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1. California Medicare Northern Region Part B page 1 of 3 pdf 8 California Medicare Northern Region Part B page 2 of 3 pdf 9 California Medicare Northern Region Part B page 3 of 3 pdf 10 California Medicare Southern Region EDI Enrollment form3 10 2006 pdf 11 CAMCD cmcenrollform 6153 z01 doc 12 Cigna IDMCR NCMCR TNMCR EDI Profile pdf 13 COMCD EDI Update form 1006 Final pdf 14 Connecticut New Hampshire Maine CTBCS MEBCS NHBCS Enrollment pdf 15 DMERC Reg D EDI Enrollment Form 100802 pdf 16 DMERC REGION A HEALTHNOW EDI Enrollment Form 10 27 03 pdf 17 DMERC REGION C Palmetto GBA EDI EnrollPack Oct03 pdf 18 DME Reg B AdminastarMed pdf 19 EMDEON Claim Provider Setup Form 2007 2 doc 20 EMDEON ERA SETUP FORM 03 2007 doc 21 EMDEON ERA SETUP FORM 04 2007 pdf 22 EMDEON Delaware Blue Cross Blue Shield pdf 23 Florida Medicare Part B edi getstarted EDI Enrollment Form with instructions pdf 24 Florida Medicare Part B FL edr form 101603 pdf 25 Florida EMC Change of Information Form pdf 26 Georgia Blue Cross GABCS TPEF website pdf 27 Georgia Medicaid GAMCD GA Provider Form 03012005 pdf 28 Georgia Medicaid GAMCD POWER OF ATTORNEY FOR ELECTRONIC CLAIMS SUBMISSION pdf 29 Georgia Medicare GAMCR EDI Enrollment pdf 30 Hawaii Medicaid HI WA3 Enrollment Form pdf 31 Idaho Medicare Cigna Medicare profile013103 pdf 32 ILLINOIS MICHIGAN MINNESOTA WISCONSIN WPS Medicare Part B Enroll pdf 33 Indiana and Kentucky Medicare Pa
2. BLVD STE A106 2550 PARKLANE BLVD STE A10 03 21 2008 CITY STATE FRISCO Tx ZIP PHONE 75034 972888777 25215817 1225215817 HetsubmitGlaim to Payor Void This Claim Close The display of the claim form is informational however the form may also be used to correct error claims and resubmit which will be described in section Manage Claims and Tools FreeClaims com Page 14 Searching by Claim is accomplished by entering a search string identified by the dropdown search criteria Entering no data and selecting submit displays all claims This is the fastest way to find a claims submitted to FreeClaims Lastname Firstname H Lastname Firsiname Insured Id Policy Trace Number Account Number Figure 6 1 Claims can be managed in several places on the FreeClaims application First we will look at the Manage Claims option Manage Claims Home Process Claims View Mailbox Invoices View Claims Manage Claims Tools There are four options under Manage Claims You can manage your error claims pending payer or network ID claims and see claims flagged as resubmitted after correcting online FreeClaims com Page 15 Error Claims Select Error claims from the Manage Claims toolbar dropdown Click on the trace number of the claim containing an error to display the claim View All Error Claims from Submitter 1111 BLUE Good claims that are queued to go out or have been sent to Pa
3. P144 OQ QD howwe sd Home About Us Our Products Links Contact Us FreeClaims com A Medical Claims Clearinghouse Electronic Claims Patient Statements Eligibility HCFA Printing Members Login FreeClaims com provides healthcare providers and related entities the tools and services that assist in cost reduction while improving business efficiencies WELCOME TO FREECLAIMS COM gt Members Login Doing our part to reduce administrative medical costs Freeclaims Benefits include gt Payor List TT gt P EMOA e Verify patient eligibility real time on line gt FAQ s e Find and fix claim errors immediately rather than waiting days or weeks e Reduce reimbursement times gt FreeClaims Manual e Submit all your electronic claims at once rather than submitting separately to each individual payer e One location to manage all your electronic claims and medical transactions e Reduce paper printing and postage cost e Overall administration simplification Copyright FreeClaims com All Rights Reserved Home About Us Our Products Links Contact Us Please Browse our Website to find out about all of our time and cost saving services FreeClaims com Page 1 Join Freeclaims Join FreeClaims Instructions Read and accept our terms then fill out the short form below and click submit a documentation the Software Application BY CLICKING THE I ACCEPT ICON BELOW or by othe
4. reeClaims com User Manual ez cita E Jon ree 09 RR X Members Home Mu ROS P E T PITE GI PENDET UU RE Manage Claims Error Claims Resubmitted Claims to Send page 1 page 2 Secure Members Logi odiosa ou soeivscacicacanscan onesie iosa canatqeasainsaucesuqansonnsasspesnetasasane PIU t amico beum dt sm Eos cade B OT Account SUEIgE V cessent best EU Ode Ui erax tute dpi d utr Ou MU FINE SI SI Seir tU a vm PU CEU ES IU RS PEDIR reap hc edite DOE D n page 6 Upload E Gc RW E I E i o aooaa ACIS page 11 page 13 page 15 eee aa eee le Pending Payer ID or Edit My Payer ID Match essere nnne nnne nenne ener nen enn rns e tinae Pending Network ID or Edit My Network ID Match NPI eese nnne nnne enne nnns page 17 page 18 page 19 Dp M o HNEEERERPRRLEREREEEPE e CIAR Access to FreeClaims com can be obtained by entering our URL in your internet browser address bar www freeclaims com E FreeClaims com Free online medical claims clearinghouse Microsoft Internet Explorer Address http www freeclaims com File Edit View Favorites Tools Help Ax Geek O x 2 N 72 Seach Se Favorites OZ amp J en Ex
5. ETWORK ID PROVIDER NO GROUP NETWORK ID INDIVIDUAL NPI GROUP NO Box Box 24j White 33 b Area GROUP NPI Box Box 24j Shaded 33 a Area TaxId 111373670 Clinic Zip 75034 fe eer ABUS T 1534662890 9876543210 1234567890 9876543210 Facility Address Payorld txmcr MEDICARE TEXAS Enter the correct ID numbers for Medicare enter the NPI or Group NPI in the network ID and Group Network ID fields then click on submit FreeClaims com Page 18 Resubmitted Claims to Send Click on Manage Claims gt View Submitted Claims to send and all claims that are corrected will be flagged for resubmission and will be picked up during payer batching to be sent to the payers BLUE Good claims that are queued to go out or have been sent to Payors PURPLE Pending claims Claims on hold due to missing payor id and or network id RED Error claims BLACK Void or deleted claims 1 17607629 1041339 RESUBMITTED WHITE ADAM 7 651WHIT 62308 NEIC 03 11 2008 135 00 1225215817 DC9077 ABLE DAVID 4 25 2008 Home Process Claims View Mailbox Invoices View Claims Manage Claims Tools 7 Void Delete Claims 9 Contact Anvicare Edit my Payer ID Match and Edit my Network ID Match are covered on pages 17 and 18 Maintain EMC Submitter ID For some payors in order to receive claims from FreeClaims the payor would assign what we call Emc Submitter ID to each of our client This ID does not exist anywhere on the HCFA form This ID is u
