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1 | OSCIF MCCF EDI TAS_Sept2018.zip\Remaining Doc.zip | ib_2_0_p608_edi_ug.docx | Thu Sep 6 16:40:02 2018 UTC |
2 | OSCIF MCCF EDI TAS_Sept2018.zip\Remaining Doc.zip | ib_2_0_p608_edi_ug.docx | Tue Sep 11 13:49:28 2018 UTC |
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1 | Electronic Data Inte rchange (E DI) | |
2 | Billing Us er Guide | |
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19 | Version 2. 9 | |
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22 | August 200 5 | |
23 | Revised: O ctober 201 8 | |
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39 | ||
40 | Revision H istory | |
41 | ||
42 | Date | |
43 | Revision | |
44 | Descriptio n | |
45 | Author | |
46 | August 200 5 | |
47 | 1 | |
48 | Patch IB*2 *296 | |
49 | PII | |
50 | July 2006 | |
51 | 1.1 | |
52 | Patch IB*2 *320 | |
53 | PII | |
54 | February 2 007 | |
55 | 1.2 | |
56 | Patches IB *2*343, 34 8 and 349 | |
57 | PII | |
58 | PII | |
59 | July 2007 | |
60 | 1.3 | |
61 | Patch IB*2 *374 | |
62 | PII | |
63 | November 2 007 | |
64 | 1.4 | |
65 | Patch IB*2 *368 and 3 71 | |
66 | PII | |
67 | PII | |
68 | May 2008 | |
69 | 1.5 | |
70 | Patch IB*2 *377 | |
71 | PII | |
72 | February 2 009 | |
73 | 1.6 | |
74 | Patch IB*2 *400 | |
75 | PII | |
76 | November 2 010 | |
77 | 1.7 | |
78 | Patch IB*2 *436 – Sec tion 4 and | |
79 | Section 4. 5.3.1 | |
80 | Also repla ced refere nces to Em deon and E xpress Bil l with “cl earinghous e” | |
81 | PII | |
82 | PII | |
83 | January 20 11 | |
84 | 1.8 | |
85 | Edits by T raining De partment a nd removed reference to patch IB*2*433 | |
86 | PII | |
87 | May 2011 | |
88 | 1.9 | |
89 | Patch IB*2 *433 – Sec tion 6.7 | |
90 | ||
91 | PII | |
92 | PII | |
93 | September 2011 | |
94 | 1.10 | |
95 | Patch IB*2 *432 | |
96 | Revised Se ctions: 1, 2, 4, 6 | |
97 | Added Sect ions: 7 an d 8 | |
98 | PII | |
99 | PII | |
100 | March 201 2 | |
101 | 1.11 | |
102 | Patch IB*2 *447 and P RCA*4.5*27 5 | |
103 | Revised Se ctions: 6, 7 | |
104 | PII | |
105 | PII | |
106 | PII | |
107 | March 2014 | |
108 | 1.12 | |
109 | Patch IB*2 .0*476 | |
110 | Revised Se ctions: 4. 4.1, 4.5.3 | |
111 | PII | |
112 | August 201 4 | |
113 | 2.0 | |
114 | Patch IB*2 *488 (Buil d 1) | |
115 | Revised Se ctions: 2. 1.1.1. (St eps 1 & 2) , 2.2.1, 4 .4.1 (Step s 5 & 9), 6.2.2, 6.6 .1, 6.7 (n ote after Step 5), 6 .8 (note a fter Step 5), 6.9 (n otes after Steps 6 & 7), 6.10, 9.3.16, A ppendix A & B | |
116 | General gr ammar, spe lling and format cha nges appli ed | |
117 | PII | |
118 | FirstView | |
119 | ||
120 | January 20 15 | |
121 | 2.1 | |
122 | Patch IB*2 *521 | |
123 | Revised ED I Paramete r Report S ection 9.3 .14, Appen dix B | |
124 | PII | |
125 | PII | |
126 | April 2015 | |
127 | 2.2 | |
128 | Patch IB*2 *516 | |
129 | Revised Se ctions: 2. 1.1.1, 2.1 .1.2, 2.1. 2, 3, 3.1, 4.4.1, 6. 2.3, 6.2.3 .1, 6.2.3. 2, 6.3.2, 5.7, 6.7, 6.8, 6.9, 6.10, 6.11 , 6.12, 72 , 7.2.1, 9 .3.14, 9.3 .16, 9.3.1 7 | |
130 | ||
131 | PII | |
132 | PII | |
133 | April 2015 | |
134 | 2.3 | |
135 | IOC Exit R eview Pat ch IB*2*51 6 | |
136 | Revised Se ctions: 6. 11, 6.2.3. 1, 6.2.3.2 , 6.3.2, 9.2.3 | |
137 | PII | |
138 | August 201 6 | |
139 | 2.4 | |
140 | Patch IB*2 *547 | |
141 | Revised Se ctions: 2. 1.1.1, 2.1 .2, 6.2.4 and all su b-sections , 6.3.3, 6 .7, 6.9, 6 .10, 6.14, 7.2, 8., 9.3, 9.4, 9.5, 10.2 .1, 10.3.1 6, 10.3.17 , 10.3.19, Appendix B | |
142 | PII | |
143 | August 201 6 | |
144 | 2.5 | |
145 | Patch IB*2 *549 | |
146 | Revised Se ctions: 2. 1.1.2, 2.1 .2, 5.1.1 | |
147 | PII | |
148 | July 2017 | |
149 | 2.6 | |
150 | Patch IB*2 *576 Adde d sub-sect ions 6.2.5 and 6.3.4 | |
151 | PII | |
152 | October 2 017 | |
153 | 2.7 | |
154 | Patch IB*2 *577 Added sub-secti on 10.3.20 , Modified sub-secti on 6.2.3.2 and 6.7 a nd 6.8 | |
155 | PII | |
156 | June 2018 | |
157 | 2.8 | |
158 | Patch IB*2 *592 Added sections 6.3.5, 6.9 and 9.6. Modified s ections/su b-sections 2.1.1.1, 2.1.1.2, 2 .1.2, 2.1. 3, 4.0, 4. 1, 4.3.2, 4.5, 6.1, 6.4, 6.6.1 , 6.15, 7. 2, 10.3.16 , 10.3.18, 10.3.20, 11 and 12 | |
159 | PII | |
160 | PII | |
161 | October 20 18 | |
162 | 2.9 | |
163 | Patch IB*2 *608 Added section 9 .7. Modifi ed section s/subsecti ons 2.1.2, 2.1.3. 3, 3.1, 3.2, 3.3, 6.2. 3.1, 6.3.6 , 6.4, 6.1 5, 9.1 and 10.3.17 | |
164 | PII | |
165 | ||
166 | ||
167 | (This pag e included for two-s ided copyi ng.) | |
168 | ||
169 | ||
170 | ||
171 | ||
172 | Table of C ontents | |
173 | ||
174 | 1.Introduc tion1 | |
175 | 1.1.Revenu e Process1 | |
176 | 1.2.Critic al EDI Pro cess Terms 2 | |
177 | 1.3.EDI Pr ocess Flow 3 | |
178 | 2.Insuranc e Company Set-up4 | |
179 | 2.1.Insura nce Compan y Setup4 | |
180 | 2.1.1Activ ate New Pa yer to Tra nsmit eCla ims4 | |
181 | 2.1.2Activ ate Existi ng Commerc ial Payer to Transmi t eClaims1 0 | |
182 | 2.1.3Activ ate Existi ng Payer t o Test Pri mary Blue Cross/Blue Shield eC laims15 | |
183 | 3.Pay-to P rovider(s) Set-up18 | |
184 | 3.1.Define Default P ay-to Prov ider19 | |
185 | 3.2.Associ ate Divisi ons with n on-Default Pay-to Pr ovider21 | |
186 | 3.3.Rate T ypes for N on-MCCF Pa y-to Provi der22 | |
187 | 4.Provider ID Set-up 24 | |
188 | 4.1.Table of IDs25 | |
189 | 4.2.Pay-to Provider IDs30 | |
190 | 4.2.1Defin e the Pay- to Provide r Primary ID/NPI30 | |
191 | 4.2.2Defin e the Pay- to Provide r Secondar y IDs30 | |
192 | 4.3.Billin g Provider IDs30 | |
193 | 4.3.1Defin e the Bill ing Provid er Primary ID/NPI31 | |
194 | 4.3.2Defin e the Bill ing Provid er Seconda ry IDs32 | |
195 | 4.4.Servic e Facility IDs (Labo ratory or Facility I Ds)38 | |
196 | 4.4.1Defin e Non-VA L aboratory or Facilit y Primary IDs/NPI39 | |
197 | 4.4.2Defin e Non-VA L aboratory or Facilit y Secondar y IDs41 | |
198 | 4.4.3Defin e VA Labor atory or F acility Pr imary IDs/ NPI43 | |
199 | 4.4.4Defin e VA Labor atory or F acility Se condary ID s43 | |
200 | 4.5.Attend ing, Opera ting and O ther Physi cians and Rendering, Referring and Super vising Pro viders44 | |
201 | 4.5.1Defin e a VA Phy sician/Pro vider’s Pr imary ID/N PI45 | |
202 | 4.5.2Defin e a VA Phy sician/Pro vider’s Se condary ID s45 | |
203 | 4.5.3Defin e a non-VA Physician /Provider’ s Secondar y IDs52 | |
204 | 4.5.4Defin e Insuranc e Company IDs56 | |
205 | 4.5.5Defin e either a Default o r Individu al Physici an/Provide r Secondar y ID60 | |
206 | 4.6.Care U nits62 | |
207 | 4.6.1Defin e Care Uni ts for Phy sician/Pro vider Seco ndary IDs6 2 | |
208 | 4.6.2Defin e Care Uni ts for Bil ling Provi der Second ary IDs65 | |
209 | 4.7.ID Par ameters by Insurance Company67 | |
210 | 4.7.1Defin e Attendin g/Renderin g Provider Secondary ID Parame ters69 | |
211 | 4.7.2Defin e Referrin g Provider Secondary ID Parame ters70 | |
212 | 4.7.3Defin e Billing Provider S econdary I D Paramete rs70 | |
213 | 4.7.4Defin e No Billi ng Provide r Secondar y IDs by P lan Type70 | |
214 | 4.7.5View Associated Insurance Companies , Provider IDs, and ID Paramet ers71 | |
215 | 4.8.Associ ated Insur ance Compa nies and C opying Ph ysician/Pr ovider Sec ondary IDs and Addit ional Bill ing Provid er Seconda ry IDs73 | |
216 | 4.8.1Desig nate a Par ent Insura nce Compan y73 | |
217 | 4.8.2Desig nate a Chi ld Insuran ce Company 75 | |
218 | 4.8.3Copy Physician/ Provider S econdary I Ds75 | |
219 | 4.8.4Copy Additional Billing P rovider Se condary ID s76 | |
220 | 4.8.5Synch ronizing A ssociated Insurance Company ID s76 | |
221 | 5.Subscrib er and Pat ient ID Se t-Up77 | |
222 | 5.1.Subscr iber and P atient Ins urance Pro vided IDs7 7 | |
223 | 5.1.1Defin e Subscrib er Primary ID77 | |
224 | 5.1.2Defin e Subscrib er and Pat ient Prima ry IDs79 | |
225 | 5.1.3Defin e Subscrib er and Pat ient Secon dary IDs81 | |
226 | 6.Entering Electroni c Claims83 | |
227 | 6.1.Summar y of Enter /Edit Bill ing Inform ation to S upport ASC X12N/5010 83 | |
228 | 6.2.Change s Made by Specific P atches83 | |
229 | 6.2.1Patch IB*2*4478 3 | |
230 | 6.2.2Patch IB*2*488: 85 | |
231 | 6.2.3Patch IB*2*5168 6 | |
232 | 6.2.4Patch IB*2*5478 7 | |
233 | 6.2.5Patch IB.2.5768 8 | |
234 | 6.2.6Patch IB*2*5778 9 | |
235 | 6.3.Handli ng Error M essages an d Warnings 89 | |
236 | 6.3.1Patch IB*2*4889 0 | |
237 | 6.3.2Patch IB*2*5169 0 | |
238 | 6.3.3Patch IB*2*5479 0 | |
239 | 6.3.4Patch IB*2*5769 0 | |
240 | 6.3.5Patch IB*2*5929 0 | |
241 | 6.3.6Patch IB*2*6089 0 | |
242 | 6.4.Claim versus Lin e Level Da ta91 | |
243 | 6.5.Screen 3 – Payer Informati on91 | |
244 | 6.5.1EDI F ields91 | |
245 | 6.5.2Using Care Unit s for Bill ing Provid er Seconda ry IDs92 | |
246 | 6.6.Screen 10 – Phys ician/Prov ider and P rint Infor mation93 | |
247 | 6.6.1EDI F ields UB-0 4/CMS-1500 /J430D93 | |
248 | 6.7.UB-04 Claims94 | |
249 | 6.8.CMS-15 00 Claims1 02 | |
250 | 6.9.J430D Claims111 | |
251 | 6.10.Lab C laims115 | |
252 | 6.11.Pharm acy Claims 119 | |
253 | 6.12.Corre ct Rejecte d or Denie d Claims12 3 | |
254 | 6.13.Viewe d Cancelle d Claims12 6 | |
255 | 6.14.Print ed Claims1 26 | |
256 | 6.15.View/ Resubmit C laims – Li ve or Test – Synonym : RCB127 | |
257 | 7.Processi ng of Seco ndary/Tert iary Claim s131 | |
258 | 7.1.Criter ia for the Automatic Processin g of Secon dary or Te rtiary Cla ims131 | |
259 | 7.2.COB Ma nagement W orklist132 | |
260 | 7.2.1Data Displayed for Claims on the CO B Manageme nt Worklis t132 | |
261 | 7.2.2Avail able COB M anagement Worklist A ctions133 | |
262 | 8.Requests for Addit ional Data to Suppor t Claims13 4 | |
263 | 9.IB Site Parameters 136 | |
264 | 9.1.Define Printers for Automa tically Pr ocessed Se condary/Te rtiary Cla ims136 | |
265 | 9.2.Enable Automatic Processin g of Secon dary/Terti ary Claims 138 | |
266 | 9.3.Printe d Claims R ev Code Ex cl: 17 Act ivated Cod es Defined 140 | |
267 | 9.4.Altern ate Primar y Payer ID Types141 | |
268 | 9.5.ASC X1 2N Health Care Claim Request f or Additio nal Inform ation (277 RFAI)142 | |
269 | 9.6.New ED I Paramete r for Dent al Process ing143 | |
270 | 9.7.CMN CP T Code Inc lusion: XX CMN CPT C odes Inclu ded144 | |
271 | 10.Reports 145 | |
272 | 10.1.EDI R eports – O verview145 | |
273 | 10.2.Most Frequently Used Menu s/Reports1 46 | |
274 | 10.2.1Clai ms Status Awaiting R esolution – Synonym CSA146 | |
275 | 10.2.2Mult iple CSA M essage Man agement – Synonym: M CS147 | |
276 | 10.2.3Elec tronic Rep ort Dispos ition148 | |
277 | 10.2.4EDI Claim Stat us Report- Synonym: ECS149 | |
278 | 10.3.Addit ional Repo rts and Op tions150 | |
279 | 10.3.1Read y for Extr act Status Report - Synonym: R EX150 | |
280 | 10.3.2Tran smit EDI B ills – Man ual - Syno nym: SEND1 50 | |
281 | 10.3.3EDI Return Mes sage Manag ement Menu – Synonym : MM151 | |
282 | 10.3.4EDI Message Te xt to Scre en Mainten ance151 | |
283 | 10.3.5EDI Messages N ot Reviewe d Report15 1 | |
284 | 10.3.6Elec tronic Err or Report1 51 | |
285 | 10.3.7Retu rn Message s Filing E xceptions1 52 | |
286 | 10.3.8Stat us Message Managemen t152 | |
287 | 10.3.9Bill s Awaiting Resubmiss ion – Syno nym: BAR15 3 | |
288 | 10.3.10EDI Messages Not Yet Fi led –Synon ym: MP153 | |
289 | 10.3.11Pen ding Batch Transmiss ion Status Report – Synonym: P BT153 | |
290 | 10.3.12EDI Batches P ending Rec eipt– Syno nym: PND15 3 | |
291 | 10.3.13Vie w/Print ED I Bill Ext ract Data – Synonym: VPE155 | |
292 | 10.3.14Ins urance Com pany EDI P arameter R eport – Sy nonym: EPR 155 | |
293 | 10.3.15Tes t Claim ED I Transmis sion Repor t – Synony m: TCS156 | |
294 | 10.3.16Thi rd Party J oint Inqui ry – Synon ym: TPJI15 7 | |
295 | 10.3.17Re- generate U nbilled Am ounts Repo rt159 | |
296 | 10.3.18Pat ient Billi ng Inquiry – Synonym : INQU160 | |
297 | 10.3.19Pri nted Claim s Report16 0 | |
298 | 10.3.20HCC H Payer ID Report161 | |
299 | 11.APPENDI X A – BATC H PROCESSI NG SETUP16 2 | |
300 | 12.APPENDI X B – GLOS SARY165 | |
301 | 13.APPENDI X C – HIPA A Provider ID – Refe rence Guid e169 | |
302 | ||
303 | ||
304 | ||
305 | (This page included for two-si ded copyin g.) | |
306 | ||
307 | ||
308 | ||
309 | Introducti on | |
310 | In 1996, C ongress pa ssed into law the He alth Insur ance Porta bility and Accountab ility Act (HIPAA). T his Act di rects the federal go vernment t o adopt na tional ele ctronic st andards fo r automate d transfer of certai n healthca re data be tween heal thcare pay ers, plans , and prov iders. Now that thes e standard s are in p lace, the Veterans H ealth Admi nistration (VHA) wil l submit c laims cont aining the required standard d ata conten t to all p ayers acce pting elec tronic dat a intercha nge (EDI). | |
311 | Revenue Pr ocess | |
312 | The overal l patient billing re venue proc ess for th e VHA is s ummarized in the tab le below: | |
313 | ||
314 | Intake | |
315 | Utilizatio n Review | |
316 | Billing | |
317 | Collection | |
318 | Utilizatio n Review | |
319 | Patient Re gistration | |
320 | Insurance Identifica tion | |
321 | Insurance Verificati on | |
322 | Pre-certif ication & Certificat ion | |
323 | Continued Stay | |
324 | Documentat ion | |
325 | EDI Bill G eneration | |
326 | MRA | |
327 | Claim stat us message s | |
328 | Establish Receivable s | |
329 | A/R Follow -up | |
330 | Lockbox | |
331 | Collection Correspon dence | |
332 | Appeals | |
333 | ||
334 | During the Intake ph ase, the p atient is registered . Insuranc e informat ion is ide ntified an d/or verif ied. | |
335 | ||
336 | In the Uti lization R eview phas e, the pat ient is pr e-certifie d and cert ified, and continued stay revi ews are pe rformed. | |
337 | ||
338 | In the Bil ling phase , the pati ent encoun ter is doc umented an d coded. A n electron ic data in terchange (EDI) bill and/or Me dicare Rem ittance Ad vice (MRA) request i s generate d and sent to the pa yer. Claim status me ssages inc lude infor mation tha t appears on the Cla ims Status Awaiting Resolution (CSA) rep ort. | |
339 | ||
340 | During the Collectio ns phase, establishm ent of rec eivables, accounts r eceivables follow-up , lockbox, and any c ollection correspond ence take place. | |
341 | ||
342 | Another Ut ilization Review can take plac e if there are any a ppeals. | |
343 | ||
344 | EDI Billin g provides the VHA w ith the ca pability t o submit I nstitution al and Pro fessional claims ele ctronicall y as 837 H ealth Care Claim tra nsmissions , rather t han printi ng and mai ling claim s from eac h facility . | |
345 | ||
346 | ||
347 | ||
348 | ||
349 | ||
350 | ||
351 | ||
352 | ||
353 | ||
354 | ||
355 | ||
356 | ||
357 | Critical E DI Process Terms | |
358 | Also see A PPENDIX B – GLOSSARY . | |
359 | ||
360 | 835 Health Care Clai m Payment/ Advice – T he HIPAA a dopted sta ndard for electronic remittanc e advice t o report t he process ing of all claim typ es (includ ing retail pharmacy) . The term “835” rep resents th e data set that is s ent from h ealth plan s to healt hcare prov iders and contains d etailed in formation about the processing of the cl aim. This includes p ayment inf ormation a nd reducti on or reje ction reas ons. All h ealth plan s are requ ired to us e the same explanati on of bene fit codes (adjustmen t reason c odes) and adhere to very speci fic report ing requir ements. Th e term “83 5” is used interchan geably wit h Electron ic Remitta nce Advice (ERA) and Medicare Remittance Advice (M RA). | |
361 | 837 Health Care Clai m – The HI PAA adopte d standard for elect ronic subm ission of hospital, outpatient and denta l claims. The term “ 837” repre sents the data set t hat is sen t from hea lthcare pr oviders to insurance companies (payers). The 837 s tandard in cludes the data requ ired for c oordinatio n of benef its and is used for primary an d secondar y payer cl aims submi ssion. The term “837 ” is used interchang eably with electroni c claim. | |
362 | 277 Claim Status Mes sages – El ectronic m essages re turned to the VAMC p roviding s tatus info rmation on a claim f rom the Fi nancial Se rvice Cent er (FSC) i n Austin, Texas. The se message s can orig inate at F SC, at the payer or at the cle aringhouse . | |
363 | Clearingho use – A co mpany that provides batch and real-time transactio n processi ng service s and conn ectivity t o payers o r provider s. Transac tions incl ude insura nce eligib ility veri fication, claims sub mission pr ocessing, electronic remittanc e processi ng and pay ment posti ng for ele ctronic cl aims. | |
364 | eClaim – A claim tha t is trans mitted ele ctronicall y to FSC f rom the VH A. | |
365 | EDI – Elec tronic Dat a Intercha nge (EDI) is the pro cess of tr ansacting business b y exchangi ng data el ectronical ly. It inc ludes subm itting cla ims electr onically ( paperless claims pro cessing), as well as electroni c funds tr ansfer (EF T) and ele ctronic in quiry for claim stat us and pat ient eligi bility. | |
366 | EOB – An E xplanation of Benefi ts (EOB) r eports the dispositi on of an i ndividual claim. Man y EOBs may be contai ned within a single 835 ERA fi le. | |
367 | ePayer – P ayer that accepts el ectronic c laims from the clear inghouse. | |
368 | Fiscal Int ermediary – A fiscal intermedi ary perfor ms service s on behal f of healt h-care pay ers. These services include cl aim adjudi cation, re imbursemen t and coll ections. T railblazer Health En terprises is an exam ple of a f iscal inte rmediary t hat acts o n behalf o f Medicare . Trailbla zer receiv es claims from the V A in the f orm of an 837 file a nd then ad judicates the claims to create a MRA 835 file. | |
369 | FSC – The FSC receiv es 837 Hea lth Care C laim trans missions f rom VistA and transm its this d ata to the clearingh ouse. FSC also recei ves error/ informatio nal messag es and 835 Health Ca re Claim P ayment/Adv ice transm issions fr om the cle aringhouse and trans mits this data to Vi stA. | |
370 | HIPAA – In 1996, Con gress pass ed into la w the Heal th Insuran ce Portabi lity and A ccountabil ity Act (H IPAA). Thi s Act is c omprised o f two majo r legislat ive action s: Health Insurance Reform and Administr ative Simp lification . The Admi nistrative Simplific ation prov isions of HIPAA dire ct the fed eral gover nment to a dopt natio nal electr onic stand ards for a utomated t ransfer of certain h ealthcare data betwe en health- care payer s, plans, and provid ers. This enables th e entire h ealthcare industry t o communic ate electr onic data using a si ngle set o f standard s, thus el iminating all non-st andard for mats curre ntly in us e. Once th ese standa rds are in place, a healthcare provider will be ab le to subm it a stand ard transa ction for eligibilit y, authori zation, re ferrals, c laims, or attachment s containi ng the sam e standard data cont ent to any health pl an. This will "simp lify" many clinical, billing, and other financial applicatio ns, and re duces cost s. | |
371 | ASC X12 (a lso known as ANSI AS C X12) – T his is the official designatio n of the U .S. nation al standar ds body fo r the deve lopment an d maintena nce of Ele ctronic Da ta Interch ange (EDI) standards . The HIPA A transact ions are b ased upon these stan dards. | |
372 | ||
373 | Billing | |
374 | VistA | |
375 | Clearingho use | |
376 | Austin FSC | |
377 | Printed Bi lls | |
378 | EDI Transm issions | |
379 | Payer | |
380 | R | |
381 | EGULAR | |
382 | M | |
383 | AIL | |
384 | 1 DAY | |
385 | OVERNIGHT | |
386 | UP TO 3 DA YS | |
387 | 1 TO 14 DA YS | |
388 | Billing | |
389 | VistA | |
390 | Clearingho use | |
391 | Austin FSC | |
392 | Printed Bi lls | |
393 | EDI Transm issions | |
394 | Payer | |
395 | R | |
396 | EGULAR | |
397 | M | |
398 | AIL | |
399 | 1 DAY | |
400 | OVERNIGHT | |
401 | UP TO 3 DA YS | |
402 | 1 TO 14 DA YSEDI Proc ess Flow | |
403 | ||
404 | ||
405 | ||
406 | ||
407 | ||
408 | ||
409 | ||
410 | ||
411 | ||
412 | ||
413 | ||
414 | ||
415 | ||
416 | The above flowchart (EDI Proce ss Flow) r epresents the path t hat electr onic claim s follow. The object ive of ele ctronic bi lling is t o submit c ompletely correct cl aims. Clai ms sent el ectronical ly reach t he payer f aster, are processed faster, a nd are pai d faster t han claims submitted to the pa yer on pap er via the mail. | |
417 | ||
418 | From the u ser’s desk top, the c laim goes to the FSC as a Vist A Mailman message. T he FSC tra nslates th e claim in to the HIP AA 837 Hea lth Care C laim forma t and forw ards it to the clear inghouse. | |
419 | ||
420 | From the c learinghou se, the ar row pointi ng upwards represent s the path claims tr avel if th ey can be submitted electronic ally to th e payer. I f the clea ringhouse does not h ave an ele ctronic co nnection w ith a paye r, or if s pecific cl aims must be submitt ed on pape r, the cla im is prin ted at Exp ress Bill and mailed to the pa yers. | |
421 | ||
422 | Electronic claims st atus messa ges from e Payers ret urn to the VAMCs alo ng the sam e path. Pa yers recei ving print ed claims do not ret urn electr onic messa ges. Howev er, the cl earinghous e returns a message indicating that the claim was printed an d mailed. | |
423 | ||
424 | Different electronic edits are in place at each tr ansmission point tha t may init iate the s ending of a claims s tatus mess age. Claim status me ssages ret urned by t he clearin ghouse and /or payer will provi de informa tion on a specific c laim. Ther e is no st andard con tent for m essages. T he informa tion conta ined withi n a claim status mes sage varie s from pay er to paye r. | |
425 | ||
426 | ||
427 | ||
428 | ||
429 | Insurance Company Se t-up | |
430 | The most c ommon caus e of claim s rejectio n is the i mproper se tup of the insurance company a nd/or prov ider IDs w ithin Vist A. With ED I Billing, there are fields in an 837 cl aim transm ission tha t are auto -populated with the data defin ed in Vist A. This in formation must be ac curate to generate a clean ele ctronic cl aim. | |
431 | Insurance Company Se tup | |
432 | Activate N ew Payer t o Transmit eClaims | |
433 | ||
434 | The typica l business process f or setting up new pa yers is: | |
435 | The Insura nce Verifi cation Off ice initia lly enters a new pay er into Vi stA. | |
436 | Lists of n ew payers are printe d and prov ided to th e medical center’s b illing off ice on a r egular bas is (daily/ weekly). S ome indivi duals beco me members of the IB New Insur ance mail group so t hey receiv e e-mail b ulletins w henever a new insura nce policy is added to VistA. | |
437 | Billing st aff uses t he Insuran ce Company Editor to define Pr ovider IDs : Type of Coverage; Electronic Insurance Type and Electronic Transmit? by Insura nce Compan y. The Pro fession/In stitutiona l Payer Pr imary and Secondary IDs are al so defined using the Insurance Company E ditor. | |
438 | Billing st aff use Th e Insuranc e Company Editor to specify th e correct Electronic Plan Type for each Insurance Plan. | |
439 | ||
440 | Note: Sele cting the correct el ectronic p lan type i s importan t. This fi eld may de termine wh ich provid er IDs are transmitt ed and/or printed. C hoosing th e wrong el ectronic p lan type f or an Insu rance Plan could res ult in cla ims being rejected b y the clea ringhouse or by the payer. | |
441 | ||
442 | Note: When Patch IB* 2*477 is i nstalled a nd a claim is author ized with more than one payer, a warning is displa yed unless all the P ayer IDs a re on the claim. | |
443 | ||
444 | Note: When Patch IB* 2*576 is i nstalled a nd a claim is sent w ithout a P ayer ID an d the clea ring house returns a Payer ID in the 277 Stat messa ges that d eliver cle aring hous e claims r eports, th e system w ill update the Payer ID in the Insurance Company f ile if the field is BLANK. Re fer to the new HCCH Payer ID R eport for further de tail. | |
445 | ||
446 | Define EDI settings for a Blue Cross/Blu e (BC/BS) Shield Ins urance Com pany | |
447 | ||
448 | Step | |
449 | Procedure | |
450 | 1 | |
451 | At the Bil ling Param eters scre en in the Insurance Company Ed itor, ente r BP – Bil ling/EDI P aram. | |
452 | ||
453 | ||
454 | Insurance Company Ed itor Oct 01, 20 07@10:15:1 4 Page: 1 of 9 | |
455 | Insurance Company In formation for: BLUE CROSS | |
456 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
457 | ||
458 | Bil ling Param eters | |
459 | Signatur e Required ?: NO Fil ing Time F rame: | |
460 | Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN | |
461 | Mult. Bedsection s: Billing P hone: 800/ 933-9146 | |
462 | Diff. Rev. Code s: Veri fication P hone: 800/ 933-9146 | |
463 | One Opt. Visi t: NO Prec ert Comp. Name: | |
464 | Amb. Sur . Rev. Cod e: Precert P hone: 800/ 274-7767 | |
465 | Rx Refil l Rev. Cod e: | |
466 | ||
467 | ||
468 | EDI Parame ters | |
469 | Transm it?: YES-L IVE In surance Ty pe: | |
470 | + Enter ?? f or more ac tions >>> | |
471 | BP Billin g/EDI Para m RE Remarks DC Dele te Company | |
472 | AD Billin g Addresse s SY Synonyms VP View Plans | |
473 | AC Associ ate Compan ies EA Edit All EX Exit | |
474 | ID Prov I Ds/ID Para m AI (In)Activa te Company | |
475 | PA Payer CC Change Ins urance Co. | |
476 | Select Act ion: Next Screen//BP Billing/ EDI Param | |
477 | ||
478 | ||
479 | Note: When Patch IB* 2*488 is i nstalled a nd users c reate a ne w Insuranc e Company, the syste m will set the value of the ED I – Transm it? field in the In surance Co mpany Entr y/Edit opt ion, equal to YES-LI VE. | |
480 | ||
481 | Note: When Patch IB* 2*592 is i nstalled, there will be a new Dental Pay er Primary ID field. This will make it p ossible to route Den tal claims to a diff erent enti ty for pro cessing de ntal claim s than Ins titutional or Profes sional cla ims. | |
482 | ||
483 | Note: When Patch IB* 2*592 is i nstalled, the initia l Insuranc e Company screen wil l no longe r have Act ions for m odifying e ach Insura nce Compan y address. Instead, the addres ses have b een moved to their o wn Listman screen an d there wi ll be a ne w Action f or definin g an addre ss, teleph one number and FAX n umber for Dental cla ims. | |
484 | ||
485 | The follow ing prompt s will dis play. | |
486 | ||
487 | SIGNATURE REQUIRED O N BILL?: N O// | |
488 | REIMBURSE? : WILL REI MBURSE// | |
489 | ALLOW MULT IPLE BEDSE CTIONS: | |
490 | DIFFERENT REVENUE CO DES TO USE : | |
491 | ONE OPT. V ISIT ON BI LL ONLY: | |
492 | AMBULATORY SURG. REV . CODE: | |
493 | PRESCRIPTI ON REFILL REV. CODE: | |
494 | FILING TIM E FRAME: | |
495 | TYPE OF CO VERAGE: HE ALTH INSUR ANCE// | |
496 | BILLING PH ONE NUMBER : 800/933- 9146// | |
497 | VERIFICATI ON PHONE N UMBER: 800 /933-9146/ / | |
498 | Are Precer ts Process ed by Anot her Insura nce Co.?: | |
499 | PRECERTIFI CATION PHO NE NUMBER: 800/274-7 767// | |
500 | EDI - Tran smit?:YES- LIVE// YES -LIVE | |
501 | EDI - Inst Payer Pri mary ID: 1 2B30 | |
502 | EDI - Alt Inst Payer Primary I D Type: | |
503 | EDI - 1ST Inst Payer Sec. ID Q ualifier: | |
504 | EDI - Prof Payer Pri mary ID: S B960 | |
505 | EDI - Alt Prof Payer Primary I D Type: | |
506 | EDI - 1ST Prof Payer Sec. ID Q ualifier: | |
507 | EDI - Dent al Payer P rimary ID: | |
508 | EDI - Insu rance Type : GROUP PO LICY // | |
509 | EDI – Prin t Sec/Tert Auto Clai ms?: | |
510 | EDI – Prin t Medicare Sec Claim s w/o MRA? :YES// | |
511 | EDI - Bin Number: .. .......... ......... | |
512 | ||
513 | Step | |
514 | Procedure | |
515 | ||
516 | Patch IB*2 .0*320 add ed a new s ecurity ke y, IB EDI INSURANCE EDIT. A u ser must h old this k ey to edit the EDI-T ransmit, E DI Prof Pa yer ID; ED I Inst Pay er ID and EDI-Insura nce Type f ields. | |
517 | 2 | |
518 | At the EDI - Inst Pa yer Primar y ID: prom pt, enter the Payer Primary ID provided by the cle aringhouse . | |
519 | ||
520 | Patch IB*2 .0*488 wil l make cha nges that prevent a user from entering a ny value c ontaining PRNT/prnt as a Prima ry Payer I D. | |
521 | ||
522 | When editi ng the Pay er Primary ID fields for a com mercial pa yer, (not BC/BS) the se fields may be lef t blank. The cleari nghouse wi ll try to match the VistA paye r name and address t o an entry in its Pa yer Lookup Table and auto-popu late these fields. Payer ID n umbers are available at https: // u r l /. | |
523 | 3 | |
524 | At the EDI - 1ST Ins t Payer Se c. ID Qual ifier: pro mpt, press the <Ente r> key to leave fiel d blank. | |
525 | ||
526 | Patch IB*2 *371 added the abili ty to defi ne Payer S econdary I Ds. They are unusua l and shou ld only be populated if the cl earing hou se or eBus iness Solu tions Offi ce provide s you with a seconda ry ID numb er. | |
527 | 4 | |
528 | At the EDI - Prof Pa yer Primar y ID: prom pt, enter the Payer Primary ID provided by the cle aringhouse . | |
529 | 5 | |
530 | At the EDI - 1ST Pro f Payer Se c. ID Qual ifier: pro mpt, press the <Ente r> key to leave fiel d blank. | |
531 | 6 | |
532 | At the EDI - Insuran ce Type: p rompt, ent er ?? to s ee the cho ices avail able. For this exam ple, selec t Group Po licy. This will resu lt in a ch eckmark in the GROUP insurance box of th e CMS-1500 /BOX 1. | |
533 | 7 | |
534 | Press the <Enter> ke y until th e Billing Parameters screen re appears. | |
535 | ||
536 | When Patch IB*2*371 is loaded, the patch will auto matically define a P rofessiona l Payer Se condary fo r Medicare WNR that will have a Qualifie r = Payer ID Number and an ID = VA plus the site’s ID. | |
537 | ||
538 | EDI - Tran smit?: YES -LIVE// | |
539 | EDI - Inst Payer Pri mary ID: 1 2M61// | |
540 | EDI - Alt Inst Payer Primary I D Type: | |
541 | EDI - 1ST Inst Payer Sec. ID Q ualifier: | |
542 | EDI - Prof Payer Pri mary ID: S MTX1// | |
543 | EDI - Alt Prof Payer Primary I D Type: | |
544 | EDI - 1ST Prof Payer Sec. ID Q ualifier: PAYER ID # // | |
545 | EDI - 1ST Prof Payer Sec. ID: VA442// | |
546 | ||
547 | ||
548 | Patch IB*2 *432 added the abili ty to defi ne whether or not th e payer wi ll accept MRA second ary claims electroni cally when the prima ry claim w as never s ent to Med icare and no MRA was ever rece ived. When the patch is loaded , this fie ld will be set to ‘0 ’ which me ans that t he claims will be tr ansmitted electronic ally unles s this fie ld is chan ged by the site. | |
549 | This only pertains t o claims t hat cannot be submit ted thru M RA due to the servic e being on the Payer Excluded Service li st. | |
550 | ||
551 | Patch IB*2 *432 added the abili ty to defi ne whether or not th e payer wi ll accept MRA second ary claims electroni cally when the prima ry claim w as never s ent to Med icare and no MRA was ever rece ived. When the patch is loaded , this fie ld will be set to ‘0 ’ which me ans that t he claims will be tr ansmitted electronic ally unles s this fie ld is chan ged by the site. | |
552 | ||
553 | Note: Once Patch IB* 2*516 is i nstalled, a new fiel d, HPID/OE ID, will d isplay in the EDI Pa rameters s ection. T he field w ill not be editable. The HPID or OEID n umber will come from the Natio nal Insura nce File. | |
554 | ||
555 | EDI - Dent al Payer P rimary ID: | |
556 | EDI - Insu rance Type : GROUP PO LICY // | |
557 | EDI - Bin Number: | |
558 | EDI - UMO (278) ID: | |
559 | EDI - Prin t Sec/Tert Auto Clai ms?: | |
560 | EDI - Prin t Medicare Sec Claim s w/o MRA? : | |
561 | ||
562 | Define EDI settings for a Blue Cross/Blu e Shield G roup Insur ance Plan | |
563 | ||
564 | Step | |
565 | Procedure | |
566 | 1 | |
567 | At the Bil ling Param eters Scre en in the Insurance Company Ed itor, ente r VP -View Plans and press the <Enter> k ey. | |
568 | ||
569 | Insurance Company Ed itor Oct 01, 20 07@10:15:1 4 Page: 1 of 9 | |
570 | Insurance Company In formation for: BLUE CROSS | |
571 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
572 | ||
573 | Bil ling Param eters | |
574 | Signatur e Required ?: NO Fil ing Time F rame: | |
575 | Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN | |
576 | Mult. Bedsection s: Billing P hone: 800/ 933-9146 | |
577 | Diff. Rev. Code s: Veri fication P hone: 800/ 933-9146 | |
578 | One Opt. Visi t: NO Prec ert Comp. Name: | |
579 | Amb. Sur . Rev. Cod e: Precert P hone: 800/ 274-7767 | |
580 | Rx Refil l Rev. Cod e: | |
581 | ||
582 | ||
583 | EDI Parame ters | |
584 | Transm it?: YES-L IVE I nsurance T ype: GROUP POLICY | |
585 | + Enter ?? f or more ac tions >>> | |
586 | BP Billin g/EDI Para m RE Remarks DC Dele te Company | |
587 | AD Billin g Addresse s SY Synonyms VP View Plans | |
588 | AC Associ ate Compan ies EA Edit All EX Exit | |
589 | ID Prov I Ds/ID Para m AI (In)Activa te Company | |
590 | PA Payer CC Change Ins urance Co. | |
591 | Select Act ion: Next Screen//VP View Pla ns | |
592 | ||
593 | Step | |
594 | Procedure | |
595 | 2 | |
596 | The Insura nce Plan L ist appear s. Select the approp riate plan from the list. In t his exampl e, Plan 1 is selecte d by typin g VP=1 and pressing the Enter key. | |
597 | ||
598 | ||
599 | Insurance Plan List Mar 31, 2 004@16:12: 52 Page: 1 of 1 | |
600 | All Plans for: BLUE CROSS BLUE SHIELD DE MO Insuran ce Company | |
601 | ||
602 | # + => In div. Plan * => In active Pla n Pre- P re- Ben | |
603 | Group Name Group Number Type of Plan UR ? Ct? E xC? As? | |
604 | 1 DEMO F OR TRAININ G 87654 COMPREH ENSIVE NO YES Y ES YES | |
605 | ||
606 | ||
607 | ||
608 | Enter ?? f or more ac tions | |
609 | VP View/E dit Plan IP (In)Ac tivate Pla n | |
610 | AB Annual Benefits EX Exit | |
611 | Select Act ion: Quit/ / VP=1 | |
612 | ||
613 | Step | |
614 | Procedure | |
615 | 3 | |
616 | The View/E dit Plan s creen disp lays. To edit plan informatio n, type PI and press the <Ente r> key. | |
617 | ||
618 | Note: The IB GROUP P LAN EDIT s ecurity ke y is requi red to use PI. | |
619 | ||
620 | View/Edit Plan Mar 31, 20 04@16:19:5 1 Page: 1 of 3 | |
621 | Plan Infor mation for : BLUE CRO SS Insura nce Compan y | |
622 | ** Plan Cu rrently Ac tive ** | |
623 | ||
624 | Plan Inf ormation Utiliza tion Revie w Info | |
625 | Is Gro up Plan: Y ES Require U R: NO | |
626 | Gro up Name: D EMO FOR TR AINING Requi re Amb Cer t: YES | |
627 | Group Number: 8 7654 Requi re Pre-Cer t: YES | |
628 | Type of Plan: C OMPREHENSI VE MAJOR M ED Exclu de Pre-Con d: YES | |
629 | Plan Fi ling TF: Benefits Assignabl e: YES | |
630 | ||
631 | Plan Cov erage Limi tations | |
632 | Coverag e Effecti ve Date Covered? Limit Comments | |
633 | ------- - ------- ------- -------- ----- --------- | |
634 | INPATIE NT 02/10/0 4 YES | |
635 | OUTPATI ENT 02/10/0 4 YES | |
636 | PHARMAC Y 02/10/0 4 NO | |
637 | + Enter ?? f or more ac tions | |
638 | PI Change Plan Info IP (In)Ac tivate Pla n | |
639 | UI UR Inf o AB Annual Benefits | |
640 | CV Add/Ed it Coverag e CP Change Plan | |
641 | PC Plan C omments EX Exit | |
642 | Select Act ion: Next Screen// P I Change Plan Info | |
643 | ||
644 | Step | |
645 | Procedure | |
646 | 4 | |
647 | For this s cenario NO is typed in for the Do you wi sh to chan ge this pl an to an I ndividual Plan? fiel d. | |
648 | 5 | |
649 | Continue t o press th e <Enter> key until Electronic Plan Type field is displayed. | |
650 | 6 | |
651 | Type in th e appropri ate code a nd press t he <Enter> key. The chosen pl an will be displayed . In this example B L has been selected. | |
652 | ||
653 | Selecting the correc t electron ic plan ty pe is crit ical. The electronic plan type for BC/BS payers sh ould usual ly be set to BL - no t commerci al. Choosi ng the wro ng electro nic plan t ype for a Group Insu rance Plan could res ult in cla ims being rejected b y the clea ringhouse or by the payer. | |
654 | ||
655 | Note: Patc h IB*2*432 added the ability t o define t wo additio nal types of Electro nic Plan T ype: 17 – Dental and FI – Fede ral Employ ee Plan. | |
656 | ||
657 | Note: Patc h IB*2*436 added the ability t o define a n addition al plan ty pe for Med iGap F and G plans. MEDIGAP (S UPPL - COI NS, DED, P ART B EXC) | |
658 | ||
659 | This plan is current ly defined as a Grou p Plan. | |
660 | Do you wis h to chang e this pla n to an In dividual P lan? NO | |
661 | No change was made. | |
662 | ||
663 | GROUP PLAN NAME: DEM O GROUP// | |
664 | GROUP PLAN NUMBER: 7 878787878/ / | |
665 | TYPE OF PL AN: COMPRE HENSIVE MA JOR MED | |
666 | ELECTRONIC PLAN TYPE : ? | |
667 | Enter the appropriat e type of plan to be used for electronic billing. | |
668 | Choos e from: | |
669 | 16 HMO MEDICARE | |
670 | MX MEDI CARE A or B | |
671 | TV TITL E V | |
672 | MC MEDI CAID | |
673 | BL BC/B S | |
674 | CH TRIC ARE | |
675 | 15 INDE MNITY | |
676 | CI COMM ERCIAL | |
677 | HM HMO | |
678 | DS DISA BILITY | |
679 | 12 PPO | |
680 | 13 POS | |
681 | ZZ OTHE R | |
682 | FI FEP – Do not u se for BC/ BS | |
683 | 17 DENT AL | |
684 | ELECTRONIC PLAN TYPE : BL BCBS | |
685 | ||
686 | The follow ing screen will disp lay. | |
687 | ||
688 | View/Edit Plan Mar 31, 20 04@16:19:5 1 Page: 1 of 3 | |
689 | Plan Infor mation for : BLUE CRO SS Insuran ce Company | |
690 | ** Plan Cu rrently Ac tive ** | |
691 | ||
692 | Plan Inf ormation Utiliza tion Revie w Info | |
693 | Is Gro up Plan: Y ES Require U R: NO | |
694 | Gro up Name: D EMO FOR TR AINING Requi re Amb Cer t: YES | |
695 | Group Number: 8 7654 Requi re Pre-Cer t: YES | |
696 | Type of Plan: C OMPREHENSI VE MAJOR M ED Exclu de Pre-Con d: YES | |
697 | Electro nic Type: BC/BS Benef its Assign able: YES | |
698 | ||
699 | ||
700 | ||
701 | + Enter ?? f or more ac tions | |
702 | ||
703 | Select Act ion: Next Screen// | |
704 | ||
705 | Activate E xisting Co mmercial P ayer to Tr ansmit eCl aims | |
706 | ||
707 | To activat e an exist ing payer to receive electroni c claims, use the Bi lling Para meters scr een in the Insurance Company E ditor. The EDI - Tra nsmit? fie ld on this screen mu st be set to YES-LIV E. In the Live mode , bills ar e automati cally sent electroni cally and cannot be printed un til the co nfirmation of a rece ipt messag e has been received from the F SC. | |
708 | ||
709 | Follow the se steps t o change t he EDI - T ransmit? F ield: | |
710 | ||
711 | Step | |
712 | Procedure | |
713 | 1 | |
714 | On the Bil ling Param eters scre en in the Insurance Company Ed itor, type BP and pr ess the <E nter> key. | |
715 | ||
716 | Insurance Company Ed itor Oct 01, 20 07@10:40:1 6 Page: 1 of 8 | |
717 | Insurance Company In formation for: AETNA | |
718 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Inacti ve | |
719 | ||
720 | Bil ling Param eters | |
721 | Signatur e Required ?: NO Fil ing Time F rame: 12 M OS | |
722 | Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN | |
723 | Mult. Bedsection s: Billing P hone: | |
724 | Diff. Rev. Code s: Veri fication P hone: | |
725 | One Opt. Visi t: NO Prec ert Comp. Name: | |
726 | Amb. Sur . Rev. Cod e: Precert P hone: | |
727 | Rx Refil l Rev. Cod e: | |
728 | ||
729 | ||
730 | EDI Parame ters | |
731 | Transm it?: NO Insurance Type: | |
732 | + Enter ?? f or more ac tions >>> | |
733 | BP Billin g/EDI Para m RE Remarks DC Dele te Company | |
734 | AD Billin g Addresse s SY Synonyms VP View Plans | |
735 | AC Associ ate Compan ies EA Edit All EX Exit | |
736 | ID Prov I Ds/ID Para m AI (In)Activa te Company | |
737 | PA Payer CC Change Ins urance Co. | |
738 | Select Act ion: Next Screen//BP Billing/E DI Param | |
739 | ||
740 | Step | |
741 | Procedure | |
742 | ||
743 | Patch IB*2 .0*320 add ed a new s ecurity ke y, IB EDI INSURANCE EDIT. A u ser must h old this k ey to edit the EDI-T ransmit, E DI Prof Pa yer ID; ED I Inst Pay er ID and EDI-Insura nce Type f ields. | |
744 | 2 | |
745 | At the EDI - Transmi t? field, make sure the field is defined as YES-LI VE. | |
746 | 3 | |
747 | At the EDI - Insuran ce Type fi eld, enter the corre ct respons e for the Insurance Company be ing edited . For thi s example, the corre ct Electro nic Insura nce Type i s Group. | |
748 | ||
749 | Except for the testi ng of Prim ary BC/BS and some s econdary e nd to end claims, it is no lon ger necess ary to cha nge the ED I - Transm it? field to YES-TES T. Instea d, use the new optio n, RCB – V iew/Resubm it Claims- Live or Te st. Ref er to Sect ion 4. | |
750 | ||
751 | Note: Once Patch IB* 2*516 is i nstalled, a new fiel d, HPID/OE ID, will d isplay in the EDI Pa rameters s ection. T he field w ill not be editable. The HPID or OEID n umber will come from the Natio nal Insura nce File. | |
752 | ||
753 | Note: Patc h IB*2*547 will add a field, U MO (278)ID , to the E DI Paramet ers sectio n which wi ll allow u sers to de fine a pri mary payer identific ation numb er which w ill be tra nsmitted i n ASC X12N 5010 Heal th Care Se rvices Rev iew – Requ est for Re view and R esponse (2 78) transa ctions. | |
754 | ||
755 | Note: Patc h IB*2*547 will add the fields , EDI - Al t Inst Pay er Primary ID Type, | |
756 | EDI - Alt Inst Payer Primary I D, EDI - A lt Prof Pa yer Primar y ID Type and | |
757 | EDI - Alt Prof Payer Primary I D, to the EDI Parame ters secti on which w ill allow users to d efine one or more pr imary paye r identifi cation num bers which will be t ransmitted in ASC X1 2N 5010 He alth Care Claims (83 7) transac tions whic h need to be routed to contrac tors who a djudicate specific c laim types such as c laims for durable me dical equi pment (DME ). | |
758 | ||
759 | Note: Patc h IB*2*592 will add the abilit y to defin e an EDI - Dental Pa yer Primar y ID. The ID will th en be used on Dental Claims wh en they ne ed to be r outed to a different entity th an institu tional or profession al claims. | |
760 | ||
761 | Note: Patc h IB*2*608 will no l onger prov ide the ab ility to s elect 0 - NO for EDI – Transmi t. | |
762 | ||
763 | ||
764 | SIGNATURE REQUIRED O N BILL?: N O// | |
765 | REIMBURSE? : WILL REI MBURSE// | |
766 | ALLOW MULT IPLE BEDSE CTIONS: YE S// | |
767 | DIFFERENT REVENUE CO DES TO USE : | |
768 | ONE OPT. V ISIT ON BI LL ONLY: N O// | |
769 | AMBULATORY SURG. REV . CODE: | |
770 | PRESCRIPTI ON REFILL REV. CODE: 253// | |
771 | FILING TIM E FRAME: O NE YEAR// | |
772 | TYPE OF CO VERAGE: HE ALTH INSUR ANCE// | |
773 | BILLING PH ONE NUMBER : 800-555- 5298// | |
774 | VERIFICATI ON PHONE N UMBER: 800 -555-5298/ / | |
775 | Are Precer ts Process ed by Anot her Insura nce Co.?: NO | |
776 | / / | |
777 | PRECERTIFI CATION PHO NE NUMBER: XXX-XXX-X XXX// | |
778 | EDI - Tran smit?: ?? | |
779 | Th is is the flag that says wheth er or not an insuran ce company is ready | |
780 | to be billed electroni cally via 837/EDI fu nctions. | |
781 | ||
782 | Choos e from: | |
783 | 1 YES- LIVE | |
784 | 2 YES- TEST | |
785 | EDI - Tran smit?: 1 YES-LIVE | |
786 | EDI - Inst Payer Pri mary ID: | |
787 | EDI - Inst Payer Pri mary ID: A vailable f rom Cleari nghouse | |
788 | EDI - Alt Inst Payer Primary I D Type: LT C// | |
789 | EDI - Al t Inst Pay er Primary ID Type: LTC// | |
790 | EDI - Al t Inst Pay er Primary ID: LTC12 34// | |
791 | Select EDI - Alt Ins t Payer Pr imary ID T ype: | |
792 | EDI - 1ST Inst Payer Sec. ID Q ualifier: | |
793 | EDI - Prof Payer Pri mary ID: | |
794 | EDI - Prof Payer Pri mary ID: A vailable f rom Cleari nghouse | |
795 | EDI - Alt Prof Payer Primary I D Type: LT C// | |
796 | EDI - Al t Prof Pay er Primary ID Type: LTC// | |
797 | EDI - Al t Prof Pay er Primary ID: LTC12 34P// | |
798 | Select EDI - Alt Pro f Payer Pr imary ID T ype: | |
799 | EDI - 1ST Prof Payer Sec. ID Q ualifier: | |
800 | EDI - Dent al Payer P rimary ID: | |
801 | EDI – Insu rance Type : ?? | |
802 | Choos e from: | |
803 | 1 HMO | |
804 | 2 COMM ERCIAL | |
805 | 3 MEDI CARE | |
806 | 4 MEDI CAID | |
807 | 5 GROU P POLICY | |
808 | 9 OTHE R | |
809 | EDI – Insu rance Type : 5 GROUP POLICY | |
810 | EDI - Bin Number: | |
811 | EDI - UMO (278) ID: | |
812 | EDI - Prin t Sec/Tert Auto Clai ms?: | |
813 | EDI - Prin t Medicare Sec Claim s w/o MRA? : | |
814 | ||
815 | The follow ing steps show you h ow to ente r the Elec tronic Pla n Type for a Commerc ial Group Insurance Plan: | |
816 | ||
817 | Step | |
818 | Procedure | |
819 | 1 | |
820 | At the Bil ling Param eters Scre en in the Insurance Company Ed itor type in VP (Vie w Plans) a nd press t he <Enter> key. | |
821 | ||
822 | Insurance Company Ed itor Oct 01, 20 07@10:40:1 6 Page: 1 of 8 | |
823 | Insurance Company In formation for: AETNA | |
824 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Inacti ve | |
825 | ||
826 | Bil ling Param eters | |
827 | Signatur e Required ?: NO Fil ing Time F rame: 12 M OS | |
828 | Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN | |
829 | Mult. Bedsection s: Billing P hone: | |
830 | Diff. Rev. Code s: Veri fication P hone: | |
831 | One Opt. Visi t: NO Prec ert Comp. Name: | |
832 | Amb. Sur . Rev. Cod e: Precert P hone: | |
833 | Rx Refil l Rev. Cod e: | |
834 | ||
835 | ||
836 | EDI Parame ters | |
837 | Transm it?: YES-L IVE I nsurance T ype: GROUP POLICY | |
838 | + Enter ?? f or more ac tions >>> | |
839 | BP Billin g/EDI Para m RE Remarks DC Dele te Company | |
840 | AD Billin g Addresse s SY Synonyms VP View Plans | |
841 | AC Associ ate Compan ies EA Edit All EX Exit | |
842 | ID Prov I Ds/ID Para m AI (In)Activa te Company | |
843 | PA Payer CC Change Ins urance Co. | |
844 | Select Act ion: Next Screen//VP View Pla ns | |
845 | ||
846 | Step | |
847 | Procedure | |
848 | 2 | |
849 | The Insura nce Plan L ist appear s. In thi s example, Plan 1 is selected by typing VP=1 and p ressing th e <Enter> key. | |
850 | ||
851 | Insurance Plan List Apr 14, 2 004@09:21: 12 Page: 1 of 1 | |
852 | All Plans for: AETNA Insurance Company | |
853 | ||
854 | # + => In div. Plan * => In active Pla n Pre- P re- Ben | |
855 | Group Name Group Number Type of Plan UR ? Ct? E xC? As? | |
856 | 1 MANAGE D CHOICE 55555- 111-00001 COMPREH ENSIVE YE S YES U NK YES | |
857 | ||
858 | ||
859 | ||
860 | Enter ?? f or more ac tions | |
861 | VP View/E dit Plan IP (In)Ac tivate Pla n | |
862 | AB Annual Benefits EX Exit | |
863 | Select Act ion: Quit/ / VP=1 | |
864 | ||
865 | Step | |
866 | Procedure | |
867 | 3 | |
868 | The View/E dit Plan s creen appe ars. To e dit plan i nformation , type PI and press the <Enter > key. | |
869 | ||
870 | Note: The IB GROUP P LAN EDIT s ecurity ke y is requi red to use PI. | |
871 | ||
872 | ||
873 | View/Edit Plan Apr 14, 20 04@09:22:1 1 Page: 1 of 3 | |
874 | Plan Infor mation for : AETNA In surance Co mpany | |
875 | ** Plan Cu rrently Ac tive ** | |
876 | ||
877 | Plan Inf ormation Utiliza tion Revie w Info | |
878 | Is Gro up Plan: Y ES Require U R: YES | |
879 | Gro up Name: M ANAGED CHO ICE Requi re Amb Cer t: | |
880 | Group Number: 5 5555-111-0 0001 Requi re Pre-Cer t: YES | |
881 | Type of Plan: C OMPREHENSI VE MAJOR M ED Exclu de Pre-Con d: | |
882 | Plan Fi ling TF: Benefits Assignabl e: YES | |
883 | ||
884 | Plan Cov erage Limi tations | |
885 | Coverag e Effecti ve Date Covered? Limit Comments | |
886 | ------- - ------- ------- -------- ----- --------- | |
887 | INPATIE NT 02/01/0 4 YES | |
888 | OUTPATI ENT 02/01/0 4 YES | |
889 | PHARMAC Y 02/01/0 4 NO | |
890 | + Enter ?? f or more ac tions | |
891 | PI Change Plan Info IP (In)Ac tivate Pla n | |
892 | UI UR Inf o AB Annual Benefits | |
893 | CV Add/Ed it Coverag e CP Change Plan | |
894 | PC Plan C omments EX Exit | |
895 | Select Act ion: Next Screen// P I Change Plan Info | |
896 | ||
897 | Step | |
898 | Procedure | |
899 | 4 | |
900 | For this s cenario, N O is enter ed for the Do you wi sh to chan ge this pl an to an I ndividual Plan? fiel d. | |
901 | 5 | |
902 | Continue t o press th e <Enter> key until Electronic Plan Type field is activated. | |
903 | 6 | |
904 | Type in th e appropri ate code a nd press t he <Enter> key. The chosen pl an will be displayed . In this example C I has been selected. | |
905 | ||
906 | Selecting the correc t electron ic plan ty pe is impo rtant. Cho osing the wrong elec tronic pla n type for a Group I nsurance P lan could result in claims bei ng rejecte d by the c learinghou se or by t he payer. | |
907 | ||
908 | ||
909 | This plan is current ly defined as a Grou p Plan. | |
910 | Do you wis h to chang e this pla n to an In dividual P lan? NO | |
911 | No change was made. | |
912 | ||
913 | GROUP PLAN NAME: MAN AGED CHOIC E// | |
914 | GROUP PLAN NUMBER: 5 5555-111-0 0001// | |
915 | TYPE OF PL AN: COMPRE HENSIVE MA JOR MEDICA L// | |
916 | ELECTRONIC PLAN TYPE : ? | |
917 | Enter the appropriat e type of plan to be used for electronic billing. | |
918 | Choos e from: | |
919 | 16 HMO MEDICARE | |
920 | MX MEDI CARE A or B | |
921 | TV TITL E V | |
922 | MC MEDI CAID | |
923 | BL BC/B S | |
924 | CH TRIC ARE | |
925 | 15 INDE MNITY | |
926 | CI COMM ERCIAL | |
927 | HM HMO | |
928 | DS DISA BILITY | |
929 | 12 PPO | |
930 | 13 POS | |
931 | ZZ OTHE R | |
932 | 17 D ental | |
933 | FI F EP – Do no t use for BC/BS | |
934 | ELECTRONIC PLAN TYPE : CI COMM ERCIAL | |
935 | PLAN FILIN G TIME FRA ME: ..... | |
936 | ||
937 | The follow ing screen will disp lay. | |
938 | ||
939 | View/Edit Plan Apr 14, 20 04@09:24:0 2 Page: 1 of 3 | |
940 | Plan Infor mation for : AETNA DE MO INSURAN CE Insuran ce Company | |
941 | ** Plan Cu rrently Ac tive ** | |
942 | ||
943 | Plan Inf ormation Utiliza tion Revie w Info | |
944 | Is Gro up Plan: Y ES Require U R: YES | |
945 | Gro up Name: M ANAGED CHO ICE Requi re Amb Cer t: | |
946 | Group Number: 5 5555-111-0 0001 Requi re Pre-Cer t: YES | |
947 | Type of Plan: C OMPREHENSI VE MAJOR M ED Exclu de Pre-Con d: | |
948 | Electron ic Type: C OMMERCIAL Benefits Assignabl e: YES | |
949 | ||
950 | ||
951 | ||
952 | + Enter ?? f or more ac tions | |
953 | ||
954 | Select Act ion: Next Screen// | |
955 | ||
956 | Activate E xisting Pa yer to Tes t Primary Blue Cross /Blue Shie ld eClaims | |
957 | Blue Cross and Blue Shield pay ers requir e the subm ission of test claim s before a ccepting l ive claims . A membe r of the e Billing Te am contact s someone at the fac ility to c oordinate this testi ng. | |
958 | ||
959 | ||
960 | When testi ng the ele ctronic su bmission o f secondar y claims u sing the R CB – View/ Resubmit C laims-Live or Test, it is not necessary to change Electronic Transmit? to YES-TE ST nor is it necessa ry to prin t and mail claims se nt using R CB. | |
961 | ||
962 | If an eBil ling Team member, re quest clai ms submitt ed electro nically as a Live te st enables the BC/BS payer to receive pr imary clai ms electro nically bu t in a tes ting mode, use the B illing Par ameters sc reen in th e Insuranc e Company Editor. Th e EDI -Tra nsmit? fie ld on this screen mu st be set to YES-TES T. In tes ting mode, bills are automatic ally sent electronic ally and c annot be p rinted unt il the con firmation of receipt message h as been re ceived fro m the FSC. | |
963 | ||
964 | The follow ing steps show you h ow to chan ge the Ele ctronic Tr ansmit? fi eld: | |
965 | ||
966 | Step | |
967 | Procedure | |
968 | 1 | |
969 | On the Bil ling Param eters scre en in the Insurance Company Ed itor, type BP and pr ess the <E nter> key. | |
970 | ||
971 | Insurance Company Ed itor Oct 01, 20 07@10:15:1 4 Page: 1 of 9 | |
972 | Insurance Company In formation for: BLUE CROSS | |
973 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
974 | ||
975 | Bil ling Param eters | |
976 | Signatur e Required ?: NO Fil ing Time F rame: | |
977 | Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN | |
978 | Mult. Bedsection s: Billing P hone: 800/ 933-9146 | |
979 | Diff. Rev. Code s: Veri fication P hone: 800/ 933-9146 | |
980 | One Opt. Visi t: NO Prec ert Comp. Name: | |
981 | Amb. Sur . Rev. Cod e: Precert P hone: 800/ 274-7767 | |
982 | Rx Refil l Rev. Cod e: | |
983 | ||
984 | ||
985 | EDI Parame ters | |
986 | Transm it?: NO Insurance Type: | |
987 | + Enter ?? f or more ac tions >>> | |
988 | BP Billin g/EDI Para m RE Remarks DC Dele te Company | |
989 | AD Billin g Addresse s SY Synonyms VP View Plans | |
990 | AC Associ ate Compan ies EA Edit All EX Exit | |
991 | ID Prov I Ds/ID Para m AI (In)Activa te Company | |
992 | PA Payer CC Change Ins urance Co. | |
993 | ||
994 | Select Act ion: Next Screen//BP Billing/ EDI Param | |
995 | ||
996 | Step | |
997 | Procedure | |
998 | 2 | |
999 | At the EDI - Transmi t? field, type 2 to change the field to YES-TEST. Continue to press t he <Enter> key until the Billi ng Paramet ers screen reappears . | |
1000 | ||
1001 | When using the TEST mode setti ng for BC/ BS claims for which payment is expected, it is imp ortant to note the c arrier wil l not proc ess bills sent in te st mode. These bill s must be printed lo cally and mailed in order to r eceive pay ment. | |
1002 | ||
1003 | ||
1004 | SIGNATURE REQUIRED O N BILL?: N O// | |
1005 | REIMBURSE? : WILL REI MBURSE// | |
1006 | ALLOW MULT IPLE BEDSE CTIONS: YE S// | |
1007 | DIFFERENT REVENUE CO DES TO USE : | |
1008 | ONE OPT. V ISIT ON BI LL ONLY: N O// | |
1009 | AMBULATORY SURG. REV . CODE: 49 0// | |
1010 | PRESCRIPTI ON REFILL REV. CODE: 250// | |
1011 | FILING TIM E FRAME: O NE YEAR FR OM DATE OF SERVICE | |
1012 | TYPE OF CO VERAGE: HE ALTH INSUR ANCE// | |
1013 | BILLING PH ONE NUMBER : 205-988- 2213// | |
1014 | VERIFICATI ON PHONE N UMBER: ITS :800-253-9 307// | |
1015 | Are Precer ts Process ed by Anot her Insura nce Co.?: NO | |
1016 | / / | |
1017 | PRECERTIFI CATION PHO NE NUMBER: 800-248-2 342// | |
1018 | EDI - Tran smit?: NO/ / ?? | |
1019 | Th is is the flag that says wheth er or not an insuran ce company is | |
1020 | ready to b e billed e lectronica lly via 83 7/EDI func tions. | |
1021 | ||
1022 | Choos e from: | |
1023 | 1 YES- LIVE | |
1024 | 2 YES- TEST | |
1025 | EDI - Tran smit?: 1 YES-LIVE | |
1026 | EDI - Inst Payer Pri mary ID: A vailable f rom Cleari nghouse | |
1027 | Select EDI - Alt Ins t Payer Pr imary ID T ype: | |
1028 | EDI - 1ST Inst Payer Sec. ID Q ualifier: | |
1029 | EDI - Prof Payer Pri mary ID: A vailable f rom Cleari nghouse | |
1030 | Select EDI - Alt Pro f Payer Pr imary ID T ype: | |
1031 | EDI - 1ST Prof Payer Sec. ID Q ualifier: | |
1032 | EDI - Dent al Payer P rimary ID: | |
1033 | EDI – Insu rance Type : 5 GROUP POLICY | |
1034 | EDI - Bin Number: | |
1035 | EDI - UMO (278) ID: | |
1036 | EDI - Prin t Sec/Tert Auto Clai ms?: | |
1037 | EDI - Prin t Medicare Sec Claim s w/o MRA? : | |
1038 | ||
1039 | Pay-to Pro vider(s) S et-up | |
1040 | Each VA da tabase can have one or more Pa y-to Provi ders. Eac h VA datab ase must h ave at lea st one Pay -to Provid er. A Pay -to Provid er is the entity whi ch is seek ing paymen t for a cl aim (who w ill receiv e the paym ent). The Pay-to Pr ovider doe s not need to have a physical location. It can ha ve a stree t address or a Post Office Box number. | |
1041 | ||
1042 | With Patch IB*2*516, sites wil l gain the ability t o define a second se t of Pay-t o Provider s to be us ed on clai ms with th e Rate Typ e of TRICA RE REIMB. or TRICARE . To defin e the Non- MCCF Pay-t o Provider s, the ste ps are the same as t he followi ng steps f or regular Pay-to Pr oviders. A new sect ion has be en added t o the IB S ite Parame ters. | |
1043 | ||
1044 | With Patch IB*2*608, sites wil l gain the ability t o define t he Rate Ty pe to be u sed for No n-MCCF Pay -To Provid ers (forme rly the TR ICARE Pay- To Provide rs) addres s. The sys tem will u se the Non -MCCF Pay- To address data on c laims with specified Rate Type s only whe n the Non- MCCF Pay-T o Provider s address is not the same as t he billing Pay-To Pr oviders ad dress. | |
1045 | IB Site Pa rameters Jun 16, 20 14@11:34:0 9 Page: 3 of 5 | |
1046 | Only autho rized pers ons may ed it this da ta. | |
1047 | + | |
1048 | ||
1049 | [11]Pay-To Providers : 1 def ined, defa ult - CHEY ENNE VAMC | |
1050 | ||
1051 | [12]Non-MC CF Pay-To Providers: 0 defined | |
1052 | ||
1053 | [13]Inpt H ealth Summ ary: INPAT IENT HEALT H SUMMARY | |
1054 | Opt He alth Summa ry : OUTPA TIENT HEAL TH SUMMARY | |
1055 | ||
1056 | [14]HIPPA NCPDP Acti ve Flag : A ctive | |
1057 | ||
1058 | [15]Inpati ent TP Act ive : YES | |
1059 | Outpat ient TP Ac tive: YES | |
1060 | Pharma cy TP Acti ve : YES | |
1061 | Prosth etic TP Ac tive: YES | |
1062 | ||
1063 | [16] EDI/M RA Activat ed : B OTH EDI AN D MRA | |
1064 | EDI C ontact Pho ne : ( 307)778-75 81 | |
1065 | + Enter ?? f or more ac tions | |
1066 | EP Edit S et EX Exit | |
1067 | Select Act ion: Next Screen// | |
1068 | ||
1069 | Define Def ault Pay-t o Provider | |
1070 | Step | |
1071 | Procedure | |
1072 | ||
1073 | Note: With Patch IB* 2*516, two new Secur ity Keys h ave been a dded: IB E DIT PAY-TO and IB ED IT PAY-TO TC. Users must be a ssigned th ese keys b efore addi ng or edit ing a Pay- to Provide r. | |
1074 | 1 | |
1075 | Access the option SI TEMCCR Sit e Paramete r Display/ Edit. | |
1076 | 2 | |
1077 | From the M CCR Site P arameters screen, en ter the ac tion: IB S ite Parame ters. | |
1078 | 3 | |
1079 | Press the <Enter> ke y for Next Screen un til Page 2 is displa yed. | |
1080 | 4 | |
1081 | From the I B Site Par ameters sc reen, ente r the acti on: EP Edi t Set. | |
1082 | 5 | |
1083 | Enter the number 11. | |
1084 | 6 | |
1085 | From the P ay-to Prov iders scre en, enter the action : AP Add P rovider. | |
1086 | 7 | |
1087 | From the E nter Pay-t o Provider : prompt, enter CHEY ENNE VAMC for this e xample. | |
1088 | ||
1089 | Note: A P ay-to Prov ider shoul d be a VAM C level fa cility wit h a valid NPI. The Pay-to Pro vider can be an inst itution ou tside your own datab ase. Exam ple: VAMC A could p rocess pay ments for services p rovided by VAMC B. | |
1090 | 8 | |
1091 | At the Are you addin g 'CHEYENN E VAMC' as a new PAY -TO PROVID ERS (the 1 ST for thi s IB SITE PARAMETERS )? No// pr ompt, ente r YES for this examp le. | |
1092 | 9 | |
1093 | At the Pay -to Provid er Name pr ompt, pres s the <Ent er> key to accept th e default name from the Instit ution file . | |
1094 | 10 | |
1095 | At the Pay -to Provid er Address Line 1 pr ompt; pres s the <Ent er> key to accept th e default address fr om the Ins titution f ile. | |
1096 | 11 | |
1097 | At the Pay -to Provid er Address Line 2 pr ompt; pres s the <Ent er> key to accept th e default address fr om the Ins titution f ile. | |
1098 | 12 | |
1099 | At the Pay -to Provid er City pr ompt; pres s the <Ent er> key to accept th e default City from the Instit ution file . | |
1100 | 13 | |
