The Service Line holds all Charge and Payment information required for submitting a claim to the Payer. The Service Line may be customized by adding additional columns using the Column Chooser.
Right click on any column heading and select ‘Column Chooser’. Drag and drop column selection into the header area at desired location. See Column Chooser for additional information on working with Column Headings.
The ‘Add’ button is only enabled when a Srvc Date has been entered. The ‘Add’ button can be used instead of clicking a calendar date.
When changing the number of Units on a service line, the Patient Amount Due, Cost and Adjustment columns are not changed. Only the Charge and Allowed columns are updated.
When changing the number of Units, the current charge is
divided by the original units to get the ‘per unit’ amount; it is then
multiplied by the new number of units.
<New Charge> = <Old
Charge> / <Old Units> * <New Units>.
If an adjustment is entered on the ‘Add’ line, it will be saved as a contract adjustment with a group code of CO and a reason code of 45.
Service lines print (and export electronically) regardless of the display order on the screen based on the internal ID generated upon service line creation. The ‘Sort’ column can be pulled into the grid and will display a ‘1’ for each service line. You can then reorder the service lines as needed within a particular DOS. Other service lines will be sorted in date order. Don’t forget to tab out of the ‘Sort’ field after editing. The claim also needs to be saved to refresh your changes.
Note: The SrvID cannot be edited as this is an internal ID generated by Premier.
To open the ‘Procedure Code Lookup’ window, double click in the Procedure code field. The program will filter the code list based on the Bill To payer, Billing Provider, and Rate Class associated with the claim.
See Procedure Code Library for more information about the procedure code library.
In the ‘Procedure Code Lookup’ window, double click on the Procedure Code to enter it into the service line.
The following fields are populated from the library: Procedure, Product, Modifiers 1-4, Charges, Units, Allowed, Adjustment, Cost, NDC (Drug) Code, Drug Unit Measurement, Drug Unit Count, and Revenue Code.
If Set Description is checked in the library, the Service Line Description field will populate with the corresponding description.
If Set Pat. Amt. Due is checked in the library, the program will enter a patient amount due based on the Copay fields located on the upper right side of the Patient Information screen.
Additional Information
•If you select the same code from the lookup library that is already on the service line, nothing will happen.
•The combination of Procedure Code and Product Code determines which library entry to use. The product code column is normally not displayed and is used only in special situations where you want Premier to keep different data points (charge, description, etc.) for multiple iterations of the same procedure code.
•Looking up a procedure code will not replace existing data on the service line: If a code in the procedure code library does not have a modifier or a unit value, it will not replace those values with blanks if they already exist on the service line.
The Resp. Party is used to determine who is responsible for the line item balance. The field is managed by EZClaim but can be manually set by the end user. Click in the ‘Resp. Party’ field to display the drop-down arrow.
Whenever the responsible party changes at the service line level, Premier will re-evaluate the claim to determine whether the ‘Bill To’ needs to be changed.
Exceptions:
•If using tracking type Adjustments, the responsible party will not change.
Examples:
|
Current Resp. Party |
Payer used when entering a Payment or Adjustment |
New Resp. Party |
|
Primary |
Primary |
Secondary |
|
Primary |
Secondary |
Primary (no change because the payers do not match) |
|
Primary |
Blank |
Primary (no change because no payer was set) |
Right click on any column heading to select ‘Column Chooser’ dialog box.
Scroll to ‘Service Line Description’ and drag and drop within the column headings or below the column headings.
Click in area below the service line and enter ‘Line Item’ notes.
837 Notes: Data entered in this area will be exported electronically in Loop 2400 Segment NTE Field 2.
Additional fields are available when billing for drug administration using the required National Drug Codes also referred to as NDC codes. When NDC codes are submitted, other required fields include the Drug Unit Count and Drug Unit Measurement. Per ANSI 5010 guidelines, drug information is exported ONLY if the NDC code is entered.
IMPORTANT: Because EZClaim Advanced 10 stored NDC data differently – essentially all required data being entered in a single field – Premier upgrade clients will need to reformat this data before submitting electronic claims to the clearinghouse or payer.
NDC Data Entry in Advanced 10:
NDC Data Entry in Premier:
Column headings can be ordered as desired. Use the dropdown menu in Drug Unit Measurement to make the appropriate selection, as this field does not allow data entry. Other fields (such as Description) are situational. Consult your payer with any questions as to the required data.
If the same code needs to be associated with different NDC specifications, you can enter the code multiple times in the Procedure Code Library, using the ‘Product’ field to assign a unique label to each instance to assist the program in filtering and sorting your data appropriately, e.g., in Procedure Code Lookup. You can also bypass the Procedure Code Library and simply add the fields (via the Column/Band Chooser) to your Service Line grid.
.
These fields are:
•NDC Code – National Drug Code used in Loop 2410 - LIN02 segment.
•Drug Unit Count – Enter a unit count if different from the service units. Exported in Loop 2410 - CTP04 segment.
•Drug Unit Measurement – Enter the Unit Measurement Code. If left blank, ‘UN’ will be used in Loop 2410 - CTP05. Valid values include:
o F2 – International Unit
o GR – Gram
o ME – Milligram
o ML – Milliliter
o UN - Unit
•Drug Unit Price – No longer used in the 5010 version of ANSI 837.
•Prescription Number – Exports the prescription number (preceded by an XZ qualifier) in Loop 2410 REF*XZ. The REF*XZ segment will only be exported if an NDC Code is entered on the service line.
Cost – This field is for your reference only. It is not used when printing or exporting claims. It is available in the procedure code library and will be populated when using the procedure code lookup. The amount is not recalculated when changing the number of units.
Expected Pmt. – This field is for your reference only. It is not used when printing or exporting claims.
NOC Override – This field is used when you need to supply a description in the SV101-7 field in the ANSI 837 file. Any data in this field will override the NOC information from the Procedure Code library. See Not Otherwise Classified (NOC) Codes for more information on NOC codes in the procedure code library.
Print/Export – If unchecked, the service line will not be printed or exported. This is often helpful on claim resubmissions when the payer does not want to receive a service line already paid in full.
Procedure Code – If the procedure code is the word ‘BLANK’, the program will treat it as truly being blank and will not print or export the procedure code.
Test Results – This field is available if you need to supply test results in the Loop 2400 MEA segments in the ANSI 837.
Unit Measurement – You can assign a specific unit measurement of days or units. This is used in the ANSI 837 Institutional export in SV204. Units = UN and Days = DA. If blank, the program will export UN.