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This screen contains the Submitter and Default Field Sources for electronic claim formats.
Submitter Tab
Lookup
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Lookup value assigned to describe the Format
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Name
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Practice or Provider Name
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Address
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Address consisting of:
The tab order will skip from Street Address (Add'l) to the Postal Code. The Postal Code lookup will complete the City and State. In addition, the Postal Code lookup will default the Area Code of the telephone numbers if the Area Code is defined in Postal Code Maintenance.
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Country
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A foreign country may be entered if needed.
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Phone
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Contact Phone Number
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Contact
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Contact Lookup
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Submitter Code
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Code assigned by Payer or Clearinghouse to the practiceor Provider
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File Name / Seq
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File name assigned to output files. The name is made up of a clearinghouse assigned code and a file sequence number starting at 1. For each file created the sequence is incremented by 1. When it hits 999, it rolls-over back to 1.
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Subm No
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Submission Number assigned to the claims file. This numberis stored internally in thefile and is incremented by 1 for each file.
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Create Report
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Unused
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Save Archive Files
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Unused
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Default Field Sources
These fields should be set carefully with guidance from MedSuite and the clearinghouse or payer. Failure to set this field properly will likely result in high levels of claim rejections.
Provider ID Source (2010AA)
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The provider id in the ANSI Billing Provider Loop is pulled based on the information provided in this drop-down:
| • | Staff UDF 1-4 (Staff Level) |
| • | Staff Details UDF 1-4 (Staff/Plan Level) |
If the ID to be submitted is plan specific, then the user should fill out the EMC Claim Formats - Plan.
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Qualifier
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Select the ANSI Qualifier code for the Provider ID Source (2010AA). This field is only used for ANSI claims.
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Provider Tax ID (2010AA)
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Select the Default Tax ID to be submitted on electronic claims.
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Provider ID Source (2310B)
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Select the appropriate field for the default vaule of the provider id in the ANSI Line Item records from the drop-down:
| • | Staff UDF 1-4 (Staff Level) |
| • | Staff Details UDF 1-4 (Staff/Plan Level) |
If the ID to be submitted is plan specific, then the user should fill out the EMC Claim Formats - Plan.
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Qualifier
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Select the ANSI Qualifier code for the Provider ID Source (FA0). This field is only used for ANSI claims.
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Facility ID Source
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Select the default Facility ID from the available fields in the drop-down:
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Place of Service Source
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Select the default Place of Service from the available fields in the drop-down:
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Type of Service Source
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Select the default Type of Service from the available fields in the drop-down:
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Procedure Code Source
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Select the default Procedure Code to report in the line item records of the electronic claim:
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PSP ID Source
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Select the default source of the PSP ID to report on PSP claims
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CLIA Source
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Select the default source of the CLIA number to report on claims
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Site Code
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Enter the Site Code assigned by the clearinghouse
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Organization Type
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Enter the Organization Type of the practice. Values are defined as follows:
001 - Solo Practitioner
002 - Partnership
003 - Professional Association
007 - Individual Corporation
008 - Corporation
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Library Change Logs
The Change Log button at the bottom of any MedSuite Maintenance File will track the following:
$ Date Changed - The date the change was made to the file.
$ User Name - The name of the user that made the change.
$ Item Changed - The file name of the item that was changed.
$ Old Value - The system value before the change was made.
$ New Value - The system value after the change was made and saved.
NOTE: Items not tracked are description fields such as degrees and titles.
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