Category: FAQs- EDI

1. How to send Delay reason codes in Institutional Claims Enter the Delay reason code in UB04 screen Box No.: 80 ‘Remarks’ as follows: DELAYCODE-<CODE>(Note: There is a dash(-) after the text.) eg: DELAYCODE-15 Valid codes are 1, 2, 3, 4, 5, 6, 7,8, 9, 10, 11, 15 Description for each delay code is available […]

How to Setup Mammography Certification# For Use in Claims Mammography Certification# for practices is set up from the legal entity setup page, as in Image 1. Once mammography certification# is set up for your LE, all procedure codes related to mammography can have this certification# defaulted to the claims they are part of. This is […]

To populate line level REF IDs in electronic claims, enter the ID in Line Notes in the given format Format REF:<Qualifier>:<ID>  Permitted Qualifiers  ‘9B’,’9D’,’G1′,’2U’,’6R’,’EW’,’X4′,’F4′,’BT’. For eg. in order to populate Additional/Referring CLIA# on electronic claim should enter the ID in format REF:F4:<CLIA#> to the Line Note. Table describes the qualifiers used. Qualifier Description 9B REPRICED LINE […]

1. What is EDI? EDI stands for Electronic Data Interchange. It is the electronic exchange of data such as Claims, Electronic Remittance Advices and subscriber Eligibility transactions. In healthcare billing, Electronic Data Interchange (EDI) simplifies the process of sending information between the provider and insurance payer. 2. Why is EDI enrollment required? This is the […]

Demonstration Project Identifier field is used for sending National Clinical Trial(NCT) Numbers. How to populate “DEMONSTRATION PROJECT IDENTIFIER” on EDI claim under 2300>Ref segment with qualifier ‘P4’ In claim note put P4 hyphen followed by demonstration project identifier. eg. P4-747473D

How to populate DRG code in HL segment on UB04 EDI Claims Select the required claim and add DRG code in box 70(a) and the text “DRG” in box 80.  

Hospice Employee Indicator is required on Medicare Hospice claims. Segment CRC (Hospice Employee Indicator) is required on all Medicare claims involving physician services to Hospice patients. Hospice Employee Indicator is expected in Loop 2400>CRC with indicator 70. Missing indicator may result in claim rejection. How To Add  Hospice Employee Indicator Putting ‘CRC:70’ at line note […]

Method 1: This sets the POA field of a single claim. User can enter a text POA in the Remarks field of UB04 Charge Entry that will populate the POA. Method 2: This updates the POA field of all claim sent to a specific payer or for all payers. EDI has a rule that will […]

1. Go to Service Location Set up page( Under Advanced Setup).  2. Set the “Secondary ID” field in the following format X4-<clianumber> eg. X4-1234567.  

To send Patient SSN in the Claim: 1)  Go to Charge Master (Edit Charges screen) and navigate to the Encounter section. 2)  Move to Details tab and then click on the Others tab inside it. 3)  In the Claim Note/Special Instruction field, enter the SSN in the below given format. “SSN-<<ssn number>>” eg:  SSN-123456789 4)  […]