Home   Package List   Routine Alphabetical List   Global Alphabetical List   FileMan Files List   FileMan Sub-Files List   Package Component Lists   Package-Namespace Mapping  
Info |  Details |  All
Print Page as PDF
Sub-Field: 9002274.091

Package: Third Party Billing

3P INSURER(#9002274.09)-->9002274.091

Sub-Field: 9002274.091


Information

Parent File Name Number Package
3P INSURER(#9002274.09) VISIT TYPE 9002274.091 Third Party Billing

Details

Field # Name Loc Type Details
.01 VISIT TYPE 0;1 POINTER TO 3P VISIT TYPE FILE (#9002274.8) 3P VISIT TYPE(#9002274.8)

  • INPUT TRANSFORM:  S DINUM=X
  • LAST EDITED:  MAY 29, 1991
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  9002274.091^B
    1)= S ^ABMNINS(DUZ(2),DA(1),1,"B",$E(X,1,30),DA)=""
    2)= K ^ABMNINS(DUZ(2),DA(1),1,"B",$E(X,1,30),DA)
.02 PROCEDURE CODING METHOD 0;2 SET
  • 'C' FOR CPT;
  • 'I' FOR ICD;
  • 'A' FOR ADA;

  • LAST EDITED:  SEP 06, 1994
.03 REVENUE CODE 0;3 POINTER TO REVENUE CODES FILE (#9999999.72) REVENUE CODES(#9999999.72)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),U,5)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JUL 23, 1990
  • HELP-PROMPT:  The REVENUE CODE field is applicable and mandatory when the billing is to be done in a Flat Rate (All Inclusive) manner.
  • SCREEN:  S DIC("S")="I $P(^(0),U,5)"
  • EXPLANATION:  REVENUE CODE MUST APPLY TO ALL INCLUSIVE RATE
.04 MODE OF EXPORT 0;4 POINTER TO 3P EXPORT MODE FILE (#9002274.08) 3P EXPORT MODE(#9002274.08)

  • LAST EDITED:  MAR 05, 1991
  • HELP-PROMPT:  The default MODE OF EXPORT used by the Third Party Billing System is a UB-82 for Inpatient and HCFA-1500 for all other visits. If the default is inaccurate enter the appropriate Mode of Export.
.05 FEE SCHEDULE 0;5 POINTER TO 3P FEE TABLE FILE (#9002274.01) 3P FEE TABLE(#9002274.01)

  • LAST EDITED:  JUL 23, 1990
  • HELP-PROMPT:  Leave blank unless the fee schedule to be used for this payer and visit type is different than the default fee schedule identified under Site Parameters.
  • AUDIT:  YES, ALWAYS
.06 MULTIPLE FORMS? 0;6 SET
  • 'Y' FOR YES;
  • 'N' FOR NO;

  • LAST EDITED:  AUG 20, 1996
  • HELP-PROMPT:  If the PROFESSIONAL COMPONENT is to be produced separate to the Hospital Services answer YES, otherwise answer NO.
.07 BILLABLE STATUS 0;7 SET
  • 'Y' FOR YES;
  • 'N' FOR NO;
  • 'E' FOR BILLABLE-BILLED ELSEWHERE;

  • LAST EDITED:  JUN 17, 1997
  • HELP-PROMPT:  Enter status for this visit type and payor.
.08 INSURER ASSIGNED NUMBER 0;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>13!($L(X)<3) X
  • LAST EDITED:  MAR 04, 1991
  • HELP-PROMPT:  If the Insurer has Assigned a PROVIDER NUMBER based on Visit Type then enter it, otherwise leave this field blank. Answer must be 3-13 characters in length.
.09 REVENUE DESCRIPTION 0;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>37!($L(X)<3) X
  • LAST EDITED:  MAY 29, 1991
  • HELP-PROMPT:  The REVENUE DESCRIPTION which is displayed in Block 43 of the UB-92 corresponds to either that specified in this field or to the selected Revenue Code description. Answer can't exceed 37 characters.
.11 UB92 BILL TYPE 0;11 POINTER TO 3P CODES FILE (#9002274.03) 3P CODES(#9002274.03)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),U,2)=""B""" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  FEB 24, 1997
  • SCREEN:  S DIC("S")="I $P(^(0),U,2)=""B"""
  • EXPLANATION:  Allows for Bill Type Codes only.
.12 ITEMIZED UB-92? 0;12 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  APR 06, 1994
.125 PRINT MEDS ON TWO LINES? 0;26 SET
  • 'Y' FOR YES;
  • 'N' FOR NO;

