November 2005 Newsletter
How Attached Are You to Your Claims?
By:
, EDI Project Leader
Report type codes
| Code |
Description |
| 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 |
Physical Therapy Notes |
| PO |
Prosthetics or Orthotic Certification |
| PZ |
Physical Therapy Certification |
| RB |
Radiology Films |
| RR |
Radiology Reports |
| RT |
Report of Tests and Analysis Report |
Report transmission codes
| Code |
Description |
| AA |
Available on Request at Provider Site |
| BM |
By Mail |
| EL |
Electronically Only (This will be used once attachment segments have been finalized) |
| EM |
By e-mail |
| FX |
By Fax |
|
There has been some confusion lately about the topic of attachments on UB-92 claims and how to report them electronically to the payers correctly. Technically, sending a complete attachment that might contain a patient’s medical record history is currently not possible. Standardized HIPAA ANSI transactions are currently being reviewed by the Centers for Medicare and Medicaid Services (CMS), the X12 Group, and members of the health care community to finalize a specification for the health care industry.
However, what you can currently do is enter coded information on the UB-92 that will be interpreted by Quadax and sent to the payer. This additional information will indicate how you will be sending attachment information. Attachment information or information that notifies a payer about the availability of an attachment can currently be sent through standard mail, e-mail, or as a faxed document. Some payers will only accept attachments sent in a certain manner, so be sure to check with the payer in question to determine the appropriate transmission method.
By entering the information listed below, on the fourth line of Block 84 (Remarks), Quadax will generate what is known as the PWK (Paperwork) segment in the ANSI 837 output, along with the claim. This segment tells the payer how the attachment information will be sent as a subsequent submission to the actual claim.
The format and coding is as follows (starting in the first position of Line 4 of Remarks):
| Contents |
Positions |
| PWK Segment |
1-4 |
| Report Type Code* |
5-6 |
| Report Transmission Code* |
7-8 |
| Attachment Control Number |
9-28 |
See a listing of valid codes at the right.
It is important to make sure that the Attachment Control Number is printed clearly on the Attachment(s) that you send to the payer. They will use this unique number to match the hard copy attachment (sent by you or printed out by the payer, in the case of e-mail or faxes) to the incoming electronic claim. In most cases, the payer will pend the claim until the attachment documentation is received so that they may adjudicate the claim appropriately. Once new ANSI 837 segments have been finalized, Quadax will be at the forefront of implementing the ability to electronically send the full attachment along with the claim.
|
