OnSTAFF 2000
OnSTAFF 2000's various Encounter screens provide fields to add necessary claim specific information to complete CMS 1500 and UB04 or their electronic equivalents
UB04 REVIEW Training Documentation
This review will note, per box, where the printed information may be found in On-Staff.
This review mentions the encounter screen. To determine if and what encounter has been attached to a charge, go to Charges --►Modify and pull up the patient and date of service in question. The encounter number will be displayed under the EN# heading. To relate or change an encounter, move the cursor next to the charge. From the C (command) column press M to modify that line. Press [Enter] until the cursor is under the EN# heading and enter the appropriate encounter number. To exit the line, press [Enter] until the cursor is under the C (command) column.
This review will mention billing methods. Your billing method is determined by the following:
Billing method C (clinic):
Utility --►Set Up --►Parameter <Billing> = C. If this field is left blank, then
Utility --►Category <Billing (D/C/N)> = C.
Billing method D (doctor):
Utility --►Set Up --► Parameter <Billing > = D. If this field is left blank, then
Utility --►Category <Billing (D/C/N)> = D
This review mentions primary, secondary, and tertiary (third) insurance. Insurance is defined as such by the following:
Primary insurance:
Registration --► Regular --►Patient insurance screen <Primary/Secondary> =P1, P2, P3, etc.
Secondary insurance:
Registration --► Regular --►Patient insurance screen <Primary/Secondary> =S1, S2, S3, etc.
Tertiary (third) insurance:
Registration --► Regular --►Patient insurance screen <Primary/Secondary> =T1, T2, T3, etc.
This review also mentions referring doctor. To determine the origin of the referring source, go to Utility --►Set Up --► Parameter <Referring>:
P Referring source originates from Registration --►Regular --►Patient <Referral>. When this is not a doctor (i.e., Yellow Pages, Friend, etc., Utility --►Referring <Doctor/Other (D/O)> =O) the treating physician’s information will be used.
C Referring source originates from that which was entered at the time of posting the charge (Charges --►Charge <Rdr.>). When no referring source was entered at the time of posting, the treating physician’s information will be used.
F Referring source first originates from the charge screen (Charges --►Charge <Rdr.>). When none entered, System uses Registration --►Regular --►Patient <Referral>. When this is not a doctor (i.e., Yellow Pages, Friend, etc., Utility --►Referring <Doctor/Other> (D/O) =O) the treating physician’s information will be used.
Adding or modifying a referring source after the charge(s) have been posted (when Utility --►Set Up/Parameter <Referring> is C or F), may be done through:
Ledger- -►Accounting <Ref> by moving the cursor next to the charge, from the C (command) column press M (modify), press [Enter] until the cursor is under the Ref heading, enter the Utility --►Referring <Referring Code> (pressing the [F2] search key will display the Searching Referring screen to search for the referring code), press [Enter] until the cursor returns to the C (command) column.
Ledger --►Open Item <Rdr> by moving the cursor next to the charge, from the C (command) column press M (modify), press [Enter] until the cursor is under the Rdr heading, enter the Utility --►Referring <Referring Code> (pressing the [F2] search key will display the Searching Referring screen to search for the referring code), press [Enter] until the cursor returns to the C (command) column.
Charges --►Modify <Rdr.> by moving the cursor next to the charge, from the C (command) column press M (modify), press [Enter] until the cursor is under the Rdr heading, enter the Utility --►Referring <Referring Code>, (pressing the [F2] search key will display the Searching Referring screen to search for the referring code), press [Enter] until the cursor returns to the C (command) column.
UB04 REVIEW
Box 1
Billing Method C: Utility --►Set Up --►Clinic Name, Address, Zip Code, City, State.
Billing Method D: Utility --►Provider Organization Name (Name when Organization Name is blank), Address, Zip Code, City, and State.
837 Institutional Loop 2010 AA NM103, NM3, N4
and Phone number Loop 2010 AA PER04
Box 2
Not used.
Box 3a PAT CNTL NO.
Registration --►Regular --►Patient <Patient Account No.>.
837 Institutional Loop 2300 CLM01
Box 3b MED REC NO.
Registration --►Regular --►Patient <Patient Account No.>.
