The topics of this section include...
- Viewing
records
- Entry Screen Top Section
- Sender and Receiver Authentications
- Submitter Name, Address, Organization
- Submission Information
- Submission Specifications
- Automated Log-on Information
- Export FileName Parameters
- ECS Toolbox
- File Management
Viewing the current entries
Three carriers are typically pre-loaded in the ECS Control module. To view a record just click on its name in the list. You can sort this list by either ECS Number or Carrier Name. For this example we will click on Medicare so we can review the entered data.
This section has tabs to take you to the Menu, ECS Toolbox and to navigate out of this module to other modules and to your telecom program. There are buttons with various functions (to be discussed later), and a field for the Carrier Name, the ECS Number and the carrier's Website URL if there is any. Clicking the goto web button opens your default web browser and goes to the URL listed in the field.
Section by Section
Let's go over each of the sections, and the associated fields, so you can understand their importance. Many fields are labeled using the new HIPAA standard field names (i.e. ISA01/02) so that you can more easily match your carrier's requirements to the correct data.
Sender and Receiver Authentications
- The top four fields on the left side in this section have associated pop-up lists that describe what data appears in its related field. For example, ISA05 describes or "qualifies" the data that is in ISA06. This matchup is equivalent for all the ISA fields.
- The Receiver ID is usually the SAME as the ISA08, the Appl Recvr Code in the Submission Information section, and
in the NAIC Code field in the
Insurance Module for this insurance.
- The Receiver Type should be correctly picked to describe the receiver. Above, Medicare was selected.
- The Submit ID should be the same as the Sender IC (IC is short for interchange) Data field (also called the ISA06).
- The EMC Prov No is for NSF claims.
- The Secondary ID field is only selected
if required by the insurance.
This section is rather straightforward. However, keep the following in mind...
- Use no punctuation in any field. Do not abbreviate (i.e. Avenue is NOT "Ave.")!
- Do not leave the Contact or Phone fields blank. Otherwise the
file
will reject and you will call us asking why your file rejected.
- If you are a group practice (that is ONE provider number shared by all billing providers) then leave the name fields blank. Fill in the Organization Name field with the group practice's name (i.e. Cardiology Associates).
- In Practice Type choose
the
type
of practice you are. Here Solo wis selected. The wrong
selection
here will cause the wrong data to be included in your ANSI upload
file! A "Group" practice is one that has a unifying provider number
that is different from each provider in the practice. If you are a
Group practice and you select Solo the file will reject and you will
call us on the phone asking why our software does not work. Please read
and follow these instructions.
- (Re)trans. Status is not used in ANSI but defaults to "0".
- Orig Submission ID is not used in ANSI, and rarely is NSF.
- Test or Prod tells the receiving computer if the file you are sending is a "Test" or "Production" file. The default is "Test". To set a carrier to production will require a password from Medical Databases.
- Last Subm
No is the batch number assigned by the software for each
submission of claims. This number is stamped onto an invoice when it is
sent. This way the claims of a particular submission can be quickly
found by clicking the
icon. - Last Sent is stamped with the date you last sent a file (using our automated system).
- Last Batch is the last day you created a file.
- Recon Delay has the number of days delay between sending a file and when your carrier has your reconciliation file ready.
- Because some carriers require
different data, you may need to select "Yes" for or 2310B Required or TOS Required.
This section tells the software important information about the structure of the file you are about to create.
- ANSI/NSF version - Select which version the software will use to create the file. For HIPAA compliant claims the selection above is correct!
- Appl
Recvr Code - This is short for "Application Receiver Code" and
this varies from carrier to carrier. It is usually filled with the NAIC
code of the receiving carrier. For example, Medicare of PA is 00865.
For Medicare carriers is this he SAME value found in the Insurance
Module record for your Medicare carrier as shown below.
- Format - Some states have special formatting built into the software. Do NOT change this setting from "0-None" unless told to by Medical Databases.
- The Looping Format defaults to ST-SE. Do
not change this unless told do by Medical Databases tech support.
- The Sort Order varies by carrier and format.
- Claim Types should remain as above unless you are told otherwise.
- Vendor
SWV stands for vendor software version and is obsolete for HIPPA.
- The Vendor ID is different for each state and identifies Medical Databases as the software vendor.
Log-on Information
This section has the following information...
- Phone 1 is the primary phone
number for this carrier.
- Phone
2 is an alternative phone
number. In some states you can send and receive many files toll-free,
but if you want to download a reconciliation file (ANSI 835) you need
to use a non toll-free line (this IS the case in Pennsylvania).
- Logon is the logon name you were assigned by the carrier. This may be the same as your Submit ID.
- Password is a masked field where you can store your password.
Export FileName Parameters
When PracticeMaker® creates your file, you want it to be named with a standard "convention".
- In File Prefix enter what you want the filename of this carrier's files to begin with, as with "MCPA_" for Medicare of PA (do not forget the underscore). The date is then added followed by the submission number ("_361") and the file name ends with either ".doc" or ".txt".
- Last Export Name shows you
the name of the LAST file created for this carrier.
- File Override Name allows you to always name your file name each time. Some carriers will give you free software to submit your claims with and expect the same filename each time.
- For Print Report there are three choices as to whether a list of all claims sent in the file are printed. "Ask" will ask the user, "No" will never print the list and "Yes" will always print the list.
