NGS Medicare Home Health (HH), 837I 4010A1 Electronic
In Administration>Financial>Insurance Codes>General, define the insurance code with the following parameters:
In Administration>Financial>Insurance Codes>EMC, complete the following fields to send claims in electronic format. Also, check for this information in your Trading Partner Agreement with your intermediary.
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Field
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Recommended Setup
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EMC Format
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Select (Billing Format) from the drop-down list.
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Receiver ID (File Recipient)
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Enter 00450 or 00456 depending on your region that must be identified in your Trading Partner Agreement.
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Receiver ID (Payer)
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Leave this field blank.
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Receiver Name (Payer)
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Leave this field blank.
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Payer Type
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Select C (Medicare) from the drop-down list.
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POT Indicator
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Select None from the drop-down list.
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EMC Template
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Select 837I NGS-UGS Medicare Home Health PPS from the drop-down list (use the appropriate template version depending on your Allscripts Homecare application version).
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Clearing House
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Leave this field blank.
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Submitter ID
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Enter the value provided in your Trading Partner Agreement by an intermediary (differs by provider).
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ERA ID
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The field can be left blank unless an intermediary returns the value different from submitter ID, provider ID, or receiver code (used only for remittances).
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Receiver Code
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Enter the value provided in your Trading Partner Agreement by an intermediary (differs by provider; used only for remittances).
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Special Handling
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Select the value appropriate for your agency option (most frequently 0).
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Request Paper EOB
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To receive a paper EOB, select the Request Paper EOB check box.
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Test Submission Indicator
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Select this check box only if you are submitting test claims.
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Form must be printed
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Select this check box to print claims for this pay source before closing the cycle.
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Defer claims when orders are not signed
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Medicare does not accept Final claims without signed certifications orders (485's), so selecting this option will defer the claims from the electronic file. This option also defers RAP claims unless the Do not defer Episodic Initial claims when orders are not signed check box is selected.
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|
Defer claims when supplemental orders are not signed
|
Medicare does not accept Final claims without signed orders, so selecting this option will defer the claims from the electronic file. This option also defers RAP claims unless the Do not defer Episodic Initial claims when orders are not signed check box is selected.
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Do not defer Episodic Initial claims when orders are not signed
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Select this option to allow processing Initial claims even if orders are not signed.
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In Administration>Financial>Insurance Codes>NPI, perform the following setup.
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Section or Field
|
Recommended Setup
|
|
IDs to include in EMC files
|
Select the National Provider IDs (NPI) radio button.
|
|
IDs to include in Paper Claims
|
Select the National Provider IDs (NPI) radio button.
|
|
IDs to include in OASIS Export files
|
Select the National Provider IDs (NPI) radio button.
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|
Provider NPI
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Select the appropriate provider NPI on your Business Unit level or Branch level (defined on the Provider NPI and Branches tabs in Administration>Configuration>Business Units).
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Bill by Rendering Provider NPI
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Make sure this check box is clear.
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Use agency name and NPI when no resource NPI
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Make sure this check box is clear.
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NGS Medicare Home Health (HH), 837I 5010A2 Electronic
In Administration>Financial>Insurance Codes>General, define the insurance code with the following parameters:
For NSG Medicare 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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In Administration>Financial>Insurance Codes>EMC, complete the following fields to send claims in electronic format. Also, check for this information in your Trading Partner Agreement with your intermediary.
|
Field
|
Recommended Setup
|
|
EMC Format
|
Select (Billing Format) from the drop-down list.
|
|
Receiver ID (File Recipient)
|
Enter 00450 or 00456 depending on your region that must be identified in your Trading Partner Agreement.
|
|
Receiver ID (Payer)
|
Leave this field blank.
|
|
Receiver Name (Payer)
|
Leave this field blank.
|
|
Payer Type
|
Select C (Medicare) from the drop-down list.
|
|
POT Indicator
|
Select None from the drop-down list.
|
|
EMC Template
|
Select 837I NGS-UGS Medicare Home Health PPS from the drop-down list (use the appropriate template version depending on your Allscripts Homecare application version).
|
|
Clearing House
|
Leave this field blank.