6. Internet Explorer Account Status TEST Claims will NOT go out Please contact us if you A ae ready to switch to PRODUCTION Example 2 1 Windows Internet Explorer NOTE ERA will be billed at 15 00 provider month starting March 1 A 2007 PLEASE SELECT HOME gt VIEW BULLETIN for more Example 2 2 SSS SSS SSS FreeClaims com Page 4 The Account Summary page contains important summarized information about your account While all the information on this page is important flashing text indicates immediate attention to a batch or specific claims FreeClaims com Home Process Claims View Mailbox Invoices View Claims Manage Claims Tools Regular Account Summary You have pending 76 or rejected claims 24 These claims WILL NOT GET PAID Scroll down for instructions or contact customer service for help The oldest date from these claims dated back to 2 17 2005 For a free 30 days trial of FreeClaims premium service please call or email us Last Claim File Submitted You have not submitted any files yet Account Status TEST All blue color claims will NOT be sent out Please contact customer service if you want to be in PRODUCTION Number Of Pending Claims 76 Pending claims show up in PURPLE color when you view a batch Claims are put to pending status for missing Payor Id and or Network Id To un pend PURPLE claims select PROCESS CLAIMS then MATCH PAYOR ID Next select PROCESS CLAIM
7. N 03 17 2008 135 00 1111115817 DC9077 ABLE Figure 6 0b The Trace number is underlined indicating you can view the claim in full by clicking on it t FreeClaims com Page 13 Clicking on the Trace number will allow you to open up the claim HEALTH INSURANCE CLAIM FORM HCFA 1500 NPI SUBMITTER ID PAYOR NAME PAYOR ID ma CIGNA BATCH NO PAYOR ADDRESS ADDRESS line2 1027325 P o BOX 14079 TRACE NO CITY STATE ZIP 17383397 LEXINGTON KY 405724079 1 MEDICARE MEDICAID CHAMPUS CHAMPVA GROUP FECA OTHER 1a INSURED S I D c c e e c wABc530587 2 PATIENT S NAME Last First Middle I 3 PATIENT S SEX 4 INSURED S NAME Last First M I wHITE ADAM 7 DOB WHITE ADAM 0543972 m eFC 5 PATIENT S ADDRESS 6 PATIENT REL TO INSURED 7 INSURED S ADDRESS 7961 GRAYSTONE ST Self Spouse Child Other 7967 GRAYSTONE ST CITY STATE B PATIENT STATUS CITY STATE FRISCO TX E v H fc es FRISCO TX E ZIP CODE TELEPHONE A z ZIP CODE TELEPHONE Student Full Time C Part Time 75034 5553625529 75034 5553625529 10 PATIENT S 11 INSURED S POLICY GROUP CONDITION RELATED TO 381113001100146 9 OTHER INSURED S NAME Last First M I a EMPLOYMENT 2 OTHER INSURED S POLICY OR GROUP INSURED S DOB SEX YES no 1071471978 M F b OTHER INSURED S DOB SEX ESI STATE b EMPLOYER S NAME OR SCHOOL NAME ACCIDENT mM F6 yes wo E
8. S then MATCH NETWORK ID Note Match Payor Id and Network Id are needed so that you do not have to correct individual claim Instead correction will be applied to all purple claims that matched the criteria Number Of Error Claims 24 Error or rejected claims show up in RED color when you view a batch To correct error claims select MANAGE CLAIMS then select ERROR CLAIMS Next click on the TRACE NO to view the red HCFA form The error message will be at the top of the HCFA form Correct all the errors and click RESUBMIT CLAIM TO PAYOR Note Correcting RED rejected claims is a one by one correction FreeClaims com Members Area Toolbar Figure 3 0 contains 6 links which expand into dropdown items to complete tasks associated with working on claims and claims related functions Placing the mouse over the link will display the dropdown selections FreeClaims com Home Process Claims View Mailbox Invoices View Claims Manage Claims Tools Figure 3 0 FreeClaims com Page 5 Members Home Home Process Claims View Mailbox Invoices View Claims Manage Claims Tools 1 Logout 2 Account Status 3 View Bulletin 4 Seven Steps 5 Post Payments to Claims Figure 3 1 Home offers 5 options Logout log out of FreeClaims Members Area Account Status Summary of Account Status View Bulletin Up to date general information or specific changes about FreeClaims payers processing reports etc Seven Steps S
9. S MedB Enroll pdf FreeClaims com Page 22 Contact Anvicare fyou need additional information about FreeClaims or any of the AnviCare systems or services contact AnviCare Sales To inquire about employment opportunities or to submit a resume contact info anvicare com For technical assistance with any of the AnviCare products contact AnviCare Customer Support or call 877 268 4676 To report problems with this site notify our webmaster Corporate Headquarters 12946 Dairy Ashford Rd Ste 230 Toll Free 877 268 4676 Sugar Land TX 77478 Phone 281 325 0208 Fax 281 313 0925 FreeClaims com Page 23
10. SPRINT c INSURANCE PLAN NAME CIGNA c EMPLOYER S NAME OR SCHOOL NAME c OTHER ACCIDENT Yes no INSURANCE PLAN NAME 10d RESERVED FOR d ANOTHER HEALTH BENEFIT PLAN LOCAL USE m yes no 12 PATIENT S SIGNATURE Release of med info 13 INSURED S AUTHORIZE PAYMENT SIGNATURE SIGNATURE ON FILE DATE o37 1 2008 SIGNED 15 DATE OF SAME ILLNESS 16 DATES UNABLE TO WORK PUES FROM e 08 20 2007 17 REFERRING PHYSICIAN YT 18 HOSPITALIZATION DATES HC FROM tol 17b NPI 19 RESERVED FOR LOCAL USE 20 OUTSIDE LAB CHARGE Yes no 21 DIAGNOSIS 22 MEDICAID RESUBMISSION 17395 CODE ORG REF 2 7394 14 DATE OF ILLNESS First symptom OR INJURY CURRENT Accident OR PREGNANCY LMP 23 PRIOR AUTHORIZATION K pr ee ee ee DATE OF SERVICE EMG CPT CODE DCODE CHARGES Days Units LOCAL USE FROM TO 225215817 poU a piwmos Renwxws CT CC FR FD AUF NAMBAREA UM BIUSANESLUDATURRDUMI RERUMS N LE pros Renwxws pw p Ew 1 7 FR Re RF ii N kenwaws pw REww 5 RB Eee FE FU a ae ee aa Josri1s2008 fosiruzos fi eozes if pP peo p p ppp ie EIE hls ue qo qe 25 TAX I D SSN EIN 26 PATIENT S ACC 27 ACCEPT ASSIGN 28 CHARGE 29 PAID 30 BALL 31 PHYSICIAN NAME 32 FACILITY NAME AND ADDRESS 33 CLINIC NAME AND ADDRESS JABLE DAVID vib ABLE DC DAVID ABLE DC ADDRESS ADDRESS DATE 50 PARKLANE
