RN Classic 5010

7/31/2019 RN Classic 5010

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®

HIPAA X12 Version 5010 Release Notes

for Healthland Classic

7/31/2019 RN Classic 5010


C i ht © S t b 26 2011 H lthl d® All Ri ht R d

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3

H I P A A X 1 2 V e r s i o n 5 0 1 0 U p d a t e

contents

Chapter 1

Introduction.................................................................................................... 5

About the HIPAA X12 Version 5010 Regulatory Update ...................................................................6

Chapter 2

Hospital System............................................................................................. 7

837 Billing Changes .......................................................................................................................... 8

Admissions/Discharges/Transfers (ADTs)................................................................................... 8

Patient Management ................................................................................................................. 12Billing .................................................................................................................................12

Patient Information (File Maintenance) ..............................................................................15

Doctor Setup: Changed processes to include the attending and operating provider secondary

identification in the v5010 837 download only if an individual record for that doctor is set up. The

default record set up for all doctors will not be considered for secondary identification. Health

Information Management .......................................................................................................... 16

5010 Setup Instructions for Hospital 837 Billing ..............................................................................19

Eligibility Verification (270/271) Changes ........................................................................................24

Admissions/Discharges/Transfers (ADTs).................................................................................24Patient Information (File Maintenance) .....................................................................................24

5010 Setup Instructions for Hospital Eligibility Verification (270/271) ............................................. 25

835 Processing Changes ................................................................................................................ 26

5010 Setup Instructions for Hospital 835 Processing ......................................................................26

Chapter 3

Clinic System (PPM).................................................................................... 27

837 Billing Changes ........................................................................................................................28

Physician Practice Management...............................................................................................28

Billing .................................................................................................................................28

Daily Work.......................................................................................................................... 31

File Maintenance 31

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4

Appendix A: Database Changes ................................................................. 45

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Introduction

In This Chapter

About the HIPAA X12 Version 5010 Regulatory Update 6

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6 About the HIPAA X12 Version 5010 Regulatory Update

About the HIPAA X12 Version 5010 Regulatory Update

The HIPAA X12 Version 5010 Regulatory Update is a new set of standards that regulate the electronic transmission of health care

transactions, including eligibility benefit inquiry and response, claim remittances, and claim submissions.

Healthland is releasing this update in phases, with Phase 1 containing changes for the 270/271 Eligibility Verification transaction

sets and 837 Institutional and Professional (837I and 837P) Billing. Phase 2 contain changes for 835 Billing (ERAs). This software is

compliant with the HIPAA X12 Version 5010 transactions set. If an individual or State has or in the future set requirements outside

the HIPAA X12 transaction set, they may not be supported in this release. Individual State companion guides are beginning to

appear on the internet sites if you have concerns about your state.

The compliance date for use of the 5010 standards is January 1, 2012 as required by Federal law. The 5010 standards

accommodates the upcoming ICD-10-CM code sets, which are scheduled to be implemented on October 1, 2013.

This document contains a list of 837 and 270/271 changes made to the Healthland system in accordance with HIPAA regulations, as

well as accompanying setup instructions to properly configure your system for the 5010 format so you can begin testing your 270

and 837 download files with your clearing house.

No changes were made to paper UB and 1500 forms.

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Hospital System

In This Chapter

837 Billing Changes 8 Admissions/Discharges/Transfers (ADTs) 8

Patient Management 12

Doctor Setup: Changed processes to include the attending and operating provider secondary identi-

fication in the v5010 837 download only if an individual record for that doctor is set up. The default

record set up for all doctors will not be considered for secondary identification. Health Information

Management 16

5010 Setup Instructions for Hospital 837 Billing 19

Eligibility Verification (270/271) Changes 24

5010 Setup Instructions for Hospital Eligibility Verification (270/271) 25

835 Processing Changes 26

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8 837 Billing Changes

837 Billing Changes

The following modules in the Hospital system were changed for 837 Billing to accommodate the HIPAA X12 Version 5010

Regulatory Update:

• Patient Management

• Health Information Management

Admissions/Discharges/Transfers (ADTs)

• Admission > Physician tab:

- Added the Rendering field on the Physicians tab for clerks to enter the rendering provider

at the claim level. This is required in the 837I and 837P downloads when the rendering

provider is different than the billing provider. The rendering provider is the person or

company (lab or other company) who rendered the care, i.e. delivers or completes a

particular medical service or non-surgical procedure. In the case of a substitute provider,

enter the provider’s information here.

- Added the Supervising field on the Physicians tab for clerks to enter the supervising

physician at the claim level. This is required in the 837P download (1500) when the

Rendering Provider is supervised by a physician.

Valid code qualifiers have changed for v5010. Only data with valid qualifiers will be processed in the

837 file; data with invalid qualifiers will be ignored or sent to the assignment work bucket in the

Healthland system. Refer to your companion guide(s) for valid qualifiers and determine if you need to change your setup based on the 5010 specifications. Refer to Healthland’s 837 5010 Data

Element Reference Guides (located on Central Station) to learn where data elements are set up in

the Healthland system.

Verify the information in the following screens in Patient Management:

- Doctor Setup

- Payer Code Setup

- UB 837 > Billing/Pay To Provider Info

- 1500 837 > Billing/Pay To Provider Info

All previous codes will still be available so that they can be used for the 4010 format until you begin

using the 5010 format. Once you switch to the 5010 format, only the valid qualifiers will be

processed for the 5010 format.

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837 Billing Changes 9

• Admission > Ambulance tab: Added the ability to enter the point of destination (drop-off)

information. This information is required for ambulance claims that are being billed in the v5010

837P. To accommodate this change, the Point of Pick-Up Information and Point of Drop-Off

Information are displayed on two separate sub tabs. (See Figure: 1.2 )

Figure 1.1: New Rendering and Supervising fields on the Admission > Physicians tab

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ambulatory location codes, go to Patient Management > Patient Information > File

Maintenance > Add/Change Screens > Location Setup. Press <F1> in the application for

instructions on how to use this screen.

• Admissions > Ambulance tab: Added a new Condition Indicator, 12 = Patient is confined to

a bed or chair . Use code 12 only in the v5010 format to indicate the patient was bedridden

during transport. In addition, the 02, 03, and 60 condition indicators will become inactive at the

end of the 2011 year once v5010 goes into effect. NOTE: The Condition Indicator is required in

the 837P download for ambulance billing.

• Admissions > Admission tab: Condition codes are now sent in the v5010 837P download in

the new HI segment. There are additional condition codes, which must be added to the CON1

or CON2 insurance table based on your current table setup. If your CON1 and CON2 tables are

full, you will need to delete conditional codes that are no longer used to make room for the new

codes as needed. These tables can be set up 4 columns wide. If you need to add columns, you

will need to delete the current table(s) and re-create it. Keep in mind, if you make changes to

these tables, they do not take effect until after the nightly build.

The Condition Codes approved for use on the 1500 Claim Form are available at www.nucc.org

under code sets.