|
|
Submitter ID
|
Enter the value provided in your Trading Partner Agreement by an intermediary (differs by provider).
|
|
ERA ID
|
The field can be left blank unless an intermediary returns the value different from submitter ID, provider ID, or receiver code (used only for remittances).
|
|
Receiver Code
|
Enter the value provided in your Trading Partner Agreement by an intermediary (differs by provider; used only for remittances).
|
|
Special Handling
|
Select the value appropriate for your agency option (most frequently 0).
|
|
Request Paper EOB
|
To receive a paper EOB, select the Request Paper EOB check box.
|
|
Test Submission Indicator
|
Select this check box only if you are submitting test claims.
|
|
Form must be printed
|
Select this check box to print claims for this pay source before closing the cycle.
|
|
Defer claims when orders are not signed
|
Medicare does not accept Final claims without signed certifications orders (485's), so selecting this option will defer the claims from the electronic file. This option also defers RAP claims unless the Do not defer Episodic Initial claims when orders are not signed check box is selected.
|
|
Defer claims when supplemental orders are not signed
|
Medicare does not accept Final claims without signed orders, so selecting this option will defer the claims from the electronic file. This option also defers Initial claims unless the Do not defer Episodic Initial claims when orders are not signed check box is selected.
|
|
Do not defer Episodic Initial claims when orders are not signed
|
Select this option to allow processing Initial claims even if orders are not signed.
|
In Administration>Financial>Insurance Codes>NPI, it is recommended to select the National Provider IDs (NPI) radio button in the IDs to include in EMC files section.
NGS Medicare Hospice (HO), 837I 4010A1 Electronic
In Administration>Financial>Insurance Codes>General, define the insurance code with the following parameters:
In Administration>Financial>Insurance Codes>EMC, complete the following fields to send claims in electronic format. Also, check for this information in your Trading Partner Agreement with your intermediary.
|
Option
|
Recommended Entry
|
|
EMC Format
|
Select (Billing Format) from the drop-down list.
|
|
Receiver ID (File Recipient)
|
Enter 00450 or 00456 depending on your region that must be identified in your Trading Partner Agreement.
|
|
Receiver ID (Payer)
|
Leave this field blank.
|
|
Receiver Name (Payer)
|
Leave this field blank.
|
|
Payer Type
|
Select C (Medicare) from the drop-down list.
|
|
POT Indicator
|
Select None from the drop-down list.
|
|
EMC Template
|
Select 837I NGS-UGS Medicare Hospice Per Diem from the drop-down list (use the appropriate template version depending on your Allscripts Homecare application version).
|
|
Clearing House
|
Leave this field blank.
|
|
Submitter ID
|
Enter the value provided in your Trading Partner Agreement by an intermediary (differs by provider).
|
|
ERA ID
|
The field can be left blank unless an intermediary returns the value different from submitter ID, provider ID, or receiver code (used only for remittances).
|
|
Receiver Code
|
Enter the value provided in your Trading Partner Agreement by an intermediary (differs by provider; used only for remittances).
|
|
Special Handling
|
Select the value appropriate for your agency option (most frequently 0).
|
|
Request Paper EOB
|
To receive a paper EOB, select the Request Paper EOB check box.
|
|
Test Submission Indicator
|
Select this check box only if you are submitting test claims.
|
|
Form must be printed
|
Make sure this check box is clear.
|
|
Defer claims when orders are not signed
|
Make sure this check box is clear.
|
|
Defer claims when supplemental orders are not signed
|
Make sure this check box is clear.
|
In Administration>Financial>Insurance Codes>NPI, perform the following setup.
|
Section or Field
|
Recommended Setup
|
|
IDs to include in EMC files
|
Select the National Provider IDs (NPI) radio button.
|
|
IDs to include in Paper Claims
|
Select the National Provider IDs (NPI) radio button.
|
|
IDs to include in OASIS Export files
|
Select the National Provider IDs (NPI) radio button.
|
|
Provider NPI
|
Select the appropriate provider NPI on your Business Unit level or Branch level (defined on the Provider NPI and Branches tabs in Administration>Configuration>Business Units).