11. ST mode which means no claims will be sent to the payers for processing however TEST mode gives you an opportunity to set up the system and learn how to use it Following all the steps below will allow you to be in production mode within 30 minutes in most cases STEP 1 prepare about 20 test claims from your billing software and submit them to Freeclaims using your Userld and Password above Test claims should be real claims but old and have been paid If you can t get old real claims then it is acceptable to make up claims If you need help to create the test data from your billing software please contact your software vendor FreeClaims com Page 2 If asked by your software vendor please inform them that we accept Print Image National Standard Format NSF MCDS old NEIC format or Ansi X12 4010 STEP 2 send in your first test file please login using the userID and password above Once logged in you will see a menu bar STEP 3 upload your test file select PROCESS CLAIMS then UPLOAD CLAIM FILE STEP 4 click on BROWSE and locate the file in your hard drive Please do not zip the file STEP 5 Click UPLOAD FILE to initiate the transfer Please only click once You will see a progress bar at the bottom of your browser moving from left to right Once the file has uploaded completely the website will let you know the filename it had assigned to this file This is an indication that the file was received successfully Please note unti
12. TIME RECVD 16 40 23 BATCH TYP NO COMMERCIAL ONLY MEDICARE ONLY COMMERCIAL amp MEDICARE BATCH TOTALS 188 81 1 B amp i TOTALS 1 o n 1 ROVIDER TOTALS E AAAA EEEE A AA A A A A A A A E L A I HM 5 Ste me te ee ee ae ae aes ae ae See See me Sa ee aa ae ake Ske eee a tee Ste eae See ae ae ae et ae Se one eo eB A T C H E Eg LEZZIIIIIIJ INPUT ACCEPTED REJECTED INPUT ACCEPTED REJECTED NUMBER VALUE NUMBER amp VALUE NUMBER amp VALUE NUMBER NUMBER 5 NUMBER amp DLY 1 1 830 00 1 100 270 00 0 n 00 1 1 100 0 n MTD 3 1 830 00 3 100 1 830 00 0 p 00 YTD 1109 185 437 00 4094 99 186 852 00 15 1 2 585 00 s RO2 HEIC PAGE 1 RUN DATE 12 04 07 MEDICAL DENTAL CLAIMS DISTRIBUTION SYSTEMS eee DAILY eee ACCEPTANCE REPORT BY PROVIDER SUBMITTER ID 752655275 PROVIDER ID 111606056 1111 SERIAL PROCESSING DATE TIME CARENET SYSTEMS DAVID ABLE DC NUMBER DATE RECEIVED EULESS TX FRISCO TX 003477 04 08 08 04 08 08 16 40 23 BAT ATIENI PATIENT PATIEN BATCH PATIENT PATIENT PATIENT TYPE NO CONTROL NUMBER LAST NAME FRST NAME ML SOP TYPE NO CONTROL NUMBER LAST NAME FRST NAME MI SOP 100 01 7 652CREN GREEN ALEX COM 100 01 7 651WHIT WHITE ADAM COM Figure 5 3 Search Reports NEW Feature You can now search for information in the reports in your mailbox from the View Mailbox Invoices select Search Reports from the dropdown Enter your search criteria must be exact match to find and
13. UE You have already assign a payor id to these records PURPLE Pending payor id Go to PROCESS CLAIMS gt MATCH PAYORID to match these records no stom sua srarus raxmo pavor w PAYOR KEY 1 198909 1111 PENDING 111373670 CIGNA P O BOX 14079 LEXINGTON KY 40512 Eynlorer porer a Here a Sa Snagit Fl E Use this look up list to match your payor with FreeClaims payor list Toggle between this window and the original window by hit ALT TAB Click the BACK button to begin new search NETWORK ID is the provider number HCFA Box 33 pin field GROUP NETWORK ID is the group number HCFA Box 33 grp field REGISTER means enrollment may be needed with the payor There are many payors with like names Please contact the payor and ask for their NEIC or THIN payor id Then verify against our list CLAIMS CIGNA PPA N CLAIMS CIGNA PPO N CLAIMS Internet Protected Mode On n PAYOR FOUND ASSIGN THIS ID PAPER VOID IGNORE CIGNA C 1 P O BOX 14079 62308 LEXINGTON KY 40512 Click submit and the payer ID will be added Master List of Payor Id Match for submitter 1111 BLUE You have already assign a payor id to these records PURPLE Pending payor id Go to PROCESS CLAIMS gt MATCH PAYORID to match these records ro scar sunm lernme l rco enon pavor Kev 198909 1111 DONE 111373670 62308 CIGNA P O BOX 14079 LEXINGTON KY 40512 FreeClaims com Page 17 Pending Network ID Cla
14. click submit The results will display all reports containing the criteria you entered Select the report you want to view Home Process Claims View Mailbox Invoices View Claims Manage Claims Tools Search Mailbox Submit Reset FreeClaims com Page 12 View Claims Claims can be viewed by all claims in a Batch or by Claim search Figure 6 0a displays claims by batch figure 6 0b displays each claim after clicking on the Batch number to drill down to the claim level of the batch Home Process Claims View Mailbox Invoices View Claims Manage Claims Tools Batches Submitted By 1111 View frequently asked questions about this page NOTE The statistics below are from the initial upload and will not change after you correct the rejected claims to see if your claims are OK just read the Summary Screen when you first login or select Manage Claims then view Rejected Payor Id Pending or Networkid Pending claims 1 1027325 1111 2 2 o 2134 4 8 2008 4 22 36 PM ABLE DAVID 2 1027315 1111 2 2 Oo 2122 4 8 2008 4 19 25 PM ABLE DAVID Figure 6 0a View Claims from batch 1027325 Submitter 1111 BLUE Good claims that are queued to go out or have been sent to Payors PURPLE Pending claims Claims on hold due to missing payor id and or network id RED Error claims BLACK Void or deleted claims 1 17383397 1027325 PENDING WHITE ADAM 7 651WHIT 03 11 2008 135 00 1225215817 DC9077 ABLE 2 17383398 1027325 PENDING GREEN ALEX 7 652GRE
