P2.7.8^7.8. SENDING ELECTRONIC CLAIM ATTACHMENTS^237^240^,,^8150^8271%
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7.8
SENDING ELECTRONIC CLAIM ATTACHMENTS

When a claim is sent electronically, an attachment that needs to accompany the claim, such as radiology films, must be referred to in the claim. In Medisoft, the EDI Report area within the Diagnosis tab of the Case dialog box is used to indicate to the payer when an attachment will accompany the claim and how the attachment will be transmitted (see Figure 7-22).

The EDI Notes box can be used for entering extra information for procedures and diagnoses that might be required by the patient's insurance carriers to process the electronic claim.

Figure 7-22
Diagnosis Tab with EDI Notes and EDI Report Fields Highlighted
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The EDI Report section contains three boxes:

  1. Report Type Code This box is used to record the report type code—a two-digit code that indicates the type of report being attached. For example, DG is the code for a diagnostic report. Other codes include

    77 Support data for verification. REFERRAL: use this code to indicate a completed referral form

    AS Admission summary
    B2 Prescription
    B3 Physician order
    B4 Referral form
    CT Certification
    DA Dental models
    DG Diagnostic report
    DS Discharge summary
    EB Explanation of benefits (coordination of benefits or Medicare secondary payer)
    MT Models
    NN Nursing notes
    OB Operative note
    OZ Support data for claim
    PN Physician therapy notes
    PO Prosthetics or orthotic certification
    PZ Physical therapy certification
    RB Radiology films
    RR Radiology reports
    RT Report of tests and analysis report
  2. Report Transmission Code This box is used to record the report transmission code, a two-character code that indicates the means by which the report will be transmitted to the payer (for example, via mail, e-mail, or fax). Possible codes include

    AA Available on request at provider site. This means that the paperwork is not being sent with the claim at this time. Instead, it is available to the payer (or appropriate entity) at its request.
    BM By mail
    EL Electronically only. Used to indicate that the attachment is being transmitted in a separate X12 functional group.
    EM E-mail
    FX By fax
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  4. Attachment Control Number This box contains the attachment's reference number (up to seven digits, assigned by the practice). This number is required if the transmission code is anything other than AA.

APPLYING YOUR SKILLS
4: REVIEWING CLAIMS

November 4, 2016

Using the List Only … feature, identify all claims for the insurance carrier EastOhio PPO. (Note: Do not include claims with a status of Done.)

Remember to create a backup of your work before exiting Medisoft! To help you keep track of your work, name the backup file after the chapter you are working on, for example, StudentID-c7.mbk.

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CHAPTER 7 WORKSHEET

Name: Date:

After completing all the exercises in the chapter, answer the following questions in the spaces provided.

  1. LO 7.3 Claims were created for which patients in Exercise 7-1?

  2. LO 7.6 After completing Exercise 7-1, what was listed in the Status 1 column for the claims created?

  3. LO 7.5 What transactions are listed on Lawana Brooks's insurance claim?

  4. LO 7.6 After completing Exercise 7-4, what is listed in the Status 1 column for the claims for John Fitzwilliams and Elizabeth Jones?

  5. LO 7.5 What transactions are listed on Lisa Wright's insurance claim?