CMS Flags Button: The user can add or select Charge Code-level information from the CMS Flags button. On a claim, all reported charge codes have the 'CMS Flags' button enabled. Information captured via this button is sent through EDI and the CMS 1500.

Cell 24 Info: Information captured in this section is transmitted to insurances through CMS 1500 cells 24C and 24H, as well as the 24H Grey field.

24C: If this checkbox is checked, then on the CMS 1500 Cell 24C, the user will see an 'X' mark, which indicates that an emergency service was provided for the visit. In EDI, this information is sent in the 2400 SV1 segment.

24H.FP: If this checkbox is checked, then on the CMS 1500 Cell 24H (Grey Band), the user will see an 'X' mark. Here, FP stands for Family Planning.

24H: If this checkbox is checked, then in the EDI file under the loop 2300 NTE segment, the user will see the selected options. Abbreviations for the options are: YO – Other, YV – Vision, YH – Hearing, YB – Behavioral, YM – Medical, and YD – Dental. This information is not sent out on the CMS 1500.

Note: To show the respective condition indicator on the claim, ensure that the Claims --> I button indicates EPSDT condition usage.

Patient Discount: The user can apply a discount on selected charge rows as necessary by clicking on the Patient Discount option. The discount can be given as a percentage. Once the percentage is entered, upon clicking OK, the same percentage will be calculated, and the Actual Discount Amount will be plotted for the selected Charge Row. For example, if the user enters 5% as a discount amount, it will calculate the actual discount (Total Charges * Discount %) and will plot the same in the Patient Discount Amount section.

Note: The discount is applicable only on Bill to Patient charges.

Note: The user can click on the Apply to All Charge Rows checkbox to apply the Patient discount (%) on all Bill to Patient charge rows for the selected Claim.

Patient Discount Amount: The user can apply a discount on selected charge rows as necessary by clicking on the Patient Discount option. The discount can be given as a percentage or as an amount. When the user applies a discount for a specific charge code, the discount amount can be seen in this field.

Note: This is only applicable for a Self-Pay Claim or if the Charge Codes are Billed to the Patient.

Note: After the user applies a discount for Charge Codes and saves the Claim, the 'Patient Discount Amount' field and the 'Apply to All Charges' checkbox are reset.

Info on Gray Band: The information captured in this section is sent in the CMS 1500 Cell 24A Grey Band (above the Charge Row).

·         General Info: Enter free text which provides additional information for the services reported. For services which are marked as NOC or Not Otherwise Classified on the CPT / HCPCS Master; a default NOC comment is populated on the General Info tab.

·         NDC Information: NDC is an 11-digit numeric field. Insurances may ask for the NDC (National Drug Code) for the drug along with the dispensed or administered quantity of the same drug to be mentioned on claim forms. Set this information for a given HCPCS or CPT code at the Master level, and the same will be carried over to the claim when the claim is created.

·         Units: The applicable units of administration are International Unit, Gram, Milliliter, Unit, and Milligram.

·         Quantity: Define the administered quantity. This field accepts 10 characters without a decimal restriction. Hence, the maximum value that can be entered in this field is 9999999999.

Ordering Provider on Claims: For certain radiology services and labs, an Ordering Provider is needed on the claims. The Ordering Doctor is the provider who has ordered the services. For in-house lab and in-house radiology orders, 'Ordering Physician' will be transmitted on the billing side, and the same will be added to the Claims → CMS Flags → Ordering Physician field.

·         If a Referring Provider is present, then the Referring Provider is plotted in Cell 17A with the qualifier DN.

·         If a Referring Provider is not present, but an Ordering Provider is present on any of the charge rows, then the Ordering Provider is plotted in Cell 17A with the qualifier DK.

·         Note: If there are more than one Ordering Provider present on Claims > Charge Rows, the Ordering Provider on the first row will be selected to be plotted in Box 17A.

·        If both the Referring and Ordering Providers are not present on the claim, then the Supervising Provider will be plotted in Cell 17A with the qualifier DQ.

Outside Lab and Purchased Provider: When a Billing Provider or the provider billing the claims purchases lab services from an outside lab and bills for these services, then on such bills, providers are expected to document the name of the external lab vendor from whom the services were purchased and the purchased amounts.

·         On the CMS 1500, Box 20 is checked when Outside Lab is selected on the CMS Flags popup. The total purchased amount for all charge rows is calculated and populated.

·      The purchased provider will be reflected in Box 24J on the CMS 1500 form.

Mark Void Checkbox: The user can 'Void' a particular Charge Row from the claim.

Note: The discount is applicable only on Self-Pay charges.

Charge Code for Secondary: The select charge row option is only enabled for claims with a secondary insurance defined. Select the specific Charge Code, Modifier, and Units that need to be sent to the secondary insurance instead of the ones sent with the primary claim.

OK: Click the OK button to save the changes and close the 'CMS Flags' popup.

Cancel: Click the Cancel button to cancel the changes before the last save and close the 'CMS Flags' popup.