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| 1 | IB_2.0_577.zip | edi_user_guide_r1017.doc | Tue Aug 1 17:53:50 2017 UTC |
| 2 | IB_2.0_577.zip | edi_user_guide_r1017.doc | Fri Aug 4 12:18:57 2017 UTC |
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| 1 | E
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| 2 | Billing Us er Guide | ||
| 3 | |||
| 4 | Version 2. 7 | ||
| 5 | August 200 5 | ||
| 6 | Revised: O ctober 201 7 | ||
| 7 | Revision H istory | ||
| 8 | DateRevisi onDescript ionAuthorA ugust 2005 1Patch IB* 2*296M. Si monsJuly 2 0061.1Patc h IB*2*320 M. SimonsF ebruary 20 071.2Patch es IB*2*34 3, 348 and 349C. Smi th | ||
| 9 | M. SimonsJ uly 20071. 3Patch IB* 2*374C. Sm ithNovembe r 20071.4P atch IB*2* 368 and 37 1S. Hooper | ||
| 10 | M. SimonsM ay 20081.5 Patch IB*2 *377M. Sim onsFebruar y 20091.6P atch IB*2* 400M. Simo nsNovember 20101.7Pa tch IB*2*4 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 IB*2 *433 B. An dersonMay 20111.9Pat ch IB*2*43 3 – Sectio n 6.7 | ||
| 14 | M. Simons | ||
| 15 | B. Anderso nSeptember 20111.10P atch IB*2* 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 IB*2*447 and PRCA* 4.5*275 | ||
| 19 | Revised Se ctions: 6, 7B. Ander son | ||
| 20 | M. Simons | ||
| 21 | C. MinchMa rch 2014 1 .12Patch I B*2.0*476 | ||
| 22 | Revised Se ctions: 4. 4.1, 4.5.3 T. ReedAug ust 2014 2 .0Patch IB *2*488 (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 IB*2*521 | ||
| 27 | Revised ED I Paramete r Report S ection 9.3 .14, Appen dix BM. Wi ndsor | ||
| 28 | A. FinkApr il 20152.2 Patch IB*2 *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 IB*2 *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 IB*2*5 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 IB*2*549 | ||
| 34 | Revised Se ctions: 2. 1.1.2, 2.1 .2, 5.1.1D . WhiteJul y 20172.6P atch IB*2* 576 Added sub-secti ons 6.2.5 and 6.3.4M . Simons O ctober 201 72.7Patch IB*2*577 A dded sub-s ection 10. 3.20, Modi fied sub-s ection 6.2 .3.2 and 6 .7 and 6.8 M. Simons (This page included for two-si ded copyin g.) | ||
| 35 | Table of C ontents | ||
| 36 | 11. | ||
| 37 | Introducti on | ||
| 38 | |||
| 39 | |||
| 40 | 11.1. | ||
| 41 | Revenue Pr ocess | ||
| 42 | |||
| 43 | |||
| 44 | 21.2. | ||
| 45 | Critical E DI Process Terms | ||
| 46 | |||
| 47 | |||
| 48 | 31.3. | ||
| 49 | EDI Proces s Flow | ||
| 50 | |||
| 51 | |||
| 52 | 42. | ||
| 53 | Insurance Company Se t-up | ||
| 54 | |||
| 55 | |||
| 56 | 42.1. | ||
| 57 | Insurance Company Se tup | ||
| 58 | |||
| 59 | |||
| 60 | 42.1.1 | ||
| 61 | Activate N ew Payer t o Transmit eClaims | ||
| 62 | |||
| 63 | |||
| 64 | 92.1.2 | ||
| 65 | Activate E xisting Co mmercial P ayer to Tr ansmit eCl aims | ||
| 66 | |||
| 67 | |||
| 68 | 142.1.3 | ||
| 69 | Activate E xisting Pa yer to Tes t Primary Blue Cross /Blue Shie ld eClaims | ||
| 70 | |||
| 71 | |||
| 72 | 173. | ||
| 73 | Pay-to Pro vider(s) S et-up | ||
| 74 | |||
| 75 | |||
| 76 | 183.1. | ||
| 77 | Define Def ault Pay-t o Provider | ||
| 78 | |||
| 79 | |||
| 80 | 203.2. | ||
| 81 | Associate Divisions with non-D efault Pay -to Provid er | ||
| 82 | |||
| 83 | |||
| 84 | 224. | ||
| 85 | Provider I D Set-up | ||
| 86 | |||
| 87 | |||
| 88 | 234.1. | ||
| 89 | Table of I Ds | ||
| 90 | |||
| 91 | |||
| 92 | 284.2. | ||
| 93 | Pay-to Pro vider IDs | ||
| 94 | |||
| 95 | |||
| 96 | 284.2.1 | ||
| 97 | Define the Pay-to Pr ovider Pri mary ID/NP I | ||
| 98 | |||
| 99 | |||
| 100 | 284.2.2 | ||
| 101 | Define the Pay-to Pr ovider Sec ondary IDs | ||
| 102 | |||
| 103 | |||
| 104 | 284.3. | ||
| 105 | Billing Pr ovider IDs | ||
| 106 | |||
| 107 | |||
| 108 | 294.3.1 | ||
| 109 | Define the Billing P rovider Pr imary ID/N PI | ||
| 110 | |||
| 111 | |||
| 112 | 304.3.2 | ||
| 113 | Define the Billing P rovider Se condary ID s | ||
| 114 | |||
| 115 | |||
| 116 | 374.4. | ||
| 117 | Service Fa cility IDs (Laborato ry or Faci lity IDs) | ||
| 118 | |||
| 119 | |||
| 120 | 374.4.1 | ||
| 121 | Define Non -VA Labora tory or Fa cility Pri mary IDs/N PI | ||
| 122 | |||
| 123 | |||
| 124 | 394.4.2 | ||
| 125 | Define Non -VA Labora tory or Fa cility Sec ondary IDs | ||
| 126 | |||
| 127 | |||
| 128 | 414.4.3 | ||
| 129 | Define VA Laboratory or Facili ty Primary IDs/NPI | ||
| 130 | |||
| 131 | |||
| 132 | 414.4.4 | ||
| 133 | Define VA Laboratory or Facili ty Seconda ry IDs | ||
| 134 | |||
| 135 | |||
| 136 | 424.5. | ||
| 137 | Attending, Operating and Other Physician s and Rend ering, Ref erring and Supervisi ng Provide rs | ||
| 138 | |||
| 139 | |||
| 140 | 434.5.1 | ||
| 141 | Define a V A Physicia n/Provider ’s Primary ID/NPI | ||
| 142 | |||
| 143 | |||
| 144 | 434.5.2 | ||
| 145 | Define a V A Physicia n/Provider ’s Seconda ry IDs | ||
| 146 | |||
| 147 | |||
| 148 | 504.5.3 | ||
| 149 | Define a n on-VA Phys ician/Prov ider’s Sec ondary IDs | ||
| 150 | |||
| 151 | |||
| 152 | 544.5.4 | ||
| 153 | Define Ins urance Com pany IDs | ||
| 154 | |||
| 155 | |||
| 156 | 584.5.5 | ||
| 157 | Define eit her a Defa ult or Ind ividual Ph ysician/Pr ovider Sec ondary ID | ||
| 158 | |||
| 159 | |||
| 160 | 604.6. | ||
| 161 | Care Units | ||
| 162 | |||
| 163 | |||
| 164 | 604.6.1 | ||
| 165 | Define Car e Units fo r Physicia n/Provider Secondary IDs | ||
| 166 | |||
| 167 | |||
| 168 | 634.6.2 | ||
| 169 | Define Car e Units fo r Billing Provider S econdary I Ds | ||
| 170 | |||
| 171 | |||
| 172 | 654.7. | ||
| 173 | ID Paramet ers by Ins urance Com pany | ||
| 174 | |||
| 175 | |||
| 176 | 674.7.1 | ||
| 177 | Define Att ending/Ren dering Pro vider Seco ndary ID P arameters | ||
| 178 | |||
| 179 | |||
| 180 | 684.7.2 | ||
| 181 | Define Ref erring Pro vider Seco ndary ID P arameters | ||
| 182 | |||
| 183 | |||
| 184 | 684.7.3 | ||
| 185 | Define Bil ling Provi der Second ary ID Par ameters | ||
| 186 | |||
| 187 | |||
| 188 | 684.7.4 | ||
| 189 | Define Bil ling Provi der/Servic e Facility Parameter s | ||
| 190 | |||
| 191 | |||
| 192 | 694.7.5 | ||
| 193 | Define VA Service Fa cility Par ameters | ||
| 194 | |||
| 195 | |||
| 196 | 694.7.6 | ||
| 197 | Define No Billing Pr ovider Sec ondary IDs by Plan T ype | ||
| 198 | |||
| 199 | |||
| 200 | 704.7.7 | ||
| 201 | View Assoc iated Insu rance Comp anies, Pro vider IDs, and ID Pa rameters | ||
| 202 | |||
| 203 | |||
| 204 | 724.8. | ||
| 205 | Associated Insurance Companies and Copyi ng Physici an/Provide r Secondar y IDs and Additional Billing P rovider Se condary ID s | ||
| 206 | |||
| 207 | |||
| 208 | 724.8.1 | ||
| 209 | Designate a Parent I nsurance C ompany | ||
| 210 | |||
| 211 | |||
| 212 | 744.8.2 | ||
| 213 | Designate a Child In surance Co mpany | ||
| 214 | |||
| 215 | |||
| 216 | 744.8.3 | ||
| 217 | Copy Physi cian/Provi der Second ary IDs | ||
| 218 | |||
| 219 | |||
| 220 | 754.8.4 | ||
| 221 | Copy Addit ional Bill ing Provid er Seconda ry IDs | ||
| 222 | |||
| 223 | |||
| 224 | 754.8.5 | ||
| 225 | Synchroniz ing Associ ated Insur ance Compa ny IDs | ||
| 226 | |||
| 227 | |||
| 228 | 765. | ||
| 229 | Subscriber and Patie nt ID Set- Up | ||
| 230 | |||
| 231 | |||
| 232 | 765.1. | ||
| 233 | Subscriber and Patie nt Insuran ce Provide d IDs | ||
| 234 | |||
| 235 | |||
| 236 | 765.1.1 | ||
| 237 | Define Sub scriber Pr imary ID | ||
| 238 | |||
| 239 | |||
| 240 | 785.1.2 | ||
| 241 | Define Sub scriber an d Patient Primary ID s | ||
| 242 | |||
| 243 | |||
| 244 | 805.1.3 | ||
| 245 | Define Sub scriber an d Patient Secondary IDs | ||
| 246 | |||
| 247 | |||
| 248 | 826. | ||
| 249 | Entering E lectronic Claims | ||
| 250 | |||
| 251 | |||
| 252 | 826.1. | ||
| 253 | Summary of Enter/Edi t Billing Informatio n to Suppo rt ASC X12 N/5010 | ||
| 254 | |||
| 255 | |||
| 256 | 826.2. | ||
| 257 | Changes Ma de by Spec ific Patch es | ||
| 258 | |||
| 259 | |||
| 260 | 826.2.1 | ||
| 261 | Patch IB*2 *447 | ||
| 262 | |||
| 263 | |||
| 264 | 836.2.2 | ||
| 265 | Patch IB*2 *488: | ||
| 266 | |||
| 267 | |||
| 268 | 856.2.3 | ||
| 269 | Patch IB*2 *516 | ||
| 270 | |||
| 271 | |||
| 272 | 856.2.4 | ||
| 273 | Patch IB*2 *547 | ||
| 274 | |||
| 275 | |||
| 276 | 876.2.5 | ||
| 277 | Patch IB.2 .576 | ||
| 278 | |||
| 279 | |||
| 280 | 886.3. | ||
| 281 | Handling E rror Messa ges and Wa rnings | ||
| 282 | |||
| 283 | |||
| 284 | 896.3.1 | ||
| 285 | Patch IB*2 *488 | ||
| 286 | |||
| 287 | |||
| 288 | 896.3.2 | ||
| 289 | Patch IB*2 *516 | ||
| 290 | |||
| 291 | |||
| 292 | 896.3.3 | ||
| 293 | Patch IB*2 *547 | ||
| 294 | |||
| 295 | |||
| 296 | 896.3.4 | ||
| 297 | Patch IB.2 .576 | ||
| 298 | |||
| 299 | |||
| 300 | 896.4. | ||
| 301 | Claim vers us Line Le vel Data | ||
| 302 | |||
| 303 | |||
| 304 | 906.5. | ||
| 305 | Screen 3 – Payer Inf ormation | ||
| 306 | |||
| 307 | |||
| 308 | 906.5.1 | ||
| 309 | EDI Fields | ||
| 310 | |||
| 311 | |||
| 312 | 916.5.2 | ||
| 313 | Using Care Units for Billing P rovider Se condary ID s | ||
| 314 | |||
| 315 | |||
| 316 | 926.6. | ||
| 317 | Screen 10 – Physicia n/Provider and Print Informati on | ||
| 318 | |||
| 319 | |||
| 320 | 926.6.1 | ||
| 321 | EDI Fields UB-04/CMS -1500 | ||
| 322 | |||
| 323 | |||
| 324 | 936.7. | ||
| 325 | UB-04 Clai ms | ||
| 326 | |||
| 327 | |||
| 328 | 1016.8. | ||
| 329 | CMS-1500 C laims | ||
| 330 | |||
| 331 | |||
| 332 | 1106.9. | ||
| 333 | Lab Claims | ||
| 334 | |||
| 335 | |||
| 336 | 1146.10. | ||
| 337 | Pharmacy C laims | ||
| 338 | |||
| 339 | |||
| 340 | 1196.11. | ||
| 341 | Correct Re jected or Denied Cla ims | ||
| 342 | |||
| 343 | |||
| 344 | 1216.12. | ||
| 345 | Viewed Can celled Cla ims | ||
| 346 | |||
| 347 | |||
| 348 | 1216.13. | ||
| 349 | Printed Cl aims | ||
| 350 | |||
| 351 | |||
| 352 | 1226.14. | ||
| 353 | View/Resub mit Claims – Live or Test – Sy nonym: RCB | ||
| 354 | |||
| 355 | |||
| 356 | 1267. | ||
| 357 | Processing of Second ary/Tertia ry Claims | ||
| 358 | |||
| 359 | |||
| 360 | 1267.1. | ||
| 361 | Criteria f or the Aut omatic Pro cessing of Secondary or Tertia ry Claims | ||
| 362 | |||
| 363 | |||
| 364 | 1277.2. | ||
| 365 | COB Manage ment Workl ist | ||
| 366 | |||
| 367 | |||
| 368 | 1287.2.1 | ||
| 369 | Data Displ ayed for C laims on t he COB Man agement Wo rklist | ||
| 370 | |||
| 371 | |||
| 372 | 1287.2.2 | ||
| 373 | Available COB Manage ment Workl ist Action s | ||
| 374 | |||
| 375 | |||
| 376 | 1298. | ||
| 377 | Requests f or Additio nal Data t o Support Claims | ||
| 378 | |||
| 379 | |||
| 380 | 1319. | ||
| 381 | IB Site Pa rameters | ||
| 382 | |||
| 383 | |||
| 384 | 1319.1. | ||
| 385 | Define Pri nters for Automatica lly Proces sed Second ary/Tertia ry Claims | ||
| 386 | |||
| 387 | |||
| 388 | 1339.2. | ||
| 389 | Enable Aut omatic Pro cessing of Secondary /Tertiary Claims | ||
| 390 | |||
| 391 | |||
| 392 | 1359.3. | ||
| 393 | Printed Cl aims Rev C ode Excl: 17 Activat ed Codes D efined | ||
| 394 | |||
| 395 | |||
| 396 | 1369.4. | ||
| 397 | Alternate Primary Pa yer ID Typ es | ||
| 398 | |||
| 399 | |||
| 400 | 1379.5. | ||
| 401 | ASC X12N H ealth Care Claim Req uest for A dditional Informatio n (277RFAI ) | ||
| 402 | |||
| 403 | |||
| 404 | 13910. | ||
| 405 | Reports | ||
| 406 | |||
| 407 | |||
| 408 | 13910.1. | ||
| 409 | EDI Report s – Overvi ew | ||
| 410 | |||
| 411 | |||
| 412 | 14010.2. | ||
| 413 | Most Frequ ently Used Menus/Rep orts | ||
| 414 | |||
| 415 | |||
| 416 | 14010.2.1 | ||
| 417 | Claims Sta tus Awaiti ng Resolut ion – Syno nym CSA | ||
| 418 | |||
| 419 | |||
| 420 | 14110.2.2 | ||
| 421 | Multiple C SA Message Managemen t – Synony m: MCS | ||
| 422 | |||
| 423 | |||
| 424 | 14210.2.3 | ||
| 425 | Electronic Report Di sposition | ||
| 426 | |||
| 427 | |||
| 428 | 14310.2.4 | ||
| 429 | EDI Claim Status Rep ort- Synon ym: ECS | ||
| 430 | |||
| 431 | |||
| 432 | 14410.3. | ||
| 433 | Additional Reports a nd Options | ||
| 434 | |||
| 435 | |||
| 436 | 14410.3.1 | ||
| 437 | Ready for Extract St atus Repor t - Synony m: REX | ||
| 438 | |||
| 439 | |||
| 440 | 14410.3.2 | ||
| 441 | Transmit E DI Bills – Manual - Synonym: S END | ||
| 442 | |||
| 443 | |||
| 444 | 14510.3.3 | ||
| 445 | EDI Return Message M anagement Menu – Syn onym: MM | ||
| 446 | |||
| 447 | |||
| 448 | 14510.3.4 | ||
| 449 | EDI Messag e Text to Screen Mai ntenance | ||
| 450 | |||
| 451 | |||
| 452 | 14510.3.5 | ||
| 453 | EDI Messag es Not Rev iewed Repo rt | ||
| 454 | |||
| 455 | |||
| 456 | 14510.3.6 | ||
| 457 | Electronic Error Rep ort | ||
| 458 | |||
| 459 | |||
| 460 | 14610.3.7 | ||
| 461 | Return Mes sages Fili ng Excepti ons | ||
| 462 | |||
| 463 | |||
| 464 | 14610.3.8 | ||
| 465 | Status Mes sage Manag ement | ||
| 466 | |||
| 467 | |||
| 468 | 14710.3.9 | ||
| 469 | Bills Awai ting Resub mission – Synonym: B AR | ||
| 470 | |||
| 471 | |||
| 472 | 14710.3.10 | ||
| 473 | EDI Messag es Not Yet Filed –Sy nonym: MP | ||
| 474 | |||
| 475 | |||
| 476 | 14710.3.11 | ||
| 477 | Pending Ba tch Transm ission Sta tus Report – Synonym : PBT | ||
| 478 | |||
| 479 | |||
| 480 | 14710.3.12 | ||
| 481 | EDI Batche s Pending Receipt– S ynonym: PN D | ||
| 482 | |||
| 483 | |||
| 484 | 14910.3.13 | ||
| 485 | View/Print EDI Bill Extract Da ta – Synon ym: VPE | ||
| 486 | |||
| 487 | |||
| 488 | 14910.3.14 | ||
| 489 | Insurance Company ED I Paramete r Report – Synonym: EPR | ||
| 490 | |||
| 491 | |||
| 492 | 15010.3.15 | ||
| 493 | Test Claim EDI Trans mission Re port – Syn onym: TCS | ||
| 494 | |||
| 495 | |||
| 496 | 15110.3.16 | ||
| 497 | Third Part y Joint In quiry – Sy nonym: TPJ I | ||
| 498 | |||
| 499 | |||
| 500 | 15310.3.17 | ||
| 501 | Re-generat e Unbilled Amounts R eport | ||
| 502 | |||
| 503 | |||
| 504 | 15410.3.18 | ||
| 505 | Patient Bi lling Inqu iry – Syno nym: INQU | ||
| 506 | |||
| 507 | |||
| 508 | 15410.3.19 | ||
| 509 | Printed Cl aims Repor t | ||
| 510 | |||
| 511 | |||
| 512 | 15511. | ||
| 513 | APPENDIX A – BATCH P ROCESSING SETUP | ||
| 514 | |||
| 515 | |||
| 516 | 15812. | ||
| 517 | APPENDIX B – GLOSSAR Y | ||
| 518 | |||
| 519 | |||
| 520 | 16213. | ||
| 521 | APPENDIX C – HIPAA P rovider ID – Referen ce Guide | ||
| 522 | |||
| 523 | |||
| 524 | |||
| 525 | |||
| 526 | (This page included for two-si ded copyin g.) | ||
| 527 | Introducti on | ||
| 528 | 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). | ||
| 529 | Revenue Pr ocess | ||
| 530 | The overal l patient billing re venue proc ess for th e VHA is s ummarized in the tab le below: | ||
| 531 | IntakeUtil ization Re view Billi ngCollecti onUtilizat ion Review Patient R egistratio n | ||
| 532 | Insurance Identifica tion | ||
| 533 | Insurance Verificati onPre-cert ification & Certific ation | ||
| 534 | Continued StayDocume ntation | ||
| 535 | EDI Bill G eneration | ||
| 536 | MRA | ||
| 537 | Claim stat us message sEstablish Receivabl es | ||
| 538 | A/R Follow -up | ||
| 539 | Lockbox | ||
| 540 | 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. | ||
| 541 | 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. | ||
| 542 | 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. | ||
| 543 | During the Collectio ns phase, establishm ent of rec eivables, accounts r eceivables follow-up , lockbox, and any c ollection correspond ence take place. | ||
| 544 | Another Ut ilization Review can take plac e if there are any a ppeals. | ||
| 545 | 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 . | ||
| 546 | Critical E DI Process Terms | ||
| 547 | Also see A PPENDIX B – GLOSSARY . | ||
| 548 | 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). | ||
| 549 | 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. | ||
| 550 | 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 . | ||
| 551 | 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. | ||
| 552 | eClaim – A claim tha t is trans mitted ele ctronicall y to FSC f rom the VH A. | ||
| 553 | 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. | ||
| 554 | 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. | ||
| 555 | ePayer – P ayer that accepts el ectronic c laims from the clear inghouse. | ||
| 556 | 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. | ||
| 557 | 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. | ||
| 558 | 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. | ||
| 559 | 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. | ||
| 560 | EDI Proces s Flow | ||
| 561 | 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. | ||
| 562 | 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. | ||
| 563 | 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. | ||
| 564 | 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. | ||
| 565 | 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. | ||
| 566 | Insurance Company Se t-up | ||
| 567 | 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. | ||
| 568 | Insurance Company Se tup | ||
| 569 | Activate N ew Payer t o Transmit eClaims | ||
| 570 | The typica l business process f or setting up new pa yers is: | ||
| 571 | The Insura nce Verifi cation Off ice initia lly enters a new pay er into Vi stA. | ||
| 572 | 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. | ||
| 573 | 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. | ||
| 574 | Billing st aff use Th e Insuranc e Company Editor to specify th e correct Electronic Plan Type for each Insurance Plan. | ||
| 575 | 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 IB*2*4 77 is inst alled and a claim is authorize d with mor e than one payer, a warning is displayed unless al l the Paye r IDs are on the cla im.Note: W hen Patch IB*2*576 i s installe d and a cl aim is sen t without a Payer ID and the c learing ho use return s a Payer ID in the 277Stat me ssages tha t deliver clearing h ouse claim s reports, the syste m will upd ate the Pa yer ID in the Insura nce Compan y file if the field is BLANK. Refer to the new HC CH Payer I D Report f or further detail.De fine EDI s ettings fo r a Blue C ross/Blue (BC/BS) Sh ield Insur ance Compa ny | ||
| 576 | 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 | ||
| 577 | Insurance Company In formation for: BLUE CROSS | ||
| 578 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | ||
| 579 | Bil ling Param eters | ||
| 580 | Signatur e Required ?: NO Fil ing Time F rame: | ||
| 581 | Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN | ||
| 582 | Mult. Bedsection s: Billing P hone: 800/ 933-9146 | ||
| 583 | Diff. Rev. Code s: Veri fication P hone: 800/ 933-9146 | ||
| 584 | One Opt. Visi t: NO Prec ert Comp. Name: | ||
| 585 | Amb. Sur . Rev. Cod e: Precert P hone: 800/ 274-7767 | ||
| 586 | Rx Refil l Rev. Cod e: | ||
| 587 | EDI Parame ters | ||
| 588 | Transm it?: YES-L IVE In surance Ty pe: | ||
| 589 | + Enter ?? f or more ac tions >>> | ||
| 590 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | ||
| 591 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | ||
| 592 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | ||
| 593 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | ||
| 594 | PC Prescr Claims Of RE Remarks VP View Plans | ||
| 595 | AO Appeal s Office SY Synonyms EX Exit | ||
| 596 | Select Act ion: Next Screen//BP Billing/ EDI Param | ||
| 597 | 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. | ||
| 598 | SIGNATURE REQUIRED O N BILL?: N O// | ||
| 599 | REIMBURSE? : WILL REI MBURSE// | ||
| 600 | ALLOW MULT IPLE BEDSE CTIONS: | ||
| 601 | DIFFERENT REVENUE CO DES TO USE : | ||
| 602 | ONE OPT. V ISIT ON BI LL ONLY: | ||
| 603 | AMBULATORY SURG. REV . CODE: | ||
| 604 | PRESCRIPTI ON REFILL REV. CODE: | ||
| 605 | FILING TIM E FRAME: | ||
| 606 | TYPE OF CO VERAGE: HE ALTH INSUR ANCE// | ||
| 607 | BILLING PH ONE NUMBER : 800/933- 9146// | ||
| 608 | VERIFICATI ON PHONE N UMBER: 800 /933-9146/ / | ||
| 609 | Are Precer ts Process ed by Anot her Insura nce Co.?: | ||
| 610 | PRECERTIFI CATION PHO NE NUMBER: 800/274-7 767// | ||
| 611 | EDI - Tran smit?:YES- LIVE// YES -LIVE | ||
| 612 | EDI - Inst Payer Pri mary ID: 1 2B30 | ||
| 613 | EDI - Alt Inst Payer Primary I D Type: | ||
| 614 | EDI - 1ST Inst Payer Sec. ID Q ualifier: | ||
| 615 | EDI - Prof Payer Pri mary ID: S B960 | ||
| 616 | EDI - Alt Prof Payer Primary I D Type: | ||
| 617 | EDI - 1ST Prof Payer Sec. ID Q ualifier: | ||
| 618 | EDI - Insu rance Type : GROUP PO LICY // | ||
| 619 | EDI – Prin t Sec/Tert Auto Clai ms?: | ||
| 620 | EDI – Prin t Medicare Sec Claim s w/o MRA? :YES// | ||
| 621 | EDI - Bin Number: .. .......... ......... | ||
| 622 | StepProced urePatch I B*2.0*320 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 *2.0*488 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 IB*2*371 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 B*2*371 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// | ||
| 623 | EDI - Inst Payer Pri mary ID: 1 2M61// | ||
| 624 | EDI - Alt Inst Payer Primary I D Type: | ||
| 625 | EDI - 1ST Inst Payer Sec. ID Q ualifier: | ||
| 626 | EDI - Prof Payer Pri mary ID: S MTX1// | ||
| 627 | EDI - Alt Prof Payer Primary I D Type: | ||
| 628 | EDI - 1ST Prof Payer Sec. ID Q ualifier: PAYER ID # // | ||
| 629 | EDI - 1ST Prof Payer Sec. ID: VA442// | ||
| 630 | Patch IB*2 *432 added the abili ty to defi ne whether or not th e payer wi ll accept MRA second ary claims electroni cally when the prima ry claim w as never s ent to Med icare and no MRA was ever rece ived. When the patch is loaded , this fie ld will be set to ‘0 ’ which me ans that t he claims will be tr ansmitted electronic ally unles s this fie ld is chan ged by the site. | ||
| 631 | 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 B*2*432 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 IB*2 *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 // | ||
| 632 | EDI - Bin Number: | ||
| 633 | EDI - UMO (278) ID: | ||
| 634 | EDI - Prin t Sec/Tert Auto Clai ms?: | ||
| 635 | EDI - Prin t Medicare Sec Claim s w/o MRA? : | ||
| 636 | Define EDI settings for a Blue Cross/Blu e Shield G roup Insur ance Plan | ||
| 637 | 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 | ||
| 638 | Insurance Company In formation for: BLUE CROSS | ||
| 639 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | ||
| 640 | Bil ling Param eters | ||
| 641 | Signatur e Required ?: NO Fil ing Time F rame: | ||
| 642 | Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN | ||
| 643 | Mult. Bedsection s: Billing P hone: 800/ 933-9146 | ||
| 644 | Diff. Rev. Code s: Veri fication P hone: 800/ 933-9146 | ||
| 645 | One Opt. Visi t: NO Prec ert Comp. Name: | ||
| 646 | Amb. Sur . Rev. Cod e: Precert P hone: 800/ 274-7767 | ||
| 647 | Rx Refil l Rev. Cod e: | ||
| 648 | EDI Parame ters | ||
| 649 | Transm it?: YES-L IVE I nsurance T ype: GROUP POLICY | ||
| 650 | + Enter ?? f or more ac tions >>> | ||
| 651 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | ||
| 652 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | ||
| 653 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | ||
| 654 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | ||
| 655 | PC Prescr Claims Of RE Remarks VP View Plans | ||
| 656 | AO Appeal s Office SY Synonyms EX Exit | ||
| 657 | Select Act ion: Next Screen//VP View Pla ns | ||
| 658 | 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 | ||
| 659 | All Plans for: BLUE CROSS BLUE SHIELD DE MO Insuran ce Company | ||
| 660 | # + => In div. Plan * => In active Pla n Pre- P re- Ben | ||
| 661 | Group Name Group Number Type of Plan UR ? Ct? E xC? As? | ||
| 662 | 1 DEMO F OR TRAININ G 87654 COMPREH ENSIVE NO YES Y ES YES | ||
| 663 | Enter ?? f or more ac tions | ||
| 664 | VP View/E dit Plan IP (In)Ac tivate Pla n | ||
| 665 | AB Annual Benefits EX Exit | ||
| 666 | Select Act ion: Quit/ / VP=1 | ||
| 667 | 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 | ||
| 668 | Plan Infor mation for : BLUE CRO SS Insura nce Compan y | ||
| 669 | ** Plan Cu rrently Ac tive ** | ||
| 670 | Plan Inf ormation Utiliza tion Revie w Info | ||
| 671 | Is Gro up Plan: Y ES Require U R: NO | ||
| 672 | Gro up Name: D EMO FOR TR AINING Requi re Amb Cer t: YES | ||
| 673 | Group Number: 8 7654 Requi re Pre-Cer t: YES | ||
| 674 | Type of Plan: C OMPREHENSI VE MAJOR M ED Exclu de Pre-Con d: YES | ||
| 675 | Plan Fi ling TF: Benefits Assignabl e: YES | ||
| 676 | Plan Cov erage Limi tations | ||
| 677 | Coverag e Effecti ve Date Covered? Limit Comments | ||
| 678 | ------- - ------- ------- -------- ----- --------- | ||
| 679 | INPATIE NT 02/10/0 4 YES | ||
| 680 | OUTPATI ENT 02/10/0 4 YES | ||
| 681 | PHARMAC Y 02/10/0 4 NO | ||
| 682 | + Enter ?? f or more ac tions | ||
| 683 | PI Change Plan Info IP (In)Ac tivate Pla n | ||
| 684 | UI UR Inf o AB Annual Benefits | ||
| 685 | CV Add/Ed it Coverag e CP Change Plan | ||
| 686 | PC Plan C omments EX Exit | ||
| 687 | Select Act ion: Next Screen// P I Change Plan Info | ||
| 688 | 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 IB*2 *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 IB*2*4 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. | ||
| 689 | Do you wis h to chang e this pla n to an In dividual P lan? NO | ||
| 690 | No change was made. | ||
| 691 | GROUP PLAN NAME: DEM O GROUP// | ||
| 692 | GROUP PLAN NUMBER: 7 878787878/ / | ||
| 693 | TYPE OF PL AN: COMPRE HENSIVE MA JOR MED | ||
| 694 | ELECTRONIC PLAN TYPE : ? | ||
| 695 | Enter the appropriat e type of plan to be used for electronic billing. | ||
| 696 | Choos e from: | ||
| 697 | 16 HMO MEDICARE | ||
| 698 | MX MEDI CARE A or B | ||
| 699 | TV TITL E V | ||
| 700 | MC MEDI CAID | ||
| 701 | BL BC/B S | ||
| 702 | CH TRIC ARE | ||
| 703 | 15 INDE MNITY | ||
| 704 | CI COMM ERCIAL | ||
| 705 | HM HMO | ||
| 706 | DS DISA BILITY | ||
| 707 | 12 PPO | ||
| 708 | 13 POS | ||
| 709 | ZZ OTHE R | ||
| 710 | FI FEP – Do not u se for BC/ BS | ||
| 711 | 17 DENT AL | ||
| 712 | ELECTRONIC PLAN TYPE : BL BCBS | ||
| 713 | The follow ing screen will disp lay. | ||
| 714 | View/Edit Plan Mar 31, 20 04@16:19:5 1 Page: 1 of 3 | ||
| 715 | Plan Infor mation for : BLUE CRO SS Insuran ce Company | ||
| 716 | ** Plan Cu rrently Ac tive ** | ||
| 717 | Plan Inf ormation Utiliza tion Revie w Info | ||
| 718 | Is Gro up Plan: Y ES Require U R: NO | ||
| 719 | Gro up Name: D EMO FOR TR AINING Requi re Amb Cer t: YES | ||
| 720 | Group Number: 8 7654 Requi re Pre-Cer t: YES | ||
| 721 | Type of Plan: C OMPREHENSI VE MAJOR M ED Exclu de Pre-Con d: YES | ||
| 722 | Electro nic Type: BC/BS Benef its Assign able: YES | ||
| 723 | + Enter ?? f or more ac tions | ||
| 724 | Select Act ion: Next Screen// | ||
| 725 | Activate E xisting Co mmercial P ayer to Tr ansmit eCl aims | ||
| 726 | 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. | ||
| 727 | Follow the se steps t o change t he EDI - T ransmit? F ield: | ||
| 728 | 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 | ||
| 729 | Insurance Company In formation for: AETNA | ||
| 730 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Inacti ve | ||
| 731 | Bil ling Param eters | ||
| 732 | Signatur e Required ?: NO Fil ing Time F rame: 12 M OS | ||
| 733 | Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN | ||
| 734 | Mult. Bedsection s: Billing P hone: | ||
| 735 | Diff. Rev. Code s: Veri fication P hone: | ||
| 736 | One Opt. Visi t: NO Prec ert Comp. Name: | ||
| 737 | Amb. Sur . Rev. Cod e: Precert P hone: | ||
| 738 | Rx Refil l Rev. Cod e: | ||
| 739 | EDI Parame ters | ||
| 740 | Transm it?: NO Insurance Type: | ||
| 741 | + Enter ?? f or more ac tions >>> | ||
| 742 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | ||
| 743 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | ||
| 744 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | ||
| 745 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | ||
| 746 | PC Prescr Claims Of RE Remarks VP View Plans | ||
| 747 | AO Appeal s Office SY Synonyms EX Exit | ||
| 748 | Select Act ion: Next Screen//BP Billing/E DI Param | ||
| 749 | StepProced urePatch I B*2.0*320 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* 2*516 is i nstalled, a new fiel d, HPID/OE ID, will d isplay in the EDI Pa rameters s ection. T he field w ill not be editable. The HPID or OEID n umber will come from the Natio nal Insura nce File.N ote: Patch IB*2*547 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, | ||
| 750 | EDI - Alt Inst Payer Primary I D, EDI - A lt Prof Pa yer Primar y ID Type and | ||
| 751 | 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// | ||
| 752 | REIMBURSE? : WILL REI MBURSE// | ||
| 753 | ALLOW MULT IPLE BEDSE CTIONS: YE S// | ||
| 754 | DIFFERENT REVENUE CO DES TO USE : | ||
| 755 | ONE OPT. V ISIT ON BI LL ONLY: N O// | ||
| 756 | AMBULATORY SURG. REV . CODE: | ||
| 757 | PRESCRIPTI ON REFILL REV. CODE: 253// | ||
| 758 | FILING TIM E FRAME: O NE YEAR// | ||
| 759 | TYPE OF CO VERAGE: HE ALTH INSUR ANCE// | ||
| 760 | BILLING PH ONE NUMBER : 800-555- 5298// | ||
| 761 | VERIFICATI ON PHONE N UMBER: 800 -555-5298/ / | ||
| 762 | Are Precer ts Process ed by Anot her Insura nce Co.?: NO | ||
| 763 | / / | ||
| 764 | PRECERTIFI CATION PHO NE NUMBER: XXX-XXX-X XXX// | ||
| 765 | EDI - Tran smit?: ?? | ||
| 766 | Th is is the flag that says wheth er or not an insuran ce company is ready | ||
| 767 | to be billed electroni cally via 837/EDI fu nctions. | ||
| 768 | Choos e from: | ||
| 769 | 0 NO | ||
| 770 | 1 YES- LIVE | ||
| 771 | 2 YES- TEST | ||
| 772 | EDI - Tran smit?: 1 YES-LIVE | ||
| 773 | EDI - Inst Payer Pri mary ID: | ||
| 774 | EDI - Inst Payer Pri mary ID: A vailable f rom Emdeon | ||
| 775 | EDI - Alt Inst Payer Primary I D Type: LT C// | ||
| 776 | EDI - Al t Inst Pay er Primary ID Type: LTC// | ||
| 777 | EDI - Al t Inst Pay er Primary ID: LTC12 34// | ||
| 778 | Select EDI - Alt Ins t Payer Pr imary ID T ype: | ||
| 779 | EDI - 1ST Inst Payer Sec. ID Q ualifier: | ||
| 780 | EDI - Prof Payer Pri mary ID: | ||
| 781 | EDI - Prof Payer Pri mary ID: A vailable f rom Emdeon | ||
| 782 | EDI - Alt Prof Payer Primary I D Type: LT C// | ||
| 783 | EDI - Al t Prof Pay er Primary ID Type: LTC// | ||
| 784 | EDI - Al t Prof Pay er Primary ID: LTC12 34P// | ||
| 785 | Select EDI - Alt Pro f Payer Pr imary ID T ype: | ||
| 786 | EDI - 1ST Prof Payer Sec. ID Q ualifier: | ||
| 787 | EDI – Insu rance Type : ?? | ||
| 788 | Choos e from: | ||
| 789 | 1 HMO | ||
| 790 | 2 COMM ERCIAL | ||
| 791 | 3 MEDI CARE | ||
| 792 | 4 MEDI CAID | ||
| 793 | 5 GROU P POLICY | ||
| 794 | 9 OTHE R | ||
| 795 | EDI – Insu rance Type : 5 GROUP POLICY | ||
| 796 | EDI - Bin Number: | ||
| 797 | EDI - UMO (278) ID: | ||
| 798 | EDI - Prin t Sec/Tert Auto Clai ms?: | ||
| 799 | EDI - Prin t Medicare Sec Claim s w/o MRA? : | ||
| 800 | The follow ing steps show you h ow to ente r the Elec tronic Pla n Type for a Commerc ial Group Insurance Plan: | ||
| 801 | 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 | ||
| 802 | Insurance Company In formation for: AETNA | ||
| 803 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Inacti ve | ||
| 804 | Bil ling Param eters | ||
| 805 | Signatur e Required ?: NO Fil ing Time F rame: 12 M OS | ||
| 806 | Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN | ||
| 807 | Mult. Bedsection s: Billing P hone: | ||
| 808 | Diff. Rev. Code s: Veri fication P hone: | ||
| 809 | One Opt. Visi t: NO Prec ert Comp. Name: | ||
| 810 | Amb. Sur . Rev. Cod e: Precert P hone: | ||
| 811 | Rx Refil l Rev. Cod e: | ||
| 812 | EDI Parame ters | ||
| 813 | Transm it?: YES-L IVE I nsurance T ype: GROUP POLICY | ||
| 814 | + Enter ?? f or more ac tions >>> | ||
| 815 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | ||
| 816 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | ||
| 817 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | ||
| 818 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | ||
| 819 | PC Prescr Claims Of RE Remarks VP View Plans | ||
| 820 | AO Appeal s Office SY Synonyms EX Exit | ||
| 821 | Select Act ion: Next Screen//VP View Pla ns | ||
| 822 | 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 | ||
| 823 | All Plans for: AETNA Insurance Company | ||
| 824 | # + => In div. Plan * => In active Pla n Pre- P re- Ben | ||
| 825 | Group Name Group Number Type of Plan UR ? Ct? E xC? As? | ||
| 826 | 1 MANAGE D CHOICE 55555- 111-00001 COMPREH ENSIVE YE S YES U NK YES | ||
| 827 | Enter ?? f or more ac tions | ||
| 828 | VP View/E dit Plan IP (In)Ac tivate Pla n | ||
| 829 | AB Annual Benefits EX Exit | ||
| 830 | Select Act ion: Quit/ / VP=1 | ||
| 831 | 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 | ||
| 832 | Plan Infor mation for : AETNA In surance Co mpany | ||
| 833 | ** Plan Cu rrently Ac tive ** | ||
| 834 | Plan Inf ormation Utiliza tion Revie w Info | ||
| 835 | Is Gro up Plan: Y ES Require U R: YES | ||
| 836 | Gro up Name: M ANAGED CHO ICE Requi re Amb Cer t: | ||
| 837 | Group Number: 5 5555-111-0 0001 Requi re Pre-Cer t: YES | ||
| 838 | Type of Plan: C OMPREHENSI VE MAJOR M ED Exclu de Pre-Con d: | ||
| 839 | Plan Fi ling TF: Benefits Assignabl e: YES | ||
| 840 | Plan Cov erage Limi tations | ||
| 841 | Coverag e Effecti ve Date Covered? Limit Comments | ||
| 842 | ------- - ------- ------- -------- ----- --------- | ||
| 843 | INPATIE NT 02/01/0 4 YES | ||
| 844 | OUTPATI ENT 02/01/0 4 YES | ||
| 845 | PHARMAC Y 02/01/0 4 NO | ||
| 846 | + Enter ?? f or more ac tions | ||
| 847 | PI Change Plan Info IP (In)Ac tivate Pla n | ||
| 848 | UI UR Inf o AB Annual Benefits | ||
| 849 | CV Add/Ed it Coverag e CP Change Plan | ||
| 850 | PC Plan C omments EX Exit | ||
| 851 | Select Act ion: Next Screen// P I Change Plan Info | ||
| 852 | 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. | ||
| 853 | Do you wis h to chang e this pla n to an In dividual P lan? NO | ||
| 854 | No change was made. | ||
| 855 | GROUP PLAN NAME: MAN AGED CHOIC E// | ||
| 856 | GROUP PLAN NUMBER: 5 5555-111-0 0001// | ||
| 857 | TYPE OF PL AN: COMPRE HENSIVE MA JOR MEDICA L// | ||
| 858 | ELECTRONIC PLAN TYPE : ? | ||
| 859 | Enter the appropriat e type of plan to be used for electronic billing. | ||
| 860 | Choos e from: | ||
| 861 | 16 HMO MEDICARE | ||
| 862 | MX MEDI CARE A or B | ||
| 863 | TV TITL E V | ||
| 864 | MC MEDI CAID | ||
| 865 | BL BC/B S | ||
| 866 | CH TRIC ARE | ||
| 867 | 15 INDE MNITY | ||
| 868 | CI COMM ERCIAL | ||
| 869 | HM HMO | ||
| 870 | DS DISA BILITY | ||
| 871 | 12 PPO | ||
| 872 | 13 POS | ||