1101 | At the Pay -to Provid er State p rompt; pre ss the <En ter> key t o accept t he default State fro m the Inst itution fi le. | |
1102 | 14 | |
1103 | At the Pay -to Provid er Zip Cod e prompt; press the <Enter> ke y to accep t the defa ult ZIP fr om the Ins titution f ile. | |
1104 | 15 | |
1105 | At the Pay -to Provid er Phone N umber prom pt; enter the Phone Number tha t a payer should use to contac t the site . | |
1106 | 16 | |
1107 | At the Pay -to Provid er Federal Tax ID Nu mber promp t; press t he <Enter> key to ac cept the d efault Tax ID. | |
1108 | ||
1109 | Note: The re will be a default Tax ID on ly when th e institut ion select ed as the Pay-to Pro vider is t he same as the main division i n the site ’s databas e. This i s taken fr om the IB Site Param eters. | |
1110 | ||
1111 | Do not add your site ’s Tax ID if the Pay -to Provid er is anot her VAMC. Make sure to obtain and enter the other site’s Ta x ID. | |
1112 | ||
1113 | Note: A P ay-to Prov ider does not have t o have an actual str eet addres s. You ca n enter a P.O. Box a s an addre ss. | |
1114 | ||
1115 | ||
1116 | Pay-To Pro viders D ec 22, 200 8@13:58:13 Page: 1 of 1 | |
1117 | No Pay-T o Provider s defined. | |
1118 | ||
1119 | ||
1120 | ||
1121 | ||
1122 | ||
1123 | ||
1124 | ||
1125 | ||
1126 | ||
1127 | ||
1128 | * = Defaul t Pay-to p rovider | |
1129 | AP Add Pr ovider DP Delete Pro vider RT Rate Types | |
1130 | EP Edit P rovider AS Associate Divisions | |
1131 | Select Ite m(s): Quit // AP Ad d Provider | |
1132 | Enter Pay- to Provide r: CHEYENN E VAMC W Y M&ROC 442 | |
1133 | Are you adding 'CH EYENNE VAM C' as a ne w PAY-TO P ROVIDERS ( the 1ST fo r this IB | |
1134 | SITE PARAM ETERS)? No // y (Yes ) | |
1135 | Pay-to Pro vider Name : CHEYENNE VAMC// | |
1136 | Pay-to Pro vider Addr ess Line 1 : 2360 E P ERSHING BL VD | |
1137 | Replace | |
1138 | Pay-to Pro vider Addr ess Line 2 : Mail Sto p 10234 | |
1139 | Pay-to Pro vider City : CHEYENNE // | |
1140 | Pay-to Pro vider Stat e: WYOMING // | |
1141 | Pay-to Pro vider Zip Code: 8200 1-5356// | |
1142 | Pay-to Pro vider Phon e Number: 555-555-55 55 | |
1143 | Pay-to Pro vider Fede ral Tax ID Number: 8 3-0168494/ / | |
1144 | ||
1145 | ||
1146 | The follow ing screen will disp lay. | |
1147 | ||
1148 | Pay-To Pro viders D ec 22, 200 8@14:38:21 Page: 1 of 1 | |
1149 | 1. *Nam e : CH EYENNE VAM C State : WY | |
1150 | Add ress 1: 23 60 E PERSH ING BLVD Zip Cod e: 82001-5 356 | |
1151 | Add ress 2: Phone : | |
1152 | Cit y : CH EYENNE Tax ID : 83-0168 494 | |
1153 | ||
1154 | ||
1155 | ||
1156 | ||
1157 | ||
1158 | ||
1159 | ||
1160 | * = Defaul t Pay-to p rovider | |
1161 | AP Add Pr ovider DP Delete Pro vider RT Rate Types | |
1162 | EP Edit P rovider AS Associate Divisions | |
1163 | Select Ite m(s): Quit // | |
1164 | ||
1165 | When the f irst Pay-t o Provider is entere d, it beco mes the de fault Pay- to Provide r and all the divisi ons in the database are assign ed automat ically to the defaul t provider . | |
1166 | ||
1167 | Step | |
1168 | Procedure | |
1169 | 17 | |
1170 | From the P ay-to Prov iders scre en, enter the action AS Associ ate Divisi ons. | |
1171 | ||
1172 | ||
1173 | ||
1174 | The follow ing screen will disp lay. | |
1175 | ||
1176 | Pay-To Pro vider Asso ciations D ec 22, 200 8@14:42:27 Page: 1 of 1 | |
1177 | CHEYENNE VAMC (Def ault) | |
1178 | 1 442GA CASPER | |
1179 | 2 442GC FORT CO LLINS | |
1180 | 3 442GD GREELEY | |
1181 | 4 442 CHEYENN E VAMROC | |
1182 | 5 442GB SIDNEY | |
1183 | 6 442GE TEST MO RC | |
1184 | ||
1185 | ||
1186 | ||
1187 | Enter ?? f or more ac tions | |
1188 | AS Associ ate Divisi on EX Exit | |
1189 | Select Ite m(s): Quit // | |
1190 | Associate Divisions with non-D efault Pay -to Provid er | |
1191 | When addin g a second Pay-to Pr ovider, us ers will b e prompted to make i t the defa ult Pay-to Provider, Is this t he default Pay-To Pr ovider? NO //. If us ers make t he new Pay -to Provid er the def ault provi der, all d ivisions w ill be ass ociated wi th the new default. If users do not mak e the new provider t he default , then the y will hav e to assoc iate selec t division s with the new Pay-t o Provider . | |
1192 | ||
1193 | Step | |
1194 | Procedure | |
1195 | ||
1196 | Note: When there is more than one Pay-to Provider, users mus t associat ed divisio ns with th e non-defa ult Pay-to Provider( s). | |
1197 | 1 | |
1198 | From the P ay-to Prov iders scre en, enter the action AS Associ ate Divisi ons. | |
1199 | ||
1200 | Pay-To Pro viders D ec 22, 200 8@14:55:32 Page: 1 of 1 | |
1201 | 1. *Nam e : CH EYENNE VAM C State : WY | |
1202 | Add ress 1: 23 60 E PERSH ING BLVD Zip Cod e: 82001-5 356 | |
1203 | Add ress 2: Phone : | |
1204 | Cit y : CH EYENNE Tax ID : 83-0168 494 | |
1205 | ||
1206 | 2. Nam e : MO NTANA HEAL TH CARE SY STEM - FT. H State : MT | |
1207 | Add ress 1: VA Medical C enter Zip Cod e: 59636 | |
1208 | Add ress 2: Phone : 666-666 -6666 | |
1209 | Cit y : FO RT HARRISO N Tax ID : 11-1111 111 | |
1210 | ||
1211 | ||
1212 | ||
1213 | * = Defaul t Pay-to p rovider | |
1214 | AP Add Pr ovider DP Delete Pro vider RT Rate Types | |
1215 | EP Edit P rovider AS Associate Divisions | |
1216 | Select Ite m(s): Quit // AS Asso ciate Divi sions | |
1217 | ||
1218 | The follow ing screen will disp lay. | |
1219 | ||
1220 | Pay-To Pro vider Asso ciations D ec 22, 200 8@15:32:45 Page: 1 of 1 | |
1221 | CHEYENNE VAMC (Def ault) | |
1222 | 1 442GA CASPER | |
1223 | 2 442GC FORT CO LLINS | |
1224 | 3 442GD GREELEY | |
1225 | 4 442 CHEYENN E VAMROC | |
1226 | 5 442GB SIDNEY | |
1227 | 6 442GE TEST MO RC | |
1228 | ||
1229 | MONTANA H EALTH CARE SYSTEM - FT. HARRIS ON DIVISIO N | |
1230 | No Divisions found. | |
1231 | ||
1232 | ||
1233 | ||
1234 | Enter ?? f or more ac tions | |
1235 | AS Associ ate Divisi on EX Exit | |
1236 | Select Ite m(s): Quit // AS Asso ciate Divi sion | |
1237 | Select Div ision (1-6 ): 5 | |
1238 | Select Pay -To Provid er: Montan a | |
1239 | ||
1240 | Step | |
1241 | Procedure | |
1242 | 2 | |
1243 | At the Sel ect Item(s ): prompt, enter the action AS Associate Divisions . | |
1244 | 3 | |
1245 | At the Div ision (1-6 ): prompt, enter 5 f or this ex ample. | |
1246 | 4 | |
1247 | At the Pay -to Provid er: prompt , enter Mo ntana for this examp le. | |
1248 | ||
1249 | Note: Use rs can not associate a divisio n that is defined as a Pay-to Provider, to another Pay-to Pr ovider. U sers will get the fo llowing er ror if the y try: A d ivision us ed as a Pa y-to Provi der can no t be assoc iated with another P ay-to Prov ider. | |
1250 | 5 | |
1251 | Repeat ste ps 2 - 4 i f necessar y. | |
1252 | ||
1253 | Note: Onc e a divisi on has bee n explicit ly associa ted with a particula r Pay-to P rovider, c hanging th e default Pay-to Pro vider will not autom atically c hange the division’s associate d Pay-to P rovider. | |
1254 | ||
1255 | The follow ing screen will disp lay. | |
1256 | ||
1257 | Pay-To Pro vider Asso ciations D ec 22, 200 8@15:34:39 Page: 1 of 1 | |
1258 | CHEYENNE VAMC (Def ault) | |
1259 | 1 442GA CASPER | |
1260 | 2 442GC FORT CO LLINS | |
1261 | 3 442GD GREELEY | |
1262 | 4 442 CHEYENN E VAMROC | |
1263 | 5 442GE TEST MO RC | |
1264 | ||
1265 | MONTANA H EALTH CARE SYSTEM - FT. HARRIS ON DIVISIO N | |
1266 | 6 442GB SIDNEY | |
1267 | ||
1268 | ||
1269 | ||
1270 | Enter ?? f or more ac tions | |
1271 | AS Associ ate Divisi on EX Exit | |
1272 | Select Ite m(s): Quit // | |
1273 | Rate Types for Non-M CCF Pay-to Provider | |
1274 | ||
1275 | Step | |
1276 | Procedure | |
1277 | ||
1278 | Note: User s with acc ess to IB Site Param eters and IB EDIT PA Y-TO TC se curity key will be a ble to add and delet e a Rate T ype. | |
1279 | 1 | |
1280 | From the N on-MCCF Pa y-to Provi ders scree n, enter t he action RT Rate Ty pes. | |
1281 | 2 | |
1282 | At the Sel ect Item(s ): prompt, enter the action AR Add Rate Type. | |
1283 | 3 | |
1284 | At the Sel ect a Rate Type to b e added pr ompt, ente r INELIGIB LE for thi s example. | |
1285 | 4 | |
1286 | Repeat ste p 3 if nec essary. | |
1287 | ||
1288 | Non-MCCF P ay-To Prov iders Dec 22, 2008@ 14:55:32 Pa ge: 1 o f 1 | |
1289 | 1. *Nam e : CH EYENNE VAM C | |
1290 | Add ress 1: 23 60 E PERSH ING BLVD | |
1291 | Add ress 2: | |
1292 | Cit y : CH EYENNE | |
1293 | Sta te : WY | |
1294 | Zip Code: 820 01-5356 | |
1295 | Pho ne : | |
1296 | Tax ID : 83- 0168494 | |
1297 | ||
1298 | 2. Nam e : MO NTANA HEAL TH CARE SY STEM - FT. H | |
1299 | Add ress 1: VA Medical C enter | |
1300 | Add ress 2: | |
1301 | Cit y : FO RT HARRISO N | |
1302 | Sta te : MT | |
1303 | Zip Code: 596 36 | |
1304 | Pho ne : 666 -666-6666 | |
1305 | Tax ID : 11- 1111111 | |
1306 | ||
1307 | ||
1308 | ||
1309 | * = Defaul t Pay-to p rovider | |
1310 | AP Add Pr ovider DP Delete Pro vider RT Rate Types | |
1311 | EP Edit P rovider AS Associate Divisions | |
1312 | Select Ite m(s): Quit // RT Rate types | |
1313 | ||
1314 | The follow ing screen will disp lay. | |
1315 | ||
1316 | Non-MCCF P ay-To Prov ider Dec 22, 2 008@15:32: 45 Page: 1 of 1 | |
1317 | ||
1318 | ||
1319 | # R TY DESC RIPTION | |
1320 | No Rate Types defi ned. | |
1321 | ||
1322 | ||
1323 | ||
1324 | ||
1325 | ||
1326 | Enter ?? f or more ac tions | |
1327 | AR Add Ra te Type RR R emove Rate Type | |
1328 | Select Ite m(s): Quit // AR Add Rate Type | |
1329 | Select a R ate Type t o be added : INELIGIB LE Who' s Responsi ble: PATIE NT | |
1330 | Select a R ate Type t o be added : | |
1331 | ||
1332 | Non-MCCF R ate Types Jun 27, 20 18@14:17:4 8 Page: 1 of 1 | |
1333 | ||
1334 | # R TY DESC RIPTION | |
1335 | 1. 17 INEL IGIBLE | |
1336 | ||
1337 | ||
1338 | ||
1339 | Enter ?? f or more ac tions | |
1340 | AR Add Ra te Type RR Remove Rat e Type | |
1341 | Select Ite m(s): Quit // | |
1342 | ||
1343 | Provider I D Set-up | |
1344 | Payers req uire the u se of a va riety of p rovider id entifiers on claims submitted for adjudi cation. P rinted cla im forms h ave boxes where thes e IDs can be printed . | |
1345 | ||
1346 | The genera l term, Pr ovider ID, can refer to an ID that belon gs to a hu man being such as an Attending physician or it can refer to an ID that belongs t o an organ ization th at provide s healthca re service s to a vet eran such as a VAMC or an outs ide labora tory. Bot h VA and n on-VA peop le and org anizations have IDs. | |
1347 | ||
1348 | IDs have q ualifiers that ident ify what t ype of ID is being t ransmitted . For exa mple, a Bl ue Cross I D is trans mitted wit h a qualif ier (1A) w hich indic ates that this numbe r is a Blu e Cross nu mber. App endix C ha s a list o f qualifie rs and whi ch ones ca n be trans mitted in which 837 records. | |
1349 | ||
1350 | The NPI (N ational Pr ovider Ide ntifier) i s a HIPAA requiremen t with a u sage requi rement dat e beginnin g May 23, 2007. It is transmi tted on 83 7 records along with treating specialty taxonomies from the National U niform Cla ims Commit tee (NUCC) published code list . | |
1351 | ||
1352 | Patch IB*2 .0*343 add ed the abi lity to de fine the N PI and Tax onomy Code s for the VAMC, Non- VA facilit ies and bo th VA and Non-VA hum an provide rs. | |
1353 | ||
1354 | Patches IB *2.0*348 a nd 349 add ed the abi lity to pr int the NP I on the n ew UB-04 a nd CMS-150 0 claim fo rms. | |
1355 | ||
1356 | After Patc h IB*2*436 , old clai ms can be reprinted locally fo r legal pu rposes and sent to R egional Co unsel even though th e original claim was created p rior to th e requirem ent for pr oviders to have an a ssigned NP I. A legal claim is defined as having a Billing Ra te Type of “NO FAULT INS”, “WO RKERS’ COM P”, or “TO RT FEASOR” . | |
1357 | ||
1358 | When Patch IB*2.0*43 2 is loade d, the Soc ial Securi ty Number (SSN) will no longer be transm itted in t he 837 rec ords as a human prov iders Prim ary ID. T he NPI wil l be trans mitted in the 837 He alth Care Claim tran smission a s the Prim ary ID for both huma n provider s and orga nizational providers such as t he Billing Provider. | |
1359 | ||
1360 | The HIPAA 837 transa ction set includes a number of segments in which t o transmit multiple IDs and qu alifiers f or a singl e claim. The list b elow indic ates the V istA recor d name, th e type of informatio n being tr ansmitted, the maxim um number of IDs tha t can go i n that rec ord for on e claim an d if the I Ds will pr int on a p aper claim (P), tran smit elect ronically (T), or do both (B). | |
1361 | ||
1362 | Segment | |
1363 | Type of ID | |
1364 | Max # of I Ds | |
1365 | (P)rint | |
1366 | (T)ransmit | |
1367 | (B)oth | |
1368 | PRV:9 | |
1369 | Billing Pr ovider Pri mary ID | |
1370 | 1 | |
1371 | B | |
1372 | PRV1:6 | |
1373 | Pay-to Pro vider Prim ary ID | |
1374 | 1 | |
1375 | T | |
1376 | CI1A:2-17 | |
1377 | Billing Pr ovider Sec ondary IDs | |
1378 | 8 | |
1379 | B | |
1380 | OPR1 | |
1381 | Attending, Other Ope rating or Operating Physician Primary ID | |
1382 | 1/Physicia n | |
1383 | B | |
1384 | OPR1 | |
1385 | Referring Provider P rimary ID | |
1386 | 1/Provider | |
1387 | B | |
1388 | OPR7 | |
1389 | Supervisin g Provider Primary I D | |
1390 | 1/Provider | |
1391 | B | |
1392 | OPR9 | |
1393 | Rendering Provider P rimary ID | |
1394 | 1 | |
1395 | B | |
1396 | OPRB | |
1397 | Assistant Surgeon Pr imary ID | |
1398 | 1 | |
1399 | B | |
1400 | OPR2 | |
1401 | Attending Physician Secondary IDs | |
1402 | 5 | |
1403 | B | |
1404 | OPRA | |
1405 | Rendering Provider S econdary I D | |
1406 | 4 | |
1407 | B | |
1408 | OPR3 | |
1409 | Operating Physician Secondary IDs | |
1410 | 5 | |
1411 | B | |
1412 | OPR4 | |
1413 | Other Phys ician Seco ndary IDs | |
1414 | 5 | |
1415 | B | |
1416 | OPR5 | |
1417 | Referring Provider S econdary I Ds | |
1418 | 5 | |
1419 | B | |
1420 | OPR8 | |
1421 | Supervisin g Provider Secondary IDs | |
1422 | 5 | |
1423 | B | |
1424 | SUB2 | |
1425 | Laboratory or Facili ty Primary ID | |
1426 | 1 | |
1427 | B | |
1428 | SUB2 | |
1429 | Laboratory or Facili ty Seconda ry IDs | |
1430 | 5 | |
1431 | T | |
1432 | Table of I Ds | |
1433 | The follow ing table shows wher e IDs are defined in VistA; wh ere they a re stored in VistA; where they appear on billing f orms; and where they appear in the VistA option Vi ew/Print E DI Bill Ex tract Data (VPE) and the EDI 8 37 transac tion recor d location . | |
1434 | ||
1435 | Pay-to Pro vider NPI | |
1436 | VistA Opti on | |
1437 | The Instit ution file is not av ailable to Billing p ersonnel | |
1438 | VistA File | |
1439 | Institutio n (#4) | |
1440 | UB-04 | |
1441 | N/A | |
1442 | CMS-1500 | |
1443 | N/A | |
1444 | VPE (837 R ecord) | |
1445 | PRV1, Piec e 6 | |
1446 | ||
1447 | ||
1448 | Pay-to Pro vider Prim ary ID (Fe deral Tax Number of the VAMC) - Legacy | |
1449 | VistA Opti on | |
1450 | MCCR Site Parameter Display/Ed it | |
1451 | VistA File | |
1452 | IB SITE PA RAMETERS ( #350.9) | |
1453 | UB-04 | |
1454 | N/A | |
1455 | CMS-1500 | |
1456 | N/A | |
1457 | VPE (837 R ecord) | |
1458 | N/A | |
1459 | ||
1460 | ||
1461 | Billing Pr ovider NPI | |
1462 | VistA Opti on | |
1463 | The Instit ution file is not av ailable to Billing p ersonnel | |
1464 | VistA File | |
1465 | Institutio n (#4) | |
1466 | UB-04 | |
1467 | FL 56 | |
1468 | CMS-1500 | |
1469 | Box 33a | |
1470 | VPE (837 R ecord) | |
1471 | PRV, Piece 9 | |
1472 | ||
1473 | ||
1474 | Billing Pr ovider Tax onomy Code | |
1475 | VistA Opti on | |
1476 | The Instit ution file is not av ailable to Billing p ersonnel | |
1477 | VistA File | |
1478 | Institutio n (#4) | |
1479 | UB-04 | |
1480 | N/A | |
1481 | CMS-1500 | |
1482 | N/A | |
1483 | VPE (837 R ecord) | |
1484 | PRV, Piece 14 | |
1485 | ||
1486 | ||
1487 | Billing Pr ovider Sec ondary ID (Federal T ax Number of the VAM C) | |
1488 | VistA Opti on | |
1489 | MCCR Site Parameter Display/Ed it | |
1490 | VistA File | |
1491 | IB SITE PA RAMETERS ( #350.9) | |
1492 | UB-04 | |
1493 | FL 5 | |
1494 | CMS-1500 | |
1495 | Box 25 | |
1496 | VPE (837 R ecord) | |
1497 | CI1A, Piec e 5 | |
1498 | ||
1499 | ||
1500 | Billing Pr ovider Sec ondary IDs - Legacy | |
1501 | Note: If n one are de fined, the default i s the Fede ral Tax ID . | |
1502 | VistA Opti on | |
1503 | Insurance Company En try/EditID Prov IDs/ ID Param | |
1504 | VistA File | |
1505 | FACILITY B ILLING ID (#355.92) | |
1506 | UB-04 | |
1507 | FL 57 | |
1508 | CMS-1500 | |
1509 | Box 33b | |
1510 | VPE (837 R ecord) | |
1511 | CI1A, Piec es 6-17 | |
1512 | ||
1513 | ||
1514 | VA - Atten ding, Othe r Operatin g or Opera ting Physi cian NPI | |
1515 | VistA Opti on | |
1516 | Provider S elf Entry (Not avail able to Bi lling pers onnel) | |
1517 | Add/Edit N PI values for Provid ers | |
1518 | VistA File | |
1519 | NEW PERSON (#200) | |
1520 | UB-04 | |
1521 | FL 76-79 | |
1522 | CMS-1500 | |
1523 | N/A | |
1524 | VPE (837 R ecord) | |
1525 | OPR1, Piec e 3, 6, or 9 | |
1526 | ||
1527 | ||
1528 | VA – Atten ding Provi der Taxono my Code | |
1529 | VistA Opti on | |
1530 | Add a New User to th e System ( Not availa ble to Bil ling perso nnel) | |
1531 | Edit an Ex isting Use r | |
1532 | Person Cla ss Edit | |
1533 | VistA File | |
1534 | PERSON CLA SS (#8932. 1) | |
1535 | UB-04 | |
1536 | N/A | |
1537 | CMS-1500 | |
1538 | N/A | |
1539 | VPE (837 R ecord) | |
1540 | OPR, Piece 17 | |
1541 | ||
1542 | ||
1543 | VA - Refer ring Provi der NPI | |
1544 | VistA Opti on | |
1545 | Provider S elf Entry (Not avail able to Bi lling pers onnel) | |
1546 | Add/Edit N PI values for Provid ers | |
1547 | VistA File | |
1548 | NEW PERSON (#200) | |
1549 | UB-04 | |
1550 | FL 78 or 7 9 | |
1551 | CMS-1500 | |
1552 | Box 17b | |
1553 | VPE (837 R ecord) | |
1554 | OPR1, Piec e 12 | |
1555 | ||
1556 | ||
1557 | VA – Rende ring Provi der NPI | |
1558 | VistA Opti on | |
1559 | Provider S elf Entry (Not avail able to Bi lling pers onnel) | |
1560 | Add/Edit N PI values for Provid ers | |
1561 | VistA File | |
1562 | NEW PERSON (#200) | |
1563 | UB-04 | |
1564 | FL 78 or 7 9 | |
1565 | CMS-1500 | |
1566 | 24J (Rende ring) | |
1567 | VPE (837 R ecord) | |
1568 | OPR9, Piec e 9 | |
1569 | ||
1570 | ||
1571 | VA - Rende ring Taxon omy Code | |
1572 | VistA Opti on | |
1573 | Add a New User to th e System ( Not availa ble to Bil ling perso nnel) | |
1574 | Edit an Ex isting Use r | |
1575 | Person Cla ss Edit | |
1576 | VistA File | |
1577 | PERSON CLA SS (#8932. 1) | |
1578 | UB-04 | |
1579 | N/A | |
1580 | CMS-1500 | |
1581 | N/A | |
1582 | VPE (837 R ecord) | |
1583 | OPR9, Piec e 11 | |
1584 | ||
1585 | ||
1586 | VA - Super vising Pro vider NPI | |
1587 | VistA Opti on | |
1588 | Provider S elf Entry (Not avail able to Bi lling pers onnel) | |
1589 | Add/Edit N PI values for Provid ers | |
1590 | VistA File | |
1591 | NEW PERSON file #200 | |
1592 | UB-04 | |
1593 | N/A | |
1594 | CMS-1500 | |
1595 | N/A | |
1596 | VPE (837 R ecord) | |
1597 | OPR7, Piec e 7 | |
1598 | ||
1599 | VA – Assis tant Surge on NPI | |
1600 | VistA Opti on | |
1601 | Provider S elf Entry (Not avail able to Bi lling pers onnel) | |
1602 | Add/Edit N PI values for Provid ers | |
1603 | VistA File | |
1604 | NEW PERSON file #200 | |
1605 | VPE (837 R ecord) | |
1606 | OPRB, Piec e 9 | |
1607 | ||
1608 | VA – Assis tant Surge on Taxonom y Code | |
1609 | VistA Opti on | |
1610 | Add a New User to th e System ( Not availa ble to Bil ling perso nnel) | |
1611 | Edit an Ex isting Use r | |
1612 | Person Cla ss Edit | |
1613 | VistA File | |
1614 | PERSON CLA SS (#8932. 1) | |
1615 | VPE (837 R ecord) | |
1616 | OPRB, Piec e 11 | |
1617 | ||
1618 | Non-VA - A ttending, Other Oper ating or O perating P hysician N PI | |
1619 | VistA Opti on | |
1620 | Provider I D Maintena nceNon/Oth er VA Prov iderIndivi dual | |
1621 | VistA File | |
1622 | IB NON VA/ OTHER BILL ING PROVID ER (#355.9 3) | |
1623 | UB-04 | |
1624 | FL 76-79 | |
1625 | CMS-1500 | |
1626 | N/A | |
1627 | VPE (837 R ecord) | |
1628 | OPR1, Piec e 3,6, or 9 | |
1629 | ||
1630 | ||
1631 | Non-VA – A ttending P rovider Ta xonomy Cod e | |
1632 | VistA Opti on | |
1633 | Provider I D Maintena nceNon/Oth er VA Prov iderIndivi dual | |
1634 | VistA File | |
1635 | IB NON VA/ OTHER BILL ING PROVID ER (#355.9 3) | |
1636 | UB-04 | |
1637 | FL 76-79 | |
1638 | CMS-1500 | |
1639 | N/A | |
1640 | VPE (837 R ecord) | |
1641 | OPR, Piece 17 | |
1642 | ||
1643 | ||
1644 | Non-VA – R endering P rovider NP I | |
1645 | VistA Opti on | |
1646 | Provider I D Maintena nceNon/Oth er VA Prov iderIndivi dual | |
1647 | VistA File s | |
1648 | IB NON VA/ OTHER BILL ING PROVID ER (#355.9 3) | |
1649 | UB-04 | |
1650 | FL 78-79 | |
1651 | CMS-1500 | |
1652 | 24J | |
1653 | VPE (837 R ecord) | |
1654 | OPR9, Piec e 9 | |
1655 | ||
1656 | ||
1657 | Non-VA – R eferring P rovider NP I | |
1658 | VistA Opti on | |
1659 | Provider I D Maintena nceNon/Oth er VA Prov iderIndivi dual | |
1660 | VistA File s | |
1661 | IB NON VA/ OTHER BILL ING PROVID ER (#355.9 3) | |
1662 | UB-04 | |
1663 | FL 78-79 | |
1664 | CMS-1500 | |
1665 | 17b | |
1666 | VPE (837 R ecord) | |
1667 | OPR1, Piec e 12 | |
1668 | ||
1669 | ||
1670 | Non-VA – R endering P rovider Ta xonomy Cod e | |
1671 | VistA Opti on | |
1672 | Provider I D Maintena nceNon/Oth er VA Prov iderIndivi dual | |
1673 | VistA File s | |
1674 | IB NON/OTH ER VA BILL ING PROVID ER (#355.9 3) | |
1675 | UB-04 | |
1676 | N/A | |
1677 | CMS-1500 | |
1678 | N/A | |
1679 | VPE (837 R ecord) | |
1680 | OPR9, Piec e 11 | |
1681 | ||
1682 | ||
1683 | Non-VA – S upervising Provider NPI | |
1684 | VistA Opti on | |
1685 | Provider I D Maintena nceNon/Oth er VA Prov iderIndivi dual | |
1686 | VistA File s | |
1687 | IB NON VA/ OTHER BILL ING PROVID ER (#355.9 3) | |
1688 | UB-04 | |
1689 | N/A | |
1690 | CMS-1500 | |
1691 | N/A | |
1692 | VPE (837 R ecord) | |
1693 | OPR7, Piec e 7 | |
1694 | ||
1695 | ||
1696 | VA - Atten ding, Othe r Operatin g or Opera ting Physi cian Secon dary IDs - Legacy | |
1697 | VistA Opti on | |
1698 | Provider I D Maintena nce Provid er Specifi c IDs | |
1699 | Provider’s Own IDs | |
1700 | Provider I Ds Furnish ed by Insu rance Co | |
1701 | VistA File s | |
1702 | IB Billing Practitio ner ID (#3 55.9) | |
1703 | UB-04 | |
1704 | FL 76-79 | |
1705 | CMS-1500 | |
1706 | N/A | |
1707 | VPE (837 R ecord) | |
1708 | OPR2, OPR3 , OPR4 Pie ces 3, 5, 7, 9 or 11 | |
1709 | ||
1710 | ||
1711 | VA – Rende ring Provi der Second ary IDs - Legacy | |
1712 | VistA Opti on | |
1713 | Provider I D Maintena nce Provid er Specifi c IDs | |
1714 | Provider’s Own IDs | |
1715 | Provider I Ds Furnish ed by Insu rance Co | |
1716 | VistA File s | |
1717 | IB Billing Practitio ner ID (#3 55.9) | |
1718 | UB-04 | |
1719 | FL 78-79 | |
1720 | CMS-1500 | |
1721 | Box 24J | |
1722 | VPE (837 R ecord) | |
1723 | OPRA, Piec es 2-9 | |
1724 | ||
1725 | ||
1726 | VA – Refer ring Provi der Second ary IDs - Legacy | |
1727 | VistA Opti on | |
1728 | Provider I D Maintena nce Provid er Specifi c IDs | |
1729 | Provider’s Own IDs | |
1730 | Provider I Ds Furnish ed by Insu rance Co | |
1731 | VistA File s | |
1732 | IB Billing Practitio ner ID (#3 55.9) | |
1733 | UB-04 | |
1734 | FL 78-79 | |
1735 | CMS-1500 | |
1736 | Box 17a | |
1737 | VPE (837 R ecord) | |
1738 | OPR5, Piec es 2-10 | |
1739 | ||
1740 | ||
1741 | VA – Super vising Pro vider Seco ndary IDs - Legacy | |
1742 | VistA Opti on | |
1743 | Provider I D Maintena nce Provid er Specifi c IDs | |
1744 | Provider’s Own IDs | |
1745 | Provider I Ds Furnish ed by Insu rance Co | |
1746 | VistA File s | |
1747 | IB Billing Practitio ner ID (#3 55.9) | |
1748 | UB-04 | |
1749 | N/A | |
1750 | CMS-1500 | |
1751 | N/A | |
1752 | VPE (837 R ecord) | |
1753 | OPR 8, Pie ces 2-11 | |
1754 | ||
1755 | VA – Assis tant Surge on Seconda ry IDs - L egacy - N /A | |
1756 | ||
1757 | Non - VA - Attending , Other Op erating or Operating Physician Secondary IDs - Leg acy | |
1758 | VistA Opti on | |
1759 | Provider I D Maintena nce Non/Ot her VA Pro vider ID I nformation | |
1760 | Provider I D Maintena nce Provid er Specifi c IDs | |
1761 | Provider’s Own IDs | |
1762 | Provider I Ds Furnish ed by Insu rance Co | |
1763 | VistA File s | |
1764 | IB Billing Practitio ner ID (#3 55.9) | |
1765 | UB-04 | |
1766 | FL 76-79 | |
1767 | CMS-1500 | |
1768 | N/A | |
1769 | VPE (837 R ecord) | |
1770 | OPR2, OPR3 , OPR4 Pie ces 2-11 | |
1771 | ||
1772 | Non - VA – Rendering Provider Secondary IDs - Lega cy | |
1773 | VistA Opti on | |
1774 | Provider I D Maintena nce Non/Ot her VA Pro vider ID I nformation | |
1775 | Provider I D Maintena nce Provid er Specifi c IDs | |
1776 | Provider’s Own IDs | |
1777 | Provider I Ds Furnish ed by Insu rance Co | |
1778 | VistA File s | |
1779 | IB Billing Practitio ner ID (#3 55.9) | |
1780 | UB-04 | |
1781 | FL 78-79 | |
1782 | CMS-1500 | |
1783 | Box 24J | |
1784 | VPE (837 R ecord) | |
1785 | OPRA, Piec es 2-9 | |
1786 | ||
1787 | ||
1788 | Non-VA - R eferring P rovider Se condary ID s - Legacy | |
1789 | VistA Opti on | |
1790 | Provider I D Maintena nce Provid er Specifi c IDs | |
1791 | Provider’s Own IDs | |
1792 | Provider I Ds Furnish ed by Insu rance Co | |
1793 | VistA File s | |
1794 | IB Billing Practitio ner ID (#3 55.9) | |
1795 | UB-04 | |
1796 | FL 78-79 | |
1797 | CMS-1500 | |
1798 | Box 17a | |
1799 | VPE (837 R ecord) | |
1800 | OPR5, Piec es 2-10 | |
1801 | ||
1802 | Non - VA – Supervisi ng Provide r Secondar y IDs - Le gacy | |
1803 | VistA Opti on | |
1804 | Provider I D Maintena nce Non/Ot her VA Pro vider ID I nformation | |
1805 | Provider I D Maintena nce Provid er Specifi c IDs | |
1806 | Provider’s Own IDs | |
1807 | Provider I Ds Furnish ed by Insu rance Co | |
1808 | VistA File s | |
1809 | IB Billing Practitio ner ID (#3 55.9) | |
1810 | UB-04 | |
1811 | N/A | |
1812 | CMS-1500 | |
1813 | N/A | |
1814 | VPE (837 R ecord) | |
1815 | OPR8, Piec es 2-11 | |
1816 | ||
1817 | ||
1818 | VA - Servi ce Facilit y – Labora tory or Fa cility NPI | |
1819 | After Patc h IB*2*400 , only VA facility t ypes that do not hav e NPIs (e. g., MORC) are used a s VA Servi ce Facilit ies. Most often the Service F acility is blank. | |
1820 | ||
1821 | ||
1822 | VA - Servi ce Facilit y – Labora tory or Fa cility Fed eral Tax I D | |
1823 | VistA Opti on | |
1824 | MCCR Site Parameter Display/Ed it | |
1825 | Insurance Company En try/Edit | |
1826 | VistA File | |
1827 | IB SITE PA RAMETERS ( #350.9) | |
1828 | UB-04 | |
1829 | N/A | |
1830 | CMS-1500 | |
1831 | N/A | |
1832 | VPE (837 R ecord) | |
1833 | SUB, Piece 9 | |
1834 | ||
1835 | ||
1836 | VA - Servi ce Facilit y – Labora tory or Fa cility Sec ondary IDs - Legacy | |
1837 | VistA Opti on | |
1838 | Insurance Company En try/Edit I D Prov IDs /ID Param VA-Lab/Fac ility IDs | |
1839 | VistA File | |
1840 | FACILITY B ILLING ID (#355.92) | |
1841 | UB-04 | |
1842 | N/A | |
1843 | CMS-1500 | |
1844 | Box 32b | |
1845 | VPE (837 R ecord) | |
1846 | SUB2, Piec es 7-16 | |
1847 | ||
1848 | ||
1849 | Non-VA - S ervice Fac ility – La boratory o r Facility NPI | |
1850 | VistA Opti on | |
1851 | Provider I D Maintena nce Non/Ot her VA Pro vider ID I nformation FacilityFa cility Inf o | |
1852 | VistA File | |
1853 | IB NON VA/ OTHER BILL ING PROVID ER file #3 55.93 | |
1854 | UB-04 | |
1855 | N/A | |
1856 | CMS-1500 | |
1857 | Box 32a | |
1858 | VPE (837 R ecord) | |
1859 | SUB2, Piec e 6 | |
1860 | ||
1861 | ||
1862 | Non-VA - S ervice Fac ility – La boratory o r Facility Secondary IDs - Leg acy | |
1863 | VistA Opti on | |
1864 | Provider I D Maintena nce Non/Ot her VA Pro vider ID I nformation FacilitySe condary ID Maint | |
1865 | VistA File | |
1866 | IB BILLING PRACTITIO NER ID (#3 55.9) | |
1867 | UB-04 | |
1868 | Not Printe d | |
1869 | CMS-1500 | |
1870 | 32b | |
1871 | VPE (837 R ecord) | |
1872 | SUB2, Piec es 7-16 | |
1873 | Pay-to Pro vider IDs | |
1874 | Define the Pay-to Pr ovider Pri mary ID/NP I | |
1875 | The Pay-to Provider NPI is not entered o r maintain ed by Bill ing person nel. The Pay-to Pro vider NPI is retriev ed from th e Institut ion file ( #4). | |
1876 | ||
1877 | Beginning with Patch IB*2*432, the Pay-t o Provider Primary I D is the N PI number of the sit e defined as the Pay -to Provid er. The F ederal Tax Number is defined w hen the Pa y-to Provi der is def ined, but will no lo nger be us ed as the Primary ID . Refer t o Section 3.1. | |
1878 | ||
1879 | Define the Pay-to Pr ovider Sec ondary IDs | |
1880 | With Patch IB*2*400, the CI1B segment wa s added to the outbo und 837 cl aim transm ission map to transm it Pay-to Provider S econdary I Ds if the need shoul d arise in the futur e. The CI 1B segment was remov ed with Pa tch IB*2*4 32. | |
1881 | Billing Pr ovider IDs | |
1882 | The Billin g Provider Primary I D and the Billing Pr ovider Sec ondary IDs are IDs t hat identi fy the fac ility at w hich the p atient ser vice was p rovided. This is a facility w ith a phys ical locat ion (stree t address) . The Bil ling Provi der on a c laim must be one of the follow ing Facili ty Types t hat have b een assign ed NPI num bers: | |
1883 | CBOC – Com munity Bas ed Outpati ent Clinic | |
1884 | HCS – Heal th Care Sy stem | |
1885 | M&ROC – Me dical and Regional O ffice Cent er | |
1886 | OC – Outpa tient Clin ic (Indepe ndent) | |
1887 | OPC – Out Patient Cl inic | |
1888 | PHARM – Ph armacy | |
1889 | VAMC – VA Medical Ce nter | |
1890 | RO-OC – Re gional Off ice – Outp atient Cli nic | |
1891 | ||
1892 | When care is provide d at any o ther facil ity type ( i.e. a mob ile unit), the Billi ng Provide r becomes the Parent facility as defined in the In stitution file (#4) and the mo bile unit becomes th e Service Facility. | |
1893 | ||
1894 | With Patch IB*2*432, the name for the Bi lling Prov ider on a claim is e xtracted f rom the ne w Billing Facility N ame field (#200) of the Instit ution file (#4). If this fiel d is not p opulated, the IB sof tware cont inues to e xtract the name from the .01 f ield of th e Institut ion file. | |
1895 | Define the Billing P rovider Pr imary ID/N PI | |
1896 | For all cl aims gener ated by th e VA, the Billing Pr ovider Sec ondary ID is the Fed eral Tax N umber of t he site. Once defin ed, the IB software will autom atically a ssign this ID to a c laim. | |
1897 | ||
1898 | The Billin g Provider NPI is th e Billing Provider P rimary ID. The Bill ing Provid er NPI is defined in the Insti tution fil e. Once d efined, th e IB softw are automa tically as signs this ID to a c laim. | |
1899 | ||
1900 | The VA Bil ling Provi der NPI an d Taxonomy Code will not be en tered or m aintained by Billing personnel . Users m ay change the defaul t Billing Provider t axonomy co de for a c laim but u sers canno t change t he Billing Provider NPI. | |
1901 | ||
1902 | Step | |
1903 | Procedure | |
1904 | 1 | |
1905 | Access the option SI TEMCCR Sit e Paramete r Display/ Edit. | |
1906 | 2 | |
1907 | From the M CCR Site P arameters screen, en ter the ac tion: IB S ite Parame ters. | |
1908 | 3 | |
1909 | Press the <Enter> ke y for Next Screen un til Page 2 is displa yed. | |
1910 | 4 | |
1911 | From the I B Site Par ameters sc reen, ente r the acti on: EP Edi t Set. | |
1912 | 5 | |
1913 | Enter the number 9. | |
1914 | 6 | |
1915 | At the Fed eral Tax N umber prom pt, enter the site’s Federal T ax Number. | |
1916 | ||
1917 | IB Site Pa rameters Oct 20, 20 05@16:23:1 6 Page: 2 of 6 | |
1918 | Only autho rized pers ons may ed it this da ta. | |
1919 | + | |
1920 | [5] Medica l Center : LOMA LIN DA VAMC Default Di vision :
|
|
1921 | MAS Servic e : PATIENT ELIGIBILIT Y Billing Su pervisor : PII | |
1922 | ||
1923 | [6] Initia tor Author ize: YES Xfer Proc to S ched : NO | |
1924 | Ask HI NQ in MCCR : YES Use Non-PTF Co des : YES | |
1925 | Multip le Form Ty pes: YES Use OP CPT scr een : YES | |
1926 | ||
1927 | [7] UB-04 Print IDs : YES UB-0 4 Address Col : | |
1928 | CMS-15 00 Print I Ds : YES CMS- 1500 Addr Col : 28 | |
1929 | ||
1930 | [8] Defaul t RX DX Cd : 780.9 9 Defa ult ASC Re v Cd : 490 | |
1931 | Defaul t RX CPT C d : Defa ult RX Rev Cd : 251 | |
1932 | ||
1933 | [9] Bill S igner Name : <No l onger used > Fede ral Tax # : | |
1934 | Bill S igner Titl e : <No l onger used > | |
1935 | Remark on Each B ill: BILL # MUST BE ON ALL REM ITTANCE | |
1936 | ||
1937 | + Enter ?? f or more ac tions | |
1938 | EP Edit S et EX Exit Action | |
1939 | Select Act ion: Next Screen// e p Edit S et | |
1940 | Select Par ameter Set (s): (5-9 ): 9 | |
1941 | NAME OF CL AIM FORM S IGNER: BUS INESS OFFI CE// | |
1942 | TITLE OF C LAIM FORM SIGNER: | |
1943 | FEDERAL TA X NUMBER: XXX123456 | |
1944 | ||
1945 | Define the Billing P rovider Se condary ID s | |
1946 | The Billin g Provider Secondary IDs are I Ds and Qua lifiers th at are pro vided to a site by t he insuran ce company . There c an be a to tal of eig ht Billing Provider Secondary IDs per cl aim. The first ID i s calculat ed by the system and used by t he clearin ghouse to sort claim s. The se cond ID is always th e site’s F ederal Tax ID, and t he remaini ng six IDs must be d efined by the IB sta ff if requ ired. | |
1947 | ||
1948 | Users can define one Billing P rovider Se condary ID for a CMS -1500, and another f or a UB-04 for the m ain divisi on. If no other Bil ling Provi der Second ary IDs ar e defined, these two IDs becom e the defa ult IDs fo r all clai ms. At thi s time, th ere will n ot be any Billing Pr ovider sec ondary IDs for Denta l claims. | |
1949 | ||
1950 | Billing Pr ovider Sec ondary IDs can be de fined by D ivision, F orm Type, and Care U nit. | |
1951 | ||
1952 | Define Def ault Billi ng Provide r Secondar y IDs by F orm Type | |
1953 | ||
1954 | Step | |
1955 | Procedure | |
1956 | 1 | |
1957 | Access the option MC CR SYSTEM DEFINITION MENUInsur ance Compa ny Entry/E dit. | |
1958 | 2 | |
1959 | At the Sel ect Insura nce Compan y Name: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple. | |
1960 | 3 | |
1961 | From the I nsurance C ompany Edi tor screen , enter th e action: ID Prov ID s/ID Param . | |
1962 | 4 | |
1963 | From the B illing Pro vider IDs screen, en ter the ac tion Add a n ID. | |
1964 | 5 | |
1965 | At the Def ine Billin g Provider Secondary IDs by Ca re Units? No// promp t, press t he <Enter> key to ac cept the d efault of No. | |
1966 | 6 | |
1967 | At the Div ision prom pt, accept the defau lt for the main Divi sion. | |
1968 | 7 | |
1969 | At the ID Qualifier: Electroni c Plan Typ e// prompt , enter Bl ue Shield to overrid e the defa ult value for this e xample. | |
1970 | ||
1971 | Note: The default va lue for th e Billing Provider S econdary I D Qualifie r is still based upo n the Elec tronic Pla n Type of the patien t’s insura nce plan. Users now have the a bility to override t his defaul t. | |
1972 | 8 | |
1973 | At the For m Type pro mpt, enter CMS-1500 for this e xample. | |
1974 | 9 | |
1975 | At the Bil ling Provi der Second ary ID pro mpt, enter the ID XX XXXXXX1B f or this ex ample. | |
1976 | 10 | |
1977 | Repeat the se steps f or the For m Type = U B-04, Qual ifier = Bl ue Cross a nd ID = XX XXXX1A. | |
1978 | ||
1979 | Note: Begi nning with Patch IB* 2*432, if no Billing Provider Secondary IDs are de fined, the Federal T ax ID will no longer be used a s a defaul t value. | |
1980 | Billing Pr ovider IDs (Parent) May 27, 2005@ 12:48:29 Pa ge: 1 o f 1 | |
1981 | Insurance Co: BLUE C ROSS OF CA LIFORNIA Billing P rovider Se condary ID s | |
1982 | ID Qu alifier ID # Form Type | |
1983 | ||
1984 | No Billing Provider IDs found | |
1985 | ||
1986 | ||
1987 | ||
1988 | Enter ?? f or more ac tions | |
1989 | Add an ID Addit ional IDs Exi t | |
1990 | Edit a n ID ID Pa rameters | |
1991 | Delete an ID VA-Lab/Fa cility IDs | |
1992 | ||
1993 | Select Act ion: Quit/ / a Add ID | |
1994 | Define Bil ling Provi der Second ary IDs by Care Unit s? No//?? | |
1995 | ||
1996 | Enter N o to defin e a Billin g Provider Secondary ID | |
1997 | for the Division. | |
1998 | Enter Y es to defi ne a Billi ng Provide r Secondar y ID | |
1999 | for a s pecific Ca re Unit. | |
2000 | If no C are Unit i s entered on Billing Screen 3, the | |
2001 | Billing Provider Secondary ID defined for the D ivision wi ll | |
2002 | be tran smitted in the claim . | |
2003 | ||
2004 | 0 No | |
2005 | 1 Yes | |
2006 | ||
2007 | Define Bil ling Provi der Second ary IDs by Care Unit s? No//No | |
2008 | Division: Main Divis ion// Main Division | |
2009 | ID Qualifi er: Electr onic Plan Type//Blue Shield | |
2010 | Enter Form Type for ID: CMS-15 00 | |
2011 | Billing Pr ovider Sec ondary ID: XXXXXX1B | |
2012 | ||
2013 | The follow ing screen will disp lay. Thes e two IDs will be th e default IDs for al l claims a nd will ap pear on Bi lling Scre en 3. | |
2014 | ||
2015 | Billing Pr ovider IDs (Parent) May 27, 2005@ 12:48:29 Pa ge: 1 o f 1 | |
2016 | Insurance Co: BLUE C ROSS OF CA LIFORNIA Billing P rovider Se condary ID s | |
2017 | ID Qu alifier ID # Form Type | |
2018 | Division: Name of Ma in Divisio n/Default for All Di visions | |
2019 | 1 Blue Cross XX XXXX1A UB04 | |
2020 | 2 Blue Shield XX XXXX1B 1500 | |
2021 | ||
2022 | ||
2023 | ||
2024 | ||
2025 | Enter ?? f or more ac tions | |
2026 | Add an ID Addit ional IDs Exi t | |
2027 | Edit a n ID ID Pa rameters | |
2028 | Delete an ID VA-Lab/Fa cility IDs | |
2029 | ||
2030 | Select Act ion: Quit/ / | |
2031 | Define Bil ling Provi der Second ary IDs by Division and Form T ype | |
2032 | If an insu rance comp any requir es differe nt Billing Provider Secondary IDs for ea ch divisio n, then us ers must d efine more than just the defau lt IDs. | |
2033 | ||
2034 | Step | |
2035 | Procedure | |
2036 | 1 | |
2037 | Access the option MC CR SYSTEM DEFINITION MENUInsur ance Compa ny Entry/E dit. | |
2038 | 2 | |
2039 | At the Sel ect Insura nce Compan y Name: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple. | |
2040 | 3 | |
2041 | From the I nsurance C ompany Edi tor screen , enter th e action I D Prov IDs /ID Param. | |
2042 | 4 | |
2043 | From the B illing Pro vider IDs screen, en ter the ac tion Add a n ID. | |
2044 | 5 | |
2045 | At the Def ine Billin g Provider Secondary IDs by Ca re Units? No// promp t, press t he <Enter> key to ac cept the d efault of No. | |
2046 | 6 | |
2047 | At the Div ision prom pt, overri de the def ault for t he main di vision by entering t he name of another d ivision, R emote Clin ic for thi s example. | |
2048 | 7 | |
2049 | At the ID Qualifier: Electroni c Plan Typ e// prompt , enter Bl ue Shield to overrid e the defa ult value for this e xample. | |
2050 | 8 | |
2051 | At the For m Type pro mpt, enter CMS-1500 for this e xample. | |
2052 | 9 | |
2053 | At the Bil ling Provi der Second ary ID pro mpt, enter the ID 1X XXXX1B for this exam ple. | |
2054 | 10 | |
2055 | Repeat the se steps f or the For m Type = U B-04, Qual ifier = Bl ue Cross a nd ID = 1X XXXX1A. | |
2056 | ||
2057 | Note: User s may repe at these s teps to de fine diffe rent Billi ng Provide r Secondar y IDs for each divis ion if req uired by t he insuran ce company . | |
2058 | ||
2059 | Billing Pr ovider IDs (Parent) May 27, 2005@1 2:48:29 Pag e: 1 of 1 | |
2060 | Insurance Co: BLUE C ROSS OF CA LIFORNIA Billi ng Provide r Secondar y IDs | |
2061 | ID Qu alifier ID # Form Type | |
2062 | Division: Name of Ma in Divisio n/Default for All Di visions | |
2063 | 1 Blue Cross XX XXXX1A UB04 | |
2064 | 2 Blue Shield XX XXXX1B 1500 | |
2065 | ||
2066 | ||
2067 | ||
2068 | ||
2069 | Enter ?? f or more ac tions | |
2070 | Add an ID Addit ional IDs Exi t | |
2071 | Edit a n ID ID Pa rameters | |
2072 | Delete an ID VA-Lab/Fa cility IDs | |
2073 | ||
2074 | Select Act ion: Quit/ / a Add ID | |
2075 | Define Bil ling Provi der Second ary IDs by Care Unit s? No//No | |
2076 | Division: Main Divis ion// Remo te Clinic | |
2077 | ID Qualifi er: Electr onic Plan Type//Blue Shield | |
2078 | Enter Form Type for ID: CMS-15 00 | |
2079 | Billing Pr ovider Sec ondary ID: 1XXXXX1B | |
2080 | ||
2081 | The follow ing screen will disp lay. | |
2082 | ||
2083 | ||
2084 | Note: The two IDs fo r the Remo te Clinic division a re availab le to the clerk on B illing Scr een 3 for claims for services provided b y this div ision. | |
2085 | ||
2086 | ||
2087 | Billing Pr ovider IDs May 27, 20 05@12:48:2 9 Page: 1 of 1 | |
2088 | Insurance Co: BLUE C ROSS OF CA LIFORNIA Billing P rovider Se condary ID s | |
2089 | ID Qu alifier ID # Form Type | |
2090 | Division: Name of Ma in Divisio n/Default for All Di visions | |
2091 | 1 Blue Cross XX XXXX1A UB04 | |
2092 | 2 Blue Shield XX XXXX1B 1500 | |
2093 | ||
2094 | ||
2095 | Division: Remote Cli nic | |
2096 | 3 Blue Cross 1X XXXX1A UB04 | |
2097 | 4 Blue Shield 1X XXXX1B 1500 | |
2098 | ||
2099 | ||
2100 | ||
2101 | Enter ?? f or more ac tions | |
2102 | Add an ID Addit ional IDs Exi t | |
2103 | Edit a n ID ID Pa rameters | |
2104 | Delete an ID VA-Lab/Fa cility IDs | |
2105 | ||
2106 | Select Act ion: Quit/ / | |
2107 | Define Bil ling Provi der Second ary IDs by Division, Form Type and Care Unit | |
2108 | If an insu rance comp any requir es differe nt Billing Provider Secondary IDs for se rvices pro vided by p articular Care Units , users ca n define t hem by Div ision, For m Type, an d Care Uni t. | |
2109 | ||
2110 | Step | |
2111 | Procedure | |
2112 | 1 | |
2113 | Access the option MC CR SYSTEM DEFINITION MENUInsur ance Compa ny Entry/E dit. | |
2114 | 2 | |
2115 | At the Sel ect Insura nce Compan y Name: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple. | |
2116 | 3 | |
2117 | From the I nsurance C ompany Edi tor screen , enter th e action I D Prov IDs /ID Parame ters. | |
2118 | 4 | |
2119 | From the B illing Pro vider IDs screen, en ter the ac tion Add a n ID. | |
2120 | 5 | |
2121 | At the Def ine Billin g Provider Secondary IDs by Ca re Units? No// promp t, enter Y ES to over ride the d efault. | |
2122 | 6 | |
2123 | At the Div ision prom pt, press the <Enter > key to a ccept the default fo r the Main Division. | |
2124 | 7 | |
2125 | At the Car e Unit: pr ompt, ente r ?? to se e a pick l ist of ava ilable Car e Units. | |
2126 | ||
2127 | Refer to S ection 3.4 .2 to lear n how to c reate this list of a vailable C are Units. | |
2128 | 8 | |
2129 | At the Car e Unit: pr ompt, ente r Anesthes ia for thi s example. | |
2130 | 9 | |
2131 | At the ID Qualifier: Electroni c Plan Typ e// prompt , enter Bl ue Shield to overrid e the defa ult value for this e xample. | |
2132 | 10 | |
2133 | At the For m Type pro mpt, enter CMS-1500 for this e xample. | |
2134 | 11 | |
2135 | At the Bil ling Provi der Second ary ID pro mpt, enter the ID 11 XXXX1B for this exam ple. | |
2136 | 12 | |
2137 | Repeat the se steps f or the For m Type = U B-04, Qual ifier = Bl ue Cross a nd ID = 11 XXXX1A. | |
2138 | 13 | |
2139 | Repeat the se steps f or Care Un its Refere nce Lab an d Home Hea lth. | |
2140 | ||
2141 | ||
2142 | ||
2143 | ||
2144 | ||
2145 | ||
2146 | ||
2147 | Billing Pr ovider IDs May 27, 20 05@12:48:2 9 Page: 1 of 1 | |
2148 | Insurance Co: BLUE C ROSS OF CA LIFORNIA Billing P rovider Se condary ID s | |
2149 | ID Qu alifier ID # Form Type | |
2150 | Division: Name of Ma in Divisio n/Default for All Di visions | |
2151 | 1 Blue Cross XX XXXX1A UB04 | |
2152 | 2 Blue Shield XX XXXX1B 1500 | |
2153 | ||
2154 | Division: Remote Cli nic | |
2155 | 3 Blue Cross 1X XXXX1A UB04 | |
2156 | 4 Blue Shield 1X XXXX1B 1500 | |
2157 | ||
2158 | Enter ?? f or more ac tions | |
2159 | Add an ID Addit ional IDs Exi t | |
2160 | Edit a n ID ID Pa rameters | |
2161 | Delete an ID VA-Lab/Fa cility IDs | |
2162 | ||
2163 | Select Act ion: Quit/ / a Add ID | |
2164 | Define Bil ling Provi der Second ary IDs by Care Unit s? No//?? | |
2165 | ||
2166 | Enter N o to defin e a Billin g Provider Secondary ID | |
2167 | for the Division. | |
2168 | Enter Y es to defi ne a Billi ng Provide r Secondar y ID | |
2169 | for a s pecific Ca re Unit. | |
2170 | If no C are Unit i s entered on Billing Screen 3, the | |
2171 | Billing Provider Secondary ID defined for the D ivision wi ll | |
2172 | be tran smitted in the claim . | |
2173 | ||
2174 | 0 No | |
2175 | 1 Yes | |
2176 | Define Bil ling Provi der Second ary IDs by Care Unit s? No//1 Yes | |
2177 | Division: Main Divis ion// Main Division | |
2178 | Care Unit: ?? | |
2179 | Select a Care Uni t from the list: | |
2180 | 1 Anes thesia | |
2181 | 2 Referenc e Lab | |
2182 | 3 Home Hea lth | |
2183 | Care Unit: 1 Anest hesia | |
2184 | ID Qualifi er: Electr onic Plan Type//Blue Shield | |
2185 | Enter Form Type for ID: CMS-15 00 | |
2186 | Billing Pr ovider Sec ondary ID: 11XXXX1B | |
2187 | ||
2188 | ||
2189 | ||
2190 | ||
2191 | ||
2192 | ||
2193 | ||
2194 | ||
2195 | ||
2196 | ||
2197 | ||
2198 | ||
2199 | ||
2200 | ||
2201 | ||
2202 | ||
2203 | ||
2204 | ||
2205 | The follow ing screen will disp lay. | |
2206 | ||
2207 | Billing Pr ovider IDs May 27, 20 05@12:48:2 9 Page: 1 of 1 | |
2208 | Insurance Co: BLUE C ROSS OF CA LIFORNIA Billing P rovider Se condary ID s | |
2209 | ID Qu alifier ID # Form Type | |
2210 | Division: Name of Ma in Divisio n/Default for All Di visions | |
2211 | 1 Blue Cross XX XXXX1A UB04 | |
2212 | 2 Blue Shield XX XXXX1B 1500 | |
2213 | Care Unit : Anesthes ia | |
2214 | 3 Blue Cross 11 XXXX1A UB04 | |
2215 | 4 Blue Shield 11 XXXX1B 1500 | |
2216 | Care Unit : Referenc e Lab | |
2217 | 5 Blue Cross 12 XXXX1A UB04 | |
2218 | 6 Blue Shield 12 XXXX1B 1500 | |
2219 | Care Unit : Home Hea lth | |
2220 | 7 Blue Cross 13 XXXX1A UB04 | |
2221 | 8 Blue Shield 13 XXXX1B 1500 | |
2222 | + | |
2223 | Enter ?? f or more ac tions | |
2224 | Add an ID Addit ional IDs Exit | |
2225 | Edit a n ID ID Pa rameters | |
2226 | Delete an ID VA-Lab/Fa cility IDs | |
2227 | ||
2228 | Select Act ion: Quit/ / | |
2229 | ||
2230 | ||
2231 | If users w ant a defa ult Billin g Provider Secondary ID to pop ulate Bill ing Screen 3, define a default ID for th e division and defin e IDs for the divisi on and spe cific care units. U sers can t hen accept the defau lt ID or o verride it with one of the Car e Unit IDs during th e creation of a clai m. | |
2232 | Define Add itional Bi lling Prov ider Secon dary IDs b y Division and Form Type | |
2233 | In additio n to the B illing Pro vider Seco ndary ID t hat appear s on Billi ng Screen 3 for each insurance company o n the bill , there ca n be five additional Billing P rovider Se condary ID s that wil l be trans mitted wit h claims f or an insu rance comp any. | |
2234 | ||
2235 | Prior to P atch IB*2. 0*320, the IDs defin ed in IB S ite Parame ters, Sect ion 14 and Provider ID Mainten ance, Numb er 3, were transmitt ed with al l claims t o all paye rs. These options f or definin g IDs were removed w ith Patch IB*2.0*320 . | |
2236 | ||
2237 | If an insu rance comp any requir es additio nal Billin g Provider Secondary IDs, user s can defi ne them in Insurance Company E ntry/Edit. | |
2238 | ||
2239 | Step | |
2240 | Procedure | |
2241 | 1 | |
2242 | Access the option MC CR SYSTEM DEFINITION MENUInsur ance Compa ny Entry/E dit. | |
2243 | 2 | |
2244 | At the Sel ect Insura nce Compan y Name: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple. | |
2245 | 3 | |
2246 | From the I nsurance C ompany Edi tor screen , enter th e action: ID Prov ID s/ID Param . | |
2247 | 4 | |
2248 | From the B illing Pro vider IDs screen, en ter the ac tion Addit ional IDs. | |
2249 | 5 | |
2250 | From the B illing Pro vider IDs – Addition al Billing Provider Sec. IDs s creen, ent er the act ion Add an ID. | |
2251 | 6 | |
2252 | At the ID Qualifier: prompt, e nter Medic are for th is example . | |
2253 | ||
2254 | Note: Ther e cannot b e two Bill ing Provid er Seconda ry IDs on a claim wi th the sam e Qualifie r. If you enter an ID with th e same Qua lifier her e as one d efined und er Billing Provider Secondary IDs for th e Division on a clai m, the Add itional Bi lling Prov ider Secon dary ID wi th the sam e Qualifie r will not be transm itted on t he claim. | |
2255 | 7 | |
2256 | At the For m Type pro mpt, enter CMS-1500 for this e xample. | |
2257 | 9 | |
2258 | At the Bil ling Provi der Second ary ID pro mpt, enter the ID 14 XXXX1C for this exam ple. | |
2259 | 10 | |
2260 | Repeat the se steps f or the For m Type = U B-04, Qual ifier = Me dicare, ID = 14XXXX1 C. | |
2261 | ||
2262 | Note: User s can repe at these s teps to de fine multi ple additi onal Billi ng Provide r Secondar y IDs if required b y the insu rance comp any. | |
2263 | ||
2264 | Billing Pr ovider IDs (Parent) May 27, 20 05@12:48:2 9 Page: 1 of 1 | |
2265 | Insurance Co: BLUE C ROSS OF CA LIFORNIA Additional Billing P rovider Se c. IDs | |
2266 | ID Qu alifier ID # Form Type | |
2267 | ||
2268 | No Additio nal Billin g Provider IDs found | |
2269 | ||
2270 | ||
2271 | ||
2272 | ||
2273 | ||
2274 | Enter ?? f or more ac tions | |
2275 | Add an ID Delete an ID Exit | |
2276 | Edit a n ID Copy I Ds | |
2277 | ||
2278 | Select Act ion: Quit/ / Add an I D | |
2279 | Type of ID : Medicare | |
2280 | Form Type: 1500 | |
2281 | Billing Pr ovider Sec ondary ID: 14XXXX1C | |
2282 | ||
2283 | The follow ing screen will disp lay. | |
2284 | ||
2285 | Billing Pr ovider IDs (Parent) May 27, 20 05@12:48:2 9 Page: 1 of 1 | |
2286 | Insurance Co: BLUE C ROSS OF CA LIFORNIA Additional Billing P rovider Se c. IDs | |
2287 | ID Qu alifier ID # Form Type | |
2288 | Division: Name of Ma in Divisio n/Default for All Di visions | |
2289 | 1 Medic are 14XXXX1 C UB04 | |
2290 | 2 Medic are 14XXXX1 C 1500 | |
2291 | ||
2292 | ||
2293 | ||
2294 | ||
2295 | ||
2296 | Enter ?? f or more ac tions | |
2297 | Add an ID Delete an ID Exit | |
2298 | Edit a n ID Copy I Ds | |
2299 | ||
2300 | Select Act ion: Quit/ / Add an I D | |
2301 | Type of ID : Medicare | |
2302 | Form Type: UB-04 | |
2303 | Billing Pr ovider Sec ondary ID: XXXXXXX11 | |
2304 | Service Fa cility IDs (Laborato ry or Faci lity IDs) | |
2305 | The 837 cl aims trans mission re cords cont ain Servic e Facility data like the name and addres s of a fac ility and primary an d secondar y IDs for that facil ity. Ofte n this is an outside , non-VA f acility. T hese IDs a re called the Labora tory or Fa cility Pri mary ID an d the Labo ratory or Facility S econdary I Ds. | |
2306 | ||
2307 | If there i s a non-VA facility on a claim because a veteran r eceived ca re at an o utside lab oratory or a private hospital or clinic, an insura nce compan y can requ ire the cl aim to con tain prima ry and sec ondary Lab oratory or Facility IDs for th e organiza tion that provided t he care. | |
2308 | ||
2309 | If there i s not an o utside fac ility on a claim, bu t the care was provi ded by the VA at a f acility su ch as a Mo bile clini c, an insu rance comp any can re quire the claim to c ontain pri mary and s econdary L aboratory or Facilit y IDs for the clinic . | |
2310 | ||
2311 | Patch IB*2 .0*320 pro vided enha ncements t o allow us ers to mor e easily d efine Labo ratory or Facility I Ds for the VA or non -VA. | |
2312 | ||
2313 | Beginning with Patch es IB*2.0* 348 and 34 9, the Ser vice Facil ity NPI wi ll be prin ted on loc ally print ed CMS-150 0 claims. | |
2314 | ||
2315 | Beginning with Patch IB*2.0*40 0, the Ser vice Facil ity loop w ill not be populated if the ca re was pro vided at a VA locati on that ha s an NPI s uch as a C BOC, VAMC or Pharmac y. | |
2316 | ||
2317 | The non-VA Service F acility NP I and Taxo nomy Code will be en tered and maintained by Billin g personne l. | |
2318 | Define Non -VA Labora tory or Fa cility Pri mary IDs/N PI | |
2319 | For outsid e, non-VA facilities such as a n independ ent labora tory, the Laboratory or Facili ty Primary ID should be the en tity’s NPI . | |
2320 | ||
2321 | In additio n to the F ederal Tax ID, an NP I and one or more Ta xonomy Cod es can be defined fo r outside, non-VA fa cilities. | |
2322 | ||
2323 | Step | |
2324 | Procedure | |
2325 | 1 | |
2326 | Access the option MC CR SYSTEM DEFINITION MENUProvi der ID Mai ntenance. | |
2327 | 2 | |
2328 | At the Sel ect Provid er ID Main tenance Op tion: prom pt, enter NF for Non -VA Facili ty. | |
2329 | 3 | |
2330 | At the Sel ect a NON/ Other VA P rovider: p rompt, ent er IB Outs ide Facili ty for thi s example. | |
2331 | 4 | |
2332 | From the N on-VA Lab or Facilit y Info scr een, enter the actio n FI for L ab/Facilit y Info. | |
2333 | 5 | |
2334 | At the Str eet Addres s: prompt, enter 123 Westbend Street for this exam ple. | |
2335 | ||
2336 | Effective with Patch IB*2*488, only a ph ysical str eet addres s may be e ntered (no post offi ce box). A ny entry t hat begins with “P.O .” or “PO” or “Box” is prohibi ted. | |
2337 | 6 | |
2338 | At the Str eet Addres s Line 2: prompt, pr ess the <E nter> key to leave b lank. | |
2339 | 7 | |
2340 | At the Cit y prompt, enter Long Beach for this exam ple. | |
2341 | 8 | |
2342 | At the Sta te: prompt , enter Ca lifornia f or this ex ample. | |
2343 | 9 | |
2344 | At the Zip Code prom pt, enter 920601234 for this e xample. | |
2345 | ||
2346 | Effective with Patch IB*2*488, only a 9- or 10-dig it ZIP cod e may be e ntered: 99 9999999/99 999-9999. | |
2347 | ||
2348 | With 5010, claims mu st be subm itted with a street address an d a full n ine-digit zip code w hen report ing a non- VA service facility locations | |
2349 | 10 | |
2350 | At the Con tact Name: prompt, e nter IB,CO NTACT O fo r this exa mple. | |
2351 | 11 | |
2352 | At the Con tact Phone Number: p rompt, ent er 703-333 -3333 for this examp le. | |
2353 | 12 | |
2354 | At the Con tact Phone Extension : prompt, enter 1234 78. | |
2355 | 13 | |
2356 | At the ID Qualifier: prompt, p ress the < Enter> key to accept the defau lt. | |
2357 | 14 | |
2358 | At the Lab or Facili ty Primary ID: promp t, enter 1 11111112. | |
2359 | 15 | |
2360 | At the X12 Type of F acility: p rompt, ent er FA - Fa cility for this exam ple. | |
2361 | ||
2362 | With Patch IB*2*371, FA will b e sent as the Type o f Facility on all in stitutiona l claims r egardless of what is defined. HIPAA onl y allows F A on insti tutional c laims. | |
2363 | 16 | |
2364 | At the Mam mography C ertificati on Number: prompt, p ress the < Enter> key to leave it blank. If you kn ow the Mam mography n umber you can enter it here. | |
2365 | 17 | |
2366 | At the NPI : prompt, enter XXXX XXXXXX for this exam ple. | |
2367 | ||
2368 | Note: With Patch IB* 2*516, use rs will ha ve the abi lity to de fine a Non -VA Facili ty as a so le-proprie torship an d link it to a human provider. If a fac ility is l inked to a human pro vider, the n the huma n’s NPI ma y be used for both t he human a nd the fac ility. The individua l provider must be d efined in VistA befo re he/she can be lin ked to the facility. | |
2369 | 18 | |
2370 | At the Sel ect Taxono my Code: p rompt, ent er 954 for this exam ple. | |
2371 | 19 | |
2372 | At the OK? Prompt, p ress the < Enter> key to accept the defau lt. | |
2373 | 20 | |
2374 | At the Are you addin g 'General Acute Car e Hospital ' as a new TAXONOMY CODE (the 1ST for th is IB NON/ OTHER VA B ILLING PRO VIDER)? No // prompt, enter Yes . | |
2375 | 21 | |
2376 | At the Pri mary Code: prompt, e nter Yes f or this ex ample. | |
2377 | 22 | |
2378 | At the Sta tus: promp t, enter A ctive. | |
2379 | 23 | |
2380 | At the Sel ect Taxono my Code: p rompt, pre ss the <En ter> key. | |
2381 | ||
2382 | Note: With Patch IB* 2*432, the ability t o define t he name of a contact person at the outsi de facilit y and the telephone number for that pers on will be available to users. | |
2383 | 24 | |
2384 | At the All ow future updates by FEE BASIS automatic interface ? YES// pr ompt, pres s the <Ent er> key to accept th e default. (Note: Th is questio n does not impact cu rrent func tionality as this is part of F uture Deve lopment) | |
2385 | ||
2386 | STREET ADD RESS: 123 Test Stree t | |
2387 | STREET ADD RESS LINE 2: | |
2388 | CITY: CHEY ENNE// Lon g Beach | |
2389 | STATE: CAL IFORNIA | |
2390 | ZIP CODE: 920601234/ / | |
2391 | CONTACT NA ME: IB,CON TACT O// | |
2392 | CONTACT PH ONE NUMBER : 703-333- 3333// | |
2393 | CONTACT PH ONE EXTENS ION: 12347 8// | |
2394 | ID Qualifi er: 24 - E MPLOYER'S IDENTIFICA TION # | |
2395 | Lab or Fac ility Prim ary ID: 11 1111112// | |
2396 | X12 TYPE O F FACILITY : FACILITY // | |
2397 | MAMMOGRAPH Y CERTIFIC ATION #: | |
2398 | SOLE PROPR IETORSHIP? : NO | |
2399 | NPI: XXXXX XXXXX | |
2400 | Select TAX ONOMY CODE : 954 Gen eral Acute Care Hosp ital 2 82N000 | |
2401 | 00X | |
2402 | . ..OK? Yes/ / (Yes) | |
2403 | ||
2404 | Are you adding 'Ge neral Acut e Care Hos pital' as | |
2405 | a new TAXONOMY C ODE (the 1 ST for thi s IB NON/O THER VA BI LLING PROV IDER)? No/ | |
2406 | / y (Yes) | |
2407 | PRIMARY CODE: y Y ES | |
2408 | STATUS: a ACTIVE | |
2409 | Select TAX ONOMY CODE : | |
2410 | ||
2411 | The follow ing screen will disp lay. | |
2412 | ||
2413 | Non-VA Lab or Facili ty Info Jul 05, 20 126@16:04: 07 Page: 1 of 1 | |
2414 | ||
2415 | ||
2416 | N ame: IB OU TSIDE FACI LITY | |
2417 | Addr ess: 123 T est Street | |
2418 | Long Beach, CAL IFORNIA 9 2060 | |
2419 | Contact N ame: IB,CO NTACT O | |
2420 | Contact Ph one: 703-3 33-3333 1 23478 | |
2421 | ||
2422 | Type of Facility: FACILITY | |
2423 | Pr imary ID: 111111112 | |
2424 | ID Q ualifier: 24 - EMPLO YER'S IDEN TIFICATION # | |
2425 | Mammograp hy Certifi cation #: | |
2426 | NPI: XXXXXXXXXX | |
2427 | Taxon omy Code: 261QV0200X (Primary) | |
2428 | ||
2429 | Allow f uture upda tes by FEE BASIS aut omatic int erface? : YES | |
2430 | ||
2431 | ||
2432 | Enter ?? f or more ac tions | |
2433 | FI Lab/F acility In fo LI Lab/F acility In s ID | |
2434 | LO Lab/F acility Ow n ID EX Exit | |
2435 | Select Act ion: Quit/ / | |
2436 | Define Non -VA Labora tory or Fa cility Sec ondary IDs | |
2437 | For outsid e, non-VA facilities , users ca n define m ultiple La boratory o r Facility Secondary IDs. The se IDs can be either the facil ity’s own IDs, such as a Clini cal Labora tory Impro vement Ame ndment (CL IA) number , or IDs a ssigned to the facil ity by an insurance company. | |
2438 | Define a n on-VA Faci lity’s Own Laborator y or Facil ity Second ary IDs | |
2439 | ||
2440 | Step | |
2441 | Procedure | |
2442 | 1 | |
