MO HealthNet Internet Provider Training Program Presented by the Provider Education Unit MO HealthNet Division. Proper Completion of the Online Outpatient Claim. Presented by the Provider Education Unit MO HealthNet Division. - PowerPoint PPT Presentation
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
2Mo HealthNet Division
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.
3Mo HealthNet Division
3
4Mo HealthNet Division
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5Mo HealthNet Division
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6Mo HealthNet Division
6
Participant Information
010101017Mo HealthNet Division
7Participant Information
8Mo HealthNet Division
PATIENT8
Participant Information
IMA9Mo HealthNet Division
9
Participant Information
10Mo HealthNet Division
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
Mo HealthNet Division
14 Save Claim Header Information
15Mo HealthNet Division
15
Detail Line Information
16Mo HealthNet Division11/15/2012
16
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
17
Detail Line Information
18Mo HealthNet Division0270
18
Detail Line Information
19Mo HealthNet Division250.00
19
Detail Line Information
20Mo HealthNet Division1NOTE: WHEN BILLING A FACILITY SUPPLY
CODE (0260, 0270, AND 0274) THE DAY/UNITS FIELD SHOULD BE 1
20
Detail Line Information
21Mo HealthNet Division
21
Detail Line Information
22Mo HealthNet Division
22
Detail Line Information
23Mo HealthNet Division
23Detail Line Information Mo HealthNet Division24
24
Detail Line Information
25Mo HealthNet Division11/15/2012
25
Detail Line Information
26Mo HealthNet Division85025
26
Detail Line Information
27Mo HealthNet Division0305
27
Detail Line Information
28Mo HealthNet Division75.00
28
Detail Line Information
29Mo HealthNet Division1
29Detail Line Information Mo HealthNet Division30
30Detail Line Information Mo HealthNet Division31
11/15/2012
31Detail Line Information Mo HealthNet Division32
12002
32Detail Line Information Mo HealthNet Division33
NOTE: FOR REPORTING LINE THE MODIFIERS FIELDS SHOULD BE LEFT
BLANK
33Detail Line Information Mo HealthNet Division34
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
45
Other Payer Information
46Mo HealthNet Division1
46
Other Payer Information
47Mo HealthNet DivisionABC INSURANCE CO
47
Other Payer Information
48Mo HealthNet Division11/26/2012
48
Other Payer Information
49Mo HealthNet Division325.00
49
Other Payer Information
50Mo HealthNet Division0.00
50
Other Payer Information
51Mo HealthNet Division
51 Other Payer Detail Summary
52Mo HealthNet DivisionAssociated Line Items
52Other Payer Detail Summary Mo HealthNet Division53
53
Other Payer Detail Summary
54Mo HealthNet Division2
54
Other Payer Detail Summary
55Mo HealthNet Division50.00
55
Other Payer Detail Summary
56Mo HealthNet Division
56
Other Payer Detail Summary
57Mo HealthNet Division45
57
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
70Other Payer Detail Summary Mo HealthNet Division71
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
77
78Mo HealthNet Division
78 Claim Status
79Mo HealthNet Division
79Claim Status
80Mo HealthNet Division
80 Payment Details
81Mo HealthNet Division
81
82Mo HealthNet Division
82
83Mo HealthNet Division
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
84Mo HealthNet Division
84
