EDI

Refer to your EDI documentation for detailed descriptions on the functionality of these fields. Some insurance companies and or insurance clearinghouses have unique information requirements and that information might be entered here on this screen.


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Allergies and Notes: This is a reminder field entry box only.  Enter any special conditions for the patient.  Data entered here will appear in pop-up windows in Transaction Entry and/or Office Hours, if enabled.

EDI Notes: This section is specifically for sending ambulance claims electronically.

Contract Information: The Contract Information fields populate Loop 2400, Segment CN1 in electronic claims.

 

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Multimedia

The Multimedia tab allows you to attach multi-media files of various types to a case. One of the most common uses for this tab is attaching images, such as pictures or scanned insurance cards, to a patient account. You can also attach sound files, such as recorded voice notes.


To attach a new file, click the New button. You will be brought to the following screen:


Here you will be asked to attach a description to the file you are uploading. You also have the option to give the file a note, and designate it for viewing on the Patient screen.

Click the button labeled Load From File. A Browse window will open, allowing you to browse to the Multimedia file you wish to attach. Once all options and files are selected, click Save.

Tips and Tricks:
The Multimedia tab of the case is a great tool for some users. However, if you are using older equipment, you may run into performance issues if you extensively utilize this feature. It will significantly increase the size of your dataset.

 

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Medicaid and Tricare

Similar to the Condition tab, the Medicaid and Tricare tab contains information that will affect both paper and electronic claims. For specifics on these situations, refer to the Help File and the Clickable CMS (HCFA) form, or to your EDI Documentation.


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Condition

The condition tab contains various fields related to the patient’s condition. Most of these fields are necessary for insurance billing in certain situations. We will not discuss each of these fields. For information on when to use these fields, refer to the Clickable CMS (HCFA) form within the Help File, or your Electronic Claims documentation for information on how to populate these fields.

In this section we will focus on different functionality available within the fields listed on this screen.

As you can see, there are date fields that offer the drop down calendar, such as the First Consultation Date. There are also date fields, such as the Injury/Illness/LMP Date, that do not offer the drop down calendar. The fields without the drop down calendar are used to enter non-date values into these fields.

There are two valid non-date values for these fields:

G: This value is used to designate the field as Gradual. If you type a G and tab off of the field, you will notice that it fills in with the word Gradual.

N: This value is used to designate N/A or Not Applicable.


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Diagnosis


Default Diagnosis 1-4: Medisoft offers you the ability to assign default diagnosis codes to patient cases. Transactions entered into this case will automatically be assigned any diagnosis codes entered into the Default Diagnosis code fields. These fields do not contain the diagnosis codes that will appear or transmit on an insurance claim, rather they only set the default codes for transaction entry when this case is used. It is important to note that many doctors, such as family practitioners, will not have a use for default diagnosis codes, as their patients are always coming in for different ailments. This functionality is better used by specialty offices who will only be seeing that patient for one particular ailment.

Allergies and Notes: The allergies and notes field is used to give you pop up messages when certain functions are performed within Medisoft. These messages will appear when this case is accessed in either Transaction Entry or Office Hours. The messages can be used to warn of allergies a patient may have, or that a patient previously bounced a check.

EDI Report Type and Transmission Codes: Refer to your electronic claims documentation for specifics regarding these triggers.

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Account


Assigned Provider: The Assigned Provider is another required field. Because the Case is used to hold related groups of transactions together, each of those transactions must be linked to a provider. This provider will be the provider who defaults as the provider on each transaction entered under that case. When creating claims, you are given the option to create claims by assigned provider or attending provider. If you create claims by assigned provider, the provider entered into this field in the case screen will be the provider whose information is listed on the claims created for transactions entered under this case.

Referring Provider: In the chapter dealing with setting up a referring provider list, we discussed some of the reasons a patient would need to have a referring provider entered for them. It is imperative that you enter the provider into this field. This field will affect both paper and electronic claims.

Supervising Provider: There are some medical procedures that can be performed by people who are not doctors. These procedures are usually performed by Registered Nurses or Physicians Assistants. Whenever billing is done for these procedures, there must be a designated Physician who is “Supervising” the medical care offered by these professionals.

Referral Source: We have not yet discussed what a referral source is. This field is used to track patient responses to the question “How did you hear about us?” You would create a referral source for each unique answer to this question. For example, if you have an ad in the yellow pages, you would want to create a referral source for Yellow Page Ad. If you utilize this feature, you will be able to report on how much business your office is receiving from different sources.

Facility: The facility field is where you select the facility that will default into the Facility field available in Transaction Entry. In versions prior to Medisoft v11 this field WAS the field you would modify if you wanted to change the facility information on the claim. In Medisoft v11 and higher, we have the ability to modify the facility on a transaction by transaction basis.

Case Billing Code: The case billing code will default to the value entered in the Patient Setup screen as the Patient Billing Code. You can change this value on a case by case basis. Keep in mind that most reports that filter for billing codes do so based on the PATIENT billing code, not the case billing code.

Price Code: When entering the price code field, you will need to think back to the procedure code setup chapter. When entering your procedure codes, you were given the option of entering in various prices that were designated by a letter A through Z.

The Price Code field is where you designate which of these prices will default into transaction entry when the procedure is entered into Transaction Entry. The value you enter should be the letter of the price you wish to assign to this case.

Tips and Tricks:
You will want to make sure that each of your procedure codes follows the same pattern for prices entered. For example, Charge Amount C would be the field used to enter the Cash Patient price for all procedure codes. If this is not done, you may see undesired results when using different procedure codes.

 

Other Arrangements: This four-character field can show any special arrangements like student discount, extended payment program, professional discount, or anything else you may need. The code or designation you use is up to you. Data entered in this field displays in the Transaction Entry window as a reminder during the creation of new charges.


Treatment Authorized Through: For easy reference, enter the date through which treatment has been authorized by the patient’s insurance carrier.

Visit Series Information: Many times, insurance carriers will authorize a certain number of visits for a certain type of service. For example, a patient may be eligible for 20 chiropractic visits during a calendar year. When dealing with this type of restriction, you will want to fill out the following fields as described.

Authorization Number: When pre-authorization from the insurance carrier is needed for a series of visits, there may be an authorization number. Enter the authorization number in the Authorization Number field.

Last Visit Date: This is an edit field for making corrections (as needed) to the date of last visit. Each time a visit is recorded in Transaction Entry, this field is updated to match the Date of Service. Click in the field or the down arrow to the right of the field and the calendar opens.

Last Visit Number: The Last Visit Number field tracks how many visits have been entered for this case. This field automatically increments by one when a visit is entered into Transaction Entry. You can also manually manipulate this number from either the case entry window, or from Transaction Entry.

 

Tips and Tricks:
A visit in Transaction Entry is defined as any unique date for which a patient has CHARGES entered. Entering Payments or Adjustments into Transaction Entry will not update the Last Visit Date, or the Last Visit Number.

 

Authorized Number of Visits: Almost any number of visits can be authorized by the insurance carrier in one series. The default is 100. Enter the number of authorized visits in this field. The program reduces the number by one with each visit for medical treatment.

Visit Series ID: A pre-authorized visit series is assigned an ID value. Valid entry is one letter (A-Z) or digit (1-9). Enter the series ID in this field. The default ID is the letter A. When one series of pre-authorized visits is completed, the program automatically moves to the next series (B). You can type a different letter if you want to override the series ID sequence.

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