EMC Claim Formats File

This screen contains payer-specific or clearinghouse-specific electronic claim filing information. It allows one or more EMC Format PLans to be grouped into a single file. Most MedSuite clients will only have one EMC Claim Format File as ther eis generally only a single clearinghouse in use. However, certain MedSuite clients use multiple clearinghouses and therefore need to separate the claims for each clearinghouse into a separate ANSI claim file.

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.

Lookup

Lookup value assigned to describe the EMC File

Name

Long description assigned to describe the EMC File

File Name/Seq

Enter the beginning of the claim file name and the next sequence number to be used. For example if you enter ANEGRP and 123, then the next file created will be called ANEGRP.123.

Include Date/Time Stamp in File Name

Indicates if the date and time the file is cretaed should be included in its name. If this option is selected, the file name example from above could be ANEGRP_200707010430.123.

Break 2000A by Provider

Indicates if the claim file should be sorted and broken each time the "Bill To" provider on the claim changes.

This issue is dependent on the clearinghouse's or payer's requriements. If there is any doubt on this, this option should be checked "on".

Break 2000B by Claim

Indicates if multiple claims for the same subscriber can be submitted under a single subscriber (2000B) segment or if each claim needs a separate subscriber (2000B) segment.

This issue is dependent on the clearinghouse's or payer's requriements. If there is any doubt on this, this option should be checked "on".

Carrier Code XRef

Indicates which field from the Carier Setup will be used for as the "Payer Code" in the claims file.

•

NAIC No

•	Per-Se Code

•	Other EMC Code

Qualifier

Select the ANSI Qualifier code for the Provider ID Source (BA0). This field is only used for ANSI claims.

Provider Tax ID (2010AA)

Select the Default Tax ID to be submitted on electronic claims.

•

blank

•	Division Tax No

•	Staff Social Security

Suppress 2310B

Some payer cannot accept the 2310B Segment when the provider in the 2310B Sgement is the same as the 2010AA Segment. The 2310B Segment may be suppressed when necessary.

MedSuite will instruct you which file version to select from the list

Provider ID Source (2310B)

Select the appropriate field for the default vaule of the provider id in the ANSI Line Item records from the drop-down:

•

blank

•	Staff Social Security

•	Staff Tax ID

•	Staff Individual ID

•	Staff Group ID

•	Staff NPID

•	Staff UPIN

•	Staff UDF 1-4 (Staff Level)

•	Staff Details UDF 1-4 (Staff/Plan Level)

Qualifier

Select the ANSI Qualifier code for the Provider ID Source (FA0). This field is only used for ANSI claims.

Facility ID Source

Select the default Facility ID from the available fields in the drop-down:

•	blank (none)

•	Facility UDF 1-4

Place of Service Source

Select the default Place of Service from the available fields in the drop-down:

•

POS-HCFA

•	POS UDF 1-4

Type of Service Source

Select the default Type of Service from the available fields in the drop-down:

•

TOS-HCFA

•	TOS UDF 1-4

Procedure Code Source

Select the default Procedure Code to report in the line item records of the electronic claim:

•

CPT Code

•

ASA Code

•	HCPCS Code

•	User Defined Code 1

•	User Defined Code 2

Service Units

Indicates what field will be reported in the claims fiel for the number of units. On anesthesia claims this is often the quantity (001). However, certain carriers may have other requirements.

Improperly setting this field can result in improper claim payments!!

This setting is only used for NSF Claims!!

Anesthesia Units

Indicates what field will be reported in the claims fiel for the "anesthesia minutes". Not all carriers want the numbe rof minutes in this field. some want time Units or total units. On non-anesthesia claims this field will be set to 000.

Improperly setting this field can result in improper claim payments!!

Report Start/Stop in NTE

Indicates if the anesthesia start and stop times will be automatically reported in the NTE (Notes / Narrative) Segment in the ANSI Claim File.

PSP ID Source

Select the source of the PSP ID to report on PSP claims

PSP ID Name

Select the source of the PSP Name to report on PSP claims

The Change Log button at the bottom of any MedSuite Maintenance File will track the following: