2. EPMO Open Source Coordination Office Redaction File Detail Report

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2.1 Files compared

#	Location	File	Last Modified
1	MCCF.zip\MCCF\docs	edi_user_guide_r0717.doc	Wed Apr 5 18:16:34 2017 UTC
2	MCCF.zip\MCCF\docs	edi_user_guide_r0717.doc	Fri Apr 28 18:38:10 2017 UTC

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	1	E lectronic Data Inter change (ED I)
	2	Billing Us er Guide
	3
	4	Version 2. 6
	5	August 200 5
	6	Revised: J uly 2017
	7	Revision H istory
	8	DateRevisi onDescript ionAuthorA ugust 2005 1Patch IB* 2296M. Si monsJuly 2 0061.1Patc h IB2320 M. SimonsF ebruary 20 071.2Patch es IB2*34 3, 348 and 349C. Smi th
	9	M. SimonsJ uly 20071. 3Patch IB* 2374C. Sm ithNovembe r 20071.4P atch IB2* 368 and 37 1S. Hooper
	10	M. SimonsM ay 20081.5 Patch IB2 377M. Sim onsFebruar y 20091.6P atch IB2 400M. Simo nsNovember 20101.7Pa tch IB24 36 – Secti on 4 and
	11	Section 4. 5.3.1
	12	Also repla ced refere nces to Em deon and E xpress Bil l with “cl earinghous e”M. Simon s
	13	B. Anderso nJanuary 2 0111.8Edit s by Train ing Depart ment and r emoved ref erence to patch IB2 433 B. An dersonMay 20111.9Pat ch IB243 3 – Sectio n 6.7
	14	M. Simons
	15	B. Anderso nSeptember 20111.10P atch IB2 432
	16	Revised Se ctions: 1, 2, 4, 6
	17	Added Sect ions: 7 an d 8 M. Sim ons
	18	B. Anderso nMarch 20 121.11Patc h IB2447 and PRCA* 4.5*275
	19	Revised Se ctions: 6, 7B. Ander son
	20	M. Simons
	21	C. MinchMa rch 2014 1 .12Patch I B2.0476
	22	Revised Se ctions: 4. 4.1, 4.5.3 T. ReedAug ust 2014 2 .0Patch IB 2488 (Bu ild 1)
	23	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
	24	General gr ammar, spe lling and format cha nges appli edM. Simon s
	25	FirstView
	26	January 20 152.1Patch IB2521
	27	Revised ED I Paramete r Report S ection 9.3 .14, Appen dix BM. Wi ndsor
	28	A. FinkApr il 20152.2 Patch IB2 516
	29	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
	30	M. Simons
	31	M. Windsor April 2015 2.3IOC Exi t Review Patch IB2 516
	32	Revised Se ctions: 6. 11, 6.2.3. 1, 6.2.3.2 , 6.3.2, 9.2.3M. Si monsAugust 20162.4Pa tch IB25 47
	33	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 BM. Simons August 201 62.5Patch IB2549
	34	Revised Se ctions: 2. 1.1.2, 2.1 .2, 5.1.1D . WhiteJul y 20172.6P atch IB2 576 Added sub-secti ons 6.2.5 and 6.3.4M . Simons ( This page included f or two-sid ed copying .)
	35	Table of C ontents
	36	1 .
	37	Introducti on
	38	1
	39	1 .1.

	40	Revenue Pr ocess
	41	1
	42	1.2.

	43	Critical E DI Process Terms
	44	2
	45	1.3.

	46	EDI Proces s Flow
	47	3
	48	2.

	49	Insurance Company Se t-up
	50	4
	51	2.1.

	52	Insurance Company Se tup
	53	4
	54	2.1.1

	55	Activate N ew Payer t o Transmit eClaims
	56	4
	57	2.1.2

	58	Activate E xisting Co mmercial P ayer to Tr ansmit eCl aims
	59	9
	60	2.1.3

	61	Activate E xisting Pa yer to Tes t Primary Blue Cross /Blue Shie ld eClaims
	62	14
	63	3.

	64	Pay-to Pro vider(s) S et-up
	65	17
	66	3.1.

	67	Define Def ault Pay-t o Provider
	68	18
	69	3.2.

	70	Associate Divisions with non-D efault Pay -to Provid er
	71	20
	72	4.

	73	Provider I D Set-up
	74	22
	75	4.1.

	76	Table of I Ds
	77	23
	78	4.2.

	79	Pay-to Pro vider IDs
	80	28
	81	4.2.1

	82	Define the Pay-to Pr ovider Pri mary ID/NP I
	83	28
	84	4.2.2

	85	Define the Pay-to Pr ovider Sec ondary IDs
	86	28
	87	4.3.

	88	Billing Pr ovider IDs
	89	28
	90	4.3.1

	91	Define the Billing P rovider Pr imary ID/N PI
	92	29
	93	4.3.2

	94	Define the Billing P rovider Se condary ID s
	95	30
	96	4.4.

	97	Service Fa cility IDs (Laborato ry or Faci lity IDs)
	98	37
	99	4.4.1

	100	Define Non -VA Labora tory or Fa cility Pri mary IDs/N PI
	101	37
	102	4.4.2

	103	Define Non -VA Labora tory or Fa cility Sec ondary IDs
	104	39
	105	4 .4.3

	106	Define VA Laboratory or Facili ty Primary IDs/NPI
	107	41
	108	4 .4.4

	109	Define VA Laboratory or Facili ty Seconda ry IDs
	110	41
	111	4 .5.

	112	Attending, Operating and Other Physician s and Rend ering, Ref erring and Supervisi ng Provide rs
	113	42
	114	4 .5.1

	115	Define a V A Physicia n/Provider ’s Primary ID/NPI
	116	43
	117	4 .5.2

	118	Define a V A Physicia n/Provider ’s Seconda ry IDs
	119	43
	120	4.5.3

	121	Define a n on-VA Phys ician/Prov ider’s Sec ondary IDs
	122	50
	123	4.5.4

	124	Define Ins urance Com pany IDs
	125	54
	126	4.5.5

	127	Define eit her a Defa ult or Ind ividual Ph ysician/Pr ovider Sec ondary ID
	128	58
	129	4.6.

	130	Care Units
	131	60
	132	4.6.1

	133	Define Car e Units fo r Physicia n/Provider Secondary IDs
	134	60
	135	4.6.2

	136	Define Car e Units fo r Billing Provider S econdary I Ds
	137	63
	138	4.7.

	139	ID Paramet ers by Ins urance Com pany
	140	65
	141	4.7.1

	142	Define Att ending/Ren dering Pro vider Seco ndary ID P arameters
	143	67
	144	4.7.2

	145	Define Ref erring Pro vider Seco ndary ID P arameters
	146	68
	147	4.7.3

	148	Define Bil ling Provi der Second ary ID Par ameters
	149	68
	150	4.7.4

	151	Define Bil ling Provi der/Servic e Facility Parameter s
	152	68
	153	4.7.5

	154	Define VA Service Fa cility Par ameters
	155	69
	156	4.7.6

	157	Define No Billing Pr ovider Sec ondary IDs by Plan T ype
	158	69
	159	4.7.7

	160	View Assoc iated Insu rance Comp anies, Pro vider IDs, and ID Pa rameters
	161	70
	162	4.8.

	163	Associated Insurance Companies and Copyi ng Physici an/Provide r Secondar y IDs and Additional Billing P rovider Se condary ID s
	164	72
	165	4.8.1

	166	Designate a Parent I nsurance C ompany
	167	72
	168	4.8.2

	169	Designate a Child In surance Co mpany
	170	74
	171	4.8.3

	172	Copy Physi cian/Provi der Second ary IDs
	173	74
	174	4.8.4

	175	Copy Addit ional Bill ing Provid er Seconda ry IDs
	176	75
	177	4.8.5

	178	Synchroniz ing Associ ated Insur ance Compa ny IDs
	179	75
	180	5.

	181	Subscriber and Patie nt ID Set- Up
	182	76
	183	5.1.

	184	Subscriber and Patie nt Insuran ce Provide d IDs
	185	76
	186	5.1.1

	187	Define Sub scriber Pr imary ID
	188	76
	189	5.1.2

	190	Define Sub scriber an d Patient Primary ID s
	191	78
	192	5.1.3

	193	Define Sub scriber an d Patient Secondary IDs
	194	80
	195	6.

	196	Entering E lectronic Claims
	197	82
	198	6.1.

	199	Summary of Enter/Edi t Billing Informatio n to Suppo rt ASC X12 N/5010
	200	82
	201	6.2.

	202	Changes Ma de by Spec ific Patch es
	203	82
	204	6.2.1

	205	Patch IB2 447
	206	82
	207	6.2.2

	208	Patch IB2 488:
	209	83
	210	6.2.3

	211	Patch IB2 516
	212	85
	213	6.2.4

	214	Patch IB2 547
	215	85
	216	6.2.5

	217	Patch IB.2 .576
	218	87
	219	6.3.

	220	Handling E rror Messa ges and Wa rnings
	221	88
	222	6.3.1

	223	Patch IB2 488
	224	89
	225	6.3.2

	226	Patch IB2 516
	227	89
	228	6.3.3

	229	Patch IB2 547
	230	89
	231	6.3.4

	232	Patch IB.2 .576
	233	89
	234	6.4.

	235	Claim vers us Line Le vel Data
	236	89
	237	6.5.

	238	Screen 3 – Payer Inf ormation
	239	90
	240	6.5.1

	241	EDI Fields
	242	90
	243	6.5.2

	244	Using Care Units for Billing P rovider Se condary ID s
	245	91
	246	6.6.

	247	Screen 10 – Physicia n/Provider and Print Informati on
	248	92
	249	6.6.1

	250	EDI Fields UB-04/CMS -1500
	251	92
	252	6.7.

	253	UB-04 Clai ms
	254	93
	255	6.8.

	256	CMS-1500 C laims
	257	101
	258	6.9.

	259	Lab Claims
	260	110
	261	6.10.

	262	Pharmacy C laims
	263	114
	264	6.11.

	265	Correct Re jected or Denied Cla ims
	266	119
	267	6.12.

	268	Viewed Can celled Cla ims
	269	121
	270	6.13.

	271	Printed Cl aims
	272	121
	273	6.14.

	274	View/Resub mit Claims – Live or Test – Sy nonym: RCB
	275	122
	276	7.

	277	Processing of Second ary/Tertia ry Claims
	278	126
	279	7.1.

	280	Criteria f or the Aut omatic Pro cessing of Secondary or Tertia ry Claims
	281	126
	282	7.2.

	283	COB Manage ment Workl ist
	284	127
	285	7.2.1

	286	Data Displ ayed for C laims on t he COB Man agement Wo rklist
	287	128
	288	7.2.2

	289	Available COB Manage ment Workl ist Action s
	290	128
	291	8.

	292	Requests f or Additio nal Data t o Support Claims
	293	129
	294	9.

	295	IB Site Pa rameters
	296	131
	297	9.1.

	298	Define Pri nters for Automatica lly Proces sed Second ary/Tertia ry Claims
	299	131
	300	9.2.

	301	Enable Aut omatic Pro cessing of Secondary /Tertiary Claims
	302	133
	303	9.3.

	304	Printed Cl aims Rev C ode Excl: 17 Activat ed Codes D efined
	305	135
	306	9.4.

	307	Alternate Primary Pa yer ID Typ es
	308	136
	309	9.5.

	310	ASC X12N H ealth Care Claim Req uest for A dditional Informatio n (277RFAI )
	311	137
	312	1 0.

	313	Reports
	314	139
	315	1 0.1.

	316	EDI Report s – Overvi ew
	317	139
	318	1 0.2.

	319	Most Frequ ently Used Menus/Rep orts
	320	140
	321	1 0.2.1

	322	Claims Sta tus Awaiti ng Resolut ion – Syno nym CSA
	323	140
	324	1 0.2.2

	325	Multiple C SA Message Managemen t – Synony m: MCS
	326	141
	327	1 0.2.3

	328	Electronic Report Di sposition
	329	142
	330	1 0.2.4

	331	EDI Claim Status Rep ort- Synon ym: ECS
	332	143
	333	1 0.3.

	334	Additional Reports a nd Options
	335	144
	336	1 0.3.1

	337	Ready for Extract St atus Repor t - Synony m: REX
	338	144
	339	1 0.3.2

	340	Transmit E DI Bills – Manual - Synonym: S END
	341	144
	342	1 0.3.3

	343	EDI Return Message M anagement Menu – Syn onym: MM
	344	145
	345	1 0.3.4

	346	EDI Messag e Text to Screen Mai ntenance
	347	145
	348	1 0.3.5

	349	EDI Messag es Not Rev iewed Repo rt
	350	145
	351	1 0.3.6

	352	Electronic Error Rep ort
	353	145
	354	1 0.3.7

	355	Return Mes sages Fili ng Excepti ons
	356	146
	357	1 0.3.8

	358	Status Mes sage Manag ement
	359	146
	360	1 0.3.9

	361	Bills Awai ting Resub mission – Synonym: B AR
	362	147
	363	1 0.3.10

	364	EDI Messag es Not Yet Filed –Sy nonym: MP
	365	147
	366	1 0.3.11

	367	Pending Ba tch Transm ission Sta tus Report – Synonym : PBT
	368	147
	369	1 0.3.12

	370	EDI Batche s Pending Receipt– S ynonym: PN D
	371	147
	372	1 0.3.13

	373	View/Print EDI Bill Extract Da ta – Synon ym: VPE
	374	149
	375	1 0.3.14

	376	Insurance Company ED I Paramete r Report – Synonym: EPR
	377	149
	378	1 0.3.15

	379	Test Claim EDI Trans mission Re port – Syn onym: TCS
	380	150
	381	1 0.3.16

	382	Third Part y Joint In quiry – Sy nonym: TPJ I
	383	151
	384	1 0.3.17

	385	Re-generat e Unbilled Amounts R eport
	386	153
	387	1 0.3.18

	388	Patient Bi lling Inqu iry – Syno nym: INQU
	389	154
	390	1 0.3.19

	391	Printed Cl aims Repor t
	392	154
	393	1 1.

	394	APPENDIX A – BATCH P ROCESSING SETUP
	395	155
	396	1 2.

	397	APPENDIX B – GLOSSAR Y
	398	158
	399	1 3.

	400	APPENDIX C – HIPAA P rovider ID – Referen ce Guide
	401	162



	402	(This page included for two-si ded copyin g.)
	403	Introducti on
	404	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).
	405	Revenue Pr ocess
	406	The overal l patient billing re venue proc ess for th e VHA is s ummarized in the tab le below:
	407	IntakeUtil ization Re view Billi ngCollecti onUtilizat ion Review Patient R egistratio n
	408	Insurance Identifica tion
	409	Insurance Verificati onPre-cert ification & Certific ation
	410	Continued StayDocume ntation
	411	EDI Bill G eneration
	412	MRA
	413	Claim stat us message sEstablish Receivabl es
	414	A/R Follow -up
	415	Lockbox
	416	Collection Correspon denceAppea lsDuring t he Intake phase, the patient i s register ed. Insura nce inform ation is i dentified and/or ver ified.
	417	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.
	418	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.
	419	During the Collectio ns phase, establishm ent of rec eivables, accounts r eceivables follow-up , lockbox, and any c ollection correspond ence take place.
	420	Another Ut ilization Review can take plac e if there are any a ppeals.
	421	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 .
	422	Critical E DI Process Terms
	423	Also see A PPENDIX B – GLOSSARY .
	424	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).
	425	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.
	426	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 .
	427	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.
	428	eClaim – A claim tha t is trans mitted ele ctronicall y to FSC f rom the VH A.
	429	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.
	430	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.
	431	ePayer – P ayer that accepts el ectronic c laims from the clear inghouse.
	432	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.
	433	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.
	434	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.
	435	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.
	436	EDI Proces s Flow
	437	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.
	438	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.
	439	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.
	440	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.
	441	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.
	442	Insurance Company Se t-up
	443	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.
	444	Insurance Company Se tup
	445	Activate N ew Payer t o Transmit eClaims
	446	The typica l business process f or setting up new pa yers is:
	447	The Insura nce Verifi cation Off ice initia lly enters a new pay er into Vi stA.
	448	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.
	449	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.
	450	Billing st aff use Th e Insuranc e Company Editor to specify th e correct Electronic Plan Type for each Insurance Plan.
	451	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. Not e: When Pa tch IB24 77 is inst alled, and a claim i s authoriz ed with mo re than on e payer, a warning i s displaye d unless a ll the Pay er IDs are on the cl aim.Define EDI setti ngs for a Blue Cross /Blue (BC/ BS) Shield Insurance Company
	452	StepProced ure1At the Billing P arameters screen in the Insura nce Compan y Editor, enter BP – Billing/E DI Param.I nsurance C ompany Edi tor O ct 01, 200 7@10:15:14 Page: 1 of 9
	453	Insurance Company In formation for: BLUE CROSS
	454	Type of Co mpany: HEA LTH INSURA NCE Curren tly Active
	455	Bil ling Param eters
	456	Signatur e Required ?: NO Fil ing Time F rame:
	457	Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN
	458	Mult. Bedsection s: Billing P hone: 800/ 933-9146
	459	Diff. Rev. Code s: Veri fication P hone: 800/ 933-9146
	460	One Opt. Visi t: NO Prec ert Comp. Name:
	461	Amb. Sur . Rev. Cod e: Precert P hone: 800/ 274-7767
	462	Rx Refil l Rev. Cod e:
	463	EDI Parame ters
	464	Transm it?: YES-L IVE In surance Ty pe:
	465	+ Enter ?? f or more ac tions >>>
	466	BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All
	467	MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany
	468	IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co.
	469	OC Opt Cl aims Offic e PA Payer DC Dele te Company
	470	PC Prescr Claims Of RE Remarks VP View Plans
	471	AO Appeal s Office SY Synonyms EX Exit
	472	Select Act ion: Next Screen//BP Billing/ EDI Param
	473	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.The fol lowing pro mpts will display.
	474	SIGNATURE REQUIRED O N BILL?: N O//
	475	REIMBURSE? : WILL REI MBURSE//
	476	ALLOW MULT IPLE BEDSE CTIONS:
	477	DIFFERENT REVENUE CO DES TO USE :
	478	ONE OPT. V ISIT ON BI LL ONLY:
	479	AMBULATORY SURG. REV . CODE:
	480	PRESCRIPTI ON REFILL REV. CODE:
	481	FILING TIM E FRAME:
	482	TYPE OF CO VERAGE: HE ALTH INSUR ANCE//
	483	BILLING PH ONE NUMBER : 800/933- 9146//
	484	VERIFICATI ON PHONE N UMBER: 800 /933-9146/ /
	485	Are Precer ts Process ed by Anot her Insura nce Co.?:
	486	PRECERTIFI CATION PHO NE NUMBER: 800/274-7 767//
	487	EDI - Tran smit?:YES- LIVE// YES -LIVE
	488	EDI - Inst Payer Pri mary ID: 1 2B30
	489	EDI - Alt Inst Payer Primary I D Type:
	490	EDI - 1ST Inst Payer Sec. ID Q ualifier:
	491	EDI - Prof Payer Pri mary ID: S B960
	492	EDI - Alt Prof Payer Primary I D Type:
	493	EDI - 1ST Prof Payer Sec. ID Q ualifier:
	494	EDI - Insu rance Type : GROUP PO LICY //
	495	EDI – Prin t Sec/Tert Auto Clai ms?:
	496	EDI – Prin t Medicare Sec Claim s w/o MRA? :YES//
	497	EDI - Bin Number: .. .......... .........
	498	StepProced urePatch I B2.0320 added a ne w security key, IB E DI INSURAN CE EDIT. A user mus t hold thi s key to e dit the ED I-Transmit , EDI Prof Payer ID; EDI Inst Payer ID a nd EDI-Ins urance Typ e fields. 2At the ED I - Inst P ayer Prima ry ID: pro mpt, enter the Payer Primary I D provided by the cl earinghous e.Patch IB 2.0488 w ill make c hanges tha t prevent a user fro m entering any value containin g PRNT/prn t as a Pri mary Payer ID.When e diting the Payer Pri mary ID fi elds for a commercia l payer, ( not BC/BS) these fie lds may be left blan k. The cl earinghous e will try to match the VistA payer name and addre ss to an e ntry in it s Payer Lo okup Table and auto- populate t hese field s. Payer ID numbers are avail able at ht tps://acce ss.emdeon. com/PayerL ists/.3At the EDI - 1ST Inst P ayer Sec. ID Qualifi er: prompt , press th e <Enter> key to lea ve field b lank.Patch IB2371 added the ability to define Pa yer Second ary IDs. They are u nusual and should on ly be popu lated if t he clearin g house or eBusiness Solutions Office pr ovides you with a se condary ID number.4A t the EDI - Prof Pay er Primary ID: promp t, enter t he Payer P rimary ID provided b y the clea ringhouse. 5At the ED I - 1ST Pr of Payer S ec. ID Qua lifier: pr ompt, pres s the <Ent er> key to leave fie ld blank.6 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. 7 Press the <Enter> ke y until th e Billing Parameters screen re appears.Wh en Patch I B2371 is loaded, t he patch w ill automa tically de fine a Pro fessional Payer Seco ndary for Medicare W NR that wi ll have a Qualifier = Payer ID Number an d an ID = VA plus th e site’s I D.EDI - Tr ansmit?: Y ES-LIVE//
	499	EDI - Inst Payer Pri mary ID: 1 2M61//
	500	EDI - Alt Inst Payer Primary I D Type:
	501	EDI - 1ST Inst Payer Sec. ID Q ualifier:
	502	EDI - Prof Payer Pri mary ID: S MTX1//
	503	EDI - Alt Prof Payer Primary I D Type:
	504	EDI - 1ST Prof Payer Sec. ID Q ualifier: D A N E S D # /
	505	EDI - 1ST Prof Payer Sec. ID: VA442//
	506	Patch IB2 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.
	507	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.Patch I B2432 ad ded the ab ility to d efine whet her or not the payer will acce pt MRA sec ondary cla ims electr onically w hen the pr imary clai m was neve r sent to Medicare a nd no MRA was ever r eceived. W hen the pa tch is loa ded, this field will be set to ‘0’ which means tha t the clai ms will be transmitt ed electro nically un less this field is c hanged by the site.N ote: Once Patch IB2 516 is in stalled, a new field , HPID/OEI D, will di splay in t he EDI Par ameters se ction. Th e field wi ll not be editable. The HPID or OEID nu mber will come from the Nation al Insuran ce File.ED I - Insura nce Type: GROUP POLI CY //
	508	EDI - Bin Number:
	509	EDI - UMO (278) ID:
	510	EDI - Prin t Sec/Tert Auto Clai ms?:
	511	EDI - Prin t Medicare Sec Claim s w/o MRA? :
	512	Define EDI settings for a Blue Cross/Blu e Shield G roup Insur ance Plan
	513	StepProced ure1At the Billing P arameters Screen in the Insura nce Compan y Editor, enter VP - View Plans and press the <Ente r> key.Ins urance Com pany Edito r Oct 01, 2007@ 10:15:14 Pa ge: 1 o f 9
	514	Insurance Company In formation for: BLUE CROSS
	515	Type of Co mpany: HEA LTH INSURA NCE Curren tly Active
	516	Bil ling Param eters
	517	Signatur e Required ?: NO Fil ing Time F rame:
	518	Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN
	519	Mult. Bedsection s: Billing P hone: 800/ 933-9146
	520	Diff. Rev. Code s: Veri fication P hone: 800/ 933-9146
	521	One Opt. Visi t: NO Prec ert Comp. Name:
	522	Amb. Sur . Rev. Cod e: Precert P hone: 800/ 274-7767
	523	Rx Refil l Rev. Cod e:
	524	EDI Parame ters
	525	Transm it?: YES-L IVE I nsurance T ype: GROUP POLICY
	526	+ Enter ?? f or more ac tions >>>
	527	BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All
	528	MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany
	529	IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co.
	530	OC Opt Cl aims Offic e PA Payer DC Dele te Company
	531	PC Prescr Claims Of RE Remarks VP View Plans
	532	AO Appeal s Office SY Synonyms EX Exit
	533	Select Act ion: Next Screen//VP View Pla ns
	534	StepProced ure2The In surance Pl an List ap pears. Sel ect the ap propriate plan from the list. In this ex ample, Pla n 1 is sel ected by t yping VP=1 and press ing the En ter key. I nsurance P lan List Mar 31, 20 04@16:12:5 2 Page: 1 of 1
	535	All Plans for: BLUE CROSS BLUE SHIELD DE MO Insuran ce Company
	536	# + => In div. Plan * => In active Pla n Pre- P re- Ben
	537	Group Name Group Number Type of Plan UR ? Ct? E xC? As?
	538	1 DEMO F OR TRAININ G 87654 COMPREH ENSIVE NO YES Y ES YES
	539	Enter ?? f or more ac tions
	540	VP View/E dit Plan IP (In)Ac tivate Pla n
	541	AB Annual Benefits EX Exit
	542	Select Act ion: Quit/ / VP=1
	543	StepProced ure3The Vi ew/Edit Pl an screen displays. To edit p lan inform ation, typ e PI and p ress the < Enter> key .Note: The IB GROUP PLAN EDIT security k ey is requ ired to us e PI.View/ Edit Plan Mar 3 1, 2004@16 :19:51 Page : 1 of 3
	544	Plan Infor mation for : BLUE CRO SS Insura nce Compan y
	545	Plan Cu rrently Ac tive
	546	Plan Inf ormation Utiliza tion Revie w Info
	547	Is Gro up Plan: Y ES Require U R: NO
	548	Gro up Name: D EMO FOR TR AINING Requi re Amb Cer t: YES
	549	Group Number: 8 7654 Requi re Pre-Cer t: YES
	550	Type of Plan: C OMPREHENSI VE MAJOR M ED Exclu de Pre-Con d: YES
	551	Plan Fi ling TF: Benefits Assignabl e: YES
	552	Plan Cov erage Limi tations
	553	Coverag e Effecti ve Date Covered? Limit Comments
	554	------- - ------- ------- -------- ----- ---------
	555	INPATIE NT 02/10/0 4 YES
	556	OUTPATI ENT 02/10/0 4 YES
	557	PHARMAC Y 02/10/0 4 NO
	558	+ Enter ?? f or more ac tions
	559	PI Change Plan Info IP (In)Ac tivate Pla n
	560	UI UR Inf o AB Annual Benefits
	561	CV Add/Ed it Coverag e CP Change Plan
	562	PC Plan C omments EX Exit
	563	Select Act ion: Next Screen// P I Change Plan Info
	564	StepProced ure4For th is scenari o NO is ty ped in for the Do yo u wish to change thi s plan to an Individ ual Plan? field.5Con tinue to p ress the < Enter> key until Ele ctronic Pl an Type fi eld is dis played.6Ty pe in the appropriat e code and press the <Enter> k ey. The c hosen plan will be d isplayed. In this e xample BL has been s elected.Se lecting th e correct electronic plan type is critic al. The el ectronic p lan type f or BC/BS p ayers shou ld usually be set to BL - not commercial . Choosing the wrong electroni c plan typ e for a Gr oup Insura nce Plan c ould resul t in claim s being re jected by the cleari nghouse or by the pa yer.Note: Patch IB2 432 added the abili ty to defi ne two add itional ty pes of Ele ctronic Pl an Type: 1 7 – Dental and FI – Federal Em ployee Pla n.Note: Pa tch IB24 36 added t he ability to define an additi onal plan type for M ediGap F a nd G plans . MEDIGAP (SUPPL - C OINS, DED, PART B EX C)This pla n is curre ntly defin ed as a Gr oup Plan.
	565	Do you wis h to chang e this pla n to an In dividual P lan? NO
	566	No change was made.
	567	GROUP PLAN NAME: DEM O GROUP//
	568	GROUP PLAN NUMBER: 7 878787878/ /
	569	TYPE OF PL AN: COMPRE HENSIVE MA JOR MED
	570	ELECTRONIC PLAN TYPE : ?
	571	Enter the appropriat e type of plan to be used for electronic billing.
	572	Choos e from:
	573	16 HMO MEDICARE
	574	MX MEDI CARE A or B
	575	TV TITL E V
	576	MC MEDI CAID
	577	BL BC/B S
	578	CH TRIC ARE
	579	15 INDE MNITY
	580	CI COMM ERCIAL
	581	HM HMO
	582	DS DISA BILITY
	583	12 PPO
	584	13 POS
	585	ZZ OTHE R
	586	FI FEP – Do not u se for BC/ BS
	587	17 DENT AL
	588	ELECTRONIC PLAN TYPE : BL BCBS
	589	The follow ing screen will disp lay.
	590	View/Edit Plan Mar 31, 20 04@16:19:5 1 Page: 1 of 3
	591	Plan Infor mation for : BLUE CRO SS Insuran ce Company
	592	Plan Cu rrently Ac tive
	593	Plan Inf ormation Utiliza tion Revie w Info
	594	Is Gro up Plan: Y ES Require U R: NO
	595	Gro up Name: D EMO FOR TR AINING Requi re Amb Cer t: YES
	596	Group Number: 8 7654 Requi re Pre-Cer t: YES
	597	Type of Plan: C OMPREHENSI VE MAJOR M ED Exclu de Pre-Con d: YES
	598	Electro nic Type: BC/BS Benef its Assign able: YES
	599	+ Enter ?? f or more ac tions
	600	Select Act ion: Next Screen//
	601	Activate E xisting Co mmercial P ayer to Tr ansmit eCl aims
	602	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.
	603	Follow the se steps t o change t he EDI - T ransmit? F ield:
	604	StepProced ure1On the Billing P arameters screen in the Insura nce Compan y Editor, type BP an d press th e <Enter> key.Insura nce Compan y Editor Oct 01 , 2007@10: 40:16 Page: 1 of 8
	605	Insurance Company In formation for: AETNA
	606	Type of Co mpany: HEA LTH INSURA NCE Curren tly Inacti ve
	607	Bil ling Param eters
	608	Signatur e Required ?: NO Fil ing Time F rame: 12 M OS
	609	Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN
	610	Mult. Bedsection s: Billing P hone:
	611	Diff. Rev. Code s: Veri fication P hone:
	612	One Opt. Visi t: NO Prec ert Comp. Name:
	613	Amb. Sur . Rev. Cod e: Precert P hone:
	614	Rx Refil l Rev. Cod e:
	615	EDI Parame ters
	616	Transm it?: NO Insurance Type:
	617	+ Enter ?? f or more ac tions >>>
	618	BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All
	619	MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany
	620	IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co.
	621	OC Opt Cl aims Offic e PA Payer DC Dele te Company
	622	PC Prescr Claims Of RE Remarks VP View Plans
	623	AO Appeal s Office SY Synonyms EX Exit
	624	Select Act ion: Next Screen//BP Billing/E DI Param
	625	StepProced urePatch I B2.0320 added a ne w security key, IB E DI INSURAN CE EDIT. A user mus t hold thi s key to e dit the ED I-Transmit , EDI Prof Payer ID; EDI Inst Payer ID a nd EDI-Ins urance Typ e fields.2 At the EDI - Transmi t? field, make sure the field is defined as YES-LI VE. 3At t he EDI - I nsurance T ype field, enter the correct r esponse fo r the Insu rance Comp any being edited. F or this ex ample, the correct E lectronic Insurance Type is Gr oup.Except for the t esting of Primary BC /BS and so me seconda ry end to end claims , it is no longer ne cessary to change th e EDI - Tr ansmit? fi eld to YES -TEST. In stead, use the new o ption, RCB – View/Re submit Cla ims-Live o r Test. Refer to Section 4. Note: Once Patch IB* 2516 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.N ote: Patch IB2547 will add a field, UM O (278)ID, to the ED I Paramete rs section which wil l allow us ers to def ine a prim ary payer identifica tion numbe r which wi ll be tran smitted in ASC X12N 5010 Healt h Care Ser vices Revi ew – Reque st for Rev iew and Re sponse (27 8) transac tions.Note : Patch IB 2*547 wil l add the fields, ED I - Alt In st Payer P rimary ID Type,
	626	EDI - Alt Inst Payer Primary I D, EDI - A lt Prof Pa yer Primar y ID Type and
	627	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 ).SIGNATUR E REQUIRED ON BILL?: NO//
	628	REIMBURSE? : WILL REI MBURSE//
	629	ALLOW MULT IPLE BEDSE CTIONS: YE S//
	630	DIFFERENT REVENUE CO DES TO USE :
	631	ONE OPT. V ISIT ON BI LL ONLY: N O//
	632	AMBULATORY SURG. REV . CODE:
	633	PRESCRIPTI ON REFILL REV. CODE: 253//
	634	FILING TIM E FRAME: O NE YEAR//
	635	TYPE OF CO VERAGE: HE ALTH INSUR ANCE//
	636	BILLING PH ONE NUMBER : 800-555- 5298//
	637	VERIFICATI ON PHONE N UMBER: 800 -555-5298/ /
	638	Are Precer ts Process ed by Anot her Insura nce Co.?: NO
	639	/ /
	640	PRECERTIFI CATION PHO NE NUMBER: XXX-XXX-X XXX//
	641	EDI - Tran smit?: ??
	642	Th is is the flag that says wheth er or not an insuran ce company is ready
	643	to be billed electroni cally via 837/EDI fu nctions.
	644	Choos e from:
	645	0 NO
	646	1 YES- LIVE
	647	2 YES- TEST
	648	EDI - Tran smit?: 1 YES-LIVE
	649	EDI - Inst Payer Pri mary ID:
	650	EDI - Inst Payer Pri mary ID: A vailable f rom Emdeon
	651	EDI - Alt Inst Payer Primary I D Type: LT C//
	652	EDI - Al t Inst Pay er Primary ID Type: LTC//
	653	EDI - Al t Inst Pay er Primary ID: LTC12 34//
	654	Select EDI - Alt Ins t Payer Pr imary ID T ype:
	655	EDI - 1ST Inst Payer Sec. ID Q ualifier:
	656	EDI - Prof Payer Pri mary ID:
	657	EDI - Prof Payer Pri mary ID: A vailable f rom Emdeon
	658	EDI - Alt Prof Payer Primary I D Type: LT C//
	659	EDI - Al t Prof Pay er Primary ID Type: LTC//
	660	EDI - Al t Prof Pay er Primary ID: LTC12 34P//
	661	Select EDI - Alt Pro f Payer Pr imary ID T ype:
	662	EDI - 1ST Prof Payer Sec. ID Q ualifier:
	663	EDI – Insu rance Type : ??
	664	Choos e from:
	665	1 HMO
	666	2 COMM ERCIAL
	667	3 MEDI CARE
	668	4 MEDI CAID
	669	5 GROU P POLICY
	670	9 OTHE R
	671	EDI – Insu rance Type : 5 GROUP POLICY
	672	EDI - Bin Number:
	673	EDI - UMO (278) ID:
	674	EDI - Prin t Sec/Tert Auto Clai ms?:
	675	EDI - Prin t Medicare Sec Claim s w/o MRA? :
	676	The follow ing steps show you h ow to ente r the Elec tronic Pla n Type for a Commerc ial Group Insurance Plan:
	677	StepProced ure1At the Billing P arameters Screen in the Insura nce Compan y Editor t ype in VP (View Plan s) and pre ss the <En ter> key.I nsurance C ompany Edi tor O ct 01, 200 7@10:40:16 Page: 1 of 8
	678	Insurance Company In formation for: AETNA
	679	Type of Co mpany: HEA LTH INSURA NCE Curren tly Inacti ve
	680	Bil ling Param eters
	681	Signatur e Required ?: NO Fil ing Time F rame: 12 M OS
	682	Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN
	683	Mult. Bedsection s: Billing P hone:
	684	Diff. Rev. Code s: Veri fication P hone:
	685	One Opt. Visi t: NO Prec ert Comp. Name:
	686	Amb. Sur . Rev. Cod e: Precert P hone:
	687	Rx Refil l Rev. Cod e:
	688	EDI Parame ters
	689	Transm it?: YES-L IVE I nsurance T ype: GROUP POLICY
	690	+ Enter ?? f or more ac tions >>>
	691	BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All
	692	MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany
	693	IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co.
	694	OC Opt Cl aims Offic e PA Payer DC Dele te Company
	695	PC Prescr Claims Of RE Remarks VP View Plans
	696	AO Appeal s Office SY Synonyms EX Exit
	697	Select Act ion: Next Screen//VP View Pla ns
	698	StepProced ure2The In surance Pl an List ap pears. In this exam ple, Plan 1 is selec ted by typ ing VP=1 a nd pressin g the <Ent er> key.In surance Pl an List A pr 14, 200 4@09:21:12 Page: 1 of 1
	699	All Plans for: AETNA Insurance Company
	700	# + => In div. Plan * => In active Pla n Pre- P re- Ben
	701	Group Name Group Number Type of Plan UR ? Ct? E xC? As?
	702	1 MANAGE D CHOICE 55555- 111-00001 COMPREH ENSIVE YE S YES U NK YES
	703	Enter ?? f or more ac tions
	704	VP View/E dit Plan IP (In)Ac tivate Pla n
	705	AB Annual Benefits EX Exit
	706	Select Act ion: Quit/ / VP=1
	707	StepProced ure3The Vi ew/Edit Pl an screen appears. To edit pl an informa tion, type PI and pr ess the <E nter> key. Note: The IB GROUP P LAN EDIT s ecurity ke y is requi red to use PI.View/E dit Plan Apr 14 , 2004@09: 22:11 Page: 1 of 3
	708	Plan Infor mation for : AETNA In surance Co mpany
	709	Plan Cu rrently Ac tive
	710	Plan Inf ormation Utiliza tion Revie w Info
	711	Is Gro up Plan: Y ES Require U R: YES
	712	Gro up Name: M ANAGED CHO ICE Requi re Amb Cer t:
	713	Group Number: 5 5555-111-0 0001 Requi re Pre-Cer t: YES
	714	Type of Plan: C OMPREHENSI VE MAJOR M ED Exclu de Pre-Con d:
	715	Plan Fi ling TF: Benefits Assignabl e: YES
	716	Plan Cov erage Limi tations
	717	Coverag e Effecti ve Date Covered? Limit Comments
	718	------- - ------- ------- -------- ----- ---------
	719	INPATIE NT 02/01/0 4 YES
	720	OUTPATI ENT 02/01/0 4 YES
	721	PHARMAC Y 02/01/0 4 NO
	722	+ Enter ?? f or more ac tions
	723	PI Change Plan Info IP (In)Ac tivate Pla n
	724	UI UR Inf o AB Annual Benefits
	725	CV Add/Ed it Coverag e CP Change Plan
	726	PC Plan C omments EX Exit
	727	Select Act ion: Next Screen// P I Change Plan Info
	728	StepProced ure4For th is scenari o, NO is e ntered for the Do yo u wish to change thi s plan to an Individ ual Plan? field.5Con tinue to p ress the < Enter> key until Ele ctronic Pl an Type fi eld is act ivated.6Ty pe in the appropriat e code and press the <Enter> k ey. The c hosen plan will be d isplayed. In this e xample CI has been s elected.Se lecting th e correct electronic plan type is import ant. Choos ing the wr ong electr onic plan type for a Group Ins urance Pla n could re sult in cl aims being rejected by the cle aringhouse or by the payer.Thi s plan is currently defined as a Group P lan.
	729	Do you wis h to chang e this pla n to an In dividual P lan? NO
	730	No change was made.
	731	GROUP PLAN NAME: MAN AGED CHOIC E//
	732	GROUP PLAN NUMBER: 5 5555-111-0 0001//
	733	TYPE OF PL AN: COMPRE HENSIVE MA JOR MEDICA L//
	734	ELECTRONIC PLAN TYPE : ?
	735	Enter the appropriat e type of plan to be used for electronic billing.
	736	Choos e from:
	737	16 HMO MEDICARE
	738	MX MEDI CARE A or B
	739	TV TITL E V
	740	MC MEDI CAID
	741	BL BC/B S
	742	CH TRIC ARE
	743	15 INDE MNITY
	744	CI COMM ERCIAL
	745	HM HMO
	746	DS DISA BILITY
	747	12 PPO
	748	13 POS
	749	ZZ OTHE R
	750
	751	17 D ental
	752
	753	FI F EP – Do no t use for BC/BS
	754	ELECTRONIC PLAN TYPE : CI COMM ERCIAL
	755	PLAN FILIN G TIME FRA ME: .....
	756	The follow ing screen will disp lay.
	757	View/Edit Plan Apr 14, 20 04@09:24:0 2 Page: 1 of 3
	758	Plan Infor mation for : AETNA DE MO INSURAN CE Insuran ce Company
	759	Plan Cu rrently Ac tive
	760	Plan Inf ormation Utiliza tion Revie w Info
	761	Is Gro up Plan: Y ES Require U R: YES
	762	Gro up Name: M ANAGED CHO ICE Requi re Amb Cer t:
	763	Group Number: 5 5555-111-0 0001 Requi re Pre-Cer t: YES
	764	Type of Plan: C OMPREHENSI VE MAJOR M ED Exclu de Pre-Con d:
	765	Electron ic Type: C OMMERCIAL Benefits Assignabl e: YES
	766	+ Enter ?? f or more ac tions
	767	Select Act ion: Next Screen//
	768	Activate E xisting Pa yer to Tes t Primary Blue Cross /Blue Shie ld eClaims
	769	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.
	770	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.If an e Billing Te am member, request c laims subm itted elec tronically as a Live test enab les the BC /BS payer to receive primary c laims elec tronically but in a testing mo de, use th e Billing Parameters screen in the Insur ance Compa ny Editor. The EDI - Transmit? field on t his screen must be s et to YES- TEST. In testing mo de, bills are automa tically se nt electro nically an d cannot b e printed until the confirmati on of rece ipt messag e has been received from the F SC.
	771	The follow ing steps show you h ow to chan ge the Ele ctronic Tr ansmit? fi eld:
	772	StepProced ure1On the Billing P arameters screen in the Insura nce Compan y Editor, type BP an d press th e <Enter> key.Insura nce Compan y Editor Oct 01 , 2007@10: 15:14 Page: 1 of 9
	773	Insurance Company In formation for: BLUE CROSS
	774	Type of Co mpany: HEA LTH INSURA NCE Curren tly Active
	775	Bil ling Param eters
	776	Signatur e Required ?: NO Fil ing Time F rame:
	777	Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN
	778	Mult. Bedsection s: Billing P hone: 800/ 933-9146
	779	Diff. Rev. Code s: Veri fication P hone: 800/ 933-9146
	780	One Opt. Visi t: NO Prec ert Comp. Name:
	781	Amb. Sur . Rev. Cod e: Precert P hone: 800/ 274-7767
	782	Rx Refil l Rev. Cod e:
	783	EDI Parame ters
	784	Transm it?: NO Insurance Type:
	785	+ Enter ?? f or more ac tions >>>
	786	BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All
	787	MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany
	788	IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co.
	789	OC Opt Cl aims Offic e PA Payer DC Dele te Company
	790	PC Prescr Claims Of RE Remarks VP View Plans
	791	AO Appeal s Office SY Synonyms EX Exit
	792	Select Act ion: Next Screen//BP Billing/ EDI Param
	793	StepProced ure2At the EDI - Tra nsmit? fie ld, type 2 to change the field to YES-TE ST. Conti nue to pre ss the <En ter> key u ntil the B illing Par ameters sc reen reapp ears.When using the TEST mode setting fo r BC/BS cl aims for w hich payme nt is expe cted, it i s importan t to note the carrie r will not process b ills sent in test mo de. These bills mus t be print ed locally and maile d in order to receiv e payment. SIGNATURE REQUIRED ON BILL?: NO//
	794	REIMBURSE? : WILL REI MBURSE//
	795	ALLOW MULT IPLE BEDSE CTIONS: YE S//
	796	DIFFERENT REVENUE CO DES TO USE :
	797	ONE OPT. V ISIT ON BI LL ONLY: N O//
	798	AMBULATORY SURG. REV . CODE: 49 0//
	799	PRESCRIPTI ON REFILL REV. CODE: 250//
	800	FILING TIM E FRAME: O NE YEAR FR OM DATE OF SERVICE
	801	TYPE OF CO VERAGE: HE ALTH INSUR ANCE//
	802	BILLING PH ONE NUMBER : 205-988- 2213//
	803	VERIFICATI ON PHONE N UMBER: ITS :800-253-9 307//
	804	Are Precer ts Process ed by Anot her Insura nce Co.?: NO
	805	/ /
	806	PRECERTIFI CATION PHO NE NUMBER: 800-248-2 342//
	807	EDI - Tran smit?: NO/ / ??
	808	Th is is the flag that says wheth er or not an insuran ce company is
	809	ready to b e billed e lectronica lly via 83 7/EDI func tions.
	810	Choos e from:
	811	0 NO
	812	1 YES- LIVE
	813	2 YES- TEST
	814	EDI - Tran smit?: 1 YES-LIVE
	815	EDI - Inst Payer Pri mary ID: A vailable f rom Emdeon
	816	Select EDI - Alt Ins t Payer Pr imary ID T ype:
	817	EDI - 1ST Inst Payer Sec. ID Q ualifier:
	818	EDI - Prof Payer Pri mary ID: A vailable f rom Emdeon
	819	Select EDI - Alt Pro f Payer Pr imary ID T ype:
	820	EDI - 1ST Prof Payer Sec. ID Q ualifier:
	821	EDI – Insu rance Type : 5 GROUP POLICY
	822	EDI - Bin Number:
	823	EDI - UMO (278) ID:
	824	EDI - Prin t Sec/Tert Auto Clai ms?:
	825	EDI - Prin t Medicare Sec Claim s w/o MRA? :
	826	Pay-to Pro vider(s) S et-up
	827	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.
	828	With Patch IB2516, 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 TRIC ARE Pay-to Providers , the step s are the same as th e followin g steps fo r regular Pay-to Pro viders. A new secti on has bee n added to the IB Si te Paramet ers.
	829	IB Site Pa rameters Jun 16, 20 14@11:34:0 9 Page: 3 of 5
	830	Only autho rized pers ons may ed it this da ta.
	831	+
	832	[10]Pay-To Providers : 1 define d, default - DNS ENNE VAMC
	833	[11]TRICAR E Pay-To P roviders: 0 defined
	834	[12]Inpt H ealth Summ ary: INPAT IENT HEALT H SUMMARY
	835	Opt He alth Summa ry : OUTPA TIENT HEAL TH SUMMARY
	836	[13]HIPPA NCPDP Acti ve Flag : A ctive
	837	[14]Inpati ent TP Act ive : YES
	838	Outpat ient TP Ac tive: YES
	839	Pharma cy TP Acti ve : YES
	840	Prosth etic TP Ac tive: YES
	841	[15] EDI/M RA Activat ed : B OTH EDI AN D MRA
	842	EDI C ontact Pho ne : ( 307)778-75 81
	843	+ Enter ?? f or more ac tions
	844	EP Edit S et EX Exit
	845	Select Act ion: Next Screen//
	846	Define Def ault Pay-t o Provider
	847	StepProced ureNote: W ith Patch IB2516, two new Se curity Key s have bee n added: I B EDIT PAY -TO and IB EDIT PAY- TO TC. Users must be assign ed these k eys before adding or editing a Pay-to Pr ovider.1Ac cess the o ption SITE (MCCR Site Parameter Display/E dit.2From the MCCR S ite Parame ters scree n, enter t he action: IB Site P arameters. 3Press the <Enter> k ey for Nex t Screen u ntil Page 2 is displ ayed.4From the IB Si te Paramet ers screen , enter th e action: EP Edit Se t.5Enter t he number 10.6From t he Pay-to Providers screen, en ter the ac tion: AP A dd Provide r.7From th e Enter Pa y-to Provi der: promp t, enter DNS ENNE VAMC for this e xample.Not e: A Pay-to P rovider sh ould be a VAMC level facility with a val id NPI. The Pay-to Provider can be an institutio n outside your own d atabase. Example: VAMC A cou ld process payments for servic es provide d by VAMC B.8At the Are you ad ding ' DNS ENNE VAMC' as a new PAY-TO PRO VIDERS (th e 1ST for this IB SI TE PARAMET ERS)? No// prompt, e nter YES f or this ex ample.9At the Pay-to Provider Name promp t, press t he <Enter> key to ac cept the d efault nam e from the Instituti on file.10 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.11At t he Pay-to Provider A ddress Lin e 2 prompt ; press th e <Enter> key to acc ept the de fault addr ess from t he Institu tion file. 12At the P ay-to Prov ider City prompt; pr ess the <E nter> key to accept the defaul t City fro m the Inst itution fi le.13At th e Pay-to P rovider St ate prompt ; press th e <Enter> key to acc ept the de fault Stat e from the Instituti on file.14 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.15At t he Pay-to Provider P hone Numbe r prompt; enter the Phone Numb er that a payer shou ld use to contact th e site.16A t the Pay- to Provide r Federal Tax ID Num ber prompt ; press th e <Enter> key to acc ept the de fault Tax ID.Note: There will be a defa ult Tax ID only when the insti tution sel ected as t he Pay-to Provider i s the same as the ma in divisio n in the s ite’s data base. This is ta ken from t he IB Site Parameter s. 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 Tax ID.Note: A Pay-to P rovider do es not hav e to have an actual street add ress. You can en ter a P.O. Box as an address.P ay-To Prov iders Dec 22, 20 08@13:58:1 3 Page: 1 of 1
	848	No Pay-T o Provider s defined.
	849	* = Defaul t Pay-to p rovider
	850	AP Add Pr ovider DP Delete Pro vider EX Exit
	851	EP Edit P rovider AS Associate Divisions
	852	Select Ite m(s): Quit // AP Ad d Provider
	853	Enter Pay- to Provide r: DNS ENNE VAMC WY M&ROC 442
	854	Are you ad ding ' DNS ENNE VAMC' as a new PAY-TO PRO VIDERS (th e 1ST for this IB
	855	SITE PARAM ETERS)? No // y (Yes )
	856	Pay-to Pro vider Name : DNS ENNE VAMC/ /
	857	Pay-to Pro vider Addr ess Line 1 : 2360 E P ERSHING BL VD
	858	Replace
	859	Pay-to Pro vider Addr ess Line 2 : Mail Sto p 10234
	860	Pay-to Pro vider City : DNS ENNE//
	861	Pay-to Pro vider Stat e: WYOMING //
	862	Pay-to Pro vider Zip Code: 8200 1-5356//
	863	Pay-to Pro vider Phon e Number: 555-555-55 55
	864	Pay-to Pro vider Fede ral Tax ID Number: 8 3-0168494/ /
	865	The follow ing screen will disp lay.
	866	Pay-To Pro viders D ec 22, 200 8@14:38:21 Page: 1 of 1
	867	1. *Name : DNS ENNE VAMC State : WY
	868	Add ress 1: 23 60 E PERSH ING BLVD Zip Cod e: 82001-5 356
	869	Add ress 2: Phone :
	870	City : DNS ENNE Tax ID : 83-01684 94
	871	* = Defaul t Pay-to p rovider
	872	AP Add Pr ovider DP Delete Pro vider EX Exit
	873	EP Edit P rovider AS Associate Divisions
	874	Select Ite m(s): Quit //
	875	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 .
	876	StepProced ure17From the Pay-to Providers screen, e nter the a ction AS A ssociate D ivisions.T he followi ng screen will displ ay.
	877	Pay-To Pro vider Asso ciations D ec 22, 200 8@14:42:27 Page: 1 of 1
	878	DNS ENNE VAMC (Default)
	879	1 442GA CASPER
	880	2 442GC FORT CO LLINS
	881	3 442GD GREELEY
	882	4 442 DNS ENNE VAMRO C
	883	5 442GB SIDNEY
	884	6 442GE TEST MO RC
	885	Enter ?? f or more ac tions
	886	AS Associ ate Divisi on EX Exit
	887	Select Ite m(s): Quit //
	888	Associate Divisions with non-D efault Pay -to Provid er
	889	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 .
	890	StepProced ureNote: W hen there is more th an one Pay -to Provid er, users must assoc iated divi sions with the non-d efault Pay -to Provid er(s).1Fro m the Pay- to Provide rs screen, enter the action AS Associate Divisions .Pay-To Pr oviders Dec 22, 20 08@14:55:3 2 Page: 1 of 1
	891	1. *Name : DNS ENNE VAMC State : WY
	892	Add ress 1: 23 60 E PERSH ING BLVD Zip Cod e: 82001-5 356
	893	Add ress 2: Phone :
	894	City : DNS ENNE Tax ID : 83-01684 94
	895	2. Nam e : MO NTANA HEAL TH CARE SY STEM - FT. H State : MT
	896	Add ress 1: VA Medical C enter Zip Cod e: 59636
	897	Add ress 2: Phone : 666-666 -6666
	898	Cit y : FO RT HARRISO N Tax ID : 11-1111 111
	899	* = Defaul t Pay-to p rovider
	900	AP Add Pr ovider DP Delete Pro vider EX Exit
	901	EP Edit P rovider AS Associate Divisions
	902	Select Ite m(s): Quit // AS Asso ciate Divi sions
	903	The follow ing screen will disp lay.
	904	Pay-To Pro vider Asso ciations D ec 22, 200 8@15:32:45 Page: 1 of 1
	905	DNS ENNE VAMC (Default)
	906	1 442GA CASPER
	907	2 442GC FORT CO LLINS
	908	3 442GD GREELEY
	909	4 442 DNS ENNE VAMRO C
	910	5 442GB SIDNEY
	911	6 442GE TEST MO RC
	912	MONTANA H EALTH CARE SYSTEM - FT. HARRIS ON DIVISIO N
	913	No Divisions found.
	914	Enter ?? f or more ac tions
	915	AS Associ ate Divisi on EX Exit
	916	Select Ite m(s): Quit // AS Asso ciate Divi sion
	917	Select Div ision (1-6 ): 5
	918	Select Pay -To Provid er: Montan a
	919	StepProced ure2At the Select It em(s): pro mpt, enter the actio n AS Assoc iate Divis ions.3At t he Divisio n (1-6): p rompt, ent er 5 for t his exampl e.4 At t he Pay-to Provider: prompt, en ter Montan a for this example.N ote: User s can not associate a division that is d efined as a Pay-to P rovider, t o another Pay-to Pro vider. Us ers will g et the fol lowing err or if they try: A di vision use d as a Pay -to Provid er can not be associ ated with another Pa y-to Provi der.5Repea t steps 2 - 4 if nec essary.Not e: Once a division has been e xplicitly associated with a pa rticular P ay-to Prov ider, chan ging the d efault Pay -to Provid er will no t automati cally chan ge the div ision’s as sociated P ay-to Prov ider.The f ollowing s creen will display.
	920	Pay-To Pro vider Asso ciations D ec 22, 200 8@15:34:39 Page: 1 of 1
	921	DNS ENNE VAMC (Default)
	922	1 442GA CASPER
	923	2 442GC FORT CO LLINS
	924	3 442GD GREELEY
	925	4 442 DNS ENNE VAMRO C
	926	5 442GE TEST MO RC
	927	MONTANA H EALTH CARE SYSTEM - FT. HARRIS ON DIVISIO N
	928	6 442GB SIDNEY
	929	Enter ?? f or more ac tions
	930	AS Associ ate Divisi on EX Exit
	931	Select Ite m(s): Quit //
	932	Provider I D Set-up
	933	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 .
	934	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.
	935	IDs have q ualifiers that ident ify what t ype of ID is being t ransmitted . An Atte nding phys ician’s pr imary ID i s his/her Social Sec urity Numb er (SSN). This SSN is transmi tted with a qualifie r (34) whi ch indicat es that th is number is an SSN. A Blue C ross ID is transmitt ed with a qualifier (1A) which indicates that this number is a Blue Cr oss number . Appendi x C has a list of qu alifiers a nd which o nes can be transmitt ed in whic h 837 reco rds.
	936	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 .
	937	Patch IB2 .0343 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.
	938	Patches IB 2.0348 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.
	939	After Patc h IB2436 , 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” .
	940	When Patch IB2.043 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.
	941	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).
	942	Segment Ty pe of IDMa x # of IDs (P)rint
	943	(T)ransmit
	944	(B)othPRV: 9Billing P rovider Pr imary ID 1 BPRV1:6Pay -to Provid er Primary ID1TCI1A: 2-17Billin g Provider Secondary IDs8BOPR1 Attending, Other Ope rating or Operating Physician Primary ID 1/Physicia nBOPR1Refe rring Prov ider Prima ry ID1/Pro viderBOPR7 Supervisin g Provider ’s Primary ID1/Provi derBOPR9Re ndering Pr ovider Pri mary ID1BO PR2Attendi ng Physici an Seconda ry IDs5BOP RARenderin g Provider Secondary ID4BOPR3O perating P hysician S econdary I Ds5BOPR4Ot her Physic ian Second ary IDs5BO PR5Referri ng Provide r Secondar y IDs5BOPR 8Supervisi ng Provide r Secondar y IDs1BSUB 2Laborator y or Facil ity Primar y ID1BSUB2 Laboratory or Facili ty Seconda ry IDs5TTa ble of IDs
	945	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 .
	946	Pay-to Pro vider NPIV istA Optio nThe Insti tution fil e is not a vailable t o Billing personnelV istA FileI nstitution (#4)UB-04 N/ACMS-150 0N/AVPE (8 37 Record) PRV1, Piec e 6Pay-to Provider P rimary ID (Federal T ax Number of the VAM C) - Legac y VistA Op tion MCCR Site Param eter Displ ay/Edit Vi stA FileIB SITE PARA METERS (#3 50.9)UB-04 N/ACMS-150 0 N/A VPE (837 Recor d)N/ABilli ng Provide r NPIVistA OptionThe Instituti on file is not avail able to Bi lling pers onnelVistA FileInsti tution (#4 )UB-04FL 5 6CMS-1500B ox 33a VPE (837 Reco rd)PRV, Pi ece 9Billi ng Provide r Taxonomy CodeVistA OptionThe Instituti on file is not avail able to Bi lling pers onnelVistA FileInsti tution (#4 )UB-04N/AC MS-1500N/A VPE (837 R ecord)PRV, Piece 14B illing Pro vider Seco ndary ID ( Federal Ta x Number o f the VAMC )VistA Opt ion MCCR S ite Parame ter Displa y/Edit Vis tA FileIB SITE PARAM ETERS (#35 0.9)UB-04F L 5CMS-150 0 Box 25 V PE (837 Re cord)CI1A, Piece 5Bi lling Prov ider Secon dary IDs - Legacy No te: If non e are defi ned, the d efault is the Federa l Tax ID.V istA Optio n Insuranc e Company Entry/Edit (ID Prov I Ds/ID Para mVistA Fil eFACILITY BILLING ID (#355.92) UB-04FL 57 CMS-1500Bo x 33bVPE ( 837 Record )CI1A, Pie ces 6-17VA - Attendi ng, Other Operating or Operati ng Physici an NPI Vis tA Option Provider S elf Entry (Not avail able to Bi lling pers onnel)
	947	Add/Edit N PI values for Provid ersVistA F ileNEW PER SON (#200 )UB-04FL 7 6-79CMS-15 00N/AVPE ( 837 Record )OPR1, Pie ce 3, 6, o r 9VA – At tending Pr ovider Tax onomy Code VistA Opti on Add a N ew User to the Syste m (Not ava ilable to Billing pe rsonnel)
	948	Edit an Ex isting Use r
	949	Person Cla ss EditVis tA FilePER SON CLASS (#8932.1)U B-04N/ACMS -1500N/AVP E (837 Rec ord)OPR, P iece 17VA - Referrin g Provider NPIVistA OptionProv ider Self Entry (Not available to Billin g personne l)
	950	Add/Edit N PI values for Provid ersVistA F ileNEW PER SON (#200) UB-04FL 78 or 79CMS- 1500Box 17 bVPE (837 Record)OPR 1, Piece 1 2VA – Rend ering Prov ider NPIVi stA Option Provider S elf Entry (Not avail able to Bi lling pers onnel)
	951	Add/Edit N PI values for Provid ersVistA F ileNEW PER SON (#200) UB-04FL 78 or 79CMS- 150024J (R endering)V PE (837 Re cord)OPR9, Piece 9VA - Renderi ng Taxonom y CodeVist A Option A dd a New U ser to the System (N ot availab le to Bill ing person nel)
	952	Edit an Ex isting Use r
	953	Person Cla ss EditVis tA FilePER SON CLASS (#8932.1)U B-04N/ACMS -1500N/AVP E (837 Rec ord)OPR9, Piece 11VA - Supervi sing Provi der NPI Vi stA Option Provider Self Entry (Not avai lable to B illing per sonnel)
	954	Add/Edit N PI values for Provid ersVistA F ileNEW PER SON file # 200UB-04N/ ACMS-1500N /AVPE (837 Record)OP R7, Piece 7Non-VA - Attending, Other Ope rating or Operating Physician NPI VistA Option Pro vider ID M aintenance (Non/Other VA Provid er(Individ ualVistA F ileIB NON VA/OTHER B ILLING PRO VIDER (#35 5.93)UB-04 FL 76-79CM S-1500N/AV PE (837 Re cord)OPR1, Piece 3,6 , or 9Non- VA – Atten ding Provi der Taxono my CodeVis tA Option Provider I D Maintena nce(Non/Ot her VA Pro vider(Indi vidualVist A FileIB N ON VA/OTHE R BILLING PROVIDER ( #355.93)UB -04FL 76-7 9CMS-1500N /AVPE (837 Record)OP R, Piece 1 7Non-VA – Rendering Provider N PIVistA Op tion Provi der ID Mai ntenance(N on/Other V A Provider (Individua lVistA Fil esIB NON V A/OTHER BI LLING PROV IDER (#355 .93)UB-04F L 78-79CMS -150024J V PE (837 Re cord)OPR9, Piece 9No n-VA – Ref erring Pro vider NPIV istA Optio n Provider ID Mainte nance(Non/ Other VA P rovider(In dividualVi stA FilesI B NON VA/O THER BILLI NG PROVIDE R (#355.93 )UB-04FL 7 8-79CMS-15 0017b VPE (837 Recor d)OPR1, Pi ece 12Non- VA – Rende ring Provi der Taxono my CodeVis tA Option Provider I D Maintena nce(Non/Ot her VA Pro vider(Indi vidualVist A FilesIB NON/OTHER D A N B S L I G PROVIDER (#355.93) UB-04N/ACM S-1500N/AV PE (837 Re cord)OPR9, Piece 11N on-VA – Su pervising Provider N PIVistA Op tionProvid er ID Main tenance(No n/Other VA Provider( Individual VistA File sIB NON VA /OTHER BIL LING PROVI DER (#355. 93)UB-04N/ ACMS-1500N /AVPE (837 Record)OP R7, Piece 7VA - Atte nding, Oth er Operati ng or Oper ating Phys ician Seco ndary IDs - LegacyVi stA Option Provider ID Mainten ance( Prov ider Speci fic IDs(
	955	Provider’s Own IDs
	956	Provider I Ds Furnish ed by Insu rance Co VistA File sIB Billin g Practiti oner ID (# 355.9)UB-0 4FL 76-79C MS-1500N/A VPE (837 R ecord)OPR2 , OPR3, OP R4 Pieces 3, 5, 7, 9 or 11VA – Rendering Provider Secondary IDs - Lega cyVistA Op tionProvid er ID Main tenance( P rovider Sp ecific IDs (
	957	Provider’s Own IDs
	958	Provider I Ds Furnish ed by Insu rance Co VistA File sIB Billin g Practiti oner ID (# 355.9)UB-0 4FL 78-79C MS-1500Box 24JVPE (8 37 Record) OPRA, Piec es 2-9VA – Referring Provider Secondary IDs - Lega cyVistA Op tionProvid er ID Main tenance( P rovider Sp ecific IDs (
	959	Provider’s Own IDs
	960	Provider I Ds Furnish ed by Insu rance Co VistA File sIB Billin g Practiti oner ID (# 355.9)UB-0 4FL 78-79C MS-1500Box 17a VPE ( 837 Record )OPR5, Pie ces 2-10VA – Supervi sing Provi der Second ary IDs - LegacyVist A OptionPr ovider ID Maintenanc e( Provide r Specific IDs(
	961	Provider’s Own IDs
	962	Provider I Ds Furnish ed by Insu rance Co VistA File sIB Billin g Practiti oner ID (# 355.9)UB-0 4N/ACMS-15 00N/AVPE ( 837 Record )OPR 8, Pi eces 2-11N on - VA - Attending, Other Ope rating or Operating Physician Secondary IDs - Lega cy VistA O ption Prov ider ID Ma intenance( Non/Other VA Provid er ID Info rmation
	963	Provider I D Maintena nce( Provi der Specif ic IDs(
	964	Provider’s Own IDs
	965	Provider I Ds Furnish ed by Insu rance Co VistA File sIB Billin g Practiti oner ID (# 355.9)UB-0 4FL 76-79 CMS-1500N/ AVPE (837 Record)OPR 2, OPR3, O PR4 Pieces 2-11Non - VA – Rend ering Prov ider Secon dary IDs - Legacy Vi stA Option Provider I D Maintena nce( Non/O ther VA Pr ovider ID Informatio n
	966	Provider I D Maintena nce( Provi der Specif ic IDs(
	967	Provider’s Own IDs
	968	Provider I Ds Furnish ed by Insu rance Co VistA File sIB Billin g Practiti oner ID (# 355.9)UB-0 4FL 78-79C MS-1500Box 24J VPE (837 Reco rd)OPRA, P ieces 2-9N on-VA - Re ferring Pr ovider Sec ondary IDs - LegacyV istA Optio nProvider ID Mainten ance( Prov ider Speci fic IDs(
	969	Provider’s Own IDs
	970	Provider I Ds Furnish ed by Insu rance Co VistA File sIB Billin g Practiti oner ID (# 355.9)UB-0 4FL 78-79C MS-1500Box 17a VPE ( 837 Record )OPR5, Pie ces 2-10No n - VA – S upervising Provider Secondary IDs - Lega cyVistA Op tionProvid er ID Main tenance( N on/Other V A Provider ID Inform ation
	971	Provider I D Maintena nce( Provi der Specif ic IDs(
	972	Provider’s Own IDs
	973	Provider I Ds Furnish ed by Insu rance Co VistA File sIB Billin g Practiti oner ID (# 355.9)UB-0 4N/ACMS-15 00N/AVPE ( 837 Record )OPR8, Pie ces 2-11VA - Service Facility – Laborato ry or Faci lity NPIAf ter Patch IB2400, only VA fa cility typ es that do not have NPIs (e.g. , MORC) ar e used as VA Service Facilitie s. Most o ften the S ervice Fac ility is b lank.VA - Service Fa cility – L aboratory or Facilit y Federal Tax IDVist A Option M CCR Site P arameter D isplay/Edi t
	974	Insurance Company En try/Edit V istA FileI B SITE PAR AMETERS (# 350.9)UB-0 4N/ACMS-15 00 N/AVPE (837 Recor d)SUB, Pie ce 9VA - S ervice Fac ility – La boratory o r Facility Secondary IDs - Leg acyVistA O ption Insu rance Comp any Entry/ Edit (ID P rov IDs/ID Param (VA -Lab/Facil ity IDsVis tA FileFAC ILITY BILL ING ID (#3 55.92)UB-0 4N/ACMS-15 00Box 32bV PE (837 Re cord)SUB2, Pieces 7- 16Non-VA - Service F acility – Laboratory or Facili ty NPIVist A Option P rovider ID Maintenan ce( Non/Ot her VA Pro vider ID I nformation (Facility( Facility I nfoVistA F ileIB NON VA/OTHER B ILLING PRO VIDER file #355.93UB -04N/ACMS- 1500Box 32 aVPE (837 Record)SUB 2, Piece 6 Non-VA - S ervice Fac ility – La boratory o r Facility Secondary IDs - Leg acyVistA O ption Prov ider ID Ma intenance( Non/Other VA Provid er ID Info rmation(Fa cility(Sec ondary ID MaintVistA FileIB BI LLING PRAC TITIONER I D (#355.9) UB-04Not P rintedCMS- 150032bVPE (837 Reco rd)SUB2, P ieces 7-16 Pay-to Pro vider IDs
	975	Define the Pay-to Pr ovider Pri mary ID/NP I
	976	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).
	977	Beginning with Patch IB2432, 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.
	978	Define the Pay-to Pr ovider Sec ondary IDs
	979	With Patch IB2400, 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 IB24 32.
	980	Billing Pr ovider IDs
	981	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:
	982	CBOC – Com munity Bas ed Outpati ent Clinic
	983	HCS – Heal th Care Sy stem
	984	M&ROC – Me dical and Regional O ffice Cent er
	985	OC – Outpa tient Clin ic (Indepe ndent)
	986	OPC – Out Patient Cl inic
	987	PHARM – Ph armacy
	988	VAMC – VA Medical Ce nter
	989	RO-OC – Re gional Off ice – Outp atient Cli nic
	990	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.
	991	With Patch IB2432, 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.
	992	Define the Billing P rovider Pr imary ID/N PI
	993	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.
	994	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.
	995	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.
	996	StepProced ure1Access the optio n SITE(MCC R Site Par ameter Dis play/Edit. 2From the MCCR Site Parameters screen, e nter the a ction: IB Site Param eters.3Pre ss the <En ter> key f or Next Sc reen until Page 2 is displayed .4From the IB Site P arameters screen, en ter the ac tion: EP E dit Set.5E nter the n umber 9.6A t the Fede ral Tax Nu mber promp t, enter t he site’s Federal Ta x Number.I B Site Par ameters O ct 20, 200 5@16:23:16 Page: 2 of 6
	997	Only autho rized pers ons may ed it this da ta.
	998	+
	999	[5] Medica l Center : LOMA LINDA VAMC Defa ult Divisi on : JER RY L PETTI
	1000	MAS Se rvice : PATIE NT ELIGIBI LITY Bill ing Superv isor : KYD FES,SHUUN
	1001	[6] Initia tor Author ize: YES Xfer Proc to S ched : NO
	1002	Ask HI NQ in MCCR : YES Use Non-PTF Co des : YES
	1003	Multip le Form Ty pes: YES Use OP CPT scr een : YES
	1004	[7] UB-04 Print IDs : YES UB-0 4 Address Col :
	1005	CMS-15 00 Print I Ds : YES CMS- 1500 Addr Col : 28
	1006	[8] Defaul t RX DX Cd : 780.9 9 Defa ult ASC Re v Cd : 490
	1007	Defaul t RX CPT C d : Defa ult RX Rev Cd : 251
	1008	[9] Bill S igner Name : <No l onger used > Fede ral Tax # :
	1009	Bill S igner Titl e : <No l onger used >
	1010	Remark on Each B ill: BILL # MUST BE ON ALL REM ITTANCE
	1011	+ Enter ?? f or more ac tions
	1012	EP Edit S et EX Exit Action
	1013	Select Act ion: Next Screen// e p Edit S et
	1014	Select Par ameter Set (s): (5-9 ): 9
	1015	NAME OF CL AIM FORM S IGNER: BUS INESS OFFI CE//
	1016	TITLE OF C LAIM FORM SIGNER:
	1017	FEDERAL TA X NUMBER: XXX123456
	1018	Define the Billing P rovider Se condary ID s
	1019	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.
	1020	Users can define one Billing P rovider Se condary ID for a CMS -1500 and another fo r a UB-04 for the ma in divisio n. If no other Bill ing Provid er Seconda ry IDs are defined, these two IDs become the defau lt IDs for all claim s.
	1021	Billing Pr ovider Sec ondary IDs can be de fined by D ivision, F orm Type, and Care U nit.
	1022	Define Def ault Billi ng Provide r Secondar y IDs by F orm Type
	1023	StepProced ure1Access the optio n MCCR SYS TEM DEFINI TION MENU( Insurance Company En try/Edit.2 At the Sel ect Insura nce Compan y Name: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple.3From the Insura nce Compan y Editor s creen, ent er the act ion: ID Pr ov IDs/ID Param.4Fro m the Bill ing Provid er IDs scr een, enter the actio n Add an I D.5At the Define Bil ling Provi der Second ary IDs by Care Unit s? No// pr ompt, pres s the <Ent er> key to accept th e default of No.6At the Divisi on prompt, accept th e default for the ma in Divisio n.7At the ID Qualifi er: Electr onic Plan Type// pro mpt, enter Blue Shie ld to over ride the d efault val ue for thi s example. 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.8At the Form Type prompt, en ter CMS-15 00 for thi s example. 9 At the B illing Pro vider Seco ndary ID p rompt, ent er the ID XXXXXXXX1B for this example.10 Repeat the se steps f or the For m Type = U B-04, Qual ifier = Bl ue Cross a nd ID = XX XXXX1A.Not e: Beginni ng with Pa tch IB24 32, if no Billing Pr ovider Sec ondary IDs are defin ed, the Fe deral Tax ID will no longer be used as a default v alue.Billi ng Provide r IDs (Par ent) May 27, 2005@12:48 :29 Page: 1 of 1
	1024	Insurance Co: BLUE C ROSS OF CA LIFORNIA Billing P rovider Se condary ID s
	1025	ID Qu alifier ID # Form Type
	1026	No Billing Provider IDs found
	1027	Enter ?? f or more ac tions
	1028	Add an ID Addit ional IDs Exi t
	1029	Edit a n ID ID Pa rameters
	1030	Delete an ID
	1031	VA-La b/Facility IDs
	1032	Select Act ion: Quit/ / a Add ID
	1033	Define Bil ling Provi der Second ary IDs by Care Unit s? No//??
	1034	Enter N o to defin e a Billin g Provider Secondary ID
	1035	for the Division.
	1036	Enter Y es to defi ne a Billi ng Provide r Secondar y ID
	1037	for a s pecific Ca re Unit.
	1038	If no C are Unit i s entered on Billing Screen 3, the
	1039	Billing Provider Secondary ID defined for the D ivision wi ll
	1040	be tran smitted in the claim .
	1041	0 No
	1042	1 Yes
	1043	Define Bil ling Provi der Second ary IDs by Care Unit s? No//No
	1044	Division: Main Divis ion// Main Division
	1045	ID Qualifi er: Electr onic Plan Type//Blue Shield
	1046	Enter Form Type for ID: CMS-15 00
	1047	Billing Pr ovider Sec ondary ID: XXXXXX1B
	1048	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.
	1049	Billing Pr ovider IDs (Parent) May 27, 2005@ 12:48:29 Pa ge: 1 o f 1
	1050	Insurance Co: BLUE C ROSS OF CA LIFORNIA Billing P rovider Se condary ID s
	1051	ID Qu alifier ID # Form Type
	1052	Division: Name of Ma in Divisio n/Default for All Di visions
	1053	1 Blue Cross XX XXXX1A UB04
	1054	2 Blue Shield XX XXXX1B 1500
	1055	Enter ?? f or more ac tions
	1056	Add an ID Addit ional IDs Exi t
	1057	Edit a n ID ID Pa rameters
	1058	Delete an ID
	1059	VA-La b/Facility IDs
	1060	Select Act ion: Quit/ /
	1061	Define Bil ling Provi der Second ary IDs by Division and Form T ype
	1062	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.
	1063	StepProced ure1Access the optio n MCCR SYS TEM DEFINI TION MENU( Insurance Company En try/Edit.2 At the Sel ect Insura nce Compan y Name: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple.3From the Insura nce Compan y Editor s creen, ent er the act ion ID Pro v IDs/ID P aram.4From the Billi ng Provide r IDs scre en, enter the action Add an ID .5At the D efine Bill ing Provid er Seconda ry IDs by Care Units ? No// pro mpt, press the <Ente r> key to accept the default o f No.6At t he Divisio n prompt, override t he default for the m ain divisi on by ente ring the n ame of ano ther divis ion, Remot e Clinic f or this ex ample.7At the ID Qua lifier: El ectronic P lan Type// prompt, e nter Blue Shield to override t he default value for this exam ple.8At th e Form Typ e prompt, enter CMS- 1500 for t his exampl e.9 At the Billing P rovider Se condary ID prompt, e nter the I D 1XXXXX1B for this example.10 Repeat the se steps f or the For m Type = U B-04, Qual ifier = Bl ue Cross a nd ID = 1X XXXX1A.Not e: Users m ay repeat these step s to defin e differen t Billing Provider S econdary I Ds for eac h division if requir ed by the insurance company.Bi lling Prov ider IDs ( Parent) May 27 , 2005@12: 48:29 Page: 1 of 1
	1064	Insurance Co: BLUE C ROSS OF CA LIFORNIA Billi ng Provide r Secondar y IDs
	1065	ID Qu alifier ID # Form Type
	1066	Division: Name of Ma in Divisio n/Default for All Di visions
	1067	1 Blue Cross XX XXXX1A UB04
	1068	2 Blue Shield XX XXXX1B 1500
	1069	Enter ?? f or more ac tions
	1070	Add an ID Addit ional IDs Exi t
	1071	Edit a n ID ID Pa rameters
	1072	Delete an ID
	1073	VA-La b/Facility IDs
	1074	Select Act ion: Quit/ / a Add ID
	1075	Define Bil ling Provi der Second ary IDs by Care Unit s? No//No
	1076	Division: Main Divis ion// Remo te Clinic
	1077	ID Qualifi er: Electr onic Plan Type//Blue Shield
	1078	Enter Form Type for ID: CMS-15 00
	1079	Billing Pr ovider Sec ondary ID: 1XXXXX1B
	1080	The follow ing screen will disp lay.
	1081	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.Bill ing Provid er IDs May 27, 2005@1 2:48:29 Pag e: 1 of 1
	1082	Insurance Co: BLUE C ROSS OF CA LIFORNIA Billing P rovider Se condary ID s
	1083	ID Qu alifier ID # Form Type
	1084	Division: Name of Ma in Divisio n/Default for All Di visions
	1085	1 Blue Cross XX XXXX1A UB04
	1086	2 Blue Shield XX XXXX1B HCFA
	1087	Division: Remote Cli nic
	1088	3 Blue Cross 1X XXXX1A UB04
	1089	4 Blue Shield 1X XXXX1B 1500
	1090	Enter ?? f or more ac tions
	1091	Add an ID Addit ional IDs Exi t
	1092	Edit a n ID ID Pa rameters
	1093	Delete an ID
	1094	VA-La b/Facility IDs
	1095	Select Act ion: Quit/ /
	1096	Define Bil ling Provi der Second ary IDs by Division, Form Type and Care Unit
	1097	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.
	1098	StepProced ure1Access the optio n MCCR SYS TEM DEFINI TION MENU( Insurance Company En try/Edit.2 At the Sel ect Insura nce Compan y Name: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple.3From the Insura nce Compan y Editor s creen, ent er the act ion ID Pro v IDs/ID P arameters. 4From the Billing Pr ovider IDs screen, e nter the a ction Add an ID.5At the Define Billing P rovider Se condary ID s by Care Units? No/ / prompt, enter YES to overrid e the defa ult.6At th e Division prompt, p ress the < Enter> key to accept the defau lt for the Main Divi sion.7At t he Care Un it: prompt , enter ?? to see a pick list of availab le Care Un its.Refer to Section 3.4.2 to learn how to create this list of availab le Care Un its.8At th e Care Uni t: prompt, enter Ane sthesia fo r this exa mple.9At t he ID Qual ifier: Ele ctronic Pl an Type// prompt, en ter Blue S hield to o verride th e default value for this examp le.10At th e Form Typ e prompt, enter CMS- 1500 for t his exampl e.11At the Billing P rovider Se condary ID prompt, e nter the I D 11XXXX1B for this example.12 Repeat the se steps f or the For m Type = U B-04, Qual ifier = Bl ue Cross a nd ID = 11 XXXX1A.13R epeat thes e steps fo r Care Uni ts Referen ce Lab and Home Heal th.Billing Provider IDs May 27, 2005@12:4 8:29 Page: 1 of 1
	1099	Insurance Co: BLUE C ROSS OF CA LIFORNIA Billing P rovider Se condary ID s
	1100	ID Qu alifier ID # Form Type
	1101	Division: Name of Ma in Divisio n/Default for All Di visions
	1102	1 Blue Cross XX XXXX1A UB04
	1103	2 Blue Shield XX XXXX1B 1500
	1104	Division: Remote Cli nic
	1105	3 Blue Cross 1X XXXX1A UB04
	1106	4 Blue Shield 1X XXXX1B 1500
	1107	Enter ?? f or more ac tions
	1108	Add an ID Addit ional IDs Exi t
	1109	Edit a n ID ID Pa rameters
	1110	Delete an ID
	1111	VA-La b/Facility IDs
	1112	Select Act ion: Quit/ / a Add ID
	1113	Define Bil ling Provi der Second ary IDs by Care Unit s? No//??
	1114	Enter N o to defin e a Billin g Provider Secondary ID
	1115	for the Division.
	1116	Enter Y es to defi ne a Billi ng Provide r Secondar y ID
	1117	for a s pecific Ca re Unit.
	1118	If no C are Unit i s entered on Billing Screen 3, the
	1119	Billing Provider Secondary ID defined for the D ivision wi ll
	1120	be tran smitted in the claim .
	1121	0 No
	1122	1 Yes
	1123	Define Bil ling Provi der Second ary IDs by Care Unit s? No//1 Yes
	1124	Division: Main Divis ion// Main Division
	1125	Care Unit: ??
	1126	Select a Care Uni t from the list:
	1127
	1128	1 Anesthes ia
	1129
	1130	2 Referenc e Lab
	1131
	1132	3 Home Hea lth
	1133	Care Unit: 1 Anest hesia
	1134	ID Qualifi er: Electr onic Plan Type//Blue Shield
	1135	Enter Form Type for ID: CMS-15 00
	1136	Billing Pr ovider Sec ondary ID: 11XXXX1B
	1137	The follow ing screen will disp lay.
	1138	Billing Pr ovider IDs May 27, 20 05@12:48:2 9 Page: 1 of 1
	1139	Insurance Co: BLUE C ROSS OF CA LIFORNIA Billing P rovider Se condary ID s
	1140	ID Qu alifier ID # Form Type
	1141	Division: Name of Ma in Divisio n/Default for All Di visions
	1142	1 Blue Cross XX XXXX1A UB04
	1143	2 Blue Shield XX XXXX1B 1500
	1144	Care Unit : Anesthes ia
	1145	3 Blue Cross 11 XXXX1A UB04
	1146	4 Blue Shield 11 XXXX1B 1500
	1147	Care Unit : Referenc e Lab
	1148	5 Blue Cross 12 XXXX1A UB04
	1149	6 Blue Shield 12 XXXX1B 1500
	1150	Care Unit : Home Hea lth
	1151	7 Blue Cross 13 XXXX1A UB04
	1152	8 Blue Shield 13 XXXX1B 1500
	1153	+
	1154	Enter ?? f or more ac tions
	1155	Add an ID Addit ional IDs
	1156	Exit
	1157	Edit a n ID ID Pa rameters
	1158	Delete an ID
	1159	VA-La b/Facility IDs
	1160	Select Act ion: Quit/ /
	1161	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. Define Additiona l Billing Provider S econdary I Ds by Divi sion and F orm Type
	1162	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.
	1163	Prior to P atch IB2. 0320, 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 IB2.0320 .
	1164	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.
	1165	StepProced ure1Access the optio n MCCR SYS TEM DEFINI TION MENU( Insurance Company En try/Edit.2 At the Sel ect Insura nce Compan y Name: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple.3From the Insura nce Compan y Editor s creen, ent er the act ion: ID Pr ov IDs/ID Param.4Fro m the Bill ing Provid er IDs scr een, enter the actio n Addition al IDs.5Fr om the Bil ling Provi der IDs – Additional Billing P rovider Se c. IDs scr een, enter the actio n Add an I D.6At the ID Qualifi er: prompt , enter Me dicare for this exam ple.Note: There cann ot be two Billing Pr ovider Sec ondary IDs on a clai m with the same Qual ifier. If you enter an ID wit h the same Qualifier here as o ne defined under Bil ling Provi der Second ary IDs fo r the Divi sion on a claim, the Additiona l Billing Provider S econdary I D with the same Qual ifier will not be tr ansmitted on the cla im.7At the Form Type prompt, e nter CMS-1 500 for th is example .9 At the Billing Pr ovider Sec ondary ID prompt, en ter the ID 14XXXX1C for this e xample.10R epeat thes e steps fo r the Form Type = UB -04, Quali fier = Med icare, ID = 14XXXX1C .Note: Use rs can rep eat these steps to d efine mult iple addit ional Bill ing Provid er Seconda ry IDs if required by the ins urance com pany.Billi ng Provide r IDs (Par ent) May 2 7, 2005@12 :48:29 Page : 1 of 1
	1166	Insurance Co: BLUE C ROSS OF CA LIFORNIA Additional Billing P rovider Se c. IDs
	1167	ID Qu alifier ID # Form Type
	1168	No Additio nal Billin g Provider IDs found
	1169	Enter ?? f or more ac tions
	1170	Add an ID Delete an ID Exit
	1171	Edit a n ID Copy I Ds
	1172	Select Act ion: Quit/ / Add an I D
	1173	Type of ID : Medicare
	1174	Form Type: 1500
	1175	Billing Pr ovider Sec ondary ID: 14XXXX1C
	1176	The follow ing screen will disp lay.
	1177	Billing Pr ovider IDs (Parent) May 27, 20 05@12:48:2 9 Page: 1 of 1
	1178	Insurance Co: BLUE C ROSS OF CA LIFORNIA Additional Billing P rovider Se c. IDs
	1179	ID Qu alifier ID # Form Type
	1180	Division: Name of Ma in Divisio n/Default for All Di visions
	1181	1 Medic are 14XXXX1 C UB04
	1182	2 Medic are 14XXXX1 C 1500
	1183	Enter ?? f or more ac tions
	1184	Add an ID Delete an ID Exit
	1185	Edit a n ID Copy I Ds
	1186	Select Act ion: Quit/ / Add an I D
	1187	Type of ID : Medicare
	1188	Form Type: UB-04
	1189	Billing Pr ovider Sec ondary ID: XXXXXXX11
	1190	Service Fa cility IDs (Laborato ry or Faci lity IDs)
	1191	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.
	1192	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.
	1193	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 .
	1194	Patch IB2 .0320 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.
	1195	Beginning with Patch es IB2.0 348 and 34 9, the Ser vice Facil ity NPI wi ll be prin ted on loc ally print ed CMS-150 0 claims.
	1196	Beginning with Patch IB2.040 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.
	1197	The non-VA Service F acility NP I and Taxo nomy Code will be en tered and maintained by Billin g personne l.
	1198	Define Non -VA Labora tory or Fa cility Pri mary IDs/N PI
	1199	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 .
	1200	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.
	1201	StepProced ure1Access the optio n MCCR SYS TEM DEFINI TION MENU( Provider I D Maintena nce.2At th e Select P rovider ID Maintenan ce Option: prompt, e nter NF fo r Non-VA F acility.3A t the Sele ct a NON/O ther VA Pr ovider: pr ompt, ente r IB Outsi de Facilit y for this example.4 From the N on-VA Lab or Facilit y Info scr een, enter the actio n FI for L ab/Facilit y Info.5At the Stree t Address: prompt, e nter 123 W estbend St reet for t his exampl e.Effectiv e with Pat ch IB248 8, only a physical s treet addr ess may be entered ( no post of fice box). Any entry that begi ns with “P .O.” or “P O” or “Box ” is prohi bited. 6At the Stree t Address Line 2: pr ompt, pres s the <Ent er> key to leave bla nk.7At the City prom pt, enter Long Beach for this example.8A t the Stat e: prompt, enter Cal ifornia fo r this exa mple.9At t he Zip Cod e prompt, enter 9206 01234 for this examp le.Effecti ve with Pa tch IB24 88, only a 9- or 10- digit ZIP code may b e entered: 999999999 /99999-999 9. With 50 10, claims must be s ubmitted w ith a stre et address and a ful l nine-dig it zip cod e when rep orting a n on-VA serv ice facili ty locatio ns10At the Contact N ame: promp t, enter I B,CONTACT O for this example.1 1At the Co ntact Phon e Number: prompt, en ter 703-33 3-3333 for this exam ple.12At t he Contact Phone Ext ension: pr ompt, ente r 123478.1 3At the ID Qualifier : prompt, press the <Enter> ke y to accep t the defa ult.14At t he Lab or Facility P rimary ID: prompt, e nter 11111 1112.15At the X12 Ty pe of Faci lity: prom pt, enter FA - Facil ity for th is example .With Patc h IB2371 , FA will be sent as the Type of Facilit y on all i nstitution al claims regardless of what i s defined. HIPAA only allows FA on instit utional cl aims.16At the Mammog raphy Cert ification Number: pr ompt, pres s the <Ent er> key to leave it blank. If you kno w the Mamm ography nu mber you c an enter i t here.17A t the NPI: prompt, e nter XXXXX XXXXX for this examp le.Note: W ith Patch IB2516, users will have the ability to define a Non-VA Fac ility as a sole-prop rietorship and link it to a hu man provid er. If a facil ity is lin ked to a h uman provi der, then the human’ s NPI may be used fo r both the human and the facil ity. The i ndividual provider m ust be def ined in Vi stA before he/she ca n be linke d to the f acility.18 At the Sel ect Taxono my Code: p rompt, ent er 954 for this exam ple.19At t he OK? Pro mpt, press the <Ente r> key to accept the default.2 0At the Ar e you addi ng 'Genera l Acute Ca re Hospita l' as a ne w TAXONOMY CODE (the 1ST for t his IB NON /OTHER D A N B S L I G PROVIDER )? No// pr ompt, ente r Yes.21At the Prima ry Code: p rompt, ent er Yes for this exam ple.22At t he Status: prompt, e nter Activ e.23At the Select Ta xonomy Cod e: prompt, press the <Enter> k ey.Note: W ith Patch IB2432, the abilit y to defin e the name of a cont act person at the ou tside faci lity and t he telepho ne number for that p erson will be availa ble to use rs.24At th e Allow fu ture updat es by FEE BASIS auto matic inte rface? YES // prompt, press the <Enter> k ey to acce pt the def ault. (Not e: This qu estion doe s not impa ct current functiona lity as th is is part of Future Developme nt)STREET ADDRESS: 1 23 Test St reet
	1202	STREET ADD RESS LINE 2:
	1203	CITY: DNS ENNE// Lon g Beach
	1204	STATE: CAL IFORNIA
	1205	ZIP CODE: 920601234/ /
	1206	CONTACT NA ME: IB,CON TACT O//
	1207	CONTACT PH ONE NUMBER : 703-333- 3333//
	1208	CONTACT PH ONE EXTENS ION: 12347 8//
	1209	ID Qualifi er: 24 - E MPLOYER'S IDENTIFICA TION #
	1210	Lab or Fac ility Prim ary ID: 11 1111112//
	1211	X12 TYPE O F FACILITY : FACILITY //
	1212	MAMMOGRAPH Y CERTIFIC ATION #:
	1213	SOLE PROPR IETORSHIP? : NO
	1214	NPI: XXXXX XXXXX
	1215	Select TAX ONOMY CODE : 954 Gen eral Acute Care Hosp ital 2 82N000
	1216	00X
	1217	. ..OK? Yes/ / (Yes)
	1218	Are you adding 'Ge neral Acut e Care Hos pital' as
	1219	a new TAXO NOMY CODE (the 1ST f or this IB NON/OTHER D A N B S L I G PROVIDER )? No/
	1220	/ y (Yes)
	1221	PRIMARY CODE: y Y ES
	1222	STATUS: a ACTIVE
	1223	Select TAX ONOMY CODE :
	1224	The follow ing screen will disp lay.
	1225	Non-VA Lab or Facili ty Info Jul 05, 20 126@16:04: 07 Page: 1 of 1
	1226	N ame: IB OU TSIDE FACI LITY
	1227	Addr ess: 123 T est Street
	1228	Long Beach, CAL IFORNIA 9 2060
	1229	Contact N ame: IB,CO NTACT O
	1230	Contact Ph one: 703-3 33-3333 1 23478
	1231	Type of Facility: FACILITY
	1232	Pr imary ID: 111111112
	1233	ID Q ualifier: 24 - EMPLO YER'S IDEN TIFICATION #
	1234	Mammograp hy Certifi cation #:
	1235	NPI: XXXXXXXXXX
	1236	Taxon omy Code: 261QV0200X (Primary)
	1237	Allow f uture upda tes by FEE BASIS aut omatic int erface? : YES
	1238	Enter ?? f or more ac tions
	1239	FI Lab/F acility In fo LI Lab/F acility In s ID
	1240	LO Lab/F acility Ow n ID EX Exit
	1241	Select Act ion: Quit/ /
	1242	Define Non -VA Labora tory or Fa cility Sec ondary IDs
	1243	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.
	1244	Define a n on-VA Faci lity’s Own Laborator y or Facil ity Second ary IDs
	1245	StepProced ure1Access the optio n MCCR Sys tem Defini tion Menu( Provider I D Maintena nce.2At th e Select P rovider ID Maintenan ce Option: prompt, e nter NF fo r Non-VA F acility.3F rom the No n-VA Lab o r Facility Info scre en, enter the action LO for Lab/Facili ty Own ID. 4From the Secondary Provider I D screen, enter the action AI for Add an ID.5At th e Enter Pr ovider ID Qualifier prompt, en ter X5 CLI A Number f or this ex ample.6At the Form T ype Applie d to: prom pt, enter CMS-1500 F D R NS S O L or this ex ample.7At the Care T ype: promp t, enter O UTPATIENT ONLY for t his exampl e.8 At the Enter Lab or Facili ty Seconda ry ID prom pt, enter DXXXXX for this exam ple.Note: Users may repeat the se steps t o define m ore Labora tory or Fa cility Sec ondary IDs .Secondary Provider ID May 11, 20 05@11:17:2 0 Page: 1 of 1
	1246	Lab or Facility’ s Own IDs (No Specif ic Insuran ce Co)
	1247	Provider: IB Outside Facility (Non-VA La b or Facil ity)
	1248	ID Qualifi er For m Care T ype
	1249	ID#
	1250	No ID's f ound for p rovider
	1251	Enter ?? f or more ac tions
	1252	AI Add a n ID DI Delet e an ID
	1253	EI Edit an ID EX Exit
	1254	Select Act ion: Quit/ / AI Add a n ID
	1255
	1256	Select Pro vider ID Q ualifier: X5 CLIA Nu mber
	1257	FORM TYPE APPLIED TO : CMS-1500 F D R NS S O L
	1258	ILL CARE T YPE: OUTPA TIENT ONLY
	1259	THE FOLLOW ING WAS CH OSEN:
	1260	INSURAN CE: ALL IN SURANCE
	1261	PROV TY PE: CLIA #
	1262	FORM TY PE: CMS-15 00 FORM ON LY
	1263	CARE TY PE: OUTPAT IENT ONLY
	1264	Provider I D: DXXXXX
	1265	The follow ing screen will disp lay.
	1266	Secondary Provider I D May 11, 20 05@11:17:2 0 Page: 1 of 1
	1267	Lab or Facility’ s Own IDs (No Specif ic Insuran ce Co)
	1268	Provider: IB Outside Facility (Non-VA La b or Facil ity)
	1269	ID Qu alifier
	1270
	1271
	1272	Form
	1273	Care Type
	1274	ID#
	1275	1 CLIA #
	1276
	1277	150 0
	1278	OUTPT
	1279
	1280	DXXXXX
	1281	Enter ?? f or more ac tions
	1282	AI Add a n ID DI Delet e an ID
	1283	EI Edit an ID EX Exit
	1284	Select Act ion: Quit/ /
	1285	Define a n on-VA Faci lity’s Lab oratory or Facility Secondary IDs Assign ed by an I nsurance C ompany
	1286	StepProced ure1Access the optio n MCCR SYS TEM DEFINI TION MENU( Provider I D Maintena nce.2At th e Select P rovider ID Maintenan ce Option: prompt, e nter NF fo r Non-VA F acility.3F rom the No n-VA Lab o r Facility Info scre en, enter the action LI for La b/Facility Ins ID.4F rom the Se condary Pr ovider ID screen, en ter the ac tion AI fo r Add an I D.5At the Enter Prov ider ID Qu alifier pr ompt, ente r Blue Shi eld for th is example .6At the F orm Type A pplied to: prompt, e nter CMS-1 500 F D R NS S O L or this ex ample.7At the Care T ype: promp t, enter B OTH for th is example .8 At the Enter Lab or Facilit y Secondar y ID promp t, enter 1 11XXX1B fo r this exa mple.Note: Users may repeat th ese steps to define more Labor atory or F acility Se condary ID s. A maximum of 5 Labor atory or F acility Se condary ID s can be d efined per insurance company. A maximum of 5 Labor atory or F acility Se condary ID s can be t ransmitted in a clai m.Secondar y Provider ID May 11, 20 05@11:17:2 0 Page: 1 of 1
	1287	Lab or Facility S econdary I Ds from In surance Co
	1288	Provider: IB Outside Facility (Non-VA La b or Facil ity)
	1289	Insurance Co: BLUE C ROSS OF CA LIFORNIA
	1290	ID Qu alifier Form C are Type ID#
	1291	No ID's found for provider a nd selecte d insuranc e co
	1292	Enter ?? f or more ac tions
	1293	AI Add a n ID DI Delet e an ID
	1294	EI Edit an ID EX Exit
	1295	Select Act ion: Quit/ / AI Add an ID
	1296	Select Pro vider ID Q ualifier: BLUE SHIEL D ID
	1297	FORM TYPE APPLIED TO : 1500 F D R NS S O L
	1298	ILL CARE T YPE: b BOTH INPAT IENT AND O UTPATIENT
	1299	THE FOLLOW ING WAS CH OSEN:
	1300	INSURAN CE: BLUE C ROSS OF CA LIFORNIA
	1301	PROV TY PE: BLUE S HIELD ID
	1302	FORM TY PE: 1500 F ORM ONLY
	1303	CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT
	1304	Provider I D: 111XXX1 B
	1305	The follow ing screen will disp lay.
	1306	Secondary Provider I D May 11, 20 05@11:17:2 0 Page: 1 of 1
	1307	Lab or Facility S econdary I Ds from In surance Co
	1308	Provider: IB Outside Facility (Non-VA La b or Facil ity)
	1309	Insurance Co: BLUE C ROSS OF CA LIFORNIA
	1310	ID Qu alifier Form C are Type ID#
	1311	1 BLUE SHIELD ID 1500 I NPT/OUTPT 111XXX1B
	1312	Enter ?? f or more ac tions
	1313	AI Add a n ID DI Delet e an ID
	1314	EI Edit an ID EX Exit
	1315	Select Act ion: Quit/ /
	1316	Define VA Laboratory or Facili ty Primary IDs/NPI
	1317	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 IB2.0 400, 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.
	1318	Define VA Laboratory or Facili ty Seconda ry IDs
	1319	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.
	1320	StepProced ure1Access the optio n Patient Insurance Menu ... ( Insurance Company En try/Edit.2 At the Sel ect Insura nce Compan y Name: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple.3From the Insura nce Compan y Editor s creen, ent er the act ion ID Pro v IDs/ID P arameters. 4From the Billing Pr ovider IDs screen, e nter the a ction VA-L ab/Facilit y IDs.5Fro m the VA-L ab/Facilit y IDs scre en, enter the action Add an ID .6At the D ivision pr ompt, acce pt the def ault for t he main Di vision.7At the ID Qu alifier: p rompt, ent er Blue Sh ield for t his exampl e.8At the Form Type prompt, en ter CMS-15 00 for thi s example. 9 At the V A Lab or F acility Se condary ID prompt, e nter the I D 1212XX1B for this example.10 Repeat the se steps f or the For m Type = U B-04, Qual ifier = Bl ue Cross a nd ID = 12 12XX1A.11R epeat thes e steps fo r the Form Type = UB -04, Quali fier = Com mercial an d ID = 131 3XXG2.Note : Users ma y repeat t hese steps to define more Labo ratory or Facility S econdary I Ds. A max imum of 5 Laboratory or Facili ty Seconda ry IDs can be define d per divi sion, form and insur ance compa ny. VA-La b/Facility IDs M ay 27, 200 5@12:48:29 Page: 1 of 1
	1321	Insurance Co.: BLUE CROSS OF C ALIFORNIA
	1322	VA-Lab/Fac ility Prim ary ID: XX 123456
	1323	VA-Lab/Fac ility Seco ndary IDs
	1324	ID Qual ifier I D # Form Type
	1325	No Laborat ory or Fac ility IDs found
	1326	Enter ?? f or more ac tions
	1327	Add an ID Delete an ID
	1328	Edit a n ID Exit
	1329	Select Act ion: Add a n ID
	1330	The follow ing screen will disp lay.
	1331	VA-Lab/Fac ility IDs May 27 , 2005@12: 48:29 Page: 1 of 1
	1332	Insurance Co.: BLUE CROSS OF C ALIFORNIA
	1333	VA-Lab/Fac ility Prim ary ID: Fe deral Tax ID
	1334	VA-Lab/Fac ility Seco ndary IDs
	1335	ID Qu alifier ID# Form Type
	1336	Division: Name of Ma in Divisio n/Default for All Di visions
	1337	1 Blue Cross 1212XX1 A UB04
	1338	2 Blue Shield 1212XX1 B 1500
	1339	Division: CBOC
	1340	3 Comme rcial 1313XXG 2 UB04
	1341	Enter ?? f or more ac tions
	1342	Add an ID Delete an ID
	1343	Edit a n ID Exit
	1344	Select Act ion: Edit/ /
	1345	Attending, Operating and Other Physician s and Rend ering, Ref erring and Supervisi ng Provide rs
	1346	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 IB24 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.
	1347	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 .
	1348	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.
	1349	A human pr ovider’s N PI is tran smitted in the 837 H ealth Care Claim tra nsmission, and since Patches I B2.0348 and 349 it is printe d on local ly printed claim for ms.
	1350	All of the se types o f healthca re provide rs can be either VA or non-VA employees.
	1351	Define a V A Physicia n/Provider ’s Primary ID/NPI
	1352	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.
	1353	Note: Beg inning wit h Patch IB 2432, 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.Defi ne a VA Ph ysician/Pr ovider’s S econdary I Ds
	1354	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.
	1355	Define a V A Physicia n/Provider ’s Own Sec ondary IDs
	1356	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:
	1357	OB – State License N umber
	1358	EI – EIN
	1359	SY – SSN (VA SSNs are define d in the N ew Person file)
	1360	X5 – State Industria l Accident Provider Number
	1361	1G – UPIN Number
	1362	StepProced ure1Access the optio n MCCR SYS TEM DEFINI TION MENU( Provider I D Maintena nce.2At th e Select P rovider ID Maintenan ce Option: prompt, e nter PO fo r Provider Own IDs.3 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 .4At the S elect V.A. PROVIDER NAME: prom pt, enter IB,DOCTOR 1.This scr een can be accessed through th e MCCR Sys tem Defini tion Menu. Users mus t hold the IB PROVID ER EDIT se curity key to access this opti on.Note: W ith Patch IB2447, IB will pr event the user from authorizin g a claim in which a human pro vider has an EIN or SSN consis ting of an ything oth er than ni ne digits. Provider I D Maintena nce Main M enu
	1363	Enter a code fro m the list .
	1364	Prov ider IDs
	1365	PO Provid er Own IDs
	1366	PI Provid er Insuran ce IDs
	1367	Insu rance IDs
	1368	BI Batch ID Entry
	1369	II Insura nce Co IDs
	1370	Care Units
	1371	CP Care U nits for P roviders
	1372	CB Care U nits for B illing Pro vider
	1373	Non- VA Items
	1374	NP Non-VA Provider
	1375	NF Non-VA Facility
	1376	Select Provider ID Mainten ance Optio n: PO Pro vider Own IDs
	1377	(V)A or (N )on-VA pro vider: V// A PROVIDE R
	1378	Select V.A . PROVIDER NAME:IB,D OCTOR 1
	1379
	1380	StepProced ure6At the Select Ac tion: prom pt, enter AI for Add an ID.7At the Selec t ID Quali fier: pro mpt, enter State Lic ense for t his exampl e. 8At th e Select L ICENSING S TATE: prom pt, enter California for this example.9W hen asked if you are entering California as the 1s t state fo r this pro vider, ent er Yes.10A t the LICE NSING STAT E: prompt, press the <Enter> k ey to acce pt the def ault.11At the LICENS ING NUMBER : prompt, enter XXXX STATE for this examp le.Physici an/Provide r ID Nov 02, 20 05@10:24:4 6 Page: 1 of 1
	1381	Phy sician/Pro vider's Ow n IDs (No Specific I nsurance C o)
	1382	Provider : IB,DOCTO RB ( D A N P S O I ER)
	1383	ID Qu alifier Form Care Type Ca re Unit ID#
	1384	No ID's found for provider
	1385	Enter ?? f or more ac tions
	1386	AI Add a n ID DI Delet e an ID
	1387	EI Edit an ID EX Exit
	1388	Select Act ion: Quit/ / AI Add an ID
	1389	Select ID Qualifier: ??
	1390	Choose from:
	1391	EIN EI
	1392	SOCIAL SECURITY N UMBER SY
	1393	STATE I NDUSTRIAL ACCIDENT P ROV X5
	1394	STATE L ICENSE 0B
	1395	UPIN 1G
	1396	Enter the Qualifier that ident ifies the type of ID .
	1397	Select Pro vider ID T ype: 0B S tate Licen se
	1398	Select LIC ENSING STA TE: CALIFO RNIA
	1399	Are you adding 'CA LIFORNIA' as a new L ICENSING S TATE (the 1ST for th is NEW PER
	1400	SON)? No// y (Yes)
	1401	LICENSING STATE: CAL IFORNIA//
	1402	LICENSE NU MBER: XXXX STATE
	1403	The follow ing screen will disp lay.
	1404	Physician/ Provider I D Nov 02, 2005@ 10:24:46 Pa ge: 1 o f 1
	1405	Phy sician/Pro vider's Ow n IDs (No Specific I nsurance C o)
	1406	Provider : IB,DOCTO RB ( D A N P S O I ER)
	1407	ID Qu alifier Form Care Type Ca re Unit ID#
	1408	1 CA STA TE LICENSE # XXXXST ATE
	1409	Enter ?? f or more ac tions
	1410	AI Add a n ID DI Delet e an ID
	1411	EI Edit an ID EX Exit
	1412	Select Act ion: Quit/ /
	1413	Define a V A Physicia n/Provider ’s Insuran ce Company Secondary IDs
	1414	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 :
	1415	1A - Blue Cross
	1416	1B - Blue Shield
	1417	1C - Medic are
	1418	1H - CHAMP US
	1419	G2 - Comme rcial
	1420	LU - Locat ion #
	1421	N5 - Provi der Plan N etwork
	1422	1G - UPIN
	1423	StepProced ure1Access the optio n MCCR SYS TEM DEFINI TION MENU( Provider I D Maintena nce.2At th e Select P rovider ID Maintenan ce Option: prompt, e nter PI fo r Provider Insurance IDs.3At t he (V)A or (N)on-VA provider: V//: promp t, press t he <Enter> key to ac cept the d efault.4At the Selec t V.A. PRO VIDER NAME : prompt, enter IB,D OCTOR 1.5A t the Sele ct Insuran ce Co.: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple.Provid er ID Main tenance Ma in Menu
	1424	Enter a code fro m the list .
	1425	Prov ider IDs
	1426	PO Provid er Own IDs
	1427	PI Provid er Insuran ce IDs
	1428	Insu rance IDs
	1429	BI Batch ID Entry
	1430	II Insura nce Co IDs
	1431	Care Units
	1432	CP Care U nits for P roviders
	1433	CB Care U nits for B illing Pro vider
	1434	Non- VA Items
	1435	NP Non-VA Provider
	1436	NF Non-VA Facility
	1437	Select Provider ID Mainten ance Optio n: PI Prov ider Insur ance IDs
	1438	(V)A or ( N)on-VA pr ovider: V/ / A PROVID ER
	1439	Select V.A . PROVIDER NAME:IB,D OCTOR 1
	1440	Select INS URANCE CO: BLUE CROS S OF CALIF ORNIA
	1441
	1442	StepProced ure6At the Select Ac tion: prom pt, enter AI for Add an ID.7At the Selec t ID Quali fier: prom pt, enter 1B – Blue Shield for this exam ple.8At th e FORM TYP E APPLIED TO: prompt , enter CM S-1500 Onl y for this example.9 At the BIL L CARE TYP E: prompt, enter 0 f or this ex ample.10At the CARE UNIT: prom pt, enter Surgery fo r this exa mple. 11At the PROVI DER ID: pr ompt, ente r XXXXBSHI ELD for th is example .Defining an insuran ce company provided ID for a p articular Care Unit is only ne cessary wh en the ins urance com pany assig ns physici an/provide r IDs by c are unit.U sers can r epeat thes e steps fo r this Phy sician/Pro vider addi ng more ID s from thi s insuranc e company or change insurance company or change ph ysician/pr ovider. Re fer to Sec tion 3.7 to learn a bout copyi ng IDs to multiple i nsurance c ompanies.N ote: If yo u do not d efine a Ne twork ID f or TRICARE claims, t he system will autom atically i nclude the provider’ s SSN as t he Network ID.Physic ian/Provid er ID Nov 02, 2 005@10:24: 46 Page: 1 of 1
	1443	Phy sician/Pro vider's ID s from Ins urance Co
	1444	Provider : IB,DOCTO RB ( D A N P S O I ER)
	1445	INSURANCE CO: BLUE C ROSS OF CA LIFORNIA ( Parent)
	1446	ID Qu alifier Form Care Type Ca re Unit ID#
	1447	No ID's found for provider
	1448	Enter ?? f or more ac tions
	1449	AI Add a n ID DI Delet e an ID
	1450	EI Edit an ID EX Exit
	1451	Select Act ion: Quit/ / AI Add an ID
	1452	Select ID Qualifier: ??
	1453	Choose from:
	1454	BLUE CR OSS 1A
	1455	BLUE SH IELD 1B
	1456	CHAMPUS 1H
	1457	COMMERC IAL G2
	1458	LOCATIO N NUMBER LU
	1459	MEDICAR E PART A 1C
	1460	MEDICAR E PART B 1C
	1461	PROVIDE R PLAN NET WORK N5
	1462	UPIN 1G
	1463	Enter the Qualifier that ident ifies the type of ID .
	1464	Select Pro vider ID T ype: Blue Shield
	1465	FORM TYPE APPLIED TO : CMS-1500 F D R NS S O L
	1466	ILL CARE T YPE: 0 BOTH INPAT IENT AND O UTPATIENT
	1467	Select IB PROVIDER I D CARE UNI T: Surgery
	1468	THE FOLLOW ING WAS CH OSEN:
	1469	INSURAN CE: BLUE C ROSS OF CA LIFORNIA
	1470	PROV TY PE: BLUE S HIELD ID
	1471	FORM TY PE: CMS-15 00 FORM ON LY
	1472	CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT
	1473	CARE UN IT: Surger y
	1474	PROVIDER I D: XXXXBSH IELD
	1475	The follow ing screen will disp lay.
	1476	Physician/ Provider I D Nov 02, 2005@ 10:24:46 Pa ge: 1 o f 1
	1477	Phy sician/Pro vider's ID s from Ins urance Co
	1478	Provider : IB,DOCTO RB ( D A N P S O I ER)
	1479	INSURANCE CO: BLUE C ROSS OF CA LIFORNIA ( Parent)
	1480	ID Qu alifier For m Care T ype Car e Unit ID#
	1481	1 BLUE SHIELD ID 150 0 INPT/O UTPT XXXXBSH IELD
	1482	Enter ?? f or more ac tions
	1483	AI Add a n ID DI Delet e an ID
	1484	EI Edit an ID EX Exit
	1485	Select Act ion: Quit/ /
	1486	Define no n-VA Physi cian and P rovider Pr imary IDs/ NPI
	1487	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.