2443 | Access the option MC CR System Definition MenuProvi der ID Mai ntenance. | |
2444 | 2 | |
2445 | At the Sel ect Provid er ID Main tenance Op tion: prom pt, enter NF for Non -VA Facili ty. | |
2446 | 3 | |
2447 | From the N on-VA Lab or Facilit y Info scr een, enter the actio n LO for Lab/Facili ty Own ID. | |
2448 | 4 | |
2449 | From the S econdary P rovider ID screen, e nter the a ction AI f or Add an ID. | |
2450 | 5 | |
2451 | At the Ent er Provide r ID Quali fier promp t, enter X 5 CLIA Num ber for th is example . | |
2452 | 6 | |
2453 | At the For m Type App lied to: p rompt, ent er CMS-150 0 FORMS ON LY for thi s example. | |
2454 | 7 | |
2455 | At the Car e Type: pr ompt, ente r OUTPATIE NT ONLY fo r this exa mple. | |
2456 | 8 | |
2457 | At the Ent er Lab or Facility S econdary I D prompt, enter DXXX XX for thi s example. | |
2458 | ||
2459 | Note: User s may repe at these s teps to de fine more Laboratory or Facili ty Seconda ry IDs. | |
2460 | ||
2461 | Secondary Provider I D May 11, 20 05@11:17:2 0 Page: 1 of 1 | |
2462 | ** Lab or Facility’ s Own IDs (No Specif ic Insuran ce Co) ** | |
2463 | ||
2464 | Provider: IB Outside Facility (Non-VA La b or Facil ity) | |
2465 | ||
2466 | ID Qualifi er For m Care T ype ID# | |
2467 | No ID's f ound for p rovider | |
2468 | ||
2469 | ||
2470 | Enter ?? f or more ac tions | |
2471 | AI Add a n ID DI Delet e an ID | |
2472 | EI Edit an ID EX Exit | |
2473 | Select Act ion: Quit/ / AI Add a n ID | |
2474 | Select Pro vider ID Q ualifier: X5 CLIA Nu mber | |
2475 | FORM TYPE APPLIED TO : CMS-1500 FORMS ONL Y | |
2476 | BILL CARE TYPE: OUTP ATIENT ONL Y | |
2477 | ||
2478 | THE FOLLOW ING WAS CH OSEN: | |
2479 | INSURAN CE: ALL IN SURANCE | |
2480 | PROV TY PE: CLIA # | |
2481 | FORM TY PE: CMS-15 00 FORM ON LY | |
2482 | CARE TY PE: OUTPAT IENT ONLY | |
2483 | ||
2484 | Provider I D: DXXXXX | |
2485 | The follow ing screen will disp lay. | |
2486 | ||
2487 | Secondary Provider I D May 11, 20 05@11:17:2 0 Page: 1 of 1 | |
2488 | ** Lab or Facility’ s Own IDs (No Specif ic Insuran ce Co) ** | |
2489 | ||
2490 | Provider: IB Outside Facility (Non-VA La b or Facil ity) | |
2491 | ||
2492 | ID Qu alifierFor mCare Type ID# | |
2493 | 1 CLIA # 1500 OUTPTDXXXX X | |
2494 | ||
2495 | ||
2496 | ||
2497 | ||
2498 | ||
2499 | Enter ?? f or more ac tions | |
2500 | AI Add a n ID DI Delet e an ID | |
2501 | EI Edit an ID EX Exit | |
2502 | Select Act ion: Quit/ / | |
2503 | Define a n on-VA Faci lity’s Lab oratory or Facility Secondary IDs Assign ed by an I nsurance C ompany | |
2504 | ||
2505 | Step | |
2506 | Procedure | |
2507 | 1 | |
2508 | Access the option MC CR SYSTEM DEFINITION MENUProvi der ID Mai ntenance. | |
2509 | 2 | |
2510 | At the Sel ect Provid er ID Main tenance Op tion: prom pt, enter NF for Non -VA Facili ty. | |
2511 | 3 | |
2512 | From the N on-VA Lab or Facilit y Info scr een, enter the actio n LI for L ab/Facilit y Ins ID. | |
2513 | 4 | |
2514 | From the S econdary P rovider ID screen, e nter the a ction AI f or Add an ID. | |
2515 | 5 | |
2516 | At the Ent er Provide r ID Quali fier promp t, enter B lue Shield for this example. | |
2517 | 6 | |
2518 | At the For m Type App lied to: p rompt, ent er CMS-150 0 FORMS ON LY for thi s example. | |
2519 | 7 | |
2520 | At the Car e Type: pr ompt, ente r BOTH for this exam ple. | |
2521 | 8 | |
2522 | At the Ent er Lab or Facility S econdary I D prompt, enter 111X XX1B for t his exampl e. | |
2523 | ||
2524 | Note: User s may repe at these s teps to de fine more Laboratory or Facili ty Seconda ry IDs. A maximum o f 5 Labora tory or Fa cility Sec ondary IDs can be de fined per insurance company. A maximum of 5 Labor atory or F acility Se condary ID s can be t ransmitted in a clai m. | |
2525 | ||
2526 | Secondary Provider I D May 11, 20 05@11:17:2 0 Page: 1 of 1 | |
2527 | ** Lab or Facility S econdary I Ds from In surance Co ** | |
2528 | ||
2529 | Provider: IB Outside Facility (Non-VA La b or Facil ity) | |
2530 | Insurance Co: BLUE C ROSS OF CA LIFORNIA | |
2531 | ||
2532 | ID Qu alifier Form C are Type ID# | |
2533 | ||
2534 | No ID's found for provider a nd selecte d insuranc e co | |
2535 | ||
2536 | ||
2537 | ||
2538 | Enter ?? f or more ac tions | |
2539 | AI Add a n ID DI Delet e an ID | |
2540 | EI Edit an ID EX Exit | |
2541 | Select Act ion: Quit/ / AI Add an ID | |
2542 | Select Pro vider ID Q ualifier: BLUE SHIEL D ID | |
2543 | FORM TYPE APPLIED TO : 1500 FOR MS ONLY | |
2544 | BILL CARE TYPE: b B OTH INPATI ENT AND OU TPATIENT | |
2545 | ||
2546 | THE FOLLOW ING WAS CH OSEN: | |
2547 | INSURAN CE: BLUE C ROSS OF CA LIFORNIA | |
2548 | PROV TY PE: BLUE S HIELD ID | |
2549 | FORM TY PE: 1500 F ORM ONLY | |
2550 | CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT | |
2551 | ||
2552 | Provider I D: 111XXX1 B | |
2553 | ||
2554 | The follow ing screen will disp lay. | |
2555 | ||
2556 | Secondary Provider I D May 11, 20 05@11:17:2 0 Page: 1 of 1 | |
2557 | ** Lab or Facility S econdary I Ds from In surance Co ** | |
2558 | ||
2559 | Provider: IB Outside Facility (Non-VA La b or Facil ity) | |
2560 | Insurance Co: BLUE C ROSS OF CA LIFORNIA | |
2561 | ||
2562 | ID Qu alifier Form C are Type ID# | |
2563 | 1 BLUE SHIELD ID 1500 I NPT/OUTPT 111XXX1B | |
2564 | ||
2565 | ||
2566 | ||
2567 | ||
2568 | Enter ?? f or more ac tions | |
2569 | AI Add a n ID DI Delet e an ID | |
2570 | EI Edit an ID EX Exit | |
2571 | Select Act ion: Quit/ / | |
2572 | Define VA Laboratory or Facili ty Primary IDs/NPI | |
2573 | The VA Ser vice Facil ity NPI an d Taxonomy Code will not be en tered or m aintained by Billing personnel . Beginni ng with Pa tch IB*2.0 *400, only those VA locations for which no NPI num bers were obtained, (i.e. MORC , CMOP) wi ll populat e the Serv ice Facili ty. Becau se of this , there wi ll usually be no VA Laboratory or Facili ty NPI in the 837 cl aim transm ission. | |
2574 | Define VA Laboratory or Facili ty Seconda ry IDs | |
2575 | For each i nsurance c ompany, us ers can de fine multi ple Labora tory or Fa cility Sec ondary IDs for the V A by divis ion and fo rm type. | |
2576 | ||
2577 | Step | |
2578 | Procedure | |
2579 | 1 | |
2580 | Access the option Pa tient Insu rance Menu ... Insur ance Compa ny Entry/E dit. | |
2581 | 2 | |
2582 | At the Sel ect Insura nce Compan y Name: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple. | |
2583 | 3 | |
2584 | From the I nsurance C ompany Edi tor screen , enter th e action I D Prov IDs /ID Parame ters. | |
2585 | 4 | |
2586 | From the B illing Pro vider IDs screen, en ter the ac tion VA-La b/Facility IDs. | |
2587 | 5 | |
2588 | From the V A-Lab/Faci lity IDs s creen, ent er the act ion Add an ID. | |
2589 | 6 | |
2590 | At the Div ision prom pt, accept the defau lt for the main Divi sion. | |
2591 | 7 | |
2592 | At the ID Qualifier: prompt, e nter Blue Shield for this exam ple. | |
2593 | 8 | |
2594 | At the For m Type pro mpt, enter CMS-1500 for this e xample. | |
2595 | 9 | |
2596 | At the VA Lab or Fac ility Seco ndary ID p rompt, ent er the ID 1212XX1B f or this ex ample. | |
2597 | 10 | |
2598 | Repeat the se steps f or the For m Type = U B-04, Qual ifier = Bl ue Cross a nd ID = 12 12XX1A. | |
2599 | 11 | |
2600 | Repeat the se steps f or the For m Type = U B-04, Qual ifier = Co mmercial a nd ID = 13 13XXG2. | |
2601 | ||
2602 | Note: User s may repe at these s teps to de fine more Laboratory or Facili ty Seconda ry IDs. A maximum o f 5 Labora tory or Fa cility Sec ondary IDs can be de fined per division, form and i nsurance c ompany. | |
2603 | ||
2604 | VA-Lab/Fac ility IDs May 27 , 2005@12: 48:29 Page: 1 of 1 | |
2605 | Insurance Co.: BLUE CROSS OF C ALIFORNIA | |
2606 | ||
2607 | VA-Lab/Fac ility Prim ary ID: XX 123456 | |
2608 | ||
2609 | VA-Lab/Fac ility Seco ndary IDs | |
2610 | ID Qual ifier I D # Form Type | |
2611 | ||
2612 | No Laborat ory or Fac ility IDs found | |
2613 | ||
2614 | ||
2615 | ||
2616 | ||
2617 | Enter ?? f or more ac tions | |
2618 | Add an ID Delete an ID | |
2619 | Edit a n ID Exit | |
2620 | ||
2621 | Select Act ion: Add a n ID | |
2622 | ||
2623 | The follow ing screen will disp lay. | |
2624 | ||
2625 | VA-Lab/Fac ility IDs May 27 , 2005@12: 48:29 Page: 1 of 1 | |
2626 | Insurance Co.: BLUE CROSS OF C ALIFORNIA | |
2627 | ||
2628 | VA-Lab/Fac ility Prim ary ID: Fe deral Tax ID | |
2629 | ||
2630 | VA-Lab/Fac ility Seco ndary IDs | |
2631 | ID Qu alifier ID# Form Type | |
2632 | Division: Name of Ma in Divisio n/Default for All Di visions | |
2633 | 1 Blue Cross 1212XX1 A UB04 | |
2634 | 2 Blue Shield 1212XX1 B 1500 | |
2635 | ||
2636 | Division: CBOC | |
2637 | 3 Comme rcial 1313XXG 2 UB04 | |
2638 | ||
2639 | ||
2640 | Enter ?? f or more ac tions | |
2641 | Add an ID Delete an ID | |
2642 | Edit a n ID Exit | |
2643 | ||
2644 | Select Act ion: Edit/ / | |
2645 | Attending, Operating and Other Physician s and Rend ering, Ref erring and Supervisi ng Provide rs | |
2646 | A physicia n can appe ar on a UB -04 claim form as an Attending , Operatin g or Other Operating Physician . Beginni ng with Pa tch IB*2*4 32, Render ing and Re ferring Pr oviders ca n also be added to a n Institut ional clai m. A hea lthcare pr ovider (ph ysician, n urse, phys ical thera pist, etc. ) can appe ar on a 15 00 claim f orm as a R endering, Referring or Supervi sing Provi der. Begin ning with Patch IB*2 *592 and t he introdu ction of t he Dental claim, an Assistant Surgeon ca n be added to a clai m for dent al service s. Dental claims are a type of professio nal claim and can ha ve a Rende ring or As sistant Su rgeon and/ or a Refer ring and S upervising Provider. | |
2647 | ||
2648 | All of the se healthc are provid ers have a primary I D. Their primary ID is their NPI. Thes e physicia ns/provide rs can als o have mul tiple seco ndary IDs that are e ither thei r own IDs, or IDs pr ovided by an insuran ce company . | |
2649 | ||
2650 | The VA Phy sician’s o r Provider ’s NPI is stored in the New Pe rson file. This fil e is not m aintained by Billing personnel . The Non -VA Physic ian’s or P rovider’s NPI is def ined in Pr ovider ID Maintenanc e. | |
2651 | ||
2652 | A human pr ovider’s N PI is tran smitted in the 837 H ealth Care Claim tra nsmission, and since Patches I B*2.0*348 and 349 it is printe d on local ly printed claim for ms. | |
2653 | ||
2654 | All of the se types o f healthca re provide rs can be either VA or non-VA employees. | |
2655 | Define a V A Physicia n/Provider ’s Primary ID/NPI | |
2656 | The VA Phy sician’s o r Provider ’s SSN and NPI are s tored in t he New Per son file ( #200). Th ese IDs sh ould be en tered when the user is origina lly added to the sys tem. The provider’s Taxonomy code is en tered alon g with the Person Cl ass. | |
2657 | ||
2658 | ||
2659 | Note: Beg inning wit h Patch IB *2*432, SS Ns will co ntinue to be defined in the Ne w Person f ile for VA Providers and users may conti nue to def ine SSNs a s secondar y IDs for non-VA pro viders but VistA wil l no longe r transmit SSNs as h uman provi ders’ Prim ary IDs. There will no longer be a edit check in Enter/Edit Billing I nformation to insure that a pr ovider’s S SN is avai lable. | |
2660 | ||
2661 | Define a V A Physicia n/Provider ’s Seconda ry IDs | |
2662 | Physicians and Provi ders can h ave both t heir own I D, such as a state m edical lic ense, and an ID prov ided by an insurance company. | |
2663 | Define a V A Physicia n/Provider ’s Own Sec ondary IDs | |
2664 | Physicians and other healthcar e provider s are assi gned IDs t hat identi fy them. These IDs include an NPI which serves as their pri mary ID. In additio n to their NPI, they may also have one o r more of the follow ing types of seconda ry IDs: | |
2665 | OB – State License N umber | |
2666 | EI – EIN | |
2667 | SY – SSN (VA SSNs are define d in the N ew Person file) | |
2668 | X5 – State Industria l Accident Provider Number | |
2669 | 1G – UPIN Number | |
2670 | ||
2671 | Step | |
2672 | Procedure | |
2673 | 1 | |
2674 | Access the option MC CR SYSTEM DEFINITION MENUProvi der ID Mai ntenance. | |
2675 | 2 | |
2676 | At the Sel ect Provid er ID Main tenance Op tion: prom pt, enter PO for Pro vider Own IDs. | |
2677 | 3 | |
2678 | At the (V) A or (N)on -VA provid er: V//: p rompt, pre ss the <En ter> key t o accept t he default . | |
2679 | 4 | |
2680 | At the Sel ect V.A. P ROVIDER NA ME: prompt , enter IB ,DOCTOR 1. | |
2681 | ||
2682 | This scree n can be a ccessed th rough the MCCR Syste m Definiti on Menu. U sers must hold the I B PROVIDER EDIT secu rity key t o access t his option . | |
2683 | ||
2684 | Note: With Patch IB* 2*447, IB will preve nt the use r from aut horizing a claim in which a hu man provid er has an EIN or SSN consistin g of anyth ing other than nine digits. | |
2685 | ||
2686 | Provider I D Maintena nce Main M enu | |
2687 | ||
2688 | Enter a code fro m the list . | |
2689 | ||
2690 | Prov ider IDs | |
2691 | PO Provid er Own IDs | |
2692 | PI Provid er Insuran ce IDs | |
2693 | ||
2694 | Insu rance IDs | |
2695 | BI Batch ID Entry | |
2696 | II Insura nce Co IDs | |
2697 | ||
2698 | Care Units | |
2699 | CP Care U nits for P roviders | |
2700 | CB Care U nits for B illing Pro vider | |
2701 | ||
2702 | Non- VA Items | |
2703 | NP Non-VA Provider | |
2704 | NF Non-VA Facility | |
2705 | ||
2706 | Select Provider ID Mainten ance Optio n: PO Pro vider Own IDs | |
2707 | ||
2708 | (V)A or (N )on-VA pro vider: V// A PROVIDE R | |
2709 | Select V.A . PROVIDER NAME:IB,D OCTOR 1 | |
2710 | ||
2711 | Step | |
2712 | Procedure | |
2713 | 6 | |
2714 | At the Sel ect Action : prompt, enter AI f or Add an ID. | |
2715 | 7 | |
2716 | At the Sel ect ID Qua lifier: p rompt, ent er State L icense for this exam ple. | |
2717 | 8 | |
2718 | At the Sel ect LICENS ING STATE: prompt, e nter Calif ornia for this examp le. | |
2719 | 9 | |
2720 | When asked if you ar e entering Californi a as the 1 st state f or this pr ovider, en ter Yes. | |
2721 | 10 | |
2722 | At the LIC ENSING STA TE: prompt , press th e <Enter> key to acc ept the de fault. | |
2723 | 11 | |
2724 | At the LIC ENSING NUM BER: promp t, enter X XXXSTATE f or this ex ample. | |
2725 | ||
2726 | Physician/ Provider I D Nov 02, 2005@ 10:24:46 Pa ge: 1 o f 1 | |
2727 | ** Phy sician/Pro vider's Ow n IDs (No Specific I nsurance C o) ** | |
2728 | Provider : IB,DOC TORB (VA P ROVIDER) | |
2729 | ||
2730 | ID Qu alifier Form Care Type Ca re Unit ID# | |
2731 | ||
2732 | No ID's found for provider | |
2733 | ||
2734 | ||
2735 | Enter ?? f or more ac tions | |
2736 | AI Add a n ID DI Delet e an ID | |
2737 | EI Edit an ID EX Exit | |
2738 | Select Act ion: Quit/ / AI Add an ID | |
2739 | Select ID Qualifier: ?? | |
2740 | ||
2741 | Choose from: | |
2742 | EIN EI | |
2743 | SOCIAL SECURITY N UMBER SY | |
2744 | STATE I NDUSTRIAL ACCIDENT P ROV X5 | |
2745 | STATE L ICENSE 0B | |
2746 | UPIN 1G | |
2747 | ||
2748 | Enter the Qualifier that ident ifies the type of ID . | |
2749 | ||
2750 | Select Pro vider ID T ype: 0B S tate Licen se | |
2751 | Select LIC ENSING STA TE: CALIFO RNIA | |
2752 | Are you adding 'CA LIFORNIA' as a new L ICENSING S TATE (the 1ST for th is NEW PER | |
2753 | SON)? No// y (Yes) | |
2754 | LICENSING STATE: CAL IFORNIA// | |
2755 | LICENSE NU MBER: XXXX STATE | |
2756 | ||
2757 | The follow ing screen will disp lay. | |
2758 | ||
2759 | Physician/ Provider I D Nov 02, 2005@ 10:24:46 Pa ge: 1 o f 1 | |
2760 | ** Phy sician/Pro vider's Ow n IDs (No Specific I nsurance C o) ** | |
2761 | Provider : IB,DOC TORB (VA P ROVIDER) | |
2762 | ||
2763 | ID Qu alifier Form Care Type Ca re Unit ID# | |
2764 | 1 CA STA TE LICENSE # XXXXST ATE | |
2765 | ||
2766 | ||
2767 | ||
2768 | ||
2769 | ||
2770 | Enter ?? f or more ac tions | |
2771 | AI Add a n ID DI Delet e an ID | |
2772 | EI Edit an ID EX Exit | |
2773 | Select Act ion: Quit/ / | |
2774 | Define a V A Physicia n/Provider ’s Insuran ce Company Secondary IDs | |
2775 | Physicians and other healthcar e provider s can be a ssigned se condary ID s by insur ance compa nies. Som e insuranc e companie s assign o ne ID to b e used by every phys ician/prov ider at a site. Oth er insuran ce compani es assign each physi cian/provi der his or her own I D. In add ition to t heir NPI, they may a lso have o ne or more of the fo llowing ty pes of sec ondary IDs : | |
2776 | 1A - Blue Cross | |
2777 | 1B - Blue Shield | |
2778 | 1C - Medic are | |
2779 | 1H - CHAMP US | |
2780 | G2 - Comme rcial | |
2781 | LU - Locat ion # | |
2782 | N5 - Provi der Plan N etwork | |
2783 | 1G - UPIN | |
2784 | ||
2785 | Step | |
2786 | Procedure | |
2787 | 1 | |
2788 | Access the option MC CR SYSTEM DEFINITION MENUProvi der ID Mai ntenance. | |
2789 | 2 | |
2790 | At the Sel ect Provid er ID Main tenance Op tion: prom pt, enter PI for Pro vider Insu rance IDs. | |
2791 | 3 | |
2792 | At the (V) A or (N)on -VA provid er: V//: p rompt, pre ss the <En ter> key t o accept t he default . | |
2793 | 4 | |
2794 | At the Sel ect V.A. P ROVIDER NA ME: prompt , enter IB ,DOCTOR 1. | |
2795 | 5 | |
2796 | At the Sel ect Insura nce Co.: p rompt, ent er Blue Cr oss of Cal ifornia fo r this exa mple. | |
2797 | ||
2798 | Provider I D Maintena nce Main M enu | |
2799 | ||
2800 | Enter a code fro m the list . | |
2801 | ||
2802 | Prov ider IDs | |
2803 | PO Provid er Own IDs | |
2804 | PI Provid er Insuran ce IDs | |
2805 | ||
2806 | Insu rance IDs | |
2807 | BI Batch ID Entry | |
2808 | II Insura nce Co IDs | |
2809 | ||
2810 | Care Units | |
2811 | CP Care U nits for P roviders | |
2812 | CB Care U nits for B illing Pro vider | |
2813 | ||
2814 | Non- VA Items | |
2815 | NP Non-VA Provider | |
2816 | NF Non-VA Facility | |
2817 | ||
2818 | Select Provider ID Mainten ance Optio n: PI Prov ider Insur ance IDs | |
2819 | ||
2820 | (V)A or ( N)on-VA pr ovider: V/ / A PROVID ER | |
2821 | Select V.A . PROVIDER NAME:IB,D OCTOR 1 | |
2822 | Select INS URANCE CO: BLUE CROS S OF CALIF ORNIA | |
2823 | ||
2824 | Step | |
2825 | Procedure | |
2826 | 6 | |
2827 | At the Sel ect Action : prompt, enter AI f or Add an ID. | |
2828 | 7 | |
2829 | At the Sel ect ID Qua lifier: pr ompt, ente r 1B – Blu e Shield f or this ex ample. | |
2830 | 8 | |
2831 | At the FOR M TYPE APP LIED TO: p rompt, ent er CMS-150 0 Only for this exam ple. | |
2832 | 9 | |
2833 | At the BIL L CARE TYP E: prompt, enter 0 f or this ex ample. | |
2834 | 10 | |
2835 | At the CAR E UNIT: pr ompt, ente r Surgery for this e xample. | |
2836 | 11 | |
2837 | At the PRO VIDER ID: prompt, en ter XXXXBS HIELD for this examp le. | |
2838 | ||
2839 | Defining a n insuranc e company provided I D for a pa rticular C are Unit i s only nec essary whe n the insu rance comp any assign s physicia n/provider IDs by ca re unit. | |
2840 | ||
2841 | Users can repeat the se steps f or this Ph ysician/Pr ovider add ing more I Ds from th is insuran ce company or change insurance company o r change p hysician/p rovider. R efer to Se ction 3.7 to learn about copy ing IDs to multiple insurance companies. | |
2842 | ||
2843 | Note: If y ou do not define a N etwork ID for TRICAR E claims, the system will auto matically include th e provider ’s SSN as the Networ k ID. | |
2844 | ||
2845 | Physician/ Provider I D Nov 02, 2005@ 10:24:46 Pa ge: 1 o f 1 | |
2846 | ** Phy sician/Pro vider's ID s from Ins urance Co ** | |
2847 | Provider : IB,DOC TORB (VA P ROVIDER) | |
2848 | INSURANCE CO: BLUE C ROSS OF CA LIFORNIA ( Parent) | |
2849 | ||
2850 | ID Qu alifier Form Care Type Ca re Unit ID# | |
2851 | No ID's found for provider | |
2852 | ||
2853 | ||
2854 | Enter ?? f or more ac tions | |
2855 | AI Add a n ID DI Delet e an ID | |
2856 | EI Edit an ID EX Exit | |
2857 | Select Act ion: Quit/ / AI Add an ID | |
2858 | Select ID Qualifier: ?? | |
2859 | Choose from: | |
2860 | BLUE CR OSS 1A | |
2861 | BLUE SH IELD 1B | |
2862 | CHAMPUS 1H | |
2863 | COMMERC IAL G2 | |
2864 | LOCATIO N NUMBER LU | |
2865 | MEDICAR E PART A 1C | |
2866 | MEDICAR E PART B 1C | |
2867 | PROVIDE R PLAN NET WORK N5 | |
2868 | UPIN 1G | |
2869 | ||
2870 | Enter the Qualifier that ident ifies the type of ID . | |
2871 | ||
2872 | Select Pro vider ID T ype: Blue Shield | |
2873 | FORM TYPE APPLIED TO : CMS-1500 FORMS ONL Y | |
2874 | BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT | |
2875 | Select IB PROVIDER I D CARE UNI T: Surgery | |
2876 | ||
2877 | THE FOLLOW ING WAS CH OSEN: | |
2878 | INSURAN CE: BLUE C ROSS OF CA LIFORNIA | |
2879 | PROV TY PE: BLUE S HIELD ID | |
2880 | FORM TY PE: CMS-15 00 FORM ON LY | |
2881 | CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT | |
2882 | CARE UN IT: Surger y | |
2883 | ||
2884 | PROVIDER I D: XXXXBSH IELD | |
2885 | ||
2886 | The follow ing screen will disp lay. | |
2887 | ||
2888 | Physician/ Provider I D Nov 02, 2005@ 10:24:46 Pa ge: 1 o f 1 | |
2889 | ** Phy sician/Pro vider's ID s from Ins urance Co ** | |
2890 | Provider : IB,DOC TORB (VA P ROVIDER) | |
2891 | INSURANCE CO: BLUE C ROSS OF CA LIFORNIA ( Parent) | |
2892 | ||
2893 | ID Qu alifier For m Care T ype Car e Unit ID# | |
2894 | 1 BLUE SHIELD ID 150 0 INPT/O UTPT XXXXBSH IELD | |
2895 | ||
2896 | ||
2897 | ||
2898 | ||
2899 | Enter ?? f or more ac tions | |
2900 | AI Add a n ID DI Delet e an ID | |
2901 | EI Edit an ID EX Exit | |
2902 | Select Act ion: Quit/ / | |
2903 | Define no n-VA Physi cian and P rovider Pr imary IDs/ NPI | |
2904 | Non-VA phy sicians an d other he althcare p roviders a re not Vis tA users, so they ar e not norm ally in th e New Pers on file un less they are also c urrent/pre vious VA e mployees. Even if a physician /provider functions in both a VA and non -VA role, the SSN, NPI and T axonomy Co de of a no n-VA Physi cian/Provi der must b e entered by Billing personnel using Pro vider ID M aintenance . Non-VA physician/ provider p rimary and secondary legacy ID s are both defined t he same wa y and the system use s the SSN as the pri mary ID. Refer to S ection 3.4 .4.1. | |
2905 | ||
2906 | ||
2907 | Note: Non- VA Physici an/Provide r IDs can be defined through P rovider ID Maintenan ce through PO > Prov ider Own I DS or thr ough NP > Non- VA PR OVIDER. | |
2908 | ||
2909 | Define a n on-VA Phys ician/Prov ider’s NPI | |
2910 | The NPI an d Taxonomy Code for a non-VA P hysician o r Provider can be en tered by B illing per sonnel usi ng Provide r ID Maint enance. | |
2911 | ||
2912 | Step | |
2913 | Procedure | |
2914 | 1 | |
2915 | Access the option MC CR SYSTEM DEFINITION MENUProvi der ID Mai ntenance. | |
2916 | 2 | |
2917 | At the Sel ect Provid er ID Main tenance Op tion: prom pt, enter NP for Non -VA Provid er. | |
2918 | 3 | |
2919 | At the Sel ect a Non- VA Provide r: prompt, enter IB, OUTSIDEPRO V for this example. | |
2920 | ||
2921 | When acces sing an ex isting ent ry, press ENTER to c ontinue or , if neces sary, the spelling o f the prov ider’s nam e can be c orrected a t the NAME prompt. N ames shoul d be enter ed in the following format: LA ST NAME,FI RST NAME M IDDLE INIT IAL. | |
2922 | ||
2923 | Note: Begi nning with Patch IB* 2*436, it will be po ssible to enter a pr ovider int o the VA N ew Person file as a VA provide r and then enter tha t same pro vider in P rovider Ma intenance as a non-V A provider using the same name . It will no longer be necess ary to man ipulate th e name by adding a m iddle init ial (for e xample). | |
2924 | ||
2925 | Users must hold the IB PROVIDE R EDIT sec urity key to access this optio n. | |
2926 | ||
2927 | Provider I D Maintena nce Main M enu | |
2928 | ||
2929 | Enter a code fro m the list . | |
2930 | ||
2931 | Prov ider IDs | |
2932 | PO Provid er Own IDs | |
2933 | PI Provid er Insuran ce IDs | |
2934 | ||
2935 | Insu rance IDs | |
2936 | BI Batch ID Entry | |
2937 | II Insura nce Co IDs | |
2938 | ||
2939 | Care Units | |
2940 | CP Care U nits for P roviders | |
2941 | CB Care U nits for B illing Pro vider | |
2942 | ||
2943 | Non- VA Items | |
2944 | NP Non-VA Provider | |
2945 | NF Non-VA Facility | |
2946 | ||
2947 | Select Provider ID Mainten ance Optio n: NP Non- VA Provide r | |
2948 | Select a N ON-VA PROV IDER: IB,O UTSIDEPROV IND IVIDUAL | |
2949 | For indivi dual type entries: T he name sh ould be en tered in | |
2950 | L AST,FIRST MIDDLE for mat. | |
2951 | Select a N ON-VA PROV IDER: IB,O UTSIDEPROV INDIVIDUA L | |
2952 | NAME: IB,O UTSIDEPROV //: | |
2953 | ||
2954 | The follow ing screen will disp lay. | |
2955 | ||
2956 | NON-VA PRO VIDER INFO RMATION Dec 07, 20 06@12:40:5 1 Page: 1 of 1 | |
2957 | ||
2958 | N ame: IB,OU TSIDEPROV | |
2959 | T ype: INDIV IDUAL PROV IDER | |
2960 | Credenti als: MD | |
2961 | Specia lty: 30 | |
2962 | NPI: | |
2963 | Taxonomy C ode: | |
2964 | ||
2965 | Enter ?? f or more ac tions | |
2966 | ED Edit Demographi cs PI Provi der Ins ID | |
2967 | PO Provi der Own ID EX Exit | |
2968 | Select Act ion: Quit/ / | |
2969 | ||
2970 | ||
2971 | Step | |
2972 | Procedure | |
2973 | 4 | |
2974 | At the Sel ect Action : prompt, enter ED f or Edit De mographics . | |
2975 | 5 | |
2976 | At the Cre dentials: prompt, pr ess the <E nter> key to accept the defaul t. | |
2977 | 6 | |
2978 | At the Spe cialty: pr ompt, pres s the <Ent er> key to accept th e default. | |
2979 | 7 | |
2980 | At the NPI : prompt, enter 0000 000006 for this exam ple. | |
2981 | 8 | |
2982 | At the Tax onomy: pro mpt, enter 15 Allopa thic and O steopathic Physician s – Intern al Medicin e Cardiova scular Dis ease 207RC 0000X for this examp le. | |
2983 | 9 | |
2984 | At the Are you addin g 'Allopat hic and Os teopathic Physicians ' as | |
2985 | a new TAXONOMY C ODE (the 1 ST for thi s IB NON/O THER VA BI LLING PROV IDER)? No/ / prompt, enter Yes for this e xample. | |
2986 | 10 | |
2987 | At the Pri mary Code: prompt, e nter Yes f or this ex ample. | |
2988 | 11 | |
2989 | At the Sta tus: promp t, enter A ctive for this examp le. | |
2990 | ||
2991 | A provider may have more than one Taxono my Code. | |
2992 | 12 | |
2993 | At the All ow future updates by FEE BASIS automatic interface ? YES// pr ompt, pres s t the <E nter> key to accept the defaul t. | |
2994 | ||
2995 | ||
2996 | NAME: IB,O UTSIDEPROV // | |
2997 | CREDENTIAL S: MD// | |
2998 | ||
2999 | SPECIALTY: 30// | |
3000 | NPI: 00000 00006 | |
3001 | Select TAX ONOMY CODE : 15 Allo pathic and Osteopath ic Physici ans 20 7RC0000X | |
3002 | Internal M edicine | |
3003 | Cardi ovascular Disease | |
3004 | Are you adding 'Al lopathic a nd Osteopa thic Physi cians' as | |
3005 | a new TAXONOMY C ODE (the 1 ST for thi s IB NON/O THER VA BI LLING PROV IDER)? No/ | |
3006 | / y (Yes) | |
3007 | PRIMARY CODE: y Y ES | |
3008 | STATUS: a ACTIVE | |
3009 | Select TAX ONOMY CODE : | |
3010 | ||
3011 | The follow ing screen will disp lay. | |
3012 | ||
3013 | NON-VA PRO VIDER INFO RMATION Jul 05, 20 126@14:49: 53 Page: 1 of 1 | |
3014 | ||
3015 | ||
3016 | N ame: IB,OU TSIDEPROV | |
3017 | T ype: INDIV IDUAL PROV IDER | |
3018 | Credenti als: MD | |
3019 | Specia lty: 30 | |
3020 | NPI: 00000 00006 | |
3021 | Taxonomy C ode: 207RC 0000X (Pri mary) | |
3022 | ||
3023 | Allow futu re updates by FEE BA SIS automa tic interf ace? : YES | |
3024 | ||
3025 | Enter ?? f or more ac tions | |
3026 | ED Edit Demographi cs PI Provi der Ins ID | |
3027 | PO Provi der Own ID EX Exit | |
3028 | Select Act ion: Quit/ / | |
3029 | ||
3030 | Define a n on-VA Phys ician/Prov ider’s Sec ondary IDs | |
3031 | ||
3032 | Define a n on-VA Phys ician/Prov ider’s Own IDs | |
3033 | Non-VA Phy sicians an d other he althcare p roviders a re assigne d IDs that identify them. Afte r Patch IB *2*432, it is not ne cessary to define th e outside provider’s SSN. The SSN will no longer serve as t he Primary ID. The Primary ID will be t he provide r’s NPI. I n addition to their provider’s SSN, they may also have one o r more of the follow ing types of seconda ry IDs: | |
3034 | OB – State License N umber | |
3035 | EI – EIN | |
3036 | TJ – Feder al Taxpaye r’s Number | |
3037 | X5 – State Industria l Accident Provider Number | |
3038 | 1G – UPIN | |
3039 | SY – SSN | |
3040 | ||
3041 | Step | |
3042 | Procedure | |
3043 | 1 | |
3044 | Access the option MC CR SYSTEM DEFINITION MENUProvi der ID Mai ntenance. | |
3045 | 2 | |
3046 | At the Sel ect Provid er ID Main tenance Op tion: prom pt, enter PO for Pro vider Own IDs. | |
3047 | 3 | |
3048 | At the (V) A or (N)on -VA provid er: V//: p rompt, ent er N for N on-VA prov ider. | |
3049 | 4 | |
3050 | At the Sel ect Non V. A. PROVIDE R NAME: pr ompt, ente r IB,OUTSI DEDOC for this examp le. | |
3051 | ||
3052 | Provider I D Maintena nce Main M enu | |
3053 | ||
3054 | Enter a code fro m the list . | |
3055 | ||
3056 | Prov ider IDs | |
3057 | PO Provid er Own IDs | |
3058 | PI Provid er Insuran ce IDs | |
3059 | ||
3060 | Insu rance IDs | |
3061 | BI Batch ID Entry | |
3062 | II Insura nce Co IDs | |
3063 | ||
3064 | Care Units | |
3065 | CP Care U nits for P roviders | |
3066 | CB Care U nits for B illing Pro vider | |
3067 | ||
3068 | Non- VA Items | |
3069 | NP Non-VA Provider | |
3070 | NF Non-VA Facility | |
3071 | ||
3072 | Select Provider ID Mainten ance Optio n: PO Prov ider Own I Ds | |
3073 | ||
3074 | (V)A or (N )on-VA pro vider: V// n NON-V A PROVIDER | |
3075 | Select Non V.A. PROV IDER NAME: IB,OUTSIDE DOC | |
3076 | ||
3077 | Step | |
3078 | Procedure | |
3079 | 5 | |
3080 | At the Sel ect Action : prompt, enter AI for Add an ID. | |
3081 | 6 | |
3082 | At the Ent er Provide r ID Quali fier: pro mpt, enter Social Se curity Num ber for th is example . | |
3083 | 7 | |
3084 | At the FOR M TYPE APP LIED TO: p rompt, ent er 0 for t his exampl e. | |
3085 | 8 | |
3086 | At the BIL L CARE TYP E: prompt, enter 0 f or this ex ample. | |
3087 | 9 | |
3088 | At the PRO VIDER ID: prompt, en ter XXXXX1 212 for th is example . | |
3089 | ||
3090 | Note: Use rs may rep eat the ab ove steps to enter a dditional IDs for a physician/ provider. | |
3091 | ||
3092 | Performing Provider ID Nov 02, 2005@ 10:24:46 Pa ge: 1 o f 1 | |
3093 | ** Per forming Pr ovider's O wn IDs (No Specific Insurance Co) ** | |
3094 | Provider : IB,OUT SIDEDOC (N ON-VA PROV IDER) | |
3095 | ||
3096 | ID Qu alifier Form Care Type Ca re Unit ID# | |
3097 | ||
3098 | No ID's found for provider | |
3099 | ||
3100 | ||
3101 | ||
3102 | ||
3103 | ||
3104 | Enter ?? f or more ac tions | |
3105 | AI Add a n ID DI Delet e an ID | |
3106 | EI Edit an ID EX Exit | |
3107 | Select Act ion: Quit/ / AI Add an ID | |
3108 | Select ID Qualifier: ?? | |
3109 | ||
3110 | Choose from: | |
3111 | EIN EI | |
3112 | SOCIAL SECURITY N UMBER SY | |
3113 | STATE I NDUSTRIAL ACCIDENT P ROV X5 | |
3114 | STATE L ICENSE 0B | |
3115 | UPIN 1G | |
3116 | ||
3117 | Enter the Qualifier that ident ifies the type of ID . | |
3118 | ||
3119 | Select ID Qualifier: SY Social Security Number | |
3120 | FORM TYPE APPLIED TO : 0 BOTH UB-04 AND CMS-1500 F ORMS | |
3121 | BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT | |
3122 | ||
3123 | THE FOLLOW ING WAS CH OSEN: | |
3124 | INSURAN CE: ALL IN SURANCE | |
3125 | PROV TY PE: SOCIAL SECURITY NUMBER | |
3126 | FORM TY PE: BOTH U B-04 & CMS -1500 FORM S | |
3127 | CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT | |
3128 | ||
3129 | PROVIDER I D: XXXXX12 12 | |
3130 | ||
3131 | The follow ing screen will disp lay. | |
3132 | ||
3133 | Performing Provider ID Nov 02, 2005@1 0:24:46 Pag e: 1 of 1 | |
3134 | ** Per forming Pr ovider's O wn IDs (No Specific Insurance Co) ** | |
3135 | Provider : IB,OUT SIDEDOC (N ON-VA PROV IDER) | |
3136 | ||
3137 | ID Qu alifier Form Care Type Ca re Unit ID# | |
3138 | 1 SOCIA L SECURITY NUMB BOT H INPT/O UTPT XXXXX12 12 | |
3139 | ||
3140 | ||
3141 | ||
3142 | ||
3143 | Enter ?? f or more ac tions | |
3144 | AI Add a n ID DI Delet e an ID | |
3145 | EI Edit an ID EX Exit | |
3146 | Select Act ion: Quit/ / | |
3147 | ||
3148 | Define a n on-VA Phys ician/Prov ider’s Ins urance Com pany Secon dary IDs | |
3149 | Physicians and other healthcar e provider s are assi gned secon dary IDs b y insuranc e companie s. In add ition to t heir provi der’s own IDs, they may also h ave one or more of t he followi ng types o f secondar y IDs: | |
3150 | 1A – Blue Cross | |
3151 | 1B – Blue Shield | |
3152 | 1C – Medic are | |
3153 | 1G – UPIN | |
3154 | 1H – CHAMP US | |
3155 | G2 – Comme rcial | |
3156 | LU – Locat ion # | |
3157 | N5 – Provi der Plan N etwork | |
3158 | ||
3159 | Step | |
3160 | Procedure | |
3161 | 1 | |
3162 | Access the option MC CR SYSTEM DEFINITION MENUProvi der ID Mai ntenance. | |
3163 | 2 | |
3164 | At the Sel ect Provid er ID Main tenance Op tion: prom pt, enter NP for Non -VA Provid er. | |
3165 | 3 | |
3166 | At the Sel ect a NON- VA PROVIDE R: prompt, enter IB, OUTSIDEDOC . | |
3167 | ||
3168 | Provider I D Maintena nce Main M enu | |
3169 | ||
3170 | Enter a code fro m the list . | |
3171 | ||
3172 | Prov ider IDs | |
3173 | PO Provid er Own IDs | |
3174 | PI Provid er Insuran ce IDs | |
3175 | ||
3176 | Insu rance IDs | |
3177 | BI Batch ID Entry | |
3178 | II Insura nce Co IDs | |
3179 | ||
3180 | Care Units | |
3181 | CP Care U nits for P roviders | |
3182 | CB Care U nits for B illing Pro vider | |
3183 | ||
3184 | Non- VA Items | |
3185 | NP Non-VA Provider | |
3186 | NF Non-VA Facility | |
3187 | ||
3188 | Select Provider ID Mainten ance Optio n: NP Non- VA Provide r | |
3189 | ||
3190 | (V)A or (N )on-VA pro vider: V// N Non-VA PROVIDER | |
3191 | Select a N ON-VA PROV IDER: IB,O UTSIDEDOC | |
3192 | Select INS URANCE CO: BLUE CROS S OF CALIF ORNIA | |
3193 | ||
3194 | Step | |
3195 | Procedure | |
3196 | 4 | |
3197 | At the Sel ect Action : prompt, enter PI f or Provide r Ins ID. | |
3198 | 5 | |
3199 | At the Sel ect INSURA NCE CO: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple. | |
3200 | 6 | |
3201 | At the Sel ect Action : prompt, enter AI f or Add an ID. | |
3202 | 7 | |
3203 | At the Sel ect ID Qua lifier: pr ompt, ente r 1B – Blu e Shield f or this ex ample. | |
3204 | 8 | |
3205 | At the FOR M TYPE APP LIED TO: p rompt, ent er CMS-150 0 Only for this exam ple. | |
3206 | 9 | |
3207 | At the BIL L CARE TYP E: prompt, enter 0 f or this ex ample. | |
3208 | 10 | |
3209 | At the PRO VIDER ID: prompt, en ter XXBSHI ELD for th is example . | |
3210 | ||
3211 | Users can repeat the se steps f or this Ph ysician/Pr ovider add ing more I Ds from th is insuran ce company or change insurance company o r change p hysician/p rovider. | |
3212 | ||
3213 | Performing Provider ID Nov 02, 2005@1 0:24:46 Pag e: 1 of 1 | |
3214 | ** Per forming Pr ovider's I Ds from In surance Co ** | |
3215 | Provider : IB,OUT SIDEDOC (N on-VA PROV IDER) | |
3216 | INSURANCE CO: BLUE C ROSS OF CA LIFORNIA ( Parent) | |
3217 | ||
3218 | ID Qu alifier Form Care Type Ca re Unit ID# | |
3219 | ||
3220 | No ID's found for this insur ance co. | |
3221 | ||
3222 | ||
3223 | ||
3224 | Enter ?? f or more ac tions | |
3225 | AI Add a n ID DI Delet e an ID | |
3226 | EI Edit an ID EX Exit | |
3227 | Select Act ion: Quit/ / AI Add an ID | |
3228 | Select ID Qualifier: ?? | |
3229 | ||
3230 | Choose from: | |
3231 | BLUE CR OSS 1A | |
3232 | BLUE SH IELD 1B | |
3233 | CHAMPUS 1H | |
3234 | COMMERC IAL G2 | |
3235 | LOCATIO N NUMBER LU | |
3236 | MEDICAR E PART A 1C | |
3237 | MEDICAR E PART B 1C | |
3238 | PROVIDE R PLAN NET WORK N5 | |
3239 | UPIN 1G | |
3240 | ||
3241 | Enter the Qualifier that ident ifies the type of ID . | |
3242 | ||
3243 | Select Pro vider ID T ype: Blue Shield | |
3244 | FORM TYPE APPLIED TO : CMS-1500 FORMS ONL Y | |
3245 | BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT | |
3246 | ||
3247 | THE FOLLOW ING WAS CH OSEN: | |
3248 | INSURAN CE: BLUE C ROSS OF CA LIFORNIA | |
3249 | PROV TY PE: BLUE S HIELD ID | |
3250 | FORM TY PE: CMS-15 00 FORM ON LY | |
3251 | CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT | |
3252 | PROVIDER I D: XXBSHIE LD | |
3253 | ||
3254 | The follow ing screen will disp lay. | |
3255 | ||
3256 | Performing Provider ID Nov 02, 2005@1 0:24:46 Pag e: 1 of 1 | |
3257 | ** Per forming Pr ovider's I Ds from In surance Co ** | |
3258 | Provider : IB,OUT SIDEDOC (N on-VA PROV IDER) | |
3259 | INSURANCE CO: BLUE C ROSS OF CA LIFORNIA ( Parent) | |
3260 | ||
3261 | ID Qu alifier For m Care T ype Car e Unit ID# | |
3262 | 1 BLUE SHIELD ID 150 0 INPT/O UTPT XXXXBSH IELD | |
3263 | ||
3264 | Enter ?? f or more ac tions | |
3265 | AI Add a n ID DI Delet e an ID | |
3266 | EI Edit an ID EX Exit | |
3267 | Select Act ion: Quit/ / | |
3268 | ||
3269 | Define Ins urance Com pany IDs | |
3270 | Both indiv idual Phys ician/Prov ider secon dary IDs a nd insuran ce company default P hysician/P rovider se condary ID s provided by an ins urance com pany can b e entered and copied from with in Insuran ce Company IDs. | |
3271 | ||
3272 | There are three opti ons: | |
3273 | I – Indivi dual IDs | |
3274 | A – Indivi dual and D efault IDs | |
3275 | D – Defaul t IDs | |
3276 | ||
3277 | Option A i s the basi cally the same as I and D comb ined, so u sers can a dd Physici an/Provide r secondar y IDs and/ or default secondary IDs. | |
3278 | Define Def ault Physi cian/Provi der Insura nce Compan y Secondar y IDs | |
3279 | Users can use the Pr ovider ID Maintenanc e option, Insurance Company ID s, to ente r numbers that are a ssigned by an insura nce compan y to be us ed as defa ult Attend ing, Opera ting, Othe r, Renderi ng, Referr ing and Su pervising Secondary IDs for al l physicia ns and hea lthcare pr oviders. These IDs with be au tomaticall y sent wit h all 837 claims to the insura nce compan y for whic h the defa ult IDs ar e defined. | |
3280 | ||
3281 | Step | |
3282 | Procedure | |
3283 | 1 | |
3284 | Access the option MC CR SYSTEM DEFINITION MENUProvi der ID Mai ntenance. | |
3285 | 2 | |
3286 | At the Sel ect Provid er ID Main tenance Op tion: prom pt, enter II for Ins urance Co IDs. | |
3287 | 3 | |
3288 | At the Sel ect Insura nce Compan y Name: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple. | |
3289 | 4 | |
3290 | At the Sel ect Displa y Content: prompt, e nter D. | |
3291 | ||
3292 | Provider I D Maintena nce Main M enu | |
3293 | ||
3294 | Enter a code fro m the list . | |
3295 | ||
3296 | Prov ider IDs | |
3297 | PO Provid er Own IDs | |
3298 | PI Provid er Insuran ce IDs | |
3299 | ||
3300 | Insu rance IDs | |
3301 | BI Batch ID Entry | |
3302 | II Insura nce Co IDs | |
3303 | ||
3304 | Care Units | |
3305 | CP Care U nits for P roviders | |
3306 | CB Care U nits for B illing Pro vider | |
3307 | ||
3308 | Non- VA Items | |
3309 | NP Non-VA Provider | |
3310 | NF Non-VA Facility | |
3311 | ||
3312 | Select Provider ID Mainten ance Optio n: II Ins urance Co IDs | |
3313 | Select INS URANCE COM PANY NAME: BLUE CRO SS OF CALI FORNIA PO BOX 60 007 LOS ANGE LES CA LIFORNIA Y | |
3314 | SELECT DIS PLAY CONTE NT: A//D INSURANCE CO DEFAULT IDS | |
3315 | ||
3316 | ||
3317 | ||
3318 | Step | |
3319 | Procedure | |
3320 | 5 | |
3321 | At the Sel ect Action : prompt, enter AI f or Add an ID. | |
3322 | ||
3323 | ||
3324 | INSURANCE CO PROVIDE R ID Dec 19, 20 05@12:24:4 1 Page: 1 of 2 | |
3325 | Insurance Co: BLUE C ROSS OF CA LIFORNIA ( Parent) | |
3326 | PROVI DER NAME FOR M CARE T YPE CAR E UNIT ID# | |
3327 | ||
3328 | ||
3329 | Provider I D Type: BL UE SHIELD | |
3330 | 1 <<INS CO DEFAUL T>> BOT H INPT/O UTPT BSDEFAU LT | |
3331 | ||
3332 | Provider I D Type: CO MMERCIAL | |
3333 | 2 <<INS CO DEFAUL T>> BOT H INPT/O UTPT COMDEFA ULT | |
3334 | ||
3335 | Provider I D Type: PR OVIDER PLA N NETWORK | |
3336 | 3 <<INS CO DEFAUL T>> BOT H INPT/O UTPT NETDEFA ULT | |
3337 | ||
3338 | Provider I D Type: UP IN | |
3339 | 4 <<INS CO DEFAUL T>> BOT H INPT/O UTPT UPINDEF AULT | |
3340 | ||
3341 | + Enter ?? f or more ac tions | |
3342 | AI Add a n ID DP Display I ns Params VI Vie w IDs by T ype | |
3343 | DI Delet e an ID CI Change In s Co CU Car e Unit Mai nt | |
3344 | EI Edit an ID CD Change Di splay EX Exi t | |
3345 | Select Act ion: Next Screen//AI Add an ID | |
3346 | ||
3347 | Step | |
3348 | Procedure | |
3349 | 6 | |
3350 | At the Sel ect Provid er (option al): promp t, press t he <Enter> key to le ave the pr ompt blank . | |
3351 | 7 | |
3352 | At the YOU ARE ADDIN G A PROVID ER ID THAT WILL BE T HE INSURAN CE CO DEFA ULT IS THI S OK?: pro mpt, enter YES. | |
3353 | 8 | |
3354 | At the Sel ect Provid er ID Type : prompt, enter Blue Cross for this exam ple. | |
3355 | 9 | |
3356 | At the FOR M TYPE APP LIED TO: p rompt, ent er UB-04 F orms Only for this e xample. | |
3357 | 10 | |
3358 | At the BIL L CARE TYP E: prompt, enter 0 for BOTH I NPATIENT A ND OUTPATI ENT for th is example . | |
3359 | 11 | |
3360 | At the PRO VIDER ID: prompt, en ter BCDEFA ULT for th is example . | |
3361 | ||
3362 | YOU ARE AD DING A PRO VIDER ID T HAT WILL B E THE INSU RANCE CO D EFAULT | |
3363 | ||
3364 | ||
3365 | Select Pro vider ID T ype: BLUE CROSS 1A | |
3366 | ||
3367 | FORM TYPE APPLIED TO : UB-04// UB-04 FORM S ONLY | |
3368 | BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT | |
3369 | ||
3370 | THE FOLLOW ING WAS CH OSEN: | |
3371 | INSURAN CE: BLUE C ROSS OF CA LIFORNIA | |
3372 | PROV TY PE: BLUE C ROSS | |
3373 | FORM TY PE: UB-04 FORM ONLY | |
3374 | CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT | |
3375 | ||
3376 | PROVIDER I D: BCDEFAU LT | |
3377 | ||
3378 | The follow ing screen will disp lay. | |
3379 | ||
3380 | INSURANCE CO PROVIDE R ID Dec 19, 20 05@12:34:0 1 Page: 1 of 2 | |
3381 | Insurance Co: BLUE C ROSS OF CA LIFORNIA ( Parent) | |
3382 | PROVIDER N AME FORM C ARE TYPE CARE UNI T ID # | |
3383 | ||
3384 | Provider I D Type: BL UE CROSS | |
3385 | 1 <<INS CO DEFAUL T>> UB- 04 INPT/O UTPT BCDEFAU LT | |
3386 | ||
3387 | Provider I D Type: BL UE SHIELD | |
3388 | 2 <<INS CO DEFAUL T>> BOT H INPT/O UTPT DEFALLP rov | |
3389 | ||
3390 | Provider I D Type: CO MMERCIAL | |
3391 | 3 <<INS CO DEFAUL T>> BOT H INPT/O UTPT COMDEFA ULT | |
3392 | ||
3393 | Provider I D Type: PR OVIDER PLA N NETWORK | |
3394 | 4 <<INS CO DEFAUL T>> BOT H INPT/O UTPT NETDEFA ULT | |
3395 | ||
3396 | + Enter ?? f or more ac tions | |
3397 | AI Add a n ID DP Display I ns Params VI Vie w IDs by T ype | |
3398 | DI Delet e an ID CI Change In s Co CU Car e Unit Mai nt | |
3399 | EI Edit an ID CD Change Di splay EX Exi t | |
3400 | Select Act ion: Next Screen// | |
3401 | ||
3402 | ||
3403 | Note: Thi s default ID will be transmitt ed on all claims whe re Blue Cr oss of Cal ifornia is the payer as a Phys ician/Prov ider secon dary ID. | |
3404 | Define Ind ividual Ph ysician/Pr ovider Ins urance Com pany Secon dary IDs | |
3405 | Users can use the Pr ovider ID Maintenanc e option, Insurance Company ID s, to ente r numbers that are a ssigned by an insura nce compan y as indiv idual Atte nding, Ope rating, Ot her, Rende ring, Refe rring, and Supervisi ng Seconda ry IDs. | |
3406 | ||
3407 | Step | |
3408 | Procedure | |
3409 | 1 | |
3410 | Access the option MC CR SYSTEM DEFINITION MENUProvi der ID Mai ntenance. | |
3411 | 2 | |
3412 | At the Sel ect Provid er ID Main tenance Op tion: prom pt, enter II for Ins urance Co IDs. | |
3413 | 3 | |
3414 | At the Sel ect Insura nce Compan y Name: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple. | |
3415 | ||
3416 | Provider I D Maintena nce Main M enu | |
3417 | ||
3418 | Enter a code fro m the list . | |
3419 | ||
3420 | Prov ider IDs | |
3421 | PO Provid er Own IDs | |
3422 | PI Provid er Insuran ce IDs | |
3423 | ||
3424 | Insu rance IDs | |
3425 | BI Batch ID Entry | |
3426 | II Insura nce Co IDs | |
3427 | ||
3428 | Care Units | |
3429 | CP Care U nits for P roviders | |
3430 | CB Care U nits for B illing Pro vider | |
3431 | ||
3432 | Non- VA Items | |
3433 | NP Non-VA Provider | |
3434 | NF Non-VA Facility | |
3435 | ||
3436 | Select Provider ID Mainten ance Optio n: ii Ins urance Co IDs | |
3437 | ||
3438 | Select INS URANCE COM PANY NAME: BLUE CR OSS OF CAL IFORNIA PO BOX 6 0007 LOS ANG ELES C ALIFORNIA Y | |
3439 | ||
3440 | Step | |
3441 | Procedure | |
3442 | 4 | |
3443 | At the Sel ect Displa y Content: prompt, e nter I for this exam ple. | |
3444 | 5 | |
3445 | At the Do you want t o display IDs for a Specific P rovider: p rompt, ent er No for this examp le. | |
3446 | ||
3447 | SELECT DIS PLAY CONTE NT: A// ?? | |
3448 | ||
3449 | (D) DISPLA Y CONTAINS ONLY THOS E IDS ASSI GNED AS DE FAULTS TO THE FACILI TY BY | |
3450 | THE IN SURANCE CO MPANY | |
3451 | (I) DISPLA Y CONTAINS ONLY THOS E IDS ASSI GNED TO IN DIVIDUAL P ROVIDERS B Y THE | |
3452 | INSURA NCE COMPAN Y | |
3453 | (A) DISPLA Y CONTAINS ALL IDS A SSIGNED BY THE INSUR ANCE COMPA NY FOR ONE OR ALL PR OVIDER ID TYPES | |
3454 | ||
3455 | Selec t one of t he followi ng: | |
3456 | ||
3457 | D INSURANCE CO DEFAULT IDS | |
3458 | I INDIVIDUAL PROVIDER IDS FURNIS HED BY THE INS CO | |
3459 | A ALL IDS FU RNISHED BY THE INS C O BY PROVI DER TYPE | |
3460 | ||
3461 | SELECT DIS PLAY CONTE NT: A// I INDIVIDUA L PROVIDER IDS FURNI SHED BY TH E INS CO | |
3462 | DO YOU WAN T TO DISPL AY IDS FOR A SPECIFI C PROVIDER ?: NO// | |
3463 | ||
3464 | Step | |
3465 | Procedure | |
3466 | 6 | |
3467 | At the Sel ect Action : prompt, enter AI f or Add an ID. | |
3468 | ||
3469 | INSURANCE CO PROVIDE R ID Dec 15, 20 05@15:36:3 1 Page: 1 of 89 | |
3470 | Insurance Co: BLUE C ROSS OF CA LIFORNIA ( Parent) | |
3471 | PERFORMI NG PROV ID MAY REQUI RE CARE UN IT | |
3472 | ||
3473 | PROVI DER ID TYP E FOR M CARE T YPE CAR E UNIT ID# | |
3474 | ||
3475 | Provider: IB,DOCTOR3 | |
3476 | 1 PROVI DER PLAN N ETWOR BOT H INPT/O UTPT MDXXXXX A | |
3477 | ||
3478 | Provider: IB,DOCTOR9 | |
3479 | 2 PROVI DER PLAN N ETWOR BOT H INPT/O UTPT GXXXXXA | |
3480 | ||
3481 | Provider: IB,DOCTOR1 0 | |
3482 | 3 PROVI DER PLAN N ETWOR BOT H INPT/O UTPT GXXXXXX | |
3483 | ||
3484 | Provider: IB,DOCTOR7 6 | |
3485 | 4 PROVI DER PLAN N ETWOR BOT H INPT/O UTPT GXXXXXX | |
3486 | ||
3487 | + Enter ?? f or more ac tions | |
3488 | AI Add a n ID DP Display I ns Params VI Vie w IDs by T ype | |
3489 | DI Delet e an ID CI Change In s Co CU Car e Unit Mai nt | |
3490 | EI Edit an ID CD Change Di splay EX Exi t | |
3491 | Select Act ion: Next Screen// A I Add an ID | |
3492 | ||
3493 | Step | |
3494 | Procedure | |
3495 | 7 | |
3496 | At the Sel ect ID Qua lifier: pr ompt, ente r 1B – Blu e Shield f or this ex ample. | |
3497 | 8 | |
3498 | At the FOR M TYPE APP LIED TO: p rompt, ent er CMS-150 0 Only for this exam ple. | |
3499 | 9 | |
3500 | At the BIL L CARE TYP E: prompt, enter 0 f or this ex ample. | |
3501 | 10 | |
3502 | At the CAR E UNIT: pr ompt, ente r Surgery for this e xample. | |
3503 | 11 | |
3504 | At the PRO VIDER ID: prompt, en ter BSXXXX X for this example. | |
3505 | ||
3506 | Select PRO VIDER: IB, DOCTOR7 | |
3507 | ||
3508 | Select Pro vider ID T ype: BLUE SHIELD 1B | |
3509 | ||
3510 | FORM TYPE APPLIED TO : CMS-1500 FORMS ONL Y | |
3511 | BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT | |
3512 | Select IB PROVIDER I D CARE UNI T: Surgery | |
3513 | ||
3514 | THE FOLLOW ING WAS CH OSEN: | |
3515 | INSURAN CE: BLUE C ROSS OF CA LIFORNIA | |
3516 | PROV TY PE: BLUE S HIELD | |
3517 | FORM TY PE: CMS-15 00 FORM ON LY | |
3518 | CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT | |
3519 | CARE UN IT: Surger y | |
3520 | ||
3521 | PROVIDER I D: BSXXXXX | |
3522 | ||
3523 | The follow ing screen will disp lay. | |
3524 | ||
3525 | INSURANCE CO PROVIDE R ID Dec 15, 20 05@16:11:3 1 Page: 4 9 of 89 | |
3526 | Insurance Co: BLUE C ROSS OF CA LIFORNIA ( Parent) | |
3527 | PERFORMI NG PROV ID MAY REQUI RE CARE UN IT | |
3528 | ||
3529 | PROVI DER ID TYP E FOR M CARE T YPE CAR E UNIT ID# | |
3530 | + | |
3531 | ||
3532 | Provider: IB,DOCTOR1 5 | |
3533 | 194 PROVI DER PLAN N ETWOR BOT H INPT/O UTPT GXXXXX | |
3534 | ||
3535 | Provider: IB,DOCTOR5 4 | |
3536 | 195 PROVI DER PLAN N ETWOR BOT H INPT/O UTPT G4XXXXX | |
3537 | ||
3538 | Provider: IB,DOCTOR7 | |
3539 | 196 BLUE CROSS UB- 04 INPT/O UTPT BCXXXXX X2 | |
3540 | 197 BLUE SHIELD 150 0 INPT/O UTPT Su rgery BSXXXXX | |
3541 | ||
3542 | Provider: IB,DOCTOR6 | |
3543 | + Enter ?? f or more ac tions | |
3544 | AI Add a n ID DP Display I ns Params VI Vie w IDs by T ype | |
3545 | DI Delet e an ID CI Change In s Co CU Car e Unit Mai nt | |
3546 | EI Edit an ID CD Change Di splay EX Exi t | |
3547 | Select Act ion: Next Screen// | |
3548 | Define eit her a Defa ult or Ind ividual Ph ysician/Pr ovider Sec ondary ID | |
3549 | ||
3550 | Step | |
3551 | Procedure | |
3552 | 1 | |
3553 | Access the option MC CR SYSTEM DEFINITION MENUProvi der ID Mai ntenance. | |
3554 | 2 | |
3555 | At the Sel ect Provid er ID Main tenance Op tion: prom pt, enter II for Ins urance Co IDs. | |
3556 | 3 | |
3557 | At the Sel ect Insura nce Compan y Name: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple (the P arent comp any). | |
3558 | 4 | |
3559 | At the Sel ect Displa y Content: prompt, e nter A for this exam ple. | |
3560 | 5 | |
3561 | At the DO YOU WANT T O DISPLAY IDS FOR A SPECIFIC P ROVIDER ID TYPE?: NO // prompt, accept th e default. | |
3562 | ||
3563 | ||
3564 | Provider I D Maintena nce Main M enu | |
3565 | ||
3566 | Enter a code fro m the list . | |
3567 | ||
3568 | Prov ider IDs | |
3569 | PO Provid er Own IDs | |
3570 | PI Provid er Insuran ce IDs | |
3571 | ||
3572 | Insu rance IDs | |
3573 | BI Batch ID Entry | |
3574 | II Insura nce Co IDs | |
3575 | ||
3576 | Care Units | |
3577 | CP Care U nits for P roviders | |
3578 | CB Care U nits for B illing Pro vider | |
3579 | ||
3580 | Non- VA Items | |
3581 | NP Non-VA Provider | |
3582 | NF Non-VA Facility | |
3583 | ||
3584 | Select Provider ID Mainten ance Optio n: II Ins urance Co IDs | |
3585 | ||
3586 | Select INS URANCE COM PANY NAME: BLUE C ROSS OF CA LIFORNIA PO BOX 60007 | |
3587 | LOS AN GELES CALIFORNIA Y | |
3588 | ||
3589 | SELECT DIS PLAY CONTE NT: A// LL IDS FURNI SHED BY TH E INS CO B Y PROVIDER TYPE | |
3590 | ||
3591 | DO YOU WAN T TO DISPL AY IDS FOR A SPECIFI C PROVIDER ID TYPE?: NO// | |
3592 | ||
3593 | Step | |
3594 | Procedure | |
3595 | 6 | |
3596 | At the Sel ect Action : prompt, enter AI f or Add an ID. | |
3597 | ||
3598 | INSURANCE CO PROVIDE R ID Dec 15, 20 05@16:18:0 7 Page: 1 of 31 | |
3599 | Insurance Co: BLUE C ROSS OF CA LIFORNIA ( Parent) | |
3600 | PERFORMI NG PROV ID MAY REQUI RE CARE UN IT | |
3601 | ||
3602 | PROVI DER NAME FOR M CARE T YPE CAR E UNIT ID# | |
3603 | ||
3604 | Provider I D Type: BL UE CROSS | |
3605 | 1 IB,DO CTOR7 UB- 04 INPT/O UTPT BCXXXXX | |
3606 | ||
3607 | Provider I D Type: BL UE SHIELD | |
3608 | 2 <<INS CO DEFAUL T>> BOT H INPT/O UTPT DEFALLP rov | |
3609 | 3 IB Ou tside Faci lity BOT H INPT/O UTPT BSFACXX XX | |
3610 | 4 IB,DO CTOR8 BOT H INPT/O UTPT BSINDOU T | |
3611 | 5 IB,DO CTOR33 BOT H INPT/O UTPT BSLIM | |
3612 | 6 IB,DO CTOR7 150 0 INPT/O UTPT BSXXXXX | |
3613 | ||
3614 | Provider I D Type: PR OVIDER PLA N NETWORK | |
3615 | 7 IB,DO CTOR64 BOT H INPT/O UTPT MD22356 A | |
3616 | + Enter ?? f or more ac tions | |
3617 | AI Add a n ID DP Display I ns Params VI Vie w IDs by T ype | |
3618 | DI Delet e an ID CI Change In s Co CU Car e Unit Mai nt | |
3619 | EI Edit an ID CD Change Di splay EX Exi t | |
3620 | Select Act ion: Next Screen//AI Add an ID | |
3621 | ||
3622 | Step | |
3623 | Procedure | |
3624 | ||
3625 | At the Sel ect Provid er (option al) prompt , enter a Provider’s Name to e nter an in dividual I D or leave it blank to enter a default I D and then continue to define the ID as before. | |
3626 | ||
3627 | Select PRO VIDER (opt ional): IB ,DOCTOR7 | |
3628 | ||
3629 | Searc hing for a VA PROVID ER | |
3630 | IB,DOCTO R7 1XX XX LZZ 114 RESIDEN T PHYSICIA N | |
3631 | .. .OK? Yes// (Yes) | |
3632 | ||
3633 | ||
3634 | Select Pro vider ID T ype: COMME RCIAL G2 | |
3635 | ||
3636 | FORM TYPE APPLIED TO : 0 BOTH UB-04 AND CMS-1500 F ORMS | |
3637 | BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT | |
3638 | ||
3639 | THE FOLLOW ING WAS CH OSEN: | |
3640 | INSURAN CE: BLUE C ROSS OF CA LIFORNIA | |
3641 | PROV TY PE: COMMER CIAL | |
3642 | FORM TY PE: BOTH U B-04 & CMS -1500 FORM S | |
3643 | CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT | |
3644 | ||
3645 | PROVIDER I D: CMXXXXX X | |
3646 | Care Units | |
3647 | Some insur ance compa nies assig n the same IDs to mu ltiple Phy sician/Pro viders, ba sed upon C are Units, to be use d as Physi cian/Provi der Second ary IDs on claims. This allow s more tha n one pers on to have the same ID without everyone having the same ID. | |
3648 | ||
3649 | Example: Insurance Company A assigns th e number X XXXXX1 to a care uni t called Care Unit A and assi gns this n umber and care unit to Dr. A, Dr. B, Dr. C and Dr. E. as the ir Physici an/Provide r Secondar y ID. The same insur ance compa ny assigns the numbe r XXXXXX2 to a care unit calle d Care Uni t B and as signs this number an d care uni t to Dr. F , Dr. G, D r. H and D r. I. as t heir Physi cian/Provi der Second ary IDs. | |
3650 | ||
3651 | Some insur ance compa nies assig n IDs to b e used as Billing Pr ovider Sec ondary IDs on claims for servi ces perfor med for sp ecific typ es of care . | |
3652 | ||
3653 | Example: Insurance Company A assigns th e number X XXXHH to b e used as the Billin g Provider Secondary ID (Billi ng Screen 3) when Ho me Health services a re provide d. The sa me insuran ce company assigns t he number XXXXER as the Billin g Provider Secondary ID (Billi ng Screen 3) when Em ergency se rvices are provided. | |
3654 | ||
3655 | The names of the “ca re unit” u sed by ins urance com panies are specified by the in surance co mpanies an d do not r elate dire ctly to th e medical services o r departme nts of the medical c enter. Fo r this rea son, users must defi ne these C are Units in Provide r ID Maint enance. | |
3656 | Define Car e Units fo r Physicia n/Provider Secondary IDs | |
3657 | ||
3658 | Step | |
3659 | Procedure | |
3660 | 1 | |
3661 | Access the option MC CR SYSTEM DEFINITION MENUProvi der ID Mai ntenance. | |
3662 | 2 | |
3663 | At the Sel ect Provid er ID Main tenance Op tion: prom pt, enter CP for Car e Units fo r Provider s. | |
3664 | 3 | |
3665 | At the Sel ect INSURA NCE CO: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple. | |
3666 | ||
3667 | Provider I D Maintena nce Main M enu | |
3668 | ||
3669 | Enter a code fro m the list . | |
3670 | ||
3671 | Prov ider IDs | |
3672 | PO Provid er Own IDs | |
3673 | PI Provid er Insuran ce IDs | |
3674 | ||
3675 | Insu rance IDs | |
3676 | BI Batch ID Entry | |
3677 | II Insura nce Co IDs | |
3678 | ||
3679 | Care Units | |
3680 | CP Care U nits for P roviders | |
3681 | CB Care U nits for B illing Pro vider | |
3682 | ||
3683 | Non- VA Items | |
3684 | NP Non-VA Provider | |
3685 | NF Non-VA Facility | |
3686 | ||
3687 | Select Provider ID Mainten ance Optio n: CP Car e Units fo r Provider s | |
3688 | ||
3689 | Select INS URANCE CO: Blue Cro ss of Cali fornia | |
3690 | ||
3691 | Step | |
3692 | Procedure | |
3693 | 4 | |
3694 | At the Sel ect Action : prompt, enter AU f or Add a U nit. | |
3695 | 5 | |
3696 | At the SEL ECT CARE U NIT FOR TH E INSURANC E CO: pro mpt, enter Surgery f or this ex ample. Con firm Surge ry. | |
3697 | 6 | |
3698 | At the IB PROVIDER I D CARE UNI T DESCRIPT ION: promp t, enter a free-text descripti on of the Care Unit. | |
3699 | 7 | |
3700 | At the ID Qualifier: prompt, e nter Blue Shield for this exam ple. | |
3701 | 8 | |
3702 | At the FOR M TYPE APP LIED TO: p rompt, ent er 0 for B OTH UB-04 & CMS-1500 FORMS. | |
3703 | 9 | |
3704 | At the BIL L CARE TYP E: prompt, enter 0 f or BOTH IN PATIENT AN D OUTPATIE NT. | |
3705 | ||
3706 | Remember, ‘Blue Cros s’ ID can only be us ed on Inst itutional claims. | |
3707 | ||
3708 | ||
3709 | PROVIDER I D CARE UNI TS Nov 03, 20 05@11:56:4 5 Page: 1 of 1 | |
3710 | Insurance Co: BLUE C ROSS OF CA LIFORNIA | |
3711 | ||
3712 | CARE U NIT NAME DESC RIPTION | |
3713 | No CARE UN ITs Found for Insura nce Co | |
3714 | ||
3715 | ||
3716 | Enter ?? f or more ac tions | |
3717 | AU Add a Unit DU Delet e a Unit | |
3718 | EU Edit a Unit EX Exit | |
3719 | Select Act ion: Quit/ / AU Add a Unit | |
3720 | SELECT CAR E UNIT FOR THE INSUR ANCE CO: S urgery | |
3721 | Are you adding 'Su rgery' as a new IB P ROVIDER ID CARE UNIT ? No// y (Yes) | |
3722 | IB PROV IDER ID CA RE UNIT DE SCRIPTION: Ambulator y Surgery | |
3723 | ||
3724 | ID TYPE: B LUE SHIELD | |
3725 | FORM TYPE APPLIED TO : 0 BOTH UB-04 & CM S-1500 FOR MS | |
3726 | BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT | |
3727 | CARE UNIT: Surgery | |
3728 | ||
3729 | >> CARE UNIT COMBI NATION FIL ED FOR THE INSURANCE CO | |
3730 | PRESS ENTE R TO CONTI NUE | |
3731 | ||
3732 | The follow ing screen will disp lay. | |
3733 | ||
3734 | PROVIDER I D CARE UNI TS Nov 03, 20 05@11:56:4 5 Page: 1 of 1 | |
3735 | ||
3736 | Insurance Co: BLUE C ROSS OF CA LIFORNIA | |
3737 | ||
3738 | CARE U NIT NAME DESC RIPTION | |
3739 | 1 Surger y Ambu latory Sur gery | |
3740 | o BLUE SHIEL D ID Both for m types I npt/Outpt | |
3741 | ||
3742 | ||
3743 | ||
3744 | ||
3745 | ||
3746 | Enter ?? f or more ac tions | |
3747 | AU Add a Unit DU Delet e a Unit | |
3748 | EU Edit a Unit EX Exit | |
3749 | Select Act ion: Quit/ / | |
3750 | ||
3751 | ||
3752 | Once you h ave define d a Care U nit, when you go to define phy sician/pro vider’s ID s furnishe d by an in surance co mpany, you will be p rompted to enter the name of t he Care Un it if you enter the same ID Qu alifier, F orm Type a nd Bill Ca re Type as those for which you previousl y defined a Care Uni t. | |
3753 | ||
3754 | ||
3755 | PROVIDER I D Nov 21, 20 05@09:52:3 9 Page: 1 of 1 | |
3756 | ** Provider IDs Furnis hed by Ins urance Co ** | |
3757 | PROVIDER : IB,DOC TOR7 (VA P ROVIDER) | |
3758 | INSURANCE CO: BLUE C ROSS OF CA LIFORNIA | |
3759 | PROVI DER ID TYP E FOR M CARE T YPE CAR E UNIT ID # | |
3760 | ||
3761 | No ID's found for provider a nd selecte d insuranc e co | |
3762 | ||
3763 | ||
3764 | ||
3765 | ||
3766 | ||
3767 | Enter ?? f or more ac tions | |
3768 | AU Add a Unit DU Delet e a Unit | |
3769 | EU Edit a Unit EX Exit | |
