Claim entry: Medicare primary

General

• Setup: Institutional Claims Menu, Enter Claims, Patient Info & General
• Required: LOB (MCA will auto populate), Patient Control No, right click to select from Patient database, Type of Bill, Statement Covers Period.
• Optional: The remaining fields are optional depending upon the type of billing you are billing. The program will edit the claim
  based on the Type of Bill entered.

Line item details

• Setup: Institutional Claims Menu, Enter Claims, Billing Line Items, Line Item Details
• Tips: Right click to access information from databases or available pull-down menus
  • F4: Field Duplication
  • F5: Line Duplication
  • F7: Line deletion
  • F8: Advance to next line
• Required: Rev. Cd., HCPC, From Date, Units/Days, Total Charges
• Optional: Modifiers, Rate, Thru Date, Non-Cov Chgs
• Auto Populated: When Recalculate is selected, it will update the totals for Total Charges and Non-Cov Chgs based upon information entered on each detail line.

Payer info

• Setup: Institutional Claims Menu, Enter Claims, Payer Info

Diagnosis / Procedures

• Setup: Institutional Claims Menu, Enter Claims, Diagnosis/Procedure
• Required: Principal Diag., Attending Physician
• Optional: Fields are optional based on the TOB entered

Edit validation errors list

Once “Save” is selected, the claim will edit for known requirements.

• Error message will indicate the line or field the error is associated with
• Double click on error to jump to corresponding field
• Once error is corrected select “Save” again to re-edit claim
• Red X error must be corrected before transmitting

Claim entry: Medicare secondary / payment made

General

• Setup: Institutional Claims Menu, Enter Claims, Patient Info & General
• Required: LOB (MCA will auto populate), Patient Control No, right click to select from Patient database auto populating all associated fields Type of Bill, Statement Covers Period, and Value Code and Amount. The Value Code can be obtained by right clicking in the Code field and selecting from the list (12 - 16, 41 - 43, or 47), and the amount is equal to the amount paid on the entire claim
• Optional: The remaining fields are optional based on your specific type of bill.

Line item details: MSP

• Setup: Institutional Claims Menu, Enter Claims, Billing Line Items, Line Item Details
• Required: Rev. Cd., HCPCS, From Date, Units/Days, Total Charges.
• Optional: Modifiers, Rate, Thru Date, Non-Cov Chgs.
• Auto populated: When Recalculate is selected, it will update the totals for Total Charges and Non-Cov Chgs based upon information entered on each detail line.

MSP: Payment made

• Setup: Institutional Claims Menu, Enter Claims, Payer Info

Line item details: MSP/COB line 1

• Setup: Institutional Claims Menu, Billing Line Items, MSP/COB Line 1
• SVD = Primary Paid amount
• CAS = Difference between billed amount minus primary paid amount
• Adj/Payment Date = Date of Provider Claim Summary from Primary Insurance
• Tips: F5 function key can be used to copy from Line Item Details, but you must edit the paid amount.

Line item details: MSP/COB line 2

• Setup: Institutional Claims Menu, Billing Line Items, MSP/COB Line 2
• Required: P/S, Rev. Code, Qual/Code, Paid Amount, Paid Units, Group, Reason, Amount, Units, Adj/Payment Date
• Leave blank: All fields for lines 2 and 3 under SVD and CAS, and Remaining Owed

 

 

 

Line item details: MSP/COB line 3

• Setup: Institutional Claims Menu, Billing Line Items, MSP/COB Line 3
• Required: P/S, Rev. Code, Qual/Code, Paid Amount, Paid Units, Group, Reason, Amount, Units, Adj/Payment Date
• Leave blank: All fields for lines 2 and 3 under SVD and CAS, and Remaining Owed

Line item details: MSP/COB line 4

• Setup: Institutional Claims Menu, Billing Line Items, MSP/COB Line 4
• Required: P/S, Rev. Code, Qual/Code, Paid Amount, Paid Units, Group, Reason, Amount, Units, Adj/Payment Date
• Leave blank: All fields for lines 2 and 3 under SVD and CAS, and Remaining Owed

Ext payer insured: COB info primary

• Setup: Institutional Claims Menu, Enter Claims, Extended Payer, COB Info (Primary)
• Required: Total amount paid on the entire 
  claim
• Enter D in the COB/MIA/MOA 
  Amounts code field to indicate 
  Payer Paid Amount
• Enter Amount equal to the total 
  of all Service Line Adjudication
  (SVD) amounts