15. d the error message at the top of the form and make appropriate corrections e Next scroll down and click RESUBMIT CLAIM TO PAYOR Step 6 Read Payor Reports and correct claims e Read new payer reports in your mailbox every day Read the whole report thoroughly e If there are rejected claims found Find the claims and click on the TRACE NUMBER correct and resubmit e If you have Premium Service you can read the message at the claim level display view Claims Batch or Claim however we suggest you read the actual reports under the Report tab Step 7 Work aging report from your billing systems e Print an aging report from your billing software every week and make sure you follow up on all unpaid claims e Give special priority to claims that are about to pass the payer filing deadline and to claims with high dollar value Most importantly work the claims the way you feel most comfortable We provide you with information we receive from either the entity we pass the claim to or the payer we pass the claim to Most claims today pass thru multiple clearinghouses then to the payer which accepts the claims directly from that clearinghouse T FreeClaims com Page 7 Upload Claim File Create a batch of claims from your billing or practice management system If you need help to create the claim data batch from your billing software please contact your software vendor If asked by your software vendor please inform them that we accep
16. der Name Alias Master List of Provider Name Alias for submitter 1111 SEQ NO SUBMITTER ID PROVIDER NAME FIRST MIDDLE CREDENTIA 2 1111 751234567 BUSH III GEORGE R M D BUSH GEORGE H PHD 2 i 1111 751234567 JOHN H SMITH L P L A C PHO SMITH JOHN H LP LAC PHD Click on the SEQ NO to view or edit FreeClaims com Page 20 View Edit Referring Doctor Process Claims View Mailbox Invoices View Claims Manage Claims Tools 1 Edit My Payor Id Match 2 Edit My Network Id Match 3 Maintain EMC Submitter Id 4 Maintain Provider Name Alias Search for one or more Refer Dr record s 6 View Edit Facility Id 7 Void Delete Claims 9 Contact Anvicare Instructions Enter Lastname comma First Name of Refer Dr Search Criteria Search for this string Lastname Firstname Fl Select View Edit Refer Dr from the main toolbar You can then search by name or other information by entering a search string or you can simply click on submit to list all REFER LAST BLUE CROSS 1 LINTON JAMES 22 Poooces4s Jil 522522522 2 PA BOB 31234 1444555666 3 ZISMANM M T ROM Edit as required Click Submit View Edit Facility ID Home Process Claims View Mailbox Invoices View Claims Manage Claims Tools 1 Edit My Payor Id Match X md Edit My Network Id Match Master List of Facility NPI Maintain EMC Subm
17. eceives information from payers or intermediaries which forward the claims to the payers Figure 5 2 displays an additional report posted to the mailbox This report would be available within 24 to 48 hours after the claims have been cleared or all errors or pending status and the claims are batched to payer Pending and Error claims will be described in sections Manage Claims and Tools Clicking on the link identified as report No 1 will display the contents of the report Figure 5 3 This example displays one of many types of reports that can be posted to the mailbox This report contains one zero payment claims and verification of the two claims from the batch numbered 1027325 see Figure 5 1 View Reports For a free 30 days trial of FreeClaims premium service Please call or email us Listed below are all the reports you submitted Clicking on the report s name will bring the report forward for you to review print etc Please read every report in this mailbox If your claim is rejected by payors it will be in these reports The claims will not be marked in RED color unless you have a premium account You must locate the BLUE color claim and make the necessary correction and resubmit This is one of the most common error our users made You may mark a report for archiving by checking the box next to the report name To initiate the archiving of the selected reports click the Archive Reports button Click here for Medicare Summar
18. illing software vendor They should be able to help If your vendor cannot or is not willing to help please contact us If you use another clearinghouse a good step is to send us the same data file you sent the old clearinghouse KK OK K CE GE K K K CE CE K K CK CK K CE K CE CK K CE CE K K K K CE CE K CK K K CE CE CK K CE K CE CE K K K K GE CE K CK K CE CE K K K CE CE K K CK CK CE CE K CE K K CE CE K K K K GE CE K K K CE CE CE CK K CE K CE CE K K K K CE CE K CK K CE CE K CK K CE CE CE K CK CK EK FreeClaims com Page 3 Secure Members Login Home About Us Our Products Links Contact Us IE FreeClaims com Flectronic Claims Patient Statements Eligibility HCFA Printing FreeClaims com provides healthcare providers and related entities the tools gt Members Login Member Login gt Join Free Claims gt Payor List Sign on with your User ID and Password gt FAQ s Your password is case sensitive Username Password Logn gt FreeClaims Manual Can t login Enter your userID and password Your userlD is how we identify your account so please remember this number and reference it when emailing support or speaking with FreeClaims personnel Enter your userID and Password and click on Login and you will have secure access to your account Successful login will result in one of several screens The example 2 1 below identifies this account as TEST status example 2 2 indicates a price change for ERA Windows
