You can set regional and other user-specific options that do not apply to all users. Follow the instructions below.
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To configure the program options, select Setup  Specific Options in the main menu.
The "Specific Options" menu |
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The following screen will appear.
The "Specific Options" window |
| 3. |
You can enable/disable the following options: |
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Do not use calculated Values in Claim Forms — The HIPAA Claim Master calculates the Open Amount from charges minus previous payments and patient paid amounts and some other values. If you prefer not to do this, check this option. |
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Export POA and ICD Version information with Diagnosis Codes, separated by a colon — You can opt out of writing POA and ICD version information to the database. The default is now to write this information to the database. This option changed. The default behavior is required to create valid claims. |
Present on Admission (POA) information is now often required by insurers to exclude "hospital infections" from coverage. These are diseases that are acquired by the patient after admission to the hospital and often cause high costs and even death. In the SQL export the POA codes are colon separated from the diagnosis codes. If this causes problems, you can deselect this here. With the introduction of ICD-10 it is important to save the version of ICD codes that are in the claim to the database. Since it is intrinsically linked to the Diagnosis code we decided against creating another set of fields. It would mean creating another 80 or so fields for POA and ICD version. Instead we opted to concatenate the ICD version qualifier and the POA indicator with Diagnosis Code qualifier separated by a colon (:)
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Principal Diagnosis Code has POA and ICD version. Example: |
Z77.22:Y:ABK with the diagnosis code in first position, followed by the POA indicator 'Y' and the ICD-10 qualifier
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Other Diagnosis Code has POA and ICD version. same as above |
Example: J151::ABF Here the POA code is committed
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E-Codes also have both POA and ICD version, same as above |
Example E8600:Y:ABN
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Admit Diagnosis Code has no POA info. By definition is the diagnosis code under which a patient was admitted present at admission. |
Example L01.03:ABJ Only the ICD version qualifier is added to the diagnosis code
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Reason for Visit codes have no POA info. Same as Admit diagnosis |
This way of connecting diagnosis information with POA and ICD codes is bi-directional, meaning if you create 837 files from database, then the above example is the way to do it. Internally HIPAA Claim Master will parse out the information and assemble the respective HI segment within all applicable rules.
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Display Drug Information with accordance with Medical NDC reporting requirements (CMS-1500: in box 24A, UB-04: in box 43) — The Medi-Cal NDC reporting requirement is concerned with the transmission of drug data that belongs to a specific procedure. In the 837, this information is in the LIN and CPT segments of the 2400 loop. Here the display of NDC in the CMS-1500:
The NDC code is in the upper half of field 24 A. The quantity in 24 D.
The format for the quantity is a full 10-digit number. The 10 digits consist of seven digits for the whole number, followed by the three-digit decimal portion of the number. In the example above line 1 indicates 20 milliliter, line 2 1000 units, line 3 250 milliliter and line 4 10 grams.
The NDC information in the UB04 form
In the UB04 the NDC information goes into the "Description" field 43 as one string with quantities in the same format as in the CMS-1500. |
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CMS-1500: Display line remarks (NTE*ADD) in 24D (overrides description) |
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CMS-1500: Do not display Pay-To Provider information in Box 33 - When a Pay-To provider is specified in loop 2010AB, the address information is usually displayed in box 33. |
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CMS-1500: Copy Billing Provider to Facility if not specified; box 33 to 32 |
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CMS-1500: Populate line providers only if different from claim level - Display cleaned up in EDI files where the rendering provider is repeated on every line. |
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UB 04: Show description of Procedure Code (Revenue code is default) |
Field locator 43 will be populated with the procedure code description in case such code is in SV2 segment
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Use Facsimile Mode in UB 04 and CMS-1500 - For the purists, this mode strives to make the claim look like it has been filled with a Dot-Matrix printer. More here. |
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Once you have finished editing the options, click "Save." |