	1488	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 through NP > Non- D A N P S O I ER. Define a n on-VA Phys ician/Prov ider’s NPI
	1489	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.
	1490	StepProced ure1Access the optio n MCCR SYS TEM DEFINI TION MENU( Provider I D Maintena nce.2At th e Select P rovider ID Maintenan ce Option: prompt, e nter NP fo r Non-VA P rovider.3A t the Sele ct a Non-V A Provider : prompt, enter IB,O UTSIDEPROV for this example.Wh en accessi ng an exis ting entry , press EN TER to con tinue or, if necessa ry, the sp elling of the provid er’s name can be cor rected at the NAME p rompt. Nam es should be entered in the fo llowing fo rmat: LAST NAME,FIRS T NAME MID DLE INITIA L.Note: Be ginning wi th Patch I B2436, i t will be possible t o enter a provider i nto the VA New Perso n file as a VA provi der and th en enter t hat same p rovider in Provider Maintenanc e as a non -VA provid er using t he same na me. It wi ll no long er be nece ssary to m anipulate the name b y adding a middle in itial (for example). Users must hold the IB PROVIDE R EDIT sec urity key to access this optio n.Provider ID Mainte nance Main Menu
	1491	Enter a code fro m the list .
	1492	Prov ider IDs
	1493	PO Provid er Own IDs
	1494	PI Provid er Insuran ce IDs
	1495	Insu rance IDs
	1496	BI Batch ID Entry
	1497	II Insura nce Co IDs
	1498	Care Units
	1499	CP Care U nits for P roviders
	1500	CB Care U nits for B illing Pro vider
	1501	Non- VA Items
	1502	NP Non-VA Provider
	1503	NF Non-VA Facility
	1504	Select Provider ID Mainten ance Optio n: NP Non- VA Provide r
	1505	Select a N ON- D A N P S O I ER: IB,OUT SIDEPROV INDIVIDUAL
	1506	For indivi dual type entries: T he name sh ould be en tered in
	1507	L AST,FIRST MIDDLE for mat.
	1508	Select a N ON- D A N P S O I ER: IB,OUT SIDEPROV I NDIVIDUAL
	1509	NAME: IB,O UTSIDEPROV //:
	1510	The follow ing screen will disp lay.
	1511	NON- D A N P S O I ER INFORMA TION Dec 07, 20 06@12:40:5 1 Page: 1 of 1
	1512	N ame: IB,OU TSIDEPROV
	1513	T ype: INDIV IDUAL PROV IDER
	1514	Credenti als: MD
	1515	Specia lty: 30
	1516	NPI:
	1517	Taxonomy C ode:
	1518	Enter ?? f or more ac tions
	1519	ED Edit Demographi cs PI Provi der Ins ID
	1520	PO Provi der Own ID EX Exit
	1521	Select Act ion: Quit/ /
	1522	StepProced ure4At the Select Ac tion: prom pt, enter ED for Edi t Demograp hics.5At t he Credent ials: prom pt, press the <Enter > key to a ccept the default.6A t the Spec ialty: pro mpt, press the <Ente r> key to accept the default.7 At the NPI : prompt, enter 0000 000006 for this exam ple.8At th e Taxonomy : prompt, enter 15 A llopathic and Osteop athic Phys icians – I nternal Me dicine Car diovascula r Disease 207RC0000X for this example.9A t the Are you adding 'Allopath ic and Ost eopathic P hysicians' as
	1523	a new TAXO NOMY CODE (the 1ST f or this IB NON/OTHER D A N B S L I G PROVIDER )? No// pr ompt, ente r Yes for this examp le.10At th e Primary Code: prom pt, enter Yes for th is example .11At the Status: pr ompt, ente r Active f or this ex ample.A pr ovider may have more than one Taxonomy C ode.12At t he Allow f uture upda tes by FEE BASIS aut omatic int erface? YE S// prompt , press t the <Enter > key to a ccept the default.NA ME: IB,OUT SIDEPROV//
	1524	CREDENTIAL S: MD//
	1525	SPECIALTY: 30//
	1526	NPI: 00000 00006
	1527	Select TAX ONOMY CODE : 15 Allo pathic and Osteopath ic Physici ans 20 7RC0000X
	1528	Internal M edicine
	1529	Cardi ovascular Disease
	1530	Are you adding 'Al lopathic a nd Osteopa thic Physi cians' as
	1531	a new TAXO NOMY CODE (the 1ST f or this IB NON/OTHER D A N B S L I G PROVIDER )? No/
	1532	/ y (Yes)
	1533	PRIMARY CODE: y Y ES
	1534	STATUS: a ACTIVE
	1535	Select TAX ONOMY CODE :
	1536	The follow ing screen will disp lay.
	1537	NON- D A N P S O I ER INFORMA TION Jul 05, 20 126@14:49: 53 Page: 1 of 1
	1538	N ame: IB,OU TSIDEPROV
	1539	T ype: INDIV IDUAL PROV IDER
	1540	Credenti als: MD
	1541	Specia lty: 30
	1542	NPI: 00000 00006
	1543	Taxonomy C ode: 207RC 0000X (Pri mary)
	1544	Allow futu re updates by FEE BA SIS automa tic interf ace? : YES
	1545	Enter ?? f or more ac tions
	1546	ED Edit Demographi cs PI Provi der Ins ID
	1547	PO Provi der Own ID EX Exit
	1548	Select Act ion: Quit/ /
	1549	Define a n on-VA Phys ician/Prov ider’s Sec ondary IDs
	1550	Define a n on-VA Phys ician/Prov ider’s Own IDs
	1551	Non-VA Phy sicians an d other he althcare p roviders a re assigne d IDs that identify them. Afte r Patch IB 2432, 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:
	1552	OB – State License N umber
	1553	EI – EIN
	1554	TJ – Feder al Taxpaye r’s Number
	1555	X5 – State Industria l Accident Provider Number
	1556	1G – UPIN
	1557	SY – SSN
	1558	StepProced ure1Access the optio n MCCR SYS TEM DEFINI TION MENU( Provider I D Maintena nce.2At th e Select P rovider ID Maintenan ce Option: prompt, e nter PO fo r Provider Own IDs.3 At the (V) A or (N)on -VA provid er: V//: p rompt, ent er N for N on-VA prov ider.4At t he Select Non V.A. P ROVIDER NA ME: prompt , enter IB ,OUTSIDEDO C for this example.P rovider ID Maintenan ce Main Me nu
	1559	Enter a code fro m the list .
	1560	Prov ider IDs
	1561	PO Provid er Own IDs
	1562	PI Provid er Insuran ce IDs
	1563	Insu rance IDs
	1564	BI Batch ID Entry
	1565	II Insura nce Co IDs
	1566	Care Units
	1567	CP Care U nits for P roviders
	1568	CB Care U nits for B illing Pro vider
	1569	Non- VA Items
	1570	NP Non-VA Provider
	1571	NF Non-VA Facility
	1572	Select Provider ID Mainten ance Optio n: PO Prov ider Own I Ds
	1573	(V)A or (N )on-VA pro vider: V// n NON- D A N P S O I ER
	1574	Select Non V.A. PROV IDER NAME: IB,OUTSIDE DOC
	1575
	1576	StepProced ure5At the Select Ac tion: pro mpt, enter AI for Ad d an ID.6A t the Ente r Provider ID Qualif ier: prom pt, enter Social Sec urity Numb er for thi s example. 7At the FORM TYPE APPLIED TO : prompt, enter 0 fo r this exa mple.8At t he BILL CA RE TYPE: p rompt, ent er 0 for t his exampl e.9At the PROVIDER I D: prompt, enter XXX XX1212 for this exam ple.Note: Users may repeat th e above st eps to ent er additio nal IDs fo r a physic ian/provid er.Perform ing Provid er ID Nov 02, 20 05@10:24:4 6 Page: 1 of 1
	1577	Per forming Pr ovider's O wn IDs (No Specific Insurance Co)
	1578	Provider : IB,OUTSI DEDOC (NON - D A N P S O I ER)
	1579	ID Qu alifier Form Care Type Ca re Unit ID#
	1580	No ID's found for provider
	1581	Enter ?? f or more ac tions
	1582	AI Add a n ID DI Delet e an ID
	1583	EI Edit an ID EX Exit
	1584	Select Act ion: Quit/ / AI Add an ID
	1585	Select ID Qualifier: ??
	1586	Choose from:
	1587	EIN EI
	1588	SOCIAL SECURITY N UMBER SY
	1589	STATE I NDUSTRIAL ACCIDENT P ROV X5
	1590	STATE L ICENSE 0B
	1591	UPIN 1G
	1592	Enter the Qualifier that ident ifies the type of ID .
	1593	Select ID Qualifier: SY Social Security Number
	1594	FORM TYPE APPLIED TO : 0 BOTH UB-04 AND CMS-1500 F ORMS
	1595	BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT
	1596	THE FOLLOW ING WAS CH OSEN:
	1597	INSURAN CE: ALL IN SURANCE
	1598	PROV TY PE: SOCIAL SECURITY NUMBER
	1599	FORM TY PE: BOTH U B-04 & CMS -1500 FORM S
	1600	CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT
	1601	PROVIDER I D: XXXXX12 12
	1602	The follow ing screen will disp lay.
	1603	Performing Provider ID Nov 02, 2005@1 0:24:46 Pag e: 1 of 1
	1604	Per forming Pr ovider's O wn IDs (No Specific Insurance Co)
	1605	Provider : IB,OUTSI DEDOC (NON - D A N P S O I ER)
	1606	ID Qu alifier Form Care Type Ca re Unit ID#
	1607	1 SOCIA L SECURITY NUMB BOT H INPT/O UTPT XXXXX12 12
	1608	Enter ?? f or more ac tions
	1609	AI Add a n ID DI Delet e an ID
	1610	EI Edit an ID EX Exit
	1611	Select Act ion: Quit/ /
	1612	Define a n on-VA Phys ician/Prov ider’s Ins urance Com pany Secon dary IDs
	1613	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:
	1614	1A – Blue Cross
	1615	1B – Blue Shield
	1616	1C – Medic are
	1617	1G – UPIN
	1618	1H – CHAMP US
	1619	G2 – Comme rcial
	1620	LU – Locat ion #
	1621	N5 – Provi der Plan N etwork
	1622	StepProced ure1Access the optio n MCCR SYS TEM DEFINI TION MENU( Provider I D Maintena nce.2At th e Select P rovider ID Maintenan ce Option: prompt, e nter NP fo r Non-VA P rovider.3A t the Sele ct a NON- D A N P S O I ER: prompt , enter IB ,OUTSIDEDO C.Provider ID Mainte nance Main Menu
	1623	Enter a code fro m the list .
	1624	Prov ider IDs
	1625	PO Provid er Own IDs
	1626	PI Provid er Insuran ce IDs
	1627	Insu rance IDs
	1628	BI Batch ID Entry
	1629	II Insura nce Co IDs
	1630	Care Units
	1631	CP Care U nits for P roviders
	1632	CB Care U nits for B illing Pro vider
	1633	Non- VA Items
	1634	NP Non-VA Provider
	1635	NF Non-VA Facility
	1636	Select Provider ID Mainten ance Optio n: NP Non- VA Provide r
	1637	(V)A or (N )on-VA pro vider: V// N Non- D A N P S O I ER
	1638	Select a N ON- D A N P S O I ER: IB,OUT SIDEDOC
	1639
	1640	Select INS URANCE CO: BLUE CROS S OF CALIF ORNIA
	1641	StepProced ure4At the Select Ac tion: prom pt, enter PI for Pro vider Ins ID.5At the Select IN SURANCE CO : prompt, enter Blue Cross of California for this example.6A t the Sele ct Action: prompt, e nter AI fo r Add an I D.6At the Select ID Qualifier: prompt, e nter 1B – Blue Shiel d for this example.7 At the FOR M TYPE APP LIED TO: p rompt, ent er CMS-150 0 Only for this exam ple.8At th e BILL CAR E TYPE: pr ompt, ente r 0 for th is example .9At the P ROVIDER ID : prompt, enter XXBS HIELD for this examp le.Users c an repeat these step s for this Physician /Provider adding mor e IDs from this insu rance comp any or cha nge insura nce compan y or chang e physicia n/provider . Performi ng Provide r ID No v 02, 2005 @10:24:46 P age: 1 of 1
	1642	Per forming Pr ovider's I Ds from In surance Co
	1643	Provider : IB,OUTSI DEDOC (Non - D A N P S O I ER)
	1644	INSURANCE CO: BLUE C ROSS OF CA LIFORNIA ( Parent)
	1645	ID Qu alifier Form Care Type Ca re Unit ID#
	1646	No ID's found for this insur ance co.
	1647	Enter ?? f or more ac tions
	1648	AI Add a n ID DI Delet e an ID
	1649	EI Edit an ID EX Exit
	1650	Select Act ion: Quit/ / AI Add an ID
	1651	Select ID Qualifier: ??
	1652	Choose from:
	1653	BLUE CR OSS 1A
	1654	BLUE SH IELD 1B
	1655	CHAMPUS 1H
	1656	COMMERC IAL G2
	1657	LOCATIO N NUMBER LU
	1658	MEDICAR E PART A 1C
	1659	MEDICAR E PART B 1C
	1660	PROVIDE R PLAN NET WORK N5
	1661	UPIN 1G
	1662	Enter the Qualifier that ident ifies the type of ID .
	1663	Select Pro vider ID T ype: Blue Shield
	1664	FORM TYPE APPLIED TO : CMS-1500 F D R NS S O L
	1665	ILL CARE T YPE: 0 BOTH INPAT IENT AND O UTPATIENT
	1666	THE FOLLOW ING WAS CH OSEN:
	1667	INSURAN CE: BLUE C ROSS OF CA LIFORNIA
	1668	PROV TY PE: BLUE S HIELD ID
	1669	FORM TY PE: CMS-15 00 FORM ON LY
	1670	CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT
	1671	PROVIDER I D: XXBSHIE LD
	1672	The follow ing screen will disp lay.
	1673	Performing Provider ID Nov 02, 2005@1 0:24:46 Pag e: 1 of 1
	1674	Per forming Pr ovider's I Ds from In surance Co
	1675	Provider : IB,OUTSI DEDOC (Non - D A N P S O I ER)
	1676	INSURANCE CO: BLUE C ROSS OF CA LIFORNIA ( Parent)
	1677	ID Qu alifier For m Care T ype Car e Unit ID#
	1678	1 BLUE SHIELD ID 150 0 INPT/O UTPT XXXXBSH IELD
	1679	Enter ?? f or more ac tions
	1680	AI Add a n ID DI Delet e an ID
	1681	EI Edit an ID EX Exit
	1682	Select Act ion: Quit/ /
	1683	Define Ins urance Com pany IDs
	1684	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.
	1685	There are three opti ons:
	1686	I – Indivi dual IDs
	1687	A – Indivi dual and D efault IDs
	1688	D – Defaul t IDs
	1689	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.
	1690	Define Def ault Physi cian/Provi der Insura nce Compan y Secondar y IDs
	1691	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.
	1692	StepProced ure1Access the optio n MCCR SYS TEM DEFINI TION MENU( Provider I D Maintena nce.2At th e Select P rovider ID Maintenan ce Option: prompt, e nter II fo r Insuranc e Co IDs.3 At the Sel ect Insura nce Compan y Name: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple.4At th e Select D isplay Con tent: prom pt, enter D.Provider ID Mainte nance Main Menu
	1693	Enter a code fro m the list .
	1694	Prov ider IDs
	1695	PO Provid er Own IDs
	1696	PI Provid er Insuran ce IDs
	1697	Insu rance IDs
	1698	BI Batch ID Entry
	1699	II Insura nce Co IDs
	1700	Care Units
	1701	CP Care U nits for P roviders
	1702	CB Care U nits for B illing Pro vider
	1703	Non- VA Items
	1704	NP Non-VA Provider
	1705	NF Non-VA Facility
	1706	Select Provider ID Mainten ance Optio n: II Ins urance Co IDs
	1707	Select INS URANCE COM PANY NAME: BLUE CRO SS OF CALI FORNIA PO BOX 60 007 LOS ANGE LES CA LIFORNIA Y
	1708	SELECT DIS PLAY CONTE NT: A//D INSURANCE CO DEFAULT IDS
	1709	StepProced ure5At the Select Ac tion: prom pt, enter AI for Add an ID.INS URANCE CO PROVIDER I D Dec 19, 2005@ 12:24:41 Pa ge: 1 o f 2
	1710	Insurance Co: BLUE C ROSS OF CA LIFORNIA ( Parent)
	1711	PROVI DER NAME FOR M CARE T YPE CAR E UNIT ID#
	1712	Provider I D Type: BL UE SHIELD
	1713	1 <<INS CO DEFAUL T>> BOT H INPT/O UTPT BSDEFAU LT
	1714	Provider I D Type: CO MMERCIAL
	1715	2 <<INS CO DEFAUL T>> BOT H INPT/O UTPT COMDEFA ULT
	1716	Provider I D Type: PR OVIDER PLA N NETWORK
	1717	3 <<INS CO DEFAUL T>> BOT H INPT/O UTPT NETDEFA ULT
	1718	Provider I D Type: UP IN
	1719	4 <<INS CO DEFAUL T>> BOT H INPT/O UTPT UPINDEF AULT
	1720	+ Enter ?? f or more ac tions
	1721	AI Add a n ID DP Display I ns Params VI Vie w IDs by T ype
	1722	DI Delet e an ID CI Change In s Co CU Car e Unit Mai nt
	1723	EI Edit an ID CD Change Di splay EX Exi t
	1724	Select Act ion: Next Screen//AI Add an ID
	1725	StepProced ure6At the Select Pr ovider (op tional): p rompt, pre ss the <En ter> key t o leave th e prompt b lank.7At t he YOU ARE ADDING A PROVIDER I D THAT WIL L BE THE I NSURANCE C O DEFAULT IS THIS OK ?: prompt, enter YES .8At the S elect Prov ider ID Ty pe: prompt , enter Bl ue Cross f or this ex ample.9At the FORM T YPE APPLIE D TO: prom pt, enter UB-04 Form s Only for this exam ple.10At t he BILL CA RE TYPE: p rompt, ent er 0 for BOTH INPAT IENT AND O UTPATIENT for this e xample.11A t the PROV IDER ID: p rompt, ent er BCDEFAU LT for thi s example. YOU ARE AD DING A PRO VIDER ID T HAT WILL B E THE INSU RANCE CO D EFAULT
	1726	Select Pro vider ID T ype: BLUE CROSS 1A
	1727	FORM TYPE APPLIED TO : UB-04// UB-04 F D R NS S O L
	1728	ILL CARE T YPE: 0 BOTH INPAT IENT AND O UTPATIENT
	1729	THE FOLLOW ING WAS CH OSEN:
	1730	INSURAN CE: BLUE C ROSS OF CA LIFORNIA
	1731	PROV TY PE: BLUE C ROSS
	1732	FORM TY PE: UB-04 FORM ONLY
	1733	CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT
	1734	PROVIDER I D: BCDEFAU LT
	1735	The follow ing screen will disp lay.
	1736	INSURANCE CO PROVIDE R ID Dec 19, 20 05@12:34:0 1 Page: 1 of 2
	1737	Insurance Co: BLUE C ROSS OF CA LIFORNIA ( Parent)
	1738	PROVIDER N AME FORM C ARE TYPE CARE UNI T ID #
	1739	Provider I D Type: BL UE CROSS
	1740	1 <<INS CO DEFAUL T>> UB- 04 INPT/O UTPT BCDEFAU LT
	1741	Provider I D Type: BL UE SHIELD
	1742	2 <<INS CO DEFAUL T>> BOT H INPT/O UTPT DEFALLP rov
	1743	Provider I D Type: CO MMERCIAL
	1744	3 <<INS CO DEFAUL T>> BOT H INPT/O UTPT COMDEFA ULT
	1745	Provider I D Type: PR OVIDER PLA N NETWORK
	1746	4 <<INS CO DEFAUL T>> BOT H INPT/O UTPT NETDEFA ULT
	1747	+ Enter ?? f or more ac tions
	1748	AI Add a n ID DP Display I ns Params VI Vie w IDs by T ype
	1749	DI Delet e an ID CI Change In s Co CU Car e Unit Mai nt
	1750	EI Edit an ID CD Change Di splay EX Exi t
	1751	Select Act ion: Next Screen//
	1752	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.De fine Indiv idual Phys ician/Prov ider Insur ance Compa ny Seconda ry IDs
	1753	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.
	1754	StepProced ure1Access the optio n MCCR SYS TEM DEFINI TION MENU( Provider I D Maintena nce.2At th e Select P rovider ID Maintenan ce Option: prompt, e nter II fo r Insuranc e Co IDs.3 At the Sel ect Insura nce Compan y Name: pr ompt, ente r Blue Cro ss of Cali fornia for this exam ple.Provid er ID Main tenance Ma in Menu
	1755	Enter a code fro m the list .
	1756	Prov ider IDs
	1757	PO Provid er Own IDs
	1758	PI Provid er Insuran ce IDs
	1759	Insu rance IDs
	1760	BI Batch ID Entry
	1761	II Insura nce Co IDs
	1762	Care Units
	1763	CP Care U nits for P roviders
	1764	CB Care U nits for B illing Pro vider
	1765	Non- VA Items
	1766	NP Non-VA Provider
	1767	NF Non-VA Facility
	1768	Select Provider ID Mainten ance Optio n: ii Ins urance Co IDs
	1769	Select INS URANCE COM PANY NAME: BLUE CR OSS OF CAL IFORNIA PO BOX 6 0007 LOS ANG ELES C ALIFORNIA Y
	1770	StepProced ure4At the Select Di splay Cont ent: promp t, enter I for this example.5A t the Do y ou want to display I Ds for a S pecific Pr ovider: pr ompt, ente r No for t his exampl e.SELECT D ISPLAY CON TENT: A// ??
	1771	(D) DISPLA Y CONTAINS ONLY THOS E IDS ASSI GNED AS DE FAULTS TO THE FACILI TY BY
	1772	THE IN SURANCE CO MPANY
	1773	(I) DISPLA Y CONTAINS ONLY THOS E IDS ASSI GNED TO IN DIVIDUAL P ROVIDERS B Y THE
	1774	INSURA NCE COMPAN Y
	1775	(A) DISPLA Y CONTAINS ALL IDS A SSIGNED BY THE INSUR ANCE COMPA NY FOR ONE OR ALL PR OVIDER ID TYPES
	1776	Selec t one of t he followi ng:
	1777	D INSURANCE CO DEFAULT IDS
	1778	I INDIVIDUAL PROVIDER IDS FURNIS HED BY THE INS CO
	1779	A ALL IDS FU RNISHED BY THE INS C O BY PROVI DER TYPE
	1780	SELECT DIS PLAY CONTE NT: A// I INDIVIDUA L PROVIDER IDS FURNI SHED BY TH E INS CO
	1781	DO YOU WAN T TO DISPL AY IDS FOR A SPECIFI C PROVIDER ?: NO//
	1782	StepProced ure6At the Select Ac tion: prom pt, enter AI for Add an ID.INS URANCE CO PROVIDER I D Dec 15, 2005@ 15:36:31 Pa ge: 1 o f 89
	1783	Insurance Co: BLUE C ROSS OF CA LIFORNIA ( Parent)
	1784	PERFORMI NG PROV ID MAY REQUI RE CARE UN IT
	1785	PROVI DER ID TYP E FOR M CARE T YPE CAR E UNIT ID#
	1786	Provider: IB,DOCTOR3
	1787	1 PROVI DER PLAN N ETWOR BOT H INPT/O UTPT MDXXXXX A
	1788	Provider: IB,DOCTOR9
	1789	2 PROVI DER PLAN N ETWOR BOT H INPT/O UTPT GXXXXXA
	1790	Provider: IB,DOCTOR1 0
	1791	3 PROVI DER PLAN N ETWOR BOT H INPT/O UTPT GXXXXXX
	1792	Provider: IB,DOCTOR7 6
	1793	4 PROVI DER PLAN N ETWOR BOT H INPT/O UTPT GXXXXXX
	1794	+ Enter ?? f or more ac tions
	1795	AI Add a n ID DP Display I ns Params VI Vie w IDs by T ype
	1796	DI Delet e an ID CI Change In s Co CU Car e Unit Mai nt
	1797	EI Edit an ID CD Change Di splay EX Exi t
	1798	Select Act ion: Next Screen// A I Add an ID
	1799	StepProced ure7At the Select ID Qualifier : prompt, enter 1B – Blue Shie ld for thi s example. 8At the FO RM TYPE AP PLIED TO: prompt, en ter CMS-15 00 Only fo r this exa mple.9At t he BILL CA RE TYPE: p rompt, ent er 0 for t his exampl e.10At the CARE UNIT : prompt, enter Surg ery for th is example . 11At the PROVIDER ID: prompt , enter BS XXXXX for this examp le.Select PROVIDER: IB,DOCTOR7
	1800	Select Pro vider ID T ype: BLUE SHIELD 1B
	1801	FORM TYPE APPLIED TO : CMS-1500 F D R NS S O L
	1802	ILL CARE T YPE: 0 BOTH INPAT IENT AND O UTPATIENT
	1803	Select IB PROVIDER I D CARE UNI T: Surgery
	1804	THE FOLLOW ING WAS CH OSEN:
	1805	INSURAN CE: BLUE C ROSS OF CA LIFORNIA
	1806	PROV TY PE: BLUE S HIELD
	1807	FORM TY PE: CMS-15 00 FORM ON LY
	1808	CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT
	1809	CARE UN IT: Surger y
	1810	PROVIDER I D: BSXXXXX
	1811	The follow ing screen will disp lay.
	1812	INSURANCE CO PROVIDE R ID Dec 15, 20 05@16:11:3 1 Page: 4 9 of 89
	1813	Insurance Co: BLUE C ROSS OF CA LIFORNIA ( Parent)
	1814	PERFORMI NG PROV ID MAY REQUI RE CARE UN IT
	1815	PROVI DER ID TYP E FOR M CARE T YPE CAR E UNIT ID#
	1816	+
	1817	Provider: IB,DOCTOR1 5
	1818	194 PROVI DER PLAN N ETWOR BOT H INPT/O UTPT GXXXXX
	1819	Provider: IB,DOCTOR5 4
	1820	195 PROVI DER PLAN N ETWOR BOT H INPT/O UTPT G4XXXXX
	1821	Provider: IB,DOCTOR7
	1822	196 BLUE CROSS UB- 04 INPT/O UTPT BCXXXXX X2
	1823	197 BLUE SHIELD 150 0 INPT/O UTPT Su rgery BSXXXXX
	1824	Provider: IB,DOCTOR6
	1825	+ Enter ?? f or more ac tions
	1826	AI Add a n ID DP Display I ns Params VI Vie w IDs by T ype
	1827	DI Delet e an ID CI Change In s Co CU Car e Unit Mai nt
	1828	EI Edit an ID CD Change Di splay EX Exi t
	1829	Select Act ion: Next Screen//
	1830	Define eit her a Defa ult or Ind ividual Ph ysician/Pr ovider Sec ondary ID
	1831	StepProced ure1Access the optio n MCCR SYS TEM DEFINI TION MENU( Provider I D Maintena nce.2At th e Select P rovider ID Maintenan ce Option: prompt, e nter II fo r Insuranc e Co IDs.3 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).4At t he Select Display Co ntent: pro mpt, enter A for thi s example. 5At the DO YOU WANT TO DISPLAY IDS FOR A SPECIFIC PROVIDER I D TYPE?: N O// prompt , accept t he default .Provider ID Mainten ance Main Menu
	1832	Enter a code fro m the list .
	1833	Prov ider IDs
	1834	PO Provid er Own IDs
	1835	PI Provid er Insuran ce IDs
	1836	Insu rance IDs
	1837	BI Batch ID Entry
	1838	II Insura nce Co IDs
	1839	Care Units
	1840	CP Care U nits for P roviders
	1841	CB Care U nits for B illing Pro vider
	1842	Non- VA Items
	1843	NP Non-VA Provider
	1844	NF Non-VA Facility
	1845	Select Provider ID Mainten ance Optio n: II Ins urance Co IDs
	1846	Select INS URANCE COM PANY NAME: BLUE C ROSS OF CA LIFORNIA PO BOX 60007
	1847	LOS AN GELES CALIFORNIA Y
	1848	SELECT DIS PLAY CONTE NT: A// LL IDS FURNI SHED BY TH E INS CO B Y PROVIDER TYPE
	1849	DO YOU WAN T TO DISPL AY IDS FOR A SPECIFI C PROVIDER ID TYPE?: NO//
	1850	StepProced ure6At the Select Ac tion: prom pt, enter AI for Add an ID.INS URANCE CO PROVIDER I D Dec 15, 2005@ 16:18:07 Pa ge: 1 o f 31
	1851	Insurance Co: BLUE C ROSS OF CA LIFORNIA ( Parent)
	1852	PERFORMI NG PROV ID MAY REQUI RE CARE UN IT
	1853	PROVI DER NAME FOR M CARE T YPE CAR E UNIT ID#
	1854	Provider I D Type: BL UE CROSS
	1855	1 IB,DO CTOR7 UB- 04 INPT/O UTPT BCXXXXX
	1856	Provider I D Type: BL UE SHIELD
	1857	2 <<INS CO DEFAUL T>> BOT H INPT/O UTPT DEFALLP rov
	1858	3 IB Ou tside Faci lity BOT H INPT/O UTPT BSFACXX XX
	1859	4 IB,DO CTOR8 BOT H INPT/O UTPT BSINDOU T
	1860	5 IB,DO CTOR33 BOT H INPT/O UTPT BSLIM
	1861	6 IB,DO CTOR7 150 0 INPT/O UTPT BSXXXXX
	1862	Provider I D Type: PR OVIDER PLA N NETWORK
	1863	7 IB,DO CTOR64 BOT H INPT/O UTPT MD22356 A
	1864	+ Enter ?? f or more ac tions
	1865	AI Add a n ID DP Display I ns Params VI Vie w IDs by T ype
	1866	DI Delet e an ID CI Change In s Co CU Car e Unit Mai nt
	1867	EI Edit an ID CD Change Di splay EX Exi t
	1868	Select Act ion: Next Screen//AI Add an ID
	1869	StepProced ureAt the Select Pro vider (opt ional) pro mpt, enter a Provide r’s Name t o enter an individua l ID or le ave it bla nk to ente r a defaul t ID and t hen contin ue to defi ne the ID as before. Select PRO VIDER (opt ional): IB ,DOCTOR7
	1870	Searching for a D A N P S O I ER
	1871	IB,DOCTO R7 1XX XX LZZ 114 RESIDEN T PHYSICIA N
	1872	.. .OK? Yes// (Yes)
	1873	Select Pro vider ID T ype: COMME RCIAL G2
	1874	FORM TYPE APPLIED TO : 0 BOTH UB-04 AND CMS-1500 F ORMS
	1875	BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT
	1876	THE FOLLOW ING WAS CH OSEN:
	1877	INSURAN CE: BLUE C ROSS OF CA LIFORNIA
	1878	PROV TY PE: COMMER CIAL
	1879	FORM TY PE: BOTH U B-04 & CMS -1500 FORM S
	1880	CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT
	1881	PROVIDER I D: CMXXXXX X
	1882	Care Units
	1883	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.
	1884	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.
	1885	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 .
	1886	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.
	1887	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.
	1888	Define Car e Units fo r Physicia n/Provider Secondary IDs
	1889	StepProced ure1Access the optio n MCCR SYS TEM DEFINI TION MENU( Provider I D Maintena nce.2At th e Select P rovider ID Maintenan ce Option: prompt, e nter CP fo r Care Uni ts for Pro viders.3At the Selec t INSURANC E CO: prom pt, enter Blue Cross of Califo rnia for t his exampl e.Provider ID Mainte nance Main Menu
	1890	Enter a code fro m the list .
	1891	Prov ider IDs
	1892	PO Provid er Own IDs
	1893	PI Provid er Insuran ce IDs
	1894	Insu rance IDs
	1895	BI Batch ID Entry
	1896	II Insura nce Co IDs
	1897	Care Units
	1898	CP Care U nits for P roviders
	1899	CB Care U nits for B illing Pro vider
	1900	Non- VA Items
	1901	NP Non-VA Provider
	1902	NF Non-VA Facility
	1903	Select Provider ID Mainten ance Optio n: CP Car e Units fo r Provider s
	1904	Select INS URANCE CO: Blue Cro ss of Cali fornia
	1905	StepProced ure4At the Select Ac tion: prom pt, enter AU for Add a Unit.5A t the SELE CT CARE UN IT FOR THE INSURANCE CO: prom pt, enter Surgery fo r this exa mple. Conf irm Surger y.6At the IB PROVIDE R ID CARE UNIT DESCR IPTION: pr ompt, ente r a free-t ext descri ption of t he Care Un it.7At the ID Qualif ier: promp t, enter B lue Shield for this example.8A t the FORM TYPE APPL IED TO: pr ompt, ente r 0 for BO TH UB-04 & CMS-1500 FORMS.9At the BILL C ARE TYPE: prompt, en ter 0 for BOTH INPAT IENT AND O UTPATIENT. Remember, ‘Blue Cros s’ ID can only be us ed on Inst itutional claims. PR OVIDER ID CARE UNITS No v 03, 2005 @11:56:45 P age: 1 of 1
	1906	Insurance Co: BLUE C ROSS OF CA LIFORNIA
	1907	CARE U NIT NAME DESC RIPTION
	1908	No CARE UN ITs Found for Insura nce Co
	1909	Enter ?? f or more ac tions
	1910	AU Add a Unit DU Delet e a Unit
	1911	EU Edit a Unit EX Exit
	1912	Select Act ion: Quit/ / AU Add a Unit
	1913	SELECT CAR E UNIT FOR THE INSUR ANCE CO: S urgery
	1914	Are you adding 'Su rgery' as a new IB P ROVIDER ID CARE UNIT ? No// y (Yes)
	1915	IB PROV IDER ID CA RE UNIT DE SCRIPTION: Ambulator y Surgery
	1916	ID TYPE: B LUE SHIELD
	1917	FORM TYPE APPLIED TO : 0 BOTH UB-04 & CM S-1500 FOR MS
	1918	BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT
	1919	CARE UNIT: Surgery
	1920	>> CARE UNIT COMBI NATION FIL ED FOR THE INSURANCE CO
	1921	PRESS ENTE R TO CONTI NUE
	1922	The follow ing screen will disp lay.
	1923	PROVIDER I D CARE UNI TS Nov 03, 20 05@11:56:4 5 Page: 1 of 1
	1924	Insurance Co: BLUE C ROSS OF CA LIFORNIA
	1925	CARE U NIT NAME DESC RIPTION
	1926	1 Surger y Ambu latory Sur gery
	1927	o BLUE SHIEL D ID Both for m types I npt/Outpt
	1928	Enter ?? f or more ac tions
	1929	AU Add a Unit DU Delet e a Unit
	1930	EU Edit a Unit EX Exit
	1931	Select Act ion: Quit/ /
	1932	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.PROVIDER ID Nov 21, 2005@09:52 :39 Page: 1 of 1
	1933	Provider IDs Furnis hed by Ins urance Co
	1934	PROVIDER : IB,DOCTO R7 ( D A N P S O I ER)
	1935	INSURANCE CO: BLUE C ROSS OF CA LIFORNIA
	1936	PROVI DER ID TYP E FOR M CARE T YPE CAR E UNIT ID #
	1937	No ID's found for provider a nd selecte d insuranc e co
	1938	Enter ?? f or more ac tions
	1939	AU Add a Unit DU Delet e a Unit
	1940	EU Edit a Unit EX Exit
	1941	Select Act ion: Quit/ / AU Add a Unit
	1942	CHOOSE 1-2 : 2 BLUE SHIELD ID
	1943	FORM TYPE APPLIED TO : 0 BOTH UB-04 AND CMS-1500 F ORMS
	1944	BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT
	1945	Select IB PROVIDER I D CARE UNI T: Surgery Amb ulatory Su rgery BLUE CROSS
	1946	OF CALIFO RNIA
	1947	THE FOLLOW ING WAS CH OSEN:
	1948	INSURAN CE: BLUE C ROSS OF CA LIFORNIA
	1949	PROV TY PE: BLUE S HIELD ID
	1950	FORM TY PE: BOTH U B-04 & CMS -1500 FORM S
	1951	CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT
	1952	CARE UN IT: Surger y
	1953	PROVIDER I D: XXXXBS
	1954	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. SECONDA RY PERFORM ING PROVID ER IDs *** *
	1955	PRIMARY IN SURANCE CO : BLUE CRO SS OF CALI FORNIA
	1956	PROVIDER: IB,DOCTOR7 (RENDERIN G)
	1957	SELECT A S ECONDARY I D OR ACTIO N FROM THE LIST BELO W:
	1958	1 - N O SECONDAR Y ID NEEDE D
	1959	2 - A DD AN ID F OR THIS CL AIM ONLY
	1960	3 - X XXXBS BLUE SHIEL D ID Sur gery
	1961	Selection: 1//
	1962	Define Car e Units fo r Billing Provider S econdary I Ds
	1963	StepProced ure1Access the optio n MCCR SYS TEM DEFINI TION MENU( Provider I D Maintena nce.2At th e Select P rovider ID Maintenan ce Option: prompt, e nter CB fo r Care Uni ts for Bil ling Provi der.3At th e Select I NSURANCE C O: prompt, enter Blu e Cross of Californi a for this example.P rovider ID Maintenan ce Main Me nu
	1964	Enter a code fro m the list .
	1965	Prov ider IDs
	1966	PO Provid er Own IDs
	1967	PI Provid er Insuran ce IDs
	1968	Insu rance IDs
	1969	BI Batch ID Entry
	1970	II Insura nce Co IDs
	1971	Care Units
	1972	CP Care U nits for P roviders
	1973	CB Care U nits for B illing Pro vider
	1974	Non- VA Items
	1975	NP Non-VA Provider
	1976	NF Non-VA Facility
	1977	Select Provider ID Mainten ance Optio n: CB Car e Units fo r Billing Provider
	1978	Select INS URANCE CO: Blue Cros s of Calif ornia
	1979	StepProced ure4At the Select Ac tion: prom pt, enter AU for Add a Unit.5A t the Ente r the Divi sion for t his Care U nit: promp t, press t he <Enter> key to ac cept the d efault.6At the Enter Care Unit Name: pro mpt, enter Anesthesi a for this example.7 At the Ent er a Care Unit Descr iption: pr ompt, ente r a free t ext descri ption.User s may repe at these s teps to cr eate multi ple Care U nits for m ultiple di visions.Re fer to Sec tion 3.1.2 .3 to lear n how to a ssign Bill ing Provid er Seconda ry IDs to Care Units .Care Unit s – Billin g Provider May 27, 2005@11:17 :46 Page: 1 of 0
	1980	Insurance Co: BLUE C ROSS OF CA LIFORNIA
	1981	Care Unit Name Div ision D escription
	1982	No Care Un its define d for this Insurance Co.
	1983	Enter ?? f or more ac tions
	1984	AU Add a Unit DU Delet e a Unit
	1985	EU Edit a Unit EX Exit
	1986	Select Act ion: Quit/ / AU Add a Unit
	1987	Enter the Division f or this Ca re Unit: M ain Divisi on//
	1988	Enter Care Unit name : Anesthes ia
	1989	Are you adding 'An esthesia' as
	1990	a new Care Unit for Main D ivision? N o// y (Ye s)
	1991	Enter a Ca re Unit De scription: Free Text Descripti on
	1992	Care Unit combinatio n filed fo r this Ins urance Co.
	1993	The follow ing screen will disp lay.
	1994	Care Units – Billing Provider May 27, 20 05@11:17:4 6 Page: 1 of 0
	1995	Insurance Co: BLUE C ROSS/BLUE SHIELD
	1996	Care Uni t Name Desc ription
	1997	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	1998	Division: Main Divis ion
	1999	Anesthes ia Free Text Desc ription
	2000	Referenc e Lab Free Text Desc ription
	2001	Home Hea lth
	2002
	2003	Free Text Desc ription
	2004	Division: Remote Cli nic
	2005	Referenc e Lab Free Text Desc ription
	2006	Enter ?? f or more ac tions
	2007	AU Add a Unit DU Delet e a Unit
	2008	EU Edit a Unit EX Exit
	2009	Select Act ion: Quit/ / QUIT
	2010	ID Paramet ers by Ins urance Com pany
	2011	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.
	2012	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.
	2013	StepProced ure1Access the optio n Insuranc e Company Entry/Edit .2At the S elect INSU RANCE COMP ANY NAME: prompt, en ter BLUE C ROSS OF CA LIFORNIA f or this ex ample.3Fro m the Insu rance Comp any Editor , enter th e Prov IDs /ID Param action.Ins urance Com pany Edito r Oct 01, 2007@ 14:27:13 Pa ge: 1 o f 9
	2014	Insurance Company In formation for: BLUE CROSS OF C ALIFORNIA
	2015	Type of Co mpany: HEA LTH INSURA NCE Curren tly Active
	2016	Bil ling Param eters
	2017	Signatur e Required ?: NO Fil ing Time F rame:
	2018	Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN
	2019	Mult. Bedsection s: Billing P hone: 800/ 933-9146
	2020	Diff. Rev. Code s: Veri fication P hone: 800/ 933-9146
	2021	One Opt. Visi t: NO Prec ert Comp. Name:
	2022	Amb. Sur . Rev. Cod e: Precert P hone: 800/ 274-7767
	2023	Rx Refil l Rev. Cod e:
	2024	EDI Parame ters
	2025	Transm it?: YES-L IVE Insurance Type: HMO
	2026	+ Enter ?? f or more ac tions >>>
	2027	BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All
	2028	MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany
	2029	IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co.
	2030	OC Opt Cl aims Offic e PA Payer DC Dele te Company
	2031	PC Prescr Claims Of RE Remarks VP View Plans
	2032	AO Appeal s Office SY Synonyms EX Exit
	2033	Action: Ne xt Screen/ / ID Prov IDs/ID Pa ram
	2034	StepProced ure4From t he Billing Provider IDs screen , enter th e ID Param eters acti on.Billing Provider IDs (Paren t) May 27, 2005@12:4 8:29 Page: 1 of 1
	2035	Insurance Co: BLUE C ROSS OF CA LIFORNIA Billing Provider S econdary I Ds
	2036	ID Qu alifier ID # Form Type
	2037	Division: Name of Ma in Divisio n/Default for All Di visions
	2038	1 Elect ronic Plan Type XXXXXXX XX UB-04
	2039	2 Elect ronic Plan Type XXXXXXX X1X 1500
	2040	Enter ?? f or more ac tions
	2041	Add an ID Addit ional IDs
	2042
	2043	Exit
	2044	Edit a n ID ID Pa rameters
	2045	Delete an ID
	2046	VA-La b/Facility IDs
	2047	Select Act ion: Edit/ / ID Param eters
	2048	StepProced ureNote: T he ID Para meter Main t. Screen displays t he current parameter values.5A t the Sele ct Action: prompt, e nter the E dit Params action.ID Parameter Maint. May 27, 2005@1 2:48:29 Pag e: 1 of 1
	2049	Insurance Co.: BLUE CROSS OF C ALIFORNIA
	2050	Attending/ Rendering Provider S econdary I D
	2051	Default ID (1500): B LUE SHIELD
	2052	Default ID (UB): BLU E CROSS
	2053	Require ID on Claim: BOTH UB-0 4 AND CMS- 1500 REQUI RED
	2054	Referring Provider S econdary I D
	2055	Referring Provider S econdary I D
	2056	Default ID (1500): B LUE SHIELD
	2057	Require ID on Claim: CMS-1500
	2058	Billing Pr ovider Sec ondary IDs
	2059	Use Attend ing/Render ing ID as Billing Pr ovider Sec . ID?: NO
	2060	Transmit n o Billing Provider S ec ID for the follow ing Electr onic Plan Types:
	2061	Billing Pr ovider/Ser vice Facil ity
	2062	+ Enter ?? for more a ctions
	2063	Edit P arams Edit Bill ing Prov P arams Exit
	2064	Select Act ion: Next Screen// E dit Params
	2065	The follow ing will d isplay.
	2066	Attending/ Rendering Provider S econdary I D
	2067	Default ID (1500): B LUE SHIELD //
	2068	Default ID (UB): BLU E CROSS//
	2069	Require ID on Claim: BOTH UB-0 4 AND CMS- 1500 REQUI RED
	2070	/ /
	2071	Referring Provider S econdary I D
	2072	Default ID (1500): B LUE SHIELD //
	2073	Require ID on Claim: CMS-1500/ /
	2074	Billing Pr ovider Sec ondary IDs
	2075	Use Att/Re nd ID as B illing Pro vider Sec. ID (1500) ?: NO
	2076	/ /
	2077	Use Att/Re nd ID as B illing Pro vider Sec. ID (UB)?: NO
	2078	/ /
	2079	Billing Pr ovider/Ser vice Facil ity
	2080	Always use main VAMC as Billin g Provider (1500)?: NO
	2081	/ /
	2082	Always use main VAMC as Billin g Provider (UB-04)?: NO
	2083	/ /
	2084	Define Att ending/Ren dering Pro vider Seco ndary ID P arameters
	2085	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 .
	2086	A type of default se condary ID can be de fined for a CMS-1500 claim and /or a UB-0 4 claim.
	2087	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.
	2088	Attending/ Rendering Provider S econdary I D
	2089	Default ID (1500): B LUE SHIELD ID
	2090	Default ID (UB04): B LUE CROSS ID
	2091	Require ID on Claim: BOTH
	2092	Define Ref erring Pro vider Seco ndary ID P arameters
	2093	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.
	2094	A type of default se condary ID can be de fined for a CMS-1500 claim.
	2095	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.
	2096	The defaul t type of ID for a R eferring P rovider is a UPIN; u sers can, however, o verride th is default .
	2097	Referring Provider S econdary I D
	2098	Default ID (1500): U PIN// BLUE SHIELD ID
	2099	Require ID on Claim: CMS-1500 REQUIRED
	2100	Define Bil ling Provi der Second ary ID Par ameters
	2101	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.
	2102	Billing Pr ovider Sec ondary IDs
	2103	Send Atten ding/Rende ring ID as Billing P rovider Se c. ID?: No // Yes
	2104	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.D efine Bill ing Provid er/Service Facility Parameters
	2105	For those payers who are unabl e to accep t claims w here the B illing Pro vider is t he lowest enumerated entity su ch as a CB OC or Phar macy, user s can set one of the following parameter s, by paye r and form type, whi ch will fo rce the Bi lling Prov ider to al ways be th e main div ision in t he databas e (VAMC).
	2106	Billing Pr ovider/Ser vice Facil ity
	2107	Always use main VAMC as Billin g Provider (1500)?: NO// YES
	2108	Always use main VAMC as Billin g Provider (UB-04)?: NO
	2109	Once one o r both of these para meters has been set to YES, th en the fol lowing par ameters wi ll become available.
	2110	Send VA La b/Facility IDs or Fa cility Dat a for VAMC ?: YES//
	2111	Use the Bi lling Prov ider (VAMC ) Name and Street Ad dress?: NO //
	2112	When set t o NO, the first para meter will suppress the transm ission of the Servic e Facility loop data when the service is provided at the VAM C. When s et to YES, the secon d paramete r will cau se the VAM C’s street address f rom the In stitution file to be transmitt ed as the Billing Pr ovider’s a ddress ins tead of th e Pay-to P rovider’s address.
	2113	This group of parame ters was d esigned to allow a s ite to ret urn, as mu ch as poss ible, to a pre-Patch IB2400 state wher e the Bill ing Provid er was alw ays the VA MC and the Service F acility wa s where th e care was provided. Define VA Service Fa cility Par ameters
	2114	This param eter was c hanged wit h Patch IB 2400. T he paramet er will on ly exist a s part of the Billin g Provider /Service F acility pa rameters i n Section 4.7.4. Th e VA Billi ng Provide r informat ion will n o longer b e repeated in the Se rvice Faci lity loops for non-F ee Basis c laims. Th e Service Facility w ill be bla nk for mos t VA claim s.
	2115	VA-Laborat ory or Fac ility IDs
	2116	Send VA La b/Facility IDs or Fa cility Dat a?: No//
	2117	Define No Billing Pr ovider Sec ondary IDs by Plan T ype
	2118	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.
	2119	To define which plan types req uire no Bi lling Prov ider Secon dary IDs, users must enter the plan type s.
	2120	StepProced ure1From t he ID Para meter Main t. screen, enter the Edit Bill ing Prov P arams acti on.The fir st Billing Provider Secondary ID will st ill be sen t with the claim reg ardless of this para meter. Th e first ID is a calc ulated val ue used by the clear inghouse f or sorting purposes. 2At the Se lect Actio n: prompt, enter Add Plan.3At the Enter Electronic Plan Type : prompt, enter PPO for this e xample.Bil ling Provi der Parame ters May 27, 2005@ 12:48:29 Pa ge: 1 o f 1
	2121	Insurance Co.: BLUE CROSS OF C ALIFORNIA
	2122	Transmit N o Billing Provider S ec ID for the follow ing Electr onic Plan Types:
	2123	1 HMO
	2124	Enter ?? f or more ac tions
	2125	Add Pl an De lete Plan Exit
	2126	Select Act ion: Add P lan
	2127	Enter Elec tronic Pla n Type: PP O
	2128	The follow ing screen will disp lay.
	2129	Billing Pr ovider Par ameters May 27, 20 05@12:48:2 9 Page: 1 of 1
	2130	Insurance Co.: BLUE CROSS OF C ALIFORNIA
	2131	Transmit N o Billing Provider S ec ID for the follow ing Electr onic Plan Types:
	2132	1 HMO
	2133	2 PPO
	2134	Enter ?? f or more ac tions
	2135	Add Pl an De lete Plan Exit
	2136	Select Act ion: Add P lan
	2137	View Assoc iated Insu rance Comp anies, Pro vider IDs, and ID Pa rameters
	2138	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.
	2139	Patch IB2 .0320 add ed section s to displ ay: Associ ated Insur ance Compa nies; Prov ider IDs a nd ID Para meters.
	2140	Insurance Company Ed itor Nov 22, 20 05@10:26:1 1 Page: 5 of 7
	2141	Insurance Company In formation for: BLUE CROSS OF C ALIFORNIA
	2142	Type of Co mpany: BLU E CROSS Cu rrently Ac tive
	2143	+
	2144	Associate d Insuranc e Companie s
	2145	This ins urance com pany is de fined as a Parent In surance Co mpany.
	2146	There ar e 4 Child Insurance Companies associated with it.
	2147	Select t he "AC As sociate Co mpanies" a ction to e nter/edit the childr en.
	2148	Pr ovider IDs
	2149	Billing Pr ovider Sec ondary ID
	2150	Main Divi sion and D efault for All Divis ions/1500:
	2151	Main Divi sion and D efault for All Divis ions/UB-04 :
	2152	Main D ivision Ca re Units:
	2153	Anesth esia/1500:
	2154	Refere nce Lab/15 00:
	2155	Refere nce Lab/UB -04:
	2156
	2157	Home H ealth/UB-0 4:
	2158	2nd Divis ion Name/1 500:
	2159	2nd Divis ion Name/U B-04:
	2160	Additional Billing P rovider Se condary ID s
	2161	Main Divi sion and D efault for All Divis ions/1500:
	2162	1st ID
	2163	2nd ID
	2164	3rd ID
	2165	Maximu m of 6 add itional ID s
	2166	Main Divi sion and D efault for All Divis ions/UB-04 :
	2167	1st ID
	2168	2nd ID
	2169	3rd ID
	2170	Maximu m of 6 add itional ID s
	2171	VA-Laborat ory or Fac ility Seco ndary IDs
	2172	Main Divi sion and D efault for All Divis ions/1500:
	2173	1st ID
	2174	2nd ID
	2175	3rd ID
	2176	Maximu m of 5 add itional ID s
	2177	ID Parameter s
	2178	Attending /Rendering Provider Secondary ID Qualifi er (1500):
	2179	Attending /Rendering Provider Secondary ID Qualifi er (UB-04) :
	2180	Attending /Rendering Secondary ID Requir ement: NON E REQUIRED
	2181	Referring Provider Secondary ID Qualifi er (1500):
	2182	Referring Provider Secondary ID Require ment:
	2183	Use Atten ding/Rende ring ID as Billing P rovider Se c. ID: No
	2184	Transmit no Billing Provider Sec. ID fo r the Elec tronic Pla n Types:
	2185	HMO
	2186	PPO
	2187	Send VA L ab/Facilit y IDs or F acility Da ta: No
	2188	Associated Insurance Companies and Copyi ng Physici an/Provide r Secondar y IDs and Additional Billing P rovider Se condary ID s
	2189	Patch IB2 .0320 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 .
	2190	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.
	2191	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 .
	2192	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.
	2193	Designate a Parent I nsurance C ompany
	2194	StepProced ure1Access the Insur ance Compa ny Editor. 2At the Se lect INSUR ANCE COMPA NY NAME: p rompt, ent er Blue Cr oss of Cal ifornia fo r this exa mple.3At t he Define Insurance Company as Parent or Child: pr ompt, ente r Parent.I nsurance C ompany Edi tor O ct 01, 200 7@14:27:13 Page: 1 of 9
	2195	Insurance Company In formation for: BLUE CROSS OF C ALIFORNIA
	2196	Type of Co mpany: HEA LTH INSURA NCE Curren tly Active
	2197	Bil ling Param eters
	2198	Signatur e Required ?: NO Fil ing Time F rame:
	2199	Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN
	2200	Mult. Bedsection s: Billing P hone: 800/ 933-9146
	2201	Diff. Rev. Code s: Veri fication P hone: 800/ 933-9146
	2202	One Opt. Visi t: NO Prec ert Comp. Name:
	2203	Amb. Sur . Rev. Cod e: Precert P hone: 800/ 274-7767
	2204	Rx Refil l Rev. Cod e:
	2205	EDI Parame ters
	2206	Transm it?: YES-L IVE Insurance Type: GROU P
	2207	+ Enter ?? f or more ac tions >>>
	2208	BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All
	2209	MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany
	2210	IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co.
	2211	OC Opt Cl aims Offic e PA Payer DC Dele te Company
	2212	PC Prescr Claims Of RE Remarks VP View Plans
	2213	AO Appeal s Office SY Synonyms EX Exit
	2214	Select Act ion: Next Screen//AC Associate Companies
	2215	Define Ins urance Com pany as Pa rent or Ch ild: P PA RENT
	2216	StepProced ure4At the Select Ac tion: prom pt, enter Associate Companies for this e xample.5At the Selec t INSURANC E COMPANY NAME: prom pt, enter BLUE CROSS /BLUE SHIE LD 801 PIN E ST. CHA TTANOOGA,T N for this example.S teps 2 - 4 can be re peated to associate additional Insurance Companies with Blue Cross of California .A Parent – Child as sociation can be rem oved using the Disas sociate Co mpanies ac tion.To st op an insu rance comp any from b eing a Par ent, all a ssociation s with any Child ent ries must be removed . After d isassociat ing all th e Child en tries, use rs may del ete the Pa rent using the ‘@’ s ign at the Define In surance Co mpany as P arent or C hild: PARE NT// promp t.Associat ed Insuran ce Co's Nov 21, 2005@11:13 :53 Page: 1 of 1
