Home Health Direct Data Entry Oline Presentation
Contents
1. status means the claim is completely processed and was rejected Look at the reason code on the rejected claim and resubmit a NEW claim WITH corrections noted from the reason code PARTNERS IN EXCELLENCE ba Palmetto GBA Status Descriptions T status RTP means the claim has been Returned To Provider for correction RTP Correct this claim Do NOT submit a new claim 32 Palmetto GBA 2 TW LP PARTNERS EXCELLENCE Status Descriptions T status means the Intermediary has either inactivated OR specially processed your claim RTPs more then 60 days old and suppressed claims are moved to an I B9997 status for 3 yrs then purged Anew claim may be submitted Palmetto GBA 2 TW PARTNERS EXCELLENCE Main Menu PALMETTO GBA _ INQUIRIES CLAIMS ATTACHMENTS CLAIMS CORRECTION ONLINE REPORTS VIEW ENTER MENU SELECTION 01 PLEASE ENTER DATA OR PRESS PF3 TO EXIT 33 1 Palmetto DI PARTNERS IN EXCELLENCE PALMETTO GOVT BENEFITS ADMINISTRATORS INQUIRY MENU SUB MENU BENEFICIARY CWF 10 HCPC CODES DRG PRICER GROUPER 11 DX PROC CODES CLAIMS 12 ADJUSTMENT REASON CODES REVENUE CODES 13 REASON CODES CLAIM COUNT SUMMARY ANSI REASON CODES CHECK HISTORY ENTER MENU SELECTION 12 PLEASE ENTER DATA OR PRESS PF3 TO EXIT Palmetto GBA PARTNERS IN EXCELLENCE MAPnnnn MED I CARE A ONLINE SY TEM sc CLAIM SUMMAR2. 11 ba Palmetto GBA PARTNERS IN EXCELLENCE HIQHCOP CWF HOSPICE PERIODS PAGE 06 OF 07 HOSP REC CN XXXXXXXXXA NM IT I DB DDMMYYYY SX M HOSPICE DATE PERIOD OWNER CHANGE PERIOD OWNER CHANGE START DATEI TERM DATE1 PROVI INTER 1 DOEBA DATE DOLBA DATE DAYS USED START DATE2 PROV2 INTER 2 REVOCATION IND NO DATA ON FILE FOR THIS BENEFICIARY PF1 INQ SCREEN PF3 CLEAR END PF7 PREV PF8 NEXT ba Palmetto GBA PARTNERS IN EXCELLENCE Understanding DDE Basics 12 Palmetto 7 L It EZ PARTNERS IN EXCELLENCE Standards and Conventions TAB Press the TAB key to move forward between fields CTRL R If your screen Freezes Up hold down the CTRL key and press the R key to reset the screen X Displays at the bottom of the screen when the system is processing your request Do not press any key until the symbol goes away and the blinking cursor returns Palmetto GBA 2 TW PARTNERS EXCELLENCE Function Keys Access reason code file From any claim page Exit a menu or Submenu Exit the Claims System Scroll Back in a Screen Page 13 ba Palmetto GBA PARTNERS IN EXCELLENCE Function Keys Scroll Forward in a Screen Page View Previous Page Page Forward Update Data Sends Claim to Palmetto GBA PARTNERS IN EXCELLENCE ba Palmetto GBA Claims Entry CATS CENTERS for MEDICARE amp MEDICAID SERVICES 2008 Palmetto GBA
3. 14 ba Palmetto GBA SU PARTNERS IN EXCELLENCE Claims Entry Field names within the DDE system will not always follow the same order as the UB 04 A FORM LOCATOR field has been added to the DDE manual to direct you to the appropriate field on the UB 04 PARTNERS IN EXCELLENCE ba Palmetto GBA Claims Entry Patient Information Revenue HCPCS Codes and Charges Payer Information DX Procedure Codes Remarks Other Payer MSP MSP Other Inquiry 15 ba Palmetto GBA D PARTNERS IN EXCELLENCE DDE Main Menu PARTNERS IN EXCELLENCE ba Palmetto GBA D DFHCE3549 Sign on is complete Language E Palmetto GBA vy w PARTNERS IN EXCELLENCE MAP1701 PALMETTO GBA MAIN MENU FOR REGION A6504A9P 01 INQUIRIES 02 CLAIMS ATTACHMENTS 03 CLAIMS CORRECTION 04 ONLINE REPORTS VIEW ENTER MENU SELECTION 02 PLEASE ENTER DATA OR PRESS PF3 TO EXIT Palmetto GBA 95 PARTNERS IN EXCELLENCE MAPnnnn PALMETTO GBA CLAIM AND ATTACHMENTS ENTRY MENU CLAIMS ENTRY INPATIENT 20 OUTPATIENT 22 SNF 24 HOME HEALTH 26 HOSPICE 28 NOE NOA 49 ROSTER BILL ENTRY 87 ATTACHMENT ENTRY HOME HEALTH 4l DME HISTORY 54 ESRD CMS 382 FORM ENTER MENU SELECTION 26 PLEASE ENTER DATA OR PRESS PF3 TO EXIT Palmetto cea 470 PARTNERS IN EXCELLENCE MEDICARE A ONLINE SYSTEM CLAIM PAGE 01 CLAIM ENTRY SV S LOCS OSCAR UB FORM TRANSFERING HOSPICE
4. no charges 0001 revenue code on line 2 is optional 27 Palmetto GBA 2 TW LP PARTNERS IN EXCELLENCE Key Points RAP First Episode date fields must match Admission date From and To date 0023 line date e Subsequent Episodes From and To date is the first date of the next episode 0023 line date is the FIRST BILLABLE visit in the episode TES GBA 2 TW PARTNERS EXCELLENCE Key Points Final Claim First Episode Admission date From date and 0023 line date will match The To date is the 60 day OR an earlier discharge date from the episode A discipline revenue code MUST be present and the date MUST match the date on the 0023 line 28 PARTNERS IN EXCELLENCE ba Palmetto GBA D Key Points Final Claim Subsequent Episode From and To date are the dates of episode 0023 line date 15 the FIRST BILLABLE visit date Adiscipline revenue code MUST be present and the date MUST match the date on the 0023 line No RAP LUPA Submitted the same as any other final claim PARTNERS IN EXCELLENCE ba Palmetto GBA Claim Inquiries CATS CENTERS for MEDICARE amp MEDICAID SERVICES 2008 Palmetto GBA 29 TES 7 Ge EZ PARTNERS IN EXCELLENCE Status Location S LOC Status Location of the claim Know the Status and Location of your claims at all times Tells you what you can
5. More about DDE Main Menu 01 Inquiries 12 Claims Make it work for you Enter one or all fields or a combination Enter one status S T P ora S LOC such as S B6001 ADR Remember delete 3x s in TOB field before pressing Enter PARTNERS IN EXCELLENCE ba Palmetto GBA Thank you for attending 68
