CMS Flag Button: User can add or select Charge Code level iformation from CMS flags button. On Claim, all reported charge codes has 'CMS Flags' button' enabled. Information captured in this button is sent through EDI and CMS 1500.

Cell 24 Info: Information captured in this section is transmitted to Insurances through CMS 1500 cell 24C, & 24H, 24H Grey field

24C: If this Check box is checked then on CMS 1500 cell 24 C, user could see 'X' mark. Which indicates an Emergency service was provided for the visit. In EDI this information is sent in 2400 SV1 segment.

24H.FP: If this Check box is checked then on CMS 1500 cell 24H (Grey Band), user could see 'X' mark. Here FP stands for Family Pan.

24H: If this Check box is checked then in EDI file under loop 2300 NTE segment user could see selected options. Abbrevaion for opiton is : YO – Other YV – Vision YH – Hearing YB – Behavioral YM – Medical YD – Dental. This information is not sent out in CMS 1500.

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

Patient Discount: User can apply a discount on selected charge rows as per necessity by clicking on the Patient Discount option. The discount can be given as a percentage. Once the Percentage is entered on click of OK the same percentage will get calculated and Actual Discount Amount would get plotted for a selected Charge Row. For e.g., If the user enters 5% as a discount amount, It will calculate the actual discount (Total Charges * Discount %) and would plot the same in Patient Discount Amount section.

Note: Discount is applicable only on Bill to Patient Charges

Note: User can click on Apply to all Charge Rows check box to apply Patient discount (%) on all Bill to Patient charge rows for selectd Claim.

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

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

Note: After the user avails discount for Charge Codes and Saves the Claim, then 'Patient Discount amount' and 'Apply to all charges' checkbox gets reset.

Info on Gray Band: The information captured in this section is sent in CMS1500 Cell(24A) Grey Band (above 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 CPT / HCPC Master; a default Comment NOC is populated on General info tab.

·         NDC Information: NDC is an 11 digit numeric field. Insurances may ask for NDC (National Drug Code) for the Drug along with Dispensed or Administered quantity of the same drug to be mentioned on Claim forms. Set this information for given HCPC or CPT code at Master level and same would be crossed over to the claim when the claim is created.

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

·         Quantity: Define the administered quantity. This field accepts 10 characters without decimal restriction. Hence the maximum number of characters 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. Ordering Doctor is the provider who has ordered the services. For In-house Lab and In-house Radiology orders ‘Ordering Physician’ will get transmitted on billing side and same will be added to Claims →CMS Flags →Ordering Physician field.

·         If Referring Provider is present, then Plot Referring Provider is in Cell 17 A with Qualifier DN.

·         If Referring Provider is Not Present, however; if Ordering Provider is present on any of the Charge Rows then Plot Ordering Provider is in Cell 17A with Qualifier DK.

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

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

Outside Lab and  Purchased Provider : When Billing Provider or Provider who is billing the claims does purchase Lab services from outside lab and yet 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 CMS1500, Box 20 gets checked when Outside lab is selected on CMS flag. The total Purchased amount for all charge rows gets calculated and populated.

·      The purchased provider would reflect on Box 24J on CMS 1500 Form

Mark Void Checkbox: User can ‘Void’ a particular Charge row from the claim.

Note: Discount is applicable only on Self Pay Charges

Charge Code for Secondary: Select charge row is only enabled with Claim having secondary Insurance defined. Select specific Charge Code, Modifier, and Units which needs to be sent to Secondary Insurance instead of the one which is sent to Primary Claim.

OK: Click on the 'SAVE' button to save the changes and close the 'CMS Flag' popup.

CANCEL: Click on the 'CANCEL' button to cancel the changes before the last save and close the 'CMS Flag' popup.