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EDI Transaction Ids are defined for a Provider - Insurance company combination. These can be defined in this option. Business Unit: 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: 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: User can select the Provider from the search icon. Clicking on the search icon, only active Provider list are available for selection. Providers with 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: 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): User can provide a unique number which is assigned for selected Provider for selected Insurance. This number is sent in CMS1500 form in box 24J Gray shaded area and its electronic equivalent Location Number (LU Qualifier): User can provide a unique number which is assigned for selected Provider for selected Insurance for selected location. If the user saves the record without adding Provider Number and Location Number then on save 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 , Provider Number would 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 it is displayed under 2310B loop of the EDI file. For CMS1500, G2 and LU is displayed under Rendering 2310B (CMS:24I/J Gray) Qualifiers New property ins.eligibility.location.code has been introduced. This is an Admin level property. Once the property is defined, the expected behaviour is it will consider Location as a parameter and Forward Q4 Qualifier. If Clinic on Ins Master Screen is selected then Clinic Codes Group Number will get displayed in 270IE File and If Provider on Ins Master Screen is selected then EDI Codes Provider Number will get displayed in 270IE File. |