837 Institutional Loop 2300 REF02
Box 4 TYPE OF BILL
Charges --►Encounter --►UB-Encounter <Bill Type>. If charges do not have an encounter then Utility --►Set Up --►Clinic <Specialty>.
The UB-04 now uses 4 digits, first digit is a leading zero.
837 Institutional Loop 2300 CLM05
Box 5 FED. TAX NO.
Billing Method C: Utility --►Set Up --►Clinic <I.R.S. Number>.
Billing Method D: Utility --►Provider <I.R.S. Id.>.
Box 6 STATEMENT COVERS PERIOD / FROM / THROUGH
Charges --►Charge <From Date >and <To> (date).
837 Institutional Loop 2300 DTP03
Box 7
Not Used
Box 8a (Patient ID)
Not required by Medi-Cal.
Box 8b Patient Name
Registration --►Regular --►Patient <Last Name>, <First Name>, <Middle Initial>.
837 Institutional Loop 2010BA NM103, NM104 NM105
Box 9a PATIENT ADDRESS
Registration --►Regular --►Patient <Address>.
837 Institutional Loop 2010BA N301
Box 9b
Registration --►Regular --►Patient <City>.
837 Institutional Loop 2010BA N401
Box 9c
Registration --►Regular --►Patient <State>
837 Institutional Loop 2010BA N402
Box 9D
Registration --►Regular --►Patient <Zip Code>
837 Institutional Loop 2010BA N403
Box 10 BIRTHDATE
Registration --►Regular --►Patient <DOB>.
837 Institutional Loop 2010BA DMG02
Registration --►Regular --►Patient <Sex (M/F/U)>
837 Institutional Loop 2010BA DMG03
Box 12 Admission DATE
Charges --►UB-Encounter <Admission Date>.
Not required by Medi-Cal.
Inpatient Only Not Used
Not required by Medi-Cal.
Box 14 Admission TYPE
Inpatient Only Not Used
Box 15 Admission SRC
Charges --►UB-Encounter <Admission Src>.
837 Institutional Loop 2300 CL102
Box 16 DHR
Inpatient Only Not Used
Box 17 STAT
Charges --►UB-Encounter <Status>.
837 Institutional Loop 2300 CL103
Box 18 CONDITION CODES
Charges --►UB-Encounter <Condition Code 1>.
837 Institutional Loop 2300 HI*BH
Box 19 CONDITION CODES
Charges --►Encounter- -►UB-Encounter <Condition Code 2>.
Box 20 CONDITION CODES
Charges --►UB-Encounter <Condition Code 3>.
Box 21 CONDITION CODES
Charges --►UB-Encounter <Condition Code 4>.
Box 22 CONDITION CODES
Charges --►UB-Encounter <Condition Code 5>.
Box 23 CONDITION CODES
Charges --►UB-Encounter <Condition Code 6>.
Box 24 CONDITION CODES
Charges --►UB-Encounter <Condition Code 7>.
Box 25 CONDITION CODES
NO FIELD
Box 26 CONDITION CODES
NO FIELD
Box 27 CONDITION CODES
NO FIELD
Box 28 CONDITION CODES
NO FIELD
Box 29 ACDT
Not Used
Box 30
Not Used
Charges --►UB-Encounter <Occurrence Code 1> and <Date>.
837 Institutional Loop 2300 HI*BH
HI*BH:42:D8 (Date)
Box 32 OCCURRENCE CODE / DATE
Charges --►UB-Encounter <Occurrence Code 2> and <Date>.
Box 33 OCCURRENCE CODE / DATE
Charges --►UB-Encounter <Occurrence Code 3> and <Date>.
Box 34 OCCURRENCE CODE / DATE
Charges --►UB-Encounter <Occurrence Code 4> and <Date>.
Charges --►UB-Encounter <Occurrence Code Span A>.
Charges --►UB-Encounter <Occurrence Code Span From A>.
Charges --►UB-Encounter <Occurrence Code Span To A>.
Box 36 OCCURRENCE SPAN CODE/ FROM / THROUGH
Charges --►UB-Encounter <Occurrence Code Span B>.
Charges --►UB-Encounter <Occurrence Code Span From B>.
Charges --►UB-Encounter <Occurrence Code Span To B>.
Box 37
Not used.
Box 38
Utility --►Insurance <Name>, <Address>, <City>, <State>, and <Zip> (for the insurance being billed).
