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Case / Additional Case Information Tab

Case / Additional Case Information Tab

Mar 28, 2024

 

Overview

 

 

Field Definitions

Field

Type

Required

Description

Field

Type

Required

Description

Additional Dates Section

 

 

 

Onset of Illness/Symptom

Calendar Date

(mm/dd/yyyy)

No

The date the illness or symptom began.

Same/Similar Illness

Calendar Date

(mm/dd/yyyy)

No

The date the patient was treated for the same or similar illness. 

Initial Treatment

Calendar Date

(mm/dd/yyyy)

No

The date the patient was initially treated for the illness or symptom. 

Last Seen

Calendar Date

(mm/dd/yyyy)

No

The date the patient was last seen by the provider.

Last X-Ray

Calendar Date

(mm/dd/yyyy)

No

The date the patient had the last x-ray. 

Date of First Contact

Calendar Date

(mm/dd/yyyy)

No

The date the provider initially examined the patient. 

Assumed Care

Calendar Date

(mm/dd/yyyy)

No

The date the provider began caring for the patient. 

Relinquished Care

Calendar Date

(mm/dd/yyyy)

No

The date the provider no longer provided care for the patient. 

Last Date Worked

Calendar Date

(mm/dd/yyyy)

No

The date the patient last worked.

Authorized Return to Work

Calendar Date

(mm/dd/yyyy)

No

The date the patient is authorized to return to work.

Reason for Delayed Submission of Claim Section

 

 

 

Reason

Drop Down

No

Indicates why claims have not been submitted, or why submission has been delayed. If the claim is being submitted more than six months after the original date of service, you can specify a reason code indicating the reason for the delay in filing.

Options include:

1 - Proof of Eligibility Unknown or Unavailable

2 - Litigation

3 - Authorization Delays

4 - Delay in Certifying Provider

5 - Delay in Supplying Billing Forms

6 - Delay in Delivery of Custom-Made Appliances

7 - Third Party Processing Delay

8 - Delay in Eligibility Determination

9 - Original Claim Rejected or Denied Due to Reason Unrelated to Billing Limitation Rules

10 - Administration Delay in the Prior Approval Process

11 - Other

15 - Natural Disaster

Programs & Exceptions Section

 

 

 

Special Program Type

Drop Down

No

Indicates the type of special program under which the patient was treated.

Options include:

  • 01 NU - EPSDT or CHAP: No Referral Provided

  • 01 AV - EPSDT or CHAP: Patient Refused Referral

  • 01 S2 - EPSDT or CHAP: Under Treatment

  • 01 ST - EPSDT or CHAP: New Services Requested

  • 02 - Physically Handicapped Children's Program

  • 03 - Special Federal Funding

  • 05 - Disability

  • 07 - Induced Abortion - Danger to Life

  • 08 - Induced Abortion - Rape or Incest

  • 09 - Second Opinion or Surgery

    • Family Planning

    • Sterilization

    • A - Induced Abortion - Danger to the woman's life

    • B - Induced Abortion - Physical health damage to the woman

    • C - Induced Abortion - Victim of rape or incest

    • D - Induced Abortion - Medically necessary

    • E - Induced Abortion - Elective (i.e., Not considered medically necessary by the attending physician. Provision of elective abortions is restricted to New York City members.)

    • F - Procedure performed for the purpose of sterilization

Service Authorization Exception

Drop Down

No

Indicates the HIPAA recognized exception under which the patient was treated.

Options include:

  • 1 - Immediate/Urgent Care

  • 2 - Services Rendered in a Retroactive Period

  • 3 - Emergency Care

  • 4 - Client as Temporary Medicaid

  • 5 - Request from County for Second Opinion to Determine if Recipient Can Work

  • 6 - Request for Override Pending

  • 7 - Special Handling

Signature & Release Section

 

 

 

Patient Signature on File

Drop Down

Yes

Indicates which form the patient signed to grant authorization for filing the claim on behalf of the patient. By default, this option is set to B - Signed Signature Authorization Form or Forms for Both HCFA-1500 Claim Form Block 12 and Block 13 are on file. This information prints in box 13 on the CMS-1500 claim form.

Options include:

  • B - Signed signature authorization form or forms for both HCFA-1500 Claim Form Block 12 and Block 13 are on file

  • C - Signed HCFA-1500 Claim Form on file

  • M - Signed signature authorization form for HCFA-1500 Claim Form Block 13 on file

  • P - Signature generated by provider because the patient was not physically present for services

  • S - Signed signature authorization form for HCFA-1500 Claim Form Block 12 on file

Release of Information

Drop Down

Yes

Indicates whether the provider has authorization from the patient or guarantor to release medical information about the patient. By default, this option is set to Y - Yes, Provider Has a Signed Statement Permitting Release of Medical Billing Data Related to a Claim. This information prints in box 12 on the CMS-1500 claim form.

Options include:

  • I - Informed Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statutes

  • Y - Yes, Provider Has a Signed Statement Permitting Release of Medical Billing Data Related to a Claim.