19. ims or Edit My Network ID Match Master List of Network Id Group Network Id Match for submitter 1111 View frequently asked question about this page BLUE You have already assign a Network Id and or Group Network Id to these records PURPLE Pending Network id Group Network Id Go to PROCESS CLAIMS gt MATCH NETWORK ID to match these records NETWORK ID NTW NPI Box 24j eeil b des Box 24j White Maaa MATCH HINT PAYOR NAME Shaded Area i Area i 1 47435 1111 PENDING 1111 111373670 75034 ABLE DAVID txmcr MEDICARE TEXAS Click on the Seq ID underlined to allow changes or entries Please assign a networkid group networkid to each entry below Listed below are Practice Provider information blocks ready for you to assign a either a network id or group network id Please note we are displaying only 10 entries at a time As you assign an id s to an entry that entry will be removed and new ones would take its place a You do not have to match all the entry before clicking SUBMIT You may match as many entries as you wish and click SUBMIT Blank entries will remain on this list if you wish do match them at a later time What s a network id Network Id is the same as what you would call Provider Number Network Id can be found on block 24K of the HCFA It can also be found on block 33 in the PIN field This field goes out in 2310B Loop and 2420A Loop in the HIPAA Ansi 837 Specifications Group Network Id is the same as what you wo
20. itter Id 4 Maintain Provider Name Alias SEQ 5 View Edit Refer Dr ID SUB ID TAX ID FACILITY View Edit Facility Id VID ABLE DC S0 PARKLANE BLVD STE AIOG ISCO TxX 5034 1 15417 1111 111373670 7 Void Delete Claims 9 Contact Anvicare Click on Tools gt View Edit Facility ID Edit as required Click Submit Forms FreeClaims com Page 21 The forms page is set up to assist with required paperwork and documentation for payer setups Not all payers require setup Complete the paperwork for any of the following payers or payers that indicate enrollment Y on our payer list Should a form not be found contact support anvicare com for assistance Some forms are pre filled with FreeClaims Anvicare information Contact support anvicare com if you have other questions FreeClaims com Home Process Claims View Mailbox Invoices View Claims Manage Claims Tools FreeClaims Forms Anvicare FreeClaims Credit Card Authorization pdf Freeclaims Price List doc Sample Print Image Claim File txt Payor Forms CMS Medicare Remit Easy Print MREP 1 00882 RR Medicare ERA enrollment pdf 2 Alabama Blue Cross Request for Sign on and Client ID pdf 3 Alabama Blue Cross Alabama Medicare EDI Enrollment BCBSAL pdf 4 Alabama Blue Cross Alabama Medicare EDI Enrollment Medicare 052003 pdf 5 Alabama Blue Crosss Change Request Form pdf 6 Arkansas Blue Cross ARBCS letter of authorization 012606 pdf 7
21. l we set your account to production your file will not appear right away like it normally does when you are in production i e disregard the message about waiting for up to 30 minutes Instead after you see the Server Assigned Batch No please contact us by email to let us know that the test file has been uploaded Support anvicare com STEP 6 Read the User Manual and follow each step We will map the file and load it to our database under TEST mode allowing you to learn how to use the system Later we will provide you with information on our 7 steps to processing which will assist you in making sure you complete the necessary steps to complete the claim payment cycle Again thank you for your interest in FreeClaims com Please browse our website to learn about our other valuable time and cost Saving services NOTE BROWSER It is important that you use Microsoft Internet Explorer Version 5 5 or higher While other browser may work we only guarantee that our site will work with IE5 5 or higher If you are using AOL login to AOL as normal then stay connected but minimize AOL click on the dash icon at the top right of the AOL window Then double click on Internet Explorer BlueE Icon on your desktop TEST FILE A test file is a claim file extracted from your billing software The file can be in print image or National Standards Format If you don t know how to create this test file from your billing software please contact your b
22. laims you uploaded from you billing or practice management program Step 2 Confirm All Claims Loaded OK e Go to VIEW CLAIMS then select BATCH e Click on the batch number of the batch you have just uploaded FreeClaims will display all the claims inside the batch along the patient name date of service etc e Each claim is numbered Scroll down to the bottom of the list and make sure the number of claims loaded is the same as the number of claims found in the file from step 1 Step 3 Match Payor ID e While in Step 2 if there are purple color claims the color of the text displayed is purple and the payer id field is blank select PROCESS CLAIMS MATCH PAYOR ID and assign the payer id to each payer found e Typically this is done once per variation of payer address so the first few batches will consume some time Step 4 Match Network ID e While in Step 2 if there are purple color claims go to PROCESS CLAIMS then select MATCH NETWORK ID e Enter your Provider Number for each payer found If the payer assigned a Group Provider Number enter that also Otherwise leave the Group Network Id blank If you have Premium Service you can read the message at the claim level display view Claims Batch or Claim however we suggest you read the actual reports under the Report tab Step 5 Correct Rejected Claims e While in Step 2 if there are red color claims click on the TRACE NUMBER to bring up the HCFA 1500 claim form e Rea
23. ms under View Claims Batch Your next recommended step is to please wait for a few minutes up to 30 min to have your uploaded claims processed then go straight to CORRECT CLAIMS WITH MISSING PAYOR ID or CORRECT CLAIMS WITH MISSING NETWORK ID under UPLOAD CLAIM FILE menu Please note TO FIND OUT if your claims have been processed select VIEW BATCHES If you see a 1l in any column of the VIEW BATCHES table it means NOT ALL claims have yet been processed However you still can go on and do the above steps and repeat those steps again for the remaining claims later on Thank you for your patience FreeClaims com Page 9 View Mailbox Invoices Confirmation Report Home Process Claims View Mailbox Invoices View Claims Manage Claims Tools 1 FreeClaims Reports 2 FreeClaims Invoices 3 View Archived Reports The first report received after you submit a batch of claims to FreeClaims will be a Batch Confirmation report This report lists all the claims received within the uploaded file and the total dollar amount of the batch Some claims may contain errors and need to be corrected which is covered under error correction of the user documentation Clicking on the underlined link of the report you wish to view will display the report on the screen Figure 5 0 displays a Batch report for claims uploaded and processed Figure 5 1 displays the contents of the Batch Confirmation report View Repo
