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Direct Data Entry 1

Direct Data Entry 1. Eligibility and Inquiries. July 10, 2012. Disclaimer. This resource is not a legal document. This presentation was prepared as a tool to assist our providers. This presentation was current at the time it was created.

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Direct Data Entry 1

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  1. Direct Data Entry 1 Eligibility and Inquiries July 10, 2012

  2. Disclaimer This resource is not a legal document. This presentation was prepared as a tool to assist our providers. This presentation was current at the time it was created. Although every reasonable effort has been made to assure accurate information, responsibility for correct claims submission lies with the provider of services. Reproduction of this material for profit is prohibited.

  3. Access to DDE • Cahaba GBA EDI Services department • 866-582-3253 • Fax: 205-402-5706 • Email at PartAEDIServices@cahabagba.com • Download and print “Electronic Billing with Cahaba GBA” • www.cahabagba.com/documents/2012/02/part-a-guidetobilling.pdf

  4. Self Service Tools FISS Reference Guide • Published by Cahaba GBA www.cahabagba.com/part-a/education/educational-materials/ Cahaba Online courses • Verifying Beneficiary Eligibility • Checking Claim Status www.cahabagba.com/part-a/education/cahaba-u-18358/

  5. Eligibility Systems • Two eligibility systems • ELGA • ELGH • Accessible through FISS connection • Availability • Monday – Friday • 6:00 a.m. – 7:00 p.m. (CT) • Saturday • 7:00 a.m. – 3:00 p.m. (CT)

  6. Eligibility Systems Means to access beneficiaries’ eligibility data from Common Working File (CWF) • Medicare entitlement (Part A & Part B) • Home health episodes • Hospice elections • Hospital/SNF benefit periods • Medicare Advantage (HMO) plan enrollment • Preventive benefits data • Smoking Cessation • Rehabilitation Sessions • HH Certification Plan of Care • Telehealth services • Behavioral services • Medicare Secondary Payer (MSP) records

  7. Eligibility Screens • Access prior to admission and each billing transaction • Determines • Eligibility for benefits • Potential conflicts with payments • Reduces claim errors • Helps ensure payment

  8. Eligibility Screens • ELGA designed for Hospitals & Skilled Nursing Facilities • Hospital days/SNF days • Screening • Detailed MSP information • ELGH designed for Home Health Agencies and Hospice • Provider number of HHA and hospice • Patient status code for home health • Home health cancel indicator

  9. ELGA ELGA CWF PART A ELIGIBILITY SYSTEM ELGASAT1 07/10/2012 12:30:07 INQUIRY BY PROVIDERS ENTER THE FOLLOWING FIELDS: HIC NUMBER : 111222333B SURNAME : PATIEN INITIAL : A DATE OF BIRTH : 12251930 (MMDDCCYY) SEX CODE : F REQUESTOR ID : KEM INTER NO : 10101,10201,10301 NPI INDICATOR : N-NPI or Blank PROVIDER NO : XXXXXX HOST-ID : GL, GW,KS,MA,PA,NE,SE,SO,SW APP DATE : (MMDDCCYY) REASON CODE : 1 RESPONSE CODE : P

  10. Beneficiary Information ELGA CWF PART A ELIGIBILITY SYSTEM ELGACRO 07/10/2012 11:33:54 BENEFICIARY INFORMATION PAGE 01 OF 13 IP-REC CN 111222333B NM PATIEN IT A DB 12251930 SX F INT 10101 PN XXXXXX APP REAS 1 REQ YMM DISP-CODE 05 MSG APPLICABLE SERVICE DATE > DOD CORRECT CN NM IT DB SX A-ENT 12011995 A-TRM B-ENT 12011995 B-TRM DOD LRSV 60 LPSY DAYS LEFT FULL-HOSP CO-HOSP FULL-SNF CO-SNF IP-DED DOEBA DOLBA CURRENT 60 30 20 80 11000 09012010 09042010 PHYS THER OCC THER PARTB YR DED-TBM PSYC TBM TBM 20100101 0 186000 186000 FULL-NAME PATIENT.JOSEPHINE.J PLAN-TYPE HMO CURR-ID H1234 OPT C ENR 01012005 TERM 01012006 ESRD: CODE-1 EFF DATE CODE-2 EFF DATE