	2217	Parent Ins urance Com pany:
	2218	BLUE CROSS OF C ALIFORNIA PO BOX 6 0007 LO S ANGELES, CA
	2219	Ins C ompany Nam e Address Ci ty
	2220	No Ch ildren Ins urance Com panies Fou nd
	2221	Enter ?? f or more ac tions
	2222	Assoc iate Compa nies Exit
	2223	Disas sociate Co mpanies
	2224	Select Act ion: Quit/ / as Ass ociate Com panies
	2225	Select Ins urance Com pany: BLUE CROSS/BLU E SHIELD80 1 PINE ST. CHATTANO OGA,TN
	2226	The follow ing screen will disp lay.
	2227	Associated Insurance Co's Nov 21, 20 05@11:30:2 5 Page: 1 of 1
	2228	Parent Ins urance Com pany:
	2229	BLUE CROSS OF C ALIFORNIA PO BOX 6 0007 LO S ANGELES, CA
	2230	Ins C ompany Nam e Address Ci ty
	2231	1 BLUE CROSS FEP PO BOX 7 0000 VA N NUYS,CA
	2232	2 BLUE CROSS/BLUE SHIELD 9901 LIN N STA RD LO UISVILLE,K Y
	2233	3 BLUE CROSS/BLUE SHIELD 801 PINE ST. CH ATTANOOGA, TN
	2234	Enter ?? f or more ac tions
	2235	Assoc iate Compa nies Exit
	2236	Disas sociate Co mpanies
	2237	Select Act ion: Quit/ /
	2238	Designate a Child In surance Co mpany
	2239	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.
	2240	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.
	2241	StepProced ure1Access the Insur ance Compa ny Editor. 2At the Se lect INSUR ANCE COMPA NY NAME: p rompt, ent er Aetna f or this ex ample.3At the Define Insurance Company a s Parent o r Child: p rompt, ent er Child f or this ex ample.4At the Associ ate with w hich Paren t Insuranc e Company: prompt, e nter the n ame of the insurance company t hat will b e the Pare nt.‘??’ wi ll provide a list of available Parent in surance co mpanies.In surance Co mpany Edit or Oc t 01, 2007 @14:33:41 P age: 1 of 8
	2242	Insurance Company In formation for: AETNA
	2243	Type of Co mpany: HEA LTH INSURA NCE Curren tly Inacti ve
	2244	Bil ling Param eters
	2245	Signatur e Required ?: NO Fil ing Time F rame: 12 M OS
	2246	Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN
	2247	Mult. Bedsection s: Billing P hone:
	2248	Diff. Rev. Code s: Veri fication P hone:
	2249	One Opt. Visi t: NO Prec ert Comp. Name:
	2250	Amb. Sur . Rev. Cod e: Precert P hone:
	2251	Rx Refil l Rev. Cod e:
	2252	EDI Parame ters
	2253	Transm it?: YES-L IVE I nsurance T ype: GROUP POLICY
	2254	+ Enter ?? f or more ac tions >>>
	2255	BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All
	2256	MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany
	2257	IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co.
	2258	OC Opt Cl aims Offic e PA Payer DC Dele te Company
	2259	PC Prescr Claims Of RE Remarks VP View Plans
	2260	AO Appeal s Office SY Synonyms EX Exit
	2261	Select Act ion: Next Screen// a c Associ ate Compan ies
	2262	Define Ins urance Com pany as Pa rent or Ch ild: Child CHILD
	2263	Associate with which Parent In surance Co mpany: Aet NA LIFE IN SURANCE 3541 W
	2264	INCHESTER RD. ALLENTOW N PENN SYLVANIA Y.... .......... ......
	2265	Copy Physi cian/Provi der Second ary IDs
	2266	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).
	2267	This can b e done usi ng the fol lowing Pro vider ID M aintenance options:
	2268	Provider I D Maint(PI Provider Insurance IDs;
	2269	Provider I D Maint(II Insuranc e Co IDs; and
	2270	Provider I D Maint(BI Batch ID Entry
	2271	Copy Addit ional Bill ing Provid er Seconda ry IDs
	2272	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.
	2273	Synchroniz ing Associ ated Insur ance Compa ny IDs
	2274	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.
	2275	Subscriber and Patie nt ID Set- Up
	2276	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 .
	2277	Subscriber and Patie nt Insuran ce Provide d IDs
	2278	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.
	2279	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.
	2280	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.
	2281	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.
	2282	Define Sub scriber Pr imary ID
	2283	When the p atient is the subscr iber, user s will be prompted f or the Sub scriber’s Primary ID .
	2284	StepProced ure1Access the optio n Patient Insurance Info View/ Edit.2At t he Select Patient Na me: prompt , enter IB ,PATIENT T WO.3At the Select It ems: promp t, enter P olicy Edit /View.4At the Select Policy(s) : prompt, enter 1 fo r this exa mple.Patie nt Insuran ce Managem ent Sep 2 4, 2007@10 :18:49 Page : 1 of 1
	2285	Insurance Management for Patie nt: IB,PAT IENT TWO I XXXX XX/X X/XXXX
	2286	Insura nce Co. Type of P olicy Gr oup Holder Effect. Expires
	2287	1 AETNA US HEALTH COMPREHEN SIVE M 65 5555-19- SELF 03/06/07
	2288	2 BLUE C ROSS CA ( PREFERRED PROVI 17 3084 SPOUSE 05/15/07
	2289	3 IB INS URANCE CO COMPREHEN SIVE M XX XPLANNUM OTHER 05/16/07
	2290	4 NEW YO RK LIFE MEDIGAP ( SUPPLE F OTHER 09/29/06
	2291	Enter ?? f or more ac tions >>>
	2292	AP Add Po licy EA Fast Edit All CP Chan ge Patient
	2293	VP Policy Edit/View BU Benefits U sed WP Work sheet Prin t
	2294	DP Delete Policy VC Verify Cov erage PC Prin t Insuranc e Cov.
	2295	AB Annual Benefits RI Personal R iders EB Expa nd Benefit s
	2296	RX RX COB Determina tion EX Exit
	2297	Select Ite m(s): Quit // VP Po licy Edit/ View
	2298	Select Pol icy(s): ( 1-4): 1... .......... ......
	2299	The follow ing screen will disp lay.
	2300	Patient Po licy Infor mation Sep 24, 20 07@11:20:5 4 Page: 1 of 6
	2301	For: IB,PA TIENT TWO XXX-XX-XX XX XX/XX /XXXX DOD: XX/ XX/XXXX
	2302	AETNA US H EALTHCARE Insurance Company Plan Curre ntly Activ e
	2303	Insurance Company
	2304	Compan y: AETNA U S HEALTHCA RE
	2305	Stree t: PO BOX 2561
	2306	City/Stat e: FT. WAY NE, IN 468 01
	2307	Billing P h: 800/367 -4552
	2308	Precert P h:
	2309	Plan Inf ormation
	2310	Is Gro up Plan: Y ES
	2311	Gro up Name: F T JAMES CO RP
	2312	Group Number: 6 55555-19-2 30
	2313	BIN:
	2314	PCN:
	2315	Type of Plan: C OMPREHENSI VE MAJOR M ED
	2316	Electron ic Type: C OMMERCIAL
	2317	Plan Fi ling TF: 2 YRS
	2318	Utilizat ion Review Info Effective Dates & S ource
	2319	Require UR : Effec tive Date: 03/06/07
	2320	+ Enter ?? f or more ac tions
	2321	PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan
	2322	UI UR Inf o EM Employer I nfo VC Veri fy Coverag e
	2323	ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s
	2324	SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used
	2325	IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s
	2326	EX Exit
	2327	Select Act ion: Next Screen// S U Subscri ber Update
	2328	StepProced ure5At the Select Ac tion: prom pt, enter Subscriber Update.6A t the Pt. Relationsh ip to Subs criber: pr ompt, ente r Patient. Note: With Patch IB* 2371, the Whose Ins urance? pr ompt was r emoved.Wit h Patch IB 2377, th e list of available choices fo r Pt. Rela tionship t o Insured was modifi ed to have an expand ed list of HIPAA val id choices .7At the N ame of Sub scriber: p rompt, pre ss the <En ter> key t o accept t he default of IB,Pat ient Two.N ote: Once Patch IB2 547 is in stalled, a patient a nd/or a su bscriber w ith only a last name will be a cceptable in Enter/E dit Billin g Informat ion.With P atch IB2* 371, users will have the abili ty to upda te the pat ient’s nam e for any patient an d any insu rance comp any. This will allo w users to make the patient’s name match what is o n file at the payer even when it is diff erent from what is i n the Vist A patient file.8At t he Effecti ve Date of Policy: p rompt, pre ss the <En ter> key t o accept t he default of MAR 6, 2007.9At the Coordi nation of Benefits: prompt, en ter Primar y for this example.1 0At the So urce of In formation: prompt, p ress the < Enter> key to accept the defau lt of Inte rview.11At the Subsc riber Prim ary ID: pr ompt, ente r IDXXXXX for this e xample.12A t the Do y ou want to enter/upd ate Subscr iber Secon dary IDs? Prompt, pr ess the <E nter> key to accept the defaul t of No.13 At the Sub scriber's DOB: promp t, press t he <Enter> key to ac cept the d efault.14A t the Subs criber’s S ex: prompt , press th e <Enter> key to acc ept the de fault.With Patch IB* 2*361, the Insured’s Sex promp t was adde d. This i s required by HIPAA as is the Insured’s DOB.The In sured’s ad dress is n ot require d by HIPAA but HIPAA will not accept a p artial add ress. Whe n the insu red is the patient, the patien t’s addres s will be defaulted from the p atient fil e.Select A ction: Nex t Screen// Subscrib er Update
	2329	PT. RELATI ONSHIP TO SUBSCRIBER : PATIENT
	2330	NAME OF SU BSCRIBER: IB,PATIENT TWO//
	2331	EFFECTIVE DATE OF PO LICY: MAR 6,2007
	2332	INSURANCE EXPIRATION DATE:
	2333	PRIMARY CA RE PROVIDE R:
	2334	PRIMARY PR OVIDER PHO NE:
	2335	COORDINATI ON OF BENE FITS: PRIM ARY
	2336	SOURCE OF INFORMATIO N: INTERVI EW//
	2337	SUBSCRIBER PRIMARY I D: IDXXXXX
	2338	Do you wan t to enter /update Su bscriber S econdary I Ds? No// NO
	2339	SUBSCRIBER 'S DOB: XX X XX,XXXX/ /
	2340	SUBSCRIBER 'S SEX: MA LE//
	2341	SUBSCRIBER 'S BRANCH: NAVY//
	2342	SUBSCRIBER 'S RANK:
	2343	SUBSCRIBER 'S STREET 1: 123 E.T EST BLVD//
	2344	SUBSCRIBER 'S STREET 2:
	2345	SUBSCRIBER 'S CITY: DNS ENNE//
	2346	SUBSCRIBER 'S STATE: WYOMING//
	2347	SUBSCRIBER 'S ZIP: 82 001//
	2348	Patch IB2 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.Define Subscribe r and Pati ent Primar y IDs
	2349	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 .
	2350	StepProced ure1Access the optio n Patient Insurance Info View/ Edit.2At t he Select Patient Na me: prompt , enter IB ,PATIENT T WO.3At the Select It ems: promp t, enter P olicy Edit /View.4At the Select Policy(s) : prompt, enter 3 fo r this exa mple.Patie nt Insuran ce Managem ent Sep 2 4, 2007@10 :18:49 Page : 1 of 1
	2351	Insurance Management for Patie nt: IB,PAT IENT TWO I 4444 XX/X X/XXXX
	2352	Insura nce Co. Type of P olicy Gr oup Holder Effect. Expires
	2353	1 AETNA US HEALTH COMPREHEN SIVE M 65 5555-19- SELF 03/06/07
	2354	2 BLUE C ROSS CA ( PREFERRED PROVI 17 3084 SPOUSE 05/15/07
	2355	3 IB INS URANCE CO COMPREHEN SIVE M XX XPLANNUM SPOUSE 05/16/07
	2356	4 NEW YO RK LIFE MEDIGAP ( SUPPLE F OTHER 09/29/06
	2357	Enter ?? f or more ac tions >>>
	2358	AP Add Po licy EA Fast Edit All CP Chan ge Patient
	2359	VP Policy Edit/View BU Benefits U sed WP Work sheet Prin t
	2360	DP Delete Policy VC Verify Cov erage PC Prin t Insuranc e Cov.
	2361	AB Annual Benefits RI Personal R iders EX Exit
	2362	Select Ite m(s): Quit // VP Po licy Edit/ View
	2363	Select Pol icy(s): ( 1-4): 3... .......... ......
	2364	The follow ing screen will disp lay.
	2365	Patient Po licy Infor mation Sep 24, 20 07@10:33:4 9 Page: 2 of 6
	2366	For: IB,PA TIENT TWO XXX-XX-XX XX XX/XX /XXXX DOD: XX/ XX/XXXX
	2367	IB INSURAN CE CO Insu rance Comp any Plan Curre ntly Activ e
	2368	+
	2369	Subscrib er Informa tion Subscriber 's Employe r Informat ion
	2370	Whose In surance: S POUSE E mp Sponsor ed Plan: N o
	2371	Subscrib er Name: E mployer:
	2372	Relat ionship: Employment Status:
	2373	Pri mary ID: Retireme nt Date:
	2374	Coord. B enefits: C laims to E mployer: N o, Send to Insurance
	2375	Primary P rovider: Street:
	2376	Prim Pro v Phone: Cit y/State:
	2377	Phone:
	2378	Insure d Person's Informati on (use Su bscriber U pdate Acti on)
	2379	Ins ured's DOB : XX/XX/XX XX Str 1: 123 E.TEST BLVD
	2380	+ Enter ?? f or more ac tions
	2381	PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan
	2382	UI UR Inf o EM Employer I nfo VC Veri fy Coverag e
	2383	ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s
	2384	SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used
	2385	IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s
	2386	EX Exit
	2387	Select Act ion: Next Screen// S U Subscri ber Update
	2388	StepProced ure5At the Select Ac tion: prom pt, enter Subscriber Update.6A t the PT. RELATIONSH IP TO SUBS CRIBER: pr ompt, ente r SPOUSE f or this ex ample.With Patch IB* 2377, an expanded l ist of HIP AA complia nt codes f or Pt. Rel ationship to Insured , was adde d.With Pat ch IB237 1, the Who se Insuran ce? prompt was remov ed.7At the Name of S ubscriber: prompt, e nter IB,Sp ouse Two f or this ex ample.8At the Effect ive Date o f Policy: prompt, pr ess the <E nter> key to accept the defaul t of May 1 5, 2007.9A t the Coor dination o f Benefits : prompt, enter Seco ndary for this examp le.10At th e Source o f Informat ion: promp t, press t he <Enter> key to ac cept the d efault of Interview. 11At the S ubscriber Primary ID : prompt, enter XXXX XID for th is example .12At the Do you wan t to enter /update Su bscriber S econdary I Ds? Prompt , press th e <Enter> key to acc ept the de fault of N o.13At the Patient P rimary ID: prompt, e nter XXXXX ID2 for th is example .14At the Do you wan t to enter /update Pa tient Seco ndary IDs? Prompt, p ress the < Enter> key to accept the defau lt of No.1 5At the Su bscriber’s DOB: prom pt, enter August 12, 1945 for this examp le.16At th e Subscrib er’s Sex: prompt, en ter Female for this example.Wi th Patch I B2*361, t he Insured ’s Sex pro mpt was ad ded. This is requir ed by HIPA A as is th e Insured’ s DOB.If t he Patient ’s Relatio nship to t he Insured is spouse , then the patient’s address w ill be the default a ddress of the Insure d. Users may enter different values if the spouse ’s address is differ ent from t he patient ’s.The Ins ured’s add ress is no t required by HIPAA but HIPAA will not a ccept a pa rtial addr ess.Select Action: N ext Screen // SU Su bscriber U pdate
	2389	PT. RELATI ONSHIP TO SUBSCRIBER : SPOUSE//
	2390	NAME OF SU BSCRIBER: IB,SPOUSE TWO
	2391	EFFECTIVE DATE OF PO LICY: MAY 15,2007
	2392	INSURANCE EXPIRATION DATE:
	2393	PRIMARY CA RE PROVIDE R:
	2394	PRIMARY PR OVIDER PHO NE:
	2395	COORDINATI ON OF BENE FITS: SECO NDARY
	2396	SOURCE OF INFORMATIO N: INTERVI EW//
	2397	SUBSCRIBER PRIMARY I D: XXXXXID
	2398	Do you wan t to enter /update Su bscriber S econdary I Ds? No// NO
	2399	PATIENT PR IMARY ID: XXXXXID2
	2400	Do you wan t to enter /update Pa tient Seco ndary IDs? No// NO
	2401	SUBSCRIBER 'S DOB: AU G 12,1945
	2402	SUBSCRIBER 'S SEX: FE MALE
	2403	SUBSCRIBER 'S BRANCH:
	2404	SUBSCRIBER 'S RANK:
	2405	SUBSCRIBER 'S STREET 1: 123 E.T EST BLVD//
	2406	SUBSCRIBER 'S STREET 2:
	2407	SUBSCRIBER 'S CITY: DNS ENNE//
	2408	SUBSCRIBER 'S STATE: WYOMING//
	2409	SUBSCRIBER 'S ZIP: 82 001//
	2410	Define Sub scriber an d Patient Secondary IDs
	2411	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:
	2412	23 C lient Numb er
	2413	IG I nsurance P olicy Numb er
	2414	SY S ocial Secu rity Numbe r
	2415	SUBSCRIBER PRIMARY I D: XXXXXID //
	2416	Do you wan t to enter /update Su bscriber S econdary I Ds? No// y YES
	2417	SUBSCRIBER 'S SEC QUA LIFIER(1): ??
	2418	Enter a Qualifi er to iden tify the t ype of ID number.
	2419	Choos e from:
	2420	23 Clie nt Number
	2421	IG Insu rance Poli cy Number
	2422	SY Soci al Securit y Number
	2423	SUBSCRIBER 'S SEC QUA LIFIER(1): IG Insur ance Polic y Number
	2424	SUBSCRIBER 'S SEC ID( 1): XXXXID 2
	2425	SUBSCRIBER 'S SEC QUA LIFIER(2):
	2426	PATIENT PR IMARY ID: IDXXXXX//
	2427	Do you wan t to enter /update Pa tient Seco ndary IDs? No// y Y ES
	2428	PATIENT'S SEC QUALIF IER(1): IG Insuranc e Policy N umber
	2429	PATIENT'S SECONDARY ID(1): ID2 XXXX
	2430	PATIENT'S SEC QUALIF IER(2):
	2431	StepProced ure1Access Subscribe r Update a gain.2At t he Do you want to en ter/update Subscribe r Secondar y IDs? No/ /: prompt, enter Yes .3At the S ubscriber’ s Sec Qual ifier (1): prompt, e nter IG fo r this exa mple.23 Cl ient Numbe r is used for claims to the In dian Healt h Service/ Contract H ealth Serv ices (HIS/ CHS).VistA will not allow user s to enter SY for SN N if the p ayer is Me dicare. M edicare wi ll not acc ept the SS N as a sub scriber’s secondary ID.4At the Subscribe r’s Sec ID (1): prom pt, enter XXXXID2 fo r this exa mple.5At t he Subscri ber’s Sec Qualifier (2): promp t, press t he <Enter> key if yo u do not w ant to add another I D.6At the Patient Pr imary ID ( 1): prompt , press th e <Enter> key to acc ept the de fault.7At the Do you want to e nter/updat e Patient Secondary IDs? No//: prompt, e nter Yes.8 At the Pat ient’s Sec Qualifier (1): prom pt, enter IG for thi s example. 9At the Pa tient’s Se c ID (1): prompt, en ter ID2XXX X for this example.1 0At the Pa tient’s Se c Qualifie r (2): pro mpt, press the <Ente r> key if you do not want to a dd another ID.Enteri ng Electro nic Claims
	2432	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.
	2433	Summary of Enter/Edi t Billing Informatio n to Suppo rt ASC X12 N/5010
	2434	There have been nume rous chang es with Pa tch IB24 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.
	2435	ScreenSect ionChange5 3Addition of Priorit y (Type) o f Admissio n53Additio n of Defau lt Priorit y (Type) o f Admissio n8Screen 9 contains all inform ation prev iously fou nd on Scre en 8 secti on 3 9Adde d Ambulanc e Transpor t Informat ion (Claim Level)9Ad ded Ambula nce Certif ication Da ta (Claim Level)11Lo cal screen 9 informa tion was m oved to sc reen 11Not e: After P atch IB2 432 is ins talled, us ers will n o longer r eceive War nings when there is more than one divisi on or non- matching p roviders o n a claim. It will b e possible to have m ulti-divis ional clai ms with li ne-level a nd claim-l evel provi ders, of t he same ty pe, who do not match .Note: Aft er Patch I B2432 is installed , users wi ll no long er receive an Error when a hum an provide r does not have an S SN or EIN defined.Ch anges Made by Specif ic Patches
	2436	Patch IB2 447
	2437	The follow ing change s are in P atch IB2 447 not co vered else where in t his docume nt.
	2438	Enter/Edit Billing I nformation
	2439	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 .
	2440	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) .
	2441	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.
	2442	MEDIGAP C alculation s
	2443	This optio n is curre ntly not a vailable a nd can be turned on at a futur e time.
	2444	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
	2445	MEDIGAP A (COINS, NO DED, NO B EXC)
	2446	MEDIGAP B (COINS, A DED, NO B DED, NO B EXC)
	2447	MEDIGAP C (COINS, A/ B DED,NO B EXC)
	2448	MEDIGAP D (COINS, A DED, NO B DED, NO B EXC)
	2449	MEDIGAP F (COINS, DE D, NO B EX C)
	2450	MEDIGAP G (COINS, A DED, NO B DED, NO B EXC,)
	2451	MEDIGAP K (A COINS, 50% B COIN S, 50% A D ED, NO B D ED, NO B E XC)
	2452	MEDIGAP L (A COINS, 75% B COIN S, 75% A D ED, NO B D ED, NO B E XC)
	2453	MEDIGAP M (COINS, 50 % A DED, N O B DED, N O B EXC)
	2454	MEDIGAP N (COINS, A DED, NO B DED, NO B EXC)
	2455	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:
	2456	Medicare S econdary ( COINS, DED , No B EXC )
	2457	Medicare S econdary ( COINS, DED , B EXC)
	2458	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)
	2459	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:
	2460	CARVE-OUT (COINS, DE D, B EXC)
	2461	COMPREHENS IVE (COINS , DED, B E XC)
	2462	MEDICAL EX PENSE (OPT /PROF) (CO INS, DED, B EXC)
	2463	MENTAL HEA LTH (COINS , DED, B E XC)
	2464	POINT OF S ERVICE (CO INS, DED, B EXC)
	2465	PREFERRED PROVIDER O RGANIZATIO N (PPO) (C OINS, DED, B EXC)
	2466	RETIREE (C OINS, DED, B EXC)
	2467	SURGICAL E XPENSE INS URANCE (CO INS, DED, B EXC)
	2468	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:
	2469	Remove the procedure that gene rated the Revenue Co de and mon etary valu e;
	2470	Execute th e Rate Sch edule reca lculation of charges function;
	2471	Change the division associated with the procedure;
	2472	Change the Charge Ty pe;
	2473	Change the division associated with the claim.
	2474	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).
	2475	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.
	2476	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:
	2477	Patient’s Weight Qua lifier = L B
	2478	Patient’s Weight
	2479	Transport Reason Cod e
	2480	Transport Distance Q ualifier = DH
	2481	Transport Distance
	2482	Round Trip Purpose D escription (Free Tex t)
	2483	Stretcher Purpose De scription (Free Text )
	2484	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:
	2485	Code Categ ory – 07
	2486	Certificat ion Condit ion Indica tor – YES
	2487	Condition Codes (1-5 codes)
	2488	Patch IB2 488:
	2489	Patch IB2 488 inclu des the fo llowing ch anges not covered el sewhere in this docu ment.
	2490	Enter/Edit Billing I nformation
	2491	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)
	2492	MRA Manage ment Workl ist (MRW)
	2493	Patch IB2 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.
	2494	The Follow ing types of errors will be di splayed:
	2495	Procedure Code misma tch
	2496	Procedure Modifier m ismatch
	2497	Revenue Co de mismatc h
	2498	Charge Amo unt mismat ch
	2499	Number of Units mism atch
	2500	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.
	2501	View an EO B Apr 14, 20 14@18:25:5 5 Page: 4 of 6
	2502	BI LL #:442-K 101EVT
	2503	CURRENT I NSURANCE C OMPANY (PR IMARY): ME DICARE (WN R)
	2504	+
	2505	VistA coul d not matc h all of t he Line Le vel data r eceived in the EEOB
	2506	(835 Recor d 40) to t he claim i n VistA.
	2507	Mismatched Procedure Code:
	2508	Payer repo rted the f ollowing w as billed via the Cl aim (837):
	2509	Proc:7 1010 Mods :59 Rev C d:324 Chg :227.40 U nits:1
	2510	Payer repo rted adjud ication vi a the EOB (835) as f ollows:
	2511	Proc:7 1015 Mods :59 Rev C d:324 Chg :227.40 U nits:1
	2512	Amt:10 0.00
	2513	---------- ---------- ---------- ---------- ---------- ---------- ---------
	2514	Service li ne adjustm ent (EEOB Record 41) has no ma tching ser vice line
	2515	+ Enter ?? f or more ac tions
	2516	Genera l Info Claim Leve l Adj Revi ew Info
	2517	Payer Info Medicare I nfo Exit
	2518	Claim Level Pay Line Level Adj
	2519	Select Act ion: Next Screen//
	2520	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.
	2521	MRA Manage ment WorkL ist Nov 25, 20 13@14:06:5 8 Page: 1 of 35
	2522	Bill # Svc Date P atient Nam e SS N Pt Res p Bill A mt Type
	2523	BILLER: IB ,CLERK F
	2524	1 !442-K XXXXXX* 06/02/10 I B,PATIENT 234 XXX X 0.0 0 1710. 76 O/I
	2525	Insu rers: MED ICARE (WNR ), NAT'L A SSOC OF LE TTER CARRI ERS
	2526	MRA St atus: DEN IED, Jul 1 2, 2010
	2527	2 442-KX XXXXX 06/02/10 I B,PATIENT 33 XXX X 0.0 0 380. 22 O/P
	2528	Insu rers: MED ICARE (WNR ), NAT'L A SSOC OF LE TTER CARRI ERS
	2529	MRA St atus: DEN IED, Jul 0 7, 2010
	2530	3 442-KX XXXXX 05/14/10 I B,PATIENT 12 XXX X 0.0 0 132. 20 O/P
	2531	Insu rers: MED ICARE (WNR ), UNITEDH EALTHCARE
	2532	MRA St atus: DEN IED, Aug 1 6, 2010
	2533	4 442-KX XXXXX 06/11/10 I B,PATIENT 12 XXX X 0.0 0 132. 20 O/P
	2534	Insu rers: MED ICARE (WNR ), UNITEDH EALTHCARE
	2535	MRA St atus: DEN IED, Aug 1 6, 2010
	2536	5 442-KX XXXXX 06/14/10 I B,PATIENT 103 XXX X 0.0 0 81. 22 I/P
	2537	+ ! =835 Data Mismatch Enter ?? for mor e actions
	2538	PC Proces s COB VC View Comme nts PM Prin t MRA
	2539	VE View a n EOB CB Cancel Bil l TP Thir d Party Jo int Inq.
	2540	SU Summar y MRA Info CR Correct Bi ll Q Exit
	2541	EC Enter Comments CC Cancel/Clo ne A Bill
	2542	RS Review Status VB View Bill
	2543	Select Act ion: Next Screen//
	2544	If users a ttempt to access any of the fo llowing Ac tions, the system wi ll display a warning message.
	2545	PC - Proce ss COB
	2546	VE - View an EOB
	2547	SU – Summa ry MRA Inf o
	2548	PM - Print MRA
	2549	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.
	2550	Do you wis h to conti nue?: No/ /
	2551	Enhanced C MS-1500 Pr inted Clai m Form
	2552	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.
	2553	Patch IB2 516
	2554	Patch IB2 516 inclu des the fo llowing ch anges not covered el sewhere in this docu ment.
	2555	TRICARE/TR ICARE REIM B. Pay-to Providers
	2556	If the Rat e Type of a claim is either TR ICARE or T RICARE REI MB., the n ew TRICARE Pay-to Pr ovider wil l be print ed or tran smitted in the same manner as the regula r Pay-to P rovider in formation is for oth er Rate Ty pes.
	2557	The TRICAR E Pay-to P rovider’s address wi ll print o n the CMS – 1500 for m in Box 3 2
	2558	The TRICAR E Pay-to P rovider’s data will print on t he UB04 in FL2 only when the i nformation is not ex actly the same as th e Billing Provider i nformation
	2559	The TRICAR E Pay-to P rovider da ta will be transmitt ed in the 837 claim transactio n in Recor d PRV1/Loo p 2010A/B
	2560	NDC Number s for non- RX Claims
	2561	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:
	2562	CMS – 1500 – Box 24: Shaded ar ea – Forma t: N4NDC#< space>UN#o f Units – if transmi tted, the NDC number is transm itted in R ecord PRF/ Loop 2410
	2563	UB04 – FL8 0 - Format : N4NDC#<s pace>UN#of Units – i f transmit ted the ND C number i s transmit ted in Rec ord INS/Lo op 2410
	2564	Patch IB2 547
	2565	Patch IB2 547 inclu des the fo llowing ch anges not covered el sewhere in this docu ment:
	2566	Service Li nes with N o Print Or der
	2567	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.
	2568	Last Names Only
	2569	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 .
	2570	Blank Pres ent on Adm ission
	2571	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:
	2572	Y – Yes
	2573	N – No
	2574	U – No Inf ormation i n the Reco rd
	2575	W – Clinic ally Undet ermined
	2576	Printed CM S 1500 For ms
	2577	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.
	2578	Printed UB 04 Forms
	2579	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.
	2580	Insurance Company En try/Edit/V iew Insura nce Compan y
	2581	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:
	2582	Main Maili ng Address
	2583	Inpt Claim s Office
	2584	Opt Claims Office
	2585	Prescr Cla ims Office
	2586	Appeals Of fice
	2587	Inquiry Of fice
	2588	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. EDI Menu f or Electro nic Bills… . Print EO B
	2589	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.
	2590	Copy and C ancel (CLO N)
	2591	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:
	2592	Copy prima ry claim w ith EOB to a new pri mary claim – Do not copy COB d ata
	2593	Copy secon dary claim to new se condary cl aim – Copy primary C OB data
	2594	Copy terti ary claim to new ter tiary clai m – Copy p rimary and secondary COB data
	2595	ASC X12N 5 010 Health Care Clai m (837) Tr ansactions
	2596	The follow ing change s were mad e to 837 t ransaction s:
	2597	An inpatie nt instit utional 83 7 transact ion no lon ger requir es a POA f or each di agnosis
	2598	An inpatie nt admissi on date ca n no longe r be trans mitted on outpatient claims
	2599	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
	2600	Institutio nal 837 tr ansactions can now t ransmit up to twenty -five proc edure code s
	2601	Institutio nal 837 tr ansactions can now t ransmit up to 12 Ext ernal Caus e of Injur y codes
	2602	Patch IB.2 .576
	2603	Enhanced C MS-1500 Pr inted Clai m Form
	2604	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:
	2605	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
	2606	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 .
	2607	MRA Manage ment Workl ist (MRW)
	2608	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.
	2609	MRA Manage ment WorkL ist Nov 25, 20 13@14:06:5 8 Page: 1 of 35
	2610	Bill # Svc Date P atient Nam e SS N Pt Res p Bill A mt Type
	2611	BILLER: IB ,CLERK F
	2612	1 !442-K XXXXXX* 06/02/10 I B,PATIENT 234 XXX X 0.0 0 1710. 76 O/I
	2613	Insu rers: MED ICARE (WNR ), NAT'L A SSOC OF LE TTER CARRI ERS
	2614	MRA St atus: DEN IED, Jul 1 2, 2010
	2615	2 442-KX XXXXX 06/02/10 I B,PATIENT 33 XXX X 0.0 0 380. 22 O/P
	2616	Insu rers: MED ICARE (WNR ), NAT'L A SSOC OF LE TTER CARRI ERS
	2617	MRA St atus: DEN IED, Jul 0 7, 2010
	2618	3 442-KX XXXXX 05/14/10 I B,PATIENT 12 XXX X 0.0 0 132. 20 O/P
	2619	Insu rers: MED ICARE (WNR ), UNITEDH EALTHCARE
	2620	MRA St atus: DEN IED, Aug 1 6, 2010
	2621	4 442-KX XXXXX 06/11/10 I B,PATIENT 12 XXX X 0.0 0 132. 20 O/P
	2622	Insu rers: MED ICARE (WNR ), UNITEDH EALTHCARE
	2623	MRA St atus: DEN IED, Aug 1 6, 2010
	2624	5 442-KX XXXXX 06/14/10 I B,PATIENT 103 XXX X 0.0 0 81. 22 I/P
	2625	+ ! =835 Data Mismatch *=Revi ew in Proc ess
	2626	PC Proces s COB VC View Comme nts PM Prin t MRA
	2627	VE View a n EOB CB Cancel Bil l TP Thir d Party Jo int Inq.
	2628	SU Summar y MRA Info CR Correct Bi ll Q Exit
	2629	EC Enter Comments CC Cancel/Clo ne A Bill
	2630	RS Review Status VB View Bill
	2631	Select Act ion: Next Screen//
	2632	Insurance Company En try/Edit
	2633	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 :
	2634	Main Maili ng Address
	2635	Inpatient Claims Off ice Addres s
	2636	Appeals Of fice Addre ss
	2637	Inquiry Of fice Addre ss
	2638	Outpatient Claims Of fice Addre ss
	2639	Prescripti on Claims Office Add ress
	2640	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.
	2641	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:
	2642	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 '.
	2643	Handling E rror Messa ges and Wa rnings
	2644	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.IB Edit Checks are done befo re claim a uthorizati on.
	2645
	2646	... Execut ing nation al IB edit s
	2647
	2648	ERROR/WARN ING OUTPUT DEVICE: H OME// TE LNET TERMI NAL
	2649
	2650	War nings:
	2651	Prov secondary id type fo r the PRIM ARY RENDER ING is inv alid/won't transmit
	2652	BLUE CROSS CA ( WY) requir es Amb Car e Certific ation
	2653
	2654	Err ors:
	2655	A CPT procedure is missin g an assoc iated diag nosis.
	2656	Place of Servic e not ente red for at least one procedure .
	2657	Type of Service not enter ed for at least one procedure.
	2658	Claim s with mul tiple paye rs require all Payer IDs.
	2659	A cla im cannot have a Pri mary Payer ID value of HPRNT/S PRNT.
	2660
	2661	Do you wis h to edit the incons istencies now? NO// y YES
	2662
	2663	Patch IB2 488
	2664	Patch IB2 .0488 add ed several new error messages to Enter/E dit Billin g Informat ion:
	2665	Error - wh en a profe ssional cl aim contai ns no proc edures cod es
	2666	Error - wh en an outp atient, in stitutiona l claim co ntains no procedures codes
	2667	Error - wh en a Prima ry Payer I D is a PRN T/prnt val ue
	2668	Patch IB2 516
	2669	Patch IB2 516 made several c hanges to existing e rror and w arnings me ssages:
	2670	Error - wh en a claim contains a procedur e code out side the 1 00-999 ran ge – Remov ed
	2671	Error - wh en a human provider has no NPI - Added
	2672	Error - wh en a non-V A facility has no NP I – Added
	2673	Warning - when a non -VA Facili ty has no Taxonomy c ode – Remo ved
	2674	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.Patc h IB2547
	2675	Patch IB2 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:
	2676	Error - Pa tient's fi rst and la st name mu st begin w ith an alp ha charact er
	2677	Error - Pr imary insu rance subs criber's n ame is mis sing or in valid
	2678	Error - Se condary in surance su bscriber's name is m issing or invalid
	2679	Error - Te rtiary ins urance sub scriber's name is mi ssing or i nvalid
	2680	Patch IB.2 .576
	2681	Patch IB2 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 :
	2682	Error - Oc c. Codes O nset of Il lness (11) and LMP ( 10) not al lowed on s ame bill.
	2683	Claim vers us Line Le vel Data
	2684	With the i ntroductio n of addit ional Line Level dat a (includi ng Line Le vel provid ers) in Pa tch IB24 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 .
	2685	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.
	2686	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.
	2687	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 .
	2688	Screen 3 – Payer Inf ormation
	2689	EDI Fields
	2690	Section 1 – Transmit 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.Se ction 2 – Primary, S econdary a nd Tertiar y PayerThe se fields display th e Billing Provider S econdary I Ds for the payers on the bill. These IDs are defin ed in the Insurance Company Ed itor. Note : If users set the I D Paramete r: Send At tending/Re ndering ID as Billin g Provider Sec. ID? to Yes for a payer o n the clai m, the Att ending/Ren dering ID will be se nt.Section 3 – Maili ng Address 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.Se ction 3 – Electronic IDThis fi eld contai ns the Ins t Payer Pr imary ID o r Prof Pay er Primary ID define d in the I nsurance C ompany Edi tor. Paye r Primary IDs are pr ovided by the cleari nghouse an d can be f ound at ww w.emdeon.c om.IB,PATI ENT 1 XX -XX-XXXX BILL#: K5 01XXX - Ou tpat/1500 SCR EEN <3>
	2691	========== ========== ========== ========== ========== ========== ========== =========
	2692	D A N E S N O MATION
	2693	[1] Rate T ype : REI MBURSABLE INS. Form Type: CMS- 1500
	2694	Respon sible: INS URER Payer Sequence: Primary
	2695	Bill P ayer : CIG NA Trans mit: Yes
	2696	Ins 1: CIGNA Policy #: 126781678
	2697	Grp #: GRP NUM 2 277 Whose: VET ERAN Rel to In sd: PATIEN T
	2698	Grp Nm : TEST GRO UP Insd Sex: MALE Insured: IB,PATIENT IN
	2699	Ins 2: BLUE CROS S CA (W Policy #: R76543210
	2700	Grp #: UNSPECIFI ED Whose: SPO USE Rel to In sd: SPOUSE
	2701	Grp Nm : TEST BCB S Insd Sex: FEMALE Insured: ib,wife in
	2702	* Patient has Insura nce Buffer entries *
	2703	[2] Billin g Provider Secondary IDs:
	2704	Prima ry Payer:
	2705	Secon dary Payer : XXXXXXX Te rtiary Pay er:
	2706	[3] Mailin g Address : Elec tronic ID: XXXID
	2707	CIGNA
	2708	PO BOX 9358
	2709	SHERMA N, TX 750 91
	2710	<RET> to C ONTINUE, 1 -3 to EDIT , '^N' for screen N, or '^' to QUIT:
	2711	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.Note: Pa tch IB24 32 made ch anges so t hat the Fe deral Tax ID Number will no lo nger be us ed as a de fault valu e when no other Bill ing Provid er Seconda ry ID is d efined for a payer – Section 2 .Using Car e Units fo r Billing Provider S econdary I Ds
	2712	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.
	2713	StepProced ure1At the <RET> to CONTINUE, 1-3 to EDI T, '^N' fo r screen N , or '^' t o QUIT: pr ompt, ente r 2.2At th e Current Bill Payer Sequence: prompt, p ress the < Enter> key to accept the defau lt.3At the Define Pr imary Paye r ID by Ca re Unit?: prompt, pr ess the <E nter> key to accept the defaul t.4At the Primary Pa yer ID: pr ompt, pres s the <Ent er> key to accept th e default. 5At the De fine Secon dary Payer ID by Car e Unit?: p rompt, ent er Yes for this exam ple.6At th e Division : prompt, press the <Enter> ke y to accep t the defa ult for th is example .7At the C are Unit: prompt, en ter Anesth esia for t his exampl e.8At the Secondary Payer ID: prompt, pr ess the <E nter> key to accept the defaul t.Note: Th e Care Uni ts must be defined i n Provider ID Mainte nance and the ID num bers must be defined in the In surance Co mpany Edit or. IB,PAT IENT 1 X X-XX-XXXX BILL#: K 501XXX - O utpat/1500 SC REEN <3>
	2714	========== ========== ========== ========== ========== ========== ========== =========
	2715	D A N E S N O MATION
	2716	[1] Rate T ype : REI MBURSABLE INS. Form Type: CMS- 1500
	2717	Respon sible: INS URER Payer Sequence: Primary
	2718	Bill P ayer : MRA NEEDED FR OM MEDICAR E Trans mit: Yes
	2719	Ins 1: MEDICARE (WNR) WILL NOT R EIMBURSE Policy #: XXXXXXXXA
	2720	Grp #: PART A Whose: VET ERAN Rel to In sd: PATIEN T
	2721	Grp Nm : PART A Insd Sex: MALE Insured: IB,PATIENT 1
	2722	Ins 2: BLUE CROS S OF CA Policy #: MES3456
	2723	Grp #: PLAN 2 Whose: VET ERAN Rel to In sd: PATIEN T
	2724	Grp Nm : PROTECTI ON PLUS Insd Sex: MALE Insured: IB,PATIENT 1
	2725	[2] Billin g Provider Secondary IDs:
	2726	Primar y Payer: 6 70899
	2727	Second ary Payer: XXXXXX1X Tertia ry Payer:
	2728	[3] Mailin g Address : Elec tronic ID: XXXXID
	2729	NO MAI LING ADDRE SS HAS BEE N SPECIFIE D! (Pati ent has Me dicare)
	2730	Send B ill to PAY ER listed above.
	2731	<RET> to C ONTINUE, 1 -3 to EDIT , '^N' for screen N, or '^' to QUIT: 2
	2732	Current Bi ll Payer S equence: P RIMARY INS URANCE//
	2733	Define Pri mary Payer ID by Car e Unit? No //
	2734	Primary Pa yer ID: 67 0899//
	2735	Define Sec ondary Pay er ID by C are Unit? No//Yes
	2736	Division: Main Divis ion//
	2737	Care Unit: ??
	2738	1 A nesthesia
	2739	2 R eference L ab
	2740	3 H ome Health
	2741	Care Unit: 1 Anesthe sia
	2742	Secondary Payer ID: XXXXXXX//
	2743	Screen 10 – Physicia n/Provider and Print Informati on
	2744	EDI Fields UB-04/CMS -1500
	2745	Section 3/ 3 – Provid ersWhen a Physician/ Provider i s entered here, the system fin ds the app ropriate I Ds and Tax onomy Code s for him/ her. The Primary ID s are the providers’ NPIs and their seco ndary IDs are those IDs that u sers have defined as the provi der’s own or as thos e provided by an ins urance com pany. Cla im Level p roviders m ay not be required i f each Lin e Item has a provide r associat ed with it .Section 4 – Other F acility, C LIA#, Mamm ography Ce rtificatio n Number
	2746	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.
	2747	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.Section 5/7 – Bill ing Provid erThese se ctions dis play the c alculated Billing Pr ovider and the Billi ng Provide r’s Taxono my Code. Only the t axonomy co de can be editedSect ion 6/8 – Force to P rintUsers can set th is field t o force a claim to p rint local ly.
	2748	Patch IB2 488 remov ed the for mer option to force a Professi onal or In stitutiona l claim to print at the cleari nghouse.Se ction 7/9 – Provider ID MaintT his is a l ink to the Provider ID Mainten ance funct ion.IB,PAT IENT2 XX -XX-XXXX BILL#: K3 00XX - Out pat/UB-04 SCREEN <1 0>
	2749	========== ========== ========== ========== ========== ========== ========== ======
	2750	BILLI NG - SPECI FIC INFORM ATION
	2751	[1] Bill R emarks
	2752	- FL- 80 : UNSPEC IFIED [NOT REQUIRED]
	2753	ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED]
	2754	Auth/R eferral : UNSPEC IFIED [NOT REQUIRED]
	2755	Admiss ion Source : UNSPEC IFIED
	2756	[2] Pt Rea son f/Visi t : UNSPEC IFIED
	2757	[3] Provid ers :
	2758	- ATT ENDING : UNSPEC IFIED
	2759	[4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED]
	2760	[5] Billin g Provider : DNS ENNE VAMC
	2761	Taxono my Code : 282N00 000X
	2762	[6] Force To Print? : NO FOR CED PRINT
	2763	[7] Provid er ID Main t : (Edit Provider I D informat ion)
	2764	<RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT:
	2765	IB,PATIENT 3 XX-XX -XXXX BI LL#: K600X X - Outpat /1500 SCREEN <10>
	2766	========== ========== ========== ========== ========== ========== ========== =========
	2767	BILLI NG - SPECI FIC INFORM ATION
	2768	[1] Unable To Work F rom: UNSPE CIFIED [NO T REQUIRED ]
	2769	Unable To Work T o : UNSPE CIFIED [NO T REQUIRED ]
	2770	[2] ICN/DC N(s) : UNSPE CIFIED [NO T REQUIRED ]
	2771	Auth/R eferral : UNSPE CIFIED [NO T REQUIRED ]
	2772	[3] Provid ers :
	2773	- REN DERING (MD ) : IB,DO CTOR 1
	2774	Taxono my: UNSPEC IFIED
	2775	[4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED]
	2776	Lab CL IA # : UNSPE CIFIED [NO T REQUIRED ]
	2777	Mammog raphy Cert # : UNSPE CIFIED [NO T REQUIRED ]
	2778	[5] Chirop ractic Dat a : UNSPE CIFIED [NO T REQUIRED ]
	2779	[6] Form L ocator 19 : UNSPE CIFIED [NO T REQUIRED ]
	2780	[7] Billin g Provider : DNS ENNE VAMC
	2781	Taxono my Code : 282N0 0000X
	2782	[8] Force To Print? : NO FO RCED PRINT
	2783	[9] Provid er ID Main t : (Edit Provider ID informa tion)
	2784	<RET> to C ONTINUE, 1 -9 to EDIT , '^N' for screen N, or '^' to QUIT: 8
	2785	FORCE CLAI M TO PRINT : NO FORCE D PRINT// ??
	2786	If this fi eld is set to 1, the claim wil l be print ed locally .
	2787	If field i s set to 0 , the clai m will be transmitte d
	2788	electronic ally to th e payer.
	2789	Choos e from:
	2790	0 NO F ORCED PRIN T
	2791	1 FORC E LOCAL PR INT
	2792	FORCE CLAI M TO PRINT : NO FORCE D PRINT//
	2793	Note that with Patch IB2488, the forme r option t o force a claim to p rint at th e clearing house has been remov ed.UB-04 C laims
	2794	The follow ing screen s provide a simplifi ed example of a UB-0 4 claim:
	2795	StepProced ure1When p rocessing a UB-04 cl aim, infor mation on Screens 1 and 2 shou ld be revi ewed for c orrectness . Press th e <Enter> key to mov e from one screen to the next. 2On Screen 3, the pa yer inform ation is r eviewed fo r correctn ess. The p atient may have more than one insurance policy. If the corre ct informa tion is no t displaye d, 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. 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.I B,PATIENT3 XX-XX-X XXX BILL #: K300XX - Outpat/U B-04 SCREEN < 3>
	2796	========== ========== ========== ========== ========== ========== ========== ======
	2797	D A N E S N O MATION
	2798	[1] Rate T ype : REI MBURSABLE INS. Form Type: UB-0 4
	2799	Respon sible: INS URER Payer Sequence: Primary
	2800	Bill P ayer : Blu e Cross Fe p Tran smit: Yes
	2801	Ins 1: Blue Cros s Fep Policy #: RXXXXXXXX X
	2802	Grp #: 100 Whose: VET ERAN Rel to In sd: PATIEN T
	2803	Grp Nm : STANDARD FAMILY Insd Sex: MALE Insured: IB,PATIENT 3
	2804	[2] Billin g Provider Secondary IDs:
	2805	Prima ry Payer: 00059001
	2806	Secon dary Payer : Te rtiary Pay er:
	2807	[3] Mailin g Address : Elec tronic ID: 12B54
	2808	Blue C ross Fep
	2809	P O Bo x 10401
	2810	Birmin gham, AL 352020401
	2811	<RET> to C ONTINUE, 1 -3 to EDIT , '^N' for screen N, or '^' to QUIT:
	2812	StepProced ure3On Scr een 5, ent er section s 1-7 to t ype in the diagnosis informati on, the se rvices/pro cedures pr ovided and the date of service . Include the Admiss ion Type C ode, Occur rence, and Condition Code when required. Press the <Enter> k ey to move to Screen 7. Note: With Patch IB2516, users wil l be able to look up Occurrenc e Codes, C ondition C odes, and Value Code s by the e xternal NU BC code nu mbers.Note : After Pa tch IB24 77 is inst alled user s can ente r a Priori ty (Type) of Visit t o an outpa tient, ins titutional claim. T he value w ill no lon ger be har d-coded wi th 9 – Inf ormation n ot availab le. The d efault val ue will be elective. This is a required field.Note : A new fa tal error message wi ll prevent the autho rization o f a claim when the T otal Charg e dollar a mount does not equal the sum o f the doll ar amounts for the l ine items on the cla im. IB,PAT IENT3 XX -XX-XXXX BILL#: K3 00XX - Out pat/UB-04 SCREEN <5 >
	2813	========== ========== ========== ========== ========== ========== ========== ======
	2814	EVENT - OUTPATI ENT INFORM ATION
	2815	[1] Event Date : XXX XX, XXXX
	2816	[2] Prin. Diag.: ABD OM PAIN, L L QUADR - 789.04
	2817	Other Diag.: BEN IGN NEOPLA SM LG BOWE L - 211.3
	2818	Other Diag.: DIV ERTICULOSI S OF COLON - 562.10
	2819	[3] OP Vis its : XXX XX, XXXX
	2820	Type :
	2821	[4] Cod. M ethod: HCP CS
	2822	CPT Co de : LES ION REMOVE COLONOSCO PY 45384 XXX XX, XXXX
	2823	CPT Co de : OFF ICE/OUTPAT IENT VISIT , NEW 9920 1 XXX XX, XXXX
	2824	CPT Co de : CHE ST X-RAY 7 1010-ET XXX XX, XXXX
	2825	[5] Rx. Re fills: UNS PECIFIED [ NOT REQUIR ED]
	2826	[6] Pros. Items: UNS PECIFIED [ NOT REQUIR ED]
	2827	[7] Occ. C ode : ONS ET OF SYMP TOMS/ILLNE SS XXX X X, XXXX
	2828	[8] Cond. Code : UNS PECIFIED [ NOT REQUIR ED]
	2829	[9] Value Code : UNS PECIFIED [ NOT REQUIR ED]
	2830	<RET> to C ONTINUE, 1 -9 to EDIT , '^N' for screen N, or '^' to QUIT:
	2831	StepProced ure4If all informati on has bee n entered correctly, Screen 7 will be au to-populat ed (as sho wn below) with the n ecessary i nformation to send t he claim e lectronica lly. Make sure that the Disch Stat field in Sectio n 1 is pop ulated. Pr ess the <E nter> key to move to Screen 8. 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.No te: With P atch IB2 516, new p rompts hav e been add ed to Scre ens 4 and 5 to allow users to enter NDCs and Units to non-RX procedure s for medi cations ad ministered in an out patient se tting.Note : With Pat ch IB251 6, new pro mpts have been added to Screen s 4 and 5t o allow us ers to ent er 80 char acter desc riptions t o CPT/HCPC S procedur e codes fo r services Not Other wise Class ified.IB,P ATIENT3 XX-XX-XXXX BILL#: K300XX - O utpat/UB-0 4 SCR EEN <7>
	2832	========== ========== ========== ========== ========== ========== ========== ======
	2833	BILL ING - GENE RAL INFORM ATION
	2834	[1] Bill T ype : 13 1 Loc. of Care: H OSPITAL - INPT OR OP T (INCLU
	2835	Charge Type : IN STITUTIONA L Dis ch Stat: D ISCHARGED TO HOME OR SELF CAR
	2836	Form T ype : UB -04 Ti meframe: A DMIT THRU DISCHARGE
	2837	Bill Class if: OUTPAT IENT Division: DNS ENNE VAMRO C
	2838	[2] Sensit ive? : UN SPECIFIED Assi gnment: YE S
	2839	[3] Bill F rom : XX X XX, XXXX B ill To: XX X XX, XXXX
	2840	[4] OP Vis its : XX X XX, XXXX
	2841	[5] Rev. C ode : 75 0-GASTR-IN ST SVS 45384 $2,137.4 4 OUTPATI ENT VISIT
	2842	Rev. C ode : 32 4-DX X-RAY /CHEST 71010 $225.5 3 OUTPATI ENT VISIT
	2843	Rev. C ode : 51 0-CLINIC 99201 $108.9 2 OUTPATI ENT VISIT
	2844	OFFSET : $0.00 [NO OFFS ET RECORDE D]
	2845	BILL T OTAL : $2,471.89
	2846	[6] Rate S ched : (r e-calculat e charges)
	2847	[7] Prior Claims: UN SPECIFIED
	2848	<RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT:
	2849	StepProced ureNote: A fter Patch IB2432, it will n o longer b e possible to author ize a Sens itive clai m unless u sers indic ated that a Release of Informa tion has b een comple ted.5On Sc reens 8 an d 9, enter any neces sary Claim level dat a to the c laim. Note : IB2447 moved Scr een 8, Sec tion 3 Amb ulance Inf ormation t o a new Sc reen 9.IB, PATIENT MR A XX-XX- XXXX BIL L#: K20003 D - Inpat/ UB04 SCREEN <8>
	2850	========== ========== ========== ========== ========== ========== ========== =======
	2851	BIL LING - CLA IM INFORMA TION
	2852	[1] COB No n-Covered Charge Amt :
	2853	[2] Proper ty Casualt y Informat ion
	2854	Claim Number: Contact N ame:
	2855	Date o f 1st Cont act: Contact P hone:
	2856	[3] Surgic al Codes f or Anesthe sia Claims
	2857	Primar y Code: Secondary Code:
	2858	[4] Paperw ork Attach ment Infor mation
	2859	Report Type: NN Transmiss ion Method : XX
	2860	Attach ment Contr ol #: 123 4890701
	2861	[5] Disabi lity Start Date: Disabilit y End Date :
	2862	[6] Assume d Care Dat e: Relinquis hed Care D ate:
	2863	<RET> to C ONTINUE '^ N' for scr een N, or '^' to QUI T:
	2864	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.IB,PATI ENT F BILL#: K1 0001D - Ou tpat/1500 SCREEN < 9>
	2865	========== ========== ========== ========== ========== ========== ========== ==========
	2866	AMBULANCE INFORMATIO N
	2867	[1] Ambula nce Transp ort Data
	2868	D/O Locat ion:
	2869	P/U Ad dress1: D/O Addre ss1:
	2870	P/U Ad dress2: D/O Addre ss2:
	2871	P/U Ci ty: D/O City:
	2872	P/U St ate/Zip: D/O State /Zip:
	2873	Patien t Weight: 195 Transport Distance: 200
	2874	Transp ort Reason : Patient was transp orted to n earest fac ility for care
	2875	of sympt oms, compl aints or b oth.
	2876	R/T Pu rpose: Pat ient fell and sustai ned possib le injurie s to neck
	2877	Stretc her Purpos e: Patient unable to walk due to possibl e injuries to
	2878	neck
	2879	[2] Ambula nce Certif ication Da ta
	2880	Condit ion Indica tor: 01 - Admitted t o hospital
	2881	04 - Moved by s tretcher
	2882	06 - Transporte d in emerg ency situa tion
	2883	08 - Visible he morrhaging
	2884	09 - Medically necessary service
	2885	<RET> to C ONTINUE '^ N' for scr een N, or '^' to QUI T:
	2886	StepProced ure6On Scr een 10, en ter 3 to e nter the n ame of the Attending Physician . The clai m level at tending is still req uired. An outpatient UB-04 cla im can als o contain a line-lev el or clai m level Re ferring, O perating a nd/or Othe r Operatin g Physicia n(s). Reme mber: Patc h IB2432 will make it possib le to ente r and tran smit Line Level prov iders. Lin e Level an d Claim Le vel provid ers should not be th e same. Cl aim Level providers apply to t he entire claim. Lin e Level pr oviders ar e exceptio ns.Note: W ith Patch IB2432, users cann ot authori ze a claim which has an Other Operating Physician unless the re is an O perating P hysician o n the clai m.Note: Pa tch IB24 32 will ma ke it poss ible to en ter a Refe rral Numbe r for each payer on the claim. IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ UB-04 S CREEN <10>
	2887	========== ========== ========== ========== ========== ========== ========== ======
	2888	BILLIN G - SPECIF IC INFORMA TION
	2889	[1] Bill R emarks
	2890	- FL- 80 : UNSPEC IFIED [NOT REQUIRED]
	2891	ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED]
	2892	Auth/R eferral : UNSPEC IFIED [NOT REQUIRED]
	2893	Admiss ion Source : UNSPEC IFIED
	2894	[2] Pt Rea son f/Visi t : UNSPEC IFIED
	2895	[3] Provid ers :
	2896	- ATT ENDING : UNSPEC IFIED
	2897	[4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED]
	2898	[5] Billin g Provider : DNS ENNE VAMC
	2899	Taxono my Code : 282N00 000X
	2900	[6] Alt Pr im Payer I D : P: ALT IDHOSPICE1 23
	2901	[7] Force To Print? : NO FOR CED PRINT
	2902	[8] Provid er ID Main t : (Edit Provider I D informat ion)
	2903	<RET> to C ONTINUE, 1 -8 to EDIT , '^N' for screen N, or '^' to QUIT:
	2904	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.The Se condary ID s for the Attending, Operating or Other Operating Physician are determ ined from what the u ser enters and from entries in Provider ID Mainten ance.If us ers have s et a defau lt ID type and made it require d for the current or other pay ers, the c laim canno t be autho rized if t he physici an does no t have an ID of that type defi ned.Note: A fatal e rror messa ge will pr event user s from aut horizing a n adjustme nt claim, Type of Bi ll Frequen cy Code of 7 or 8, i n which th e destinat ion payer (primary/s econdary/t ertiary) i ndividual control nu mber (ICN/ DCN) is no t presentP atch IB2 547added a field to Screen 10 for altern ative paye r primary IDs which are used t o direct c laims to a dministrat ive contra ctors who process sp ecialized claims suc h as Durab le Medical Equipment (DME) cla ims. Unles s an alter native ID is added t o the clai m by the b illing cle rk, the re gular EDI – Primary Payer ID w ill be sen t with a c laim.When a provider is first added to S creen 10, the user w ill be sho wn a scree n that con tains a li st of all the provid er’s IDs, the ID typ e and, opt ionally, t he care un it on file for the p rovider's IDs. This will inclu de the pro vider's ow n IDs, the provider' s IDs assi gned by th e insuranc e company, the insur ance compa ny default s, if any, and all I Ds assigne d to the p rovider by care unit .
	2905	The first 2 entries in this li st will al ways be:
	2906	1 - NO S ECONDARY I D NEEDED
	2907	2 - ADD AN ID FOR THIS CLAIM ONLY
	2908	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. * * SECOND ARY PERFOR MING PROVI DER IDs **
	2909	PRIMARY IN SURANCE CO : BLUE CRO SS CA (WY)
	2910	PROVIDER: IB,PHYSICI AN4 (ATTEN DING)
	2911	INS. COMPA NY'S DEFAU LT SECONDA RY ID TYPE IS: BLUE CROSS ID
	2912	SELECT A S ECONDARY I D OR ACTIO N FROM THE LIST BELO W:
	2913	1 - N O SECONDAR Y ID NEEDE D
	2914	2 - A DD AN ID F OR THIS CL AIM ONLY
	2915	3 - < DEFAULT> X XXXBCROSS BLUE CROS S ID
	2916	4 - W YXXXX ST LIC (W Y)
	2917	Selection: 3//
	2918	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.
	2919	If no defa ult ID exi sts, the d efault for the selec tion promp t will be 1 – No Sec ondary ID needed.
	2920	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.
	2921	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.
	2922	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 .Note: Wit h Patch IB 2432, ID s for Line Level pro viders are determine d in the s ame manner as Claim Level Prov iders.If n one of the IDs are v alid for t he provide r for the claim, you can add a new ID fo r this cla im only.
	2923	StepProced ure7At the Selection prompt, t ype 2 to a dd an ID f or this cl aim only.8 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).9 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.S election: 3// 2
	2924	PRIM INS PERF PROV SECONDARY ID TYPE: ??
	2925	Choose from:
	2926	BLUE CR OSS ID
	2927	BLUE SH IELD ID
	2928	COMMERC IAL ID
	2929	LOCATIO N NUMBER
	2930	MEDICAR E PART A
	2931	MEDICAR E PART B
	2932	PRIM INS PERF PROV SECONDARY ID TYPE: LOCATION N UMBER
	2933	PRIM INS PERF PROV SECONDARY ID: XXXXA
	2934	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 .
	2935	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.
	2936	Valid Seco ndary ID T ypes for C urrent Pay erAttendin g/Referrin g/Operatin g/Other Op erating (U B-04)State License; Blue Cross ; Blue Shi eld; Medic are Part A ; UPIN; TR ICARE; Com mercial ID ; Location Number; N etwork ID; SSN; Stat e Industri al and Acc ident Prov iderRender ing/Referr ing/Superv ising (150 0)State Li cense; Blu e Shield; Medicare P art B; UPI N; TRICARE ; Commerci al ID; Loc ation Numb er; Networ k ID; SSN; State Ind ustrial an d Accident ProviderV alid Secon dary ID Ty pes for Ot her Payer (Not Curre nt)Attendi ng/Operati ng/Other ( UB-04)Blue Cross; Bl ue Shield; Medicare; Commercia l ID; Loca tion Numbe rRendering (1500)Blu e Shield; Medicare P art A and Part B; Co mmercial I D; Locatio n Number; Network ID Referring (1500)Blue Shield; M edicare Pa rt A and P art B; Com mercial ID ; Location Number; N etwork IDS upervising (1500)Blu e Shield; Medicare P art A and Part B; Co mmercial I D; Network IDStepPro cedure10At the <RET> to Contin ue: prompt (any scre en), enter ?PRV to s ee summary informati on about a particula r provider .IB,PATIEN T3 XX-XX -XXXX BI LL#: K300X X - Outpat /UB-04 S CREEN <10>
	2937	========== ========== ========== ========== ========== ========== ========== ========== ==
	2938	B ILLING - S PECIFIC IN FORMATION
	2939	[1] Bill R emarks
	2940	- FL- 80 : UNSPEC IFIED [NOT REQUIRED]
	2941	ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED]
	2942	Auth/R eferral : UNSPEC IFIED [NOT REQUIRED]
	2943	Admiss ion Source : PHYSIC IAN REFERR AL
	2944	[2] Pt Rea son f/Visi t : COUGH - 786.2
	2945	[3] Provid ers :
	2946	- ATT ENDING (MD ) : IB,DOC TOR4 Taxono my: 208G00 000X (33)
	2947	[4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED]
	2948	[5] Billin g Provider : DNS ENNE VAMC
	2949	Taxono my Code : 282N00 000X
	2950	[6] Force To Print? : NO FOR CED PRINT
	2951	[7] Provid er ID Main t : (Edit Provider I D informat ion)
	2952	<RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT: ?PR V
	2953	(V)A or (N )on-VA Pro vider: V// A PROVIDE R
	2954	This is a display of provider specific i nformation .
	2955	This bill is UB-04/O utpatient
	2956	This is a display of provider specific i nformation .
	2957	This bill is UB-04/O utpatient
	2958	The valid provider f unctions f or this bi ll are:
	2959	1 REFERRI NG SITUATIONA L - ALREAD Y ON BILL
	2960	2 OPERATI NG SITUATIONA L - NOT ON BILL
	2961	3 RENDERI NG SITUATIONA L - ALREAD Y ON BILL
	2962	4 ATTENDI NG REQUIRED - ALREADY O N BILL
	2963	9 OTHER O PERATING OPTIONAL - NOT ON BI LL
	2964	Select PRO VIDER NAME : IB,Docto r RAD PI
	2965	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	2966	Signature Name: DOC TOR RAD IB
	2967	Signature Title:
	2968	D egree: MD
	2969	NPI: 111 2220037
	2970	Licen se(s): WY: 1289340B
	2971	Person Class: V18 3001
	2972	PROVIDER TYPE: All opathic an d Osteopat hic Physic ians
	2973	CLASSIFIC ATION: Rad iology
	2974	SPECIALIZ ATION: Bod y Imaging
	2975	TAX ONOMY: 208 5B0100X (8 88)
	2976	EFFE CTIVE: 6/7 /10
	2977	RC Provide r Group: N one
	2978	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	2979	Select PRO VIDER NAME :
	2980	StepProced ure11At th e <RET> to Continue: prompt (a ny screen) , enter ?I D to see w hat IDs wi ll be tran smitted wi th the cla im.IB,PATI ENT3 XX- XX-XXXX BILL#: K30 0XX - Outp at/UB-04 SCREEN <10 >
	2981	========== ========== ========== ========== ========== ========== ========== ========== ==
	2982	BILLIN G - SPECIF IC INFORMA TION
	2983	[1] Bill R emarks
	2984	- FL- 80 : UNSPEC IFIED [NOT REQUIRED]
	2985	ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED]
	2986	Auth/R eferral : UNSPEC IFIED [NOT REQUIRED]
	2987	Admiss ion Source : PHYSIC IAN REFERR AL
	2988	[2] Pt Rea son f/Visi t : COUGH - 786.2
	2989	[3] Provid ers :
	2990	- REFE RRING (MD) : IB,DOCT OR GP Ta xonomy: 20 8G00000X ( 33)
	2991	[P]VAD000 [S]8301684 94
	2992	- REND ERING (MD) : IB,DOCT OR CARD Ta xonomy: 20 7RA0000X ( 33)
	2993	[P]VAD000 [S]8301684 94
	2994	- ATTE NDING (MD) : IB,DOCT OR4 Ta xonomy: 20 7XS0106X ( 40)
	2995	[P]VAD000 [S]8301684 94
	2996	[4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED]
	2997	[5] Billin g Provider : DNS ENNE VAMC
	2998	Taxono my Code : 282N00 000X
	2999	[6] Force To Print? : NO FOR CED PRINT
	3000	[7] Provid er ID Main t : (Edit Provider I D informat ion)
	3001	<RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT: ?ID
	3002	If this bi ll is tran smitted el ectronical ly, the fo llowing ID s will be sent:
	3003	Primary Ins Co: BL UE CROSS C A (WY) <<<Cur rent Ins
	3004	Secondary Ins Co: AE TNA US HEA LTHCARE
	3005	Provider I Ds: (VistA Records O P1,OP2,OP4 ,OP8,OP9,O PR2,OPR3,O PR4,OPR5,O PR8):
	3006	ATTEN DING: IB,D OCTOR4
	3007	NP I: 8731245386
	3008	Se condary ID s
	3009	(P ) BLUE CRO SS VAD000
	3010	REFER RING: IB,D OCTOR GP
	3011	NP I: 8731245394
	3012	(P ) BLUE CRO SS VAD000
	3013	RENDE RING: IB,D OCTOR CARD
	3014	NP I: 1112220029
	3015	(P ) BLUE CRO SS VAD000
	3016	Billing Pr ovider Nam e and ID I nformation
	3017	Billing Pr ovider: DNS ENNE VAMC
	3018	Billi ng Provide r NPI: 11 64471991
	3019	Billi ng Provide r Tax ID ( VistA Reco rd PRV): 830168494
	3020	Billi ng Provide r Secondar y IDs (Vis tA Record CI1A):
	3021	(P ) PROVIDER SITE NUMB ER 0000 <<<Sys tem Genera ted ID
	3022	(P ) BLUE CRO SS 007484
	3023	Service Li ne Provide rs
	3024	Servi ce Line: 3
	3025	RENDE RING: IB,D OCTOR RAD
	3026	NP I: 1112220037
	3027	(P ) BLUE CRO SS VAD000
	3028	(P ) EIN 022221111
	3029	(P ) STATE LI CENSE 1289340B
	3030	Press ENTE R to conti nue
	3031	StepProced ure12Press the <Ente r> key to move throu gh the fie lds. At t he Want To Authorize Bill At T his Time?: and Autho rize Bill Generation ?: prompts , enter Ye s. The cl aim is now complete and will b e transmit ted to the FSC in Au stin at th e next reg ularly sch eduled tra nsmission time. WAN T TO EDIT SCREENS? N O// <ENTER >
	3032	WANT TO AU THORIZE BI LL AT THIS TIME? No/ / YES
	3033	AUTHORIZE BILL GENER ATION?: YE S
	3034	Adding bi ll to BILL TRANSMISS ION File.
	3035	Bill wil l be submi tted elect ronically
	3036	Passing co mpleted Bi ll to Acco unts Recei vable. Bi ll is no l onger edit able.
	3037	Completed Bill Succe ssfully se nt to Acco unts Recei vable.
	3038	This Bill Can Not Be Printed U ntil Trans mit Confir med
	3039	This Outpa tient INST ITUTIONAL bill may h ave corres ponding PR OFESSIONAL
	3040	charges.
	3041	CMS-1500 C laims
	3042	The follow ing screen s provide a simplifi ed example of a CMS- 1500 claim .
	3043	StepProced ure1When p rocessing a CMS-1500 claim, in formation on Screens 1 and 2 s hould be r eviewed fo r correctn ess. Press the <Ente r> key to move from one screen to the ne xt.2On Scr een 3, the payer inf ormation i s reviewed for corre ctness. Th e patient may have m ore than o ne insuran ce policy. If the co rrect info rmation is not displ ayed, sele ct a secti on (1, 2, or 3 ) and edit the necessary fields. Pr ess the <E nter> key to continu e to Scree n 4.Note: With Patch IB2516, users wil l have the ability t o add a on e-time HPI D, per pay er, to a c laim if th e HPID in the Insura nce Compan y file is not the co rrect one. The HPID will not b e stored i n the Insu rance Comp any file. It will o nly apply to the cla im.IB,PATI ENT3 XX- XX-XXXX BILL#: K30 0XX - Inpa t/1500 SCREE N <3>
	3044	========== ========== ========== ========== ========== ========== ========== ======
	3045	D A N E S N O MATION
	3046	[1] Rate T ype : REI MBURSABLE INS. Form Type: CMS 1500
	3047	Respon sible: INS URER Payer Sequence: Primary
	3048	Bill P ayer : Blu e Cross Fe p Tran smit: Yes
	3049	Ins 1: Blue Cros s Fep Policy #: R00000000
	3050	Grp #: 100 Whose: VET ERAN Rel to In sd: PATIEN T
	3051	Grp Nm : STANDARD FAMILY Insd Sex: MALE Insured: IB,PATIENT 3
	3052	[2] Billin g Provider Secondary IDs:
	3053	Primar y : 01010 0
	3054	Second ary: Terti ary :
	3055	[3] Mailin g Address : Elec tronic ID: 12B54
	3056	Blue C ross Fep
	3057	P O Bo x 10401
	3058	Birmin gham, AL 352020401
	3059	<RET> to C ONTINUE, 1 -3 to EDIT , '^N' for screen N, or '^' to QUIT:
	3060	StepProced ure3Specif y the corr ect diagno sis and pr ocedure co de(s) that must be o n this cla im. Press the <Ente r> key to move to Sc reen 6.Not e: With Pa tch IB25 16, users will have the abilit y to re-se quence dia gnosis cod es that ha ve been li nked to a specific p rocedure w ithout bre aking the link.Note: With Patc h IB2516 , new prom pts have b een added to Screens 4 and 5 t o allow us ers to ent er NDCs an d Units to non-RX pr ocedures f or medicat ions admin istered in an outpat ient setti ng.Note: W ith Patch IB2516, new prompt s have bee n added to Screens 4 and 5to a llow users to enter 80 charact er descrip tions to C PT/HCPCS p rocedure c odes for s ervices No t Otherwis e Classifi ed.IB,PATI ENT3 XX- XX-XXXX BILL#: K30 0XX - Outp at/1500 SCRE EN <5>
	3061	========== ========== ========== ========== ========== ========== ========== ======
	3062	EVENT - OU TPATIENT I NFORMATION
	3063	<1> Event Date : OCT 12, 2010
	3064	[2] Prin. Diag.: ACU TE BRONCHI TIS - 466. 0
	3065	Other Diag.: DMI WO CMP NT ST UNCNTR L - 250.01
	3066	[3] OP Vis its : OCT 12,2010,
	3067	[4] Cod. M ethod: HCP CS
	3068	CPT Co de : CHE ST X-RAY 7 1010-26 46 6.0 OCT 12, 2010
	3069	[5] Rx. Re fills: UNS PECIFIED [ NOT REQUIR ED]
	3070	[6] Pros. Items: UNS PECIFIED [ NOT REQUIR ED]
	3071	[7] Occ. C ode : UNS PECIFIED [ NOT REQUIR ED]
	3072	[8] Cond. Code : UNS PECIFIED [ NOT REQUIR ED]
	3073	<9> Value Code : UNS PECIFIED [ NOT REQUIR ED]
	3074	<RET> to C ONTINUE, 1 -9 to EDIT , '^N' for screen N, or '^' to QUIT:
	3075	StepProced ure4Verify that the Form Type is CMS-150 0 and that the date of billing is entere d. Make su re the Dis ch Stat fi eld is pop ulated. If all the d ata have b een entere d correctl y, section 5 should display th e correct revenue co des and co sts. Press the <Ente r> key to move to Sc reen 8.Not e: There i s a new no n-fatal Wa rning mess age when a claim con tains a Re venue code (s) which generates a zero dol lar amount charge. N ote: After Patch IB* 2432, it will no lo nger be po ssible to authorize a Sensitiv e claim un less users indicated that a Re lease of I nformation has been completed. Note: Afte r Patch IB 2432, 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.N ote: Allow able dolla r amounts have been increased to 9999999 .99 before users wil l be force d to split lines.Not e: After P atch IB2* 432, it wi ll be poss ible to ad d line-lev el Additio nal OB Min utes to an anesthesi a claim fo r an Obste tric proce dure that requires m ore than t he normal amount of minutes.IB ,PATIENT3 XX-XX-XX XX BILL# : K300XX - Outpat/15 00 SCREEN < 7>
	3076	========== ========== ========== ========== ========== ========== ========== ======
	3077	BIL LING - GEN ERAL INFOR MATION
	3078	[1] Bill T ype : 13 1 Loc. of Care: H OSPITAL - INPT OR OP T (INCLU
	3079	Charge Type : PR OFESSIONAL Dis ch Stat: D ISCHARGED TO HOME OR SELF CAR
	3080	Form T ype : CM S-1500 Ti meframe: A DMIT THRU DISCHARGE
	3081	Bill Class if: OUTPAT IENT Division: DNS ENNE VAMRO C
	3082	[2] Sensit ive? : NO Assi gnment: YE S
	3083	[3] Bill F rom : OC T 12, 2010 B ill To: OC T 13, 2010
	3084	[4] OP Vis its : OC T 12,2010,
	3085	[5] Rev. C ode : 32 4-DX X-RAY /CHEST 71010 $45.3 0 OUTPATI ENT VISIT
	3086	OFFSET : $0.00 [NO OFFS ET RECORDE D]
	3087	BILL T OTAL : $45.30
	3088	[6] Rate S ched : (r e-calculat e charges)
	3089	[7] Prior Claims: UN SPECIFIED
	3090	<RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT:
	3091	StepProced ure5On Scr eens 8 and 9, enter any necess ary Claim level data to the cl aim. Note: IB2447 moved Scre en 8, Sect ion 3 Ambu lance Info rmation to a new Scr een 9.Note : IB2448 moved Scr een 10 IB, PATIENT MR A XX-XX- XXXX BIL L#: K20003 D - Outpat /1500 SCREEN <8>
	3092	========== ========== ========== ========== ========== ========== ========== =======
	3093	BIL LING - CLA IM INFORMA TION
	3094	[1] COB No n-Covered Charge Amt :
	3095	[2] Proper ty Casualt y Informat ion
	3096	Claim Number: Contact N ame:
	3097	Date o f 1st Cont act: Contact P hone:
	3098	[3] Surgic al Codes f or Anesthe sia Claims
	3099	Primar y Code: Secondary Code:
	3100	[4] Paperw ork Attach ment Infor mation
	3101	Report Type: Transmiss ion Method :
	3102	Attach ment Contr ol #:
	3103	[5] Disabi lity Start Date: Disabilit y End Date :
	3104	[6] Assume d Care Dat e: Relinquis hed Care D ate:
	3105	[7] Specia l Program: ??
	3106	Thi s is the S pecial Pro gram with which a cl aim is ass ociated. R efer to
	3107	MED ICARE regu lations to decide wh en to use this field .
	3108	Choos e from:
	3109	01 EPSD T/CHAP
	3110	02 Phys Handicapp ed Childre n Program
	3111	03 Spec ial Fed Fu nding
	3112	05 Disa bility
	3113	07 Indu ced Aborti on - Dange r to Life
	3114	08 Indu ced Aborti on - Rape or Incest
	3115	09 2nd Opinion/Su rgery
	3116	Special Pr ogram:
	3117	[8] Homebo und: ??
	3118	Thi s is to in dicate tha t the pati ent is hom ebound or
	3119	ins titutional ized. Refe r to MEDIC ARE regula tions on w hen to
	3120	use this fiel d.
	3121	Choos e from:
	3122	0 NO
	3123	1 YES
	3124	Homebound:
	3125	[9] Date L ast Seen:? ?
	3126	Thi s is the d ate a pati ent was la st seen. R efer to ME DICARE
	3127	reg ulations o n when to use this f ield.
	3128	Date Last Seen:
	3129	<RET> to C ONTINUE '^ N' for scr een N, or '^' to QUI T:
	3130	Note: IB2 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.No te: The pr ompts on S creen 8 ar e smart pr ompts, ava ilable for the corre ct form ty pe.IB,PATI ENT MRA XX-XX-XXXX BILL#: K20003E - Outpat/150 0 SCREEN <9>
	3131	========== ========== ========== ========== ========== ========== ========== ==========
	3132	AMBULANCE INFORMATIO N
	3133	[1] Ambula nce Transp ort Data
	3134	D/O Locat ion:
	3135	P/U Ad dress1: D/O Addre ss1:
	3136	P/U Ad dress2: D/O Addre ss2:
	3137	P/U Ci ty: D/O City:
	3138	P/U St ate/Zip: D/O State /Zip:
	3139	Patien t Weight: Transport Distance:
	3140	Transp ort Reason :
	3141	R/T Pu rpose:
	3142	Stretc her Purpos e:
	3143	[2] Ambula nce Certif ication Da ta
	3144	Condit ion Indica tor: 12 - Confined t o a bed or chair
	3145	01 - Admitted t o hospital
	3146	<RET> to C ONTINUE, 1 -2 to EDIT , '^N' for screen N, or '^' to QUIT: 1
	3147	P/U Addres s1:
	3148	P/U Addres s 2:
	3149	P/U City:
	3150	P/U State:
	3151	P/U Zip:
	3152	D/O Locati on:
	3153	D/O Addres s1:
	3154	D/O Addres s2:
	3155	D/O City:
	3156	D/O State:
	3157	D/O Zip:
	3158	Patient We ight:
	3159	Transport Distance:
	3160	Transport Reason:
	3161	R/T Purpos e:
	3162	Stretcher Purpose:
	3163	<RET> to C ONTINUE, 1 -2 to EDIT , '^N' for screen N, or '^' to QUIT: 2
	3164	Select Amb ulance Con dition Ind icator: 01 // ?
	3165	Answer with AMBU LANCE COND ITION INDI CATOR
	3166	Choose from:
	3167	12
	3168	01
	3169	Yo u may ente r a new AM BULANCE CO NDITION IN DICATOR, i f you wish
	3170	Se lect an Am bulance Co ndition In dicator. Answer mus t be 1-2
	3171	ch aracters i n length.
	3172	Th is limits the entry to five co ndition in dicators.
	3173	Answer with AMBUL ANCE CONDI TION INDIC ATORS CODE
	3174	Choose from:
	3175	12 Confine d to a bed or chair
	3176	01 Admitte d to hospi tal
	3177	04 Moved b y stretche r
	3178	05 Unconsc ious or in Shock
	3179	06 Transpo rted in em ergency si tuation
	3180	07 Had to be physica lly restra ined
	3181	08 Visible hemorrhag ing
	3182	09 Medical ly necessa ry service
	3183	Select Amb ulance Con dition Ind icator: 01 //
	3184	StepProced ure6From S creen 10, select sec tion 3 to enter the name of th e Renderin g Provider if necess ary. Enter a Referri ng Provide r and/or S upervising Provider if require d by the p ayer for t he procedu re codes o n the clai m. Remembe r: Patch I B2432 wi ll make it possible to enter a nd transmi t Line Lev el provide rs. Line L evel and C laim Level providers should no t be the s ame. Claim Level pro viders app ly to the entire cla im. Line L evel provi ders are e xceptions. Note: Afte r Patch IB 2432, 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. IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ 1500 SCREE N <10>
	3185	========== ========== ========== ========== ========== ========== ========== ======
	3186	BILLI NG - SPECI FIC INFORM ATION
	3187	[1] Unable To Work F rom: UNSPE CIFIED [NO T REQUIRED ]
	3188	Unable To Work T o : UNSPE CIFIED [NO T REQUIRED ]
	3189	[2] ICN/DC N(s) : UNSPE CIFIED [NO T REQUIRED ]
	3190	Tx Aut h. Code(s) : UNSPE CIFIED [NO T REQUIRED ]
	3191	[3] Provid ers :
	3192	- REN DERING (MD ) : IB,DO CTOR4
	3193
	3194	Taxonomy: 000000000X
	3195	[P]XXXXBCR OSS
	3196	[4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED]
	3197	Lab CL IA # : UNSPE CIFIED [NO T REQUIRED ]
	3198	Mammog raphy Cert # : UNSPE CIFIED [NO T REQUIRED ]
	3199	[5] Chirop ractic Dat a : UNSPE CIFIED [NO T REQUIRED ]
	3200	[6] Form L ocator 19 : UNSPE CIFIED [NO T REQUIRED ]
	3201	[7] Billin g Provider : DNS ENNE VAMC
	3202	Taxono my Code : 282N0 0000X
	3203	[8] Force To Print? : NO FO RCED PRINT
	3204	[9] Provid er ID Main t : (Edit Provider ID informa tion)
	3205	<RET> to C ONTINUE, 1 -6 to EDIT , '^N' for screen N, or '^' to QUIT:
	3206	The Primar y ID (NPI) for the A ttending, Operating or Other P hysician i s always t ransmitted with a cl aim.The Se condary ID s for the Attending, Operating or Other Physician are determ ined from what the u ser enters and from entries in Provider ID Mainten ance.If us ers have s et a defau lt ID type and made it require d for the current or other pay er, the cl aim cannot be author ized if th e physicia n does not have an I D of that type defin ed.When a provider i s first ad ded to Scr een 10, th e user wil l be shown a screen that conta ins a list of all th e provider ’s IDs, th e ID type and, optio nally, the care unit on file f or the pro vider's ID s. This wi ll include the provi der's own IDs, the p rovider's IDs assign ed by the insurance company, t he insuran ce company defaults, if any, a nd all IDs assigned to the pro vider by c are unit.
	3207	The first 2 entries in this li st will al ways be:
	3208	1 - NO SEC ONDARY ID NEEDED
	3209	2 - ADD AN ID FOR TH IS CLAIM O NLY
	3210	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. * * SECOND ARY PERFOR MING PROVI DER IDs **
	3211	PRIMARY IN SURANCE CO : BLUE CRO SS CA (WY)
	3212	PROVIDER: IB,PHYSICI AN4 (ATTEN DING)
	3213	INS. COMPA NY'S DEFAU LT SECONDA RY ID TYPE IS: BLUE SHIELD ID
	3214	SELECT A S ECONDARY I D OR ACTIO N FROM THE LIST BELO W:
	3215	1 - N O SECONDAR Y ID NEEDE D
	3216	2 - A DD AN ID F OR THIS CL AIM ONLY
	3217	3 - < DEFAULT> X XXXBSHIELD BLUE SHI ELD ID
	3218	4 - W YXXXX ST LIC (W Y)
	3219	Selection: 3//
	3220	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.
	3221	If no defa ult ID exi sts, the d efault for the selec tion promp t will be 1 – No Sec ondary ID needed.
	3222	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.
	3223	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.
	3224	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 .If none o f the IDs are valid for the pr ovider for the claim , you can add a new ID for thi s claim on ly.
	3225	StepProced ure7At the Selection prompt, t ype 2 to a dd an ID f or this cl aim only.8 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).9 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.S election: 3// 2
	3226	PRIM INS PERF PROV SECONDARY ID TYPE: ??
	3227	Choose from:
	3228	BLUE CR OSS ID
	3229	BLUE SH IELD ID
	3230	COMMERC IAL ID
	3231	LOCATIO N NUMBER
	3232	MEDICAR E PART A
	3233	MEDICAR E PART B
	3234	PRIM INS PERF PROV SECONDARY ID TYPE: LOCATION N UMBER
	3235	PRIM INS PERF PROV SECONDARY ID: XXXXA
	3236	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 .
	3237	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.
	3238	Valid Seco ndary ID T ypes for C urrent Pay erAttendin g/Operatin g/Other (U B-04)State License; Blue Cross ; Blue Shi eld; Medic are Part A ; UPIN; TR ICARE; Com mercial ID ; Location Number; N etwork ID; SSN; Stat e Industri al and Acc ident Prov iderRender ing/Referr ing/Superv ising (150 0)State Li cense; Blu e Shield; Medicare P art B; UPI N; TRICARE ; Commerci al ID; Loc ation Numb er; Networ k ID; SSN; State Ind ustrial an d Accident ProviderV alid Secon dary ID Ty pes for Ot her Payer (Not Curre nt)Attendi ng/Operati ng/Other ( UB-04)Blue Cross; Bl ue Shield; Medicare Part A and Part B; U PIN; TRICA RE; Commer cial ID; L ocation Nu mberRender ing (1500) Blue Shiel d; Medicar e Part A a nd Part B; Commercia l ID; Loca tion Numbe r; Network IDReferri ng (1500)B lue Shield ; Medicare Part A an d Part B; Commercial ID; Locat ion Number ; Network IDSupervis ing (1500) Blue Shiel d; Medicar e Part A a nd Part B; Commercia l ID; Netw ork IDStep Procedure1 0At the <R ET> to Con tinue: pro mpt (any s creen), en ter ?PRV t o see summ ary inform ation abou t a partic ular provi der.IB,PAT IENT3 XX -XX-XXXX BILL#: K3 00XX - Out pat/UB04 SCREEN <1 0>
	3239	========== ========== ========== ========== ========== ========== ========== ========== ==
	3240	B ILLING - S PECIFIC IN FORMATION
	3241	[1] Bill R emarks
	3242	- FL- 80 : UNSPEC IFIED [NOT REQUIRED]
	3243	ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED]
	3244	Auth/R eferral : UNSPEC IFIED [NOT REQUIRED]
	3245	Admiss ion Source : PHYSIC IAN REFERR AL
	3246	[3] Provid ers :
	3247	- REN DERING (MD ) : IB,DO CTOR4
	3248
	3249	Taxonomy: 390200000X
	3250
	3251
	3252
	3253
	3254
	3255	[P]XXXXBCR OSS
	3256	[4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED]
	3257	Lab CL IA # : UNSPE CIFIED [NO T REQUIRED ]
	3258	Mammog raphy Cert # : UNSPE CIFIED [NO T REQUIRED ]
	3259	[5] Chirop ractic Dat a : UNSPE CIFIED [NO T REQUIRED ]
	3260	[6] Form L ocator 19 : UNSPE CIFIED [NO T REQUIRED ]
	3261	[7] Billin g Provider : MONTG OMERY VAMC
	3262	Taxono my Code : 282N0 0000X
	3263	[8] Force To Print? : NO FO RCED PRINT
	3264	[9] Provid er ID Main t : (Edit Provider ID informa tion)
	3265	<RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT:?PRV
	3266	(V)A or (N )on-VA Pro vider: V// NON- D A N P S O I ER
	3267	Select NON - D A N P S O I ER NAME: I B,OUTSIDED OC OI
	3268	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	3269	Signature Name: OUT SIDEDOC IB
	3270	NPI: 123 4567892
	3271	Licen se(s): Non e Active o n X/X/XX
	3272	Person Class: V11 5500
	3273	PROVIDER TYPE: All opathic an d Osteopat hic Physic ians
	3274	CLASSIFIC ATION: Res ident, All opathic (i ncludes In terns, Res idents, Fe llows)
	3275	SPECIALIZ ATION:
	3276	TAX ONOMY: 390 200000X (1 44)
	3277	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	3278	Select NON - D A N P S O I ER NAME:
	3279	StepProced ure11At th e <RET> to Continue: prompt (a ny screen) , enter ?I D to see w hat IDs wi ll be tran smitted wi th the cla im.IB,PATI ENT3 XX- XX-XXXX BILL#: K30 0XX - Outp at/UB04 SCREEN <1 0>
	3280	========== ========== ========== ========== ========== ========== ========== ========== ==
	3281	BILLIN G - SPECIF IC INFORMA TION
	3282	[1] Bill R emarks
	3283	- FL- 80 : UNSPEC IFIED [NOT REQUIRED]
	3284	ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED]
	3285	Auth/R eferral : UNSPEC IFIED [NOT REQUIRED]
	3286	Admiss ion Source : PHYSIC IAN REFERR AL
	3287	[3] Provid ers :
	3288	- REN DERING (MD ) : IB,DO CTOR4
	3289
	3290	Taxonomy: 000000000X
	3291
	3292
	3293
	3294
	3295
	3296	[P]XXXXBC ROSS
	3297	[4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED]
	3298	Lab CL IA # : UNSPE CIFIED [NO T REQUIRED ]
	3299	Mammog raphy Cert # : UNSPE CIFIED [NO T REQUIRED ]
	3300	[5] Chirop ractic Dat a : UNSPE CIFIED [NO T REQUIRED ]
	3301	[6] Form L ocator 19 : UNSPE CIFIED [NO T REQUIRED ]
	3302	[7] Billin g Provider : MONTG OMERY VAMC
	3303	Taxono my Code : 282N0 0000X
	3304	[8] Force To Print? : NO FO RCED PRINT
	3305	[9] Provid er ID Main t : (Edit Provider ID informa tion)
	3306	<RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT: ?ID
	3307	IF THIS BI LL IS TRAN SMITTED EL ECTRONICAL LY, THE FO LLOWING ID S WILL BE SENT:
	3308	PRIMARY INS CO: BL UE CROSS C A (WY) <<< Current In s
	3309	SECONDARY INS CO: TP M TRUST
	3310	PROVIDER I Ds: (VISTA RECORDS O P1,OP2,OP4 ,OP8,OP9,O PR2,OPR3,O PR4,OPR5,O PR8):
	3311	ATTEN DING/RENDE RING: IB,D OCTOR 4
	3312
	3313	NPI:
	3314
	3315
	3316
	3317	000000000X
	3318
	3319	SSN:
	3320
	3321
	3322
	3323	XXXXXXXXX
	3324	SEC ONDARY IDs
	3325
	3326	(P ) LOCATION NUMBER XXXXA
	3327	(P ) BLUE CRO SS ID XXXXB CROSS
	3328	(P ) ST LIC ( WY) WYXXX X
	3329	StepProced ure12Press the <Ente r> key to move throu gh the fie lds. At t he Want To Authorize Bill At T his Time?: and Autho rize Bill Generation ?: prompts , enter Ye s. The cl aim is now complete and will b e transmit ted to the FSC at th e next reg ularly sch eduled tra nsmission time. Exe cuting A/R edits
	3330	No A/R err ors found
	3331	WANT TO ED IT SCREENS ? NO//
	3332	THIS BILL WILL BE TR ANSMITTED ELECTRONIC ALLY
	3333	WANT TO AU THORIZE BI LL AT THIS TIME? No/ / YES
	3334	AUTHORIZE BILL GENER ATION?: YE S
	3335	Adding bill to BI LL TRANSMI SSION File .
	3336	Bill wil l be submi tted elect ronically
	3337	Passing co mpleted Bi ll to Acco unts Recei vable. Bi ll is no l onger edit able.
	3338	Completed Bill Succe ssfully se nt to Acco unts Recei vable.
	3339	This Bill Can Not Be Printed U ntil Trans mit Confir med
	3340	Lab Claims
	3341	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.
	3342	The follow ing screen s provide a simplifi ed example of a lab claim:
	3343	StepProced ure1When p rocessing a Laborato ry claim, informatio n on Scree ns 1 and 2 should be reviewed for correc tness. Pr ess the <E nter> key to move fr om one scr een to the next.2On Screen 3, the payer informatio n is 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.N ote: With Patch IB2 516, user s will hav e the abil ity to add a one-tim e HPID, pe r payer, t o a claim if the HPI D in the I nsurance C ompany fil e is not t he correct one. The HPID will not be sto red in the Insurance Company f ile. It w ill only a pply to th e claim.IB ,PATIENT3 XX-XX-XX XX BILL# : K300XX - Outpat/15 00 S CREEN <3>
	3344	========== ========== ========== ========== ========== ========== ========== ======
	3345	D A N E S N O MATION
	3346	[1] Rate T ype : REI MBURSABLE INS. Form Type: CMS 1500
	3347	Respon sible: INS URER Payer Sequence: Primary
	3348	Bill P ayer : Blu e Cross Fe p Tran smit: Yes
	3349	Ins 1: Blue Cros s Fep Policy #: R00000000
	3350	Grp #: 100 Whose: VET ERAN Rel to In sd: PATIEN T
	3351	Grp Nm : STANDARD FAMILY Insd Sex: MALE Insured: IB,PATIENT 3
	3352	[2] Billin g Provider Secondary IDs:
	3353	Primar y : 01010 0
	3354	Second ary: Terti ary :
	3355	[3] Mailin g Address : Elec tronic ID: 12B54
	3356	Blue C ross Fep
	3357	P O Bo x 10401
	3358	Birmin gham, AL 352020401
	3359	<RET> to C ONTINUE, 1 -3 to EDIT , '^N' for screen N, or '^' to QUIT:
	3360	StepProced ure3Specif y the corr ect diagno sis and pr ocedure co de(s) that must be o n this cla im. Press the <Enter > key to m ove to Scr een 7.IB,P ATIENT3 XX-XX-XXXX BILL#: K300XX - O utpat/1500 SC REEN <5>
	3361	========== ========== ========== ========== ========== ========== ========== ======
	3362	EVENT - OUTPATI ENT INFORM ATION
	3363	[1] Event Date : XX XX,XXXX
	3364	[2] Prin. Diag.: URI NARY FREQU ENCY - 788 .41
	3365	[3] OP Vis its : XXX XX,XXXX
	3366	[4] Cod. M ethod: HCP CS
	3367	CPT Co de : URI NALYSIS, A UTO W/SCOP E 81001 XXX X X,XXXX
	3368	CPT Co de : URI NE BACTERI A CULTURE 87088 XXX X X,XXXX
	3369	[5] Rx. Re fills: UNS PECIFIED [ NOT REQUIR ED]
	3370	[6] Pros. Items: UNS PECIFIED [ NOT REQUIR ED]
	3371	[7] Occ. C ode : UNS PECIFIED [ NOT REQUIR ED]
	3372	[8] Cond. Code : UNS PECIFIED [ NOT REQUIR ED]
	3373	[9] Value Code : UNS PECIFIED [ NOT REQUIR ED]
	3374	<RET> to C ONTINUE, 1 -9 to EDIT , '^N' for screen N, or '^' to QUIT:
	3375	StepProced ure4Verify that the Form Type is CMS-150 0 and that the date of billing is entere d. Make su re the Dis ch Stat fi eld is pop ulated. I f all the data have been enter ed correct ly, sectio n 5 should display t he correct revenue c odes and c osts. Pres s the <Ent er> key to move to S creen 8.IB ,PATIENT3 XX-XX-XX XX BILL# : K300XX - Outpat/15 00 SCREEN <7>
	3376	========== ========== ========== ========== ========== ========== ========== ======
	3377	BILL ING - GENE RAL INFORM ATION
	3378	[1] Bill T ype : 13 1 Loc. of Care: H OSPITAL - INPT OR OP T (INCLU
	3379	Charge Type : PR OFESSIONAL Dis ch Stat: D ISCHARGED TO HOME OR SELF CAR
	3380	Form T ype : CM S-1500 Ti meframe: A DMIT THRU DISCHARGE
	3381	Bill Class if: OUTPAT IENT Division: DNS ENNE VAMRO CY VAMC
	3382	[2] Sensit ive? : UN SPECIFIED Assi gnment: YE S
	3383	[3] Bill F rom : XX X XX,XXXX Bi ll To: XXX XX,XXXX
	3384	[4] OP Vis its : XX X XX,XXXX
	3385	[5] Rev. C ode : 30 6-LAB/BACT -MICRO 87088 $33.20 OUTPATIENT VISIT
	3386	Rev. C ode : 30 7-GASTR-IN ST SVS 81001 $12.77 OUTPATIENT VISIT
	3387	OFFSET : $0.00 [NO OFFS ET RECORDE D]
	3388	BILL T OTAL : $45.97
	3389	[6] Rate S ched : (r e-calculat e charges)
	3390	[7] Prior Claims: UN SPECIFIED
	3391	<RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT:
	3392	StepProced ure5On Scr eens 8 and 9, enter any necess ary Claim level data to the cl aim and pr ess the EN TER key to move to S creen 10. Note: IB2 447 moved Screen 8, Section 3 Ambulance Informati on to a ne w Screen 9 .IB,PATIEN T MRA XX -XX-XXXX BILL#: K2 0003D - Ou tpat/1500 SC REEN <8>
	3393	========== ========== ========== ========== ========== ========== ========== =======
	3394	BIL LING - CLA IM INFORMA TION
	3395	[1] COB No n-Covered Charge Amt :
	3396	[2] Proper ty Casualt y Informat ion
	3397	Claim Number: Contact N ame:
	3398	Date o f 1st Cont act: Contact P hone:
	3399	[3] Surgic al Codes f or Anesthe sia Claims
	3400	Primar y Code: Secondary Code:
	3401	[4] Paperw ork Attach ment Infor mation
	3402	Report Type: Transmiss ion Method :
	3403	Attach ment Contr ol #:
	3404	[5] Disabi lity Start Date: Disabilit y End Date :
	3405	[6] Assume d Care Dat e: Relinquis hed Care D ate:
	3406	[7] Specia l Program:
	3407	[8] Homebo und:
	3408	[9] Date L ast Seen:
	3409	<RET> to C ONTINUE '^ N' for scr een N, or '^' to QUI T:
	3410	Note: IB2 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.IB ,PATIENT M RA XX-XX -XXXX BI LL#: K2000 3E - Outpa t/1500 SCREE N <9>
	3411	========== ========== ========== ========== ========== ========== ========== =======
	3412	AMBULANCE INFORMATIO N
	3413	[1] Ambula nce Transp ort Data
	3414	D/O Locat ion:
	3415	P/U Ad dress1: D/O Addre ss1:
	3416	P/U Ad dress2: D/O Addre ss2:
	3417	P/U Ci ty: D/O City:
	3418	P/U St ate/Zip: D/O State /Zip:
	3419	Patien t Weight: Transport Distance:
	3420	Transp ort Reason :
	3421	R/T Pu rpose:
	3422	Stretc her Purpos e:
	3423	[2] Ambula nce Certif ication Da ta
	3424	Condit ion Indica tor: 12 - Confined t o a bed or chair
	3425	01 - Admitted t o hospital
	3426	<RET> to C ONTINUE, 1 -2 to EDIT , '^N' for screen N, or '^' to QUIT: 1
	3427	P/U Addres s1:
	3428	P/U Addres s 2:
	3429	P/U City:
	3430	P/U State:
	3431	P/U Zip:
	3432	D/O Locati on:
	3433	D/O Addres s1:
	3434	D/O Addres s2:
	3435	D/O City:
	3436	D/O State:
	3437	D/O Zip:
	3438	Patient We ight:
	3439	Transport Distance:
	3440	Transport Reason:
	3441	R/T Purpos e:
	3442	Stretcher Purpose:
	3443	<RET> to C ONTINUE, 1 -2 to EDIT , '^N' for screen N, or '^' to QUIT: 2
	3444	Select Amb ulance Con dition Ind icator: 01 // ?
	3445	Answer with AMBU LANCE COND ITION INDI CATOR
	3446	Choose from:
	3447	12
	3448	01
	3449	Yo u may ente r a new AM BULANCE CO NDITION IN DICATOR, i f you wish
	3450	Se lect an Am bulance Co ndition In dicator. Answer mus t be 1-2
	3451	ch aracters i n length.
	3452	Th is limits the entry to five co ndition in dicators.
	3453	Answer with AMBU LANCE COND ITION INDI CATORS COD E
	3454	Choose from:
	3455	12 Confine d to a bed or chair
	3456	01 Admitte d to hospi tal
	3457	04 Moved b y stretche r
	3458	05 Unconsc ious or in Shock
	3459	06 Transpo rted in em ergency si tuation
	3460	07 Had to be physica lly restra ined
	3461	08 Visible hemorrhag ing
	3462	09 Medical ly necessa ry service
	3463	Select Amb ulance Con dition Ind icator: 01 //
	3464	StepProced ure6From S creen 10, enter 3 to add a Ren dering and Referring and Super vising pro vider, if necessary. 7To edit, select Se ction 5 an d enter th e CLIA # i f required by the pa yer.After Patch IB2 .0320, th e billing software w ill automa tically po pulate the CLIA# for the divis ion on the claim whe n the clai m is for t he Service Type = 5 (Diagnosti c Laborato ry) if the CLIA# exi sts in the VistA Ins titution f ile. User s may over ride this value for the curren t claim on ly.For out side labor atory serv ices, the billing so ftware wil l automati cally popu late the C LIA# if th ere is a L aboratory or Facilit y secondar y ID defin ed for the outside f acility wi th a ID Qu alifier of X4 (CLIA #).There w ill be an Error Mess age for la boratory c laims to M edicare wh en there i s no CLIA# on the cl aim and a Warning Me ssage for laboratory claims to other pay ers when t here is no CLIA# on the claim. IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX X - Outpat /1500 S CREEN <10>
	3465	========== ========== ========== ========== ========== ========== ========== ======
	3466	BILLI NG - SPECI FIC INFORM ATION
	3467	[[1] Bill Remarks
	3468	- FL- 80 : UNSPEC IFIED [NOT REQUIRED]
	3469	ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED]
	3470	Auth/R eferral : UNSPEC IFIED [NOT REQUIRED]
	3471	Admiss ion Source : PHYSIC IAN REFERR AL
	3472	[3] Provid ers :
	3473	- REF ERRING (MD ) : IB,DO CTOR5
	3474	Taxonomy: XXXXXXXXXX (XX)
	3475	[P]XX 0000
	3476	- REN DERING (MD ) : IB,DO CTOR4
	3477	Taxonomy: XXXXXXXXXX (XX)
	3478	[P]XX X123
	3479	[4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED]
	3480	Lab CL IA # : DXXXX 000
	3481	Mammog raphy Cert # : UNSPE CIFIED [NO T REQUIRED ]
	3482	[5] Chirop ractic Dat a : UNSPE CIFIED [NO T REQUIRED ]
	3483	[6] CMS-15 00 Box 19 : UNSPE CIFIED [NO T REQUIRED ]
	3484	[7] Billin g Provider : DNS ENNE VAMC
	3485	Taxono my Code : 282N0 0000X
	3486	[8] Alt Pr im Payer I D : UNSPE CIFIED [NO T REQUIRED ]
	3487	[9] Force To Print? : NO FO RCED PRINT
	3488	[10] Provi der ID Mai nt : (Edi t Provider ID inform ation)
	3489	<RET> to C ONTINUE, 1 -10 to EDI T, '^N' fo r screen N , or '^' t o QUIT: 6
	3490	CMS-1500 B ox 19: ??
	3491	This is an 71 character free-text field that will prin t in Box 1 9
	3492	of t he CMS-150 0. Use th is field t o enter ad ditional P ayer requi red