6. A2 CONTRACTUAL ADJUSTMENT MEDICARE SECONDARY PAYER PATIENT LIABILITY A4 MEDICARE DAY CLAIM PPS CAPITAL OUTLIER AMOUNT AS MEDICARE COST CLAIM PPS CAPITAL OUTLIER AMOUNT 6 PRIOR HOSPITALIZATION 30 DAY TRANSFER REQUIREMENT NOT AT PRESUMPTIVE PAYMENT ADJUSTMENT A8 CLAIM DENIED UNGROUPABLE DRG B1 NON COVERED VISITS B10 ALLOWED AMOUNT HAS BEEN REDUCED BECAUSE A COMPONENT OF THE BASIC B11 THE CLAIM SERVICE HAS BEEN TRANSFERRED TO THE PROPER PAYER PROCESS B12 SERVICES NOT DOCUMENTED IN PATIENTS MEDICAL RECORDS B13 PREVIOUSLY PAID PAYMENT FOR THIS CLAIM SERVICE MAY HAVE BEEN PRO B14 PAYMENT DENIED BECAUSE ONLY ONE VISIT OR CONSULTATION PER PROCESS COMPLETED PLEASE CONTINUE PLEASE MAKE A SELECTION ENTER NEW KEY DATA PRESS PF3 EXIT PF6 SCROLL Palmetto GBA 5 PARTNERS EXCELLENCE Corrections Return To Provider for Correction RTP s 2008 Palmetto GBA CENTERS for MEDICARE amp MEDICAID SERVICES 44 Palmetto GBA PARTNERS IN EXCELLENCE PALMETTO GOVT BENEFITS ADMINISTRATORS MAIN MENU FOR REGION A6504A7P INQUIRIES CLAIMS ATTACHMENTS CLAIMS CORRECTION ON LINE REPORTS VIEW ENTER MENU SELECTION 03 PLEASE ENTER DATA OR PRESS PF3 TO EXIT Palmetto GBA PARTNERS IN EXCELLENCE PALMETTO GOVT BENEFITS ADMINISTRATORS CLAIM AND ATTACHMENTS CORRECTION MENU CLAIMS CORRECTION INPATIENT OUTPATIENT SNF HOME HEALTH
7. PARTNERS IN EX 4 LI E RESPONSE CODE CLAIM NUMBER SURNAME INITIAL DATE OF BIRTH SEX CODE REQUESTOR ID PRINTER DEST INTER NO NPI INDICATOR PROVIDER NO HOST ID APP DATE REASON CODE HICN Medicare Number from Medicare card HICN First 6 letters of last name First initial of first name Patient s date of birth Patient s sex Always 1 00380 for Palmetto GBA N NPI or Blank Your provider number PTAN Oscar Legacy GL GW KS MA PA NE SE SO SW If date entered records will reflect two episodes closest to the APP date qiti nti A Palmetto GBA 8 PARTNERS EXCELLENCE CWF Host Sites GL Great Lakes PA Pacific IL MI MN WI AK AZ CA HI NV GW Great Western NE North East ID IA KS MO MT NE ND OR SD VIE EL UT WA WY SE South East KS Keystone AL MS NC SC TN DE NJ NY PA SO South FL GA MA Mid Atlantic SW South West IN MD OH VA WV AR CO LA NM OK TX A Palmetto GBA D PARTNERS IN EXCELLENCE HIQHCRO CWF HOME HEALTH INQUIRY REPLY PAGE 01 OF 07 IP REC CN XXXXXXXXXA NM IT DB MMDDYYYY SX F INT 00380 PN Prov APP REAS 1 DATETIME 120806 REQ 1 DISP CODE 01 MSG UNCONDITIONAL ACCEPT CORRECT XXXXXXXXXA NM IT DB SX A ENT 070105 A TRM 000000 B ENT 070105 B TRM 000000 DOD 000000 PARTB YR 06 DED TBM 00000 FULL NAME PF1 INQ SCREEN PF3 CLEA
8. 080806 0551 60154 00003 00003 28 081506 0551 G0154 00003 00003 28 082106 0551 G0154 00004 00004 28 082406 0551 G0154 00003 00003 28 082806 0551 G0154 00004 00004 28 083006 PROCESS COMPLETED PLEASE CONTINUE PRESS PF2 171D PF3 EXIT PF5 UP PF6 DOWN PF7 PREV PF8 NEXT PF9 UPDT PF11 RIGHT MAKE CHANGES Palmetto GBA 5 PARTNERS EXCELLENCE Correcting Line Items e Remove a line Enter 4 d s in revenue code line Example 0551 change to dddd HIT HOME do not enter Addaline Go to next available line and type in correct line HIT HOME do not enter 59 ba Palmetto GBA PARTNERS IN EXCELLENCE Correcting Line Items Total Line Don t forget the total line may need to be removed and then re entered Palmetto GBA PARTNERS IN EXCELLENCE MAP1713 MEDICARE A ONLINE SYSTEM CLAIM PAGE 03 sc CLAIM ADJUSTMENT XXXXXXXXXA TOB 337 S LOC S B0100 PROVIDER XXXXXX OFFSITE ZIPCD ID PAYER OSCAR RI AB PRIOR PAY EST AMT DUE MEDICARE PROV Yo 0 00 0 00 0 00 0 00 0 00 0 00 FROM PATIENT 0 00 0 00 MEDICAL RECORD NBR 0000000000000000 COST RPT DAYS NON COST RPT DAYS DIAGNOSIS CODES 1 9190 2 45932 3 4280 4 72887 5 V1302 6 7 8 9 ADMITTING DIAGNOSIS E CODE HOSPICE TERM ILL IND IDE PROCEDURE CODES AND DATES 1 3 4 5 ESRD HOURS 00 ADJUSTMENT REASON cong pect CODE NONPAY CODE ATT PHYS DXXXXX NPI 0000000000 LN ARE FN BEN MI OPR PHYS NPI 0000000000 LN FN MI OTH PHYS NPI 0000000000 LN FN
9. HOSPICE CLAIM ADJUSTMENTS INPATIENT OUTPATIENT SNF HOME HEALTH HOSPICE ATTACHMENTS PACEMAKER AMBULANCE THERAPY HOME HEALTH ENTER MENU SELECTION 27 PLEASE ENTER DATA OR PRESS PF3 TO EXIT Palmetto GBA PARTNERS IN EXCELLENCE MAP1741 MEDICARE A ONLINE SYSTEM sc CLAIM SUMMARY INQUIRY NPI PROVIDER XXXXXX S LOC B9997 OPERATOR ID XXXXXXXX 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 DT REAS DAYS OPTIONS 1 One Medicare number at a time Hit enter and 1 claim will appear 2 Leave the HIC field blank and just hit enter This will pull up ALL claims for your provider number that are in the T status REMEMBER TO HIT THE DELETE KEY 3 TIMES IN THE TOB FIELD BEFORE HITTING ENTER Palmetto GBA PARTNERS IN EXCELLENCE MAP1741 MED A ONLINE CLAIM SUMMARY INQUIRY NPI PROVIDER S LOC B9997 OPERATOR ID FROM DATE 092906 TO DATE 092906 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 XXXXXXXXXA PROV T B9997 322 073106 092906 092906 100406 NAME I 101006 W7A01 30 EXAMPLE OF OPTION 1 One Medicare Number at a Time PROCESS COMPLETED NO MORE DATA THIS TYPE P
10. MAP1711 MEDICARE A ONLINE SYSTEM CLAIM PAGE 01 sc CLAIM INQUIRY SV TOB 322 S LOC T B9997 OSCAR PROV FORM NPI 0000000000 TRANS HOSP PROV PROCESS NEW Y XXXXXXXXXA PATIENT CONTROL NBR 000000000000000 FED TAX NO 000000000 TAX SUB STMT DATES FROM 100106 TO 100106 DAYS COV N C co LTR LAST DOE FIRST JOHN MI F DOB MMDDYYYY ADDR 1 34650 US HWY 19 N 2 PALM HARBOR FL 3 4 5 6 ZIP 346833670 SEX F MS ADMIT DATE 073106 HR 00 TYPE SRC 1 D HM STAT 30 COND CODES 01 02 03 04 05 06 07 08 09 10 OCC CDS DATE 01 02 03 04 05 06 07 08 09 10 SPAN CODES DATES 01 02 04 05 06 08 09 10 DCN VALUE CODES AMOUNTS ANSI APP IND 01 61 45300 00 02 65 914 16 03 04 05 06 07 08 09 37185 REASON CODES PRESS PF5 SCROLL BKWD PF6 SCROLL FWD PF8 NEXT ba Palmetto GBA PARTNERS IN EXCELLENCE 55 Palmetto GBA PARTNERS IN EXCELLENCE PALMETTO GOVT BENEFITS ADMINISTRATORS MAIN MENU FOR REGION A6504A7P INQUIRIES CLAIMS ATTACHMENTS CLAIMS CORRECTION ON LINE REPORTS VIEW ENTER MENU SELECTION 03 PLEASE ENTER DATA OR PRESS PF3 TO EXIT ba Palmetto GBA PARTNERS IN EXCELLENCE MAP1704 PALMETTO GBA CLAIM AND ATTACHMENTS CORRECTION MENU CLAIMS CORRECTION INPATIENT 21 OUTPATIENT 23 SNF 25 HOME HEALTH 27 HOSPICE 29 CLAIM ADJUSTMENTS CANCELS INPATIENT 30 50 OUTPATIENT 31 51 SNF 32 52 HOME HEALTH 33 53 HOSPICE 35 55 ATTACHMENTS PACEMAKER AMBULANCE THERAPY HOME HE