  11. Hospice Information ELGA CWF PART A ELIGIBILITY SYSTEM ELGACRO 07/10/2012 11:33:54 HOSPICE INFORMATION PAGE 02 OF 13 IP-REC CN 111222333B NM PATIEN IT J DB 12251930 SX F INT 10101 PAP: PAP DATE: IMMUNO/TRANS: TRANS IND: DISCHARGE DATE: HOSPICE PERIOD 002 PERIOD 001 PERIOD PERIOD START DATE 06012007 02012006 TERM DATE 09012007 05012006 REVOC IND 1

  12. Home Health Episodes ELGA CWF PART A ELIGIBILITY SYSTEM ELGACRO 07/10/2012 11:33:54 HOME HEALTH BENEFIT EPISODES PAGE 03 OF 13 IP-REC CN 111222333B NM PATIEN IT J DB 12251930 SX F INT 10101 EARLIEST LATEST PART A VISISTS PART B VISITS BILLING DATE BILLING DATE REMAINING APPLIED

  13. Home Health PPS Episodes ELGA CWF PART A ELIGIBILITY SYSTEM ELGACRO 07/10/2012 11:33:54 HOME HEALTH PPS EPISODES PAGE 04 OF 13 IP-REC CN 111222333B NM PATIEN IT J DB 12251930 SX F INT 10101 EPISODE EPISODE DOEBA DOLBA START END 11172006 01152007 11172006 11272006 07182006 09152006 07182006 09072006 DOEBA = date of first home health visit in episode DOLBA = date of last home health visit in episode

  14. Screening Information ELGA CWF PART A ELIGIBILITY SYSTEM ELGACRO 07/10/2012 11:33:54 SCREENING INFORMATION PAGE 05 OF 13 IP-REC CN 111222333A NM PATIEN IT J DB 12251930 SX F INT 10101 HCPCS TECH/ CODE PROF RECENT DATES OF SERVICE G0107 26 08282002 G0202 07192007 76092 11122002 PF1=INQ SCREEN PF3/CLEAR=END PF7=PREV PF8=NEXT

  15. Preventive Services ELGA CWF PART A ELIGIBILITY SYSTEM ELGACRO 07/10/2012 11:35:22 NEXT ELIGIBLE DATE PAGE 06 OF 13 IP-REC CN 111222333B NM PATIEN IT J DB 12251930 SX F INT 10101 PREVENTIVE SERVICE TECH DTE PROF DTE | PREVENTIVE SERVICE TECH DTE PROF DTE MMDDCCYY MMDDCCYY | MMDDCCYY MMDDCCYY CARDIOVASC (80061) 01012005 01012005 | PCB EXAM (G0101) 07012001 07012001 CARDIOVASC (82465) 01012005 01012005 | PP VACCINE (90732) VACCINTD VACCINTD CARDIOVASC (82718) 01012005 01012005 | PROSTATE (G0102) GDRNOELG GDRNOELG CARDIOVASC (84478) 01012005 01012005 | PROSTATE (G0103) GDRNOELG GDRNOELG COLORECTAL (G0104) 01011998 01011998 | PAP TEST (Q0091) 07012005 07012005 COLORECTAL (G0105) 01011998 01011998 | DIABETES (82947) 01012005 01012005 COLORECTAL (G0106) 01011998 01011998 | DIABETES (82950) 01012005 01012005 COLORECTAL (G0120) 01011998 01011998 | DIABETES (82951) 01012005 01012005 COLORECTAL (G0121) 07012001 07012001 | GLAU (G0117,G0118) 01012002 01012002 FOB TEST (G0107) 01011998 08012003 | MAMM (G0202,G0203) 07012008 07012008 FOB TEST (G0328) 01012004 08012003 | MAMM (76092) HCPCTERM HCPCTERM FOB TEST (82270) 01012007 01012007 | MAMM (77057) 07012008 07012008 IPP EXAM (G0344) SRVNOELG SRVNOELG | PAPT (P3000,G0123, 07012001 07012001 IPP EXAM (G0366) SRVNOELG SRVNOELG | G0143,G0144, IPP EXAM (G0367) SRVNOELG 00000000 | G0145,G0147, IPP EXAM (G0368) 00000000 SRVNOELG | G0148)