|
|
Bill by Rendering Provider NPI
|
Make sure this check box is clear.
|
|
Use agency name and NPI when no resource NPI
|
Make sure this check box is clear.
|
NGS Medicare Hospice (HO), 837I 5010A2 Electronic
Starting from January 1, 2014, CMS requires reporting additional data on claims when a hospice issues an Advanced Beneficiary Notice (ABN) to a patient receiving General Inpatient Care (GIP) acuity. To comply with the regulation, enter the occurrence code 32 and the issue date of the ABN in:
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>
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The Occurrence section in Claims>Process>Annotate Claims
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>
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Patient>General>Claim Constants for FL 31–34 - Occurrence Codes and Dates
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After setup, the occurrence code 32 and the ABN issue date is reported in FL 31–33 on the UB-04 form and in the Loop 2300 HI*BH segment.
CMS will reimburse the agency for the days of General Inpatient Care that began with the ABN date at the lower Routine Home Care rate.
In Administration>Financial>Insurance Codes>General, define the insurance code with the following parameters:
For NSG Medicare Hospice (HO), 837I 5010A2 Electronic, define the following items:
|
>
|
In Administration>Financial>Insurance Codes>Print Variations, select the check box under FL 14–15 to ensure the ANSI 5010 Billing Template compliance.
|
Note: If values other than 3 or 1 are required, enter them in Patient>General>Claim Constants or Administration>Financial>Claim Constants.
|
>
|
Ensure that either I or Y is selected for ANSI 5010 in the Rel Infor(Release of Information) field in Patient>General>Payers>HIPAA.
|
In Administration>Financial>Insurance Codes>EMC, complete the following fields to send claims in electronic format. Also, check for this information in your Trading Partner Agreement with your intermediary.
|
Option
|
Recommended Entry
|
|
EMC Format
|
Select (Billing Format) from the drop-down list.
|
|
Receiver ID (File Recipient)
|
Enter 00450 or 00456 depending on your region that must be identified in your Trading Partner Agreement.
|
|
Receiver ID (Payer)
|
Leave this field blank.
|
|
Receiver Name (Payer)
|
Leave this field blank.
|
|
Payer Type
|
Select C (Medicare) from the drop-down list.
|
|
POT Indicator
|
Select None from the drop-down list.
|
|
EMC Template
|
Select 837I NGS-UGS Medicare Hospice Per Diem from the drop-down list (use the appropriate template version depending on your Allscripts Homecare application version).
|
|
Clearing House
|
Leave this field blank.
|
|
Submitter ID
|
Enter the value provided in your Trading Partner Agreement by an intermediary (differs by provider).
|
|
ERA ID
|
The field can be left blank unless an intermediary returns the value different from submitter ID, provider ID, or receiver code (used only for remittances).
|
|
Receiver Code
|
Enter the value provided in your Trading Partner Agreement by an intermediary (differs by provider; used only for remittances).
|
|
Special Handling
|
Select the value appropriate for your agency option (most frequently 0).
|
|
Request Paper EOB
|
To receive a paper EOB, select the Request Paper EOB check box.
|
|
Test Submission Indicator
|
Select this check box only if you are submitting test claims.
|
|
Form must be printed
|
Make sure this check box is clear.
|
|
Defer claims when orders are not signed
|
Make sure this check box is clear.
|
|
Defer claims when supplemental orders are not signed
|
Make sure this check box is clear.
|
In Administration>Financial>Insurance Codes>NPI, perform the following setup.
|
Section or Field
|
Recommended Setup
|
|
IDs to include in EMC files
|
Select the National Provider IDs (NPI) radio button.
|
|
IDs to include in Paper Claims
|
Select the National Provider IDs (NPI) radio button.
|
|
IDs to include in OASIS Export files
|
Select the National Provider IDs (NPI) radio button.
|
|
Provider NPI
|
Select the appropriate provider NPI on your Business Unit level or Branch level (defined on the Provider NPI and Branches tabs in Administration>Configuration>Business Units).
|
|
Bill by Rendering Provider NPI
|
Make sure this check box is clear.
|
|
Use agency name and NPI when no resource NPI
|
Make sure this check box is clear.
|