11. NBR 000000000000000 FED TAX NO 000000000 TAX SUB STMT DATES FROM 100106 TO 120106 DAYS COV N C co LTR LAST XXXXXXXXXX FIRST XXXXX MI X DOB MMDDYYYY ADDR 1 17 TECHNOLOGY CIRCLE 2 COLUMBIA SC 3 4 5 6 ZIP 29203 SEX M MS ADMIT DATE 073106 HR 00 TYPE SRC 1 D HM STAT 30 COND CODES 01 02 03 04 05 06 07 08 09 10 CDS DATE 01 02 03 04 05 06 07 08 09 10 SPAN CODES DATES 01 02 04 05 06 08 09 10 DCN VALUE CODES AMOUNTS ANSI MSP APP IND 01 61 17900 00 02 17 OUTLIER 03 04 05 07 08 09 37185 lt REASON CODES PRESS PF3 EXIT PF5 SCROLL BKWD PF6 SCROLL FWD PF8 NEXT PARTNERS IN EXCELLENCE ba Palmetto GBA Monitor Additional Development Requests ADR S To see the total number of claims in ADR status At main menu select 01 for inquiry Select 56 for Claims Count Summary Tab to the S LOC field and enter SB6001 Status location SB6001 will show the total number of claims in ADR status PARTNERS IN EXCELLENCE ba Palmetto GBA Monitor ADRs Via DDE To view individual claims in ADR status At Main Menu select 01 for inquiry Select 12 for claims sub menu Tab to the S LOC field and enter SB6001 To view print ADR letter select the claim and press enter The ADR letter follows claim page 6 DO NOT press the F9 key while in these claims it may generate another ADR 36 1 Palmetto GBA PARTNERS IN EXCELLENCE PALMETTO GOVT BENEFITS ADMINISTRATO
12. PROVIDER PROCESS NEW HIC PATIENT CNTL TAX SUB TAXO CD STMT DATES FROM TO DAYSCOV N C CO LTR LAST FIRST MI DOB ADDR 1 2 3 4 5 6 ZIP SEX MS ADMIT DATE HR TYPE SRC DHM STAT COND CODES 01 02 03 04 05 06 07 08 09 10 OCC CDS DATE 01 02 03 04 05 06 07 08 SPAN CODES DATES 01 04 05 08 09 DCN VALUE CODES AMOUNTS ANSI MSP APP IND lt REASON CODES PLEASE ENTER DATA PRESS PF5 SCROLL BKWD PF6 SCROLL FWD 7 PF8 NEXT Palmetto GBA uw PARTNERS EXCELLENCE Page 1 Required Field Locators HICN Medicare Number TOB Type of Bill RAPs are 322 All Final Claims 329 Oscar Number PTAN Provider NPI 18 ba Palmetto GBA PARTNERS EXCELLENCE Page 1 Required Field Locators Stmt Dates From Date is the same for RAP s From and To date of the episode for final claim Last and First name DOB date of birth 8 digits Addr 1 street address Addr 2 city and state Zip Beneficiary PARTNERS IN EXCELLENCE ba Palmetto GBA Page 1 Required Field Locators Sex 1 digit Admit Date Admission Remains the same until discharge Stat Patient Status RAPs 30 Fac Zip Facility Zip Code Value Code 61 CBSA Code 5 digit number decimal two zeros Example XXXXX 00 19 MAP1 sc HIC MAP1 sc HIC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7186 Palmetto GBA TW LE PARTNERS IN EX
13. 1 0 MSW Rev Cd 0561 0 AIDE Rev Cd 0871 0 Last line 0001 Total line Totals for each column Palmetto 7 EZ PARTNERS IN EXCELLENCE Revenue Codes con t Subsequent lines 2 3 4 etc Revenue codes for supplies 0270 Non Routine Medical Supplies 0623 Wound Care Supplies Do not duplicate on 0270 Reminder Claims with receipt dates of Octoberl 2008 forward with a HIPPS code ending with a letter must report at least one of these supply revenue codes on the bill 21 Palmetto GBA 2 TW LP PARTNERS EXCELLENCE Page 2 Required Field Locators con t e HCPC Healthcare Common Procedure Code HIPPS Code online 1 Subsequent Lines 2 3 4 etc Corresponding Discipline HCPC G Codes 0151 OT 0152 SLP 0153 SN G0184 MSW HCPC G0155 HCPC G0156 Not required for supply revenue codes 0270 and 0623 Palmetto GBA 2 TW PARTNERS EXCELLENCE Page 2 Required Field Locators con t TOT Unit Total Units Enter on each line item l unit 15 minutes of care Example 4 1 hour of care Example 6 90 minutes of care Not required for 0270 and 0623 22 PARTNERS IN EXCELLENCE ba Palmetto GBA Page 2 Required Field Locators con t TOT CHARGE Total visit charge for that line item Determi
14. 6 DAYS COV 031 co LTR LAST DOE FIRST JOHN MI F DOB MMDDYYYY ADDR 1 34650 US HWY 19 N 2 PALM HARBOR FL 3 4 5 6 ZIP 346833670 SEX F MS ADMIT DATE 073106 HR 00 TYPE SRC 1 D HM STAT 30 COND CODES 01 bs 92 03 04 05 06 07 08 09 10 OCC CDS DATE 01 02 03 04 05 06 07 08 10 SPAN CODES DATES 01 02 03 04 05 06 07 09 10 DCN 20628603021405 01 VALUE CODES AMOUNTS MSP APP IND 45300 00 02 62 31 00 1828 31 05 08 PROCESS COMPLETED PLEASE CONTINUE PRESS PF3 EXIT PF5 SCROLL BKWD PF6 SCROLL FWD PF8 NEXT PF9 UPDT Palmetto GBA pu PARTNERS IN EXCELLENCE Acceptable Adjustment Condition Codes DO Changes to Service Dates 01 Changes to Charges D2 Changes to Revenue HCPCS and HIPPS codes D7 Change to make Medicare the Secondary Payer D8 Change to make Medicare the Primary Payer D9 Any other Change EO Change the Patient Status Code Palmetto GBA PARTNERS IN EXCELLENCE MAP1712 MEDICARE A ONLINE SYSTEM CLAIM PAGE 02 sc UB92 CLAIM ADJUSTMENT REV CD PAGE 01 337 5 10 5 B0100 PROVIDER XXXXXX TOT REV HCPC MODIFS UNIT UNIT TOT CHARGE NCOV CHARGE SERV DT 0023 XXXXX 00060 00060 1828 31 073106 0421 G0151 00006 00006 106 36 073106 0421 G0151 00003 00003 106 36 080906 0421 G0151 00003 00003 106 36 081106 0421 G0151 00003 00003 106 36 081506 0421 G0151 00003 00003 106 36 081706 0421 G0151 00003 00003 106 36 082306 0421 G0151 00002 00002 106 36 082506 0551 G0154 00003 00003 28