- AA=Abortion Performed due to Rape

- AB=Abortion Performed due to Incest- AC=Abortion Performed due to Serious Fetal Genetic, Defect, Deformity, or Abnormality

- AD=Abortion Performed due to Life Endangering Physical Condition Caused by, Arising

from or Exacerbated by the Pregnancy itself

- AE=Abortion Performed due to Physical Health of Mother that is not Life Endangering

- AF=Abortion Performed due to Emotional/psychological health of the Mother

AG=Abortion Performed due to Social or Economic Reasons

When setting up ambulatory location codes, Healthland recommends that you create new location

codes and use the AMB conflict code. DO NOT change the existing location codes that have a

conflict code of ADT. This is because if your site has the ADTLOC alpha table set up, only location

codes with the ADT conflict code are available in the Location field for the admission. If you change

the conflict code from ADT to AMB, those locations will no longer be available. If the table is not set

up, all locations including those with the AMB conflict code will be available. (See Figure: 1.3 )

Figure 1.3: Location field for the admission

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To set up the CON1 and CON2 tables:

1) Go to Patient Management > Patient Information > File Maintenance > Add/

Change Screens > Insurance File Tables:

2) In the Table ID field, type CON1 or CON2. (NOTE: If the table is already set up, the

remaining information is displayed.)

3) In the Title field, type Condition Code.

4) In the Columns field, type 2 or up to 4 depending on the number of condition codes

you want to enter.

5) Enter column descriptions if desired. The first and third columns contain the condition

code, the second and fourth columns contain the code description.

6) Enter the condition code information in the columns, entering a condition code in the

first column and corresponding description in the second. If you have 4 columns, enter

another code in the third column and its corresponding description in the fourth

column. Keep in mind, each table can have a maximum of 256 characters.

7) When setting up the CON1 table and you are going to also set up the CON2 table, be

sure to type the word, CON2, in the row before the final row of the CON1 table to

indicate a continuation of the table. See below for an example.

8) In the first column of the last row, type END.

9) Click Apply or OK to save the table.

10) If you need to set up both the CON1 and CON2 tables, repeat these steps for the

second table. NOTE: Do not do step 7 for the CON2 table.

• Admission > Billing Information tab: Special Program Indicators 05 and 09 have been added

for 837P v5010 specifications for Medicaid claims. Codes 02, 03, and 60 are now invalid for

v5010. Update the SPI insurance file table to add the new codes. During the testing phase,

keep the unused codes until you change to production mode, then change the code

descriptions for 02, 03, and 60 to DO NOT USE or remove them from the table.

To edit the SPI table:

1) Go to Patient Management >Patient Information > File Maintenance > Add

Change Screens > Insurance File Tables.

2) In the Table ID field, type SPI. The table information is displayed.

3) Click Insert Line to add a row in the table, and add the 05 code and description.

Repeat for the 09 code and description.

4) Click OK to save.

• Admission > Insurance tab: Changed processes to only accept options I or Y as the Release

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Patient Management

Billing

The following changes apply to both UB and 1500 Billing.

• EMC Header Information: Changed the Control Version Number and Version/Release/

Industry ID fields to be drop-down lists and added options to these lists to accommodate the

new 5010 format. See 5010 Setup Instructions for Hospital 837 Billing on page 19 to activate

the 5010 format for 837 processing.

• EMC Header Information: HIPAA X12 v5010 837 specifications require a nine-digit zip code

for the billing provider (2010AA segment). The Zip Code field is not validated in the Healthland

system. Please verify that you have entered all nine digits for your billing provider(s).

• Assign Attachments: Updated the Transmission Code field inquiry to remove obsolete

transmission codes.

UB Billing

• EMC File Number Assignment: Added the ability to enter a file type for 5010 file submissionsso that you can generate the UB billing run in the 5010 format. See 5010 Setup Instructions for

Hospital 837 Billing on page 19 for instructions on how to set up the 5010 EMC file number.

• The full nine-digit zip code is now required for service facilities in the U.S. Ensure you have all

nine digits of the zip code entered in your service facility location alpha table (see Figure: 1.4).

See the Patient Management Setup & Maintenance Guide for a detailed explanation of this

table.

If secondary identification is required, ensure your service location table also contains the

following codes, which are the only valid codes for service facility secondary identification in

v5010:

- 0B = State License Number

- G2 = Provider Commercial Number.

- LU = Location Number

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• Added the Edit Billing/Claim Note screen so that billing and claim notes can be submitted in

the 837 download file when required by the provider to substantiate the medical treatment.

To access this new screen, go to Patient Management > Billing > UB Billing > Edit Billing/Claim Note. Press <F1> in the application for additional information and instructions on how to

use this screen. This screen is also accessible in the Enhanced 1500 Billing menu and in the

Health Information Management application under the Links menu.

1500 Billing

• EMC File Number Assignment: Added the ability to enter a file type for 5010 file submissions

so that you can generate the 1500 billing run in the 5010 format. See 5010 Setup Instructions

for Hospital 837 Billing on page 19 for instructions on how to set up the 5010 EMC file number.

• 1500 Reconstruct: Added the Payer Claim Control Number field for users to enter the control

number, if known, when the 837 professional (1500) claim is a replacement or is void to a

i l dj di t d l i Thi b ld b id d b th

For the 837I download, if a billing note is not entered in this screen, then the download file will

contain information based on how the UB Parameter Setup screen is set up for Locator 80 instead.

Figure 1.5: UB Edit Billing/Claim Note screen in Patient Management

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• The full nine-digit zip code is now required for service facilities in the U.S. Ensure you have all

nine digits of the zip code entered based on how your system is configured to pull information

for the 837P download. The Rendering Facility (Box 32) field in the Form Control Parameter

controls which address to include in the download, (Billing > Enhanced 1500 Billing >

Parameter/Maintenance Screens > Form Control Parameter > Box 32-33 tab):

- If Header Info, then Billing > Enhanced 1500 Billing > Process EMCS > Professional

837 Setup > EMC Header Information

- If Location, then Patient Information > File Maintenance > Add/Change Screens >

Location Setup

- If Alternate Address, then Billing > Enhanced 1500 Billing > Parameter/Maintenance

Screens > Form Control Parameter > Box 32-33 tab

• Added the Edit Billing/Claim Note screen so that billing notes can be submitted in the 837

download file when required by the provider to substantiate the medical treatment.

NOTE: This screen is identical to the UB Edit Billing/Claim Note screen; however, only the

billing note option is used for the 837P download; claim notes are not included in the 837P

download.

To access this new screen, go to Patient Management > Billing > 1500 Enhanced Billing >

Edit Billing/Claim Note. Press <F1> in the application for additional information and

instructions on how to use this screen. This screen is also accessible in the UB Billing menu andin the Health Information Management application under the Links menu. (See Figure: 1.6 )

Figure 1.6: 1500 Edit Billing/Claim Note screen in Patient Management

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Patient Information (File Maintenance)

• Charge File Maintenance: Added new Product/Service ID Qualifiers, which allow compound

drug information to be submitted in the 837 download. These qualifiers are available via the

Prod/Serv ID Code field.