| 873 | ZZ OTHE R | ||
| 874 | |||
| 875 | 17 D ental | ||
| 876 | |||
| 877 | FI F EP – Do no t use for BC/BS | ||
| 878 | ELECTRONIC PLAN TYPE : CI COMM ERCIAL | ||
| 879 | PLAN FILIN G TIME FRA ME: ..... | ||
| 880 | The follow ing screen will disp lay. | ||
| 881 | View/Edit Plan Apr 14, 20 04@09:24:0 2 Page: 1 of 3 | ||
| 882 | Plan Infor mation for : AETNA DE MO INSURAN CE Insuran ce Company | ||
| 883 | ** Plan Cu rrently Ac tive ** | ||
| 884 | Plan Inf ormation Utiliza tion Revie w Info | ||
| 885 | Is Gro up Plan: Y ES Require U R: YES | ||
| 886 | Gro up Name: M ANAGED CHO ICE Requi re Amb Cer t: | ||
| 887 | Group Number: 5 5555-111-0 0001 Requi re Pre-Cer t: YES | ||
| 888 | Type of Plan: C OMPREHENSI VE MAJOR M ED Exclu de Pre-Con d: | ||
| 889 | Electron ic Type: C OMMERCIAL Benefits Assignabl e: YES | ||
| 890 | + Enter ?? f or more ac tions | ||
| 891 | Select Act ion: Next Screen// | ||
| 892 | Activate E xisting Pa yer to Tes t Primary Blue Cross /Blue Shie ld eClaims | ||
| 893 | 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. | ||
| 894 | 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. | ||
| 895 | The follow ing steps show you h ow to chan ge the Ele ctronic Tr ansmit? fi eld: | ||
| 896 | 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 | ||
| 897 | Insurance Company In formation for: BLUE CROSS | ||
| 898 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | ||
| 899 | Bil ling Param eters | ||
| 900 | Signatur e Required ?: NO Fil ing Time F rame: | ||
| 901 | Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN | ||
| 902 | Mult. Bedsection s: Billing P hone: 800/ 933-9146 | ||
| 903 | Diff. Rev. Code s: Veri fication P hone: 800/ 933-9146 | ||
| 904 | One Opt. Visi t: NO Prec ert Comp. Name: | ||
| 905 | Amb. Sur . Rev. Cod e: Precert P hone: 800/ 274-7767 | ||
| 906 | Rx Refil l Rev. Cod e: | ||
| 907 | EDI Parame ters | ||
| 908 | Transm it?: NO Insurance Type: | ||
| 909 | + Enter ?? f or more ac tions >>> | ||
| 910 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | ||
| 911 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | ||
| 912 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | ||
| 913 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | ||
| 914 | PC Prescr Claims Of RE Remarks VP View Plans | ||
| 915 | AO Appeal s Office SY Synonyms EX Exit | ||
| 916 | Select Act ion: Next Screen//BP Billing/ EDI Param | ||
| 917 | 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// | ||
| 918 | REIMBURSE? : WILL REI MBURSE// | ||
| 919 | ALLOW MULT IPLE BEDSE CTIONS: YE S// | ||
| 920 | DIFFERENT REVENUE CO DES TO USE : | ||
| 921 | ONE OPT. V ISIT ON BI LL ONLY: N O// | ||
| 922 | AMBULATORY SURG. REV . CODE: 49 0// | ||
| 923 | PRESCRIPTI ON REFILL REV. CODE: 250// | ||
| 924 | FILING TIM E FRAME: O NE YEAR FR OM DATE OF SERVICE | ||
| 925 | TYPE OF CO VERAGE: HE ALTH INSUR ANCE// | ||
| 926 | BILLING PH ONE NUMBER : PII // | ||
| 927 | VERIFICATI ON PHONE N UMBER: ITS : PII // | ||
| 928 | Are Precer ts Process ed by Anot her Insura nce Co.?: NO | ||
| 929 | / / | ||
| 930 | PRECERTIFI CATION PHO NE NUMBER: PII // | ||
| 931 | EDI - Tran smit?: NO/ / ?? | ||
| 932 | Th is is the flag that says wheth er or not an insuran ce company is | ||
| 933 | ready to b e billed e lectronica lly via 83 7/EDI func tions. | ||
| 934 | Choos e from: | ||
| 935 | 0 NO | ||
| 936 | 1 YES- LIVE | ||
| 937 | 2 YES- TEST | ||
| 938 | EDI - Tran smit?: 1 YES-LIVE | ||
| 939 | EDI - Inst Payer Pri mary ID: A vailable f rom Emdeon | ||
| 940 | Select EDI - Alt Ins t Payer Pr imary ID T ype: | ||
| 941 | EDI - 1ST Inst Payer Sec. ID Q ualifier: | ||
| 942 | EDI - Prof Payer Pri mary ID: A vailable f rom Emdeon | ||
| 943 | Select EDI - Alt Pro f Payer Pr imary ID T ype: | ||
| 944 | EDI - 1ST Prof Payer Sec. ID Q ualifier: | ||
| 945 | EDI – Insu rance Type : 5 GROUP POLICY | ||
| 946 | EDI - Bin Number: | ||
| 947 | EDI - UMO (278) ID: | ||
| 948 | EDI - Prin t Sec/Tert Auto Clai ms?: | ||
| 949 | EDI - Prin t Medicare Sec Claim s w/o MRA? : | ||
| 950 | Pay-to Pro vider(s) S et-up | ||
| 951 | 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. | ||
| 952 | With Patch IB*2*516, sites wil l gain the ability t o define a second se t of Pay-t o Provider s to be us ed on clai ms with th e Rate Typ e of TRICA RE REIMB. or TRICARE . To defin e the 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. | ||
| 953 | IB Site Pa rameters Jun 16, 20 14@11:34:0 9 Page: 3 of 5 | ||
| 954 | Only autho rized pers ons may ed it this da ta. | ||
| 955 | + | ||
| 956 | [10]Pay-To Providers : 1 define d, default - DNS ENNE VAMC | ||
| 957 | [11]TRICAR E Pay-To P roviders: 0 defined | ||
| 958 | [12]Inpt H ealth Summ ary: INPAT IENT HEALT H SUMMARY | ||
| 959 | Opt He alth Summa ry : OUTPA TIENT HEAL TH SUMMARY | ||
| 960 | [13]HIPPA NCPDP Acti ve Flag : A ctive | ||
| 961 | [14]Inpati ent TP Act ive : YES | ||
| 962 | Outpat ient TP Ac tive: YES | ||
| 963 | Pharma cy TP Acti ve : YES | ||
| 964 | Prosth etic TP Ac tive: YES | ||
| 965 | [15] EDI/M RA Activat ed : B OTH EDI AN D MRA | ||
| 966 | EDI Contac t Phone : ( PII )
|
||
| 967 | + Enter ?? f or more ac tions | ||
| 968 | EP Edit S et EX Exit | ||
| 969 | Select Act ion: Next Screen// | ||
| 970 | Define Def ault Pay-t o Provider | ||
| 971 | StepProced ureNote: W ith Patch IB*2*516, 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 | ||
| 972 | No Pay-T o Provider s defined. | ||
| 973 | * = Defaul t Pay-to p rovider | ||
| 974 | AP Add Pr ovider DP Delete Pro vider EX Exit | ||
| 975 | EP Edit P rovider AS Associate Divisions | ||
| 976 | Select Ite m(s): Quit // AP Ad d Provider | ||
| 977 | Enter Pay- to Provide r: DNS ENNE VAMC WY M&ROC 442 | ||
| 978 | Are you ad ding ' DNS ENNE VAMC' as a new PAY-TO PRO VIDERS (th e 1ST for this IB | ||
| 979 | SITE PARAM ETERS)? No // y (Yes ) | ||
| 980 | Pay-to Pro vider Name : DNS ENNE VAMC/ / | ||
| 981 | Pay-to Pro vider Addr ess Line 1 : 2360 E P ERSHING BL VD | ||
| 982 | Replace | ||
| 983 | Pay-to Pro vider Addr ess Line 2 : Mail Sto p 10234 | ||
| 984 | Pay-to Pro vider City : DNS ENNE// | ||
| 985 | Pay-to Pro vider Stat e: WYOMING // | ||
| 986 | Pay-to Pro vider Zip Code: 8200 1-5356// | ||
| 987 | Pay-to Pro vider Phon e Number: PII | ||
| 988 | Pay-to Pro vider Fede ral Tax ID Number: 8 3-0168494/ / | ||
| 989 | The follow ing screen will disp lay. | ||
| 990 | Pay-To Pro viders D ec 22, 200 8@14:38:21 Page: 1 of 1 | ||
| 991 | 1. *Name : DNS ENNE VAMC State : WY | ||
| 992 | Add ress 1: 23 60 E PERSH ING BLVD Zip Cod e: 82001-5 356 | ||
| 993 | Add ress 2: Phone : | ||
| 994 | City : DNS ENNE Tax ID : 83-01684 94 | ||
| 995 | * = Defaul t Pay-to p rovider | ||
| 996 | AP Add Pr ovider DP Delete Pro vider EX Exit | ||
| 997 | EP Edit P rovider AS Associate Divisions | ||
| 998 | Select Ite m(s): Quit // | ||
| 999 | 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 . | ||
| 1000 | 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. | ||
| 1001 | Pay-To Pro vider Asso ciations D ec 22, 200 8@14:42:27 Page: 1 of 1 | ||
| 1002 | DNS ENNE VAMC (Default) | ||
| 1003 | 1 442GA CASPER | ||
| 1004 | 2 442GC FORT CO LLINS | ||
| 1005 | 3 442GD GREELEY | ||
| 1006 | 4 442 DNS ENNE VAMRO C | ||
| 1007 | 5 442GB SIDNEY | ||
| 1008 | 6 442GE TEST MO RC | ||
| 1009 | Enter ?? f or more ac tions | ||
| 1010 | AS Associ ate Divisi on EX Exit | ||
| 1011 | Select Ite m(s): Quit // | ||
| 1012 | Associate Divisions with non-D efault Pay -to Provid er | ||
| 1013 | 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 . | ||
| 1014 | 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 | ||
| 1015 | 1. *Name : DNS ENNE VAMC State : WY | ||
| 1016 | Add ress 1: 23 60 E PERSH ING BLVD Zip Cod e: 82001-5 356 | ||
| 1017 | Add ress 2: Phone : | ||
| 1018 | City : DNS ENNE Tax ID : 83-01684 94 | ||
| 1019 | 2. Nam e : MO NTANA HEAL TH CARE SY STEM - FT. H State : MT | ||
| 1020 | Add ress 1: VA Medical C enter Zip Cod e: 59636 | ||
| 1021 | Add ress 2: Phone : 666-666 -6666 | ||
| 1022 | Cit y : FO RT HARRISO N Tax ID : 11-1111 111 | ||
| 1023 | * = Defaul t Pay-to p rovider | ||
| 1024 | AP Add Pr ovider DP Delete Pro vider EX Exit | ||
| 1025 | EP Edit P rovider AS Associate Divisions | ||
| 1026 | Select Ite m(s): Quit // AS Asso ciate Divi sions | ||
| 1027 | The follow ing screen will disp lay. | ||
| 1028 | Pay-To Pro vider Asso ciations D ec 22, 200 8@15:32:45 Page: 1 of 1 | ||
| 1029 | DNS ENNE VAMC (Default) | ||
| 1030 | 1 442GA CASPER | ||
| 1031 | 2 442GC FORT CO LLINS | ||
| 1032 | 3 442GD GREELEY | ||
| 1033 | 4 442 DNS ENNE VAMRO C | ||
| 1034 | 5 442GB SIDNEY | ||
| 1035 | 6 442GE TEST MO RC | ||
| 1036 | MONTANA H EALTH CARE SYSTEM - FT. HARRIS ON DIVISIO N | ||
| 1037 | No Divisions found. | ||
| 1038 | Enter ?? f or more ac tions | ||
| 1039 | AS Associ ate Divisi on EX Exit | ||
| 1040 | Select Ite m(s): Quit // AS Asso ciate Divi sion | ||
| 1041 | Select Div ision (1-6 ): 5 | ||
| 1042 | Select Pay -To Provid er: Montan a | ||
| 1043 | 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. | ||
| 1044 | Pay-To Pro vider Asso ciations D ec 22, 200 8@15:34:39 Page: 1 of 1 | ||
| 1045 | DNS ENNE VAMC (Default) | ||
| 1046 | 1 442GA CASPER | ||
| 1047 | 2 442GC FORT CO LLINS | ||
| 1048 | 3 442GD GREELEY | ||
| 1049 | 4 442 DNS ENNE VAMRO C | ||
| 1050 | 5 442GE TEST MO RC | ||
| 1051 | MONTANA H EALTH CARE SYSTEM - FT. HARRIS ON DIVISIO N | ||
| 1052 | 6 442GB SIDNEY | ||
| 1053 | Enter ?? f or more ac tions | ||
| 1054 | AS Associ ate Divisi on EX Exit | ||
| 1055 | Select Ite m(s): Quit // | ||
| 1056 | Provider I D Set-up | ||
| 1057 | 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 . | ||
| 1058 | 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. | ||
| 1059 | 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. | ||
| 1060 | 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 . | ||
| 1061 | Patch IB*2 .0*343 add ed the abi lity to de fine the N PI and Tax onomy Code s for the VAMC, Non- VA facilit ies and bo th VA and Non-VA hum an provide rs. | ||
| 1062 | Patches IB *2.0*348 a nd 349 add ed the abi lity to pr int the NP I on the n ew UB-04 a nd CMS-150 0 claim fo rms. | ||
| 1063 | After Patc h IB*2*436 , old clai ms can be reprinted locally fo r legal pu rposes and sent to R egional Co unsel even though th e original claim was created p rior to th e requirem ent for pr oviders to have an a ssigned NP I. A legal claim is defined as having a Billing Ra te Type of “NO FAULT INS”, “WO RKERS’ COM P”, or “TO RT FEASOR” . | ||
| 1064 | When Patch IB*2.0*43 2 is loade d, the Soc ial Securi ty Number (SSN) will no longer be transm itted in t he 837 rec ords as a human prov iders Prim ary ID. T he NPI wil l be trans mitted in the 837 He alth Care Claim tran smission a s the Prim ary ID for both huma n provider s and orga nizational providers such as t he Billing Provider. | ||
| 1065 | 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). | ||
| 1066 | Segment Ty pe of IDMa x # of IDs (P)rint | ||
| 1067 | (T)ransmit | ||
| 1068 | (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 | ||
| 1069 | 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 . | ||
| 1070 | 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) | ||
| 1071 | 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) | ||
| 1072 | Edit an Ex isting Use r | ||
| 1073 | 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) | ||
| 1074 | 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) | ||
| 1075 | 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) | ||
| 1076 | Edit an Ex isting Use r | ||
| 1077 | 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) | ||
| 1078 | 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 VA BILLING PROVIDER (#355.93)U B-04N/ACMS -1500N/AVP E (837 Rec ord)OPR9, Piece 11No n-VA – Sup ervising P rovider NP IVistA Opt ionProvide r ID Maint enance(Non /Other VA Provider(I ndividualV istA Files IB NON VA/ OTHER BILL ING PROVID ER (#355.9 3)UB-04N/A CMS-1500N/ AVPE (837 Record)OPR 7, Piece 7 VA - Atten ding, Othe r Operatin g or Opera ting Physi cian Secon dary IDs - LegacyVis tA Option Provider I D Maintena nce( Provi der Specif ic IDs( | ||
| 1079 | Provider’s Own IDs | ||
| 1080 | 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 ( | ||
| 1081 | Provider’s Own IDs | ||
| 1082 | 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 ( | ||
| 1083 | Provider’s Own IDs | ||
| 1084 | 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( | ||
| 1085 | Provider’s Own IDs | ||
| 1086 | 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 | ||
| 1087 | Provider I D Maintena nce( Provi der Specif ic IDs( | ||
| 1088 | Provider’s Own IDs | ||
| 1089 | 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 | ||
| 1090 | Provider I D Maintena nce( Provi der Specif ic IDs( | ||
| 1091 | Provider’s Own IDs | ||
| 1092 | 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( | ||
| 1093 | Provider’s Own IDs | ||
| 1094 | 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 | ||
| 1095 | Provider I D Maintena nce( Provi der Specif ic IDs( | ||
| 1096 | Provider’s Own IDs | ||
| 1097 | 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 IB*2*400, 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 | ||
| 1098 | 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 | ||
| 1099 | Define the Pay-to Pr ovider Pri mary ID/NP I | ||
| 1100 | 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). | ||
| 1101 | Beginning with Patch IB*2*432, the Pay-t o Provider Primary I D is the N PI number of the sit e defined as the Pay -to Provid er. The F ederal Tax Number is defined w hen the Pa y-to Provi der is def ined, but will no lo nger be us ed as the Primary ID . Refer t o Section 3.1. | ||
| 1102 | Define the Pay-to Pr ovider Sec ondary IDs | ||
| 1103 | With Patch IB*2*400, the CI1B segment wa s added to the outbo und 837 cl aim transm ission map to transm it Pay-to Provider S econdary I Ds if the need shoul d arise in the futur e. The CI 1B segment was remov ed with Pa tch IB*2*4 32. | ||
| 1104 | Billing Pr ovider IDs | ||
| 1105 | 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: | ||
| 1106 | CBOC – Com munity Bas ed Outpati ent Clinic | ||
| 1107 | HCS – Heal th Care Sy stem | ||
| 1108 | M&ROC – Me dical and Regional O ffice Cent er | ||
| 1109 | OC – Outpa tient Clin ic (Indepe ndent) | ||
| 1110 | OPC – Out Patient Cl inic | ||
| 1111 | PHARM – Ph armacy | ||
| 1112 | VAMC – VA Medical Ce nter | ||
| 1113 | RO-OC – Re gional Off ice – Outp atient Cli nic | ||
| 1114 | 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. | ||
| 1115 | With Patch IB*2*432, the name for the Bi lling Prov ider on a claim is e xtracted f rom the ne w Billing Facility N ame field (#200) of the Instit ution file (#4). If this fiel d is not p opulated, the IB sof tware cont inues to e xtract the name from the .01 f ield of th e Institut ion file. | ||
| 1116 | Define the Billing P rovider Pr imary ID/N PI | ||
| 1117 | 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. | ||
| 1118 | 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. | ||
| 1119 | 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. | ||
| 1120 | 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 | ||
| 1121 | Only autho rized pers ons may ed it this da ta. | ||
| 1122 | + | ||
| 1123 | [5] Medica l Center : LOMA LINDA VAMC Defa ult Divisi on : JER RY L PETTI | ||
| 1124 | MAS Se rvice : PATIE NT ELIGIBI LITY Bill ing Superv isor : KYD FES,SHUUN | ||
| 1125 | [6] Initia tor Author ize: YES Xfer Proc to S ched : NO | ||
| 1126 | Ask HI NQ in MCCR : YES Use Non-PTF Co des : YES | ||
| 1127 | Multip le Form Ty pes: YES Use OP CPT scr een : YES | ||
| 1128 | [7] UB-04 Print IDs : YES UB-0 4 Address Col : | ||
| 1129 | CMS-15 00 Print I Ds : YES CMS- 1500 Addr Col : 28 | ||
| 1130 | [8] Defaul t RX DX Cd : 780.9 9 Defa ult ASC Re v Cd : 490 | ||
| 1131 | Defaul t RX CPT C d : Defa ult RX Rev Cd : 251 | ||
| 1132 | [9] Bill S igner Name : <No l onger used > Fede ral Tax # : | ||
| 1133 | Bill S igner Titl e : <No l onger used > | ||
| 1134 | Remark on Each B ill: BILL # MUST BE ON ALL REM ITTANCE | ||
| 1135 | + Enter ?? f or more ac tions | ||
| 1136 | EP Edit S et EX Exit Action | ||
| 1137 | Select Act ion: Next Screen// e p Edit S et | ||
| 1138 | Select Par ameter Set (s): (5-9 ): 9 | ||
| 1139 | NAME OF CL AIM FORM S IGNER: BUS INESS OFFI CE// | ||
| 1140 | TITLE OF C LAIM FORM SIGNER: | ||
| 1141 | FEDERAL TA X NUMBER: XXX123456 | ||
| 1142 | Define the Billing P rovider Se condary ID s | ||
| 1143 | 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. | ||
| 1144 | 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. | ||
| 1145 | Billing Pr ovider Sec ondary IDs can be de fined by D ivision, F orm Type, and Care U nit. | ||
| 1146 | Define Def ault Billi ng Provide r Secondar y IDs by F orm Type | ||
| 1147 | 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 IB*2*4 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 | ||
| 1148 | Insurance Co: BLUE C ROSS OF CA LIFORNIA Billing P rovider Se condary ID s | ||
| 1149 | ID Qu alifier ID # Form Type | ||
| 1150 | No Billing Provider IDs found | ||
| 1151 | Enter ?? f or more ac tions | ||
| 1152 | Add an ID Addit ional IDs Exi t | ||
| 1153 | Edit a n ID ID Pa rameters | ||
| 1154 | Delete an ID | ||
| 1155 | VA-La b/Facility IDs | ||
| 1156 | Select Act ion: Quit/ / a Add ID | ||
| 1157 | Define Bil ling Provi der Second ary IDs by Care Unit s? No//?? | ||
| 1158 | Enter N o to defin e a Billin g Provider Secondary ID | ||
| 1159 | for the Division. | ||
| 1160 | Enter Y es to defi ne a Billi ng Provide r Secondar y ID | ||
| 1161 | for a s pecific Ca re Unit. | ||
| 1162 | If no C are Unit i s entered on Billing Screen 3, the | ||
| 1163 | Billing Provider Secondary ID defined for the D ivision wi ll | ||
| 1164 | be tran smitted in the claim . | ||
| 1165 | 0 No | ||
| 1166 | 1 Yes | ||
| 1167 | Define Bil ling Provi der Second ary IDs by Care Unit s? No//No | ||
| 1168 | Division: Main Divis ion// Main Division | ||
| 1169 | ID Qualifi er: Electr onic Plan Type//Blue Shield | ||
| 1170 | Enter Form Type for ID: CMS-15 00 | ||
| 1171 | Billing Pr ovider Sec ondary ID: XXXXXX1B | ||
| 1172 | 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. | ||
| 1173 | Billing Pr ovider IDs (Parent) May 27, 2005@ 12:48:29 Pa ge: 1 o f 1 | ||
| 1174 | Insurance Co: BLUE C ROSS OF CA LIFORNIA Billing P rovider Se condary ID s | ||
| 1175 | ID Qu alifier ID # Form Type | ||
| 1176 | Division: Name of Ma in Divisio n/Default for All Di visions | ||
| 1177 | 1 Blue Cross XX XXXX1A UB04 | ||
| 1178 | 2 Blue Shield XX XXXX1B 1500 | ||
| 1179 | Enter ?? f or more ac tions | ||
| 1180 | Add an ID Addit ional IDs Exi t | ||
| 1181 | Edit a n ID ID Pa rameters | ||
| 1182 | Delete an ID | ||
| 1183 | VA-La b/Facility IDs | ||
| 1184 | Select Act ion: Quit/ / | ||
| 1185 | Define Bil ling Provi der Second ary IDs by Division and Form T ype | ||
| 1186 | 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. | ||
| 1187 | 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 | ||
| 1188 | Insurance Co: BLUE C ROSS OF CA LIFORNIA Billi ng Provide r Secondar y IDs | ||
| 1189 | ID Qu alifier ID # Form Type | ||
| 1190 | Division: Name of Ma in Divisio n/Default for All Di visions | ||
| 1191 | 1 Blue Cross XX XXXX1A UB04 | ||
| 1192 | 2 Blue Shield XX XXXX1B 1500 | ||
| 1193 | Enter ?? f or more ac tions | ||
| 1194 | Add an ID Addit ional IDs Exi t | ||
| 1195 | Edit a n ID ID Pa rameters | ||
| 1196 | Delete an ID | ||
| 1197 | VA-La b/Facility IDs | ||
| 1198 | Select Act ion: Quit/ / a Add ID | ||
| 1199 | Define Bil ling Provi der Second ary IDs by Care Unit s? No//No | ||
| 1200 | Division: Main Divis ion// Remo te Clinic | ||
| 1201 | ID Qualifi er: Electr onic Plan Type//Blue Shield | ||
| 1202 | Enter Form Type for ID: CMS-15 00 | ||
| 1203 | Billing Pr ovider Sec ondary ID: 1XXXXX1B | ||
| 1204 | The follow ing screen will disp lay. | ||
| 1205 | 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 | ||
| 1206 | Insurance Co: BLUE C ROSS OF CA LIFORNIA Billing P rovider Se condary ID s | ||
| 1207 | ID Qu alifier ID # Form Type | ||
| 1208 | Division: Name of Ma in Divisio n/Default for All Di visions | ||
| 1209 | 1 Blue Cross XX XXXX1A UB04 | ||
| 1210 | 2 Blue Shield XX XXXX1B HCFA | ||
| 1211 | Division: Remote Cli nic | ||
| 1212 | 3 Blue Cross 1X XXXX1A UB04 | ||
| 1213 | 4 Blue Shield 1X XXXX1B 1500 | ||
| 1214 | Enter ?? f or more ac tions | ||
| 1215 | Add an ID Addit ional IDs Exi t | ||
| 1216 | Edit a n ID ID Pa rameters | ||
| 1217 | Delete an ID | ||
| 1218 | VA-La b/Facility IDs | ||
| 1219 | Select Act ion: Quit/ / | ||
| 1220 | Define Bil ling Provi der Second ary IDs by Division, Form Type and Care Unit | ||
| 1221 | 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. | ||
| 1222 | 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 | ||
| 1223 | Insurance Co: BLUE C ROSS OF CA LIFORNIA Billing P rovider Se condary ID s | ||
| 1224 | ID Qu alifier ID # Form Type | ||
| 1225 | Division: Name of Ma in Divisio n/Default for All Di visions | ||
| 1226 | 1 Blue Cross XX XXXX1A UB04 | ||
| 1227 | 2 Blue Shield XX XXXX1B 1500 | ||
| 1228 | Division: Remote Cli nic | ||
| 1229 | 3 Blue Cross 1X XXXX1A UB04 | ||
| 1230 | 4 Blue Shield 1X XXXX1B 1500 | ||
| 1231 | Enter ?? f or more ac tions | ||
| 1232 | Add an ID Addit ional IDs Exi t | ||
| 1233 | Edit a n ID ID Pa rameters | ||
| 1234 | Delete an ID | ||
| 1235 | VA-La b/Facility IDs | ||
| 1236 | Select Act ion: Quit/ / a Add ID | ||
| 1237 | Define Bil ling Provi der Second ary IDs by Care Unit s? No//?? | ||
| 1238 | Enter N o to defin e a Billin g Provider Secondary ID | ||
| 1239 | for the Division. | ||
| 1240 | Enter Y es to defi ne a Billi ng Provide r Secondar y ID | ||
| 1241 | for a s pecific Ca re Unit. | ||
| 1242 | If no C are Unit i s entered on Billing Screen 3, the | ||
| 1243 | Billing Provider Secondary ID defined for the D ivision wi ll | ||
| 1244 | be tran smitted in the claim . | ||
| 1245 | 0 No | ||
| 1246 | 1 Yes | ||
| 1247 | Define Bil ling Provi der Second ary IDs by Care Unit s? No//1 Yes | ||
| 1248 | Division: Main Divis ion// Main Division | ||
| 1249 | Care Unit: ?? | ||
| 1250 | Select a Care Uni t from the list: | ||
| 1251 | |||
| 1252 | 1 Anesthes ia | ||
| 1253 | |||
| 1254 | 2 Referenc e Lab | ||
| 1255 | |||
| 1256 | 3 Home Hea lth | ||
| 1257 | Care Unit: 1 Anest hesia | ||
| 1258 | ID Qualifi er: Electr onic Plan Type//Blue Shield | ||
| 1259 | Enter Form Type for ID: CMS-15 00 | ||
| 1260 | Billing Pr ovider Sec ondary ID: 11XXXX1B | ||
| 1261 | The follow ing screen will disp lay. | ||
| 1262 | Billing Pr ovider IDs May 27, 20 05@12:48:2 9 Page: 1 of 1 | ||
| 1263 | Insurance Co: BLUE C ROSS OF CA LIFORNIA Billing P rovider Se condary ID s | ||
| 1264 | ID Qu alifier ID # Form Type | ||
| 1265 | Division: Name of Ma in Divisio n/Default for All Di visions | ||
| 1266 | 1 Blue Cross XX XXXX1A UB04 | ||
| 1267 | 2 Blue Shield XX XXXX1B 1500 | ||
| 1268 | Care Unit : Anesthes ia | ||
| 1269 | 3 Blue Cross 11 XXXX1A UB04 | ||
| 1270 | 4 Blue Shield 11 XXXX1B 1500 | ||
| 1271 | Care Unit : Referenc e Lab | ||
| 1272 | 5 Blue Cross 12 XXXX1A UB04 | ||
| 1273 | 6 Blue Shield 12 XXXX1B 1500 | ||
| 1274 | Care Unit : Home Hea lth | ||
| 1275 | 7 Blue Cross 13 XXXX1A UB04 | ||
| 1276 | 8 Blue Shield 13 XXXX1B 1500 | ||
| 1277 | + | ||
| 1278 | Enter ?? f or more ac tions | ||
| 1279 | Add an ID Addit ional IDs | ||
| 1280 | Exit | ||
| 1281 | Edit a n ID ID Pa rameters | ||
| 1282 | Delete an ID | ||
| 1283 | VA-La b/Facility IDs | ||
| 1284 | Select Act ion: Quit/ / | ||
| 1285 | 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 | ||
| 1286 | 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. | ||
| 1287 | Prior to P atch IB*2. 0*320, the IDs defin ed in IB S ite Parame ters, Sect ion 14 and Provider ID Mainten ance, Numb er 3, were transmitt ed with al l claims t o all paye rs. These options f or definin g IDs were removed w ith Patch IB*2.0*320 . | ||
| 1288 | 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. | ||
| 1289 | 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 | ||
| 1290 | Insurance Co: BLUE C ROSS OF CA LIFORNIA Additional Billing P rovider Se c. IDs | ||
| 1291 | ID Qu alifier ID # Form Type | ||
| 1292 | No Additio nal Billin g Provider IDs found | ||
| 1293 | Enter ?? f or more ac tions | ||
| 1294 | Add an ID Delete an ID Exit | ||
| 1295 | Edit a n ID Copy I Ds | ||
| 1296 | Select Act ion: Quit/ / Add an I D | ||
| 1297 | Type of ID : Medicare | ||
| 1298 | Form Type: 1500 | ||
| 1299 | Billing Pr ovider Sec ondary ID: 14XXXX1C | ||
| 1300 | The follow ing screen will disp lay. | ||
| 1301 | Billing Pr ovider IDs (Parent) May 27, 20 05@12:48:2 9 Page: 1 of 1 | ||
| 1302 | Insurance Co: BLUE C ROSS OF CA LIFORNIA Additional Billing P rovider Se c. IDs | ||
| 1303 | ID Qu alifier ID # Form Type | ||
| 1304 | Division: Name of Ma in Divisio n/Default for All Di visions | ||
| 1305 | 1 Medic are 14XXXX1 C UB04 | ||
| 1306 | 2 Medic are 14XXXX1 C 1500 | ||
| 1307 | Enter ?? f or more ac tions | ||
| 1308 | Add an ID Delete an ID Exit | ||
| 1309 | Edit a n ID Copy I Ds | ||
| 1310 | Select Act ion: Quit/ / Add an I D | ||
| 1311 | Type of ID : Medicare | ||
| 1312 | Form Type: UB-04 | ||
| 1313 | Billing Pr ovider Sec ondary ID: XXXXXXX11 | ||
| 1314 | Service Fa cility IDs (Laborato ry or Faci lity IDs) | ||
| 1315 | 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. | ||
| 1316 | 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. | ||
| 1317 | 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 . | ||
| 1318 | Patch IB*2 .0*320 pro vided enha ncements t o allow us ers to mor e easily d efine Labo ratory or Facility I Ds for the VA or non -VA. | ||
| 1319 | Beginning with Patch es IB*2.0* 348 and 34 9, the Ser vice Facil ity NPI wi ll be prin ted on loc ally print ed CMS-150 0 claims. | ||
| 1320 | Beginning with Patch IB*2.0*40 0, the Ser vice Facil ity loop w ill not be populated if the ca re was pro vided at a VA locati on that ha s an NPI s uch as a C BOC, VAMC or Pharmac y. | ||
| 1321 | The non-VA Service F acility NP I and Taxo nomy Code will be en tered and maintained by Billin g personne l. | ||
| 1322 | Define Non -VA Labora tory or Fa cility Pri mary IDs/N PI | ||
| 1323 | 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 . | ||
| 1324 | 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. | ||
| 1325 | 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 IB*2*48 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 IB*2*4 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 IB*2*371 , FA will be sent as the Type of Facilit y on all i nstitution al claims regardless of what i s defined. HIPAA on ly allows FA on inst itutional claims.16A t the Mamm ography Ce rtificatio n Number: prompt, pr ess the <E nter> key to leave i t 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 IB*2*516, 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 facility i s linked t o a human provider, then the h uman’s NPI may be us ed for bot h the huma n and the facility. The indivi dual provi der must b e defined in VistA b efore he/s he can be linked to the facili ty.18At th e Select T axonomy Co de: prompt , enter 95 4 for this example.1 9At the OK ? Prompt, press the <Enter> ke y to accep t the defa ult.20At t he Are you adding 'G eneral Acu te Care Ho spital' as a new TAX ONOMY CODE (the 1ST for this I B NON/OTHE R VA BILLI NG PROVIDE R)? No// p rompt, ent er Yes.21A t the Prim ary Code: prompt, en ter Yes fo r this exa mple.22At the Status : prompt, enter Acti ve.23At th e Select T axonomy Co de: prompt , press th e <Enter> key.Note: With Patch IB*2*432, the abili ty to defi ne the nam e of a con tact perso n at the o utside fac ility and the teleph one number for that person wil l be avail able to us ers.24At t he Allow f uture upda tes by FEE BASIS aut omatic int erface? YE S// prompt , press th e <Enter> key to acc ept the de fault. (No te: This q uestion do es not imp act curren t function ality as t his is par t of Futur e Developm ent)STREET ADDRESS: 123 Test S treet | ||
| 1326 | STREET ADD RESS LINE 2: | ||
| 1327 | CITY: DNS ENNE// Lon g Beach | ||
| 1328 | STATE: CAL IFORNIA | ||
| 1329 | ZIP CODE: 920601234/ / | ||
| 1330 | CONTACT NA ME: IB,CON TACT O// | ||
| 1331 | CONTACT PH ONE NUMBER : 703-333- 3333// | ||
| 1332 | CONTACT PH ONE EXTENS ION: 12347 8// | ||
| 1333 | ID Qualifi er: 24 - E MPLOYER'S IDENTIFICA TION # | ||
| 1334 | Lab or Fac ility Prim ary ID: 11 1111112// | ||
| 1335 | X12 TYPE O F FACILITY : FACILITY // | ||
| 1336 | MAMMOGRAPH Y CERTIFIC ATION #: | ||
| 1337 | SOLE PROPR IETORSHIP? : NO | ||
| 1338 | NPI: XXXXX XXXXX | ||
| 1339 | Select TAX ONOMY CODE : 954 Gen eral Acute Care Hosp ital 2 82N000 | ||
| 1340 | 00X | ||
| 1341 | . ..OK? Yes/ / (Yes) | ||
| 1342 | Are you adding 'Ge neral Acut e Care Hos pital' as | ||
| 1343 | a new TAXONOMY C ODE (the 1 ST for thi s IB NON/O THER VA BI LLING PROV IDER)? No/ | ||
| 1344 | / y (Yes) | ||
| 1345 | PRIMARY CODE: y Y ES | ||
| 1346 | STATUS: a ACTIVE | ||
| 1347 | Select TAX ONOMY CODE : | ||
| 1348 | The follow ing screen will disp lay. | ||
| 1349 | Non-VA Lab or Facili ty Info Jul 05, 20 126@16:04: 07 Page: 1 of 1 | ||
| 1350 | N ame: IB OU TSIDE FACI LITY | ||
| 1351 | Addr ess: 123 T est Street | ||
| 1352 | Long Beach, CAL IFORNIA 9 2060 | ||
| 1353 | Contact N ame: IB,CO NTACT O | ||
| 1354 | Contact Ph one: 703-3 33-3333 1 23478 | ||
| 1355 | Type of Facility: FACILITY | ||
| 1356 | Pr imary ID: 111111112 | ||
| 1357 | ID Q ualifier: 24 - EMPLO YER'S IDEN TIFICATION # | ||
| 1358 | Mammograp hy Certifi cation #: | ||
| 1359 | NPI: XXXXXXXXXX | ||
| 1360 | Taxon omy Code: 261QV0200X (Primary) | ||
| 1361 | Allow f uture upda tes by FEE BASIS aut omatic int erface? : YES | ||
| 1362 | Enter ?? f or more ac tions | ||
| 1363 | FI Lab/F acility In fo LI Lab/F acility In s ID | ||
| 1364 | LO Lab/F acility Ow n ID EX Exit | ||
| 1365 | Select Act ion: Quit/ / | ||
| 1366 | Define Non -VA Labora tory or Fa cility Sec ondary IDs | ||
| 1367 | 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. | ||
| 1368 | Define a n on-VA Faci lity’s Own Laborator y or Facil ity Second ary IDs | ||
| 1369 | 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 L ab/Facilit y Own ID.4 From the S econdary P rovider ID screen, e nter the a ction AI f or Add an ID.5At the Enter Pro vider ID Q ualifier p rompt, ent er X5 CLIA Number fo r this exa mple.6At t he Form Ty pe Applied to: promp t, enter C MS-1500 FO RMS ONLY f 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, 2 005@11:17: 20 Page: 1 of 1 | ||
| 1370 | ** Lab or Facility’ s Own IDs (No Specif ic Insuran ce Co) ** | ||
| 1371 | Provider: IB Outside Facility (Non-VA La b or Facil ity) | ||
| 1372 | ID Qualifi er For m Care T ype | ||
| 1373 | ID# | ||
| 1374 | No ID's f ound for p rovider | ||
| 1375 | Enter ?? f or more ac tions | ||
| 1376 | AI Add a n ID DI Delet e an ID | ||
| 1377 | EI Edit an ID EX Exit | ||
| 1378 | Select Act ion: Quit/ / AI Add a n ID | ||
| 1379 | |||
| 1380 | Select Pro vider ID Q ualifier: X5 CLIA Nu mber | ||
| 1381 | FORM TYPE APPLIED TO : CMS-1500 FORMS ONL Y | ||
| 1382 | BILL CARE TYPE: OUTP ATIENT ONL Y | ||
| 1383 | THE FOLLOW ING WAS CH OSEN: | ||
| 1384 | INSURAN CE: ALL IN SURANCE | ||
| 1385 | PROV TY PE: CLIA # | ||
| 1386 | FORM TY PE: CMS-15 00 FORM ON LY | ||
| 1387 | CARE TY PE: OUTPAT IENT ONLY | ||
| 1388 | Provider I D: DXXXXX | ||
| 1389 | The follow ing screen will disp lay. | ||
| 1390 | Secondary Provider I D May 11, 20 05@11:17:2 0 Page: 1 of 1 | ||
| 1391 | ** Lab or Facility’ s Own IDs (No Specif ic Insuran ce Co) ** | ||
| 1392 | Provider: IB Outside Facility (Non-VA La b or Facil ity) | ||
| 1393 | ID Qu alifier | ||
| 1394 | |||
| 1395 | |||
| 1396 | Form | ||
| 1397 | Care Type | ||
| 1398 | ID# | ||
| 1399 | 1 CLIA # | ||
| 1400 | |||
| 1401 | 150 0 | ||
| 1402 | OUTPT | ||
| 1403 | |||
| 1404 | DXXXXX | ||
| 1405 | Enter ?? f or more ac tions | ||
| 1406 | AI Add a n ID DI Delet e an ID | ||
| 1407 | EI Edit an ID EX Exit | ||
| 1408 | Select Act ion: Quit/ / | ||
| 1409 | Define a n on-VA Faci lity’s Lab oratory or Facility Secondary IDs Assign ed by an I nsurance C ompany | ||
| 1410 | 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 FORMS ONLY for t his exampl e.7At the Care Type: prompt, e nter BOTH for this e xample.8 A t the Ente r Lab or F acility Se condary ID prompt, e nter 111XX X1B for th is example .Note: Use rs may rep eat these steps to d efine more Laborator y or Facil ity Second ary IDs. A maximum of 5 Labor atory or F acility Se condary ID s can be d efined per insurance company. A maximum of 5 Labo ratory or Facility S econdary I Ds can be transmitte d in a cla im.Seconda ry Provide r ID May 11, 2005@11:1 7:20 Page: 1 of 1 | ||
| 1411 | ** Lab or Facility S econdary I Ds from In surance Co ** | ||
| 1412 | Provider: IB Outside Facility (Non-VA La b or Facil ity) | ||
| 1413 | Insurance Co: BLUE C ROSS OF CA LIFORNIA | ||
| 1414 | ID Qu alifier Form C are Type ID# | ||
| 1415 | No ID's found for provider a nd selecte d insuranc e co | ||
| 1416 | Enter ?? f or more ac tions | ||
| 1417 | AI Add a n ID DI Delet e an ID | ||
| 1418 | EI Edit an ID EX Exit | ||
| 1419 | Select Act ion: Quit/ / AI Add an ID | ||
| 1420 | Select Pro vider ID Q ualifier: BLUE SHIEL D ID | ||
| 1421 | FORM TYPE APPLIED TO : 1500 FOR MS ONLY | ||
| 1422 | BILL CARE TYPE: b B OTH INPATI ENT AND OU TPATIENT | ||
| 1423 | THE FOLLOW ING WAS CH OSEN: | ||
| 1424 | INSURAN CE: BLUE C ROSS OF CA LIFORNIA | ||
| 1425 | PROV TY PE: BLUE S HIELD ID | ||
| 1426 | FORM TY PE: 1500 F ORM ONLY | ||
| 1427 | CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT | ||
| 1428 | Provider I D: 111XXX1 B | ||
| 1429 | The follow ing screen will disp lay. | ||
| 1430 | Secondary Provider I D May 11, 20 05@11:17:2 0 Page: 1 of 1 | ||
| 1431 | ** Lab or Facility S econdary I Ds from In surance Co ** | ||
| 1432 | Provider: IB Outside Facility (Non-VA La b or Facil ity) | ||
| 1433 | Insurance Co: BLUE C ROSS OF CA LIFORNIA | ||
