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MO HealthNet Internet Provider Training ProgramPresented by the Provider Education Unit MO HealthNet Division

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Proper Completion of the Online Medicare Part B of A Crossover ClaimPresented by the Provider Education UnitMO HealthNet Division Mo HealthNet Division2

To file a claim go to the Internet Web site www.emomed.com and log on. This will bring up the eProvider Home Page. At the top of each page is a Help button in the form of a question mark. You can print out field-by-field instructions.MO HealthNet Division3

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CLAIM MANAGEMENT

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NEW XOVER CLAIM

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MEDICARE UB-04 PART B PROFESSIONAL

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PARTICIPANT DCNPARTICIPANT LAST NAMEPARTICIPANT FIRST NAMEPATIENT ACCOUNT NUMBERPARTICIPANT MEDICARE ID (HIC)

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PARTICIPANT DCNPARTICIPANT LAST NAMEPARTICIPANT FIRST NAMEPATIENT ACCOUNT NUMBERPARTICIPANT MEDICARE ID (HIC)

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PARTICIPANT DCNPARTICIPANT LAST NAMEPARTICIPANT FIRST NAMEPATIENT ACCOUNT NUMBERPARTICIPANT MEDICARE ID (HIC)

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PARTICIPANT DCNPARTICIPANT LAST NAMEPARTICIPANT FIRST NAMEPATIENT ACCOUNT NUMBERPARTICIPANT MEDICARE ID (HIC)

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PARTICIPANT DCNPARTICIPANT LAST NAMEPARTICIPANT FIRST NAMEPATIENT ACCOUNT NUMBERPARTICIPANT MEDICARE ID (HIC)

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MEDICARE PROVIDER NPIPERFORMING PROVIDER NPIDIAGNOSIS CODESTYPE OF BILLSAVE CLAIM HEADER

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MEDICARE PROVIDER NPIPERFORMING PROVIDER NPIDIAGNOSIS CODESTYPE OF BILLSAVE CLAIM HEADER

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MEDICARE PROVIDER NPIPERFORMING PROVIDER NPIDIAGNOSIS CODESTYPE OF BILLSAVE CLAIM HEADER

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MEDICARE PROVIDER NPIPERFORMING PROVIDER NPIDIAGNOSIS CODESTYPE OF BILLSAVE CLAIM HEADER

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MEDICARE PROVIDER NPIPERFORMING PROVIDER NPIDIAGNOSIS CODESTYPE OF BILLSAVE CLAIM HEADER

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DATE OF SERVICEPROCEDURE CODEMODIFIERSREVENUE CODENATIONAL DRUG CODEDECIMAL QUANTITY

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DATE OF SERVICEPROCEDURE CODEMODIFIERSREVENUE CODENATIONAL DRUG CODEDECIMAL QUANTITY

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DATE OF SERVICEPROCEDURE CODEMODIFIERSREVENUE CODENATIONAL DRUG CODEDECIMAL QUANTITY

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DATE OF SERVICEPROCEDURE CODEMODIFIERSREVENUE CODENATIONAL DRUG CODEDECIMAL QUANTITY

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DATE OF SERVICEPROCEDURE CODEMODIFIERSREVENUE CODENATIONAL DRUG CODEDECIMAL QUANTITY

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DATE OF SERVICEPROCEDURE CODEMODIFIERSREVENUE CODENATIONAL DRUG CODEDECIMAL QUANTITY

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BILLED CHARGESDAYS/UNITS BILLEDPAID AMOUNTSAVE DETAIL LINE TO CLAIM

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BILLED CHARGESDAYS/UNITS BILLEDPAID AMOUNTSAVE DETAIL LINE TO CLAIM

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BILLED CHARGESDAYS/UNITS BILLEDPAID AMOUNTSAVE DETAIL LINE TO CLAIM

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BILLED CHARGESDAYS/UNITS BILLEDPAID AMOUNTSAVE DETAIL LINE TO CLAIM

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DATE OF SERVICEPROCEDURE CODEMODIFIERSREVENUE CODE

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DATE OF SERVICEPROCEDURE CODEMODIFIERSREVENUE CODE

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DATE OF SERVICEPROCEDURE CODEMODIFIERSREVENUE CODE

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DATE OF SERVICEPROCEDURE CODEMODIFIERSREVENUE CODE

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BILLED CHARGESDAYS/UNITS BILLEDPAID AMOUNTSAVE DETAIL LINE TO CLAIM

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BILLED CHARGESDAYS/UNITS BILLEDPAID AMOUNTSAVE DETAIL LINE TO CLAIM

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BILLED CHARGESDAYS/UNITS BILLEDPAID AMOUNTSAVE DETAIL LINE TO CLAIM

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BILLED CHARGESDAYS/UNITS BILLEDPAID AMOUNTSAVE DETAIL LINE TO CLAIM

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FILING INDICATOROTHER PAYER IDOTHER PAYER NAMEPAID DATE

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FILING INDICATOROTHER PAYER IDOTHER PAYER NAMEPAID DATE

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FILING INDICATOROTHER PAYER IDOTHER PAYER NAMEPAID DATE

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FILING INDICATOROTHER PAYER IDOTHER PAYER NAMEPAID DATE

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PAID AMOUNTTOTAL DENIED AMOUNTRA REMARK CODESSAVE OTHER PAYER DATA AND MANAGE CODES