The following codes are valid for v5010:

- ER = Jurisdiction Specific Procedure and Supply Codes

- HC = Health Care Financing Administration Common Procedural Coding System (HCPCS)

Codes

- HP = Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate

Code

- IV = Home Infusion EDI Coalition (HIEC) Product/Service Code- WK = Advanced Billing Concepts (ABC) Codes

In addition, the following values have an inactive date of 12/31/2011:

- ID

- N1

- N2

- N3

- N4

- ZZ

The Prod/Serv ID Code field inquiry was updated so that active codes with a future inactive

date are now displayed.

• Charge File Maintenance / Combined Charge Maintenance: Added the ME = Milligram

option to the NDC Unit of Measurement field.

• Payer Code Setup: A new source of payment code, K = Federal Employees Program, is now

available. If your site will be using this source of payment, you will need to update your

SCPYMT insurance file table in Patient Management to make this new code available in the

Source of Payment drop-down list in the Payer Code Setup screen. See the instructions below

to update the SCPYMT table.


Change Screens > Insurance Tables.

2) In the Table ID field, type SCPYMT. The table information will display.

3) Click Insert Line A blank row will be added to the table

The above Prod/Serv ID code changes apply to the stand-alone Charge File Maintenance and Tier

Charge Setup screens, as well as the combined Charge File Maintenance screen. In the combined

Charge File Maintenance, the Prod/Serv ID Code field is located on the Base and Tier sub tabs of

the PM tab, and on the Base sub tab of the PPM tab.

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Follow the steps below to update the source of payment for those payers associated with the

Federal Employees Program.


Change Screens > Payer Code Setup.

2) In the Payer Code field, select the payer code you want to set up with the Federal

Employees Program source of payment. The remaining fields are displayed.

3) In the Source of Payment field, use the drop-down to select K - FED EMP PRG.

4) Click Apply to save and remain in the window or click OK to save and exit.

• Payer Code Setup: Updated Primary ID Code Qualifier field to mark invalid values (for 4010

or 5010) with an inactive date of 12/31/2011.

The following codes are valid for the 4010 & 5010 formats:

- PI = Jurisdiction Specific Procedure and Supply Codes

- XV = Health Care Financing Administration Common Procedural Coding System (HCPCS)

Codes; (not yet mandated)

NOTE: Use PI until the HIPAA National Plan Identifier is mandated.

Doctor Setup: Changed processes to include the attending and operating provider secondary identification in the v5010 837 down-

l d l if i di id l d f th t d t i t Th d f lt d t f ll d t ill t b id d f d

Figure 1.7: The updated SCPYMT insurance file table

TESTING NOTE: If you are submitting a 5010 test file and need to continue using the 4010 format

until the test file is approved, you will need to return to this screen after you have generated the test

file to change the payer(s) back to the source of payment code you used for the 4010 format.

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- Added the Rendering field on the Physician Info tab so that coders and billers can enter

the rendering provider at the claim level. This is required in the 837I and 837P downloads

when the rendering provider is different than the billing provider. The rendering provider is

the person or company (lab or other company) who rendered the care, i.e. delivers or

completes a particular medical service or non-surgical procedure. In the case of a

substitute provider, enter the provider’s information here.

- Added the Supervising field on the Physicians tab for clerks to enter the supervising

physician at the claim level. This is required in the 837P download (1500) when the

Rendering Provider is supervised by a physician.

• Physician Information: Added the Charge Phy tab to this screen so that the HIM Coder can

edit the provider attached to each charge so the correct rendering/performing provider is billed.

Press <F1> in the screen for detailed instructions on this tab.

Figure 1.8: New Rendering and Supervising fields in the Physician Information screen

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• Patient Data: Added the Initial Treatment Date and Date Last Seen fields to allow for more

accurate billing. This information, if entered, is included in the 5010 format of the 837 download.

Figure 1.9: New ChargePhy tab in the Physician Information screen

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5010 Setup Instructions for Hospital 837 Billing

The instructions below allows you to configure your Hospital system for submitting the 837 file(s) in the 5010 format. Assuming youneed to send a test file to your clearing house, these instructions include steps for setting up and submitting the test file.

To set up the v5010 format

STEP 1 - Edit EMC File Numbers

This step allows you to set up your EMC file numbers with the 5010 file type so that you can

generate and submit the 837 file in the 5010 format. You will need to complete this step for both the

837I and 837P downloads as it applies to your site.

1. Edit the EMC File Numbers in the following screens as it applies to your site:

• 837 Institutional (UB): Go to Patient Management > Billing > UB Billing > Parameters

Menu > Parameter Menu #2 > EMC File Number Assignment.

• 837 Professional (1500): Go to Patient Management > Billing > Enhanced 1500 Billing

> Process EMCs > EMC File Number Assignment.

TEST FILE SUBMISSION:

If you are required to send a 5010 test file to your clearing house, pay close attention to the

TESTING NOTES for each step. If you need to continue using the 4010 format until your test file is

approved by the clearing house, you will need to change your settings back to the 4010 format after

you have generated your 5010 test file.

Before you change to the 5010 settings in this screen, record your current 4010 settings so that you

can re-enter the information if you should need to return to the 4010 format after you have submitted

your 5010 test file.

The following screen examples illustrate how the screen appears based on which version (4010 or

5010) you are setting up. (See Figure: 1.11 and Figure: 1.12 ). Once the v5010 format is set up,

there are fields that are no longer used and that information will need to be re-entered if you return

to v4010. Healthland suggests you take a screenshot or take note of that information should you

need to re-enter it.

If returning to the v4010 format, please note that the 4010 version should be entered asUB92837V4010Aux.mmc -T ; there must be a space between mmc and -T.

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20 5010 Setup Instructions for Hospital 837 Billing

Figure 1.11: Example of EMC File Number Assignment for v4010

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3. Click Apply to save and remain in the window, or click OK to save and exit.

STEP 2 - Update the Control Version Number

1. Set the Control Version Number in the following screens as it applies to your site:

• 837 Institutional (UB): Go to Patient Management > Billing > UB Billing > Process

EMCs > UB 837 Setup > EMC Header Information.

• 837 Professional (1500): Go to Patient Management > Billing > Enhanced 1500 Billing> Process EMC > Professional 837’s Setup > EMC Header Information.

2. In the [UB/1500] EMC File No. field, select the EMC file number for which you want to activate

the 5010 format. The remaining fields are displayed.

3. In the Control Version Number field, select 00501 for the 5010 format.

4. The Usage Indicator field is set to Production to generate the 837 download file and indicates



file to change your EMC file numbers back to the file type for the 4010 format.

Figure 1.13: Example of Control Version Number settings for the 5010 format

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22 5010 Setup Instructions for Hospital 837 Billing

6. Click Apply or OK.

To generate v5010 EMC files

STEP 1 - Resubmit the EMC files

1. Resubmit your EMC files using the following screens as it applies to your site:

• Go to Patient Management > Billing > UB Billing > Process EMCs > Resubmit EMC

File.

• Go to Patient Management > Billing > Enhanced 1500 Billing > Process EMCs >

Resubmit EMC File.

2. In the EMC File No field, select the EMC file number you have set up for your 5010 file.

3. In the Sub Date From field, enter the submission date of the last bill run that was completed.You must enter a From and To date; if not entered, you will recall all past claims and cause

performance issues with your system.

4. Click OK.

STEP 2 - Run EMC Formula

1. Go to Patient Management > Billing > Automated Billing Run/Setup.

2. From the grid, select the formula that corresponds to the EMC files you are trying to create.

3. Click Run.

STEP 3 - Download and submit EMC file

Verify that the Zip Code field contains all nine digits based on 5010 837 requirements for the billing

provider (2010AA segment).



file and enter the following settings:

• In the Control Version Number field, select 00401 for the 4010 format.

• In the Usage Indicator field, select Production.

• In the Version/Release/Industry ID field, select the appropriate 4010 version.

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5. Select your download options and click OK.

6. Submit your file to the clearing house according to your facility’s procedures.

STEP 4 - Reset parameters to 4010 format

If you submitted a test file, reset the following parameters to the 4010 format until the file is

approved. Complete this step for both UB and 1500 billing as it applies to your site.

• EMC File Number Assignment screen:

- 837 Institutional (UB): Go to Patient Management > Billing > UB Billing > Parameters

Menu > Parameter Menu #2 > EMC File Number Assignment. Select the EMC file

number you used for the 5010 test, and reset the File Type field back to 3 - 837Transaction Set.

- 837 Professional (1500): Go to Patient Management > Billing > Enhanced 1500 Billing

> Process EMCs > EMC File Number Assignment. Select the EMC file number you used

for the 5010 test, and reset the File Type field back to 837 Transaction Set (4010).

• EMC Header Information screen:

- 837 Institutional (UB): Go to Patient Management > Billing > UB Billing > Process

EMCs > UB 837 Setup > EMC Header Information.

- 837 Professional (1500): Go to Patient Management > Billing > Enhanced 1500 Billing> Process EMC > Professional 837’s Setup > EMC Header Information.

Select the EMC file number you used for the 5010 test, and reset the following fields:

- In the Control Version Number field, select 00401 for the 4010 format.

- In the Usage Indicator field, select Production.

- In the Version/Release/Industry ID field, select the appropriate 4010 version.

• UB - 004010X096A1

• 1500 - 004010X098A1

STEP 5 - Assign a submission date to claims in test mode

1. Assign a submission date to your test file claims using the following screens as it applies to your

site:

• Go to Patient Management > Billing > UB Billing > Process EMCs > Assign

Submission Date to EMC Claims.

• Go to Patient Management > Billing > Enhanced 1500 Billing > Process EMCs >

Use a submission date that is NOT the same as the date actually used. Healthland recommends a

weekend date or holiday date. This is because if you should need to recall the file you submitted in

the 4010 format, you can get back only the claims you submitted in that file and not those used for

testing.

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24 Eligibility Verification (270/271) Changes

Eligibility Verification (270/271) Changes

The following areas of the Patient Management module in the Hospital system were changed for Eligibility Verification toaccommodate the HIPAA X12 Version 5010 Regulatory Update:

Admissions/Discharges/Transfers (ADTs)

• Single Eligibility (SEND button) > Diagnosis Code Selection: Added the following codes to

the Place of Service Type search screen:• 01 - Pharmacy

• 03 - School

• 04 - Homeless Shelter

• 05 - Indian Health Service Free-standing Facility

• 06 - Indian Health Service Provider-based Facility

• 07 - Tribal 638 Free-standing Facility

• 08 - Tribal 638 Provider-based Facility

• 13 - Assisted Living Facility

• 14 - Group Home

• 15 - Mobile Unit

• 20 - Urgent Care Facility

• 49 - Independent Clinic

• 57 - Non-residential Substance Abuse Treatment Facility

• Removed the Eligibility Verification Background Process menu option from the Eligibility

Verification menu.

Patient Information (File Maintenance)

• Control Numbers: Changed the Control Numbers screen (in the Eligibility Verification Setup

menu) to include the following changes:

- Added the Version (GS08) field, which defaults the version specified in the EDI Payer

Maintenance screen for all payers and is read-only. This field toggles between the 4010

and 5010 (005010X279A1) versions so that the 4010 version can be used for payers until

the 5010 test file is verified with the clearing house.

- Added the Usage Indicator (ISA15) field to select Test when you are sending a test file to

the clearing house, or Production once the test file has been approved.

- Added the Update Usage Indicator in All EDI Payer Records check box to apply the

25

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5010 Setup Instructions for Hospital Eligibility Verification (270/271) 25

• EDI Payer Maintenance:

- On the General tab, changed the Version (GS08) field on the General tab to be read-only

based on the version as set up in the Control Numbers screen.

- On the ISA tab, changed the Usage Indicator on the ISA tab to display the default value

from the EDI Control Numbers screen. This can be edited for a single payer as needed;

however, can be overwritten by the Update Usage Indicator in All EDI Payer Records

check box in the Control Numbers parameter if checked and applied.

- On the Reference tab, when using the Information Receiver qualifier OB for the state

license code, you are required to enter the correct two-character state code in the

Description field.

- On the Subscriber/Dependent tab, additional ID codes have been added; however, only

the following IDs are allowed:

• For the Subscriber area:

- Plan Number (18)

- Group / Policy Number (IL)

- Insurance Policy Number (IG)

- Social Security Number (SY)

• For the Dependent area:

- Social Security Number (SY)

- On the PRV/Provider Info tab, removed the PRV02 Qualifier field as this value is set

according to the version in the Taxonomy ID field.

- Increased the Description field from 35 characters up to 60 characters.

5010 Setup Instructions for Hospital Eligibility Verification (270/271)

Healthland staff will be contacting you to activate the v5010 format.

If, for any reason, you need to revert back to the 4010 format, and you do not want to update the

Test/Production Usage Indicator on all payers, you can uncheck this box. You can toggle the Usage

Indicator for a single payer directly in the EDI Payer Maintenance screen. This is particularly useful

when you need to add a new payer record and need to test the payer with the clearing house (i.e.

Test mode) before it can be put in Production mode.

26 83 C

7/31/2019 RN Classic 5010


26 835 Processing Changes

835 Processing Changes

Phase 2 of the v5010 update contains changes to allow payments from an 835 file in the v5010 format to be processed. Please notethe following:

• The v5010 format can be identified in the 835 file as 005010X221A1.

• The CAS segment from the 835 file will be included in the v5010 837 download file for

secondary claims.

5010 Setup Instructions for Hospital 835 Processing

Healthland Classic Financial v9.6 contains changes to improve the overall 835 process. While these changes are not specific to thev5010 update, you must review and complete the following parameters before you can upload and process an 835 file after you

have upgraded to v9.6.

• ERA File Transfer Parameters - Ensure the 835 Archived Location field is entered with the

directory path where you want to copy or FTP the actual 835 file to be stored for troubleshooting

purposes (i.e. 835archive). (Go to Patient Management > Patient Information > File

Maintenance > ERA Setup/Work > Edit File Transfer Parameters. Press <F1> in the

application for detailed instructions.)