3770 | Select Act ion: Quit/ / AU Add a Unit | |
3771 | CHOOSE 1-2 : 2 BLUE SHIELD ID | |
3772 | FORM TYPE APPLIED TO : 0 BOTH UB-04 AND CMS-1500 F ORMS | |
3773 | BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT | |
3774 | Select IB PROVIDER I D CARE UNI T: Surgery Amb ulatory Su rgery BLUE CROSS | |
3775 | OF CALIFO RNIA | |
3776 | ||
3777 | THE FOLLOW ING WAS CH OSEN: | |
3778 | INSURAN CE: BLUE C ROSS OF CA LIFORNIA | |
3779 | PROV TY PE: BLUE S HIELD ID | |
3780 | FORM TY PE: BOTH U B-04 & CMS -1500 FORM S | |
3781 | CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT | |
3782 | CARE UN IT: Surger y | |
3783 | ||
3784 | PROVIDER I D: XXXXBS | |
3785 | ||
3786 | ||
3787 | When creat ing a bill for a pat ient with this payer , if IB,Do ctor7 is e ntered on Screen 8, this ID fo r the Care Unit, Sur gery, will be one of the Physi cian/Provi der’s Seco ndary IDs available. | |
3788 | ||
3789 | ** ** SECONDA RY PERFORM ING PROVID ER IDs *** * | |
3790 | ||
3791 | PRIMARY IN SURANCE CO : BLUE CRO SS OF CALI FORNIA | |
3792 | PROVIDER: IB,DOCTOR7 (RENDERIN G) | |
3793 | ||
3794 | ||
3795 | SELECT A S ECONDARY I D OR ACTIO N FROM THE LIST BELO W: | |
3796 | ||
3797 | 1 - N O SECONDAR Y ID NEEDE D | |
3798 | 2 - A DD AN ID F OR THIS CL AIM ONLY | |
3799 | 3 - X XXXBS BLUE SHIEL D ID Sur gery | |
3800 | ||
3801 | Selection: 1// | |
3802 | Define Car e Units fo r Billing Provider S econdary I Ds | |
3803 | ||
3804 | Step | |
3805 | Procedure | |
3806 | 1 | |
3807 | Access the option MC CR SYSTEM DEFINITION MENUProvi der ID Mai ntenance. | |
3808 | 2 | |
3809 | At the Sel ect Provid er ID Main tenance Op tion: prom pt, enter CB for Car e Units fo r Billing Provider. | |
3810 | 3 | |
3811 | At the Sel ect INSURA NCE CO: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple. | |
3812 | ||
3813 | ||
3814 | Provider I D Maintena nce Main M enu | |
3815 | ||
3816 | Enter a code fro m the list . | |
3817 | ||
3818 | Prov ider IDs | |
3819 | PO Provid er Own IDs | |
3820 | PI Provid er Insuran ce IDs | |
3821 | ||
3822 | Insu rance IDs | |
3823 | BI Batch ID Entry | |
3824 | II Insura nce Co IDs | |
3825 | ||
3826 | Care Units | |
3827 | CP Care U nits for P roviders | |
3828 | CB Care U nits for B illing Pro vider | |
3829 | ||
3830 | Non- VA Items | |
3831 | NP Non-VA Provider | |
3832 | NF Non-VA Facility | |
3833 | ||
3834 | Select Provider ID Mainten ance Optio n: CB Car e Units fo r Billing Provider | |
3835 | ||
3836 | Select INS URANCE CO: Blue Cros s of Calif ornia | |
3837 | ||
3838 | Step | |
3839 | Procedure | |
3840 | 4 | |
3841 | At the Sel ect Action : prompt, enter AU f or Add a U nit. | |
3842 | 5 | |
3843 | At the Ent er the Div ision for this Care Unit: prom pt, press the <Enter > key to a ccept the default. | |
3844 | 6 | |
3845 | At the Ent er Care Un it Name: p rompt, ent er Anesthe sia for th is example . | |
3846 | 7 | |
3847 | At the Ent er a Care Unit Descr iption: pr ompt, ente r a free t ext descri ption. | |
3848 | ||
3849 | Users may repeat the se steps t o create m ultiple Ca re Units f or multipl e division s. | |
3850 | ||
3851 | Refer to S ection 3.1 .2.3 to le arn how to assign Bi lling Prov ider Secon dary IDs t o Care Uni ts. | |
3852 | ||
3853 | Care Units – Billing Provider May 27, 2 005@11:17: 46 Page: 1 of 0 | |
3854 | ||
3855 | Insurance Co: BLUE C ROSS OF CA LIFORNIA | |
3856 | ||
3857 | Care Unit Name Div ision D escription | |
3858 | No Care Un its define d for this Insurance Co. | |
3859 | ||
3860 | Enter ?? f or more ac tions | |
3861 | AU Add a Unit DU Delet e a Unit | |
3862 | EU Edit a Unit EX Exit | |
3863 | Select Act ion: Quit/ / AU Add a Unit | |
3864 | Enter the Division f or this Ca re Unit: M ain Divisi on// | |
3865 | Enter Care Unit name : Anesthes ia | |
3866 | Are you adding 'An esthesia' as | |
3867 | a new Care Unit for Main D ivision? N o// y (Ye s) | |
3868 | Enter a Ca re Unit De scription: Free Text Descripti on | |
3869 | ||
3870 | Care Unit combinatio n filed fo r this Ins urance Co. | |
3871 | ||
3872 | The follow ing screen will disp lay. | |
3873 | ||
3874 | Care Units – Billing Provider May 27, 20 05@11:17:4 6 Page: 1 of 0 | |
3875 | ||
3876 | Insurance Co: BLUE C ROSS/BLUE SHIELD | |
3877 | ||
3878 | Care Uni t Name Desc ription | |
3879 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
3880 | Division: Main Divis ion | |
3881 | Anesthes ia Free Text Desc ription | |
3882 | Referenc e Lab Free Text Desc ription | |
3883 | Home Hea lth F ree Text D escription | |
3884 | ||
3885 | Division: Remote Cli nic | |
3886 | Referenc e Lab Free Text Desc ription | |
3887 | ||
3888 | ||
3889 | Enter ?? f or more ac tions | |
3890 | AU Add a Unit DU Delet e a Unit | |
3891 | EU Edit a Unit EX Exit | |
3892 | Select Act ion: Quit/ / QUIT | |
3893 | ID Paramet ers by Ins urance Com pany | |
3894 | In additio n to defin ing Care U nits and P hysician/P rovider ID s in Provi der ID Mai ntenance, there are also ID pa rameters t hat can be set for a n insuranc e company that effec t which ID s get sent on 837 cl aims trans missions t o an insur ance compa ny. | |
3895 | ||
3896 | Users need to be awa re of thes e paramete rs so they can be se t if neede d. They d o not need to be set unless th ere is a s pecific ne ed for a p articular insurance company. | |
3897 | ||
3898 | Step | |
3899 | Procedure | |
3900 | 1 | |
3901 | Access the option In surance Co mpany Entr y/Edit. | |
3902 | 2 | |
3903 | At the Sel ect INSURA NCE COMPAN Y NAME: pr ompt, ente r BLUE CRO SS OF CALI FORNIA for this exam ple. | |
3904 | 3 | |
3905 | From the I nsurance C ompany Edi tor, enter the Prov IDs/ID Par am action. | |
3906 | ||
3907 | ||
3908 | Insurance Company Ed itor Oct 01, 20 07@14:27:1 3 Page: 1 of 9 | |
3909 | Insurance Company In formation for: BLUE CROSS OF C ALIFORNIA | |
3910 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
3911 | ||
3912 | Bil ling Param eters | |
3913 | Signatur e Required ?: NO Fil ing Time F rame: | |
3914 | Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN | |
3915 | Mult. Bedsection s: Billing P hone: 800/ 933-9146 | |
3916 | Diff. Rev. Code s: Veri fication P hone: 800/ 933-9146 | |
3917 | One Opt. Visi t: NO Prec ert Comp. Name: | |
3918 | Amb. Sur . Rev. Cod e: Precert P hone: 800/ 274-7767 | |
3919 | Rx Refil l Rev. Cod e: | |
3920 | ||
3921 | ||
3922 | EDI Parame ters | |
3923 | Transm it?: YES-L IVE Insurance Type: HMO | |
3924 | + Enter ?? f or more ac tions >>> | |
3925 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
3926 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
3927 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
3928 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
3929 | PC Prescr Claims Of RE Remarks VP View Plans | |
3930 | AO Appeal s Office SY Synonyms EX Exit | |
3931 | Action: Ne xt Screen/ / ID Prov IDs/ID Pa ram | |
3932 | ||
3933 | Step | |
3934 | Procedure | |
3935 | 4 | |
3936 | From the B illing Pro vider IDs screen, en ter the ID Parameter s action. | |
3937 | ||
3938 | Billing Pr ovider IDs (Parent) May 27, 20 05@12:48:2 9 Page: 1 of 1 | |
3939 | Insurance Co: BLUE C ROSS OF CA LIFORNIA Billing Provider S econdary I Ds | |
3940 | ID Qu alifier ID # Form Type | |
3941 | Division: Name of Ma in Divisio n/Default for All Di visions | |
3942 | 1 Elect ronic Plan Type XXXXXXX XX UB-04 | |
3943 | 2 Elect ronic Plan Type XXXXXXX X1X 1500 | |
3944 | ||
3945 | ||
3946 | ||
3947 | ||
3948 | Enter ?? f or more ac tions | |
3949 | Add an ID Addit ional IDs Exit | |
3950 | Edit a n ID ID Pa rameters | |
3951 | Delete an ID VA-Lab/Fa cility IDs | |
3952 | ||
3953 | Select Act ion: Edit/ / ID Param eters | |
3954 | ||
3955 | Step | |
3956 | Procedure | |
3957 | ||
3958 | Note: The ID Paramet er Maint. Screen dis plays the current pa rameter va lues. | |
3959 | 5 | |
3960 | At the Sel ect Action : prompt, enter the Edit Param s action. | |
3961 | ||
3962 | ||
3963 | Transmit n o Billing Provider S ec ID for the follow ing Electr onic Plan Types: | |
3964 | ||
3965 | Billing Pr ovider/Ser vice Facil ity | |
3966 | + Enter ?? for more a ctions | |
3967 | Edit P arams Edit Bill ing Prov P arams Exit | |
3968 | ||
3969 | Select Act ion: Next Screen// E dit Params | |
3970 | ||
3971 | The follow ing will d isplay. | |
3972 | ||
3973 | Attending/ Rendering Provider S econdary I D | |
3974 | Default ID (1500): B LUE SHIELD // | |
3975 | Default ID (UB): BLU E CROSS// | |
3976 | Require ID on Claim: BOTH UB-0 4 AND CMS- 1500 REQUI RED | |
3977 | / / | |
3978 | ||
3979 | Referring Provider S econdary I D | |
3980 | Default ID (1500): B LUE SHIELD // | |
3981 | Require ID on Claim: CMS-1500/ / | |
3982 | ||
3983 | Billing Pr ovider Sec ondary IDs | |
3984 | Use Att/Re nd ID as B illing Pro vider Sec. ID (1500) ?: NO | |
3985 | / / | |
3986 | Use Att/Re nd ID as B illing Pro vider Sec. ID (UB)?: NO | |
3987 | / / | |
3988 | Billing Pr ovider/Ser vice Facil ity | |
3989 | Always use main VAMC as Billin g Provider (1500)?: NO | |
3990 | / / | |
3991 | Always use main VAMC as Billin g Provider (UB-04)?: NO | |
3992 | / / | |
3993 | Define Att ending/Ren dering Pro vider Seco ndary ID P arameters | |
3994 | Users can define the type of I D that wil l be the d efault sec ondary ID for the Re ndering Pr ovider or Attending Physician during the creation of a claim . | |
3995 | ||
3996 | A type of default se condary ID can be de fined for a CMS-1500 claim and /or a UB-0 4 claim. | |
3997 | ||
3998 | Users can also set a parameter that will make thes e IDs requ ired on a claim. If they are required, and the ph ysician/pr ovider on the claim does not h ave a seco ndary ID o f the type required, the claim cannot be authorize d. | |
3999 | ||
4000 | ||
4001 | Attending/ Rendering Provider S econdary I D | |
4002 | Default ID (1500): B LUE SHIELD ID | |
4003 | Default ID (UB04): B LUE CROSS ID | |
4004 | Require ID on Claim: BOTH | |
4005 | Define Ref erring Pro vider Seco ndary ID P arameters | |
4006 | Users can define the type of I D that wil l be the d efault sec ondary ID for the Re ferring Pr ovider dur ing the cr eation of a CMS-1500 claim. | |
4007 | ||
4008 | A type of default se condary ID can be de fined for a CMS-1500 claim. | |
4009 | ||
4010 | Users can also set a parameter that will make this ID requir ed on a cl aim. If i t is requi red, and t he referri ng provide r on the c laim does not have a secondary ID of the type requ ired, the claim cann ot be auth orized. | |
4011 | ||
4012 | The defaul t type of ID for a R eferring P rovider is a UPIN; u sers can, however, o verride th is default . | |
4013 | ||
4014 | Referring Provider S econdary I D | |
4015 | Default ID (1500): U PIN// BLUE SHIELD ID | |
4016 | Require ID on Claim: CMS-1500 REQUIRED | |
4017 | Define Bil ling Provi der Second ary ID Par ameters | |
4018 | If an insu rance comp any wants the Billin g Provider Secondary ID (Billi ng Screen 3) to be t he same as the Atten ding Physi cian’s or the Render ing Provid er’s ID, u sers can s et the Sen d Attendin g/Renderin g ID as Bi lling Prov ider Sec. ID?: param eter to Ye s. The de fault valu e is No. | |
4019 | ||
4020 | Billing Pr ovider Sec ondary IDs | |
4021 | Use Att/Re nd ID as B illing Pro vider Sec. ID (1500) ?: YES | |
4022 | Use Att/Re nd ID as B illing Pro vider Sec. ID (UB-04 )?: NO | |
4023 | ||
4024 | ||
4025 | If the pay er require s the Atte nding/Rend ering Phys ician/Prov ider’s Sec ondary ID as the Bil ling Provi der Second ary ID, th is paramet er can be set and a default At tending/Re ndering ID type can be set and then user s can just accept th e default ID on Bill ing Screen 8 and it will be tr ansmitted as the Phy sician/Pro vider’s Se condary ID and the B illing Pro vider Seco ndary ID. | |
4026 | Define No Billing Pr ovider Sec ondary IDs by Plan T ype | |
4027 | Some insur ance compa nies do no t want any Billing P rovider Se condary ID s to be tr ansmitted in the 837 claim tra nsmission for claims to specif ic plan ty pes. | |
4028 | ||
4029 | To define which plan types req uire no Bi lling Prov ider Secon dary IDs, users must enter the plan type s. | |
4030 | ||
4031 | Step | |
4032 | Procedure | |
4033 | 1 | |
4034 | From the I D Paramete r Maint. s creen, ent er the Edi t Billing Prov Param s action. | |
4035 | ||
4036 | The first Billing Pr ovider Sec ondary ID will still be sent w ith the cl aim regard less of th is paramet er. The f irst ID is a calcula ted value used by th e clearing house for sorting pu rposes. | |
4037 | 2 | |
4038 | At the Sel ect Action : prompt, enter Add Plan. | |
4039 | 3 | |
4040 | At the Ent er Electro nic Plan T ype: promp t, enter P PO for thi s example. | |
4041 | ||
4042 | Billing Pr ovider Par ameters May 27, 20 05@12:48:2 9 Page: 1 of 1 | |
4043 | Insurance Co.: BLUE CROSS OF C ALIFORNIA | |
4044 | ||
4045 | Transmit N o Billing Provider S ec ID for the follow ing Electr onic Plan Types: | |
4046 | 1 HMO | |
4047 | ||
4048 | ||
4049 | ||
4050 | Enter ?? f or more ac tions | |
4051 | Add Pl an De lete Plan Exit | |
4052 | ||
4053 | Select Act ion: Add P lan | |
4054 | Enter Elec tronic Pla n Type: PP O | |
4055 | ||
4056 | The follow ing screen will disp lay. | |
4057 | ||
4058 | Billing Pr ovider Par ameters May 27, 20 05@12:48:2 9 Page: 1 of 1 | |
4059 | Insurance Co.: BLUE CROSS OF C ALIFORNIA | |
4060 | ||
4061 | Transmit N o Billing Provider S ec ID for the follow ing Electr onic Plan Types: | |
4062 | 1 HMO | |
4063 | 2 PPO | |
4064 | ||
4065 | Enter ?? f or more ac tions | |
4066 | Add Pl an De lete Plan Exit | |
4067 | ||
4068 | Select Act ion: Add P lan | |
4069 | View Assoc iated Insu rance Comp anies, Pro vider IDs, and ID Pa rameters | |
4070 | When in th e Insuranc e Company Editor, us ers can sc roll throu gh the inf ormation t hat has be en defined for a par ticular in surance co mpany. | |
4071 | ||
4072 | Patch IB*2 .0*320 add ed section s to displ ay: Associ ated Insur ance Compa nies; Prov ider IDs a nd ID Para meters. | |
4073 | ||
4074 | Insurance Company Ed itor Nov 22, 20 05@10:26:1 1 Page: 5 of 7 | |
4075 | Insurance Company In formation for: BLUE CROSS OF C ALIFORNIA | |
4076 | Type of Co mpany: BLU E CROSS Cu rrently Ac tive | |
4077 | + | |
4078 | Associate d Insuranc e Companie s | |
4079 | This ins urance com pany is de fined as a Parent In surance Co mpany. | |
4080 | There ar e 4 Child Insurance Companies associated with it. | |
4081 | Select t he "AC As sociate Co mpanies" a ction to e nter/edit the childr en. | |
4082 | ||
4083 | Pr ovider IDs | |
4084 | Billing Pr ovider Sec ondary ID | |
4085 | Main Divi sion and D efault for All Divis ions/1500: | |
4086 | Main Divi sion and D efault for All Divis ions/UB-04 : | |
4087 | Main D ivision Ca re Units: | |
4088 | Anesth esia/1500: | |
4089 | Refere nce Lab/15 00: | |
4090 | Refere nce Lab/UB -04: | |
4091 | Home H ealth/UB-0 4: | |
4092 | 2nd Divis ion Name/1 500: | |
4093 | 2nd Divis ion Name/U B-04: | |
4094 | Additional Billing P rovider Se condary ID s | |
4095 | Main Divi sion and D efault for All Divis ions/1500: | |
4096 | 1st ID | |
4097 | 2nd ID | |
4098 | 3rd ID | |
4099 | Maximu m of 6 add itional ID s | |
4100 | Main Divi sion and D efault for All Divis ions/UB-04 : | |
4101 | 1st ID | |
4102 | 2nd ID | |
4103 | 3rd ID | |
4104 | Maximu m of 6 add itional ID s | |
4105 | VA-Laborat ory or Fac ility Seco ndary IDs | |
4106 | Main Divi sion and D efault for All Divis ions/1500: | |
4107 | 1st ID | |
4108 | 2nd ID | |
4109 | 3rd ID | |
4110 | Maximu m of 5 add itional ID s | |
4111 | ||
4112 | ID Parameter s | |
4113 | Attending /Rendering Provider Secondary ID Qualifi er (1500): | |
4114 | Attending /Rendering Provider Secondary ID Qualifi er (UB-04) : | |
4115 | Attending /Rendering Secondary ID Requir ement: NON E REQUIRED | |
4116 | Referring Provider Secondary ID Qualifi er (1500): | |
4117 | Referring Provider Secondary ID Require ment: | |
4118 | Use Atten ding/Rende ring ID as Billing P rovider Se c. ID: No | |
4119 | Transmit no Billing Provider Sec. ID fo r the Elec tronic Pla n Types: | |
4120 | HMO | |
4121 | PPO | |
4122 | Send VA L ab/Facilit y IDs or F acility Da ta: No | |
4123 | ||
4124 | ||
4125 | Associated Insurance Companies and Copyi ng Physic ian/Provid er Seconda ry IDs and Additiona l Billing Provider S econdary I Ds | |
4126 | Patch IB*2 .0*320 pro videds the ability f or users t o associat e multiple Insurance Company e ntries wit h each oth er. Examp le: If the re are 45 Blue Cross /Blue Shie ld entries in the In surance Co mpany file , users ca n make one of these entries th e Parent c ompany and make 1 to 44 of the other ent ries a Chi ld company . | |
4127 | ||
4128 | Making the se associa tions will cause the software to automat ically mak e the Phys ician/Prov ider Secon dary IDs a nd the Add itional Bi lling Prov ider Secon dary IDs t he same fo r all asso ciated com panies. | |
4129 | ||
4130 | Once these associati ons are ma de and the IDs synch ronized fo r all the associated companies , users ca n Add, Edi t, and/or Delete IDs for the a ssociated companies from the P arent comp any. Chan ges to the IDs from a Child co mpany, how ever, are prohibited . | |
4131 | ||
4132 | If a situa tion chang es and it becomes ne cessary fo r a Child company to have IDs that diffe r from tho se of the Parent com pany, user s may disa ssociated the Child company fr om the Par ent compan y. | |
4133 | Designate a Parent I nsurance C ompany | |
4134 | ||
4135 | Step | |
4136 | Procedure | |
4137 | 1 | |
4138 | Access the Insurance Company E ditor. | |
4139 | 2 | |
4140 | At the Sel ect INSURA NCE COMPAN Y NAME: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple. | |
4141 | 3 | |
4142 | At the Def ine Insura nce Compan y as Paren t or Child : prompt, enter Pare nt. | |
4143 | ||
4144 | Insurance Company Ed itor Oct 01, 20 07@14:27:1 3 Page: 1 of 9 | |
4145 | Insurance Company In formation for: BLUE CROSS OF C ALIFORNIA | |
4146 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | |
4147 | ||
4148 | Bil ling Param eters | |
4149 | Signatur e Required ?: NO Fil ing Time F rame: | |
4150 | Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN | |
4151 | Mult. Bedsection s: Billing P hone: 800/ 933-9146 | |
4152 | Diff. Rev. Code s: Veri fication P hone: 800/ 933-9146 | |
4153 | One Opt. Visi t: NO Prec ert Comp. Name: | |
4154 | Amb. Sur . Rev. Cod e: Precert P hone: 800/ 274-7767 | |
4155 | Rx Refil l Rev. Cod e: | |
4156 | ||
4157 | ||
4158 | EDI Parame ters | |
4159 | Transm it?: YES-L IVE Insurance Type: GROU P | |
4160 | + Enter ?? f or more ac tions >>> | |
4161 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
4162 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
4163 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
4164 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
4165 | PC Prescr Claims Of RE Remarks VP View Plans | |
4166 | AO Appeal s Office SY Synonyms EX Exit | |
4167 | Select Act ion: Next Screen//AC Associate Companies | |
4168 | ||
4169 | Define Ins urance Com pany as Pa rent or Ch ild: P PA RENT | |
4170 | ||
4171 | Step | |
4172 | Procedure | |
4173 | 4 | |
4174 | At the Sel ect Action : prompt, enter Asso ciate Comp anies for this examp le. | |
4175 | 5 | |
4176 | At the Sel ect INSURA NCE COMPAN Y NAME: pr ompt, ente r BLUE CRO SS/BLUE SH IELD 801 P INE ST. C HATTANOOGA ,TN for th is example . | |
4177 | ||
4178 | Steps 2 - 4 can be r epeated to associate additiona l Insuranc e Companie s with Blu e Cross of Californi a. | |
4179 | ||
4180 | A Parent – Child ass ociation c an be remo ved using the Disass ociate Com panies act ion. | |
4181 | ||
4182 | To stop an insurance company f rom being a Parent, all associ ations wit h any Chil d entries must be re moved. Af ter disass ociating a ll the Chi ld entries , users ma y delete t he Parent using the ‘@’ sign a t the Defi ne Insuran ce Company as Parent or Child: PARENT// prompt. | |
4183 | ||
4184 | Associated Insurance Co's Nov 21, 20 05@11:13:5 3 Page: 1 of 1 | |
4185 | Parent Ins urance Com pany: | |
4186 | BLUE CROSS OF C ALIFORNIA PO BOX 6 0007 LO S ANGELES, CA | |
4187 | ||
4188 | Ins C ompany Nam e Address Ci ty | |
4189 | ||
4190 | No Ch ildren Ins urance Com panies Fou nd | |
4191 | ||
4192 | ||
4193 | ||
4194 | ||
4195 | ||
4196 | Enter ?? f or more ac tions | |
4197 | Assoc iate Compa nies Exit | |
4198 | Disas sociate Co mpanies | |
4199 | Select Act ion: Quit/ / as Ass ociate Com panies | |
4200 | ||
4201 | Select Ins urance Com pany: BLUE CROSS/BLU E SHIELD80 1 PINE ST. CHATTANO OGA,TN | |
4202 | ||
4203 | ||
4204 | The follow ing screen will disp lay. | |
4205 | ||
4206 | Associated Insurance Co's Nov 21, 20 05@11:30:2 5 Page: 1 of 1 | |
4207 | Parent Ins urance Com pany: | |
4208 | BLUE CROSS OF C ALIFORNIA PO BOX 6 0007 LO S ANGELES, CA | |
4209 | ||
4210 | Ins C ompany Nam e Address Ci ty | |
4211 | 1 BLUE CROSS FEP PO BOX 7 0000 VA N NUYS,CA | |
4212 | 2 BLUE CROSS/BLUE SHIELD 9901 LIN N STA RD LO UISVILLE,K Y | |
4213 | 3 BLUE CROSS/BLUE SHIELD 801 PINE ST. CH ATTANOOGA, TN | |
4214 | ||
4215 | ||
4216 | ||
4217 | ||
4218 | ||
4219 | ||
4220 | Enter ?? f or more ac tions | |
4221 | Assoc iate Compa nies Exit | |
4222 | Disas sociate Co mpanies | |
4223 | Select Act ion: Quit/ / | |
4224 | ||
4225 | Designate a Child In surance Co mpany | |
4226 | An insuran ce company can be de signated a s a Child, from the Parent ins urance com pany as de monstrated in Sectio n 4.8.1. | |
4227 | ||
4228 | If users w ant to qui ckly defin e a single insurance company a s a Child, they can do this fr om the Ins urance Com pany Edito r. | |
4229 | ||
4230 | Step | |
4231 | Procedure | |
4232 | 1 | |
4233 | Access the Insurance Company E ditor. | |
4234 | 2 | |
4235 | At the Sel ect INSURA NCE COMPAN Y NAME: pr ompt, ente r Aetna fo r this exa mple. | |
4236 | 3 | |
4237 | At the Def ine Insura nce Compan y as Paren t or Child : prompt, enter Chil d for this example. | |
4238 | 4 | |
4239 | At the Ass ociate wit h which Pa rent Insur ance Compa ny: prompt , enter th e name of the insura nce compan y that wil l be the P arent. | |
4240 | ||
4241 | ‘??’ will provide a list of av ailable Pa rent insur ance compa nies. | |
4242 | ||
4243 | Insurance Company Ed itor Oct 01, 20 07@14:33:4 1 Page: 1 of 8 | |
4244 | Insurance Company In formation for: AETNA | |
4245 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Inacti ve | |
4246 | ||
4247 | Bil ling Param eters | |
4248 | Signatur e Required ?: NO Fil ing Time F rame: 12 M OS | |
4249 | Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN | |
4250 | Mult. Bedsection s: Billing P hone: | |
4251 | Diff. Rev. Code s: Veri fication P hone: | |
4252 | One Opt. Visi t: NO Prec ert Comp. Name: | |
4253 | Amb. Sur . Rev. Cod e: Precert P hone: | |
4254 | Rx Refil l Rev. Cod e: | |
4255 | ||
4256 | ||
4257 | EDI Parame ters | |
4258 | Transm it?: YES-L IVE I nsurance T ype: GROUP POLICY | |
4259 | + Enter ?? f or more ac tions >>> | |
4260 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | |
4261 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | |
4262 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | |
4263 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | |
4264 | PC Prescr Claims Of RE Remarks VP View Plans | |
4265 | AO Appeal s Office SY Synonyms EX Exit | |
4266 | Select Act ion: Next Screen// a c Associ ate Compan ies | |
4267 | ||
4268 | Define Ins urance Com pany as Pa rent or Ch ild: Child CHILD | |
4269 | Associate with which Parent In surance Co mpany: Aet NA LIFE IN SURANCE 3541 W | |
4270 | INCHESTER RD. ALLENTOW N PENN SYLVANIA Y.... .......... ...... | |
4271 | Copy Physi cian/Provi der Second ary IDs | |
4272 | Individual Physician /Provider Secondary IDs can be entered, edited or deleted on e time fro m the Pare nt insuran ce company and these changes w ill be cop ied to all associate d insuranc e companie s (Child). | |
4273 | ||
4274 | This can b e done usi ng the fol lowing Pro vider ID M aintenance options: | |
4275 | Provider I D MaintPI Provider Insurance IDs; | |
4276 | Provider I D MaintII Insurance Co IDs; a nd | |
4277 | Provider I D MaintBI Batch ID E ntry | |
4278 | ||
4279 | Copy Addit ional Bill ing Provid er Seconda ry IDs | |
4280 | When users are done adding, ed iting, or deleting A dditional IDs from t he Parent insurance company, t he changes will be c opied to a ll associa ted insura nce compan ies. | |
4281 | Synchroniz ing Associ ated Insur ance Compa ny IDs | |
4282 | There is a n IRM opti on for syn chronizing the IDs o f a Parent insurance company w ith all of the assoc iated Chil d companie s. This o ption is i ntended as a back-up option if the IDs o f a Parent have beco me out of synch with the Child companies due to a system pro blem. | |
4283 | ||
4284 | Subscriber and Patie nt ID Set- Up | |
4285 | Insurance Companies issue iden tification numbers t o the peop le that th ey insure. The pers on who pay s for the insurance policy or whose empl oyer pays for the in surance po licy or wh o receives Medicare is referre d to as th e subscrib er. A vet eran can b e the subs criber, or a veteran can be in sured thro ugh an ins urance pol icy that b elongs to some other subscribe r such as the vetera n’s spouse or parent . | |
4286 | Subscriber and Patie nt Insuran ce Provide d IDs | |
4287 | Some insur ance compa nies issue identific ation numb ers only t o the subs criber. S ome others issue uni que identi fication n umbers to each perso n covered by the sub scriber’s policy. | |
4288 | ||
4289 | Insurance companies can issue both Subsc riber Prim ary and Se condary ID numbers a nd Patient Primary a nd Seconda ry ID numb ers. | |
4290 | ||
4291 | These ID n umbers can be entere d when a p olicy is i nitially a dded in Vi stA throug h Add a po licy. Som etimes the primary I Ds will be added dur ing the in itial Pati ent Regist ration pro cess and p laced in t he insuran ce company buffer. | |
4292 | ||
4293 | Both Patie nt and Sub scriber, P rimary and Secondary IDs can b e added or edited at any time using the option Pat ient Insur ance Info View/Edit. | |
4294 | Define Sub scriber Pr imary ID | |
4295 | When the p atient is the subscr iber, user s will be prompted f or the Sub scriber’s Primary ID . | |
4296 | ||
4297 | Step | |
4298 | Procedure | |
4299 | 1 | |
4300 | Access the option Pa tient Insu rance Info View/Edit . | |
4301 | 2 | |
4302 | At the Sel ect Patien t Name: pr ompt, ente r IB,PATIE NT TWO. | |
4303 | 3 | |
4304 | At the Sel ect Items: prompt, e nter Polic y Edit/Vie w. | |
4305 | 4 | |
4306 | At the Sel ect Policy (s): promp t, enter 1 for this example. | |
4307 | ||
4308 | Patient In surance Ma nagement Sep 24, 20 07@10:18:4 9 Page: 1 of 1 | |
4309 | Insurance Management for Patie nt: IB,PAT IENT TWO I XXXX XX/X X/XXXX | |
4310 | ||
4311 | Insura nce Co. Type of P olicy Gr oup Holder Effect. Expires | |
4312 | 1 AETNA US HEALTH COMPREHEN SIVE M 65 5555-19- SELF 03/06/07 | |
4313 | 2 BLUE CROSS CA ( PREFERRED PROVI PII SPOUSE 05/15/07 | |
4314 | 3 IB INS URANCE CO COMPREHEN SIVE M XX XPLANNUM OTHER 05/16/07 | |
4315 | 4 NEW YO RK LIFE MEDIGAP ( SUPPLE F OTHER 09/29/06 | |
4316 | ||
4317 | ||
4318 | Enter ?? f or more ac tions >>> | |
4319 | AP Add Po licy EA Fast Edit All CP Chan ge Patient | |
4320 | VP Policy Edit/View BU Benefits U sed WP Work sheet Prin t | |
4321 | DP Delete Policy VC Verify Cov erage PC Prin t Insuranc e Cov. | |
4322 | AB Annual Benefits RI Personal R iders EB Expa nd Benefit s | |
4323 | RX RX COB Determina tion EX Exit | |
4324 | Select Ite m(s): Quit // VP Po licy Edit/ View | |
4325 | Select Pol icy(s): ( 1-4): 1... .......... ...... | |
4326 | ||
4327 | The follow ing screen will disp lay. | |
4328 | ||
4329 | Patient Po licy Infor mation Sep 24, 20 07@11:20:5 4 Page: 1 of 6 | |
4330 | For: IB,PA TIENT TWO XXX-XX-XX XX XX/XX /XXXX DOD: XX/ XX/XXXX | |
4331 | AETNA US H EALTHCARE Insurance Company ** Plan Curre ntly Activ e ** | |
4332 | ||
4333 | ||
4334 | Insurance Company | |
4335 | Compan y: AETNA U S HEALTHCA RE | |
4336 | Stree t: PO BOX 2561 | |
4337 | City/Stat e: FT. WAY NE, IN 468 01 | |
4338 | Billing P h: 800/367 -4552 | |
4339 | Precert P h: | |
4340 | ||
4341 | Plan Inf ormation | |
4342 | Is Gro up Plan: Y ES | |
4343 | Gro up Name: F T JAMES CO RP | |
4344 | Group Numb er: PII | |
4345 | BIN: | |
4346 | PCN: | |
4347 | Type of Plan: C OMPREHENSI VE MAJOR M ED | |
4348 | Electron ic Type: C OMMERCIAL | |
4349 | Plan Fi ling TF: 2 YRS | |
4350 | ||
4351 | ||
4352 | Utilizat ion Review Info Effective Dates & S ource | |
4353 | Require UR : Effec tive Date: 03/06/07 | |
4354 | + Enter ?? f or more ac tions | |
4355 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
4356 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
4357 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
4358 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
4359 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
4360 | EX Exit | |
4361 | Select Act ion: Next Screen// S U Subscri ber Update | |
4362 | ||
4363 | Step | |
4364 | Procedure | |
4365 | 5 | |
4366 | At the Sel ect Action : prompt, enter Subs criber Upd ate. | |
4367 | 6 | |
4368 | At the Pt. Relations hip to Sub scriber: p rompt, ent er Patient . | |
4369 | ||
4370 | Note: With Patch IB* 2*371, the Whose Ins urance? pr ompt was r emoved. | |
4371 | ||
4372 | With Patch IB*2*377, the list of availab le choices for Pt. R elationshi p to Insur ed was mod ified to h ave an exp anded list of HIPAA valid choi ces. | |
4373 | 7 | |
4374 | At the Nam e of Subsc riber: pro mpt, press the <Ente r> key to accept the default o f IB,Patie nt Two. | |
4375 | ||
4376 | Note: Once Patch IB* 2*547 is i nstalled, a patient and/or a s ubscriber with only a last nam e will be acceptable in Enter/ Edit Billi ng Informa tion. | |
4377 | ||
4378 | With Patch IB*2*371, users wil l have the ability t o update t he patient ’s name fo r any pati ent and an y insuranc e company. This wil l allow us ers to mak e the pati ent’s name match wha t is on fi le at the payer even when it i s differen t from wha t is in th e VistA pa tient file . | |
4379 | 8 | |
4380 | At the Eff ective Dat e of Polic y: prompt, press the <Enter> k ey to acce pt the def ault of MA R 6, 2007. | |
4381 | 9 | |
4382 | At the Coo rdination of Benefit s: prompt, enter Pri mary for t his exampl e. | |
4383 | 10 | |
4384 | At the Sou rce of Inf ormation: prompt, pr ess the <E nter> key to accept the defaul t of Inter view. | |
4385 | 11 | |
4386 | At the Sub scriber Pr imary ID: prompt, en ter IDXXXX X for this example. | |
4387 | 12 | |
4388 | At the Do you want t o enter/up date Subsc riber Seco ndary IDs? Prompt, p ress the < Enter> key to accept the defau lt of No. | |
4389 | 13 | |
4390 | At the Sub scriber's DOB: promp t, press t he <Enter> key to ac cept the d efault. | |
4391 | 14 | |
4392 | At the Sub scriber’s Sex: promp t, press t he <Enter> key to ac cept the d efault. | |
4393 | ||
4394 | With Patch IB*2*361, the Insur ed’s Sex p rompt was added. Th is is requ ired by HI PAA as is the Insure d’s DOB. | |
4395 | ||
4396 | The Insure d’s addres s is not r equired by HIPAA but HIPAA wil l not acce pt a parti al address . When th e insured is the pat ient, the patient’s address wi ll be defa ulted from the patie nt file. | |
4397 | ||
4398 | Select Act ion: Next Screen// Subscriber Update | |
4399 | PT. RELATI ONSHIP TO SUBSCRIBER : PATIENT | |
4400 | NAME OF SU BSCRIBER: IB,PATIENT TWO// | |
4401 | EFFECTIVE DATE OF PO LICY: MAR 6,2007 | |
4402 | INSURANCE EXPIRATION DATE: | |
4403 | PRIMARY CA RE PROVIDE R: | |
4404 | PRIMARY PR OVIDER PHO NE: | |
4405 | COORDINATI ON OF BENE FITS: PRIM ARY | |
4406 | SOURCE OF INFORMATIO N: INTERVI EW// | |
4407 | ||
4408 | SUBSCRIBER PRIMARY I D: IDXXXXX | |
4409 | ||
4410 | Do you wan t to enter /update Su bscriber S econdary I Ds? No// NO | |
4411 | ||
4412 | SUBSCRIBER 'S DOB: XX X XX,XXXX/ / | |
4413 | SUBSCRIBER 'S SEX: MA LE// | |
4414 | SUBSCRIBER 'S BRANCH: NAVY// | |
4415 | SUBSCRIBER 'S RANK: | |
4416 | SUBSCRIBER 'S STREET 1: 123 E.T EST BLVD// | |
4417 | SUBSCRIBER 'S STREET 2: | |
4418 | SUBSCRIBER 'S CITY: C HEYENNE// | |
4419 | SUBSCRIBER 'S STATE: WYOMING// | |
4420 | SUBSCRIBER 'S ZIP: 82 001// | |
4421 | ||
4422 | ||
4423 | Patch IB*2 *377 will provide t he ability for the N ame of the Subscribe r and the Subscriber ’s primary ID (HIC#) to be aut omatically updated i n the Pati ent’s Medi care (WNR) Insurance when an M RA is rece ived in Vi stA that c ontains a corrected name and/o r ID. The PATIENT f ile will n ot be chan ged. | |
4424 | Define Sub scriber an d Patient Primary ID s | |
4425 | When the p atient is not the su bscriber, users will be prompt ed for the Patient’s Primary I D as well as the Sub scriber’s Primary ID . | |
4426 | ||
4427 | Step | |
4428 | Procedure | |
4429 | 1 | |
4430 | Access the option Pa tient Insu rance Info View/Edit . | |
4431 | 2 | |
4432 | At the Sel ect Patien t Name: pr ompt, ente r IB,PATIE NT TWO. | |
4433 | 3 | |
4434 | At the Sel ect Items: prompt, e nter Polic y Edit/Vie w. | |
4435 | 4 | |
4436 | At the Sel ect Policy (s): promp t, enter 3 for this example. | |
4437 | ||
4438 | ||
4439 | Patient In surance Ma nagement Sep 24, 20 07@10:18:4 9 Page: 1 of 1 | |
4440 | Insurance Management for Patie nt: IB,PAT IENT TWO I 4444 XX/X X/XXXX | |
4441 | ||
4442 | Insura nce Co. Type of P olicy Gr oup Holder Effect. Expires | |
4443 | 1 AETNA US HEALTH COMPREHEN SIVE M 65 5555-19- SELF 03/06/07 | |
4444 | 2 BLUE CROSS CA ( PREFERRED PROVI PII SPOUSE 05/15/07 | |
4445 | 3 IB INS URANCE CO COMPREHEN SIVE M XX XPLANNUM SPOUSE 05/16/07 | |
4446 | 4 NEW YO RK LIFE MEDIGAP ( SUPPLE F OTHER 09/29/06 | |
4447 | ||
4448 | ||
4449 | Enter ?? f or more ac tions >>> | |
4450 | AP Add Po licy EA Fast Edit All CP Chan ge Patient | |
4451 | VP Policy Edit/View BU Benefits U sed WP Work sheet Prin t | |
4452 | DP Delete Policy VC Verify Cov erage PC Prin t Insuranc e Cov. | |
4453 | AB Annual Benefits RI Personal R iders EX Exit | |
4454 | Select Ite m(s): Quit // VP Po licy Edit/ View | |
4455 | Select Pol icy(s): ( 1-4): 3... .......... ...... | |
4456 | ||
4457 | The follow ing screen will disp lay. | |
4458 | ||
4459 | Patient Po licy Infor mation Sep 24, 20 07@10:33:4 9 Page: 2 of 6 | |
4460 | For: IB,PA TIENT TWO XXX-XX-XX XX XX/XX /XXXX DOD: XX/ XX/XXXX | |
4461 | IB INSURAN CE CO Insu rance Comp any ** Plan Curre ntly Activ e ** | |
4462 | + | |
4463 | Subscrib er Informa tion Subscriber 's Employe r Informat ion | |
4464 | Whose In surance: S POUSE E mp Sponsor ed Plan: N o | |
4465 | Subscrib er Name: E mployer: | |
4466 | Relat ionship: Employment Status: | |
4467 | Pri mary ID: Retireme nt Date: | |
4468 | Coord. B enefits: C laims to E mployer: N o, Send to Insurance | |
4469 | Primary P rovider: Street: | |
4470 | Prim Pro v Phone: Cit y/State: | |
4471 | Phone: | |
4472 | ||
4473 | Insure d Person's Informati on (use Su bscriber U pdate Acti on) | |
4474 | Ins ured's DOB : XX/XX/XX XX Str 1: 123 E.TEST BLVD | |
4475 | + Enter ?? f or more ac tions | |
4476 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | |
4477 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | |
4478 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | |
4479 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | |
4480 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | |
4481 | EX Exit | |
4482 | Select Act ion: Next Screen// S U Subscri ber Update | |
4483 | ||
4484 | Step | |
4485 | Procedure | |
4486 | 5 | |
4487 | At the Sel ect Action : prompt, enter Subs criber Upd ate. | |
4488 | 6 | |
4489 | At the PT. RELATIONS HIP TO SUB SCRIBER: p rompt, ent er SPOUSE for this e xample. | |
4490 | ||
4491 | With Patch IB*2*377, an expand ed list of HIPAA com pliant cod es for Pt. Relations hip to Ins ured, was added. | |
4492 | ||
4493 | With Patch IB*2*371, the Whose Insurance ? prompt w as removed . | |
4494 | 7 | |
4495 | At the Nam e of Subsc riber: pro mpt, enter IB,Spouse Two for t his exampl e. | |
4496 | 8 | |
4497 | At the Eff ective Dat e of Polic y: prompt, press the <Enter> k ey to acce pt the def ault of Ma y 15, 2007 . | |
4498 | 9 | |
4499 | At the Coo rdination of Benefit s: prompt, enter Sec ondary for this exam ple. | |
4500 | 10 | |
4501 | At the Sou rce of Inf ormation: prompt, pr ess the <E nter> key to accept the defaul t of Inter view. | |
4502 | 11 | |
4503 | At the Sub scriber Pr imary ID: prompt, en ter XXXXXI D for this example. | |
4504 | 12 | |
4505 | At the Do you want t o enter/up date Subsc riber Seco ndary IDs? Prompt, p ress the < Enter> key to accept the defau lt of No. | |
4506 | 13 | |
4507 | At the Pat ient Prima ry ID: pro mpt, enter XXXXXID2 for this e xample. | |
4508 | 14 | |
4509 | At the Do you want t o enter/up date Patie nt Seconda ry IDs? Pr ompt, pres s the <Ent er> key to accept th e default of No. | |
4510 | 15 | |
4511 | At the Sub scriber’s DOB: promp t, enter A ugust 12, 1945 for t his exampl e. | |
4512 | 16 | |
4513 | At the Sub scriber’s Sex: promp t, enter F emale for this examp le. | |
4514 | ||
4515 | With Patch IB*2*361, the Insur ed’s Sex p rompt was added. Th is is requ ired by HI PAA as is the Insure d’s DOB. | |
4516 | ||
4517 | If the Pat ient’s Rel ationship to the Ins ured is sp ouse, then the patie nt’s addre ss will be the defau lt address of the In sured. Us ers may en ter differ ent values if the sp ouse’s add ress is di fferent fr om the pat ient’s. | |
4518 | ||
4519 | The Insure d’s addres s is not r equired by HIPAA but HIPAA wil l not acce pt a parti al address . | |
4520 | ||
4521 | Select Act ion: Next Screen// S U Subscr iber Updat e | |
4522 | PT. RELATI ONSHIP TO SUBSCRIBER : SPOUSE// | |
4523 | NAME OF SU BSCRIBER: IB,SPOUSE TWO | |
4524 | EFFECTIVE DATE OF PO LICY: MAY 15,2007 | |
4525 | INSURANCE EXPIRATION DATE: | |
4526 | PRIMARY CA RE PROVIDE R: | |
4527 | PRIMARY PR OVIDER PHO NE: | |
4528 | COORDINATI ON OF BENE FITS: SECO NDARY | |
4529 | SOURCE OF INFORMATIO N: INTERVI EW// | |
4530 | ||
4531 | SUBSCRIBER PRIMARY I D: XXXXXID | |
4532 | ||
4533 | Do you wan t to enter /update Su bscriber S econdary I Ds? No// NO | |
4534 | ||
4535 | PATIENT PR IMARY ID: XXXXXID2 | |
4536 | ||
4537 | Do you wan t to enter /update Pa tient Seco ndary IDs? No// NO | |
4538 | ||
4539 | SUBSCRIBER 'S DOB: AU G 12,1945 | |
4540 | SUBSCRIBER 'S SEX: FE MALE | |
4541 | SUBSCRIBER 'S BRANCH: | |
4542 | SUBSCRIBER 'S RANK: | |
4543 | SUBSCRIBER 'S STREET 1: 123 E.T EST BLVD// | |
4544 | SUBSCRIBER 'S STREET 2: | |
4545 | SUBSCRIBER 'S CITY: C HEYENNE// | |
4546 | SUBSCRIBER 'S STATE: WYOMING// | |
4547 | SUBSCRIBER 'S ZIP: 82 001// | |
4548 | Define Sub scriber an d Patient Secondary IDs | |
4549 | In additio n to Subsc riber and Patient Pr imary IDs, it is pos sible for insurance companies to issue s econdary I Ds, althou gh this is unusual. A subscri ber or a p atient may also have one or mo re seconda ry IDs of the follow ing types: | |
4550 | 23 C lient Numb er | |
4551 | IG I nsurance P olicy Numb er | |
4552 | SY S ocial Secu rity Numbe r | |
4553 | ||
4554 | SUBSCRIBER PRIMARY I D: XXXXXID // | |
4555 | ||
4556 | Do you wan t to enter /update Su bscriber S econdary I Ds? No// y YES | |
4557 | ||
4558 | SUBSCRIBER 'S SEC QUA LIFIER(1): ?? | |
4559 | Enter a Qualifi er to iden tify the t ype of ID number. | |
4560 | Choos e from: | |
4561 | 23 Clie nt Number | |
4562 | IG Insu rance Poli cy Number | |
4563 | SY Soci al Securit y Number | |
4564 | SUBSCRIBER 'S SEC QUA LIFIER(1): IG Insur ance Polic y Number | |
4565 | SUBSCRIBER 'S SEC ID( 1): XXXXID 2 | |
4566 | SUBSCRIBER 'S SEC QUA LIFIER(2): | |
4567 | ||
4568 | PATIENT PR IMARY ID: IDXXXXX// | |
4569 | ||
4570 | Do you wan t to enter /update Pa tient Seco ndary IDs? No// y Y ES | |
4571 | ||
4572 | PATIENT'S SEC QUALIF IER(1): IG Insuranc e Policy N umber | |
4573 | PATIENT'S SECONDARY ID(1): ID2 XXXX | |
4574 | PATIENT'S SEC QUALIF IER(2): | |
4575 | ||
4576 | Step | |
4577 | Procedure | |
4578 | 1 | |
4579 | Access Sub scriber Up date again . | |
4580 | 2 | |
4581 | At the Do you want t o enter/up date Subsc riber Seco ndary IDs? No//: pro mpt, enter Yes. | |
4582 | 3 | |
4583 | At the Sub scriber’s Sec Qualif ier (1): p rompt, ent er IG for this examp le. | |
4584 | ||
4585 | 23 Client Number is used for c laims to t he Indian Health Ser vice/Contr act Health Services (HIS/CHS). | |
4586 | ||
4587 | VistA will not allow users to enter SY f or SNN if the payer is Medicar e. Medica re will no t accept t he SSN as a subscrib er’s secon dary ID. | |
4588 | 4 | |
4589 | At the Sub scriber’s Sec ID (1) : prompt, enter XXXX ID2 for th is example . | |
4590 | 5 | |
4591 | At the Sub scriber’s Sec Qualif ier (2): p rompt, pre ss the <En ter> key i f you do n ot want to add anoth er ID. | |
4592 | 6 | |
4593 | At the Pat ient Prima ry ID (1): prompt, p ress the < Enter> key to accept the defau lt. | |
4594 | 7 | |
4595 | At the Do you want t o enter/up date Patie nt Seconda ry IDs? No //: prompt , enter Ye s. | |
4596 | 8 | |
4597 | At the Pat ient’s Sec Qualifier (1): prom pt, enter IG for thi s example. | |
4598 | 9 | |
4599 | At the Pat ient’s Sec ID (1): p rompt, ent er ID2XXXX for this example. | |
4600 | 10 | |
4601 | At the Pat ient’s Sec Qualifier (2): prom pt, press the <Enter > key if y ou do not want to ad d another ID. | |
4602 | ||
4603 | Entering E lectronic Claims | |
4604 | This secti on briefly identifie s the scre ens used i n the bill ing proces s that con tain field s critical to EDI bi lling. It is importa nt that al l the data transmitt ed in an e lectronic claim be a ccurate an d appropri ate. This section is just mean t to highl ight some specific f ields that pertain t o electron ic process ing. | |
4605 | Summary of Enter/Edi t Billing Informatio n to Suppo rt ASC X12 N/5010 | |
4606 | There have been nume rous chang es with Pa tch IB*2*4 47 to the Enter/Edit Billing I nformation option to support c hanges in the Health Care Clai m (837) Te chnical Re ports (ASC X12N/ 501 0) for bot h Institut ional and Profession al claims. | |
4607 | ||
4608 | Patch IB*2 *592 intro duces the additional claim typ e of Denta l. The Den tal claims are also transmitte d in the A SC X12N/50 10 Health Care Claim (837) tra nsaction. | |
4609 | ||
4610 | Screen | |
4611 | Section | |
4612 | Change | |
4613 | 5 | |
4614 | 3 | |
4615 | Addition o f Priority (Type) of Admission | |
4616 | 5 | |
4617 | 3 | |
4618 | Addition o f Default Priority ( Type) of A dmission | |
4619 | 8 | |
4620 | ||
4621 | Screen 9 c ontains al l informat ion previo usly found on Screen 8 section 3 | |
4622 | 9 | |
4623 | ||
4624 | Added Ambu lance Tran sport Info rmation (C laim Level ) | |
4625 | 9 | |
4626 | ||
4627 | Added Ambu lance Cert ification Data (Clai m Level) | |
4628 | 11 | |
4629 | ||
4630 | Local scre en 9 infor mation was moved to screen 11 | |
4631 | ||
4632 | ||
4633 | Note: Afte r Patch IB *2*432 is installed, users wil l no longe r receive Warnings w hen there is more th an one div ision or n on-matchin g provider s on a cla im. It wil l be possi ble to hav e multi-di visional c laims with line-leve l and clai m-level pr oviders, o f the same type, who do not ma tch. | |
4634 | ||
4635 | Note: Afte r Patch IB *2*432 is installed, users wil l no longe r receive an Error w hen a huma n provider does not have an SS N or EIN d efined. | |
4636 | Changes Ma de by Spec ific Patch es | |
4637 | Patch IB*2 *447 | |
4638 | The follow ing change s are in P atch IB*2* 447 not co vered else where in t his docume nt. | |
4639 | Enter/Edit Billing I nformation | |
4640 | The proced ure in the first lin e-level po sition (fi rst entere d or set t o 1 by use r) on a cl aim, will no longer be designa ted a clai m level Pr incipal pr ocedure (Q ualifier B R) on an o utpatient, instituti onal claim . | |
4641 | The additi onal proce dures in t he line it ems of an outpatient , institut ional will no longer be design ated a cla im level O ther proce dures (Qua lifier BQ) . | |
4642 | IB will ca lculate th e amount d ue from th e MediGap secondary payer base d upon the beginning Date of S ervice on a claim an d the effe ctive date of the Me diGap Plan s. | |
4643 | MEDIGAP C alculation s | |
4644 | This optio n is curre ntly not a vailable a nd can be turned on at a futur e time. | |
4645 | The amount due from the Medica re seconda ry Medigap payer wil l be based upon the Type of Pl an of the Insurance Plan | |
4646 | MEDIGAP A (COINS, NO DED, NO B EXC) | |
4647 | MEDIGAP B (COINS, A DED, NO B DED, NO B EXC) | |
4648 | MEDIGAP C (COINS, A/ B DED,NO B EXC) | |
4649 | MEDIGAP D (COINS, A DED, NO B DED, NO B EXC) | |
4650 | MEDIGAP F (COINS, DE D, NO B EX C) | |
4651 | MEDIGAP G (COINS, A DED, NO B DED, NO B EXC,) | |
4652 | MEDIGAP K (A COINS, 50% B COIN S, 50% A D ED, NO B D ED, NO B E XC) | |
4653 | MEDIGAP L (A COINS, 75% B COIN S, 75% A D ED, NO B D ED, NO B E XC) | |
4654 | MEDIGAP M (COINS, 50 % A DED, N O B DED, N O B EXC) | |
4655 | MEDIGAP N (COINS, A DED, NO B DED, NO B EXC) | |
4656 | The amount due from the Medica re Seconda ry payer w ill be bas ed upon th e Type of Plan defin ed for the Insurance Plan: | |
4657 | Medicare S econdary ( COINS, DED , No B EXC ) | |
4658 | Medicare S econdary ( COINS, DED , B EXC) | |
4659 | The amount due from the Medica re Seconda ry Supplem ental paye r will be based upon the Type of Plan de fined for the Insura nce Plan. Medicare ( Supplement al) (COINS , DED, No B EXC) | |
4660 | The amount due from the Medica re Seconda ry Employe r Group He alth Plan (EGHP) pay er will be based upo n the Type of Plan d efined for the Insur ance Plan: | |
4661 | CARVE-OUT (COINS, DE D, B EXC) | |
4662 | COMPREHENS IVE (COINS , DED, B E XC) | |
4663 | MEDICAL EX PENSE (OPT /PROF) (CO INS, DED, B EXC) | |
4664 | MENTAL HEA LTH (COINS , DED, B E XC) | |
4665 | POINT OF S ERVICE (CO INS, DED, B EXC) | |
4666 | PREFERRED PROVIDER O RGANIZATIO N (PPO) (C OINS, DED, B EXC) | |
4667 | RETIREE (C OINS, DED, B EXC) | |
4668 | SURGICAL E XPENSE INS URANCE (CO INS, DED, B EXC) | |
4669 | The moneta ry value e ntered by users in S ection 5 o f Screen 7 , Rev. Cod e, for out patient an d inpatien t Professi onal claim s will be retained u nless user s: | |
4670 | Remove the procedure that gene rated the Revenue Co de and mon etary valu e; | |
4671 | Execute th e Rate Sch edule reca lculation of charges function; | |
4672 | Change the division associated with the procedure; | |
4673 | Change the Charge Ty pe; | |
4674 | Change the division associated with the claim. | |
4675 | It will be possible to transmi t Revenue/ Procedure codes whic h generate zero char ge amounts in an 837 Health Ca re Claim T ransmissio ns (PRF, P iece 5 and INS, Piec e 9). | |
4676 | Users will be able t o enter an d transmit a Priorit y (Type) o f Visit (A dmission T ype Code) code field in an out patient, i nstitution al 837 Hea lth Care C laim Trans mission (C L1, Piece 23). Ther e will no longer be a hard-cod ed value, 9, transmi tted or pr inted. | |
4677 | Users will be able t o enter an d transmit the follo wing Ambul ance Trans port Data in a profe ssional 83 7 Health C are Claim Transmissi on: | |
4678 | Patient’s Weight Qua lifier = L B | |
4679 | Patient’s Weight | |
4680 | Transport Reason Cod e | |
4681 | Transport Distance Q ualifier = DH | |
4682 | Transport Distance | |
4683 | Round Trip Purpose D escription (Free Tex t) | |
4684 | Stretcher Purpose De scription (Free Text ) | |
4685 | Users will be able t o enter an d transmit the follo wing Ambul ance Certi fication D ata in a p rofessiona l 837 Heal th Care Cl aim Transm ission: | |
4686 | Code Categ ory – 07 | |
4687 | Certificat ion Condit ion Indica tor – YES | |
4688 | Condition Codes (1-5 codes) | |
4689 | Patch IB*2 *488: | |
4690 | Patch IB*2 *488 inclu des the fo llowing ch anges not covered el sewhere in this docu ment. | |
4691 | Enter/Edit Billing I nformation | |
4692 | The system no longer provides the abilit y for user s to force instituti onal or pr ofessional claims to be printe d at the H ealth Care Clearing House (HCC H) | |
4693 | MRA Manage ment Workl ist (MRW) | |
4694 | Patch IB*2 *488 modif ied the wa y message storage er rors (crea ted when a n EEOB or MRA is rec eived and all the li ne items c annot be m atched cor rectly) ar e displaye d in TPJI. Internal code will no longer be displa yed to the users. I n addition to the ch anges in T PJI, simil ar changes exist in MRW for Me dicare cla ims. | |
4695 | ||
4696 | The Follow ing types of errors will be di splayed: | |
4697 | Procedure Code misma tch | |
4698 | Procedure Modifier m ismatch | |
4699 | Revenue Co de mismatc h | |
4700 | Charge Amo unt mismat ch | |
4701 | Number of Units mism atch | |
4702 | ||
4703 | The type o f mismatch error and the value s that wer e in the o utbound 83 7 transact ion will b e displaye d along wi th the val ues that w ere receiv ed in the inbound 83 5 transact ion. | |
4704 | ||
4705 | View an EO B Apr 14, 20 14@18:25:5 5 Page: 4 of 6 | |
4706 | BI LL #:442-K 101EVT | |
4707 | CURRENT I NSURANCE C OMPANY (PR IMARY): ME DICARE (WN R) | |
4708 | + | |
4709 | VistA coul d not matc h all of t he Line Le vel data r eceived in the EEOB | |
4710 | (835 Recor d 40) to t he claim i n VistA. | |
4711 | ||
4712 | Mismatched Procedure Code: | |
4713 | ||
4714 | Payer repo rted the f ollowing w as billed via the Cl aim (837): | |
4715 | Proc:7 1010 Mods :59 Rev C d:324 Chg :227.40 U nits:1 | |
4716 | Payer repo rted adjud ication vi a the EOB (835) as f ollows: | |
4717 | Proc:7 1015 Mods :59 Rev C d:324 Chg :227.40 U nits:1 | |
4718 | Amt:10 0.00 | |
4719 | ||
4720 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
4721 | Service li ne adjustm ent (EEOB Record 41) has no ma tching ser vice line | |
4722 | + Enter ?? f or more ac tions | |
4723 | Genera l Info Claim Leve l Adj Revi ew Info | |
4724 | Payer Info Medicare I nfo Exit | |
4725 | Claim Level Pay Line Level Adj | |
4726 | Select Act ion: Next Screen// | |
4727 | ||
4728 | Users can now identi fy those M edicare cl aims with associated MSEs as a n exclamat ion point will appea r to the l eft of the claim num ber. | |
4729 | ||
4730 | MRA Manage ment WorkL ist Nov 25, 20 13@14:06:5 8 Page: 1 of 35 | |
4731 | ||
4732 | Bill # Svc Date P atient Nam e SS N Pt Res p Bill A mt Type | |
4733 | BILLER: IB ,CLERK F | |
4734 | 1 !442-K XXXXXX* 06/02/10 I B,PATIENT 234 XXX X 0.0 0 1710. 76 O/I | |
4735 | Insu rers: MED ICARE (WNR ), NAT'L A SSOC OF LE TTER CARRI ERS | |
4736 | MRA St atus: DEN IED, Jul 1 2, 2010 | |
4737 | 2 442-KX XXXXX 06/02/10 I B,PATIENT 33 XXX X 0.0 0 380. 22 O/P | |
4738 | Insu rers: MED ICARE (WNR ), NAT'L A SSOC OF LE TTER CARRI ERS | |
4739 | MRA St atus: DEN IED, Jul 0 7, 2010 | |
4740 | 3 442-KX XXXXX 05/14/10 I B,PATIENT 12 XXX X 0.0 0 132. 20 O/P | |
4741 | Insu rers: MED ICARE (WNR ), UNITEDH EALTHCARE | |
4742 | MRA St atus: DEN IED, Aug 1 6, 2010 | |
4743 | 4 442-KX XXXXX 06/11/10 I B,PATIENT 12 XXX X 0.0 0 132. 20 O/P | |
4744 | Insu rers: MED ICARE (WNR ), UNITEDH EALTHCARE | |
4745 | MRA St atus: DEN IED, Aug 1 6, 2010 | |
4746 | 5 442-KX XXXXX 06/14/10 I B,PATIENT 103 XXX X 0.0 0 81. 22 I/P | |
4747 | + ! =835 Data Mismatch Enter ?? for mor e actions | |
4748 | PC Proces s COB VC View Comme nts PM Prin t MRA | |
4749 | VE View a n EOB CB Cancel Bil l TP Thir d Party Jo int Inq. | |
4750 | SU Summar y MRA Info CR Correct Bi ll Q Exit | |
4751 | EC Enter Comments CC Cancel/Clo ne A Bill | |
4752 | RS Review Status VB View Bill | |
4753 | Select Act ion: Next Screen// | |
4754 | ||
4755 | If users a ttempt to access any of the fo llowing Ac tions, the system wi ll display a warning message. | |
4756 | PC - Proce ss COB | |
4757 | VE - View an EOB | |
4758 | SU – Summa ry MRA Inf o | |
4759 | PM - Print MRA | |
4760 | ||
4761 | Warning : The MRA fo r this cla im caused a Data Mis match/Mess age Storag e Error. If you con tinue, the secondary claim may not conta in the cor rect data. | |
4762 | Do you wis h to conti nue?: No/ / | |
4763 | ||
4764 | Enhanced C MS-1500 Pr inted Clai m Form | |
4765 | The CMS-15 00 Printed Claim For m has been updated t o comply w ith the ne w National Uniform C laim Commi ttee (NUCC ) standard s. | |
4766 | Patch IB*2 *516 | |
4767 | Patch IB*2 *516 inclu des the fo llowing ch anges not covered el sewhere in this docu ment. | |
4768 | TRICARE/TR ICARE REIM B. Pay-to Providers | |
4769 | If the Rat e Type of a claim is either TR ICARE or T RICARE REI MB., the n ew Non-MCC F Pay-to P rovider wi ll be prin ted or tra nsmitted i n the same manner as the regul ar Pay-to Provider i nformation is for ot her Rate T ypes. | |
4770 | The Non-MC CF Pay-to Provider’s address w ill print on the CMS – 1500 fo rm in Box 32 | |
4771 | The Non-MC CF Pay-to Provider’s data will print on the UB04 i n FL2 only when the informatio n is not e xactly the same as t he Billing Provider informatio n | |
4772 | The Non-MC CF Pay-to Provider d ata will b e transmit ted in the 837 claim transacti on in Reco rd PRV1/Lo op 2010A/B | |
4773 | NDC Number s for non- RX Claims | |
4774 | If an NDC number and the units administe red to the patient a re entered on either a profess ional or i nstitution al claim, the inform ation will print in the follow ing locati ons if the claim is printed lo cally: | |
4775 | CMS – 1500 – Box 24: Shaded ar ea – Forma t: N4NDC#< space>Unit Qualifier #of Units – if trans mitted, th e NDC numb er is tran smitted in Record PR F/Loop 241 0 | |
4776 | UB04 – FL4 3 - Format : N4NDC#<s pace>Unit Qualifier# of Units – if transm itted the NDC number is transm itted in R ecord INS/ Loop 2410 | |
4777 | ||
4778 | ||
4779 | Note: The ability to select a Unit Quali fier was a dded in pa tch IB*2*5 77. | |
4780 | ||
4781 | Patch IB*2 *547 | |
4782 | Patch IB*2 *547 inclu des the fo llowing ch anges not covered el sewhere in this docu ment: | |
4783 | Service Li nes with N o Print Or der | |
4784 | Identical CPT/HCPCS procedures that have the exact same data elements and no pri nt order w ill be ass igned to t he same Re venue code with a co mbined num ber of uni ts and mon etary valu e. | |
4785 | Last Names Only | |
4786 | Claims can now be su bmitted fo r both pat ients and/ or subscri bers who h ave only o ne name (l ast name). A patient and/or su bscriber w ith only a last name will no l onger trig ger a fata l error wh en trying to authori ze a claim . | |
4787 | Blank Pres ent on Adm ission | |
4788 | Inpatient institutio nal claims no longer require a Present o n Admissio n (POA) va lue for al l diagnosi s codes. I f a POA in dicator is needed, t he allowab le values are now th e followin g: | |
4789 | Y – Yes | |
4790 | N – No | |
4791 | U – No Inf ormation i n the Reco rd | |
4792 | W – Clinic ally Undet ermined | |
4793 | Printed CM S 1500 For ms | |
4794 | Printed se condary/te rtiary cla ims on CMS 1500 form s will dis play the d ollar amou nt of prev ious prima ry and sec ondary pay er payment s in Box 2 9 - Amount Paid. | |
4795 | Printed UB 04 Forms | |
4796 | The admiss ion date a nd time wi ll print o n the UB04 form in F L 12 and 1 3 on claim s for inpa tient admi ssions onl y. | |
4797 | Insurance Company En try/Edit/V iew Insura nce Compan y | |
4798 | Though IB will conti nue to use only comp lete addre sses in 83 7 transact ions, the address fi elds in th e insuranc e company editor wil l display whatever a ddress dat a is store d in VistA for the f ollowing f ields even when the address da ta is inco mplete: | |
4799 | Main Maili ng Address | |
4800 | Inpt Claim s Office | |
4801 | Opt Claims Office | |
4802 | Prescr Cla ims Office | |
4803 | Appeals Of fice | |
4804 | Inquiry Of fice | |
4805 | ||
4806 | ||
4807 | Note: View Insurance Company, which is j ust a view only opti on of what is in the Insurance Company E ntry/Edit option, wi ll display the same address in formation. | |
4808 | EDI Menu f or Electro nic Bills… . Print EO B | |
4809 | Print EOB will displ ay the com plete and current te xtual desc ription as sociated w ith the Cl aims Adjus tment Reas on Codes/R emittance Advice Rem ark Codes (CARC/RARC ) received in an ele ctronic EO B. | |
4810 | Copy and C ancel (CLO N) | |
4811 | The existi ng CLON op tion logic for the i nclusion o f Coordina tion of Be nefits (CO B) data wa s enhanced to incorp orate the following rules: | |
4812 | Copy prima ry claim w ith EOB to a new pri mary claim – Do not copy COB d ata | |
4813 | Copy secon dary claim to new se condary cl aim – Copy primary C OB data | |
4814 | Copy terti ary claim to new ter tiary clai m – Copy p rimary and secondary COB data | |
4815 | ASC X12N 5 010 Health Care Clai m (837) Tr ansactions | |
4816 | The follow ing change s were mad e to 837 t ransaction s: | |
4817 | An inpatie nt instit utional 83 7 transact ion no lon ger requir es a POA f or each di agnosis | |
4818 | An inpatie nt admissi on date ca n no longe r be trans mitted on outpatient claims | |
4819 | All Rate T ypes for w hich the r esponsible party is equal to i nsurer can now be tr ansmitted electronic ally when appropriat e | |
4820 | Institutio nal 837 tr ansactions can now t ransmit up to twenty -five proc edure code s | |
4821 | Institutio nal 837 tr ansactions can now t ransmit up to 12 Ext ernal Caus e of Injur y codes | |
4822 | Patch IB.2 .576 | |
4823 | Patch IB*2 *576 inclu des the fo llowing ch anges not covered el sewhere in this docu ment: | |
4824 | Enhanced C MS-1500 Pr inted Clai m Form | |
4825 | The CMS-15 00 Printed Claim For m has been updated t o comply w ith the Na tional Uni form Claim Committee (NUCC) st andards: | |
4826 | The Event Date will no longer be used as a default value for Box 14. If there i s no Occur rence Code 10 – Last Menstrual Period Da te or Occu rrence Cod e 11 – Ons et of Illn ess Date o n the clai m, no date or date q ualifier w ill print in Box 14 | |
