The Extra Info button is split into subsections or groups as below:
Eligibility
This section controls the information to be sent to the Payer / clearing house while requesting eligibility status and have two options:IE NPI Credentials PC (Provider/Clinic): The dropdown contains two values Clinic or Provider. When selected appropriate NPI is sent as “Requesting Provider” while Eligibility enquiries are queried to the clearinghouse / payer. Depending on how a particular practice is credentialed (Individual / Group) an appropriate selection is expected to be made.
IE REF Qualifier like EI,SY,Q4,TJ: If Insurance demands a specific secondary ID along with Nip related to the requesting provider is added to eligibility request by using this field.
For e.g. If user selects “Provider” as an option in section IE NPI Credentials, the secondary ID with their specific qualifiers such as EI : For Tax ID, SY: For SSN,Q4: For Legacy Number or Insurance specific Provider ID, TJ : Tax ID is added to the request. The respective Secondary IDs are pulled from Settings → Configuration → EDI Codes when “Provider” option is selected and from Settings → Configuration → Clinic Codes when clinic option is selected.
Note: For practices where Multiple
Business Units and Multiple Locations are present, PrognoCIS limits only
One BU or One Location to be configured as “Default” when Clinic
option is selected. The properties which control this setting are
ins.eligibility.bu.code and ins.eligibility.location.code, user is
expected to make use of Only of these two properties. Enrollment for SecureConnect Eligibility: This dropdown has the options 'Not Required', 'Enrolled' and 'Not Enrolled'. If the Clearing House dropdown on Insurance master has Secure Connect selected and Enrollment for Secure Connect Eligibility dropdown is saved as 'Not Required' or 'Enrolled' then Eligibility will be fetched through Secure Connect. If the Clearing House dropdown on Insurance master has Secure Connect selected and Enrollment for Secure Connect Eligibility dropdown is saved as 'Not Enrolled' then Eligibility will be fetched through Clearing House selected on the EDI Setup Master screen.
Billing Provider Info
IDs for Billing Provider to be transmitted on both CMS 1500 and UB04 and their electronic Variants is controlled by this section. The section has two optionsTax ID 2010AA Ref (CMS:25): User can select EI / Tax ID or SSN
Other ID 2010BB Ref (CMS:33B): The secondary ID specific to the billing Provider selected on Claims → Edit Claims → I Button would be populated on the claims based on this selection. User can select any ID from the available list of qualifier 0B – State License Number (Added from Provider / Group Master) 1G – UPIN Number (Added from Provider / Group Master) G2 – Provider ID Given by insurance (Added from Settings → Configuration → EDI Codes when Billing Provider is an individual. And from Settings → Configuration → Clinic Codes when Billing Provider is NOT an individual) LU – Location Specific Provider ID Given by insurance (Added from Settings → Configuration → EDI Codes when Billing Provider is an individual. And from Settings → Configuration → Clinic Codes when Billing Provider is NOT an individual) ZZ – Taxonomy Code (Added from Provider / Group Master.
Other Provider Secondary IDs
The secondary IDs – Other than NPI are transmitted on the claims based on the selection made in this section.Rendering 2310B(CMS:24I/J Gray) Qualifiers: The secondary ID specific to the Rendering Provider selected on Claims → Edit Claims → I Button would be populated on the claims based on this selection. User can select any ID from the available list of qualifiers:
0B – State License Number (Added from Provider / Group Master)
1G – UPIN Number (Added from Provider / Group Master)
G2 – Provider ID Given by insurance (Added from Settings → Configuration → EDI Codes when Billing Provider is an individual. And from Settings → Configuration → Clinic Codes when Billing Provider is NOT an individual)
LU – Location Specific Provider ID Given by insurance (Added from Settings → Configuration → EDI Codes when Billing Provider is an individual. And from Settings → Configuration → Clinic Codes when Billing Provider is NOT an individual)
ZZ – Taxonomy Code (Added from Provider / Group Master
Referring 2310A(CMS:17a) Ref Qualifier: The secondary ID specific to the Referring Provider selected on Claims → Edit Claims → I Button would be populated on the claims based on this selection. User can select any ID from the available list of qualifiers:
0B – State License Number (Added from Provider / Group Master)
1G – UPIN Number (Added from Provider / Group Master)
G2 – Provider ID Given by insurance (Added from Settings → Configuration → EDI Codes when Billing Provider is an individual. And from Settings → Configuration → Clinic Codes when Billing Provider is NOT an individual)
Ordering 2420E (CMS:17a) Qualifiers: The secondary ID specific to the Ordering Provider selected on Claims → CMS Flag button would be populated on the claims based on this selection. User can select any ID from the available list of qualifiers:
0B – State License Number (Added from Provider / Group Master)
1G – UPIN Number (Added from Provider / Group Master)
G2 – Provider ID Given by insurance (Added from Settings → Configuration → EDI Codes when Billing Provider is an individual. And from Settings → Configuration → Clinic Codes when Billing Provider is NOT an individual)
Supervising 2310D(CMS:17a) Ref Qualifier: The secondary ID specific to the Supervising Provider selected on Claims → Edit Claims → I Button would be populated on the claims based on this selection. User can select any ID from the available list of qualifiers:
0B – State License Number (Added from Provider / Group Master)
1G – UPIN Number (Added from Provider / Group Master)
G2 – Provider ID Given by insurance (Added from Settings → Configuration → EDI Codes when Billing Provider is an individual. And from Settings → Configuration → Clinic Codes when Billing Provider is NOT an individual)
LU – Location Specific Provider ID Given by insurance (Added from Settings → Configuration → EDI Codes when Billing Provider is an individual. And from Settings → Configuration → Clinic Codes when Billing Provider is NOT an individual)
Notes:If user selects all the checkboxes - 0B, 1G and G2 then all of them would get populated one below the other in the same sequence - 0b,1G and G2 on EDI Claim. On CMS1500 in Box 17A Shaded area the order of populating the Secondary ID is as below:
1. G2
2. 0B
3. 1G
4. LU
Order of priorities between Ordering and Referring and Supervising physician on CMS 1500 box 17 would be as below :
The Referring Provider will have highest preference
If the Referring Provider is Not present Ordering Provider will be populated
If the Ordering provider is Not Present, the Supervising provider will be populated.
