Neighborhood Health Plans

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Make separate claims (with totals) for claims.

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Suppress dots & dashes in ICD codes, dates and insured information.

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Print upper case letters only.

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Print total line on last line in revenue section.

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Include units in total line.

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Print net charges on the claim.

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Suppress printing of summary, print visit detail only, separate line per visit.

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Include a separate line for each supply.

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Print physician information on line B.

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Print Physician License number.

Field

Description

Submitter Name

Enter the submitter name provided by NHP in the Receiver ID (Payer) field in Administration>Financial>Insurance Codes>EMC.

Note: This is usually the submitter's name according to Neighborhood Health Plans.

Receiver ID

(File Recipient)

Enter NHP in the Receiver ID (File Recipient) field in Administration>Financial>Insurance Companies>Company or Administration>Financial>Insurance Codes>EMC.

Receiver ID

(Payer)

Enter submitter name provided by NHP in the Receiver ID (Payer) field in Administration>Financial>Insurance Companies>Company or Administration>Financial>Insurance Codes>EMC.

Note: This is usually the submitter's name according to Neighborhood Health Plans.

Test 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.

Federal Tax ID

Enter the agency's federal tax ID in the Federal Tax ID column in Administration>Configuration>Business Units>Teams and Legal Entities>Legal Entities.

Prior Authorizations

If you do not want to include the prior authorizations in the claim file, select the Do not Print on Claim check box in Patient>General>Authorizations.

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 Yby default for each carrier. Change to N where applicable.

Patient Sign (Patient Signature Code)

If the Rel Infor (Release of Information) field in Patient>General>Payers>HIPAA is set to Y, select the appropriate patient signature code, if different from the default code of B (Signed authorization form for CMS-1500 (08/05), Block 12/13 on file).

Program (Special Program Code)

In Patient>General>Payers>Pay Source>HIPAA, select 01 (EPSDT) if the services are provided under the EPSDT problem.

Insurance Type Code

Select the appropriate code identifying the type of insurance policy within a specific insurance program in the Insurance Type Code field in Administration>Financial>Insurance Codes>General and/or Administration>Financial>Insurance Companies>Company.

Federal Tax ID

-OR-

Social Security Number

For the patient's attending or referring physician, enter either the doctors' federal tax ID or Social Security Number in Resource>General>Roles>Other Physician. 
Note: If the federal tax ID is left blank, the application automatically writes 999999999.

Secondary Provider ID

If you have a secondary other payer ID code, enter the payer ID number in the Secondary Provider ID field in Administration>Financial>Insurance Companies>Company. If this field is empty, the value from Administration>Financial>Insurance Codes>EMC is used.

Locator

Locator Name

Setup

N/A

General Rules

Select the following print variations:

FL 3b

Medical/Health Record Number

Select the Print Patient ID print variation.

FL 10

Patient Birth Date

Select the Print Birth Date in MMDDYY format print variation.

FL 14–15

Priority (Type) of Admission or Visit

Select the Print '3' and '1' Admission Type/Src print variation.

Note: If needed, report values other than 3 or 1 in Patient>General>Claim Constants or Administration>Financial>Claim Constants.

FL 38

Print Insured Name and Address

Select the Print the commercial insurance company address print variation.

FL 42–49

Billing Detail Locators

Select the following print variations:

FL 52–53

Release of Information Certification Indicator

Select the Print 'Y' in release and info print variation.

FL 59

Patient's Relationship to Insured

Select the Suppress printing of Patient Relationship print variation.

FL 80

Remarks

Select the Print physician name, address & telephone no. print variation.

Locator Name

Setup

Submitter Name

Enter the submitter name provided by NHP in the Receiver ID (Payer) field in Administration>Financial>Insurance Codes>EMC.

Note: This is usually the submitter's name according to Neighborhood Health Plans.

Receiver ID

(File Recipient)

Enter NHP in the Receiver ID (File Recipient) field in Administration>Financial>Insurance Companies>Company or Administration>Financial>Insurance Codes>EMC.

Receiver ID

(Payer)

Enter submitter name provided by NHP in the Receiver ID (Payer) field in Administration>Financial>Insurance Companies>Company or Administration>Financial>Insurance Codes>EMC.

Note: This is usually the submitter's name according to Neighborhood Health Plans.

Test 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.

Federal Tax ID

Enter the agency's federal tax ID in the Federal Tax ID column in Administration>Configuration>Business Units>Teams and Legal Entities>Legal Entities.

Prior Authorizations

If you do not want to include the prior authorizations in the claim file, select the Do not Print on Claim check box in Patient>General>Authorizations.

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.

Patient Sign (Patient Signature Code)

If the Rel Infor (Release of Information) field in Patient>General>Payers>HIPAA is set to Y, select the appropriate patient signature code, if different from the default code of B (Signed authorization form for CMS-1500 (08/05), Block 12/13 on file).

Program (Special Program Code)

In Patient>General>Payers>Pay Source>HIPAA, select 01 (EPSDT) if the services are provided under the EPSDT problem.

Insurance Type Code

Select the appropriate code identifying the type of insurance policy within a specific insurance program in the Insurance Type Code field in Administration>Financial>Insurance Codes>General and/or Administration>Financial>Insurance Companies>Company.

Federal Tax ID

-OR-

Social Security Number

For the patient's attending or referring physician, enter either the doctors' federal tax ID or Social Security Number in Resource>General>Roles>Other Physician. 
Note: If the federal tax ID is left blank, the application automatically writes 999999999.

Secondary Provider ID

If you have a secondary other payer ID code, enter it in the Secondary Provider ID field in Administration>Financial>Insurance Companies>Company. If this field is empty, the value from Administration>Financial>Insurance Codes>EMC is used.