Univera New York (NY) Commercial Home Health (HH), CMS-1500 (08/05) Hardcopy
Univera New York Commercial Home Health is a fee-for-service claim.
In Administration>Financial>Insurance Codes>General, define the following items:
In Administration>Financial>Insurance Codes>Print Variations, define the following items for Univera (NY) Commercial Home Health (HH), CMS-1500 (08/05) Hardcopy.
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Locator
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Locator Name
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Setup
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N/A
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Specialized Formats
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Make no selection.
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N/A
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Printer
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Select the appropriate printer.
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FL 10
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Patient's Condition Related to
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If needed, change the default No response as appropriate in Claims>Process>Annotate Claims.
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FL 27
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Accept Assignment
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If needed, change the default Yes response as appropriate in Claims>Process>Annotate Claims.
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FL 31
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Signature of Physician or Supplier
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The name of an operator who closes the claim cycle is printed in this locator. Ensure that real names are used for a resource that is connected to each operator. Avoid sharing operator accounts.
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Univera New York (NY) Commercial Home Health (HH), 837I 4010A1 Electronic
Refer to the Univera New York (NY) Commercial Home Health (HH), CMS-1500 (08/05) Hardcopy instructions for additional setup information.
The following fields in the application are required for Univera 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 Yby default for each carrier. Change to N where applicable.
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Federal Tax ID
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Enter the agency's federal tax ID in the Federal Tax ID column in Administration>Configuration>Business Units>Teams and Legal Entities>Legal Entities.
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ID Code
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The value of 16107 required by Univera is automatically defined in the ID Code field of the Other Payer Name loop.
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Insurance Type Code
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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.
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Medicare Assign (Medicare Assignment Code)
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The Medicare assignment code is defined in the patient's/payer's Medicare Assign field in Patient>General>Payers>Pay Source>HIPAA.
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Patient Sign (Patient Signature Code)
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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).
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Program (Special Program Code)
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In Patient>General>Payers>Pay Source>HIPAA, select 01 (EPSDT) if the services are provided under the EPSDT problem.
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Provider ID
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Enter the agency's provider number in the Provider ID field in Administration>Financial>Insurance Companies>Company.
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Receiver ID (File Recipient)
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Enter 00302 in the Receiver ID (File Recipient) field in Administration>Financial>Insurance Codes>EMC.
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Receiver Name (Payer)
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Enter UNIVERA in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC.
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Secondary Provider ID Number
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If Univera is a secondary payer in a claim, enter the payer ID number assigned to the primary insurance in the Secondary Provider ID field in Administration>Financial>Insurance Companies>Company for the primary payer in the claim. Do not enter the secondary provider number in the Secondary Provider ID field in Administration>Financial>Insurance Companies>Company for the Univera insurance company.
If this field is empty, the value from Administration>Financial>Insurance Codes>EMC is used.
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Submitter ID
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Enter the agency's submitter ID assigned by Univera in the Submitter ID field in Administration>Financial>Insurance Codes>EMC.
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Subscriber ID
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Enter the patient's subscriber ID in the Insurance ID column in Patient>General>Payers>Pay Source>General.
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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.
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Test 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.
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Univera New York (NY) Commercial Home Health (HH), 837I 5010A2 Electronic
Refer to the Univera New York (NY) Commercial Home Health (HH), CMS-1500 (08/05) Hardcopy instructions for additional setup information.
For Univera 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 Univera Commercial Home Health (HH), 837I 5010A2 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 Yby default for each carrier. Change to N where applicable.
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Federal Tax ID
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Enter the agency's federal tax ID in the Federal Tax ID column in Administration>Configuration>Business Units>Teams and Legal Entities>Legal Entities.
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ID Code
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The value of 16107 required by Univera is automatically defined in the ID Code field of the Other Payer Name loop.
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Insurance Type Code
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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.
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Medicare Assign (Medicare Assignment Code)
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The Medicare assignment code is defined in the patient's/payer's Medicare Assign field in Patient>General>Payers>Pay Source>HIPAA.
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Patient Sign (Patient Signature Code)
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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).
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Program (Special Program Code)
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In Patient>General>Payers>Pay Source>HIPAA, select 01 (EPSDT) if the services are provided under the EPSDT problem.
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Provider ID
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Enter the agency's provider number in the Provider ID field in Administration>Financial>Insurance Companies>Company.
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Receiver ID (File Recipient)
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Enter 00302 in the Receiver ID (File Recipient) field in Administration>Financial>Insurance Codes>EMC.
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Receiver Name (Payer)
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Enter UNIVERA in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC.
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Secondary Provider ID Number
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If Univera is a secondary payer in a claim, enter the payer ID number assigned to the primary insurance in the Secondary Provider ID field in Administration>Financial>Insurance Companies>Company for the primary payer in the claim. Do not enter the secondary provider number in the Secondary Provider ID field in Administration>Financial>Insurance Companies>Company for the Univera insurance company.
If this field is empty, the value from Administration>Financial>Insurance Codes>EMC is used.
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Submitter ID
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Enter the agency's submitter ID assigned by Univera in the Submitter ID field in Administration>Financial>Insurance Codes>EMC.
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Subscriber ID
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Enter the patient's subscriber ID in the Insurance ID column in Patient>General>Payers>Pay Source>General.
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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.
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Test 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.
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