HIPAA Compliant File Maintenance For Electronic Billing
To comply with the new 837 format for electronic billing perform the following maintenance.
1. Open Insurance Maintenance by clicking File Maintenance from the Menu Bar, Standard Maintenance and then Insurance.
2. Maintain the following fields:
a. Assign a Payer Code as the Contact - Payer ID field.
Important:
For Medicare only, assign 31142 as the Payer Code.
For all other insurances, if they do not have a Payer Code, you must assign OTHER in the contact field and set the Claim Rec'vr type to Z.
To get an updated list of Payer Codes go to www.emdeom.com and select payer lists. Generally, the Payer Lists are updated every couple of months. Its important to maintain the most up-to-date list.
b. Assign a Claim Receiver Type.
Below are the valid Claim Receiver Types:
c. Assign the appropriate EMC Table ID.
Below are the appropriate EMC Table IDs.
|
Claim Receiver Types |
||
|
Insurance |
Claim Receiver Type |
EMC Table ID |
|
Medicare |
C |
NSFME |
|
Medicaid |
D |
MCAID |
|
Blue Cross |
G |
ANTHME |
|
Commercial |
F |
WEBMD |
|
Other |
Z |
|
d. Maintain the appropriate Medigap Number.
Note: Medicare has an updated list of MEDIGAP codes that you can download @ www.medicarenhic.com/download.
1. Open Provider Maintenance by clicking File Maintenance from the Menu Bar, Standard Maintenance and then Provider.
2. Verify that the Provider number for the Medicare form type print code is only 6 digits long.
Tip: Years ago the Provider numbers began with the first two letters of the Physician's last name.
3. Verify that there are no hyphens (-) in the provider Federal ID number or in the form type print codes.
1. Open Provider Miscellaneous Information Maintenance by clicking Additional from the Provider Maintenance Menu Bar and then click Misc. Provider Info.
2. Verify that the Providers Last Name, First Name, Middle Initial, and Suffix are filled in properly.
3. Verify that Prevent Autobill is set to No.
1. Open Provider Set Maintenance by clicking Additional from the Provider Maintenance Menu Bar and then Provider Set.
2. Press [TAB] through the Location, Department and Insurance Set so they default to ALL.
3. Maintain the following Provider Set fields:
a. Enter the provider's Federal ID number.
b. Enter the Billing Number, if the insurance carrier requires it.
c. Enter the Network ID, if the insurance carrier requires it.
d. Enter the provider's NPI as the National ID field.
e. Enter the Taxonomy code (if the site chooses to) for the Specialty field.
f. Enter the Site Number for insurance carrier WEB MD.
When entering policy holder information during Patient Entry - Insurance Policy Holder Area, if the policy holder is the patient (self), DO NOT free type the name, simply press [TAB] through the fields to default to the patient's name.