hipaa 5010 changes to the integrated system - lacdmh

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HIPAA 5010 Changes to theIntegrated System

Client Information – Contact Tab

Outpatient – Service, Claim and Other Payer

Day Treatment – Service, Claim, and Other Payer

Inpatient – Admission, Service, Claim and OtherPayer

Edit Messages – Outpatient, Day Treatment andInpatient

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Client Information/Contact Tab

If the ZIP Code is NOT 5 digitsor numeric the following editmessage will be displayed.

ZIP now allowsfor 9-digits

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Outpatient Service

New field that allowsuser to indicate IF thePatient Signature wasNot available when theservice was provided.

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Outpatient Service Cont.

Required check boxindicating that theProvider Signature ison file.

Edit message will displayif check box for ProviderSignature on file is NOTchecked.

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Outpatient Claim – DO onlyService Facility Address is required forMedicare & Medi-Medi claims whenPlace of Service (POS):• POS = Home & Client = Homeless, or• POS ≠ Home & POS ≠ Office.

If Service FacilityAddress is NOTentered the followingedit message displays.

Edit messageif 9 digit ZIPNOT entered.

ZIP code mustbe 9-digits

If the 4 digit extensionis unknown use ‘9998’

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Outpatient Claim – Other Payer

For every ‘Other Insurance’ payeron the claim the sequential orderof responsibility must be entered.

If the responsibility order for each OtherInsurance payer specified in the claim isNOT in sequence, or is duplicated, thisedit message displays.

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Outpatient Claim – OtherPayer Cont.

Insurance Type Code is requiredon Claims when Other Insurance,Medicare and Medi-Cal are payersin the claim, making Medicare thesecondary payer.

When Medicare is a secondaryPayer; if Insurance Type Code isNOT indicated this edit messagedisplays on the Claim screen.

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Day Treatment Service

New field that allowsuser to indicate if thePatient Signaturewas NOT availablefor the service.

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Day Treatment Service Cont.

Edit message will displayif check box for ProviderSignature on file is notchecked.

Required check boxindicating that theProvider Signature ison file.

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Day Treatment – DO Only

Service Facility Address is requiredfor Medicare & Medi-Medi claims whenPlace of Service (POS):• POS = Home & Client = Homeless, or• POS ≠ Home & POS ≠ Office.

If Service FacilityAddress is NOTentered thefollowing editmessage displays.

ZIP code mustbe 9-digits

Edit messageif 9-digit ZIPNOT entered.

If the 4 digit extensionis unknown use ‘9998’Do NOT fill field withzeros.

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Day Treatment – Other Payer

For every ‘Other Insurance’ payeron the claim the sequential orderof responsibility must be entered.

If the responsibility order for each OtherInsurance payer specified in the claim isNOT in sequence, or is duplicated, thisedit message displays.

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Day Treatment – Other Payer

When Medicare is a secondaryPayer; if Insurance Type Code isNOT indicated this edit messagedisplays on the Claim screen.

Insurance Type Code is requiredon Claims when Other Insurance,Medicare and Medi-Cal are payersin the claim, making Medicare thesecondary payer.

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Inpatient Admission

New for InpatientAdmission. ThePoint of Originfield and it’srequired!

If Point of Origin forAdmission is NOTselected for theepisode this editmessage displays.

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Inpatient Service

Field was “Place ofService”, now it’s theFacility Type Code.

Edit message will displayif you do NOT select aFacility Type Code.

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Inpatient Service Cont.

Type of Admissionwas the Necessity fieldon the Admissionscreen, HIPAA 5010requires this field onevery Inpatient service.

Edit message will displayif you do NOT select aType of Admission.

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Patient Status Codeis required on everyInpatient service.

Edit message displays ifyou do NOT select aPatient Status Code.

Inpatient Service Cont.

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Edit message will display ifcheck box for ProviderSignature on file is NOTchecked.

Required check boxindicating that theProvider Signature ison file.

Inpatient Service Cont.

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Inpatient Claim – Other Payer

For every ‘Other Insurance’ payeron the claim the sequential orderof responsibility must be entered.

If the responsibility order for each OtherInsurance payer specified in the claim isNOT in sequence, or is duplicated, thisedit message displays.

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Edit MessagesFor Outpatient, Day Treatment and Inpatient Claims

If Other Insurance is a payer and PayerResponsibility is not entered or is not an integervalue between 1 and 5, the following editmessage is displayed:

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If Other Insurance is the payer and PayerResponsibility value has been used by anotherOther Insurance payer for the claim the followingedit message is displayed:

Edit Messages Cont.For Outpatient, Day Treatment and Inpatient Claims

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If Payment Date is not entered on Payer screenwhen Detail Adjustment is added the followingmessage is displayed:

Edit Messages Cont.For Outpatient, Day Treatment and Inpatient Claims

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If a duplicate Adjustment Group code andReason combination are entered the followingedit message is displayed:

Edit Messages Cont.For Outpatient, Day Treatment and Inpatient Claims

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Edit Message Cont.Applies only to Inpatient Service

If the facility type code is not valid for theprocedure code the following message isdisplayed.

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IS Shut Down

For EDI Providers – Tuesday, March13, 2012 at 11:59 p.m.

For Direct Data Entry – Friday, March16, 2012 at 5:00 p.m.

IS will be up Monday, April 2, 2012