| 1434 | ID Qu alifier Form C are Type ID# | ||
| 1435 | 1 BLUE SHIELD ID 1500 I NPT/OUTPT 111XXX1B | ||
| 1436 | Enter ?? f or more ac tions | ||
| 1437 | AI Add a n ID DI Delet e an ID | ||
| 1438 | EI Edit an ID EX Exit | ||
| 1439 | Select Act ion: Quit/ / | ||
| 1440 | Define VA Laboratory or Facili ty Primary IDs/NPI | ||
| 1441 | The VA Ser vice Facil ity NPI an d Taxonomy Code will not be en tered or m aintained by Billing personnel . Beginni ng with Pa tch IB*2.0 *400, only those VA locations for which no NPI num bers were obtained, (i.e. MORC , CMOP) wi ll populat e the Serv ice Facili ty. Becau se of this , there wi ll usually be no VA Laboratory or Facili ty NPI in the 837 cl aim transm ission. | ||
| 1442 | Define VA Laboratory or Facili ty Seconda ry IDs | ||
| 1443 | 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. | ||
| 1444 | 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 | ||
| 1445 | Insurance Co.: BLUE CROSS OF C ALIFORNIA | ||
| 1446 | VA-Lab/Fac ility Prim ary ID: XX 123456 | ||
| 1447 | VA-Lab/Fac ility Seco ndary IDs | ||
| 1448 | ID Qual ifier I D # Form Type | ||
| 1449 | No Laborat ory or Fac ility IDs found | ||
| 1450 | Enter ?? f or more ac tions | ||
| 1451 | Add an ID Delete an ID | ||
| 1452 | Edit a n ID Exit | ||
| 1453 | Select Act ion: Add a n ID | ||
| 1454 | The follow ing screen will disp lay. | ||
| 1455 | VA-Lab/Fac ility IDs May 27 , 2005@12: 48:29 Page: 1 of 1 | ||
| 1456 | Insurance Co.: BLUE CROSS OF C ALIFORNIA | ||
| 1457 | VA-Lab/Fac ility Prim ary ID: Fe deral Tax ID | ||
| 1458 | VA-Lab/Fac ility Seco ndary IDs | ||
| 1459 | ID Qu alifier ID# Form Type | ||
| 1460 | Division: Name of Ma in Divisio n/Default for All Di visions | ||
| 1461 | 1 Blue Cross 1212XX1 A UB04 | ||
| 1462 | 2 Blue Shield 1212XX1 B 1500 | ||
| 1463 | Division: CBOC | ||
| 1464 | 3 Comme rcial 1313XXG 2 UB04 | ||
| 1465 | Enter ?? f or more ac tions | ||
| 1466 | Add an ID Delete an ID | ||
| 1467 | Edit a n ID Exit | ||
| 1468 | Select Act ion: Edit/ / | ||
| 1469 | Attending, Operating and Other Physician s and Rend ering, Ref erring and Supervisi ng Provide rs | ||
| 1470 | A physicia n can appe ar on a UB -04 claim form as an Attending , Operatin g or Other Operating Physician . Beginni ng with Pa tch IB*2*4 32, Render ing and Re ferring Pr oviders ca n also be added to a n Institut ional clai m. A hea lthcare pr ovider (ph ysician, n urse, phys ical thera pist, etc. ) can appe ar on a 15 00 claim f orm as a R endering, Referring or Supervi sing Provi der. | ||
| 1471 | 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 . | ||
| 1472 | 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. | ||
| 1473 | A human pr ovider’s N PI is tran smitted in the 837 H ealth Care Claim tra nsmission, and since Patches I B*2.0*348 and 349 it is printe d on local ly printed claim for ms. | ||
| 1474 | All of the se types o f healthca re provide rs can be either VA or non-VA employees. | ||
| 1475 | Define a V A Physicia n/Provider ’s Primary ID/NPI | ||
| 1476 | 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. | ||
| 1477 | Note: Beg inning wit h Patch IB *2*432, SS Ns will co ntinue to be defined in the Ne w Person f ile for VA Providers and users may conti nue to def ine SSNs a s secondar y IDs for non-VA pro viders but VistA wil l no longe r transmit SSNs as h uman provi ders’ Prim ary IDs. There will no longer be a edit check in Enter/Edit Billing I nformation to insure that a pr ovider’s S SN is avai lable.Defi ne a VA Ph ysician/Pr ovider’s S econdary I Ds | ||
| 1478 | 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. | ||
| 1479 | Define a V A Physicia n/Provider ’s Own Sec ondary IDs | ||
| 1480 | 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: | ||
| 1481 | OB – State License N umber | ||
| 1482 | EI – EIN | ||
| 1483 | SY – SSN (VA SSNs are define d in the N ew Person file) | ||
| 1484 | X5 – State Industria l Accident Provider Number | ||
| 1485 | 1G – UPIN Number | ||
| 1486 | 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 IB*2*447, 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 | ||
| 1487 | Enter a code fro m the list . | ||
| 1488 | Prov ider IDs | ||
| 1489 | PO Provid er Own IDs | ||
| 1490 | PI Provid er Insuran ce IDs | ||
| 1491 | Insu rance IDs | ||
| 1492 | BI Batch ID Entry | ||
| 1493 | II Insura nce Co IDs | ||
| 1494 | Care Units | ||
| 1495 | CP Care U nits for P roviders | ||
| 1496 | CB Care U nits for B illing Pro vider | ||
| 1497 | Non- VA Items | ||
| 1498 | NP Non-VA Provider | ||
| 1499 | NF Non-VA Facility | ||
| 1500 | Select Provider ID Mainten ance Optio n: PO Pro vider Own IDs | ||
| 1501 | (V)A or (N )on-VA pro vider: V// A PROVIDE R | ||
| 1502 | Select V.A . PROVIDER NAME:IB,D OCTOR 1 | ||
| 1503 | |||
| 1504 | 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 | ||
| 1505 | ** Phy sician/Pro vider's Ow n IDs (No Specific I nsurance C o) ** | ||
| 1506 | Provider : IB,DOC TORB (VA P ROVIDER) | ||
| 1507 | ID Qu alifier Form Care Type Ca re Unit ID# | ||
| 1508 | No ID's found for provider | ||
| 1509 | Enter ?? f or more ac tions | ||
| 1510 | AI Add a n ID DI Delet e an ID | ||
| 1511 | EI Edit an ID EX Exit | ||
| 1512 | Select Act ion: Quit/ / AI Add an ID | ||
| 1513 | Select ID Qualifier: ?? | ||
| 1514 | Choose from: | ||
| 1515 | EIN EI | ||
| 1516 | SOCIAL SECURITY N UMBER SY | ||
| 1517 | STATE I NDUSTRIAL ACCIDENT P ROV X5 | ||
| 1518 | STATE L ICENSE 0B | ||
| 1519 | UPIN 1G | ||
| 1520 | Enter the Qualifier that ident ifies the type of ID . | ||
| 1521 | Select Pro vider ID T ype: 0B S tate Licen se | ||
| 1522 | Select LIC ENSING STA TE: CALIFO RNIA | ||
| 1523 | Are you adding 'CA LIFORNIA' as a new L ICENSING S TATE (the 1ST for th is NEW PER | ||
| 1524 | SON)? No// y (Yes) | ||
| 1525 | LICENSING STATE: CAL IFORNIA// | ||
| 1526 | LICENSE NU MBER: XXXX STATE | ||
| 1527 | The follow ing screen will disp lay. | ||
| 1528 | Physician/ Provider I D Nov 02, 2005@ 10:24:46 Pa ge: 1 o f 1 | ||
| 1529 | ** Phy sician/Pro vider's Ow n IDs (No Specific I nsurance C o) ** | ||
| 1530 | Provider : IB,DOC TORB (VA P ROVIDER) | ||
| 1531 | ID Qu alifier Form Care Type Ca re Unit ID# | ||
| 1532 | 1 CA STA TE LICENSE # XXXXST ATE | ||
| 1533 | Enter ?? f or more ac tions | ||
| 1534 | AI Add a n ID DI Delet e an ID | ||
| 1535 | EI Edit an ID EX Exit | ||
| 1536 | Select Act ion: Quit/ / | ||
| 1537 | Define a V A Physicia n/Provider ’s Insuran ce Company Secondary IDs | ||
| 1538 | 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 : | ||
| 1539 | 1A - Blue Cross | ||
| 1540 | 1B - Blue Shield | ||
| 1541 | 1C - Medic are | ||
| 1542 | 1H - CHAMP US | ||
| 1543 | G2 - Comme rcial | ||
| 1544 | LU - Locat ion # | ||
| 1545 | N5 - Provi der Plan N etwork | ||
| 1546 | 1G - UPIN | ||
| 1547 | 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 | ||
| 1548 | Enter a code fro m the list . | ||
| 1549 | Prov ider IDs | ||
| 1550 | PO Provid er Own IDs | ||
| 1551 | PI Provid er Insuran ce IDs | ||
| 1552 | Insu rance IDs | ||
| 1553 | BI Batch ID Entry | ||
| 1554 | II Insura nce Co IDs | ||
| 1555 | Care Units | ||
| 1556 | CP Care U nits for P roviders | ||
| 1557 | CB Care U nits for B illing Pro vider | ||
| 1558 | Non- VA Items | ||
| 1559 | NP Non-VA Provider | ||
| 1560 | NF Non-VA Facility | ||
| 1561 | Select Provider ID Mainten ance Optio n: PI Prov ider Insur ance IDs | ||
| 1562 | (V)A or ( N)on-VA pr ovider: V/ / A PROVID ER | ||
| 1563 | Select V.A . PROVIDER NAME:IB,D OCTOR 1 | ||
| 1564 | Select INS URANCE CO: BLUE CROS S OF CALIF ORNIA | ||
| 1565 | |||
| 1566 | 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 | ||
| 1567 | ** Phy sician/Pro vider's ID s from Ins urance Co ** | ||
| 1568 | Provider : IB,DOC TORB (VA P ROVIDER) | ||
| 1569 | INSURANCE CO: BLUE C ROSS OF CA LIFORNIA ( Parent) | ||
| 1570 | ID Qu alifier Form Care Type Ca re Unit ID# | ||
| 1571 | No ID's found for provider | ||
| 1572 | Enter ?? f or more ac tions | ||
| 1573 | AI Add a n ID DI Delet e an ID | ||
| 1574 | EI Edit an ID EX Exit | ||
| 1575 | Select Act ion: Quit/ / AI Add an ID | ||
| 1576 | Select ID Qualifier: ?? | ||
| 1577 | Choose from: | ||
| 1578 | BLUE CR OSS 1A | ||
| 1579 | BLUE SH IELD 1B | ||
| 1580 | CHAMPUS 1H | ||
| 1581 | COMMERC IAL G2 | ||
| 1582 | LOCATIO N NUMBER LU | ||
| 1583 | MEDICAR E PART A 1C | ||
| 1584 | MEDICAR E PART B 1C | ||
| 1585 | PROVIDE R PLAN NET WORK N5 | ||
| 1586 | UPIN 1G | ||
| 1587 | Enter the Qualifier that ident ifies the type of ID . | ||
| 1588 | Select Pro vider ID T ype: Blue Shield | ||
| 1589 | FORM TYPE APPLIED TO : CMS-1500 FORMS ONL Y | ||
| 1590 | BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT | ||
| 1591 | Select IB PROVIDER I D CARE UNI T: Surgery | ||
| 1592 | THE FOLLOW ING WAS CH OSEN: | ||
| 1593 | INSURAN CE: BLUE C ROSS OF CA LIFORNIA | ||
| 1594 | PROV TY PE: BLUE S HIELD ID | ||
| 1595 | FORM TY PE: CMS-15 00 FORM ON LY | ||
| 1596 | CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT | ||
| 1597 | CARE UN IT: Surger y | ||
| 1598 | PROVIDER I D: XXXXBSH IELD | ||
| 1599 | The follow ing screen will disp lay. | ||
| 1600 | Physician/ Provider I D Nov 02, 2005@ 10:24:46 Pa ge: 1 o f 1 | ||
| 1601 | ** Phy sician/Pro vider's ID s from Ins urance Co ** | ||
| 1602 | Provider : IB,DOC TORB (VA P ROVIDER) | ||
| 1603 | INSURANCE CO: BLUE C ROSS OF CA LIFORNIA ( Parent) | ||
| 1604 | ID Qu alifier For m Care T ype Car e Unit ID# | ||
| 1605 | 1 BLUE SHIELD ID 150 0 INPT/O UTPT XXXXBSH IELD | ||
| 1606 | Enter ?? f or more ac tions | ||
| 1607 | AI Add a n ID DI Delet e an ID | ||
| 1608 | EI Edit an ID EX Exit | ||
| 1609 | Select Act ion: Quit/ / | ||
| 1610 | Define no n-VA Physi cian and P rovider Pr imary IDs/ NPI | ||
| 1611 | 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. | ||
| 1612 | Note: Non- VA Physici an/Provide r IDs can be defined through P rovider ID Maintenan ce through PO > Prov ider Own I DS or thr ough NP > Non- VA PR OVIDER. Define a non-VA Physician/ Provider’s NPI | ||
| 1613 | 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. | ||
| 1614 | 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 B*2*436, 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 | ||
| 1615 | Enter a code fro m the list . | ||
| 1616 | Prov ider IDs | ||
| 1617 | PO Provid er Own IDs | ||
| 1618 | PI Provid er Insuran ce IDs | ||
| 1619 | Insu rance IDs | ||
| 1620 | BI Batch ID Entry | ||
| 1621 | II Insura nce Co IDs | ||
| 1622 | Care Units | ||
| 1623 | CP Care U nits for P roviders | ||
| 1624 | CB Care U nits for B illing Pro vider | ||
| 1625 | Non- VA Items | ||
| 1626 | NP Non-VA Provider | ||
| 1627 | NF Non-VA Facility | ||
| 1628 | Select Provider ID Mainten ance Optio n: NP Non- VA Provide r | ||
| 1629 | Select a N ON-VA PROV IDER: IB,O UTSIDEPROV IND IVIDUAL | ||
| 1630 | For indivi dual type entries: T he name sh ould be en tered in | ||
| 1631 | L AST,FIRST MIDDLE for mat. | ||
| 1632 | Select a N ON-VA PROV IDER: IB,O UTSIDEPROV INDIVIDUA L | ||
| 1633 | NAME: IB,O UTSIDEPROV //: | ||
| 1634 | The follow ing screen will disp lay. | ||
| 1635 | NON-VA PRO VIDER INFO RMATION Dec 07, 20 06@12:40:5 1 Page: 1 of 1 | ||
| 1636 | N ame: IB,OU TSIDEPROV | ||
| 1637 | T ype: INDIV IDUAL PROV IDER | ||
| 1638 | Credenti als: MD | ||
| 1639 | Specia lty: 30 | ||
| 1640 | NPI: | ||
| 1641 | Taxonomy C ode: | ||
| 1642 | Enter ?? f or more ac tions | ||
| 1643 | ED Edit Demographi cs PI Provi der Ins ID | ||
| 1644 | PO Provi der Own ID EX Exit | ||
| 1645 | Select Act ion: Quit/ / | ||
| 1646 | 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 | ||
| 1647 | a new TAXONOMY C ODE (the 1 ST for thi s IB NON/O THER VA BI LLING PROV IDER)? No/ / prompt, enter Yes for this e xample.10A t the Prim ary Code: prompt, en ter Yes fo r this exa mple.11At the Status : prompt, enter Acti ve for thi s example. A provider may have more than one Taxono my Code.12 At the All ow future updates by FEE BASIS automatic interface ? YES// pr ompt, pres s t the <E nter> key to accept the defaul t.NAME: IB ,OUTSIDEPR OV// | ||
| 1648 | CREDENTIAL S: MD// | ||
| 1649 | SPECIALTY: 30// | ||
| 1650 | NPI: 00000 00006 | ||
| 1651 | Select TAX ONOMY CODE : 15 Allo pathic and Osteopath ic Physici ans 20 7RC0000X | ||
| 1652 | Internal M edicine | ||
| 1653 | Cardi ovascular Disease | ||
| 1654 | Are you adding 'Al lopathic a nd Osteopa thic Physi cians' as | ||
| 1655 | a new TAXONOMY C ODE (the 1 ST for thi s IB NON/O THER VA BI LLING PROV IDER)? No/ | ||
| 1656 | / y (Yes) | ||
| 1657 | PRIMARY CODE: y Y ES | ||
| 1658 | STATUS: a ACTIVE | ||
| 1659 | Select TAX ONOMY CODE : | ||
| 1660 | The follow ing screen will disp lay. | ||
| 1661 | NON-VA PRO VIDER INFO RMATION Jul 05, 20 126@14:49: 53 Page: 1 of 1 | ||
| 1662 | N ame: IB,OU TSIDEPROV | ||
| 1663 | T ype: INDIV IDUAL PROV IDER | ||
| 1664 | Credenti als: MD | ||
| 1665 | Specia lty: 30 | ||
| 1666 | NPI: 00000 00006 | ||
| 1667 | Taxonomy C ode: 207RC 0000X (Pri mary) | ||
| 1668 | Allow futu re updates by FEE BA SIS automa tic interf ace? : YES | ||
| 1669 | Enter ?? f or more ac tions | ||
| 1670 | ED Edit Demographi cs PI Provi der Ins ID | ||
| 1671 | PO Provi der Own ID EX Exit | ||
| 1672 | Select Act ion: Quit/ / | ||
| 1673 | Define a n on-VA Phys ician/Prov ider’s Sec ondary IDs | ||
| 1674 | Define a n on-VA Phys ician/Prov ider’s Own IDs | ||
| 1675 | Non-VA Phy sicians an d other he althcare p roviders a re assigne d IDs that identify them. Afte r Patch IB *2*432, it is not ne cessary to define th e outside provider’s SSN. The SSN will no longer serve as t he Primary ID. The Primary ID will be t he provide r’s NPI. I n addition to their provider’s SSN, they may also have one o r more of the follow ing types of seconda ry IDs: | ||
| 1676 | OB – State License N umber | ||
| 1677 | EI – EIN | ||
| 1678 | TJ – Feder al Taxpaye r’s Number | ||
| 1679 | X5 – State Industria l Accident Provider Number | ||
| 1680 | 1G – UPIN | ||
| 1681 | SY – SSN | ||
| 1682 | 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 | ||
| 1683 | Enter a code fro m the list . | ||
| 1684 | Prov ider IDs | ||
| 1685 | PO Provid er Own IDs | ||
| 1686 | PI Provid er Insuran ce IDs | ||
| 1687 | Insu rance IDs | ||
| 1688 | BI Batch ID Entry | ||
| 1689 | II Insura nce Co IDs | ||
| 1690 | Care Units | ||
| 1691 | CP Care U nits for P roviders | ||
| 1692 | CB Care U nits for B illing Pro vider | ||
| 1693 | Non- VA Items | ||
| 1694 | NP Non-VA Provider | ||
| 1695 | NF Non-VA Facility | ||
| 1696 | Select Provider ID Mainten ance Optio n: PO Prov ider Own I Ds | ||
| 1697 | (V)A or (N )on-VA pro vider: V// n NON-V A PROVIDER | ||
| 1698 | Select Non V.A. PROV IDER NAME: IB,OUTSIDE DOC | ||
| 1699 | |||
| 1700 | 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 | ||
| 1701 | ** Per forming Pr ovider's O wn IDs (No Specific Insurance Co) ** | ||
| 1702 | Provider : IB,OUT SIDEDOC (N ON-VA PROV IDER) | ||
| 1703 | ID Qu alifier Form Care Type Ca re Unit ID# | ||
| 1704 | No ID's found for provider | ||
| 1705 | Enter ?? f or more ac tions | ||
| 1706 | AI Add a n ID DI Delet e an ID | ||
| 1707 | EI Edit an ID EX Exit | ||
| 1708 | Select Act ion: Quit/ / AI Add an ID | ||
| 1709 | Select ID Qualifier: ?? | ||
| 1710 | Choose from: | ||
| 1711 | EIN EI | ||
| 1712 | SOCIAL SECURITY N UMBER SY | ||
| 1713 | STATE I NDUSTRIAL ACCIDENT P ROV X5 | ||
| 1714 | STATE L ICENSE 0B | ||
| 1715 | UPIN 1G | ||
| 1716 | Enter the Qualifier that ident ifies the type of ID . | ||
| 1717 | Select ID Qualifier: SY Social Security Number | ||
| 1718 | FORM TYPE APPLIED TO : 0 BOTH UB-04 AND CMS-1500 F ORMS | ||
| 1719 | BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT | ||
| 1720 | THE FOLLOW ING WAS CH OSEN: | ||
| 1721 | INSURAN CE: ALL IN SURANCE | ||
| 1722 | PROV TY PE: SOCIAL SECURITY NUMBER | ||
| 1723 | FORM TY PE: BOTH U B-04 & CMS -1500 FORM S | ||
| 1724 | CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT | ||
| 1725 | PROVIDER I D: XXXXX12 12 | ||
| 1726 | The follow ing screen will disp lay. | ||
| 1727 | Performing Provider ID Nov 02, 2005@1 0:24:46 Pag e: 1 of 1 | ||
| 1728 | ** Per forming Pr ovider's O wn IDs (No Specific Insurance Co) ** | ||
| 1729 | Provider : IB,OUT SIDEDOC (N ON-VA PROV IDER) | ||
| 1730 | ID Qu alifier Form Care Type Ca re Unit ID# | ||
| 1731 | 1 SOCIA L SECURITY NUMB BOT H INPT/O UTPT XXXXX12 12 | ||
| 1732 | Enter ?? f or more ac tions | ||
| 1733 | AI Add a n ID DI Delet e an ID | ||
| 1734 | EI Edit an ID EX Exit | ||
| 1735 | Select Act ion: Quit/ / | ||
| 1736 | Define a n on-VA Phys ician/Prov ider’s Ins urance Com pany Secon dary IDs | ||
| 1737 | 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: | ||
| 1738 | 1A – Blue Cross | ||
| 1739 | 1B – Blue Shield | ||
| 1740 | 1C – Medic are | ||
| 1741 | 1G – UPIN | ||
| 1742 | 1H – CHAMP US | ||
| 1743 | G2 – Comme rcial | ||
| 1744 | LU – Locat ion # | ||
| 1745 | N5 – Provi der Plan N etwork | ||
| 1746 | 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 UTSIDEDOC. Provider I D Maintena nce Main M enu | ||
| 1747 | Enter a code fro m the list . | ||
| 1748 | Prov ider IDs | ||
| 1749 | PO Provid er Own IDs | ||
| 1750 | PI Provid er Insuran ce IDs | ||
| 1751 | Insu rance IDs | ||
| 1752 | BI Batch ID Entry | ||
| 1753 | II Insura nce Co IDs | ||
| 1754 | Care Units | ||
| 1755 | CP Care U nits for P roviders | ||
| 1756 | CB Care U nits for B illing Pro vider | ||
| 1757 | Non- VA Items | ||
| 1758 | NP Non-VA Provider | ||
| 1759 | NF Non-VA Facility | ||
| 1760 | Select Provider ID Mainten ance Optio n: NP Non- VA Provide r | ||
| 1761 | (V)A or (N )on-VA pro vider: V// N Non-VA PROVIDER | ||
| 1762 | Select a N ON-VA PROV IDER: IB,O UTSIDEDOC | ||
| 1763 | |||
| 1764 | Select INS URANCE CO: BLUE CROS S OF CALIF ORNIA | ||
| 1765 | 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 | ||
| 1766 | ** Per forming Pr ovider's I Ds from In surance Co ** | ||
| 1767 | Provider : IB,OUT SIDEDOC (N on-VA PROV IDER) | ||
| 1768 | INSURANCE CO: BLUE C ROSS OF CA LIFORNIA ( Parent) | ||
| 1769 | ID Qu alifier Form Care Type Ca re Unit ID# | ||
| 1770 | No ID's found for this insur ance co. | ||
| 1771 | Enter ?? f or more ac tions | ||
| 1772 | AI Add a n ID DI Delet e an ID | ||
| 1773 | EI Edit an ID EX Exit | ||
| 1774 | Select Act ion: Quit/ / AI Add an ID | ||
| 1775 | Select ID Qualifier: ?? | ||
| 1776 | Choose from: | ||
| 1777 | BLUE CR OSS 1A | ||
| 1778 | BLUE SH IELD 1B | ||
| 1779 | CHAMPUS 1H | ||
| 1780 | COMMERC IAL G2 | ||
| 1781 | LOCATIO N NUMBER LU | ||
| 1782 | MEDICAR E PART A 1C | ||
| 1783 | MEDICAR E PART B 1C | ||
| 1784 | PROVIDE R PLAN NET WORK N5 | ||
| 1785 | UPIN 1G | ||
| 1786 | Enter the Qualifier that ident ifies the type of ID . | ||
| 1787 | Select Pro vider ID T ype: Blue Shield | ||
| 1788 | FORM TYPE APPLIED TO : CMS-1500 FORMS ONL Y | ||
| 1789 | BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT | ||
| 1790 | THE FOLLOW ING WAS CH OSEN: | ||
| 1791 | INSURAN CE: BLUE C ROSS OF CA LIFORNIA | ||
| 1792 | PROV TY PE: BLUE S HIELD ID | ||
| 1793 | FORM TY PE: CMS-15 00 FORM ON LY | ||
| 1794 | CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT | ||
| 1795 | PROVIDER I D: XXBSHIE LD | ||
| 1796 | The follow ing screen will disp lay. | ||
| 1797 | Performing Provider ID Nov 02, 2005@1 0:24:46 Pag e: 1 of 1 | ||
| 1798 | ** Per forming Pr ovider's I Ds from In surance Co ** | ||
| 1799 | Provider : IB,OUT SIDEDOC (N on-VA PROV IDER) | ||
| 1800 | INSURANCE CO: BLUE C ROSS OF CA LIFORNIA ( Parent) | ||
| 1801 | ID Qu alifier For m Care T ype Car e Unit ID# | ||
| 1802 | 1 BLUE SHIELD ID 150 0 INPT/O UTPT XXXXBSH IELD | ||
| 1803 | Enter ?? f or more ac tions | ||
| 1804 | AI Add a n ID DI Delet e an ID | ||
| 1805 | EI Edit an ID EX Exit | ||
| 1806 | Select Act ion: Quit/ / | ||
| 1807 | Define Ins urance Com pany IDs | ||
| 1808 | 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. | ||
| 1809 | There are three opti ons: | ||
| 1810 | I – Indivi dual IDs | ||
| 1811 | A – Indivi dual and D efault IDs | ||
| 1812 | D – Defaul t IDs | ||
| 1813 | 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. | ||
| 1814 | Define Def ault Physi cian/Provi der Insura nce Compan y Secondar y IDs | ||
| 1815 | 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. | ||
| 1816 | 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 | ||
| 1817 | Enter a code fro m the list . | ||
| 1818 | Prov ider IDs | ||
| 1819 | PO Provid er Own IDs | ||
| 1820 | PI Provid er Insuran ce IDs | ||
| 1821 | Insu rance IDs | ||
| 1822 | BI Batch ID Entry | ||
| 1823 | II Insura nce Co IDs | ||
| 1824 | Care Units | ||
| 1825 | CP Care U nits for P roviders | ||
| 1826 | CB Care U nits for B illing Pro vider | ||
| 1827 | Non- VA Items | ||
| 1828 | NP Non-VA Provider | ||
| 1829 | NF Non-VA Facility | ||
| 1830 | Select Provider ID Mainten ance Optio n: II Ins urance Co IDs | ||
| 1831 | Select INS URANCE COM PANY NAME: BLUE CRO SS OF CALI FORNIA PO BOX 60 007 LOS ANGE LES CA LIFORNIA Y | ||
| 1832 | SELECT DIS PLAY CONTE NT: A//D INSURANCE CO DEFAULT IDS | ||
| 1833 | 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 | ||
| 1834 | Insurance Co: BLUE C ROSS OF CA LIFORNIA ( Parent) | ||
| 1835 | PROVI DER NAME FOR M CARE T YPE CAR E UNIT ID# | ||
| 1836 | Provider I D Type: BL UE SHIELD | ||
| 1837 | 1 <<INS CO DEFAUL T>> BOT H INPT/O UTPT BSDEFAU LT | ||
| 1838 | Provider I D Type: CO MMERCIAL | ||
| 1839 | 2 <<INS CO DEFAUL T>> BOT H INPT/O UTPT COMDEFA ULT | ||
| 1840 | Provider I D Type: PR OVIDER PLA N NETWORK | ||
| 1841 | 3 <<INS CO DEFAUL T>> BOT H INPT/O UTPT NETDEFA ULT | ||
| 1842 | Provider I D Type: UP IN | ||
| 1843 | 4 <<INS CO DEFAUL T>> BOT H INPT/O UTPT UPINDEF AULT | ||
| 1844 | + Enter ?? f or more ac tions | ||
| 1845 | AI Add a n ID DP Display I ns Params VI Vie w IDs by T ype | ||
| 1846 | DI Delet e an ID CI Change In s Co CU Car e Unit Mai nt | ||
| 1847 | EI Edit an ID CD Change Di splay EX Exi t | ||
| 1848 | Select Act ion: Next Screen//AI Add an ID | ||
| 1849 | 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 | ||
| 1850 | Select Pro vider ID T ype: BLUE CROSS 1A | ||
| 1851 | FORM TYPE APPLIED TO : UB-04// UB-04 FORM S ONLY | ||
| 1852 | BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT | ||
| 1853 | THE FOLLOW ING WAS CH OSEN: | ||
| 1854 | INSURAN CE: BLUE C ROSS OF CA LIFORNIA | ||
| 1855 | PROV TY PE: BLUE C ROSS | ||
| 1856 | FORM TY PE: UB-04 FORM ONLY | ||
| 1857 | CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT | ||
| 1858 | PROVIDER I D: BCDEFAU LT | ||
| 1859 | The follow ing screen will disp lay. | ||
| 1860 | INSURANCE CO PROVIDE R ID Dec 19, 20 05@12:34:0 1 Page: 1 of 2 | ||
| 1861 | Insurance Co: BLUE C ROSS OF CA LIFORNIA ( Parent) | ||
| 1862 | PROVIDER N AME FORM C ARE TYPE CARE UNI T ID # | ||
| 1863 | Provider I D Type: BL UE CROSS | ||
| 1864 | 1 <<INS CO DEFAUL T>> UB- 04 INPT/O UTPT BCDEFAU LT | ||
| 1865 | Provider I D Type: BL UE SHIELD | ||
| 1866 | 2 <<INS CO DEFAUL T>> BOT H INPT/O UTPT DEFALLP rov | ||
| 1867 | Provider I D Type: CO MMERCIAL | ||
| 1868 | 3 <<INS CO DEFAUL T>> BOT H INPT/O UTPT COMDEFA ULT | ||
| 1869 | Provider I D Type: PR OVIDER PLA N NETWORK | ||
| 1870 | 4 <<INS CO DEFAUL T>> BOT H INPT/O UTPT NETDEFA ULT | ||
| 1871 | + Enter ?? f or more ac tions | ||
| 1872 | AI Add a n ID DP Display I ns Params VI Vie w IDs by T ype | ||
| 1873 | DI Delet e an ID CI Change In s Co CU Car e Unit Mai nt | ||
| 1874 | EI Edit an ID CD Change Di splay EX Exi t | ||
| 1875 | Select Act ion: Next Screen// | ||
| 1876 | 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 | ||
| 1877 | 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. | ||
| 1878 | 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 | ||
| 1879 | Enter a code fro m the list . | ||
| 1880 | Prov ider IDs | ||
| 1881 | PO Provid er Own IDs | ||
| 1882 | PI Provid er Insuran ce IDs | ||
| 1883 | Insu rance IDs | ||
| 1884 | BI Batch ID Entry | ||
| 1885 | II Insura nce Co IDs | ||
| 1886 | Care Units | ||
| 1887 | CP Care U nits for P roviders | ||
| 1888 | CB Care U nits for B illing Pro vider | ||
| 1889 | Non- VA Items | ||
| 1890 | NP Non-VA Provider | ||
| 1891 | NF Non-VA Facility | ||
| 1892 | Select Provider ID Mainten ance Optio n: ii Ins urance Co IDs | ||
| 1893 | Select INS URANCE COM PANY NAME: BLUE CR OSS OF CAL IFORNIA PO BOX 6 0007 LOS ANG ELES C ALIFORNIA Y | ||
| 1894 | 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// ?? | ||
| 1895 | (D) DISPLA Y CONTAINS ONLY THOS E IDS ASSI GNED AS DE FAULTS TO THE FACILI TY BY | ||
| 1896 | THE IN SURANCE CO MPANY | ||
| 1897 | (I) DISPLA Y CONTAINS ONLY THOS E IDS ASSI GNED TO IN DIVIDUAL P ROVIDERS B Y THE | ||
| 1898 | INSURA NCE COMPAN Y | ||
| 1899 | (A) DISPLA Y CONTAINS ALL IDS A SSIGNED BY THE INSUR ANCE COMPA NY FOR ONE OR ALL PR OVIDER ID TYPES | ||
| 1900 | Selec t one of t he followi ng: | ||
| 1901 | D INSURANCE CO DEFAULT IDS | ||
| 1902 | I INDIVIDUAL PROVIDER IDS FURNIS HED BY THE INS CO | ||
| 1903 | A ALL IDS FU RNISHED BY THE INS C O BY PROVI DER TYPE | ||
| 1904 | SELECT DIS PLAY CONTE NT: A// I INDIVIDUA L PROVIDER IDS FURNI SHED BY TH E INS CO | ||
| 1905 | DO YOU WAN T TO DISPL AY IDS FOR A SPECIFI C PROVIDER ?: NO// | ||
| 1906 | 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 | ||
| 1907 | Insurance Co: BLUE C ROSS OF CA LIFORNIA ( Parent) | ||
| 1908 | PERFORMI NG PROV ID MAY REQUI RE CARE UN IT | ||
| 1909 | PROVI DER ID TYP E FOR M CARE T YPE CAR E UNIT ID# | ||
| 1910 | Provider: IB,DOCTOR3 | ||
| 1911 | 1 PROVI DER PLAN N ETWOR BOT H INPT/O UTPT MDXXXXX A | ||
| 1912 | Provider: IB,DOCTOR9 | ||
| 1913 | 2 PROVI DER PLAN N ETWOR BOT H INPT/O UTPT GXXXXXA | ||
| 1914 | Provider: IB,DOCTOR1 0 | ||
| 1915 | 3 PROVI DER PLAN N ETWOR BOT H INPT/O UTPT GXXXXXX | ||
| 1916 | Provider: IB,DOCTOR7 6 | ||
| 1917 | 4 PROVI DER PLAN N ETWOR BOT H INPT/O UTPT GXXXXXX | ||
| 1918 | + Enter ?? f or more ac tions | ||
| 1919 | AI Add a n ID DP Display I ns Params VI Vie w IDs by T ype | ||
| 1920 | DI Delet e an ID CI Change In s Co CU Car e Unit Mai nt | ||
| 1921 | EI Edit an ID CD Change Di splay EX Exi t | ||
| 1922 | Select Act ion: Next Screen// A I Add an ID | ||
| 1923 | 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 | ||
| 1924 | Select Pro vider ID T ype: BLUE SHIELD 1B | ||
| 1925 | FORM TYPE APPLIED TO : CMS-1500 FORMS ONL Y | ||
| 1926 | BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT | ||
| 1927 | Select IB PROVIDER I D CARE UNI T: Surgery | ||
| 1928 | THE FOLLOW ING WAS CH OSEN: | ||
| 1929 | INSURAN CE: BLUE C ROSS OF CA LIFORNIA | ||
| 1930 | PROV TY PE: BLUE S HIELD | ||
| 1931 | FORM TY PE: CMS-15 00 FORM ON LY | ||
| 1932 | CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT | ||
| 1933 | CARE UN IT: Surger y | ||
| 1934 | PROVIDER I D: BSXXXXX | ||
| 1935 | The follow ing screen will disp lay. | ||
| 1936 | INSURANCE CO PROVIDE R ID Dec 15, 20 05@16:11:3 1 Page: 4 9 of 89 | ||
| 1937 | Insurance Co: BLUE C ROSS OF CA LIFORNIA ( Parent) | ||
| 1938 | PERFORMI NG PROV ID MAY REQUI RE CARE UN IT | ||
| 1939 | PROVI DER ID TYP E FOR M CARE T YPE CAR E UNIT ID# | ||
| 1940 | + | ||
| 1941 | Provider: IB,DOCTOR1 5 | ||
| 1942 | 194 PROVI DER PLAN N ETWOR BOT H INPT/O UTPT GXXXXX | ||
| 1943 | Provider: IB,DOCTOR5 4 | ||
| 1944 | 195 PROVI DER PLAN N ETWOR BOT H INPT/O UTPT G4XXXXX | ||
| 1945 | Provider: IB,DOCTOR7 | ||
| 1946 | 196 BLUE CROSS UB- 04 INPT/O UTPT BCXXXXX X2 | ||
| 1947 | 197 BLUE SHIELD 150 0 INPT/O UTPT Su rgery BSXXXXX | ||
| 1948 | Provider: IB,DOCTOR6 | ||
| 1949 | + Enter ?? f or more ac tions | ||
| 1950 | AI Add a n ID DP Display I ns Params VI Vie w IDs by T ype | ||
| 1951 | DI Delet e an ID CI Change In s Co CU Car e Unit Mai nt | ||
| 1952 | EI Edit an ID CD Change Di splay EX Exi t | ||
| 1953 | Select Act ion: Next Screen// | ||
| 1954 | Define eit her a Defa ult or Ind ividual Ph ysician/Pr ovider Sec ondary ID | ||
| 1955 | 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 | ||
| 1956 | Enter a code fro m the list . | ||
| 1957 | Prov ider IDs | ||
| 1958 | PO Provid er Own IDs | ||
| 1959 | PI Provid er Insuran ce IDs | ||
| 1960 | Insu rance IDs | ||
| 1961 | BI Batch ID Entry | ||
| 1962 | II Insura nce Co IDs | ||
| 1963 | Care Units | ||
| 1964 | CP Care U nits for P roviders | ||
| 1965 | CB Care U nits for B illing Pro vider | ||
| 1966 | Non- VA Items | ||
| 1967 | NP Non-VA Provider | ||
| 1968 | NF Non-VA Facility | ||
| 1969 | Select Provider ID Mainten ance Optio n: II Ins urance Co IDs | ||
| 1970 | Select INS URANCE COM PANY NAME: BLUE C ROSS OF CA LIFORNIA PO BOX 60007 | ||
| 1971 | LOS AN GELES CALIFORNIA Y | ||
| 1972 | SELECT DIS PLAY CONTE NT: A// LL IDS FURNI SHED BY TH E INS CO B Y PROVIDER TYPE | ||
| 1973 | DO YOU WAN T TO DISPL AY IDS FOR A SPECIFI C PROVIDER ID TYPE?: NO// | ||
| 1974 | 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 | ||
| 1975 | Insurance Co: BLUE C ROSS OF CA LIFORNIA ( Parent) | ||
| 1976 | PERFORMI NG PROV ID MAY REQUI RE CARE UN IT | ||
| 1977 | PROVI DER NAME FOR M CARE T YPE CAR E UNIT ID# | ||
| 1978 | Provider I D Type: BL UE CROSS | ||
| 1979 | 1 IB,DO CTOR7 UB- 04 INPT/O UTPT BCXXXXX | ||
| 1980 | Provider I D Type: BL UE SHIELD | ||
| 1981 | 2 <<INS CO DEFAUL T>> BOT H INPT/O UTPT DEFALLP rov | ||
| 1982 | 3 IB Ou tside Faci lity BOT H INPT/O UTPT BSFACXX XX | ||
| 1983 | 4 IB,DO CTOR8 BOT H INPT/O UTPT BSINDOU T | ||
| 1984 | 5 IB,DO CTOR33 BOT H INPT/O UTPT BSLIM | ||
| 1985 | 6 IB,DO CTOR7 150 0 INPT/O UTPT BSXXXXX | ||
| 1986 | Provider I D Type: PR OVIDER PLA N NETWORK | ||
| 1987 | 7 IB,DO CTOR64 BOT H INPT/O UTPT MD22356 A | ||
| 1988 | + Enter ?? f or more ac tions | ||
| 1989 | AI Add a n ID DP Display I ns Params VI Vie w IDs by T ype | ||
| 1990 | DI Delet e an ID CI Change In s Co CU Car e Unit Mai nt | ||
| 1991 | EI Edit an ID CD Change Di splay EX Exi t | ||
| 1992 | Select Act ion: Next Screen//AI Add an ID | ||
| 1993 | 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 | ||
| 1994 | Searc hing for a VA PROVID ER | ||
| 1995 | IB,DOCTO R7 1XX XX LZZ 114 RESIDEN T PHYSICIA N | ||
| 1996 | .. .OK? Yes// (Yes) | ||
| 1997 | Select Pro vider ID T ype: COMME RCIAL G2 | ||
| 1998 | FORM TYPE APPLIED TO : 0 BOTH UB-04 AND CMS-1500 F ORMS | ||
| 1999 | BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT | ||
| 2000 | THE FOLLOW ING WAS CH OSEN: | ||
| 2001 | INSURAN CE: BLUE C ROSS OF CA LIFORNIA | ||
| 2002 | PROV TY PE: COMMER CIAL | ||
| 2003 | FORM TY PE: BOTH U B-04 & CMS -1500 FORM S | ||
| 2004 | CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT | ||
| 2005 | PROVIDER I D: CMXXXXX X | ||
| 2006 | Care Units | ||
| 2007 | 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. | ||
| 2008 | 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. | ||
| 2009 | 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 . | ||
| 2010 | 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. | ||
| 2011 | 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. | ||
| 2012 | Define Car e Units fo r Physicia n/Provider Secondary IDs | ||
| 2013 | 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 | ||
| 2014 | Enter a code fro m the list . | ||
| 2015 | Prov ider IDs | ||
| 2016 | PO Provid er Own IDs | ||
| 2017 | PI Provid er Insuran ce IDs | ||
| 2018 | Insu rance IDs | ||
| 2019 | BI Batch ID Entry | ||
| 2020 | II Insura nce Co IDs | ||
| 2021 | Care Units | ||
| 2022 | CP Care U nits for P roviders | ||
| 2023 | CB Care U nits for B illing Pro vider | ||
| 2024 | Non- VA Items | ||
| 2025 | NP Non-VA Provider | ||
| 2026 | NF Non-VA Facility | ||
| 2027 | Select Provider ID Mainten ance Optio n: CP Car e Units fo r Provider s | ||
| 2028 | Select INS URANCE CO: Blue Cro ss of Cali fornia | ||
| 2029 | 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 | ||
| 2030 | Insurance Co: BLUE C ROSS OF CA LIFORNIA | ||
| 2031 | CARE U NIT NAME DESC RIPTION | ||
| 2032 | No CARE UN ITs Found for Insura nce Co | ||
| 2033 | Enter ?? f or more ac tions | ||
| 2034 | AU Add a Unit DU Delet e a Unit | ||
| 2035 | EU Edit a Unit EX Exit | ||
| 2036 | Select Act ion: Quit/ / AU Add a Unit | ||
| 2037 | SELECT CAR E UNIT FOR THE INSUR ANCE CO: S urgery | ||
| 2038 | Are you adding 'Su rgery' as a new IB P ROVIDER ID CARE UNIT ? No// y (Yes) | ||
| 2039 | IB PROV IDER ID CA RE UNIT DE SCRIPTION: Ambulator y Surgery | ||
| 2040 | ID TYPE: B LUE SHIELD | ||
| 2041 | FORM TYPE APPLIED TO : 0 BOTH UB-04 & CM S-1500 FOR MS | ||
| 2042 | BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT | ||
| 2043 | CARE UNIT: Surgery | ||
| 2044 | >> CARE UNIT COMBI NATION FIL ED FOR THE INSURANCE CO | ||
| 2045 | PRESS ENTE R TO CONTI NUE | ||
| 2046 | The follow ing screen will disp lay. | ||
| 2047 | PROVIDER I D CARE UNI TS Nov 03, 20 05@11:56:4 5 Page: 1 of 1 | ||
| 2048 | Insurance Co: BLUE C ROSS OF CA LIFORNIA | ||
| 2049 | CARE U NIT NAME DESC RIPTION | ||
| 2050 | 1 Surger y Ambu latory Sur gery | ||
| 2051 | o BLUE SHIEL D ID Both for m types I npt/Outpt | ||
| 2052 | Enter ?? f or more ac tions | ||
| 2053 | AU Add a Unit DU Delet e a Unit | ||
| 2054 | EU Edit a Unit EX Exit | ||
| 2055 | Select Act ion: Quit/ / | ||
| 2056 | 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 | ||
| 2057 | ** Provider IDs Furnis hed by Ins urance Co ** | ||
| 2058 | PROVIDER : IB,DOC TOR7 (VA P ROVIDER) | ||
| 2059 | INSURANCE CO: BLUE C ROSS OF CA LIFORNIA | ||
| 2060 | PROVI DER ID TYP E FOR M CARE T YPE CAR E UNIT ID # | ||
| 2061 | No ID's found for provider a nd selecte d insuranc e co | ||
| 2062 | Enter ?? f or more ac tions | ||
| 2063 | AU Add a Unit DU Delet e a Unit | ||
| 2064 | EU Edit a Unit EX Exit | ||
| 2065 | Select Act ion: Quit/ / AU Add a Unit | ||
| 2066 | CHOOSE 1-2 : 2 BLUE SHIELD ID | ||
| 2067 | FORM TYPE APPLIED TO : 0 BOTH UB-04 AND CMS-1500 F ORMS | ||
| 2068 | BILL CARE TYPE: 0 B OTH INPATI ENT AND OU TPATIENT | ||
| 2069 | Select IB PROVIDER I D CARE UNI T: Surgery Amb ulatory Su rgery BLUE CROSS | ||
| 2070 | OF CALIFO RNIA | ||
| 2071 | THE FOLLOW ING WAS CH OSEN: | ||
| 2072 | INSURAN CE: BLUE C ROSS OF CA LIFORNIA | ||
| 2073 | PROV TY PE: BLUE S HIELD ID | ||
| 2074 | FORM TY PE: BOTH U B-04 & CMS -1500 FORM S | ||