4827 | The Timefr ame of Bil l value of either 7 – REPLACEM ENT CLAIM or 8 - VOI D/CANCEL P RIOR CLAIM will prin t in Box 2 2 (left-ha nd side) a nd the Int ernal Cont rol Number (ICN) fro m the paye r will pri nt in Box 22 (right- hand side) for repla cement cla ims 7 or 8 . | |
4828 | MRA Manage ment Workl ist (MRW) | |
4829 | The legend on the MR W screen h as been en hanced to include th e explanan tion for a n asterisk s displayi ng next to a claim n umber. | |
4830 | ||
4831 | MRA Manage ment WorkL ist Nov 25, 20 13@14:06:5 8 Page: 1 of 35 | |
4832 | ||
4833 | Bill # Svc Date P atient Nam e SS N Pt Res p Bill A mt Type | |
4834 | BILLER: IB ,CLERK F | |
4835 | 1 !442-K XXXXXX* 06/02/10 I B,PATIENT 234 XXX X 0.0 0 1710. 76 O/I | |
4836 | Insu rers: MED ICARE (WNR ), NAT'L A SSOC OF LE TTER CARRI ERS | |
4837 | MRA St atus: DEN IED, Jul 1 2, 2010 | |
4838 | 2 442-KX XXXXX 06/02/10 I B,PATIENT 33 XXX X 0.0 0 380. 22 O/P | |
4839 | Insu rers: MED ICARE (WNR ), NAT'L A SSOC OF LE TTER CARRI ERS | |
4840 | MRA St atus: DEN IED, Jul 0 7, 2010 | |
4841 | 3 442-KX XXXXX 05/14/10 I B,PATIENT 12 XXX X 0.0 0 132. 20 O/P | |
4842 | Insu rers: MED ICARE (WNR ), UNITEDH EALTHCARE | |
4843 | MRA St atus: DEN IED, Aug 1 6, 2010 | |
4844 | 4 442-KX XXXXX 06/11/10 I B,PATIENT 12 XXX X 0.0 0 132. 20 O/P | |
4845 | Insu rers: MED ICARE (WNR ), UNITEDH EALTHCARE | |
4846 | MRA St atus: DEN IED, Aug 1 6, 2010 | |
4847 | 5 442-KX XXXXX 06/14/10 I B,PATIENT 103 XXX X 0.0 0 81. 22 I/P | |
4848 | + ! =835 Data Mismatch *=Revi ew in Proc ess | |
4849 | PC Proces s COB VC View Comme nts PM Prin t MRA | |
4850 | VE View a n EOB CB Cancel Bil l TP Thir d Party Jo int Inq. | |
4851 | SU Summar y MRA Info CR Correct Bi ll Q Exit | |
4852 | EC Enter Comments CC Cancel/Clo ne A Bill | |
4853 | RS Review Status VB View Bill | |
4854 | Select Act ion: Next Screen// | |
4855 | Insurance Company En try/Edit | |
4856 | The Insura nce Compan y Editor h as been mo dified to prevent th e creation of new 5 character ZIP codes or 9 digit codes whi ch include invalid f inal four digits (00 00 or 9999 ). This ch ange will affect the following addresses : | |
4857 | Main Maili ng Address | |
4858 | Inpatient Claims Off ice Addres s | |
4859 | Appeals Of fice Addre ss | |
4860 | Inquiry Of fice Addre ss | |
4861 | Outpatient Claims Of fice Addre ss | |
4862 | Prescripti on Claims Office Add ress | |
4863 | ||
4864 | This chang e will not affect ex isting ZIP code valu es or usag e unless s omeone att empts to u pdate the current va lue. | |
4865 | ||
4866 | All new ZI P codes sh ould be 9 valid digi ts. If use rs do not enter the correctly formatted data, they will not be able to proceed. The follow ing will b e displaye d: | |
4867 | ||
4868 | Answer mus t be nine (999999999 ) or ten c haracters (99999-999 9) in leng th. The la st 4 canno t be '0000 ' or '9999 '. | |
4869 | Patch IB*2 *577 | |
4870 | Patch IB*2 *577 inclu des the fo llowing ch anges not covered el sewhere in this docu ment: | |
4871 | CLON | |
4872 | In additio n to the c hanges mad e to CLON in patch I B*2*547, C LON has be en enhance d to recal culate the monetary amount bei ng billed to the des tination p ayer when a claim is Canceled and Copied and the payer sequ ence is ch anged. | |
4873 | ||
4874 | Example: A secondary claim is Clon’d to make a new claim and then the payer sequ ence is ch anged to P rimary, to be resubm itted as a n adjustme nt claim. Because th e claim is going to the primar y payer, t he amount billed wil l be equal to the or iginal amo unt billed to the pr imary paye r. | |
4875 | Handling E rror Messa ges and Wa rnings | |
4876 | ||
4877 | Note: Warn ings will not preven t users fr om authori zing a cla im, Errors will. If one or mo re errors exist, the user will be prompt ed to corr ect them. If a user answers Y es, the sy stem will display th e billing screens to allow the user to m ake change s. | |
4878 | ||
4879 | IB Edit Ch ecks are d one before claim aut horization . | |
4880 | ||
4881 | ||
4882 | ... Execut ing nation al IB edit s | |
4883 | ||
4884 | ERROR/WARN ING OUTPUT DEVICE: H OME// TE LNET TERMI NAL | |
4885 | ||
4886 | **War nings**: | |
4887 | Prov secondary id type fo r the PRIM ARY RENDER ING is inv alid/won't transmit | |
4888 | BLUE CROSS CA ( WY) requir es Amb Car e Certific ation | |
4889 | ||
4890 | **Err ors**: | |
4891 | A CPT procedure is missin g an assoc iated diag nosis. | |
4892 | Place of Servic e not ente red for at least one procedure . | |
4893 | Type of Service not enter ed for at least one procedure. | |
4894 | Claim s with mul tiple paye rs require all Payer IDs. | |
4895 | A cla im cannot have a Pri mary Payer ID value of HPRNT/S PRNT. | |
4896 | ||
4897 | Do you wis h to edit the incons istencies now? NO// y YES | |
4898 | ||
4899 | Patch IB*2 *488 | |
4900 | Patch IB*2 .0*488 add ed several new error messages to Enter/E dit Billin g Informat ion: | |
4901 | Error - wh en a profe ssional cl aim contai ns no proc edures cod es | |
4902 | Error - wh en an outp atient, in stitutiona l claim co ntains no procedures codes | |
4903 | Error - wh en a Prima ry Payer I D is a PRN T/prnt val ue | |
4904 | Patch IB*2 *516 | |
4905 | Patch IB*2 *516 made several c hanges to existing e rror and w arnings me ssages: | |
4906 | Error - wh en a claim contains a procedur e code out side the 1 00-999 ran ge – Remov ed | |
4907 | Error - wh en a human provider has no NPI - Added | |
4908 | Error - wh en a non-V A facility has no NP I – Added | |
4909 | Warning - when a non -VA Facili ty has no Taxonomy c ode – Remo ved | |
4910 | ||
4911 | ||
4912 | Note: The system wil l try to a utomatical ly remove non-billab le provide rs from a claim as t he auto bi ller creat es a claim . The new error is for those cases wher e the prov ider has n ot been re moved. | |
4913 | Patch IB*2 *547 | |
4914 | Patch IB*2 *547 made several ch anges to t he existin g logic fo r these er ror messag es. The fo llowing er ror messag es will no longer be triggered if the pa tient or s ubscriber only has a last name defined i n VistA: | |
4915 | Error - Pa tient's fi rst and la st name mu st begin w ith an alp ha charact er | |
4916 | Error - Pr imary insu rance subs criber's n ame is mis sing or in valid | |
4917 | Error - Se condary in surance su bscriber's name is m issing or invalid | |
4918 | Error - Te rtiary ins urance sub scriber's name is mi ssing or i nvalid | |
4919 | Patch IB*2 *576 | |
4920 | Patch IB*2 *576 made changes to the exist ing logic for this e rror messa ge. The fo llowing er ror messag e will onl y display when there are both Occurrence Codes 10 – Last Men strual Per iod and 11 – Onset o f Illness on a claim : | |
4921 | Error - Oc c. Codes O nset of Il lness (11) and LMP ( 10) not al lowed on s ame bill. | |
4922 | Patch IB*2 *592 | |
4923 | Error - Re ndering Pr ovider or Assistant Surgeon re quired on Dental Cla ims | |
4924 | Error - As sistant Su rgeon's NP I is requi red | |
4925 | Error - As sistant Su rgeon taxo nomy missi ng | |
4926 | Error - Cl aim Level Assistant Surgeon di ffers from all Line Level Assi stant Surg eons | |
4927 | Error - Me dicare (WN R) does no t accept D ental clai ms | |
4928 | Error - In surance Co mpany does not have Dental Cov erage | |
4929 | Error - Cl aim Level Rendering and Asst S urgeon NOT allowed o n same Den tal Claim | |
4930 | Patch IB*2 *608 | |
4931 | Error - CM N form-spe cific data missing f or the For m Type cho sen | |
4932 | Error - Pr ocedure A Calories" missing | |
4933 | Error - Da te of last "ABG PO2" and/or "O 2 Saturati on" Test(s ) missing | |
4934 | Error - Pr ocedure B Calories" missing | |
4935 | Error - Da te of Late st 4 LPM T est(s) mis sing | |
4936 | Error - Th e followin g CMN fiel d(s) missi ng or in e rror for a t least 1 procedure: | |
4937 | ||
4938 | Claim vers us Line Le vel Data | |
4939 | With the i ntroductio n of addit ional Line Level dat a (includi ng Line Le vel provid ers) in Pa tch IB*2*4 47, it is important to underst and the co ncept of C laim Level data appl ying to al l the line items on a claim. C laim Level data appl ies to all the line items on a claim, wh ile Line L evel data should be used to pr ovide exce ptions to the Claim Level data . | |
4940 | ||
4941 | Example: I f all the procedures on a clai m were per formed by the same R endering p rovider, t he claim s hould only have a Cl aim Level Rendering provider. If all but one proce dure is do ne by the same Rende ring provi der and on e procedur e is done by a secon d Renderin g provider , the clai m should h ave a Clai m Level Re ndering pr ovider and one diffe rent Line Level Rend ering prov ider. Line Level pro viders wil l be trans mitted in 837 Health Care Clai m transmis sions. | |
4942 | ||
4943 | In additio n, Institu tional cla ims can ha ve both li ne-level a nd/or clai m-level Re ndering, R eferring, and Other Operating Providers. The Atten ding Provi der is sti ll the onl y provider required on an inst itutional claim and there is n o longer a generic O ther Provi der. | |
4944 | ||
4945 | Profession al claims continue t o allow Re ndering, R eferring, and Superv ising Prov iders on a claim. Th e Renderin g Provider is still the only p rovider re quired on a professi onal claim . | |
4946 | ||
4947 | ||
4948 | Note: Afte r Patch IB *2*592 is installed, users wil l be able to add a n ew type of provider, Assistant Surgeon, to a new f orm type J 430D (Dent al). | |
4949 | ||
4950 | Note: Afte r Patch IB *2*608 is installed, users wil l be able to submit a professi onal claim without a Rendering provider. Users wil l receive a non-fata l warning message wh en a profe ssional cl aim does n ot contain a Renderi ng provide r. | |
4951 | Screen 3 – Payer Inf ormation | |
4952 | EDI Fields | |
4953 | ||
4954 | Section 1 – Transmit | |
4955 | When a pay er has bee n set up t o transmit claims el ectronical ly, this f ield will say “Yes”. If the fi eld says “ No” the cl aim will b e printed locally. | |
4956 | Section 2 – Primary, Secondary and Terti ary Payer | |
4957 | These fiel ds display the Billi ng Provide r Secondar y IDs for the payers on the bi ll. These IDs are de fined in t he Insuran ce Company Editor. N ote: If us ers set th e ID Param eter: Send Attending /Rendering ID as Bil ling Provi der Sec. I D? to Yes for a paye r on the c laim, the Attending/ Rendering ID will be sent. | |
4958 | Section 3 – Mailing Address | |
4959 | This field should co ntain a va lid mailin g address for the cu rrent paye r. In orde r to avoid EDI error s, there s hould be n o periods or dashes such as P. O. Box, Wi nston-Sale m, St. Pau l, etc. Ex ception: M edicare do es not hav e a valid address. | |
4960 | Section 3 – Electron ic ID | |
4961 | This field contains the Inst P ayer Prima ry ID or P rof Payer Primary ID defined i n the Insu rance Comp any Editor . Payer P rimary IDs are provi ded by the clearingh ouse and c an be foun d at www.e mdeon.com. | |
4962 | ||
4963 | IB,PATIENT 1 XX-XX -XXXX BI LL#: K501X XX - Outpa t/1500 SCREEN <3> | |
4964 | ========== ========== ========== ========== ========== ========== ========== ========= | |
4965 | PAYER I NFORMATION | |
4966 | [1] Rate T ype : REI MBURSABLE INS. Form Type: CMS- 1500 | |
4967 | Respon sible: INS URER Payer Sequence: Primary | |
4968 | Bill P ayer : CIG NA Trans mit: Yes | |
4969 | ||
4970 | Ins 1: CIGNA Policy #: 126781678 | |
4971 | Grp #: GRP NUM 2 277 Whose: VET ERAN Rel to In sd: PATIEN T | |
4972 | Grp Nm : TEST GRO UP Insd Sex: MALE Insured: IB,PATIENT IN | |
4973 | ||
4974 | Ins 2: BLUE CROS S CA (W Policy #: R76543210 | |
4975 | Grp #: UNSPECIFI ED Whose: SPO USE Rel to In sd: SPOUSE | |
4976 | Grp Nm : TEST BCB S Insd Sex: FEMALE Insured: ib,wife in | |
4977 | ||
4978 | *** Patient has Insura nce Buffer entries *** | |
4979 | ||
4980 | [2] Billin g Provider Secondary IDs: | |
4981 | Prima ry Payer: | |
4982 | Secon dary Payer : XXXXXXX Te rtiary Pay er: | |
4983 | ||
4984 | [3] Mailin g Address : Elec tronic ID: XXXID | |
4985 | CIGNA | |
4986 | PO BOX 9358 | |
4987 | SHERMA N, TX 750 91 | |
4988 | <RET> to C ONTINUE, 1 -3 to EDIT , '^N' for screen N, or '^' to QUIT: | |
4989 | ||
4990 | ||
4991 | The 3-line mailing a ddress dis played her e is used also used by the cle aringhouse to look u p the Elec tronic ID for the pa yer when a claim is sent witho ut a defin ed Electro nic Bill I D. | |
4992 | ||
4993 | Note: Patc h IB*2*432 made chan ges so tha t the Fede ral Tax ID Number wi ll no long er be used as a defa ult value when no ot her Billin g Provider Secondary ID is def ined for a payer – S ection 2. | |
4994 | Using Care Units for Billing P rovider Se condary ID s | |
4995 | Section 2 of Billing Screen 3 contains f ields for the Billin g Provider Secondary IDs for t he primary , secondar y and tert iary payer s on a cla im. Normal ly the def ault value s for the site or th e defined values for the divis ion on the claim pop ulate thes e fields. If any ins urance com pany on th e claim re quires dif ferent Bil ling Provi der Second ary IDs ba sed upon C are Units, users can change th e default values to the value defined fo r the Care Unit wher e the serv ices were provided. | |
4996 | ||
4997 | Step | |
4998 | Procedure | |
4999 | 1 | |
5000 | At the <RE T> to CONT INUE, 1-3 to EDIT, ' ^N' for sc reen N, or '^' to QU IT: prompt , enter 2. | |
5001 | 2 | |
5002 | At the Cur rent Bill Payer Sequ ence: prom pt, press the <Enter > key to a ccept the default. | |
5003 | 3 | |
5004 | At the Def ine Primar y Payer ID by Care U nit?: prom pt, press the <Enter > key to a ccept the default. | |
5005 | 4 | |
5006 | At the Pri mary Payer ID: promp t, press t he <Enter> key to ac cept the d efault. | |
5007 | 5 | |
5008 | At the Def ine Second ary Payer ID by Care Unit?: pr ompt, ente r Yes for this examp le. | |
5009 | 6 | |
5010 | At the Div ision: pro mpt, press the <Ente r> key to accept the default f or this ex ample. | |
5011 | 7 | |
5012 | At the Car e Unit: pr ompt, ente r Anesthes ia for thi s example. | |
5013 | 8 | |
5014 | At the Sec ondary Pay er ID: pro mpt, press the <Ente r> key to accept the default. | |
5015 | ||
5016 | Note: The Care Units must be d efined in Provider I D Maintena nce and th e ID numbe rs must be defined i n the Insu rance Comp any Editor . | |
5017 | ||
5018 | IB,PATIENT 1 XX-XX -XXXX BI LL#: K501X XX - Outpa t/1500 SCREEN <3> | |
5019 | ========== ========== ========== ========== ========== ========== ========== ========= | |
5020 | PAYER IN FORMATION | |
5021 | [1] Rate T ype : REI MBURSABLE INS. Form Type: CMS- 1500 | |
5022 | Respon sible: INS URER Payer Sequence: Primary | |
5023 | Bill P ayer : MRA NEEDED FR OM MEDICAR E Trans mit: Yes | |
5024 | ||
5025 | Ins 1: MEDICARE (WNR) WILL NOT R EIMBURSE Policy #: XXXXXXXXA | |
5026 | Grp #: PART A Whose: VET ERAN Rel to In sd: PATIEN T | |
5027 | Grp Nm : PART A Insd Sex: MALE Insured: IB,PATIENT 1 | |
5028 | ||
5029 | Ins 2: BLUE CROS S OF CA Policy #: MES3456 | |
5030 | Grp #: PLAN 2 Whose: VET ERAN Rel to In sd: PATIEN T | |
5031 | Grp Nm : PROTECTI ON PLUS Insd Sex: MALE Insured: IB,PATIENT 1 | |
5032 | ||
5033 | [2] Billin g Provider Secondary IDs: | |
5034 | Primar y Payer: 6 70899 | |
5035 | Second ary Payer: XXXXXX1X Tertia ry Payer: | |
5036 | ||
5037 | [3] Mailin g Address : Elec tronic ID: XXXXID | |
5038 | NO MAI LING ADDRE SS HAS BEE N SPECIFIE D! (Pati ent has Me dicare) | |
5039 | Send B ill to PAY ER listed above. | |
5040 | <RET> to C ONTINUE, 1 -3 to EDIT , '^N' for screen N, or '^' to QUIT: 2 | |
5041 | Current Bi ll Payer S equence: P RIMARY INS URANCE// | |
5042 | Define Pri mary Payer ID by Car e Unit? No // | |
5043 | Primary Pa yer ID: 67 0899// | |
5044 | Define Sec ondary Pay er ID by C are Unit? No//Yes | |
5045 | Division: Main Divis ion// | |
5046 | Care Unit: ?? | |
5047 | 1 A nesthesia | |
5048 | 2 R eference L ab | |
5049 | 3 H ome Health | |
5050 | Care Unit: 1 Anesthe sia | |
5051 | Secondary Payer ID: XXXXXXX// | |
5052 | Screen 10 – Physicia n/Provider and Print Informati on | |
5053 | EDI Fields UB-04/CMS -1500/J430 D | |
5054 | ||
5055 | Section 3/ 3 – Provid ers | |
5056 | When a Phy sician/Pro vider is e ntered her e, the sys tem finds the approp riate IDs and Taxono my Codes f or him/her . The Pri mary IDs a re the pro viders’ NP Is and the ir seconda ry IDs are those IDs that user s have def ined as th e provider ’s own or as those p rovided by an insura nce compan y. Claim Level prov iders may not be req uired if e ach Line I tem has a provider a ssociated with it. | |
5057 | Section 4 – Other Fa cility, CL IA#, Mammo graphy Cer tification Number | |
5058 | ||
5059 | These are the sectio ns through which out side facil ities are entered. The primar y and seco ndary Labo ratory or Facility I Ds and Tax onomy Code s are then transmitt ed with th e claim. | |
5060 | The CLIA# and Mammog raphy Cert ification Number can also be s ent with a professio nal labora tory claim or mammog raphy clai m. | |
5061 | Dental doe s not curr ently allo w for bill ing for ca re provide d at a non -VA facili ty | |
5062 | Section 5/ 7 – Billin g Provider | |
5063 | These sect ions displ ay the cal culated Bi lling Prov ider and t he Billing Provider’ s Taxonomy Code. On ly the tax onomy code can be ed ited | |
5064 | Section 6/ 8 – Force to Print | |
5065 | Users can set this f ield to fo rce a clai m to print locally. | |
5066 | Patch IB*2 *488 remov ed the for mer option to force a Professi onal or In stitutiona l claim to print at the cleari nghouse. | |
5067 | Dental doe s not curr ently allo w for the local prin ting of J4 30D forms. | |
5068 | Section 7/ 9 – Provid er ID Main t | |
5069 | This is a link to th e Provider ID Mainte nance func tion. | |
5070 | ||
5071 | IB,PATIENT 2 XX-XX- XXXX BIL L#: K300XX - Outpat/ UB-04 SCR EEN <10> | |
5072 | ========== ========== ========== ========== ========== ========== ========== ====== | |
5073 | BILLI NG - SPECI FIC INFORM ATION | |
5074 | [1] Bill R emarks | |
5075 | - FL- 80 : UNSPEC IFIED [NOT REQUIRED] | |
5076 | ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED] | |
5077 | Auth/R eferral : UNSPEC IFIED [NOT REQUIRED] | |
5078 | Admiss ion Source : UNSPEC IFIED | |
5079 | [2] Pt Rea son f/Visi t : UNSPEC IFIED | |
5080 | [3] Provid ers : | |
5081 | - ATT ENDING : UNSPEC IFIED | |
5082 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | |
5083 | [5] Billin g Provider : CHEYEN NE VAMC | |
5084 | Taxono my Code : 282N00 000X | |
5085 | [6] Force To Print? : NO FOR CED PRINT | |
5086 | [7] Provid er ID Main t : (Edit Provider I D informat ion) | |
5087 | ||
5088 | ||
5089 | <RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT: | |
5090 | ||
5091 | IB,PATIENT 3 XX-XX -XXXX BI LL#: K600X X - Outpat /1500 SCREEN <10> | |
5092 | ========== ========== ========== ========== ========== ========== ========== ========= | |
5093 | BILLI NG - SPECI FIC INFORM ATION | |
5094 | [1] Unable To Work F rom: UNSPE CIFIED [NO T REQUIRED ] | |
5095 | Unable To Work T o : UNSPE CIFIED [NO T REQUIRED ] | |
5096 | [2] ICN/DC N(s) : UNSPE CIFIED [NO T REQUIRED ] | |
5097 | Auth/R eferral : UNSPE CIFIED [NO T REQUIRED ] | |
5098 | [3] Provid ers : | |
5099 | - REN DERING (MD ) : IB,DO CTOR 1 Taxonomy: UNSPECIFI ED | |
5100 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | |
5101 | Lab CL IA # : UNSPE CIFIED [NO T REQUIRED ] | |
5102 | Mammog raphy Cert # : UNSPE CIFIED [NO T REQUIRED ] | |
5103 | [5] Chirop ractic Dat a : UNSPE CIFIED [NO T REQUIRED ] | |
5104 | [6] Form L ocator 19 : UNSPE CIFIED [NO T REQUIRED ] | |
5105 | [7] Billin g Provider : CHEYE NNE VAMC | |
5106 | Taxono my Code : 282N0 0000X | |
5107 | [8] Force To Print? : NO FO RCED PRINT | |
5108 | [9] Provid er ID Main t : (Edit Provider ID informa tion) | |
5109 | ||
5110 | <RET> to C ONTINUE, 1 -9 to EDIT , '^N' for screen N, or '^' to QUIT: 8 | |
5111 | FORCE CLAI M TO PRINT : NO FORCE D PRINT// ?? | |
5112 | If this fi eld is set to 1, the claim wil l be print ed locally . | |
5113 | If field i s set to 0 , the clai m will be transmitte d | |
5114 | electronic ally to th e payer. | |
5115 | ||
5116 | Choos e from: | |
5117 | 0 NO F ORCED PRIN T | |
5118 | 1 FORC E LOCAL PR INT | |
5119 | FORCE CLAI M TO PRINT : NO FORCE D PRINT// | |
5120 | ||
5121 | ||
5122 | Note that with Patch IB*2*488, the forme r option t o force a claim to p rint at th e clearing house has been remov ed. | |
5123 | UB-04 Clai ms | |
5124 | The follow ing screen s provide a simplifi ed example of a UB-0 4 claim: | |
5125 | ||
5126 | Step | |
5127 | Procedure | |
5128 | 1 | |
5129 | When proce ssing a UB -04 claim, informati on on Scre ens 1 and 2 should b e reviewed for corre ctness. Pr ess the <E nter> key to move fr om one scr een to the next. | |
5130 | 2 | |
5131 | On Screen 3, the pay er informa tion is re viewed for correctne ss. The pa tient may have more than one i nsurance p olicy. If the correc t informat ion is not displayed , select a section ( 1, 2, or 3 ) and edit the neces sary field s. Press t he <Enter> key to co ntinue to Screen 5. | |
5132 | ||
5133 | Note: With Patch IB* 2*516, use rs will ha ve the abi lity to ad d a one-ti me HPID, p er payer, to a claim if the HP ID in the Insurance Company fi le is not the correc t one. The HPID will not be st ored in th e Insuranc e Company file. It will only apply to t he claim. | |
5134 | ||
5135 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ UB-04 SCREEN <3> | |
5136 | ========== ========== ========== ========== ========== ========== ========== ====== | |
5137 | PAYER IN FORMATION | |
5138 | [1] Rate T ype : REI MBURSABLE INS. Form Type: UB-0 4 | |
5139 | Respon sible: INS URER Payer Sequence: Primary | |
5140 | Bill P ayer : Blu e Cross Fe p Tran smit: Yes | |
5141 | ||
5142 | Ins 1: Blue Cros s Fep Policy #: RXXXXXXXX X | |
5143 | Grp #: 100 Whose: VET ERAN Rel to In sd: PATIEN T | |
5144 | Grp Nm : STANDARD FAMILY Insd Sex: MALE Insured: IB,PATIENT 3 | |
5145 | ||
5146 | [2] Billin g Provider Secondary IDs: | |
5147 | Prima ry Payer: 00059001 | |
5148 | Secon dary Payer : Te rtiary Pay er: | |
5149 | [3] Mailin g Address : Elec tronic ID: 12B54 | |
5150 | Blue C ross Fep | |
5151 | P O Bo x 10401 | |
5152 | Birmin gham, AL 352020401 | |
5153 | ||
5154 | <RET> to C ONTINUE, 1 -3 to EDIT , '^N' for screen N, or '^' to QUIT: | |
5155 | ||
5156 | Step | |
5157 | Procedure | |
5158 | 3 | |
5159 | On Screen 5, enter s ections 1- 7 to type in the dia gnosis inf ormation, the servic es/procedu res provid ed and the date of s ervice. In clude the Admission Type Code, Occurrenc e, and Con dition Cod e when req uired. Pre ss the <En ter> key t o move to Screen 7. | |
5160 | ||
5161 | Note: With Patch IB* 2*516, use rs will be able to l ook up Occ urrence Co des, Condi tion Codes , and Valu e Codes by the exter nal NUBC c ode number s. | |
5162 | ||
5163 | Note: Afte r Patch IB *2*477 is installed users can enter a Pr iority (Ty pe) of Vis it to an o utpatient, instituti onal claim . The val ue will no longer be hard-code d with 9 – Informati on not ava ilable. T he default value wil l be elect ive. This is a requi red field. | |
5164 | ||
5165 | Note: A ne w fatal er ror messag e will pre vent the a uthorizati on of a cl aim when t he Total C harge doll ar amount does not e qual the s um of the dollar amo unts for t he line it ems on the claim. | |
5166 | ||
5167 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ UB-04 SCR EEN <5> | |
5168 | ========== ========== ========== ========== ========== ========== ========== ====== | |
5169 | EVENT - OUTPATI ENT INFORM ATION | |
5170 | [1] Event Date : XXX XX, XXXX | |
5171 | [2] Prin. Diag.: ABD OM PAIN, L L QUADR - 789.04 | |
5172 | Other Diag.: BEN IGN NEOPLA SM LG BOWE L - 211.3 | |
5173 | Other Diag.: DIV ERTICULOSI S OF COLON - 562.10 | |
5174 | [3] OP Vis its : XXX XX, XXXX | |
5175 | Type : | |
5176 | [4] Cod. M ethod: HCP CS | |
5177 | CPT Co de : LES ION REMOVE COLONOSCO PY 45384 XXX XX, XXXX | |
5178 | CPT Co de : OFF ICE/OUTPAT IENT VISIT , NEW 9920 1 XXX XX, XXXX | |
5179 | CPT Co de : CHE ST X-RAY 7 1010-ET XXX XX, XXXX | |
5180 | [5] Rx. Re fills: UNS PECIFIED [ NOT REQUIR ED] | |
5181 | [6] Pros. Items: UNS PECIFIED [ NOT REQUIR ED] | |
5182 | [7] Occ. C ode : ONS ET OF SYMP TOMS/ILLNE SS XXX X X, XXXX | |
5183 | [8] Cond. Code : UNS PECIFIED [ NOT REQUIR ED] | |
5184 | [9] Value Code : UNS PECIFIED [ NOT REQUIR ED] | |
5185 | ||
5186 | ||
5187 | <RET> to C ONTINUE, 1 -9 to EDIT , '^N' for screen N, or '^' to QUIT: | |
5188 | ||
5189 | Step | |
5190 | Procedure | |
5191 | 4 | |
5192 | If all inf ormation h as been en tered corr ectly, Scr een 7 will be auto-p opulated ( as shown b elow) with the neces sary infor mation to send the c laim elect ronically. Make sure that the Disch Stat field in Section 1 is populat ed. Press the <Enter > key to m ove to Scr een 8. | |
5193 | ||
5194 | Note: Allo wable doll ar amounts have been increased to 999999 9.99 befor e users wi ll be forc ed to spli t lines. | |
5195 | ||
5196 | Note: With Patch IB* 2*516, new prompts h ave been a dded to Sc reens 4 an d 5 to all ow users t o enter ND Cs and Uni ts to non- RX procedu res for me dications administer ed in an o utpatient setting. W ith Patch IB*2*577, users will gain the ability to define th e type of Units. The y will no longer def ault to Un its. The new choice s are: Int ernational Unit; Gra m; Milligr am; Millil iter or Un it. | |
5197 | ||
5198 | Note: With Patch IB* 2*516, new prompts h ave been a dded to Sc reens 4 an d 5to allo w users to enter 80 character descriptio ns to CPT/ HCPCS proc edure code s for serv ices Not O therwise C lassified. | |
5199 | ||
5200 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ UB-04 SCREEN <7 > | |
5201 | ========== ========== ========== ========== ========== ========== ========== ====== | |
5202 | BILL ING - GENE RAL INFORM ATION | |
5203 | [1] Bill T ype : 13 1 Loc. of Care: H OSPITAL - INPT OR OP T (INCLU | |
5204 | Charge Type : IN STITUTIONA L Dis ch Stat: D ISCHARGED TO HOME OR SELF CAR | |
5205 | Form T ype : UB -04 Ti meframe: A DMIT THRU DISCHARGE | |
5206 | Bill C lassif: OU TPATIENT D ivision: C HEYENNE VA MROC | |
5207 | [2] Sensit ive? : UN SPECIFIED Assi gnment: YE S | |
5208 | [3] Bill F rom : XX X XX, XXXX B ill To: XX X XX, XXXX | |
5209 | [4] OP Vis its : XX X XX, XXXX | |
5210 | [5] Rev. C ode : 75 0-GASTR-IN ST SVS 45384 $2,137.4 4 OUTPATI ENT VISIT | |
5211 | Rev. C ode : 32 4-DX X-RAY /CHEST 71010 $225.5 3 OUTPATI ENT VISIT | |
5212 | Rev. C ode : 51 0-CLINIC 99201 $108.9 2 OUTPATI ENT VISIT | |
5213 | OFFSET : $0.00 [NO OFFS ET RECORDE D] | |
5214 | BILL T OTAL : $2,471.89 | |
5215 | [6] Rate S ched : (r e-calculat e charges) | |
5216 | [7] Prior Claims: UN SPECIFIED | |
5217 | ||
5218 | <RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT: | |
5219 | ||
5220 | Step | |
5221 | Procedure | |
5222 | ||
5223 | Note: Afte r Patch IB *2*432, it will no l onger be p ossible to authorize a Sensiti ve claim u nless user s indicate d that a R elease of Informatio n has been completed . | |
5224 | 5 | |
5225 | On Screens 8 and 9, enter any necessary Claim leve l data to the claim. | |
5226 | ||
5227 | Note: IB*2 *447 moved Screen 8, Section 3 Ambulance Informati on to a ne w Screen 9 . | |
5228 | ||
5229 | IB,PATIENT MRA XX- XX-XXXX BILL#: K20 0XXX - Inp at/UB04 SCRE EN <8> | |
5230 | ========== ========== ========== ========== ========== ========== ========== ======= | |
5231 | BIL LING - CLA IM INFORMA TION | |
5232 | [1] COB No n-Covered Charge Amt : | |
5233 | [2] Proper ty Casualt y Informat ion | |
5234 | Claim Number: Contact N ame: | |
5235 | Date o f 1st Cont act: Contact P hone: | |
5236 | [3] Surgic al Codes f or Anesthe sia Claims | |
5237 | Primar y Code: Secondary Code: | |
5238 | [4] Paperw ork Attach ment Infor mation | |
5239 | Report Type: NN Transmiss ion Method : XX | |
5240 | Attach ment Contr ol #: 123 4890701 | |
5241 | [5] Disabi lity Start Date: Disabilit y End Date : | |
5242 | [6] Assume d Care Dat e: Relinquis hed Care D ate: | |
5243 | ||
5244 | ||
5245 | <RET> to C ONTINUE '^ N' for scr een N, or '^' to QUI T: | |
5246 | ||
5247 | ||
5248 | Note: For Worker’s C ompensatio n Claims O nly (Rate Type = Wor ker’s Comp .): The Pa perwork At tachment I nformation will now AUTOMATICA LLY print in CMS-150 0 Box 19, in the fol lowing for mat: PWKNN FX12348907 01. | |
5249 | ||
5250 | IB,PATIENT F BI LL#: K100X XX - Outpa t/1500 S CREEN <9> | |
5251 | ========== ========== ========== ========== ========== ========== ========== ========== | |
5252 | AMBULANCE INFORMATIO N | |
5253 | [1] Ambula nce Transp ort Data | |
5254 | D/O Locat ion: | |
5255 | P/U Ad dress1: D/O Addre ss1: | |
5256 | P/U Ad dress2: D/O Addre ss2: | |
5257 | P/U Ci ty: D/O City: | |
5258 | P/U St ate/Zip: D/O State /Zip: | |
5259 | Patien t Weight: 195 Transport Distance: 200 | |
5260 | Transp ort Reason : Patient was transp orted to n earest fac ility for care | |
5261 | of sympt oms, compl aints or b oth. | |
5262 | R/T Pu rpose: Pat ient fell and sustai ned possib le injurie s to neck | |
5263 | Stretc her Purpos e: Patient unable to walk due to possibl e injuries to | |
5264 | neck | |
5265 | [2] Ambula nce Certif ication Da ta | |
5266 | Condit ion Indica tor: 01 - Admitted t o hospital | |
5267 | 04 - Moved by s tretcher | |
5268 | 06 - Transporte d in emerg ency situa tion | |
5269 | 08 - Visible he morrhaging | |
5270 | 09 - Medically necessary service | |
5271 | ||
5272 | <RET> to C ONTINUE '^ N' for scr een N, or '^' to QUI T: | |
5273 | ||
5274 | Step | |
5275 | Procedure | |
5276 | 6 | |
5277 | On Screen 10, enter 3 to enter the name of the Att ending Phy sician. Th e claim le vel attend ing is sti ll require d. An outp atient UB- 04 claim c an also co ntain a li ne-level o r claim le vel Referr ing, Opera ting and/o r Other Op erating Ph ysician(s) . | |
5278 | ||
5279 | Remember: Patch IB*2 *432 will make it po ssible to enter and transmit L ine Level providers. Line Leve l and Clai m Level pr oviders sh ould not b e the same . Claim Le vel provid ers apply to the ent ire claim. Line Leve l provider s are exce ptions. | |
5280 | ||
5281 | Note: With Patch IB* 2*432, use rs cannot authorize a claim wh ich has an Other Ope rating Phy sician unl ess there is an Oper ating Phys ician on t he claim. | |
5282 | ||
5283 | Note: Patc h IB*2*432 will make it possib le to ente r a Referr al Number for each p ayer on th e claim. | |
5284 | ||
5285 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ UB-04 S CREEN <10> | |
5286 | ========== ========== ========== ========== ========== ========== ========== ====== | |
5287 | ||
5288 | BILLIN G - SPECIF IC INFORMA TION | |
5289 | [1] Bill R emarks | |
5290 | - FL- 80 : UNSPEC IFIED [NOT REQUIRED] | |
5291 | ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED] | |
5292 | Auth/R eferral : UNSPEC IFIED [NOT REQUIRED] | |
5293 | Admiss ion Source : UNSPEC IFIED | |
5294 | [2] Pt Rea son f/Visi t : UNSPEC IFIED | |
5295 | [3] Provid ers : | |
5296 | - ATT ENDING : UNSPEC IFIED | |
5297 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | |
5298 | [5] Billin g Provider : CHEYEN NE VAMC | |
5299 | Taxono my Code : 282N00 000X | |
5300 | [6] Alt Pr im Payer I D : P: ALT IDHOSPICE1 23 | |
5301 | [7] Force To Print? : NO FOR CED PRINT | |
5302 | [8] Provid er ID Main t : (Edit Provider I D informat ion) | |
5303 | ||
5304 | ||
5305 | ||
5306 | <RET> to C ONTINUE, 1 -8 to EDIT , '^N' for screen N, or '^' to QUIT: | |
5307 | ||
5308 | ||
5309 | ||
5310 | The Primar y ID (NPI) for the A ttending, Operating or Other O perating P hysician i s always t ransmitted with a cl aim. | |
5311 | ||
5312 | The Second ary IDs fo r the Atte nding, Ope rating or Other Oper ating Phys ician are determined from what the user enters and from entr ies in Pro vider ID M aintenance . | |
5313 | ||
5314 | If users h ave set a default ID type and made it re quired for the curre nt or othe r payers, the claim cannot be authorized if the ph ysician do es not hav e an ID of that type defined. | |
5315 | ||
5316 | Note: A f atal error message w ill preven t users fr om authori zing an ad justment c laim, Type of Bill F requency C ode of 7 o r 8, in wh ich the de stination payer (pri mary/secon dary/terti ary) indiv idual cont rol number (ICN/DCN) is not pr esent | |
5317 | ||
5318 | Patch IB*2 *547added a field to Screen 10 for alter native pay er primary IDs which are used to direct claims to administra tive contr actors who process s pecialized claims su ch as Dura ble Medica l Equipmen t (DME) cl aims. Unle ss an alte rnative ID is added to the cla im by the billing cl erk, the r egular EDI – Primary Payer ID will be se nt with a claim. | |
5319 | ||
5320 | When a pro vider is f irst added to Screen 10, the u ser will b e shown a screen tha t contains a list of all the p rovider’s IDs, the I D type and , optional ly, the ca re unit on file for the provid er's IDs. This will include th e provider 's own IDs , the prov ider's IDs assigned by the ins urance com pany, the insurance company de faults, if any, and all IDs as signed to the provid er by care unit. | |
5321 | ||
5322 | The first 2 entries in this li st will al ways be: | |
5323 | 1 - NO S ECONDARY I D NEEDED 2 - ADD A N ID FOR T HIS CLAIM ONLY | |
5324 | ||
5325 | ||
5326 | Any ID ent ered on Sc reen 10 wi ll automat ically ove rride any default pr ovider sec ondary ID that exist s for the same ID Qu alifier fo r this cla im ONLY. | |
5327 | ||
5328 | **** SECON DARY PERFO RMING PROV IDER IDs * *** | |
5329 | ||
5330 | PRIMARY IN SURANCE CO : BLUE CRO SS CA (WY) | |
5331 | PROVIDER: IB,PHYSICI AN4 (ATTEN DING) | |
5332 | ||
5333 | INS. COMPA NY'S DEFAU LT SECONDA RY ID TYPE IS: BLUE CROSS ID | |
5334 | ||
5335 | SELECT A S ECONDARY I D OR ACTIO N FROM THE LIST BELO W: | |
5336 | ||
5337 | 1 - N O SECONDAR Y ID NEEDE D | |
5338 | 2 - A DD AN ID F OR THIS CL AIM ONLY | |
5339 | 3 - < DEFAULT> X XXXBCROSS BLUE CROS S ID | |
5340 | 4 - W YXXXX ST LIC (W Y) | |
5341 | ||
5342 | Selection: 3// | |
5343 | ||
5344 | If there i s a defaul t secondar y ID found , based on the insur ance compa ny paramet ers and th e Provider ID is def ined in th e Provider ID Mainte nance, thi s will be the 3rd en try in the list and will be pr eceded wit h the text <DEFAULT> . If this ID exists, the defau lt for the Selection prompt wi ll be 3. | |
5345 | ||
5346 | If no defa ult ID exi sts, the d efault for the selec tion promp t will be 1 – No Sec ondary ID needed. | |
5347 | ||
5348 | Any care u nits assig ned to an ID using P rovider ID Maintenan ce are dis played at the far ri ght of the ID line. You no lon ger have t o enter a care unit on the bil l. | |
5349 | ||
5350 | You can ma ke a selec tion from the list b y choosing the numbe r precedin g the ID y ou want to assign to the provi der for th e bill. Th is will ad d both the ID Qualif ier and th e ID numbe r to the c laim. | |
5351 | ||
5352 | ||
5353 | Note: If t he Provide r has mult iple IDs d efined, th e one you select or the new on e time onl y ID that you enter, will appe ar on Scre en 10 and will be th e first ID sent but the system will stil l transmit the remai ning IDs. The one yo u select w ill just b e the firs t one tran smitted. T he maximum number th at will be transmitt ed is five . | |
5354 | ||
5355 | Note: With Patch IB* 2*432, IDs for Line Level prov iders are determined in the sa me manner as Claim L evel Provi ders. | |
5356 | ||
5357 | If none of the IDs a re valid f or the pro vider for the claim, you can a dd a new I D for this claim onl y. | |
5358 | ||
5359 | Step | |
5360 | Procedure | |
5361 | 7 | |
5362 | At the Sel ection pro mpt, type 2 to add a n ID for t his claim only. | |
5363 | 8 | |
5364 | At the PRI M INS PERF PROV SECO NDARY ID T YPE: promp t, enter t he ID Qual ifier that the prima ry payer r equires as a seconda ry ID type . Type two question marks (??) to see th e list of possible c hoices. (F or this ex ample, typ e Location Number as the secon dary ID Qu alifier). | |
5365 | 9 | |
5366 | At the PRI M INS PERF PROV SECO NDARY ID: prompt, en ter the ID number pr ovided by the payer. In this e xample, ty pe XXXXA. | |
5367 | ||
5368 | Selection: 3// 2 | |
5369 | PRIM INS PERF PROV SECONDARY ID TYPE: ?? | |
5370 | Choose from: | |
5371 | BLUE CR OSS ID | |
5372 | BLUE SH IELD ID | |
5373 | COMMERC IAL ID | |
5374 | LOCATIO N NUMBER | |
5375 | MEDICAR E PART A | |
5376 | MEDICAR E PART B | |
5377 | ||
5378 | PRIM INS PERF PROV SECONDARY ID TYPE: LOCATION N UMBER | |
5379 | PRIM INS PERF PROV SECONDARY ID: XXXXA | |
5380 | ||
5381 | After an I D and ID Q ualifier a re added t o the clai m for a pr ovider, th e provider ’s name an d the sele cted ID ar e displaye d on Scree n 10. Thes e fields c an be edit ed/deleted . | |
5382 | ||
5383 | If a physi cian/provi der is del eted, the next time the provid er entry i s accessed , the list of valid IDs will b e displaye d again. | |
5384 | ||
5385 | Valid Seco ndary ID T ypes for C urrent Pay er | |
5386 | Attending/ Referring/ Operating/ Other Oper ating (UB- 04) | |
5387 | State Lice nse; Blue Cross; Blu e Shield; Medicare P art A; UPI N; TRICARE ; Commerci al ID; Loc ation Numb er; Networ k ID; SSN; State Ind ustrial an d Accident Provider | |
5388 | Rendering/ Referring/ Supervisin g (1500) | |
5389 | State Lice nse; Blue Shield; Me dicare Par t B; UPIN; TRICARE; Commercial ID; Locat ion Number ; Network ID; SSN; S tate Indus trial and Accident P rovider | |
5390 | ||
5391 | Valid Seco ndary ID T ypes for O ther Payer (Not Curr ent) | |
5392 | Attending/ Operating/ Other (UB- 04) | |
5393 | Blue Cross ; Blue Shi eld; Medic are; Comme rcial ID; Location N umber | |
5394 | Rendering (1500) | |
5395 | Blue Shiel d; Medicar e Part A a nd Part B; Commercia l ID; Loca tion Numbe r; Network ID | |
5396 | Referring (1500) | |
5397 | Blue Shiel d; Medicar e Part A a nd Part B; Commercia l ID; Loca tion Numbe r; Network ID | |
5398 | Supervisin g (1500) | |
5399 | Blue Shiel d; Medicar e Part A a nd Part B; Commercia l ID; Netw ork ID | |
5400 | ||
5401 | Step | |
5402 | Procedure | |
5403 | 10 | |
5404 | At the <RE T> to Cont inue: prom pt (any sc reen), ent er ?PRV to see summa ry informa tion about a particu lar provid er. | |
5405 | ||
5406 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ UB-04 SC REEN <10> | |
5407 | ========== ========== ========== ========== ========== ========== ========== ========== == | |
5408 | B ILLING - S PECIFIC IN FORMATION | |
5409 | [1] Bill R emarks | |
5410 | - FL- 80 : UNSPEC IFIED [NOT REQUIRED] | |
5411 | ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED] | |
5412 | Auth/R eferral : UNSPEC IFIED [NOT REQUIRED] | |
5413 | Admiss ion Source : PHYSIC IAN REFERR AL | |
5414 | [2] Pt Rea son f/Visi t : COUGH - 786.2 | |
5415 | [3] Provid ers : | |
5416 | - ATT ENDING (MD ) : IB,DOC TOR4 Taxono my: 208G00 000X (33) | |
5417 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | |
5418 | [5] Billin g Provider : CHEYEN NE VAMC | |
5419 | Taxono my Code : 282N00 000X | |
5420 | [6] Force To Print? : NO FOR CED PRINT | |
5421 | [7] Provid er ID Main t : (Edit Provider I D informat ion) | |
5422 | ||
5423 | ||
5424 | <RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT: ?PR V | |
5425 | (V)A or (N )on-VA Pro vider: V// A PROVIDE R | |
5426 | ||
5427 | This is a display of provider specific i nformation . | |
5428 | This bill is UB-04/O utpatient | |
5429 | ||
5430 | This is a display of provider specific i nformation . | |
5431 | This bill is UB-04/O utpatient | |
5432 | ||
5433 | The valid provider f unctions f or this bi ll are: | |
5434 | 1 REFERRI NG SITUATIONA L - ALREAD Y ON BILL | |
5435 | 2 OPERATI NG SITUATIONA L - NOT ON BILL | |
5436 | 3 RENDERI NG SITUATIONA L - ALREAD Y ON BILL | |
5437 | 4 ATTENDI NG REQUIRED - ALREADY O N BILL | |
5438 | 9 OTHER O PERATING OPTIONAL - NOT ON BI LL | |
5439 | ||
5440 | Select PRO VIDER NAME : IB,Docto r RAD PI | |
5441 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
5442 | Signature Name: DOC TOR RAD IB | |
5443 | Signature Title: | |
5444 | D egree: MD | |
5445 | NPI: 111 2220037 | |
5446 | ||
5447 | Licen se(s): WY: 1289340B | |
5448 | ||
5449 | Person Class: V18 3001 | |
5450 | PROVIDER TYPE: All opathic an d Osteopat hic Physic ians | |
5451 | CLASSIFIC ATION: Rad iology | |
5452 | SPECIALIZ ATION: Bod y Imaging | |
5453 | TAX ONOMY: 208 5B0100X (8 88) | |
5454 | EFFE CTIVE: 6/7 /10 | |
5455 | ||
5456 | RC Provide r Group: N one | |
5457 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
5458 | Select PRO VIDER NAME : | |
5459 | ||
5460 | Step | |
5461 | Procedure | |
5462 | 11 | |
5463 | At the <RE T> to Cont inue: prom pt (any sc reen), ent er ?ID to see what I Ds will be transmitt ed with th e claim. | |
5464 | ||
5465 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ UB-04 SCR EEN <10> | |
5466 | ========== ========== ========== ========== ========== ========== ========== ========== == | |
5467 | BILLIN G - SPECIF IC INFORMA TION | |
5468 | [1] Bill R emarks | |
5469 | - FL- 80 : UNSPEC IFIED [NOT REQUIRED] | |
5470 | ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED] | |
5471 | Auth/R eferral : UNSPEC IFIED [NOT REQUIRED] | |
5472 | Admiss ion Source : PHYSIC IAN REFERR AL | |
5473 | [2] Pt Rea son f/Visi t : COUGH - 786.2 | |
5474 | [3] Provid ers : | |
5475 | - REFE RRING (MD) : IB,DOCT OR GP Ta xonomy: 20 8G00000X ( 33) | |
5476 | [P]VAD000 [S]8301684 94 | |
5477 | - REND ERING (MD) : IB,DOCT OR CARD Ta xonomy: 20 7RA0000X ( 33) | |
5478 | [P]VAD000 [S]8301684 94 | |
5479 | - ATTE NDING (MD) : IB,DOCT OR4 Ta xonomy: 20 7XS0106X ( 40) | |
5480 | [P]VAD000 [S]8301684 94 | |
5481 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | |
5482 | [5] Billin g Provider : CHEYEN NE VAMC | |
5483 | Taxono my Code : 282N00 000X | |
5484 | [6] Force To Print? : NO FOR CED PRINT | |
5485 | [7] Provid er ID Main t : (Edit Provider I D informat ion) | |
5486 | ||
5487 | ||
5488 | <RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT: ?ID | |
5489 | ||
5490 | If this bi ll is tran smitted el ectronical ly, the fo llowing ID s will be sent: | |
5491 | Primary Ins Co: BL UE CROSS C A (WY) <<<Cur rent Ins | |
5492 | Secondary Ins Co: AE TNA US HEA LTHCARE | |
5493 | ||
5494 | Provider I Ds: (VistA Records O P1,OP2,OP4 ,OP8,OP9,O PR2,OPR3,O PR4,OPR5,O PR8): | |
5495 | ATTEN DING: IB,D OCTOR4 | |
5496 | NP I: 8731245386 | |
5497 | Se condary ID s | |
5498 | (P ) BLUE CRO SS VAD000 | |
5499 | REFER RING: IB,D OCTOR GP | |
5500 | NP I: 8731245394 | |
5501 | (P ) BLUE CRO SS VAD000 | |
5502 | RENDE RING: IB,D OCTOR CARD | |
5503 | NP I: 1112220029 | |
5504 | (P ) BLUE CRO SS VAD000 | |
5505 | Billing Pr ovider Nam e and ID I nformation | |
5506 | Billi ng Provide r: CHEYEN NE VAMC | |
5507 | Billi ng Provide r NPI: 11 64471991 | |
5508 | Billi ng Provide r Tax ID ( VistA Reco rd PRV): 830168494 | |
5509 | Billi ng Provide r Secondar y IDs (Vis tA Record CI1A): | |
5510 | (P ) PROVIDER SITE NUMB ER 0000 <<<Sys tem Genera ted ID | |
5511 | (P ) BLUE CRO SS 007484 | |
5512 | Service Li ne Provide rs | |
5513 | Servi ce Line: 3 | |
5514 | RENDE RING: IB,D OCTOR RAD | |
5515 | NP I: 1112220037 | |
5516 | (P ) BLUE CRO SS VAD000 | |
5517 | (P ) EIN 022221111 | |
5518 | (P ) STATE LI CENSE 1289340B | |
5519 | Press ENTE R to conti nue | |
5520 | ||
5521 | Step | |
5522 | Procedure | |
5523 | 12 | |
5524 | Press the <Enter> ke y to move through th e fields. At the Wa nt To Auth orize Bill At This T ime?: and Authorize Bill Gener ation?: pr ompts, ent er Yes. T he claim i s now comp lete and w ill be tra nsmitted t o the FSC in Austin at the nex t regularl y schedule d transmis sion time. | |
5525 | ||
5526 | WANT TO ED IT SCREENS ? NO// <EN TER> | |
5527 | WANT TO AU THORIZE BI LL AT THIS TIME? No/ / YES | |
5528 | AUTHORIZE BILL GENER ATION?: YE S | |
5529 | Adding bi ll to BILL TRANSMISS ION File. | |
5530 | ||
5531 | Bill wil l be submi tted elect ronically | |
5532 | Passing co mpleted Bi ll to Acco unts Recei vable. Bi ll is no l onger edit able. | |
5533 | Completed Bill Succe ssfully se nt to Acco unts Recei vable. | |
5534 | ||
5535 | This Bill Can Not Be Printed U ntil Trans mit Confir med | |
5536 | ||
5537 | This Outpa tient INST ITUTIONAL bill may h ave corres ponding PR OFESSIONAL | |
5538 | charges. | |
5539 | CMS-1500 C laims | |
5540 | The follow ing screen s provide a simplifi ed example of a CMS- 1500 claim . | |
5541 | ||
5542 | Step | |
5543 | Procedure | |
5544 | 1 | |
5545 | When proce ssing a CM S-1500 cla im, inform ation on S creens 1 a nd 2 shoul d be revie wed for co rrectness. Press the <Enter> k ey to move from one screen to the next. | |
5546 | 2 | |
5547 | On Screen 3, the pay er informa tion is re viewed for correctne ss. The pa tient may have more than one i nsurance p olicy. If the correc t informat ion is not displayed , select a section ( 1, 2, or 3 ) and edi t the nece ssary fiel ds. Press the <Enter > key to c ontinue to Screen 4. | |
5548 | ||
5549 | Note: With Patch IB* 2*516, use rs will ha ve the abi lity to ad d a one-ti me HPID, p er payer, to a claim if the HP ID in the Insurance Company fi le is not the correc t one. The HPID will not be st ored in th e Insuranc e Company file. It will only apply to t he claim. | |
5550 | ||
5551 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Inpat/1 500 SCREEN < 3> | |
5552 | ========== ========== ========== ========== ========== ========== ========== ====== | |
5553 | PAYER IN FORMATION | |
5554 | [1] Rate T ype : REI MBURSABLE INS. Form Type: CMS 1500 | |
5555 | Respon sible: INS URER Payer Sequence: Primary | |
5556 | Bill P ayer : Blu e Cross Fe p Tran smit: Yes | |
5557 | ||
5558 | Ins 1: Blue Cros s Fep Policy #: R00000000 | |
5559 | Grp #: 100 Whose: VET ERAN Rel to In sd: PATIEN T | |
5560 | Grp Nm : STANDARD FAMILY Insd Sex: MALE Insured: IB,PATIENT 3 | |
5561 | ||
5562 | [2] Billin g Provider Secondary IDs: | |
5563 | Primar y : 01010 0 | |
5564 | Second ary: Terti ary : | |
5565 | ||
5566 | [3] Mailin g Address : Elec tronic ID: 12B54 | |
5567 | Blue C ross Fep | |
5568 | P O Bo x 10401 | |
5569 | Birmin gham, AL 352020401 | |
5570 | ||
5571 | <RET> to C ONTINUE, 1 -3 to EDIT , '^N' for screen N, or '^' to QUIT: | |
5572 | ||
5573 | Step | |
5574 | Procedure | |
5575 | 3 | |
5576 | Specify th e correct diagnosis and proced ure code(s ) that mus t be on th is claim. Press the <Enter> k ey to move to Screen 6. | |
5577 | ||
5578 | Note: With Patch IB* 2*516, use rs will ha ve the abi lity to re -sequence diagnosis codes that have been linked to a specifi c procedur e without breaking t he link. | |
5579 | ||
5580 | Note: With Patch IB* 2*516, new prompts h ave been a dded to Sc reens 4 an d 5 to all ow users t o enter ND Cs and Uni ts to non- RX procedu res for me dications administer ed in an o utpatient setting. W ith Patch IB*2*577, users can also selec t the type of units. | |
5581 | ||
5582 | Note: With Patch IB* 2*516, new prompts h ave been a dded to Sc reens 4 an d 5to allo w users to enter 80 character descriptio ns to CPT/ HCPCS proc edure code s for serv ices Not O therwise C lassified. | |
5583 | ||
5584 | Note: Patc h IB*2*608 will prov ide the ab ility to e nter the d ata for Ce rtificate of Medical Necessity -CMS-484-O xygen and DME Inform ation Form (DIF)-CMS -10126-Ent eral and P arenteral Nutrition. When a CM N CPT code that has been defin ed in the IB Site Pa rameters i s entered, the “CMN Required? will be pr ompted. | |
5585 | ||
5586 | ||
5587 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ 1500 SCREEN <5> | |
5588 | ========== ========== ========== ========== ========== ========== ========== ====== | |
5589 | EVENT - OU TPATIENT I NFORMATION | |
5590 | <1> Event Date : OCT 12, 2010 | |
5591 | [2] Prin. Diag.: ACU TE BRONCHI TIS - 466. 0 | |
5592 | Other Diag.: DMI WO CMP NT ST UNCNTR L - 250.01 | |
5593 | [3] OP Vis its : OCT 12,2010, | |
5594 | [4] Cod. M ethod: HCP CS | |
5595 | CPT Co de : CHE ST X-RAY 7 1010-26 46 6.0 OCT 12, 2010 | |
5596 | [5] Rx. Re fills: UNS PECIFIED [ NOT REQUIR ED] | |
5597 | [6] Pros. Items: UNS PECIFIED [ NOT REQUIR ED] | |
5598 | [7] Occ. C ode : UNS PECIFIED [ NOT REQUIR ED] | |
5599 | [8] Cond. Code : UNS PECIFIED [ NOT REQUIR ED] | |
5600 | <9> Value Code : UNS PECIFIED [ NOT REQUIR ED] | |
5601 | ||
5602 | <RET> to C ONTINUE, 1 -9 to EDIT , '^N' for screen N, or '^' to QUIT: | |
5603 | ||
5604 | Step | |
5605 | Procedure | |
5606 | 4 | |
5607 | Verify tha t the Form Type is C MS-1500 an d that the date of b illing is entered. M ake sure t he Disch S tat field is populat ed. If all the data have been entered co rrectly, s ection 5 s hould disp lay the co rrect reve nue codes and costs. Press the <Enter> k ey to move to Screen 8. | |
5608 | ||
5609 | Note: Ther e is a new non-fatal Warning m essage whe n a claim contains a Revenue c ode(s) whi ch generat es a zero dollar amo unt charge . | |
5610 | ||
5611 | Note: Afte r Patch IB *2*432, it will no l onger be p ossible to authorize a Sensiti ve claim u nless user s indicate d that a R elease of Informatio n has been completed . | |
5612 | ||
5613 | Note: Afte r Patch IB *2*432, Se ction 1 of screens 6 /7 will no longer ha ve fields for Covere d, non-Cov ered or Co -insurance Days. Thi s informat ion will n eed to be added to a claim usi ng Conditi on Codes. | |
5614 | ||
5615 | Note: Allo wable doll ar amounts have been increased to 999999 9.99 befor e users wi ll be forc ed to spli t lines. | |
5616 | ||
5617 | Note: Afte r Patch IB *2*432, it will be p ossible to add line- level Addi tional OB Minutes to an anesth esia claim for an Ob stetric pr ocedure th at require s more tha n the norm al amount of minutes . | |
5618 | ||
5619 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ 1500 SCREEN <7> | |
5620 | ========== ========== ========== ========== ========== ========== ========== ====== | |
5621 | BIL LING - GEN ERAL INFOR MATION | |
5622 | [1] Bill T ype : 13 1 Loc. of Care: H OSPITAL - INPT OR OP T (INCLU | |
5623 | Charge Type : PR OFESSIONAL Dis ch Stat: D ISCHARGED TO HOME OR SELF CAR | |
5624 | Form T ype : CM S-1500 Ti meframe: A DMIT THRU DISCHARGE | |
5625 | Bill C lassif: OU TPATIENT D ivision: C HEYENNE VA MROC | |
5626 | [2] Sensit ive? : NO Assi gnment: YE S | |
5627 | [3] Bill F rom : OC T 12, 2010 B ill To: OC T 13, 2010 | |
5628 | [4] OP Vis its : OC T 12,2010, | |
5629 | [5] Rev. C ode : 32 4-DX X-RAY /CHEST 71010 $45.3 0 OUTPATI ENT VISIT | |
5630 | OFFSET : $0.00 [NO OFFS ET RECORDE D] | |
5631 | BILL T OTAL : $45.30 | |
5632 | [6] Rate S ched : (r e-calculat e charges) | |
5633 | [7] Prior Claims: UN SPECIFIED | |
5634 | ||
5635 | ||
5636 | <RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT: | |
5637 | ||
5638 | Step | |
5639 | Procedure | |
5640 | 5 | |
5641 | On Screens 8 and 9, enter any necessary Claim leve l data to the claim. | |
5642 | ||
5643 | Note: IB*2 *447 moved Screen 8, Section 3 Ambulance Informati on to a ne w Screen 9 . | |
5644 | ||
5645 | Note: IB*2 *448 moved Screen 10 | |
5646 | ||
5647 | IB,PATIENT MRA XX- XX-XXXX BILL#: K20 003D - Out pat/1500 SCR EEN <8> | |
5648 | ========== ========== ========== ========== ========== ========== ========== ======= | |
5649 | BIL LING - CLA IM INFORMA TION | |
5650 | [1] COB No n-Covered Charge Amt : | |
5651 | [2] Proper ty Casualt y Informat ion | |
5652 | Claim Number: Contact N ame: | |
5653 | Date o f 1st Cont act: Contact P hone: | |
5654 | [3] Surgic al Codes f or Anesthe sia Claims | |
5655 | Primar y Code: Secondary Code: | |
5656 | [4] Paperw ork Attach ment Infor mation | |
5657 | Report Type: Transmiss ion Method : | |
5658 | Attach ment Contr ol #: | |
5659 | [5] Disabi lity Start Date: Disabilit y End Date : | |
5660 | [6] Assume d Care Dat e: Relinquis hed Care D ate: | |
5661 | [7] Specia l Program: ?? | |
5662 | Thi s is the S pecial Pro gram with which a cl aim is ass ociated. R efer to | |
5663 | MED ICARE regu lations to decide wh en to use this field . | |
5664 | ||
5665 | Choos e from: | |
5666 | 01 EPSD T/CHAP | |
5667 | 02 Phys Handicapp ed Childre n Program | |
5668 | 03 Spec ial Fed Fu nding | |
5669 | 05 Disa bility | |
5670 | 07 Indu ced Aborti on - Dange r to Life | |
5671 | 08 Indu ced Aborti on - Rape or Incest | |
5672 | 09 2nd Opinion/Su rgery | |
5673 | Special Pr ogram: | |
5674 | [8] Homebo und: ?? | |
5675 | Thi s is to in dicate tha t the pati ent is hom ebound or | |
5676 | ins titutional ized. Refe r to MEDIC ARE regula tions on w hen to | |
5677 | use this fiel d. | |
5678 | ||
5679 | Choos e from: | |
5680 | 0 NO | |
5681 | 1 YES | |
5682 | Homebound: | |
5683 | [9] Date L ast Seen:? ? | |
5684 | Thi s is the d ate a pati ent was la st seen. R efer to ME DICARE | |
5685 | reg ulations o n when to use this f ield. | |
5686 | ||
5687 | Date Last Seen: | |
5688 | ||
5689 | <RET> to C ONTINUE '^ N' for scr een N, or '^' to QUI T: | |
5690 | ||
5691 | ||
5692 | Note: IB*2 *488 moved the follo wing Scree n 10 field s to Scree n 8: Speci al Program ; Date Las t Seen; Ho mebound. T hese field s no longe r print in Box 19. | |
5693 | ||
5694 | Note: The prompts on Screen 8 are smart prompts, a vailable f or the cor rect form type. | |
5695 | ||
5696 | ||
5697 | ||
5698 | IB,PATIENT MRA XX- XX-XXXX BILL#: K20 003E - Out pat/1500 SCREEN <9 > | |
5699 | ========== ========== ========== ========== ========== ========== ========== ========== | |
5700 | AMBULANCE INFORMATIO N | |
5701 | [1] Ambula nce Transp ort Data | |
5702 | D/O Locat ion: | |
5703 | P/U Ad dress1: D/O Addre ss1: | |
5704 | P/U Ad dress2: D/O Addre ss2: | |
5705 | P/U Ci ty: D/O City: | |
5706 | P/U St ate/Zip: D/O State /Zip: | |
5707 | Patien t Weight: Transport Distance: | |
5708 | Transp ort Reason : | |
5709 | R/T Pu rpose: | |
5710 | Stretc her Purpos e: | |
5711 | [2] Ambula nce Certif ication Da ta | |
5712 | Condit ion Indica tor: 12 - Confined t o a bed or chair | |
5713 | 01 - Admitted t o hospital | |
5714 | ||
5715 | <RET> to C ONTINUE, 1 -2 to EDIT , '^N' for screen N, or '^' to QUIT: 1 | |
5716 | P/U Addres s1: | |
5717 | P/U Addres s 2: | |
5718 | P/U City: | |
5719 | P/U State: | |
5720 | P/U Zip: | |
5721 | D/O Locati on: | |
5722 | D/O Addres s1: | |
5723 | D/O Addres s2: | |
5724 | D/O City: | |
5725 | D/O State: | |
5726 | D/O Zip: | |
5727 | Patient We ight: | |
5728 | Transport Distance: | |
5729 | Transport Reason: | |
5730 | R/T Purpos e: | |
5731 | Stretcher Purpose: | |
5732 | ||
5733 | <RET> to C ONTINUE, 1 -2 to EDIT , '^N' for screen N, or '^' to QUIT: 2 | |
5734 | Select Amb ulance Con dition Ind icator: 01 // ? | |
5735 | Answer with AMBU LANCE COND ITION INDI CATOR | |
5736 | Choose from: | |
5737 | 12 | |
5738 | 01 | |
5739 | ||
5740 | Yo u may ente r a new AM BULANCE CO NDITION IN DICATOR, i f you wish | |
5741 | Se lect an Am bulance Co ndition In dicator. Answer mus t be 1-2 | |
5742 | ch aracters i n length. | |
5743 | Th is limits the entry to five co ndition in dicators. | |
5744 | ||
5745 | Answer with AMBUL ANCE CONDI TION INDIC ATORS CODE | |
5746 | Choose from: | |
5747 | 12 Confine d to a bed or chair | |
5748 | 01 Admitte d to hospi tal | |
5749 | 04 Moved b y stretche r | |
5750 | 05 Unconsc ious or in Shock | |
5751 | 06 Transpo rted in em ergency si tuation | |
5752 | 07 Had to be physica lly restra ined | |
5753 | 08 Visible hemorrhag ing | |
5754 | 09 Medical ly necessa ry service | |
5755 | ||
5756 | Select Amb ulance Con dition Ind icator: 01 // | |
5757 | ||
5758 | Step | |
5759 | Procedure | |
5760 | 6 | |
5761 | From Scree n 10, sele ct section 3 to ente r the name of the Re ndering Pr ovider if necessary. Enter a R eferring P rovider an d/or Super vising Pro vider if r equired by the payer for the p rocedure c odes on th e claim. | |
5762 | ||
5763 | Remember: Patch IB*2 *432 will make it po ssible to enter and transmit L ine Level providers. Line Leve l and Clai m Level pr oviders sh ould not b e the same . Claim Le vel provid ers apply to the ent ire claim. Line Leve l provider s are exce ptions. | |
5764 | ||
5765 | Note: Afte r Patch IB *2*432, it will no l onger be p ossible to authorize a Sensiti ve claim u nless user s indicate that a Re lease of I nformation has been completed. | |
5766 | ||
5767 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ 1500 SCREE N <10> | |
5768 | ========== ========== ========== ========== ========== ========== ========== ====== | |
5769 | BILLI NG - SPECI FIC INFORM ATION | |
5770 | [1] Unable To Work F rom: UNSPE CIFIED [NO T REQUIRED ] | |
5771 | Unable To Work T o : UNSPE CIFIED [NO T REQUIRED ] | |
5772 | [2] ICN/DC N(s) : UNSPE CIFIED [NO T REQUIRED ] | |
5773 | Tx Aut h. Code(s) : UNSPE CIFIED [NO T REQUIRED ] | |
5774 | [3] Provid ers : | |
5775 | - REN DERING (MD ) : IB,DO CTOR4 Taxo nomy: 0000 00000X | |
5776 | [P]XXXXBCR OSS | |
5777 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | |
5778 | Lab CL IA # : UNSPE CIFIED [NO T REQUIRED ] | |
5779 | Mammog raphy Cert # : UNSPE CIFIED [NO T REQUIRED ] | |
5780 | [5] Chirop ractic Dat a : UNSPE CIFIED [NO T REQUIRED ] | |
5781 | [6] Form L ocator 19 : UNSPE CIFIED [NO T REQUIRED ] | |
5782 | [7] Billin g Provider : CHEYE NNE VAMC | |
5783 | Taxono my Code : 282N0 0000X | |
5784 | [8] Force To Print? : NO FO RCED PRINT | |
5785 | [9] Provid er ID Main t : (Edit Provider ID informa tion) | |
5786 | ||
5787 | <RET> to C ONTINUE, 1 -6 to EDIT , '^N' for screen N, or '^' to QUIT: | |
5788 | ||
5789 | ||
5790 | The Primar y ID (NPI) for the A ttending, Operating or Other P hysician i s always t ransmitted with a cl aim. | |
5791 | ||
5792 | The Second ary IDs fo r the Atte nding, Ope rating or Other Phys ician are determined from what the user enters and from entr ies in Pro vider ID M aintenance . | |
5793 | ||
5794 | If users h ave set a default ID type and made it re quired for the curre nt or othe r payer, t he claim c annot be a uthorized if the phy sician doe s not have an ID of that type defined. | |
5795 | ||