	3493	IDs in the for mat of Qua lifier<no space>ID n umber<3 sp aces>
	3494	Qual ifier<no s pace>ID nu mber.
	3495	CMS-1500 B ox 19: ??
	3496	DISPLAY TH E FULL CMS -1500 BOX 19?: NO//
	3497	Note: Patc h IB2488 changed t he prompt Form Locat or 19 to C MS-1500 Bo x 19 and u pdated the Help text . Note: Th ere is a n ew field i n Section 4 for the Mammograph y Certific ation Numb er where u sers can e nter a cer tification number on claims fo r mammogra phy exams. The know n Mammogra phy Certif ication Nu mbers will be stored in the In stitution file, one per site.P atch IB2 547 added 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.Pharm acy Claims
	3498	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.
	3499	The follow ing screen s give a s implified example of a pharmac y claim.
	3500	StepProced ure1When p rocessing a Pharmacy claim, in formation on Screens 1 and 2 s hould be r eviewed fo r correctn ess. Pres s the <Ent er> key to move from one scree n to the n ext.2On Sc reen 3, th e payer in formation should be reviewed f or correct ness. The patient m ay have mo re than on e insuranc e policy. If the co rrect info rmation is not displ ayed, sele ct a secti on (1, 2, or 3 ) and edit the necessary fields. Pr ess the <E nter> key to continu e to Scree n 5.For Ph armacy cla ims, chang e the form type to a CMS-1500. Note: Wit h Patch IB 2516, us ers will h ave the ab ility to a dd a one-t ime HPID, per payer, to a clai m if the H PID in the Insurance Company f ile is not the corre ct one. Th e HPID wil l not be s tored in t he Insuran ce Company file. It will only apply to the claim. IB,PATIENT 5 XX-XX -XXXX BI LL#: K303X XX - Outpa t/1500 SC REEN <3>
	3501	========== ========== ========== ========== ========== ========== ========== =========
	3502	D A N E S N O MATION
	3503	[1] Rate T ype : REI MBURSABLE INS. Form Type: CMS- 1500
	3504	Respon sible: INS URER Payer Sequence: Primary
	3505	Bill P ayer : CIG NA Trans mit: Yes
	3506	Ins 1: CIGNA Policy #: 126781678
	3507	Grp #: GRP NUM 2 277 Whose: VET ERAN Rel to In sd: PATIEN T
	3508	Grp Nm : CHALKER Insd Sex: MALE Insured: IB,PATIENT 5
	3509	Ins 2: BLUE CROS S CA (W Policy #: R76543210
	3510	Grp #: GRP NUM 1 0891 Whose: SPO USE Rel to In sd: SPOUSE
	3511	Grp Nm : HARTLY Insd Sex: FEMALE Insured: IB,WIFE5
	3512	[2] Billin g Provider Secondary IDs: UNSP ECIFIED [N OT REQUIRE D]
	3513	[3] Mailin g Address :
	3514	NO MAI LING ADDRE SS HAS BEE N SPECIFIE D! (Pati ent has Me dicare)
	3515	Send B ill to PAY ER listed above.
	3516	<RET> to C ONTINUE, 1 -3 to EDIT , '^N' for screen N, or '^' to QUIT:
	3517	StepProced ure3The hi ghlighted fields are auto-popu lated. Re member tha t this is a professi onal bill that is be ing transm itting as a CMS-1500 , so each HCPCS code will have to be ass ociated wi th a diagn osis code. To begin this proc ess, type 4 to edit the Cod. M ethod fiel d and pres s the <Ent er> key.No te: With Patch IB2 432, when adding a refill to a claim, u sers will be able to view the date a pre scription was order along with the other data.ADD/ EDIT RX FI LL 2054788 FOR Oct 2 6, 2010 CO RRECT? YES //
	3518	Date RX Or dered: Oc t 26, 2010
	3519	RX #: 2054 788//
	3520	DATE: OCT 26,2010//
	3521	DRUG: HYDR OCHLOROTHI AZIDE 25MG TAB//
	3522	DAYS SUPPL Y: 30//
	3523	QTY: 15//
	3524	NDC #: 001 72-2083-80 //
	3525	FORMAT OF NDC#: 5-4- 2 FORMAT//
	3526	IB,PATIENT 5 XX-XX -XXXX BI LL#: K303X XX - Outpa t/1500 SCREE N <5>
	3527	========== ========== ========== ========== ========== ========== ========== =========
	3528	EVENT - OUTPATI ENT INFORM ATION
	3529	<1> Event Date : XXX XX,XXXX
	3530	[2] Prin. Diag.: ISS UE REPEAT PRESCRIPT - V68.1
	3531	[3] OP Vis its : UNS PECIFIED
	3532	[4] Cod. M ethod: HCP CS
	3533	CPT Co de : Ora l prescrip drug non chemo J849 9 V6 8.1 XXX XX,XXXX
	3534	[5] Rx. Re fills: HYD ROCHLOROTH IAZIDE 25M G TAB XXX XX,XX XX
	3535	[6] Pros. Items: UNS PECIFIED [ NOT REQUIR ED]
	3536	[7] Occ. C ode : UNS PECIFIED [ NOT REQUIR ED]
	3537	[8] Cond. Code : UNS PECIFIED [ NOT REQUIR ED]
	3538	<9> Value Code : UNS PECIFIED [ NOT REQUIR ED]
	3539	<RET> to C ONTINUE, 1 -9 to EDIT , '^N' for screen N, or '^' to QUIT:
	3540	StepProced ure4At the Select Pr ocedure Da te field, re-type th e date.5At the Selec t Procedur e field, t ype the ap propriate code. Onc e the code auto-popu lates the data, type YES to co nfirm.6At the Provid er field, type the n ame of the physician . Informa tion relat ed to that provider will auto- populate.7 Type the a ppropriate data rela ted to the Place of Service an d the Type of Servic e.8Press t he <Enter> key until Screen 5 appears.<< CURRENT PR OCEDURAL T ERMINOLOGY CODES>>
	3541	LISTING FR OM VISIT D ATES WITH ASSOCIATED CPT CODES
	3542	IN OUTPT E NCOUNTERS FILE
	3543	========== ========== ========== ========== ========== ========== ========== =========
	3544	NO. CODE SHORT N AME C LINIC DATE
	3545	========== ========== ========== ========== ========== ========== ========== =========
	3546	NO CPT COD ES ON FILE FOR THE V ISIT DATES ON THIS B ILL
	3547	PROCEDURE CODING MET HOD: HCPCS (1500 COM MON PROCED URE CODING SYSTEM)
	3548	/ /
	3549	Select PRO CEDURE DAT E (X/XX/XX -XX/XX/XX) : XX-XX-XX
	3550	* Patient has no Vis its for th is date...
	3551	Select PROCEDURE: J
	3552	Searching for a CPT ,(pointed- to by PROC EDURES)
	3553	J8499 Oral pre scrip drug non chemo
	3554	.. .OK? Yes// Yes Oral prescrip drug non c hem Rx: 0 000000D
	3555	PROCEDURES : J8499//
	3556	Select CPT MODIFIER SEQUENCE:
	3557	PROVIDER: IB,DOCTOR6 //
	3558	ASSOCIATED CLINIC: C ARDIAC CON SULT
	3559	DIVISION: MONTGOMERY VAMC// 619
	3560	PLACE OF S ERVICE: 22 OUT PATIENT HO SPITAL
	3561	TYPE OF SE RVICE: 1 MEDIC AL CARE
	3562	EMERGENCY PROCEDURE? : NO// N O
	3563	PRINT ORDE R:
	3564	StepProced ure9Notice the assoc iation has been made between t he diagnos is code an d the requ ired proce dure code. Press th e <Enter> key to mov e to Scree n 7.IB,PAT IENT5 X X-XX-XXXX BILL#: K 303XX - Ou tpat/1500 S CREEN <5>
	3565	========== ========== ========== ========== ========== ========== ========== =========
	3566	EVENT - OUTPATI ENT INFORM ATION
	3567	<1> Event Date : XXX XX,XXXX
	3568	[2] Prin. Diag.: ISS UE REPEAT PRESCRIPT - V68.1
	3569	[3] OP Vis its : XXX XX,XXXX
	3570	[4] Cod. M ethod: HCP CS
	3571	CPT Co de : Ora l prescrip drug non chemo J8 499 V68.1 XXX XX,X XXX
	3572	[5] Rx. Re fills: RAN ITIDINE HC L 150MG (Z ANTAC) TAB XXX XX,X XXX
	3573	[6] Pros. Items: UNS PECIFIED [ NOT REQUIR ED]
	3574	[7] Occ. C ode : UNS PECIFIED [ NOT REQUIR ED]
	3575	[8] Cond. Code : UNS PECIFIED [ NOT REQUIR ED]
	3576	<9> Value Code : UNS PECIFIED [ NOT REQUIR ED]
	3577	<RET> to C ONTINUE, 1 -9 to EDIT , '^N' for screen N, or '^' to QUIT:
	3578	StepProced ure10If al l the data have been entered c orrectly, section 5 should dis play the c orrect rev enue code and charge s.. Press the <Ente r> key to move to Sc reen 8.IB, PATIENT5 XX-XX-XX XX BILL# : K303XX - Outpat/15 00 SCREEN <7>
	3579	========== ========== ========== ========== ========== ========== ========== =========
	3580	BILL ING - GENE RAL INFORM ATION
	3581	[1] Bill T ype : 13 1 Loc. o f Care: HO SPITAL - I NPT OR OPT (INCLU
	3582	Covere d Days: UN SPECIFIED Bill C lassif: OU TPATIENT
	3583	Non-Co v Days: UN SPECIFIED Tim eframe: AD MIT THRU D ISCHARGE
	3584	Charge Type : UN SPECIFIED Disc h Stat:
	3585	Form T ype : CM S-1500 Di vision: MO NTGOMERY V AMC
	3586	[2] Sensit ive? : UN SPECIFIED Assi gnment: YE S
	3587	[3] Bill F rom : XX X XX,XXXX Bi ll To: XXX XX,XXXX
	3588	[4] OP Vis its : UN SPECIFIED
	3589	[5] Rev. C ode : 25 3-WARFARIN SODIUM 5 J8499 1 $36.0 0 PRESCRI PTION
	3590	OFFSET: $0 .00 [NO OFFSET REC ORDED]
	3591	BILL T OTAL : $36.00
	3592	[6] Rate S ched : (r e-calculat e charges)
	3593	[7] Prior Claims: UN SPECIFIED
	3594	StepProced ure11On Sc reens 8 an d 9, enter any neces sary claim -level dat a to the c laim and p ress the < Enter> key to move t o Screen 1 0. Note: I B2447 mo ved Screen 8, Sectio n 3 Ambula nce Inform ation to a new Scree n 9.IB,PAT IENT MRA XX-XX-XXX X BILL#: K20003D - Outpat/15 00 SCREE N <8>
	3595	========== ========== ========== ========== ========== ========== ========== ==========
	3596	BIL LING - CLA IM INFORMA TION
	3597	<1> COB No n-Covered Charge Amt :
	3598	<2> Proper ty Casualt y Informat ion
	3599	Claim Number: Contact N ame:
	3600	Date o f 1st Cont act: Contact P hone:
	3601	<3> Surgic al Codes f or Anesthe sia Claims
	3602	Primar y Code: Secondary Code:
	3603	<4> Paperw ork Attach ment Infor mation
	3604	Report Type: Transmiss ion Method :
	3605	Attach ment Contr ol #:
	3606	<5> Disabi lity Start Date: Disabilit y End Date :
	3607	<6> Assume d Care Dat e: Relinquis hed Care D ate:
	3608	[7] Specia l Program:
	3609	[8] Homebo und:
	3610	[9] Date L ast Seen:
	3611	<RET> to C ONTINUE '^ N' for scr een N, or '^' to QUI T:
	3612	IB,PATIENT M M XXX- XX-XXXX BILL#: K10 1ES8 - Out pat/UB04 SCREEN <9>
	3613	========== ========== ========== ========== ========== ========== ========== ==========
	3614	AMBULANCE INFORMATIO N
	3615	<1> Ambula nce Transp ort Data
	3616	D/O Locat ion:
	3617	P/U Ad dress1: D/O Addre ss1:
	3618	P/U Ad dress2: D/O Addre ss2:
	3619	P/U Ci ty: D/O City:
	3620	P/U St ate/Zip: D/O State /Zip:
	3621	Patien t Weight: Transport Distance:
	3622	Transp ort Reason :
	3623	R/T Pu rpose:
	3624	Stretc her Purpos e:
	3625	<2> Ambula nce Certif ication Da ta
	3626	Condit ion Indica tor:
	3627	<RET> to C ONTINUE, 1 -2 to EDIT , '^N' for screen N, or '^' to QUIT:
	3628	StepProced ure12From Screen 10, enter 3 t o add a Re ndering pr ovider. Pa tch IB25 47 added a field to Screen 10 for altern ative paye r primary IDs which are used t o direct c laims to a dministrat ive contra ctors who process sp ecialized claims suc h as Durab le Medical Equipment (DME) cla ims.IB,PAT IENT5 XX -XX-XXXX BILL#: K3 03XXX - Ou tpat/1500 SCREEN <1 0>
	3629	========== ========== ========== ========== ========== ========== ========== ==========
	3630	B ILLING - S PECIFIC IN FORMATION
	3631	[1] Unable To Work F rom: UNSPE CIFIED [NO T REQUIRED ]
	3632	Unable To Work T o : UNSPE CIFIED [NO T REQUIRED ]
	3633	[2] ICN/DC N(s) : UNSPE CIFIED [NO T REQUIRED ]
	3634	Auth/R eferral : UNSPE CIFIED [NO T REQUIRED ]
	3635	[3] Provid ers :
	3636	- REN DERING : UNSPE CIFIED
	3637	[4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED]
	3638	Lab CL IA # : UNSPE CIFIED [NO T REQUIRED ]
	3639	Mammog raphy Cert # : UNSPE CIFIED [NO T REQUIRED ]
	3640	[5] Chirop ractic Dat a : UNSPE CIFIED [NO T REQUIRED ]
	3641	[6] CMS-15 00 Box 19 : UNSPE CIFIED [NO T REQUIRED ]
	3642	[7] Billin g Provider : DNS ENNE VAMC
	3643	Taxono my Code : 282N0 0000X
	3644	[8] Alt Pr im Payer I D : UNSPE CIFED [NOT REQUIRED]
	3645	[9] Force To Print? : NO FO RCED PRINT
	3646	[10] Provi der ID Mai nt : (Edi t Provider ID inform ation)
	3647	<RET> to C ONTINUE, 1 -10 to EDI T, '^N' fo r screen N , or '^' t o QUIT:
	3648	This claim is now re ady for au thorizatio n.
	3649	Correct Re jected or Denied Cla ims
	3650	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.
	3651	With Patch IB2433, 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.
	3652	With Patch IB2447, 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 :
	3653	INTERAGENC Y
	3654	SHARING AG REEMENT
	3655	TRICARE
	3656	WORKMAN’S COMP
	3657	StepProced ure1Access the optio n Third Pa rty Billin g Menu.2At the Selec t Third Pa rty Billin g Menu Opt ion: promp t, enter C RD for Cor rect Rejec ted/Denied Bill.3At the Enter BILL NUMBE R or Patie nt NAME: p rompt, ent er the cla im number of the cla im that re quires cor rection.4A t the ARE YOU SURE Y OU WANT TO CANCEL TH IS BILL? N o// prompt , enter Ye s to overr ide the de fault.5At the CANCEL BILL?: pr ompt, ente r YES.6At the REASON CANCELLED : prompt, enter a fr ee-text co mment.Note : This ne w option w as designe d to repla ce the exi sting opti on CLON Co py and Can cel under the majori ty of circ umstances. The exis ting CLON Copy and C ancel opti on will no w be locke d with a n ew Securit y Key name d IB CLON. Note: Th e existing CLON Copy and Cance l option s hould only be used t o correct denied cla ims agains t which a payment ha s been pos ted or to correct a claim with one of th e Bill Rat e Types th at are exc luded from the new p rocesses.. 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.N ote: The I B CLON sec urity key which rest ricted the use of th e CLON opt ion , was removed wi th Patch I B2516.Th e followin g screen w ill displa y.
	3658	IB,PATIENT 4 (XX-X X-XXXX) DOB: X XX XX,XXXX
	3659	========== ========== ========== ========== ========== ========== ========== ==========
	3660	Rate Type : REI MBURSABLE INS.
	3661	Event Date : XXX XX XXXX
	3662	Sensitive : NO
	3663	Responsibl e : INS URANCE CAR RIER (Sp ecify CARR IER on SCR EEN 3)
	3664	Loc of Car e : HOS PITAL (INC LUDES CLIN IC) - INPT . OR OPT.
	3665	Event Sour ce : Out patient
	3666	Timeframe : ADM IT THRU DI SCHARGE
	3667	(Sp ecify actu al bill ty pe fields on SCREENs 6/7)
	3668	Bill From : XXX XX,XXXX
	3669	Bill To : XXX XX,XXXX
	3670	Initial Bi ll# : K70 1XXX-01
	3671	Copied Bil l# : K70 1XXX-01
	3672	Please ver ify the ab ove inform ation for the bill y ou just en tered. On ce this
	3673	informatio n is accep ted it wil l no longe r be edita ble and yo u will be required
	3674	to CANCEL THE BILL i f changes to this in formation are necess ary.
	3675	IS THE ABO VE INFORMA TION CORRE CT AS SHOW N? Yes//
	3676	StepProced ure7Return through t he claim s creens cor recting wh atever dat a requires correctio n.8Complet e and auth orize the claim.Note : The numb er of the original c laim has b een increm ented and now displa ys with a -01 after the claim number. T he origina l claim nu mber has b een assign ed to the new claim. Each tim e a claim is correct ed, the pr evious can celled ver sion will be increme nted -01, -02, -03, etc..When users atte mpt to use the CRD C orrect Rej ected/Deni ed Bill op tion to co rrect a cl aim agains t which a payment ha s been pos ted, they will be wa rned that they must use the ex isting CLO N Copy and Cancel op tion.
	3677	Select T hird Party Billing M enu Option : CRD Cor rect Rejec ted/Denied Bill
	3678	Enter BILL NUMBER or Patient N AME: K6 00XXX IB,PATIENT 1 XX-X X-XX
	3679	Outpat ient R EIMBURSABL E INS. PRNT/TX
	3680	Please not e a PAYMEN T of $45 has bee n POSTED t o this bil l. Copy an d cancel
	3681	(CLON) mus t be used to correct this bill .
	3682	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.
	3683	Select Thi rd Party B illing Men u Option: CRD Corre ct Rejecte d/Denied B ill
	3684	Enter BILL NUMBER or Patient N AME: K6 00XXX IB,PATIENT 1 XX-X X-XX
	3685	Outpat ient R EIMBURSABL E INS. PRNT/TX
	3686	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.
	3687	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.
	3688	Select Thi rd Party B illing Men u Option: CRD Corre ct Rejecte d/Denied B ill
	3689	Enter BILL NUMBER or Patient N AME: K6 00XXX IB,PATIENT 1 XX-X X-XX
	3690	Outpat ient R EIMBURSABL E INS. PRNT/TX
	3691	This optio n cannot b e used to correct so me Billing Rate Type s (Example : TRICARE) .
	3692	Use Copy a nd Cancel (CLON) to correct th is bill.
	3693	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.
	3694	Please not e that COB data exis ts for thi s bill.
	3695	Copy and c ancel (CLO N) must be used to c orrect thi s bill.
	3696	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.
	3697	This bill is in a st atus of RE QUEST MRA.
	3698	No MRA s have bee n received and there are no re jection me ssages on file
	3699	for th e most rec ent transm ission of this MRA r equest bil l.
	3700	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.T he history of correc ted claims will be a vailable f rom the fo llowing lo cations:
	3701	BILL - Ent er/Edit Bi lling Info rmation
	3702	INQ – Pati ent Billin g Inquiry
	3703	Viewed Can celled Cla ims
	3704	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.
	3705	The View C ancelled B ill option is on the Third Par ty Billing Menu.
	3706	ADPR Print Bill Addendum Sheet
	3707	AUTH Authorize Bill Gener ation
	3708	BILL Enter/Edit Billing I nformation
	3709	CANC Cancel Bil l
	3710	CLA Multiple C LAIMSMANAG ER Claim S end
	3711	CLON Copy and C ancel
	3712	CRD Correct Re jected/Den ied Bill
	3713	DLST Delete Aut o Biller R esults
	3714	GEN Print Bill
	3715	INQU Patient Bi lling Inqu iry
	3716	LIST Print Auto Biller Re sults
	3717	PRNT Print Auth orized Bil ls
	3718	RETN Return Bil l Menu ...
	3719	VCB View Cance lled Bill
	3720	VIEW View Bills Pending T ransmissio n
	3721	VIST Outpatient Visit Dat e Inquiry
	3722	Select Thi rd Party B illing Men u <TEST AC COUNT> Opt ion:
	3723	Printed Cl aims
	3724	Some claim s should n ot be tran smitted el ectronical ly and sho uld be pri nted local ly.
	3725	These incl ude:
	3726	Claims req uiring cli nical atta chments su ch as prog ress notes ;
	3727	Profession al claims containing more than the maxim um number of 8 diagn osis codes ;
	3728	Profession al claims containing more than the maxim um number of diagnos is pointer s (4);
	3729	Institutio nal claims containin g more tha n the maxi mum number of proced ure codes (999);
	3730	Profession al claims containing more than the maxim um number of procedu re codes/l ine items (50);
	3731	Institutio nal pharma cy claims; and
	3732	Secondary claims to Medicare W NR (When M edicare WN R is NOT t he primary insurance ).
	3733	View/Resub mit Claims – Live or Test – Sy nonym: RCB
	3734	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.
	3735	Patch IB2 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.
	3736	StepProced ure1At the Select ED I Menu For Electroni c Bills Op tion, type RCB and p ress the R eturn key. 2At the R un report for (P)rin ted or (T) ransmitted claims?: Transmitte d// prompt , press th e Enter ke y to accep t the defa ult3At the SELECT BY : (C)LAIM, (B)ATCH O R SEE A (L )IST TO PI CK FROM: p rompt, pre ss the Ent er key to accept the default o f List.4At the Run f or (A)ll p ayers or ( S)elected Payers? pr ompt, type S for Sel ected Paye rs.If you choose Sel ected paye rs, after you enter Blue Cross of CA, fo r example, you will be prompte d to inclu ded all in surance co mpanies wi th the sam e Electron ic Billing ID. This will preve nt you fro m having t o enter ev ery BC/BS company de fined in y our Insura nce file.5 At the Sel ect Insura nce Compan y: prompt, enter an EDI Payer Primary ID 6At the Se lect Insur ance Compa ny prompt, press the Enter key when done selecting payers7At the Run f or (U)B-04 , (C)MS-15 00 or (B)O TH: prompt , press th e Enter ke y to accep t the defa ult of Bot h.The Date Range for the searc h for clai ms has bee n restrict ed to a ma ximum of 9 0 days to minimize t he impact of the sea rch on the system.8A t the Star t with Dat e Last Tra nsmitted: prompt, ty pe T-200 f or this ex ample. 9At the Go to Date Last Transmitt ed: prompt , press th e Enter ke y to accep t the defa ult of 12/ 1/04. This will retu rn results for 90 da ys.10At th e Select A dditional Limiting C riteria (o ptional): prompt, pr ess the En ter key wi thout sele cting anyt hing addit ional.Sele ct EDI Men u For Elec tronic Bil ls Option: RCB View /Resubmit Claims-Liv e or Test
	3737	*** NOTE: 2 '^' ARE NEEDED TO ABORT THE OPTION (^^ )
	3738	1 '^' BRIN GS YOU BAC K TO THE P REVIOUS SE LECTION PR OMPT(^)
	3739	Run report for (P)ri nted or (T )ransmitte d claims?: Transmitt ed//Transm itted
	3740	Select By: (C)laim o r see a (L )ist to pi ck from?: List//
	3741	PAYER SELE CTION:
	3742	Run for (A )ll Payers or (S)ele cted Payer s?: Select ed Payers/ /Selected Payers
	3743	Include all payer s with the same elec tronic Pay er ID? Yes // YES
	3744	Select Insurance Company: 6 0054
	3745	1 6 0054 AETN A HEALTH P LANS4501 N STERLING PEORIA,IL 6 0054/60054
	3746	2 6 0054 AETN A HEALTH P LANS620 ER IE BLVD WE ST SYRACU SE,NY 6 0054/60054
	3747	3 6 0054 AETN A HEALTH P LANSPO BOX 16516 C OLUMBUS,OH 6 0054/60054
	3748	4 6 0054 AETN A HEALTH P LANS3541 W INCHESTER ROAD ALLE NTOWN,PA 60054/6005
	3749	4
	3750	5 6 0054 AETN A HEALTH P LANSPO BOX 112 P ORTLAND,OR 6 0054/60054
	3751	Press <RET URN> to se e more, '^ ' to exit this list, OR
	3752	CHOOSE 1-5 : 1 AETNA HEALTH PL ANS4501 N STERLING PEORIA,IL 6 0054/60054
	3753	Select Another In surance Co mpany:
	3754	BILL FORM TYPE SELEC TION:
	3755	Run for (U )B-04, (C) MS-1500 or (B)oth: B oth// Both
	3756	LAST BATCH TRANSMIT DATE RANGE SELECTION :
	3757	Start with Date Last Transmitt ed: T-200 (XXX XX, XXXX)
	3758	Go to Date Last Tran smitted:(T -200 – T-1 10): T-110 // (XXX XX, XXXX)
	3759	ADDITIONAL SELECTION CRITERIA:
	3760	1 - MRA Se condary On ly
	3761	2 - Primar y Claims O nly
	3762	3 - Second ary Claims Only
	3763	4 - Claims Sent to P rint at Cl earinghous e Only
	3764	StepProced ure11At th e Would yo u like to include ca ncelled cl aims? No// : prompt, enter No.1 2At the Wo uld you li ke to incl ude claims Forced to Print at the Cleari nghouse? N o// prompt , enter No .13At the Sort By pr ompt, ente r B to ove rride the default of Current P ayer.Sort by Batch i f you want to resubm it batches of claims or Curren t Payer if you want to resubmi t a variet y of indiv idual clai ms.14At th e DO YOU W ANT A (R)E PORT OR A (S)CREEN L IST FORMAT ?: prompt, press the <Enter> k ey to acce pt the def ault of Sc reen List. Would you like to i nclude can celled cla ims? No// NO
	3765	Would you like to in clude clai ms Forced to Print a t the Clea ringhouse? No// NO
	3766	Sort By: C urrent Pay er// ??
	3767	Enter a co de from th e list.
	3768	Selec t one of t he followi ng:
	3769	1 Batch By L ast Transm itted Date (Claims w ithin a Ba tch)
	3770	2 Current Pa yer (Insur ance Compa ny)
	3771	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//
	3772	The follow ing screen is displa yed:
	3773	PREVIOUSLY TRANSMITT ED CLAIMS Mar 21, 20 05@15:52:1 0 Page: 1 of 1215
	3774	A claim may appea r multiple times if transmitte d more tha n once.
	3775	T = Tes t Claim R = Batch Rejected
	3776	>>># of Cl aims Selec ted: 0 (ma rked with *)
	3777	Claim # Form Type S eq Status Current P ayer
	3778	Batch: 605001118 2 Date La st Transmi tted: Nov 30, 2004
	3779	1 K500XX X UB-0 4 OUTPT P PRNT/ TX AETNA US HEALTHCAR E
	3780	Batch: 605001118 3 Date La st Transmi tted: Nov 30, 2004
	3781	2 K500XX X UB-0 4 OUTPT P PRNT/ TX AETNA US HEALTHCAR E
	3782	Batch: 605001118 4 Date La st Transmi tted: Nov 30, 2004
	3783	3 K500XX X 1500 OUTPT P PRNT/T X AETNA
	3784	Batch: 605001118 5 Date La st Transmi tted: Nov 3 0, 2004
	3785	4 K500XX X 1500 OUTPT S PRNT/T X AETNA Batch: 60 50011186 Date Last Transmitte d: Nov 30, 2004
	3786	5 K500XX X UB-0 4 OUTPT P PRNT/ TX AETNA US HEALTHCAR E
	3787	Batch: 605001118 7 Date La st Transmi tted: Nov 30, 2004
	3788	6 K500XX X 1500 OUTPT P PRNT/T X AETNA US HEALTHCAR E
	3789	+ Enter ?? f or more ac tions >>>
	3790	Claim(s) Select/De select View Claim s Selected
	3791	Batch Se lect/De se lect
	3792	Print Repo rt
	3793	Resubmit Claims
	3794
	3795
	3796
	3797	Exit
	3798	Action: Ne xt Screen/ /
	3799	StepProced ure15At th e Action p rompt, typ e B to sel ect batche s of claim s to resub mit as tes t or ‘C’ t o select c laims.16At the Selec t EDI Tran smission B atch Numbe r: prompt, enter the number of the desir ed batch.Y ou may rep eat the ab ove, enter ing as man y batch nu mbers as y ou want.PR EVIOUSLY T RANSMITTED CLAIMS Ma r 21, 2005 @16:07:38 P age: 1 of 1215
	3800	A claim may appea r multiple times if transmitte d more tha n once.
	3801	>>># of Cl aims Selec ted: 1 (ma rked with *)
	3802	Claim # Form Type S eq Status Current P ayer
	3803	Batch: 605001118 2 Date La st Transmi tted: Nov 30, 2004
	3804	1 *K500YR J UB-0 4 OUTPT P PRNT/ TX UNITED H EALTHCARE
	3805	Batch: 605001118 3 Date La st Transmi tted: Nov 30, 2004
	3806	2 K50092 T UB-0 4 OUTPT P REQUE ST MRA MEDICARE (WNR)
	3807	Batch: 605001118 4 Date La st Transmi tted: Nov 30, 2004
	3808	3 K500YS F 1500 OUTPT P PRNT/T X UNITED HE ALTHCARE
	3809	Batch: 605001118 5 Date La st Transmi tted: Nov 30, 2004
	3810	4 K500YS Z 1500 OUTPT S PRNT/T X SOUTHWEST ADMINISTR ATORS
	3811	Batch: 605001118 6 Date La st Transmi tted: Nov 30, 2004
	3812	5 K500YU D UB-0 4 OUTPT P PRNT/ TX AETNA US HEALTHCAR E
	3813	Batch: 605001118 7 Date La st Transmi tted: Nov 30, 2004
	3814	6 K500YU E 1500 OUTPT P PRNT/T X AETNA US HEALTHCARE
	3815	+ Enter ?? f or more ac tions >>>
	3816	Claim(s) Select/De select View Cla ims Select ed
	3817	Batch Se lect/Desel ect Print Re port
	3818	Resubmit Claims as TEST Exit
	3819	Action: Ne xt Screen/ / b Bat ch Select/ De select
	3820	Select EDI TRANSMISS ION BATCH NUMBER: 60 50011183
	3821	StepProced ure17When you have e ntered all of the ba tches you want, at t he ACTION prompt, ty pe ‘R’ for Resubmit Claims.18A t the Resu bmit Claim s: prompt, press the <Enter> k ey to resu bmit the c laims for payment.Th e system w ill inform you of th e number o f claims t hat will b e resubmit ted and wh ether or n ot they ar e being su bmitted fo r payment or testing .19At the Are You Su re You Wan t To Conti nue?: prom pt, type Y ES to over ride the d efault.You are about to resubm it 2 claim s as Produ ction clai ms.
	3822	Are you su re you wan t to conti nue?: NO// y YES
	3823	Resubmissi on in proc ess...
	3824	Processing of Second ary/Tertia ry Claims
	3825	With Patch IB2432 installed, the proce dures for the proces sing of se condary an d tertiary non-MRA c laims have changed.
	3826	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.
	3827	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.
	3828	Patch IB2 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 IB2.0432 and the i ntroductio n of the n ew CBW (CO B Manageme nt Work li st).
	3829	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.
	3830	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 :
	3831	All Explan ation of B enefit (EO Bs), 835 H ealth Care Claim Pay ment Advic e, have be en receive d ; and
	3832	Payment fr om the pre vious paye r has been posted by AR; and
	3833	The bill s tatus for the previo us payer i s Collecte d/Closed.
	3834	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.
	3835	Note: Seco ndary and Tertiary c laims will be create d with a n ew claim n umber.Reme mber: Whe ther or no t a Second ary or Ter tiary clai m to an el ectronic p ayer is tr ansmitted or printed , is deter mined by t he new par ameter in the Insura nce Compan y Editor. Refer to Section 2. 1.1.1.Crit eria for t he Automat ic Process ing of Sec ondary or Tertiary C laims
	3836	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:
	3837	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
	3838	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
	3839	The sum of the deduc tible, coi nsurance a nd co-paym ent amount s is great er than $0 .00; and
	3840	The EOB st atus is Pr ocessed (T he Claim S tatus Code is either 1, 2, or 3).
	3841	COB Manage ment Workl ist
	3842	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.
	3843	StepProced ure1Access the EDI M enu For El ectronic B ills menu. 2At the Se lect EDI M enu For El ectronic B ills Optio n: prompt, enter CBW for COB M anagement Worklist.N ote: Patch IB2516 provided t he ability for users to run th e worklist by one or more divi sions.3At the Select Division: ALL// pro mpt; press the <Ente r> key to accept the default.4 At the Sel ect BILLER : ALL// pr ompt, pres s the <Ent er> key to accept th e default. 5At the So rt By: BIL LER// prom pt, press the <Enter > key to a ccept the default.6A t the Do y ou want to include D enied EOBs for Dupli cate Claim /Service? No// promp t, press t he <Enter> key to ac cept the d efault.Not e: A non-M RA claim w hich recei ves a DENI ED EOB and which is Collected/ Closed by AR and whi ch has a s ubsequent payer, wil l also be placed on the CBW. This inclu des claims that have potential patient r esponsibil ity such a s TRICARE and CHAMPV A.Note: Pa tch IB25 47 provide s addition al search and sort c riteria fo r this wor klist. Use rs can cre ate a list of just p rimary cla ims or jus t secondar y claims o r both and they can now sort b y primary or seconda ry insuran ce company .Note: Com plete CARC /RARC text ual descri ptions wil l display from Print or View a n EOB from within th e COB Mana gement Wor klist.The following screen wil l display.
	3844	COB Manage ment WorkL ist JAN 01, 20 11@13:41:1 6 Page: 1 of 20
	3845	Bill # Svc Date Pati ent Name SSN Pt Resp Bill Amt Care/Form
	3846	BILLER: IB ,CLERK 1
	3847	1 442-K4 01XXX* 12/ 07/10 IB,P ATIENT 27 XXXX 0.00 87.58 OP/1500
	3848	Insu rers: AET NA US HEAL THCARE
	3849	EOB St atus: DEN IED, Feb 2 5, 2004
	3850	2 442-K4 01XXX* 12/ 07/10 IB,P ATIENT 4 XXXX 86.40 72.00 OP/UB-04
	3851	Insu rers: AET NA US HEAL THCARE
	3852	EOB St atus: DEN IED, Jun 0 9, 2004
	3853	3 442-K4 01XXX 12/ 08/10 IB,P ATIENT 33 XXXX 0.00 243.16 OP/UB-04
	3854	Insu rers: AET NA US HEAL THCARE
	3855	EOB St atus: DEN IED, Jul 2 8, 2004
	3856	4 442-K4 01XXX 12/ 08/10 IB,P ATIENT 102 XXXX 0.00 45.61 OP/1500
	3857	Insu rers: AET NA US HEAL THCARE
	3858	EOB St atus: DEN IED, Jun 0 9, 2004
	3859	5 442-K4 02XXX 12/ 14/10 IB,P ATIENT 10 XXXX 0.00 30.74 OP/1500
	3860	Insu rers: AET NA US HEAL THCARE
	3861	+ Enter ?? f or more ac tions
	3862	PC Proces s COB CB Cancel Bil l RM Remo ve from Wo rklist
	3863	VE View a n EOB CR Correct Bi ll PE Prin t EOB/MRA
	3864	EC Enter/ View Comme nts CC Cancel/Clo ne A Bill TP Thir d Party Jo int Inq.
	3865	RS Review Status VB View Bill EX Exit
	3866	Select Act ion: Next Screen//
	3867	Data Displ ayed for C laims on t he COB Man agement Wo rklist
	3868	The follow ing data i s displaye d on the C OB Managem ent Workli st:
	3869	List numbe r
	3870	Claim numb er
	3871	Asterisk – when clai m is under review
	3872	Claim date
	3873	Patient na me
	3874	Last 4 num bers of pa tient’s SS N
	3875	Patient Re sponsibili ty monetar y amount
	3876	Monetary a mount on t he claim
	3877	Patient st atus, Inpa tient/Outp atient
	3878	Claim form type
	3879	Status of EOB
	3880	Insurance company(s)
	3881	Clerk name – depends on Sort c riteria
	3882	Division(s )
	3883	Days since last tran smission – depends o n Sort cri teria
	3884	Date of EO B - depend s on Sort criteria
	3885	Available COB Manage ment Workl ist Action s
	3886	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:
	3887	PC Proces s COB – Pr ocess a cl aim on the list to t he next pa yer on the bill
	3888	VE View a n EOB – Vi ew the EOB (s) associ ated with a claim on the list
	3889	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
	3890	RS Review Status – Change the review st atus for a claim on the list
	3891	CB Cancel Bill – Ca ncel a bil l that doe s not need to be res ubmitted
	3892	CR Correc t Bill – C orrect a b ill that n eeds to be resubmitt ed
	3893	CC Cancel /Clone A B ill – Clon a bill th at needs t o be resub mitted (lo cked with IB CLON)
	3894	VB View B ill – View the billi ng screens
	3895	RM Remove from Work list – Rem ove claim from workl ist if no need to re submit
	3896	PE Print EOB/MRA – Print asso ciated MRA s or EOB
	3897	TP Third Party Join t Inq. – S elect a cl aim and go directly to it in T PJI
	3898	EX Exit – Exit the worklist a nd return to the EDI Menu
	3899	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.Remembe r: It is possible t hat a tert iary claim on the CO B Manageme nt Worklis t began as an MRA cl aim. The Print EOB/ MRA action will prov ide users with the o ption to p rint both EOBs and M RAs.Reques ts for Add itional Da ta to Supp ort Claims
	3900	Patch IB2 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 IB2547 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.
	3901	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.
	3902	StepProced ure1Access the EDI M enu For El ectronic B ills menu. 2At the Se lect EDI M enu For El ectronic B ills Optio n: prompt, enter RFI for RFAI Management Worklist3 At the Sel ect Author izing Bill er: ALL// prompt, pr ess the En ter key to accept th e default 4At the Se lect Prima ry Sort: L OINC Code/ / prompt, press the Enter key to accept the defaul t of LOINC The follow ing screen is displa yed:
	3903	RFAI Manag ement Work list A pr 28, 201 5@14:25:12 Page: 1 of 16
	3904	Bill # Payer Name Patien t Name SSN Svc Date Curr Bal
	3905	1 K100X XX MEDICA RE (WNR) IB,PAT IENT 333 XXXX 06/29/09 $43851.78
	3906	55115 -0 - Reque sted imagi ng studies informati on Documen t
	3907	2 K100X XX MEDICA RE (WNR) IB,PAT IENT 22 XXXX 11/05/10 $1226.18
	3908	64286 -8 — Depre cated Diag nostic ima ging order
	3909	3 K100X XX UNITED HEALTHCARE IB,PAT IENT 765 XXXX 11/05/10 $9.65
	3910	55115 -0 — Reque sted imagi ng studies informati on Documen t
	3911	4 K100X XX MEDICA RE (WNR) IB,PAT IENT 22 XXXX 11/05/10 $1226.18
	3912	22034 -3 — Path report.tot al Cancer
	3913	+ * Indicate s RFAI rev iew in pro gress
	3914	Select Message Exit
	3915	ReSort Messages
	3916	Select Act ion: Next Screen//Se lect Messa ge
	3917	Select RFA I Message: (1-4):1
	3918	StepProced ure5At the Select RF AI Message : (1-4) : prompt, en ter 1 to s elect a me ssage to e xpandThe f ollowing s creen is d isplayed:
	3919	RFAI Messa ge Apr 2 8, 2015@14 :43:44 Page : 1 of 2
	3920	Bill # Payer Na me Patient Name SSN S vc Date Curr Bal
	3921	K100XXX IB INSUR ANCE CO IB,PATIE NT 33 XXXX 0 6/29/09 $ 43851.78
	3922	Informatio n Source
	3923	Payer Name : IB INSUR ANCE COMPA NY
	3924	Payer Cont act 1: FAX Number ( There can be up to 3 contact m ethods
	3925	Payer Cont act #: XXX XXX-XXXX
	3926	Payer Cont act 2: Tel ephone
	3927	Payer Cont act #: XXX XXX-XXXX EXT: XXXXX XX
	3928	Payer Resp onse Conta ct 1: ( Th ere can be up to 3 c ontact met hods
	3929	Payer Resp onse Conta ct #: XXX XXX-XXXX
	3930	Payer Resp onse Conta ct 2: Tele phone
	3931	Payer Resp onse Conta ct #: XXX XXX-XXXX E XT: XXXXXX X
	3932	Payer Addr ess: PO BO X XYZ New York, New York 10001
	3933	Payer Clai m Control Number: XX XXXXXXXXXX XXXXXXXXXX XXXXXXXXXX XXXXXXXXXX XXXXXXXX
	3934	Claim Leve l Status I nformation
	3935	Patient Co ntrol #: X XXXXXX ( C laim Numbe r
	3936	Date of Se rvice: XX/ XX/XX
	3937	Medical Re cords Numb er: XXXXXX XX
	3938	Member Ide ntificatio n Number: XXXXXXXXXX
	3939	Type of Se rvice: XXX ( Instit utional On ly Type of Bill
	3940	Health Car e Claim St atus Categ ory: ( The se 3 can r epeat
	3941	Additional Informati on Request Modifier: ( Show L OINC Code Text not j ust code
	3942	Status Inf ormation E ffective D ate: XX/XX /XX
	3943	Response D ue Date: X X/XX/XX
	3944	Service Li ne Informa tion/ Serv ice Line S tatus Info rmation
	3945	Line Item Control Nu mber: XXXX XX
	3946	Service Li ne Date:
	3947	Revenue Co de:
	3948	Coding Met hod: HCPCS
	3949	Procedure Code:XXXXX XX
	3950	Procedure Modifier: ( There ca n be up to 4
	3951	Procedure Modifier:
	3952	Line Item Charge Amo unt: XXXXX XXXXXXXXXX XXX
	3953	Health Car e Claim St atus Categ ory: ( The se 3 can r epeat
	3954	Additional Informati on Request Modifier: ( Show L OINC Code Text not j ust code
	3955	Status Inf ormation E ffective D ate: XX/XX /XX
	3956	Response D ue Date: X X/XX/XX
	3957	+ Enter ?? f or more ac tions
	3958	EC Ente r Comments
	3959	TJ Third P arty Joint Inq.
	3960	RS Revi ew Status
	3961	EX Exit
	3962	RE Remo ve Entry
	3963	Select Act ion: Next Screen// R emove Entr y
	3964	From the R FAI messag e Screen, users can take the f ollowing a ctions:
	3965	Enter comm ents – use r name and date/time will be a utomatical ly capture d
	3966	Change the Review St atus – the entry wit h be marke d by an as terisk
	3967	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
	3968	Jump to th e claim in TPJI – co mments fro m the RFAI Managemen t Worklist will be v iewable fr om within TPJI
	3969	IB Site Pa rameters
	3970	Define Pri nters for Automatica lly Proces sed Second ary/Tertia ry Claims
	3971	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.
	3972	StepProced ure1Access the MCCR System Def inition Me nu.2At the Select MC CR System Definition Menu Opti on: prompt , enter Si te for MCC R Site Par ameter Dis play/Edit. 3At the Se lect Actio n: prompt, Enter IB to access the IB Sit e Paramete rs.MCCR Si te Paramet ers Feb 01, 2011@15:0 4:47 Page: 1 of 1
	3973	Display/Ed it MCCR Si te Paramet ers.
	3974	Only autho rized pers ons may ed it this da ta.
	3975	IB Site P arameters Claims Tracking P arameters
	3976	Facili ty Definit ion Gene ral Parame ters
	3977	Mail G roups Trac king Param eters
	3978	Patien t Billing Rand om Samplin g
	3979	Third Party Bill ing
	3980	Provid er Id
	3981	EDI Tr ansmission
	3982	Third Par ty Auto Bi lling Para meters Insuran ce Verific ation
	3983	Genera l Paramete rs Gene ral Parame ters
	3984	Inpati ent Admiss ion Batc h Extracts Parameter s
	3985	Outpat ient Visit Serv ice Type C odes
	3986	Prescr iption Ref ill
	3987	Enter ?? f or more ac tions
	3988	IB Site P arameter AB Automated Billing EX Exit
	3989	CT Claims Tracking IV Ins. Verif ication
	3990	Select Act ion: Quit/ / IB Site Parameters
	3991	The follow ing screen will disp lay.
	3992	IB Site Pa rameters Feb 01, 20 11@16:22:0 2 Page: 1 of 5
	3993	Only autho rized pers ons may ed it this da ta.
	3994	[1] Copay Background Error Mg: IB ERROR
	3995	Copay Exemption Mailgroup: IB ERROR
	3996	Use Al erts for E xemption : NO
	3997	[2] Hold M T Bills w/ Ins : YES # of Days Char ges Held: 90
	3998	Suppre ss MT Ins Bulletin : NO
	3999	Means Test Mailg roup : IB MEANS TEST
	4000	Per Di em Start D ate : 11/05/90
	4001	[3] Disapp roval Mail group : MCCR - BU SINESS OFF ICE
	4002	Cancel lation Mai lgroup : UB-82 CAN CELL
	4003	Cancel lation Rem ark : BILL CANC ELLED IN B USINESS OF FICE
	4004	[4] New In surance Ma ilgroup : IB NEW IN SURANCE
	4005	Unbill ed Mailgro up : IB UNBILL ED AMOUNTS
	4006	Auto P rint Unbil led List : NO
	4007	+ Enter ?? f or more ac tions
	4008	EP Edit S et EX Exit
	4009	Select Act ion: Next Screen//
	4010	StepProced ure4At the Select Ac tion: prom pt, press the <Enter > key to a ccept the default of Next Scre en until S ection 7 i s displaye d.IB Site Parameters Feb 01, 2011@16:25 :43 Page: 2 of 5
	4011	Only autho rized pers ons may ed it this da ta.
	4012	+
	4013	[5] Medica l Center : DNS ENNE VAMC Default Di vision : DNS ENNE VAMR
	4014	MAS Se rvice : BUSIN ESS OFFICE Bill ing Superv isor : WAI THE,MOSES
	4015	[6] Initia tor Author ize: YES Xfer Proc to S ched : YES
	4016	Ask HI NQ in MCCR : YES Use Non-PTF Co des : YES
	4017	Multip le Form Ty pes: YES Use OP CPT scr een : YES
	4018	[7] UB-04 Print IDs : YES UB-0 4 Address Col :
	4019	CMS-15 00 Print I Ds : YES CMS- 1500 Addr Col : 40
	4020	CMS-15 00 Auto Pr ter: RM340 UB-0 4 Auto Prt er : RM3 40
	4021	EOB Au to Prter : RM340 MRA Auto Prter : RM3 40
	4022	[8] Defaul t RX DX Cd : V68.1 Defa ult ASC Re v Cd : 490
	4023	Defaul t RX CPT C d : J8499 Defa ult RX Rev Cd : 250
	4024	[9] Bill S igner Name : <No l onger used > Fede ral Tax # : 83- 0168494
	4025	Bill S igner Titl e : <No l onger used >
	4026	+ Enter ?? f or more ac tions
	4027	EP Edit S et EX Exit
	4028	Select Act ion: Next Screen//
	4029	StepProced ure5At the Select Ac tion: prom pt, enter EP=7.6 At the CMS-15 00 Auto Pr inter: pro mpt, enter the name of the pri nter to wh ich CMS se condary or tertiary claims wil l print.7A t the UB04 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.8At the EOB Au to Printer : prompt, enter the name of th e printer to which C MS seconda ry or tert iary claim s will pri nt.9At the MRA Auto Printer: p rompt, ent er the nam e of the p rinter to which CMS secondary or tertiar y claims w ill print. 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.Remem ber: The M RA is a 13 2 column p rintout.UB -04 PRINT LEGACY ID: YES//
	4030	CMS-1500 P RINT LEGAC Y ID: YES/ /
	4031	UB-04 ADDR ESS COLUMN :
	4032	CMS-1500 A DDRESS COL UMN: 40//
	4033	CMS-1500 A uto Printe r:
	4034	UB-04 Auto Printer:
	4035	EOB Auto P rinter:
	4036	MRA Auto P rinter:
	4037	Enable Aut omatic Pro cessing of Secondary /Tertiary Claims
	4038	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.
	4039	StepProced ure1Access the MCCR System Def inition Me nu.2At the Select MC CR System Definition Menu Opti on: prompt , enter Si te for MCC R Site Par ameter Dis play/Edit. 3At the Se lect Actio n: prompt, Enter IB to access the IB Sit e Paramete rs.MCCR Si te Paramet ers Feb 01, 2011@15:0 4:47 Page: 1 of 1
	4040	Display/Ed it MCCR Si te Paramet ers.
	4041	Only autho rized pers ons may ed it this da ta.
	4042	IB Site P arameters Claims Tracking P arameters
	4043	Facili ty Definit ion Gene ral Parame ters
	4044	Mail G roups Trac king Param eters
	4045	Patien t Billing Rand om Samplin g
	4046	Third Party Bill ing
	4047	Provid er Id
	4048	EDI Tr ansmission
	4049	Third Par ty Auto Bi lling Para meters Insuran ce Verific ation
	4050	Genera l Paramete rs Gene ral Parame ters
	4051	Inpati ent Admiss ion Batc h Extracts Parameter s
	4052	Outpat ient Visit Serv ice Type C odes
	4053	Prescr iption Ref ill
	4054	Enter ?? f or more ac tions
	4055	IB Site P arameter AB Automated Billing EX Exit
	4056	CT Claims Tracking IV Ins. Verif ication
	4057	Select Act ion: Quit/ / IB Site Parameters
	4058	The follow ing screen will disp lay.
	4059	IB Site Pa rameters Feb 01, 20 11@16:22:0 2 Page: 1 of 5
	4060	Only autho rized pers ons may ed it this da ta.
	4061	[1] Copay Background Error Mg: IB ERROR
	4062	Copay Exemption Mailgroup: IB ERROR
	4063	Use Al erts for E xemption : NO
	4064	[2] Hold M T Bills w/ Ins : YES # of Days Char ges Held: 90
	4065	Suppre ss MT Ins Bulletin : NO
	4066	Means Test Mailg roup : IB MEANS TEST
	4067	Per Di em Start D ate : 11/05/90
	4068	[3] Disapp roval Mail group : MCCR - BU SINESS OFF ICE
	4069	Cancel lation Mai lgroup : UB-82 CAN CELL
	4070	Cancel lation Rem ark : BILL CANC ELLED IN B USINESS OF FICE
	4071	[4] New In surance Ma ilgroup : IB NEW IN SURANCE
	4072	Unbill ed Mailgro up : IB UNBILL ED AMOUNTS
	4073	Auto P rint Unbil led List : NO
	4074	+ Enter ?? f or more ac tions
	4075	EP Edit S et EX Exit
	4076	Select Act ion: Next Screen//
	4077	StepProced ure4At the Select Ac tion: prom pt, press the <Enter > key to a ccept the default of Next Scre en until S ection 14 is display ed.IB Site Parameter s Sep 16, 2011@14:3 2:21 Page: 3 of 5
	4078	Only autho rized pers ons may ed it this da ta.
	4079	+
	4080	[10]Pay-To Providers : 1 define d, default - DNS ENNE TEST1 VAMC
	4081	[11]Inpt H ealth Summ ary: INPAT IENT HEALT H SUMMARY
	4082	Opt He alth Summa ry : OUTPA TIENT HEAL TH SUMMARY
	4083	[12]HIPPA NCPDP Acti ve Flag : N ot Active
	4084	Drug N on Covered Recheck P eriod : 0 days(s)
	4085	Non Co vered Reje ct Codes
	4086	: 7 0 Product/ Service No t Covered
	4087	[13]Inpati ent TP Act ive : YES
	4088	Outpat ient TP Ac tive: YES
	4089	Pharma cy TP Acti ve : YES
	4090	Prosth etic TP Ac tive: YES
	4091	[14] EDI/M RA Activat ed : B OTH EDI AN D MRA
	4092	+ Enter ?? f or more ac tions
	4093	EP Edit S et EX Exit
	4094	Select Act ion: Next Screen//
	4095	StepProced ure5At the Select Ac tion: prom pt, enter EP=14.6 Th e Enable A uto Reg EO B Processi ng?: promp t will be set to YES .This para meter shou ld not be changed un less there is a comp elling rea son to sto p the auto matic proc essing of secondary/ tertiary c laims.Sele ct Action: Next Scre en// ep=14 Edit Se t
	4096	SITE CONTA CT PHONE N UMBER: 307 -778-7581/ /