| 2075 | CARE TY PE: BOTH I NPATIENT A ND OUTPATI ENT | ||
| 2076 | CARE UN IT: Surger y | ||
| 2077 | PROVIDER I D: XXXXBS | ||
| 2078 | 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 *** * | ||
| 2079 | PRIMARY IN SURANCE CO : BLUE CRO SS OF CALI FORNIA | ||
| 2080 | PROVIDER: IB,DOCTOR7 (RENDERIN G) | ||
| 2081 | SELECT A S ECONDARY I D OR ACTIO N FROM THE LIST BELO W: | ||
| 2082 | 1 - N O SECONDAR Y ID NEEDE D | ||
| 2083 | 2 - A DD AN ID F OR THIS CL AIM ONLY | ||
| 2084 | 3 - X XXXBS BLUE SHIEL D ID Sur gery | ||
| 2085 | Selection: 1// | ||
| 2086 | Define Car e Units fo r Billing Provider S econdary I Ds | ||
| 2087 | 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 | ||
| 2088 | Enter a code fro m the list . | ||
| 2089 | Prov ider IDs | ||
| 2090 | PO Provid er Own IDs | ||
| 2091 | PI Provid er Insuran ce IDs | ||
| 2092 | Insu rance IDs | ||
| 2093 | BI Batch ID Entry | ||
| 2094 | II Insura nce Co IDs | ||
| 2095 | Care Units | ||
| 2096 | CP Care U nits for P roviders | ||
| 2097 | CB Care U nits for B illing Pro vider | ||
| 2098 | Non- VA Items | ||
| 2099 | NP Non-VA Provider | ||
| 2100 | NF Non-VA Facility | ||
| 2101 | Select Provider ID Mainten ance Optio n: CB Car e Units fo r Billing Provider | ||
| 2102 | Select INS URANCE CO: Blue Cros s of Calif ornia | ||
| 2103 | 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 | ||
| 2104 | Insurance Co: BLUE C ROSS OF CA LIFORNIA | ||
| 2105 | Care Unit Name Div ision D escription | ||
| 2106 | No Care Un its define d for this Insurance Co. | ||
| 2107 | Enter ?? f or more ac tions | ||
| 2108 | AU Add a Unit DU Delet e a Unit | ||
| 2109 | EU Edit a Unit EX Exit | ||
| 2110 | Select Act ion: Quit/ / AU Add a Unit | ||
| 2111 | Enter the Division f or this Ca re Unit: M ain Divisi on// | ||
| 2112 | Enter Care Unit name : Anesthes ia | ||
| 2113 | Are you adding 'An esthesia' as | ||
| 2114 | a new Care Unit for Main D ivision? N o// y (Ye s) | ||
| 2115 | Enter a Ca re Unit De scription: Free Text Descripti on | ||
| 2116 | Care Unit combinatio n filed fo r this Ins urance Co. | ||
| 2117 | The follow ing screen will disp lay. | ||
| 2118 | Care Units – Billing Provider May 27, 20 05@11:17:4 6 Page: 1 of 0 | ||
| 2119 | Insurance Co: BLUE C ROSS/BLUE SHIELD | ||
| 2120 | Care Uni t Name Desc ription | ||
| 2121 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- --------- | ||
| 2122 | Division: Main Divis ion | ||
| 2123 | Anesthes ia Free Text Desc ription | ||
| 2124 | Referenc e Lab Free Text Desc ription | ||
| 2125 | Home Hea lth | ||
| 2126 | |||
| 2127 | Free Text Desc ription | ||
| 2128 | Division: Remote Cli nic | ||
| 2129 | Referenc e Lab Free Text Desc ription | ||
| 2130 | Enter ?? f or more ac tions | ||
| 2131 | AU Add a Unit DU Delet e a Unit | ||
| 2132 | EU Edit a Unit EX Exit | ||
| 2133 | Select Act ion: Quit/ / QUIT | ||
| 2134 | ID Paramet ers by Ins urance Com pany | ||
| 2135 | 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. | ||
| 2136 | 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. | ||
| 2137 | 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 | ||
| 2138 | Insurance Company In formation for: BLUE CROSS OF C ALIFORNIA | ||
| 2139 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | ||
| 2140 | Bil ling Param eters | ||
| 2141 | Signatur e Required ?: NO Fil ing Time F rame: | ||
| 2142 | Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN | ||
| 2143 | Mult. Bedsection s: Billing P hone: 800/ 933-9146 | ||
| 2144 | Diff. Rev. Code s: Veri fication P hone: 800/ 933-9146 | ||
| 2145 | One Opt. Visi t: NO Prec ert Comp. Name: | ||
| 2146 | Amb. Sur . Rev. Cod e: Precert P hone: 800/ 274-7767 | ||
| 2147 | Rx Refil l Rev. Cod e: | ||
| 2148 | EDI Parame ters | ||
| 2149 | Transm it?: YES-L IVE Insurance Type: HMO | ||
| 2150 | + Enter ?? f or more ac tions >>> | ||
| 2151 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | ||
| 2152 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | ||
| 2153 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | ||
| 2154 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | ||
| 2155 | PC Prescr Claims Of RE Remarks VP View Plans | ||
| 2156 | AO Appeal s Office SY Synonyms EX Exit | ||
| 2157 | Action: Ne xt Screen/ / ID Prov IDs/ID Pa ram | ||
| 2158 | 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 | ||
| 2159 | Insurance Co: BLUE C ROSS OF CA LIFORNIA Billing Provider S econdary I Ds | ||
| 2160 | ID Qu alifier ID # Form Type | ||
| 2161 | Division: Name of Ma in Divisio n/Default for All Di visions | ||
| 2162 | 1 Elect ronic Plan Type XXXXXXX XX UB-04 | ||
| 2163 | 2 Elect ronic Plan Type XXXXXXX X1X 1500 | ||
| 2164 | Enter ?? f or more ac tions | ||
| 2165 | Add an ID Addit ional IDs | ||
| 2166 | |||
| 2167 | Exit | ||
| 2168 | Edit a n ID ID Pa rameters | ||
| 2169 | Delete an ID | ||
| 2170 | VA-La b/Facility IDs | ||
| 2171 | Select Act ion: Edit/ / ID Param eters | ||
| 2172 | 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 | ||
| 2173 | Insurance Co.: BLUE CROSS OF C ALIFORNIA | ||
| 2174 | Attending/ Rendering Provider S econdary I D | ||
| 2175 | Default ID (1500): B LUE SHIELD | ||
| 2176 | Default ID (UB): BLU E CROSS | ||
| 2177 | Require ID on Claim: BOTH UB-0 4 AND CMS- 1500 REQUI RED | ||
| 2178 | Referring Provider S econdary I D | ||
| 2179 | Referring Provider S econdary I D | ||
| 2180 | Default ID (1500): B LUE SHIELD | ||
| 2181 | Require ID on Claim: CMS-1500 | ||
| 2182 | Billing Pr ovider Sec ondary IDs | ||
| 2183 | Use Attend ing/Render ing ID as Billing Pr ovider Sec . ID?: NO | ||
| 2184 | Transmit n o Billing Provider S ec ID for the follow ing Electr onic Plan Types: | ||
| 2185 | Billing Pr ovider/Ser vice Facil ity | ||
| 2186 | + Enter ?? for more a ctions | ||
| 2187 | Edit P arams Edit Bill ing Prov P arams Exit | ||
| 2188 | Select Act ion: Next Screen// E dit Params | ||
| 2189 | The follow ing will d isplay. | ||
| 2190 | Attending/ Rendering Provider S econdary I D | ||
| 2191 | Default ID (1500): B LUE SHIELD // | ||
| 2192 | Default ID (UB): BLU E CROSS// | ||
| 2193 | Require ID on Claim: BOTH UB-0 4 AND CMS- 1500 REQUI RED | ||
| 2194 | / / | ||
| 2195 | Referring Provider S econdary I D | ||
| 2196 | Default ID (1500): B LUE SHIELD // | ||
| 2197 | Require ID on Claim: CMS-1500/ / | ||
| 2198 | Billing Pr ovider Sec ondary IDs | ||
| 2199 | Use Att/Re nd ID as B illing Pro vider Sec. ID (1500) ?: NO | ||
| 2200 | / / | ||
| 2201 | Use Att/Re nd ID as B illing Pro vider Sec. ID (UB)?: NO | ||
| 2202 | / / | ||
| 2203 | Billing Pr ovider/Ser vice Facil ity | ||
| 2204 | Always use main VAMC as Billin g Provider (1500)?: NO | ||
| 2205 | / / | ||
| 2206 | Always use main VAMC as Billin g Provider (UB-04)?: NO | ||
| 2207 | / / | ||
| 2208 | Define Att ending/Ren dering Pro vider Seco ndary ID P arameters | ||
| 2209 | 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 . | ||
| 2210 | A type of default se condary ID can be de fined for a CMS-1500 claim and /or a UB-0 4 claim. | ||
| 2211 | 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. | ||
| 2212 | Attending/ Rendering Provider S econdary I D | ||
| 2213 | Default ID (1500): B LUE SHIELD ID | ||
| 2214 | Default ID (UB04): B LUE CROSS ID | ||
| 2215 | Require ID on Claim: BOTH | ||
| 2216 | Define Ref erring Pro vider Seco ndary ID P arameters | ||
| 2217 | 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. | ||
| 2218 | A type of default se condary ID can be de fined for a CMS-1500 claim. | ||
| 2219 | 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. | ||
| 2220 | The defaul t type of ID for a R eferring P rovider is a UPIN; u sers can, however, o verride th is default . | ||
| 2221 | Referring Provider S econdary I D | ||
| 2222 | Default ID (1500): U PIN// BLUE SHIELD ID | ||
| 2223 | Require ID on Claim: CMS-1500 REQUIRED | ||
| 2224 | Define Bil ling Provi der Second ary ID Par ameters | ||
| 2225 | 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. | ||
| 2226 | Billing Pr ovider Sec ondary IDs | ||
| 2227 | Send Atten ding/Rende ring ID as Billing P rovider Se c. ID?: No // Yes | ||
| 2228 | 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 | ||
| 2229 | 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). | ||
| 2230 | Billing Pr ovider/Ser vice Facil ity | ||
| 2231 | Always use main VAMC as Billin g Provider (1500)?: NO// YES | ||
| 2232 | Always use main VAMC as Billin g Provider (UB-04)?: NO | ||
| 2233 | 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. | ||
| 2234 | Send VA La b/Facility IDs or Fa cility Dat a for VAMC ?: YES// | ||
| 2235 | Use the Bi lling Prov ider (VAMC ) Name and Street Ad dress?: NO // | ||
| 2236 | 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. | ||
| 2237 | 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 IB*2*400 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 | ||
| 2238 | This param eter was c hanged wit h Patch IB *2*400. 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. | ||
| 2239 | VA-Laborat ory or Fac ility IDs | ||
| 2240 | Send VA La b/Facility IDs or Fa cility Dat a?: No// | ||
| 2241 | Define No Billing Pr ovider Sec ondary IDs by Plan T ype | ||
| 2242 | 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. | ||
| 2243 | To define which plan types req uire no Bi lling Prov ider Secon dary IDs, users must enter the plan type s. | ||
| 2244 | 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 | ||
| 2245 | Insurance Co.: BLUE CROSS OF C ALIFORNIA | ||
| 2246 | Transmit N o Billing Provider S ec ID for the follow ing Electr onic Plan Types: | ||
| 2247 | 1 HMO | ||
| 2248 | Enter ?? f or more ac tions | ||
| 2249 | Add Pl an De lete Plan Exit | ||
| 2250 | Select Act ion: Add P lan | ||
| 2251 | Enter Elec tronic Pla n Type: PP O | ||
| 2252 | The follow ing screen will disp lay. | ||
| 2253 | Billing Pr ovider Par ameters May 27, 20 05@12:48:2 9 Page: 1 of 1 | ||
| 2254 | Insurance Co.: BLUE CROSS OF C ALIFORNIA | ||
| 2255 | Transmit N o Billing Provider S ec ID for the follow ing Electr onic Plan Types: | ||
| 2256 | 1 HMO | ||
| 2257 | 2 PPO | ||
| 2258 | Enter ?? f or more ac tions | ||
| 2259 | Add Pl an De lete Plan Exit | ||
| 2260 | Select Act ion: Add P lan | ||
| 2261 | View Assoc iated Insu rance Comp anies, Pro vider IDs, and ID Pa rameters | ||
| 2262 | 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. | ||
| 2263 | Patch IB*2 .0*320 add ed section s to displ ay: Associ ated Insur ance Compa nies; Prov ider IDs a nd ID Para meters. | ||
| 2264 | Insurance Company Ed itor Nov 22, 20 05@10:26:1 1 Page: 5 of 7 | ||
| 2265 | Insurance Company In formation for: BLUE CROSS OF C ALIFORNIA | ||
| 2266 | Type of Co mpany: BLU E CROSS Cu rrently Ac tive | ||
| 2267 | + | ||
| 2268 | Associate d Insuranc e Companie s | ||
| 2269 | This ins urance com pany is de fined as a Parent In surance Co mpany. | ||
| 2270 | There ar e 4 Child Insurance Companies associated with it. | ||
| 2271 | Select t he "AC As sociate Co mpanies" a ction to e nter/edit the childr en. | ||
| 2272 | Pr ovider IDs | ||
| 2273 | Billing Pr ovider Sec ondary ID | ||
| 2274 | Main Divi sion and D efault for All Divis ions/1500: | ||
| 2275 | Main Divi sion and D efault for All Divis ions/UB-04 : | ||
| 2276 | Main D ivision Ca re Units: | ||
| 2277 | Anesth esia/1500: | ||
| 2278 | Refere nce Lab/15 00: | ||
| 2279 | Refere nce Lab/UB -04: | ||
| 2280 | |||
| 2281 | Home H ealth/UB-0 4: | ||
| 2282 | 2nd Divis ion Name/1 500: | ||
| 2283 | 2nd Divis ion Name/U B-04: | ||
| 2284 | Additional Billing P rovider Se condary ID s | ||
| 2285 | Main Divi sion and D efault for All Divis ions/1500: | ||
| 2286 | 1st ID | ||
| 2287 | 2nd ID | ||
| 2288 | 3rd ID | ||
| 2289 | Maximu m of 6 add itional ID s | ||
| 2290 | Main Divi sion and D efault for All Divis ions/UB-04 : | ||
| 2291 | 1st ID | ||
| 2292 | 2nd ID | ||
| 2293 | 3rd ID | ||
| 2294 | Maximu m of 6 add itional ID s | ||
| 2295 | VA-Laborat ory or Fac ility Seco ndary IDs | ||
| 2296 | Main Divi sion and D efault for All Divis ions/1500: | ||
| 2297 | 1st ID | ||
| 2298 | 2nd ID | ||
| 2299 | 3rd ID | ||
| 2300 | Maximu m of 5 add itional ID s | ||
| 2301 | ID Parameter s | ||
| 2302 | Attending /Rendering Provider Secondary ID Qualifi er (1500): | ||
| 2303 | Attending /Rendering Provider Secondary ID Qualifi er (UB-04) : | ||
| 2304 | Attending /Rendering Secondary ID Requir ement: NON E REQUIRED | ||
| 2305 | Referring Provider Secondary ID Qualifi er (1500): | ||
| 2306 | Referring Provider Secondary ID Require ment: | ||
| 2307 | Use Atten ding/Rende ring ID as Billing P rovider Se c. ID: No | ||
| 2308 | Transmit no Billing Provider Sec. ID fo r the Elec tronic Pla n Types: | ||
| 2309 | HMO | ||
| 2310 | PPO | ||
| 2311 | Send VA L ab/Facilit y IDs or F acility Da ta: No | ||
| 2312 | Associated Insurance Companies and Copyi ng Physici an/Provide r Secondar y IDs and Additional Billing P rovider Se condary ID s | ||
| 2313 | Patch IB*2 .0*320 pro videds the ability f or users t o associat e multiple Insurance Company e ntries wit h each oth er. Examp le: If the re are 45 Blue Cross /Blue Shie ld entries in the In surance Co mpany file , users ca n make one of these entries th e Parent c ompany and make 1 to 44 of the other ent ries a Chi ld company . | ||
| 2314 | 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. | ||
| 2315 | 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 . | ||
| 2316 | 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. | ||
| 2317 | Designate a Parent I nsurance C ompany | ||
| 2318 | 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 | ||
| 2319 | Insurance Company In formation for: BLUE CROSS OF C ALIFORNIA | ||
| 2320 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Active | ||
| 2321 | Bil ling Param eters | ||
| 2322 | Signatur e Required ?: NO Fil ing Time F rame: | ||
| 2323 | Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN | ||
| 2324 | Mult. Bedsection s: Billing P hone: 800/ 933-9146 | ||
| 2325 | Diff. Rev. Code s: Veri fication P hone: 800/ 933-9146 | ||
| 2326 | One Opt. Visi t: NO Prec ert Comp. Name: | ||
| 2327 | Amb. Sur . Rev. Cod e: Precert P hone: 800/ 274-7767 | ||
| 2328 | Rx Refil l Rev. Cod e: | ||
| 2329 | EDI Parame ters | ||
| 2330 | Transm it?: YES-L IVE Insurance Type: GROU P | ||
| 2331 | + Enter ?? f or more ac tions >>> | ||
| 2332 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | ||
| 2333 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | ||
| 2334 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | ||
| 2335 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | ||
| 2336 | PC Prescr Claims Of RE Remarks VP View Plans | ||
| 2337 | AO Appeal s Office SY Synonyms EX Exit | ||
| 2338 | Select Act ion: Next Screen//AC Associate Companies | ||
| 2339 | Define Ins urance Com pany as Pa rent or Ch ild: P PA RENT | ||
| 2340 | 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 | ||
| 2341 | Parent Ins urance Com pany: | ||
| 2342 | BLUE CROSS OF C ALIFORNIA PO BOX 6 0007 LO S ANGELES, CA | ||
| 2343 | Ins C ompany Nam e Address Ci ty | ||
| 2344 | No Ch ildren Ins urance Com panies Fou nd | ||
| 2345 | Enter ?? f or more ac tions | ||
| 2346 | Assoc iate Compa nies Exit | ||
| 2347 | Disas sociate Co mpanies | ||
| 2348 | Select Act ion: Quit/ / as Ass ociate Com panies | ||
| 2349 | Select Ins urance Com pany: BLUE CROSS/BLU E SHIELD80 1 PINE ST. CHATTANO OGA,TN | ||
| 2350 | The follow ing screen will disp lay. | ||
| 2351 | Associated Insurance Co's Nov 21, 20 05@11:30:2 5 Page: 1 of 1 | ||
| 2352 | Parent Ins urance Com pany: | ||
| 2353 | BLUE CROSS OF C ALIFORNIA PO BOX 6 0007 LO S ANGELES, CA | ||
| 2354 | Ins C ompany Nam e Address Ci ty | ||
| 2355 | 1 BLUE CROSS FEP PO BOX 7 0000 VA N NUYS,CA | ||
| 2356 | 2 BLUE CROSS/BLUE SHIELD 9901 LIN N STA RD LO UISVILLE,K Y | ||
| 2357 | 3 BLUE CROSS/BLUE SHIELD 801 PINE ST. CH ATTANOOGA, TN | ||
| 2358 | Enter ?? f or more ac tions | ||
| 2359 | Assoc iate Compa nies Exit | ||
| 2360 | Disas sociate Co mpanies | ||
| 2361 | Select Act ion: Quit/ / | ||
| 2362 | Designate a Child In surance Co mpany | ||
| 2363 | 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. | ||
| 2364 | 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. | ||
| 2365 | 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 | ||
| 2366 | Insurance Company In formation for: AETNA | ||
| 2367 | Type of Co mpany: HEA LTH INSURA NCE Curren tly Inacti ve | ||
| 2368 | Bil ling Param eters | ||
| 2369 | Signatur e Required ?: NO Fil ing Time F rame: 12 M OS | ||
| 2370 | Reimburse ?: WILL RE IMBURSE Ty pe Of Cove rage: HEAL TH INSURAN | ||
| 2371 | Mult. Bedsection s: Billing P hone: | ||
| 2372 | Diff. Rev. Code s: Veri fication P hone: | ||
| 2373 | One Opt. Visi t: NO Prec ert Comp. Name: | ||
| 2374 | Amb. Sur . Rev. Cod e: Precert P hone: | ||
| 2375 | Rx Refil l Rev. Cod e: | ||
| 2376 | EDI Parame ters | ||
| 2377 | Transm it?: YES-L IVE I nsurance T ype: GROUP POLICY | ||
| 2378 | + Enter ?? f or more ac tions >>> | ||
| 2379 | BP Billin g/EDI Para m IO Inquiry Of fice EA Edit All | ||
| 2380 | MM Main M ailing Add ress AC Associate Companies AI (In) Activate C ompany | ||
| 2381 | IC Inpt C laims Offi ce ID Prov IDs/I D Param CC Chan ge Insuran ce Co. | ||
| 2382 | OC Opt Cl aims Offic e PA Payer DC Dele te Company | ||
| 2383 | PC Prescr Claims Of RE Remarks VP View Plans | ||
| 2384 | AO Appeal s Office SY Synonyms EX Exit | ||
| 2385 | Select Act ion: Next Screen// a c Associ ate Compan ies | ||
| 2386 | Define Ins urance Com pany as Pa rent or Ch ild: Child CHILD | ||
| 2387 | Associate with which Parent In surance Co mpany: Aet NA LIFE IN SURANCE 3541 W | ||
| 2388 | INCHESTER RD. ALLENTOW N PENN SYLVANIA Y.... .......... ...... | ||
| 2389 | Copy Physi cian/Provi der Second ary IDs | ||
| 2390 | 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). | ||
| 2391 | This can b e done usi ng the fol lowing Pro vider ID M aintenance options: | ||
| 2392 | Provider I D Maint(PI Provider Insurance IDs; | ||
| 2393 | Provider I D Maint(II Insuranc e Co IDs; and | ||
| 2394 | Provider I D Maint(BI Batch ID Entry | ||
| 2395 | Copy Addit ional Bill ing Provid er Seconda ry IDs | ||
| 2396 | 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. | ||
| 2397 | Synchroniz ing Associ ated Insur ance Compa ny IDs | ||
| 2398 | 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. | ||
| 2399 | Subscriber and Patie nt ID Set- Up | ||
| 2400 | 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 . | ||
| 2401 | Subscriber and Patie nt Insuran ce Provide d IDs | ||
| 2402 | 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. | ||
| 2403 | 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. | ||
| 2404 | 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. | ||
| 2405 | 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. | ||
| 2406 | Define Sub scriber Pr imary ID | ||
| 2407 | When the p atient is the subscr iber, user s will be prompted f or the Sub scriber’s Primary ID . | ||
| 2408 | 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 | ||
| 2409 | Insurance Management for Patie nt: IB,PAT IENT TWO I XXXX XX/X X/XXXX | ||
| 2410 | Insura nce Co. Type of P olicy Gr oup Holder Effect. Expires | ||
| 2411 | 1 AETNA US HEALTH COMPREHEN SIVE M 65 5555-19- SELF 03/06/07 | ||
| 2412 | 2 BLUE C ROSS CA ( PREFERRED PROVI 17 3084 SPOUSE 05/15/07 | ||
| 2413 | 3 IB INS URANCE CO COMPREHEN SIVE M XX XPLANNUM OTHER 05/16/07 | ||
| 2414 | 4 NEW YO RK LIFE MEDIGAP ( SUPPLE F OTHER 09/29/06 | ||
| 2415 | Enter ?? f or more ac tions >>> | ||
| 2416 | AP Add Po licy EA Fast Edit All CP Chan ge Patient | ||
| 2417 | VP Policy Edit/View BU Benefits U sed WP Work sheet Prin t | ||
| 2418 | DP Delete Policy VC Verify Cov erage PC Prin t Insuranc e Cov. | ||
| 2419 | AB Annual Benefits RI Personal R iders EB Expa nd Benefit s | ||
| 2420 | RX RX COB Determina tion EX Exit | ||
| 2421 | Select Ite m(s): Quit // VP Po licy Edit/ View | ||
| 2422 | Select Pol icy(s): ( 1-4): 1... .......... ...... | ||
| 2423 | The follow ing screen will disp lay. | ||
| 2424 | Patient Po licy Infor mation Sep 24, 20 07@11:20:5 4 Page: 1 of 6 | ||
| 2425 | For: IB,PA TIENT TWO XXX-XX-XX XX XX/XX /XXXX DOD: XX/ XX/XXXX | ||
| 2426 | AETNA US H EALTHCARE Insurance Company ** Plan Curre ntly Activ e ** | ||
| 2427 | Insurance Company | ||
| 2428 | Compan y: AETNA U S HEALTHCA RE | ||
| 2429 | Stree t: PO BOX 2561 | ||
| 2430 | City/Stat e: FT. WAY NE, IN 468 01 | ||
| 2431 | Billing P h: 800/367 -4552 | ||
| 2432 | Precert P h: | ||
| 2433 | Plan Inf ormation | ||
| 2434 | Is Gro up Plan: Y ES | ||
| 2435 | Gro up Name: F T JAMES CO RP | ||
| 2436 | Group Number: 6 55555-19-2 30 | ||
| 2437 | BIN: | ||
| 2438 | PCN: | ||
| 2439 | Type of Plan: C OMPREHENSI VE MAJOR M ED | ||
| 2440 | Electron ic Type: C OMMERCIAL | ||
| 2441 | Plan Fi ling TF: 2 YRS | ||
| 2442 | Utilizat ion Review Info Effective Dates & S ource | ||
| 2443 | Require UR : Effec tive Date: 03/06/07 | ||
| 2444 | + Enter ?? f or more ac tions | ||
| 2445 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | ||
| 2446 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | ||
| 2447 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | ||
| 2448 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | ||
| 2449 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | ||
| 2450 | EX Exit | ||
| 2451 | Select Act ion: Next Screen// S U Subscri ber Update | ||
| 2452 | 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* 2*371, the Whose Ins urance? pr ompt was r emoved.Wit h Patch IB *2*377, 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 IB*2 *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 IB*2* 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 | ||
| 2453 | PT. RELATI ONSHIP TO SUBSCRIBER : PATIENT | ||
| 2454 | NAME OF SU BSCRIBER: IB,PATIENT TWO// | ||
| 2455 | EFFECTIVE DATE OF PO LICY: MAR 6,2007 | ||
| 2456 | INSURANCE EXPIRATION DATE: | ||
| 2457 | PRIMARY CA RE PROVIDE R: | ||
| 2458 | PRIMARY PR OVIDER PHO NE: | ||
| 2459 | COORDINATI ON OF BENE FITS: PRIM ARY | ||
| 2460 | SOURCE OF INFORMATIO N: INTERVI EW// | ||
| 2461 | SUBSCRIBER PRIMARY I D: IDXXXXX | ||
| 2462 | Do you wan t to enter /update Su bscriber S econdary I Ds? No// NO | ||
| 2463 | SUBSCRIBER 'S DOB: XX X XX,XXXX/ / | ||
| 2464 | SUBSCRIBER 'S SEX: MA LE// | ||
| 2465 | SUBSCRIBER 'S BRANCH: NAVY// | ||
| 2466 | SUBSCRIBER 'S RANK: | ||
| 2467 | SUBSCRIBER 'S STREET 1: 123 E.T EST BLVD// | ||
| 2468 | SUBSCRIBER 'S STREET 2: | ||
| 2469 | SUBSCRIBER 'S CITY: DNS ENNE// | ||
| 2470 | SUBSCRIBER 'S STATE: WYOMING// | ||
| 2471 | SUBSCRIBER 'S ZIP: 82 001// | ||
| 2472 | Patch IB*2 *377 will provide t he ability for the N ame of the Subscribe r and the Subscriber ’s primary ID (HIC#) to be aut omatically updated i n the Pati ent’s Medi care (WNR) Insurance when an M RA is rece ived in Vi stA that c ontains a corrected name and/o r ID. The PATIENT f ile will n ot be chan ged.Define Subscribe r and Pati ent Primar y IDs | ||
| 2473 | 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 . | ||
| 2474 | 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 | ||
| 2475 | Insurance Management for Patie nt: IB,PAT IENT TWO I 4444 XX/X X/XXXX | ||
| 2476 | Insura nce Co. Type of P olicy Gr oup Holder Effect. Expires | ||
| 2477 | 1 AETNA US HEALTH COMPREHEN SIVE M 65 5555-19- SELF 03/06/07 | ||
| 2478 | 2 BLUE C ROSS CA ( PREFERRED PROVI 17 3084 SPOUSE 05/15/07 | ||
| 2479 | 3 IB INS URANCE CO COMPREHEN SIVE M XX XPLANNUM SPOUSE 05/16/07 | ||
| 2480 | 4 NEW YO RK LIFE MEDIGAP ( SUPPLE F OTHER 09/29/06 | ||
| 2481 | Enter ?? f or more ac tions >>> | ||
| 2482 | AP Add Po licy EA Fast Edit All CP Chan ge Patient | ||
| 2483 | VP Policy Edit/View BU Benefits U sed WP Work sheet Prin t | ||
| 2484 | DP Delete Policy VC Verify Cov erage PC Prin t Insuranc e Cov. | ||
| 2485 | AB Annual Benefits RI Personal R iders EX Exit | ||
| 2486 | Select Ite m(s): Quit // VP Po licy Edit/ View | ||
| 2487 | Select Pol icy(s): ( 1-4): 3... .......... ...... | ||
| 2488 | The follow ing screen will disp lay. | ||
| 2489 | Patient Po licy Infor mation Sep 24, 20 07@10:33:4 9 Page: 2 of 6 | ||
| 2490 | For: IB,PA TIENT TWO XXX-XX-XX XX XX/XX /XXXX DOD: XX/ XX/XXXX | ||
| 2491 | IB INSURAN CE CO Insu rance Comp any ** Plan Curre ntly Activ e ** | ||
| 2492 | + | ||
| 2493 | Subscrib er Informa tion Subscriber 's Employe r Informat ion | ||
| 2494 | Whose In surance: S POUSE E mp Sponsor ed Plan: N o | ||
| 2495 | Subscrib er Name: E mployer: | ||
| 2496 | Relat ionship: Employment Status: | ||
| 2497 | Pri mary ID: Retireme nt Date: | ||
| 2498 | Coord. B enefits: C laims to E mployer: N o, Send to Insurance | ||
| 2499 | Primary P rovider: Street: | ||
| 2500 | Prim Pro v Phone: Cit y/State: | ||
| 2501 | Phone: | ||
| 2502 | Insure d Person's Informati on (use Su bscriber U pdate Acti on) | ||
| 2503 | Ins ured's DOB : XX/XX/XX XX Str 1: 123 E.TEST BLVD | ||
| 2504 | + Enter ?? f or more ac tions | ||
| 2505 | PI Change Plan Info GC Group Plan Comments CP Chan ge Policy Plan | ||
| 2506 | UI UR Inf o EM Employer I nfo VC Veri fy Coverag e | ||
| 2507 | ED Effect ive Dates CV Add/Edit C overage AB Annu al Benefit s | ||
| 2508 | SU Subscr iber Updat e PT Pt Policy Comments BU Bene fits Used | ||
| 2509 | IP Inacti vate Plan EA Fast Edit All EB Expa nd Benefit s | ||
| 2510 | EX Exit | ||
| 2511 | Select Act ion: Next Screen// S U Subscri ber Update | ||
| 2512 | 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* 2*377, an expanded l ist of HIP AA complia nt codes f or Pt. Rel ationship to Insured , was adde d.With Pat ch IB*2*37 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 B*2*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 | ||
| 2513 | PT. RELATI ONSHIP TO SUBSCRIBER : SPOUSE// | ||
| 2514 | NAME OF SU BSCRIBER: IB,SPOUSE TWO | ||
| 2515 | EFFECTIVE DATE OF PO LICY: MAY 15,2007 | ||
| 2516 | INSURANCE EXPIRATION DATE: | ||
| 2517 | PRIMARY CA RE PROVIDE R: | ||
| 2518 | PRIMARY PR OVIDER PHO NE: | ||
| 2519 | COORDINATI ON OF BENE FITS: SECO NDARY | ||
| 2520 | SOURCE OF INFORMATIO N: INTERVI EW// | ||
| 2521 | SUBSCRIBER PRIMARY I D: XXXXXID | ||
| 2522 | Do you wan t to enter /update Su bscriber S econdary I Ds? No// NO | ||
| 2523 | PATIENT PR IMARY ID: XXXXXID2 | ||
| 2524 | Do you wan t to enter /update Pa tient Seco ndary IDs? No// NO | ||
| 2525 | SUBSCRIBER 'S DOB: AU G 12,1945 | ||
| 2526 | SUBSCRIBER 'S SEX: FE MALE | ||
| 2527 | SUBSCRIBER 'S BRANCH: | ||
| 2528 | SUBSCRIBER 'S RANK: | ||
| 2529 | SUBSCRIBER 'S STREET 1: 123 E.T EST BLVD// | ||
| 2530 | SUBSCRIBER 'S STREET 2: | ||
| 2531 | SUBSCRIBER 'S CITY: DNS ENNE// | ||
| 2532 | SUBSCRIBER 'S STATE: WYOMING// | ||
| 2533 | SUBSCRIBER 'S ZIP: 82 001// | ||
| 2534 | Define Sub scriber an d Patient Secondary IDs | ||
| 2535 | 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: | ||
| 2536 | 23 C lient Numb er | ||
| 2537 | IG I nsurance P olicy Numb er | ||
| 2538 | SY S ocial Secu rity Numbe r | ||
| 2539 | SUBSCRIBER PRIMARY I D: XXXXXID // | ||
| 2540 | Do you wan t to enter /update Su bscriber S econdary I Ds? No// y YES | ||
| 2541 | SUBSCRIBER 'S SEC QUA LIFIER(1): ?? | ||
| 2542 | Enter a Qualifi er to iden tify the t ype of ID number. | ||
| 2543 | Choos e from: | ||
| 2544 | 23 Clie nt Number | ||
| 2545 | IG Insu rance Poli cy Number | ||
| 2546 | SY Soci al Securit y Number | ||
| 2547 | SUBSCRIBER 'S SEC QUA LIFIER(1): IG Insur ance Polic y Number | ||
| 2548 | SUBSCRIBER 'S SEC ID( 1): XXXXID 2 | ||
| 2549 | SUBSCRIBER 'S SEC QUA LIFIER(2): | ||
| 2550 | PATIENT PR IMARY ID: IDXXXXX// | ||
| 2551 | Do you wan t to enter /update Pa tient Seco ndary IDs? No// y Y ES | ||
| 2552 | PATIENT'S SEC QUALIF IER(1): IG Insuranc e Policy N umber | ||
| 2553 | PATIENT'S SECONDARY ID(1): ID2 XXXX | ||
| 2554 | PATIENT'S SEC QUALIF IER(2): | ||
| 2555 | 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 | ||
| 2556 | 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. | ||
| 2557 | Summary of Enter/Edi t Billing Informatio n to Suppo rt ASC X12 N/5010 | ||
| 2558 | There have been nume rous chang es with Pa tch IB*2*4 47 to the Enter/Edit Billing I nformation option to support c hanges in the Health Care Clai m (837) Te chnical Re ports (ASC X12N/ 501 0) for bot h Institut ional and Profession al claims. | ||
| 2559 | 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 IB*2* 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 B*2*432 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 | ||
| 2560 | Patch IB*2 *447 | ||
| 2561 | The follow ing change s are in P atch IB*2* 447 not co vered else where in t his docume nt. | ||
| 2562 | Enter/Edit Billing I nformation | ||
| 2563 | 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 . | ||
| 2564 | 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) . | ||
| 2565 | 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. | ||
| 2566 | MEDIGAP C alculation s | ||
| 2567 | This optio n is curre ntly not a vailable a nd can be turned on at a futur e time. | ||
| 2568 | 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 | ||
| 2569 | MEDIGAP A (COINS, NO DED, NO B EXC) | ||
| 2570 | MEDIGAP B (COINS, A DED, NO B DED, NO B EXC) | ||
| 2571 | MEDIGAP C (COINS, A/ B DED,NO B EXC) | ||
| 2572 | MEDIGAP D (COINS, A DED, NO B DED, NO B EXC) | ||
| 2573 | MEDIGAP F (COINS, DE D, NO B EX C) | ||
| 2574 | MEDIGAP G (COINS, A DED, NO B DED, NO B EXC,) | ||
| 2575 | MEDIGAP K (A COINS, 50% B COIN S, 50% A D ED, NO B D ED, NO B E XC) | ||
| 2576 | MEDIGAP L (A COINS, 75% B COIN S, 75% A D ED, NO B D ED, NO B E XC) | ||
| 2577 | MEDIGAP M (COINS, 50 % A DED, N O B DED, N O B EXC) | ||
| 2578 | MEDIGAP N (COINS, A DED, NO B DED, NO B EXC) | ||
| 2579 | 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: | ||
| 2580 | Medicare S econdary ( COINS, DED , No B EXC ) | ||
| 2581 | Medicare S econdary ( COINS, DED , B EXC) | ||
| 2582 | 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) | ||
| 2583 | 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: | ||
| 2584 | CARVE-OUT (COINS, DE D, B EXC) | ||
| 2585 | COMPREHENS IVE (COINS , DED, B E XC) | ||
| 2586 | MEDICAL EX PENSE (OPT /PROF) (CO INS, DED, B EXC) | ||
| 2587 | MENTAL HEA LTH (COINS , DED, B E XC) | ||
| 2588 | POINT OF S ERVICE (CO INS, DED, B EXC) | ||
| 2589 | PREFERRED PROVIDER O RGANIZATIO N (PPO) (C OINS, DED, B EXC) | ||
| 2590 | RETIREE (C OINS, DED, B EXC) | ||
| 2591 | SURGICAL E XPENSE INS URANCE (CO INS, DED, B EXC) | ||
| 2592 | 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: | ||
| 2593 | Remove the procedure that gene rated the Revenue Co de and mon etary valu e; | ||
| 2594 | Execute th e Rate Sch edule reca lculation of charges function; | ||
| 2595 | Change the division associated with the procedure; | ||
| 2596 | Change the Charge Ty pe; | ||
| 2597 | Change the division associated with the claim. | ||
| 2598 | 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). | ||
| 2599 | 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. | ||
| 2600 | 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: | ||
| 2601 | Patient’s Weight Qua lifier = L B | ||
| 2602 | Patient’s Weight | ||
| 2603 | Transport Reason Cod e | ||
| 2604 | Transport Distance Q ualifier = DH | ||
| 2605 | Transport Distance | ||
| 2606 | Round Trip Purpose D escription (Free Tex t) | ||
| 2607 | Stretcher Purpose De scription (Free Text ) | ||
| 2608 | 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: | ||
| 2609 | Code Categ ory – 07 | ||
| 2610 | Certificat ion Condit ion Indica tor – YES | ||
| 2611 | Condition Codes (1-5 codes) | ||
| 2612 | Patch IB*2 *488: | ||
| 2613 | Patch IB*2 *488 inclu des the fo llowing ch anges not covered el sewhere in this docu ment. | ||
| 2614 | Enter/Edit Billing I nformation | ||
| 2615 | 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) | ||
| 2616 | MRA Manage ment Workl ist (MRW) | ||
| 2617 | Patch IB*2 *488 modif ied the wa y message storage er rors (crea ted when a n EEOB or MRA is rec eived and all the li ne items c annot be m atched cor rectly) ar e displaye d in TPJI. Internal code will no longer be displa yed to the users. I n addition to the ch anges in T PJI, simil ar changes exist in MRW for Me dicare cla ims. | ||
| 2618 | The Follow ing types of errors will be di splayed: | ||
| 2619 | Procedure Code misma tch | ||
| 2620 | Procedure Modifier m ismatch | ||
| 2621 | Revenue Co de mismatc h | ||
| 2622 | Charge Amo unt mismat ch | ||
| 2623 | Number of Units mism atch | ||
| 2624 | 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. | ||
| 2625 | View an EO B Apr 14, 20 14@18:25:5 5 Page: 4 of 6 | ||
| 2626 | BI LL #:442-K 101EVT | ||
| 2627 | CURRENT I NSURANCE C OMPANY (PR IMARY): ME DICARE (WN R) | ||
| 2628 | + | ||
| 2629 | VistA coul d not matc h all of t he Line Le vel data r eceived in the EEOB | ||
| 2630 | (835 Recor d 40) to t he claim i n VistA. | ||
| 2631 | Mismatched Procedure Code: | ||
| 2632 | Payer repo rted the f ollowing w as billed via the Cl aim (837): | ||
| 2633 | Proc:7 1010 Mods :59 Rev C d:324 Chg :227.40 U nits:1 | ||
| 2634 | Payer repo rted adjud ication vi a the EOB (835) as f ollows: | ||
| 2635 | Proc:7 1015 Mods :59 Rev C d:324 Chg :227.40 U nits:1 | ||
| 2636 | Amt:10 0.00 | ||
| 2637 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | ||
| 2638 | Service li ne adjustm ent (EEOB Record 41) has no ma tching ser vice line | ||
| 2639 | + Enter ?? f or more ac tions | ||
| 2640 | Genera l Info Claim Leve l Adj Revi ew Info | ||
| 2641 | Payer Info Medicare I nfo Exit | ||
| 2642 | Claim Level Pay Line Level Adj | ||
| 2643 | Select Act ion: Next Screen// | ||
| 2644 | 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. | ||
| 2645 | MRA Manage ment WorkL ist Nov 25, 20 13@14:06:5 8 Page: 1 of 35 | ||
| 2646 | Bill # Svc Date P atient Nam e SS N Pt Res p Bill A mt Type | ||
| 2647 | BILLER: IB ,CLERK F | ||
| 2648 | 1 !442-K XXXXXX* 06/02/10 I B,PATIENT 234 XXX X 0.0 0 1710. 76 O/I | ||
| 2649 | Insu rers: MED ICARE (WNR ), NAT'L A SSOC OF LE TTER CARRI ERS | ||
| 2650 | MRA St atus: DEN IED, Jul 1 2, 2010 | ||
| 2651 | 2 442-KX XXXXX 06/02/10 I B,PATIENT 33 XXX X 0.0 0 380. 22 O/P | ||
