1 implementation and training provider taxonomy changes for hipaa 837 claims processing audience for...

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Implementation and Training

Provider Taxonomy Changes for HIPAA 837 Claims Processing

Audience for Training

Database Administrators

Clinical users The following slides will be discussed during the training session:• mapping of CHCS specialties to HIPAA Provider Taxonomy- p. 8• multiple taxonomy codes per provider- p.8• screen shot of provider specialty field- p. 10• example of HIPAA Taxonomy Code table- p. 11

• Please print presentation with notes pages. Go to Print→Print What→Notes Pages

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Implementation and Training

Provider Taxonomy Changes for HIPAA 837 Claims Processing

Electronic Billing of

Third Party Insurance Claims

27 October 2003

ACS Federal Healthcare, Inc.

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Purpose

The Purpose of the HIPAA 837 Claims Processing training is to ensure

that all the required data for the X12 837 Professional and Institutional

Claims are provided to TPOCS. This will provide compliant 837

transaction for claims processing.

TPOCS is the MHS standard system for the processing of third-party

claims for outpatient services, and supports billing processes. TPOCS

sends the data captured to the clearinghouse to allow electronic billing

for claims.

HIPAA Compliance of 837 Claims

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Benefits of Electronic Billing


Standardizes Data Requirements & Format

Increases Patient, Insurance, Coding and Billing Data Accuracy

Increases security of Patient Health Information

Eliminates costs and delays associated with paper documents

Reduces initial claims rejections and increase collections

Shortens waiting periods for reimbursement to MTF

A. Scheduling A. Scheduling

B. VerificationB. Verification

D. Disposition D. Disposition

E. CodingE. Coding

F. F.

Verification1. Insurance Confirmation2. Insurance Verification3. Pre-Cert Requirements

Patient Access1. Appointment Scheduling2. Pre-Registration3. Walk-in

C. Patient CareC. Patient Care

EOB

Billing/Collections1. Claims Submission2. Follow-up3. Claims Status

Health Information Mgmt.1. Documentation2. Diagnosis/Procedure Coding

MTF Revenue Cycle

CHCS /ADMTPOCS

Billing/Collections

MTFPaper EOB/Payment

Clearinghouse

Third PartyPayer

TPOCSElectronic filetransmission

HIPAA 837Transaction

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Overview Business Process Issues & Concerns

CHCS Data Quality Requirements Provider Files-Provider Taxonomy

HIPAA Compliance of 837 Claims Processing

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Overview Data Requirements from CHCS Users

CHCS Data Quality Requirements Provider Files-Provider Taxonomy


Information Required to Allow Electronic Billing on TPOCS with 837 HIPAA Compliant Claims Processing

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HIPAA II Taxonomy Phase II Project Overview


The CHCS System has been enhanced to store multiple HIPAA Provider Taxonomy values in the HIPAA Provider Taxonomy Code field of the Provider file.

The CHCS Data Administration Provider Enter/Edit screen has been modified to permit users to designate a Primary HIPAA Provider Taxonomy value for a provider.

The Provider ASCII file download to TPOCS (Third Party Outpatient Collection System) has been modified to reflect multiple HIPAA Provider Taxonomy values for a provider and to designate the Primary HIPAA Provider Taxonomy value and allow for appropriate billing.

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ADM Priority I Phase II Overview (use of HIPAA Provider Taxonomy III table)- summer 04


Residents have been mapped to their respective specialties on the taxonomy table, thus associating GME with a CMAC Provider class and CHCS Specialty Code (billable.)

Residents will continue to occupy Appointment Provider field in ADM and Supervising Provider will occupy second field (residents require supervising provider since GME is mapped to a non privileged provider status)

ADM Priority I Phase II, upon conversion, will trigger all billable events involving residents (for prior x months) to be pushed to TPOCS and be billed. Billers will see a one time higher volume of resident billable events upon conversion.)