5796 | When a pro vider is f irst added to Screen 10, the u ser will b e shown a screen tha t contains a list of all the p rovider’s IDs, the I D type and , optional ly, the ca re unit on file for the provid er's IDs. This will include th e provider 's own IDs , the prov ider's IDs assigned by the ins urance com pany, the insurance company de faults, if any, and all IDs as signed to the provid er by care unit. | |
5797 | ||
5798 | The first 2 entries in this li st will al ways be: | |
5799 | 1 - NO SEC ONDARY ID NEEDED 2 - ADD AN ID FOR THIS CLAIM ONLY | |
5800 | ||
5801 | ||
5802 | Any ID ent ered on Sc reen 10 wi ll automat ically ove rride any default pr ovider sec ondary ID that exist s for the same ID Qu alifier fo r this cla im ONLY. | |
5803 | ||
5804 | ||
5805 | **** SECON DARY PERFO RMING PROV IDER IDs * *** | |
5806 | ||
5807 | PRIMARY IN SURANCE CO : BLUE CRO SS CA (WY) | |
5808 | PROVIDER: IB,PHYSICI AN4 (ATTEN DING) | |
5809 | ||
5810 | INS. COMPA NY'S DEFAU LT SECONDA RY ID TYPE IS: BLUE SHIELD ID | |
5811 | ||
5812 | SELECT A S ECONDARY I D OR ACTIO N FROM THE LIST BELO W: | |
5813 | ||
5814 | 1 - N O SECONDAR Y ID NEEDE D | |
5815 | 2 - A DD AN ID F OR THIS CL AIM ONLY | |
5816 | 3 - < DEFAULT> X XXXBSHIELD BLUE SHI ELD ID | |
5817 | 4 - W YXXXX ST LIC (W Y) | |
5818 | ||
5819 | Selection: 3// | |
5820 | ||
5821 | If there i s a defaul t secondar y ID found , based on the insur ance compa ny paramet ers and th e Provider ID is def ined in th e Provider ID Mainte nance, thi s will be the 3rd en try in the list and will be pr eceded wit h the text <DEFAULT> . If this ID exists, the defau lt for the Selection prompt wi ll be 3. | |
5822 | ||
5823 | If no defa ult ID exi sts, the d efault for the selec tion promp t will be 1 – No Sec ondary ID needed. | |
5824 | ||
5825 | Any care u nits assig ned to an ID using P rovider ID Maintenan ce are dis played at the far ri ght of the ID line. You no lon ger have t o enter a care unit on the bil l. | |
5826 | ||
5827 | You can ma ke a selec tion from the list b y choosing the numbe r precedin g the ID y ou want to assign to the provi der for th e bill. Th is will ad d both the ID Qualif ier and th e ID numbe r to the c laim. | |
5828 | ||
5829 | ||
5830 | Note: If t he Provide r has mult iple IDs d efined, th e one you select or the new on e time onl y ID that you enter, will appe ar on Scre en 10 and will be th e first ID sent but the system will stil l transmit the remai ning IDs. The one yo u select w ill just b e the firs t one tran smitted. T he maximum number th at will be transmitt ed is five . | |
5831 | ||
5832 | If none of the IDs a re valid f or the pro vider for the claim, you can a dd a new I D for this claim onl y. | |
5833 | ||
5834 | Step | |
5835 | Procedure | |
5836 | 7 | |
5837 | At the Sel ection pro mpt, type 2 to add a n ID for t his claim only. | |
5838 | 8 | |
5839 | At the PRI M INS PERF PROV SECO NDARY ID T YPE: promp t, enter t he ID Qual ifier that the prima ry payer r equires as a seconda ry ID type . Type two question marks (??) to see th e list of possible c hoices. (F or this ex ample, typ e Location Number as the secon dary ID Qu alifier). | |
5840 | 9 | |
5841 | At the PRI M INS PERF PROV SECO NDARY ID: prompt, en ter the ID number pr ovided by the payer. In this e xample, ty pe XXXXA. | |
5842 | ||
5843 | Selection: 3// 2 | |
5844 | PRIM INS PERF PROV SECONDARY ID TYPE: ?? | |
5845 | Choose from: | |
5846 | BLUE CR OSS ID | |
5847 | BLUE SH IELD ID | |
5848 | COMMERC IAL ID | |
5849 | LOCATIO N NUMBER | |
5850 | MEDICAR E PART A | |
5851 | MEDICAR E PART B | |
5852 | ||
5853 | PRIM INS PERF PROV SECONDARY ID TYPE: LOCATION N UMBER | |
5854 | PRIM INS PERF PROV SECONDARY ID: XXXXA | |
5855 | ||
5856 | ||
5857 | After an I D and ID Q ualifier a re added t o the clai m for a pr ovider, th e provider ’s name an d the sele cted ID ar e displaye d on Scree n 8. Thes e fields c an be edit ed/deleted . | |
5858 | ||
5859 | If a physi cian/provi der is del eted, the next time the provid er entry i s accessed , the list of valid IDs will b e displaye d again. | |
5860 | ||
5861 | Valid Seco ndary ID T ypes for C urrent Pay er | |
5862 | Attending/ Operating/ Other (UB- 04) | |
5863 | State Lice nse; Blue Cross; Blu e Shield; Medicare P art A; UPI N; TRICARE ; Commerci al ID; Loc ation Numb er; Networ k ID; SSN; State Ind ustrial an d Accident Provider | |
5864 | Rendering/ Referring/ Supervisin g (1500) | |
5865 | State Lice nse; Blue Shield; Me dicare Par t B; UPIN; TRICARE; Commercial ID; Locat ion Number ; Network ID; SSN; S tate Indus trial and Accident P rovider | |
5866 | ||
5867 | Valid Seco ndary ID T ypes for O ther Payer (Not Curr ent) | |
5868 | Attending/ Operating/ Other (UB- 04) | |
5869 | Blue Cross ; Blue Shi eld; Medic are Part A and Part B; UPIN; T RICARE; Co mmercial I D; Locatio n Number | |
5870 | Rendering (1500) | |
5871 | Blue Shiel d; Medicar e Part A a nd Part B; Commercia l ID; Loca tion Numbe r; Network ID | |
5872 | Referring (1500) | |
5873 | Blue Shiel d; Medicar e Part A a nd Part B; Commercia l ID; Loca tion Numbe r; Network ID | |
5874 | Supervisin g (1500) | |
5875 | Blue Shiel d; Medicar e Part A a nd Part B; Commercia l ID; Netw ork ID | |
5876 | ||
5877 | Step | |
5878 | Procedure | |
5879 | 10 | |
5880 | At the <RE T> to Cont inue: prom pt (any sc reen), ent er ?PRV to see summa ry informa tion about a particu lar provid er. | |
5881 | ||
5882 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ UB04 SCR EEN <10> | |
5883 | ========== ========== ========== ========== ========== ========== ========== ========== == | |
5884 | B ILLING - S PECIFIC IN FORMATION | |
5885 | [1] Bill R emarks | |
5886 | - FL- 80 : UNSPEC IFIED [NOT REQUIRED] | |
5887 | ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED] | |
5888 | Auth/R eferral : UNSPEC IFIED [NOT REQUIRED] | |
5889 | Admiss ion Source : PHYSIC IAN REFERR AL | |
5890 | [3] Provid ers : | |
5891 | - REN DERING (MD ) : IB,DO CTOR4Taxon omy: 39020 0000X | |
5892 | [P]XXXXBCR OSS | |
5893 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | |
5894 | Lab CL IA # : UNSPE CIFIED [NO T REQUIRED ] | |
5895 | Mammog raphy Cert # : UNSPE CIFIED [NO T REQUIRED ] | |
5896 | [5] Chirop ractic Dat a : UNSPE CIFIED [NO T REQUIRED ] | |
5897 | [6] Form L ocator 19 : UNSPE CIFIED [NO T REQUIRED ] | |
5898 | [7] Billin g Provider : MONTG OMERY VAMC | |
5899 | Taxono my Code : 282N0 0000X | |
5900 | [8] Force To Print? : NO FO RCED PRINT | |
5901 | [9] Provid er ID Main t : (Edit Provider ID informa tion) | |
5902 | ||
5903 | ||
5904 | <RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT:?PRV | |
5905 | (V)A or (N )on-VA Pro vider: V// NON-VA PR OVIDER | |
5906 | ||
5907 | ||
5908 | Select NON -VA PROVID ER NAME: I B,OUTSIDED OC O I | |
5909 | ||
5910 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
5911 | Signature Name: OUT SIDEDOC IB | |
5912 | NPI: 123 4567892 | |
5913 | ||
5914 | Licen se(s): Non e Active o n X/X/XX | |
5915 | ||
5916 | Person Class: V11 5500 | |
5917 | PROVIDER TYPE: All opathic an d Osteopat hic Physic ians | |
5918 | CLASSIFIC ATION: Res ident, All opathic (i ncludes In terns, Res idents, Fe llows) | |
5919 | SPECIALIZ ATION: | |
5920 | TAX ONOMY: 390 200000X (1 44) | |
5921 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
5922 | ||
5923 | Select NON -VA PROVID ER NAME: | |
5924 | ||
5925 | Step | |
5926 | Procedure | |
5927 | 11 | |
5928 | At the <RE T> to Cont inue: prom pt (any sc reen), ent er ?ID to see what I Ds will be transmitt ed with th e claim. | |
5929 | ||
5930 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ UB04 SC REEN <10> | |
5931 | ========== ========== ========== ========== ========== ========== ========== ========== == | |
5932 | BILLIN G - SPECIF IC INFORMA TION | |
5933 | [1] Bill R emarks | |
5934 | - FL- 80 : UNSPEC IFIED [NOT REQUIRED] | |
5935 | ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED] | |
5936 | Auth/R eferral : UNSPEC IFIED [NOT REQUIRED] | |
5937 | Admiss ion Source : PHYSIC IAN REFERR AL | |
5938 | [3] Provid ers : | |
5939 | - REN DERING (MD ) : IB,DO CTOR4Taxon omy: 00000 0000X | |
5940 | [P]XXXXBC ROSS | |
5941 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | |
5942 | Lab CL IA # : UNSPE CIFIED [NO T REQUIRED ] | |
5943 | Mammog raphy Cert # : UNSPE CIFIED [NO T REQUIRED ] | |
5944 | [5] Chirop ractic Dat a : UNSPE CIFIED [NO T REQUIRED ] | |
5945 | [6] Form L ocator 19 : UNSPE CIFIED [NO T REQUIRED ] | |
5946 | [7] Billin g Provider : MONTG OMERY VAMC | |
5947 | Taxono my Code : 282N0 0000X | |
5948 | [8] Force To Print? : NO FO RCED PRINT | |
5949 | [9] Provid er ID Main t : (Edit Provider ID informa tion) | |
5950 | ||
5951 | ||
5952 | <RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT: ?ID | |
5953 | ||
5954 | ||
5955 | IF THIS BI LL IS TRAN SMITTED EL ECTRONICAL LY, THE FO LLOWING ID S WILL BE SENT: | |
5956 | PRIMARY INS CO: BL UE CROSS C A (WY) <<< Current In s | |
5957 | SECONDARY INS CO: TP M TRUST | |
5958 | ||
5959 | PROVIDER I Ds: (VISTA RECORDS O P1,OP2,OP4 ,OP8,OP9,O PR2,OPR3,O PR4,OPR5,O PR8): | |
5960 | ATTEN DING/RENDE RING: IB,D OCTOR 4 | |
5961 | NPI:000000 000X | |
5962 | SSN:XXXXXX XXX | |
5963 | SEC ONDARY IDs | |
5964 | (P ) LOCATION NUMBER XXXXA | |
5965 | (P ) BLUE CRO SS ID XXXXB CROSS | |
5966 | (P ) ST LIC ( WY) WYXXX X | |
5967 | ||
5968 | Step | |
5969 | Procedure | |
5970 | 12 | |
5971 | Press the <Enter> ke y to move through th e fields. At the Wa nt To Auth orize Bill At This T ime?: and Authorize Bill Gener ation?: pr ompts, ent er Yes. T he claim i s now comp lete and w ill be tra nsmitted t o the FSC at the nex t regularl y schedule d transmis sion time. | |
5972 | ||
5973 | Executing A/R edits | |
5974 | No A/R err ors found | |
5975 | ||
5976 | WANT TO ED IT SCREENS ? NO// | |
5977 | ||
5978 | THIS BILL WILL BE TR ANSMITTED ELECTRONIC ALLY | |
5979 | ||
5980 | WANT TO AU THORIZE BI LL AT THIS TIME? No/ / YES | |
5981 | AUTHORIZE BILL GENER ATION?: YE S | |
5982 | Adding bill to BI LL TRANSMI SSION File . | |
5983 | ||
5984 | Bill wil l be submi tted elect ronically | |
5985 | Passing co mpleted Bi ll to Acco unts Recei vable. Bi ll is no l onger edit able. | |
5986 | Completed Bill Succe ssfully se nt to Acco unts Recei vable. | |
5987 | ||
5988 | This Bill Can Not Be Printed U ntil Trans mit Confir med | |
5989 | J430D Clai ms | |
5990 | The follow ing screen s provide a simplifi ed example of a J430 D claim. | |
5991 | ||
5992 | Step | |
5993 | Procedure | |
5994 | 1 | |
5995 | When proce ssing a J4 30D claim, informati on on Scre ens 1 and 2 should b e reviewed for corre ctness. Pr ess the <E nter> key to move fr om one scr een to the next. | |
5996 | 2 | |
5997 | On Screen 3, the pay er informa tion is re viewed for correctne ss. The pa tient may have more than one i nsurance p olicy. If the correc t informat ion is not displayed , select a section ( 1, 2, or 3 ) and edi t the nece ssary fiel ds. Press the <Enter > key to c ontinue to Screen 5. | |
5998 | ||
5999 | Note:Medic are does N OT accept Dental cla ims. If yo u attempt to bill Me dicare, yo u will get a Fatal E rror messa ge. | |
6000 | **E rrors**: | |
6001 | Medic are (WNR) does not a ccept Dent al claims. | |
6002 | ||
6003 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpt/J 430D SCREEN <3> | |
6004 | ========== ========== ========== ========== ========== ========== ========== ====== | |
6005 | PAYER IN FORMATION | |
6006 | [1] Rate T ype : REI MBURSABLE INS. Form Type: J430 D | |
6007 | Respon sible: INS URER Payer Sequence: Primary | |
6008 | Bill P ayer : Del ta Dental Trans mit: Yes | |
6009 | ||
6010 | Ins 1: Dental De lta Policy #: R00000000 | |
6011 | Grp #: XXXX Whose: VET ERAN Rel to In sd: PATIEN T | |
6012 | Grp Nm : STANDARD FAMILY Insd Sex: MALE Insured: IB,PATIENT 3 | |
6013 | ||
6014 | [2] Billin g Provider Secondary IDs: | |
6015 | Primar y : | |
6016 | Second ary: Terti ary : | |
6017 | ||
6018 | [3] Mailin g Address : Elec tronic ID: XXXXX | |
6019 | Delta Dental | |
6020 | P O Bo x 10401 | |
6021 | Pleasa ntville, F L 3377410 10 | |
6022 | ||
6023 | <RET> to C ONTINUE, 1 -3 to EDIT , '^N' for screen N, or '^' to QUIT: | |
6024 | ||
6025 | Step | |
6026 | Procedure | |
6027 | 3 | |
6028 | Specify th e correct diagnosis and proced ure code(s ) that mus t be on th is claim. Press the <Enter> k ey to move to Screen 7. | |
6029 | ||
6030 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ J430D SCREEN <5> | |
6031 | ========== ========== ========== ========== ========== ========== ========== ====== | |
6032 | EVENT - OU TPATIENT I NFORMATION | |
6033 | <1> Event Date : OCT 12, 2017 | |
6034 | [2] Prin. Diag.: Arr ested dent al caries - K02.3 | |
6035 | [3] OP Vis its : OCT 12,2017, | |
6036 | [4] Cod. M ethod: HCP CS | |
6037 | CPT Co de : DEN TAL SEALAN T PER TOOT H D1351 K0 2.3 OCT 12, 2017 | |
6038 | <5> Rx. Re fills: UNS PECIFIED [ NOT REQUIR ED] | |
6039 | <6> Pros. Items: UNS PECIFIED [ NOT REQUIR ED] | |
6040 | [7] Occ. C ode : UNS PECIFIED [ NOT REQUIR ED] | |
6041 | ||
6042 | <RET> to C ONTINUE, 1 -9 to EDIT , '^N' for screen N, or '^' to QUIT: | |
6043 | ||
6044 | Step | |
6045 | Procedure | |
6046 | 4 | |
6047 | Verify tha t the Form Type is J 430D and t hat the da te of bill ing is ent ered. Make sure the Disch Stat field is populated. If all th e data hav e been ent ered corre ctly, sect ion 5 shou ld display the corre ct revenue codes and costs. Pr ess the <E nter> key to move to Screen 8. | |
6048 | ||
6049 | Note: The Occurrence Code fiel d can be u sed to add Accident Informatio n to a Den tal claim if necessa ry. The O ccurrence codes will not be tr ansmitted as Occurre nce codes but the Ac cident inf ormation w ill be tra nsmitted. An acciden t date is required o n Dental c laims that contain a Property and Casual ty number. | |
6050 | ||
6051 | Note: Ther e are new Line Level data fiel ds specifi c to Denta l claims: | |
6052 | Oral Cavit y Designat ion (1): | |
6053 | Prosthesis /Crown/Inl ay Code: | |
6054 | Prior Plac ement Date Qualifier : | |
6055 | Tooth Code: | |
6056 | To oth Surfac e: | |
6057 | Orthodonti c Banding Date: | |
6058 | Orthodonti c Banding Replacemen t Date: | |
6059 | Treatment Start Date : | |
6060 | Treatment Completion Date: | |
6061 | ||
6062 | Note: Type of Servic e is not a vailable f or Dental Claims. | |
6063 | ||
6064 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ J430D SCREE N <7> | |
6065 | ========== ========== ========== ========== ========== ========== ========== ====== | |
6066 | BI LLING - GE NERAL INFO RMATION | |
6067 | [1] Bill T ype : 13 1 Loc. of Care: H OSPITAL - INPT OR OP T (INCLU | |
6068 | Charge Type : PR OFESSIONAL Dis ch Stat: D ISCHARGED TO HOME OR SELF CAR | |
6069 | Form T ype : J4 30D Ti meframe: A DMIT THRU DISCHARGE | |
6070 | Bill C lassif: OU TPATIENT D ivision: C HEYENNE VA MROC | |
6071 | [2] Sensit ive? : NO Assi gnment: YE S | |
6072 | [3] Bill F rom : OC T 12, 2017 B ill To: OC T 12, 2017 | |
6073 | [4] OP Vis its : OC T 12,2017, | |
6074 | [5] Rev. C ode : 51 2-DENTAL C LINIC D1351 $64.2 9 OUTPATI ENT VISIT | |
6075 | OFFSET : $0.00 [NO OFFS ET RECORDE D] | |
6076 | BILL T OTAL : $64.29 | |
6077 | [6] Rate S ched : (r e-calculat e charges) | |
6078 | [7] Prior Claims: UN SPECIFIED | |
6079 | ||
6080 | ||
6081 | ||
6082 | <RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT: | |
6083 | ||
6084 | Step | |
6085 | Procedure | |
6086 | 5 | |
6087 | On Screens 8, enter any necess ary Claim level data to the cl aim. | |
6088 | ||
6089 | Note: The claim data is specif ic to Dent al Claims. The Denta l Paperwor k function s as it do es for oth er claims except the list of a vailable a ttachments is differ ent and mo re specifi c to denta l. | |
6090 | ||
6091 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpt/J 430D SCREEN <8> | |
6092 | ========== ========== ========== ========== ========== ========== ========== ======= | |
6093 | DENT AL - CLAIM INFORMATI ON | |
6094 | [1] Tooth Status | |
6095 | [2] Orthod ontic Info rmation | |
6096 | Bandin g Date: | |
6097 | Treatm ent Months Count: | |
6098 | Treatm ent Months Remaining Count: | |
6099 | Treatm ent Indica tor: | |
6100 | [3] Dental Paperwork Attachmen t | |
6101 | Report Type: Trans Met hod: | |
6102 | Attach ment Contr ol #: | |
6103 | [4] Proper ty Casualt y Informat ion | |
6104 | Claim Number: | |
6105 | ||
6106 | ||
6107 | ||
6108 | ||
6109 | ||
6110 | ||
6111 | <RET> to C ONTINUE, 1 -4 to EDIT , '^N' for screen N, or '^' to QUIT: | |
6112 | ||
6113 | ||
6114 | Step | |
6115 | Procedure | |
6116 | 6 | |
6117 | From Scree n 10, sele ct section 3 to ente r the name of the Re ndering Pr ovider or Assistant Surgeon if necessary . Enter a Referring Provider a nd/or Supe rvising Pr ovider if required b y the paye r for the procedure codes on t he claim. | |
6118 | ||
6119 | Note: Both a Renderi ng Provide r and an A ssistant S urgeon are not allow ed on the same Denta l claim. | |
6120 | ||
6121 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ J430D SC REEN <10> | |
6122 | ========== ========== ========== ========== ========== ========== ========== ====== | |
6123 | BILLING - SPECIFIC INFORMATIO N | |
6124 | <1> Unable To Work F rom: UNSPE CIFIED [NO T REQUIRED ] | |
6125 | Unable To Work T o : UNSPE CIFIED [NO T REQUIRED ] | |
6126 | [2] ICN/DC N(s) : UNSPE CIFIED [NO T REQUIRED ] | |
6127 | Auth/R eferral : UNSPE CIFIED [NO T REQUIRED ] | |
6128 | [3] Provid ers : UNSPE CIFIED | |
6129 | <4> Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | |
6130 | Lab CL IA # : UNSPE CIFIED [NO T REQUIRED ] | |
6131 | Mammog raphy Cert # : UNSPE CIFIED [NO T REQUIRED ] | |
6132 | <5> Chirop ractic Dat a : UNSPE CIFIED [NO T REQUIRED ] | |
6133 | [6] Dental Claim Not e : UNSPE CIFIED [NO T REQUIRED ] | |
6134 | [7] Billin g Provider : CHEYE NNE VAMC | |
6135 | Taxono my Code : 282N0 0000X | |
6136 | [8] Alt Pr im Payer I D : UNSPE CIFIED [NO T REQUIRED ] | |
6137 | <9> Force To Print? : NO FO RCED PRINT | |
6138 | [10] Provi der ID Mai nt : (Edi t Provider ID inform ation) | |
6139 | ||
6140 | ||
6141 | <RET> to C ONTINUE, 1 -10 to EDI T, '^N' fo r screen N , or '^' t o QUIT: | |
6142 | ||
6143 | ||
6144 | Note: Sect ion 4 is d isabled. U sers canno t create c laims for non-VA Den tal servic es. | |
6145 | ||
6146 | Note: Sect ion 6 allo ws users t o enter a free text, up to 80 character, dental sp ecific com ment. | |
6147 | ||
6148 | Note: Sect ion 9 is d isabled. U sers canno t print De ntal claim s. | |
6149 | ||
6150 | Note: Thou gh allowed , VistA wi ll not pro vide the a bility to define sec ondary IDs for Denta l Claims. | |
6151 | ||
6152 | ||
6153 | Valid Seco ndary ID T ypes for C urrent Pay er | |
6154 | Rendering/ Supervisin g (J430D) | |
6155 | State Lice nse; UPIN; Commercia l ID; Loca tion Numbe r | |
6156 | Assistant Surgeon (J 430D | |
6157 | State Lice nse; UPIN; Commercia l ID; Loca tion Numbe r | |
6158 | Referring (J430D) | |
6159 | State Lice nse; UPIN; Commercia l ID | |
6160 | ||
6161 | Valid Seco ndary ID T ypes for O ther Payer (Not Curr ent) | |
6162 | Rendering (J430D) | |
6163 | State Lice nse; UPIN; Commercia l ID; Loca tion Numbe r | |
6164 | Referring (J430D) | |
6165 | State Lice nse; UPIN; Commercia l ID | |
6166 | Supervisin g (J430D) | |
6167 | State Lice nse; UPIN; Commercia l ID; Loca tion Numbe r | |
6168 | Assistant Surgeon (J 430D) | |
6169 | State Lice nse; UPIN; Commercia l ID; Loca tion Numbe r | |
6170 | ||
6171 | Step | |
6172 | Procedure | |
6173 | 7 | |
6174 | Press the <Enter> ke y to move through th e fields. At the Wa nt To Auth orize Bill At This T ime?: and Authorize Bill Gener ation?: pr ompts, ent er Yes. T he claim i s now comp lete and w ill be tra nsmitted t o the FSC at the nex t regularl y schedule d transmis sion time. | |
6175 | ||
6176 | Executing A/R edits | |
6177 | No A/R err ors found | |
6178 | ||
6179 | WANT TO ED IT SCREENS ? NO// | |
6180 | ||
6181 | THIS BILL WILL BE TR ANSMITTED ELECTRONIC ALLY | |
6182 | ||
6183 | WANT TO AU THORIZE BI LL AT THIS TIME? No/ / YES | |
6184 | AUTHORIZE BILL GENER ATION?: YE S | |
6185 | Adding bill to BI LL TRANSMI SSION File . | |
6186 | ||
6187 | Bill wil l be submi tted elect ronically | |
6188 | Passing co mpleted Bi ll to Acco unts Recei vable. Bi ll is no l onger edit able. | |
6189 | Completed Bill Succe ssfully se nt to Acco unts Recei vable. | |
6190 | Lab Claims | |
6191 | EDI Enhanc ed HIPAA f ormat allo ws users t o enter a CLIA# when billing f or certain laborator y procedur es. The V A’s CLIA # must be e ntered on Screen 8 w hen billin g a Medica re seconda ry payer f or laborat ory and pa thology pr ocedures t hat are no t reimburs ed in full by Medica re. | |
6192 | ||
6193 | The follow ing screen s provide a simplifi ed example of a lab claim: | |
6194 | ||
6195 | Step | |
6196 | Procedure | |
6197 | 1 | |
6198 | When proce ssing a La boratory c laim, info rmation on Screens 1 and 2 sho uld be rev iewed for correctnes s. Press the <Enter > key to m ove from o ne screen to the nex t. | |
6199 | 2 | |
6200 | On Screen 3, the pay er informa tion is re viewed for correctne ss. The p atient may have more than one insurance policy. I f the corr ect inform ation is n ot display ed, select a section (1, 2, or 3 ) and e dit the ne cessary fi elds. Pres s the <Ent er> key to continue to Screen 5. | |
6201 | ||
6202 | Note: With Patch IB* 2*516, use rs will ha ve the abi lity to ad d a one-ti me HPID, p er payer, to a claim if the HP ID in the Insurance Company fi le is not the correc t one. The HPID will not be st ored in th e Insuranc e Company file. It will only apply to t he claim. | |
6203 | ||
6204 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ 1500 SCREEN <3 > | |
6205 | ========== ========== ========== ========== ========== ========== ========== ====== | |
6206 | PAYER IN FORMATION | |
6207 | [1] Rate T ype : REI MBURSABLE INS. Form Type: CMS 1500 | |
6208 | Respon sible: INS URER Payer Sequence: Primary | |
6209 | Bill P ayer : Blu e Cross Fe p Tran smit: Yes | |
6210 | ||
6211 | Ins 1: Blue Cros s Fep Policy #: R00000000 | |
6212 | Grp #: 100 Whose: VET ERAN Rel to In sd: PATIEN T | |
6213 | Grp Nm : STANDARD FAMILY Insd Sex: MALE Insured: IB,PATIENT 3 | |
6214 | ||
6215 | ||
6216 | [2] Billin g Provider Secondary IDs: | |
6217 | Primar y : 01010 0 | |
6218 | Second ary: Terti ary : | |
6219 | ||
6220 | [3] Mailin g Address : Elec tronic ID: 12B54 | |
6221 | Blue C ross Fep | |
6222 | P O Bo x 10401 | |
6223 | Birmin gham, AL 352020401 | |
6224 | ||
6225 | ||
6226 | <RET> to C ONTINUE, 1 -3 to EDIT , '^N' for screen N, or '^' to QUIT: | |
6227 | ||
6228 | Step | |
6229 | Procedure | |
6230 | 3 | |
6231 | Specify th e correct diagnosis and proced ure code(s ) that mus t be on th is claim. Press the <Enter> ke y to move to Screen 7. | |
6232 | ||
6233 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ 1500 SCREEN < 5> | |
6234 | ========== ========== ========== ========== ========== ========== ========== ====== | |
6235 | EVENT - OUTPATI ENT INFORM ATION | |
6236 | [1] Event Date : XX XX,XXXX | |
6237 | [2] Prin. Diag.: URI NARY FREQU ENCY - 788 .41 | |
6238 | [3] OP Vis its : XXX XX,XXXX | |
6239 | [4] Cod. M ethod: HCP CS | |
6240 | CPT Co de : URI NALYSIS, A UTO W/SCOP E 81001 XXX X X,XXXX | |
6241 | CPT Co de : URI NE BACTERI A CULTURE 87088 XXX X X,XXXX | |
6242 | [5] Rx. Re fills: UNS PECIFIED [ NOT REQUIR ED] | |
6243 | [6] Pros. Items: UNS PECIFIED [ NOT REQUIR ED] | |
6244 | [7] Occ. C ode : UNS PECIFIED [ NOT REQUIR ED] | |
6245 | [8] Cond. Code : UNS PECIFIED [ NOT REQUIR ED] | |
6246 | [9] Value Code : UNS PECIFIED [ NOT REQUIR ED] | |
6247 | ||
6248 | <RET> to C ONTINUE, 1 -9 to EDIT , '^N' for screen N, or '^' to QUIT: | |
6249 | ||
6250 | Step | |
6251 | Procedure | |
6252 | 4 | |
6253 | Verify tha t the Form Type is C MS-1500 an d that the date of b illing is entered. M ake sure t he Disch S tat field is populat ed. If al l the data have been entered c orrectly, section 5 should dis play the c orrect rev enue codes and costs . Press th e <Enter> key to mov e to Scree n 8. | |
6254 | ||
6255 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ 1500 SCREE N <7> | |
6256 | ========== ========== ========== ========== ========== ========== ========== ====== | |
6257 | BILL ING - GENE RAL INFORM ATION | |
6258 | [1] Bill T ype : 13 1 Loc. of Care: H OSPITAL - INPT OR OP T (INCLU | |
6259 | Charge Type : PR OFESSIONAL Dis ch Stat: D ISCHARGED TO HOME OR SELF CAR | |
6260 | Form T ype : CM S-1500 Ti meframe: A DMIT THRU DISCHARGE | |
6261 | Bill C lassif: OU TPATIENT D ivision: C HEYENNE VA MROCY VAMC | |
6262 | [2] Sensit ive? : UN SPECIFIED Assi gnment: YE S | |
6263 | [3] Bill F rom : XX X XX,XXXX Bi ll To: XXX XX,XXXX | |
6264 | [4] OP Vis its : XX X XX,XXXX | |
6265 | [5] Rev. C ode : 30 6-LAB/BACT -MICRO 87088 $33.20 OUTPATIENT VISIT | |
6266 | Rev. C ode : 30 7-GASTR-IN ST SVS 81001 $12.77 OUTPATIENT VISIT | |
6267 | OFFSET : $0.00 [NO OFFS ET RECORDE D] | |
6268 | BILL T OTAL : $45.97 | |
6269 | [6] Rate S ched : (r e-calculat e charges) | |
6270 | [7] Prior Claims: UN SPECIFIED | |
6271 | ||
6272 | ||
6273 | <RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT: | |
6274 | ||
6275 | Step | |
6276 | Procedure | |
6277 | 5 | |
6278 | On Screens 8 and 9, enter any necessary Claim leve l data to the claim and press the ENTER key to mov e to Scree n 10. | |
6279 | ||
6280 | Note: IB*2 *447 moved Screen 8, Section 3 Ambulance Informati on to a ne w Screen 9 . | |
6281 | ||
6282 | IB,PATIENT MRA XX- XX-XXXX BILL#: K20 003D - Out pat/1500 SCR EEN <8> | |
6283 | ========== ========== ========== ========== ========== ========== ========== ======= | |
6284 | BIL LING - CLA IM INFORMA TION | |
6285 | [1] COB No n-Covered Charge Amt : | |
6286 | [2] Proper ty Casualt y Informat ion | |
6287 | Claim Number: Contact N ame: | |
6288 | Date o f 1st Cont act: Contact P hone: | |
6289 | [3] Surgic al Codes f or Anesthe sia Claims | |
6290 | Primar y Code: Secondary Code: | |
6291 | [4] Paperw ork Attach ment Infor mation | |
6292 | Report Type: Transmiss ion Method : | |
6293 | Attach ment Contr ol #: | |
6294 | [5] Disabi lity Start Date: Disabilit y End Date : | |
6295 | [6] Assume d Care Dat e: Relinquis hed Care D ate: | |
6296 | [7] Specia l Program: | |
6297 | [8] Homebo und: | |
6298 | [9] Date L ast Seen: | |
6299 | ||
6300 | <RET> to C ONTINUE '^ N' for scr een N, or '^' to QUI T: | |
6301 | ||
6302 | ||
6303 | Note: IB*2 *488 moved the follo wing Scree n 10 field s to Scree n 8: Speci al Program ; Date Las t Seen; Ho mebound. T hese field s no longe r print in Box 19. | |
6304 | ||
6305 | IB,PATIENT MRA XX- XX-XXXX BILL#: K20 003E - Out pat/1500 SCR EEN <9> | |
6306 | ========== ========== ========== ========== ========== ========== ========== ======= | |
6307 | AMBULANCE INFORMATIO N | |
6308 | [1] Ambula nce Transp ort Data | |
6309 | D/O Locat ion: | |
6310 | P/U Ad dress1: D/O Addre ss1: | |
6311 | P/U Ad dress2: D/O Addre ss2: | |
6312 | P/U Ci ty: D/O City: | |
6313 | P/U St ate/Zip: D/O State /Zip: | |
6314 | Patien t Weight: Transport Distance: | |
6315 | Transp ort Reason : | |
6316 | R/T Pu rpose: | |
6317 | Stretc her Purpos e: | |
6318 | [2] Ambula nce Certif ication Da ta | |
6319 | Condit ion Indica tor: 12 - Confined t o a bed or chair | |
6320 | 01 - Admitted t o hospital | |
6321 | ||
6322 | <RET> to C ONTINUE, 1 -2 to EDIT , '^N' for screen N, or '^' to QUIT: 1 | |
6323 | P/U Addres s1: | |
6324 | P/U Addres s 2: | |
6325 | P/U City: | |
6326 | P/U State: | |
6327 | P/U Zip: | |
6328 | D/O Locati on: | |
6329 | D/O Addres s1: | |
6330 | D/O Addres s2: | |
6331 | D/O City: | |
6332 | D/O State: | |
6333 | D/O Zip: | |
6334 | Patient We ight: | |
6335 | Transport Distance: | |
6336 | Transport Reason: | |
6337 | R/T Purpos e: | |
6338 | Stretcher Purpose: | |
6339 | ||
6340 | <RET> to C ONTINUE, 1 -2 to EDIT , '^N' for screen N, or '^' to QUIT: 2 | |
6341 | Select Amb ulance Con dition Ind icator: 01 // ? | |
6342 | Answer with AMBU LANCE COND ITION INDI CATOR | |
6343 | Choose from: | |
6344 | 12 | |
6345 | 01 | |
6346 | ||
6347 | Yo u may ente r a new AM BULANCE CO NDITION IN DICATOR, i f you wish | |
6348 | Se lect an Am bulance Co ndition In dicator. Answer mus t be 1-2 | |
6349 | ch aracters i n length. | |
6350 | Th is limits the entry to five co ndition in dicators. | |
6351 | ||
6352 | Answer with AMBU LANCE COND ITION INDI CATORS COD E | |
6353 | Choose from: | |
6354 | 12 Confine d to a bed or chair | |
6355 | 01 Admitte d to hospi tal | |
6356 | 04 Moved b y stretche r | |
6357 | 05 Unconsc ious or in Shock | |
6358 | 06 Transpo rted in em ergency si tuation | |
6359 | 07 Had to be physica lly restra ined | |
6360 | 08 Visible hemorrhag ing | |
6361 | 09 Medical ly necessa ry service | |
6362 | ||
6363 | Select Amb ulance Con dition Ind icator: 01 // | |
6364 | ||
6365 | Step | |
6366 | Procedure | |
6367 | 6 | |
6368 | From Scree n 10, ente r 3 to add a Renderi ng and Ref erring and Supervisi ng provide r, if nece ssary. | |
6369 | 7 | |
6370 | To edit, s elect Sect ion 5 and enter the CLIA # if required b y the paye r. | |
6371 | ||
6372 | After Patc h IB*2.0*3 20, the bi lling soft ware will automatica lly popula te the CLI A# for the division on the cla im when th e claim is for the S ervice Typ e = 5 (Dia gnostic La boratory) if the CLI A# exists in the Vis tA Institu tion file. Users ma y override this valu e for the current cl aim only. | |
6373 | ||
6374 | For outsid e laborato ry service s, the bil ling softw are will a utomatical ly populat e the CLIA # if there is a Labo ratory or Facility s econdary I D defined for the ou tside faci lity with a ID Quali fier of X4 (CLIA #). | |
6375 | ||
6376 | There will be an Err or Message for labor atory clai ms to Medi care when there is n o CLIA# on the claim and a War ning Messa ge for lab oratory cl aims to ot her payers when ther e is no CL IA# on the claim. | |
6377 | ||
6378 | IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX X - Outpat /1500 S CREEN <10> | |
6379 | ========== ========== ========== ========== ========== ========== ========== ====== | |
6380 | BILLI NG - SPECI FIC INFORM ATION | |
6381 | [[1] Bill Remarks | |
6382 | - FL- 80 : UNSPEC IFIED [NOT REQUIRED] | |
6383 | ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED] | |
6384 | Auth/R eferral : UNSPEC IFIED [NOT REQUIRED] | |
6385 | Admiss ion Source : PHYSIC IAN REFERR AL | |
6386 | [3] Provid ers : | |
6387 | - REF ERRING (MD ) : IB,DO CTOR5 Tax onomy: XXX XXXXXXX (X X) | |
6388 | [P]XX 0000 | |
6389 | - REN DERING (MD ) : IB,DO CTOR4 Tax onomy: XXX XXXXXXX (X X) | |
6390 | [P]XX X123 | |
6391 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | |
6392 | Lab CL IA # : DXXXX 000 | |
6393 | Mammog raphy Cert # : UNSPE CIFIED [NO T REQUIRED ] | |
6394 | [5] Chirop ractic Dat a : UNSPE CIFIED [NO T REQUIRED ] | |
6395 | [6] CMS-15 00 Box 19 : UNSPE CIFIED [NO T REQUIRED ] | |
6396 | [7] Billin g Provider : CHEYE NNE VAMC | |
6397 | Taxono my Code : 282N0 0000X | |
6398 | [8] Alt Pr im Payer I D : UNSPE CIFIED [NO T REQUIRED ] | |
6399 | [9] Force To Print? : NO FO RCED PRINT | |
6400 | [10] Provi der ID Mai nt : (Edi t Provider ID inform ation) | |
6401 | ||
6402 | <RET> to C ONTINUE, 1 -10 to EDI T, '^N' fo r screen N , or '^' t o QUIT: 6 | |
6403 | CMS-1500 B ox 19: ?? | |
6404 | This is an 71 character free-text field that will prin t in Box 1 9 | |
6405 | of t he CMS-150 0. Use th is field t o enter ad ditional P ayer requi red | |
6406 | IDs in the for mat of Qua lifier<no space>ID n umber<3 sp aces> | |
6407 | Qual ifier<no s pace>ID nu mber. | |
6408 | CMS-1500 B ox 19: ?? | |
6409 | DISPLAY TH E FULL CMS -1500 BOX 19?: NO// | |
6410 | ||
6411 | ||
6412 | Note: Patc h IB*2*488 changed t he prompt Form Locat or 19 to C MS-1500 Bo x 19 and u pdated the Help text . | |
6413 | ||
6414 | Note: Ther e is a new field in Section 4 for the Ma mmography Certificat ion Number where use rs can ent er a certi fication n umber on c laims for mammograph y exams. The known Mammograph y Certific ation Numb ers will b e stored i n the Inst itution fi le, one pe r site. | |
6415 | ||
6416 | Patch IB*2 *547 added a field t o Screen 1 0 for alte rnative pa yer primar y IDs whic h are used to direct claims to administr ative cont ractors wh o process specialize d claims s uch as Dur able Medic al Equipme nt (DME) c laims. | |
6417 | Pharmacy C laims | |
6418 | 1500 pharm acy claims can be su bmitted el ectronical ly to the clearingho use where they will be printed and maile d. If a p harmacy cl aim is ent ered on a UB04, it m ust be pri nted local ly. | |
6419 | ||
6420 | The follow ing screen s give a s implified example of a pharmac y claim. | |
6421 | ||
6422 | Step | |
6423 | Procedure | |
6424 | 1 | |
6425 | When proce ssing a Ph armacy cla im, inform ation on S creens 1 a nd 2 shoul d be revie wed for co rrectness. Press th e <Enter> key to mov e from one screen to the next. | |
6426 | 2 | |
6427 | On Screen 3, the pay er informa tion shoul d be revie wed for co rrectness. The pati ent may ha ve more th an one ins urance pol icy. If t he correct informati on is not displayed, select a section (1 , 2, or 3 ) and edit the neces sary field s. Press t he <Enter> key to co ntinue to Screen 5. | |
6428 | ||
6429 | For Pharma cy claims, change th e form typ e to a CMS -1500. | |
6430 | ||
6431 | Note: With Patch IB* 2*516, use rs will ha ve the abi lity to ad d a one-ti me HPID, p er payer, to a claim if the HP ID in the Insurance Company fi le is not the correc t one. The HPID will not be st ored in th e Insuranc e Company file. It will only apply to t he claim. | |
6432 | ||
6433 | IB,PATIENT 5 XX-XX -XXXX BI LL#: K303X XX - Outpa t/1500 SC REEN <3> | |
6434 | ========== ========== ========== ========== ========== ========== ========== ========= | |
6435 | PAYER IN FORMATION | |
6436 | [1] Rate T ype : REI MBURSABLE INS. Form Type: CMS- 1500 | |
6437 | Respon sible: INS URER Payer Sequence: Primary | |
6438 | Bill P ayer : CIG NA Trans mit: Yes | |
6439 | ||
6440 | Ins 1: CIG NA Policy #: PII | |
6441 | Grp #: GRP NUM PII Whose: VET ERAN Rel to Ins d: PATIENT | |
6442 | Grp Nm: PII Insd Sex: MALE Insured: I B,PATIENT5 | |
6443 | ||
6444 | Ins 2: BLU E CROSS CA (W Policy #: PII | |
6445 | Grp #: GRP NUM PII Whose: SPO USE Rel to Ins d: SPOUSE | |
6446 | Grp Nm: PII Insd Sex: FEMALE Insured: I B,WIFE5 | |
6447 | [2] Billin g Provider Secondary IDs: UNSP ECIFIED [N OT REQUIRE D] | |
6448 | ||
6449 | [3] Mailin g Address : | |
6450 | NO MAI LING ADDRE SS HAS BEE N SPECIFIE D! (Pati ent has Me dicare) | |
6451 | Send B ill to PAY ER listed above. | |
6452 | ||
6453 | <RET> to C ONTINUE, 1 -3 to EDIT , '^N' for screen N, or '^' to QUIT: | |
6454 | ||
6455 | Step | |
6456 | Procedure | |
6457 | 3 | |
6458 | The highli ghted fiel ds are aut o-populate d. Rememb er that th is is a pr ofessional bill that is being transmitti ng as a CM S-1500, so each HCPC S code wil l have to be associa ted with a diagnosis code. To begin thi s process, type 4 to edit the Cod. Metho d field an d press th e <Enter> key. | |
6459 | ||
6460 | Note: Wit h Patch IB *2*432, wh en adding a refill t o a claim, users wil l be able to view th e date a p rescriptio n was orde r along wi th the oth er data. | |
6461 | ||
6462 | ADD/EDIT R X FILL 205 4788 FOR O ct 26, 201 0 CORRECT? YES// | |
6463 | Date RX Or dered: Oc t 26, 2010 | |
6464 | RX #: 2054 788// | |
6465 | DATE: OCT 26,2010// | |
6466 | DRUG: HYDR OCHLOROTHI AZIDE 25MG TAB// | |
6467 | DAYS SUPPL Y: 30// | |
6468 | QTY: 15// | |
6469 | NDC #: 001 72-2083-80 // | |
6470 | FORMAT OF NDC#: 5-4- 2 FORMAT// | |
6471 | ||
6472 | IB,PATIENT 5 XX-XX -XXXX BI LL#: K303X XX - Outpa t/1500 SCREE N <5> | |
6473 | ========== ========== ========== ========== ========== ========== ========== ========= | |
6474 | EVENT - OUTPATI ENT INFORM ATION | |
6475 | <1> Event Date : XXX XX,XXXX | |
6476 | [2] Prin. Diag.: ISS UE REPEAT PRESCRIPT - V68.1 | |
6477 | [3] OP Vis its : UNS PECIFIED | |
6478 | [4] Cod. M ethod: HCP CS | |
6479 | CPT Co de : Ora l prescrip drug non chemo J849 9 V6 8.1 XXX XX,XXXX | |
6480 | [5] Rx. Re fills: HYD ROCHLOROTH IAZIDE 25M G TAB XXX XX,XX XX | |
6481 | [6] Pros. Items: UNS PECIFIED [ NOT REQUIR ED] | |
6482 | [7] Occ. C ode : UNS PECIFIED [ NOT REQUIR ED] | |
6483 | [8] Cond. Code : UNS PECIFIED [ NOT REQUIR ED] | |
6484 | <9> Value Code : UNS PECIFIED [ NOT REQUIR ED] | |
6485 | ||
6486 | <RET> to C ONTINUE, 1 -9 to EDIT , '^N' for screen N, or '^' to QUIT: | |
6487 | ||
6488 | Step | |
6489 | Procedure | |
6490 | 4 | |
6491 | At the Sel ect Proced ure Date f ield, re-t ype the da te. | |
6492 | 5 | |
6493 | At the Sel ect Proced ure field, type the appropriat e code. O nce the co de auto-po pulates th e data, ty pe YES to confirm. | |
6494 | 6 | |
6495 | At the Pro vider fiel d, type th e name of the physic ian. Info rmation re lated to t hat provid er will au to-populat e. | |
6496 | 7 | |
6497 | Type the a ppropriate data rela ted to the Place of Service an d the Type of Servic e. | |
6498 | 8 | |
6499 | Press the <Enter> ke y until Sc reen 5 app ears. | |
6500 | ||
6501 | <<CURRENT PROCEDURAL TERMINOLO GY CODES>> | |
6502 | ||
6503 | LISTING FR OM VISIT D ATES WITH ASSOCIATED CPT CODES | |
6504 | IN OUTPT E NCOUNTERS FILE | |
6505 | ||
6506 | ========== ========== ========== ========== ========== ========== ========== ========= | |
6507 | NO. CODE SHORT N AME C LINIC DATE | |
6508 | ========== ========== ========== ========== ========== ========== ========== ========= | |
6509 | ||
6510 | NO CPT COD ES ON FILE FOR THE V ISIT DATES ON THIS B ILL | |
6511 | ||
6512 | ||
6513 | PROCEDURE CODING MET HOD: HCPCS (1500 COM MON PROCED URE CODING SYSTEM) | |
6514 | / / | |
6515 | Select PRO CEDURE DAT E (X/XX/XX -XX/XX/XX) : XX-XX-XX | |
6516 | * Patient has no Vis its for th is date... | |
6517 | ||
6518 | Select PROCEDURE: J | |
6519 | Searching for a CPT ,(pointed- to by PROC EDURES) | |
6520 | J8499 Oral pre scrip drug non chemo | |
6521 | .. .OK? Yes// Yes Oral prescrip drug non c hem Rx: 0 000000D | |
6522 | PROCEDURES : J8499// | |
6523 | Select CPT MODIFIER SEQUENCE: | |
6524 | PROVIDER: IB,DOCTOR6 // | |
6525 | ASSOCIATED CLINIC: C ARDIAC CON SULT | |
6526 | DIVISION: MONTGOMERY VAMC// 619 | |
6527 | PLACE OF S ERVICE: 22 OUT PATIENT HO SPITAL | |
6528 | TYPE OF SE RVICE: 1 MEDIC AL CARE | |
6529 | EMERGENCY PROCEDURE? : NO// N O | |
6530 | PRINT ORDE R: | |
6531 | ||
6532 | Step | |
6533 | Procedure | |
6534 | 9 | |
6535 | Notice the associati on has bee n made bet ween the d iagnosis c ode and th e required procedure code. Pr ess the <E nter> key to move to Screen 7. | |
6536 | ||
6537 | ||
6538 | IB,PATIENT 5 XX-XX -XXXX BI LL#: K303X X - Outpat /1500 SCREE N <5> | |
6539 | ========== ========== ========== ========== ========== ========== ========== ========= | |
6540 | EVENT - OUTPATI ENT INFORM ATION | |
6541 | <1> Event Date : XXX XX,XXXX | |
6542 | [2] Prin. Diag.: ISS UE REPEAT PRESCRIPT - V68.1 | |
6543 | [3] OP Vis its : XXX XX,XXXX | |
6544 | [4] Cod. M ethod: HCP CS | |
6545 | CPT Co de : Ora l prescrip drug non chemo J8 499 V68.1 XXX XX,X XXX | |
6546 | [5] Rx. Re fills: RAN ITIDINE HC L 150MG (Z ANTAC) TAB XXX XX,X XXX | |
6547 | [6] Pros. Items: UNS PECIFIED [ NOT REQUIR ED] | |
6548 | [7] Occ. C ode : UNS PECIFIED [ NOT REQUIR ED] | |
6549 | [8] Cond. Code : UNS PECIFIED [ NOT REQUIR ED] | |
6550 | <9> Value Code : UNS PECIFIED [ NOT REQUIR ED] | |
6551 | ||
6552 | <RET> to C ONTINUE, 1 -9 to EDIT , '^N' for screen N, or '^' to QUIT: | |
6553 | ||
6554 | Step | |
6555 | Procedure | |
6556 | 10 | |
6557 | If all the data have been ente red correc tly, secti on 5 shoul d display the correc t revenue code and c harges.. Press the <Enter> ke y to move to Screen 8. | |
6558 | ||
6559 | IB,PATIENT 5 XX-XX -XXXX BI LL#: K303X X - Outpat /1500 SCR EEN <7> | |
6560 | ========== ========== ========== ========== ========== ========== ========== ========= | |
6561 | BILL ING - GENE RAL INFORM ATION | |
6562 | [1] Bill T ype : 13 1 Loc. o f Care: HO SPITAL - I NPT OR OPT (INCLU | |
6563 | Covere d Days: UN SPECIFIED Bill C lassif: OU TPATIENT | |
6564 | Non-Co v Days: UN SPECIFIED Tim eframe: AD MIT THRU D ISCHARGE | |
6565 | Charge Type : UN SPECIFIED Disc h Stat: | |
6566 | Form T ype : CM S-1500 Di vision: MO NTGOMERY V AMC | |
6567 | [2] Sensit ive? : UN SPECIFIED Assi gnment: YE S | |
6568 | [3] Bill F rom : XX X XX,XXXX Bi ll To: XXX XX,XXXX | |
6569 | [4] OP Vis its : UN SPECIFIED | |
6570 | [5] Rev. C ode : 25 3-WARFARIN SODIUM 5 J8499 1 $36.0 0 PRESCRI PTION | |
6571 | OFFSET: $0 .00 [NO OFFSET REC ORDED] | |
6572 | BILL T OTAL : $36.00 | |
6573 | [6] Rate S ched : (r e-calculat e charges) | |
6574 | [7] Prior Claims: UN SPECIFIED | |
6575 | ||
6576 | Step | |
6577 | Procedure | |
6578 | 11 | |
6579 | On Screens 8 and 9, enter any necessary claim-leve l data to the claim and press the <Enter > key to m ove to Scr een 10. | |
6580 | ||
6581 | Note: IB*2 *447 moved Screen 8, Section 3 Ambulance Informati on to a ne w Screen 9 . | |
6582 | ||
6583 | IB,PATIENT MRA XX- XX-XXXX BILL#: K20 003D - Out pat/1500 SCREEN <8 > | |
6584 | ========== ========== ========== ========== ========== ========== ========== ========== | |
6585 | BIL LING - CLA IM INFORMA TION | |
6586 | <1> COB No n-Covered Charge Amt : | |
6587 | <2> Proper ty Casualt y Informat ion | |
6588 | Claim Number: Contact N ame: | |
6589 | Date o f 1st Cont act: Contact P hone: | |
6590 | <3> Surgic al Codes f or Anesthe sia Claims | |
6591 | Primar y Code: Secondary Code: | |
6592 | <4> Paperw ork Attach ment Infor mation | |
6593 | Report Type: Transmiss ion Method : | |
6594 | Attach ment Contr ol #: | |
6595 | <5> Disabi lity Start Date: Disabilit y End Date : | |
6596 | <6> Assume d Care Dat e: Relinquis hed Care D ate: | |
6597 | [7] Specia l Program: | |
6598 | [8] Homebo und: | |
6599 | [9] Date L ast Seen: | |
6600 | ||
6601 | <RET> to C ONTINUE '^ N' for scr een N, or '^' to QUI T: | |
6602 | ||
6603 | IB,PATIENT M M XXX- XX-XXXX BILL#: K10 1ES8 - Out pat/UB04 SCREEN <9> | |
6604 | ========== ========== ========== ========== ========== ========== ========== ========== | |
6605 | AMBULANCE INFORMATIO N | |
6606 | <1> Ambula nce Transp ort Data | |
6607 | D/O Locat ion: | |
6608 | P/U Ad dress1: D/O Addre ss1: | |
6609 | P/U Ad dress2: D/O Addre ss2: | |
6610 | P/U Ci ty: D/O City: | |
6611 | P/U St ate/Zip: D/O State /Zip: | |
6612 | Patien t Weight: Transport Distance: | |
6613 | Transp ort Reason : | |
6614 | R/T Pu rpose: | |
6615 | Stretc her Purpos e: | |
6616 | <2> Ambula nce Certif ication Da ta | |
6617 | Condit ion Indica tor: | |
6618 | ||
6619 | ||
6620 | <RET> to C ONTINUE, 1 -2 to EDIT , '^N' for screen N, or '^' to QUIT: | |
6621 | ||
6622 | Step | |
6623 | Procedure | |
6624 | 12 | |
6625 | From Scree n 10, ente r 3 to add a Renderi ng provide r. | |
6626 | ||
6627 | Patch IB*2 *547 added a field t o Screen 1 0 for alte rnative pa yer primar y IDs whic h are used to direct claims to administr ative cont ractors wh o process specialize d claims s uch as Dur able Medic al Equipme nt (DME) c laims. | |
6628 | ||
6629 | IB,PATIENT 5 XX-XX- XXXX BIL L#: K303XX X - Outpat /1500 SCR EEN <10> | |
6630 | ========== ========== ========== ========== ========== ========== ========== ========== | |
6631 | B ILLING - S PECIFIC IN FORMATION | |
6632 | [1] Unable To Work F rom: UNSPE CIFIED [NO T REQUIRED ] | |
6633 | Unable To Work T o : UNSPE CIFIED [NO T REQUIRED ] | |
6634 | [2] ICN/DC N(s) : UNSPE CIFIED [NO T REQUIRED ] | |
6635 | Auth/R eferral : UNSPE CIFIED [NO T REQUIRED ] | |
6636 | [3] Provid ers : | |
6637 | - REN DERING : UNSPE CIFIED | |
6638 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | |
6639 | Lab CL IA # : UNSPE CIFIED [NO T REQUIRED ] | |
6640 | Mammog raphy Cert # : UNSPE CIFIED [NO T REQUIRED ] | |
6641 | [5] Chirop ractic Dat a : UNSPE CIFIED [NO T REQUIRED ] | |
6642 | [6] CMS-15 00 Box 19 : UNSPE CIFIED [NO T REQUIRED ] | |
6643 | [7] Billin g Provider : CHEYE NNE VAMC | |
6644 | Taxono my Code : 282N0 0000X | |
6645 | [8] Alt Pr im Payer I D : UNSPE CIFED [NOT REQUIRED] | |
6646 | [9] Force To Print? : NO FO RCED PRINT | |
6647 | [10] Provi der ID Mai nt : (Edi t Provider ID inform ation) | |
6648 | ||
6649 | <RET> to C ONTINUE, 1 -10 to EDI T, '^N' fo r screen N , or '^' t o QUIT: | |
6650 | This claim is now re ady for au thorizatio n. | |
6651 | Correct Re jected or Denied Cla ims | |
6652 | A claim ca n be rejec ted at som e stage du ring eithe r the elec tronic or manual pro cess. A c laim can b e denied b y the paye r during t he adjudic ation proc ess. When a claim i s either r ejected or denied, i t may be f or a reaso n that can be correc ted. Once the claim is correc ted, it ca n be retra nsmitted o r resent t hrough the mail to t he payer. | |
6653 | ||
6654 | With Patch IB*2*433, a new opt ion has be en added t o the IB M odule that allows us ers to cor rect a cla im while m aintaining the origi nal claim number on the resubm itted clai m. | |
6655 | With Patch IB*2*447, users are able to c orrect all types of claims inc luding a c laim that processes to a non-a ccruing fu nds. It i s now poss ible to co rrect a cl aim with o ne of the following rate types : | |
6656 | INTERAGENC Y | |
6657 | SHARING AG REEMENT | |
6658 | TRICARE | |
6659 | WORKMAN’S COMP | |
6660 | ||
6661 | Step | |
6662 | Procedure | |
6663 | 1 | |
6664 | Access the option Th ird Party Billing Me nu. | |
6665 | 2 | |
6666 | At the Sel ect Third Party Bill ing Menu O ption: pro mpt, enter CRD for C orrect Rej ected/Deni ed Bill. | |
6667 | 3 | |
6668 | At the Ent er BILL NU MBER or Pa tient NAME : prompt, enter the claim numb er of the claim that requires correction . | |
6669 | 4 | |
6670 | At the ARE YOU SURE YOU WANT T O CANCEL T HIS BILL? No// promp t, enter Y es to over ride the d efault. | |
6671 | 5 | |
6672 | At the CAN CEL BILL?: prompt, e nter YES. | |
6673 | 6 | |
6674 | At the REA SON CANCEL LED: promp t, enter a free-text comment. | |
6675 | ||
6676 | Note: Thi s new opti on was des igned to r eplace the existing option CLO N Copy and Cancel un der the ma jority of circumstan ces. The existing C LON Copy a nd Cancel option wil l now be l ocked with a new Sec urity Key named IB C LON. | |
6677 | ||
6678 | Note: The existing CLON Copy and Cancel option sh ould only be used to correct d enied clai ms against which a p ayment has been post ed or to c orrect a c laim with one of the Bill Rate Types tha t are excl uded from the new pr ocesses.. | |
6679 | ||
6680 | Note: The existing CLON Copy and Cancel option sh ould be us ed to corr ect denied claims ag ainst whic h a paymen t has been posted, a secondary /tertiary claim or a claim in MRA Reques t status. | |
6681 | ||
6682 | Note: The IB CLON se curity key which res tricted th e use of t he CLON op tion , was removed w ith Patch IB*2*516. | |
6683 | ||
6684 | The follow ing screen will disp lay. | |
6685 | ||
6686 | IB,PATIENT 4 (XX-X X-XXXX) DOB: X XX XX,XXXX | |
6687 | ========== ========== ========== ========== ========== ========== ========== ========== | |
6688 | Rate Type : REI MBURSABLE INS. | |
6689 | Event Date : XXX XX XXXX | |
6690 | Sensitive : NO | |
6691 | Responsibl e : INS URANCE CAR RIER (Sp ecify CARR IER on SCR EEN 3) | |
6692 | ||
6693 | Loc of Car e : HOS PITAL (INC LUDES CLIN IC) - INPT . OR OPT. | |
6694 | Event Sour ce : Out patient | |
6695 | Timeframe : ADM IT THRU DI SCHARGE | |
6696 | (Sp ecify actu al bill ty pe fields on SCREENs 6/7) | |
6697 | ||
6698 | Bill From : XXX XX,XXXX | |
6699 | Bill To : XXX XX,XXXX | |
6700 | ||
6701 | Initial Bi ll# : K70 1XXX-01 | |
6702 | Copied Bil l# : K70 1XXX-01 | |
6703 | ||
6704 | Please ver ify the ab ove inform ation for the bill y ou just en tered. On ce this | |
6705 | informatio n is accep ted it wil l no longe r be edita ble and yo u will be required | |
6706 | to CANCEL THE BILL i f changes to this in formation are necess ary. | |
6707 | ||
6708 | IS THE ABO VE INFORMA TION CORRE CT AS SHOW N? Yes// | |
6709 | ||
6710 | Step | |
6711 | Procedure | |
6712 | 7 | |
6713 | Return thr ough the c laim scree ns correct ing whatev er data re quires cor rection. | |
6714 | 8 | |
6715 | Complete a nd authori ze the cla im. | |
6716 | ||
6717 | Note: The number of the origin al claim h as been in cremented and now di splays wit h a -01 af ter the cl aim number . The ori ginal clai m number h as been as signed to the new cl aim. Each time a cl aim is cor rected, th e previous cancelled version w ill be inc remented - 01, -02, - 03, etc.. | |
6718 | ||
6719 | When users attempt t o use the CRD Correc t Rejected /Denied Bi ll option to correct a claim a gainst whi ch a payme nt has bee n posted, they will be warned that they must use t he existin g CLON Cop y and Canc el option. | |
6720 | ||
6721 | Select T hird Party Billing M enu Option : CRD Cor rect Rejec ted/Denied Bill | |
6722 | ||
6723 | Enter BILL NUMBER or Patient N AME: K6 00XXX IB,PATIENT 1 XX-X X-XX | |
6724 | Outpat ient R EIMBURSABL E INS. PRNT/TX | |
6725 | ||
6726 | Please not e a PAYMEN T of **$45 ** has bee n POSTED t o this bil l. Copy an d cancel | |
6727 | (CLON) mus t be used to correct this bill . | |
6728 | ||
6729 | When users attempt t o use the CRD Correc t Rejected /Denied Bi ll option to correct a denied claim whic h has rece ived only one of its associate d split Ex planation of Benefit s (EOB), t hey will b e warned t hat they m ust wait f or the arr ival of th e second E OB before they can u se this ne w option. | |
6730 | ||
6731 | Select Thi rd Party B illing Men u Option: CRD Corre ct Rejecte d/Denied B ill | |
6732 | ||
6733 | Enter BILL NUMBER or Patient N AME: K6 00XXX IB,PATIENT 1 XX-X X-XX | |
6734 | Outpat ient R EIMBURSABL E INS. PRNT/TX | |
6735 | ||
6736 | There is a split EOB associate d with thi s claim. You cannot use this option to Correct th is claim u ntil the s econd EOB has been r eceived. | |
6737 | ||
6738 | When users attempt t o use the CRD Correc t Rejected /Denied Bi ll option to correct a rejecte d or denie d claim wh ich has an excluded Billing Ra te Type, t hey will b e warned t hat they m ust use th e existing CLON Copy and Cance l option. | |
6739 | ||
6740 | Select Thi rd Party B illing Men u Option: CRD Corre ct Rejecte d/Denied B ill | |
6741 | ||
6742 | Enter BILL NUMBER or Patient N AME: K6 00XXX IB,PATIENT 1 XX-X X-XX | |
6743 | Outpat ient R EIMBURSABL E INS. PRNT/TX | |
6744 | ||
6745 | This optio n cannot b e used to correct so me Billing Rate Type s (Example : TRICARE) . | |
6746 | Use Copy a nd Cancel (CLON) to correct th is bill. | |
6747 | ||
6748 | When users attempt t o use the CRD Correc t Rejected /Denied Bi ll option to correct a rejecte d or denie d secondar y or terti ary claim, they will be notifi ed that th ey must us e the exis ting CLON Copy and C ancel opti on. | |
6749 | ||
6750 | Please not e that COB data exis ts for thi s bill. | |
6751 | Copy and c ancel (CLO N) must be used to c orrect thi s bill. | |
6752 | ||
6753 | When users attempt t o use the CRD Correc t Rejected /Denied Bi ll option to correct a claim w ith a stat us of MRA Request, t hey will r eceive the following message. | |
6754 | ||
6755 | This bill is in a st atus of RE QUEST MRA. | |
6756 | No MRA s have bee n received and there are no re jection me ssages on file | |
6757 | for th e most rec ent transm ission of this MRA r equest bil l. | |
6758 | ||
6759 | ||
6760 | Note: The new CRD Co rrect Reje cted/Denie d Bill opt ion has be en added t o the CSA Claims Sta tus Awaiti ng Resolut ion option and the M RW MRA Wor klist opti on as Corr ect Bill. | |
6761 | ||
6762 | The histor y of corre cted claim s will be available from the f ollowing l ocations: | |
6763 | BILL - Ent er/Edit Bi lling Info rmation | |
6764 | INQ – Pati ent Billin g Inquiry | |
6765 | Viewed Can celled Cla ims | |
6766 | If a claim has been cancelled, users can view the data store d in the B ill/Claims file (#39 9) for the cancelled claim. | |
6767 | ||
6768 | The View C ancelled B ill option is on the Third Par ty Billing Menu. | |
6769 | ||
6770 | ADPR Print Bill Addendum Sheet | |
6771 | AUTH Authorize Bill Gener ation | |
6772 | BILL Enter/Edit Billing I nformation | |
6773 | CANC Cancel Bil l | |
6774 | CLA Multiple C LAIMSMANAG ER Claim S end | |
6775 | CLON Copy and C ancel | |
6776 | CRD Correct Re jected/Den ied Bill | |
6777 | DLST Delete Aut o Biller R esults | |
6778 | GEN Print Bill | |
6779 | INQU Patient Bi lling Inqu iry | |
6780 | LIST Print Auto Biller Re sults | |
6781 | PRNT Print Auth orized Bil ls | |
6782 | RETN Return Bil l Menu ... | |
6783 | VCB View Cance lled Bill | |
6784 | VIEW View Bills Pending T ransmissio n | |
6785 | VIST Outpatient Visit Dat e Inquiry | |
6786 | ||
6787 | Select Thi rd Party B illing Men u <TEST AC COUNT> Opt ion: | |
6788 | Printed Cl aims | |
6789 | Some claim s should n ot be tran smitted el ectronical ly and sho uld be pri nted local ly. | |
6790 | ||
6791 | These incl ude: | |
6792 | Claims req uiring cli nical atta chments su ch as prog ress notes ; | |
6793 | Profession al claims containing more than the maxim um number of 8 diagn osis codes ; | |
6794 | Profession al claims containing more than the maxim um number of diagnos is pointer s (4); | |
6795 | Institutio nal claims containin g more tha n the maxi mum number of proced ure codes (999); | |
6796 | Profession al claims containing more than the maxim um number of procedu re codes/l ine items (50); | |
6797 | Institutio nal pharma cy claims; and | |
6798 | Secondary claims to Medicare W NR (When M edicare WN R is NOT t he primary insurance ). | |
6799 | View/Resub mit Claims – Live or Test – Sy nonym: RCB | |
6800 | A new opti on, View/R esubmit Cl aims – Liv e or Test, has been added to t he EDI men u. This op tion repla ces: Resub mit a Bill ; Resubmit a Batch o f Bills an d View/Res ubmit Clai ms as Test . This opt ion provid es the abi lity to re submit cla ims as tes t claims f or testing or produc tion claim s for paym ent. | |
6801 | ||
6802 | Patch IB*2 *547 will add the ab ility to r un the RCB option to find prev iously pri nted claim s and to r esubmit th em to the test queue only. The y cannot b e retransm itted to t he product ion queue. The patch will also provide t he ability to look-u p claims t o specific payers us ing the ED I - Inst P ayer Prima ry ID or E DI - Prof Payer Prim ary ID. | |
6803 | ||
6804 | Patch IB*2 *608 will only inclu de the Coo rdination of Benefit (COB) dat a for the previous p ayer seque nce to be resubmitte d in the c urrent pay er sequenc e claim to the test queue. The patch wil l also fil ter out th e claim(s) with asso ciated COB data when those cla ims have b een select ed to be r etransmitt ed to the production queue. Th ese non-tr ansmitted claims wil l be liste d on the s creen as s kipped. | |
6805 | ||
6806 | Step | |
6807 | Procedure | |
6808 | 1 | |
6809 | At the Sel ect EDI Me nu For Ele ctronic Bi lls Option , type RCB and press the Retur n key. | |
6810 | 2 | |
6811 | At the Run report fo r (P)rinte d or (T)ra nsmitted c laims?: Tr ansmitted/ / prompt, press the Enter key to accept the defaul t | |
6812 | 3 | |
6813 | At the SEL ECT BY: (C )LAIM, (B) ATCH OR SE E A (L)IST TO PICK F ROM: promp t, press t he Enter k ey to acce pt the def ault of Li st. | |
6814 | 4 | |
6815 | At the Run for (A)ll payers or (S)electe d Payers? prompt, ty pe S for S elected Pa yers. | |
6816 | ||
6817 | If you cho ose Select ed payers, after you enter Blu e Cross of CA, for e xample, yo u will be prompted t o included all insur ance compa nies with the same E lectronic Billing ID . This wil l prevent you from h aving to e nter every BC/BS com pany defin ed in your Insurance file. | |
6818 | 5 | |
6819 | At the Sel ect Insura nce Compan y: prompt, enter an EDI Payer Primary ID | |
6820 | 6 | |
6821 | At the Sel ect Insura nce Compan y prompt, press the Enter key when done selecting payers | |
6822 | 7 | |
6823 | At the Run for (U)B- 04, (C)MS- 1500 or (B )OTH: prom pt, press the Enter key to acc ept the de fault of B oth. | |
6824 | ||
6825 | The Date R ange for t he search for claims has been restricted to a maxi mum of 90 days to mi nimize the impact of the searc h on the s ystem. | |
6826 | 8 | |
6827 | At the Sta rt with Da te Last Tr ansmitted: prompt, t ype T-200 for this e xample. | |
6828 | 9 | |
6829 | At the Go to Date La st Transmi tted: prom pt, press the Enter key to acc ept the de fault of 1 2/1/04. Th is will re turn resul ts for 90 days. | |
6830 | 10 | |
6831 | At the Sel ect Additi onal Limit ing Criter ia (option al): promp t, press t he Enter k ey without selecting anything additional . | |
6832 | ||
6833 | Select EDI Menu For Electronic Bills Opt ion: RCB View/Resub mit Claims -Live or T est | |
6834 | ||
6835 | *** NOTE: 2 '^' ARE NEEDED TO ABORT THE OPTION (^^ ) | |
6836 | 1 '^' BRIN GS YOU BAC K TO THE P REVIOUS SE LECTION PR OMPT(^) | |
6837 | ||
6838 | ||
6839 | Run report for (P)ri nted or (T )ransmitte d claims?: Transmitt ed//Transm itted | |
6840 | ||
6841 | Select By: (C)laim o r see a (L )ist to pi ck from?: List// | |
6842 | ||
6843 | PAYER SELE CTION: | |
6844 | Run for (A )ll Payers or (S)ele cted Payer s?: Select ed Payers/ /Selected Payers | |
6845 | ||
6846 | Include all payer s with the same elec tronic Pay er ID? Yes // YES | |
6847 | ||
6848 | Select Insurance Company: 6 0054 | |
6849 | 1 6 0054 AETN A HEALTH P LANS4501 N STERLING PEORIA,IL 6 0054/60054 | |
6850 | 2 6 0054 AETN A HEALTH P LANS620 ER IE BLVD WE ST SYRACU SE,NY 6 0054/60054 | |
6851 | 3 6 0054 AETN A HEALTH P LANSPO BOX 16516 C OLUMBUS,OH 6 0054/60054 | |
6852 | 4 6 0054 AETN A HEALTH P LANS3541 W INCHESTER ROAD ALLE NTOWN,PA 60054/6005 | |
6853 | 4 | |
6854 | 5 6 0054 AETN A HEALTH P LANSPO BOX 112 P ORTLAND,OR 6 0054/60054 | |