TPL Code
Third Party Liability Code is a code is requested by certain payers when such payer is secondary. This is controlled by two options:Send Primary TPL Code when Secondary and Payor TPL Code
For e.g. Medicaid of LA assigns TPL Codes to all the other payers and expects to add such codes on claims when Medicaid of LA is secondary. To elaborate more, If Code – 70035 is assigned by Medicaid of LA to identify Medicare of LA; User would define Payor TPL Code 70035 to Insurance Master → Extra Info tab for Medicare LA and check Send Primary TPL Code when Secondary box on Medicaid of LA so when Claim is billed where Primary Insurance is Medicare and Secondary is Medicaid, TPL Code – 70035 is transmitted in loop 2330B Segment NM109 when secondary Claim is billed to Medicaid.
Miscellaneous
Miscellaneous section controls certain validations and workflows which are relevant for Billing claims.Min Charge Amount: User can define a minimum Charge Amt applicable for charge code. This is done to prevent rejections from certain payers who do not process charges with zero $.
Sec By Paper: The checkbox indicates the Secondary Electronic Claim submission is not supported for selected insurance. When Primary EOB is posted for such Insurance, a secondary claim would get queued to Secondary CMS bucket and option – Send Secondary EDI would not be available for such insurances. Please note a property edi.send.sec.evenifpaper : this property is ONLY applicable for Trizetto or Gateway clearinghouse and enabled when practice does not have resources to print claims in-house. When turned ON, PrognoCIS would identify the payers where Sec By Paper checkbox is checked and creates and overrides the settings to create Electronic secondary claims for such payers with a dedicated payer ID – 00010 is used which replaces the payer ID defined for selected payer on Insurance Master.
Anesthesia Minutes On CMS: Checking this box would print Ansesthesia Minutes on claim form.
Subscriber ID Length: User can define length of Subscriber ID in this field. If subscriber ID of selected patient does not match the total length defined here and an error message is displayed while submitting claims
Need Referral: This checkbox indicates referring provider is required for this payer. When checked, Need Referral checkbox is enabled on Patient’s Insurance umbrella which can be used to validate claim submission
UB04 Exception: This checkbox is applicable for UB04 claims only. When checked even if the generated claim is Institutional, user would be able to create / print and submit CMS1500 and its electronic variant for such payer.
Commercial Claim Attachment: PrognoCIS supports Electronic Transmission of Claim Attachments to certain Payors through Jopari Clearinghouse. This checkbox is provided to identify such Payors. When the property, 837.commclaim.attach.usevendor has JOPARI selected, "Commercial Claim Attachment" checkbox on "Insurance Extra Information" popup is checked and "Paper work Send Mode" is selected as "EL - Electronically Only" on the "Additional Claim Information" popup of "Edit Claims" screen then a copy of the Claim is created and Claim Attachments are transferred along with the Claim to supported Clearinghouse Partner or Vendor.
Don't Bill No Show: The checkbox when selected indicates that NO SHOW penalties will not be billed for the selected patient where this insurance is defined as Primary / Secondary or Tertiary.
No Claim Status Check: The purpose of this checkbox is to track the progress for Claim status Inquiry for Secure Connect as there are some Insurances that have a provision that lets the CH login to the Insurance Portal and allow them to look at the claim status. This checkbox when selected helps us identify those insurances which allow Clearing House to see their claim status so that accordingly Clearing House would send one more status back into PrognoCIS.
ePreAuth checkbox: Check this checkbox to sent RFAs electronically. If checked, then the PreAuth Payor ID becomes mandatory and an alert message is displayed: Note: PreAuth Payor ID field is mandatory if ePreAuth box is checked and please contact interface team for further setup of ePreAuth. If unchecked, then the PreAuth Payor ID field becomes disabled, and any value entered in it is retained. If this checkbox is unchecked and saved, then the PreAuth EDI Enabled keywords on Insurance Master are removed.
Hybrid and multilocation clinic users have the flexibility to choose whether to send RFA manually or via EDI for each location for the same EDI Enabled Insurance. For such clinics, a Select Locations for ePreAuth
icon appears to the right of this checkbox when it is checked.
This icon invokes the PreAuth Location Codes popup which displays Active locations defined on the Locations Master for the clinic, all checked by default.
RFAs can be sent electronically (via EDI) only for those locations whose checkboxes are selected from this popup.
RFAs for all unselected locations must be processed manually.
Note:
If a location is selected from the PreAuth Location Codes popup and is later marked as Inactive from the Locations Master, then that location is no longer displayed in the PreAuth Location Codes popup.
Any existing RFAs for this inactive location can still be sent electronically from the PreAuth Tracking screen.
PreAuth Payor ID: Check the ePreAuth checkbox and enter the PreAuth Payor ID in this field and click on the OK button to enable PreAuth EDI setup for an Insurance. Once the interface team completes the PreAuth EDI setup for the insurance, the keywords PreAuth EDI Enabled are displayed in red font on the top right of the Insurance Master screen for that Insurance. This field accepts only alphanumeric characters and has a limit of 20 characters. Only one single Payor ID can be entered in this field.
OK: Click on this button to save the changes and close the popup.
CANCEL: Click on this button to close the popup without saving any changes.