24. nged n Searches Ex Recent Places NE Desktop jJ Computer Folders FreeClaims com Page 8 This will place the file and path location of the file into upload box Figure 4 0 Upload Claim File Step 1 Click the Browse button to select your file C ClaimFiles claims04 1408 txt Submitted files for this session Size Server assigned name no file submitted Figure 4 0 Click on the Upload File button to upload the file Do this only once per file to prevent duplicate batches of claims from being processed Upload Claim File Step 1 Click the Browse button to select your file Tip for PC users select All Files for Files of Type Step 2 Click Upload File Submitted files for this session Size Server assigned name C ClaimFiles claims041408 txt 4182 1111 1027292 EMC You may now proceed to do step 1 of 7 If you do not see your confirmation report or you do not see your claims in the system in about 5 minutes please contact us There may be a problem that we can fix here at FreeClaims Please do not upload the same file again as this will cause a duplicate file when the problem is resolved To see the recommended seven steps go to HOME gt 7 STEPS If this is your very first test file please either notify us by phone or just log back later on the day or the next day and you should see your confirmation report in the mailbox step 1 You should also be able to see your clai
25. or NPI html 91 Reference Medicare Summary Edits for NPI txt 92 Reference MedicareFourNewReject htm 93 Reference Medicare Error Codes txt 94 Reference Medicare Part B EDI Helpline pdf 95 Reference Medisoft Print To File Instructions txt 96 Reference NSF TEST File txt 97 Reference Payor List 061404 PDF 98 Reference Payor List 082604 txt 99 Reference Place Of Service List txt 100 Reference Place Of Service Table pdf 101 Reference POS List PDF 102 Reference Product Price List doc 103 Reference Sample Print Image Claim File txt 104 Reference Sample Stmt jpg 105 Reference TaxonomyCodeList PDF 106 Reference Texas Clean Claim jpg 107 Reference Texas Clean Claims cms1500 pdf 108 South Carolina Medicaid TradingPartnerAgreement100703 pdf 109 South Carolina Medicare Provider Enrollment Form PDF 110 Tennessee Blue Cross Blue Shield Profile provider pdf 111 TRAILBLAZER PART B 08 2007 TXMCR ptb penroll PREFILLED FAX TO 410 683 2937 pdf 112 TRAILBLAZER ERA Request b PreFilled pdf 113 TRAILBLAZER pta enroll pdf 114 Vermont Medicaid Registration Info txt 115 Virgin Island Medicare bbs access form pdf 116 Virgin Island Medicare edi enrollment form en pdf 117 Virginia Medicaid Enrollment Form VA MCD Form 103 PDF 118 VTBCS Provider Enrollment form Prefilled doc 119 WebMD NEIC Envoy ACD Form doc 120 West Virginia Medicaid Provider Trading Partner Agreement pdf 121 WIMCD tp agreement pdf 122 WP
26. profile013103 pdf 64 North Carolina Trading partner agreement pdf 65 North Dakota Medicaid ElectronicDataInterchangeEDIRegistration pdf 66 North Dakota Medicaid TradingPartnersAgreement pdf 67 NYMCU New York Medicare Upstate EDI Form LetterofIntent pre filled pdf 68 NYMCU New York Medicare Upstate EDIForm Enrollment 10 2006 pdf 69 NYMCU New York Medicare Upstate EDIForm ERA 10 2006 pdf 70 Oklahoma Medicaid EDI App pdf 71 OKMCR LAMCR letter of authorization pdf 72 Oregon Blue Cross Regence Section 4 Enrollment form doc 73 Oregon Medicaid edi packet pdf 74 Pennsylvania Medicare Part B Enrollment Form 1 of 3 Side 1 pdf 75 Pennsylvania Medicare Part B Enrollment Form 1 of 3 Side 2 pdf 76 Pennsylvania Medicare Part B Enrollment Form 2 of 3 pdf 77 Pennsylvania Medicare Part B Enrollment Form 3 of 3 pdf 78 RAILROAD MEDICARE 00832 rr edi enroll packet pdf 79 Reference COBAguide pdf 80 Reference Ansi 837 Place Of Service Code List mdi 81 Reference Ansi Qualifier for 17a 24j 32b 33b jpg 82 Reference CodeList 507 for 277 usage txt 83 Reference CSV Specifications txt 84 Reference FreeClaims Agreements txt 85 Reference FreeClaims Payor List as of 05 05 2005 xls 86 Reference FreeClaimsClient InstallationPackage 3034 KB zip 87 Reference HCFA 1500 Form Final pdf 88 Reference HCFA Data Element XY Coordinates htm 89 Reference HCFA New 1500 claim form pdf 90 Reference Medicare Summary Edits f
27. rt B Enrollment Package 08162004 pdf 34 IN KY MEDB ERA pdf 35 Iowa Blue Cross Blue Shield EC Registration form pdf 36 Iowa Blue Cross Blue Shield EC Signature Audit Agreement pdf 37 Iowa Blue Cross Blue Shield EC Third Pa Agreement pdf 38 Kanas Medicare EDI Change Form pdf 39 Kentucky Blue Cross pdf 40 LAMCD 2005 Annual Certification Notice to Submitters pdf 41 LAMCD 2007 Annual Certification Notice to Submitters pdf 42 LAMCD Enrollment Packet 07 2006 pdf 43 Louisiana Medicare Enrollment frm LAMCR pdf 44 LOUISIANA MEDICARE LOA LAMCR pdf 45 Lytec Print Image Template for freeclaims Ici 46 MAMCR NHMCR VTMCR PRE FILLED enrollform 1106 pdf 47 Massachusett New England Medicare edi enroll pdf 48 Minnesota BCBS Medical SB720 pdf 49 MS Request to add additional providers pdf 50 Nebraska Blue Cross TPAForm pdf 51 Nebraska Blue Cross TPRegForm pdf 52 Nebraska Medicare EDI Change Form pdf 53 NEMCR partB companion doc pdf 54 New Jersey NJMCR Enrollment Form 8276 New pdf 55 New York Medicare Part B Empire Medicare mc2752 pdf 56 NJMCD Enrollment Form PREFILLED pdf 57 NMMCR letter of authorization pdf 58 Noridian Medicare Change Form 837term change pdf 59 Noridian Medicare 837p PRE FILLED pdf 60 Noridian Medicare cms edi enroll pdf 61 North Carolina Blue Cross 837 claimform 1 of 2 pdf 62 North Carolina Blue Cross ecr instructions 2 of 2 pdf 63 North Carolina Medicare Cigna Medicare
