Late EMC window

Patient ID

The patient's ID number from Patient > General > Basic.

Patient

The patient's last and first name from Patient > General > Basic.

Claim ID

The claim ID or the virtual claim ID (identified by the V suffix, only for New York claims).

Type

The type of bill.

From Date

The from date of the claim.

Thru Date

The thru date of the claim.

 Gross

The gross of the total billing charges.

For Medicare PPS, the Gross for a type of bill 332 (RAP) claim is the total Expected Episodic Payment (EEP). The Gross for a type of bill 339 (Final Claim) is the total gross charges of the visit details of the claim.

Net

The net of the total billing.

For Medicare PPS, the Gross for a type of bill 332 (RAP) claim is the amount reimbursable by Medicare, for example fifty or sixty percent, depending on whether this is the first episode or subsequent episode. The gross for a type of bill 339 (final claim) is the total net charges of the visit details of the claim.

Actual

The actual amount is the dollar amount that is generated for accounts receivable.

 OASIS

Is selected if the OASIS assigned to the patient in Patient > General > Admissions & Status >  PPS Information is not exported. The claim is not deferred if there is no OASIS assigned to the patient or if the assigned OASIS is exported. For more information, refer to EMC Deferment Options.

NY FFS DCN

Is selected if the claim is an adjustment claim and the original claim does not have a DCN associated with it. For more information, refer to EMC Deferment Options in the Financial Setup Guide.

PECOS

Is selected if the related physician is not PECOS-enrolled and if the payer is set to defer such claims at the insurance code level (Administration > Financial > Insurance Codes > EMC). For more information, refer to EMC Deferment Options in the Financial Setup Guide.

CTI

Is selected for any benefit or hybrid payer if CTI document is missing or not signed for a patient's billing period, regardless of whether the deferment EMC option for CTI documents is selected at the insurance code level (Administration > Financial > Insurance Codes > EMC).

F2F

Is selected for any regular or EPS (for final claims only) payer if a face-to-face document is missing or not signed for a patient's admission, regardless of whether the deferment EMC option for face-to-face documents is selected at the insurance code level (Administration > Financial

>  Insurance Codes > EMC).

UTN

Select this check box if the final claim was deferred for a UTN defer option (UTN missing or not approved).

Submit

Select this check box for the claims that you want to submit. This check box is available for selection only if the OASIS, NY FFS DCN, PECOS, and CTI check boxes are clear (the reasons of automatic claim deferment are resolved).

Defer

Indicates that corresponding claim is deferred.

Exclude

Excludes the corresponding claim from processing.

EMC Status

Displays the status of the claim. Changes automatically when you select the Submit, Defer, or Exclude check box.

Submit

Document control number of the claim.