Loop Seg Qualifier Ref Name Instructions Loop Notes/Reference
1000A NM1 Sender Name EMC Receiver/EMC Submitter ID 2 is sent in NM109 2000A PRV ZZ Provider Taxonomy Code Program converts the NSF Specialty Code from Provider information, conversion is based on list provided by Medicare, place Taxonomy Code in Taxonomy Code field to override 2010AA NM1 XX National Provider Id Create a Provider Class, place the Practice NPI in the National Provider ID, then edit each provider and put the Provider Class on the Default Group tab 2010AA REF 1J Facility ID Number For Payer Number BS085, Send EMC Receiver/Submitter ID 2 in REF02 2010AA REF 0B Provider License Number EMC Payer Number = 80314 or 00621, Send License Number 2010BB REF 2U FY Payer Secondary ID Insurance Carrier/EMC Sub ID put 2 character qualifier, NF TJ 1 space, Value of REF02 Example, 2U FPPN22 2300 DTP 439 Accident Date In Patient's Case/Condition tab, Injury/Illness/LMP Date.
Accident "Related To" must equal Injury or Auto or Employment Related
must be checked.
2300 PWK Claim Supplemental Information Case/Diagnosis Tab/EDI Report section. PWK01 = Report Type Code PWK02 = Report Transmission Code PWK05 = 'AC'(entered by program) PWK06 = Attachment Control Number 2300 CN1 Contract Information Used when filing secondary emc, required if payer wants the information, look in the Secondary EMC documentation for information on how to use this segment 2300 REF P4 Demonstration Project ID Case Extra 3 = P4DEMO, 1 space, value of REF02 2300 NTE ADD CER Claim Note Case EMC Notes, First character = @, 3 character qualifier, DCP DGN 1 space, Value of NTE02
PMT TPO 2300 REF X4 CLIA Number The program first looks at the Case EDI tab CLIA Number, if that is blank then it looks at Claim Provider CLIA Number The Insurance Type Must be Medicare or Medicaid, *** with Medisoft version 16 the program uses the Facility ID rule before looking at the Provider Reference tab 2300 REF EW Mammography Certification Facility information, Mammography Certification
2300 CRC ST S2 EPSDT Referral Case EPSDT is checked, Case EPSDT Code 1 not blank CRC02=Y NU AV else CRC02=N and CRC03=NU, 2310B PRV ZZ Provider Taxonomy Code Program converts the NSF Specialty Code from Provider information, conversion is based on list provided by Medicare Group or Facility billing only, place Taxonomy Code in Extra 2 to override 2310B REF N5 Provider Plan Network ID EMC Payer Number = 90001, Provider ID is sent with N5 qualifier override in REF01 2310B REF 0B Provider License Number EMC Number = 80314 or 00621, Provider State License Number 2310C NM1 QB Purchased Service Provider Case/Facility/Purchased Service must be checked 2310D REF 0B 1A 1B 1C 1D Facility Secondary ID Facility information, ID field, put Character qualifier, 1 space, 1G 1H G2 LU N5 then the value of REF02 TJ X4 X5 2400 MEA Test Results Create a Transaction Note, make the note any EDI type, first four characters must be MEA:, followed by value of MEA01*value of MEA02*value of MEA03 Example, MEA:TR*R1*8.7 2400 NTE ADD DCP PMT TPO Transaction Note Any Note Type other than Internal Use, First character=@, 3 character qualifier, 1space, Value of NTE02 must be on separate line, i e no carriage returns 2410 LIN N4 National Drug Code Procedure information N4 qualifier is hard coded by program 2410 CTP Drug Pricing Transaction Note, any Note Type other than Internal Use, CTP:**<unit price>*<quantity>*<unit of measure> must be on separate line in note, National Drug Code must be present 2410 REF XZ Prescription Number Transaction Note, any Note Type but Internal Use, first 3 = @XZ, 4 = space, Next 30 characters = Prescription Number must be on separate line in note, National Drug Code must be present 2420A REF 0B Provider License Number Insurance Carrier/EMC Number = 80314 or 00621 |
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