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 […]
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 […]
Enter the Delay reason code in UB04 charge entry screen column 80 “Remarks” as follows and the system will map accordingly in the EDI. DELAYCODE-<code> Valid codes are 1, 2, 3, 4, 5, 6, 7,8, 9, 10, 11, 15 Description for each delay code is available in the URL “http://www.reliablehealth.com/P3162.htm”
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) […]
From the main menu on the left, navigate to Setup and then click on ‘Insurance/Plan’. When the Insurance Search screen opens, search for the payer for which the secondary Id has to be added using any of the search filters. From the list of insurances click on the specific payer for edit. Insurance master screen […]
Transport Reason Code can be passed along with miles in the MILES field. Miles field is in the Charge master; see Image 1. Image 1 For eg: if Miles is 33 and Transport Reason Code is D, then in the miles field we have to enter 33D. System will parse this and show the Transport […]