| 2652 | Insu rers: MED ICARE (WNR ), NAT'L A SSOC OF LE TTER CARRI ERS | ||
| 2653 | MRA St atus: DEN IED, Jul 0 7, 2010 | ||
| 2654 | 3 442-KX XXXXX 05/14/10 I B,PATIENT 12 XXX X 0.0 0 132. 20 O/P | ||
| 2655 | Insu rers: MED ICARE (WNR ), UNITEDH EALTHCARE | ||
| 2656 | MRA St atus: DEN IED, Aug 1 6, 2010 | ||
| 2657 | 4 442-KX XXXXX 06/11/10 I B,PATIENT 12 XXX X 0.0 0 132. 20 O/P | ||
| 2658 | Insu rers: MED ICARE (WNR ), UNITEDH EALTHCARE | ||
| 2659 | MRA St atus: DEN IED, Aug 1 6, 2010 | ||
| 2660 | 5 442-KX XXXXX 06/14/10 I B,PATIENT 103 XXX X 0.0 0 81. 22 I/P | ||
| 2661 | + ! =835 Data Mismatch Enter ?? for mor e actions | ||
| 2662 | PC Proces s COB VC View Comme nts PM Prin t MRA | ||
| 2663 | VE View a n EOB CB Cancel Bil l TP Thir d Party Jo int Inq. | ||
| 2664 | SU Summar y MRA Info CR Correct Bi ll Q Exit | ||
| 2665 | EC Enter Comments CC Cancel/Clo ne A Bill | ||
| 2666 | RS Review Status VB View Bill | ||
| 2667 | Select Act ion: Next Screen// | ||
| 2668 | If users a ttempt to access any of the fo llowing Ac tions, the system wi ll display a warning message. | ||
| 2669 | PC - Proce ss COB | ||
| 2670 | VE - View an EOB | ||
| 2671 | SU – Summa ry MRA Inf o | ||
| 2672 | PM - Print MRA | ||
| 2673 | 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. | ||
| 2674 | Do you wis h to conti nue?: No/ / | ||
| 2675 | Enhanced C MS-1500 Pr inted Clai m Form | ||
| 2676 | 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. | ||
| 2677 | Patch IB*2 *516 | ||
| 2678 | Patch IB*2 *516 inclu des the fo llowing ch anges not covered el sewhere in this docu ment. | ||
| 2679 | TRICARE/TR ICARE REIM B. Pay-to Providers | ||
| 2680 | 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. | ||
| 2681 | The TRICAR E Pay-to P rovider’s address wi ll print o n the CMS – 1500 for m in Box 3 2 | ||
| 2682 | 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 | ||
| 2683 | 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 | ||
| 2684 | NDC Number s for non- RX Claims | ||
| 2685 | 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: | ||
| 2686 | CMS – 1500 – Box 24: Shaded ar ea – Forma t: N4NDC#< space>Unit Qualifier #of Units – if trans mitted, th e NDC numb er is tran smitted in Record PR F/Loop 241 0 | ||
| 2687 | UB04 – FL4 3 - Format : N4NDC#<s pace>Unit Qualifier# of Units – if transm itted the NDC number is transm itted in R ecord INS/ Loop 2410 | ||
| 2688 | Note: The ability to select a Unit Quali fier was a dded in pa tch IB*2*5 77.Patch I B*2*547 | ||
| 2689 | Patch IB*2 *547 inclu des the fo llowing ch anges not covered el sewhere in this docu ment: | ||
| 2690 | Service Li nes with N o Print Or der | ||
| 2691 | 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. | ||
| 2692 | Last Names Only | ||
| 2693 | 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 . | ||
| 2694 | Blank Pres ent on Adm ission | ||
| 2695 | 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: | ||
| 2696 | Y – Yes | ||
| 2697 | N – No | ||
| 2698 | U – No Inf ormation i n the Reco rd | ||
| 2699 | W – Clinic ally Undet ermined | ||
| 2700 | Printed CM S 1500 For ms | ||
| 2701 | 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. | ||
| 2702 | Printed UB 04 Forms | ||
| 2703 | 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. | ||
| 2704 | Insurance Company En try/Edit/V iew Insura nce Compan y | ||
| 2705 | 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: | ||
| 2706 | Main Maili ng Address | ||
| 2707 | Inpt Claim s Office | ||
| 2708 | Opt Claims Office | ||
| 2709 | Prescr Cla ims Office | ||
| 2710 | Appeals Of fice | ||
| 2711 | Inquiry Of fice | ||
| 2712 | 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 | ||
| 2713 | 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. | ||
| 2714 | Copy and C ancel (CLO N) | ||
| 2715 | 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: | ||
| 2716 | Copy prima ry claim w ith EOB to a new pri mary claim – Do not copy COB d ata | ||
| 2717 | Copy secon dary claim to new se condary cl aim – Copy primary C OB data | ||
| 2718 | Copy terti ary claim to new ter tiary clai m – Copy p rimary and secondary COB data | ||
| 2719 | ASC X12N 5 010 Health Care Clai m (837) Tr ansactions | ||
| 2720 | The follow ing change s were mad e to 837 t ransaction s: | ||
| 2721 | An inpatie nt instit utional 83 7 transact ion no lon ger requir es a POA f or each di agnosis | ||
| 2722 | An inpatie nt admissi on date ca n no longe r be trans mitted on outpatient claims | ||
| 2723 | 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 | ||
| 2724 | Institutio nal 837 tr ansactions can now t ransmit up to twenty -five proc edure code s | ||
| 2725 | Institutio nal 837 tr ansactions can now t ransmit up to 12 Ext ernal Caus e of Injur y codes | ||
| 2726 | Patch IB.2 .576 | ||
| 2727 | Patch IB*2 *576 inclu des the fo llowing ch anges not covered el sewhere in this docu ment: | ||
| 2728 | Enhanced C MS-1500 Pr inted Clai m Form | ||
| 2729 | 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: | ||
| 2730 | 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 | ||
| 2731 | 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 . | ||
| 2732 | MRA Manage ment Workl ist (MRW) | ||
| 2733 | 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. | ||
| 2734 | MRA Manage ment WorkL ist Nov 25, 20 13@14:06:5 8 Page: 1 of 35 | ||
| 2735 | Bill # Svc Date P atient Nam e SS N Pt Res p Bill A mt Type | ||
| 2736 | BILLER: IB ,CLERK F | ||
| 2737 | 1 !442-K XXXXXX* 06/02/10 I B,PATIENT 234 XXX X 0.0 0 1710. 76 O/I | ||
| 2738 | Insu rers: MED ICARE (WNR ), NAT'L A SSOC OF LE TTER CARRI ERS | ||
| 2739 | MRA St atus: DEN IED, Jul 1 2, 2010 | ||
| 2740 | 2 442-KX XXXXX 06/02/10 I B,PATIENT 33 XXX X 0.0 0 380. 22 O/P | ||
| 2741 | Insu rers: MED ICARE (WNR ), NAT'L A SSOC OF LE TTER CARRI ERS | ||
| 2742 | MRA St atus: DEN IED, Jul 0 7, 2010 | ||
| 2743 | 3 442-KX XXXXX 05/14/10 I B,PATIENT 12 XXX X 0.0 0 132. 20 O/P | ||
| 2744 | Insu rers: MED ICARE (WNR ), UNITEDH EALTHCARE | ||
| 2745 | MRA St atus: DEN IED, Aug 1 6, 2010 | ||
| 2746 | 4 442-KX XXXXX 06/11/10 I B,PATIENT 12 XXX X 0.0 0 132. 20 O/P | ||
| 2747 | Insu rers: MED ICARE (WNR ), UNITEDH EALTHCARE | ||
| 2748 | MRA St atus: DEN IED, Aug 1 6, 2010 | ||
| 2749 | 5 442-KX XXXXX 06/14/10 I B,PATIENT 103 XXX X 0.0 0 81. 22 I/P | ||
| 2750 | + ! =835 Data Mismatch *=Revi ew in Proc ess | ||
| 2751 | PC Proces s COB VC View Comme nts PM Prin t MRA | ||
| 2752 | VE View a n EOB CB Cancel Bil l TP Thir d Party Jo int Inq. | ||
| 2753 | SU Summar y MRA Info CR Correct Bi ll Q Exit | ||
| 2754 | EC Enter Comments CC Cancel/Clo ne A Bill | ||
| 2755 | RS Review Status VB View Bill | ||
| 2756 | Select Act ion: Next Screen// | ||
| 2757 | Insurance Company En try/Edit | ||
| 2758 | 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 : | ||
| 2759 | Main Maili ng Address | ||
| 2760 | Inpatient Claims Off ice Addres s | ||
| 2761 | Appeals Of fice Addre ss | ||
| 2762 | Inquiry Of fice Addre ss | ||
| 2763 | Outpatient Claims Of fice Addre ss | ||
| 2764 | Prescripti on Claims Office Add ress | ||
| 2765 | 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. | ||
| 2766 | 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: | ||
| 2767 | 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 '. | ||
| 2768 | Patch IB*2 *577 | ||
| 2769 | Patch IB*2 *577 inclu des the fo llowing ch anges not covered el sewhere in this docu ment: | ||
| 2770 | CLON | ||
| 2771 | In additio n to the c hanges mad e to CLON in patch I B*2*547, C LON has be en enhance d to recal culate the monetary amount bei ng billed to the des tination p ayer when a claim is Canceled and Copied and the payer sequ ence is ch anged. | ||
| 2772 | Example: A secondary claim is Clon’d to make a new claim and then the payer sequ ence is ch anged to P rimary, to be resubm itted as a n adjustme nt claim. Because th e claim is going to the primar y payer, t he amount billed wil l be equal to the or iginal amo unt billed to the pr imary paye r. | ||
| 2773 | Handling E rror Messa ges and Wa rnings | ||
| 2774 | 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. | ||
| 2775 | |||
| 2776 | ... Execut ing nation al IB edit s | ||
| 2777 | |||
| 2778 | ERROR/WARN ING OUTPUT DEVICE: H OME// TE LNET TERMI NAL | ||
| 2779 | |||
| 2780 | **War nings**: | ||
| 2781 | Prov secondary id type fo r the PRIM ARY RENDER ING is inv alid/won't transmit | ||
| 2782 | BLUE CROSS CA ( WY) requir es Amb Car e Certific ation | ||
| 2783 | |||
| 2784 | **Err ors**: | ||
| 2785 | A CPT procedure is missin g an assoc iated diag nosis. | ||
| 2786 | Place of Servic e not ente red for at least one procedure . | ||
| 2787 | Type of Service not enter ed for at least one procedure. | ||
| 2788 | Claim s with mul tiple paye rs require all Payer IDs. | ||
| 2789 | A cla im cannot have a Pri mary Payer ID value of HPRNT/S PRNT. | ||
| 2790 | |||
| 2791 | Do you wis h to edit the incons istencies now? NO// y YES | ||
| 2792 | |||
| 2793 | Patch IB*2 *488 | ||
| 2794 | Patch IB*2 .0*488 add ed several new error messages to Enter/E dit Billin g Informat ion: | ||
| 2795 | Error - wh en a profe ssional cl aim contai ns no proc edures cod es | ||
| 2796 | Error - wh en an outp atient, in stitutiona l claim co ntains no procedures codes | ||
| 2797 | Error - wh en a Prima ry Payer I D is a PRN T/prnt val ue | ||
| 2798 | Patch IB*2 *516 | ||
| 2799 | Patch IB*2 *516 made several c hanges to existing e rror and w arnings me ssages: | ||
| 2800 | Error - wh en a claim contains a procedur e code out side the 1 00-999 ran ge – Remov ed | ||
| 2801 | Error - wh en a human provider has no NPI - Added | ||
| 2802 | Error - wh en a non-V A facility has no NP I – Added | ||
| 2803 | Warning - when a non -VA Facili ty has no Taxonomy c ode – Remo ved | ||
| 2804 | 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 IB*2*547 | ||
| 2805 | Patch IB*2 *547 made several ch anges to t he existin g logic fo r these er ror messag es. The fo llowing er ror messag es will no longer be triggered if the pa tient or s ubscriber only has a last name defined i n VistA: | ||
| 2806 | Error - Pa tient's fi rst and la st name mu st begin w ith an alp ha charact er | ||
| 2807 | Error - Pr imary insu rance subs criber's n ame is mis sing or in valid | ||
| 2808 | Error - Se condary in surance su bscriber's name is m issing or invalid | ||
| 2809 | Error - Te rtiary ins urance sub scriber's name is mi ssing or i nvalid | ||
| 2810 | Patch IB.2 .576 | ||
| 2811 | Patch IB*2 *576 made changes to the exist ing logic for this e rror messa ge. The fo llowing er ror messag e will onl y display when there are both Occurrence Codes 10 – Last Men strual Per iod and 11 – Onset o f Illness on a claim : | ||
| 2812 | Error - Oc c. Codes O nset of Il lness (11) and LMP ( 10) not al lowed on s ame bill. | ||
| 2813 | Claim vers us Line Le vel Data | ||
| 2814 | With the i ntroductio n of addit ional Line Level dat a (includi ng Line Le vel provid ers) in Pa tch IB*2*4 47, it is important to underst and the co ncept of C laim Level data appl ying to al l the line items on a claim. C laim Level data appl ies to all the line items on a claim, wh ile Line L evel data should be used to pr ovide exce ptions to the Claim Level data . | ||
| 2815 | 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. | ||
| 2816 | 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. | ||
| 2817 | 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 . | ||
| 2818 | Screen 3 – Payer Inf ormation | ||
| 2819 | EDI Fields | ||
| 2820 | 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> | ||
| 2821 | ========== ========== ========== ========== ========== ========== ========== ========= | ||
| 2822 | PAYER I NFORMATION | ||
| 2823 | [1] Rate T ype : REI MBURSABLE INS. Form Type: CMS- 1500 | ||
| 2824 | Respon sible: INS URER Payer Sequence: Primary | ||
| 2825 | Bill P ayer : CIG NA Trans mit: Yes | ||
| 2826 | Ins 1: CIGNA Policy #: 126781678 | ||
| 2827 | Grp #: GRP NUM 2 277 Whose: VET ERAN Rel to In sd: PATIEN T | ||
| 2828 | Grp Nm : TEST GRO UP Insd Sex: MALE Insured: IB,PATIENT IN | ||
| 2829 | Ins 2: BLUE CROS S CA (W Policy #: R76543210 | ||
| 2830 | Grp #: UNSPECIFI ED Whose: SPO USE Rel to In sd: SPOUSE | ||
| 2831 | Grp Nm : TEST BCB S Insd Sex: FEMALE Insured: ib,wife in | ||
| 2832 | *** Patient has Insura nce Buffer entries *** | ||
| 2833 | [2] Billin g Provider Secondary IDs: | ||
| 2834 | Prima ry Payer: | ||
| 2835 | Secon dary Payer : XXXXXXX Te rtiary Pay er: | ||
| 2836 | [3] Mailin g Address : Elec tronic ID: XXXID | ||
| 2837 | CIGNA | ||
| 2838 | PO BOX 9358 | ||
| 2839 | SHERMA N, TX 750 91 | ||
| 2840 | <RET> to C ONTINUE, 1 -3 to EDIT , '^N' for screen N, or '^' to QUIT: | ||
| 2841 | 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 IB*2*4 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 | ||
| 2842 | 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. | ||
| 2843 | 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> | ||
| 2844 | ========== ========== ========== ========== ========== ========== ========== ========= | ||
| 2845 | PAYER IN FORMATION | ||
| 2846 | [1] Rate T ype : REI MBURSABLE INS. Form Type: CMS- 1500 | ||
| 2847 | Respon sible: INS URER Payer Sequence: Primary | ||
| 2848 | Bill P ayer : MRA NEEDED FR OM MEDICAR E Trans mit: Yes | ||
| 2849 | Ins 1: MEDICARE (WNR) WILL NOT R EIMBURSE Policy #: XXXXXXXXA | ||
| 2850 | Grp #: PART A Whose: VET ERAN Rel to In sd: PATIEN T | ||
| 2851 | Grp Nm : PART A Insd Sex: MALE Insured: IB,PATIENT 1 | ||
| 2852 | Ins 2: BLUE CROS S OF CA Policy #: MES3456 | ||
| 2853 | Grp #: PLAN 2 Whose: VET ERAN Rel to In sd: PATIEN T | ||
| 2854 | Grp Nm : PROTECTI ON PLUS Insd Sex: MALE Insured: IB,PATIENT 1 | ||
| 2855 | [2] Billin g Provider Secondary IDs: | ||
| 2856 | Primar y Payer: 6 70899 | ||
| 2857 | Second ary Payer: XXXXXX1X Tertia ry Payer: | ||
| 2858 | [3] Mailin g Address : Elec tronic ID: XXXXID | ||
| 2859 | NO MAI LING ADDRE SS HAS BEE N SPECIFIE D! (Pati ent has Me dicare) | ||
| 2860 | Send B ill to PAY ER listed above. | ||
| 2861 | <RET> to C ONTINUE, 1 -3 to EDIT , '^N' for screen N, or '^' to QUIT: 2 | ||
| 2862 | Current Bi ll Payer S equence: P RIMARY INS URANCE// | ||
| 2863 | Define Pri mary Payer ID by Car e Unit? No // | ||
| 2864 | Primary Pa yer ID: 67 0899// | ||
| 2865 | Define Sec ondary Pay er ID by C are Unit? No//Yes | ||
| 2866 | Division: Main Divis ion// | ||
| 2867 | Care Unit: ?? | ||
| 2868 | 1 A nesthesia | ||
| 2869 | 2 R eference L ab | ||
| 2870 | 3 H ome Health | ||
| 2871 | Care Unit: 1 Anesthe sia | ||
| 2872 | Secondary Payer ID: XXXXXXX// | ||
| 2873 | Screen 10 – Physicia n/Provider and Print Informati on | ||
| 2874 | EDI Fields UB-04/CMS -1500 | ||
| 2875 | 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 | ||
| 2876 | 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. | ||
| 2877 | 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. | ||
| 2878 | Patch IB*2 *488 remov ed the for mer option to force a Professi onal or In stitutiona l claim to print at the cleari nghouse.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> | ||
| 2879 | ========== ========== ========== ========== ========== ========== ========== ====== | ||
| 2880 | BILLI NG - SPECI FIC INFORM ATION | ||
| 2881 | [1] Bill R emarks | ||
| 2882 | - FL- 80 : UNSPEC IFIED [NOT REQUIRED] | ||
| 2883 | ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED] | ||
| 2884 | Auth/R eferral : UNSPEC IFIED [NOT REQUIRED] | ||
| 2885 | Admiss ion Source : UNSPEC IFIED | ||
| 2886 | [2] Pt Rea son f/Visi t : UNSPEC IFIED | ||
| 2887 | [3] Provid ers : | ||
| 2888 | - ATT ENDING : UNSPEC IFIED | ||
| 2889 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | ||
| 2890 | [5] Billin g Provider : DNS ENNE VAMC | ||
| 2891 | Taxono my Code : 282N00 000X | ||
| 2892 | [6] Force To Print? : NO FOR CED PRINT | ||
| 2893 | [7] Provid er ID Main t : (Edit Provider I D informat ion) | ||
| 2894 | <RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT: | ||
| 2895 | IB,PATIENT 3 XX-XX -XXXX BI LL#: K600X X - Outpat /1500 SCREEN <10> | ||
| 2896 | ========== ========== ========== ========== ========== ========== ========== ========= | ||
| 2897 | BILLI NG - SPECI FIC INFORM ATION | ||
| 2898 | [1] Unable To Work F rom: UNSPE CIFIED [NO T REQUIRED ] | ||
| 2899 | Unable To Work T o : UNSPE CIFIED [NO T REQUIRED ] | ||
| 2900 | [2] ICN/DC N(s) : UNSPE CIFIED [NO T REQUIRED ] | ||
| 2901 | Auth/R eferral : UNSPE CIFIED [NO T REQUIRED ] | ||
| 2902 | [3] Provid ers : | ||
| 2903 | - REN DERING (MD ) : IB,DO CTOR 1 | ||
| 2904 | Taxono my: UNSPEC IFIED | ||
| 2905 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | ||
| 2906 | Lab CL IA # : UNSPE CIFIED [NO T REQUIRED ] | ||
| 2907 | Mammog raphy Cert # : UNSPE CIFIED [NO T REQUIRED ] | ||
| 2908 | [5] Chirop ractic Dat a : UNSPE CIFIED [NO T REQUIRED ] | ||
| 2909 | [6] Form L ocator 19 : UNSPE CIFIED [NO T REQUIRED ] | ||
| 2910 | [7] Billin g Provider : DNS ENNE VAMC | ||
| 2911 | Taxono my Code : 282N0 0000X | ||
| 2912 | [8] Force To Print? : NO FO RCED PRINT | ||
| 2913 | [9] Provid er ID Main t : (Edit Provider ID informa tion) | ||
| 2914 | <RET> to C ONTINUE, 1 -9 to EDIT , '^N' for screen N, or '^' to QUIT: 8 | ||
| 2915 | FORCE CLAI M TO PRINT : NO FORCE D PRINT// ?? | ||
| 2916 | If this fi eld is set to 1, the claim wil l be print ed locally . | ||
| 2917 | If field i s set to 0 , the clai m will be transmitte d | ||
| 2918 | electronic ally to th e payer. | ||
| 2919 | Choos e from: | ||
| 2920 | 0 NO F ORCED PRIN T | ||
| 2921 | 1 FORC E LOCAL PR INT | ||
| 2922 | FORCE CLAI M TO PRINT : NO FORCE D PRINT// | ||
| 2923 | Note that with Patch IB*2*488, the forme r option t o force a claim to p rint at th e clearing house has been remov ed.UB-04 C laims | ||
| 2924 | The follow ing screen s provide a simplifi ed example of a UB-0 4 claim: | ||
| 2925 | 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> | ||
| 2926 | ========== ========== ========== ========== ========== ========== ========== ====== | ||
| 2927 | PAYER IN FORMATION | ||
| 2928 | [1] Rate T ype : REI MBURSABLE INS. Form Type: UB-0 4 | ||
| 2929 | Respon sible: INS URER Payer Sequence: Primary | ||
| 2930 | Bill P ayer : Blu e Cross Fe p Tran smit: Yes | ||
| 2931 | Ins 1: Blue Cros s Fep Policy #: RXXXXXXXX X | ||
| 2932 | Grp #: 100 Whose: VET ERAN Rel to In sd: PATIEN T | ||
| 2933 | Grp Nm : STANDARD FAMILY Insd Sex: MALE Insured: IB,PATIENT 3 | ||
| 2934 | [2] Billin g Provider Secondary IDs: | ||
| 2935 | Prima ry Payer: 00059001 | ||
| 2936 | Secon dary Payer : Te rtiary Pay er: | ||
| 2937 | [3] Mailin g Address : Elec tronic ID: 12B54 | ||
| 2938 | Blue C ross Fep | ||
| 2939 | P O Bo x 10401 | ||
| 2940 | Birmin gham, AL 352020401 | ||
| 2941 | <RET> to C ONTINUE, 1 -3 to EDIT , '^N' for screen N, or '^' to QUIT: | ||
| 2942 | 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 IB*2*516, 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 IB*2*4 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 > | ||
| 2943 | ========== ========== ========== ========== ========== ========== ========== ====== | ||
| 2944 | EVENT - OUTPATI ENT INFORM ATION | ||
| 2945 | [1] Event Date : XXX XX, XXXX | ||
| 2946 | [2] Prin. Diag.: ABD OM PAIN, L L QUADR - 789.04 | ||
| 2947 | Other Diag.: BEN IGN NEOPLA SM LG BOWE L - 211.3 | ||
| 2948 | Other Diag.: DIV ERTICULOSI S OF COLON - 562.10 | ||
| 2949 | [3] OP Vis its : XXX XX, XXXX | ||
| 2950 | Type : | ||
| 2951 | [4] Cod. M ethod: HCP CS | ||
| 2952 | CPT Co de : LES ION REMOVE COLONOSCO PY 45384 XXX XX, XXXX | ||
| 2953 | CPT Co de : OFF ICE/OUTPAT IENT VISIT , NEW 9920 1 XXX XX, XXXX | ||
| 2954 | CPT Co de : CHE ST X-RAY 7 1010-ET XXX XX, XXXX | ||
| 2955 | [5] Rx. Re fills: UNS PECIFIED [ NOT REQUIR ED] | ||
| 2956 | [6] Pros. Items: UNS PECIFIED [ NOT REQUIR ED] | ||
| 2957 | [7] Occ. C ode : ONS ET OF SYMP TOMS/ILLNE SS XXX X X, XXXX | ||
| 2958 | [8] Cond. Code : UNS PECIFIED [ NOT REQUIR ED] | ||
| 2959 | [9] Value Code : UNS PECIFIED [ NOT REQUIR ED] | ||
| 2960 | <RET> to C ONTINUE, 1 -9 to EDIT , '^N' for screen N, or '^' to QUIT: | ||
| 2961 | 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 IB*2* 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. Wit h Patch IB *2*577, us ers will g ain the ab ility to d efine the type of Un its. They will no lo nger defau lt to Unit s. The ne w choices are: Inter national U nit; Gram; Milligram ; Millilit er or Unit .Note: Wit h Patch IB *2*516, ne w prompts have been added to S creens 4 a nd 5to all ow users t o enter 80 character descripti ons to CPT /HCPCS pro cedure cod es for ser vices Not Otherwise Classified .IB,PATIEN T3 XX-XX -XXXX BI LL#: K300X X - Outpat /UB-04 SCREEN < 7> | ||
| 2962 | ========== ========== ========== ========== ========== ========== ========== ====== | ||
| 2963 | BILL ING - GENE RAL INFORM ATION | ||
| 2964 | [1] Bill T ype : 13 1 Loc. of Care: H OSPITAL - INPT OR OP T (INCLU | ||
| 2965 | Charge Type : IN STITUTIONA L Dis ch Stat: D ISCHARGED TO HOME OR SELF CAR | ||
| 2966 | Form T ype : UB -04 Ti meframe: A DMIT THRU DISCHARGE | ||
| 2967 | Bill Class if: OUTPAT IENT Division: DNS ENNE VAMRO C | ||
| 2968 | [2] Sensit ive? : UN SPECIFIED Assi gnment: YE S | ||
| 2969 | [3] Bill F rom : XX X XX, XXXX B ill To: XX X XX, XXXX | ||
| 2970 | [4] OP Vis its : XX X XX, XXXX | ||
| 2971 | [5] Rev. C ode : 75 0-GASTR-IN ST SVS 45384 $2,137.4 4 OUTPATI ENT VISIT | ||
| 2972 | Rev. C ode : 32 4-DX X-RAY /CHEST 71010 $225.5 3 OUTPATI ENT VISIT | ||
| 2973 | Rev. C ode : 51 0-CLINIC 99201 $108.9 2 OUTPATI ENT VISIT | ||
| 2974 | OFFSET : $0.00 [NO OFFS ET RECORDE D] | ||
| 2975 | BILL T OTAL : $2,471.89 | ||
| 2976 | [6] Rate S ched : (r e-calculat e charges) | ||
| 2977 | [7] Prior Claims: UN SPECIFIED | ||
| 2978 | <RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT: | ||
| 2979 | StepProced ureNote: A fter Patch IB*2*432, 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 : IB*2*447 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> | ||
| 2980 | ========== ========== ========== ========== ========== ========== ========== ======= | ||
| 2981 | BIL LING - CLA IM INFORMA TION | ||
| 2982 | [1] COB No n-Covered Charge Amt : | ||
| 2983 | [2] Proper ty Casualt y Informat ion | ||
| 2984 | Claim Number: Contact N ame: | ||
| 2985 | Date o f 1st Cont act: Contact P hone: | ||
| 2986 | [3] Surgic al Codes f or Anesthe sia Claims | ||
| 2987 | Primar y Code: Secondary Code: | ||
| 2988 | [4] Paperw ork Attach ment Infor mation | ||
| 2989 | Report Type: NN Transmiss ion Method : XX | ||
| 2990 | Attach ment Contr ol #: 123 4890701 | ||
| 2991 | [5] Disabi lity Start Date: Disabilit y End Date : | ||
| 2992 | [6] Assume d Care Dat e: Relinquis hed Care D ate: | ||
| 2993 | <RET> to C ONTINUE '^ N' for scr een N, or '^' to QUI T: | ||
| 2994 | 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> | ||
| 2995 | ========== ========== ========== ========== ========== ========== ========== ========== | ||
| 2996 | AMBULANCE INFORMATIO N | ||
| 2997 | [1] Ambula nce Transp ort Data | ||
| 2998 | D/O Locat ion: | ||
| 2999 | P/U Ad dress1: D/O Addre ss1: | ||
| 3000 | P/U Ad dress2: D/O Addre ss2: | ||
| 3001 | P/U Ci ty: D/O City: | ||
| 3002 | P/U St ate/Zip: D/O State /Zip: | ||
| 3003 | Patien t Weight: 195 Transport Distance: 200 | ||
| 3004 | Transp ort Reason : Patient was transp orted to n earest fac ility for care | ||
| 3005 | of sympt oms, compl aints or b oth. | ||
| 3006 | R/T Pu rpose: Pat ient fell and sustai ned possib le injurie s to neck | ||
| 3007 | Stretc her Purpos e: Patient unable to walk due to possibl e injuries to | ||
| 3008 | neck | ||
| 3009 | [2] Ambula nce Certif ication Da ta | ||
| 3010 | Condit ion Indica tor: 01 - Admitted t o hospital | ||
| 3011 | 04 - Moved by s tretcher | ||
| 3012 | 06 - Transporte d in emerg ency situa tion | ||
| 3013 | 08 - Visible he morrhaging | ||
| 3014 | 09 - Medically necessary service | ||
| 3015 | <RET> to C ONTINUE '^ N' for scr een N, or '^' to QUI T: | ||
| 3016 | 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 IB*2*432 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 IB*2*432, 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 IB*2*4 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> | ||
| 3017 | ========== ========== ========== ========== ========== ========== ========== ====== | ||
| 3018 | BILLIN G - SPECIF IC INFORMA TION | ||
| 3019 | [1] Bill R emarks | ||
| 3020 | - FL- 80 : UNSPEC IFIED [NOT REQUIRED] | ||
| 3021 | ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED] | ||
| 3022 | Auth/R eferral : UNSPEC IFIED [NOT REQUIRED] | ||
| 3023 | Admiss ion Source : UNSPEC IFIED | ||
| 3024 | [2] Pt Rea son f/Visi t : UNSPEC IFIED | ||
| 3025 | [3] Provid ers : | ||
| 3026 | - ATT ENDING : UNSPEC IFIED | ||
| 3027 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | ||
| 3028 | [5] Billin g Provider : DNS ENNE VAMC | ||
| 3029 | Taxono my Code : 282N00 000X | ||
| 3030 | [6] Alt Pr im Payer I D : P: ALT IDHOSPICE1 23 | ||
| 3031 | [7] Force To Print? : NO FOR CED PRINT | ||
| 3032 | [8] Provid er ID Main t : (Edit Provider I D informat ion) | ||
| 3033 | <RET> to C ONTINUE, 1 -8 to EDIT , '^N' for screen N, or '^' to QUIT: | ||
| 3034 | 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 IB*2* 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 . | ||
| 3035 | The first 2 entries in this li st will al ways be: | ||
| 3036 | 1 - NO S ECONDARY I D NEEDED | ||
| 3037 | 2 - ADD AN ID FOR THIS CLAIM ONLY | ||
| 3038 | 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 ** ** | ||
| 3039 | PRIMARY IN SURANCE CO : BLUE CRO SS CA (WY) | ||
| 3040 | PROVIDER: IB,PHYSICI AN4 (ATTEN DING) | ||
| 3041 | INS. COMPA NY'S DEFAU LT SECONDA RY ID TYPE IS: BLUE CROSS ID | ||
| 3042 | SELECT A S ECONDARY I D OR ACTIO N FROM THE LIST BELO W: | ||
| 3043 | 1 - N O SECONDAR Y ID NEEDE D | ||
| 3044 | 2 - A DD AN ID F OR THIS CL AIM ONLY | ||
| 3045 | 3 - < DEFAULT> X XXXBCROSS BLUE CROS S ID | ||
| 3046 | 4 - W YXXXX ST LIC (W Y) | ||
| 3047 | Selection: 3// | ||
| 3048 | 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. | ||
| 3049 | If no defa ult ID exi sts, the d efault for the selec tion promp t will be 1 – No Sec ondary ID needed. | ||
| 3050 | 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. | ||
| 3051 | 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. | ||
| 3052 | 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 *2*432, 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. | ||
| 3053 | 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 | ||
| 3054 | PRIM INS PERF PROV SECONDARY ID TYPE: ?? | ||
| 3055 | Choose from: | ||
| 3056 | BLUE CR OSS ID | ||
| 3057 | BLUE SH IELD ID | ||
| 3058 | COMMERC IAL ID | ||
| 3059 | LOCATIO N NUMBER | ||
| 3060 | MEDICAR E PART A | ||
| 3061 | MEDICAR E PART B | ||
| 3062 | PRIM INS PERF PROV SECONDARY ID TYPE: LOCATION N UMBER | ||
| 3063 | PRIM INS PERF PROV SECONDARY ID: XXXXA | ||
| 3064 | 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 . | ||
| 3065 | 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. | ||
| 3066 | 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> | ||
| 3067 | ========== ========== ========== ========== ========== ========== ========== ========== == | ||
| 3068 | B ILLING - S PECIFIC IN FORMATION | ||
| 3069 | [1] Bill R emarks | ||
| 3070 | - FL- 80 : UNSPEC IFIED [NOT REQUIRED] | ||
| 3071 | ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED] | ||
| 3072 | Auth/R eferral : UNSPEC IFIED [NOT REQUIRED] | ||
| 3073 | Admiss ion Source : PHYSIC IAN REFERR AL | ||
| 3074 | [2] Pt Rea son f/Visi t : COUGH - 786.2 | ||
| 3075 | [3] Provid ers : | ||
| 3076 | - ATT ENDING (MD ) : IB,DOC TOR4 Taxono my: 208G00 000X (33) | ||
| 3077 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | ||
| 3078 | [5] Billin g Provider : DNS ENNE VAMC | ||
| 3079 | Taxono my Code : 282N00 000X | ||
| 3080 | [6] Force To Print? : NO FOR CED PRINT | ||
| 3081 | [7] Provid er ID Main t : (Edit Provider I D informat ion) | ||
| 3082 | <RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT: ?PR V | ||
| 3083 | (V)A or (N )on-VA Pro vider: V// A PROVIDE R | ||
| 3084 | This is a display of provider specific i nformation . | ||
| 3085 | This bill is UB-04/O utpatient | ||
| 3086 | This is a display of provider specific i nformation . | ||
| 3087 | This bill is UB-04/O utpatient | ||
| 3088 | The valid provider f unctions f or this bi ll are: | ||
| 3089 | 1 REFERRI NG SITUATIONA L - ALREAD Y ON BILL | ||
| 3090 | 2 OPERATI NG SITUATIONA L - NOT ON BILL | ||
| 3091 | 3 RENDERI NG SITUATIONA L - ALREAD Y ON BILL | ||
| 3092 | 4 ATTENDI NG REQUIRED - ALREADY O N BILL | ||
| 3093 | 9 OTHER O PERATING OPTIONAL - NOT ON BI LL | ||
| 3094 | Select PRO VIDER NAME : IB,Docto r RAD PI | ||
| 3095 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | ||
| 3096 | Signature Name: DOC TOR RAD IB | ||
| 3097 | Signature Title: | ||
| 3098 | D egree: MD | ||
| 3099 | NPI: 111 2220037 | ||
| 3100 | Licen se(s): WY: 1289340B | ||
| 3101 | Person Class: V18 3001 | ||
| 3102 | PROVIDER TYPE: All opathic an d Osteopat hic Physic ians | ||
| 3103 | CLASSIFIC ATION: Rad iology | ||
| 3104 | SPECIALIZ ATION: Bod y Imaging | ||
| 3105 | TAX ONOMY: 208 5B0100X (8 88) | ||
| 3106 | EFFE CTIVE: 6/7 /10 | ||
| 3107 | RC Provide r Group: N one | ||
| 3108 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | ||
| 3109 | Select PRO VIDER NAME : | ||
| 3110 | 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 > | ||
| 3111 | ========== ========== ========== ========== ========== ========== ========== ========== == | ||
| 3112 | BILLIN G - SPECIF IC INFORMA TION | ||
| 3113 | [1] Bill R emarks | ||
| 3114 | - FL- 80 : UNSPEC IFIED [NOT REQUIRED] | ||
| 3115 | ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED] | ||
| 3116 | Auth/R eferral : UNSPEC IFIED [NOT REQUIRED] | ||
| 3117 | Admiss ion Source : PHYSIC IAN REFERR AL | ||
| 3118 | [2] Pt Rea son f/Visi t : COUGH - 786.2 | ||
| 3119 | [3] Provid ers : | ||
| 3120 | - REFE RRING (MD) : IB,DOCT OR GP Ta xonomy: 20 8G00000X ( 33) | ||
| 3121 | [P]VAD000 [S]8301684 94 | ||
| 3122 | - REND ERING (MD) : IB,DOCT OR CARD Ta xonomy: 20 7RA0000X ( 33) | ||
| 3123 | [P]VAD000 [S]8301684 94 | ||
| 3124 | - ATTE NDING (MD) : IB,DOCT OR4 Ta xonomy: 20 7XS0106X ( 40) | ||
| 3125 | [P]VAD000 [S]8301684 94 | ||
| 3126 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | ||
| 3127 | [5] Billin g Provider : DNS ENNE VAMC | ||
| 3128 | Taxono my Code : 282N00 000X | ||
| 3129 | [6] Force To Print? : NO FOR CED PRINT | ||
| 3130 | [7] Provid er ID Main t : (Edit Provider I D informat ion) | ||
| 3131 | <RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT: ?ID | ||
| 3132 | If this bi ll is tran smitted el ectronical ly, the fo llowing ID s will be sent: | ||
| 3133 | Primary Ins Co: BL UE CROSS C A (WY) <<<Cur rent Ins | ||
| 3134 | Secondary Ins Co: AE TNA US HEA LTHCARE | ||
| 3135 | Provider I Ds: (VistA Records O P1,OP2,OP4 ,OP8,OP9,O PR2,OPR3,O PR4,OPR5,O PR8): | ||
| 3136 | ATTEN DING: IB,D OCTOR4 | ||
| 3137 | NP I: 8731245386 | ||
| 3138 | Se condary ID s | ||
| 3139 | (P ) BLUE CRO SS VAD000 | ||
| 3140 | REFER RING: IB,D OCTOR GP | ||
| 3141 | NP I: 8731245394 | ||
| 3142 | (P ) BLUE CRO SS VAD000 | ||
| 3143 | RENDE RING: IB,D OCTOR CARD | ||
| 3144 | NP I: 1112220029 | ||
| 3145 | (P ) BLUE CRO SS VAD000 | ||
| 3146 | Billing Pr ovider Nam e and ID I nformation | ||
| 3147 | Billing Pr ovider: DNS ENNE VAMC | ||
| 3148 | Billi ng Provide r NPI: 11 64471991 | ||
| 3149 | Billi ng Provide r Tax ID ( VistA Reco rd PRV): 830168494 | ||
| 3150 | Billi ng Provide r Secondar y IDs (Vis tA Record CI1A): | ||
| 3151 | (P ) PROVIDER SITE NUMB ER 0000 <<<Sys tem Genera ted ID | ||
| 3152 | (P ) BLUE CRO SS 007484 | ||
| 3153 | Service Li ne Provide rs | ||
| 3154 | Servi ce Line: 3 | ||
| 3155 | RENDE RING: IB,D OCTOR RAD | ||
| 3156 | NP I: 1112220037 | ||
| 3157 | (P ) BLUE CRO SS VAD000 | ||
| 3158 | (P ) EIN 022221111 | ||
| 3159 | (P ) STATE LI CENSE 1289340B | ||
| 3160 | Press ENTE R to conti nue | ||
| 3161 | 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 > | ||
| 3162 | WANT TO AU THORIZE BI LL AT THIS TIME? No/ / YES | ||
| 3163 | AUTHORIZE BILL GENER ATION?: YE S | ||
| 3164 | Adding bi ll to BILL TRANSMISS ION File. | ||
| 3165 | Bill wil l be submi tted elect ronically | ||
| 3166 | Passing co mpleted Bi ll to Acco unts Recei vable. Bi ll is no l onger edit able. | ||
| 3167 | Completed Bill Succe ssfully se nt to Acco unts Recei vable. | ||
| 3168 | This Bill Can Not Be Printed U ntil Trans mit Confir med | ||
| 3169 | This Outpa tient INST ITUTIONAL bill may h ave corres ponding PR OFESSIONAL | ||
| 3170 | charges. | ||
| 3171 | CMS-1500 C laims | ||
| 3172 | The follow ing screen s provide a simplifi ed example of a CMS- 1500 claim . | ||
| 3173 | 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 IB*2*516, 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> | ||
| 3174 | ========== ========== ========== ========== ========== ========== ========== ====== | ||
| 3175 | PAYER IN FORMATION | ||
| 3176 | [1] Rate T ype : REI MBURSABLE INS. Form Type: CMS 1500 | ||
| 3177 | Respon sible: INS URER Payer Sequence: Primary | ||
| 3178 | Bill P ayer : Blu e Cross Fe p Tran smit: Yes | ||
| 3179 | Ins 1: Blue Cros s Fep Policy #: R00000000 | ||
| 3180 | Grp #: 100 Whose: VET ERAN Rel to In sd: PATIEN T | ||
| 3181 | Grp Nm : STANDARD FAMILY Insd Sex: MALE Insured: IB,PATIENT 3 | ||
| 3182 | [2] Billin g Provider Secondary IDs: | ||
| 3183 | Primar y : 01010 0 | ||
| 3184 | Second ary: Terti ary : | ||
| 3185 | [3] Mailin g Address : Elec tronic ID: 12B54 | ||
| 3186 | Blue C ross Fep | ||
| 3187 | P O Bo x 10401 | ||
| 3188 | Birmin gham, AL 352020401 | ||
| 3189 | <RET> to C ONTINUE, 1 -3 to EDIT , '^N' for screen N, or '^' to QUIT: | ||
| 3190 | 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 IB*2*5 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 IB*2*516 , 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. With P atch IB*2* 577, users can also select the type of u nits.Note: With Patc h IB*2*516 , new prom pts have b een added to Screens 4 and 5to allow use rs to ente r 80 chara cter descr iptions to CPT/HCPCS procedure codes for services Not Otherw ise Classi fied.IB,PA TIENT3 X X-XX-XXXX BILL#: K 300XX - Ou tpat/1500 SC REEN <5> | ||
