PES Manual PES Manual, PDF version
blank space blank space
HIPAA Transactions
Equipment Requirements
Installation Types
Autorun CD
Individual PC Installation
Network Installation »
Opening PES
Initial Logon »
Setting Up Options »
Using the Keyboard
Using the Mouse
PES Main Window
Menu Bar
Command Buttons
Screen-Specific Command Buttons »
Correcting Errors
Exiting from Forms
Exiting from PES
Lists to Build »
Preloaded Lists
Working with Lists »
Lists »
Dental »
Professional »
Institutional Inpatient »
Institutional Nursing Home »
Institutional Outpatient »
WI Medicaid & Other Insurance»
WI Medicaid & Medicare »
WI Medicaid & Medicare Managed Care »
Other Insurance & Medicare on the Same Claim
Reporting Other Insurance or Medicare Denials
Copying Batch Forms
Retreiving Batch Responses
Viewing Batch Responses
Viewing Communication Logs
Detail Reports
Summary Reports
List Reports
Archive
Restore Archive
Database Recovery »
Get Upgrades
Passwords »
Security »
Web Password Reset
Forgotten Password
Options
Installation Notes
Password Rules
Setting Your Password
Registration Enrollment
Batch Tab
Web Tab
Retention
Other Insurance Screen Buttons
Service Screen Buttons
Service Adjustment Buttons
List Appendix
Adding Codes to a List
Deleting Codes on a List
Admission Type
Admit Source
Carrier
Client
Condition Code
Diagnosis
Modifier
Occurence
Other Insurance Reason Code
Other Provider
Patient Status
Place of Service
Policyholder
Procedure/HCPCS
Provider
Revenue Code
Trading Partners
Type of Bill
Value Code
Completing New Claims
Correcting Errors on Claims
Submitting New Claims
Resubmitting Claims »
Adjusting Paid Status Claims
Voiding Claims
Completing New Claims
Correcting Errors on Claims
Submitting New Claims
Resubmitting Claims »
Adjusting Paid Status Claims
Voiding Claims
Completing New Claims
Correcting Errors on Claims
Submitting New Claims
Resubmitting Claims »
Adjusting Paid Status Claims
Late Billing for Claims
Voiding Claims
Completing Claims
Correcting Errors on Claims
Edit All Feature
Submitting New Claims
Resubmitting Claims »
Adjusting Paid Status Claims
Late Billing for Claims
Voiding Claims
Completing New Claims
Correcting Errors on Claims
Edit All Feature on Claims
Submitting New Claims
Resubmitting Claims »
Adjusting Paid Status Claims
Late Billing for Claims
Voiding Claims
Compact Database
Repair Database
Unlock Database
Changing Passwords
Security Maintenance
Reporting Other Insurance Payments
Medicare Paid at the Header Level
Medicare Paid at the Detail Level
Medicare Managed Care Paid at the Header Level
Medicare Managed Care Paid at the Detail Level
Resubmitting Single Claim
Resubmitting or Copying Partial or Entire Batch
Resubmitting Single Claim
Resubmitting or Copying Partial or Entire Batch
Resubmitting Single Claim
Resubmitting or Copying Partial or Entire Batch
Resubmitting Single Claim
Resubmitting or Copying Partial or Entire Batch
Resubmitting Single Claim
Resubmitting or Copying Partial or Entire Batch

Lists

Policyholder List

The Policyholder list allows you to enter a list of information for the policyholder of commercial insurance carrier and Medicare policies. As with the Provider and Client lists, this list should be entered before completing a claim when the client has a commercial insurance carrier or Medicare. As with other lists, once the code is entered into the list, it may be accessed from drop-down boxes within the claim form screens. To enter policyholder information, follow these steps:

Tip

The most common Insurance Type Codes used in the policyholder list are:

C1: Commercial Insurance
HM: Health Maintenance Organization
MB: Medicare Part B
MP: Medicare Primary
   
  1. Select the Lists option on the menu bar.
  2. Select the Policyholder list.
  3. Enter data into all of the required boxes on the Policyholder screen using the table below as a guide.

Tip

In general, no special characters (such as apostrophes) may be entered in name boxes. Spaces and dashes are allowed.

Names must be submitted the same way they appear in Medicaid files.

Policyholder List

Field

Description

Client ID

Select or enter the client's 10-digit Wisconsin Medicaid identification number.

Carrier Code

Select the carrier code that identifies the other insurance or Medicare.

Carrier Name

Enter the name of the insurance carrier. The carrier name will default to the carrier code selected.

Insurance Type Code

Select the appropriate value that identifies the type of insurance listed.

Relationship to Insured

Select the appropriate value that identifies the relationship of the client to the policyholder.

Policyholder Information Last Name

Enter the last name of the policyholder of the other insurance or Medicare.

First Name

Enter the first name of the policyholder of the other insurance or Medicare.

ID Code

Enter the policyholder’s identification number assigned by the other insurance or Medicare, up to 16 characters in length.

Date of Birth

Enter the policyholder’s date of birth using the MM/DD/CCYY format.

Gender

Select the gender of the policyholder.

Policyholder Address Line 1

This field will be populated automatically once the Client ID is entered.

Line 2

This field will be populated automatically once the Client ID is entered.

City

This field will be populated automatically once the Client ID is entered.

State

This field will be populated automatically once the Client ID is entered.

ZIP

This field will be populated automatically once the Client ID is entered.

  1. Click Save to save the data or New to add a new policyholder.

Tip

Policyholder address fields will be populated automatically once the Client ID is entered. However, if different or updated address information is available, this function may be overridden.

Next — Procedure/HCPCS List
Previous — Place of Service List