Lookup

Lookup value assigned to describe the Format

EMC File Version

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

EMC File Format

Select the desired format from the EMC Claim Formats File lookup

NPI Usage Mode

Select from the available modes:

PPO/HMO Indicator

Sets the EMC PPO/HMO indicator in the claims file for the plan

PPO/HMO Code

Sets the EMC PPO/HMO Code in the claims file for the plan

Bill-To Provider Taxonomy Type

Indicates the source of the Bill-To Provider Taxonomy

Blank will not report a PRV Segment at the 2000A level.

Bill-To Provider Entity Type

Indicates the source of the Bill-To Provider address in the 2010AA Loop of the ANSI claims file:

Blank will continue to report the provider address

Bill-To Provider Other

Addr

Allows you to enter a "custom" address in the Bill-To Provider Information.

Provider NPI Source (2010AA)

The "Billing" Provider NPI in the ANSI 2000-Loop is pulled based on the information provided in this drop-down:

This should generally be set to Division NPI.  However is physicians and CRNAs have different NPIs, then one of the Staff fields should be used to report the NPI in the 2000-Loop.

Provider ID Source (2010AA)

The "Billing" Provider ID in the ANSI 2000-Loop is pulled based on the information provided in this drop-down:

Qualifier

Select the ANSI Qualifier code for the Provider ID Source (2010AA).  This field is only used for ANSI claims.

Provider Tax ID (2010AA)

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

Pay-To Provider Taxonomy Type

Indicates the source of the Bill-To Provider Taxonomy

Blank will not report a PRV Segment at the 2000A level.

Pay-To Provider Entity Type

Indicates the source of the Pay-To Provider address in the 2010AB Loop of the ANSI claims file:

Blank will NOT report a Pay-To Provider

Pay-To Provider Other

Addr

Allows you to enter a "custom" address in the Pay-To Provider Information.

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:

Qualifier

Select the ANSI Qualifier code for the Provider ID Source (2310B).  This field is only used for ANSI claims.

Facility ID Source

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

Place of Service Source

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

Type of Service Source

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

Procedure Code Source

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

Service Units

Indicates what field will be reported in the claims file 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 which field will be reported in the claims file for the "units or minutes" of the SV1 - Professional Service Segment.  Not all carriers want the number of 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