OnSTAFF 2000
Utility/Insurance/TELE COM
This option is part of the software requirements for electronic billing, electronic verification of Medicare eligibility as well as ERA (Electronic Remittance Advice, part of the Auto Payment feature). Insurance Codes MCAR, MM, MCAL, IMS, HPSM, NAMM, DDD, UGS, and MCAR-A are standard to On-Staff and come partially completed.
Menu Options:
Add Add new Tele Com screen
Modify Modify an existing Tele Com screen
Delete Delete an existing Tele Com screen
View View an existing Tele Com screen
Print Prints a listing of the information in this file
Exit Returns you to the Insurance Menu
The Add, Modify, View and Delete options maintain Tele Com setup, allowing you to Add new, Modify and View existing and Delete when necessary, various insurance Tele Com setup. You will need to Modify the Tele Com screens of the carriers provided by On-Staff which you have selected to electronically submit claims to. When Modify is selected, On-Staff will display the following screen:
For additional information, see Software Requirements for Electronic Billing, Auto Payment Posting, Eligibility Verification and Capitated Contract Setup at the end of this Session.
NOTE: If you need to dial a prefix (such as 8 or 9) before dialing, be sure to add it to the phone number on the Security Code, Telephone and Telephone (Eligibility) fields.
Insurance Code: Enter the /Utility/Insurance <Insurance Co. Code> of the carrier. Standard to On-Staff are:
MCAR Medicare
MM Medi-Medi
MCAL Medi-Cal (Medi-Caid)
IMS Integrated Medical Services Clearing House
HPSM Health Plan of San Mateo
(a Medi-Cal Intermediary in Northern CA)
NAMM North American Medical Management
(a Medicare Intermediary for IPA’s in Northern CA)
DDD Diversified Data Design
UGS United Government Services
(UB92 billing only)
MCAR-A Blue Cross Medicare Part A
(UB92 billing only)
Login: Enter the following values per insurance code:
MCAR Palmetto:
Enter the # assigned
Enter your submitter code assigned by Medicare. This entry should be nine digits long. Thus you may
need to add leading zeros NOT capital o’s. Example: Medicare assigns you 3008 as your submitter code. You would then enter 000003008 on the Login field.
MM See MCAR.
MCAL Enter your 3 digit submitter number.
IMS Modify the example provided by On-Staff,
56-61574053-CLRX200Z
with the 2 and 8 digit numbers given you by IMS. For example if IMS gave you 36 and 88324432, you would then modify the above example provided by On-Staff to read:
36-88324432-CLRX200Z.
HPSM Enter the number assigned by the carrier.
NAMM See HPSM.
DDD See HPSM.
UGS See HPSM.
MCAR-A See HPSM.
Password: Enter the following values per insurance code:
MCAR Palmetto:
Enter the password assigned:
Enter PRIME.
MM See MCAR.
MCAL Enter the password assigned by Medi-Cal.
IMS Enter the 3 character code assigned by IMS.
HPSM Enter the code assigned by the carrier.
NAMM See HPSM.
DDD See HPSM.
UGS See HPSM.
MCAR-A See HPSM.
Telephone: Enter the following values per insurance code:
MCAR Palmetto:
Enter your local CompuServe phone number OR
Enter: 18037889860
MM See MCAR.
MCAL Test : 19166388127
Production: 19166389838
IMS Test : 15093280719
Production: 17146688132
HPSM Enter 14156384138 (test and production).
NAMM Enter 15102734947 (test and production).
DDD Enter 13109736179 (test and production).
UGS Enter 14145233896 (test and production).
MCAR-A Enter 18187126551 (test).
Telephone
Eligibility: Enter the following values per insurance code:
MCAR Palmetto:
Enter the same # found in Telephone.
Enter 18037889860
MM See MCAR.
MCAL Enter NONE.
IMS See MCAL.
HPSM See MCAL.
NAMM See MCAL.
DDD See MCAL.
UGS See MCAL.
MCAR-A See MCAL.
Modem Device: This is system specific. Contact your vendor to verify. The standard is:
AIX Systems /dev/tty1
UNIX Systems /dev/tty1A
ISA5 Qualifier(05): Enter the Interchange Control Structure ISA05 code as required by this insurer
ISA Login:
ISA Password: Enter the Interchange Control Structure ISA04 security information.
Clearing House: If a clearing house is to be used enter “Y”
Modem Type: Enter the following values per insurance code:
MCAR Palmetto: palmetto
Enter cabbs1 when submitting direct, not through CABBS.
MM See MCAR.
MCAL Enter xsend.
IMS Enter ims.
HPSM Enter hpsm.
NAMM Enter namm.
DDD Enter uhp.
UGS Enter uws
MCAR-A Enter ansibx
ISA7 Qualifier(07):
After pressing [Enter] in the last field, the cursor will return to the Security Code field, allowing review of the entry for accuracy. If the data entered is accurate, press [“] to return to the Insurance Code field. At this point, you may either modify an additional insurance company or press [“] to return to the Tele Com Menu.
HOW DO I GET STARTED??
1) Contact the Various Carriers:
Contact each carrier to obtain the necessary paperwork for electronic billing.
When contacting Medicare, be sure to let them know you want to do:
1) Electronic Billing
2) ERA (Electronic Remittance Advice-Auto Payment Posting) for both electronic and paper submitted claims!
When contacting Medi-Cal at (916) 636-1060 be sure to inform them that you want to do:
Electronic Billing
ARDS (Automated Remittance Data Services). There are two types:
a) You will be charged $.05 a line and will receive the hard copy Medi-Cal Warrant (EOB) in the mail.
b) There is no charge and you will NOT receive the hard copy Medi-Cal Warrant (EOB) in the mail.
NOTE: For clients with more than one clinic, YOU MUST OBTAIN a separate submitter number for each clinic to utilize the Auto Payment Posting feature.
2) Complete the Software Requirements:
After receiving your submitter code, password, etc., follow the instructions found in the remainder of this handout, per carrier.
3) Send Your Test Claims:
Per each carrier's requirements, send your test claims.
Change to Production:
After Medicare has approved your test transmission, go to:
/Utility/Set Up/Clinic/Modify and set the field <Test/Production (T/P)> to P.
Log off, log on and you are ready to go!
After IMS has approved your test transmission, go to:
a) /Utility/Set Up/Clinic/Modify and set the field <Test/Production (T/P)> to P.
b) /Utility/Insurance/Tele Com and modify the Tele Com screen for IMS, changing the field <Telephone> from the Test phone number to the Production phone number found on the previous page. Log off, log on and you are ready to go!
After Medi-Cal or any other carrier has approved your test transmission, go to:
/Utility/Insurance/Tele Com and modify the Tele Com screen, changing the field Telephone from the Test phone number to the Production phone number where needed. Refer to Session II Chapter 4 /Utility/Insurance/Tele Com for additional carrier information.