Billing (X12) Setup. Complete the fields for Billing Contact, Federal Tax ID, MA Provider ID and Provider NPI.

Transcription

1 Billing (X12) Setup This session includes Community Setup, Payor Setup, Procedure Codes, Place of Service, X12 codes for Transaction Types and Service Types. Note: Before using Eldermark Software for X12 Billing, the customer is responsible for the following items: Have current provider information setup with the State Department of Health. Have up-to-date residents state service agreements, effective dates and authorization numbers to ensure proper resident setup. Determine procedure codes and modifiers needed. Community Setup: To setup the community billing information, click on File Setup Community. Double click on your community to open. Click on the AR Options tab. This field listed below in red must be activated by Eldermark Staff. Complete the fields for Billing Contact, Federal Tax ID, MA Provider ID and Provider NPI. All fields require completion; this information is used in the electronic file to identify your community.

2 Enter the name and phone number of the billing contact for your community. Billing Contact: Enter your community identification numbers. Community Identification Numbers: Federal Tax ID: A Federal Tax ID, also known as an Employer Identification Number (EIN), is a nine-digit number issued by the Internal Revenue Service for banking, tax filing, and other business purposes. MA Provider ID: The MA Provider ID is the legacy identifier that was used prior to the change to the NPI in Provider NPI: National Provider Identifier or NPI is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). EIN (Employers Identification Number): Employers Identification Number should be 9 numeric digits. This number is usually the same as the Federal Tax ID number. Mark this box below to pull the resident s primary diagnosis into all claims. Diagnosis in Claims: Payor Setup: For each organization that you wish to submit electronic claims for, you will need to complete the X12 Payor setup. To select the payor organizations, click on File Payors. This will open the list of payors. Billing (X12) Setup Revised 10/31/17 2

3 Find the appropriate payor(s). Double click on the payor to open the record. Confirm the address is correct. Click on the Electronic billing (X12) tab. The following screen will open. Billing (X12) Setup Revised 10/31/17 3

4 Check the box below for X12 Payor. ISA Interchange Control: All fields are required. Details about each field are to follow. Click on the blue question mark by each field for help with that field. ISA Status: For your initial submission, this needs to be a T for test. Keep the ISA Status at T for testing mode until DHS approves you for production status. Once it is accepted by the State and you have authorization to send production files, then you change this field to a P. Note: to test the 5010 file layout, you will need to change this field to a T. Billing (X12) Setup Revised 10/31/17 4

5 Sender ID Code: The Sender ID Code is a 2-character code that indicates what kind of value the Sender ID Value is. Sender ID Value: The Sender ID Value identifies the Sender in an X12 transaction. Sender ID Value = NPI assigned by the Dept. of Human Services. Note: The community is the sender. Receiver ID Code: The Receiver ID Code is a 2-character code that indicates what kind of value the Receiver ID Value is. Receiver ID Value: The Receiver ID Value identifies the Receiver in an X12 transaction. Note: Medical Assistance (Medicaid, Elderly Waiver) is the receiver. Billing Company NPI: If the billing company is not the same as the providing community, you may need to state the NPI of the billing company. If you do NOT populate this entry, then the Company Provider NPI will be used, or the Company Federal Tax ID. Output file with CR/LF: If this option is selected, then the output file has carriage return + line feeds in the file, to make it somewhat more readable. This option may not be supported by all providers. Setup Example for Minnesota Elderly Waiver: These are examples. Each community is responsible for obtaining the correct data from their state. Signatures: Billing (X12) Setup Revised 10/31/17 5

6 Provider Signature: This is used to indicate if the provider signature is on file. Valid values are 'Y' for Yes, or 'N' for No. M A Assignment: This is used to indicate whether the provider accepts Medicare Assignment. Benefits Assignment: This is used to indicate an assignment of benefits. A Y value indicates the insured or responsible person authorizes the resident benefits to be assigned to the provider (facility); a N value indicates benefits have not been assigned to the provider and the resident will be reimbursed. Release of Information Code: Code indicating whether the provider has a signed statement by the patient authorizing the release of medical data to other organizations on file. Patient Signature Code: Code indicating how the patient or subscriber authorization signatures were obtained and how they are being retained by the provider. These are examples. Each community is responsible for obtaining the correct data from their state. Setup Example for Minnesota Elderly Waiver: Other X12 Setup: Procedure Code System: HC - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes Because the AMA s CPT codes are also level 1 HCPCS codes, they are reported under HC. CODE SOURCE 130: Health Care Financing Administration Common Procedural Coding System. Click on the question mark for additional types. Place of Service: The 'Place of Service' is a code identifying the type of community where services were performed; the first and second positions of the Uniform Bill Type code or the Place of Service code from the Electronic Media Claims National Standard Format. 12= Home 13= Assisted Living Community Billing (X12) Setup Revised 10/31/17 6

7 Click on the question mark for additional values. Mark Use this code for ALL claims if you always use the same place of service on claims. Provider Taxonomy Code: Code indicating group or category of provider. For valid values, go to for a complete listing of codes. Examples: Home Health = 251E00000X, Assisted Living Facility = X, Assisted Living, Behavioral Disturbances = 3104A0603X. You will need to verify you are using the correct number for your community. Charges Output: Line Item Detail: Select this option if you need to submit detailed charges. As Summary: Select this option if you can submit a summary of charges. File Export Location: You will create a file in Service Minder to send to your state. The export location is where you will be saving the file you create. To set the Export Location for the data file, click on Export Location and create a file folder that will be easy to locate when you are ready to submit the file. Browse to the location you want to save the file. Click on Make New Folder. Name the folder X12 Billing or something similar. Click Ok to save your changes and close this window. Then click Save to return to the Payor listing. Billing (X12) Setup Revised 10/31/17 7

8 Place of Service: Note: If you have Use this Code for ALL claims marked in the X12 payor setup, you do not need to enter anything in this table. To access, click on File Setup X12 Place of Service. This table is shared between all communities if you are a multicommunity database. Click New to enter codes you require that are not in the table. Most communities have one Place of Service; some may have two. The Place of Service will be assigned to charges at the resident level on the monthly recurring transaction and/or the resident services. Billing (X12) Setup Revised 10/31/17 8

9 Procedure Codes: In most instances, these will be HCPCS codes. HCPCS Codes, Healthcare Common Procedure Coding System numbers, are the codes used by Medicare and monitored by CMS, the Centers for Medicare and Medicaid Services. They are based on the CPT Codes (Current Procedural Technology codes) developed by the American Medical Association. HCPCS Codes are numbers assigned to every task and service a medical practitioner may provide to a Medicare patient including medical, surgical and diagnostic services. Since everyone uses the same codes to mean the same thing, they ensure uniformity. You should be able to obtain a valid listing from your state agency. In some states the Procedure code and any required modifier can be found on the state service agreement. To access, click on File Setup Procedure Code. This table is shared between all communities. Click New to enter codes you require that are not in the table. Set-up procedure codes with: Billing (X12) Setup Revised 10/31/17 9

10 Code: Required Code and Description, as set by the State. (Make description its own section to match software fields) Unit: Type of unit minutes, daily, each, monthly, etc., as set by the State. Quantity: Standard quantity which makes a unit Program will take confirmed schedule to calculate total number of units to bill. Procedure Codes will be assigned to Transaction Types and Service Types along with any modifier needed. Transaction Type X12 Setup: To add procedure codes and modifiers to Transaction Types, click on File Setup Transaction Types. Enter the Procedure Code and/or Modifier Code associated with each Transaction that may be billed to Medical Assistance/waivered programs. Find the Transaction Type that you need to assign a procedure code to and double click to open the Transaction type record. Service Type X12 Setup: To add procedure codes and modifiers to Service Types, click on File Setup Service Types. This will bring up a listing of Service Types. Enter the Procedure Code and/or Modifier Code associated with each service that may be billed to Medical Assistance/waivered programs. Find the Service Type that you need to assign a procedure code to and double click to open the Service Type record. Enter the Procedure code and X12 modifier if appropriate. Billing (X12) Setup Revised 10/31/17 10