Montefiore-CMO Commercial Home Health (HH), 837I 4010A1 Electronic
The following fields in the application are required for Montefiore-CMO Commercial Home Health (HH), 837I 4010A1 Electronic.
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Field
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Description
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Assignment of Benefits
and
Release of Information
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In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable.
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UPIN
-AND-
Provider Taxonomy Code
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Enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Companies>Company. If this field is blank, the taxonomy code is taken from the Provider Taxonomy Code field in Administration>Financial>Insurance Codes>General.
If your commercial carrier requires reporting attending physician, enter the physician's UPIN and the provider's taxonomy code in Resource>General>Roles.
In addition, the application reports values stored in the State License and UPIN fields.
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Provider ID
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Enter the organization's carrier-assigned provider number in the Provider ID field in Administration>Financial>Insurance Companies>Company.
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Receiver ID (Payer)
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Enter 13174 in the Receiver ID (Payer) field in Administration>Financial>Insurance Companies>Company. If this field is blank, the payer's receiver ID is taken from the Receiver ID (Payer) field in Administration>Financial>Insurance Codes>EMC.
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Receiver Name (Payer)
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Enter Montefiore CMO in the Receiver Name (Payer) field in Administration>Financial>Insurance Companies>Company. If this field is blank, the payer's receiver name is taken from the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC.
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Request for paper EOB
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To receive a paper EOB, select the Request Paper EOB check box in Administration>Financial>Insurance Codes>EMC.
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Text Submission Indicator
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Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent. If a file is created for production, do not select this check box.
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Emdeon Provider Site ID
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If claims are sent through Emdeon, enter the provider site ID assigned by CMO identifying the specific agency office to be sent to (one site ID for a tax ID) in the Emdeon Provider Site ID field in Administration>Configuration>Business Units>Teams and Legal Entities>Legal Entities.
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Montefiore-CMO Commercial Home Health (HH), 837I 5010A2 Electronic
For Montefiore-CMO Commercial Home Health (HH), 837I 5010A2 Electronic, define the following items:
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>
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In Administration>Financial>Insurance Codes>Print Variations, select the check box under FL 14–15 to ensure the ANSI 5010 Billing Template compliance.
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Note: If values other than 3 or 1 are required, enter them in Patient>General>Claim Constants or Administration>Financial>Claim Constants.
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>
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Ensure that either I or Y is selected for ANSI 5010 in the Rel Infor(Release of Information) field in Patient>General>Payers>HIPAA.
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The following fields in the application are required for Montefiore-CMO Commercial Home Health (HH), 837I 5010A2 Electronic.
|
Field
|
Description
|
|
Assignment of Benefits
and
Release of Information
|
In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable.
|
|
UPIN
-AND-
Taxonomy Code
|
Enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Companies>Company. If this field is blank, the taxonomy code is taken from the Provider Taxonomy Code field in Administration>Financial>Insurance Codes>General.
If your commercial carrier requires reporting attending physician, enter the physician's UPIN and the provider's taxonomy code in Resource>General>Roles.
In addition, the application reports the values stored in the State License and UPIN fields.
|
|
Provider ID
|
Enter the organization's carrier-assigned provider number in the Provider ID field in Administration>Financial>Insurance Companies>Company.
|
|
Receiver ID (Payer)
|
Enter 13174 in the Receiver ID (Payer) field in Administration>Financial>Insurance Companies>Company. If this field is blank, the payer's receiver ID is taken from the Receiver ID (Payer) field in Administration>Financial>Insurance Codes>EMC.
|
|
Receiver Name (Payer)
|
Enter Montefiore CMO in the Receiver Name (Payer) field in Administration>Financial>Insurance Companies>Company. If this field is blank, the payer's receiver name is taken from the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC.
|
|
Request for paper EOB
|
To receive a paper EOB, select the Request Paper EOB check box in Administration>Financial>Insurance Codes>EMC.
|
|
Text Submission Indicator
|
Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent. If a file is created for production, do not select this check box.
|
|
Emdeon Provider Site ID
|
If claims are sent through Emdeon, enter the provider site ID assigned by CMO identifying the specific agency office to be sent to (one site ID for a tax ID) in the Emdeon Provider Site ID field in Administration>Configuration>Business Units>Teams and Legal Entities>Legal Entities.
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