  • LAST EDITED:  OCT 04, 2010
.13 AUTO APPROVE? 0;13 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  AUG 03, 1994
.14 START BILLING DATE 0;14 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  FEB 21, 1997
.15 HCFA FIELD 24K 0;15 SET
  • 'RX' FOR RX NUMBER;
  • 'MD' FOR MD PROVIDER NUMBER;

  • LAST EDITED:  JAN 22, 1998
.16 CPT CODE 0;16 POINTER TO CPT FILE (#81) CPT(#81)

  • LAST EDITED:  OCT 09, 1997
.17 BLOCK 29 0;17 SET
  • 'DO' FOR PRINT;
  • 'DONT' FOR DO NOT PRINT;

  • LAST EDITED:  JUL 25, 2006
.18 UB RELATIONSHIP CODE 0;18 SET
  • 'U' FOR UB92 CODES;

  • LAST EDITED:  APR 26, 2007
.19 EMC SUBMITTER ID 0;19 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  JUL 15, 2010
  • HELP-PROMPT:  1-15 characters. Will populated ISA06 of 837 followed by EMC SUBMITTER ID at top-level and then Federal Tax NO of Location
  • DESCRIPTION:  
    1-15 characters.  Will populate ISA06 of 837.  If not populated the EMC SUBMITTER ID at the Insurer top-level will be used, followed by the Location Federal Tax no.
.2 BLOCK 33 PIN# 0;20 SET
  • 'LOC' FOR LOCATION CODE;
  • 'PRO' FOR PROVIDER CODE;

  • LAST EDITED:  JUN 29, 2001
.21 SEND PARAMETER 0;21 POINTER ** TO AN UNDEFINED FILE **

  • LAST EDITED:  SEP 25, 2002
.22 STOP BILLING DATE 0;22 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  APR 06, 2005
.23 AUTO-SPLIT THIS ENTRY 0;23 SET
  • 'Y' FOR YES;
  • 'N' FOR NO;

  • LAST EDITED:  AUG 15, 2005
.24 RX IN FL44? 0;24 SET
  • 'Y' FOR YES;
  • 'N' FOR NO;

  • LAST EDITED:  MAY 01, 2006
.25 REPORTING PURPOSES ONLY 0;25 SET
  • 'Y' FOR YES;

  • LAST EDITED:  JUL 16, 2010
  • HELP-PROMPT:  Answer YES when reporting capitated encounters. This populates BHT06 with "RP"
5 HISTORY OF FEE SCHEDULES 5;0 POINTER Multiple #9002274.915 9002274.915

  • LAST EDITED:  MAR 24, 2010
11 START DATE 11;0 DATE Multiple #9002274.09111 9002274.09111
12 REPLACE INSURER EFFECTIVE DATE 12;0 DATE Multiple #9002274.09112 9002274.09112

  • LAST EDITED:  JUN 08, 2005
  • IDENTIFIED BY:  END DATE(#.02), REPLACEMENT INSURER(#.03), REPLACEMENT VISIT TYPE(#.04)
18 SUBPART NPI 1;8 POINTER TO INSTITUTION FILE (#4) INSTITUTION(#4)

  • LAST EDITED:  APR 04, 2007
101 EMC REFERENCE ID 1;1 POINTER TO 3P EMC REFERENCE ID FILE (#9002274.11) 3P EMC REFERENCE ID(#9002274.11)