6855 | Press <RET URN> to se e more, '^ ' to exit this list, OR | |
6856 | CHOOSE 1-5 : 1 AETNA HEALTH PL ANS4501 N STERLING PEORIA,IL 6 0054/60054 | |
6857 | ||
6858 | Select Another In surance Co mpany: | |
6859 | ||
6860 | BILL FORM TYPE SELEC TION: | |
6861 | Run for (U )B-04, (C) MS-1500, ( J)430D or (A)ll: All //ALL | |
6862 | ||
6863 | LAST BATCH TRANSMIT DATE RANGE SELECTION : | |
6864 | Start with Date Last Transmitt ed: T-200 (XXX XX, XXXX) | |
6865 | Go to Date Last Tran smitted:(T -200 – T-1 10): T-110 // (XXX XX, XXXX) | |
6866 | ||
6867 | ADDITIONAL SELECTION CRITERIA: | |
6868 | ||
6869 | 1 - MRA Se condary On ly | |
6870 | 2 - Primar y Claims O nly | |
6871 | 3 - Second ary Claims Only | |
6872 | 4 - Claims Sent to P rint at Cl earinghous e Only | |
6873 | ||
6874 | Step | |
6875 | Procedure | |
6876 | 11 | |
6877 | At the Wou ld you lik e to inclu de cancell ed claims? No//: pro mpt, enter No. | |
6878 | 12 | |
6879 | At the Wou ld you lik e to inclu de claims Forced to Print at t he Clearin ghouse? No // prompt, enter No. | |
6880 | 13 | |
6881 | At the Sor t By promp t, enter B to overri de the def ault of Cu rrent Paye r. | |
6882 | ||
6883 | Sort by Ba tch if you want to r esubmit ba tches of c laims or C urrent Pay er if you want to re submit a v ariety of individual claims. | |
6884 | 14 | |
6885 | At the DO YOU WANT A (R)EPORT OR A (S)CR EEN LIST F ORMAT?: pr ompt, pres s the <Ent er> key to accept th e default of Screen List. | |
6886 | ||
6887 | ||
6888 | Would you like to in clude canc elled clai ms? No// NO | |
6889 | ||
6890 | Would you like to in clude clai ms Forced to Print a t the Clea ringhouse? No// NO | |
6891 | ||
6892 | Sort By: C urrent Pay er// ?? | |
6893 | ||
6894 | Enter a co de from th e list. | |
6895 | ||
6896 | Selec t one of t he followi ng: | |
6897 | ||
6898 | 1 Batch By L ast Transm itted Date (Claims w ithin a Ba tch) | |
6899 | 2 Current Pa yer (Insur ance Compa ny) | |
6900 | ||
6901 | Sort By: C urrent Pay er// Batch By Last T ransmitted Date (Cla ims within a Batch)D o you want a (R)epor t or a (S) creen List format?: Screen Lis t// | |
6902 | ||
6903 | The follow ing screen is displa yed: | |
6904 | ||
6905 | PREVIOUSLY TRANSMITT ED CLAIMS Mar 21, 20 05@15:52:1 0 Page: 1 of 1215 | |
6906 | ** A claim may appea r multiple times if transmitte d more tha n once. ** | |
6907 | ** T = Tes t Claim ** R = Batch Rejected | |
6908 | >>># of Cl aims Selec ted: 0 (ma rked with *) | |
6909 | ||
6910 | ||
6911 | Claim # Form Type Seq Statu s Current Payer | |
6912 | Batch: 605001118 2 Date La st Transmi tted: Nov 30, 2004 | |
6913 | 1 K500XX X T UB- 04 OUTPT P PRNT /TX AETNA U S HEALTHCA RE | |
6914 | Batch: 605001118 3 Date La st Transmi tted: Nov 30, 2004 | |
6915 | 2 K500XX X UB- 04 OUTPT P PRNT /TX AETNA U S HEALTHCA RE | |
6916 | Batch: 605001118 4 Date La st Transmi tted: Nov 30, 2004 | |
6917 | 3 K500XX X T J43 0D OUTPT P PRNT /TX DELTA D ENTAL | |
6918 | Batch: 605001118 5 Date La st Transmi tted: Nov 30, 2004 | |
6919 | 4 K500XX X T 150 0 OUTPT S PRNT /TX AETNA | |
6920 | Batch: 605001118 6 Date La st Transmi tted: Nov 30, 2004 | |
6921 | 5 K500XX X UB- 04 OUTPT P PRNT /TX AETNA U S HEALTHCA RE | |
6922 | Batch: 605001118 7 Date La st Transmi tted: Nov 30, 2004 | |
6923 | 6 K500XX X 150 0 OUTPT P PRNT /TX AETNA U S HEALTHCA RE | |
6924 | + Enter ?? f or more ac tions >>> | |
6925 | Claim(s) Select/De select View Claim s Selected | |
6926 | Batch Se lect/De se lect P rint Repor t | |
6927 | Resubmit ClaimsExi t | |
6928 | Action: Ne xt Screen/ / | |
6929 | ||
6930 | Step | |
6931 | Procedure | |
6932 | 15 | |
6933 | At the Act ion prompt , type B t o select b atches of claims to resubmit a s test or ‘C’ to sel ect claims . | |
6934 | 16 | |
6935 | At the Sel ect EDI Tr ansmission Batch Num ber: promp t, enter t he number of the des ired batch . | |
6936 | ||
6937 | You may re peat the a bove, ente ring as ma ny batch n umbers as you want. | |
6938 | ||
6939 | PREVIOUSLY TRANSMITT ED CLAIMS Mar 21, 20 05@16:07:3 8 Page: 1 of 1215 | |
6940 | ** A claim may appea r multiple times if transmitte d more tha n once. ** | |
6941 | >>># of Cl aims Selec ted: 1 (ma rked with *) | |
6942 | ||
6943 | ||
6944 | Claim # Form Type S eq Status Current P ayer | |
6945 | Batch: 605001118 2 Date La st Transmi tted: Nov 30, 2004 | |
6946 | 1 *K500YR J UB-0 4 OUTPT P PRNT/ TX UNITED H EALTHCARE | |
6947 | Batch: 605001118 3 Date La st Transmi tted: Nov 30, 2004 | |
6948 | 2 K50092 T UB-0 4 OUTPT P REQUE ST MRA MEDICARE (WNR) | |
6949 | Batch: 605001118 4 Date La st Transmi tted: Nov 30, 2004 | |
6950 | 3 K500YS F 1500 OUTPT P PRNT/ TX UNITED H EALTHCARE | |
6951 | Batch: 605001118 5 Date La st Transmi tted: Nov 30, 2004 | |
6952 | 4 K500YS Z J430 D OUTPT S PRNT/ TX Delta De ntal | |
6953 | Batch: 605001118 6 Date La st Transmi tted: Nov 30, 2004 | |
6954 | 5 K500YU D UB-0 4 OUTPT P PRNT/ TX AETNA US HEALTHCAR E | |
6955 | Batch: 605001118 7 Date La st Transmi tted: Nov 30, 2004 | |
6956 | 6 K500YU E 1500 OUTPT P PRNT/ TX AETNA US HEALTHCAR E | |
6957 | + Enter ?? f or more ac tions >>> | |
6958 | Claim(s) Select/De select View Cla ims Select ed | |
6959 | Batch Se lect/Desel ect Print Re port | |
6960 | Resubmit Claims as TEST Exit | |
6961 | Action: Ne xt Screen/ / b Bat ch Select/ De select | |
6962 | Select EDI TRANSMISS ION BATCH NUMBER: 60 50011183 | |
6963 | ||
6964 | Step | |
6965 | Procedure | |
6966 | 17 | |
6967 | When you h ave entere d all of t he batches you want, at the AC TION promp t, type ‘R ’ for Resu bmit Claim s. | |
6968 | 18 | |
6969 | At the Res ubmit Clai ms: prompt , press th e <Enter> key to res ubmit the claims for payment. | |
6970 | ||
6971 | The system will info rm you of the number of claims that will be resubm itted and whether or not they are being submitted for paymen t or testi ng. | |
6972 | 19 | |
6973 | At the Are You Sure You Want T o Continue ?: prompt, type YES to overrid e the defa ult. | |
6974 | ||
6975 | You are ab out to res ubmit 2 cl aims as Pr oduction c laims. | |
6976 | Are you su re you wan t to conti nue?: NO// y YES | |
6977 | Resubmissi on in proc ess... | |
6978 | ||
6979 | ||
6980 | Processing of Second ary/Tertia ry Claims | |
6981 | With Patch IB*2*432 installed, the proce dures for the proces sing of se condary an d tertiary non-MRA c laims have changed. | |
6982 | ||
6983 | When elect ronic Expl anation of Benefits (EOBs) are received for claims that are NOT Medica re (WNR) c laims and the paymen ts are pro cessed in AR, the EO Bs will be evaluated and if th e data in the EOBs m eets certa in criteri a, the sec ondary or tertiary c laims will either be processed automatic ally or se nt to the new COB Ma nagement W orklist fo r manual p rocessing. | |
6984 | ||
6985 | When a cla im is proc essed in A R and its status bec omes Colle cted/Close d, no Mail Man messag e will be generated. Either th e subseque nt claim w ill be aut omatically processed or the cl aim will a ppear on t he new wor klist. | |
6986 | ||
6987 | Patch IB*2 *447 remov ed the opt ion, Copy for Second ary/Tertia ry Bill [I B COPY SEC OND/THIRD] . This opt ion became obsolete with the i nstall of IB*2.0*432 and the i ntroductio n of the n ew CBW (CO B Manageme nt Work li st). | |
6988 | ||
6989 | A new, non -human use r, IB,AUTH ORIZER REG , will be the clerk responsibl e for the automatic processing of non-MR A secondar y and tert iary claim s. | |
6990 | ||
6991 | In order t o be able to either create a s ubsequent claim, or to send a claim to t he new COB Managemen t Worklist for manua l processi ng, the fo llowing co nditions m ust be met : | |
6992 | All Explan ation of B enefit (EO Bs), 835 H ealth Care Claim Pay ment Advic e, have be en receive d ; and | |
6993 | Payment fr om the pre vious paye r has been posted by AR; and | |
6994 | The bill s tatus for the previo us payer i s Collecte d/Closed. | |
6995 | ||
6996 | Electronic Secondary and Terti ary claim will conta in the Coo rdination of Benefit s data fro m the EOBs in the 83 7 Health C are Claim transmissi on to FSC. | |
6997 | ||
6998 | ||
6999 | Note: Seco ndary and Tertiary c laims will be create d with a n ew claim n umber. | |
7000 | ||
7001 | Remember: Whether o r not a Se condary or Tertiary claim to a n electron ic payer i s transmit ted or pri nted, is d etermined by the new parameter in the In surance Co mpany Edit or. Refer to Sectio n 2.1.1.1. | |
7002 | Criteria f or the Aut omatic Pro cessing of Secondary or Tertia ry Claims | |
7003 | When a non -MRA claim has recei ved all as sociated E OBs and th ey meet th e followin g criteria , the subs equent cla im will be automatic ally creat ed and eit her transm itted elec tronically to the ne xt payer, or printed (along wi th the ass ociated MR As/EOBs) a nd mailed to the nex t payer: | |
7004 | EOB contai ns only Ad justment G roup Codes = Contrac tual Oblig ation (CO) associate d with one of the fo llowing Re ason Codes : A2; B6; 45; 102; 1 04; 118; 1 31; 23; 23 2; 44; 59; 94; 97; o r 10; and | |
7005 | EOB contai ns only Ad justment G roup Codes = Patient Responsib ility (PR) associate d with one of the fo llowing Re ason Codes ; 1; 2; or 66; and | |
7006 | The sum of the deduc tible, coi nsurance a nd co-paym ent amount s is great er than $0 .00; and | |
7007 | The EOB st atus is Pr ocessed (T he Claim S tatus Code is either 1, 2, or 3). | |
7008 | COB Manage ment Workl ist | |
7009 | Any non-MR A claim th at does no t meet the criteria for the au tomatic cr eation of a Secondar y or Terti ary claim will be pl aced on th e COB Mana gement Wor klist. | |
7010 | ||
7011 | Step | |
7012 | Procedure | |
7013 | 1 | |
7014 | Access the EDI Menu For Electr onic Bills menu. | |
7015 | 2 | |
7016 | At the Sel ect EDI Me nu For Ele ctronic Bi lls Option : prompt, enter CBW for COB Ma nagement W orklist. | |
7017 | ||
7018 | Note: Patc h IB*2*516 provided the abilit y for user s to run t he worklis t by one o r more div isions. | |
7019 | 3 | |
7020 | At the Sel ect Divisi on: ALL// prompt; pr ess the <E nter> key to accept the defaul t. | |
7021 | 4 | |
7022 | At the Sel ect BILLER : ALL// pr ompt, pres s the <Ent er> key to accept th e default. | |
7023 | 5 | |
7024 | At the Sor t By: BILL ER// promp t, press t he <Enter> key to ac cept the d efault. | |
7025 | 6 | |
7026 | At the Do you want t o include Denied EOB s for Dupl icate Clai m/Service? No// prom pt, press the <Enter > key to a ccept the default. | |
7027 | ||
7028 | Note: A no n-MRA clai m which re ceives a D ENIED EOB and which is Collect ed/Closed by AR and which has a subseque nt payer, will also be placed on the CBW . This in cludes cla ims that h ave potent ial patien t responsi bility suc h as TRICA RE and CHA MPVA. | |
7029 | ||
7030 | Note: Patc h IB*2*547 provides additional search an d sort cri teria for this workl ist. Users can creat e a list o f just pri mary claim s or just secondary claims or both and t hey can no w sort by primary or secondary insurance company. | |
7031 | ||
7032 | Note: Comp lete CARC/ RARC textu al descrip tions will display f rom Print or View an EOB from within the COB Manag ement Work list. | |
7033 | ||
7034 | The follow ing screen will disp lay. | |
7035 | ||
7036 | COB Manage ment WorkL ist JAN 01, 20 11@13:41:1 6 Page: 1 of 20 | |
7037 | ||
7038 | Bill # Svc Date Pati ent Name SSN Pt Resp Bill Amt Type | |
7039 | BILLER: IB ,CLERK 1 | |
7040 | 1 442-K4 01XXX* 12/ 07/10 IB,P ATIENT 273 45 XXX X 0.0 0 87.5 8 O/P | |
7041 | Insu rers: AET NA US HEAL THCARE | |
7042 | EOB St atus: DEN IED, Feb 2 5, 2004 | |
7043 | 2 442-K4 01XXX* 12/ 07/10 IB,P ATIENT 4 XXXX 86.40 72.00 O/D | |
7044 | Insu rers: DEL TA DENTAL | |
7045 | EOB St atus: DEN IED, Jun 0 9, 2004 | |
7046 | 3 442-K4 01XXX 12/ 08/10 IB,P ATIENT 33 XXXX 0.00 2243.16 I/I | |
7047 | Insu rers: AET NA US HEAL THCARE | |
7048 | EOB St atus: DEN IED, Jul 2 8, 2004 | |
7049 | 4 442-K4 01XXX 12/ 08/10 IB,P ATIENT 102 XXXX 0.00 45.61 O/P | |
7050 | Insu rers: AET NA US HEAL THCARE | |
7051 | EOB St atus: DEN IED, Jun 0 9, 2004 | |
7052 | 5 442-K4 02XXX 12/ 14/10 IB,P ATIENT 10 XXXX 0.00 30.74 O/P | |
7053 | Insu rers: AET NA US HEAL THCARE | |
7054 | + Enter ?? f or more ac tions | |
7055 | PC Proces s COB CB Cancel Bil l RM Remo ve from Wo rklist | |
7056 | VE View a n EOB CR Correct Bi ll PE Prin t EOB/MRA | |
7057 | EC Enter/ View Comme nts CC Cancel/Clo ne A Bill TP Thir d Party Jo int Inq. | |
7058 | RS Review Status VB View Bill EX Exit | |
7059 | Select Act ion: Next Screen// | |
7060 | ||
7061 | Data Displ ayed for C laims on t he COB Man agement Wo rklist | |
7062 | The follow ing data i s displaye d on the C OB Managem ent Workli st: | |
7063 | List numbe r | |
7064 | Claim numb er | |
7065 | Asterisk – when clai m is under review | |
7066 | Claim date | |
7067 | Patient na me | |
7068 | Last 4 num bers of pa tient’s SS N | |
7069 | Patient Re sponsibili ty monetar y amount | |
7070 | Monetary a mount on t he claim | |
7071 | Patient st atus, Inpa tient/Outp atient | |
7072 | Claim form type | |
7073 | Status of EOB | |
7074 | Insurance company(s) | |
7075 | Clerk name – depends on Sort c riteria | |
7076 | Division(s ) | |
7077 | Days since last tran smission – depends o n Sort cri teria | |
7078 | Date of EO B - depend s on Sort criteria | |
7079 | ||
7080 | Available COB Manage ment Workl ist Action s | |
7081 | The follow ing action s are avai lable to u sers to he lp them ma naged thos e claims w hich faile d to meet the automa tic proces sing crite ria: | |
7082 | PC Proces s COB – Pr ocess a cl aim on the list to t he next pa yer on the bill | |
7083 | VE View a n EOB – Vi ew the EOB (s) associ ated with a claim on the list | |
7084 | EC Enter/ View Comme nts – Ente r new comm ents for a claim on the list o r view pre viously en tered comm ents | |
7085 | RS Review Status – Change the review st atus for a claim on the list | |
7086 | CB Cancel Bill – Ca ncel a bil l that doe s not need to be res ubmitted | |
7087 | CR Correc t Bill – C orrect a b ill that n eeds to be resubmitt ed | |
7088 | CC Cancel /Clone A B ill – Clon a bill th at needs t o be resub mitted (lo cked with IB CLON) | |
7089 | VB View B ill – View the billi ng screens | |
7090 | RM Remove from Work list – Rem ove claim from workl ist if no need to re submit | |
7091 | PE Print EOB/MRA – Print asso ciated MRA s or EOB | |
7092 | TP Third Party Join t Inq. – S elect a cl aim and go directly to it in T PJI | |
7093 | EX Exit – Exit the worklist a nd return to the EDI Menu | |
7094 | ||
7095 | ||
7096 | Note: Rem ove from W orklist wa s added so that clai ms that ha ve been Co llected/Cl osed and p lace on th e worklist can be re moved if t here is no reason to process i t to the n ext payer (i.e. no P atient Res ponsibilit y). These claims sh ould not b e cancelle d as they have been Collected/ Closed in AR. | |
7097 | ||
7098 | Remember: It is pos sible that a tertiar y claim on the COB M anagement Worklist b egan as an MRA claim . The Pri nt EOB/MRA action wi ll provide users wit h the opti on to prin t both EOB s and MRAs . | |
7099 | ||
7100 | ||
7101 | Requests f or Additio nal Data t o Support Claims | |
7102 | Patch IB*2 *547 added a new wor klist and a new inbo und transa ction, the ASC X12N 5010 Healt h Care Cla im Request for Addit ional Info rmation (2 77RFAI) to VistA. Th e 277RFAI transactio n is initi ated by th e payer in response to a claim for healt h care ser vices when they need additiona l informat ion in ord er to adju dicate the claim cor rectly. A 277RFAI mi ght, for e xample, re quest an i mage, a te st result or a Certi ficate of Medical Ne cessity. A t the time that Patc h IB*2*547 is instal led, the m ethods for providing this addi tional dat a will be manual. In the futur e, it will be possib le to resp ond to a 2 77RFAI wit h a ASC X1 2N 5010 Ad ditional I nformation to Suppor t a Health Care Clai m or Encou nter (275) transacti on. | |
7103 | ||
7104 | The RFAI M anagement Worklist w as added t o provide a method f or display ing and ma naging the se request s for addi tional doc umentation to suppor t the adju dication o f a claim. | |
7105 | ||
7106 | Step | |
7107 | Procedure | |
7108 | 1 | |
7109 | Access the EDI Menu For Electr onic Bills menu. | |
7110 | 2 | |
7111 | At the Sel ect EDI Me nu For Ele ctronic Bi lls Option : prompt, enter RFI for RFAI M anagement Worklist | |
7112 | 3 | |
7113 | At the Sel ect Author izing Bill er: ALL// prompt, pr ess the En ter key to accept th e default | |
7114 | 4 | |
7115 | At the Sel ect Primar y Sort: LO INC Code// prompt, p ress the E nter key t o accept t he default of LOINC | |
7116 | ||
7117 | The follow ing screen is displa yed: | |
7118 | ||
7119 | RFAI Manag ement Work list A pr 28, 201 5@14:25:12 Page: 1 of 16 | |
7120 | ||
7121 | Bill # Payer Name Patien t Name SSN Svc Date Curr Bal | |
7122 | 1 K100X XX MEDICA RE (WNR) IB,PAT IENT 333 XXXX 06/29/09 $43851.78 | |
7123 | 55115 -0 - Reque sted imagi ng studies informati on Documen t | |
7124 | 2 K100X XX MEDICA RE (WNR) IB,PAT IENT 22 XXXX 11/05/10 $1226.18 | |
7125 | 64286 -8 — Depre cated Diag nostic ima ging order | |
7126 | 3 K100X XX UNITED HEALTHCARE IB,PAT IENT 765 XXXX 11/05/10 $9.65 | |
7127 | 55115 -0 — Reque sted imagi ng studies informati on Documen t | |
7128 | 4 K100X XX MEDICA RE (WNR) IB,PAT IENT 22 XXXX 11/05/10 $1226.18 | |
7129 | 22034 -3 — Path report.tot al Cancer | |
7130 | + * Indicate s RFAI rev iew in pro gress | |
7131 | Select Message Exit | |
7132 | ReSort Messages | |
7133 | Select Act ion: Next Screen//Se lect Messa ge | |
7134 | Select RFA I Message: (1-4):1 | |
7135 | ||
7136 | Step | |
7137 | Procedure | |
7138 | 5 | |
7139 | At the Sel ect RFAI M essage: (1 -4) : prom pt, enter 1 to selec t a messag e to expan d | |
7140 | ||
7141 | The follow ing screen is displa yed: | |
7142 | ||
7143 | RFAI Messa ge Apr 2 8, 2015@14 :43:44 Page : 1 of 2 | |
7144 | ||
7145 | Bill # Payer Na me Patient Name SSN S vc Date Curr Bal | |
7146 | K100XXX IB INSUR ANCE CO IB,PATIE NT 33 XXXX 0 6/29/09 $ 43851.78 | |
7147 | ||
7148 | Informatio n Source | |
7149 | Payer Name : IB INSUR ANCE COMPA NY | |
7150 | Payer Cont act 1: FAX Number T here can b e up to 3 contact me thods | |
7151 | Payer Cont act #: XXX XXX-XXXX | |
7152 | Payer Cont act 2: Tel ephone | |
7153 | Payer Cont act #: XXX XXX-XXXX EXT: XXXXX XX | |
7154 | Payer Resp onse Conta ct 1: The re can be up to 3 co ntact meth ods | |
7155 | Payer Resp onse Conta ct #: XXX XXX-XXXX | |
7156 | Payer Resp onse Conta ct 2: Tele phone | |
7157 | Payer Resp onse Conta ct #: XXX XXX-XXXX E XT: XXXXXX X | |
7158 | Payer Addr ess: PO BO X XYZ New York, New York 10001 | |
7159 | Payer Clai m Control Number: XX XXXXXXXXXX XXXXXXXXXX XXXXXXXXXX XXXXXXXXXX XXXXXXXX | |
7160 | ||
7161 | Claim Leve l Status I nformation | |
7162 | Patient Co ntrol #: X XXXXXX Cl aim Number | |
7163 | Date of Se rvice: XX/ XX/XX | |
7164 | Medical Re cords Numb er: XXXXXX XX | |
7165 | Member Ide ntificatio n Number: XXXXXXXXXX | |
7166 | Type of Se rvice: XXX Institu tional Onl y Type of Bill | |
7167 | Health Car e Claim St atus Categ ory: Thes e 3 can re peat | |
7168 | Additional Informati on Request Modifier: Show LO INC Code T ext not ju st code | |
7169 | Status Inf ormation E ffective D ate: XX/XX /XX | |
7170 | Response D ue Date: X X/XX/XX | |
7171 | ||
7172 | Service Li ne Informa tion/ Serv ice Line S tatus Info rmation | |
7173 | Line Item Control Nu mber: XXXX XX | |
7174 | Service Li ne Date: | |
7175 | Revenue Co de: | |
7176 | Coding Met hod: HCPCS | |
7177 | Procedure Code:XXXXX XX | |
7178 | Procedure Modifier: There can be up to 4 | |
7179 | Procedure Modifier: | |
7180 | Line Item Charge Amo unt: XXXXX XXXXXXXXXX XXX | |
7181 | Health Car e Claim St atus Categ ory: Thes e 3 can re peat | |
7182 | Additional Informati on Request Modifier: Show LO INC Code T ext not ju st code | |
7183 | Status Inf ormation E ffective D ate: XX/XX /XX | |
7184 | Response D ue Date: X X/XX/XX | |
7185 | ||
7186 | + Enter ?? f or more ac tions | |
7187 | EC Ente r Comments TJ Thir d Party Jo int Inq. | |
7188 | RS Revi ew Status EX Exit | |
7189 | RE Remo ve Entry | |
7190 | Select Act ion: Next Screen// R emove Entr y | |
7191 | ||
7192 | From the R FAI messag e Screen, users can take the f ollowing a ctions: | |
7193 | Enter comm ents – use r name and date/time will be a utomatical ly capture d | |
7194 | Change the Review St atus – the entry wit h be marke d by an as terisk | |
7195 | Remove an entry from the list once it ha s been add ressed – u ser name a nd date/ti me will be captured along with free text removal c omment | |
7196 | Jump to th e claim in TPJI – co mments fro m the RFAI Managemen t Worklist will be v iewable fr om within TPJI | |
7197 | ||
7198 | IB Site Pa rameters | |
7199 | Define Pri nters for Automatica lly Proces sed Second ary/Tertia ry Claims | |
7200 | New fields were adde d to the M CCR Site P arameter D isplay/Edi t option s o that use rs can def ine printe rs to whic h to print automatic ally proce ssed secon dary or te rtiary cla ims and th eir associ ated EOB/M RAs to pay ers which cannot sup port elect ronic clai m transmis sions. | |
7201 | ||
7202 | Step | |
7203 | Procedure | |
7204 | 1 | |
7205 | Access the MCCR Syst em Definit ion Menu. | |
7206 | 2 | |
7207 | At the Sel ect MCCR S ystem Defi nition Men u Option: prompt, en ter Site f or MCCR Si te Paramet er Display /Edit. | |
7208 | 3 | |
7209 | At the Sel ect Action : prompt, Enter IB t o access t he IB Site Parameter s. | |
7210 | ||
7211 | MCCR Site Parameters Feb 01, 20 11@15:04:4 7 Page: 1 of 1 | |
7212 | Display/Ed it MCCR Si te Paramet ers. | |
7213 | Only autho rized pers ons may ed it this da ta. | |
7214 | ||
7215 | ||
7216 | IB Site P arameters Claims Tracking P arameters | |
7217 | Facili ty Definit ion Gene ral Parame ters | |
7218 | Mail G roups Trac king Param eters | |
7219 | Patien t Billing Rand om Samplin g | |
7220 | Third Party Bill ing | |
7221 | Provid er Id | |
7222 | EDI Tr ansmission | |
7223 | ||
7224 | Third Par ty Auto Bi lling Para meters Insuran ce Verific ation | |
7225 | Genera l Paramete rs Gene ral Parame ters | |
7226 | Inpati ent Admiss ion Batc h Extracts Parameter s | |
7227 | Outpat ient Visit Serv ice Type C odes | |
7228 | Prescr iption Ref ill | |
7229 | ||
7230 | Enter ?? f or more ac tions | |
7231 | IB Site P arameter AB Automated Billing EX Exit | |
7232 | CT Claims Tracking IV Ins. Verif ication | |
7233 | Select Act ion: Quit/ / IB Site Parameters | |
7234 | ||
7235 | ||
7236 | ||
7237 | ||
7238 | ||
7239 | ||
7240 | ||
7241 | ||
7242 | ||
7243 | ||
7244 | ||
7245 | ||
7246 | ||
7247 | ||
7248 | ||
7249 | The follow ing screen will disp lay. | |
7250 | ||
7251 | IB Site Pa rameters Feb 01, 20 11@16:22:0 2 Page: 1 of 5 | |
7252 | Only autho rized pers ons may ed it this da ta. | |
7253 | ||
7254 | [1] Copay Background Error Mg: IB ERROR | |
7255 | Copay Exemption Mailgroup: IB ERROR | |
7256 | Use Al erts for E xemption : NO | |
7257 | ||
7258 | [2] Hold M T Bills w/ Ins : YES # of Days Char ges Held: 90 | |
7259 | Suppre ss MT Ins Bulletin : NO | |
7260 | Means Test Mailg roup : IB MEANS TEST | |
7261 | Per Di em Start D ate : 11/05/90 | |
7262 | ||
7263 | [3] Disapp roval Mail group : MCCR - BU SINESS OFF ICE | |
7264 | Cancel lation Mai lgroup : UB-82 CAN CELL | |
7265 | Cancel lation Rem ark : BILL CANC ELLED IN B USINESS OF FICE | |
7266 | ||
7267 | [4] New In surance Ma ilgroup : IB NEW IN SURANCE | |
7268 | Unbill ed Mailgro up : IB UNBILL ED AMOUNTS | |
7269 | Auto P rint Unbil led List : NO | |
7270 | ||
7271 | + Enter ?? f or more ac tions | |
7272 | EP Edit S et EX Exit | |
7273 | Select Act ion: Next Screen// | |
7274 | ||
7275 | Step | |
7276 | Procedure | |
7277 | 4 | |
7278 | At the Sel ect Action : prompt, press the <Enter> ke y to accep t the defa ult of Nex t Screen u ntil Secti on 7 is di splayed. | |
7279 | ||
7280 | IB Site Pa rameters Feb 01, 20 11@16:25:4 3 Page: 2 of 5 | |
7281 | Only autho rized pers ons may ed it this da ta. | |
7282 | + | |
7283 | [5] Medica l Center : CHEYE NNE VAMC Defa ult Divisi on : CHE YENNE VAMR | |
7284 | MAS Servic e : BUSINESS OFFICE Billing Su pervisor : PI I
|
|
7285 | ||
7286 | [6] Initia tor Author ize: YES Xfer Proc to S ched : YES | |
7287 | Ask HI NQ in MCCR : YES Use Non-PTF Co des : YES | |
7288 | Multip le Form Ty pes: YES Use OP CPT scr een : YES | |
7289 | ||
7290 | [7] UB-04 Print IDs : YES UB-0 4 Address Col : | |
7291 | CMS-15 00 Print I Ds : YES CMS- 1500 Addr Col : 40 | |
7292 | CMS-15 00 Auto Pr ter: RM340 UB-0 4 Auto Prt er : RM3 40 | |
7293 | EOB Au to Prter : RM340 MRA Auto Prter : RM3 40 | |
7294 | ||
7295 | [8] Printe d Claims R ev Code Ex cl: 16 Act ivated Cod es Defined | |
7296 | ||
7297 | [9] Defaul t RX DX Cd : V68.1 Defa ult ASC Re v Cd : 490 | |
7298 | Defaul t RX CPT C d : J8499 Defa ult RX Rev Cd : 250 | |
7299 | ||
7300 | [10] Bill Signer Nam e : <No longer use d> Fed eral Tax # : 83 -0168494 | |
7301 | Bill S igner Titl e : <No l onger used > | |
7302 | + Enter ?? f or more ac tions | |
7303 | EP Edit S et EX Exit | |
7304 | Select Act ion: Next Screen// | |
7305 | ||
7306 | Step | |
7307 | Procedure | |
7308 | 5 | |
7309 | At the Sel ect Action : prompt, enter EP=7 . | |
7310 | 6 | |
7311 | At the CMS -1500 Auto Printer: prompt, en ter the na me of the printer to which CMS secondary or tertia ry claims will print . | |
7312 | 7 | |
7313 | At the UB0 4 Auto Pri nter: prom pt, enter the name o f the prin ter to whi ch CMS sec ondary or tertiary c laims will print. | |
7314 | 8 | |
7315 | At the EOB Auto Prin ter: promp t, enter t he name of the print er to whic h CMS seco ndary or t ertiary cl aims will print. | |
7316 | 9 | |
7317 | At the MRA Auto Prin ter: promp t, enter t he name of the print er to whic h CMS seco ndary or t ertiary cl aims will print. | |
7318 | ||
7319 | Note: The same print er can be used to pr int more t han one th ing if you r printers are setup to handle more than one form type. | |
7320 | ||
7321 | Remember: The MRA is a 132 col umn printo ut. | |
7322 | ||
7323 | UB-04 PRIN T LEGACY I D: YES// | |
7324 | CMS-1500 P RINT LEGAC Y ID: YES/ / | |
7325 | UB-04 ADDR ESS COLUMN : | |
7326 | CMS-1500 A DDRESS COL UMN: 40// | |
7327 | CMS-1500 A uto Printe r: | |
7328 | UB-04 Auto Printer: | |
7329 | EOB Auto P rinter: | |
7330 | MRA Auto P rinter: | |
7331 | Enable Aut omatic Pro cessing of Secondary /Tertiary Claims | |
7332 | A new fiel d was adde d to the M CCR Site P arameter D isplay/Edi t option s o that use rs can ena ble/disabl e the auto matic proc essing of secondary/ tertiary n on-MRA cla ims. | |
7333 | ||
7334 | Step | |
7335 | Procedure | |
7336 | 1 | |
7337 | Access the MCCR Syst em Definit ion Menu. | |
7338 | 2 | |
7339 | At the Sel ect MCCR S ystem Defi nition Men u Option: prompt, en ter Site f or MCCR Si te Paramet er Display /Edit. | |
7340 | 3 | |
7341 | At the Sel ect Action : prompt, Enter IB t o access t he IB Site Parameter s. | |
7342 | ||
7343 | MCCR Site Parameters Feb 01, 20 11@15:04:4 7 Page: 1 of 1 | |
7344 | Display/Ed it MCCR Si te Paramet ers. | |
7345 | Only autho rized pers ons may ed it this da ta. | |
7346 | ||
7347 | ||
7348 | IB Site P arameters Claims Tracking P arameters | |
7349 | Facili ty Definit ion Gene ral Parame ters | |
7350 | Mail G roups Trac king Param eters | |
7351 | Patien t Billing Rand om Samplin g | |
7352 | Third Party Bill ing | |
7353 | Provid er Id | |
7354 | EDI Tr ansmission | |
7355 | ||
7356 | Third Par ty Auto Bi lling Para meters Insuran ce Verific ation | |
7357 | Genera l Paramete rs Gene ral Parame ters | |
7358 | Inpati ent Admiss ion Batc h Extracts Parameter s | |
7359 | Outpat ient Visit Serv ice Type C odes | |
7360 | Prescr iption Ref ill | |
7361 | ||
7362 | Enter ?? f or more ac tions | |
7363 | IB Site P arameter AB Automated Billing EX Exit | |
7364 | CT Claims Tracking IV Ins. Verif ication | |
7365 | Select Act ion: Quit/ / IB Site Parameters | |
7366 | ||
7367 | The follow ing screen will disp lay. | |
7368 | ||
7369 | IB Site Pa rameters Feb 01, 20 11@16:22:0 2 Page: 1 of 5 | |
7370 | Only autho rized pers ons may ed it this da ta. | |
7371 | ||
7372 | [1] Copay Background Error Mg: IB ERROR | |
7373 | Copay Exemption Mailgroup: IB ERROR | |
7374 | Use Al erts for E xemption : NO | |
7375 | ||
7376 | [2] Hold M T Bills w/ Ins : YES # of Days Char ges Held: 90 | |
7377 | Suppre ss MT Ins Bulletin : NO | |
7378 | Means Test Mailg roup : IB MEANS TEST | |
7379 | Per Di em Start D ate : 11/05/90 | |
7380 | ||
7381 | [3] Disapp roval Mail group : MCCR - BU SINESS OFF ICE | |
7382 | Cancel lation Mai lgroup : UB-82 CAN CELL | |
7383 | Cancel lation Rem ark : BILL CANC ELLED IN B USINESS OF FICE | |
7384 | ||
7385 | [4] New In surance Ma ilgroup : IB NEW IN SURANCE | |
7386 | Unbill ed Mailgro up : IB UNBILL ED AMOUNTS | |
7387 | Auto P rint Unbil led List : NO | |
7388 | ||
7389 | + Enter ?? f or more ac tions | |
7390 | EP Edit S et EX Exit | |
7391 | Select Act ion: Next Screen// | |
7392 | ||
7393 | Step | |
7394 | Procedure | |
7395 | 4 | |
7396 | At the Sel ect Action : prompt, press the <Enter> ke y to accep t the defa ult of Nex t Screen u ntil Secti on 14 is d isplayed. | |
7397 | ||
7398 | IB Site Pa rameters Sep 16, 20 11@14:32:2 1 Page: 3 of 5 | |
7399 | Only autho rized pers ons may ed it this da ta. | |
7400 | + | |
7401 | [11]Pay-To Providers : 1 def ined, defa ult - CHEY ENNE TEST1 VAMC | |
7402 | ||
7403 | [12] Non-M CCF Pay-To Providers : 2 define d, default – FORT CO LLINS CBOC | |
7404 | ||
7405 | [13]Inpt H ealth Summ ary: INPAT IENT HEALT H SUMMARY | |
7406 | Opt He alth Summa ry : OUTPA TIENT HEAL TH SUMMARY | |
7407 | ||
7408 | [14]HIPPA NCPDP Acti ve Flag : N ot Active | |
7409 | Drug N on Covered Recheck P eriod : 0 days(s) | |
7410 | Non Co vered Reje ct Codes | |
7411 | : 7 0 Product/ Service No t Covered | |
7412 | ||
7413 | [15]Inpati ent TP Act ive : YES | |
7414 | Outpat ient TP Ac tive: YES | |
7415 | Pharma cy TP Acti ve : YES | |
7416 | Prosth etic TP Ac tive: YES | |
7417 | ||
7418 | [16] EDI/M RA Activat ed : B OTH EDI AN D MRA | |
7419 | + Enter ?? f or more ac tions | |
7420 | EP Edit S et EX Exit | |
7421 | Select Act ion: Next Screen// | |
7422 | ||
7423 | Step | |
7424 | Procedure | |
7425 | 5 | |
7426 | At the Sel ect Action : prompt, enter EP=1 6. | |
7427 | 6 | |
7428 | The Enable Auto Reg EOB Proces sing?: pro mpt will b e set to Y ES. | |
7429 | ||
7430 | This param eter shoul d not be c hanged unl ess there is a compe lling reas on to stop the autom atic proce ssing of s econdary/t ertiary cl aims. | |
7431 | ||
7432 | Select Act ion: Next Screen// e p=14 Edi t Set | |
7433 | SITE CONTA CT PHONE N UMBER: 307 -778-7581/ / | |
7434 | LIVE TRANS MIT 837 QU EUE: MCT// | |
7435 | TEST TRANS MIT 837 QU EUE: MCT// | |
7436 | AUTO TRANS MIT BILL F REQUENCY: 1// | |
7437 | HOURS TO T RANSMIT BI LLS: 1130; 1500;1700/ / | |
7438 | MAX # BILL S IN A BAT CH: 10// | |
7439 | ONLY 1 INS CO PER CL AIM BATCH: YES// | |
7440 | DAYS TO WA IT TO PURG E MSGS: 15 // | |
7441 | Allow MRA Processing ?: YES// | |
7442 | Enable Aut omatic MRA Processin g?: YES// | |
7443 | Enable Aut o Reg EOB Processing ?: YES// | |
7444 | Printed Cl aims Rev C ode Excl: 17 Activat ed Codes D efined | |
7445 | Patch IB*2 *547 added Section 8 , Printed Claims Rev Code Excl :, to the IB Site Pa rameters. When the P atch is in stalled, t he followi ng revenue codes, if active, w ill be pre -populated : | |
7446 | 270-279 | |
7447 | 290-299 | |
7448 | Users will be able t o add and/ or delete additional revenue c odes. Reve nue codes that are d efined her e will be used to sc reen out c laims from the Print ed Claims report. | |
7449 | ||
7450 | IB Site Pa rameters Nov 03, 20 15@10:43:2 0 Page: 2 of 5 | |
7451 | Only autho rized pers ons may ed it this da ta. | |
7452 | + | |
7453 | [5] Medica l Center : CHEYE NNE VAMC Defa ult Divisi on : CHE YENNE VAMR | |
7454 | MAS Servic e : BUSINESS OFFICE Billing Su pervisor : PI I
|
|
7455 | ||
7456 | [6] Initia tor Author ize: YES Xfer Proc to S ched : YES | |
7457 | Ask HI NQ in MCCR : YES Use Non-PTF Co des : YES | |
7458 | Multip le Form Ty pes: YES Use OP CPT scr een : YES | |
7459 | ||
7460 | [7] UB-04 Print IDs : YES UB-0 4 Address Col : | |
7461 | CMS-15 00 Print I Ds : YES CMS- 1500 Addr Col : 40 | |
7462 | CMS-15 00 Auto Pr ter: UB-0 4 Auto Prt er : | |
7463 | EOB Au to Prter : MRA Auto Prter : | |
7464 | ||
7465 | [8] Printe d Claims R ev Code Ex cl: 17 Act ivated Cod es Defined | |
7466 | ||
7467 | [9] Defaul t RX DX Cd : Z76.0 (ICD-10) Defa ult ASC Re v Cd : 490 | |
7468 | Defaul t RX CPT C d : J8499 Defa ult RX Rev Cd : 250 | |
7469 | ||
7470 | + Enter ?? f or more ac tions | |
7471 | EP Edit S et EX Exit | |
7472 | Select Act ion: Next Screen// | |
7473 | ||
7474 | Excluded R evenue Cod es Nov 03, 20 15@11:05:0 6 Page: 1 of 1 | |
7475 | ||
7476 | # R CD DESC RIPTION | |
7477 | 1. 2 70 MED- SUR SUPPLI ES | |
7478 | 2. 2 71 NON- STER SUPPL Y | |
7479 | 3. 2 72 STER ILE SUPPLY | |
7480 | 4. 2 73 TAKE HOME SUPPL Y | |
7481 | 5. 2 74 PROS TH/ORTH DE V | |
7482 | 6. 2 75 PACE MAKER | |
7483 | 7. 2 76 INTR A OC LENS | |
7484 | 8. 2 77 O2/T AKEHOME | |
7485 | 9. 2 78 SUPP LY/IMPLANT S | |
7486 | 10. 2 79 SUPP LY/OTHER | |
7487 | 11. 2 90 MED EQUIP/DURA B | |
7488 | 12. 2 91 MED EQUIP/RENT | |
7489 | 13. 2 92 MED EQUIP/NEW | |
7490 | 14. 2 93 MED EQUIP/USED | |
7491 | 15. 2 94 MED EQUIP/SUPP LIES/DRUGS | |
7492 | 16. 2 99 MED EQUIP/OTHE R | |
7493 | Enter ?? f or more ac tions | |
7494 | AC Add Re venue Code DC Delete Rev enue Code EX Exit | |
7495 | Select Ite m(s): Quit // ac Ad d Revenue Code | |
7496 | Revenue Co de: 118 REHAB/ PVT RE HABILITATI ON | |
7497 | Revenue Co de: | |
7498 | ||
7499 | Step | |
7500 | Procedure | |
7501 | 1 | |
7502 | Access the MCCR Syst em Definit ion Menu. | |
7503 | 2 | |
7504 | At the Sel ect MCCR S ystem Defi nition Men u Option: prompt, en ter Site f or MCCR Si te Paramet er Display /Edit. | |
7505 | 3 | |
7506 | At the Sel ect Action : prompt, Enter IB t o access t he IB Site Parameter s. | |
7507 | 4 | |
7508 | At the Sel ect Action : Next Scr een// prom pt, enter EP=8 to ac cess Exclu ded Revenu e Codes | |
7509 | 5 | |
7510 | At the Sel ect Item(s ): Quit// prompt, en ter AC for Add Reven ue Code | |
7511 | 6 | |
7512 | At the Rev enue Code: prompt, e nter a Rev enue Code number | |
7513 | 7 | |
7514 | At the Rev enue Code: prompt, p ress the E nter key w hen done a dding code s | |
7515 | Alternate Primary Pa yer ID Typ es | |
7516 | Patch IB*2 *547 added Sections 17 and 18, Alt Prim Payer ID T yp-Medicar e and Alt Prim Payer ID Typ-Co mmercial. Users can define qua lifiers to be used t o define a lternative professio nal and/or instituti onal prima ry payer I Ds by type in Insura nce Compan y Entry/Ed it. These ID types p rovide the ability t o direct 8 37 transac tions to d ifferent p rocessing entities d epending o n the type of claim. | |
7517 | ||
7518 | IB Site Pa rameters Nov 03, 20 15@11:21:3 2 Page: 4 of 5 | |
7519 | Only autho rized pers ons may ed it this da ta. | |
7520 | + | |
7521 | [16] EDI/M RA Activat ed : B OTH EDI AN D MRA | |
7522 | EDI C ontact Pho ne : ( 307)778-75 81 | |
7523 | EDI 8 37 Live Tr ansmit Que ue : M CT | |
7524 | EDI 8 37 Test Tr ansmit Que ue : M CT | |
7525 | Auto- Txmt Bill Frequency : E very Day | |
7526 | Hours To Auto-T ransmit : 1 130;1500;1 700 | |
7527 | Max # Bills Per Batch : 1 0 | |
7528 | Only Allow 1 In s Co/Claim Batch?: N O | |
7529 | Last Auto-Txmt Run Date : 0 3/08/11 | |
7530 | Days To Wait To Purge Msg s : 1 5 | |
7531 | Allow MRA Proce ssing? : Y ES | |
7532 | Enabl e Automati c MRA Proc essing?: Y ES | |
7533 | Enabl e Auto Reg EOB Proce ssing? : Y ES | |
7534 | ||
7535 | [17]Alt Pr im Payer I D Typ-Medi care: 2 de fined | |
7536 | ||
7537 | [18]Alt Pr im Payer I D Typ-Comm ercial: 2 defined | |
7538 | + Enter ?? f or more ac tions | |
7539 | EP Edit S et EX Exit | |
7540 | Select Act ion: Next Screen// | |
7541 | ||
7542 | Step | |
7543 | Procedure | |
7544 | 1 | |
7545 | Access the MCCR Syst em Definit ion Menu. | |
7546 | 2 | |
7547 | At the Sel ect MCCR S ystem Defi nition Men u Option: prompt, en ter Site f or MCCR Si te Paramet er Display /Edit. | |
7548 | 3 | |
7549 | At the Sel ect Action : prompt, Enter IB t o access t he IB Site Parameter s. | |
7550 | 4 | |
7551 | At the Sel ect Action : Next Scr een// prom pt, enter EP=17 to a ccess Alt Prim Payer Typ-Medic are | |
7552 | 5 | |
7553 | At the Sel ect Item(s ): Quit// prompt, en ter AT for Add ID Ty pe | |
7554 | 6 | |
7555 | At the Ent er a Prima ry ID Type : prompt, enter a Fr ee Text ID Type | |
7556 | 7 | |
7557 | At the Are you addin g 'HOSPICE ' as a new IB ALTERN ATE PRIMAR Y ID TYPES (the 2nd) ? No// pro mpt, enter YES | |
7558 | 8 | |
7559 | At the Ent er a Prima ry ID Type : prompt, press the Enter key when done adding typ es | |
7560 | ||
7561 | Alt Primar y Payer ID Types Nov 03, 20 15@11:32:1 8 Page: 1 of 1 | |
7562 | ||
7563 | ||
7564 | 1 DME | |
7565 | ||
7566 | ||
7567 | ||
7568 | ||
7569 | ||
7570 | ||
7571 | ||
7572 | Enter ?? f or more ac tions | |
7573 | AT Add ID Type DT Delete ID Type EX Exit | |
7574 | Select Act ion: Quit/ /AT Add ID Type | |
7575 | Enter a Pr imary ID T ype: HOSPI CE | |
7576 | Are you adding 'HO SPICE' as | |
7577 | a new IB ALTERNA TE PRIMARY ID TYPES (the 4TH)? No// y | |
7578 | ||
7579 | ASC X12N H ealth Care Claim Req uest for A dditional Informatio n (277RFAI ) | |
7580 | Patch IB*2 *547 added Section 2 0 to the I B Site Par ameters. W hen the Pa tch is ins talled, th e followin g 277RFAI parameters will be p re-populat ed: | |
7581 | Days to st ore 277RFA I Transact ions | |
7582 | Days to wa it to purg e entry on RFAI Mana gement Wor klist | |
7583 | ||
7584 | IB Site Pa rameters Nov 03, 20 15@12:33:3 4 Page: 5 of 5 | |
7585 | Only autho rized pers ons may ed it this da ta. | |
7586 | + | |
7587 | ||
7588 | [19]Are we using Cla imsManager ? : NO | |
7589 | Is Cla imsManager working O K? : NO | |
7590 | Claims Manager TC P/IP Addre ss : 10.15 2.21.145 | |
7591 | Claims Manager TC P/IP Ports : 10040 | |
7592 | 10050 | |
7593 | 10060 | |
7594 | 10070 | |
7595 | 10080 | |
7596 | Genera l Error Ma ilGroup : IBCI GENERAL ER ROR | |
7597 | Commun ication Er ror MailGr oup: IBCI COMMUNICAT ION ERROR | |
7598 | MailMa n Messages : PRIOR ITY | |
7599 | ||
7600 | [20]Days t o store 27 7RFAI Tran sactions: No Purge | |
7601 | Days t o wait to purge entr y on RFAI Management Worklist: 20 | |
7602 | ||
7603 | ||
7604 | Enter ?? f or more ac tions | |
7605 | EP Edit S et EX Exit | |
7606 | Select Act ion: Quit/ / ep=20 Edit Set | |
7607 | PURGE DAYS 277 RFAI: ?? | |
7608 | En ter the nu mber of da ys (betwee n 365 and 3000) to | |
7609 | re tain 277 R FAI transa ctions in VistA. | |
7610 | A null entry (the defa ult) indic ates the t ransaction s | |
7611 | wi ll be stor ed forever . | |
7612 | ||
7613 | PURGE DAYS 277 RFAI: | |
7614 | WORKLIST P URGE DAYS 277 RFAI: 20// | |
7615 | ||
7616 | ||
7617 | Step | |
7618 | Procedure | |
7619 | 1 | |
7620 | Access the MCCR Syst em Definit ion Menu. | |
7621 | 2 | |
7622 | At the Sel ect MCCR S ystem Defi nition Men u Option: prompt, en ter Site f or MCCR Si te Paramet er Display /Edit. | |
7623 | 3 | |
7624 | At the Sel ect Action : prompt, Enter IB t o access t he IB Site Parameter s. | |
7625 | 4 | |
7626 | At the Sel ect Action : Quit// p rompt, ent er EP=20 t o access t he 277RFAI parameter s | |
7627 | 5 | |
7628 | At the PUR GE DAYS 27 7 RFAI: pr ompt, pres s the Ente r key to a ccept the default | |
7629 | 6 | |
7630 | At the WOR KLIST PURG E DAYS 277 RFAI: pro mpt, enter a Number that repre sents the number of days a 277 RFAI entr y will rem ain on the RFAI Work list befor e being au tomaticall y removed | |
7631 | New EDI Pa rameter fo r Dental P rocessing | |
7632 | Patch IB*2 *592 added a new par ameter to the IB Sit e Paramete rs (Sectio n 16). The new Allow Dental Cl aim Proces sing field will be s et to YES when the p atch is in stalled. | |
7633 | ||
7634 | If there i s ever a n eed, this field can be reset t o NO and t he new Den tal form J 430D will no longer be availab le in Ente r/Edit Bil ling Infor mation and the AutoB iller will stop crea ting Denta l claims. | |
7635 | ||
7636 | IB Site Pa rameters Dec 14, 20 17@12:02:0 8 Page: 4 of 5 | |
7637 | Only autho rized pers ons may ed it this da ta. | |
7638 | + | |
7639 | [16] EDI/M RA Activat ed : B OTH EDI AN D MRA | |
7640 | EDI C ontact Pho ne : ( 866)393-18 46 | |
7641 | EDI 8 37 Live Tr ansmit Que ue : M CT | |
7642 | EDI 8 37 Test Tr ansmit Que ue : M CT | |
7643 | Auto- Txmt Bill Frequency : E very Day | |
7644 | Hours To Auto-T ransmit : 0 900;1200;1 700 | |
7645 | Max # Bills Per Batch : 1 0 | |
7646 | Only Allow 1 In s Co/Claim Batch?: N O | |
7647 | Last Auto-Txmt Run Date : 1 2/13/17 | |
7648 | Days To Wait To Purge Msg s : 1 5 | |
7649 | Allow MRA Proce ssing? : Y ES | |
7650 | Enabl e Automati c MRA Proc essing?: Y ES | |
7651 | Enabl e Auto Reg EOB Proce ssing? : Y ES | |
7652 | Allow Dental Cl aim Proces sing? : Y ES | |
7653 | ||
7654 | [17]Alt Pr im Payer I D Typ-Medi care: 1 de fined | |
7655 | ||
7656 | + Enter ?? f or more ac tions | |
7657 | EP Edit S et EX Exit | |
7658 | Select Act ion: Next Screen// | |
7659 | ||
7660 | CMN CPT Co de Inclusi on: CMN CP T Codes In cluded | |
7661 | Patch IB*2 *608 added Section 2 1, CMN CPT Code Incl usion:, to the IB Si te Paramet ers. When the Patch is install ed, many C PT Codes w ill be pre -populated . | |
7662 | ||
7663 | Users will be able t o add and/ or delete additional CPT codes . CPT code s that are defined h ere will b e used to prompt “CM N Required ?” on CMS- 1500, scre en 5. | |
7664 | ||
7665 | IB Site Pa rameters Nov 03, 20 15@12:33:3 4 Page: 5 of 5 | |
7666 | Only autho rized pers ons may ed it this da ta. | |
7667 | + | |
7668 | ||
7669 | ||
7670 | [20]Days t o store 27 7RFAI Tran sactions: No Purge | |
7671 | Days t o wait to purge entr y on RFAI Management Worklist: 20 | |
7672 | ||
7673 | [21]CMN CP T Code Inc lusion: 50 CMN CPT C odes Inclu ded | |
7674 | ||
7675 | ||
7676 | ||
7677 | ||
7678 | ||
7679 | ||
7680 | Enter ?? f or more ac tions | |
7681 | EP Edit S et EX Exit | |
7682 | Select Act ion: Quit/ / ep=21 Edit Set | |
7683 | PURGE DAYS 277 RFAI: ?? | |
7684 | En ter the nu mber of da ys (betwee n 365 and 3000) to | |
7685 | re tain 277 R FAI transa ctions in VistA. | |
7686 | A null entry (the defa ult) indic ates the t ransaction s | |
7687 | wi ll be stor ed forever . | |
7688 | ||
7689 | PURGE DAYS 277 RFAI: | |
7690 | WORKLIST P URGE DAYS 277 RFAI: 20// | |
7691 | ||
7692 | ||
7693 | ||
7694 | CMN CPT In clusions May 03, 2018@1 1:05:06 Pag e: 1 of 4 | |
7695 | ||
7696 | # C PT DESCRI PTION | |
7697 | 1. B 4102 EF ADU LT FLUIDS AND ELECTR O | |
7698 | 2. B 4103 EF PED FLUID AND ELECTROLY TE | |
7699 | 3. B 4104 ADDITI VE FOR ENT ERAL FORMU LA | |
7700 | 4. B 4149 EF BLE NDERIZED F OODS | |
7701 | 5. B 4150 EF COM PLET W/INT ACT NUTRIE NT | |
7702 | 6. B 4152 EF CAL ORIE DENSE >/=1.5KCAL | |
7703 | 7. B 4153 EF HYD ROLYZED/AM INO ACIDS | |
7704 | 8. B 4154 EF SPE C METABOLI C NONINHER IT | |
7705 | 9. B 4155 EF INC OMPLETE/MO DULAR | |
7706 | 10. B 4157 EF SPE CIAL METAB OLIC INHER IT | |
7707 | 11. B 4158 EF PED COMPLETE INTACT NUT | |
7708 | 12. B 4159 EF PED COMPLETE SOY BASED | |
7709 | 13. B 4160 EF PED CALORIC D ENSE>/=0.7 KC | |
7710 | 14. B 4161 EF PED HYDROLYZE D/AMINO AC ID | |
7711 | 15. B 4162 EF PED SPECMETAB OLIC INHER IT | |
7712 | 16. B 4164 PARENT ERAL 50% D EXTROSE SO LU | |
7713 | Enter ?? f or more ac tions | |
7714 | AC Add CP T Code DC Dele te CPT Cod e | |
7715 | Select Ite m(s): Next Screen// ac Add C PT Code | |
7716 | CPT Code: B4172 PARENTER AL SOL AMI NO ACID 5. | |
7717 | CPT Code: | |
7718 | ||
7719 | Step | |
7720 | Procedure | |
7721 | 1 | |
7722 | Access the MCCR Syst em Definit ion Menu. | |
7723 | 2 | |
7724 | At the Sel ect MCCR S ystem Defi nition Men u Option: prompt, en ter Site f or MCCR Si te Paramet er Display /Edit. | |
7725 | 3 | |
7726 | At the Sel ect Action : prompt, Enter IB t o access t he IB Site Parameter s. | |
7727 | 4 | |
7728 | At the Sel ect Action : Next Scr een// prom pt, enter EP=21 to a ccess CMN CPT Code I nclusion | |
7729 | 5 | |
7730 | At the Sel ect Item(s ): Quit// prompt, en ter AC for Add CPT C ode | |
7731 | 6 | |
7732 | At the Rev enue Code: prompt, e nter a CPT Code numb er | |
7733 | 7 | |
7734 | At the Rev enue Code: prompt, p ress the E nter key w hen done a dding code s | |
7735 | ||
7736 | ||
7737 | Reports | |
7738 | There are a number o f reports available to monitor and manag e electron ic claims. The EDI menu optio n can be a ccessed fr om the Bil ling Clerk 's Menu. | |
7739 | EDI Report s – Overvi ew | |
7740 | TR reports provide t he end-use r with inf ormation t o monitor and manage EDI claim s still wi thin the V A, that is , between the VAMC a nd the FSC in Austin , TX. The MM report s provide the end-us er with in formation and feedba ck from pa rties exte rnal to th e VA such as the cle aringhouse and the v arious ele ctronic pa yers. | |
7741 | ||
7742 | ||
7743 | (Trading P artners) | |
7744 | (Trading P artners) | |
7745 | Outside Th e VA Syste m | |
7746 | Outside Th e VA Syste m | |
7747 | (Trading P artners) | |
7748 | (Trading P artners) | |
7749 | Outside Th e VA Syste m | |
7750 | Outside Th e VA Syste m | |
7751 | Within The VA System | |
7752 | Within The VA System | |
7753 | Within The VA System | |
7754 | Within The VA System | |
7755 | ||
7756 | ||
7757 | Payers | |
7758 | Payers | |
7759 | FSC | |
7760 | FSC | |
7761 | VistA | |
7762 | VistA | |
7763 | (Trading P artners) | |
7764 | (Trading P artners) | |
7765 | Outside Th e VA Syste m | |
7766 | Outside Th e VA Syste m | |
7767 | (Trading P artners) | |
7768 | (Trading P artners) | |
7769 | Outside Th e VA Syste m | |
7770 | Outside Th e VA Syste m | |
7771 | Within The VA System | |
7772 | Within The VA System | |
7773 | Within The VA System | |
7774 | Within The VA System | |
7775 | Payers | |
7776 | Payers | |
7777 | Emdeon | |
7778 | Emdeon | |
7779 | FSC | |
7780 | FSC | |
7781 | VistA | |
7782 | VistA | |
7783 | ||
7784 | ||
7785 | ||
7786 | ||
7787 | Clearing- | |
7788 | house | |
7789 | Clearing- | |
7790 | house | |
7791 | ||
7792 | ||
7793 | ||
7794 | ||
7795 | ||
7796 | ||
7797 | TR- EDI Tr ansmission Status Re ports - | |
7798 | TR- EDI Tr ansmission Status Re ports - | |
7799 | MM-EDI Ret urn Messag e Manageme nt | |
7800 | MM-EDI Ret urn Messag e Manageme nt | |
7801 | ||
7802 | ||
7803 | EDI Retu rn Message Managemen t Option M enu | |
7804 | CSA Claim Status Aw aiting Res olution | |
7805 | MCS Multi ple CSA Me ssage Mana gement | |
7806 | TCS Test Claim EDI Transmissi on Report | |
7807 | EDI Messag e Text to Screen Mai nt | |
7808 | EDI Messag e Not Revi ewed Repor t | |
7809 | Electronic Error Rep ort | |
7810 | Electronic Report Di sposition | |
7811 | Return Mes sage Filin g Exceptio ns | |
7812 | Status Mes sage Manag ement | |
7813 | EDI Retu rn Message Managemen t Option M enu | |
7814 | CSA Claim Status Aw aiting Res olution | |
7815 | MCS Multi ple CSA Me ssage Mana gement | |
7816 | TCS Test Claim EDI Transmissi on Report | |
7817 | EDI Messag e Text to Screen Mai nt | |
7818 | EDI Messag e Not Revi ewed Repor t | |
7819 | Electronic Error Rep ort | |
7820 | Electronic Report Di sposition | |
7821 | Return Mes sage Filin g Exceptio ns | |
7822 | Status Mes sage Manag ement | |
7823 | BAR Bills Need ing Resubm ission Act ion | |
7824 | ECS EDI Claim Status Rep ort | |
7825 | MP EDI Messa ges Not Ye t Filed | |
7826 | PBT Pending Ba tch Transm ission Sta tus Report | |
7827 | PND EDI Batche s Pending Receipt | |
7828 | REX Ready for Extract St atus Repor t | |
7829 | VPE View/Print EDI Bill Extract Da ta | |
7830 | Most Frequ ently Used Menus/Rep orts | |
7831 | Claims Sta tus Awaiti ng Resolut ion – Syno nym CSA | |
7832 | ||
7833 | What is th e purpose of this re port? | |
7834 | Billing an d Accounts Receivabl e (or Acco unts Manag ement) sta ff use CSA to review the most current st atus messa ges and to perform f ollow-up a ctions on the bills. Electroni c status m essages, w hich inclu de informa tion and r ejection m essages fr om the cle aringhouse or the pa yers, are accessed u sing this option. | |
7835 | ||
7836 | When is th is option used? | |
7837 | This is an option th at must be checked D aily to de termine wh ich claims have reje ction or w arning mes sages that were retu rned from the cleari nghouse or from paye rs. The ca use for re jections m ust be res olved. Thi s option s hould be u sed in con junction w ith suppor ting repor ts (e.g. R 022, R0SS, R0SC). | |
7838 | ||
7839 | The CSA re port conta ins a Prim ary, Secon dary and T ertiary so rt capabil ity and ca n be sorte d by: | |
7840 | AAuthorizi ng Biller | |
7841 | BBill Numb er | |
7842 | CCurrent B alance | |
7843 | SDate of S ervice | |
7844 | DDivision | |
7845 | EError Cod e Text | |
7846 | NNumber of Days Pend ing | |
7847 | MPatient N ame | |
7848 | PPayer | |
7849 | RReview in Process | |
7850 | LSSN Last 4 | |
7851 | ||
7852 | Once the C SA screen list is di splayed, u sers can s elect new sort crite ria and re -sort the list witho ut exiting the optio n. | |
7853 | ||
7854 | Reports ca n be run s howing rej ections on ly (R), or both info rmational and reject ion messag es (B). Us ers most o ften run t he CSA rep ort to sho w rejectio ns only so they can focus on t hose claim s that req uire corre ctive acti on. | |
7855 | ||
7856 | These mess ages are a utomatical ly assigne d a status of Not Re viewed and require u sers to re view them and make c orrections to update this stat us in IB. Users sele ct a bill from the l ist to vie w the deta ils and th e entire m essage tex t. Message s are mark ed as revi ewed or re view in pr ocess. Use rs may doc ument comm ents. | |
7857 | ||
7858 | ||
7859 | With Patch IB*2.0*32 0, changes were made to suppre ss the dis play of 2Q Claim Sta tus Messag es and dup licate cla im status messages. | |
7860 | ||
7861 | As message s are revi ewed they can be mar ked as fol lows: | |
7862 | Not Review ed – No ac tion has b een taken on a bill that has b een return ed from th e clearing house/paye r | |
7863 | Review in Process – While a cl aim is bei ng reworke d, the sta tus can be changed t o “Review in Process ” | |
7864 | Review Com plete – Th e error ha s been res olved and the messag e from thi s report w ill be cle ared | |
7865 | ||
7866 | Actions su ch as Canc el Bill, C opy/Cancel Bill, TPJ I and Prin t Bill are available to the us er via thi s option a nd the use r can make needed co rrections and re-sub mit claims from with in this op tion. | |
7867 | ||
7868 | Other opti ons availa ble on the CSA inclu de: | |
7869 | CSA-EDI Hi story Disp lay – The EDI Histor y display option sho ws all the status me ssages und er the sel ected bill /message. This infor mation is similar to informati on that ca n be viewe d under th e TPJI men u options. | |
7870 | CSA-Enter/ Edit Comme nts – The enter/edit comments option giv es the use r the abil ity to add a comment onto a bi ll (status message) in order t o inform A R and bill ing why th e issue ha sn't been resolved o r why the claim was printed to paper. | |
7871 | CSA-Resubm it by Prin t – The Re submit by Print acti on is used when the user revie ws the sta tus messag e or bill and determ ines the o nly way to correct t he problem is to sub mit the cl aim on har d copy as it cannot pass the e lectronic edits. The user may “resubmit by print” to the pay er instead of retran smitting e lectronica lly. If pr inted from this opti on, users will be as ked if the y wish to “review co mplete” th e status m essage, wh ich will a utomatical ly clear i t from the report. | |
7872 | CSA-Retran smit a Bil l – Simila r to the R esubmit by Print act ion, the R etransmit Bill is us ed when th e user rev iews the s tatus mess age or bil l and dete rmines the reason fo r the reje ction has been corre cted elsew here in th e system a nd the cla im just ne eds to be resent. Th e user may then retr ansmit to the payer. | |
7873 | CSA-Review Status – A bill wil l continue to show u p on the r eport unti l it is ca ncel/clone d, cancele d or the s tatus is c hanged to Review Com plete. | |
7874 | ||
7875 | Users also have acce ss to the option Mul tiple CSA Message Ma nagement f rom within the CSA l ist if the y hold the IB Messag e Manageme nt securit y key. | |
7876 | ||
7877 | ||
7878 | Note: Afte r Patch IB *2*547 is installed, the sourc e of a cla im status message wi ll include the name of the cle aringhouse when the clearingho use is the soutce. | |
7879 | ||
7880 | Multiple C SA Message Managemen t – Synony m: MCS | |
7881 | ||
7882 | What is th e purpose of this op tion? | |
7883 | This optio n is desig ned to all ow users t o take act ion on CSA messages when a pro blem arise s during t he process ing of ele ctronic cl aims that causes a l arge volum e of erron eous statu s messages to be sen t to the s ite. This option per forms task s similar to the CSA option. | |
7884 | ||
7885 | ||
7886 | This optio n is locke d by the I B Message Management security key. | |
7887 | ||
7888 | When is th is option used? | |
7889 | This optio n is used when there are pages of errone ous messag es in CSA that were caused by a processi ng problem . Use this option to take a si milar acti on (such a s retransm ission of the associ ated claim s) on mult iple claim s at the s ame time. | |
7890 | ||
7891 | The initia l search f or claims and claims status me ssages is done autom atically w hen the op tion is se lected. Th e initial search res ults in th e display of all cla ims that a re Not Can celled and for which the revie w status i s Not Revi ewed or Re view in Pr ocess. | |
7892 | ||
7893 | ||
7894 | If someone else is w orking on a claim in CSA, it w ill not di splay in M CS. Only o ne user ca n be in MC S at a tim e. The fol lowing mes sage will be display ed: Sorry, another u ser is cur rently usi ng the MCS option. P lease try again late r. | |
7895 | ||
7896 | Once the i nitial lis t has been built, us ers may fu rther refi ne their s earch or w ork from t he default list. | |
7897 | ||
7898 | ||
7899 | The purpos e of MCS i s to selec t multiple claims an d then app ly the sam e action t o all the selected c laims. For example, users can enter a co mment once and then apply the comment to 1-n claim s. | |
7900 | ||
7901 | Other acti ons availa ble on the MCS inclu de: | |
7902 | Message Se arch – All ows the us er to chan ge the cri teria upon which the list of c laims will be built | |
7903 | Change Rev iew Status – Same as CSA | |
7904 | Cancel Cla ims – Same as CSA | |
7905 | Enter Comm ent – Same as CSA | |
7906 | Resubmit b y Print – Same as CS A | |
7907 | Retransmit Bill – Sa me as CSA | |
7908 | Select/Des elect Clai ms – Allow s users to select th e claims t o which th ey want to apply an action | |
7909 | ||
7910 | ||
7911 | When using the Resub mit by Pri nt action, the claim s selected will not be removed from the list of cl aims until the claim s have act ually been printed. | |
7912 | ||
7913 | Electronic Report Di sposition | |
7914 | ||
7915 | What is th e purpose of this op tion? | |
7916 | This optio n allows t he site to determine which cle aringhouse generated electroni c messages /reports a re to be s ent to the EDI mail group and which shou ld be igno red. | |
7917 | ||
7918 | When is th is option used? | |
7919 | The defaul t setting on this re port will contain a dispositio n of “Mail Report to Mail Grou p”. It is up to the individual site’s su pervisory staff to d etermine w hat report s should b e ignored. | |
7920 | ||
7921 | ||
7922 | Further ex planations of these reports ar e availabl e in docum ents provi ded by the clearingh ouse. They are entit led Claim Submitter Reports – Providers Reference Guide. | |
7923 | ||
7924 | The follow ing report s should b e reviewed when they are recei ved. They contain in formation that canno t be trans lated into claim sta tus messag es therefo re, this i nformation is not av ailable in CSA. | |
7925 | ||
7926 | R000NETWOR K NEWS | |
7927 | Provides n ews on sys tem proble ms, update s and othe r pertinen t informat ion. | |
7928 | ||
7929 | RPT-02 F ILE STATUS REPORT | |
7930 | Provides a n initial analysis o f the file by displa ying file status of accepted o r rejected and a des cription o f the stat us. It al so indicat es the tot al number of claims and the do llar value if the fi le contain s valid cl aims. | |
7931 | ||
7932 | RPT-03 F ILE SUMMAR Y REPORT | |
7933 | Provides s ummarized informatio n on the q uantity of accepted, rejected, and pendi ng claims, as well a s the tota l number o f claims r eceived by the clea ringhouse for each s ubmitted f ile. | |
7934 | ||
7935 | RPT-08 P ROVIDER MO NTHLY SUMM ARY | |
7936 | Displays t he number and dollar value of claims acc epted and forwarded by the cle aringhouse for the m onth. Mon thly and Y -T-D Total s for both accepted and reject ed claims are includ ed as well as the pr ovider’s t op 25 erro rs for the month. | |
7937 | ||
7938 | The follow ing report s contain informatio n that is also trans lated into status me ssages and displayed on CSA. | |
7939 | ||
7940 | RPT-04 F ILE DETAIL SUMMARY R EPORT | |
7941 | Contains a detail su mmary of t he file su bmitted fo r processi ng. It pr ovides a f ile roll-u p listing of all acc epted, rej ected, and pending c laims cont ained in e ach file s ubmitted t o the clea ringhouse. It also contains p ayer name/ id and sta tus of cla im. | |
7942 | ||
7943 | RPT-04A AMENDED FI LE DETAIL SUMMARY RE PORT | |
7944 | Contains a detailed listing of all claim s for whic h the stat us was ame nded durin g the prev ious proce ssing day. Claims s tatuses ar e amended when a pen ding claim is proces sed and/or a claim i s reproces sed at the clearingh ouse. | |