  16. CMS FAQs • March 28, 2012 Medicare Preventive Services National Provider Call on the Initial Preventive Physical Exam and Annual Wellness Visit • Frequently Asked Questions • www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/IPPE-AWV-FAQs.pdf • For access to all of the related call materials, go to • www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events-Items/CMS1256439.html

  17. Preventive Services ELGA CWF PART A ELIGIBILITY SYSTEM ELGACRO 07/10/2012 11:35:22 NEXT ELIGIBLE DATE PAGE 07 OF 13 IP-REC CN 111222333B NM PATIEN IT J DB 12251930 SX F INT 10101 PREVENTIVE SERVICE TECH DTE PROF DTE PREVENTIVE SERVICE TECH DTE PROF MMDDCCYY MMDDCCYYMMDDCCYYMMDDCCYY AAA (G0389) 07012007 07012007 IPP EXAM (G0402) SRVNOELG SRVNOELG

  18. Smoking Cessation ELGA CWF PART A ELIGIBILITY SYSTEM ELGACRO 07/10/2012 11:40:16 SMOKING CESSATION PAGE 08 OF 13 IP-REC CN 111222333B NM PATIEN IT J DB 12251930 SX F INT 10101 COUNSELING PERIOD: 1 2 3 4 5 TOTAL SESSIONS: HCPCS FROM THRU PER QT TP HCPCS FROM THRU PER QT TP NO SMOKING CESSATION DATA TO DISPLAY

  19. Rehabilitation Sessions ELGA CWF PART A ELIGIBILITY SYSTEM ELGACRO 07/10/2012 11:40:16 REHABALITATION SESSIONS PAGE 09 OF 13 IP-REC CN 111222333B NM PATIEN IT A DB 12251930 SX F INT 10101 PULMONARY REMAINING: 72 CARDIAC APPLIED: 0 ICR APPLIED: 0 (HCPCS: G0422, G0423) PF1=INQ SCREEN PF3/CLEAR=END PF7=PREV PF8=NEXT

  20. HH Certification Plan of Care ELGA CWF PART A ELIGIBILITY SYSTEM ELGACRO 07/10/2012 11:40:16 HH CERTIFICATION PLAN OF CARE PAGE 10 OF 13 IP-REC CN 111222333B NM PATIEN IT A DB 12251930 SX F INT 10101 REC HCPCS FROM DT REC HCPCS FROM DT NO HH CERTIFICATION PLAN OF CARE DATA PF1=INQ SCREEN PF3/CLEAR=END PF7=PREV PF8=NEXT

  21. Telehealth Services ELGA CWF PART A ELIGIBILITY SYSTEM ELGACRO 07/10/2012 11:40:16 TELEHEALTH SERVICE NEXT ELIG DATE PAGE 11 OF 13 IP-REC CN 111222333B NM PATIEN IT A DB 12251930 SX F INT 10101 TELEHEALTH SERVICES:HOSPITAL CARE | TELEHEALTH SERVICES:NURSING CARE | HCPCS:99231, 99232, 99233 | HCPCS:99307, 99308, 99309, 99310 | NEXT ELIGIBLE DATE: 07/01/2012 | NEXT ELIGIBLE DATE: 07/01/2012 | RULE: ALLOW HCPCS 99231, 99232 | RULE: ALLOW HCPCS 99307, 99308, 99233 WITH MODIFIER GQ OR GT | 99309, 99310 WITH MODIFIER GQ OR EVERY 4TH DAY GT EVERY 31ST DAY

  22. Behavioral Services ELGA CWF PART A ELIGIBILITY SYSTEM ELGACRO 07/10/2012 11:40:16 BEHAVIORAL SERVICES PAGE 12 OF 13 IP-REC CN 111222333B NM PATIEN IT A DB 12251930 SX F INT 10101 ALCOHOL ABUSE: (G0442) NEXT ELIG TECH: 10/14/2011 NEXT ELIG PROF: 10/14/2011 ADULT DEPRESSION: (G0444) NEXT ELIG TECH: 10/14/2011 NEXT ELIG PROF: 10/14/2011 IBT FOR CVD: (G0446) NEXT ELIG TECH: 11/08/2011 NEXT ELIG PROF: 11/08/2011 REM OBESITY: (G0447) NEXT ELIG TECH: 11/29/2011 22 NEXT ELIG PROF: 11/29/2011 22