  • LAST EDITED:  AUG 04, 2005
102 X12 TRADING PARTNER NAME 1;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<3) X
  • LAST EDITED:  MAR 10, 2006
  • HELP-PROMPT:  Answer must be 3-35 characters in length.
103 DME GROUP NUMBER/NAME 1;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>29!($L(X)<3) X
  • LAST EDITED:  JUL 27, 2006
  • HELP-PROMPT:  Answer must be 3-29 characters in length.
104 DME CONTRACTOR 1;4 SET

  • LAST EDITED:  JUL 27, 2006
105 CLIA# REQ'D FOR ALL VISITS? 1;5 SET

  • LAST EDITED:  JUL 27, 2006
106 WHICH CLIA SHOULD PRINT? 1;6 SET

  • LAST EDITED:  SEP 12, 2006
107 DASH IN BLOCK 1A? 1;7 SET

  • LAST EDITED:  SEP 12, 2006
109 ICD PX ON CLAIM 1;9 SET

  • LAST EDITED:  AUG 26, 2008
  • HELP-PROMPT:  Answer YES to include ICD Pxs on Claim. Blank is the same as YES
111 CONTRACT CODE TYPE 1;11 SET

  • LAST EDITED:  SEP 04, 2008
112 CONTRACT CODE 1;12 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  SEP 04, 2008
  • HELP-PROMPT:  Answer must be 3-30 characters in length
113 CONTRACT CODE REQ'D 1;13 SET

  • LAST EDITED:  NOV 25, 2008
114 ADD ZERO FEES 1;14 SET

  • LAST EDITED:  MAY 18, 2009
  • HELP-PROMPT:  Answering YES will make codes with zero fees come across from PCC and display in claim editor
115 UB-04 FORM LOCATOR 38 1;15 SET

  • LAST EDITED:  FEB 01, 2010
116 4 OR 8 DXS ON 1500 1;16 SET

  • LAST EDITED:  SEP 20, 2011
117 INCLUDE SERVICE FACILITY LOC 1;17 SET

  • LAST EDITED:  MAR 16, 2012
  • DESCRIPTION:  According to the 837 Implementation Guide, required when the location of health care service is different than that carried in Loop ID-2010AA (Billing Provider).
    For the 5010 837P and 837D it is loop 2310C.  For the 5010 837I it is loop 2310E.





118
CONT OR TOTAL EACH 1500 PAGE
1;18
SET

  • LAST EDITED:  MAR 27, 2014
  • HELP-PROMPT:  For multi-page claims, if a 'C' is entered, FL28 on the 1500(08/05) or the 1500(02/12) will total on the last page with CONT on all other pages.  Blank will total each page (default).





119
PHYS. OR MAIL. ADDR ON ADA
1;19
SET

  • LAST EDITED:  NOV 13, 2012
  • HELP-PROMPT:  This determines what address will print in box 48 on the ADA-2006 form.





120
UB FORM LOCATOR 44 BLANK?
1;20
SET

  • LAST EDITED:  NOV 30, 2012





121
PRINT MED NAME ON PAPER CLAIM
1;21
SET

  • LAST EDITED:  MAY 19, 2017
  • HELP-PROMPT:  If not answered will default to NAM for medication name to print





122
DECIMAL IN ADA-2012 AMTS
1;22
SET

  • LAST EDITED:  MAY 22, 2017





123
BILLING PROVIDER TAXONOMY
1;23
SET

  • LAST EDITED:  JUN 25, 2018
  • HELP-PROMPT:  Selecting either entry will populate the 2000A PRV segment of the 837.  Selecting 3T will also print the location taxonomy indicator in box 81CC of the UB-04.





124
DISPLAY PRINT ORDER PAGE
1;24
SET

  • LAST EDITED:  SEP 25, 2017
  • HELP-PROMPT:  Answering YES will make another page show up in the claim editor, allowing the user to select a print order for line items







    



Info | 
Details | 
All