Not required by Medi-Cal and will not print for Utility --►Insurance <Type> = "D".
Charges --►UB-Encounter <Value Code 1> and <Amount>.
837 Institutional Loop 2300 HI*BE
HI*BE:08:::1740~ (Amount)
Box 39b VALUE CODES CODE / AMOUNT
Charges --►UB-Encounter <Value Code 4> and <Amount>
Box 39c VALUE CODES CODE / AMOUNT
Charges --►UB-Encounter <Value Code 7> and <Amount>.
Box 39d VALUE CODES CODE / AMOUNT
Not Used
Box 40a VALUE CODES CODE / AMOUNT
Charges --►UB-Encounter <Value Code 2> and <Amount>.
Box 40b VALUE CODES CODE / AMOUNT
Charges --►UB-Encounter <Value Code 5> and <Amount>.
Box 40c VALUE CODES CODE / AMOUNT
Charges --►UB-Encounter <Value Code 8> and <Amount>.
Box 40d VALUE CODES CODE / AMOUNT
Not used.
Box 41a VALUE CODES CODE / AMOUNT
Charges --►UB-Encounter <Value Code 3> and <Amount>.
Box 41b VALUE CODES CODE / AMOUNT
Charges --►UB-Encounter <Value Code 6> and <Amount>.
Box 41c VALUE CODES CODE / AMOUNT
Not used.
Box 41d VALUE CODES CODE / AMOUNT
Not used.
Box 42 REV. CD.
Utility --►Procedure <UB92 Code> as it was at the time the charge was posted.
837 Institutional Claim Loop 2400 SV201
NOTE: If Utility --►Procedure <UB92 Codes> are changed after charges are posted, contact PCS support to have the treat_hist th_UB04 field updated.
Box 43 DESCRIPTION
Line 1 through 23 Utility --►Procedure <Description>
Below Line 23 System will print values for: PAGE__OF___, CREATION DATE ___ ,TOTALS_______
NOTE: If billing on the Summarized UB04 Form 8:
Line 1 through 23 Utility --►Messages --►Remark <Description> dependent on Utility --►Procedure <UB92 Code>.
Box 44 HCPCS / RATE/ HIPPS CODE
Prints the Utility --►Procedure <Code R>, < C>, <E> or <UB92 Code> dependent on Utility --►Insurance Code (R/C/E/U).
837 Institutional Claim Loop 2400 SV202
NOTE: If billing on the Summarized UB04 Form 8:
Line 1 through 22 Utility --►Procedure <Code R>, < C>, <E> or <Revenue Code> for the first procedure posted for each unique Revenue Code.
Box 45 SERV. DATE
The posted date of service (shown under the heading of Ledger --►Accounting or Open Item <DOS>).
837 Institutional Claim Loop 2400 DTP*472*D8
Box 46 SERV. UNITS
The Utility --►Procedure <Days/Units> for the quantity of the posted charge (shown under the heading of Ledger --►Accounting <Days>).
837 Institutional Claim Loop 2400 SV205
Box 47 TOTAL CHARGES
Line 1 through 23, the posted charge amount (shown under the heading of Ledger --►Accounting or Open Item < Amount>as well as Charges --►Modify <Charge>.
837 Institutional Loop 2400 SV203
Boxes 48 and 49
48 is intended for Rural Health billing
Box 50A PAYER
Utility --►Insurance <Name> of primary insurance.
837 Institutional Loop 2010 BC NM103
Box 50B PAYER
Utility --►Insurance <Name> of secondary insurance.
Box 50C PAYER
Utility --►Insurance <Name> of tertiary (third) insurance.
Box 51A HEALTH PLAN ID
Not Used
Box 52A REL INFO
Registration --► Regular --► Patient Insurance <Assignment> of primary insurance.
837 Institutional Loop 2300 CLM09
Box 52B REL INFO
Registration --► Regular --► Patient Insurance <Assignment> of secondary insurance.
Box 52C REL INFO
Registration --► Regular --► Patient <Assignment> of tertiary (third) insurance.
Box 53A ASG BEN
Registration --► Regular --► Patient Insurance <Assignment> of primary insurance.
837 Institutional Loop 2300 CLM08
Box 53B ASG BEN
Registration --► Regular --► Patient Insurance <Assignment> of secondary insurance.