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PAID AMOUNTTOTAL DENIED AMOUNTRA REMARK CODESSAVE OTHER PAYER DATA AND MANAGE CODES

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PAID AMOUNTTOTAL DENIED AMOUNTRA REMARK CODESSAVE OTHER PAYER DATA AND MANAGE CODES

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PAID AMOUNTTOTAL DENIED AMOUNTRA REMARK CODESSAVE OTHER PAYER DATA AND MANAGE CODES

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ASSOCIATED LINE ITEMSCLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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ASSOCIATED LINE ITEMSCLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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ASSOCIATED LINE ITEMSCLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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ASSOCIATED LINE ITEMSCLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNTSAVE CODES TO OTHER PAYER

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNTSAVE CODES TO OTHER PAYER

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNTSAVE CODES TO OTHER PAYER

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNTSAVE CODES TO OTHER PAYER

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ASSOCIATED LINE ITEMSCLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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ASSOCIATED LINE ITEMSCLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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ASSOCIATED LINE ITEMSCLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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ASSOCIATED LINE ITEMSCLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNTSAVE CODES TO OTHER PAYER

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNTSAVE CODES TO OTHER PAYER

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNTSAVE CODES TO OTHER PAYER

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNTSAVE CODES TO OTHER PAYER

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SAVE OTHER PAYER TO CLAIM

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SUBMIT CLAIM

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FILING INDICATOROTHER PAYER IDOTHER PAYER NAMEPAID AMOUNTPAID DATESAVE OTHER PAYER DATA AND MANAGE CODESTOTAL DENIED AMOUNT

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FILING INDICATOROTHER PAYER IDOTHER PAYER NAMEPAID AMOUNTPAID DATESAVE OTHER PAYER DATA AND MANAGE CODESTOTAL DENIED AMOUNT

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FILING INDICATOROTHER PAYER IDOTHER PAYER NAMEPAID AMOUNTPAID DATESAVE OTHER PAYER DATA AND MANAGE CODESTOTAL DENIED AMOUNT

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FILING INDICATOROTHER PAYER IDOTHER PAYER NAMEPAID AMOUNTPAID DATESAVE OTHER PAYER DATA AND MANAGE CODESTOTAL DENIED AMOUNT

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FILING INDICATOROTHER PAYER IDOTHER PAYER NAMEPAID AMOUNTPAID DATESAVE OTHER PAYER DATA AND MANAGE CODESTOTAL DENIED AMOUNT

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FILING INDICATOROTHER PAYER IDOTHER PAYER NAMEPAID AMOUNTPAID DATESAVE OTHER PAYER DATA AND MANAGE CODESTOTAL DENIED AMOUNT

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FILING INDICATOROTHER PAYER IDOTHER PAYER NAMEPAID AMOUNTPAID DATESAVE OTHER PAYER DATA AND MANAGE CODESTOTAL DENIED AMOUNT

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ASSOCIATED LINE ITEMSCLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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ASSOCIATED LINE ITEMSCLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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ASSOCIATED LINE ITEMSCLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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ASSOCIATED LINE ITEMSCLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNTSAVE CODES TO OTHER PAYER

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNTSAVE CODES TO OTHER PAYER

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNTSAVE CODES TO OTHER PAYER

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNTSAVE CODES TO OTHER PAYER

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ASSOCIATED LINE ITEMSCLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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ASSOCIATED LINE ITEMSCLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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ASSOCIATED LINE ITEMSCLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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ASSOCIATED LINE ITEMSCLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNT

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNTSAVE CODES TO OTHER PAYER

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNTSAVE CODES TO OTHER PAYER

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNTSAVE CODES TO OTHER PAYER

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNTSAVE CODES TO OTHER PAYER

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SAVE OTHER PAYER TO CLAIM

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SUBMIT CLAIM

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CLAIM RECEIVEDCOPY CLAIMPAYMENT DETAILS

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CLAIM RECEIVEDCOPY CLAIMPAYMENT DETAILS

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CLAIM RECEIVEDCOPY CLAIMPAYMENT DETAILS

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NEW CLAIMFINISH

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NEW CLAIMFINISH

Thank you again for participating in this training program. If you have questions regarding the information in this presentation, please contact the Provider Education Unit at 573-751-6683.

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