P2.7.8^7.8. SENDING ELECTRONIC CLAIM ATTACHMENTS^237^240^,,^8150^8271%
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.
The EDI Report section contains three boxes:
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
|EB||Explanation of benefits (coordination of benefits or Medicare secondary payer)|
|OZ||Support data for claim|
|PN||Physician therapy notes|
|PO||Prosthetics or orthotic certification|
|PZ||Physical therapy certification|
|RT||Report of tests and analysis report|
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.|
|EL||Electronically only. Used to indicate that the attachment is being transmitted in a separate X12 functional group.|
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.
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.
After completing all the exercises in the chapter, answer the following questions in the spaces provided.
LO 7.5 What transactions are listed on Lawana Brooks's insurance claim?
LO 7.5 What transactions are listed on Lisa Wright's insurance claim?