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Ambulatory Data Module Overview of Changes - Provider


CA-DAA-CFT-CFM-PRO

*If the information applies, it needs to be completedto allow electronic billing*

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PROVIDER: QUARLES,GARY DA PROVIDER EDIT

Name: QUARLES,GARY Provider Flag: PROVIDER

Provider ID: 944690606 Provider Class: PHYSICIAN

SSN: 444-69-0606Select PROVIDER SPECIALITY:+ CARDIOLOGIST

Primary Provider Taxonomy: CMAC Provider Class:Select PROVIDER TAXONOMY:

Location: CLARK CENTER HCP SIDR-ID: 108116 Branch of Service: Rank: CIVILIAN

Help = HELP Exit = F10 File/exit = DO INSERT OFF

Entering a Specialty will auto-populate the Primary

Provider Taxonomy, CMAC, and Select PROVIDERTAXONOMY fields

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Primary Provider Taxonomy: ?? CMAC Provider Class: 01 - MEDICAL DOCTOR/DOCTOR OSTEOPATHYSelect PROVIDER TAXONOMY:+ 207RC0000X



204C0000X PHYSICIANS/ALLOPATHIC/OSTEOPATHIC/NEUROMUSCULOSKELETAL MEDICINE/ 204D0000X PHYSICIANS/ALLOPATHIC/OSTEOPATHIC/NEUROMUSCULOSKELETAL MEDICINE & OMM204E00000X PHYSICIANS/ALLOPATHIC/OSTEOPATHIC/ORAL & MAXILLOFACIAL SURGERY204F00000X PHYSCIIANS/ALLOPATHIC/OSTEOPATHIC/SURGERY/TRANSPLANT SURGERY

+

+

Make choice = SELECT Exit = F10

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Name: QUARLES,GARY Provider Flag: PROVIDER

Provider ID: 944690606 Provider Class: PHYSICIAN

SSN: 444-69-0606Select PROVIDER SPECIALITY:+ CARDIOLOGIST

Primary Provider Taxonomy: 207RC0000X CMAC Provider Class: 01 - MEDICAL DOCTOR/DOCTOR OSTEOPATHYSelect PROVIDER TAXONOMY:+ 207RC0000X



Hitting <ENTER> in front of code will give a description including taxonomy

code and CMAC.

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PROVIDER: QUARLES,GARY DA PROVIDER EDIT #2A

HIPAA Provider Taxonomy Code: 207RC0000X

HIPAA Provider Taxonomy Description:PHYSICIANS/ALLOPATHIC/OSTEOPATHIC/INTERNAL MEDICINE/CARDIOVASCULAR DISEASE

CMAC Provider Class: 01 - MEDICAL DOCTOR/DOCTOR OSTEOPATHY

This is the Provider’s Primary Taxonomy. It cannot be edited or deleted.

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Provider Personnel File


CA-CLN-Facility Quality Assurance-PRO-PER

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PROVIDER PERSONNEL FILE Page 1Provider: QUARLES,GARY SSN: 444-69-0606 Class: PHYSICIAN

============================================================Branch: Corps: Rank: CIVILIAN Date of Rank:

Primary Hospital Location: CLARK CENTER Department/Service: ORTHO CARE DEPT FE MEPRS:: BGAAMilitary Occupation Code: Flying Status: NO

Provider Specialty(s): CARDIOLOGIST RESIDENT SURGEON SURGERY CONSULTANT Primary Division: NH PORTSMOUTH, VAAllowable Divisions:

User File Reference: QUARLES, GARY

Help = HELP Exit = F10 File/Exit = DOPersonal Data - Privacy Act of 1974 (PL-93-579) INSERT OFF

Selecting a SPECIALTY and pressing <ENTER> will take you to a background screen and display additional information, including a description of the Provider Specialty and Taxonomy Code.

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PROVIDER PERSONNEL PROFILEProvider: QUARLES,GARY

===============================================================

Provider Specialty Code: 014

Provider Specialty Description:CARDIOLOGIST


HIPAA Provider Taxonomy Description:PHYSICIANS/ALLOPATHIC/OSTEOPATHIC/INTERNAL MEDICINE/CARDIOVASCULAR DISEASE

CMAC Provider Class: 01 - MEDICAL DOCTOR/DOCTOR OSTEOPATHY

Press <RETURN> to continue

Help = HELP Exit = F10 File/Exit = DOPersonal Data - Privacy Act of 1974 (PL-93-579)