| 3191 | ========== ========== ========== ========== ========== ========== ========== ====== | ||
| 3192 | EVENT - OU TPATIENT I NFORMATION | ||
| 3193 | <1> Event Date : OCT 12, 2010 | ||
| 3194 | [2] Prin. Diag.: ACU TE BRONCHI TIS - 466. 0 | ||
| 3195 | Other Diag.: DMI WO CMP NT ST UNCNTR L - 250.01 | ||
| 3196 | [3] OP Vis its : OCT 12,2010, | ||
| 3197 | [4] Cod. M ethod: HCP CS | ||
| 3198 | CPT Co de : CHE ST X-RAY 7 1010-26 46 6.0 OCT 12, 2010 | ||
| 3199 | [5] Rx. Re fills: UNS PECIFIED [ NOT REQUIR ED] | ||
| 3200 | [6] Pros. Items: UNS PECIFIED [ NOT REQUIR ED] | ||
| 3201 | [7] Occ. C ode : UNS PECIFIED [ NOT REQUIR ED] | ||
| 3202 | [8] Cond. Code : UNS PECIFIED [ NOT REQUIR ED] | ||
| 3203 | <9> Value Code : UNS PECIFIED [ NOT REQUIR ED] | ||
| 3204 | <RET> to C ONTINUE, 1 -9 to EDIT , '^N' for screen N, or '^' to QUIT: | ||
| 3205 | 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* 2*432, 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 *2*432, Se ction 1 of screens 6 /7 will no longer ha ve fields for Covere d, non-Cov ered or Co -insurance Days. Thi s informat ion will n eed to be added to a claim usi ng Conditi on Codes.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 IB*2* 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> | ||
| 3206 | ========== ========== ========== ========== ========== ========== ========== ====== | ||
| 3207 | BIL LING - GEN ERAL INFOR MATION | ||
| 3208 | [1] Bill T ype : 13 1 Loc. of Care: H OSPITAL - INPT OR OP T (INCLU | ||
| 3209 | Charge Type : PR OFESSIONAL Dis ch Stat: D ISCHARGED TO HOME OR SELF CAR | ||
| 3210 | Form T ype : CM S-1500 Ti meframe: A DMIT THRU DISCHARGE | ||
| 3211 | Bill Class if: OUTPAT IENT Division: DNS ENNE VAMRO C | ||
| 3212 | [2] Sensit ive? : NO Assi gnment: YE S | ||
| 3213 | [3] Bill F rom : OC T 12, 2010 B ill To: OC T 13, 2010 | ||
| 3214 | [4] OP Vis its : OC T 12,2010, | ||
| 3215 | [5] Rev. C ode : 32 4-DX X-RAY /CHEST 71010 $45.3 0 OUTPATI ENT VISIT | ||
| 3216 | OFFSET : $0.00 [NO OFFS ET RECORDE D] | ||
| 3217 | BILL T OTAL : $45.30 | ||
| 3218 | [6] Rate S ched : (r e-calculat e charges) | ||
| 3219 | [7] Prior Claims: UN SPECIFIED | ||
| 3220 | <RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT: | ||
| 3221 | StepProced ure5On Scr eens 8 and 9, enter any necess ary Claim level data to the cl aim. Note: IB*2*447 moved Scre en 8, Sect ion 3 Ambu lance Info rmation to a new Scr een 9.Note : IB*2*448 moved Scr een 10 IB, PATIENT MR A XX-XX- XXXX BIL L#: K20003 D - Outpat /1500 SCREEN <8> | ||
| 3222 | ========== ========== ========== ========== ========== ========== ========== ======= | ||
| 3223 | BIL LING - CLA IM INFORMA TION | ||
| 3224 | [1] COB No n-Covered Charge Amt : | ||
| 3225 | [2] Proper ty Casualt y Informat ion | ||
| 3226 | Claim Number: Contact N ame: | ||
| 3227 | Date o f 1st Cont act: Contact P hone: | ||
| 3228 | [3] Surgic al Codes f or Anesthe sia Claims | ||
| 3229 | Primar y Code: Secondary Code: | ||
| 3230 | [4] Paperw ork Attach ment Infor mation | ||
| 3231 | Report Type: Transmiss ion Method : | ||
| 3232 | Attach ment Contr ol #: | ||
| 3233 | [5] Disabi lity Start Date: Disabilit y End Date : | ||
| 3234 | [6] Assume d Care Dat e: Relinquis hed Care D ate: | ||
| 3235 | [7] Specia l Program: ?? | ||
| 3236 | Thi s is the S pecial Pro gram with which a cl aim is ass ociated. R efer to | ||
| 3237 | MED ICARE regu lations to decide wh en to use this field . | ||
| 3238 | Choos e from: | ||
| 3239 | 01 EPSD T/CHAP | ||
| 3240 | 02 Phys Handicapp ed Childre n Program | ||
| 3241 | 03 Spec ial Fed Fu nding | ||
| 3242 | 05 Disa bility | ||
| 3243 | 07 Indu ced Aborti on - Dange r to Life | ||
| 3244 | 08 Indu ced Aborti on - Rape or Incest | ||
| 3245 | 09 2nd Opinion/Su rgery | ||
| 3246 | Special Pr ogram: | ||
| 3247 | [8] Homebo und: ?? | ||
| 3248 | Thi s is to in dicate tha t the pati ent is hom ebound or | ||
| 3249 | ins titutional ized. Refe r to MEDIC ARE regula tions on w hen to | ||
| 3250 | use this fiel d. | ||
| 3251 | Choos e from: | ||
| 3252 | 0 NO | ||
| 3253 | 1 YES | ||
| 3254 | Homebound: | ||
| 3255 | [9] Date L ast Seen:? ? | ||
| 3256 | Thi s is the d ate a pati ent was la st seen. R efer to ME DICARE | ||
| 3257 | reg ulations o n when to use this f ield. | ||
| 3258 | Date Last Seen: | ||
| 3259 | <RET> to C ONTINUE '^ N' for scr een N, or '^' to QUI T: | ||
| 3260 | Note: IB*2 *488 moved the follo wing Scree n 10 field s to Scree n 8: Speci al Program ; Date Las t Seen; Ho mebound. T hese field s no longe r print in Box 19.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> | ||
| 3261 | ========== ========== ========== ========== ========== ========== ========== ========== | ||
| 3262 | AMBULANCE INFORMATIO N | ||
| 3263 | [1] Ambula nce Transp ort Data | ||
| 3264 | D/O Locat ion: | ||
| 3265 | P/U Ad dress1: D/O Addre ss1: | ||
| 3266 | P/U Ad dress2: D/O Addre ss2: | ||
| 3267 | P/U Ci ty: D/O City: | ||
| 3268 | P/U St ate/Zip: D/O State /Zip: | ||
| 3269 | Patien t Weight: Transport Distance: | ||
| 3270 | Transp ort Reason : | ||
| 3271 | R/T Pu rpose: | ||
| 3272 | Stretc her Purpos e: | ||
| 3273 | [2] Ambula nce Certif ication Da ta | ||
| 3274 | Condit ion Indica tor: 12 - Confined t o a bed or chair | ||
| 3275 | 01 - Admitted t o hospital | ||
| 3276 | <RET> to C ONTINUE, 1 -2 to EDIT , '^N' for screen N, or '^' to QUIT: 1 | ||
| 3277 | P/U Addres s1: | ||
| 3278 | P/U Addres s 2: | ||
| 3279 | P/U City: | ||
| 3280 | P/U State: | ||
| 3281 | P/U Zip: | ||
| 3282 | D/O Locati on: | ||
| 3283 | D/O Addres s1: | ||
| 3284 | D/O Addres s2: | ||
| 3285 | D/O City: | ||
| 3286 | D/O State: | ||
| 3287 | D/O Zip: | ||
| 3288 | Patient We ight: | ||
| 3289 | Transport Distance: | ||
| 3290 | Transport Reason: | ||
| 3291 | R/T Purpos e: | ||
| 3292 | Stretcher Purpose: | ||
| 3293 | <RET> to C ONTINUE, 1 -2 to EDIT , '^N' for screen N, or '^' to QUIT: 2 | ||
| 3294 | Select Amb ulance Con dition Ind icator: 01 // ? | ||
| 3295 | Answer with AMBU LANCE COND ITION INDI CATOR | ||
| 3296 | Choose from: | ||
| 3297 | 12 | ||
| 3298 | 01 | ||
| 3299 | Yo u may ente r a new AM BULANCE CO NDITION IN DICATOR, i f you wish | ||
| 3300 | Se lect an Am bulance Co ndition In dicator. Answer mus t be 1-2 | ||
| 3301 | ch aracters i n length. | ||
| 3302 | Th is limits the entry to five co ndition in dicators. | ||
| 3303 | Answer with AMBUL ANCE CONDI TION INDIC ATORS CODE | ||
| 3304 | Choose from: | ||
| 3305 | 12 Confine d to a bed or chair | ||
| 3306 | 01 Admitte d to hospi tal | ||
| 3307 | 04 Moved b y stretche r | ||
| 3308 | 05 Unconsc ious or in Shock | ||
| 3309 | 06 Transpo rted in em ergency si tuation | ||
| 3310 | 07 Had to be physica lly restra ined | ||
| 3311 | 08 Visible hemorrhag ing | ||
| 3312 | 09 Medical ly necessa ry service | ||
| 3313 | Select Amb ulance Con dition Ind icator: 01 // | ||
| 3314 | 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 B*2*432 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 *2*432, it will no l onger be p ossible to authorize a Sensiti ve claim u nless user s indicate that a Re lease of I nformation has been completed. IB,PATIENT 3 XX-XX- XXXX BIL L#: K300XX - Outpat/ 1500 SCREE N <10> | ||
| 3315 | ========== ========== ========== ========== ========== ========== ========== ====== | ||
| 3316 | BILLI NG - SPECI FIC INFORM ATION | ||
| 3317 | [1] Unable To Work F rom: UNSPE CIFIED [NO T REQUIRED ] | ||
| 3318 | Unable To Work T o : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3319 | [2] ICN/DC N(s) : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3320 | Tx Aut h. Code(s) : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3321 | [3] Provid ers : | ||
| 3322 | - REN DERING (MD ) : IB,DO CTOR4 | ||
| 3323 | |||
| 3324 | Taxonomy: 000000000X | ||
| 3325 | [P]XXXXBCR OSS | ||
| 3326 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | ||
| 3327 | Lab CL IA # : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3328 | Mammog raphy Cert # : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3329 | [5] Chirop ractic Dat a : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3330 | [6] Form L ocator 19 : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3331 | [7] Billin g Provider : DNS ENNE VAMC | ||
| 3332 | Taxono my Code : 282N0 0000X | ||
| 3333 | [8] Force To Print? : NO FO RCED PRINT | ||
| 3334 | [9] Provid er ID Main t : (Edit Provider ID informa tion) | ||
| 3335 | <RET> to C ONTINUE, 1 -6 to EDIT , '^N' for screen N, or '^' to QUIT: | ||
| 3336 | 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. | ||
| 3337 | The first 2 entries in this li st will al ways be: | ||
| 3338 | 1 - NO SEC ONDARY ID NEEDED | ||
| 3339 | 2 - ADD AN ID FOR TH IS CLAIM O NLY | ||
| 3340 | 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 ** ** | ||
| 3341 | PRIMARY IN SURANCE CO : BLUE CRO SS CA (WY) | ||
| 3342 | PROVIDER: IB,PHYSICI AN4 (ATTEN DING) | ||
| 3343 | INS. COMPA NY'S DEFAU LT SECONDA RY ID TYPE IS: BLUE SHIELD ID | ||
| 3344 | SELECT A S ECONDARY I D OR ACTIO N FROM THE LIST BELO W: | ||
| 3345 | 1 - N O SECONDAR Y ID NEEDE D | ||
| 3346 | 2 - A DD AN ID F OR THIS CL AIM ONLY | ||
| 3347 | 3 - < DEFAULT> X XXXBSHIELD BLUE SHI ELD ID | ||
| 3348 | 4 - W YXXXX ST LIC (W Y) | ||
| 3349 | Selection: 3// | ||
| 3350 | 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. | ||
| 3351 | If no defa ult ID exi sts, the d efault for the selec tion promp t will be 1 – No Sec ondary ID needed. | ||
| 3352 | 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. | ||
| 3353 | 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. | ||
| 3354 | 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. | ||
| 3355 | 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 | ||
| 3356 | PRIM INS PERF PROV SECONDARY ID TYPE: ?? | ||
| 3357 | Choose from: | ||
| 3358 | BLUE CR OSS ID | ||
| 3359 | BLUE SH IELD ID | ||
| 3360 | COMMERC IAL ID | ||
| 3361 | LOCATIO N NUMBER | ||
| 3362 | MEDICAR E PART A | ||
| 3363 | MEDICAR E PART B | ||
| 3364 | PRIM INS PERF PROV SECONDARY ID TYPE: LOCATION N UMBER | ||
| 3365 | PRIM INS PERF PROV SECONDARY ID: XXXXA | ||
| 3366 | 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 . | ||
| 3367 | 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. | ||
| 3368 | 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> | ||
| 3369 | ========== ========== ========== ========== ========== ========== ========== ========== == | ||
| 3370 | B ILLING - S PECIFIC IN FORMATION | ||
| 3371 | [1] Bill R emarks | ||
| 3372 | - FL- 80 : UNSPEC IFIED [NOT REQUIRED] | ||
| 3373 | ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED] | ||
| 3374 | Auth/R eferral : UNSPEC IFIED [NOT REQUIRED] | ||
| 3375 | Admiss ion Source : PHYSIC IAN REFERR AL | ||
| 3376 | [3] Provid ers : | ||
| 3377 | - REN DERING (MD ) : IB,DO CTOR4 | ||
| 3378 | |||
| 3379 | Taxonomy: 390200000X | ||
| 3380 | |||
| 3381 | |||
| 3382 | |||
| 3383 | |||
| 3384 | |||
| 3385 | [P]XXXXBCR OSS | ||
| 3386 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | ||
| 3387 | Lab CL IA # : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3388 | Mammog raphy Cert # : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3389 | [5] Chirop ractic Dat a : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3390 | [6] Form L ocator 19 : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3391 | [7] Billin g Provider : MONTG OMERY VAMC | ||
| 3392 | Taxono my Code : 282N0 0000X | ||
| 3393 | [8] Force To Print? : NO FO RCED PRINT | ||
| 3394 | [9] Provid er ID Main t : (Edit Provider ID informa tion) | ||
| 3395 | <RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT:?PRV | ||
| 3396 | (V)A or (N )on-VA Pro vider: V// NON-VA PR OVIDER | ||
| 3397 | Select NON -VA PROVID ER NAME: I B,OUTSIDED OC O I | ||
| 3398 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | ||
| 3399 | Signature Name: OUT SIDEDOC IB | ||
| 3400 | NPI: 123 4567892 | ||
| 3401 | Licen se(s): Non e Active o n X/X/XX | ||
| 3402 | Person Class: V11 5500 | ||
| 3403 | PROVIDER TYPE: All opathic an d Osteopat hic Physic ians | ||
| 3404 | CLASSIFIC ATION: Res ident, All opathic (i ncludes In terns, Res idents, Fe llows) | ||
| 3405 | SPECIALIZ ATION: | ||
| 3406 | TAX ONOMY: 390 200000X (1 44) | ||
| 3407 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | ||
| 3408 | Select NON -VA PROVID ER NAME: | ||
| 3409 | 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> | ||
| 3410 | ========== ========== ========== ========== ========== ========== ========== ========== == | ||
| 3411 | BILLIN G - SPECIF IC INFORMA TION | ||
| 3412 | [1] Bill R emarks | ||
| 3413 | - FL- 80 : UNSPEC IFIED [NOT REQUIRED] | ||
| 3414 | ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED] | ||
| 3415 | Auth/R eferral : UNSPEC IFIED [NOT REQUIRED] | ||
| 3416 | Admiss ion Source : PHYSIC IAN REFERR AL | ||
| 3417 | [3] Provid ers : | ||
| 3418 | - REN DERING (MD ) : IB,DO CTOR4 | ||
| 3419 | |||
| 3420 | Taxonomy: 000000000X | ||
| 3421 | |||
| 3422 | |||
| 3423 | |||
| 3424 | |||
| 3425 | |||
| 3426 | [P]XXXXBC ROSS | ||
| 3427 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | ||
| 3428 | Lab CL IA # : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3429 | Mammog raphy Cert # : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3430 | [5] Chirop ractic Dat a : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3431 | [6] Form L ocator 19 : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3432 | [7] Billin g Provider : MONTG OMERY VAMC | ||
| 3433 | Taxono my Code : 282N0 0000X | ||
| 3434 | [8] Force To Print? : NO FO RCED PRINT | ||
| 3435 | [9] Provid er ID Main t : (Edit Provider ID informa tion) | ||
| 3436 | <RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT: ?ID | ||
| 3437 | IF THIS BI LL IS TRAN SMITTED EL ECTRONICAL LY, THE FO LLOWING ID S WILL BE SENT: | ||
| 3438 | PRIMARY INS CO: BL UE CROSS C A (WY) <<< Current In s | ||
| 3439 | SECONDARY INS CO: TP M TRUST | ||
| 3440 | PROVIDER I Ds: (VISTA RECORDS O P1,OP2,OP4 ,OP8,OP9,O PR2,OPR3,O PR4,OPR5,O PR8): | ||
| 3441 | ATTEN DING/RENDE RING: IB,D OCTOR 4 | ||
| 3442 | |||
| 3443 | NPI: | ||
| 3444 | |||
| 3445 | |||
| 3446 | |||
| 3447 | 000000000X | ||
| 3448 | |||
| 3449 | SSN: | ||
| 3450 | |||
| 3451 | |||
| 3452 | |||
| 3453 | XXXXXXXXX | ||
| 3454 | SEC ONDARY IDs | ||
| 3455 | |||
| 3456 | (P ) LOCATION NUMBER XXXXA | ||
| 3457 | (P ) BLUE CRO SS ID XXXXB CROSS | ||
| 3458 | (P ) ST LIC ( WY) WYXXX X | ||
| 3459 | 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 | ||
| 3460 | No A/R err ors found | ||
| 3461 | WANT TO ED IT SCREENS ? NO// | ||
| 3462 | THIS BILL WILL BE TR ANSMITTED ELECTRONIC ALLY | ||
| 3463 | WANT TO AU THORIZE BI LL AT THIS TIME? No/ / YES | ||
| 3464 | AUTHORIZE BILL GENER ATION?: YE S | ||
| 3465 | Adding bill to BI LL TRANSMI SSION File . | ||
| 3466 | Bill wil l be submi tted elect ronically | ||
| 3467 | Passing co mpleted Bi ll to Acco unts Recei vable. Bi ll is no l onger edit able. | ||
| 3468 | Completed Bill Succe ssfully se nt to Acco unts Recei vable. | ||
| 3469 | This Bill Can Not Be Printed U ntil Trans mit Confir med | ||
| 3470 | Lab Claims | ||
| 3471 | 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. | ||
| 3472 | The follow ing screen s provide a simplifi ed example of a lab claim: | ||
| 3473 | 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 IB*2 *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> | ||
| 3474 | ========== ========== ========== ========== ========== ========== ========== ====== | ||
| 3475 | PAYER IN FORMATION | ||
| 3476 | [1] Rate T ype : REI MBURSABLE INS. Form Type: CMS 1500 | ||
| 3477 | Respon sible: INS URER Payer Sequence: Primary | ||
| 3478 | Bill P ayer : Blu e Cross Fe p Tran smit: Yes | ||
| 3479 | Ins 1: Blue Cros s Fep Policy #: R00000000 | ||
| 3480 | Grp #: 100 Whose: VET ERAN Rel to In sd: PATIEN T | ||
| 3481 | Grp Nm : STANDARD FAMILY Insd Sex: MALE Insured: IB,PATIENT 3 | ||
| 3482 | [2] Billin g Provider Secondary IDs: | ||
| 3483 | Primar y : 01010 0 | ||
| 3484 | Second ary: Terti ary : | ||
| 3485 | [3] Mailin g Address : Elec tronic ID: 12B54 | ||
| 3486 | Blue C ross Fep | ||
| 3487 | P O Bo x 10401 | ||
| 3488 | Birmin gham, AL 352020401 | ||
| 3489 | <RET> to C ONTINUE, 1 -3 to EDIT , '^N' for screen N, or '^' to QUIT: | ||
| 3490 | 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> | ||
| 3491 | ========== ========== ========== ========== ========== ========== ========== ====== | ||
| 3492 | EVENT - OUTPATI ENT INFORM ATION | ||
| 3493 | [1] Event Date : XX XX,XXXX | ||
| 3494 | [2] Prin. Diag.: URI NARY FREQU ENCY - 788 .41 | ||
| 3495 | [3] OP Vis its : XXX XX,XXXX | ||
| 3496 | [4] Cod. M ethod: HCP CS | ||
| 3497 | CPT Co de : URI NALYSIS, A UTO W/SCOP E 81001 XXX X X,XXXX | ||
| 3498 | CPT Co de : URI NE BACTERI A CULTURE 87088 XXX X X,XXXX | ||
| 3499 | [5] Rx. Re fills: UNS PECIFIED [ NOT REQUIR ED] | ||
| 3500 | [6] Pros. Items: UNS PECIFIED [ NOT REQUIR ED] | ||
| 3501 | [7] Occ. C ode : UNS PECIFIED [ NOT REQUIR ED] | ||
| 3502 | [8] Cond. Code : UNS PECIFIED [ NOT REQUIR ED] | ||
| 3503 | [9] Value Code : UNS PECIFIED [ NOT REQUIR ED] | ||
| 3504 | <RET> to C ONTINUE, 1 -9 to EDIT , '^N' for screen N, or '^' to QUIT: | ||
| 3505 | 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> | ||
| 3506 | ========== ========== ========== ========== ========== ========== ========== ====== | ||
| 3507 | BILL ING - GENE RAL INFORM ATION | ||
| 3508 | [1] Bill T ype : 13 1 Loc. of Care: H OSPITAL - INPT OR OP T (INCLU | ||
| 3509 | Charge Type : PR OFESSIONAL Dis ch Stat: D ISCHARGED TO HOME OR SELF CAR | ||
| 3510 | Form T ype : CM S-1500 Ti meframe: A DMIT THRU DISCHARGE | ||
| 3511 | Bill Class if: OUTPAT IENT Division: DNS ENNE VAMRO CY VAMC | ||
| 3512 | [2] Sensit ive? : UN SPECIFIED Assi gnment: YE S | ||
| 3513 | [3] Bill F rom : XX X XX,XXXX Bi ll To: XXX XX,XXXX | ||
| 3514 | [4] OP Vis its : XX X XX,XXXX | ||
| 3515 | [5] Rev. C ode : 30 6-LAB/BACT -MICRO 87088 $33.20 OUTPATIENT VISIT | ||
| 3516 | Rev. C ode : 30 7-GASTR-IN ST SVS 81001 $12.77 OUTPATIENT VISIT | ||
| 3517 | OFFSET : $0.00 [NO OFFS ET RECORDE D] | ||
| 3518 | BILL T OTAL : $45.97 | ||
| 3519 | [6] Rate S ched : (r e-calculat e charges) | ||
| 3520 | [7] Prior Claims: UN SPECIFIED | ||
| 3521 | <RET> to C ONTINUE, 1 -7 to EDIT , '^N' for screen N, or '^' to QUIT: | ||
| 3522 | 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: IB*2 *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> | ||
| 3523 | ========== ========== ========== ========== ========== ========== ========== ======= | ||
| 3524 | BIL LING - CLA IM INFORMA TION | ||
| 3525 | [1] COB No n-Covered Charge Amt : | ||
| 3526 | [2] Proper ty Casualt y Informat ion | ||
| 3527 | Claim Number: Contact N ame: | ||
| 3528 | Date o f 1st Cont act: Contact P hone: | ||
| 3529 | [3] Surgic al Codes f or Anesthe sia Claims | ||
| 3530 | Primar y Code: Secondary Code: | ||
| 3531 | [4] Paperw ork Attach ment Infor mation | ||
| 3532 | Report Type: Transmiss ion Method : | ||
| 3533 | Attach ment Contr ol #: | ||
| 3534 | [5] Disabi lity Start Date: Disabilit y End Date : | ||
| 3535 | [6] Assume d Care Dat e: Relinquis hed Care D ate: | ||
| 3536 | [7] Specia l Program: | ||
| 3537 | [8] Homebo und: | ||
| 3538 | [9] Date L ast Seen: | ||
| 3539 | <RET> to C ONTINUE '^ N' for scr een N, or '^' to QUI T: | ||
| 3540 | Note: IB*2 *488 moved the follo wing Scree n 10 field s to Scree n 8: Speci al Program ; Date Las t Seen; Ho mebound. T hese field s no longe r print in Box 19.IB ,PATIENT M RA XX-XX -XXXX BI LL#: K2000 3E - Outpa t/1500 SCREE N <9> | ||
| 3541 | ========== ========== ========== ========== ========== ========== ========== ======= | ||
| 3542 | AMBULANCE INFORMATIO N | ||
| 3543 | [1] Ambula nce Transp ort Data | ||
| 3544 | D/O Locat ion: | ||
| 3545 | P/U Ad dress1: D/O Addre ss1: | ||
| 3546 | P/U Ad dress2: D/O Addre ss2: | ||
| 3547 | P/U Ci ty: D/O City: | ||
| 3548 | P/U St ate/Zip: D/O State /Zip: | ||
| 3549 | Patien t Weight: Transport Distance: | ||
| 3550 | Transp ort Reason : | ||
| 3551 | R/T Pu rpose: | ||
| 3552 | Stretc her Purpos e: | ||
| 3553 | [2] Ambula nce Certif ication Da ta | ||
| 3554 | Condit ion Indica tor: 12 - Confined t o a bed or chair | ||
| 3555 | 01 - Admitted t o hospital | ||
| 3556 | <RET> to C ONTINUE, 1 -2 to EDIT , '^N' for screen N, or '^' to QUIT: 1 | ||
| 3557 | P/U Addres s1: | ||
| 3558 | P/U Addres s 2: | ||
| 3559 | P/U City: | ||
| 3560 | P/U State: | ||
| 3561 | P/U Zip: | ||
| 3562 | D/O Locati on: | ||
| 3563 | D/O Addres s1: | ||
| 3564 | D/O Addres s2: | ||
| 3565 | D/O City: | ||
| 3566 | D/O State: | ||
| 3567 | D/O Zip: | ||
| 3568 | Patient We ight: | ||
| 3569 | Transport Distance: | ||
| 3570 | Transport Reason: | ||
| 3571 | R/T Purpos e: | ||
| 3572 | Stretcher Purpose: | ||
| 3573 | <RET> to C ONTINUE, 1 -2 to EDIT , '^N' for screen N, or '^' to QUIT: 2 | ||
| 3574 | Select Amb ulance Con dition Ind icator: 01 // ? | ||
| 3575 | Answer with AMBU LANCE COND ITION INDI CATOR | ||
| 3576 | Choose from: | ||
| 3577 | 12 | ||
| 3578 | 01 | ||
| 3579 | Yo u may ente r a new AM BULANCE CO NDITION IN DICATOR, i f you wish | ||
| 3580 | Se lect an Am bulance Co ndition In dicator. Answer mus t be 1-2 | ||
| 3581 | ch aracters i n length. | ||
| 3582 | Th is limits the entry to five co ndition in dicators. | ||
| 3583 | Answer with AMBU LANCE COND ITION INDI CATORS COD E | ||
| 3584 | Choose from: | ||
| 3585 | 12 Confine d to a bed or chair | ||
| 3586 | 01 Admitte d to hospi tal | ||
| 3587 | 04 Moved b y stretche r | ||
| 3588 | 05 Unconsc ious or in Shock | ||
| 3589 | 06 Transpo rted in em ergency si tuation | ||
| 3590 | 07 Had to be physica lly restra ined | ||
| 3591 | 08 Visible hemorrhag ing | ||
| 3592 | 09 Medical ly necessa ry service | ||
| 3593 | Select Amb ulance Con dition Ind icator: 01 // | ||
| 3594 | 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 IB*2 .0*320, 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> | ||
| 3595 | ========== ========== ========== ========== ========== ========== ========== ====== | ||
| 3596 | BILLI NG - SPECI FIC INFORM ATION | ||
| 3597 | [[1] Bill Remarks | ||
| 3598 | - FL- 80 : UNSPEC IFIED [NOT REQUIRED] | ||
| 3599 | ICN/DC N(s) : UNSPEC IFIED [NOT REQUIRED] | ||
| 3600 | Auth/R eferral : UNSPEC IFIED [NOT REQUIRED] | ||
| 3601 | Admiss ion Source : PHYSIC IAN REFERR AL | ||
| 3602 | [3] Provid ers : | ||
| 3603 | - REF ERRING (MD ) : IB,DO CTOR5 | ||
| 3604 | Taxonomy: XXXXXXXXXX (XX) | ||
| 3605 | [P]XX 0000 | ||
| 3606 | - REN DERING (MD ) : IB,DO CTOR4 | ||
| 3607 | Taxonomy: XXXXXXXXXX (XX) | ||
| 3608 | [P]XX X123 | ||
| 3609 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | ||
| 3610 | Lab CL IA # : DXXXX 000 | ||
| 3611 | Mammog raphy Cert # : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3612 | [5] Chirop ractic Dat a : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3613 | [6] CMS-15 00 Box 19 : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3614 | [7] Billin g Provider : DNS ENNE VAMC | ||
| 3615 | Taxono my Code : 282N0 0000X | ||
| 3616 | [8] Alt Pr im Payer I D : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3617 | [9] Force To Print? : NO FO RCED PRINT | ||
| 3618 | [10] Provi der ID Mai nt : (Edi t Provider ID inform ation) | ||
| 3619 | <RET> to C ONTINUE, 1 -10 to EDI T, '^N' fo r screen N , or '^' t o QUIT: 6 | ||
| 3620 | CMS-1500 B ox 19: ?? | ||
| 3621 | This is an 71 character free-text field that will prin t in Box 1 9 | ||
| 3622 | of t he CMS-150 0. Use th is field t o enter ad ditional P ayer requi red | ||
| 3623 | IDs in the for mat of Qua lifier<no space>ID n umber<3 sp aces> | ||
| 3624 | Qual ifier<no s pace>ID nu mber. | ||
| 3625 | CMS-1500 B ox 19: ?? | ||
| 3626 | DISPLAY TH E FULL CMS -1500 BOX 19?: NO// | ||
| 3627 | Note: Patc h IB*2*488 changed t he prompt Form Locat or 19 to C MS-1500 Bo x 19 and u pdated the Help text . 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 IB*2* 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 | ||
| 3628 | 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. | ||
| 3629 | The follow ing screen s give a s implified example of a pharmac y claim. | ||
| 3630 | 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 *2*516, 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> | ||
| 3631 | ========== ========== ========== ========== ========== ========== ========== ========= | ||
| 3632 | PAYER IN FORMATION | ||
| 3633 | [1] Rate T ype : REI MBURSABLE INS. Form Type: CMS- 1500 | ||
| 3634 | Respon sible: INS URER Payer Sequence: Primary | ||
| 3635 | Bill P ayer : CIG NA Trans mit: Yes | ||
| 3636 | Ins 1: CIGNA Policy #: 126781678 | ||
| 3637 | Grp #: GRP NUM 2 277 Whose: VET ERAN Rel to In sd: PATIEN T | ||
| 3638 | Grp Nm : CHALKER Insd Sex: MALE Insured: IB,PATIENT 5 | ||
| 3639 | Ins 2: BLUE CROS S CA (W Policy #: R76543210 | ||
| 3640 | Grp #: GRP NUM 1 0891 Whose: SPO USE Rel to In sd: SPOUSE | ||
| 3641 | Grp Nm : HARTLY Insd Sex: FEMALE Insured: IB,WIFE5 | ||
| 3642 | [2] Billin g Provider Secondary IDs: UNSP ECIFIED [N OT REQUIRE D] | ||
| 3643 | [3] Mailin g Address : | ||
| 3644 | NO MAI LING ADDRE SS HAS BEE N SPECIFIE D! (Pati ent has Me dicare) | ||
| 3645 | Send B ill to PAY ER listed above. | ||
| 3646 | <RET> to C ONTINUE, 1 -3 to EDIT , '^N' for screen N, or '^' to QUIT: | ||
| 3647 | 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 IB*2 *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 // | ||
| 3648 | Date RX Or dered: Oc t 26, 2010 | ||
| 3649 | RX #: 2054 788// | ||
| 3650 | DATE: OCT 26,2010// | ||
| 3651 | DRUG: HYDR OCHLOROTHI AZIDE 25MG TAB// | ||
| 3652 | DAYS SUPPL Y: 30// | ||
| 3653 | QTY: 15// | ||
| 3654 | NDC #: 001 72-2083-80 // | ||
| 3655 | FORMAT OF NDC#: 5-4- 2 FORMAT// | ||
| 3656 | IB,PATIENT 5 XX-XX -XXXX BI LL#: K303X XX - Outpa t/1500 SCREE N <5> | ||
| 3657 | ========== ========== ========== ========== ========== ========== ========== ========= | ||
| 3658 | EVENT - OUTPATI ENT INFORM ATION | ||
| 3659 | <1> Event Date : XXX XX,XXXX | ||
| 3660 | [2] Prin. Diag.: ISS UE REPEAT PRESCRIPT - V68.1 | ||
| 3661 | [3] OP Vis its : UNS PECIFIED | ||
| 3662 | [4] Cod. M ethod: HCP CS | ||
| 3663 | CPT Co de : Ora l prescrip drug non chemo J849 9 V6 8.1 XXX XX,XXXX | ||
| 3664 | [5] Rx. Re fills: HYD ROCHLOROTH IAZIDE 25M G TAB XXX XX,XX XX | ||
| 3665 | [6] Pros. Items: UNS PECIFIED [ NOT REQUIR ED] | ||
| 3666 | [7] Occ. C ode : UNS PECIFIED [ NOT REQUIR ED] | ||
| 3667 | [8] Cond. Code : UNS PECIFIED [ NOT REQUIR ED] | ||
| 3668 | <9> Value Code : UNS PECIFIED [ NOT REQUIR ED] | ||
| 3669 | <RET> to C ONTINUE, 1 -9 to EDIT , '^N' for screen N, or '^' to QUIT: | ||
| 3670 | 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>> | ||
| 3671 | LISTING FR OM VISIT D ATES WITH ASSOCIATED CPT CODES | ||
| 3672 | IN OUTPT E NCOUNTERS FILE | ||
| 3673 | ========== ========== ========== ========== ========== ========== ========== ========= | ||
| 3674 | NO. CODE SHORT N AME C LINIC DATE | ||
| 3675 | ========== ========== ========== ========== ========== ========== ========== ========= | ||
| 3676 | NO CPT COD ES ON FILE FOR THE V ISIT DATES ON THIS B ILL | ||
| 3677 | PROCEDURE CODING MET HOD: HCPCS (1500 COM MON PROCED URE CODING SYSTEM) | ||
| 3678 | / / | ||
| 3679 | Select PRO CEDURE DAT E (X/XX/XX -XX/XX/XX) : XX-XX-XX | ||
| 3680 | * Patient has no Vis its for th is date... | ||
| 3681 | Select PROCEDURE: J | ||
| 3682 | Searching for a CPT ,(pointed- to by PROC EDURES) | ||
| 3683 | J8499 Oral pre scrip drug non chemo | ||
| 3684 | .. .OK? Yes// Yes Oral prescrip drug non c hem Rx: 0 000000D | ||
| 3685 | PROCEDURES : J8499// | ||
| 3686 | Select CPT MODIFIER SEQUENCE: | ||
| 3687 | PROVIDER: IB,DOCTOR6 // | ||
| 3688 | ASSOCIATED CLINIC: C ARDIAC CON SULT | ||
| 3689 | DIVISION: MONTGOMERY VAMC// 619 | ||
| 3690 | PLACE OF S ERVICE: 22 OUT PATIENT HO SPITAL | ||
| 3691 | TYPE OF SE RVICE: 1 MEDIC AL CARE | ||
| 3692 | EMERGENCY PROCEDURE? : NO// N O | ||
| 3693 | PRINT ORDE R: | ||
| 3694 | 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> | ||
| 3695 | ========== ========== ========== ========== ========== ========== ========== ========= | ||
| 3696 | EVENT - OUTPATI ENT INFORM ATION | ||
| 3697 | <1> Event Date : XXX XX,XXXX | ||
| 3698 | [2] Prin. Diag.: ISS UE REPEAT PRESCRIPT - V68.1 | ||
| 3699 | [3] OP Vis its : XXX XX,XXXX | ||
| 3700 | [4] Cod. M ethod: HCP CS | ||
| 3701 | CPT Co de : Ora l prescrip drug non chemo J8 499 V68.1 XXX XX,X XXX | ||
| 3702 | [5] Rx. Re fills: RAN ITIDINE HC L 150MG (Z ANTAC) TAB XXX XX,X XXX | ||
| 3703 | [6] Pros. Items: UNS PECIFIED [ NOT REQUIR ED] | ||
| 3704 | [7] Occ. C ode : UNS PECIFIED [ NOT REQUIR ED] | ||
| 3705 | [8] Cond. Code : UNS PECIFIED [ NOT REQUIR ED] | ||
| 3706 | <9> Value Code : UNS PECIFIED [ NOT REQUIR ED] | ||
| 3707 | <RET> to C ONTINUE, 1 -9 to EDIT , '^N' for screen N, or '^' to QUIT: | ||
| 3708 | 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> | ||
| 3709 | ========== ========== ========== ========== ========== ========== ========== ========= | ||
| 3710 | BILL ING - GENE RAL INFORM ATION | ||
| 3711 | [1] Bill T ype : 13 1 Loc. o f Care: HO SPITAL - I NPT OR OPT (INCLU | ||
| 3712 | Covere d Days: UN SPECIFIED Bill C lassif: OU TPATIENT | ||
| 3713 | Non-Co v Days: UN SPECIFIED Tim eframe: AD MIT THRU D ISCHARGE | ||
| 3714 | Charge Type : UN SPECIFIED Disc h Stat: | ||
| 3715 | Form T ype : CM S-1500 Di vision: MO NTGOMERY V AMC | ||
| 3716 | [2] Sensit ive? : UN SPECIFIED Assi gnment: YE S | ||
| 3717 | [3] Bill F rom : XX X XX,XXXX Bi ll To: XXX XX,XXXX | ||
| 3718 | [4] OP Vis its : UN SPECIFIED | ||
| 3719 | [5] Rev. C ode : 25 3-WARFARIN SODIUM 5 J8499 1 $36.0 0 PRESCRI PTION | ||
| 3720 | OFFSET: $0 .00 [NO OFFSET REC ORDED] | ||
| 3721 | BILL T OTAL : $36.00 | ||
| 3722 | [6] Rate S ched : (r e-calculat e charges) | ||
| 3723 | [7] Prior Claims: UN SPECIFIED | ||
| 3724 | 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 B*2*447 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> | ||
| 3725 | ========== ========== ========== ========== ========== ========== ========== ========== | ||
| 3726 | BIL LING - CLA IM INFORMA TION | ||
| 3727 | <1> COB No n-Covered Charge Amt : | ||
| 3728 | <2> Proper ty Casualt y Informat ion | ||
| 3729 | Claim Number: Contact N ame: | ||
| 3730 | Date o f 1st Cont act: Contact P hone: | ||
| 3731 | <3> Surgic al Codes f or Anesthe sia Claims | ||
| 3732 | Primar y Code: Secondary Code: | ||
| 3733 | <4> Paperw ork Attach ment Infor mation | ||
| 3734 | Report Type: Transmiss ion Method : | ||
| 3735 | Attach ment Contr ol #: | ||
| 3736 | <5> Disabi lity Start Date: Disabilit y End Date : | ||
| 3737 | <6> Assume d Care Dat e: Relinquis hed Care D ate: | ||
| 3738 | [7] Specia l Program: | ||
| 3739 | [8] Homebo und: | ||
| 3740 | [9] Date L ast Seen: | ||
| 3741 | <RET> to C ONTINUE '^ N' for scr een N, or '^' to QUI T: | ||
| 3742 | IB,PATIENT M M XXX- XX-XXXX BILL#: K10 1ES8 - Out pat/UB04 SCREEN <9> | ||
| 3743 | ========== ========== ========== ========== ========== ========== ========== ========== | ||
| 3744 | AMBULANCE INFORMATIO N | ||
| 3745 | <1> Ambula nce Transp ort Data | ||
| 3746 | D/O Locat ion: | ||
| 3747 | P/U Ad dress1: D/O Addre ss1: | ||
| 3748 | P/U Ad dress2: D/O Addre ss2: | ||
| 3749 | P/U Ci ty: D/O City: | ||
| 3750 | P/U St ate/Zip: D/O State /Zip: | ||
| 3751 | Patien t Weight: Transport Distance: | ||
| 3752 | Transp ort Reason : | ||
| 3753 | R/T Pu rpose: | ||
| 3754 | Stretc her Purpos e: | ||
| 3755 | <2> Ambula nce Certif ication Da ta | ||
| 3756 | Condit ion Indica tor: | ||
| 3757 | <RET> to C ONTINUE, 1 -2 to EDIT , '^N' for screen N, or '^' to QUIT: | ||
| 3758 | StepProced ure12From Screen 10, enter 3 t o add a Re ndering pr ovider. Pa tch IB*2*5 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> | ||
| 3759 | ========== ========== ========== ========== ========== ========== ========== ========== | ||
| 3760 | B ILLING - S PECIFIC IN FORMATION | ||
| 3761 | [1] Unable To Work F rom: UNSPE CIFIED [NO T REQUIRED ] | ||
| 3762 | Unable To Work T o : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3763 | [2] ICN/DC N(s) : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3764 | Auth/R eferral : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3765 | [3] Provid ers : | ||
| 3766 | - REN DERING : UNSPE CIFIED | ||
| 3767 | [4] Other Facility ( VA/non): U NSPECIFIED [NOT REQU IRED] | ||
| 3768 | Lab CL IA # : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3769 | Mammog raphy Cert # : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3770 | [5] Chirop ractic Dat a : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3771 | [6] CMS-15 00 Box 19 : UNSPE CIFIED [NO T REQUIRED ] | ||
| 3772 | [7] Billin g Provider : DNS ENNE VAMC | ||
| 3773 | Taxono my Code : 282N0 0000X | ||
| 3774 | [8] Alt Pr im Payer I D : UNSPE CIFED [NOT REQUIRED] | ||
| 3775 | [9] Force To Print? : NO FO RCED PRINT | ||
| 3776 | [10] Provi der ID Mai nt : (Edi t Provider ID inform ation) | ||
| 3777 | <RET> to C ONTINUE, 1 -10 to EDI T, '^N' fo r screen N , or '^' t o QUIT: | ||
| 3778 | This claim is now re ady for au thorizatio n. | ||
| 3779 | Correct Re jected or Denied Cla ims | ||
| 3780 | 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. | ||
| 3781 | With Patch IB*2*433, a new opt ion has be en added t o the IB M odule that allows us ers to cor rect a cla im while m aintaining the origi nal claim number on the resubm itted clai m. | ||
| 3782 | With Patch IB*2*447, users are able to c orrect all types of claims inc luding a c laim that processes to a non-a ccruing fu nds. It i s now poss ible to co rrect a cl aim with o ne of the following rate types : | ||
| 3783 | INTERAGENC Y | ||
| 3784 | SHARING AG REEMENT | ||
| 3785 | TRICARE | ||
| 3786 | WORKMAN’S COMP | ||
| 3787 | 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 B*2*516.Th e followin g screen w ill displa y. | ||