7945 | ||
7946 | RPT-05 B ATCH & CLA IM LEVEL R EJECTION R EPORT | |
7947 | Contains r ejected ba tches and claims lis ted with d etailed er ror explan ations. I n order to prevent “ lost” clai ms, the RP T-05 repor t must be reviewed a nd worked after each file tran smission. | |
7948 | ||
7949 | RPT-05A AMENDED BA TCH & CLAI M LEVEL RE JECTION RE PORT | |
7950 | Contains r ejected ba tches and claims lis ted with d etailed er ror explan ations. I n order to prevent “ lost” clai ms, the RP T-05A repo rt must be reviewed and worked after eac h file tra nsmission. | |
7951 | ||
7952 | RPT-10 P ROVIDER CL AIM STATUS | |
7953 | This repor t contains informati on provide d from pay ers who ar e receivin g claims f or adjudic ation from the clear inghouse. Not all p ayers who process cl aims throu gh the cle aringhouse system pr ovide info rmation fo r this Pro vider Clai m Status R eport and the amount /frequency of inform ation prod uced will vary from payer to p ayer. | |
7954 | ||
7955 | RPT-11 S PECIAL HAN DLING/UNPR OCESSED CL AIMS REPOR T | |
7956 | This repor t contains informati on provide d from pay ers who ar e receivin g claims f or adjudic ation from the clear inghouse. Not all p ayers who process cl aims throu gh the cle aringhouse system pr ovide info rmation fo r this Pro vider Clai m Status R eport and the amount /frequency of inform ation prod uced will vary from payer to p ayer. The RPT-11 ret urns Unpro cessed, Re quest for Additional Informati on, and Re jected sta tuses only . | |
7957 | EDI Cl aim Status Report- S ynonym: EC S | |
7958 | ||
7959 | What is th e purpose of this re port? | |
7960 | View elect ronic tran smission s tatus to a ssure clai ms move th rough the system in a timely f ashion. | |
7961 | ||
7962 | When is th is option used? | |
7963 | It is reco mmended th at initial ly this re port be vi ewed daily as it pro vides tran smission s tatus of a ll claims that were transmitte d to FSC. Once a com fort zone is establi shed and e verything is flowing correctly , this rep ort may on ly need to be run mo nthly. | |
7964 | ||
7965 | Reports ca n be creat ed based o n: | |
7966 | Specific C laim or Se arch Crite ria | |
7967 | Division | |
7968 | Payer | |
7969 | Transmissi on Date ra nge | |
7970 | EDI Status | |
7971 | ||
7972 | Reports ca n be sorte d by: | |
7973 | Transmissi on Date | |
7974 | Payer | |
7975 | EDI Status | |
7976 | Current Ba lance | |
7977 | Division | |
7978 | Claim Numb er | |
7979 | AR Status | |
7980 | Age | |
7981 | ||
7982 | Possible E DI claim s tatuses in clude: | |
7983 | Ready for Extract | |
7984 | Pending Au stin Recei pt | |
7985 | Accepted b y Non-Paye r | |
7986 | Accepted P ayer | |
7987 | Error Cond ition | |
7988 | Cancelled | |
7989 | Corrected/ Retransmit ted | |
7990 | Closed | |
7991 | Additional Reports a nd Options | |
7992 | Ready for Extract St atus Repor t - Synony m: REX | |
7993 | ||
7994 | What is th e purpose of this re port? | |
7995 | This repor t provides a list of claims he ld in a Re ady for Ex tract stat us. These claims are held in a queue unt il batch p rocessing occurs. | |
7996 | ||
7997 | When is th is option used? | |
7998 | Initially this optio n is used to assure claims are being tra nsmitted a t the time s set in t he MCCR Si te Paramet ers. This option sho uld by rev iewed dail y until th ere is a c omfort lev el with th e transmis sion timef rames and then less frequently based on local expe rience. | |
7999 | ||
8000 | Claims tha t are trap ped due to the EDI p arameters being turn ed off can also be v iewed. It is rare th at EDI is turned off during pr ocessing. If this oc curs, use EXT Extrac t Status M anagement to Cancel or Cancel/ Clone/Auth the trapp ed claims. | |
8001 | ||
8002 | Choices to view are: | |
8003 | 1All bills in Ready for Extrac t status | |
8004 | 2Bills tra pped due t o EDI para meter bein g turned o ff | |
8005 | (If EDI is on, no bi lls will b e trapped in extract ) | |
8006 | Transmit E DI Bills – Manual - Synonym: S END | |
8007 | ||
8008 | What is th e purpose of this op tion? | |
8009 | This optio n is used to by-pass the norma l daily/ni ghtly tran smission q ueues if t he need ar ises to ge t the clai m to the p ayer quick ly. | |
8010 | ||
8011 | When is th is option used? | |
8012 | There are occasions when there is a need to transm it a claim (s) immedi ately inst ead of wai ting for t he batchin g frequenc y as sched uled in th e MCCR Sit e Paramete r. This op tion will allow send ing indivi dual claim (s) or all claims in a ready f or extract status. | |
8013 | ||
8014 | Select one of the fo llowing: | |
8015 | ATransmit (A)LL bill s in READY FOR EXTRA CT status | |
8016 | STransmit only (S)EL ECTED bill s | |
8017 | EDI Return Message M anagement Menu – Syn onym: MM | |
8018 | This menu contains t he options needed to define th e types of electroni c reports from the c learinghou se that th e site nee ds to see and define s the text that shou ld/should not allow automatic review and filing fo r informat ional stat us message s. It also contains an option to purge o ld status messages, reports fo r maintain ing the in tegrity of the retur n message subsystem and the op tion for r eviewing e lectronica lly return ed message s. | |
8019 | EDI Messag e Text to Screen Mai ntenance | |
8020 | ||
8021 | What is th e purpose of this op tion? | |
8022 | This optio n controls what stat us and/or error mess ages users may wish to review using spec ial text w ords and/o r phrases. This will either re quire the message to be review ed or it w ill auto-f ile the me ssage and flag it as not needi ng a revie w. | |
8023 | ||
8024 | This optio n allows f or the dis play of a list of wo rds or phr ases that, if found in the tex t of an in formationa l status m essage, wi ll either always req uire the m essage to be reviewe d or will auto-file the messag e and flag it as not needing a review. | |
8025 | ||
8026 | When is th is option used? | |
8027 | Depending on what ty pes of sta tus messag es users w ish to rev iew for fo llow-up on rejected claims and /or monito ring claim s status, users may want to ad d or edit additional text as n eeded. | |
8028 | ||
8029 | The words and phrase s for “Req uiring Rev iew” and “ Not Requir ing Review ” will ini tially pop ulate as s hown in th e screen p rint below . This opt ion is use d to edit or add mor e words or phrases, as require d, to mana ge and con trol the s tatus mess ages. | |
8030 | EDI Messag es Not Rev iewed Repo rt | |
8031 | ||
8032 | What is th e purpose of this re port? | |
8033 | This optio n allows f or the dis play of al l EDI retu rn message s that wer e filed wi thout need ing a revi ew based o n the text entries i n the mess age screen text file . | |
8034 | ||
8035 | When is th is option used? | |
8036 | The report can be ru n for a us er-selecte d date ran ge, based on the dat e the mess age was re ceived at the site, and may be sorted by the messa ge text th at caused the messag e to not n eed a revi ew or by t he bill nu mber. User s may want to use th is option for analys is or revi ew of all EDI messag es that th ey were no t able to view initi ally. | |
8037 | Electronic Error Rep ort | |
8038 | ||
8039 | What is th e purpose of this re port? | |
8040 | This repor t provides a tool fo r billing supervisor s and staf f to ident ify the “w ho, what, and where” of errors in the el ectronic b illing pro cess. This is a repo rt that wi ll allow t he supervi sory staff to review “frequent ly receive d” errors. This is a n informat ional mana gement too l requirin g no actio ns on the part of th e billing staff. | |
8041 | ||
8042 | When is th is option used? | |
8043 | This optio n can be u sed at any time by a superviso r or other managemen t staff wh en they wa nt to dete rmine the reason for various e rrors (i.e ., the sam e error be ing made b y one or m ore of the billing s taff). The report ca n be sorte d by: | |
8044 | AAUTHORIZI NG BILLER | |
8045 | BBILLED AM OUNT | |
8046 | EEPISODE O F CARE | |
8047 | PPATIENT N AME | |
8048 | SPATIENT S SN | |
8049 | YPAYER NAM E | |
8050 | CERROR COD E | |
8051 | Return Mes sages Fili ng Excepti ons | |
8052 | ||
8053 | What is th e purpose of this op tion? | |
8054 | After user s have tra nsmitted c laims and they have been recei ved for ED I processi ng, a mess age will b e sent to the mail g roups show n in the s et-up sect ion of thi s manual. | |
8055 | ||
8056 | When is th is option used? | |
8057 | When a mes sage is se nt, it is temporaril y stored i n the “EDI MESSAGES” file. Nor mally, the se message s are in a nd out of this file in a matte r of secon ds. If, ho wever, a p roblem is detected a nd a messa ge cannot be filed i n the appr opriate fi le (s) for its messa ge type, t he message will rema in in this temporary file. | |
8058 | There are two (2) st atuses for messages in this fi le. | |
8059 | Pending: T he task to force a m essage to update the IB files has either not yet b een create d or has b een create d, but has not yet b egun to ru n. | |
8060 | Updating: The task t o force a message to update th e IB files has start ed. It may or may no t still be running. If you try to file a message w ith this s tatus, a c heck is ma de to see if it is c urrently r unning. If it is, th e message will not b e re-taske d. | |
8061 | ||
8062 | Any messag e may be v iewed or p rinted. Th is does no t affect t he message in any wa y, but loo king at th e message may help t o indicate the next course of action nee ded. | |
8063 | ||
8064 | There are two (2) ac tions avai lable to g et these m essages ou t of the f ile. | |
8065 | File Messa ge: This a ction re-e xecutes th e tasked j ob to upda te the dat abase with the conte nts of the message. | |
8066 | Delete Mes sage: This is a dras tic action that shou ld only be taken whe n it has b een determ ined there is no oth er possibl e way to p rocess a m essage. Wh en a messa ge is dele ted using this actio n, a bulle tin is sen t to the I B EDI Mail Group wit h the text of the me ssage and the name o f the user who delet ed the mes sage. User s must hol d the IB S UPERVISOR security k ey to perf orm this a ction. | |
8067 | Status Mes sage Manag ement | |
8068 | ||
8069 | What is th e purpose of this op tion? | |
8070 | This optio n allows u sers to pr int/purge electronic ally retur ned status messages that have been in a final revi ew status for a user -selected number of days. | |
8071 | ||
8072 | When is th is option used? | |
8073 | There will be an acc umulation of status messages i n a final review sta tus. This option wil l delete o r purge st atus messa ges in one of the Fi nal Review statuses prior to a selected date. Auto purging o f messages can also be set in the IB Sit e Paramete rs. | |
8074 | ||
8075 | This repor t can be s orted by: | |
8076 | AALL STATU S MESSAGES | |
8077 | SSELECTED STATUS MES SAGES | |
8078 | ||
8079 | Selected s tatus mess age report s can be r un showing : | |
8080 | AAuto File d/No Revie w Only | |
8081 | BBill Numb er | |
8082 | SMessage S everity | |
8083 | TSpecific Message Te xt | |
8084 | Bills Awai ting Resub mission – Synonym: B AR | |
8085 | ||
8086 | What is th e purpose of this re port? | |
8087 | This repor t lists al l batches that have been resub mitted but which did not inclu de all of the bills from the o riginal ba tch. These are batch es that ha ve at leas t one bill still not resubmitt ed or canc eled. | |
8088 | ||
8089 | When is th is option used? | |
8090 | When a bat ch is iden tified to have a cla im in erro r, the bat ch may be re-submitt ed with th e claim in error rem oved. This option wi ll track a nd report specific b ills in th is categor y. The rep ort can so rt data by : | |
8091 | BBILL NUMB ER | |
8092 | LLAST SENT DATE | |
8093 | ABILLED AM OUNT | |
8094 | NBATCH NUM BER (LAST SENT IN) | |
8095 | ||
8096 | The report also indi cates the “Bill Tran smission S tatus”. | |
8097 | EDI Messag es Not Yet Filed –Sy nonym: MP | |
8098 | ||
8099 | What is th e purpose of this re port? | |
8100 | This repor t allows y ou to sele ct receipt , rejectio n or both message ty pes and a minimum nu mber of da ys these m essages ha ve been in a PENDING or UPDATI NG status before the y will be included o n the repo rt. The re port will then list all messag es in the file that meet these criteria. | |
8101 | ||
8102 | When is th is option used? | |
8103 | This is a status rep ort that a llows for review of messages n ot yet fil ed. | |
8104 | Pending Ba tch Transm ission Sta tus Report – Synonym : PBT | |
8105 | ||
8106 | What is th e purpose of this re port? | |
8107 | This repor t shows th e current transmissi on status of a batch 's mail me ssage. It also inclu des the ma il message number; t he first a nd last da te/time it was sent. Only batc hes in a p ending tra nsmission status wil l be on th is report. | |
8108 | ||
8109 | When is th is option used? | |
8110 | This is an other opti on to trac k the batc h(s) of cl aims after authorizi ng and tra nsmission to be sure all batch es transmi tted have been recei ved in Aus tin. Users can omit both the s tation num ber prefix at the fr ont of the batch num ber and th e followin g zeroes a nd use onl y the fina l digits o f the batc h number f or lookup. | |
8111 | EDI Batche s Pending Receipt– S ynonym: PN D | |
8112 | ||
8113 | What is th e purpose of this re port? | |
8114 | This repor t lists al l batches by batch n umber that have been in a PEND ING status and have not yet re ceived con firmation of receipt from Aust in for mor e than one (1) day. The report includes individual claims if the users choose to include t hem. | |
8115 | ||
8116 | The report includes: | |
8117 | Batch Numb er | |
8118 | Transmissi on Date | |
8119 | Mail Messa ge # | |
8120 | ||
8121 | Claims dis play the f ollowing: | |
8122 | Claim Numb er | |
8123 | Payer Sequ ence | |
8124 | Balance Du e | |
8125 | EDI Status | |
8126 | IB Status | |
8127 | AR Status | |
8128 | ||
8129 | EDI Batche s Pending Austin Rec eipt After 1 Day Page: 2 | |
8130 | Run Date: 01/07/2008 @14:44:28 | |
8131 | ||
8132 | Batch # Tran smission D ate Mail Mes sage # | |
8133 | --------- ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
8134 | ||
8135 | Claim Seq Bal Due EDI Stat IB Stat us AR Status | |
8136 | K600K QD P 198.54 P PRNT/TX NEW BILL | |
8137 | K600N EU P 76.36 P PRNT/TX NEW BILL | |
8138 | K600Q R2 P 305.11 P PRNT/TX NEW BILL | |
8139 | K600W S7 P 76.36 P PRNT/TX NEW BILL | |
8140 | K600W SF P 880.71 P PRNT/TX NEW BILL | |
8141 | ||
8142 | 44200295 90 03/2 9/2006@21: 05:33 1321 | |
8143 | ||
8144 | Claim Seq Bal Due EDI Stat IB Stat us AR Status | |
8145 | K600F N7 P 76.36 P REQUEST MRA BIL L INCOMPLE TE | |
8146 | K600I PF P 73.01 P REQUEST MRA BIL L INCOMPLE TE | |
8147 | K600W SA P 4390.06 P REQUEST MRA BIL L INCOMPLE TE | |
8148 | K600W SK P 73.01 P REQUEST MRA BIL L INCOMPLE TE | |
8149 | ||
8150 | Enter ENTE R to conti nue or '^' to exit: | |
8151 | ||
8152 | ||
8153 | Members of the G.IB EDI mail g roup will receive an email mes sage when there are batches of claims th at have no t received a confirm ation mess age from A ustin afte r 1 day. | |
8154 | ||
8155 | ||
8156 | Subj: EDI BATCHES WA ITING AUST IN RECEIPT FOR OVER 1 DAY [#2 1387] | |
8157 | 06/19/04@1 9:02 6 li nes | |
8158 | From: XXXX XXXXXXX,XX XX X In ' IN' basket . Page 1 *New* | |
8159 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
8160 | There are 30 EDI bat ch(es) sti ll pending Austin re ceipt | |
8161 | for more t han 1 day. Please i nvestigate why they have not y et been co nfirmed | |
8162 | as being r eceived by Austin. | |
8163 | ||
8164 | Since ther e were mor e than 10 batches fo und, pleas e run the | |
8165 | EDI BATC HES WAITIN G FOR AUST IN RECEIPT OVER 1-DA Y report t o get a li st of the | |
8166 | se batches . | |
8167 | ||
8168 | Enter mess age action (in IN ba sket): Del ete// | |
8169 | ||
8170 | When is th is option used? | |
8171 | Users may use this o ption to o btain Batc h or Messa ges number s when a p roblem ari ses or to monitor th e status o f batches recently t ransmitted . Batches should not be in a “ Pending Au stin Recei pt” status for more than a day . | |
8172 | ||
8173 | ||
8174 | Contact IR M for assi stance in finding ou t why a co nfirmation message h as not bee n received from Aust in. | |
8175 | ||
8176 | Before con tacting IR M, note th e Message Numbers fo r the batc hes that y ou need in vestigated . These nu mbers can be found i n the PND option. | |
8177 | ||
8178 | If IRM nee ds assista nce, log a REMEDY ti cket or ca ll the Nat ional Help Desk at 1 -888-596-4 357. | |
8179 | ||
8180 | View/Print EDI Bill Extract Da ta – Synon ym: VPE | |
8181 | ||
8182 | What is th e purpose of this op tion? | |
8183 | This optio n displays the EDI e xtract dat a for a bi ll. | |
8184 | ||
8185 | When is th is option used? | |
8186 | This optio n is used only if th ere is a n eed to det ermine wha t data was transmitt ed for a s pecific bi ll. The de tailed ext ract data will conta in all the elements in the fla t file tha t is trans mitted to FSC. FSC, in turn, t ranslates the data t o a HIPAA- compliant format for transmiss ion to the clearingh ouse. | |
8187 | Insurance Company ED I Paramete r Report – Synonym: EPR | |
8188 | ||
8189 | What is th e purpose of this op tion? | |
8190 | This optio n will dis play the E DI Paramet ers of the Active In surance Co mpanies de fined in V ista. | |
8191 | ||
8192 | The conten ts of the following parameters will be i ncluded in this repo rt: | |
8193 | Insurance Company Na me | |
8194 | Street Add ress and C ity of Ins urance Com pany | |
8195 | Electronic Transmit? | |
8196 | Institutio nal Electr onic Bill ID | |
8197 | Profession al Electro nic Bill I D | |
8198 | HPID/OEID | |
8199 | Electronic Type | |
8200 | Type of Co verage | |
8201 | Always Use main VAMC as Billin g Provider | |
8202 | ||
8203 | ||
8204 | ||
8205 | All Compan ies Insuranc e Company EDI Parame ter Report Page: 1 | |
8206 | Sorted By Ins Compan y Name Mar 02, 2015@1 0:30:28 | |
8207 | Only Blank or 'PRNT' Bill ID's = NO | |
8208 | '*' indica tes the HP ID/OEID fa iled valid ation chec ks | |
8209 | Electro n Inst P rof HPID/ Electroni c | |
8210 | Insurance Company Na me Street Address Ci ty Transmi t ID ID OEID Type Covera ge Type | |
8211 | ========== ========== ========== ========== ========== ========== ========== ========== ========== =======INS URANCE COM PANY ONE PO BOX 141 159 XXX,OH YES-L 8 XXXX 8XXXX 799999999 9 GROUP PL AN HEALTH INS… | |
8212 | INSURANCE COMPANY TW O PO BOX 30101 XXX ,UT YES-L 699999 9999* OTHE R HEAL TH INS… | |
8213 | ||
8214 | When is th is option used? | |
8215 | This optio n can be u sed whenev er there i s a need t o confirm that the I nsurance C ompany par ameters ar e correctl y defined to support the elect ronic tran smission o f claims. This optio n will be of value w hen the eC laims Plus patches a re loaded and sites gain the a bility to transmit s econdary c laims to t he payers (electroni c, end-to- end proces sing). Exa mple: Site s can use this optio n to make sure the p ayers’ Ele ctronic Bi ll IDs are defined. | |
8216 | Test Claim EDI Trans mission Re port – Syn onym: TCS | |
8217 | ||
8218 | What is th e purpose of this op tion? | |
8219 | The Claim Status Mes sages for claim(s) a nd batch(e s) submitt ed via the RCB optio n as Test claims wil l not appe ar in CSA. No action will be r equired in response to these m essages. F or informa tional pur poses, the se message s will be available through th e Test Cla im EDI Tra nsmission Report. Th is option can be use d to inves tigate the status of test clai ms to see, for examp le, whethe r the tran smission w as accepte d/rejected by FSC or accepted/ rejected b y the clea ringhouse. | |
8220 | ||
8221 | ||
8222 | The messag es in this option wi ll be auto matically purged aft er 60 days . | |
8223 | ||
8224 | When is th is option used? | |
8225 | This optio n can be u sed whenev er a user needs to i nvestigate the curre nt status of a claim or batch of claims. The messa ges in thi s report w ill be lik e the mess ages in TP JI. | |
8226 | ||
8227 | Test Claim EDI Trans mission Re port Page: 1 | |
8228 | Selected B atches Ma r 22, 2005 @12:14:38 | |
8229 | ========== ========== ========== ========== ========== ========== ========== ========== | |
8230 | ||
8231 | Batch#: 6 050011719 | |
8232 | Claim#: K 404XXX IB, Patient7 (1500, Prof, Out pat) | |
8233 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | |
8234 | Transmissi on Informa tion | |
8235 | 03/17/200 5@11:11:25 Bch#1171 9 IB,Cler k2 CIGNA HEALTHCAR E (S) | |
8236 | ||
8237 | Third Part y Joint In quiry – Sy nonym: TPJ I | |
8238 | ||
8239 | What is th e purpose of this op tion? | |
8240 | This optio n provides a conveni ent locati on for bot h claim, A R, Insuran ce and EDI data rela ted to a c laim. | |
8241 | ||
8242 | When is th is option used? | |
8243 | This optio n is used by both In tegrated B illing and Accounts Receivable personnel who requi re informa tion about a claim. Both AR an d IB users can also add commen ts to an M RA Request or non-MR A Request claim usin g this opt ion. | |
8244 | ||
8245 | The follow ing action s are avai lable from TPJI: | |
8246 | BCBill Cha rges | |
8247 | DXBill Dia gnosis | |
8248 | PRBill Pro cedures | |
8249 | CBChange B ill | |
8250 | EDEDI Stat us | |
8251 | ARAccount Profile | |
8252 | CMComment History | |
8253 | IRInsuranc e Reviews | |
8254 | HSHealth S ummary | |
8255 | ALActive L ist | |
8256 | VIInsuranc e Company | |
8257 | VPPolicy | |
8258 | ABAnnual B enefits | |
8259 | ELPatient Eligibilit y | |
8260 | ||
8261 | ||
8262 | Patch IB*2 *377 inclu ded change s to allow the addit ion of and the viewi ng of MRA Request cl aim commen ts using T PJI. Comme nt History now perta ins to MRA Request c laims as w ell as reg ular claim s. MRA Req uest claim comments are not st ored as AR comments though. | |
8263 | ||
8264 | Note: Patc h IB*2*516 changed t he lists o f Active a nd Inactiv e claims t o display the claim type of ei ther Insti tutional o r Professi onal in ad dition to Inpatient, Inpatient Humanitar ian, Outpa tient, or Outpatient Humanitar ian. Patch IB*2*592 further ch anged the lists of A ctive and Inactive c laims to d isplay the additiona l claim ty pe of Dent al. | |
8265 | ||
8266 | Note: Patc h IB*2*516 also adde d the abil ity for us ers to vie w related claims for which the patient i s responsi ble, when reviewing Claim Info rmation fo r a select ed claim. | |
8267 | ||
8268 | Note: Afte r Patch IB *2*547 is installed, the sourc e of a cla im status message wi ll include the name of the cle aringhouse when the clearingho use is the source. | |
8269 | ||
8270 | Note: Afte r Patch IB *2*547 is installed, users wil l be able to view th e comments that were added to an entry o n the new RFAI Manag ement Work list in th e comment section of the TPJI. | |
8271 | ||
8272 | Note: Afte r Patch IB *2*547 is installed, users wil l be able to view th e complete and curre nt textual descripti on associa ted with t he Claims Adjustment Reason Co des/Remitt ance Advic e Remark C odes (CARC /RARC) rec eived in a n electron ic EOB. | |
8273 | ||
8274 | Patch IB*2 *488 modif ied the wa y message storage er rors (crea ted when a n EEOB or MRA is rec eived and all the li ne items c annot be m atched cor rectly) ar e displaye d in TPJI. Internal MUMPS cod e will no longer be displayed to the use rs. | |
8275 | ||
8276 | The Follow ing types of errors will be di splayed: | |
8277 | Procedure Code misma tch | |
8278 | Procedure Modifier m ismatch | |
8279 | Revenue Co de mismatc h | |
8280 | Charge Amo unt mismat ch | |
8281 | Number of Units mism atch | |
8282 | ||
8283 | Claim Info rmation Nov 25, 20 13@14:56:0 2 Page: 1 of 2 | |
8284 | %K101XXX IB,PATIEN T 123 IXXXX DOB: X X/XX/XX Subsc ID: XXXXXXXXX | |
8285 | ||
8286 | Insuranc e Demograp hics Subscrib er Demogra phics | |
8287 | Bill P ayer: IB I NSURANCE C O Group N umber: GRP PLN XXXXX | |
8288 | Claim Add ress: PO B OX XXXXX Group Name: STA TE OF WY | |
8289 | CHEY ENNE, WY 8 20031234 Subscrib er ID: XXX XXXXXXX | |
8290 | Claim P hone: 800/ XXX-XXXX Emp loyer: STA TE OF WYO | |
8291 | Insured's Name: IB, PATIENT 12 3 | |
8292 | Relatio nship: PAT IENT | |
8293 | C laim Infor mation | |
8294 | Bill Typ e: OUTPATI ENT Charge Type: INS TITUTIONAL | |
8295 | Time Fram e: ADMIT T HRU DISCHA RGE Service Dates: XX/ XX/XX – XX /XX/XX | |
8296 | Rate Typ e: REIMBUR SABLE INS. Orig Claim: 145.49 | |
8297 | AR Statu s: ACTIVE Balanc e Due: 145.49 | |
8298 | + |% EEOB | Enter ?? f or more ac tions| | |
8299 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | |
8300 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | |
8301 | PR Bill P rocedures IR Insurance Reviews AB Annu al Benefit s | |
8302 | CB Change Bill HS Health Sum mary EL Pati ent Eligib ility | |
8303 | ED EDI St atus AL Go to Acti ve List EB Expa nd Benefit s | |
8304 | RX ECME I nformation EX Exit | |
8305 | Select Act ion: Next Screen// B C Bill C harges | |
8306 | DO YOU WAN T ALL EEOB DETAILS?: NO// Y | |
8307 | ||
8308 | The type o f mismatch error and the value s that wer e in the o utbound 83 7 transact ion will b e displaye d along wi th the val ues that w ere receiv ed in the inbound 83 5 transact ion. | |
8309 | ||
8310 | Bill Charg es Apr 14, 20 14@16:27:1 8 Page: 7 of 8 | |
8311 | K101EVT IB,PATIENT MRA I432 1 DOB: 12/0 1/66 Sub sc ID: 011 871234A | |
8312 | 04/10/14 - 04/10/14 AD MIT THRU D ISCHARGE Ori g Amt: 0.0 0 | |
8313 | + | |
8314 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ----- | |
8315 | VistA coul d not matc h all of t he Line Le vel data r eceived in the EEOB | |
8316 | (835 Recor d 40) to t he claim i n VistA. | |
8317 | ||
8318 | Mismatched Procedure Code: | |
8319 | ||
8320 | Payer repo rted the f ollowing w as billed via the Cl aim (837): | |
8321 | Proc:7 1010 Mods :59 Rev C d:324 Chg :227.40 U nits:1 | |
8322 | Payer repo rted adjud ication vi a the EOB (835) as f ollows: | |
8323 | Proc:7 1015 Mods :59 Rev C d:324 Chg :227.40 U nits:1 | |
8324 | Amt:10 0.00 | |
8325 | ||
8326 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
8327 | Service li ne adjustm ent (EEOB Record 41) has no ma tching ser vice line | |
8328 | Allowe d Amt: 114 .80 Per D iem Amt: 0 .00 | |
8329 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
8330 | Service li ne adjustm ent (EEOB Record 45) has no ma tching ser vice line | |
8331 | + |% EEOB | Enter ?? f or more ac tions| | |
8332 | PR Bill P rocedures CM Comment Hi story AB Annu al Benefit slity | |
8333 | CI Go to Claim Scre en IR Insurance Reviews EL Pati ent Eligib ility | |
8334 | HS Health Sum mary EX Exit | |
8335 | ED EDI St atus AL Go to Acti ve List | |
8336 | VI Insurance Company | |
8337 | Select Act ion: Next Screen// | |
8338 | Re-generat e Unbilled Amounts R eport | |
8339 | ||
8340 | What is th e purpose of this op tion? | |
8341 | This optio n provides some basi c informat ion about billable e vents that have not yet been b illed to a payer and dollar am ounts asso ciated wit h billable events in a specifi ed time-fr ame. | |
8342 | ||
8343 | When is th is option used? | |
8344 | This optio n can be u sed to vie w the numb er of inpa tient or o utpatient care event s and/or p rescriptio ns that ha ve not bee n billed a nd the dol lar amount s attribut ed to the events. | |
8345 | ||
8346 | Subj: UNBI LLED AMOUN TS SUMMARY REPORT [ #197848] 0 6/23/14@12 :41 34 li nes | |
8347 | From: INTE GRATED BIL LING PACKA GE In 'IN ' basket. Page 1 *New* | |
8348 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- --------- | |
8349 | SUMMARY UN BILLED AMO UNTS FOR C HEYENNE VA MC (442). | |
8350 | PERIOD: FR OM 09/01/0 4 TO 09/30 /06 | |
8351 | DETAILED R EPORT PRIN TED TO '/d ev/pts/5' | |
8352 | ||
8353 | Inpatient Care: | |
8354 | Number of Unbille d Inpatien t Admissio ns : 0 | |
8355 | Number of MRA Unb illed Inpt Admission s : 2 | |
8356 | Number of Inpt. I nstitution al Cases : 0 | |
8357 | Average Inpt. Ins titutional Bill Amou nt : 15 321.18 | |
8358 | Number of Inpt. P rofessiona l Cases : 0 | |
8359 | Average Inpt. Pro fessional Bill Amoun t : 1 036.36 | |
8360 | Total U nbilled In patient Ca re : 0.00 | |
8361 | Total M RA Unbille d Inpatien t Care : 0.00 | |
8362 | ||
8363 | ||
8364 | Note: Patc h IB*2*547 provided the abilit y for user s to run t his report by divisi on (one or more) or not and to sort the report by division o r by patie nt name in alphabeti cal order. If users do search by divisio n, the Re- generate U nbilled Am ount Summa ry will di splay the summary to tals befor e the divi sion data. The displ ay of CPT codes and monetary a mounts for outpatien t claims h as also be en restore d. | |
8365 | ||
8366 | Note: Patc h IB*2*608 provided the abilit y for user s to run t his report by MCCF, Non-MCCF ( Outpatient Only), or Both. The Non-MCCF (Outpatien t Only) re port will display th e type of claims bas ed on the eligibilit y (CHAMPVA , Tricare, Employee, Ineligibl e and Shar ing Agreem ent), the appointmen t type (Em ployee and Sharing A greement) or the rat e type (CH AMPVA Reim b. Ins., C HAMPVA, Tr icare Reim b. Ins., T ricare, In teragency, Ineligibl e and Shar ing Agreem ent) | |
8367 | ||
8368 | Do you wan t to store Unbilled Amounts fi gures? NO/ / | |
8369 | ||
8370 | Search by Division?? NO// | |
8371 | ||
8372 | Search by (M)CCF, (N )on-MCCF ( Outpatient Only), or (B)oth? M // b Both | |
8373 | Start with DATE: 08/ 23/1966// t-1000 (F EB 07, 201 3) | |
8374 | Go to DATE: 11/ 04/2015// (NOV 04, 2015) | |
8375 | ||
8376 | Choose rep ort type(s ) to print : | |
8377 | ||
8378 | 1 - INP ATIENT UNB ILLED | |
8379 | 2 - OUT PATIENT UN BILLED | |
8380 | 3 - PRE SCRIPTION UNBILLED | |
8381 | 4 - ALL OF THE AB OVE | |
8382 | ||
8383 | Select: ( 1-4): 4// | |
8384 | ||
8385 | You have s elected | |
8386 | ||
8387 | 4 - AL L OF THE A BOVE | |
8388 | ||
8389 | Are you su re? NO// y YES | |
8390 | ||
8391 | Print deta il report with the U nbilled Am ounts summ ary? NO// y | |
8392 | Patient Bi lling Inqu iry – Syno nym: INQU | |
8393 | ||
8394 | What is th e purpose of this op tion? | |
8395 | This optio n provides some basi c informat ion about a particul ar claim. It is a si mple inqui ry option. | |
8396 | ||
8397 | When is th is option used? | |
8398 | This optio n can be u sed to vie w the foll owing type of inform ation rela ted to a b ill: | |
8399 | Bill Statu s | |
8400 | Rate Type | |
8401 | Form Type (UB04/CMS- 1500 and J 430D) | |
8402 | Visit Date (s) | |
8403 | Charges | |
8404 | AR Status | |
8405 | Statement Dates | |
8406 | Dates rela ted to act ions such as Entered , Cancelle d or Print ed | |
8407 | Bill Numbe r copied f rom or to | |
8408 | Patient, M ailing and Insurance Company a ddress | |
8409 | ||
8410 | The data a vailable v aries base d upon whe n the inqu iry is mad e and what actions h ave been c arried out regarding the claim | |
8411 | Printed Cl aims Repor t | |
8412 | ||
8413 | What is th e purpose of this op tion? | |
8414 | This optio n provides informati on about c laims that are print ed locally but which had the p otential t o be trans mitted ele ctronicall y. The rep ort can be generated for eithe r the Cons olidated P atient Acc ount Cente rs (CPACs) or the si tes which process TR ICARE clai ms. | |
8415 | When is th is option used? | |
8416 | This repor t is used by billing personnel to monito r the prin ting of po tentially transmitta ble claims and displ ays the fo llowing in formation: | |
8417 | Biller | |
8418 | Outpatient /Inpatient and Insti tutional/P rofessiona l | |
8419 | Rate Type | |
8420 | Plan Type | |
8421 | Division | |
8422 | Revenue Co des | |
8423 | Insurance Company | |
8424 | ||
8425 | ||
8426 | Note: The revenue co des that d etermine w hether or not a prin ted claim will be in cluded in this repor t are defi ned in the IB Site P arameters. | |
8427 | ||
8428 | Note: Clai ms to the payer – De partment o f Labor an d certain types of r ate types and types of plans a re not inc luded in t his report because t hey do not have the potential to be tran smitted el ectronical ly. | |
8429 | ||
8430 | HCCH Payer ID Report | |
8431 | ||
8432 | What is th e purpose of this op tion? | |
8433 | ||
8434 | When the V HA sends a claim to the cleari ng house w ith no def ined Prima ry Payer I D (EDI - I nst Payer Primary ID ,EDI - Pro f Payer Pr imary ID a nd/or EDI- Dental Pay er Primary ID) and t he clearin ghouse has an electr onic ID fo r the paye r, they re turn the p ayer ID to the site. VistA aut omatically takes the ID and po pulates th e field in the Insur ance Compa ny file. T his option provides informatio n about th e updates or attempt ed updates to the In surance Co mpany file . | |
8435 | ||
8436 | If a value already e xists in V istA for t he Payer I D, no upda te will be made but the attemp t will be reported. | |
8437 | ||
8438 | When is th is option used? | |
8439 | This repor t is used by billing personnel to monito r the auto mated upda tes or upd ate attemp ts to the Insurance Company fi le when th e 277STAT reports ar e received from the clearingho use. The r eport prov ides the f ollowing d ata: | |
8440 | Insurance Company Na me | |
8441 | Insurance Company Ad dress | |
8442 | Date | |
8443 | Type of ID (Professi onal or In stitutiona l) | |
8444 | Old Value | |
8445 | New Value | |
8446 | Update Mad e (Yes/No) | |
8447 | ||
8448 | ||
8449 | HCCH Payer ID Report Jan 11, 2017@0 9:53:18 Page: 1 of 1 | |
8450 | Timeframe: 12/17/16 thru 01/11 /17 | |
8451 | ||
8452 | Insurance Co Address Dat e EDI -PayerID OldValue NewValue Updated | |
8453 | __________ __________ __________ __________ __________ __________ __________ __________ __________ _______ | |
8454 | AETNA PO BOX 229 5 FT. WAYN E INDI 12/ 28/16 Pro f XXXXXX Yes | |
8455 | AETNA HEAL TH PLANS PO BOX 123 40 FRESNO CALIFO 01/ 02/16 Den t XXXXXX Yes | |
8456 | BANKERS FI DELITY PO BOX 105 652 ATLANT A GEOR 12/ 19/16 Pro f XXXXXX XXXXXX No | |
8457 | MEDICARE ( WNR) PO BOX 660 159 DALLAS 01/ 01/17 Ins t XXXXX1 XXXXX2 No | |
8458 | ||
8459 | ||
8460 | ||
8461 | APPENDIX A – BATCH P ROCESSING SETUP | |
8462 | BATCH PROC ESSING SET UP | |
8463 | ||
8464 | The follow ing exampl e shows yo u how to d efine batc h processi ng for a p ayer: | |
8465 | ||
8466 | Step | |
8467 | Procedure | |
8468 | 1 | |
8469 | Under the IB Site Pa rameters, go to fiel d [15] EDI /MRA Activ ated. | |
8470 | 2 | |
8471 | Edit field s as neces sary (fiel ds are hig hlighted i n yellow f or this ex ample). | |
8472 | ||
8473 | Details on each fiel d follow t he screen example. | |
8474 | ||
8475 | When the M RA softwar e was load ed (Patch IB*2.0*155 ), the EDI /MRA Activ ated field was remov ed from th is screen. Only an I RM is able to access this fiel d via File Man. The r eason for this is to prevent M RA from be ing activa ted before the FSC i s ready to accept MR A transmis sions from a particu lar site. | |
8476 | ||
8477 | IB Site Pa rameters Aug 13, 20 03@10:22:4 6 Page: 5 of 6 | |
8478 | Only autho rized pers ons may ed it this da ta. | |
8479 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- - | |
8480 | ||
8481 | [15] EDI/M RA Activat ed : E DI | |
8482 | EDI C ontact Pho ne : | |
8483 | EDI 8 37 Live Tr ansmit Que ue : M CH | |
8484 | EDI 8 37 Test Tr ansmit Que ue : M CT | |
8485 | Auto- Txmt Bill Frequency : E very Day | |
8486 | Hours To Auto-T ransmit : 1 300;1600 | |
8487 | Max # Bills Per Batch : 5 0 | |
8488 | Only Allow 1 In s Co/Claim Batch?: N O | |
8489 | Last Auto-Txmt Run Date : 0 8/13/03 | |
8490 | Days To Wait To Purge Msg s : 1 20 | |
8491 | ||
8492 | ||
8493 | EDI/MRA Ac tivated: Controls w hether EDI is availa ble for th e site. | |
8494 | Choose fro m: | |
8495 | 0 - NO T EDI OR M RA; | |
8496 | 1 - EDI ON LY; | |
8497 | 2 – MRA ON LY; or | |
8498 | 3 – BOTH E DI AND MRA | |
8499 | ||
8500 | ||
8501 | This promp t is no lo nger acces sible to a nyone exce pt an IRM. | |
8502 | ||
8503 | IB Site Pa rameters May 27, 20 04@14:14:2 4 Page: 5 of 6 | |
8504 | Only autho rized pers ons may ed it this da ta. | |
8505 | + | |
8506 | HMO NUMBER : | |
8507 | STAT E INDUSTRI AL ACCIDEN T PROV: | |
8508 | LOCA TION NUMBE R : | |
8509 | ||
8510 | [15] EDI/M RA Activat ed : B OTH EDI AN D MRA | |
8511 | EDI C ontact Pho ne : 2 17-554-313 5 | |
8512 | EDI 8 37 Live Tr ansmit Que ue : M CH | |
8513 | EDI 8 37 Test Tr ansmit Que ue : M CT | |
8514 | Auto- Txmt Bill Frequency : E very Day | |
8515 | Hours To Auto-T ransmit : 1 000;1400;2 000 | |
8516 | Max # Bills Per Batch : 1 0 | |
8517 | Only Allow 1 In s Co/Claim Batch?: N O | |
8518 | Last Auto-Txmt Run Date : 0 5/26/04 | |
8519 | Days To Wait To Purge Msg s : 4 5 | |
8520 | Allow MRA Proce ssing? : Y ES | |
8521 | Enabl e Automati c MRA Proc essing?: Y ES | |
8522 | Allow Dental Cl aim Proces sing? : Y ES | |
8523 | ||
8524 | + Enter ?? f or more ac tions | |
8525 | EP Edit S et EX Exit Action | |
8526 | ||
8527 | EDI Contac t Phone: T he phone n umber of t he person at the sit e contact to whom ED I inquirie s will be directed. The Pay-to Provider telephone number tha t is defin ed in Sect ion 10 for each Pay- to Provide r, will be printed o n the UB04 and CMS-1 500 form s tarting wi th Patch I B*2.0*400. | |
8528 | ||
8529 | EDI 837 Li ve Transmi t Queue: T he name of the Austi n data que ue that wi ll receive claims to be proces sed via a live conne ction to t he clearin ghouse. Th ese data a re populat ed at the time of in stallation and would not norma lly be edi ted by the site. | |
8530 | ||
8531 | EDI 837 Te st Transmi t Queue: T he name of the Austi n data que ue that wi ll receive test clai ms. These data are p opulated a t the time of instal lation and would not normally be edited by the sit e. | |
8532 | ||
8533 | Auto Txmt Bill Frequ ency: The desired nu mber of da ys between each exec ution of t he automat ed bill tr ansmitter. For examp le, if the automated bill tran smitter sh ould run o nly once a week, thi s number w ould be 7. If the au tomated bi ll transmi tter shoul d run ever y night, t hen the nu mber shoul d be 1. If this is l eft blank or zero th en the aut omated bil l transmit ter backgr ound job w ill never run. | |
8534 | ||
8535 | Hours To T ransmit Bi lls: Conta ins the ti mes of the day when EDI transm ission of bills shou ld occur. A maximum of 4 daily times dai ly may be entered an d the time s must be separated by a semi- colon. Tim es must be entered i n 4-digit military f ormat, wit hout punct uation (HH MM;HHMM;HH MM;HHMM). If no time s are ente red, EDI t ransmissio n will tak e place as a normal part of th e nightly job. | |
8536 | ||
8537 | Max # Of B ills Per B atch: The maximum nu mber of bi lls allowe d in a sin gle batch. With a ne w payer, i t is sugge sted that you begin with fairl y small ba tches (10- 20 claims) . | |
8538 | ||
8539 | Only Allow 1 Ins Co/ Claim Batc h: Indicat es whether or not th e site wis hes to lim it batches to claims for a sin gle insura nce compan y. | |
8540 | ||
8541 | Last Auto- Txmt Run D ate: The l ast date t he auto tr ansmit of bills was run at the site. The se data ar e display only and c annot be e dited. | |
8542 | ||
8543 | Days To Wa it To Purg e Msgs: Th is is the number of days after an electr onic statu s message has been m arked revi ewed, that the purge message o ption can delete it from the s ystem. | |
8544 | (This page included for two-si ded copyin g.) | |
8545 | ||
8546 | ||
8547 | APPENDIX B – GLOSSAR Y | |
8548 | ||
8549 | GLOSSARY O F TERMS | |
8550 | Acronym or Term | |
8551 | Definition /Explanati on | |
8552 | 835 | |
8553 | HIPAA Stan dard Elect ronic Tran saction AS C X12 835, Health Ca re Claim: | |
8554 | The HIPAA- adopted st andard for electroni c remittan ce advice to report the proces sing of al l claim ty pes (inclu ding retai l pharmacy ). The 835 is sent f rom health plans to healthcare providers and conta ins detail ed informa tion about the proce ssing of t he claim. This inclu des paymen t informat ion and re duction or rejection reasons. The 835 tr ansactions generally contain i nformation about mul tiple clai ms. All he alth plans are requi red to use the same explanatio n of benef it codes ( adjustment reason co des) and a dhere to v ery specif ic reporti ng require ments. The term “835 ” is used interchang eably with Electroni c Remittan ce Advice (ERA) and Medicare R emittance Advice (MR A). | |
8555 | 837 | |
8556 | HIPAA Stan dard Elect ronic Tran saction AS C X12 837, Health Ca re Claim P ayment/Rem ittance Ad vice: | |
8557 | The HIPAA- adopted st andard for electroni c submissi on of hosp ital, prof essional a nd dental claims or encounters . The 837 is sent fr om healthc are provid ers to hea lth plans (payers). The 837 tr ansactions are gener ally multi ple claims (batches) . The 837 standard i ncludes th e informat ion for co ordination of benefi ts and is also used for second ary payer claims sub mission. T he term “8 37” is use d intercha ngeably wi th electro nic claim. | |
8558 | 277 RFAI | |
8559 | Hipaa Stan dard Elect ronic Tran saction AS C X12 277, Health Ca re Claim R equest for Additiona l Informat ion | |
8560 | The HIPAA adopted st andard for requestin g addition al informa tion for h ealth care claims su bmitted. Payers uti lize this transactio n for requ esting add itional in formation or missing informati on from pr oviders on previousl y submitte d health c are claims . | |
8561 | Billing Pr ovider Sec ondary ID Number | |
8562 | This is ei ther the f acility ta x ID # (de fault) or an ID assi gned to th e facility by the in surance co mpany. | |
8563 | Care Unit | |
8564 | Specific d ata relate d to patie nt care (p re-defined by an ins urance com pany) that provides the insura nce compan y with a f iner break down of th e care bei ng billed. The data that compr ises the b reakdown a re insuran ce company specific and are no t required by all pa yers. (For example, Orthopedic s, Dermato logy, Urol ogy, etc.) . | |
8565 | Claims Sta tus Awaiti ng Resolut ion (CSA) | |
8566 | Used to re ference th e option u sed by bil ling staff to review the most current st atus messa ges receiv ed for a b ill(s) and do follow -up on the bills. Us ers will b e able to select a b ill from t he list to view the details an d the enti re message text as w ell as to mark the m essage as reviewed o r under re view and d ocument us er comment s. | |
8567 | Claim Stat us Message | |
8568 | Electronic messages returned t o the VAMC providing status in formation on a claim from the Financial Service Ce nter (FSC) , Clearing house or a payer | |
8569 | Clearingho use | |
8570 | A company that provi des batch and real-t ime transa ction proc essing ser vices. Tra nsactions include in surance el igibility verificati on, claims submissio n process and electr onic remit tance info rmation an d payment posting fo r electron ic claims. | |
8571 | CPAC | |
8572 | Consolidat ed Patient Account C enter | |
8573 | CSA | |
8574 | See Claims Status Aw aiting Res olution | |
8575 | eClaim | |
8576 | A claim th at is subm itted elec tronically from the VA | |
8577 | EDI | |
8578 | See Electr onic Data Interchang e | |
8579 | Electronic Data Inte rchange (E DI) | |
8580 | EDI is the process o f transact ing busine ss electro nically. I t includes submittin g claims e lectronica lly (paper less claim s processi ng), as we ll as elec tronic fun ds transfe r and elec tronic inq uiry for c laim statu s and pati ent eligib ility. | |
8581 | Electronic Payer | |
8582 | A payer th at has an electronic connectio n with the clearingh ouse | |
8583 | ePayer | |
8584 | Payer that accepts e lectronic claim from the clear inghouse p ays electr onically. See Payer . | |
8585 | Facility F ed Tax ID # | |
8586 | This is th e number t hat will b e the defa ult for al l provider s for the ID type at the facil ity if the payer doe s not have specific requiremen ts | |
8587 | Fiscal Int ermediary | |
8588 | A fiscal i ntermediar y performs services on behalf of healthc are payers . These se rvices inc lude claim adjudicat ion, reimb ursement a nd collect ions. Trai lblazer is an exampl e of a fis cal interm ediary tha t acts on behalf of Medicare. Trailblaze r receives claims fr om the VA in the for m of an 83 7 file and then adju dicates th e claims t o create a MRA/EOB 8 35 file. | |
8589 | Form Types | |
8590 | The UB-04, CMS-1500 o r J430D bi lling form on which services w ill be bil led | |
8591 | FSC | |
8592 | The VA Fin ancial Ser vices Cent er in Aust in. The Fi nancial Se rvice Cent er transla tes claims into an i ndustry-st andard for mat (HIPAA 837) and forwards c laims to t he clearin ghouse. Th e FSC is t he single point for the exchan ge of data between V istA and t he clearin ghouse. | |
8593 | Healthcare Company | |
8594 | See Payer | |
8595 | Health Ins urance Por tability a nd Account ability Ac t (HIPAA) | |
8596 | In 1996 Co ngress pas sed into l aw the Hea lth Insura nce Portab ility and Accountabi lity Act ( HIPAA). Th is Act is comprised of two maj or legisla tive actio ns: Health Insurance Reform an d Administ rative Sim plificatio n. The Adm inistrativ e Simplifi cation pro visions of HIPAA dir ect the fe deral gove rnment to adopt nati onal elect ronic stan dards for automated transfer o f certain healthcare data betw een health care payer s, plans, and provid ers. This will enabl e the enti re healthc are indust ry to comm unicate el ectronic d ata using a single s et of stan dards thus eliminati ng all non -standard formats cu rrently in use. Once these sta ndards are in place, a healthc are provid er will be able to s ubmit a st andard tra nsaction f or eligibi lity, auth orization, referrals , claims, or attachm ents conta ining the same stand ard data c ontent to any health plan. Thi s will "si mplify" ma ny clinica l, billing , and othe r financia l applicat ions and r educe cost s. | |
8597 | HPID | |
8598 | Health Pla n Identifi er | |
8599 | Insurance Company | |
8600 | See Payer | |
8601 | Legacy IDs | |
8602 | This term refers to those paye r-provided or users own IDs (i ndividual and organi zational) which will eventuall y be made obsolete b y the use of Nationa l Provider Identifie rs | |
8603 | Non-VA Fac ility | |
8604 | Any facili ty that pr ovides ser vices to a VA patien t and subs equently b ills the V A for thos e services | |
8605 | Non-VA Pro vider | |
8606 | Any indivi dual provi der who pr ovides ser vices to a VA patien t and subs equently b ills the V A for thes e services | |
8607 | National P rovider Id entifier | |
8608 | A standard , unique h ealth iden tifier for healthcar e provider s, both in dividuals and organi zations | |
8609 | OEID | |
8610 | Other Enti ty Identif ier | |
8611 | Parent | |
8612 | The top fa cility in a hierarch ical domai n | |
8613 | Payer | |
8614 | The insure d’s insura nce compan y. Other t erms that are used t o denote P ayer inclu de ePayer, insurance company, healthcare company, etc. | |
8615 | Payer Code | |
8616 | A code use d for enro llment tha t uniquely identifie s the paye r. | |
8617 | Payer List | |
8618 | List of pa yers that consist of the payer category, claim typ e, payer c ode, and p ayer name | |
8619 | Provider | |
8620 | Provider o f healthca re service s | |
8621 | Provider I D | |
8622 | A provider ID can re present a facility o r an indiv idual phys ician/prov ider. | |
8623 | Taxonomy C ode | |
8624 | The Health Care Prov ider Taxon omy code s et is a co llection o f unique a lphanumeri c codes, t en charact ers in len gth. The c ode set is structure d into thr ee distinc t "Levels" including Provider Type, Clas sification , and Area of Specia lization.T he Health Care Provi der Taxono my code se t allows a single pr ovider (in dividual, group, or institutio n) to iden tify their specialty category. | |
8625 | UPIN | |
8626 | Unique Pro vider Iden tification Number | |
8627 | URL | |
8628 | Uniform Re source Loc ator | |
8629 | VAMC | |
8630 | Veterans A ffairs Med ical Cente r | |
8631 | VISN | |
8632 | Veterans I ntegrated Service Ne twork | |
8633 | ||
8634 | (This page included for two-si ded coping .) | |
8635 | ||
8636 | ||
8637 | APPENDIX C – HIPAA P rovider ID – Referen ce Guide | |
8638 | This table displays the HIPAA qualifiers and assoc iated ID t ypes. This table can be used t o help ide ntify what type of P rovider ID is being used in th e electron ic format. | |
8639 | ||
8640 | Institutio nal | |
8641 | Qualifier | |
8642 | Definition | |
8643 | Billing Pr ovider | |
8644 | Attending | |
8645 | Operating | |
8646 | Other | |
8647 | Service | |
8648 | ||
8649 | ||
8650 | 2010AA | |
8651 | 2310A | |
8652 | 2330D | |
8653 | 2310B | |
8654 | 2330E | |
8655 | 2310C | |
8656 | 2330F | |
8657 | 2310E | |
8658 | 2330H | |
8659 | ||
8660 | ||
8661 | Payer Type : | |
8662 | ||
8663 | C | |
8664 | O | |
8665 | C | |
8666 | O | |
8667 | C | |
8668 | O | |
8669 | C | |
8670 | O | |
8671 | ||
8672 | VPE Segmen t: | |
8673 | PRV1 | |
8674 | OPR2 | |
8675 | OP1 | |
8676 | OPR3 | |
8677 | OP2 | |
8678 | OPR4 | |
8679 | OP9 | |
8680 | SUB2 | |
8681 | OP3 | |
8682 | OB | |
8683 | State Lice nse Number | |
8684 | - | |
8685 | OB | |
8686 | ||
8687 | OB | |
8688 | ||
8689 | OB | |
8690 | ||
8691 | OB | |
8692 | ||
8693 | 1A | |
8694 | Blue Cross Provider Number | |
8695 | 1A | |
8696 | 1A | |
8697 | 1A | |
8698 | 1A | |
8699 | 1A | |
8700 | 1A | |
8701 | 1A | |
8702 | 1A | |
8703 | - | |
8704 | 1B | |
8705 | Blue Shiel d Provider Number | |
8706 | - | |
8707 | 1B | |
8708 | 1B | |
8709 | 1B | |
8710 | 1B | |
8711 | 1B | |
8712 | 1B | |
8713 | 1B | |
8714 | 1B | |
8715 | 1C | |
8716 | Medicare P rovider Nu mber | |
8717 | 1C | |
8718 | 1C | |
8719 | 1C | |
8720 | 1C | |
8721 | 1C | |
8722 | 1C | |
8723 | 1C | |
8724 | 1C | |
8725 | 1C | |
8726 | 1D | |
8727 | Medicare P rovider Nu mber | |
8728 | 1D | |
8729 | 1D | |
8730 | 1D | |
8731 | 1D | |
8732 | 1D | |
8733 | 1D | |
8734 | 1D | |
8735 | 1D | |
8736 | 1D | |
8737 | 1G | |
8738 | Provider U PIN Number | |
8739 | 1G | |
8740 | 1G | |
8741 | 1G | |
8742 | 1G | |
8743 | 1G | |
8744 | 1G | |
8745 | 1G | |
8746 | 1G | |
8747 | - | |
8748 | 1H | |
8749 | TRICARE ID Number | |
8750 | 1H | |
8751 | 1H | |
8752 | 1H | |
8753 | 1H | |
8754 | 1H | |
8755 | 1H | |
8756 | 1H | |
8757 | 1H | |
8758 | - | |
8759 | 1J | |
8760 | Facility I D Number | |
8761 | 1J | |
8762 | - | |
8763 | - | |
8764 | - | |
8765 | - | |
8766 | - | |
8767 | - | |
8768 | 1J | |
8769 | - | |
8770 | B3 | |
8771 | PPO Number | |
8772 | B3 | |
8773 | - | |
8774 | - | |
8775 | - | |
8776 | - | |
8777 | - | |
8778 | - | |
8779 | - | |
8780 | - | |
8781 | BQ | |
8782 | HMO Code N umber | |
8783 | BQ | |
8784 | - | |
8785 | - | |
8786 | - | |
8787 | - | |
8788 | - | |
8789 | - | |
8790 | - | |
8791 | - | |
8792 | EI | |
8793 | Employer’s ID Number | |
8794 | EI | |
8795 | EI | |
8796 | EI | |
8797 | EI | |
8798 | EI | |
8799 | EI | |
8800 | EI | |
8801 | EI | |
8802 | EI | |
8803 | FH | |
8804 | Clinic Num ber | |
8805 | FH | |
8806 | - | |
8807 | - | |
8808 | - | |
8809 | - | |
8810 | - | |
8811 | - | |
8812 | FH | |
8813 | - | |
8814 | G2 | |
8815 | Provider C ommercial Number | |
8816 | G2 | |
8817 | G2 | |
8818 | G2 | |
8819 | G2 | |
8820 | G2 | |
8821 | G2 | |
8822 | G2 | |
8823 | G2 | |
8824 | G2 | |
8825 | G5 | |
8826 | Provider S ite Number | |
8827 | G5 | |
8828 | - | |
8829 | - | |
8830 | - | |
8831 | - | |
8832 | - | |
8833 | - | |
8834 | G5 | |
8835 | - | |
8836 | LU | |
8837 | Location N umber | |
8838 | LU | |
8839 | LU | |
8840 | LU | |
8841 | LU | |
8842 | LU | |
8843 | LU | |
8844 | LU | |
8845 | LU | |
8846 | LU | |
8847 | N5 | |
8848 | Provider P lan Networ k ID Numbe r | |
8849 | - | |
8850 | N5 | |
8851 | N5 | |
8852 | N5 | |
8853 | N5 | |
8854 | N5 | |
8855 | N5 | |
8856 | N5 | |
8857 | N5 | |
8858 | TJ | |
8859 | Federal Ta xpayer’s I D Number | |
8860 | - | |
8861 | ||
8862 | - | |
8863 | - | |
8864 | - | |
8865 | - | |
8866 | - | |
8867 | - | |
8868 | - | |
8869 | X4 | |
8870 | Clinical L ab Improve ment Amend ment (CLI A #) | |
8871 | - | |
8872 | - | |
8873 | - | |
8874 | - | |
8875 | - | |
8876 | - | |
8877 | - | |
8878 | - | |
8879 | - | |
8880 | U3 | |
8881 | Unique Sup plier ID N umber (USI N) | |
8882 | - | |
8883 | - | |
8884 | - | |
8885 | - | |
8886 | - | |
8887 | - | |
8888 | - | |
8889 | - | |
8890 | - | |
8891 | SY | |
8892 | Social Sec urity Numb er | |
8893 | SY | |
8894 | SY | |
8895 | - | |
8896 | SY | |
8897 | - | |
8898 | SY | |
8899 | - | |
8900 | - | |
8901 | - | |
8902 | X5 | |
8903 | State Indu strial Acc ident Prov ider Numbe r | |
8904 | X5 | |
8905 | X5 | |
8906 | - | |
8907 | X5 | |
8908 | - | |
8909 | X5 | |
8910 | - | |
8911 | X5 | |
8912 | - | |
8913 | ||
8914 | C = Curren t Payer O = Oth er Payer | |
8915 | ||
8916 | ||
8917 | ||
8918 | Profession al | |
8919 | Qualifier | |
8920 | Definition | |
8921 | Billing Pr ovider | |
8922 | Referring | |
8923 | Rendering | |
8924 | Purchased | |
8925 | Service Fa cility | |
8926 | Supervisin g | |
8927 | ||
8928 | HIPAA Loop | |
8929 | 2010AA | |
8930 | 2310A | |
8931 | 2330D | |
8932 | 2310B | |
8933 | 2330E | |
8934 | 2310C | |
8935 | 2330F | |
8936 | 2310D | |
8937 | 2330G | |
8938 | 2310E | |
8939 | 2330H | |
8940 | ||
8941 | ||
8942 | Payer Type : | |
8943 | ||
8944 | C | |
8945 | O | |
8946 | C | |
8947 | O | |
8948 | C | |
8949 | O | |
8950 | C | |
8951 | O | |
8952 | C | |
8953 | O | |
8954 | ||
8955 | VPE Record | |
8956 | PRV1 | |
8957 | OPR5 | |
8958 | OP4 | |
8959 | OPR2 | |
8960 | OP1 | |
8961 | SUB1 | |
8962 | OP6 | |
8963 | SUB2 | |
8964 | OP7 | |
8965 | OPR8 | |
8966 | OP8 | |
8967 | OB | |
8968 | State Lice nse Number | |
8969 | - | |
8970 | OB | |
8971 | - | |
8972 | OB | |
8973 | - | |
8974 | OB | |
8975 | - | |
8976 | OB | |
8977 | - | |
8978 | OB | |
8979 | - | |
8980 | 1A | |
8981 | Blue Cross Provider Number | |
8982 | - | |
8983 | - | |
8984 | - | |
8985 | - | |
8986 | - | |
8987 | 1A | |
8988 | - | |
8989 | 1A | |
8990 | - | |
8991 | - | |
8992 | - | |
8993 | 1B | |
8994 | Blue Shiel d Provider Number | |
8995 | 1B | |
8996 | 1B | |
8997 | 1B | |
8998 | 1B | |
8999 | 1B | |
9000 | 1B | |
9001 | 1B | |
9002 | 1B | |
9003 | 1B | |
9004 | 1B | |
9005 | 1B | |
9006 | 1C | |
9007 | Medicare P rovider Nu mber | |
9008 | 1C | |
9009 | 1C | |
9010 | 1C | |
9011 | 1C | |
9012 | 1C | |
9013 | 1C | |
9014 | 1C | |
9015 | 1C | |
9016 | 1C | |
9017 | 1C | |
9018 | 1C | |
9019 | 1D | |
9020 | Medicare P rovider Nu mber | |
9021 | 1D | |
9022 | 1D | |
9023 | - | |
9024 | 1D | |
9025 | - | |
9026 | 1D | |
9027 | 1D | |
9028 | 1D | |
9029 | 1D | |
9030 | 1D | |
9031 | 1D | |
9032 | 1G | |
9033 | Provider U PIN Number | |
9034 | 1G | |
9035 | 1G | |
9036 | - | |
9037 | 1G | |
9038 | - | |
9039 | 1G | |
9040 | - | |
9041 | 1G | |
9042 | - | |
9043 | 1G | |
9044 | - | |
9045 | 1H | |
9046 | TRICARE ID Number | |
9047 | 1H | |
9048 | 1H | |
9049 | - | |
9050 | 1H | |
9051 | - | |
9052 | 1H | |
9053 | - | |
9054 | 1H | |
9055 | - | |
9056 | 1H | |
9057 | - | |
9058 | 1J | |
9059 | Facility I D Number | |
9060 | 1J | |
9061 | - | |
9062 | - | |
9063 | - | |
9064 | - | |
9065 | - | |
9066 | - | |
9067 | - | |
9068 | - | |
9069 | - | |
9070 | - | |
9071 | B3 | |
9072 | PPO Number | |
9073 | B3 | |
9074 | - | |
9075 | - | |
9076 | - | |
9077 | - | |
9078 | - | |
9079 | - | |
9080 | - | |
9081 | - | |
9082 | - | |
9083 | - | |
9084 | BQ | |
9085 | HMO Code N umber | |
9086 | BQ | |
9087 | - | |
9088 | - | |
9089 | - | |
9090 | - | |
9091 | - | |
9092 | - | |
9093 | - | |
9094 | - | |
9095 | - | |
9096 | - | |
9097 | EI | |
9098 | Employer’s ID Number | |
9099 | EI | |
9100 | EI | |
9101 | EI | |
9102 | EI | |
9103 | EI | |
9104 | EI | |
9105 | EI | |
9106 | - | |
9107 | - | |
9108 | EI | |
9109 | EI | |
9110 | FH | |
9111 | Clinic Num ber | |
9112 | FH | |
9113 | - | |
9114 | - | |
9115 | - | |
9116 | - | |
9117 | - | |
9118 | - | |
9119 | - | |
9120 | - | |
9121 | - | |
9122 | - | |
9123 | G2 | |
9124 | Provider C ommercial Number | |
9125 | G2 | |
9126 | G2 | |
9127 | G2 | |
9128 | G2 | |
9129 | G2 | |
9130 | G2 | |
9131 | G2 | |
9132 | G2 | |
9133 | G2 | |
9134 | G2 | |
9135 | G2 | |
9136 | G5 | |
9137 | Provider S ite Number | |
9138 | G5 | |
9139 | - | |
9140 | - | |
9141 | - | |
9142 | - | |
9143 | - | |
9144 | - | |
9145 | - | |
9146 | - | |
9147 | - | |
9148 | - | |
9149 | LU | |
9150 | Location N umber | |
9151 | LU | |
9152 | LU | |
9153 | LU | |
9154 | LU | |
9155 | LU | |
9156 | LU | |
9157 | LU | |
9158 | LU | |
9159 | LU | |
9160 | LU | |
9161 | - | |
9162 | N5 | |
9163 | Provider P lan Networ k ID Numbe r | |
9164 | - | |
9165 | N5 | |
9166 | N5 | |
9167 | N5 | |
9168 | N5 | |
9169 | N5 | |
9170 | N5 | |
9171 | - | |
9172 | N5 | |
9173 | N5 | |
9174 | N5 | |
9175 | TJ | |
9176 | Federal Ta xpayer’s I D Number | |
9177 | - | |
9178 | - | |
9179 | - | |
9180 | - | |
9181 | - | |
9182 | - | |
9183 | - | |
9184 | TJ | |
9185 | - | |
9186 | - | |
9187 | - | |
9188 | X4 | |
9189 | Clinical L ab Improve ment Amend ment (CLI A #) | |
9190 | - | |
9191 | - | |
9192 | - | |
9193 | - | |
9194 | - | |
9195 | - | |
9196 | - | |
9197 | X4 | |
9198 | - | |
9199 | - | |
9200 | - | |
9201 | U3 | |
9202 | Unique Sup plier ID N umber (USI N) | |
9203 | U3 | |
9204 | - | |
9205 | - | |
9206 | - | |
9207 | - | |
9208 | U3 | |
9209 | - | |
9210 | - | |
9211 | - | |
9212 | - | |
9213 | - | |
9214 | SY | |
9215 | Social Sec urity Numb er | |
9216 | SY | |
9217 | SY | |
9218 | ||
9219 | SY | |
9220 | ||
9221 | SY | |
9222 | - | |
9223 | - | |
9224 | - | |
9225 | SY | |
9226 | - | |
9227 | X5 | |
9228 | State Indu strial Acc ident Prov ider Numbe r | |
9229 | X5 | |
9230 | X5 | |
9231 | - | |
9232 | X5 | |
9233 | - | |
9234 | X5 | |
9235 | - | |
9236 | X5 | |
9237 | - | |
9238 | X5 | |
9239 | - | |
9240 | ||
9241 | C = Curren t Payer O = Ot her Payer |
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