Additional Identifiers Section

 

 

 

Demonstration Project Identifier

Free Text

No

Records the Demonstration Project Identifier or clinical trial number on a case (up to 50 characters). A Medicare Demonstration Project attempts to gauge the effect of possible changes to the Medicare program. Medicare requires this information when the case includes a Demonstration Project Number. If this data is present on a case, the EDI file will include it in the 2300 loop, REF02 segment with an REF01 P4 qualifier.

Related Person Section

 

 

Section allows you to designate a person who is related to the patient.

Person

Drop Down Search

No

The last and first names of the person related to the patient.

Description

Free Text

No

The relationship of the patient to the related person, for example, spouse, mother, or father.

Errors and Warning Section

 

 

This section reports problems detected through the Error Check validation process. Use the Display options to select the validations to verify.

In addition to errors and warnings, the date and time the last error check occurred is reported. If an error check has never been performed on a charge batch or case, the text displayed will be Last Check: (pending). Each time an error check is completed, this text is updated and displayed in the following format: Last Check: mm/dd/yyyy, hh:mm:ss AM/PM, for example, Last Check:  07/08/2013, 4:35:14 PM.

Display Filters

Checkboxes

No

This filter determines the type of errors or warnings listed in the Error Check list. Errors must be corrected before a case or charge batch can be submitted and claims can be generated. Warnings may or may not cause rejection of a claim and are not required to be corrected. A checkmark next to the display filter indicates that the filter is selected.

The filter options dynamically affect the contents of the error checklist. When you clear a checkbox, the list hides the applicable errors or warnings. When you click the checkbox again, the list refreshes, showing the hidden errors or warnings.

Type

Read-only

(system-generated)

Yes

The classification of the problem detected in a category during the Error Checking process. Cases in the charge batch are validated for certain conditions reported as errors or warnings.

Type

Description

Errors

Conditions on a case that affect claims generation. Errors must be corrected before cases can be submitted and claims can be created.

Warnings

Conditions on a case that may cause the claim to be rejected by a payer. Warnings do not have to be corrected before cases can be submitted and claims can be created.

Category

Read-only

(system-generated)

Yes

The component that may contain an error or warning when either condition is detected during error check validation, for example, Concurrency or Data. By default, all categories are selected and all errors and warnings are displayed on the Charge Batch Error Check tab. Errors must be corrected before a claim can be created. Warnings do not have to be corrected before a claim can be created.

The categories listed in the error check table are controlled by the Display filters on the Charge Batch Error Check tab. The following categories are available:

Category

Description

Concurrency

Exceptions reported on anesthesia provider time for violations that occur across multiple cases. In most cases, concurrency exceptions are reported as errors unless concurrency validation is excluded on the case. If concurrency is excluded on the case, exceptions are reported as warnings.

CCI

Exceptions reported on code auditing for detecting discrepancies between the diagnosis code and the procedure code. CCI edit warnings are not required to be resolved before a claim can be created, but if not correct, the problems may result in claim rejections by the payer.

ICD-9/ICD-10

Exceptions reported on diagnosis codes for authenticating that the diagnosis is appropriate for a particular age or gender. ICD-9 edit warnings are not required to be resolved before a claim can be created, but if not correct, the problems may result in claim rejections by the payer.

Payer

Exceptions reported on payers or plans for evaluating claim filing rules specific to a payer or plan, for example, provider identification numbers, or date of service of procedure occurs after provider effective date.

Data

Exceptions reported on data for identifying primary data elements (for example, primary diagnosis code) that are missing, are required for all cases, or are required based on specific conditions within a case. Required data must be entered before a claim can be created.

Message

Read-only

(system-generated)

Yes

The description of the error or warning.

Related Cases

Link

No

A direct link to cases related to the case that has a warning or error. To go to a related case, click the direct link. If the related case has a warning or error that is corrected, the Error Check validation process will verify the case and remove it from the Charge Batch Error Check tab. 

Button Descriptions

Button

Shortcut Keys

Description

Step-By-Step Guides

Button

Shortcut Keys

Description

Step-By-Step Guides

Error and Warnings Section

 

 

 

Error Check

[Alt] + [K]

To run the Error Check validation for either a charge batch or a case in a charge batch.

Running Error Check Validation

 

 

 

 

 

 

Search this documentation

 

 

 

Overview

 

 

Field Definitions

Field

Type

Required

Description

Field

Type

Required

Description

Additional Dates Section

 

 

 

Onset of Illness/Symptom

Calendar Date

(mm/dd/yyyy)

No

The date the illness or symptom began.

Same/Similar Illness

Calendar Date

(mm/dd/yyyy)

No

The date the patient was treated for the same or similar illness. 

Initial Treatment

Calendar Date

(mm/dd/yyyy)

No

The date the patient was initially treated for the illness or symptom. 

Last Seen

Calendar Date

(mm/dd/yyyy)

No

The date the patient was last seen by the provider.

Last X-Ray

Calendar Date

(mm/dd/yyyy)

No

The date the patient had the last x-ray. 

Date of First Contact

Calendar Date

(mm/dd/yyyy)

No

The date the provider initially examined the patient. 

Assumed Care

Calendar Date

(mm/dd/yyyy)

No

The date the provider began caring for the patient. 

Relinquished Care

Calendar Date

(mm/dd/yyyy)

No