Box 53C ASG BEN
Registration --► Regular --► Patient Insurance of tertiary (third) insurance.
NOTE: Form 8 Only
Utility --►insurance
<Print Prim Ins on Sec> = Y If set to Yes: when printing the secondary ins claim:
The Secondary insurance information will print in Boxes
50a, 51a and 52a in place of the Primary
insurance information
Box 54A PRIOR PAYMENTS
Prints the calculated total of all insurance payments.
NOTE: Form 8 Only
Utility --►insurance
<Print Prim Ins on Sec> = Y Box 54a (where the Primary Insurance payment would
normally print) will be left blank.
Boxes 54B and 54C
Not used.
Box 55A EST. AMOUNT DUE
Prints the calculated total of all charges.
NOTE: Form 8 Only
Utility --►insurance
<Print Prim Ins on Sec> = Y
The total charges will print in Box 55a in place of the
balance.
Box 55B EST. AMOUNT DUE
Prints the total charges minus insurance payments and adjustments.
Box 55C
Not used.
Box 56 NPI
Billing Method C
Utility --►Insurance <NPI > number will print.
Billing Method D
The Billing Provider’s Utility --►Provider --►Facility-Provider <Group NPI> number will print.
Or
If none, the Utility --►Provider --► Provider-Provider <Group NPI> number will print.
Or
If none: the Utility --►Provider <Group NPI> will print.
837 Institutional Loop 2010 AA NM109
Box 57
For Atypical Provider's ID only
Box 58A INSURED’S NAME
When the Registration Regular Patient primary insurance screen’s Relation to Insured is:
18 Registration --►Regular --►Patient <Name> (Last, First Init.) will print.
Other than 18 Registration --►Regular --►Patient insurance screen’s <Insured’s Name>.
Box 58B INSURED’S NAME
When the Registration Regular Patient secondary insurance screen’s Relation to Insured is:
18 Registration --►Regular --►Patient <Name> (Last, First Init.) will print.
Other than 18 Registration --►Regular --►Patient insurance screen’s <Insured’s Name>
Box 58C INSURED’S NAME
When the Registration --►Regular --►Patient tertiary insurance screen’s <Relation to Insured> is:
1 Registration --►Regular --►Patient <Name> (Last, First Init.) will print.
Other than 1 Registration --►Regular --►Patient insurance screen’s <Insured’s Name>.
Box 59A P. REL
Registration --►Regular --►Patient primary insurance screen’s <Relation to Insured>.
837 Institutional Loop 2000B SBR02
Box 59B P. REL
Registration --►Regular --►Patient secondary insurance screen’s <Relation to Insured>.
Box 59C P. REL
Registration --►Regular --►Patient tertiary (third) insurance screen’s <Relation to Insured>.
Box 60A CERT. - SSN - HIC. - ID NO.
Registration --► Regular --► Patient Insurance primary insurance screen’s <Subscriber No>.
837 Institutional Loop 2010BA NM109
Box 60B CERT. - SSN - HIC. - ID NO.
Registration --► Regular --► Patient Insurance secondary insurance screen’s <Subscriber No>.
Box 60C CERT. - SSN - HIC. - ID NO.
Registration --► Regular --► Patient Insurance tertiary (third) insurance screen’s <Subscriber No>.
Boxes 61A through 61C
Not used.
Box 62A INSURANCE GROUP NO.
Registration --► Regular --► Patient Insurance primary insurance screen’s <Group No>.
NOTE: Form 8 Only
Utility --►insurance
<Print Prim Ins on Sec> = Y If set to Yes: when printing the secondary ins claim:
The Secondary insurance information will print in Boxes
60a and 62a in place of the Primary
insurance information.
Box 62B INSURANCE GROUP NO.
Registration --► Regular --► Patient Insurance secondary insurance screen’s <Group No>.
Box 62C INSURANCE GROUP NO.
Registration --►Regular --►Patient tertiary (third) insurance screen’s <Group No>.
Box 63A TREATMENT AUTHORIZATION CODES
Charges --►UB-Encounter <Authorization No>.
837 Institutional Loop 2300 REF02
Box 64A DOCUMENT CONTROL NUMBER
Charges- -►UB-Encounter <Internal Control>.