28. rts For a free 30 days trial of FreeClaims premium service Please call or email us Listed below are all the reports you submitted Clicking on the report s name will bring the report forward for you to review print etc Please read every report in this mailbox If your claim is rejected by payors it will be in these reports The claims will not be marked in RED color unless you have a premium account You must locate the BLUE color claim and make the necessary correction and resubmit This is one of the most common error our users made You may mark a report for archiving by checking the box next to the report name To initiate the archiving of the selected reports click the Archive Reports button Click here for Medicare Summary Edits for NPI Timestamp Size Archive 4 8 2008 4 22 28 PM 1288 E Figure 5 0 REPORT DATE 04 08 2008 TIHE 4 22 28 PM FREECLAIMS COM ACKNOWLEDGEMENT REPORT FreeClaims assigned batch no 1027325 Claims for TaxId 111373670 Provider ABLE DAVID STATUS PATIENT NAME PAT ACCOUNT DOS CLM CHARGE TRACENO INSURED ID PAYOR NAME BAYOR ID DELIVERY PENDING GREEN ALEX T 652GREN 03 17 2008 135 00 17383398 WBBB530587 CIGNA PENDING PENDING WHITE ADAM 7 9551WHIT 03 11 2008 135 00 17383397 WABC530587 CIGHA PENDING Total claims received 2 Total claims charged 270 00 Total claims with errorzs Figure 5 1 FreeClaims com Page 10 The report list will contain new reports as FreeClaims r
29. rwise using the software application FREECLAIMS COM YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS OF THIS AGREEMENT INCLUDING THE WARRANTY DISCLAIMERS AND LIMITATIONS OF LIABILITY PROVISIONS BELOW IF YOU DO NOT AGREE TO THE TERMS OF THIS AGREEMENT YOU MAY CLICK THE EXIT NOW ICON TO LEAVE THE FREECLAIMS COM SITE AnviCare Licensor has produced a proprietary internet software program FreeClaims com for the use of Customers desiring to submit healthcare insurance claims over the Internet The terms of this Agreement apply to the use of the Software including any revisions or new releases Licensor may provide in the future TERMS 1l License Grant Licensor hereby grants to the Customer and the Customer accepts a nonexclusive license to use the Software only as authorized in this Anreement zl FreeClaims Registration Form required fields Yes l accept the terms above wish to join FreeClaims corn Organization Narme e Address Cit State Zip Alaska Contact Name Email Address Phone Fax Billing Software Name Version PT 1 Claim File Format Print Image Tell us how did you find us which search engine did you use or leave us your comment Completing the Join FreeClaims screen will present you with an email as follows Thank you for joining FreeClaims We have set up an account for you Userld 1234 Password aaBBx45c Please follow the steps below to continue You are in TE
30. sed internally so that the payor can verify that the provider claims can come in through FreeClaims Here are some of the payors who implemented this EMC Submitter ID scheme Noridian AZMCR WAMCR NVMCR ORMCR HIMCR ALBCS ALMCR Please maintain your own EMC Submitter Id by fill in the correct number as you received this data from the payer Master List of Emc Submitter Id for submitter 1111 i requer sked estion ab his page SEQ NO PROVIDER NAME PROVIDER LAST ery 001 75 1122334 Click on the SEQ NO to edit FreeClaims com Page 19 FreeClaims com Home Process Claims View Mailbox Invoices View Claims Manage Claims Tools For some payors in order to receive claims from FreeClaims the payor would assign what we call Emc Submitter ID to each of our client This ID does not exist anywhere on the HCFA form This ID is used internally so that the payor can verify that the provider claims can come in through FreeClaims Here are some of the payors who implemented this EMC Submitter ID scheme Noridian AZMCR WAMCR NVMCR ORMCR HIMCR ALBCS ALMCR Please maintain your own EMC Submitter Id by fill in the correct number as you received this data from the payor Seq No foo1 Submitter ID LEI Tax Id 75 1 122334 Receiver Payor Id Network Id Group Network Id Emc Submitter ID Test Production Flag T P Enter the submitter number if applicable and click on submit Maintain Provi
31. sured ID entered 25 TAX I D _ SSN EIN 26 PATIENT S ACC _ 27 ACCEPT ASSIGN 111373670 A YES no 31 PHYSICIAN NAME 32 FACILITY NAME AND ADDRESS ABLE DAVID ADDRESS DATE 03 21 2008 ITY ReSubmit Claim To Payor Void This Claim Close Select Resubmit claim to payer Your claim has been saved sucessfully Please close this window 4 25 2008 Note If you select view batch again you should see that this claim has a status of RESUBMITTED and should be in BLUE You must select view batch as we have not auto refresh the screen like the old system FreeClaims com Page 16 Pending Payer ID Claims or Edit Payer ID Match Pending payer ID claims occur when a new payer is sent to FreeClaims or the spelling or address information for the payer is different than previously submitted In this case you must match the payer to a payer ID See figure below View All PayorId Pending Claims from Submitter 1111 BLUE Good claims that are queued to go out or have been sent to Payors PURPLE Pending claims Claims on hold due to missing payor id and or network id RED Error claims BLACK Void or deleted claims 1 17383397 1027325 PENDING WHITE ADAM 7 651WHIT 03 11 2008 135 00 1225215817 DC9077 ABLE DAVID 4 8 2008 2 17383398 1027325 PENDING GREEN ALEX 7 652GREN 03 17 2008 135 00 1111115817 DC9077 ABLE DAVID 4 8 2008 Master List of Payor Id Match for submitter 1111 BL
32. t Print Image National Standard Format NSF MCDS old NEIC format or ANSI 837p X12 4010 Click on Process Claims then Upload Claim File from the dropdown menu Home Process Claims View Mailbox Invoices View Claims Manage Claims Tools 1 Upload Claim File 3 Match Network Id 4 View Our Payor List 5 View Sent Batches At the Upload Claim File Screen click the Browse button on the screen to search for the file you create from your billing or practice management system The file should be saved in a directory or file folder on your local or network computer The example below shows the file saved on the Root C drive in the folder called ClaimFiles and the filename is claims041408 txt You can place the file anywhere you desire and the naming convention is up to you however we suggest placing the file in a location that you can find easily Highlight the filename and click Open or simply double click the file Home Process Claims View Mailbox Invoices View Claims Manage Claims Tools Upload Claim File Step 1 Click the Browse button to select your file Tip for PC users select All Files for Files of Type Step 2 Click Upload File Upload File E Choose file Submitted files QC Local Disk C ClaimFiles 5 li Search o ar Biy Organize ea Views my NewFolder Boo ee ee Name Date modified Type r claims041408 E Documents I Music E Pictures ji Public jj Recently Cha