• ERA Payment Type Cross Reference - This screen contains new fields: Claim Type, NPI, and

Outlier Payment Type. Before you can run the ERA Upload, this screen must be reviewed to

ensure the information for your existing cross references is complete. Verify that the Payment

Type column has a payment type entered for each record. (Go to Patient Management >

Patient Information > File Maintenance > ERA Setup/Work > ERA Payment Type Cross

Reference. Press <F1> in the application for detailed instructions.)

• ERA Adjustment Exceptions - This screen contains the most current reason codes and

default exception records so that payments and adjustments are calculated correctly from the

835 file. Review this screen and add or delete exception records based on your site’s specific

needs. (Go to Patient Management > Patient Information > File Maintenance > ERA Setup/

Work > ERA Adjustment Exceptions. Press <F1> in the application for detailed instructions.)

In addition to the 5010 ERA changes, we also made screen changes and improvements to the

overall ERA process. Please refer to the Healthland Classic v9.6 Release Notes for moreinformation.

7/31/2019 RN Classic 5010



Clinic System (PPM)

In This Chapter


5010 Setup Instructions for Clinic 837 Billing 34


5010 Setup Instructions for Eligibility Verification (270/271) 44

835 Processing Changes 44


7/31/2019 RN Classic 5010



837 Billing Changes

The following changes were made in the Physician Practice Management (PPM) application for 837 Billing to accommodate theHIPAA X12 Version 5010 Regulatory Update.

Physician Practice Management

Billing

• Assign Attachments: Updated the Transmission Code field inquiry to remove obsolete

transmission codes.

Pre-Billing Maintenance

• Edit Ticket Information: Added the Initial Treatment Date and Date Last Seen fields to allow

for more accurate billing. This information, if entered, is included in the 5010 format of the 837

download. These fields were also added to the Additional Information window in Daily Work >

Charge Entry and Daily Work > Edits & Deletes > Edit Unposted Charges.

• Edit Ticket Information: Added the ability to enter up to 20 characters for the Prior

Authorization. Also added the ability to enter a Primary, Secondary, and Tertiary Treatment

(Prior) Authorization, (at the Insurance level, the Prior Authorization Number can be up to 30

characters). This information, if entered, is submitted in the 837I download. These fields were

also added to the Additional Information window in Daily Work > Charge Entry and Daily

Work > Edits & Deletes > Edit Unposted Charges.

Valid code qualifiers have changed for v5010. Only data with valid qualifiers will be processed in the

837 file; data with invalid qualifiers will be ignored. Refer to your companion guide(s) for valid

qualifiers and determine if you need to change your setup based on the 5010 specifications. Refer

to Healthland’s 837 5010 Data Element Reference Guides (located on Central Station) to learn

where data elements are set up in the Healthland system.

Verify the information in the following screens:

- Provider Maintenance

- Insurance Maintenance

- Batch 1500 (ST) Information

- Batch Institutional (ST) Information

All previous codes will still be available so that they can be used for the 4010 format until you begin

using the 5010 format. Once you switch to the 5010 format, only the valid qualifiers will be

processed for the 5010 format.


7/31/2019 RN Classic 5010



34 to activate the 5010 format for 837 processing.

1500 Billing


the 837 download file when required by the provider to substantiate the medical treatment. User

security permissions must be set up in order to access this new screen. See the PPM 837

Setup Instructions below to configure your system.

User security permissions must be set up for users who need access to the Edit Billing/Claim

Note screen.

1) Go to Security > Entry > User Security.

2) In the Login Name field, enter the user’s login.

3) Select the PPM tab.

4) Select the Billing sub tab.

5) Locate the Billing/Claim Note option and select Yes in the Access field.

6) Click Apply or OK. Repeat steps 1-6 for each user who needs permissions set up.

To access this new screen, go to Physician Practice Management > Billing > 1500 Forms >Edit Billing/Claim Note for the 837P (1500) download. Press <F1> in the application for

additional information and instructions on how to use this screen.


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30 83 g C g

UB Billing

• 837 Institutional Download: The 2300 CL1 segment that contains the patient Discharge

Status, Admit Type, and Admission Source is now required for the 5010 format. The DischargeStatus and Admit Type are both required; the Admission Source is optional. You have a few

options for reporting this information in this segment:

- (Recommended) Set up the Institutional Validation Setup screen to have default values

populate on the claim at the time of the print and pass. Go to PPM > Billing > Billing

Setup > Institutional Validation Setup to enter the default values. (Enter the required

values in 17 Discharge Status (Patient Status) and Locator 14 Admit Type.)

- Enter the data in the Edit Institutional Information. Go to PPM > Billing > Pre Billing

Maintenance > Edit Institutional Information and enter the data for each claim.

- Edit the claim in history after it has been built. Go to PPM > Billing > Institutional > Edit

Institutional Forms and enter the data in the edit records.


the 837 download file when required by the provider to substantiate the medical treatment.

User security permissions must be set up for users who need access to the Edit Billing/Claim

Note screen.

1) Go to Security > Entry > User Security.

2) In the Login Name field, enter the user’s login.

3) Select the PPM tab.

4) Select the Billing sub tab.

5) Locate the Billing/Claim Note option and select Yes in the Access field.

6) Click Apply or OK. Repeat steps 1-6 for each user who needs permissions set up.

To access this new screen, go to Physician Practice Management > Billing > Institutional >Edit Billing/Claim Note for the 837I (UB) download, Press <F1> in the application for

additional information and instructions on how to use this screen.

For the 837I Download, if a billing note is not entered in the screen, then the download file will

contain information based on how the Institutional Parameter Record is set up for Locator 80

instead.


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g g

Daily Work

• Charge Entry > Additional Information: Added the Initial Treatment Date and Date Last

Seen fields to allow for more accurate billing. This information, if entered, is included in the

5010 format of the 837 download. These fields were also added to the Additional Information

window in Edits & Delete > Edit Unposted Charges and Pre-Billing Maintenance > Edit

Ticket Information.

• Charge Entry > Additional Information: Added the ability to enter up to 20 characters for the

Prior Authorization. Also added the ability to enter a Primary, Secondary, and Tertiary

Treatment (Prior) Authorization, (at the Insurance level, the Prior Authorization Number can be

up to 30 characters).This information, if entered, is submitted in the 837I download. These fields

were also added to the Additional Information window in Edits & Delete > Edit Unposted

Charges and Pre-Billing Maintenance > Edit Ticket Information.

• Charge Entry > Additional Information: Updated processes to send the EPSDT Indicator inthe v5010 837 file in Loop 2400 (Service Line Number) Segment SV111 (Professional Service);

as required when Medicaid services are the result of a screening referral. NOTE: This change

applies to v5010 only.