15. 92906 DAYS COV N C co LTR LAST XXXXXXXXX FIRST XXXXX MI DOB MMDDYYYY ADDR 1 17 TECHNOLOGY CIRCLE 2 COLUMBIA SC 3 4 5 6 ZIP 29203 SEX M MS ADMIT DATE 073106 HR 00 TYPE SRC 1 D HM STAT 30 COND CODES 01 02 03 04 05 06 07 08 09 10 OCC CDS DATE 01 02 03 04 05 06 07 08 09 10 SPAN CODES DATES 01 02 04 05 06 08 09 10 DCN VALUE CODES AMOUNTS ANSI MSP APP IND 01 61 17900 00 02 03 04 05 06 07 08 09 W7A01 37185 lt REASON CODES PRESS PF5 SCROLL BKWD PF6 SCROLL FWD PF8 NEXT 9 47 PARTNERS IN EXCELLENCE Palmetto GBA uj S Look Up Reason Code Flfrom any Claim Page Flisa fast track to sub category 17 Reason Codes Automatically displays the first reason code at the bottom of your claim page Write down subsequent reason codes if there are any Type in subsequent reason codes after viewing the first reason code A Palmetto GBA 99 PARTNERS EXCELLENCE MAP1881 MEDICARE A ONLINE SYSTEM OP UB03 sc REASON CODES INQUIRY DT 040704 PLAN REAS NARR EEE MSN EEE TERM EMC HC PRO PP CC IND CODE TYPE DATE REAS DATE DATE ST LOC ST LOC LOC IND 1 W7A01 E 080100 5 M1501 B HD CPY A NB ADR CAL DY NARRATIVE THE OPPS VERSION OF OCE HAS DETECTED AN ERROR IN THE 1ST DIAGNOSIS CODE PROCESS COMPLETED NO MORE DATA THIS TYPE PRESS PF6 SCROLL FWD 48 PARTNERS IN EXCELLENCE ba Palmetto GBA D Back The Claim PARTNERS IN EXC
16. ALT ENTER MENU SELECTION 33 PLEASE ENTER DATA OR PRESS PF3 TO EXIT 56 Palmetto GBA TW LE PARTNERS IN EXCELLENCE MAP1741 MEDICARE A ONLINE SYSTEM SC CLAIM SUMMARY INQUIRY NPI HIC XXXXXXXXXA PROVIDER XXXXXX S LOC P TOB XXX 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 PLEASE ENTER DATA OR PRESS PF3 TO EXIT PRESS PF5 SCROLL BKWD PF6 SCROLL FWD Palmetto GBA 95 PARTNERS IN EXCELLENCE MAP1741 MEDICARE N E SYSTEM sc CLAIM SUMMARY INQUIRY NPI PROVIDER S LOC P TOB 327 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 S XXXXXXXXXA P B9997 339 073106 073106 092806 101206 I 2813 09 1828 31 102406 37186 PROCESS COMPLETED NO MORE DATA THIS TYPE PLEASE MAKE A SELECTION ENTER NEW KEY DATA OR PRESS PF3 TO EXIT 57 Palmetto GBA PARTNERS IN EXCELLENCE MAP1711 MEDICARE A ONLINE SYSTEM CLAIM PAGE 01 sc UB92 CLAIM ADJUSTMENT SV 327 5 10 S B0100 OSCAR PROV FORM NPI 0000000000 TRANS HOSP PROV PROCESS NEW HIC PATIENT CONTROL NBR 00000000000000 FED TAX NO 000000000 TAX SUB STMT DATES FROM 073106 TO 09280
17. CELLENCE 712 MEDICARE A ONLINE SYSTEM CLAIM PAGE 02 UB04 CLAIM ENTRY REV CD PAGE 01 XXXXXXXXXA XXX S LOC S B0100 PROVIDER XXXXXXXXXX TOT cov REV HCPC MODIFS RATE UNIT UNIT TOT CHARGE NCOV CHARGE SERV DT lt REASON CODES PRESS PF2 171D PF3 EXIT PF5 UP PF6 DOWN PF7 PREV PF8 NEXT PF11 RIGHT Palmetto GBA 5 PARTNERS EXCELLENCE 712 MEDICARE A ONLINE SYSTEM CLAIM PAGE 02 UB92 CLAIM INQUIRY REV CD PAGE 01 XXXXXXXXXA 329 S LOC S B0100 PROVIDER XXXXXXXXXX TOT COV REV HCPC MODIFS UNIT UNIT TOT CHARGE NCOV CHARGE SERV DT 023 HBGJ1 00060 00060 1822 18 101206 550 G0154 00004 00004 150 00 101206 550 G0154 00004 00004 150 00 101606 550 G0154 00004 00004 150 00 101806 550 G0154 00004 00004 150 00 102006 550 G0154 00004 00004 150 00 102406 550 G0154 00004 00004 150 00 102606 570 G0156 00004 00004 150 00 101406 570 G0156 00004 00004 150 00 101606 570 G0156 00004 00004 150 00 101806 570 G0156 00004 00004 150 00 102006 570 G0156 00004 00004 150 00 102306 570 G0156 00004 00004 150 00 102506 001 1800 00 lt REASON CODES PRESS PF2 171D PF5 UP PF6 DOWN PF7 PREV PF8 NEXT PF11 RIGHT 20 TES GBA 7 EZ PARTNERS IN EXCELLENCE Page 2 Required Field Locators Rev Revenue Codes 1stline 0023 Revenue Code for Home Health Subsequent lines 2 3 4 etc Revenue Codes for Disciplines PT Rev Cd 0421 0 OT RevCd 0431 0 SLP Rev Cd 0441 0 SN Rev Cd 055
18. DDRESS 1 1ST INSURERS ADDRESS 2 CITY ST ZIP 2ND INSURERS ADDRESS 1 2ND INSURERS ADDRESS 2 CITY ST ZIP PAYMENT DATA DEDUCTIBLE COIN CROSSOVER IND PARTNER ID PAID DATE PROVIDER PAYMENT PAID BY PATIENT REIMB RATE RECEIPT DATE PROVIDER INTEREST CHECK EFT NO CHECK EFT ISSUE DATE PAYMENT CODE PRICER DATA DRG OUTLIER AMT TTL BLNDED PAYMT FED SPEC GRAMM RUDMAN ORIG REIMBURSEMENT AMT NET INL TECH PROV DAYS TECH PROV CHARGES OTHER INS ID CLINIC CODE lt REASON CODES PRESS PF3 EXIT PF7 PREV PAGE PF9 UPDT ENTER CONTINUE TES GBA 7 EZ PARTNERS IN EXCELLENCE Claims Entry Con t When you are finished entering the claim press the F 9 function key to send claim If you are successful an empty 1 claim page will appear for your next claim Process Complete will appear at the bottom of your screen If there are no front end or back end edits you will receive payment 26 Palmetto GBA 3 TW PARTNERS EXCELLENCE Claims Entry If your claim does not transmit after pressing F9 You have errors Look to the bottom left of your screen where you will see the reason codes Follow the instructions for Corrections later in this presentation Once corrected F9 again Palmetto GBA 2 TW PARTNERS EXCELLENCE Key Points RAP Patient Status is always 30 Enteronline l page 2 of claim 0023 revenue code HIPPS code date of first billable visit
19. ECK HISTORY ENTER MENU SELECTION FI PLEASE ENTER DATA OR PRESS PF3 TO EXIT 38 ba Palmetto GBA 4 PARTNERS IN EXCELLENCE PROV XXXXXX NPI 0000000000 CHECK DATE AMOUNT EFTXXXXXXX 061103 1 083 81 EFTXXXXXXX 061031 9 922 96 EFTXXXXXXX 061027 5 911 01 PROCESS COMPLETED PLEASE CONTINUE PLEASE ENTER DATA OR PRESS PF3 TO EXIT ba Palmetto GBA 4 PARTNERS IN EXCELLENCE PROV XXXXXX NPI 0000000000 CHECK DATE AMOUNT 001531XXXX 061102 3 307 04 001531XXXX 061101 849 55 001530XXXX 061027 1 379 28 PROCESS COMPLETED PLEASE CONTINUE PLEASE ENTER DATA OR PRESS PF3 TO EXIT 4 PARTNERS IN EXCELLENCE MAP1702 PALMETTO GOVT BENEFITS ADMINISTRATORS INQUIRY MENU BENEFICIARY CWF 10 HCPC CODES DRG PRICER GROUPER 11 DX PROC CODES CLAIMS 12 ADJUSTMENT REASON CODES REVENUE CODES 13 REASON CODES CLAIM COUNT SUMMARY ANSI REASON CODES CHECK HISTORY ENTER MENU SELECTION 15 PLEASE ENTER DATA OR PRESS PF3 TO EXIT Palmetto GBA D PARTNERS IN EXCELLENCE 15 DX PROC CODES For incorrect ICD 9 Codes Enter the incorrect code and ENTER Correct codes will appear Select correct current code F5 or to view more codes 40 PARTNERS IN EXCELLENCE ba Palmetto GBA D STARTING ICD9 CODE V581 ICD9 CODE DESCRIPTION EFFECTIVE TERM DATE EFFECTIVE TERM DATE EFFECTIVE TERM DATE V581 MAINTENANCE CHEMOTHERAPY 030184 093090 V581 CHEMOTHERAPY ENCOUN