  23. Medicare Secondary Payer ELGA CWF PART A ELIGIBILITY SYSTEM ELGACRO 07/10/2012 11:40:16 MSP INFORMATION PAGE 13 OF 13 IP-REC CN 111222333B NM PATIEN IT A DB 12251930 SX F INT 10101 MSP CODE: 15 EFF DATE: 03012001 TERM DATE: INSURER INFORMATION: NAME : Daisy Duck INS CO ADDRESS1 : 421 COVERAGE DRIVE ADDRESS2 : CITY : BIRMINGHAM STATE : AL ZIP : 50000 POLICY NO : 99988877766 PF1=INQ SCREEN PF3/CLEAR=END PF7=PREV PF8=NEXT

  24. IVR • IVR = Interactive Voice Response • Self service tool used to obtain eligibility information and claim status • Available 24 hours a day/ 7 days a week • Customer Service Representatives available from 8:00 a.m. – 4:00 p.m. in your time zone

  25. IVR Information • System down messages on the IVR • HMO coverage information • Hospice coverage information • Check information

  26. Let’s Inquire MAP1701 CAHABA GBA - Test MAIN MENU FOR REGION ACMFA501 01 INQUIRIES 02 CLAIMS/ATTACHMENTS 03 CLAIMS CORRECTION 04 ONLINE REPORTS VIEW ENTER MENU SELECTION: 01 PLEASE ENTER DATA - OR PRESS PF3 TO EXIT

  27. Option 01- Inquiry Menu MAP1702 CAHABA GBA - TEST INQUIRY MENU BENEFICIARY/CWF 10 HCPC CODES 14 DRG (PRICER/GROUPER) 11 DX/PROC CODES 15 CLAIMS 12 ADJUSTMENT REASON CODES 16 REVENUE CODES 13 REASON CODES 17 CLAIM COUNT SUMMARY 56 ANSI REASON CODES 68 CHECK HISTORY FI ZIP CODE FILE 19 ENTER MENU SELECTION: PLEASE ENTER DATA - OR PRESS PF3 TO EXIT

  28. Option 11 - DRG MAP1781 M E D I C A R E A O N L I N E S Y S T E M SC DRG/PPS INQUIRY DIAG CD: 78609 Y 30000 Y 3310 Y 29410 Y 78601 Y V12003 Y V1005 Y 1046 Y END OF POA IND Z PROC CD: 9904 NPI SEX M C-I 9 DISCHARGE STATUS 01 DT 010108 PROV XXXXXX REVIEW CODE TOTAL CHARGES DOB 11101914 OR AGE APPROVED LOS COV DAYS LTR DAYS PAT LIAB RETURNED FROM GROUPER: D.R.G. MAJOR DIAG CAT RTN CD PROC CD USED DIAG CD USED SEC DIAG USED GROUPER VER RETURNED FROM PRICER: RTN CD WAGE INDEX OUTLIER DAYS AVG# LENGTH OF STAY OUTLIER DAYS THRESHOLD OUTLIER COST THRESHOLD INDIRECT TEACHING ADJ# TOTAL BLENDED PAYMENT HOSPITAL SPECIFIC PORTION FEDERAL SPECIFIC PORTION DISP# SHARE HOSPITAL AMT PASS THRU PER DISCHARGE OUTLIER PORTION PTPD + TEP STANDARD DAYS USED LTR DAYS USED PROV REIMB PRICER VER PLEASE ENTER DATA - PF3 TO EXIT - PF8 FOR COST DISCLOSURE

