Palmetto Government Benefits Agency (GBA)

Palmetto Government Benefits Agency (GBA) Medicare Home Health (HH), 8371 4010A1 Electronic

When your agency is ready to start submitting production claims to Palmetto, you must contact the Technology Support Center at Palmetto with the following information before submitting production claims:

>	Provider Name

>	Contact Name

>	Submitter ID

>	Phone Number

>	Vendor System Name (Allscripts Homecare)

>	Vendor Security ID (see sections below)

Vendor Security ID: 1050SE

Arkansas, Kentucky, Louisiana, North Carolina, New Mexico, Oklahoma, South Carolina, Tennessee, and Texas.

Vendor Security ID: 2050GC

Florida, Georgia, Mississippi, Alabama, Illinois, Ohio, and Indiana.

In Administration>Financial>Insurance Codes>General, define the following items:

>	Type – M (Medicare)

>	Mode – P (Episodic)

In Administration>Financial>Insurance Codes>EMC, define the following items listed in the following table. This setup is necessary for all agencies that are sending claims in electronic format. Also, check for this information on your Trading Partner Agreement with your intermediary.


Option Name	Recommended Setup
EMC Format	(Billing Format)
Receiver ID (File Recipient)	11001
Receiver ID (Payer)	Leave this field blank.
Receiver Name (Payer)	Leave this field blank.
Payer Type	C (Medicare)
POT Indicator	None
EMC Template	837I Palmetto Medicare Home Health PPS (use the appropriate version depending on your Allscripts Homecare application version).
Clearing House	Leave this field blank.
Submitter ID	Enter the value provided in Trading Partner Agreement by your intermediary (differs by provider).
ERA ID	This field can be left blank unless intermediary returns the value different from the submitter ID, provider ID, or receiver code (only used for remittances).
Receiver Code	Enter the value provided in Trading Partner Agreement by your intermediary (differs by provider; only used for remittances).
Special Handling	Enter the agency option (suggested 0).
Request Paper EOB	Selecting this check box is optional.
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 defers the claims from the electronic file. Selecting this option also defers Initial claims unless the Do not defer Episodic Initial claims when orders are not signed is selected.
Defer claims when supplemental orders are not signed	Medicare does not accept Final claims without signed orders, so selecting this option defers the claims from the electronic file. Selecting 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	Selecting this option allows Initial claims to be processed even if orders are not signed.

In Administration>Financial>Insurance Codes>NPI, define the following items listed in the following table.


Option Name	Recommended Setup
IDs to include in EMC files	Select National Provider IDs (NPI).
IDs to include in Paper Claims	Select National Provider IDs (NPI).
IDs to include in OASIS Export files	Select National Provider IDs (NPI).
Provider NPI	Select on your Business Unit level or Branch level. Additional setup can be performed on the Provider NPI and Branches tabs in Administration>Configuration>Business Units.
Bill by Rendering Provider NPI	Clear this check box.
Use agency name and NPI when no resource NPI	Clear this check box.

Palmetto Government Benefits Agency (GBA) Medicare Home Health (HH), 8371 5010A2 Electronic

When your agency is ready to start submitting production claims to Palmetto, contact the Technology Support Center at Palmetto with the following information before submitting production claims:

>	Provider Name

>	Contact Name

>	Submitter ID

>	Phone Number

>	Vendor System Name (Allscripts Homecare)

>	Vendor ID (VS4050)

In Administration>Financial>Insurance Codes>General, define the following items:

>	Type – M (Medicare)

>	Mode – P (Episodic)

For Palmetto GBA Medicare Home Health (HH), 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, define the following items listed in the following table. This setup is necessary for all the agencies that are sending claims in electronic format. Also, check for this information in your Trading Partner Agreement with your intermediary.


Option Name	Recommended Setup
EMC Format	(Billing Format)
Receiver ID (File Recipient)	00380
Receiver ID (Payer)	Leave this field blank.
Receiver Name (Payer)	Leave this field blank.
Payer Type	C (Medicare)
POT Indicator	None
EMC Template	837I 5010 Palmetto Medicare Home Health PPS (use the appropriate version depending on your Allscripts Homecare application version).
Clearing House	Leave this field blank.
Submitter ID	Enter the value provided in Trading Partner Agreement by your intermediary (differs by provider).
ERA ID	This field can be left blank unless intermediary returns the value different from the submitter ID, provider ID, or receiver code (only used for remittances).
Receiver Code	Enter the value provided in Trading Partner Agreement by your intermediary (differs by provider; only used for remittances).
Special Handling	Enter the agency option (recommended – 0).
Request Paper EOB	Selecting this check box is optional.
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 defers the claims from the electronic file. Selecting this option also defers Initial 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 defers claims from the electronic file. Selecting 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	Selecting this option allows Initial claims to be processed even if orders are not signed.

In Administration>Financial>Insurance Codes>NPI, define the following items listed in the following table.


Option Name	Recommended Setup
IDs to include in EMC files	Select National Provider IDs (NPI).
IDs to include in Paper Claims	Select National Provider IDs (NPI).
IDs to include in OASIS Export files	Select National Provider IDs (NPI).
Provider NPI	Select the provider NPI on your Business Unit level or Branch level. Additional setup can be performed on the Provider NPI and Branchestabs in Administration>Configuration>Business Units.
Bill by Rendering Provider NPI	Clear this check box.
Use agency name and NPI when no resource NPI	Clear this check box.

Palmetto Government Benefits Agency (GBA) Medicare Hospice (HO), 837I 4010A1 Electronic

When your agency is ready to start submitting production claims to Palmetto, contact the Technology Support Center at Palmetto with the following information before submitting production claims:

>	Provider Name

>	Contact Name

>	Submitter ID

>	Phone Number

>	Vendor System Name (Allscripts Homecare)

>	Vendor Security ID (see sections below)

Vendor Security ID: 1050SE

Arkansas, Kentucky, Louisiana, North Carolina, New Mexico, Oklahoma, South Carolina, Tennessee, and Texas.

Vendor Security ID: 2050GC

Florida, Georgia, Mississippi, Alabama, Illinois, Ohio, and Indiana.

In Administration>Financial>Insurance Codes>General, define the following items:

>	Type – M (Medicare)

>	Mode – B (Benefit)

In Administration>Financial>Insurance Codes>EMC, define the following items listed in the following table. This setup is necessary for all agencies that are sending claims in electronic format. Also, check for this information on your Trading Partner Agreement with your intermediary.


Option Name	Recommended Setup
EMC Format	(Billing Format)
Receiver ID (File Recipient)	11001
Receiver ID (Payer)	Leave this field blank.
Receiver Name (Payer)	Leave this field blank.
Payer Type	C (Medicare)
POT Indicator	None
EMC Template	837I Palmetto Medicare Hospice Per Diem (use the appropriate version depending on your Allscripts Homecare application version).
Clearing House	Leave this field blank.
Submitter ID	Enter the value provided in Trading Partner Agreement by your intermediary (differs by provider).
ERA ID	This field can be left blank unless intermediary returns the value different from the submitter ID, provider ID, or receiver code (only used for remittances).
Receiver Code	Enter the value provided in Trading Partner Agreement by your intermediary (differs by provider; only used for remittances).
Special Handling	Enter the agency option (suggested 0).
Request Paper EOB	Selecting this check box is optional.
Test Submission Indicator	Select this check box only if you are submitting test claims.
Form must be printed	Clear this check box.
Defer claims when orders are not signed	Clear this check box.
Defer claims when supplemental orders are not signed	Clear this check box.

In Administration>Financial>Insurance Codes>NPI, define the following items listed in the following table.


Option Name	Recommended Setup
IDs to include in EMC files	Select National Provider IDs (NPI).
IDs to include in Paper Claims	Select National Provider IDs (NPI).
IDs to include in OASIS Export files	Select National Provider IDs (NPI).
Provider NPI	Select the provider NPI on your Business Unit level or Branch level. Additional setup can be performed on the Provider NPI and Branchestabs in Administration>Configuration>Business Units.
Bill by Rendering Provider NPI	Clear this check box.
Use agency name and NPI when no resource NPI	Clear this check box.

Palmetto Government Benefits Agency (GBA) 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:

>	The Occurrence section in Claims>Process>Annotate Claims

>	Patient>General>Claim Constants for FL 31–34 - Occurrence Codes and Dates

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.

When your agency is ready to start submitting production claims to Palmetto, contact the Technology Support Center at Palmetto with the following information before submitting production claims:

>	Provider Name

>	Contact Name

>	Submitter ID

>	Phone Number

>	Vendor System Name (Allscripts Homecare)

>	Vendor ID (VS4050)

In Administration>Financial>Insurance Codes>General, define the following items:

>	Type – M (Medicare)

>	Mode – B (Benefit)

For Palmetto GBA 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, define the following items listed in the following table. This setup is necessary for all agencies that are sending claims in electronic format. Also, check for this information in your Trading Partner Agreement with your intermediary.


Option Name	Recommended Setup
EMC Format	(Billing Format)
Receiver ID (File Recipient)	00380
Receiver ID (Payer)	Leave this field blank.
Receiver Name (Payer)	Leave this field blank.
Payer Type	C (Medicare)
POT Indicator	None
EMC Template	837I 5010 Palmetto Medicare Hospice Per Diem (use the appropriate version depending on your Allscripts Homecare application version).
Clearing House	Leave this field blank.
Submitter ID	Enter the value provided in Trading Partner Agreement by your intermediary (differs by provider).
ERA ID	This field can be left blank unless intermediary returns the value different from the submitter ID, provider ID, or receiver code (only used for remittances).
Receiver Code	Enter the value provided in Trading Partner Agreement by your intermediary (differs by provider; only used for remittances).
Special Handling	Enter the agency option (recommended – 0).
Request Paper EOB	Selecting this check box is optional.
Test Submission Indicator	Select this check box only if you are submitting test claims.
Form must be printed	Clear this check box.
Defer claims when orders are not signed	Clear this check box.
Defer claims when supplemental orders are not signed	Clear this check box.

In the IDs to include in EMC files section in Administration>Financial>Insurance Codes>NPI, select the National Provider IDs (NPI) radio button.