Figure 2.15: UB Edit Billing/Claim Note screen in PPM


7/31/2019 RN Classic 5010


- HC = Health Care Financing Administration Common Procedural Coding System (HCPCS)

Codes

- HP = Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate

Code- IV = Home Infusion EDI Coalition (HIEC) Product/Service Code

- WK = Advanced Billing Concepts (ABC) Codes

In addition, the following values have an inactive date of 12/31/2011:

- ID

- N1

- N2

- N3

- N4- ZZ

• The Prod/Serv ID Code field inquiry was updated so that active codes with a future inactive

date are now displayed.

• Procedures (CPT-4) Maintenance: Added the ME= Milligram option to the NDC Unit of

Measurement field.

• Insurance Maintenance: Added a new Source of Payment code, 20 = FED EMP PRG (Federal

Employees Program), to the Source drop-down list on the Options 1 tab.

Follow the steps below to update the source of payment for those payers associated with the

Federal Employees Program.

1) Go to Physician Practice Management > File Maintenance > File Maintenance 1 >

Insurance Maintenance.

2) In the Insurance field, select the payer code you want to set up with the Federal

Employees Program source of payment. The remaining fields are displayed.

3) In the Source field, use the drop-down to select 20 - FED EMP PRG.

4) Click Apply to save and remain in the window or click OK to save and exit.

The above Prod/Serv ID code changes apply to the stand-alone Procedures (CPT-4) Maintenance

and the combined Procedures (CPT-4) Maintenance screen (also known as Combined Charge File

Maintenance). In the combined Procedures (CPT-4) Maintenance, the Prod/Serv ID Code field is

located on the Base and Tier sub tabs of the PM tab, and on the Base sub tab of the PPM tab.

If you are submitting a 5010 test file and need to continue using the 4010 format until the test file is

approved, you will need to return to this screen after you have generated the test file to change the

payer(s) back to the source of payment code you used for the 4010 format.


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• Provider Maintenance: Changed the UPIN Number field so that it is no longer a required

entry.

• Provider Maintenance: Changed the Refer Phy Id Qual field on the Alternate Information

window (Alt Info button) so that it is no longer a required entry.

• Location Maintenance: The full nine digit zip code is now required for service facilities in the

U.S. Ensure you have the all nine digits of the zip code entered in this screen.

34 5010 Setup Instructions for Clinic 837 Billing

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5010 Setup Instructions for Clinic 837 Billing

The instructions below allows you to configure your Clinic system for submitting the 837 file(s) in the 5010 format. Assuming youneed to send a test file to your clearing house, these instructions include steps for setting up and submitting the test file.

To set up the v5010 format

STEP 1 - Edit EMC File Numbers

This step allows you to set up your EMC file numbers with the 5010 file type so that you can

generate and submit the 837 file in the 5010 format. You will need to complete this step for both the

837I and 837P downloads as it applies to your site.

1. Go to Physician Practice Management > Billing > Electronic Media Claims > EMC

Parameters > EMC Transmission Info > Transmission Information.

TEST FILE SUBMISSION:

If you are required to send a 5010 test file to your clearing house, pay close attention to the

TESTING NOTES for each step. If you need to continue using the 4010 format until your test file is

approved by the clearing house, you will need to change your settings back to the 4010 format after

you have generated your 5010 test file.

Before you change to the 5010 settings in this screen, record your current 4010 settings so that you

can re-enter the information if you should need to return to the 4010 format after you have submitted

your 5010 test file.

The following screen examples illustrate how the screen appears based on which version (4010 or

5010) you are setting up. (See Figure: 2.16 and Figure: 2.17 ). Once the v5010 format is set up,there are fields that are no longer used and that information will need to be re-entered if you return

to v4010. Healthland suggests you take a screenshot or take note of that information should you

need to re-enter it.


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Figure 2.16: Example of v4010 setup in the Transmission Information screen

Figure 2.17: Example of v5010 setup in the Transmission Information screen


7/31/2019 RN Classic 5010


4. In the EMC File Format field, select ANSI 837 (5010).

5. Click Apply to save and remain in the window, and repeat this procedure for each file number

you want to set up in the 5010 format for both the 837I and 837P downloads.

6. When all file numbers have been set up, click OK to save and exit.

STEP 2 - Update the Control Version Number


Parameters > EMC Transmission Info > EMC Header Information.

2. In the File field, select the EMC file number for which you want to activate the 5010 format. The

remaining fields are displayed.

3. In the Control Version Number field, select 00501 for the 5010 format.

4. The Usage Indicator field is set to P (Production) to generate the 837 download file and



file to change your EMC file numbers back to the file type for the 4010 format.

Figure 2.18: Example of Control Version Number settings for the 5010 format


7/31/2019 RN Classic 5010


6. Click Apply or OK.

STEP 3 - UB Validation Setup

Set up the Institutional Validation Setup screen to have default values populate on the claim at the

time of the print and pass.

1. Go to PPM > Billing > Billing Setup > Institutional Validation Setup. The Institutional

Validation Setup window is displayed.

Setup Considerations:

• Verify that when the Entity = Non-Person, only the Organization/Last Name field is entered; do

not enter the First Name, Middle Name/Initial, and Suffix fields.

• Verify that the Zip Code field contains all nine digits based on 5010 837 requirements for the

billing provider (2010AA segment).



file and enter the following settings:

• In the Control Version Number field, select 00401 for the 4010 format.

• In the Usage Indicator field, select Production.

• In the Version/Release/Industry ID field, select the appropriate 4010 version.

If you do not set up the default values in the UB Validation Setup screen, you can enter the data for

each claim in the Edit Institutional Information screen ( PPM > Billing > Pre Billing Maintenance >

Edit Institutional Information ) or you can edit the claim in history after it has been built ( PPM >

Billing > Institutional > Edit Institutional Forms ).

The Admission Source is also collected in the 5010 format; however, it is not required. Set up the

default Admission Source as needed.


7/31/2019 RN Classic 5010


2. In the Insurance field, click the binoculars button select the insurance you want to edit.

3. In the Locator field, enter 17 for the Discharge Status (Patient Status).

4. In the Sequence field, enter 1.

5. In the Default Value field, enter the appropriate value you want to default for Locator 17.

6. Click Apply to save and remain in the window.

7. Repeat this procedure for Locator 14 (Admit Type); enter 14 in the Locator field and enter the

appropriate value in the Default Value field.

8. Click OK to save and exit.

To generate v5010 EMC files

STEP 1 - Recall EMC Claims


Maintenance > Recall EMC Claims.

2. Select the EMC file type as it applies to your site:

• Select Institutional for the 837I download.

• Select 1500 for the 837P download.

Figure 2.20: Recall EMC Claims screen


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STEP 2 - Create the download file

1. Create your EMC files using the following screens as it applies to your site:

• Go to Physician Practice Management > Billing > Electronic Media Claims > EMC

Processing > Create Institutional Download File.

• Go to Physician Practice Management > Billing > Electronic Media Claims > EMC

Processing > Create 1500 Download File.

2. In the Submission Date field, enter the date of submission for this file. (The system date will

automatically display.) The date entered should be the date of actual transmission.