33. uld call Group Number Group Network Id can be found on block 33 in the GRP field This field goes out in 2010AA Loop in the HIPAA Ansi 837 Specifications NETWORK ID PROVIDER NO GROUP NETWORK ID INDIVIDUAL NPI GROUP NO Box Box 24j White 33 b Area GROUP NPI Box 33 a Box 24j Shaded Area Tax Id 111373670 Clinic Zip 75034 Provider Name DAVID ABLE Facility Address PayorId txmcr MEDICARE TEXAS Please assign a networkid group networkid to each entry below a Listed below are Practice Provider information blocks ready for you to assign a either a network id or group network id Please note we are displaying only 10 entries at a time As you assign an id s to an entry that entry will be removed and new ones would take its place a You do not have to match all the entry before clicking SUBMIT You may match as many entries as you wish and click SUBMIT Blank entries will remain on this list if you wish do match them at a later time a What s a network id Network Id is the same as what you would call Provider Number Network Id can be found on block 24K of the HCFA It can also be found on block 33 in the PIN field This field goes out in 2310B Loop and 2420A Loop in the HIPAA Ansi 837 Specifications Group Network Id is the same as what you would call Group Number Group Network Id can be found on block 33 in the GRP field This field goes out in 2010AA Loop in the HIPAA Ansi 837 Specifications N
34. ummarized description of how to work on batches or claims within FreeClaims Post Payments to Claims Coming Soon View the Bulletin daily and follow the Seven Steps Most answers to your questions are found in these two articles FreeClaims com Page 6 IMPORTANT In an effort to maintain the low cost quality service business model for our customers we ask that you print and review our Seven Step Process immediately upon your first login The Seven Steps summarize the full document in a quick and easy process to ensure you complete the required steps to ensure each claim in a batch is processed Once logged in to FreeClaims Members Area go to the Home Link on the task bar and select option 4 Seven Steps Figure 3 1 above Use your browser print option to print the steps FreeClaims com Home Process Claims View Mailbox Invoices View Claims Manage Claims Tools FreeClaims Seven Steps Please do step 1 to 5 after every file uploaded Step 1 Reconcile Claims Found e After your claim file batch of claims from your billing system is uploaded and sent via www freeclaims com look for the server assign name batchnumber e Next go to VIEW MAILBOX then FREECLAIMS REPORTS and look for a confirmation report for the file batch just uploaded e Click on the batch number to view the report Scroll down to the bottom of the report and look for the number of claims found in the file This number must match the number of c
35. y Edits for NPI Archive Reports Timestamp Size Archive 1 i 4 11 2008 1 11 23 PM 4 7 2 1111 Batch 1027325 Confirmation Report txt 4 8 2008 4 22 28 PM 1288 J Archive Reports Figure 5 2 FreeClaims com Page 11 04 05 08 MCDS CLAIM STATUS EXCEPTION REPORT ZERO PAYMENT CLAIMS PROVIDER 111606056 1301 DAVID ABLE DC FRISCO TX SUBMITTER 752655275 CLAIM STATUS MESSAGE COMPLETED NO PAYMENT WILL BE MADE FOR THIS CLAIM PATIENT STATEMENT DATES NEIC TOTAL PATIENT NAME CONTROL NUMBER FROM THRU DATE PAYOR PHONE CHARGES P CAPTAIN 2 B21CAPT 04 01 08 04 01 08 04 02 08 CIGNA 555 577 7488 180 00 MCDS ROZZ H E I PAGE 1 RUN DATE 04 03 08 MEDICAL DENTAL CLAIMS DISTRIBUTION SYSTEMS PROVIDER DAILY STATISTICS SUBMITTER ID 752655275 PROVIDER ID 111606056 1111 SERIAL NO DATE RECVD TIME RECVD CARENET SYSTEMS DAVID ABLE DC EULESS TX FRISCO TX 003477 04 08 08 16 40 23 BATCH CLAIMS INPUT CLAIMS ACCEPTED CLAIMS REJECTED IYP N0 NUMBER VALUE NUMBER VALUE NUMBER VALUE 100 01 2 270 00 1 270 00 0 00 or NEUE 2i Lok PAGE 1 RUN DATE 12 04 07 MEDICAL DENIAL CLAIMS DISTRIBUTION SYSTEMS PROVIDER DAILY SUMMARY SUBMITTER ID 752655275 PROVIDER ID 421606056 1301 CARENET SYSTEMS DAVID KAFF DC EULESS TX FRISCO TX LLLLLLLILLILILILILLILILLILILLLLILLLLLILLLLILLLLILILLIA ACCEPTED CLAIMS JOB NUMBER 85355 SERIAL NUMBER 003477 DATE RECVD 04 08 08 PROCESSING DT 04 08 08
36. yors PURPLE Pending claims Claims on hold due to missing payor id and or network id RED Error claims BLACK Void or deleted claims 1 17607629 1041339 REJECTED WHITE ADAM 7 651WHIT 62308 NEIC 03 11 2008 135 00 1225215817 DC9077 ABLE DAVID HEALTH INSURANCE CLAIM FORM HCFA 1500 NPI ERROR FOR THIS CLAIM Insured Id is missing SUBMITTER ID PAYOR NAME i PAYOR ID CIGNA 62308 PAYOR ADDRESS ADDRESS line2 P O BOX 14079 CITY MEDICARE MEDICAID CHAMPUS CHAMPVA 1a INSURED S ID 2 PATIENT S NAME Last First Middle 1 3 PATIENT S SEX 4 INSURED S NAME Last First M I WHITE ADAM e WHITE ADAM 10 4 1972 w amp ro 5 PATIENT S ADDRESS 6 PATIENT REL TO INSURED 7 INSURED S ADDRESS 7961 GRAYSTONE ST Self Spouse Child Other 7961 GRAYSTONE ST CITY 8 PATIENT STATUS STATE _ FRISCO Marital Employment TE M v ZIP CODE TELEPHONE z FA E ZIP CODE TELEPHONE 75034 5553625529 BEI 5553625529 9 OTHER INSURED S NAME Last First M I 10 PATIENT S 11 INSURED S POLICY GROUP CONDITION RELATED TO 81113001100146 PAYOR NAME PAYOR ID CIGNA 62308 PAYOR ADDRESS ADDRESS line2 P O BOX 14079 CITY 1a INSURED S I D WABC530587 4 INSURED S NAME Last First M I WHITE ADAM PATIENT S B SEX 14 1972 M FO 2ATIENT REL TO INSURED F Spouse Child Other IATICAT CTATI IC rI CTATC Correct Claim with In

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