NOE/NOTR Form and Electronic File Creation

Transcription

1 NOE/NOTR Form and Electronic File Creation Effective January 1, 2018 Medicare will accept hospice notices of election (NOE) via Electronic Data Interchange. Electronic option sets in HBS can be configured to create these non-standard 837I transaction files. If not submitting electronically, or if submitting an NOTR, a UB04 hard copy form can be configured to print an NOE or Notice of Termination/Revocation (NOTR) that can be printed or saved as a PDF for clearinghouse submission (check with your clearinghouse to confirm what format, if any, they accept). For steps on creating a CSV file via the Import/Export menu refer to the NOE/NOTR CSV Creation FAQ. CONTENTS Creating the Option Sets... 2 NOE Electronic Option Set Creatiion... 2 NOE UB04 Option Set Creation... 3 NOTR UB04 Option Set Creation... 4 Creating Electronic NOEs... 4 Printing the UB04 NOE... 5 Printing the UB04 NOTR Newman Springs Road Lincroft, NJ Tel Page 1 of 7

2 CREATING THE OPTION SETS NOE ELECTRONIC OPTION SET CREATIION Go to Billing > Electronic Claims. In the Option Set Selection, select the Baseline option set. Click the Options button and in the Billing Options Wizard click Merge and merge into All Option Sets. Press OK when done. Close the Billing Options Wizard. Select the Medicare Hospice option set. Press Options, then Copy. In the Destination ID choose an option set number not currently in use and enter the Description Medicare NOE. Click OK and exit the Electronic Billing menu. Go back to Electronic Claims and select the Medicare NOE set in the Option Set Selection. Click the Options button to access the Billing Options Wizard and make the following changes: SBR*09 Subscriber Payor Qualifier: set to Constant Value (Entered) and enter MA CLM *05 Type of Bill: set to 81A (non-hospital based) or 82A (hospital-based) DTP*434 Claim Covered Period: set to Patient Admit/Discharge and Bill Dates CL1*03 Patient Status: set to Constant Value (Entered) and enter NTE*ADD Comments: set to Bypass this Data Element HI*BK/BF Diagnosis Codes: set to Patient Diagnosis Codes HI*BE Value Code Amount A: set to Bypass this Data Element HI*BE Value Code Amount B: set to Bypass this Data Element HI*BG Condition Code 1: set to Bypass this Data Element HI*BH Occurrence Code/Date A: set to Patient Admit Date and enter code HI*BH Occurrence Code/Date B: set to Bypass this Data Element. 716 Newman Springs Road Lincroft, NJ Tel Page 2 of 7

3 HI*BH Occurrence Code/Date C: set to Bypass this Data Element HI*BH Occurrence Code/Date Override: set to Bypass this Data Element Bill Processing Type: set to Hospice NOE/NOTR.. Contact HAS Support if you need assistance with any of these steps. NOE UB04 OPTION SET CREATION Go to Billing > Printed Claims > UB04 Forms. In the Option Set Selection, select the Baseline option set. Click the Options button and in the Billing Options Wizard click Merge and merge into All Option Sets. Press OK when done. Close the Billing Options Wizard. Select the Medicare Hospice option set. Press Options, then Copy. In the Destination ID choose an option set number not currently in use and enter the Description UB04 Medicare NOE. Click OK and exit the Printed Claims menu. Go back to Printed Claims and select the UB04 Medicare NOE set in Option Set Selection. Click on the Options button to access the Billing Options Wizard and make the following changes: Box 4 - Type of Bill: Enter 81A Box 6 - Covered Dates: set to Patient Admit/Discharge and Bill Dates. Box 31 Occurrence Code/Date: set to Patient Admit Date and enter code 27. All other Occurrence Code/Date options should be set to Bypass. Box 67 a-q Diagnosis Codes: set to Patient Diagnosis Codes. Process Type: set to Process Type: Hospice NOE/NOTR. Contact HAS Support if you need assistance with any of these steps. 716 Newman Springs Road Lincroft, NJ Tel Page 3 of 7

4 NOTR UB04 OPTION SET CREATION Following the same steps as the NOE UB04 instructions above for creating a new option set, create an NOTR option set and enter the Description as UB04 Medicare NOTR. Close and reopen the Printed Claims window. Select the UB04 Medicare NOTR set in the Option Set Selection. Click on the Options button to access the Billing Options Wizard and make the following changes: Box 4 - Type of Bill: Enter 81B Process Type: set to Process Type: Hospice NOE/NOTR. Please contact HAS Support if you need assistance with any of these steps. CREATING ELECTRONIC NOES Go to Billing > Electronic Claims and select the Medicare NOE option set. Report Sequence: Patient or Insurance Selection Type: Patients or Insurance (use Specific Includes tab for selections). Submitted Type: Un-Submitted Only. Benefit Date Selection: enter benefit start date range Unit Selection: leave unchecked or check Active and select Unit if your agency submits by Unit. Filename: enter a unique filename. Press Preview to view the Electronic Claim Submission report. 716 Newman Springs Road Lincroft, NJ Tel Page 4 of 7

5 Press Mark NOE as Submitted and transmit the file to Medicare (Ability interface clients will press the Submit to Medicare button). Confirm successful receipt of NOE by Medicare. The sent date will populate the Notice of Election date field in the Patient> Admit> Add l Dates tab. PRINTING THE UB04 NOE 716 Newman Springs Road Lincroft, NJ Tel Page 5 of 7

6 Go to Billing > Printed Claims > UB04 Forms and select the UB04 Medicare NOE option set. Report Sequence: Patient or Insurance Selection Type: Patients or Insurance (use Specific Includes tab for selections). Benefit Date Selection: enter benefit start date range Printed Selection: Only Un-Printed Unit Selection: leave unchecked or check Active and select Unit if your agency submits by Unit. Press Preview to view the NOE. The NOE can be printed or saved to PDF. Press Mark NOE as Sent after it s been printed or saved. The sent date will populate the Notice of Election date field in the Patient> Admit> Add l Dates tab. PRINTING THE UB04 NOTR 716 Newman Springs Road Lincroft, NJ Tel Page 6 of 7

7 Go to Billing > Printed Claims > UB04 Forms and select the UB04 Medicare NOTR option set. Report Sequence: Patient or Insurance Selection Type: Patients or Insurance (use Specific Includes tab for selections). Discharge Date Selection: enter patient Discharge date range Unit Selection: leave unchecked or check Active and select Unit if your agency submits by Unit. Press Preview to view the NOTR. 716 Newman Springs Road Lincroft, NJ Tel Page 7 of 7