Boxes 63B through Box 64C
Not used.
Box 65A EMPLOYER NAME
When the Registration --► Regular --► Patient Insurance primary insurance screen’s <Relation to Insured> is:
18 Registration --►Regular --►Patient <Employer> will print.
Other than 18 Registration --►Regular --►Patient Insurance screen’s <Insured’s Employer>
Box 65B EMPLOYER NAME
When the Registration --► Regular --► Patient Insurance secondary insurance screen’s, Relation to Insured> is:
18 Registration --►Regular --►Patient <Employer> will print.
Other than 18 Registration --►Regular --►Patient secondary Insurance screen’s <Insured’s Employer>.
Box 65C EMPLOYER NAME
When the Registration --► Regular --► Patient Insurance tertiary (third) insurance screen’s <Relation to Insured> is:
18 Registration --►Regular --►Patient <Employer> will print.
Other than 18 Registration --►Regular --►Patient tertiary Insurance screen’s <Insured’s Employer>.
Charges --► Charge <Diagnosis Code>.
837 Institutional Loop 2300 HI*BK
Box 67A DX
Other Diagnoses Codes
Box 67B DX
Other Diagnoses Codes
Box 67C DX
Other Diagnoses Codes
Box 68 UNLABLED
Other Diagnoses Codes
Charges --►UB-Encounter <Principal Diagnosis>.
Box 70 PATIENT REASON DX
Not Used
Box 71 PPS CODE
Not Used
Box 72 ECI CODE
Not Used
Box 73 UNLABLED
Not Used
Charges --►Encounter --►UB-Encounter <Principal Procedure > and <Date>.
Box 74a OTHER PROCEDURE CODE / DATE
Charges --►Encounter --►UB-Encounter <Principal Procedure > and <Date>.
Box 74a OTHER PROCEDURE CODE / DATE
Charges --►Encounter- -►UB-Encounter <Principal Procedure > and <Date>.
Box 74b OTHER PROCEDURE CODE / DATE
Charges --►Encounter- -►UB-Encounter <Principal Procedure > and <Date>.
Box 74c OTHER PROCEDURE CODE / DATE
Charges --►Encounter --►UB-Encounter <Principal Procedure > and <Date>.
Box 74d OTHER PROCEDURE CODE / DATE
Charges- -►Encounter --►UB-Encounter <Principal Procedure > and <Date>.
Box 74e OTHER PROCEDURE CODE / DATE
Charges --►Encounter --►UB-Encounter <Principal Procedure > and <Date>.
Box 75 UNLABLED
Not Used
Boxes 76 ATTENDING
System will print the Referring physician information determined by the Utility --►Set Up --►Parameter <Referring> as completed at the time of posting:referral in the Patient File. If a referral is not posted in charges or entered in the Patient File, the treating doctor's referral information (Name and NPI) from Utility --►Referring will be used
P Referring source originates from Registration --►Regular --►Patient <Referral>.
C Referring source originates from that which was entered at the time of posting the charge through Charges --►Charge <Rdr>.
F Referring source first originates from the charge screen Charges --►Charge <Rdr>. When not entered, uses Registration --►Regular --►Patient <Referral>.
NOTE: If the Utility/Referring Doctor/Other = O (other) the referring provider information will NOT print.
Last Name 837 Institutional Loop 2310A NM103
First Name 837 Institutional Loop 2310A NM104
NPI 837 Institutional Loop 2310A NM109
Box 77 OPERATING
System will print the billing provider information as entered in Charges--►Charge <Billing Prv>.
The Utility --►Provider --►Provider --►Facility <HCFA Box 24K> number will print.
If a match is not found: the Provider-Provider HCFA Box 24Knumber will print. If a match is not found the Utility--►Provider <HCFA Box 24K 1>, <HCFA Box 24K 2> or <HCFA Box 24K 3> will print, dependent on Utility --►Insurance< Selection (1/2/3)>.
Boxes 78 OTHER
Not used.
Boxes 79 OTHER
Not used.
Boxes 80a through c REMARKS
Prints the Charges --►Charge Remarks for the first three charges posted.
837 Institutional Loop 2300 NTE02
Box 81 CC
Not used.
NOTE: Electronic claims submission will always submit detailed charge information – regardless of paper
claim billing requirements.