INSERT OFF

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Provider Specialty Type


CA-PAS-Managed Care-FMCP-PTAB-SPEC

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PROVIDER SPECIALTY TYPE Enter/Edit

Provider Specialty Type: CARDIOLOGIST Code Description

012 ALLERGISTHIPAA Provider Taxonomy Code: 207KA0200XPHYSICIANS/ALLOPATHIC/OSTEOPATHIC/ALLERGY & IMMUNOLOGY/ALLERGY

014 CARDIOLOGISTHIPAA Provider Taxonomy Code: 207RC0000XPHYSICIANS/ALLOPATHIC/OSTEOPATHIC/INTERNALMEDICINE/CARDIOVASCULAR DISEASE

<- Enter Provider Specialty

Enter Provider Specialty to add to Provider Specialty Type.Use the SELECT key to delete any Provider Specialties entered in error.

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012 ALLERGISTHIPAA Provider Taxonomy Code: 207KA0200XPHYSICIANS/ALLOPATHIC/OSTEOPATHIC/ALLERGY & IMMUNOLOGY/ALLERGY


DERMATOLOGIST <- Enter Provider Specialty

080 DERMATOLOGIST Are you adding ‘080’ as a new PROVIDER SPECIALTIES (the 3rd for this MCP PROVIDER SPECIALTY TYPE)? Y

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080 DERMATOLOGISTHIPAA Provider Taxonomy Code: 207N00000XPHYSICIANS/ALLOPATHIC/OSTEOPATHIC/DERMATOLOGY

<- Enter Provider Specialty

Enter Provider Specialty to add to Provider Specialty Type.Use the SELECT key to delete any Provider Specialties entered in error.

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Individual Provider - Place of Care Within Group


CA-PAS-Managed Care-FMCP-PTAB-PROV

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INDIVIDUAL PROVIDER - PLACE OF CARE PROFILE WITHIN GROUP

Provider: QUARLES,GARYGroup: CLARK GROUP

Place of Care: CLARK CENTER

Select Specialty------------------------------------------------------------------------------------------------------ CARDIOLOGIST RESIDENT SURGEON SURGERY CONSULTANT

Help = HELP Exit = F10 File/Exit = DO

=============================================================

INSERT OFF

Selecting one will give a description

including taxonomy code and CMAC.

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INDIVIDUAL PROVIDER - PLACE OF CARE PROFILE WITHIN GROUP

Provider: QUARLES,GARYGroup: CLARK GROUP

Place of Care: CLARK CENTER

Specialty Code: CARDIOLOGIST

Accepts Specialty Referrals Accepts PCM Assignments Associated with Specialty associated with Specialty at this Place of Care at this Place of Card YES NO


HIPAA Provider Taxonomy Description:PHYSICIANS/ALLOPATHIC/OSTEPATHIC/INTERNAL MEDICINE/CARDIOVASCULAR DISEASE

CMAC Provider Class: 01 MEDICAL DOCTOR/DOCTOR OSTEOPATHY

Help = HELP Exit = F10 File/Exit = DO

=======================================================================

INSERT OFF

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Summary


*If the information appliesIt needs to be completed To allow electronic billing*

Data Requirements Provider Files-Provider Taxonomy

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MILITARY HEALTH SYSTEM (MHS) HELP DESK


The MHS Helpdesk

provides support for U.S. Military

Health Information

systems, worldwide, 24

hours a day, 7 days a week. They are the

single Point of Contact for your MHS Application

needs.

CONUS: 800-600-9332 Direct: 210-767-5250

OCONUS: Belgium: 0800-72115 Germany: 0800-1011129

Greece: 00800-12-5629 Guam: 1-866-637-8725

Italy: 800-782407 Japan: 00531-1-20743

Korea: 00798-14-800-5242 Netherlands: 0800-0228847

Panama: 001-800-151-1005 Portugal: 800-8-12305

Turkey: 00-800-151-1005 United Kingdom: 08-005871786

Spain: 900-951895

Trouble tickets can be entered directly by authorized users on the internet at

http://www.mhs-helpdesk.com/

and use the HELPNOW tool.

To open a trouble ticket through e-mail, send to [email protected]

You can also submit a ticket using Customer Service Fax number at 210-767-0449

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