3. In the Available Download Files field, select the EMC file you have set up for the 5010 format.

4. Check the Check to run Front End Checks for the 837 box if you want to run front end checks

on the 837 file for missing information. If checked, enter a printer number in the Printer for

Front End Checks field to print the error listing.

5. Click OK.

STEP 3 - Send the file

1. Go to Physician Practice Management > Billing > View/Download EMC File.

Figure 2.21: Create Download File screen


7/31/2019 RN Classic 5010


2. Select the file you just created in Step 1 above and click Download.

3. Select your download options and click OK.

4. Submit your file to the clearing house according to your facility’s procedures.

STEP 4 - Reset parameters to 4010 format

If you submitted a test file, reset the following parameters to the 4010 format until the file is

approved. Complete this step for both UB and 1500 billing as it applies to your site.

• EMC File Number Assignment screen: Go to Physician Practice Management > Billing >

Electronic Media Claims > EMC Parameters > EMC Transmission Info > Transmission

Information.

Select the EMC file number you used for the 5010 test, and reset the File Type field back to

ANSI 837.

• EMC Header Information screen: Go to Physician Practice Management > Billing >

Electronic Media Claims > EMC Parameters > EMC Transmission Info > EMC Header

Information.

Select the EMC file number you used for the 5010 test, and reset the following fields:

- In the Control Version Number field, select 00401 for the 4010 format.- In the Usage Indicator field, select Production.

- In the Version/Release/Industry ID field, select the appropriate 4010 version.

• UB - 004010X096A1

• 1500 - 004010X098A1

STEP 5 - Hold Unprocessed Claims

This step will purge the EMC files for the next billing run.


Maintenance > Hold Unprocessed Claims.


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2. Select the EMC file type as it applies to your site:

• Select Institutional for the 837I download.

• Select 1500 for the 837P download.

3. In the Select File field, select the EMC file(s) you just processed.

4. In the Submission Date Range, enter the From and Thru dates of the claims that were

submitted.

5. Click OK.

42 Eligibility Verification (270/271) Changes

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Eligibility Verification (270/271) Changes

The following modules in the Clinic system were changed for Eligibility Verification to accommodate the HIPAA X12 Version 5010

Regulatory Update:

• Physician Practice Management

• Appointment Scheduler

Physician Practice Management

• Control Numbers: Changed the Control Numbers screen (in the Eligibility Verification Setupmenu) to include the following changes:

- Added the Version (GS08) field, which defaults the version specified in the EDI Payer

Maintenance screen for all payers and is read-only. This field toggles between the 4010

and 5010 (005010X279A1) versions so that the 4010 version can be used for payers until

the 5010 test file is verified with the clearing house.

- Added the Usage Indicator (ISA15) field to select Test when you are sending a test file to

the clearing house, or Production once the test file has been approved.

- Added the Update Usage Indicator in All EDI Payer Records check box to apply theUsage Indicator to all EDI payers. If not selected, no EDI Payer records will be updated

with the changes.

• EDI Payer Maintenance:

- On the General tab, changed the Version (GS08) field on the General tab to be read-only

based on the version as set up in the Control Numbers screen.

- On the ISA tab, changed the Usage Indicator on the ISA tab to display the default value

from the EDI Control Numbers screen. This can be edited for a single payer as needed;

however, can be overwritten by the Update Usage Indicator in All EDI Payer Records

check box in the Control Numbers parameter if checked and applied.- On the Reference tab, when using the Information Receiver qualifier OB for the state

license code, you are required to enter the correct two-character state code in the

Description field.

- On the Subscriber/Dependent tab, additional ID codes have been added; however, only

th f ll i ID ll d

If, for any reason, you need to revert back to the 4010 format, and you do not want to update the

Test/Production Usage Indicator on all payers, you can uncheck this box. You can toggle the Usage

Indicator for a single payer directly in the EDI Payer Maintenance screen. This is particularly useful

when you need to add a new payer record and need to test the payer with the clearing house (Test

mode) before it can be put in Production mode.


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- On the PRV/Provider Info tab, removed the PRV02 Qualifier field as this value is set

according to the version in the Taxonomy ID field.

- Increased the Description field from 35 characters up to 60 characters.

• Single Eligibility (SEND button) > Diagnosis Code Selection: Added the following codes tothe Place of Service Type search screen:

• 01 - Pharmacy

• 03 - School

• 04 - Homeless Shelter

• 05 - Indian Health Service Free-standing Facility

• 06 - Indian Health Service Provider-based Facility

• 07 - Tribal 638 Free-standing Facility• 08 - Tribal 638 Provider-based Facility

• 13 - Assisted Living Facility

• 14 - Group Home

• 15 - Mobile Unit

• 20 - Urgent Care Facility

• 49 - Independent Clinic

• 57 - Non-residential Substance Abuse Treatment Facility

• Changed to send the “2-Non-Person” entity type when checking insurance eligibility for non-

person entities, (i.e. for Workers Compensation and Casualty Claims). Use the following

settings for non-person entities:

There are two ways you can set up non-person entities:

Option 1: Set up the organization (employer) as a policy holder for the patient.

1) Go to Daily Work > Patient Entry, and open the patient record.

2) Select the Additional Patient tab.

3) Enter the employer’s information in the fields provided.

4) Click the Insurances button.

5) Check the Employer is Policy Holder check box. When checking eligibility, the

employer name is sent as entered on the Additional Patient tab, and the entity will

automatically be sent as a non-person; (there is no need to set the Entity field.)

Option 2: Set up the organization (employer) with their own medical record number.

1) Go to Daily Work > Patient Entry and assign a medical record to the organization.

2) Split the organization’s name between the First Name and Last Name fields on the

Patient tab as these fields cannot be blank.

44 5010 Setup Instructions for Eligibility Verification (270/271)

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5010 Setup Instructions for Eligibility Verification (270/271)

Healthland staff will be contacting you to activate the v5010 format.

835 Processing Changes

Phase 2 of the v5010 update contains changes to allow payments from an 835 file in the v5010 format to be processed. There were

no screen changes made and there are no new setup instructions needed. Please note the following:

• The v5010 format can be identified in the 835 file as 005010X221A1.

• The CAS segment from the 835 file will be included in the v5010 837 download file for

secondary claims.


