Authorization number box – Enter the prior authorization number (Required for Taxi and Non-Taxi

rides)

Is this claim accident related?

o Select No

Does this claim have backup documentation?

o Select No

Patient Account No. box – Enter the Transportation Authorization Confirmation number (TAC) – this is not

required, but helpful for claims processing.

Select the red + sign for Additional Claim Data.

o Place of Service – Select 99 Other

o Provider Signature on File – Select Yes

o Medicare Assignment Code – Select C: Not Assigned

o Benefits Assignment Certification – Select Yes

o Release of Information Code – Select Y:Provider Has Signed Release

o Patient Signature Source Code – Select P: Signature generated by provider; patient not present for

services

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BASIC LINE ITEM INFORMATION

Enter Service From To dates

Place of Service dropdown – Select the appropriate place of service (99 Other)

Procedure Code/Modifiers – Enter the procedure code

o Taxi Rides:

A0100 Base Rate – 1 unit for each one way trip

S0215 – Mileage for each mile or part of a mile (mileage is always rounded up)

o Non-Taxi Rides:

A0110 Base Rate – 1 unit for each one way trip

A0080 – Mileage for each mile or part of a mile above 15 miles (the first 15 miles are included in

the base rate. Only bill this code if mileage totaled more than 15 miles – do not include the first

15 in the total mileage).

o Lodging:

A0180 – 1 unit for each night of lodging (Lodging does NOT require a PA)

Submitted Charges box – Enter the submitted charges

Units – Enter the number of units

Select the Add Service Line Item button

Repeat this process for any additional services

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EDITING OR DELETING A LINE ITEM

To edit a line item

o Select the number next to the line item that needs edited

The information will repopulate under the Basic Service Line Items section

o Make any necessary changes

o Select the Update Service Line Item button

To delete a line item

o Select the Delete link for the line item that needs deleted

o National Drug Unit Count box – Enter the unit count

o Unit Code dropdown – Select the unit code

To verify claim

o Click on verify claim. Any possible errors detected on the claim will appear at the top of the page in red.

This function may not detect all errors, and some errors may not affect processing of the claim. Errors

found in verify will NOT prevent you from submitting your claim.

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To Submit claim

o Click on Submit Claim

To Save claim

o Click on Save Claim

ADJUSTING/VOIDING A CLAIM

Are you resubmitting this claim?

o Select Yes to submit a claim adjustment

o Resubmission Type Code box – Select the appropriate action

o ICN to Credit/Adjust box – Enter the ICN/TCN from the claim to be adjusted

Note: If 7:Replacement is selected from the Resubmission Type Code box, this will void the original claim and submit a

clean new claim. This should only be used when the originally paid claim needs voided or the originally paid claim’s paid

date is past the six month timely filing adjustment limit.

Enter the corrected claim according to the instructions within this manual for submitting a claim.