| Topics | EDI Codes | Search: |
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EDI Transaction IDs are defined for a Provider - Insurance company combination. These can be defined in this option. Business Unit: The user can select the Business Unit from the Search icon. Clicking on the Search icon, only active Business Units are available for selection. This is a mandatory field Insurance: The user can select the Insurance from the Search icon. Clicking on the Search icon, only active Insurances are available for selection. This is a mandatory field Provider: The user can select the Provider from the Search icon. Clicking on the Search icon, only the active Provider list is available for selection. Providers with the type RD - Referring Provider, ZE – Provider Organizations, ZR – Referring Provider Organizations, DR – Rendering Provider are displayed in this list. This is a mandatory field. Location: The user can select the Location from the Search icon. Clicking on the Search icon, only active Locations are available for selection Provider Number (G2 Qualifier): The user can provide a unique number which is assigned for the selected Provider for the selected Insurance. This number is sent in the CMS1500 form in Box 24J gray shaded area and its electronic equivalent Location Number (LU Qualifier): The user can provide a unique number which is assigned for the selected Provider for the selected Insurance for the selected Location. If the user saves the record without adding the Provider Number and the Location Number, then on saving, the following message "Please add either Provider Number (G2 Qualifier) or LU Location Number to save the record" will be displayed. When EDI Codes are configured, the Provider Number will get populated on claims only when the Selected Business Unit + Selected Insurance + Selected Provider + Selected Location are present on the Claim. For Rendering Provider (DR) or Organizational Provider (ZE), if G2 and LU are defined, then they are displayed under the 2310B loop of the EDI file. For CMS1500, G2 and LU are displayed under the Rendering 2310B (CMS:24I/J Gray) Qualifiers. A new property ins.eligibility.location.code has been introduced. This is an Admin-level property. Once the property is defined, the expected behavior is that it will consider Location as a parameter and forward the Q4 Qualifier. If Clinic on the Ins Master Screen is selected, then the Clinic Codes Group Number will get displayed in the 270IE File, and if Provider on the Ins Master Screen is selected, then the EDI Codes Provider Number will get displayed in the 270IE File. |