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Appendix A: Database

Changes

In This Chapter

Financial Database Changes for HIPAA X12 Version 5010 46

46 Appendix A: Database Changes

7/31/2019 RN Classic 5010


Financial Database Changes for HIPAA X12 Version 5010

TABLE NAME DESCRIPTION COLUMN NAME LENGTH /PRECISSION SQL TYPE NEW /ALTERED

CLDATA TABLES (PPM - Clinic)

CHG1AUTH added table to hold prior

authorization number for patient visit

LRN Integer New

PATIENT_NO 9 Varchar New

TICKET_NUMBER Integer New

PRIOR_AUTH_NO_1 30 Varchar New



CREATED_BY 20 Varchar New

CREATED_TS Timestamp New

UPDATED_BY 20 Varchar New

UPDATED_TS Timestamp New

CHG1ATHH added table to hold prior

authorization number for patient visit

records in history

LRN Integer New

PATIENT_NO 9 Varchar New

TICKET_NUMBER Integer New








Appendix A: Database Changes 47

7/31/2019 RN Classic 5010


®

CLMADJS altered table for ERAs to alter field

length

PAYER_INT_CNTL_NUM 50 Varchar Altered

CLMADJWK altered table for ERAs to alter field

length


CLMERAWK altered table for ERAs to alter field

length

REFERENCE 50 Varchar Altered


DETERA_ altered table for ERAs to alter field

length


DETERAWK altered table for ERAs to alter field

length


DETADJS altered table for ERAs to alter field

length


DADJSWK altered table for ERAs to alter field

length


EDIT92_4_ ( altered table to alter column length TREAT_AUTH 20 Varchar Altered

ED92HIST4 altered table to alter column length TREAT_AUTH 20 Varchar Altered

EMC1500 altered table to add column for Payer

Claim Control Number

PAYER_CLM_CTRL_NBR 50 Varchar New

ERACLAIM altered table for ERAs to alter field

length

REFERENCE 50 Varchar Altered


TABLE NAME DESCRIPTION COLUMN NAME LENGTH /

PRECISSION

SQL TYPE NEW /

ALTERED


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ERAPMTCODE Added new table for ERA Payment

Type Cross Reference screen

LRN 4 Integer New

FIN_CLASS 2 Varchar New

PAYER_CODE 4 Varchar New

PATIENT_TYPE 2 SmallInt New

CLAIM_TYPE 1 Character New

NPI 30 Varchar New

PAYMENT_TYPE 2 SmallInt New

OUTLIER_PAYMENT_TYPE 2 SmallInt New


CREATED_TS 10 Timestamp New


UPDATED_TS 10 Timestamp New

INS1500 altered table to add column for Payer



NEW1500 altered table to add column for Payer



PPMCLMNT added table for billing/claim notes LRN Integer New

TICKET_NO Integer New

CLAIM_TYPE (1 = 1500, 2 = UB) Small Int New

NOTE_REFERENCE_CODE 3 Varchar New

NOTE_DESCRIPTION 80 Varchar New





PPMCLNTH added table for billing/claim note hist LRN Integer New


PRECISSION

SQL TYPE NEW /

ALTERED


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®

TICKET_NO Integer New

CLAIM_TYPE (1 = 1500, 2 = UB) Small Int New







TKTDATES altered to add columns for Edit Ticket INITIAL_TREAT_DATE Date New

DATE_LAST_SEEN Date New

DATA TABLES (Hospital)

AMBULANCE_LOCATION added table for ambulance billing LRN Integer New

VISIT_ID Integer New

SEQ_NO Small Int NewDROPOFF_PICKUP_ID 1 Varchar New

SERVICE_LOCATION 55 Varchar New

ADDRESS_1 55 Varchar New

ADDRESS_2 55 Varchar New

CITY 30 Varchar New

STATE 2 Varchar New

ZIP_CODE 10 Varchar New

COUNTRY_CODE 3 Varchar New






PRECISSION

SQL TYPE NEW /

ALTERED


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ADMRELDT altered to add new fields INITIAL_TREAT_DATE 4 Date New

DATE_LAST_SEEN 4 Date New

CAREGIVERROLE altered to add new caregiver roles CAREGIVER_ROLE_CODE 2 Varchar Altered

CAREGIVER_ROLE_CODE_DESC 20 Varchar Altered

EDIT0315 altered table to add new column PAYER_CLM_CTRL_NBR 50 Varchar New

EDIT_HIST0315 altered table to add new column PAYER_CLM_CTRL_NBR 50 Varchar New

ERRMESS Altered to add new records for patient status and type of admit error

messages

MESSAGE_CODE Altered

ERROR_NUMBER Altered

MESSAGE_DESC Altered

FIX_DESC Altered

EV270EQLOOP altered table to add new columns DIAGNOSIS_CODE_POINTER_1 2 Small Int New

DIAGNOSIS_CODE_POINTER_2 2 Small Int New



EV270HI new table to hold 5010 segment info EV270_ID 13,0 Decimal New

LOOP_LEVEL 2 Varchar New

LOOP_SEQUENCE 2,0 Decimal New

INDUSTRY_CODE 30 Varchar NewINDUSTRY_CODE_QUALIFIER 3 Varchar New

EV271 altered table to add new columns RECEIVER_ADDR1 55 Varchar New

RECEIVER_ADDR2 55 Varchar New

RECEIVER_CITY 30 Varchar New

RECEIVER_STATE 2 Varchar New

RECEIVER_ZIP 15 Varchar New


PRECISSION

SQL TYPE NEW /

ALTERED


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®

RECEIVER_COUNTRY 3 Varchar New

EV271EBLOOP altered table to add new columns PRODUCT_SERVICE_ID 48 Varchar New





ENTITY_RELATIONSHIP_CODE 2 Varchar New

EV271HI new table to hold 5010 segment info EV270_ID 13,0 Decimal New

EV271_TRANSMISSION_TS Timestamp New


LOOP_SEQUENCE 2,0 Decimal New

EV271MPI new table to hold 5010 segment info EV270_ID 13,0 Decimal New



INFORMATION_STATUS 1 Varchar New

EMPLOYMENT_STATUS 2 Varchar New

GOVT_SERVICE_AFFILIATION_CODE 1 Varchar New

DESCRIPTION 80 Varchar New

MILITARY_SERVICE_RANK 2 Varchar New

PERIOD_FORMAT_QUALIFIER 3 Varchar New

DATE_TIME_PERIOD 35 Varchar New

EV271_III altered table to add new columns CODE_CATEGORY 2,0 Decimal New

MESSAGE_TEXT 264 Varchar New

EV271PRV added table of values returned in 271 EV270_ID 13,0 Decimal New




PRECISSION

SQL TYPE NEW /

ALTERED


TABLE NAME DESCRIPTION COLUMN NAME LENGTH / SQL TYPE NEW /

7/31/2019 RN Classic 5010


PROVIDER_CODE 3 Varchar New

PROVIDER_ID_QUALIFIER 3 Varchar New

PROVIDER_ID 30 Varchar New

EV271PER altered table to increase field sizes CONTACT_1_NUMBER 256 Varchar Altered

CONTACT_2_NUMBER 256 Varchar Altered

CONTACT_3_NUMBER 256 Varchar Altered

EVERRORS altered table to add new records for

Loop 2110C - Subscriber Eligibility or

Benefit Inquiry & 2110D - Dependent

Eligibility or Benefit Information error

messages

HIST0315 altered table to add new column PAYER_CLM_CTRL_NBR 50 Varchar New

HSPCLMNT added table for billing/claim note LRN Integer New

VISIT_ID Integer New

CYCLE_NO Small Int New

CLAIM_FORM_TYPE (1 = UB, 2 = 1500) Small Int New







SECPPMBI altered table to add new columns UB_BILL_CLAIM_NOTE 1 Varchar New

1500_BILL_CLAIM_NOTE 1 Varchar New


PRECISSION

SQL TYPE NEW /

ALTERED

Documents

RN Classic 5010