| 3788 | IB,PATIENT 4 (XX-X X-XXXX) DOB: X XX XX,XXXX | ||
| 3789 | ========== ========== ========== ========== ========== ========== ========== ========== | ||
| 3790 | Rate Type : REI MBURSABLE INS. | ||
| 3791 | Event Date : XXX XX XXXX | ||
| 3792 | Sensitive : NO | ||
| 3793 | Responsibl e : INS URANCE CAR RIER (Sp ecify CARR IER on SCR EEN 3) | ||
| 3794 | Loc of Car e : HOS PITAL (INC LUDES CLIN IC) - INPT . OR OPT. | ||
| 3795 | Event Sour ce : Out patient | ||
| 3796 | Timeframe : ADM IT THRU DI SCHARGE | ||
| 3797 | (Sp ecify actu al bill ty pe fields on SCREENs 6/7) | ||
| 3798 | Bill From : XXX XX,XXXX | ||
| 3799 | Bill To : XXX XX,XXXX | ||
| 3800 | Initial Bi ll# : K70 1XXX-01 | ||
| 3801 | Copied Bil l# : K70 1XXX-01 | ||
| 3802 | Please ver ify the ab ove inform ation for the bill y ou just en tered. On ce this | ||
| 3803 | informatio n is accep ted it wil l no longe r be edita ble and yo u will be required | ||
| 3804 | to CANCEL THE BILL i f changes to this in formation are necess ary. | ||
| 3805 | IS THE ABO VE INFORMA TION CORRE CT AS SHOW N? Yes// | ||
| 3806 | 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. | ||
| 3807 | Select T hird Party Billing M enu Option : CRD Cor rect Rejec ted/Denied Bill | ||
| 3808 | Enter BILL NUMBER or Patient N AME: K6 00XXX IB,PATIENT 1 XX-X X-XX | ||
| 3809 | Outpat ient R EIMBURSABL E INS. PRNT/TX | ||
| 3810 | Please not e a PAYMEN T of **$45 ** has bee n POSTED t o this bil l. Copy an d cancel | ||
| 3811 | (CLON) mus t be used to correct this bill . | ||
| 3812 | 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. | ||
| 3813 | Select Thi rd Party B illing Men u Option: CRD Corre ct Rejecte d/Denied B ill | ||
| 3814 | Enter BILL NUMBER or Patient N AME: K6 00XXX IB,PATIENT 1 XX-X X-XX | ||
| 3815 | Outpat ient R EIMBURSABL E INS. PRNT/TX | ||
| 3816 | 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. | ||
| 3817 | 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. | ||
| 3818 | Select Thi rd Party B illing Men u Option: CRD Corre ct Rejecte d/Denied B ill | ||
| 3819 | Enter BILL NUMBER or Patient N AME: K6 00XXX IB,PATIENT 1 XX-X X-XX | ||
| 3820 | Outpat ient R EIMBURSABL E INS. PRNT/TX | ||
| 3821 | This optio n cannot b e used to correct so me Billing Rate Type s (Example : TRICARE) . | ||
| 3822 | Use Copy a nd Cancel (CLON) to correct th is bill. | ||
| 3823 | 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. | ||
| 3824 | Please not e that COB data exis ts for thi s bill. | ||
| 3825 | Copy and c ancel (CLO N) must be used to c orrect thi s bill. | ||
| 3826 | 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. | ||
| 3827 | This bill is in a st atus of RE QUEST MRA. | ||
| 3828 | No MRA s have bee n received and there are no re jection me ssages on file | ||
| 3829 | for th e most rec ent transm ission of this MRA r equest bil l. | ||
| 3830 | 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: | ||
| 3831 | BILL - Ent er/Edit Bi lling Info rmation | ||
| 3832 | INQ – Pati ent Billin g Inquiry | ||
| 3833 | Viewed Can celled Cla ims | ||
| 3834 | 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. | ||
| 3835 | The View C ancelled B ill option is on the Third Par ty Billing Menu. | ||
| 3836 | ADPR Print Bill Addendum Sheet | ||
| 3837 | AUTH Authorize Bill Gener ation | ||
| 3838 | BILL Enter/Edit Billing I nformation | ||
| 3839 | CANC Cancel Bil l | ||
| 3840 | CLA Multiple C LAIMSMANAG ER Claim S end | ||
| 3841 | CLON Copy and C ancel | ||
| 3842 | CRD Correct Re jected/Den ied Bill | ||
| 3843 | DLST Delete Aut o Biller R esults | ||
| 3844 | GEN Print Bill | ||
| 3845 | INQU Patient Bi lling Inqu iry | ||
| 3846 | LIST Print Auto Biller Re sults | ||
| 3847 | PRNT Print Auth orized Bil ls | ||
| 3848 | RETN Return Bil l Menu ... | ||
| 3849 | VCB View Cance lled Bill | ||
| 3850 | VIEW View Bills Pending T ransmissio n | ||
| 3851 | VIST Outpatient Visit Dat e Inquiry | ||
| 3852 | Select Thi rd Party B illing Men u <TEST AC COUNT> Opt ion: | ||
| 3853 | Printed Cl aims | ||
| 3854 | Some claim s should n ot be tran smitted el ectronical ly and sho uld be pri nted local ly. | ||
| 3855 | These incl ude: | ||
| 3856 | Claims req uiring cli nical atta chments su ch as prog ress notes ; | ||
| 3857 | Profession al claims containing more than the maxim um number of 8 diagn osis codes ; | ||
| 3858 | Profession al claims containing more than the maxim um number of diagnos is pointer s (4); | ||
| 3859 | Institutio nal claims containin g more tha n the maxi mum number of proced ure codes (999); | ||
| 3860 | Profession al claims containing more than the maxim um number of procedu re codes/l ine items (50); | ||
| 3861 | Institutio nal pharma cy claims; and | ||
| 3862 | Secondary claims to Medicare W NR (When M edicare WN R is NOT t he primary insurance ). | ||
| 3863 | View/Resub mit Claims – Live or Test – Sy nonym: RCB | ||
| 3864 | 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. | ||
| 3865 | Patch IB*2 *547 will add the ab ility to r un the RCB option to find prev iously pri nted claim s and to r esubmit th em to the test queue only. The y cannot b e retransm itted to t he product ion queue. The patch will also provide t he ability to look-u p claims t o specific payers us ing the ED I - Inst P ayer Prima ry ID or E DI - Prof Payer Prim ary ID. | ||
| 3866 | 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 | ||
| 3867 | *** NOTE: 2 '^' ARE NEEDED TO ABORT THE OPTION (^^ ) | ||
| 3868 | 1 '^' BRIN GS YOU BAC K TO THE P REVIOUS SE LECTION PR OMPT(^) | ||
| 3869 | Run report for (P)ri nted or (T )ransmitte d claims?: Transmitt ed//Transm itted | ||
| 3870 | Select By: (C)laim o r see a (L )ist to pi ck from?: List// | ||
| 3871 | PAYER SELE CTION: | ||
| 3872 | Run for (A )ll Payers or (S)ele cted Payer s?: Select ed Payers/ /Selected Payers | ||
| 3873 | Include all payer s with the same elec tronic Pay er ID? Yes // YES | ||
| 3874 | Select Insurance Company: 6 0054 | ||
| 3875 | 1 6 0054 AETN A HEALTH P LANS4501 N STERLING PEORIA,IL 6 0054/60054 | ||
| 3876 | 2 6 0054 AETN A HEALTH P LANS620 ER IE BLVD WE ST SYRACU SE,NY 6 0054/60054 | ||
| 3877 | 3 6 0054 AETN A HEALTH P LANSPO BOX 16516 C OLUMBUS,OH 6 0054/60054 | ||
| 3878 | 4 6 0054 AETN A HEALTH P LANS3541 W INCHESTER ROAD ALLE NTOWN,PA 60054/6005 | ||
| 3879 | 4 | ||
| 3880 | 5 6 0054 AETN A HEALTH P LANSPO BOX 112 P ORTLAND,OR 6 0054/60054 | ||
| 3881 | Press <RET URN> to se e more, '^ ' to exit this list, OR | ||
| 3882 | CHOOSE 1-5 : 1 AETNA HEALTH PL ANS4501 N STERLING PEORIA,IL 6 0054/60054 | ||
| 3883 | Select Another In surance Co mpany: | ||
| 3884 | BILL FORM TYPE SELEC TION: | ||
| 3885 | Run for (U )B-04, (C) MS-1500 or (B)oth: B oth// Both | ||
| 3886 | LAST BATCH TRANSMIT DATE RANGE SELECTION : | ||
| 3887 | Start with Date Last Transmitt ed: T-200 (XXX XX, XXXX) | ||
| 3888 | Go to Date Last Tran smitted:(T -200 – T-1 10): T-110 // (XXX XX, XXXX) | ||
| 3889 | ADDITIONAL SELECTION CRITERIA: | ||
| 3890 | 1 - MRA Se condary On ly | ||
| 3891 | 2 - Primar y Claims O nly | ||
| 3892 | 3 - Second ary Claims Only | ||
| 3893 | 4 - Claims Sent to P rint at Cl earinghous e Only | ||
| 3894 | 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 | ||
| 3895 | Would you like to in clude clai ms Forced to Print a t the Clea ringhouse? No// NO | ||
| 3896 | Sort By: C urrent Pay er// ?? | ||
| 3897 | Enter a co de from th e list. | ||
| 3898 | Selec t one of t he followi ng: | ||
| 3899 | 1 Batch By L ast Transm itted Date (Claims w ithin a Ba tch) | ||
| 3900 | 2 Current Pa yer (Insur ance Compa ny) | ||
| 3901 | 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// | ||
| 3902 | The follow ing screen is displa yed: | ||
| 3903 | PREVIOUSLY TRANSMITT ED CLAIMS Mar 21, 20 05@15:52:1 0 Page: 1 of 1215 | ||
| 3904 | ** A claim may appea r multiple times if transmitte d more tha n once. ** | ||
| 3905 | ** T = Tes t Claim ** R = Batch Rejected | ||
| 3906 | >>># of Cl aims Selec ted: 0 (ma rked with *) | ||
| 3907 | Claim # Form Type S eq Status Current P ayer | ||
| 3908 | Batch: 605001118 2 Date La st Transmi tted: Nov 30, 2004 | ||
| 3909 | 1 K500XX X UB-0 4 OUTPT P PRNT/ TX AETNA US HEALTHCAR E | ||
| 3910 | Batch: 605001118 3 Date La st Transmi tted: Nov 30, 2004 | ||
| 3911 | 2 K500XX X UB-0 4 OUTPT P PRNT/ TX AETNA US HEALTHCAR E | ||
| 3912 | Batch: 605001118 4 Date La st Transmi tted: Nov 30, 2004 | ||
| 3913 | 3 K500XX X 1500 OUTPT P PRNT/T X AETNA | ||
| 3914 | Batch: 605001118 5 Date La st Transmi tted: Nov 3 0, 2004 | ||
| 3915 | 4 K500XX X 1500 OUTPT S PRNT/T X AETNA Batch: 60 50011186 Date Last Transmitte d: Nov 30, 2004 | ||
| 3916 | 5 K500XX X UB-0 4 OUTPT P PRNT/ TX AETNA US HEALTHCAR E | ||
| 3917 | Batch: 605001118 7 Date La st Transmi tted: Nov 30, 2004 | ||
| 3918 | 6 K500XX X 1500 OUTPT P PRNT/T X AETNA US HEALTHCAR E | ||
| 3919 | + Enter ?? f or more ac tions >>> | ||
| 3920 | Claim(s) Select/De select View Claim s Selected | ||
| 3921 | Batch Se lect/De se lect | ||
| 3922 | Print Repo rt | ||
| 3923 | Resubmit Claims | ||
| 3924 | |||
| 3925 | |||
| 3926 | |||
| 3927 | Exit | ||
| 3928 | Action: Ne xt Screen/ / | ||
| 3929 | 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 | ||
| 3930 | ** A claim may appea r multiple times if transmitte d more tha n once. ** | ||
| 3931 | >>># of Cl aims Selec ted: 1 (ma rked with *) | ||
| 3932 | Claim # Form Type S eq Status Current P ayer | ||
| 3933 | Batch: 605001118 2 Date La st Transmi tted: Nov 30, 2004 | ||
| 3934 | 1 *K500YR J UB-0 4 OUTPT P PRNT/ TX UNITED H EALTHCARE | ||
| 3935 | Batch: 605001118 3 Date La st Transmi tted: Nov 30, 2004 | ||
| 3936 | 2 K50092 T UB-0 4 OUTPT P REQUE ST MRA MEDICARE (WNR) | ||
| 3937 | Batch: 605001118 4 Date La st Transmi tted: Nov 30, 2004 | ||
| 3938 | 3 K500YS F 1500 OUTPT P PRNT/T X UNITED HE ALTHCARE | ||
| 3939 | Batch: 605001118 5 Date La st Transmi tted: Nov 30, 2004 | ||
| 3940 | 4 K500YS Z 1500 OUTPT S PRNT/T X SOUTHWEST ADMINISTR ATORS | ||
| 3941 | Batch: 605001118 6 Date La st Transmi tted: Nov 30, 2004 | ||
| 3942 | 5 K500YU D UB-0 4 OUTPT P PRNT/ TX AETNA US HEALTHCAR E | ||
| 3943 | Batch: 605001118 7 Date La st Transmi tted: Nov 30, 2004 | ||
| 3944 | 6 K500YU E 1500 OUTPT P PRNT/T X AETNA US HEALTHCARE | ||
| 3945 | + Enter ?? f or more ac tions >>> | ||
| 3946 | Claim(s) Select/De select View Cla ims Select ed | ||
| 3947 | Batch Se lect/Desel ect Print Re port | ||
| 3948 | Resubmit Claims as TEST Exit | ||
| 3949 | Action: Ne xt Screen/ / b Bat ch Select/ De select | ||
| 3950 | Select EDI TRANSMISS ION BATCH NUMBER: 60 50011183 | ||
| 3951 | 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. | ||
| 3952 | Are you su re you wan t to conti nue?: NO// y YES | ||
| 3953 | Resubmissi on in proc ess... | ||
| 3954 | Processing of Second ary/Tertia ry Claims | ||
| 3955 | With Patch IB*2*432 installed, the proce dures for the proces sing of se condary an d tertiary non-MRA c laims have changed. | ||
| 3956 | 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. | ||
| 3957 | 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. | ||
| 3958 | Patch IB*2 *447 remov ed the opt ion, Copy for Second ary/Tertia ry Bill [I B COPY SEC OND/THIRD] . This opt ion became obsolete with the i nstall of IB*2.0*432 and the i ntroductio n of the n ew CBW (CO B Manageme nt Work li st). | ||
| 3959 | 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. | ||
| 3960 | 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 : | ||
| 3961 | All Explan ation of B enefit (EO Bs), 835 H ealth Care Claim Pay ment Advic e, have be en receive d ; and | ||
| 3962 | Payment fr om the pre vious paye r has been posted by AR; and | ||
| 3963 | The bill s tatus for the previo us payer i s Collecte d/Closed. | ||
| 3964 | 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. | ||
| 3965 | 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 | ||
| 3966 | 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: | ||
| 3967 | 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 | ||
| 3968 | 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 | ||
| 3969 | The sum of the deduc tible, coi nsurance a nd co-paym ent amount s is great er than $0 .00; and | ||
| 3970 | The EOB st atus is Pr ocessed (T he Claim S tatus Code is either 1, 2, or 3). | ||
| 3971 | COB Manage ment Workl ist | ||
| 3972 | 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. | ||
| 3973 | 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 IB*2*516 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 IB*2*5 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. | ||
| 3974 | COB Manage ment WorkL ist JAN 01, 20 11@13:41:1 6 Page: 1 of 20 | ||
| 3975 | Bill # Svc Date Pati ent Name SSN Pt Resp Bill Amt Care/Form | ||
| 3976 | BILLER: IB ,CLERK 1 | ||
| 3977 | 1 442-K4 01XXX* 12/ 07/10 IB,P ATIENT 27 XXXX 0.00 87.58 OP/1500 | ||
| 3978 | Insu rers: AET NA US HEAL THCARE | ||
| 3979 | EOB St atus: DEN IED, Feb 2 5, 2004 | ||
| 3980 | 2 442-K4 01XXX* 12/ 07/10 IB,P ATIENT 4 XXXX 86.40 72.00 OP/UB-04 | ||
| 3981 | Insu rers: AET NA US HEAL THCARE | ||
| 3982 | EOB St atus: DEN IED, Jun 0 9, 2004 | ||
| 3983 | 3 442-K4 01XXX 12/ 08/10 IB,P ATIENT 33 XXXX 0.00 243.16 OP/UB-04 | ||
| 3984 | Insu rers: AET NA US HEAL THCARE | ||
| 3985 | EOB St atus: DEN IED, Jul 2 8, 2004 | ||
| 3986 | 4 442-K4 01XXX 12/ 08/10 IB,P ATIENT 102 XXXX 0.00 45.61 OP/1500 | ||
| 3987 | Insu rers: AET NA US HEAL THCARE | ||
| 3988 | EOB St atus: DEN IED, Jun 0 9, 2004 | ||
| 3989 | 5 442-K4 02XXX 12/ 14/10 IB,P ATIENT 10 XXXX 0.00 30.74 OP/1500 | ||
| 3990 | Insu rers: AET NA US HEAL THCARE | ||
| 3991 | + Enter ?? f or more ac tions | ||
| 3992 | PC Proces s COB CB Cancel Bil l RM Remo ve from Wo rklist | ||
| 3993 | VE View a n EOB CR Correct Bi ll PE Prin t EOB/MRA | ||
| 3994 | EC Enter/ View Comme nts CC Cancel/Clo ne A Bill TP Thir d Party Jo int Inq. | ||
| 3995 | RS Review Status VB View Bill EX Exit | ||
| 3996 | Select Act ion: Next Screen// | ||
| 3997 | Data Displ ayed for C laims on t he COB Man agement Wo rklist | ||
| 3998 | The follow ing data i s displaye d on the C OB Managem ent Workli st: | ||
| 3999 | List numbe r | ||
| 4000 | Claim numb er | ||
| 4001 | Asterisk – when clai m is under review | ||
| 4002 | Claim date | ||
| 4003 | Patient na me | ||
| 4004 | Last 4 num bers of pa tient’s SS N | ||
| 4005 | Patient Re sponsibili ty monetar y amount | ||
| 4006 | Monetary a mount on t he claim | ||
| 4007 | Patient st atus, Inpa tient/Outp atient | ||
| 4008 | Claim form type | ||
| 4009 | Status of EOB | ||
| 4010 | Insurance company(s) | ||
| 4011 | Clerk name – depends on Sort c riteria | ||
| 4012 | Division(s ) | ||
| 4013 | Days since last tran smission – depends o n Sort cri teria | ||
| 4014 | Date of EO B - depend s on Sort criteria | ||
| 4015 | Available COB Manage ment Workl ist Action s | ||
| 4016 | 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: | ||
| 4017 | PC Proces s COB – Pr ocess a cl aim on the list to t he next pa yer on the bill | ||
| 4018 | VE View a n EOB – Vi ew the EOB (s) associ ated with a claim on the list | ||
| 4019 | 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 | ||
| 4020 | RS Review Status – Change the review st atus for a claim on the list | ||
| 4021 | CB Cancel Bill – Ca ncel a bil l that doe s not need to be res ubmitted | ||
| 4022 | CR Correc t Bill – C orrect a b ill that n eeds to be resubmitt ed | ||
| 4023 | CC Cancel /Clone A B ill – Clon a bill th at needs t o be resub mitted (lo cked with IB CLON) | ||
| 4024 | VB View B ill – View the billi ng screens | ||
| 4025 | RM Remove from Work list – Rem ove claim from workl ist if no need to re submit | ||
| 4026 | PE Print EOB/MRA – Print asso ciated MRA s or EOB | ||
| 4027 | TP Third Party Join t Inq. – S elect a cl aim and go directly to it in T PJI | ||
| 4028 | EX Exit – Exit the worklist a nd return to the EDI Menu | ||
| 4029 | 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 | ||
| 4030 | Patch IB*2 *547 added a new wor klist and a new inbo und transa ction, the ASC X12N 5010 Healt h Care Cla im Request for Addit ional Info rmation (2 77RFAI) to VistA. Th e 277RFAI transactio n is initi ated by th e payer in response to a claim for healt h care ser vices when they need additiona l informat ion in ord er to adju dicate the claim cor rectly. A 277RFAI mi ght, for e xample, re quest an i mage, a te st result or a Certi ficate of Medical Ne cessity. A t the time that Patc h IB*2*547 is instal led, the m ethods for providing this addi tional dat a will be manual. In the futur e, it will be possib le to resp ond to a 2 77RFAI wit h a ASC X1 2N 5010 Ad ditional I nformation to Suppor t a Health Care Clai m or Encou nter (275) transacti on. | ||
| 4031 | 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. | ||
| 4032 | 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: | ||
| 4033 | RFAI Manag ement Work list A pr 28, 201 5@14:25:12 Page: 1 of 16 | ||
| 4034 | Bill # Payer Name Patien t Name SSN Svc Date Curr Bal | ||
| 4035 | 1 K100X XX MEDICA RE (WNR) IB,PAT IENT 333 XXXX 06/29/09 $43851.78 | ||
| 4036 | 55115 -0 - Reque sted imagi ng studies informati on Documen t | ||
| 4037 | 2 K100X XX MEDICA RE (WNR) IB,PAT IENT 22 XXXX 11/05/10 $1226.18 | ||
| 4038 | 64286 -8 — Depre cated Diag nostic ima ging order | ||
| 4039 | 3 K100X XX UNITED HEALTHCARE IB,PAT IENT 765 XXXX 11/05/10 $9.65 | ||
| 4040 | 55115 -0 — Reque sted imagi ng studies informati on Documen t | ||
| 4041 | 4 K100X XX MEDICA RE (WNR) IB,PAT IENT 22 XXXX 11/05/10 $1226.18 | ||
| 4042 | 22034 -3 — Path report.tot al Cancer | ||
| 4043 | + * Indicate s RFAI rev iew in pro gress | ||
| 4044 | Select Message Exit | ||
| 4045 | ReSort Messages | ||
| 4046 | Select Act ion: Next Screen//Se lect Messa ge | ||
| 4047 | Select RFA I Message: (1-4):1 | ||
| 4048 | 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: | ||
| 4049 | RFAI Messa ge Apr 2 8, 2015@14 :43:44 Page : 1 of 2 | ||
| 4050 | Bill # Payer Na me Patient Name SSN S vc Date Curr Bal | ||
| 4051 | K100XXX IB INSUR ANCE CO IB,PATIE NT 33 XXXX 0 6/29/09 $ 43851.78 | ||
| 4052 | Informatio n Source | ||
| 4053 | Payer Name : IB INSUR ANCE COMPA NY | ||
| 4054 | Payer Cont act 1: FAX Number ( There can be up to 3 contact m ethods | ||
| 4055 | Payer Cont act #: XXX XXX-XXXX | ||
| 4056 | Payer Cont act 2: Tel ephone | ||
| 4057 | Payer Cont act #: XXX XXX-XXXX EXT: XXXXX XX | ||
| 4058 | Payer Resp onse Conta ct 1: ( Th ere can be up to 3 c ontact met hods | ||
| 4059 | Payer Resp onse Conta ct #: XXX XXX-XXXX | ||
| 4060 | Payer Resp onse Conta ct 2: Tele phone | ||
| 4061 | Payer Resp onse Conta ct #: XXX XXX-XXXX E XT: XXXXXX X | ||
| 4062 | Payer Addr ess: PO BO X XYZ New York, New York 10001 | ||
| 4063 | Payer Clai m Control Number: XX XXXXXXXXXX XXXXXXXXXX XXXXXXXXXX XXXXXXXXXX XXXXXXXX | ||
| 4064 | Claim Leve l Status I nformation | ||
| 4065 | Patient Co ntrol #: X XXXXXX ( C laim Numbe r | ||
| 4066 | Date of Se rvice: XX/ XX/XX | ||
| 4067 | Medical Re cords Numb er: XXXXXX XX | ||
| 4068 | Member Ide ntificatio n Number: XXXXXXXXXX | ||
| 4069 | Type of Se rvice: XXX ( Instit utional On ly Type of Bill | ||
| 4070 | Health Car e Claim St atus Categ ory: ( The se 3 can r epeat | ||
| 4071 | Additional Informati on Request Modifier: ( Show L OINC Code Text not j ust code | ||
| 4072 | Status Inf ormation E ffective D ate: XX/XX /XX | ||
| 4073 | Response D ue Date: X X/XX/XX | ||
| 4074 | Service Li ne Informa tion/ Serv ice Line S tatus Info rmation | ||
| 4075 | Line Item Control Nu mber: XXXX XX | ||
| 4076 | Service Li ne Date: | ||
| 4077 | Revenue Co de: | ||
| 4078 | Coding Met hod: HCPCS | ||
| 4079 | Procedure Code:XXXXX XX | ||
| 4080 | Procedure Modifier: ( There ca n be up to 4 | ||
| 4081 | Procedure Modifier: | ||
| 4082 | Line Item Charge Amo unt: XXXXX XXXXXXXXXX XXX | ||
| 4083 | Health Car e Claim St atus Categ ory: ( The se 3 can r epeat | ||
| 4084 | Additional Informati on Request Modifier: ( Show L OINC Code Text not j ust code | ||
| 4085 | Status Inf ormation E ffective D ate: XX/XX /XX | ||
| 4086 | Response D ue Date: X X/XX/XX | ||
| 4087 | + Enter ?? f or more ac tions | ||
| 4088 | EC Ente r Comments | ||
| 4089 | TJ Third P arty Joint Inq. | ||
| 4090 | RS Revi ew Status | ||
| 4091 | EX Exit | ||
| 4092 | RE Remo ve Entry | ||
| 4093 | Select Act ion: Next Screen// R emove Entr y | ||
| 4094 | From the R FAI messag e Screen, users can take the f ollowing a ctions: | ||
| 4095 | Enter comm ents – use r name and date/time will be a utomatical ly capture d | ||
| 4096 | Change the Review St atus – the entry wit h be marke d by an as terisk | ||
| 4097 | 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 | ||
| 4098 | Jump to th e claim in TPJI – co mments fro m the RFAI Managemen t Worklist will be v iewable fr om within TPJI | ||
| 4099 | IB Site Pa rameters | ||
| 4100 | Define Pri nters for Automatica lly Proces sed Second ary/Tertia ry Claims | ||
| 4101 | 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. | ||
| 4102 | 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 | ||
| 4103 | Display/Ed it MCCR Si te Paramet ers. | ||
| 4104 | Only autho rized pers ons may ed it this da ta. | ||
| 4105 | IB Site P arameters Claims Tracking P arameters | ||
| 4106 | Facili ty Definit ion Gene ral Parame ters | ||
| 4107 | Mail G roups Trac king Param eters | ||
| 4108 | Patien t Billing Rand om Samplin g | ||
| 4109 | Third Party Bill ing | ||
| 4110 | Provid er Id | ||
| 4111 | EDI Tr ansmission | ||
| 4112 | Third Par ty Auto Bi lling Para meters Insuran ce Verific ation | ||
| 4113 | Genera l Paramete rs Gene ral Parame ters | ||
| 4114 | Inpati ent Admiss ion Batc h Extracts Parameter s | ||
| 4115 | Outpat ient Visit Serv ice Type C odes | ||
| 4116 | Prescr iption Ref ill | ||
| 4117 | Enter ?? f or more ac tions | ||
| 4118 | IB Site P arameter AB Automated Billing EX Exit | ||
| 4119 | CT Claims Tracking IV Ins. Verif ication | ||
| 4120 | Select Act ion: Quit/ / IB Site Parameters | ||
| 4121 | The follow ing screen will disp lay. | ||
| 4122 | IB Site Pa rameters Feb 01, 20 11@16:22:0 2 Page: 1 of 5 | ||
| 4123 | Only autho rized pers ons may ed it this da ta. | ||
| 4124 | [1] Copay Background Error Mg: IB ERROR | ||
| 4125 | Copay Exemption Mailgroup: IB ERROR | ||
| 4126 | Use Al erts for E xemption : NO | ||
| 4127 | [2] Hold M T Bills w/ Ins : YES # of Days Char ges Held: 90 | ||
| 4128 | Suppre ss MT Ins Bulletin : NO | ||
| 4129 | Means Test Mailg roup : IB MEANS TEST | ||
| 4130 | Per Di em Start D ate : 11/05/90 | ||
| 4131 | [3] Disapp roval Mail group : MCCR - BU SINESS OFF ICE | ||
| 4132 | Cancel lation Mai lgroup : UB-82 CAN CELL | ||
| 4133 | Cancel lation Rem ark : BILL CANC ELLED IN B USINESS OF FICE | ||
| 4134 | [4] New In surance Ma ilgroup : IB NEW IN SURANCE | ||
| 4135 | Unbill ed Mailgro up : IB UNBILL ED AMOUNTS | ||
| 4136 | Auto P rint Unbil led List : NO | ||
| 4137 | + Enter ?? f or more ac tions | ||
| 4138 | EP Edit S et EX Exit | ||
| 4139 | Select Act ion: Next Screen// | ||
| 4140 | 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 | ||
| 4141 | Only autho rized pers ons may ed it this da ta. | ||
| 4142 | + | ||
| 4143 | [5] Medica l Center : DNS ENNE VAMC Default Di vision : DNS ENNE VAMR | ||
| 4144 | MAS Se rvice : BUSIN ESS OFFICE Bill ing Superv isor : WAI THE,MOSES | ||
| 4145 | [6] Initia tor Author ize: YES Xfer Proc to S ched : YES | ||
| 4146 | Ask HI NQ in MCCR : YES Use Non-PTF Co des : YES | ||
| 4147 | Multip le Form Ty pes: YES Use OP CPT scr een : YES | ||
| 4148 | [7] UB-04 Print IDs : YES UB-0 4 Address Col : | ||
| 4149 | CMS-15 00 Print I Ds : YES CMS- 1500 Addr Col : 40 | ||
| 4150 | CMS-15 00 Auto Pr ter: RM340 UB-0 4 Auto Prt er : RM3 40 | ||
| 4151 | EOB Au to Prter : RM340 MRA Auto Prter : RM3 40 | ||
| 4152 | [8] Defaul t RX DX Cd : V68.1 Defa ult ASC Re v Cd : 490 | ||
| 4153 | Defaul t RX CPT C d : J8499 Defa ult RX Rev Cd : 250 | ||
| 4154 | [9] Bill S igner Name : <No l onger used > Fede ral Tax # : 83- 0168494 | ||
| 4155 | Bill S igner Titl e : <No l onger used > | ||
| 4156 | + Enter ?? f or more ac tions | ||
| 4157 | EP Edit S et EX Exit | ||
| 4158 | Select Act ion: Next Screen// | ||
| 4159 | 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// | ||
| 4160 | CMS-1500 P RINT LEGAC Y ID: YES/ / | ||
| 4161 | UB-04 ADDR ESS COLUMN : | ||
| 4162 | CMS-1500 A DDRESS COL UMN: 40// | ||
| 4163 | CMS-1500 A uto Printe r: | ||
| 4164 | UB-04 Auto Printer: | ||
| 4165 | EOB Auto P rinter: | ||
| 4166 | MRA Auto P rinter: | ||
| 4167 | Enable Aut omatic Pro cessing of Secondary /Tertiary Claims | ||
| 4168 | 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. | ||
| 4169 | 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 | ||
| 4170 | Display/Ed it MCCR Si te Paramet ers. | ||
| 4171 | Only autho rized pers ons may ed it this da ta. | ||
| 4172 | IB Site P arameters Claims Tracking P arameters | ||
| 4173 | Facili ty Definit ion Gene ral Parame ters | ||
| 4174 | Mail G roups Trac king Param eters | ||
| 4175 | Patien t Billing Rand om Samplin g | ||
| 4176 | Third Party Bill ing | ||
| 4177 | Provid er Id | ||
| 4178 | EDI Tr ansmission | ||
| 4179 | Third Par ty Auto Bi lling Para meters Insuran ce Verific ation | ||
| 4180 | Genera l Paramete rs Gene ral Parame ters | ||
| 4181 | Inpati ent Admiss ion Batc h Extracts Parameter s | ||
| 4182 | Outpat ient Visit Serv ice Type C odes | ||
| 4183 | Prescr iption Ref ill | ||
| 4184 | Enter ?? f or more ac tions | ||
| 4185 | IB Site P arameter AB Automated Billing EX Exit | ||
| 4186 | CT Claims Tracking IV Ins. Verif ication | ||
| 4187 | Select Act ion: Quit/ / IB Site Parameters | ||
| 4188 | The follow ing screen will disp lay. | ||
| 4189 | IB Site Pa rameters Feb 01, 20 11@16:22:0 2 Page: 1 of 5 | ||
| 4190 | Only autho rized pers ons may ed it this da ta. | ||
| 4191 | [1] Copay Background Error Mg: IB ERROR | ||
| 4192 | Copay Exemption Mailgroup: IB ERROR | ||
| 4193 | Use Al erts for E xemption : NO | ||
| 4194 | [2] Hold M T Bills w/ Ins : YES # of Days Char ges Held: 90 | ||
| 4195 | Suppre ss MT Ins Bulletin : NO | ||
| 4196 | Means Test Mailg roup : IB MEANS TEST | ||
| 4197 | Per Di em Start D ate : 11/05/90 | ||
| 4198 | [3] Disapp roval Mail group : MCCR - BU SINESS OFF ICE | ||
| 4199 | Cancel lation Mai lgroup : UB-82 CAN CELL | ||
| 4200 | Cancel lation Rem ark : BILL CANC ELLED IN B USINESS OF FICE | ||
| 4201 | [4] New In surance Ma ilgroup : IB NEW IN SURANCE | ||
| 4202 | Unbill ed Mailgro up : IB UNBILL ED AMOUNTS | ||
| 4203 | Auto P rint Unbil led List : NO | ||
| 4204 | + Enter ?? f or more ac tions | ||
| 4205 | EP Edit S et EX Exit | ||
| 4206 | Select Act ion: Next Screen// | ||
| 4207 | 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 | ||
| 4208 | Only autho rized pers ons may ed it this da ta. | ||
| 4209 | + | ||
| 4210 | [10]Pay-To Providers : 1 define d, default - DNS ENNE TEST1 VAMC | ||
| 4211 | [11]Inpt H ealth Summ ary: INPAT IENT HEALT H SUMMARY | ||
| 4212 | Opt He alth Summa ry : OUTPA TIENT HEAL TH SUMMARY | ||
| 4213 | [12]HIPPA NCPDP Acti ve Flag : N ot Active | ||
| 4214 | Drug N on Covered Recheck P eriod : 0 days(s) | ||
| 4215 | Non Co vered Reje ct Codes | ||
| 4216 | : 7 0 Product/ Service No t Covered | ||
| 4217 | [13]Inpati ent TP Act ive : YES | ||
| 4218 | Outpat ient TP Ac tive: YES | ||
| 4219 | Pharma cy TP Acti ve : YES | ||
| 4220 | Prosth etic TP Ac tive: YES | ||
| 4221 | [14] EDI/M RA Activat ed : B OTH EDI AN D MRA | ||
| 4222 | + Enter ?? f or more ac tions | ||
| 4223 | EP Edit S et EX Exit | ||
| 4224 | Select Act ion: Next Screen// | ||
| 4225 | 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 | ||
| 4226 | SITE CONTA CT PHONE N UMBER: 307 -778-7581/ / | ||
| 4227 | LIVE TRANS MIT 837 QU EUE: MCT// | ||
| 4228 | TEST TRANS MIT 837 QU EUE: MCT// | ||
| 4229 | AUTO TRANS MIT BILL F REQUENCY: 1// | ||
| 4230 | HOURS TO T RANSMIT BI LLS: 1130; 1500;1700/ / | ||
| 4231 | MAX # BILL S IN A BAT CH: 10// | ||
| 4232 | ONLY 1 INS CO PER CL AIM BATCH: YES// | ||
| 4233 | DAYS TO WA IT TO PURG E MSGS: 15 // | ||
| 4234 | Allow MRA Processing ?: YES// | ||
| 4235 | Enable Aut omatic MRA Processin g?: YES// | ||
| 4236 | Enable Aut o Reg EOB Processing ?: YES// | ||
| 4237 | Printed Cl aims Rev C ode Excl: 17 Activat ed Codes D efined | ||
| 4238 | Patch IB*2 *547 added Section 8 , Printed Claims Rev Code Excl :, to the IB Site Pa rameters. When the P atch is in stalled, t he followi ng revenue codes, if active, w ill be pre -populated : | ||
| 4239 | 270-279 | ||
| 4240 | 290-299 | ||
| 4241 | 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. | ||
| 4242 | IB Site Pa rameters Nov 03, 20 15@10:43:2 0 Page: 2 of 5 | ||
| 4243 | Only autho rized pers ons may ed it this da ta. | ||
| 4244 | + | ||
| 4245 | [5] Medica l Center : DNS ENNE VAMC Default Di vision : DNS ENNE VAMR | ||
| 4246 | MAS Se rvice : BUSIN ESS OFFICE Bill ing Superv isor : WAI THE,MOSES | ||
| 4247 | [6] Initia tor Author ize: YES Xfer Proc to S ched : YES | ||
| 4248 | Ask HI NQ in MCCR : YES Use Non-PTF Co des : YES | ||
| 4249 | Multip le Form Ty pes: YES Use OP CPT scr een : YES | ||
| 4250 | [7] UB-04 Print IDs : YES UB-0 4 Address Col : | ||
| 4251 | CMS-15 00 Print I Ds : YES CMS- 1500 Addr Col : 40 | ||
| 4252 | CMS-15 00 Auto Pr ter: UB-0 4 Auto Prt er : | ||
| 4253 | EOB Au to Prter : MRA Auto Prter : | ||
| 4254 | [8] Printe d Claims R ev Code Ex cl: 17 Act ivated Cod es Defined | ||
| 4255 | [9] Defaul t RX DX Cd : Z76.0 (ICD-10) Defa ult ASC Re v Cd : 490 | ||
| 4256 | Defaul t RX CPT C d : J8499 Defa ult RX Rev Cd : 250 | ||
| 4257 | + Enter ?? f or more ac tions | ||
| 4258 | EP Edit S et EX Exit | ||
| 4259 | Select Act ion: Next Screen// | ||
| 4260 | Excluded R evenue Cod es Nov 03, 20 15@11:05:0 6 Page: 1 of 1 | ||
| 4261 | # R CD DESC RIPTION | ||
| 4262 | 1. 2 70 MED- SUR SUPPLI ES | ||
| 4263 | 2. 2 71 NON- STER SUPPL Y | ||
| 4264 | 3. 2 72 STER ILE SUPPLY | ||
| 4265 | 4. 2 73 TAKE HOME SUPPL Y | ||
| 4266 | 5. 2 74 PROS TH/ORTH DE V | ||
| 4267 | 6. 2 75 PACE MAKER | ||
| 4268 | 7. 2 76 INTR A OC LENS | ||
| 4269 | 8. 2 77 O2/T AKEHOME | ||
| 4270 | 9. 2 78 SUPP LY/IMPLANT S | ||
| 4271 | 10. 2 79 SUPP LY/OTHER | ||
| 4272 | 11. 2 90 MED EQUIP/DURA B | ||
| 4273 | 12. 2 91 MED EQUIP/RENT | ||
| 4274 | 13. 2 92 MED EQUIP/NEW | ||
| 4275 | 14. 2 93 MED EQUIP/USED | ||
| 4276 | 15. 2 94 MED EQUIP/SUPP LIES/DRUGS | ||
| 4277 | 16. 2 99 MED EQUIP/OTHE R | ||
| 4278 | Enter ?? f or more ac tions | ||
| 4279 | AC Add Re venue Code DC Delete Rev enue Code EX Exit | ||
| 4280 | Select Ite m(s): Quit // ac Ad d Revenue Code | ||
| 4281 | Revenue Co de: 118 REHAB/ PVT RE HABILITATI ON | ||
| 4282 | Revenue Co de: | ||
| 4283 | 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 | ||
| 4284 | Patch IB*2 *547 added Sections 17 and 18, Alt Prim Payer ID T yp-Medicar e and Alt Prim Payer ID Typ-Co mmercial. Users can define qua lifiers to be used t o define a lternative professio nal and/or instituti onal prima ry payer I Ds by type in Insura nce Compan y Entry/Ed it. These ID types p rovide the ability t o direct 8 37 transac tions to d ifferent p rocessing entities d epending o n the type of claim. | ||
| 4285 | IB Site Pa rameters Nov 03, 20 15@11:21:3 2 Page: 4 of 5 | ||
| 4286 | Only autho rized pers ons may ed it this da ta. | ||
| 4287 | + | ||
| 4288 | [16] EDI/M RA Activat ed : B OTH EDI AN D MRA | ||
| 4289 | EDI C ontact Pho ne : ( 307)778-75 81 | ||
| 4290 | EDI 8 37 Live Tr ansmit Que ue : M CT | ||
| 4291 | EDI 8 37 Test Tr ansmit Que ue : M CT | ||
| 4292 | Auto- Txmt Bill Frequency : E very Day | ||
| 4293 | Hours To Auto-T ransmit : 1 130;1500;1 700 | ||
| 4294 | Max # Bills Per Batch : 1 0 | ||
| 4295 | Only Allow 1 In s Co/Claim Batch?: N O | ||
| 4296 | Last Auto-Txmt Run Date : 0 3/08/11 | ||
| 4297 | Days To Wait To Purge Msg s : 1 5 | ||
| 4298 | Allow MRA Proce ssing? : Y ES | ||
| 4299 | Enabl e Automati c MRA Proc essing?: Y ES | ||
| 4300 | Enabl e Auto Reg EOB Proce ssing? : Y ES | ||
| 4301 | [17]Alt Pr im Payer I D Typ-Medi care: 2 de fined | ||
| 4302 | [18]Alt Pr im Payer I D Typ-Comm ercial: 2 defined | ||
| 4303 | + Enter ?? f or more ac tions | ||
| 4304 | EP Edit S et EX Exit | ||
| 4305 | Select Act ion: Next Screen// | ||
| 4306 | 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 | ||
| 4307 | 1 DME | ||
| 4308 | Enter ?? f or more ac tions | ||
| 4309 | AT Add ID Type DT Delete ID Type EX Exit | ||
| 4310 | Select Act ion: Quit/ /AT Add ID Type | ||
| 4311 | Enter a Pr imary ID T ype: HOSPI CE | ||
| 4312 | Are you adding 'HO SPICE' as | ||
| 4313 | a new IB ALTERNA TE PRIMARY ID TYPES (the 4TH)? No// y | ||
| 4314 | ASC X12N H ealth Care Claim Req uest for A dditional Informatio n (277RFAI ) | ||
| 4315 | Patch IB*2 *547 added Section 2 0 to the I B Site Par ameters. W hen the Pa tch is ins talled, th e followin g 277RFAI parameters will be p re-populat ed: | ||
| 4316 | Days to st ore 277RFA I Transact ions | ||
| 4317 | Days to wa it to purg e entry on RFAI Mana gement Wor klist | ||
| 4318 | IB Site Pa rameters Nov 03, 20 15@12:33:3 4 Page: 5 of 5 | ||
| 4319 | Only autho rized pers ons may ed it this da ta. | ||
| 4320 | + | ||
| 4321 | [19]Are we using Cla imsManager ? : NO | ||
| 4322 | Is Cla imsManager working O K? : NO | ||
| 4323 | ClaimsMana ger TCP/IP Address : IP | ||
| 4324 | Claims Manager TC P/IP Ports : 10040 | ||
| 4325 | 10050 | ||
| 4326 | 10060 | ||
| 4327 | 10070 | ||
| 4328 | 10080 | ||
| 4329 | Genera l Error Ma ilGroup : IBCI GENERAL ER ROR | ||
| 4330 | Commun ication Er ror MailGr oup: IBCI COMMUNICAT ION ERROR | ||
| 4331 | MailMa n Messages : PRIOR ITY | ||
| 4332 | [20]Days t o store 27 7RFAI Tran sactions: No Purge | ||
| 4333 | Days t o wait to purge entr y on RFAI Management Worklist: 20 | ||
| 4334 | Enter ?? f or more ac tions | ||
| 4335 | EP Edit S et EX Exit | ||
| 4336 | Select Act ion: Quit/ / ep=20 Edit Set | ||
| 4337 | PURGE DAYS 277 RFAI: ?? | ||
| 4338 | En ter the nu mber of da ys (betwee n 365 and 3000) to | ||
| 4339 | re tain 277 R FAI transa ctions in VistA. | ||
| 4340 | A null entry (the defa ult) indic ates the t ransaction s | ||
