WWW.PRIMECLINICAL.COM

 

OnSTAFF 2000

 

When Electronic Billing Fails

Prime Clinical Systems, Inc.

 

 

Client I.D._______ Reference Number:_____________       Contact:_________________________

 

1)         Did the system print the report? (Y/N)                                                                              __________________________________

2)         Does the report have the name & the charge listed (Y/N)               __________________________________

3)         Did you hear the modem dial (Y/N)                                                                                              __________________________________

4)         If modem dialed, was it busy (Y/N)                                                                                              __________________________________

5)         Account No.                                                                                                                                                                              __________________________________

6)         Name                                                                                                                                                                                                    __________________________________

7)         Ledger                                                                                                                                                                                      __________________________________

                        a)         Rendering Provider Code                                                                                                 __________________________________

                        b)         Date of Service                                                                                                                                      __________________________________

                        c)         Date of Entry                                                                                                                                                     __________________________________

                        d)         Code Column                                                                                                                                         __________________________________

8)         Enter the patient's Category Code at Utility\Category                                __________________________________

9)         Enter the patient's Primary Insurance Code at Utility\Insurance________________________________

                        a)         RVS/CPT/E/M  (R/C/E/U)                                                                                                           __________________________________

                        b)         Insurance Type                                                                                                                                      __________________________________

                        c)         Selection (1/2/3)                                                                                                                                                __________________________________

10)        \Utlity\Setup\Systems

                        a)         Billing                                                                                                                                                                           __________________________________

                        b)         Entry/Service Date (E/S)                                                                                                 __________________________________

11)        \Utility\Provider

                        a)         Provider 1                                                                                                                                                          __________________________________

                        b)         Provider 2                                                                                                                                                          __________________________________

                        c)         Provider 3                                                                                                                                                          __________________________________

                        d)         Group 1                                                                                                                                                             __________________________________

                        e)         Group 2                                                                                                                                                             __________________________________

                        f)          Group 3                                                                                                                                                             __________________________________

                        g)         Group (Y/N)                                                                                                                                                       __________________________________

                        h)         Doctor/Cost Center (D/C)                                                                                                            __________________________________

12)        \Utility\Procedure

                        a)         Panel Code                                                                                                                                                       __________________________________

                        b)         Billing (A/N/C/E/P/S)                                                                                                                  __________________________________

                        c)         Provider                                                                                                                                                             __________________________________

                        d)         Form                                                                                                                                                                             __________________________________

                        e)         RVS Code                                                                                                                                                         __________________________________

                        f)          CPT Code                                                                                                                                                         __________________________________

                        g)         E/M Code                                                                                                                                                          __________________________________

13)        \Billing\Tele Com\Submit

                        a)         From Date                                                                                                                                                         __________________________________

                        b)         To Date                                                                                                                                                             __________________________________

                        c)         Patient No.(s) (group or batch)                                                                            __________________________________

                        d)         Carrier Type                                                                                                                                                       __________________________________

                        e)         All/Unbilled/Rebill (A/U/R)                                                                                                           __________________________________

                        f)          Insurance Code                                                                                                                                      __________________________________

                        g)         Provider Code                                                                                                                                        __________________________________

                        h)         Claim Type (4/5)                                                                                                                                                __________________________________

                        I)          Primary/Secondary                                                                                                                                __________________________________

                        j)          Billing Code                                                                                                                                                       __________________________________

 

The above information may be obtained by going to the System Status Screen (Control X).  With your cursor next to the Failed Electronic billing report press 'I'.  The Tele Com Submit Screen (by Group or Batch) will be displayed as you has originally entered the above requested information.