20. ELLENCE ba Palmetto GBA MEDICARE ONLINE SYSTEM CLAIM PAGE 03 UB92 CLAIM UPDATE 322 S LOC T B9997 PROVIDER xxxxxx OFFSITE ZIPCD ID PAYER OSCAR RI AB PRIOR PAY EST AMT DUE MEDICARE PROV TONE 0 00 0 00 0 00 0 00 0 00 0 00 DUE FROM PATIENT 0 00 0 00 MEDICAL RECORD NBR 000000000000000 COST RPT DAYS NON COST RPT DAYS DIAGNOSIS CODES 1 V5830 2 9190 3 45932 4 4280 5 72887 6 1302 7 8 9 ADMITTING DIAGNOSIS E CODE HOSPICE TERM ILL IND IDE PROCEDURE CODES AND DATES 1 3 4 5 ESRD HOURS 00 ADJUSTMENT REASON CODE REJECT CODE NONPAY CODE ATT PHYS DXXXXX XXXXXXXXXX LN XXXXXXX FN XXX MI OPR PHYS NPI 0000000000 LN FN MI OTH PHYS NPI 0000000000 LN FN MI 7A01 REASON CODES PRESS 7 PF8 NEXT PF9 UPDT Palmetto GBA 2 TW PARTNERS EXCELLENCE Sub Category SC top let corner of every claim page Think of it as a Short Cut Put your Cursor next to SC Type any 2 numbers from the Inquiries sub menu Enter F3 back to the claim You do NOT have to back out to the main menu and you have NOT lost your claim Palmetto GBA 2 TW PARTNERS EXCELLENCE Sub Category Especially useful when making corrections Example Reason code indicates wrong ICD 9 code Type 15 DX PROC Codes in SC and enter Find a correct ICD 9 code back to the claim Fix the diagnosis claim F9 t
21. EXCELLENCE ba Palmetto GBA D 1714 MEDICARE ONLINE SYSTEM CLAIM PAGE 04 sc CLAIM ADJUSTMENT REMARK PAGE 01 338 5 10 5 B0100 PROVIDER XXXXXX REMARKS CANCEL CLAIM WILL RESUBMIT WITH CORRECT SOC DATES 47 PACEMAKER 48 AMBULANCE 40 THERAPY 41 HOME HEALTH 58 HBP CLAIMS MED B E1 ESRD ATTACH ANSI CODES GROUP CO ADJ REASONS 92 APPEALS 01 PROCESS COMPLETED PLEASE CONTINUE PRESS PF5 SCROLL BKWD PF6 SCROLL FWD PF7 PREV PF8 NEXT PF9 UPDT 65 PARTNERS IN EXCELLENCE ba Palmetto GBA D Cancel Claims There are 3 Steps 1 Condition code on page 1 2 Adjustment reason code OT on page 3 3 Remarks on page 4 Do NOT change page 2 charges PARTNERS IN EXCELLENCE ba Palmetto GBA More About DDE 66 Palmetto GBA 3 TW LP PARTNERS IN EXCELLENCE More about DDE View a different page F8 forward Put cursor on claim page type page number desired press enter View outlier payment Value Code Field claim page one View medical review reason for denial Remarks screen claim page four Pametto GBA TW PARTNERS EXCELLENCE More about DDE View downcode Claim page 32 Change claim page to 32 press enter HIPPS code billed will be shown along with the downcoded HIPPS code resulting in payment 67 PARTNERS IN EXCELLENCE ba Palmetto GBA
22. IT DATE 073106 HR 00 TYPE SRC 1 D HM STAT 30 COND CODES 0 os 02 03 04 05 06 07 08 09 10 OCC CDS DATE 01 02 03 04 05 06 07 08 09 10 SPAN CODES DATES 01 02 04 05 06 08 09 10 DCN 20628603021405 01 VALUE CODES AMOUNTS ANSI MSP APP IND 01 61 50175 00 02 62 31 00 03 64 1828 31 04 05 06 07 08 09 PROCESS COMPLETED PLEASE CONTINUE PRESS PF5 SCROLL BKWD PF6 SCROLL FWD PF8 NEXT PF9 UPDT ba Palmetto GBA PARTNERS IN EXCELLENCE D Codes Acceptable Cancellation Condition Codes D5 Cancel to Correct HIC number or Provider number D6 Cancel to repay a Duplicate or Overpayment 64 PARTNERS IN EXCELLENCE ba Palmetto GBA D 1713 MEDICARE A ONLINE SYSTEM GLAIM PAGE 03 sc CLAIM ADJUSTMENT TOB 337 S LOC S B0100 PROVIDER XXXXXX OFFSITE ZIPCD cD ID PAYER OSCAR RI AB PRIOR PAY EST AMT DUE MEDICARE PROV Y Y 0 00 0 00 B 0 00 0 00 0 00 0 00 DUE FROM PATIENT 0 00 0 00 MEDICAL RECORD NBR 0000000000000000 COST RPT DAYS NON COST RPT DAYS DIAGNOSIS CODES 1 9190 2 45932 3 4280 4 72887 5 V1302 6 7 8 9 ADMITTING DIAGNOSIS E CODE HOSPICE TERM ILL IND IDE PROCEDURE CODES AND DATES 1 3 4 ESRD HOURS 00 ADJUSTMENT REASON CODE REJECT CODE NONPAY CODE ATT PHYS DXXXXX NPI 0000000000 FN BEN MI OPR PHYS NPI 0000000000 FN MI OTH PHYS NPI 0000000000 LN FN MI PROCESS COMPLETED PLEASE CONTINUE PRESS 7 PF8 NEXT PF9 UPDT PARTNERS IN
23. LEASE MAKE A SELECTION ENTER NEW KEY DATA OR PRESS PF3 TO EXIT 46 Palmetto GBA 98 S PARTNERS IN EXCELLENCE MEDICARE A ONLINE SYSTEM sc CLAIM SUMMARY INQUIRY NPI HIC OSCAR S LOC T B9997 TOB OPERATORID FROMDATE TODATE DDE SORT MEDICAL REVIEW SELECT HIC PROV MRN S LOC ADM DT DT THRU DT REC DT SEL LAST FIRST INIT TOT PROV REIMB PD DT CAN DT REAS NPC DAYS 5 B9997 322 100906 100906 100906 102506 NAME T 103006 C1273 TB9997 329 090504 082606 102406 102606 NAME T 758 03 103006 38107 TB9997 322 102706 102706 102706 103106 NAME T 110306 19203 XXXXXXXXXA XXXXXX B9997 322 082106 082106 082106 110206 NAME T 110606 31300 EXAMPLE OF OPTION 2 Pull up ALL T Claims Leave HIC blank Press Enter ALL T claims for your provider number will appear As you successfully correct and re submit a T claim it will disappear from this list PROCESS COMPLETED NO MORE DATA THIS TYPE PLEASE MAKE A SELECTION ENTER NEW KEY DATA OR PRESS PF3 TO EXIT PARTNERS IN EXCELLENCE ba Palmetto GBA 1711 MEDICARE ONLINE SYSTEM CLAIM PAGE 01 sc UB92 CLAIM UPDATE SV TOB 322 S LOC T B9997 OSCAR PROV FORM NPI 0000000000 TRANS HOSP PROV PROCESS NEW HIC PATIENT CONTROL NBR 000000000000000 FED TAX NO 000000000 TAX SUB STMT DATES FROM 092906 TO 0