	4097	LIVE TRANS MIT 837 QU EUE: MCT//
	4098	TEST TRANS MIT 837 QU EUE: MCT//
	4099	AUTO TRANS MIT BILL F REQUENCY: 1//
	4100	HOURS TO T RANSMIT BI LLS: 1130; 1500;1700/ /
	4101	MAX # BILL S IN A BAT CH: 10//
	4102	ONLY 1 INS CO PER CL AIM BATCH: YES//
	4103	DAYS TO WA IT TO PURG E MSGS: 15 //
	4104	Allow MRA Processing ?: YES//
	4105	Enable Aut omatic MRA Processin g?: YES//
	4106	Enable Aut o Reg EOB Processing ?: YES//
	4107	Printed Cl aims Rev C ode Excl: 17 Activat ed Codes D efined
	4108	Patch IB2 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 :
	4109	270-279
	4110	290-299
	4111	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.
	4112	IB Site Pa rameters Nov 03, 20 15@10:43:2 0 Page: 2 of 5
	4113	Only autho rized pers ons may ed it this da ta.
	4114	+
	4115	[5] Medica l Center : DNS ENNE VAMC Default Di vision : DNS ENNE VAMR
	4116	MAS Se rvice : BUSIN ESS OFFICE Bill ing Superv isor : WAI THE,MOSES
	4117	[6] Initia tor Author ize: YES Xfer Proc to S ched : YES
	4118	Ask HI NQ in MCCR : YES Use Non-PTF Co des : YES
	4119	Multip le Form Ty pes: YES Use OP CPT scr een : YES
	4120	[7] UB-04 Print IDs : YES UB-0 4 Address Col :
	4121	CMS-15 00 Print I Ds : YES CMS- 1500 Addr Col : 40
	4122	CMS-15 00 Auto Pr ter: UB-0 4 Auto Prt er :
	4123	EOB Au to Prter : MRA Auto Prter :
	4124	[8] Printe d Claims R ev Code Ex cl: 17 Act ivated Cod es Defined
	4125	[9] Defaul t RX DX Cd : Z76.0 (ICD-10) Defa ult ASC Re v Cd : 490
	4126	Defaul t RX CPT C d : J8499 Defa ult RX Rev Cd : 250
	4127	+ Enter ?? f or more ac tions
	4128	EP Edit S et EX Exit
	4129	Select Act ion: Next Screen//
	4130	Excluded R evenue Cod es Nov 03, 20 15@11:05:0 6 Page: 1 of 1
	4131	# R CD DESC RIPTION
	4132	1. 2 70 MED- SUR SUPPLI ES
	4133	2. 2 71 NON- STER SUPPL Y
	4134	3. 2 72 STER ILE SUPPLY
	4135	4. 2 73 TAKE HOME SUPPL Y
	4136	5. 2 74 PROS TH/ORTH DE V
	4137	6. 2 75 PACE MAKER
	4138	7. 2 76 INTR A OC LENS
	4139	8. 2 77 O2/T AKEHOME
	4140	9. 2 78 SUPP LY/IMPLANT S
	4141	10. 2 79 SUPP LY/OTHER
	4142	11. 2 90 MED EQUIP/DURA B
	4143	12. 2 91 MED EQUIP/RENT
	4144	13. 2 92 MED EQUIP/NEW
	4145	14. 2 93 MED EQUIP/USED
	4146	15. 2 94 MED EQUIP/SUPP LIES/DRUGS
	4147	16. 2 99 MED EQUIP/OTHE R
	4148	Enter ?? f or more ac tions
	4149	AC Add Re venue Code DC Delete Rev enue Code EX Exit
	4150	Select Ite m(s): Quit // ac Ad d Revenue Code
	4151	Revenue Co de: 118 REHAB/ PVT RE HABILITATI ON
	4152	Revenue Co de:
	4153	StepProced ure1Access the MCCR System Def inition Me nu.2At the Select MC CR System Definition Menu Opti on: prompt , enter Si te for MCC R Site Par ameter Dis play/Edit. 3At the Se lect Actio n: prompt, Enter IB to access the IB Sit e Paramete rs.4At the Select Ac tion: Next Screen// prompt, en ter EP=8 t o access E xcluded Re venue Code s5At the S elect Item (s): Quit/ / prompt, enter AC f or Add Rev enue Code6 At the Rev enue Code: prompt, e nter a Rev enue Code number7 At the Reven ue Code: p rompt, pre ss the Ent er key whe n done add ing codesA lternate P rimary Pay er ID Type s
	4154	Patch IB2 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.
	4155	IB Site Pa rameters Nov 03, 20 15@11:21:3 2 Page: 4 of 5
	4156	Only autho rized pers ons may ed it this da ta.
	4157	+
	4158	[16] EDI/M RA Activat ed : B OTH EDI AN D MRA
	4159	EDI C ontact Pho ne : ( 307)778-75 81
	4160	EDI 8 37 Live Tr ansmit Que ue : M CT
	4161	EDI 8 37 Test Tr ansmit Que ue : M CT
	4162	Auto- Txmt Bill Frequency : E very Day
	4163	Hours To Auto-T ransmit : 1 130;1500;1 700
	4164	Max # Bills Per Batch : 1 0
	4165	Only Allow 1 In s Co/Claim Batch?: N O
	4166	Last Auto-Txmt Run Date : 0 3/08/11
	4167	Days To Wait To Purge Msg s : 1 5
	4168	Allow MRA Proce ssing? : Y ES
	4169	Enabl e Automati c MRA Proc essing?: Y ES
	4170	Enabl e Auto Reg EOB Proce ssing? : Y ES
	4171	[17]Alt Pr im Payer I D Typ-Medi care: 2 de fined
	4172	[18]Alt Pr im Payer I D Typ-Comm ercial: 2 defined
	4173	+ Enter ?? f or more ac tions
	4174	EP Edit S et EX Exit
	4175	Select Act ion: Next Screen//
	4176	StepProced ure1Access the MCCR System Def inition Me nu.2At the Select MC CR System Definition Menu Opti on: prompt , enter Si te for MCC R Site Par ameter Dis play/Edit. 3At the Se lect Actio n: prompt, Enter IB to access the IB Sit e Paramete rs.4At the Select Ac tion: Next Screen// prompt, en ter EP=17 to access Alt Prim P ayer Typ-M edicare5At the Selec t Item(s): Quit// pr ompt, ente r AT for A dd ID Type 6At the En ter a Prim ary ID Typ e: prompt, enter a F ree Text I D Type7 At the Are y ou adding 'HOSPICE' as a new I B ALTERNAT E PRIMARY ID TYPES ( the 2nd)? No// promp t, enter Y ES8At the Enter a Pr imary ID T ype: promp t, press t he Enter k ey when do ne adding typesAlt P rimary Pay er ID Type s Nov 0 3, 2015@11 :32:18 Page : 1 of 1
	4177	1 DME
	4178	Enter ?? f or more ac tions
	4179	AT Add ID Type DT Delete ID Type EX Exit
	4180	Select Act ion: Quit/ /AT Add ID Type
	4181	Enter a Pr imary ID T ype: HOSPI CE
	4182	Are you adding 'HO SPICE' as
	4183	a new IB ALTERNA TE PRIMARY ID TYPES (the 4TH)? No// y
	4184	ASC X12N H ealth Care Claim Req uest for A dditional Informatio n (277RFAI )
	4185	Patch IB2 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:
	4186	Days to st ore 277RFA I Transact ions
	4187	Days to wa it to purg e entry on RFAI Mana gement Wor klist
	4188	IB Site Pa rameters Nov 03, 20 15@12:33:3 4 Page: 5 of 5
	4189	Only autho rized pers ons may ed it this da ta.
	4190	+
	4191	[19]Are we using Cla imsManager ? : NO
	4192	Is Cla imsManager working O K? : NO
	4193	ClaimsMana ger TCP/IP Address : IP
	4194	Claims Manager TC P/IP Ports : 10040
	4195	10050
	4196	10060
	4197	10070
	4198	10080
	4199	Genera l Error Ma ilGroup : IBCI GENERAL ER ROR
	4200	Commun ication Er ror MailGr oup: IBCI COMMUNICAT ION ERROR
	4201	MailMa n Messages : PRIOR ITY
	4202	[20]Days t o store 27 7RFAI Tran sactions: No Purge
	4203	Days t o wait to purge entr y on RFAI Management Worklist: 20
	4204	Enter ?? f or more ac tions
	4205	EP Edit S et EX Exit
	4206	Select Act ion: Quit/ / ep=20 Edit Set
	4207	PURGE DAYS 277 RFAI: ??
	4208	En ter the nu mber of da ys (betwee n 365 and 3000) to
	4209	re tain 277 R FAI transa ctions in VistA.
	4210	A null entry (the defa ult) indic ates the t ransaction s
	4211	wi ll be stor ed forever .
	4212	PURGE DAYS 277 RFAI:
	4213	WORKLIST P URGE DAYS 277 RFAI: 20//
	4214	StepProced ure1Access the MCCR System Def inition Me nu.2At the Select MC CR System Definition Menu Opti on: prompt , enter Si te for MCC R Site Par ameter Dis play/Edit. 3At the Se lect Actio n: prompt, Enter IB to access the IB Sit e Paramete rs.4At the Select Ac tion: Quit // prompt, enter EP= 20 to acce ss the 277 RFAI param eters5At t he PURGE D AYS 277 RF AI: prompt , press th e Enter ke y to accep t the defa ult6At the WORKLIST PURGE DAYS 277 RFAI: prompt, e nter a Num ber that r epresents the number of days a 277 RFAI entry will remain on the RFAI Worklist b efore bein g automati cally remo vedReports
	4215	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.
	4216	EDI Report s – Overvi ew
	4217	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.
	4218
	4219
	4220
	4221
	4222	BAR Bills Need ing Resubm ission Act ion
	4223	ECS EDI Claim Status Rep ort
	4224	MP EDI Messa ges Not Ye t Filed
	4225	PBT Pending Ba tch Transm ission Sta tus Report
	4226	PND EDI Batche s Pending Receipt
	4227	REX Ready for Extract St atus Repor t
	4228	VPE View/Print EDI Bill Extract Da ta
	4229	Most Frequ ently Used Menus/Rep orts
	4230	Claims Sta tus Awaiti ng Resolut ion – Syno nym CSA
	4231	What is th e purpose of this re port?
	4232	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.
	4233	When is th is option used?
	4234	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).
	4235	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:
	4236	A
	4237	Authorizin g Biller
	4238	B
	4239	Bill Numbe r
	4240	C
	4241	Current Ba lance
	4242	S
	4243	Date of Se rvice
	4244	D
	4245	Division
	4246	E
	4247	Error Code Text
	4248	N
	4249	Number of Days Pendi ng
	4250	M
	4251	Patient Na me
	4252	P
	4253	Payer
	4254
	4255	R
	4256	Review in Process
	4257	L
	4258	SSN Last 4
	4259	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.
	4260	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.
	4261	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.
	4262	With Patch IB2.032 0, changes were made to suppre ss the dis play of 2Q Claim Sta tus Messag es and dup licate cla im status messages.A s messages are revie wed they c an be mark ed as foll ows:
	4263	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
	4264	Review in Process – While a cl aim is bei ng reworke d, the sta tus can be changed t o “Review in Process ”
	4265	Review Com plete – Th e error ha s been res olved and the messag e from thi s report w ill be cle ared
	4266	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.
	4267	Other opti ons availa ble on the CSA inclu de:
	4268	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.
	4269	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.
	4270	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.
	4271	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.
	4272	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.
	4273	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.
	4274	Note: Afte r Patch IB 2547 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.Mu ltiple CSA Message M anagement – Synonym: MCS
	4275	What is th e purpose of this op tion?
	4276	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.
	4277	This optio n is locke d by the I B Message Management security key.When i s this opt ion used?
	4278	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.
	4279	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.
	4280	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.Once the initial l ist has be en built, users may further re fine their search or work from the defau lt list.
	4281	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.Other ac tions avai lable on t he MCS inc lude:
	4282	Message Se arch – All ows the us er to chan ge the cri teria upon which the list of c laims will be built
	4283	Change Rev iew Status – Same as CSA
	4284	Cancel Cla ims – Same as CSA
	4285	Enter Comm ent – Same as CSA
	4286	Resubmit b y Print – Same as CS A
	4287	Retransmit Bill – Sa me as CSA
	4288	Select/Des elect Clai ms – Allow s users to select th e claims t o which th ey want to apply an action
	4289	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.E lectronic Report Dis position
	4290	What is th e purpose of this op tion?
	4291	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.
	4292	When is th is option used?
	4293	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.
	4294	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. The following reports s hould be r eviewed wh en they ar e received . They con tain infor mation tha t cannot b e translat ed into cl aim status messages therefore, this info rmation is not avail able in CS A.
	4295	R000
	4296	NETWORK NE WS
	4297	Provides n ews on sys tem proble ms, update s and othe r pertinen t informat ion.
	4298	RPT-02 F ILE STATUS REPORT
	4299	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.
	4300	RPT-03 F ILE SUMMAR Y REPORT
	4301	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.
	4302	RPT-08 P ROVIDER MO NTHLY SUMM ARY
	4303	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.
	4304	The follow ing report s contain informatio n that is also trans lated into status me ssages and displayed on CSA.
	4305	RPT-04 F ILE DETAIL SUMMARY R EPORT
	4306	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.
	4307	RPT-04A AMENDED FI LE DETAIL SUMMARY RE PORT
	4308	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.
	4309	RPT-05 B ATCH & CLA IM LEVEL R EJECTION R EPORT
	4310	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.
	4311	RPT-05A AMENDED BA TCH & CLAI M LEVEL RE JECTION RE PORT
	4312	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.
	4313	RPT-10 P ROVIDER CL AIM STATUS
	4314	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.
	4315	RPT-11 S PECIAL HAN DLING/UNPR OCESSED CL AIMS REPOR T
	4316	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 .
	4317	EDI Cl aim Status Report- S ynonym: EC S
	4318	What is th e purpose of this re port?
	4319	View elect ronic tran smission s tatus to a ssure clai ms move th rough the system in a timely f ashion.
	4320	When is th is option used?
	4321	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.
	4322	Reports ca n be creat ed based o n:
	4323	Specific C laim or Se arch Crite ria
	4324	Division
	4325	Payer
	4326	Transmissi on Date ra nge
	4327	EDI Status
	4328	Reports ca n be sorte d by:
	4329	Transmissi on Date
	4330	Payer
	4331	EDI Status
	4332	Current Ba lance
	4333	Division
	4334	Claim Numb er
	4335	AR Status
	4336	Age
	4337	Possible E DI claim s tatuses in clude:
	4338	Ready for Extract
	4339	Pending Au stin Recei pt
	4340	Accepted b y Non-Paye r
	4341	Accepted P ayer
	4342	Error Cond ition
	4343	Cancelled
	4344	Corrected/ Retransmit ted
	4345	Closed
	4346	Additional Reports a nd Options
	4347	Ready for Extract St atus Repor t - Synony m: REX
	4348	What is th e purpose of this re port?
	4349	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.
	4350	When is th is option used?
	4351	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.
	4352	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.
	4353	Choices to view are:
	4354	1
	4355	All bills in Ready f or Extract status
	4356	2
	4357	Bills trap ped due to EDI param eter being turned of f
	4358	(If EDI is on, no bi lls will b e trapped in extract )
	4359	Transmit E DI Bills – Manual - Synonym: S END
	4360	What is th e purpose of this op tion?
	4361	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.
	4362	When is th is option used?
	4363	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.
	4364	Select one of the fo llowing:
	4365	A
	4366	Transmit ( A)LL bills in READY FOR EXTRAC T status
	4367	S
	4368	Transmit o nly (S)ELE CTED bills
	4369	EDI Return Message M anagement Menu – Syn onym: MM
	4370	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.
	4371	EDI Messag e Text to Screen Mai ntenance
	4372	What is th e purpose of this op tion?
	4373	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.
	4374	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.
	4375	When is th is option used?
	4376	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.
	4377	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.
	4378	EDI Messag es Not Rev iewed Repo rt
	4379	What is th e purpose of this re port?
	4380	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 .
	4381	When is th is option used?
	4382	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.
	4383	Electronic Error Rep ort
	4384	What is th e purpose of this re port?
	4385	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.
	4386	When is th is option used?
	4387	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:
	4388	A
	4389	AUTHORIZIN G BILLER
	4390	B
	4391	BILLED AMO UNT
	4392	E
	4393	EPISODE OF CARE
	4394	P
	4395	PATIENT NA ME
	4396	S
	4397	PATIENT SS N
	4398	Y
	4399	PAYER NAME
	4400	C
	4401	ERROR CODE
	4402	Return Mes sages Fili ng Excepti ons
	4403	What is th e purpose of this op tion?
	4404	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.
	4405	When is th is option used?
	4406	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.
	4407	There are two (2) st atuses for messages in this fi le.
	4408	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.
	4409	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.
	4410	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.
	4411	There are two (2) ac tions avai lable to g et these m essages ou t of the f ile.
	4412	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.
	4413	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.
	4414	Status Mes sage Manag ement
	4415	What is th e purpose of this op tion?
	4416	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.
	4417	When is th is option used?
	4418	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.
	4419	This repor t can be s orted by:
	4420	A
	4421	ALL STATUS MESSAGES
	4422	S
	4423	SELECTED S TATUS MESS AGES
	4424	Selected s tatus mess age report s can be r un showing :
	4425	A
	4426	Auto Filed /No Review Only
	4427	B
	4428	Bill Numbe r
	4429	S
	4430	Message Se verity
	4431	T
	4432	Specific M essage Tex t
	4433	Bills Awai ting Resub mission – Synonym: B AR
	4434	What is th e purpose of this re port?
	4435	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.
	4436	When is th is option used?
	4437	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 :
	4438	B
	4439	BILL NUMBE R
	4440	L
	4441	LAST SENT DATE
	4442	A
	4443	BILLED AMO UNT
	4444	N
	4445	BATCH NUMB ER (LAST S ENT IN)
	4446	The report also indi cates the “Bill Tran smission S tatus”.
	4447	EDI Messag es Not Yet Filed –Sy nonym: MP
	4448	What is th e purpose of this re port?
	4449	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.
	4450	When is th is option used?
	4451	This is a status rep ort that a llows for review of messages n ot yet fil ed.
	4452	Pending Ba tch Transm ission Sta tus Report – Synonym : PBT
	4453	What is th e purpose of this re port?
	4454	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.
	4455	When is th is option used?
	4456	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.
	4457	EDI Batche s Pending Receipt– S ynonym: PN D
	4458	What is th e purpose of this re port?
	4459	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.
	4460	The report includes:
	4461	Batch Numb er
	4462	Transmissi on Date
	4463	Mail Messa ge #
	4464	Claims dis play the f ollowing:
	4465	Claim Numb er
	4466	Payer Sequ ence
	4467	Balance Du e
	4468	EDI Status
	4469	IB Status
	4470	AR Status
	4471	EDI Batche s Pending Austin Rec eipt After 1 Day Page: 2
	4472	Run Date: 01/07/2008 @14:44:28
	4473	Batch # Tran smission D ate Mail Mes sage #
	4474	--------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	4475	Claim Seq Bal Due EDI Stat IB Stat us AR Status
	4476	K600K QD P 198.54 P PRNT/TX NEW BILL
	4477	K600N EU P 76.36 P PRNT/TX NEW BILL
	4478	K600Q R2 P 305.11 P PRNT/TX NEW BILL
	4479	K600W S7 P 76.36 P PRNT/TX NEW BILL
	4480	K600W SF P 880.71 P PRNT/TX NEW BILL
	4481	44200295 90 03/2 9/2006@21: 05:33 1321
	4482	Claim Seq Bal Due EDI Stat IB Stat us AR Status
	4483	K600F N7 P 76.36 P REQUEST MRA BIL L INCOMPLE TE
	4484	K600I PF P 73.01 P REQUEST MRA BIL L INCOMPLE TE
	4485	K600W SA P 4390.06 P REQUEST MRA BIL L INCOMPLE TE
	4486	K600W SK P 73.01 P REQUEST MRA BIL L INCOMPLE TE
	4487	Enter ENTE R to conti nue or '^' to exit:
	4488	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.Su bj: EDI BA TCHES WAIT ING AUSTIN RECEIPT F OR OVER 1 DAY [#213 87]
	4489	06/19/04@1 9:02 6 li nes
	4490	From: XXXX XXXXXXX,XX XX X In ' IN' basket . Page 1 New
	4491	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	4492	There are 30 EDI bat ch(es) sti ll pending Austin re ceipt
	4493	for more t han 1 day. Please i nvestigate why they have not y et been co nfirmed
	4494	as being r eceived by Austin.
	4495	Since ther e were mor e than 10 batches fo und, pleas e run the
	4496	EDI BATC HES WAITIN G FOR AUST IN RECEIPT OVER 1-DA Y report t o get a li st of the
	4497	se batches .
	4498	Enter mess age action (in IN ba sket): Del ete//
	4499	When is th is option used?
	4500	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 .
	4501	Contact IR M for assi stance in finding ou t why a co nfirmation message h as not bee n received from Aust in.Before contacting IRM, note the Messa ge Numbers for the b atches tha t you need investiga ted. These numbers c an be foun d in the P ND option. 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.
	4502	View/Print EDI Bill Extract Da ta – Synon ym: VPE
	4503	What is th e purpose of this op tion?
	4504	This optio n displays the EDI e xtract dat a for a bi ll.
	4505	When is th is option used?
	4506	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.
	4507	Insurance Company ED I Paramete r Report – Synonym: EPR
	4508	What is th e purpose of this op tion?
	4509	This optio n will dis play the E DI Paramet ers of the Active In surance Co mpanies de fined in V ista.
	4510	The conten ts of the following parameters will be i ncluded in this repo rt:
	4511	Insurance Company Na me
	4512	Street Add ress and C ity of Ins urance Com pany
	4513	Electronic Transmit?
	4514	Institutio nal Electr onic Bill ID
	4515	Profession al Electro nic Bill I D
	4516	HPID/OEID
	4517	Electronic Type
	4518	Type of Co verage
	4519	Always Use main VAMC as Billin g Provider
	4520	All Compan ies Insuranc e Company EDI Parame ter Report Page: 1
	4521	Sorted By Ins Compan y Name Mar 02, 2015@1 0:30:28
	4522	Only Blank or 'PRNT' Bill ID's = NO
	4523	'*' indica tes the HP ID/OEID fa iled valid ation chec ks
	4524	Electro n Inst P rof HPID/ Electroni c
	4525	Insurance Company Na me Street Address Ci ty Transmi t ID ID OEID Type Covera ge Type
	4526	========== ========== ========== ========== ========== ========== ========== ========== ========== =======INS URANCE COM PANY ONE PO BOX 141 159 XXX,OH YES-L 8 XXXX 8XXXX 799999999 9 GROUP PL AN HEALTH INS…
	4527	INSURANCE COMPANY TW O PO BOX 30101 XXX ,UT YES-L 699999 9999* OTHE R HEAL TH INS…
	4528	When is th is option used?
	4529	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.
	4530	Test Claim EDI Trans mission Re port – Syn onym: TCS
	4531	What is th e purpose of this op tion?
	4532	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.
	4533	The messag es in this option wi ll be auto matically purged aft er 60 days . When is this optio n used?
	4534	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.
	4535	Test Claim EDI Trans mission Re port Page: 1
	4536	Selected B atches Ma r 22, 2005 @12:14:38
	4537	========== ========== ========== ========== ========== ========== ========== ==========
	4538	Batch#: 6 050011719
	4539	Claim#: K 404XXX
	4540	IB,Patient 7 (15 00, Prof, Outpat)
	4541	---------- ---------- ---------- ---------- ---------- ---------- ---------- ----------
	4542	Transmissi on Informa tion
	4543	03/17/200 5@11:11:25 Bch#1171 9 IB,Cler k2 CIGNA HEALTHCAR E (S)
	4544	Third Part y Joint In quiry – Sy nonym: TPJ I
	4545	What is th e purpose of this op tion?
	4546	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.
	4547	When is th is option used?
	4548	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.
	4549	The follow ing action s are avai lable from TPJI:
	4550
	4551	BC
	4552	Bill Charg es
	4553
	4554	DX
	4555	Bill Diagn osis
	4556
	4557	PR
	4558	Bill Proce dures
	4559
	4560	CB
	4561	Change Bil l
	4562
	4563	ED
	4564	EDI Status
	4565
	4566	AR
	4567	Account Pr ofile
	4568
	4569	CM
	4570	Comment Hi story
	4571
	4572	IR
	4573	Insurance Reviews
	4574
	4575	HS
	4576	Health Sum mary
	4577
	4578	AL
	4579	Active Lis t
	4580
	4581	VI
	4582	Insurance Company
	4583
	4584	VP
	4585	Policy
	4586
	4587	AB
	4588	Annual Ben efits
	4589
	4590	EL
	4591	Patient El igibility
	4592	Patch IB2 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.Not e: Patch I B2516 ch anged the lists of A ctive and Inactive c laims to d isplay the claim typ e of eithe r Institut ional or P rofessiona l in addit ion to Inp atient, In patient Hu manitarian , Outpatie nt, or Out patient Hu manitarian .Note: Pat ch IB251 6 also add ed the abi lity for u sers to vi ew related claims fo r which th e patient is respons ible, when reviewing Claim Inf ormation f or a selec ted claim. Note: Afte r Patch IB 2547 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.No te: After Patch IB2 547 is in stalled, u sers will be able to view the comments t hat were a dded to an entry on the new RF AI Managem ent Workli st in the comment se ction of t he TPJI.No te: After Patch IB2 547 is in stalled, u sers will be able to view the complete a nd current textual d escription associate d with the Claims Ad justment R eason Code s/Remittan ce Advice Remark Cod es (CARC/R ARC) recei ved in an electronic EOB.Patch IB2488 modified t he way mes sage stora ge errors (created w hen an EEO B or MRA i s received and all t he line it ems cannot be matche d correctl y) are dis played in TPJI. Int ernal MUMP S code wil l no longe r be displ ayed to th e users.
	4593	The Follow ing types of errors will be di splayed:
	4594	Procedure Code misma tch
	4595	Procedure Modifier m ismatch
	4596	Revenue Co de mismatc h
	4597	Charge Amo unt mismat ch
	4598	Number of Units mism atch
	4599	Claim Info rmation Nov 25, 20 13@14:56:0 2 Page: 1 of 2
	4600	%K101XXX IB,PATIEN T 123 IXXXX DOB: X X/XX/XX Subsc ID: XXXXXXXXX
	4601	Insuranc e Demograp hics Subscrib er Demogra phics
	4602	Bill P ayer: IB I NSURANCE C O Group N umber: GRP PLN XXXXX
	4603	Claim Add ress: PO B OX XXXXX Group Name: STA TE OF WY
	4604	DNS ENNE, WY 8 20031234 Subscriber ID: XXXXX XXXXX
	4605	Claim P hone: 800/ XXX-XXXX Emp loyer: STA TE OF WYO
	4606	Insured's Name: IB, PATIENT 12 3
	4607	Relatio nship: PAT IENT
	4608	C laim Infor mation
	4609	Bill Typ e: OUTPATI ENT Charge Type: INS TITUTIONAL
	4610	Time Fram e: ADMIT T HRU DISCHA RGE Service Dates: XX/ XX/XX – XX /XX/XX
	4611	Rate Typ e: REIMBUR SABLE INS. Orig Claim: 145.49
	4612	AR Statu s: ACTIVE Balanc e Due: 145.49
	4613	+ \|% EEOB \| Enter ?? f or more ac tions\|
	4614	BC Bill C harges AR Account Pr ofile VI Insu rance Comp any
	4615	DX Bill D iagnosis CM Comment Hi story VP Poli cy
	4616	PR Bill P rocedures IR Insurance Reviews AB Annu al Benefit s
	4617	CB Change Bill HS Health Sum mary EL Pati ent Eligib ility
	4618	ED EDI St atus AL Go to Acti ve List EB Expa nd Benefit s
	4619	RX ECME I nformation EX Exit
	4620	Select Act ion: Next Screen// B C Bill C harges
	4621	DO YOU WAN T ALL EEOB DETAILS?: NO// Y
	4622	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.
	4623	Bill Charg es Apr 14, 20 14@16:27:1 8 Page: 7 of 8
	4624	K101EVT IB,PATIENT MRA I432 1 DOB: 12/0 1/66 Sub sc ID: 011 871234A
	4625	04/10/14 - 04/10/14 AD MIT THRU D ISCHARGE Ori g Amt: 0.0 0
	4626	+
	4627	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- -----
	4628	VistA coul d not matc h all of t he Line Le vel data r eceived in the EEOB
	4629	(835 Recor d 40) to t he claim i n VistA.
	4630	Mismatched Procedure Code:
	4631	Payer repo rted the f ollowing w as billed via the Cl aim (837):
	4632	Proc:7 1010 Mods :59 Rev C d:324 Chg :227.40 U nits:1
	4633	Payer repo rted adjud ication vi a the EOB (835) as f ollows:
	4634	Proc:7 1015 Mods :59 Rev C d:324 Chg :227.40 U nits:1
	4635	Amt:10 0.00
	4636	---------- ---------- ---------- ---------- ---------- ---------- ---------
	4637	Service li ne adjustm ent (EEOB Record 41) has no ma tching ser vice line
	4638	Allowe d Amt: 114 .80 Per D iem Amt: 0 .00
	4639	---------- ---------- ---------- ---------- ---------- ---------- ---------
	4640	Service li ne adjustm ent (EEOB Record 45) has no ma tching ser vice line
	4641	+ \|% EEOB \| Enter ?? f or more ac tions\|
	4642	PR Bill P rocedures CM Comment Hi story AB Annu al Benefit slity
	4643	CI Go to Claim Scre en IR Insurance Reviews EL Pati ent Eligib ility
	4644	HS Health Sum mary EX Exit
	4645	ED EDI St atus AL Go to Acti ve List
	4646	VI Insurance Company
	4647	Select Act ion: Next Screen//
	4648	Re-generat e Unbilled Amounts R eport
	4649	What is th e purpose of this op tion?
	4650	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.
	4651	When is th is option used?
	4652	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.
	4653	Subj: UNBI LLED AMOUN TS SUMMARY REPORT [ #197848] 0 6/23/14@12 :41 34 li nes
	4654	From: INTE GRATED BIL LING PACKA GE In 'IN ' basket. Page 1 New
	4655	---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------
	4656	SUMMARY UN BILLED AMO UNTS FOR DNS ENNE VAMC (442).
	4657	PERIOD: FR OM 09/01/0 4 TO 09/30 /06
	4658	DETAILED R EPORT PRIN TED TO '/d ev/pts/5'
	4659	Inpatient Care:
	4660	Number of Unbille d Inpatien t Admissio ns : 0
	4661	Number of MRA Unb illed Inpt Admission s : 2
	4662	Number of Inpt. I nstitution al Cases : 0
	4663	Average Inpt. Ins titutional Bill Amou nt : 15 321.18
	4664	Number of Inpt. P rofessiona l Cases : 0
	4665	Average Inpt. Pro fessional Bill Amoun t : 1 036.36
	4666	Total U nbilled In patient Ca re : 0.00
	4667	Total M RA Unbille d Inpatien t Care : 0.00
	4668	Note: Patc h IB2547 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.Do you w ant to sto re Unbille d Amounts figures? N O//
	4669	Search by Division?? NO//
	4670	Start with DATE: 08/ 23/1966// t-1000 (F EB 07, 201 3)
	4671	Go to DATE: 11/ 04/2015// (NOV 04, 2015)
	4672	Choose rep ort type(s ) to print :
	4673	1 - INP ATIENT UNB ILLED
	4674	2 - OUT PATIENT UN BILLED
	4675	3 - PRE SCRIPTION UNBILLED
	4676	4 - ALL OF THE AB OVE
	4677	Select: ( 1-4): 4//
	4678	You have s elected
	4679	4 - AL L OF THE A BOVE
	4680	Are you su re? NO// y YES
	4681	Print deta il report with the U nbilled Am ounts summ ary? NO// y
	4682	Patient Bi lling Inqu iry – Syno nym: INQU
	4683	What is th e purpose of this op tion?
	4684	This optio n provides some basi c informat ion about a particul ar claim. It is a si mple inqui ry option.
	4685	When is th is option used?
	4686	This optio n can be u sed to vie w the foll owing type of inform ation rela ted to a b ill:
	4687	Bill Statu s
	4688	Rate Type
	4689	Form Type
	4690	Visit Date (s)
	4691	Charges
	4692	AR Status
	4693	Statement Dates
	4694	Dates rela ted to act ions such as Entered , Cancelle d or Print ed
	4695	Bill Numbe r copied f rom or to
	4696	Patient, M ailing and Insurance Company a ddress
	4697	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
	4698	Printed Cl aims Repor t
	4699	What is th e purpose of this op tion?
	4700	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.
	4701	When is th is option used?
	4702	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:
	4703	Biller
	4704	Outpatient /Inpatient and Insti tutional/P rofessiona l
	4705	Rate Type
	4706	Plan Type
	4707	Division
	4708	Revenue Co des
	4709	Insurance Company
	4710	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. 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.APPENDI X A – BATC H PROCESSI NG SETUP
	4711	BATCH PROC ESSING SET UP
	4712	The follow ing exampl e shows yo u how to d efine batc h processi ng for a p ayer:
	4713	StepProced ure1Under the IB Sit e Paramete rs, go to field [15] EDI/MRA A ctivated.2 Edit field s as neces sary (fiel ds are hig hlighted i n yellow f or this ex ample).Det ails on ea ch field f ollow the screen exa mple.When the MRA so ftware was loaded (P atch IB2. 0155), th e EDI/MRA Activated field was removed fr om this sc reen. Only an IRM is able to a ccess this field via FileMan. The reason for this is to prev ent MRA fr om being a ctivated b efore the FSC is rea dy to acce pt MRA tra nsmissions from a pa rticular s ite.IB Sit e Paramete rs Aug 13 , 2003@10: 22:46 Page: 5 of 6
	4714	Only autho rized pers ons may ed it this da ta.
	4715	+--------- ---------- ---------- ---------- ---------- ---------- ---------- -
	4716	[15] EDI/M RA Activat ed : E DI
	4717	EDI C ontact Pho ne :
	4718	EDI 8 37 Live Tr ansmit Que ue : M CH
	4719	EDI 8 37 Test Tr ansmit Que ue : M CT
	4720	Auto- Txmt Bill Frequency : E very Day
	4721	Hours To Auto-T ransmit : 1 300;1600
	4722	Max # Bills Per Batch : 5 0
	4723	Only Allow 1 In s Co/Claim Batch?: N O
	4724	Last Auto-Txmt Run Date : 0 8/13/03
	4725	Days To Wait To Purge Msg s : 1 20
	4726	EDI/MRA Ac tivated: Controls w hether EDI is availa ble for th e site.
	4727	Choose fro m:
	4728
	4729	0 - NOT ED I OR MRA;
	4730	1 - EDI ON LY;
	4731	2 – MRA ON LY; or
	4732	3 – BOTH E DI AND MRA
	4733	This promp t is no lo nger acces sible to a nyone exce pt an IRM. IB Site P arameters May 27, 2 004@14:14: 24 Page: 5 of 6
	4734	Only autho rized pers ons may ed it this da ta.
	4735	+
	4736	HMO NUMBER :
	4737	STAT E INDUSTRI AL ACCIDEN T PROV:
	4738	LOCA TION NUMBE R :
	4739	[15] EDI/M RA Activat ed : B OTH EDI AN D MRA
	4740	EDI C ontact Pho ne : 2 17-554-313 5
	4741	EDI 8 37 Live Tr ansmit Que ue : M CH
	4742	EDI 8 37 Test Tr ansmit Que ue : M CT
	4743	Auto- Txmt Bill Frequency : E very Day
	4744	Hours To Auto-T ransmit : 1 000;1400;2 000
	4745	Max # Bills Per Batch : 1 0
	4746	Only Allow 1 In s Co/Claim Batch?: N O
	4747	Last Auto-Txmt Run Date : 0 5/26/04
	4748	Days To Wait To Purge Msg s : 4 5
	4749	Allow MRA Proce ssing? : Y ES
	4750	Enabl e Automati c MRA Proc essing?: Y ES
	4751	+ Enter ?? f or more ac tions
	4752	EP Edit S et EX Exit Action
	4753	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 B2.0400.
	4754	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.
	4755	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.
	4756	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.
	4757	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.
	4758	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) .
	4759	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.
	4760	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.
	4761	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.
	4762	(This page included for two-si ded copyin g.)
	4763	APPENDIX B – GLOSSAR Y
	4764	GLOSSARY O F TERMS
	4765	Acronym or TermDefin ition/Expl anation835 HIPAA Stan dard Elect ronic Tran saction AS C X12 835, Health Ca re Claim:
	4766	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). 837HIP AA Standar d Electron ic Transac tion ASC X 12 837, He alth Care Claim Paym ent/Remitt ance Advic e:
	4767	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. 277 RFAIHi paa Standa rd Electro nic Transa ction ASC X12 277, H ealth Care Claim Req uest for A dditional Informatio n
	4768	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 . Billing Provider S econdary I D NumberTh is is eith er the fac ility tax ID # (defa ult) or an ID assign ed to the facility b y the insu rance comp any. Care UnitSpecif ic data re lated to p atient car e (pre-def ined by an insurance company) that provi des the in surance co mpany with a finer b reakdown o f the care being bil led. The d ata that c omprises t he breakdo wn are ins urance com pany speci fic and ar e not requ ired by al l payers. (For examp le, Orthop edics, Der matology, Urology, e tc.).Claim s Status A waiting Re solution ( CSA)Used t o referenc e the opti on used by billing s taff to re view the m ost curren t status m essages re ceived for a bill(s) and do fo llow-up on the bills . Users wi ll be able to select a bill fr om the lis t to view the detail s and the entire mes sage text as well as to mark t he message as review ed or unde r review a nd documen t user com ments.Clai m Status M essageElec tronic mes sages retu rned to th e VAMC pro viding sta tus inform ation on a claim fro m the Fina ncial Serv ice Center (FSC), Cl earinghous e or a pay erClearing houseA com pany that provides b atch and r eal-time t ransaction processin g services . Transact ions inclu de insuran ce eligibi lity verif ication, c laims subm ission pro cess and e lectronic remittance informati on and pay ment posti ng for ele ctronic cl aims.CPACC onsolidate d Patient Account Ce nterCSASee Claims St atus Await ing Resolu tioneClaim A claim th at is subm itted elec tronically from the VAEDISee E lectronic Data Inter changeElec tronic Dat a Intercha nge (EDI)E DI is the process of transacti ng busines s electron ically. It includes submitting claims el ectronical ly (paperl ess claims processin g), as wel l as elect ronic fund s transfer and elect ronic inqu iry for cl aim status and patie nt eligibi lity.Elect ronic Paye rA payer t hat has an electroni c connecti on with th e clearing houseePaye rPayer tha t accepts electronic claim fro m the clea ringhouse pays elect ronically. See Paye r.Facility Fed Tax I D #This is the numbe r that wil l be the d efault for all provi ders for t he ID type at the fa cility if the payer does not h ave specif ic require mentsFisca l Intermed iaryA fisc al interme diary perf orms servi ces on beh alf of hea lthcare pa yers. Thes e services include c laim adjud ication, r eimburseme nt and col lections. Trailblaze r is an ex ample of a fiscal in termediary that acts on behalf of Medica re. Trailb lazer rece ives claim s from the VA in the form of a n 837 file and then adjudicate s the clai ms to crea te a MRA/E OB 835 fil e.Form Typ esThe UB-0 4 or CMS-1 500 billin g form on which serv ices will be billedF SCThe VA F inancial S ervices Ce nter in Au stin. The Financial Service Ce nter trans lates clai ms into an industry- standard f ormat (HIP AA 837) an d forwards claims to the clear inghouse. The FSC is the singl e point fo r the exch ange of da ta between VistA and the clear inghouse.H ealthcare CompanySee PayerHeal th Insuran ce Portabi lity and A ccountabil ity Act (H IPAA)In 19 96 Congres s passed i nto law th e Health I nsurance P ortability and Accou ntability Act (HIPAA ). This Ac t is compr ised of tw o major le gislative actions: H ealth Insu rance Refo rm and Adm inistrativ e Simplifi cation. Th e Administ rative Sim plificatio n provisio ns of HIPA A direct t he federal governmen t to adopt national electronic standards for autom ated trans fer of cer tain healt hcare data between h ealthcare payers, pl ans, and p roviders. This will enable the entire he althcare i ndustry to communica te electro nic data u sing a sin gle set of standards thus elim inating al l non-stan dard forma ts current ly in use. Once thes e standard s are in p lace, a he althcare p rovider wi ll be able to submit a standar d transact ion for el igibility, authoriza tion, refe rrals, cla ims, or at tachments containing the same standard d ata conten t to any h ealth plan . This wil l "simplif y" many cl inical, bi lling, and other fin ancial app lications and reduce costs.HPI DHealth Pl an Identif ierInsuran ce Company See PayerL egacy IDsT his term r efers to t hose payer -provided or users o wn IDs (in dividual a nd organiz ational) w hich will eventually be made o bsolete by the use o f National Provider Identifier sNon-VA Fa cilityAny facility t hat provid es service s to a VA patient an d subseque ntly bills the VA fo r those se rvicesNon- VA Provide rAny indiv idual prov ider who p rovides se rvices to a VA patie nt and sub sequently bills the VA for the se service sNational Provider I dentifierA standard, unique he alth ident ifier for healthcare providers , both ind ividuals a nd organiz ationsOEID Other Enti ty Identif ierParentT he top fac ility in a hierarchi cal domain PayerThe i nsured’s i nsurance c ompany. Ot her terms that are u sed to den ote Payer include eP ayer, insu rance comp any, healt hcare comp any, etc.P ayer CodeA code used for enrol lment that uniquely identifies the payer . Payer Li stList of payers tha t consist of the pay er categor y, claim t ype, payer code, and payer nam eProviderP rovider of healthcar e services Provider I DA provide r ID can r epresent a facility or an indi vidual phy sician/pro vider. Tax onomy Code 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.
	4769
	4770	The Health Care Prov ider Taxon omy code s et allows a single p rovider (i ndividual, group, or instituti on) to ide ntify thei r specialt y category .UPINUniqu e Provider Identific ation Numb erURLUnifo rm Resourc e LocatorV AMCVeteran s Affairs Medical Ce nterVISNVe terans Int egrated Se rvice Netw ork(This p age includ ed for two -sided cop ing.)
	4771	APPENDIX C – HIPAA P rovider ID – Referen ce Guide
	4772	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.
	4773	Institutio nalQualifi erDefiniti onBilling ProviderAt tendingOpe ratingOthe rService20 10AA2310A2 330D2310B2 330E2310C2 330F2310E2 330HPayer Type:COCOC OCOVPE Seg ment:PRV1O PR2OP1OPR3 OP2OPR4OP9 SUB2OP3OBS tate Licen se Number- OBOBOBOB1A Blue Cross Provider Number1A1A 1A1A1A1A1A 1A-1BBlue Shield Pro vider Numb er-1B1B1B1 B1B1B1B1B1 CMedicare Provider N umber1C1C1 C1C1C1C1C1 C1C1DMedic are Provid er Number1 D1D1D1D1D1 D1D1D1D1GP rovider UP IN Number1 G1G1G1G1G1 G1G1G-1HTR ICARE ID N umber1H1H1 H1H1H1H1H1 H-1JFacili ty ID Numb er1J------ 1J-B3PPO N umberB3--- -----BQHMO Code Numb erBQ------ --EIEmploy er’s ID Nu mberEIEIEI EIEIEIEIEI EIFHClinic NumberFH- -----FH-G2 Provider C ommercial NumberG2G2 G2G2G2G2G2 G2G2G5Prov ider Site NumberG5-- ----G5-LUL ocation Nu mberLULULU LULULULULU LUN5Provid er Plan Ne twork ID N umber-N5N5 N5N5N5N5N5 N5TJFedera l Taxpayer ’s ID Numb er-------- X4Clinical Lab Impro vement Ame ndment (C LIA #)---- -----U3Uni que Suppli er ID Numb er (USIN)- --------SY Social Sec urity Numb erSYSY-SY- SY---X5Sta te Industr ial Accide nt Provide r NumberX5 X5-X5-X5-X 5-C = Curr ent Payer O = O ther Payer Profession alQualifie rDefinitio nBilling P roviderRef erringRend eringPurch asedServic e Facility Supervisin gHIPAA Loo p2010AA231 0A2330D231 0B2330E231 0C2330F231 0D2330G231 0E2330HPay er Type:CO COCOCOCOVP E RecordPR V1OPR5OP4O PR2OP1SUB1 OP6SUB2OP7 OPR8OP8OBS tate Licen se Number- OB-OB-OB-O B-OB-1ABlu e Cross Pr ovider Num ber-----1A -1A---1BBl ue Shield Provider N umber1B1B1 B1B1B1B1B1 B1B1B1B1CM edicare Pr ovider Num ber1C1C1C1 C1C1C1C1C1 C1C1C1DMed icare Prov ider Numbe r1D1D-1D-1 D1D1D1D1D1 D1GProvide r UPIN Num ber1G1G-1G -1G-1G-1G- 1HTRICARE ID Number1 H1H-1H-1H- 1H-1H-1JFa cility ID Number1J-- --------B3 PPO Number B3-------- --BQHMO Co de NumberB Q--------- -EIEmploye r’s ID Num berEIEIEIE IEIEIEI--E IEIFHClini c NumberFH ---------- G2Provider Commercia l NumberG2 G2G2G2G2G2 G2G2G2G2G2 G5Provider Site Numb erG5------ ----LULoca tion Numbe rLULULULUL ULULULULUL U-N5Provid er Plan Ne twork ID N umber-N5N5 N5N5N5N5-N 5N5N5TJFed eral Taxpa yer’s ID N umber----- --TJ---X4C linical La b Improvem ent Amendm ent (CLIA #)------- X4---U3Uni que Suppli er ID Numb er (USIN)U 3----U3--- --SYSocial Security NumberSYSY SYSY---SY- X5State In dustrial A ccident Pr ovider Num berX5X5-X5 -X5-X5-X5- C = Curren t Payer O = Ot her Payer
	4774	Billing
	4775
	4776	VistA
	4777
	4778	Clearingho use
	4779
	4780	Austin FSC
	4781
	4782	Printed Bi lls
	4783
	4784	EDI Transm issions
	4785
	4786	Payer
	4787
	4788	R
	4789
	4790	EGULAR
	4791
	4792	M
	4793
	4794	AIL
	4795
	4796	1 DAY
	4797
	4798	OVERNIGHT
	4799
	4800	UP TO 3 DA YS
	4801
	4802	1 TO 14 DA YS
	4803
	4804	(Trading P artners)
	4805
	4806	Outside Th e VA Syste m
	4807
	4808	(Trading P artners)
	4809
	4810	Outside Th e VA Syste m
	4811
	4812	Within The VA System
	4813
	4814	Within The VA System
	4815
	4816
	4817
	4818	Payers
	4819
	4820	FSC
	4821
	4822	VistA
	4823
	4824	(Trading P artners)
	4825
	4826	Outside Th e VA Syste m
	4827
	4828	(Trading P artners)
	4829
	4830	Outside Th e VA Syste m
	4831
	4832	Within The VA System
	4833
	4834	Within The VA System
	4835
	4836	Payers
	4837
	4838	Emdeon
	4839
	4840	FSC
	4841
	4842	VistA
	4843
	4844	Clearing-
	4845	house
	4846
	4847	TR- EDI Tr ansmission Status Re ports -
	4848
	4849	MM-EDI Ret urn Messag e Manageme nt
	4850
	4851	EDI Retu rn Message Managemen t Option M enu
	4852	CSA Claim Status Aw aiting Res olution
	4853	MCS Multi ple CSA Me ssage Mana gement
	4854	TCS Test Claim EDI Transmissi on Report
	4855	EDI Messag e Text to Screen Mai nt
	4856	EDI Messag e Not Revi ewed Repor t
	4857	Electronic Error Rep ort
	4858	Electronic Report Di sposition
	4859	Return Mes sage Filin g Exceptio ns
	4860	Status Mes sage Manag ement
	4861
	4862