  29. Option 12 - Claims MAP1741 MEDICARE A ONLINE SYSTEM SC CLAIM SUMMARY INQUIRY NPI 1234567890 HIC 111222333A PROVIDER XXXXXX S/LOC PB9997 TOB OPERATOR ID FROM DATE TO DATE DDE SORT MEDICAL REVIEW SELECT HIC PROV/MRN S/LOC TOB ADM DT FRM DT THRU DT REC DT SEL LAST NAME FIRST INIT TOT CHG PROV REIMB PD DT CAN DT REAS NPC #DAYS 111222333A XXXXXX P B9997 131 080808 080808 091008 Patient A 200.00 109.41 093008 37192 111222333A XXXXXX P B9997 131 080808 080808 091008 Patient A 1500.00 109.41 092308 37192 111222333A XXXXXX P B9997 131 080808 080808 091008 Patient A 160.00 109.41 093008 37192 PROCESS COMPLETED --- PLEASE CONTINUE PRESS PF3-EXIT PF5-SCROLL BKWD PF6-SCROLL FWD

  30. Option 12 - ADRs MAP1741 M E D I C A R E A O N L I N E S Y S T E M SC CLAIM SUMMARY INQUIRY NPI 9876543210 HIC PROVIDER XXXXXX S/LOC SB6001 TOB OPERATOR ID XXXXXX FROM DATE TO DATE DDE SORT MEDICAL REVIEW SELECT HIC PROV/MRN S/LOC TOB ADM DT FRM DT THRU DT REC DT SEL LAST NAME FIRST INIT TOT CHG PROV REIMB PD DT CAN DT REAS NPC #DAYS S 111222333A XXXXXX S B6001 131 081208 081208 081808 PATIENT A 570.00 39700 Enter ‘S B6001’ in S/LOC field, press ENTER • Select each claim to view due date and information requested

  31. Option 12 - ADRs REPORT: 001 MEDICARE PART A 00010 PVDR NO : XXXXXX DATE : 07/10/2012 ADDITIONAL DEVELOPMENT REQUEST BILL TYPE: 131 ABC Hospital 300 W BROADWAY Anywhere AL 35242 WE HAVE REVIEWED THIS CLAIM RECORDS AND FOUND THAT ADDITIONAL DEVELOPMENT WILL BE NECESSARY BEFORE PROCESSING CAN BE FINALIZED. TO ASSIST YOU IN PROVIDING THE REQUIRED INFORMATION, WE HAVE ASSIGNED REASON CODES TO THE AFFECTED CLAIM RECORD (SEE BELOW) FOR YOUR REVIEW. PLEASE REFER TO THE ACCOMPANYING LIST FOR EXPLANATION OF THE ASSIGNED CODES. WE MUST RECEIVE THE REQUESTED INFORMATION BEFORE THE DUE DATE LISTED BELOW,OR THE CLAIM WILL BE DENIED LACK OF RESPONSE. SEND YOUR RESPONSE TO THE ATTENTION OF: CAHABA GBA, Alabama P.O. Box 830139 Birmingham AL 35242 PATIENT CNTRL NBR: DUE DATE: 03/10/2011 MEDICAL REC NO: DCN: 2050660615XXXX HIC: 111222333A PATIENT NAME: Patient A FROM DATE: 12/12/2010 THRU DATE: 12/12/2010 OPR/MED ANALYST: TOTAL CHARGES:$570.00 ORIG REQ DT: 01/26/2011 CLM RCPT DT: 12/18/2010 Due date found on FISS Page 07

  32. Option 12 - ADRs REASONS: 5119K REASON CODE NARRATIVES FOR HIC/DCN: 111222333A 2050660615XXXX MEDICARE NEEDS TO RECEIVE THE RETURNED ADR INFORMATION BY THE 30TH DAY. THIS ALLOWS FOR MAIL TIME AND FOR US TO MOVE THE CLAIM INTO THE MEDICAL REVIEW STATUS/LOCATION SM5013 BY DAY 45 OR IT WILL BE DENIED WITH REASON CODE 56900 ON THE 46TH DAY. TO ENABLE US TO MEDICALLY REVIEW THIS CASE, PLEASE SUBMIT THE INFORMATION REQUESTED BELOW REGARDING THIS CLAIM: *UB92 *ITEMIZED BILL *PHYSICIAN ORDERS *LAB RESULTS *TREATMENT NOTES *ANY ADDITIONAL DOCUMENTATION TO SUPPORT THE SERVICES BILLED Information requested found on FISS page 08

