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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 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

MO HealthNet Division4CLAIM MANAGEMENT

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NEW XOVER CLAIM

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MEDICARE UB-04 PART A INSTITUTIONAL

MO HealthNet Division7PARTICIPANT DCNPARTICIPANT LAST NAMEPARTICIPANT FIRST NAMEPATIENT ACCOUNT NUMBERPARTICIPANT MEDICARE ID (HIC)

MO HealthNet Division8PARTICIPANT DCNPARTICIPANT LAST NAMEPARTICIPANT FIRST NAMEPATIENT ACCOUNT NUMBERPARTICIPANT MEDICARE ID (HIC)

MO HealthNet Division9PARTICIPANT DCNPARTICIPANT LAST NAMEPARTICIPANT FIRST NAMEPATIENT ACCOUNT NUMBERPARTICIPANT MEDICARE ID (HIC)

MO HealthNet Division10PARTICIPANT DCNPARTICIPANT LAST NAMEPARTICIPANT FIRST NAMEPATIENT ACCOUNT NUMBERPARTICIPANT MEDICARE ID (HIC)

MO HealthNet Division11PARTICIPANT DCNPARTICIPANT LAST NAMEPARTICIPANT FIRST NAMEPATIENT ACCOUNT NUMBERPARTICIPANT MEDICARE ID (HIC)

MO HealthNet Division12DATE OF SERVICEPARTICIPANT STATUSADMISSION DATECOVERED DAYSNON-COVERED DAYSCO-INSURANCE DAYSLIFETIME RESERVED DAYS

MO HealthNet Division13DATE OF SERVICEPARTICIPANT STATUSADMISSION DATECOVERED DAYSNON-COVERED DAYSCO-INSURANCE DAYSLIFETIME RESERVED DAYS

MO HealthNet Division14DATE OF SERVICEPARTICIPANT STATUSADMISSION DATECOVERED DAYSNON-COVERED DAYSCO-INSURANCE DAYSLIFETIME RESERVED DAYS

MO HealthNet Division15DATE OF SERVICEPARTICIPANT STATUSADMISSION DATECOVERED DAYSNON-COVERED DAYSCO-INSURANCE DAYSLIFETIME RESERVED DAYS

MO HealthNet Division16DATE OF SERVICEPARTICIPANT STATUSADMISSION DATECOVERED DAYSNON-COVERED DAYSCO-INSURANCE DAYSLIFETIME RESERVED DAYS

MO HealthNet Division17DATE OF SERVICEPARTICIPANT STATUSADMISSION DATECOVERED DAYSNON-COVERED DAYSCO-INSURANCE DAYSLIFETIME RESERVED DAYS

MO HealthNet Division18DATE OF SERVICEPARTICIPANT STATUSADMISSION DATECOVERED DAYSNON-COVERED DAYSCO-INSURANCE DAYSLIFETIME RESERVED DAYS

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MEDICARE PROVIDER NPIATTENDING PROVIDER NPIBILLED CHARGESDIAGNOSIS CODESSURGERY PROCEDURE CODES & DATETYPE OF BILL

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MEDICARE PROVIDER NPIATTENDING PROVIDER NPIBILLED CHARGESDIAGNOSIS CODESSURGERY PROCEDURE CODES & DATETYPE OF BILL

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MEDICARE PROVIDER NPIATTENDING PROVIDER NPIBILLED CHARGESDIAGNOSIS CODESSURGERY PROCEDURE CODES & DATETYPE OF BILL

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MEDICARE PROVIDER NPIATTENDING PROVIDER NPIBILLED CHARGESDIAGNOSIS CODESSURGERY PROCEDURE CODES & DATETYPE OF BILL

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MEDICARE PROVIDER NPIATTENDING PROVIDER NPIBILLED CHARGESDIAGNOSIS CODESSURGERY PROCEDURE CODES & DATETYPE OF BILL

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MEDICARE PROVIDER NPIATTENDING PROVIDER NPIBILLED CHARGESDIAGNOSIS CODESSURGERY PROCEDURE CODES & DATETYPE OF BILL

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SAVE CLAIM HEADER

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REVENUE CODEDAYS/UNITS BILLEDSAVE DETAIL LINE TO CLAIM

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REVENUE CODEDAYS/UNITS BILLEDSAVE DETAIL LINE TO CLAIM

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REVENUE CODEDAYS/UNITS BILLEDSAVE DETAIL LINE TO CLAIM

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REVENUE CODEDAYS/UNITS BILLEDSAVE DETAIL LINE TO CLAIM

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REVENUE CODEDAYS/UNITS BILLEDSAVE DETAIL LINE TO CLAIM

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REVENUE CODEDAYS/UNITS BILLEDSAVE 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 CODESPAYER AT HEADER LEVELSAVE OTHER PAYER DATA & MANAGE CODES

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PAID AMOUNTTOTAL DENIED AMOUNTRA REMARK CODESPAYER AT HEADER LEVELSAVE OTHER PAYER DATA & MANAGE CODES

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PAID AMOUNTTOTAL DENIED AMOUNTRA REMARK CODESPAYER AT HEADER LEVELSAVE OTHER PAYER DATA & MANAGE CODES

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PAID AMOUNTTOTAL DENIED AMOUNTRA REMARK CODESPAYER AT HEADER LEVELSAVE OTHER PAYER DATA & MANAGE CODES

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PAID AMOUNTTOTAL DENIED AMOUNTRA REMARK CODESPAYER AT HEADER LEVELSAVE OTHER PAYER DATA & MANAGE CODES

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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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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 CODESPAYER AT HEADER LEVELSAVE OTHER PAYER DATA & MANAGE CODES

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PAID AMOUNTTOTAL DENIED AMOUNTRA REMARK CODESPAYER AT HEADER LEVELSAVE OTHER PAYER DATA & MANAGE CODES

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PAID AMOUNTTOTAL DENIED AMOUNTRA REMARK CODESPAYER AT HEADER LEVELSAVE OTHER PAYER DATA & MANAGE CODES

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PAID AMOUNTTOTAL DENIED AMOUNTRA REMARK CODESPAYER AT HEADER LEVELSAVE OTHER PAYER DATA & MANAGE CODES

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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 AMOUNTMEDICARE DEDUCTIBLE MINUS THE INSURANCE COMPANY PAYMENT

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNTMEDICARE DEDUCTIBLE MINUS THE INSURANCE COMPANY PAYMENT

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CLAIM GROUP CODECLAIM ADJUSTMENT REASON CODEADJUSTMENT AMOUNTMEDICARE DEDUCTIBLE MINUS THE INSURANCE COMPANY PAYMENT

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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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SAVE CODES TO OTHER PAYER

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SAVE OTHER PAYER TO CLAIM

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SUBMIT CLAIM

MO HealthNet Division71CLAIM RECEIVEDCOPY CLAIMPAYMENT DETAILS

MO HealthNet Division72CLAIM RECEIVEDCOPY CLAIMPAYMENT DETAILS

MO HealthNet Division73CLAIM 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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