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Crosswalk 2.3

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