24. MI PROCESS COMPLETED PLEASE CONTINUE PRESS PF3 EXIT PF7 PREV PF8 NEXT PF9 UPDT ba Palmetto GBA PARTNERS IN EXCELLENCE MAP1714 MEDICARE A ONLINE SYSTEM CLAIM PAGE 04 sc CLAIM ADJUSTMENT REMARK PAGE 01 337 5 10 5 B0100 PROVIDER XXXXXX REMARKS ADJUSTING CLAIM TO ADD NURSING VISIT ON 9 24 06 47 PACEMAKER 48 AMBULANCE 40 THERAPY 41 HOME HEALTH 58 HBP CLAIMS MED B E1 ESRD ATTACH ANSI CODES GROUP ADJ REASONS 92 APPEALS 01 PROCESS COMPLETED PLEASE CONTINUE PRESS PF5 SCROLL BKWD PF6 SCROLL FWD PF7 PREV PF8 NEXT PF9 UPDT ba Palmetto GBA PARTNERS IN EXCELLENCE Cancellations 61 Palmetto GBA PARTNERS IN EXCELLENCE PALMETTO GOVT BENEFITS ADMINISTRATORS ENTER MENU SELECTION 03 MAIN MENU FOR REGION A6504A7P INQUIRIES CLAIMS ATTACHMENTS CLAIMS CORRECTION ON LINE REPORTS VIEW PLEASE ENTER DATA OR PRESS PF3 TO EXIT ba Palmetto GBA PARTNERS IN EXCELLENCE CLAIMS CORRECTION INPATIENT OUTPATIENT SNF HOME HEALT HOSPICE INPATIENT OUTPATIENT SNF HOME HEALT HOSPICE ATT PACEMAKER AMBULANCE THERAPY HOME HEALT ENTER MENU SELECTION 53 21 23 25 H 27 29 CLAIM ADJUSTMENTS CANCELS 30 50 31 51 32 52 H 33 53 35 55 ACHMENTS 42 43 44 45 PLEASE ENTER DATA OR PRESS PF3 TO EXIT 62 PARTNERS IN EXCELLENCE ba Palmetto GBA SU MAP1741 MED I C ABRE A ONLINE S YS TEM s
25. NCE Now What F9 the claim once you are completely finished with your corrections Process Complete corrected claim has returned to Palmetto GBA If claim does NOT transmit Check reason codes bottom left of claim Repeat corrections process F9 again 52 PARTNERS IN EXCELLENCE ba Palmetto GBA Corrections Summary Select 02 Corrections from main menu Select 27 Home Health T B9997 will appear in the S LOC field Either enter one Medicare number OR leave HICN field blank Leaving the HIC field blank allows you to pull up ALL claims in the T status for your provider number PARTNERS IN EXCELLENCE ba Palmetto GBA Corrections Summary Make sure PTAN NPI is present Tab over to TOB and hit the delete key 3 times Enter Tab down and type an S next to the claim you want to select and correct Make the correction s ba Palmetto GBA D PARTNERS IN EXCELLENCE Corrections Summary Once the correction s is made F9 to update If the claim is fixed it will go You will now be able to enter another Medicare number OR select the next claim in T status that needs corrected If the claim is not fixed you will be given more reason codes PARTNERS IN EXCELLENCE ba Palmetto GBA Correcting a wrong HIC on an RTP CATS CENTERS for MEDICARE amp MEDICAID SERVICES 2008 Palmetto GBA 54 ba Palmetto GBA PARTNERS IN EXCELLENCE
26. OES NOT EXIST ONE OF THE FOLLOWING FIELDS ON THE FINAL TOB 329 OR 339 DO NOT MATCH TO THE RAP 1 STATEMENT FROM DATE 2 ADMISSION DATE 3 HIPPS CODE 4 LINE ITEM DATE FOR THE HIPPS CODE 0023 REVENUE LINE DATE 5 PROVIDER NUMBER OR AN 81A OR 812 HAS BEEN SUBMITTED AND THE ADMISSION DATE AND THE PROVIDER NUMBER MATCHES AN 81A OR 82A ALREADY PRESENT ON THE SUMMARY FILE PROCESS COMPLETED NO MORE DATA THIS TYPE PRESS PF6 SCROLL FWD PF8 NEXT 42 TES 7 k Im EZ PARTNERS IN EXCELLENCE MAP1702 PALMETTO GBA INQUIRY MENU BENEFICIARY CWF 10 HCPC CODES DRG PRICER GROUPER DX PROC CODES 15 CLAIMS ADJUSTMENT REASON CODES 16 REVENUE CODES REASON CODES 17 CLAIM COUNT SUMMARY ANSI REASON CODES 68 CHECK HISTORY ZIP CODE FILE 19 ENTER MENU SELECTION 68 PLEASE ENTER DATA OR PRESS PF3 TO EXIT TES 7 EZ PARTNERS IN EXCELLENCE ANSI Reason Codes American National Standards Institute These codes are found on your remittance advice Youcan press enter and it will show all ANSI reason codes if you are not looking for a specific one 43 PARTNERS IN EXCELLENCE ba Palmetto GBA 1581 M EID O NL ENE SY STEM SC ANSI STANDARD CODES INQUIRY SELECTION SCREEN ECORD TYPE C ADJ REASONS G GROUPS R REMARKS APPEALS TANDARD CODE T CLAIM CATEGORY 5 CLAIM STATUS RT CODE NARRATIVE 0 PATIENT REFUND AMOUNT AI CLAIM DENIED CHARGES
27. PARTNERS IN EXCELLENCE ba Palmetto GBA D How to retrieve the handout for this presentation Select Catalog from the top menu Select Part A Home Health Hospice under the Category heading Locate the handout same name as the course Place a checkmark next to the handout and click Add to My Learning Select My Learning from the top menu Locate the file Click Start PARTNERS IN EXCELLENCE ba Palmetto GBA Direct Data Entry Home Health CATS CENTERS for MEDICARE amp MEDICAID SERVICES 2008 Palmetto GBA PARTNERS IN EXCELLENCE ba Palmetto GBA Agenda Why use Direct Data Entry References Eligibility Understanding DDE Basics Claim Entry PARTNERS IN EXCELLENCE ba Palmetto GBA Agenda Status and Location Claims Inquiries Corrections Adjustments Cancels More About DDE PARTNERS IN EXCELLENCE ba Palmetto GBA SU Why Use Direct Data Entry PARTNERS IN EXCELLENCE ba Palmetto GBA Direct Data Entry Enter and Submit Claims Correct Adjust and Cancel Claims Inquire about Beneficiary Information Eligibility Home Health Episode Information Page 3 of HIQH PARTNERS IN EXCELLENCE ba Palmetto GBA Direct Data Entry Other Possible Insurances HMO and MSP and or HIOA Track claims for payment errors ADR s View outlier payments View downcodes and reason for medical review denials PARTNERS IN EXCELLENCE ba Pal
28. R END PF8 NEXT PARTNERS IN EXCELLENCE ba Palmetto GBA SU HIQHCOP HOME HEALTH BENEFIT PERIOD PAGE 02 OF 07 HH REC CN XXXXXXXXXA NM IT I DB MMDDYYYY SX M SPELL QUALIFYING PARTA VISITS EARLIEST LATEST PARTB VISITS NUM IND REMAINING BILLING BILLING APPLIED 02 0 0 03 21 2006 04 18 2006 SALITA 01 0 0 11 20 2005 11 29 2005 5 PF1 INQ SCREEN PF3 CLEAR END PF7 PREV PF8 NEXT PARTNERS IN EXCELLENCE ba Palmetto GBA HIQHCOP HOME HEALTH PPS EPISODE PERIODS PAGE 03 OF 07 HH REC CN XXXXXXXXXA NM I DB MMDDYYYY SX START END INTER PROV DOEBA DOLBA DATE DATE NUM NUM STAT 06 01 2007 07 30 2007 00380 Prov 06 01 2007 07 28 2007 01 0 09 01 2007 10 30 2007 00380 PROV 09 01 2007 10 16 2007 01 0 Cancel Indicator 1 Normal Processing 2 Auto cancel of Rap 3 Full episode denial by medical review PF1 INQ SCREEN PF3 CLEAR END PF7 PREV PF8 NEXT 10 ba Palmetto GBA PARTNERS IN EXCELLENCE HIQHCOP MSP PERIODS MSP REC CN XXXXXXXXXA NM ITM DB DDMMYYYY REC MSP DESCRIPTION EFF DATE TRM DATE INTER 001 L LIABILITY 07 13 2001 01 07 2004 11110 PF1 INQ SCREEN PF3 CLEAR END PF7 PREV PF8 NEXT PAGE 04 OF 07 SX M DOA 06 06 2002 ba Palmetto GBA PARTNERS IN EXCELLENCE HIQHCOP HMO PERIODS HMO REC CN XXXXXXXXXA NM ITR DB DDMMYYYY PLAN OPT EFF DATE TRM DATE H1036 03 01 98 01 31 00 1036 01 01 94 07 31 97 PF1 INQ SCREEN PF3 CLEAR END PF7 PREV PF8 NEXT PAGE 05 OF 07 SX F
29. RS INQUIRY MENU SUB MENU BENEFICIARY CWF 10 HCPC CODES DRG PRICER GROUPER DX PROC CODES CLAIMS ADJUSTMENT REASON CODES REVENUE CODES REASON CODES CLAIM COUNT SUMMARY ANSI REASON CODES CHECK HISTORY ENTER MENU SELECTION 56 PLEASE ENTER DATA OR PRESS PF3 TO EXIT PARTNERS IN EXCELLENCE ha Palmetto GBA 2 2 PROVIDER LOC CAT NPI S LOC CAT CLAIM COUNT TOTAL CHARGES TOTAL PAYMENT 46 71 451 18 795 34 00 1 985 58 7 925 18 795 3 450 4 475 1 725 1 725 00 6 925 B9996 B9996 B9996 B9996 90 1 90 1 9000 9000 9000 9000 6 925 B9099 4 050 B9099 4 050 B9997 50 826 B9997 B9997 826 77 PROCESS COMPLETED PLEASE CONTINUE PLEASE MAKE A SELECTION ENTER NEW KEY DATA PRESS PF3 EXIT PF6 SCROLL FWD 4 N N N Q Q 0 Palmetto GBA 3 TW PARTNERS IN EXCELLENCE Categories Grand Total of all categories all S LOC TC Total Count within each Status Loc AD Adjustments within each Status Loc Medical Policy RTPs where first digit of the primary reason code is a 5 NM Non Medical RTPs where first digit of the primary reason code is NOT a 5 TANE GBA x LE PARTNERS IN EXCELLENCE INQUIRY MENU BENEFICIARY CWF 10 HCPC CODES DRG PRICER GROUPER DX PROC CODES CLAIMS ADJUSTMENT REASON CODES REVENUE CODES REASON CODES CLAIM COUNT SUMMARY ANSI REASON CODES CH
30. TER 100190 093005 V5811 ANTINEOPLASTIC CHEMO ENC 100105 093007 V5812 IMMUNOTHERAPY ENCOUNTER 100105 093007 V582 BLOOD TRANSFUSION NO DX 030184 093007 V583 ATTEN SURG DRESSNG SUTUR 030184 093006 V5830 ATTN REM NONSURG DRESSNG 100106 093007 V5831 ATTN REM SURG DRESSING 100106 093007 PLEASE MAKE A SELECTION ENTER NEW KEY DATA PRESS PF6 SCROLL FWD Palmetto GBA 5 S PARTNERS IN EXCELLENCE MAP1702 PALMETTO GBA 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 CHECK HISTORY FI ZIP CODE FILE ENTER MENU SELECTION 17 PLEASE ENTER DATA OR PRESS PF3 TO EXIT Palmetto GBA TW LE PARTNERS IN EXCELLENCE MAP1881 MEDICARE AJ ONLINE SYSTEM OP SC REASON CODES INQUIRY DT PLAN REAS NARR MSN EEE TERM EMC HC PRO PP cc IND CODE TYPE DATE REAS DATE DATE ST LOC ST LOC LOC IND 1 38107 B HD CPY A B NB ADR CAL DY NARRATIVE PLEASE ENTER DATA OR PRESS PF3 TO EXIT Palmetto GBA 8 PARTNERS EXCELLENCE MAP1881 MEDICARE ONLINE SYSTEM OP UBD4 5 REASON CODES INQUIRY DT 050906 PLAN REAS NARR EFF MSN EFF TERM EMC HC PRO PP cc IND CODE TYPE DATE REAS DATE DATE ST LOC ST LOC LOC IND 1 38107 E 030194 S MMIL2 S MMIL2 B B HD CPY A B NB ADR CAL DY C L C NARRATIVE A HH FINAL TOB 329 OR 339 IS BEING PROCESSED AND A HH RAP TOB 322 OR 332 D
31. Y INQUIRY NPI HIC PROVIDER LOC TOB OPERATOR ID XXXXXXXX FROM DATE TO DATE DDE SORT MEDICAL REVIEW SELECT HIC PROV MRN S LOC ADM DT FRM DT THRU DT DT SEL LAST NAME FIRST INIT TOT CHG PROV REIMB PD DT CAN DT REAS NPC DAYS PLEASE ENTER DATA OR PRESS PF3 TO EXIT PRESS PF3 EXIT PF5 SCROLL BKWD PF6 SCROLL FWD 34 PARTNERS IN EXCELLENCE ba Palmetto GBA D 1741 MEDICARE ONLINE SYSTEM sc CLAIM SUMMARY INQUIRY NPI HIC PROVIDER Number S LOC T B9997 OPERATOR ID XXXXXX FROM DATE 010106 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 XXXXXXXXXA T 9997 322 100906 100906 100906 102506 B 103006 07273 XXXXXXXXXA B9997 329 090504 082606 102406 102606 758 03 103006 38107 T 9997 322 102706 102706 102706 103106 110306 19203 B9997 322 082106 082106 082106 110206 110606 31300 PROCESS COMPLETED NO DATA THIS PLEASE MAKE A SELECTION ENTER NEW KEY DATA OR PRESS TO EXIT Palmetto GBA Tw w PARTNERS IN EXCELLENCE MAP1711 MEDICARE DO NL SY STEM CLAIM PAGE 01 sc CLAIM INQUIRY Sv HIC 329 S LOC P B9997 OSCAR PROV UB FORM NPI XXXXXXXXXX TRANS HOSP PROV PROCESS NEW HIC PATIENT CONTROL
32. c CLAIM SUMMARY INQUIRY NPI PROVIDER XXXXXX S LOC P 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 PLEASE ENTER DATA OR PRESS PF3 TO EXIT PRESS PF5 SCROLL BKWD PF6 SCROLL FWD PARTNERS IN EXCELLENCE ba Palmetto GBA 1741 MEDICARE ONLINE SYSTEM sc CLAIM SUMMARY INQUIRY NPI PROVIDER XXXXXX S LOC P TOB 328 OPERATOR ID FROM DATE TO DATE DDE SORT MEDICAL REVIEW SELECT HIC PROV MRN S LOC ADM DT FRM DT THRU DT REC DT SEL LAST NAME FIRST INIT TOT CHG PROV REIMB PD DT CAN DT REAS NPC DAYS 5 P B9997 339 073106 073106 092806 101206 2813 09 1828 31 102406 37186 PROCESS COMPLETED NO MORE DATA THIS TYPE PLEASE MAKE A SELECTION ENTER NEW KEY DATA OR PRESS TO EXIT 63 ba Palmetto GBA PARTNERS IN EXCELLENCE MAP1711 ONLINE SY CLAIM PAGE 01 SC CLAIM ADJUSTMENT SV TOB 338 S LOC 5 B0100 OSCAR PROV UB FORM NPI 0000000000 TRANS HOSP PROV PROCESS NEW HIC PATIENT CONTROL NBR 000000000000000 FED TAX NO 000000000 TAX SUB STMT DATES FROM 073106 TO 092806 DAYS COV 031 N C co LTR LAST DOE FIRST JOHN MI F DOB MMDDYYYY ADDR 1 34650 US HWY 19N 2 PALM HARBOR FL 3 4 5 6 ZIP 346833670 S S ADM
33. metto GBA References Palmetto GBA 3 TW PARTNERS EXCELLENCE DDE Manual www palmettogba com Select Manuals Select Direct Data Entry DDE User s Manual for Medicare Part A Sign on instructions Connectivity Issues EDI Help Desk 1 866 749 4301 Palmetto GBA 3 TW PARTNERS EXCELLENCE Home Health PPS and Billing Instructions www cms hhs gov manuals Select Internet Only Manuals Medicare Claims Processing Manual CMS Pub 100 04 Ch 10 Medicare Claims Processing Manual CMS Pub 100 04 Ch 25 PARTNERS IN EXCELLENCE ba Palmetto GBA 98 Eligibility ba Palmetto GBA uw PARTNERS EXCELLENCE Health Insurance Query for Home Health PARTNERS IN EXCELLENCE ba Palmetto GBA SU HIQH CWF Part A Inquiry Screens At sign on type HIQA and Enter The CWF Part A Inquiry screen will display PARTNERS IN EXCELLENCE ba Palmetto GBA DFHCE3549 Sign on is complete Language E Palmetto GBA 3 TW LP S PARTNERS IN EXCELLENCE CWF PART A INQUIRY RESPONSE CODE C CLAIM NUMBER SURNAME INITIAL DATE OF BIRTH SEX CODE REQUESTOR ID PRINTER DEST INTER NO a NPI INDICATOR N NPI or Blank PROVIDER NO a HOST ID GL GW KS MA PA NE SE SO SW APP DATE REASON CODE Palmetto GBA
