Post on 11-Jan-2016
description
MO HealthNet Internet Provider Training ProgramPresented by the Provider Education Unit MO HealthNet Division
1Mo HealthNet Division
1Proper Completion of the Online Outpatient ClaimPresented by the Provider Education UnitMO HealthNet Division
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2 To file a claim go to the Internet Web site www.emomed.com and log on under the appropriate NPI and Taxonomy code, if applicable for the claim to be submitted. This will bring up the eProvider Home Page. At the top of each page is a Help button in the form of a question mark. You can print out field-by-field instructions.
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Participant Information
010101017Mo HealthNet Division
7Participant Information
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PATIENT8
Participant Information
IMA9Mo HealthNet Division
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Participant Information
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10 Service Information
11Mo HealthNet DivisionNOTE: BOXES IN GRAY ARE NOT REQUIRED FIELDS FOR THIS CLAIMM200000000
11 Service Information
1-Emergency
12Mo HealthNet DivisionNOTE: BOXES IN GRAY ARE NOT REQUIRED FIELDS FOR THIS CLAIM
12 Code Details
13Mo HealthNet Division4019E84908820
13 Code Details
AJ Payer Responsible for Co-payment
14NOTE: WHEN BILLING 1-EMERGENCY ADMIT TYPE A CONDITION CODE AJ MUST BE ENTERED TO EXEMPT THE PARTICIPANT FROM THE COST SHARING AMOUNT FOR THE SERVICE
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14 Save Claim Header Information
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Detail Line Information
16Mo HealthNet Division11/15/2012
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Detail Line Information
17Mo HealthNet DivisionNOTE: WHEN BILLING A FACILITY SUPPLY CODE (0260, 0270, AND 0274) THE PROCEDURE CODE AND MODIFIERS FIELDS ARE LEFT BLANK
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Detail Line Information
18Mo HealthNet Division0270
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19Mo HealthNet Division250.00
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Detail Line Information
20Mo HealthNet Division1NOTE: WHEN BILLING A FACILITY SUPPLY CODE (0260, 0270, AND 0274) THE DAY/UNITS FIELD SHOULD BE 1
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25Mo HealthNet Division11/15/2012
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26Mo HealthNet Division85025
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27Mo HealthNet Division0305
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28Mo HealthNet Division75.00
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29Mo HealthNet Division1
29Detail Line Information Mo HealthNet Division30
30Detail Line Information Mo HealthNet Division31
11/15/2012
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12002
32Detail Line Information Mo HealthNet Division33
NOTE: FOR REPORTING LINE THE MODIFIERS FIELDS SHOULD BE LEFT BLANK
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0361
34Detail Line Information Mo HealthNet Division35
0.00
35Detail Line Information Mo HealthNet Division36
1
36Detail Line Information Mo HealthNet Division37
37Detail Line Information Mo HealthNet Division38
11/15/2012
38Detail Line Information Mo HealthNet Division39
NOTE: WHEN ENTERING A FACILITY REVENUE CODE (0450, 0459, 0490, AND 0510) THE PROCEDURE CODE AND MODIFERS FIELDS ARE LEFT BLANK
39Detail Line Information Mo HealthNet Division40
0459
40Detail Line Information Mo HealthNet Division41
400.00
41Detail Line Information Mo HealthNet Division42
1NOTE: WHEN BILLING A FACILITY REVENUE CODE (0450, 0459, 0490, AND 0510) THE DAY/UNITS FIELD SHOULD BE 1
42Detail Line Information Mo HealthNet Division43
43Other Payer Information Mo HealthNet Division44
44Other Payer Information Mo HealthNet Division45
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Other Payer Information
46Mo HealthNet Division1
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Other Payer Information
47Mo HealthNet DivisionABC INSURANCE CO
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Other Payer Information
48Mo HealthNet Division11/26/2012
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Other Payer Information
49Mo HealthNet Division325.00
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Other Payer Information
50Mo HealthNet Division0.00
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Other Payer Information
51Mo HealthNet Division
51 Other Payer Detail Summary
52Mo HealthNet DivisionAssociated Line Items
52Other Payer Detail Summary Mo HealthNet Division53
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Other Payer Detail Summary
54Mo HealthNet Division2
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Other Payer Detail Summary
55Mo HealthNet Division50.00
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Other Payer Detail Summary
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Other Payer Detail Summary
57Mo HealthNet Division45
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Other Payer Detail Summary
58Mo HealthNet Division100.00
58Other Payer Detail Summary Mo HealthNet Division59
59Other Payer Detail Summary Mo HealthNet Division60
60Other Payer Detail Summary Mo HealthNet Division61
61Other Payer Detail Summary Mo HealthNet Division62
2
62Other Payer Detail Summary Mo HealthNet Division63
20.00
63Other Payer Detail Summary Mo HealthNet Division64
64Other Payer Detail Summary Mo HealthNet Division65
45
65Other Payer Detail Summary Mo HealthNet Division66
30.00
66Other Payer Detail Summary Mo HealthNet Division67
67Other Payer Detail Summary
68Mo HealthNet DivisionNOTE: LINE 3 OF THIS CLAIM IS A SURGICAL REPORTING LINE NO MONEY IS ASSOCIATED IN THE INSURANCE BREAKDOWN FOR THIS INDIVIDUAL LINE DO NOT CHECK THE ASSOCIATED LINE ITEM BOX FOR THE 3RD LINE OF THIS CLAIM
68Other Payer Detail Summary Mo HealthNet Division69
69Other Payer Detail Summary Mo HealthNet Division70
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2
71Other Payer Detail Summary Mo HealthNet Division72
50.00
72Other Payer Detail Summary Mo HealthNet Division73
73Other Payer Detail Summary Mo HealthNet Division74
45
74Other Payer Detail Summary Mo HealthNet Division75
150.00
75Other Payer Detail Summary Mo HealthNet Division76
76Other Payer Detail Summary Mo HealthNet Division77
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78 Claim Status
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79Claim Status
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80 Payment Details
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83 Thank you for participating in this training program. If you have questions regarding the information in this presentation, please contact the Provider Education Unit at 573-751-6683
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