  33. Additional Development Request • Direct Data Entry (DDE) users • Obtain ADR letters electronically • Advantages to receiving ADRs • Improves timeliness • Cost effective • Quicker response • Cahaba strives to align its goals with CMS and become paperless

  34. Option 13 – Revenue Codes MAP1761 M E D I C A R E A O N L I N E S Y S T E M SC REVENUE CODE TABLE INQUIRY REV CD 0420 EFF DT 070166 IND F TERM DT NARR PHYSICAL THERAPY GENERAL CLASSIFICATION - PHYSICAL THERP ALLOW: HCPC: UNITS: RATE: TOB EFF-DT TRM-DT EFF-DT TRM-DT EFF-DT TRM-DT EFF-DT TRM-DT --- -------------- -------------- ------------- -------------- 11X Y 070166 V N N 12X Y 070166 Y 010199 Y 070198 N 13X Y 070166 Y 010199 Y 070166 N 14X N V N N 18X Y 070166 V N N 21X Y 070166 V N N 22X Y 070166 Y 010199 Y 070198 N 23X Y 070166 Y 010199 Y 070166 N 32X Y 070166 Y 100199 Y 070166 N PROCESS COMPLETED --- PLEASE CONTINUE PRESS PF3-EXIT PF6-SCROLL FWD

  35. Option 56- Claim Count Summary MAP1371 M E D I C A R E A O N L I N E S Y S T E M SC CLAIM SUMMARY TOTALS INQUIRY PROVIDER XXXXXX S/LOC CAT NPI S/LOC CAT CLAIM COUNT TOTAL CHARGES TOTAL PAYMENT GT 70 58,486.16 5,752.37 P B9996 TC 2 4,745.00 5,752.37 P B9996 32 2 4,745.00 5,752.37 S B0100 TC 2 2,475.00 00.00 S B0100 32 2 2,475.00 00.00 S B90M2 TC 1 00.00 00.00 S B90M2 33 1 00.00 00.00 S B9099 TC 12 12,042.64 00.00 S B9099 32 8 3,708.66 00.00 S B9099 33 4 8,333.98 00.00 S M50MR TC 3 3,155.00 00.00 S M50MR 32 3 3,155.00 00.00 T B9997 NM 50 38,543.52 00.00 T B9997 TC 50 38,543.52 00.00 T B9997 32 49 36,573.52 00.00 T B9997 33 1 1,970.00 00.00 PROCESS COMPLETED --- PLEASE CONTINUE

  36. Option FI – Check History MAP1B01 M E D I C A R E A O N L I N E S Y S T E M SC CHECK HISTORY PROV XXXXXXNPI XXXXXXXXXX CHECK # DATE AMOUNT EFT2222222 080716 $3,585.36 EFT3333333 080711 $2,235.24 EFT4444444 080710 $4,512.39 PROCESS COMPLETED --- PLEASE CONTINUE PLEASE ENTER DATA - OR PRESS PF3 TO EXIT

  37. Option 14 – HCPCS Codes MAP1771 M E D I C A R E A O N L I N E S Y S T E M PAGE: 01 SC HCPC INFORMATION INQUIRY CARRIER 00826 LOC 00 HCPC 99212 MOD IND EFF DT 010192 TRM DT PROVIDER DRUG CODE E O F O C ANES EFF. TRM. F V E P A PC BASE DATE DATE F R E H T TC VAL ALLOWABLE REVENUE CODES 010106 F 0 0 010192 F 0 HCPC DESCRIPTION OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST TWO OF THESE THREE KEY COMPONENT A PROBLEM FOCUSED HISTORY; A PROBLEM FOCUSED EXAMINATION; STRAIGHTFORWARD PROCESS COMPLETED --- PLEASE CONTINUE PRESS PF3-EXIT PF5-UP PF6-DOWN PF11-RIGHT

  38. Option 15 – Dx/Proc Codes MAP1731 M E D I C A R E A O N L I N E S Y S T E M SC ICD-9-CM CODE INQUIRY STARTING ICD9 CODE: 250 ICD9 CODE DESCRIPTION: EFFECTIVE/TERM DATE EFFECTIVE/TERM DATE EFFECTIVE/TERM DATE 25000 DIABETES UNCOMPL ADULT 100185 25000 DIABETES UNCOMPL TYPE II 100190 25000 DMII WO CMP NT ST UNCNTR 100193 25001 DIABETES UNCOMPL JUVEN 100185 25001 DIABETES UNCOMPL TYPE I 100190 25001 DMI WO CMP NT ST UNCNTRL 100193 25002 DMII WO CMP UNCNTRLD 100193 25003 DMI WO CMP UNCNTRLD 100193