34. ned by the provider Supply 0270 and 0623 Total charge for each SERV DT Date of Service for that visit line Supply 0270 and 0623 Any date between the From and To dates on the claim PARTNERS IN EXCELLENCE ba Palmetto GBA Need more then 14 lines F6 to a new page 5 and continue with line item billing On the last page last line put revenue code 0001 and total of columns 23 Palmetto GBA PARTNERS EXCELLENCE MAP1713 MEDICARE A ONLINE SYSTEM CLAIM PAGE 03 C UB04 CLAIM UPDATE HIC XXXXXXXXXA S LOC S B0100 PROVIDER XXXXXXXXXX OFFSITE ZIPCD CD ID PAYER OSCAR RI AB PRIOR PAY EST AMT DUE z MEDICARE XXXXXX Y Y DUE FROM PATIENT 0 00 MEDICAL RECORD NBR COST RPT DAYS NON COST RPT DAYS DIAGNOSIS CODES 1 3 4 5 6 8 9 END OF POA IND ADMITTING DIAGNOSIS HOSPICE TERM ILL IND IDE PROCEDURE CODES AND DATES 1 3 4 5 ESRD HOURS 00 ADJUSTMENT REASON CODE REJECT CODE NONPAY CODE ATT PHYS FXXXXX NPI XXXXXXXXXX LN XXXXXXXX FN XXX MI OPR PHYS NPI 0000000000 LN MI OTH PHYS NPI 0000000000 LN X FN X MI lt REASON CODES PRESS PF3 EXIT PF7 PREV PF8 NEXT PF9 UPDT Palmetto GBA 8 PARTNERS EXCELLENCE Page 3 Required Field Locators Line A Primary Payer CD 2 Payer Medicare OSCAR Provider Legacy PTAN RI AB Release of Information Certification Indicator Enter Y under RI and AB Diagnosis Codes No decimal point
35. o send the claim 50 Palmetto GBA PARTNERS IN EXCELLENCE MAP1712 MEDICARE A ONLINE SYSTEM CLAIM PAGE 02 sc UB92 CLAIM INQUIRY REV CD PAGE 01 TOB 329 S LOC T B9997 PROVIDER TOT REV HCPC MODIFS RATE UNIT UNIT TOT CHARGE NCOV CHARGE SERV DT 0023 HBGJ1 00060 00060 1822 18 101206 0550 G0154 00004 00004 150 00 101206 0550 G0154 00004 00004 150 00 101606 0550 G0154 00004 00004 150 00 101806 0550 G0154 00004 00004 150 00 102006 0550 G0154 00004 00004 150 00 102406 0550 G0154 00004 00004 150 00 102606 0570 G0156 00004 00004 150 00 101406 0570 G0156 00004 00004 150 00 101606 0570 G0156 00004 00004 150 00 101806 0570 G0156 00004 00004 150 00 102006 0570 G0156 00004 00004 150 00 102306 0570 G0156 00004 00004 150 00 102506 0001 1800 00 7186 lt REASON CODES PRESS PF2 171D PF5 UP PF6 DOWN PF7 PREV PF8 NEXT PF11 RIGHT MAKE CORRECTIONS Palmetto GBA PARTNERS IN EXCELLENCE Correcting Line Items page 2 of claim Remove a line Enter 4 d s in revenue code line Example 0551 change to dddd HIT HOME do not enter Addaline Go to next available line and type in correct line HIT HOME do not enter 51 Palmetto GBA 2 TW LP S PARTNERS IN EXCELLENCE Correcting Line Items Total Line Don t forget the total line may need to be removed and then re entered Palmetto GBA 2 PARTNERS EXCELLE
36. or cannot do to the claim Alerts you to delays in reimbursement Description of all status and location codes may be found on Page 3 of DDE Manual Pametto GBA 7 EZ PARTNERS IN EXCELLENCE Status Location Example S LOC T B9997 First Position is Claims Current Status T status Claim needs corrections Second Position is the Claim Processing Type claim is electronic M claim is manual Medical review may be processing The Third and Fourth Positions are the Location of the Claim in Last Two Positions are For Additional Location Information 30 Palmetto GBA 3 TW LP PARTNERS EXCELLENCE Status Descriptions S status means the claim is still in process no provider intervention can be made ALLincoming claims first go to the S status Cycling in CWF In medical review Wait for the claim to move to another status Do NOT send another claim Know how long the claim stays in S status Palmetto GBA 3 TW PARTNERS EXCELLENCE Status Descriptions P status means the claim is completely processed Claim can be adjusted or cancelled Auto cancelled RAP TOB 328 can be re submitted D status means the claim is completely processed and denied by medical review Can NOT be adjusted or cancelled CAN be appealed 31 PARTNERS IN EXCELLENCE ba Palmetto GBA Status Descriptions
37. s ATT PHYS NPI Last and First Name OTH PHYS NPI Last and First Name 24 Palmetto GBA uj 98 PARTNERS IN EXCELLENCE MAPnnnn MEDICARE A ONLINE SYSTEM CLAIM PAGE 04 xx CLAIM ENTRY REMARKPAGE 01 HIC S LOCS PROVIDER REMARKS ZIP Used by provider Communication to Palmetto GBA for anything unusual that you want the claims department to know such as MSP insurance information Reason for adjustment or cancel claim Used by Palmetto GBA You may receive very important information from the claims department which may assist in the processing of your claim Medical Review denial reason 47 PACEMAKER 48 AMBULANCE 40 THERAPY 41 HOME HEALTH 58 HBP CLAIMS MED B El ESRD ATTACH ANSICODES GROUP APPEALS lt REASON CODES PRESS PF3 EXIT PF5 SCROLL BKWD PF6 SCROLL FWD PF7 PREV PF8 NEXT PF9 UPDT PARTNERS IN EXCELLENCE ba Palmetto GBA MEDIGARE A ONLINE SYSTEM CLAIM PAGE 05 CLAIM ENTRY PROVIDER XXXXXXXXXX DOB INS GROUP NUMBER MAPnnnn sc TOB 329 S LOC 5 INSURED NAME REL CERT SSN HIC SEX GROUP NAME TREAT AUTH CODE XXXXXXXXXXXXXXXXXX TREAT AUTH CODE TREAT AUTH CODE lt REASON CODES PRESS PF3 EXIT PF7 PREV PF8 NEXT PF9 UPDT Palmetto GBA L Im EZ PARTNERS IN EXCELLENCE MAPnnnn MEDICARE A ONLINE SYSTEM CLAIM PAGE 06 CLAIM ENTRY HIC S LOCS PROVIDER MSP ADDITIONAL INSURER INFORMATION 1ST INSURERS A
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