| 4341 | wi ll be stor ed forever . | ||
| 4342 | PURGE DAYS 277 RFAI: | ||
| 4343 | WORKLIST P URGE DAYS 277 RFAI: 20// | ||
| 4344 | 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 | ||
| 4345 | 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. | ||
| 4346 | EDI Report s – Overvi ew | ||
| 4347 | 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. | ||
| 4348 | |||
| 4349 | |||
| 4350 | |||
| 4351 | |||
| 4352 | BAR Bills Need ing Resubm ission Act ion | ||
| 4353 | ECS EDI Claim Status Rep ort | ||
| 4354 | MP EDI Messa ges Not Ye t Filed | ||
| 4355 | PBT Pending Ba tch Transm ission Sta tus Report | ||
| 4356 | PND EDI Batche s Pending Receipt | ||
| 4357 | REX Ready for Extract St atus Repor t | ||
| 4358 | VPE View/Print EDI Bill Extract Da ta | ||
| 4359 | Most Frequ ently Used Menus/Rep orts | ||
| 4360 | Claims Sta tus Awaiti ng Resolut ion – Syno nym CSA | ||
| 4361 | What is th e purpose of this re port? | ||
| 4362 | 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. | ||
| 4363 | When is th is option used? | ||
| 4364 | 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). | ||
| 4365 | 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: | ||
| 4366 | A | ||
| 4367 | Authorizin g Biller | ||
| 4368 | B | ||
| 4369 | Bill Numbe r | ||
| 4370 | C | ||
| 4371 | Current Ba lance | ||
| 4372 | S | ||
| 4373 | Date of Se rvice | ||
| 4374 | D | ||
| 4375 | Division | ||
| 4376 | E | ||
| 4377 | Error Code Text | ||
| 4378 | N | ||
| 4379 | Number of Days Pendi ng | ||
| 4380 | M | ||
| 4381 | Patient Na me | ||
| 4382 | P | ||
| 4383 | Payer | ||
| 4384 | |||
| 4385 | R | ||
| 4386 | Review in Process | ||
| 4387 | L | ||
| 4388 | SSN Last 4 | ||
| 4389 | 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. | ||
| 4390 | 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. | ||
| 4391 | 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. | ||
| 4392 | With Patch IB*2.0*32 0, changes were made to suppre ss the dis play of 2Q Claim Sta tus Messag es and dup licate cla im status messages.A s messages are revie wed they c an be mark ed as foll ows: | ||
| 4393 | 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 | ||
| 4394 | Review in Process – While a cl aim is bei ng reworke d, the sta tus can be changed t o “Review in Process ” | ||
| 4395 | Review Com plete – Th e error ha s been res olved and the messag e from thi s report w ill be cle ared | ||
| 4396 | 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. | ||
| 4397 | Other opti ons availa ble on the CSA inclu de: | ||
| 4398 | 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. | ||
| 4399 | 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. | ||
| 4400 | 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. | ||
| 4401 | 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. | ||
| 4402 | 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. | ||
| 4403 | 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. | ||
| 4404 | Note: Afte r Patch IB *2*547 is installed, the sourc e of a cla im status message wi ll include the name of the cle aringhouse when the clearingho use is the soutce.Mu ltiple CSA Message M anagement – Synonym: MCS | ||
| 4405 | What is th e purpose of this op tion? | ||
| 4406 | 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. | ||
| 4407 | This optio n is locke d by the I B Message Management security key.When i s this opt ion used? | ||
| 4408 | 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. | ||
| 4409 | 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. | ||
| 4410 | 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. | ||
| 4411 | 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: | ||
| 4412 | Message Se arch – All ows the us er to chan ge the cri teria upon which the list of c laims will be built | ||
| 4413 | Change Rev iew Status – Same as CSA | ||
| 4414 | Cancel Cla ims – Same as CSA | ||
| 4415 | Enter Comm ent – Same as CSA | ||
| 4416 | Resubmit b y Print – Same as CS A | ||
| 4417 | Retransmit Bill – Sa me as CSA | ||
| 4418 | Select/Des elect Clai ms – Allow s users to select th e claims t o which th ey want to apply an action | ||
| 4419 | 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 | ||
| 4420 | What is th e purpose of this op tion? | ||
| 4421 | 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. | ||
| 4422 | When is th is option used? | ||
| 4423 | 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. | ||
| 4424 | 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. | ||
| 4425 | R000 | ||
| 4426 | NETWORK NE WS | ||
| 4427 | Provides n ews on sys tem proble ms, update s and othe r pertinen t informat ion. | ||
| 4428 | RPT-02 F ILE STATUS REPORT | ||
| 4429 | 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. | ||
| 4430 | RPT-03 F ILE SUMMAR Y REPORT | ||
| 4431 | 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. | ||
| 4432 | RPT-08 P ROVIDER MO NTHLY SUMM ARY | ||
| 4433 | 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. | ||
| 4434 | The follow ing report s contain informatio n that is also trans lated into status me ssages and displayed on CSA. | ||
| 4435 | RPT-04 F ILE DETAIL SUMMARY R EPORT | ||
| 4436 | 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. | ||
| 4437 | RPT-04A AMENDED FI LE DETAIL SUMMARY RE PORT | ||
| 4438 | 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. | ||
| 4439 | RPT-05 B ATCH & CLA IM LEVEL R EJECTION R EPORT | ||
| 4440 | 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. | ||
| 4441 | RPT-05A AMENDED BA TCH & CLAI M LEVEL RE JECTION RE PORT | ||
| 4442 | 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. | ||
| 4443 | RPT-10 P ROVIDER CL AIM STATUS | ||
| 4444 | 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. | ||
| 4445 | RPT-11 S PECIAL HAN DLING/UNPR OCESSED CL AIMS REPOR T | ||
| 4446 | 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 . | ||
| 4447 | EDI Cl aim Status Report- S ynonym: EC S | ||
| 4448 | What is th e purpose of this re port? | ||
| 4449 | View elect ronic tran smission s tatus to a ssure clai ms move th rough the system in a timely f ashion. | ||
| 4450 | When is th is option used? | ||
| 4451 | 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. | ||
| 4452 | Reports ca n be creat ed based o n: | ||
| 4453 | Specific C laim or Se arch Crite ria | ||
| 4454 | Division | ||
| 4455 | Payer | ||
| 4456 | Transmissi on Date ra nge | ||
| 4457 | EDI Status | ||
| 4458 | Reports ca n be sorte d by: | ||
| 4459 | Transmissi on Date | ||
| 4460 | Payer | ||
| 4461 | EDI Status | ||
| 4462 | Current Ba lance | ||
| 4463 | Division | ||
| 4464 | Claim Numb er | ||
| 4465 | AR Status | ||
| 4466 | Age | ||
| 4467 | Possible E DI claim s tatuses in clude: | ||
| 4468 | Ready for Extract | ||
| 4469 | Pending Au stin Recei pt | ||
| 4470 | Accepted b y Non-Paye r | ||
| 4471 | Accepted P ayer | ||
| 4472 | Error Cond ition | ||
| 4473 | Cancelled | ||
| 4474 | Corrected/ Retransmit ted | ||
| 4475 | Closed | ||
| 4476 | Additional Reports a nd Options | ||
| 4477 | Ready for Extract St atus Repor t - Synony m: REX | ||
| 4478 | What is th e purpose of this re port? | ||
| 4479 | 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. | ||
| 4480 | When is th is option used? | ||
| 4481 | 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. | ||
| 4482 | 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. | ||
| 4483 | Choices to view are: | ||
| 4484 | 1 | ||
| 4485 | All bills in Ready f or Extract status | ||
| 4486 | 2 | ||
| 4487 | Bills trap ped due to EDI param eter being turned of f | ||
| 4488 | (If EDI is on, no bi lls will b e trapped in extract ) | ||
| 4489 | Transmit E DI Bills – Manual - Synonym: S END | ||
| 4490 | What is th e purpose of this op tion? | ||
| 4491 | 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. | ||
| 4492 | When is th is option used? | ||
| 4493 | 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. | ||
| 4494 | Select one of the fo llowing: | ||
| 4495 | A | ||
| 4496 | Transmit ( A)LL bills in READY FOR EXTRAC T status | ||
| 4497 | S | ||
| 4498 | Transmit o nly (S)ELE CTED bills | ||
| 4499 | EDI Return Message M anagement Menu – Syn onym: MM | ||
| 4500 | 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. | ||
| 4501 | EDI Messag e Text to Screen Mai ntenance | ||
| 4502 | What is th e purpose of this op tion? | ||
| 4503 | 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. | ||
| 4504 | 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. | ||
| 4505 | When is th is option used? | ||
| 4506 | 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. | ||
| 4507 | 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. | ||
| 4508 | EDI Messag es Not Rev iewed Repo rt | ||
| 4509 | What is th e purpose of this re port? | ||
| 4510 | 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 . | ||
| 4511 | When is th is option used? | ||
| 4512 | 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. | ||
| 4513 | Electronic Error Rep ort | ||
| 4514 | What is th e purpose of this re port? | ||
| 4515 | 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. | ||
| 4516 | When is th is option used? | ||
| 4517 | 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: | ||
| 4518 | A | ||
| 4519 | AUTHORIZIN G BILLER | ||
| 4520 | B | ||
| 4521 | BILLED AMO UNT | ||
| 4522 | E | ||
| 4523 | EPISODE OF CARE | ||
| 4524 | P | ||
| 4525 | PATIENT NA ME | ||
| 4526 | S | ||
| 4527 | PATIENT SS N | ||
| 4528 | Y | ||
| 4529 | PAYER NAME | ||
| 4530 | C | ||
| 4531 | ERROR CODE | ||
| 4532 | Return Mes sages Fili ng Excepti ons | ||
| 4533 | What is th e purpose of this op tion? | ||
| 4534 | 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. | ||
| 4535 | When is th is option used? | ||
| 4536 | 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. | ||
| 4537 | There are two (2) st atuses for messages in this fi le. | ||
| 4538 | 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. | ||
| 4539 | 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. | ||
| 4540 | 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. | ||
| 4541 | There are two (2) ac tions avai lable to g et these m essages ou t of the f ile. | ||
| 4542 | 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. | ||
| 4543 | 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. | ||
| 4544 | Status Mes sage Manag ement | ||
| 4545 | What is th e purpose of this op tion? | ||
| 4546 | 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. | ||
| 4547 | When is th is option used? | ||
| 4548 | 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. | ||
| 4549 | This repor t can be s orted by: | ||
| 4550 | A | ||
| 4551 | ALL STATUS MESSAGES | ||
| 4552 | S | ||
| 4553 | SELECTED S TATUS MESS AGES | ||
| 4554 | Selected s tatus mess age report s can be r un showing : | ||
| 4555 | A | ||
| 4556 | Auto Filed /No Review Only | ||
| 4557 | B | ||
| 4558 | Bill Numbe r | ||
| 4559 | S | ||
| 4560 | Message Se verity | ||
| 4561 | T | ||
| 4562 | Specific M essage Tex t | ||
| 4563 | Bills Awai ting Resub mission – Synonym: B AR | ||
| 4564 | What is th e purpose of this re port? | ||
| 4565 | 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. | ||
| 4566 | When is th is option used? | ||
| 4567 | 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 : | ||
| 4568 | B | ||
| 4569 | BILL NUMBE R | ||
| 4570 | L | ||
| 4571 | LAST SENT DATE | ||
| 4572 | A | ||
| 4573 | BILLED AMO UNT | ||
| 4574 | N | ||
| 4575 | BATCH NUMB ER (LAST S ENT IN) | ||
| 4576 | The report also indi cates the “Bill Tran smission S tatus”. | ||
| 4577 | EDI Messag es Not Yet Filed –Sy nonym: MP | ||
| 4578 | What is th e purpose of this re port? | ||
| 4579 | 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. | ||
| 4580 | When is th is option used? | ||
| 4581 | This is a status rep ort that a llows for review of messages n ot yet fil ed. | ||
| 4582 | Pending Ba tch Transm ission Sta tus Report – Synonym : PBT | ||
| 4583 | What is th e purpose of this re port? | ||
| 4584 | 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. | ||
| 4585 | When is th is option used? | ||
| 4586 | 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. | ||
| 4587 | EDI Batche s Pending Receipt– S ynonym: PN D | ||
| 4588 | What is th e purpose of this re port? | ||
| 4589 | 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. | ||
| 4590 | The report includes: | ||
| 4591 | Batch Numb er | ||
| 4592 | Transmissi on Date | ||
| 4593 | Mail Messa ge # | ||
| 4594 | Claims dis play the f ollowing: | ||
| 4595 | Claim Numb er | ||
| 4596 | Payer Sequ ence | ||
| 4597 | Balance Du e | ||
| 4598 | EDI Status | ||
| 4599 | IB Status | ||
| 4600 | AR Status | ||
| 4601 | EDI Batche s Pending Austin Rec eipt After 1 Day Page: 2 | ||
| 4602 | Run Date: 01/07/2008 @14:44:28 | ||
| 4603 | Batch # Tran smission D ate Mail Mes sage # | ||
| 4604 | --------- ---------- ---------- ---------- ---------- ---------- ---------- --------- | ||
| 4605 | Claim Seq Bal Due EDI Stat IB Stat us AR Status | ||
| 4606 | K600K QD P 198.54 P PRNT/TX NEW BILL | ||
| 4607 | K600N EU P 76.36 P PRNT/TX NEW BILL | ||
| 4608 | K600Q R2 P 305.11 P PRNT/TX NEW BILL | ||
| 4609 | K600W S7 P 76.36 P PRNT/TX NEW BILL | ||
| 4610 | K600W SF P 880.71 P PRNT/TX NEW BILL | ||
| 4611 | 44200295 90 03/2 9/2006@21: 05:33 1321 | ||
| 4612 | Claim Seq Bal Due EDI Stat IB Stat us AR Status | ||
| 4613 | K600F N7 P 76.36 P REQUEST MRA BIL L INCOMPLE TE | ||
| 4614 | K600I PF P 73.01 P REQUEST MRA BIL L INCOMPLE TE | ||
| 4615 | K600W SA P 4390.06 P REQUEST MRA BIL L INCOMPLE TE | ||
| 4616 | K600W SK P 73.01 P REQUEST MRA BIL L INCOMPLE TE | ||
| 4617 | Enter ENTE R to conti nue or '^' to exit: | ||
| 4618 | 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] | ||
| 4619 | 06/19/04@1 9:02 6 li nes | ||
| 4620 | From: XXXX XXXXXXX,XX XX X In ' IN' basket . Page 1 *New* | ||
| 4621 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- --------- | ||
| 4622 | There are 30 EDI bat ch(es) sti ll pending Austin re ceipt | ||
| 4623 | for more t han 1 day. Please i nvestigate why they have not y et been co nfirmed | ||
| 4624 | as being r eceived by Austin. | ||
| 4625 | Since ther e were mor e than 10 batches fo und, pleas e run the | ||
| 4626 | EDI BATC HES WAITIN G FOR AUST IN RECEIPT OVER 1-DA Y report t o get a li st of the | ||
| 4627 | se batches . | ||
| 4628 | Enter mess age action (in IN ba sket): Del ete// | ||
| 4629 | When is th is option used? | ||
| 4630 | 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 . | ||
| 4631 | 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. | ||
| 4632 | View/Print EDI Bill Extract Da ta – Synon ym: VPE | ||
| 4633 | What is th e purpose of this op tion? | ||
| 4634 | This optio n displays the EDI e xtract dat a for a bi ll. | ||
| 4635 | When is th is option used? | ||
| 4636 | 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. | ||
| 4637 | Insurance Company ED I Paramete r Report – Synonym: EPR | ||
| 4638 | What is th e purpose of this op tion? | ||
| 4639 | This optio n will dis play the E DI Paramet ers of the Active In surance Co mpanies de fined in V ista. | ||
| 4640 | The conten ts of the following parameters will be i ncluded in this repo rt: | ||
| 4641 | Insurance Company Na me | ||
| 4642 | Street Add ress and C ity of Ins urance Com pany | ||
| 4643 | Electronic Transmit? | ||
| 4644 | Institutio nal Electr onic Bill ID | ||
| 4645 | Profession al Electro nic Bill I D | ||
| 4646 | HPID/OEID | ||
| 4647 | Electronic Type | ||
| 4648 | Type of Co verage | ||
| 4649 | Always Use main VAMC as Billin g Provider | ||
| 4650 | All Compan ies Insuranc e Company EDI Parame ter Report Page: 1 | ||
| 4651 | Sorted By Ins Compan y Name Mar 02, 2015@1 0:30:28 | ||
| 4652 | Only Blank or 'PRNT' Bill ID's = NO | ||
| 4653 | '*' indica tes the HP ID/OEID fa iled valid ation chec ks | ||
| 4654 | Electro n Inst P rof HPID/ Electroni c | ||
| 4655 | Insurance Company Na me Street Address Ci ty Transmi t ID ID OEID Type Covera ge Type | ||
| 4656 | ========== ========== ========== ========== ========== ========== ========== ========== ========== =======INS URANCE COM PANY ONE PO BOX 141 159 XXX,OH YES-L 8 XXXX 8XXXX 799999999 9 GROUP PL AN HEALTH INS… | ||
| 4657 | INSURANCE COMPANY TW O PO BOX 30101 XXX ,UT YES-L 699999 9999* OTHE R HEAL TH INS… | ||
| 4658 | When is th is option used? | ||
| 4659 | 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. | ||
| 4660 | Test Claim EDI Trans mission Re port – Syn onym: TCS | ||
| 4661 | What is th e purpose of this op tion? | ||
| 4662 | 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. | ||
| 4663 | The messag es in this option wi ll be auto matically purged aft er 60 days . When is this optio n used? | ||
| 4664 | 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. | ||
| 4665 | Test Claim EDI Trans mission Re port Page: 1 | ||
| 4666 | Selected B atches Ma r 22, 2005 @12:14:38 | ||
| 4667 | ========== ========== ========== ========== ========== ========== ========== ========== | ||
| 4668 | Batch#: 6 050011719 | ||
| 4669 | Claim#: K 404XXX | ||
| 4670 | IB,Patient 7 (15 00, Prof, Outpat) | ||
| 4671 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- | ||
| 4672 | Transmissi on Informa tion | ||
| 4673 | 03/17/200 5@11:11:25 Bch#1171 9 IB,Cler k2 CIGNA HEALTHCAR E (S) | ||
| 4674 | Third Part y Joint In quiry – Sy nonym: TPJ I | ||
| 4675 | What is th e purpose of this op tion? | ||
| 4676 | 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. | ||
| 4677 | When is th is option used? | ||
| 4678 | 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. | ||
| 4679 | The follow ing action s are avai lable from TPJI: | ||
| 4680 | |||
| 4681 | BC | ||
| 4682 | Bill Charg es | ||
| 4683 | |||
| 4684 | DX | ||
| 4685 | Bill Diagn osis | ||
| 4686 | |||
| 4687 | PR | ||
| 4688 | Bill Proce dures | ||
| 4689 | |||
| 4690 | CB | ||
| 4691 | Change Bil l | ||
| 4692 | |||
| 4693 | ED | ||
| 4694 | EDI Status | ||
| 4695 | |||
| 4696 | AR | ||
| 4697 | Account Pr ofile | ||
| 4698 | |||
| 4699 | CM | ||
| 4700 | Comment Hi story | ||
| 4701 | |||
| 4702 | IR | ||
| 4703 | Insurance Reviews | ||
| 4704 | |||
| 4705 | HS | ||
| 4706 | Health Sum mary | ||
| 4707 | |||
| 4708 | AL | ||
| 4709 | Active Lis t | ||
| 4710 | |||
| 4711 | VI | ||
| 4712 | Insurance Company | ||
| 4713 | |||
| 4714 | VP | ||
| 4715 | Policy | ||
| 4716 | |||
| 4717 | AB | ||
| 4718 | Annual Ben efits | ||
| 4719 | |||
| 4720 | EL | ||
| 4721 | Patient El igibility | ||
| 4722 | Patch IB*2 *377 inclu ded change s to allow the addit ion of and the viewi ng of MRA Request cl aim commen ts using T PJI. Comme nt History now perta ins to MRA Request c laims as w ell as reg ular claim s. MRA Req uest claim comments are not st ored as AR comments though.Not e: Patch I B*2*516 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 IB*2*51 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 *2*547 is installed, the sourc e of a cla im status message wi ll include the name of the cle aringhouse when the clearingho use is the source.No te: After Patch IB*2 *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 IB*2 *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 IB*2*488 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. | ||
| 4723 | The Follow ing types of errors will be di splayed: | ||
| 4724 | Procedure Code misma tch | ||
| 4725 | Procedure Modifier m ismatch | ||
| 4726 | Revenue Co de mismatc h | ||
| 4727 | Charge Amo unt mismat ch | ||
| 4728 | Number of Units mism atch | ||
| 4729 | Claim Info rmation Nov 25, 20 13@14:56:0 2 Page: 1 of 2 | ||
| 4730 | %K101XXX IB,PATIEN T 123 IXXXX DOB: X X/XX/XX Subsc ID: XXXXXXXXX | ||
| 4731 | Insuranc e Demograp hics Subscrib er Demogra phics | ||
| 4732 | Bill P ayer: IB I NSURANCE C O Group N umber: GRP PLN XXXXX | ||
| 4733 | Claim Add ress: PO B OX XXXXX Group Name: STA TE OF WY | ||
| 4734 | DNS ENNE, WY 8 20031234 Subscriber ID: XXXXX XXXXX | ||
| 4735 | Claim P hone: 800/ XXX-XXXX Emp loyer: STA TE OF WYO | ||
| 4736 | Insured's Name: IB, PATIENT 12 3 | ||
| 4737 | Relatio nship: PAT IENT | ||
| 4738 | C laim Infor mation | ||
| 4739 | Bill Typ e: OUTPATI ENT Charge Type: INS TITUTIONAL | ||
| 4740 | Time Fram e: ADMIT T HRU DISCHA RGE Service Dates: XX/ XX/XX – XX /XX/XX | ||
| 4741 | Rate Typ e: REIMBUR SABLE INS. Orig Claim: 145.49 | ||
| 4742 | AR Statu s: ACTIVE Balanc e Due: 145.49 | ||
| 4743 | + |% EEOB | Enter ?? f or more ac tions| | ||
| 4744 | BC Bill C harges AR Account Pr ofile VI Insu rance Comp any | ||
| 4745 | DX Bill D iagnosis CM Comment Hi story VP Poli cy | ||
| 4746 | PR Bill P rocedures IR Insurance Reviews AB Annu al Benefit s | ||
| 4747 | CB Change Bill HS Health Sum mary EL Pati ent Eligib ility | ||
| 4748 | ED EDI St atus AL Go to Acti ve List EB Expa nd Benefit s | ||
| 4749 | RX ECME I nformation EX Exit | ||
| 4750 | Select Act ion: Next Screen// B C Bill C harges | ||
| 4751 | DO YOU WAN T ALL EEOB DETAILS?: NO// Y | ||
| 4752 | 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. | ||
| 4753 | Bill Charg es Apr 14, 20 14@16:27:1 8 Page: 7 of 8 | ||
| 4754 | K101EVT IB,PATIENT MRA I432 1 DOB: 12/0 1/66 Sub sc ID: 011 871234A | ||
| 4755 | 04/10/14 - 04/10/14 AD MIT THRU D ISCHARGE Ori g Amt: 0.0 0 | ||
| 4756 | + | ||
| 4757 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- ---------- ----- | ||
| 4758 | VistA coul d not matc h all of t he Line Le vel data r eceived in the EEOB | ||
| 4759 | (835 Recor d 40) to t he claim i n VistA. | ||
| 4760 | Mismatched Procedure Code: | ||
| 4761 | Payer repo rted the f ollowing w as billed via the Cl aim (837): | ||
| 4762 | Proc:7 1010 Mods :59 Rev C d:324 Chg :227.40 U nits:1 | ||
| 4763 | Payer repo rted adjud ication vi a the EOB (835) as f ollows: | ||
| 4764 | Proc:7 1015 Mods :59 Rev C d:324 Chg :227.40 U nits:1 | ||
| 4765 | Amt:10 0.00 | ||
| 4766 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | ||
| 4767 | Service li ne adjustm ent (EEOB Record 41) has no ma tching ser vice line | ||
| 4768 | Allowe d Amt: 114 .80 Per D iem Amt: 0 .00 | ||
| 4769 | ---------- ---------- ---------- ---------- ---------- ---------- --------- | ||
| 4770 | Service li ne adjustm ent (EEOB Record 45) has no ma tching ser vice line | ||
| 4771 | + |% EEOB | Enter ?? f or more ac tions| | ||
| 4772 | PR Bill P rocedures CM Comment Hi story AB Annu al Benefit slity | ||
| 4773 | CI Go to Claim Scre en IR Insurance Reviews EL Pati ent Eligib ility | ||
| 4774 | HS Health Sum mary EX Exit | ||
| 4775 | ED EDI St atus AL Go to Acti ve List | ||
| 4776 | VI Insurance Company | ||
| 4777 | Select Act ion: Next Screen// | ||
| 4778 | Re-generat e Unbilled Amounts R eport | ||
| 4779 | What is th e purpose of this op tion? | ||
| 4780 | 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. | ||
| 4781 | When is th is option used? | ||
| 4782 | 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. | ||
| 4783 | Subj: UNBI LLED AMOUN TS SUMMARY REPORT [ #197848] 0 6/23/14@12 :41 34 li nes | ||
| 4784 | From: INTE GRATED BIL LING PACKA GE In 'IN ' basket. Page 1 *New* | ||
| 4785 | ---------- ---------- ---------- ---------- ---------- ---------- ---------- --------- | ||
| 4786 | SUMMARY UN BILLED AMO UNTS FOR DNS ENNE VAMC (442). | ||
| 4787 | PERIOD: FR OM 09/01/0 4 TO 09/30 /06 | ||
| 4788 | DETAILED R EPORT PRIN TED TO '/d ev/pts/5' | ||
| 4789 | Inpatient Care: | ||
| 4790 | Number of Unbille d Inpatien t Admissio ns : 0 | ||
| 4791 | Number of MRA Unb illed Inpt Admission s : 2 | ||
| 4792 | Number of Inpt. I nstitution al Cases : 0 | ||
| 4793 | Average Inpt. Ins titutional Bill Amou nt : 15 321.18 | ||
| 4794 | Number of Inpt. P rofessiona l Cases : 0 | ||
| 4795 | Average Inpt. Pro fessional Bill Amoun t : 1 036.36 | ||
| 4796 | Total U nbilled In patient Ca re : 0.00 | ||
| 4797 | Total M RA Unbille d Inpatien t Care : 0.00 | ||
| 4798 | Note: Patc h IB*2*547 provided the abilit y for user s to run t his report by divisi on (one or more) or not and to sort the report by division o r by patie nt name in alphabeti cal order. If users do search by divisio n, the Re- generate U nbilled Am ount Summa ry will di splay the summary to tals befor e the divi sion data. The displ ay of CPT codes and monetary a mounts for outpatien t claims h as also be en restore d.Do you w ant to sto re Unbille d Amounts figures? N O// | ||
| 4799 | Search by Division?? NO// | ||
| 4800 | Start with DATE: 08/ 23/1966// t-1000 (F EB 07, 201 3) | ||
| 4801 | Go to DATE: 11/ 04/2015// (NOV 04, 2015) | ||
| 4802 | Choose rep ort type(s ) to print : | ||
| 4803 | 1 - INP ATIENT UNB ILLED | ||
| 4804 | 2 - OUT PATIENT UN BILLED | ||
| 4805 | 3 - PRE SCRIPTION UNBILLED | ||
| 4806 | 4 - ALL OF THE AB OVE | ||
| 4807 | Select: ( 1-4): 4// | ||
| 4808 | You have s elected | ||
| 4809 | 4 - AL L OF THE A BOVE | ||
| 4810 | Are you su re? NO// y YES | ||
| 4811 | Print deta il report with the U nbilled Am ounts summ ary? NO// y | ||
| 4812 | Patient Bi lling Inqu iry – Syno nym: INQU | ||
| 4813 | What is th e purpose of this op tion? | ||
| 4814 | This optio n provides some basi c informat ion about a particul ar claim. It is a si mple inqui ry option. | ||
| 4815 | When is th is option used? | ||
| 4816 | This optio n can be u sed to vie w the foll owing type of inform ation rela ted to a b ill: | ||
| 4817 | Bill Statu s | ||
| 4818 | Rate Type | ||
| 4819 | Form Type | ||
| 4820 | Visit Date (s) | ||
| 4821 | Charges | ||
| 4822 | AR Status | ||
| 4823 | Statement Dates | ||
| 4824 | Dates rela ted to act ions such as Entered , Cancelle d or Print ed | ||
| 4825 | Bill Numbe r copied f rom or to | ||
| 4826 | Patient, M ailing and Insurance Company a ddress | ||
| 4827 | 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 | ||
| 4828 | Printed Cl aims Repor t | ||
| 4829 | What is th e purpose of this op tion? | ||
| 4830 | 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. | ||
| 4831 | When is th is option used? | ||
| 4832 | 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: | ||
| 4833 | Biller | ||
| 4834 | Outpatient /Inpatient and Insti tutional/P rofessiona l | ||
| 4835 | Rate Type | ||
| 4836 | Plan Type | ||
| 4837 | Division | ||
| 4838 | Revenue Co des | ||
| 4839 | Insurance Company | ||
| 4840 | 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.HCCH Pa yer ID Rep ort | ||
| 4841 | What is th e purpose of this op tion? | ||
| 4842 | When the V HA sends a claim to the cleari ng house w ith no def ined Prima ry Payer I D (EDI - I nst Payer Primary ID and/or ED I - Prof P ayer Prima ry ID) and the clear inghouse h as an elec tronic ID for the pa yer, they return the payer ID to the sit e. VistA a utomatical ly takes t he ID and populates the field in the Ins urance Com pany file. This opti on provide s informat ion about the update s or attem pted updat es to the Insurance Company fi le. | ||
| 4843 | If a value already e xists in V istA for t he Payer I D, no upda te will be made but the attemp t will be reported.W hen is thi s option u sed? | ||
| 4844 | This repor t is used by billing personnel to monito r the auto mated upda tes or upd ate attemp ts to the Insurance Company fi le when th e 277STAT reports ar e received from the clearingho use. The r eport prov ides the f ollowing d ata: | ||
| 4845 | • | ||
| 4846 | Insurance Company Na me | ||
| 4847 | • | ||
| 4848 | Insurance Company Ad dress | ||
| 4849 | • | ||
| 4850 | Date | ||
| 4851 | • | ||
| 4852 | Type of ID (Professi onal or In stitutiona l) | ||
| 4853 | • | ||
| 4854 | Old Value | ||
| 4855 | • | ||
| 4856 | New Value | ||
| 4857 | • | ||
| 4858 | Update Mad e (Yes/No) | ||
| 4859 | HCCH Payer ID Report Jan 11, 2017@0 9:53:18 Page: 1 of 1 | ||
| 4860 | Timeframe: 12/17/16 thru 01/11 /17 | ||
| 4861 | Insurance Co Address Dat e EDI -PayerID OldValue NewValue Updated | ||
| 4862 | __________ __________ __________ __________ __________ __________ __________ __________ __________ _______ | ||
| 4863 | AETNA PO BOX 229 5 FT. WAYN E INDI 12/ 28/16 Pro f XXXXX Yes | ||
| 4864 | AETNA HEAL TH PLANS PO BOX 123 40 FRESNO CALIFO 01/ 02/16 Pro f XXXXX Yes | ||
| 4865 | BANKERS FI DELITY PO BOX 105 652 ATLANT A GEOR 12/ 19/16 Pro f XYZ123 123456 No | ||
| 4866 | MEDICARE ( WNR) PO BOX 660159 DA LLAS 01/ 01/17 Ins t XXXXX1 XXXXX2 No | ||
| 4867 | APPENDIX A – BATCH P ROCESSING SETUP | ||
| 4868 | BATCH PROC ESSING SET UP | ||
| 4869 | The follow ing exampl e shows yo u how to d efine batc h processi ng for a p ayer: | ||
| 4870 | 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 IB*2. 0*155), 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 | ||
| 4871 | Only autho rized pers ons may ed it this da ta. | ||
| 4872 | +--------- ---------- ---------- ---------- ---------- ---------- ---------- - | ||
| 4873 | [15] EDI/M RA Activat ed : E DI | ||
| 4874 | EDI C ontact Pho ne : | ||
| 4875 | EDI 8 37 Live Tr ansmit Que ue : M CH | ||
| 4876 | EDI 8 37 Test Tr ansmit Que ue : M CT | ||
| 4877 | Auto- Txmt Bill Frequency : E very Day | ||
| 4878 | Hours To Auto-T ransmit : 1 300;1600 | ||
| 4879 | Max # Bills Per Batch : 5 0 | ||
| 4880 | Only Allow 1 In s Co/Claim Batch?: N O | ||
| 4881 | Last Auto-Txmt Run Date : 0 8/13/03 | ||
| 4882 | Days To Wait To Purge Msg s : 1 20 | ||
| 4883 | EDI/MRA Ac tivated: Controls w hether EDI is availa ble for th e site. | ||
| 4884 | Choose fro m: | ||
| 4885 | |||
| 4886 | 0 - NOT ED I OR MRA; | ||
| 4887 | 1 - EDI ON LY; | ||
| 4888 | 2 – MRA ON LY; or | ||
| 4889 | 3 – BOTH E DI AND MRA | ||
| 4890 | 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 | ||
| 4891 | Only autho rized pers ons may ed it this da ta. | ||
| 4892 | + | ||
| 4893 | HMO NUMBER : | ||
| 4894 | STAT E INDUSTRI AL ACCIDEN T PROV: | ||
| 4895 | LOCA TION NUMBE R : | ||
| 4896 | [15] EDI/M RA Activat ed : B OTH EDI AN D MRA | ||
| 4897 | EDI C ontact Pho ne : 2 17-554-313 5 | ||
| 4898 | EDI 8 37 Live Tr ansmit Que ue : M CH | ||
| 4899 | EDI 8 37 Test Tr ansmit Que ue : M CT | ||
| 4900 | Auto- Txmt Bill Frequency : E very Day | ||
| 4901 | Hours To Auto-T ransmit : 1 000;1400;2 000 | ||
| 4902 | Max # Bills Per Batch : 1 0 | ||
| 4903 | Only Allow 1 In s Co/Claim Batch?: N O | ||
| 4904 | Last Auto-Txmt Run Date : 0 5/26/04 | ||
| 4905 | Days To Wait To Purge Msg s : 4 5 | ||
| 4906 | Allow MRA Proce ssing? : Y ES | ||
| 4907 | Enabl e Automati c MRA Proc essing?: Y ES | ||
| 4908 | + Enter ?? f or more ac tions | ||
| 4909 | EP Edit S et EX Exit Action | ||
| 4910 | EDI Contac t Phone: T he phone n umber of t he person at the sit e contact to whom ED I inquirie s will be directed. The Pay-to Provider telephone number tha t is defin ed in Sect ion 10 for each Pay- to Provide r, will be printed o n the UB04 and CMS-1 500 form s tarting wi th Patch I B*2.0*400. | ||
| 4911 | 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. | ||
| 4912 | 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. | ||
| 4913 | 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. | ||
| 4914 | 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. | ||
| 4915 | 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) . | ||
| 4916 | 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. | ||
| 4917 | 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. | ||
| 4918 | 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. | ||
| 4919 | (This page included for two-si ded copyin g.) | ||
| 4920 | APPENDIX B – GLOSSAR Y | ||
| 4921 | GLOSSARY O F TERMS | ||
| 4922 | Acronym or TermDefin ition/Expl anation835 HIPAA Stan dard Elect ronic Tran saction AS C X12 835, Health Ca re Claim: | ||
| 4923 | 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: | ||
| 4924 | 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 | ||
| 4925 | 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. | ||
| 4926 | |||
| 4927 | 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.) | ||
| 4928 | APPENDIX C – HIPAA P rovider ID – Referen ce Guide | ||
| 4929 | 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. | ||
| 4930 | 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 | ||
| 4931 | Billing | ||
| 4932 | |||
| 4933 | VistA | ||
| 4934 | |||
| 4935 | Clearingho use | ||
| 4936 | |||
| 4937 | Austin FSC | ||
| 4938 | |||
| 4939 | Printed Bi lls | ||
| 4940 | |||
| 4941 | EDI Transm issions | ||
| 4942 | |||
| 4943 | Payer | ||
| 4944 | |||
| 4945 | R | ||
| 4946 | |||
| 4947 | EGULAR | ||
| 4948 | |||
| 4949 | M | ||
| 4950 | |||
| 4951 | AIL | ||
| 4952 | |||
| 4953 | 1 DAY | ||
| 4954 | |||
| 4955 | OVERNIGHT | ||
| 4956 | |||
| 4957 | UP TO 3 DA YS | ||
| 4958 | |||
| 4959 | 1 TO 14 DA YS | ||
| 4960 | |||
| 4961 | (Trading P artners) | ||
| 4962 | |||
| 4963 | Outside Th e VA Syste m | ||
| 4964 | |||
| 4965 | (Trading P artners) | ||
| 4966 | |||
| 4967 | Outside Th e VA Syste m | ||
| 4968 | |||
| 4969 | Within The VA System | ||
| 4970 | |||
| 4971 | Within The VA System | ||
| 4972 | |||
| 4973 | |||
| 4974 | |||
| 4975 | Payers | ||
| 4976 | |||
| 4977 | FSC | ||
| 4978 | |||
| 4979 | VistA | ||
| 4980 | |||
| 4981 | (Trading P artners) | ||
| 4982 | |||
| 4983 | Outside Th e VA Syste m | ||
| 4984 | |||
| 4985 | (Trading P artners) | ||
| 4986 | |||
| 4987 | Outside Th e VA Syste m | ||
| 4988 | |||
| 4989 | Within The VA System | ||
| 4990 | |||
| 4991 | Within The VA System | ||
| 4992 | |||
| 4993 | Payers | ||
| 4994 | |||
| 4995 | Emdeon | ||
| 4996 | |||
| 4997 | FSC | ||
| 4998 | |||
| 4999 | VistA | ||
| 5000 | |||
| 5001 | Clearing- | ||
| 5002 | house | ||
| 5003 | |||
| 5004 | TR- EDI Tr ansmission Status Re ports - | ||
| 5005 | |||
| 5006 | MM-EDI Ret urn Messag e Manageme nt | ||
| 5007 | |||
| 5008 | EDI Retu rn Message Managemen t Option M enu | ||
| 5009 | CSA Claim Status Aw aiting Res olution | ||
| 5010 | MCS Multi ple CSA Me ssage Mana gement | ||
| 5011 | TCS Test Claim EDI Transmissi on Report | ||
| 5012 | EDI Messag e Text to Screen Mai nt | ||
| 5013 | EDI Messag e Not Revi ewed Repor t | ||
| 5014 | Electronic Error Rep ort | ||
| 5015 | Electronic Report Di sposition | ||
| 5016 | Return Mes sage Filin g Exceptio ns | ||
| 5017 | Status Mes sage Manag ement | ||
| 5018 | |||
| 5019 | |||
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