  39. Option 16 – Adjustment Reason Codes MAP1821 M E D I C A R E A O N L I N E S Y S T E M OP: XXXXXX SC ADJUSTMENT REASON CODES INQUIRY DT: 122210 SELECTION SCREEN CLAIM TYPES: I =INPATIENT/SNF,O = OUTPATIENT, H = HOME HEALTH/CORF, A = ALL CLAIMS PLAN CODE: 1 REASON CODE: S PC RC TYPE NARRATIVE S 1 AA A AUTOMATED ADJUSTMENT-SYSTEM GENERATED 1 AC A AUDIT COMPLIANCE 1 AD I ADMISSION DENIAL - TECHNICAL DENIAL (PRO REVIEW CODE - A) 1 AH A ADJUSTMENTS TO DO FULL DENIAL ON PREVIOUSLY PAID CLAIM. 1 AJ A HEARING REOPEN 1 AM I ADMISSION DENIAL-NO PAYMENT (MEDICAL DENIAL)PRO REVIEW 1 AP A HEARING PARTIAL 1 AR I ADMISSION REVERSAL -(HARDCOPY ADJUSTMENT) 1 AU A AUTOMOBILE - MSP VALUE CODE 14/PRIMARY PAYER CODE - D 1 AW I ADMISSION DENIAL-PAYABLE PER WAIVER 1 BC A CWF CORRUPTED BENE. CORRECTION 1 BL A BLACK LUNG - MSP VALUE CODE 41/PRIMARY PAYER CODE - H 1 BP A PART B REVIEW PARTIAL 1 BR A PART B REVIEW REOPEN 1 CA I COST OUTLIER APPROVED

  40. Option 16 – Adjustment Reason Codes MAP1822 M E D I C A R E A O N L I N E S Y S T E M OP: MASTER SC ADJUSTMENT REASON CODE UPDATE SCREEN INQUIRY DT: 122210 CLAIM TYPES : I = INPATIENT/SNF, O = OUTPATIENT, H = HOME HEALTH/CORF, A = ALL CLAIMS PLAN CODE: REASON CODE : AA CLAIM TYPE : A NARRATIVE AUTOMATED ADJUSTMENT PRESS PF3-EXIT PF7-PREV PAGE

  41. Option 17 – Reason Codes MAP1881 M E D I C A R E A O N L I N E S Y S T E M OP: CMCAL12 SC REASON CODES INQUIRY DT: 071012 PLAN REAS NARR EFF MSN EFF TERM EMC HC/PRO PP CC IND CODE TYPE DATE EAS DATE DATE ST/LOC ST/LOC LOC IND 1 32103 E 100106 T M15PV T M15PV TPTP A B NPCD A B HD CPY A B NB ADR CAL DY C/L C -------------------------NARRATIVE------------------------------------- THE NPI NUMBER ON THE CLAIM IS NOT PRESENT IN THE CROSSWALK ********** THIS EDIT APPLIES TO THE NPI NUMBER ASSOCIATED WITH THE OSCAR NUMBER ************************************************************************VERIFY THAT THE CORRECT NPI WAS SUBMITTED. IF CORRECT, YOU WILL NEED TO VERIFY THAT YOUR LEGACY IDENTIFIER (OSCAR/PIN) NUMBER CORRESPONDS WITH THE NPI ON FILE WITH NATIONAL PLAN AND PROVIDER ENUMERATION SYSTEM (NPPES). NPPES MAY BE CONTACTED ONLINE AT HTTPS://NPPES.CMS.GOV ************************************************************************IF NPPPES INFORMATION IS CORRECT AND YOU HAVE INCLUDED ALL MEDICARE LEGACY IDENTIFIERS (OSCAR) AND COMPLETED ALL REQUIRED FIELDS INCLUDING ANSWERING YES TO THE MEDICARE QUESTION AND YOUR CLAIM CONTAINS A VALID NPI, YOU MAY NEED TO SUBMIT A MEDICARE ENROLLMENT APPLICATION (CMS-855). << F6 >> PROCESS COMPLETED --- PLEASE CONTINUE

