Intellect™
BOX 17
Printing the Ordering Provider on HCFA's is no longer dependent on the setting of the Utility --►Procedure <Status> field. In prior software versions, Ordering Provider information from the Charges --►Encounter screen and qualifier 'DK' in HCFA box 17 were only printed if the <Status> field was set to 'D' or 'O.'
Additionally, for all Billing functions (i.e., HCFA, eBilling, UB, etc.), if the Utililty --►Referring <Last Name> field is empty, Intellect will not use that <Referring Code>. It is equivalent to an invalid Referring Code.
In prior software versions for Medicare paper claims, if the <Ref Prv> field on the Charges screen was not populated, and the <Referring Name> field was not filled on the Registration --►Regular --►Patient screen, the rendering provider was used as the referring provider on the EB file, as well as printed on Box 17 of the HCFA claims.
As of this update, the referring provider (a.k.a. ordering physician) only populates the EB file and the HCFA Box 17 if the Utility --►Insurance --►Insurance <Insurance Type> field is set to 'D,' 'C,' '1,' '5' (WI Medicaid), or 'O' and a referring provider is added in the <Ref Prv> field on the Charges screen at the time of posting charges, or when the Registration --►Regular --►Patient <Referring Name> field is filled.
ATTENTION: This IMMEDIATELY affects billing and other daily tasks.
For DME billing only, HCFA Box 17 prints the Charges --►Encounter <Ordering Provider> only if the <Status> field on Utility --►Procedure --►Procedure for one of the charges on the HCFA is set to O (DME – Oxygen Proc) or D (DME – other than Oxygen).
For general billing, when Intellect looks for a Referring Provider, Intellect first looks at the encounter screen for either <Ordering Provider> or <Referring Provider> and, when either is blank, Intellect looks at the Utility --►Set Up --►Parameter <Referring> setting and pulls the referring provider based on the setting:
• If set to P, Intellect completes Box 17 and 17a on the HCFA (CMS1500) with the referring provider name (a.k.a. ordering physician) as entered in the <Referring Name> field on the Registration --►Regular --►Patient screen.
• If set to C, Intellect completes Box 17 and 17a on the HCFA (CMS 1500) with the referring provider name (a.k.a. ordering physician) corresponding to the code entered in the <Ref Prv> field on the Charges --►Charge screen.
• If set to F, Intellect looks first to data in the <Ref Prv> field on the Charges --►Charge screen, but if it is empty, then Intellect uses the <Referring Name> field on the Registration --►Regular --►Patient screen, if available, to complete Box 17 and 17a on the HCFA (CMS 1500). If a Referring Provider is not posted in Charges or entered in the patient file, the treating doctor's referral information from Utility --►Provider is used.