  42. Option 68 – ANSI Codes MAP1581 M E D I C A R E A O N L I N E S Y S T E M SC ANSI STANDARD CODES INQUIRY SELECTION SCREEN RECORD TYPE: C = ADJ REASONS G = GROUPS R = REMARKS A = APPEALS STANDARD CODE: T = CLAIM CATEGORY S = CLAIM STATUS S RT CODE NARRATIVE A MA01 IF YOU DISAGREE WITH WHAT WE APPROVED FOR THESE SERVICES, YOU HAV S A MA02 IF YOU DISAGREE WITH THIS DETERMINATION, YOU HAVE A RIGHT TO APPE A MA04 SECONDARY PAYMENT CANNOT BE CONSIDERED WITHOUT THE IDENTITY OF OR A MA05 INCORRECT ADMISSION DATE, PATIENT STATUS OR TYPE OF BILL ENTRY ON A MA06 INCORRECT BEGINNING AND/OR ENDING DATE(S) ON CLAIM. A MA07 THE CLAIM INFORMATION HAS ALSO BEEN FORWARDED TO MEDICAID FOR A MA08 YOU SHOULD ALSO SEND THIS CLAIM TO THE PATIENT'S OTHER INSURER. W A MA09 CLAIM SUBMITTED AS UNASSIGNED BUT PROCESSED AS ASSIGNED. YOU A MA10 THE PATIENT'S PAYMENT WAS IN EXCESS OF THE AMOUNT OWED. YOU MUST A MA100 DID NOT COMPLETE OR ENTER ACCURATELY THE DATE OF CURRENT ILLNESS A MA101 DID NOT COMPLETE OR ENTER ACCURATELY THE DATES PATIENT WAS PROCESS COMPLETED --- PLEASE CONTINUE PLEASE MAKE A SELECTION, ENTER NEW KEY DATA, PRESS PF3-EXIT, PF6-SCROLL

  43. Option 68 – ANSI Codes MAP1582 M E D I C A R E A O N L I N E S Y S T E M OP: B11786 SC ANSI STANDARD REASON CODES INQUIRY DT: 122210 RECORD TYPES ARE: C = ADJ REASONS G = GROUPS R = REMARKS A = APPEALS T = CLAIM CATEGORY S = CLAIM STATUS RECORD TYPE : A STANDARD CODE : MA02 NARRATIVE: IF YOU DO NOT AGREE WITH THIS DETERMINATION, YOU HAVE A RIGHT TO APPEAL. YOU MUST FILE A WRITTEN REQUEST FOR AN APPEAL WITHIN 180 DAYS OF THE DATE YOU RECEIVE THIS NOTICE. DECISIONS MADE BY THE QUALITY IMPROVEMENT ORGANIZATION (QIO) MUST BE APPEALED TO THAT QIO WITHIN 60 DAYS. PRESS PF3-EXIT PF7-PREV PAGE

  44. Option 19 – Zip Code File MAP1171 M E D I C A R E A O N L I N E S Y S T E M OP: FSSCZIPD SC ZIP CODE INQUIRY DATE: 071012 SEL ZIP/IND 0 35242 CARR 10102 LOC 00 Z9 RURAL IND U ST AL 0 35243 10102 00 Z9 U AL 0 35244 10102 00 Z9 U AL 0 35245 10102 00 Z9 U AL 0 35246 10102 00 Z9 U AL 0 35249 10102 00 Z9 U AL 0 35253 10102 00 Z9 U AL 0 35254 10102 00 Z9 U AL 0 35255 10102 00 Z9 U AL 0 35259 10102 00 Z9 U AL 0 35260 10102 00 Z9 U AL PROCESS COMPLETED --- PLEASE CONTINUE PRESS PF3-EXIT PF7-PREV PAGE PF8-NEXT PAGE

  45. Calendar of Events https://apps.cahabagba.com/apps/course_registration/al/calendar.jsp

  46. Questions?

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