Classic EMC Table Maintenance

Use Classic EMC Table Maintenance to maintain information for the electronic billing files.  This includes specific information contained in the transmission file and information used for processing electronic medical claims.

Tips:  

• Generally, the EMC Tables are maintained during the electronic billing setup and do not change unless the carrier makes changes to their process or governmental agencies make changes to their electronic billing regulations.  For more information, contact NDS Technical Support.

• You can use both the EMC Professional Table Maintenance and the Classic EMC Table Maintenance for maintaining EMC Tables.

• When creating EMC tables for institutional billing, entries for all fields are the same except for line 2 column 1.  For specific details, please see below.

• For more information about working with data in fields, see the Data Entry Guidelines.

Directions:

To see directions for...

• Opening Classic EMC Table Maintenance, click More.

   

  1.  Click Billing Functions from the Menu Bar.

  2.  Click Communications.

  3.  Click File Maintenance.

  4.  Click Classic EMC Table Maintenance.
   

  Note:  Or, click the following sequence:
  Billing Functions from the Menu Bar; Menu Panel; File Maintenance on the Menu Bar; and Classic EMC Table Maintenance.

   

  Classic EMC Table Maintenance Window Example:

  

   

• Creating a New Classic EMC Table, click More.

   

  Classic EMC Table Maintenance Prompts Tip:  To see more information about a field, click the hyperlink for the field name.
  Table ID	Enter the Table ID assigned to the EMC Table. (up to 9 characters) Notes:   The Table ID for each carrier is assigned by NDS and is included in the script that runs the electronic billing submission. To indicate that you are building a new Classic EMC Table, New  displays near the Table ID.  Default entries display and the first field is highlighted to let you know you can begin entering information.
  	To update the new or changed information, click Save or press [ENTER]. Keyboard shortcut:  [ALT + s]
  	CAUTION To avoid losing data, you must save new or changed records.
  	Note:  Search is not active during this maintenance.
  	To display an existing Classic EMC Table, enter the Table ID and click Retrieve, or press [ENTER]. Keyboard shortcut:  [ALT + t]
  Data Source	To select a data source that identifies the data bases for electronic billing, click a choice in the drop-down list. Data Source Options: Default Main Data Source
  Active	Active identifies the state of the electronic billing setup/installation and is assigned by INSight. Valid Active Codes: 0 - No 1 - Test phase 2 - Live
  Status	Status describes the current electronic billing process and is maintained by INSight.   Valid Statuses: 0 - Not setup 1 - Setup complete 2 - Transfer has been completed and ready to send
  Last Date Setup	The date of the last electronic billing setup is maintained by INSight and displays for your reference.
  Line 1 Column 1	Enter the Submitter Identification as specified by 1000A NM109. (up to 12 characters)
  Line 1, Column 2	Enter the Submitter ID which is assigned by the Carrier as specified by ISA06 GS02. (up to 12 characters)
  Line 2, Column 1	There are two types of entries for this field.  One for submitting professional claims and another type for submitting institutional claims.   To maintain the field for professional billing, enter the following: The following flags determine the minimum length for certain fields in the transmission file. 1st position - Patient certificate length | 1 char, Y=2, 0/1/2/3/4/5/6/7/8/9 2nd position - Patient last name length | 1 char, Y=2, 0/1/2/3/4/5/6/7/8/9 3rd position - Patient first name length | 1 char, Y=2, 0/1/2/3/4/5/6/7/8/9 4th position - Patient address length | 1 char, Y=2, 0/1/2/3/4/5/6/7/8/9 5th position - Patient city length | 1 char, Y=2, 0/1/2/3/4/5/6/7/8/9 6th position - Patient state length | 1 char, Y=2, 0/1/2/3/4/5/6/7/8/9 7th position - Insurance address length | 1 char, Y=2, 0/1/2/3/4/5/6/7/8/9 8th position - Insurance city length | 1 char, Y=2, 0/1/2/3/4/5/6/7/8/9 9th position - Insurance EMC length | 1 char, Y=2, 0/1/2/3/4/5/6/7/8/9 Note:  The default value for each flag is 2, although you can maintain 0-9 as the minimum length for each field.  For example, if the minimum length is set to 9, then INSight checks to see if the specified field has 9 or more characters. To maintain the field for institutional billing, enter the following: If the Ticket Message Code (UXYZZ, where x=TypeofAdmission, Y = SourceOfAdmission, ZZ = AdmissionHour) is blank, then look to line 2, column 1 of the EMC table for ABCD, where: A = Paper EOB flag | Y/N B = Bundle charges flag | Y/N C = Type of Admission Default flag | X = leave blank, Y = 9, C = default D = Source of Admission Default flag | x = leave blank, Y = 1, D = default Notes:   If positions CD are left blank, then the Type of Admission flag defaults to 9 and the Source of Admission flag defaults to 1. For example, an entry of YNYY in this field indicates Paper EOB, No Bundle, Type of Admission is 9 and Source of Admission is 1.
  Line 2, Column 2	Enter the following flags: 1st position - Check for claim referral authorization | 1 Char, Y/N 2nd position - Bill By flag | 1 char, Y=Default, P=Provider, G=Group 3rd position - Insurance Certificate Number filter | 1 char, Y=None, N, 0-6 Note:  This filter allows special characters in the patient's Policy Holder Insurance Certificate Number to be included in the transmission file, if applicable.  Select 0-6 to indicate the level of characters to be excluded from the Certificate Number. 4th position - Suppress the not used fields | 1 char, Y/N 5th position - Single transaction set | 1 char, Y/N Note:  To submit all claims in a single transaction set in the transmission file, set to Yes. To submit claims in multiple transaction sets within the transmission file, set to No. 6th position - Narrative filter | 1 char, Y/N, 0-6 Note:  This filter allows special characters in the procedure narrative description to be included in the transmission file, if applicable.  Select 0-6 to indicate the level of characters to be excluded from the narrative. 7th position - Bundle Charges by Location | 1 char, Y/N Tip:  Defaults to Y for Yes to bundle all claims for location. 8th position - Bundle Charges by Departments | 1 char, Y/N Tip:  Defaults to Y for Yes to bundle charges by department. 9th position - Group filter | 1 char, Y/N, 0-6 Note:  This filter can allow special characters in the patient's policy holder Group Number to be included in the transmission file, if applicable.  Select 0-6 to indicate the level of characters to be excluded from the group number. 10th position - Bundle Billing Locations | 1 char, Y/N Note:  Enter Y to bundle, N to send individually. 11th position - Bundle Billing Departments | 1 char, Y/N Note:  Enter Y to bundle, No to send individually. 12th position - Report errors on Scrubber Report or during setup flag | 1 char, Y/N Note:   Generally set to N to report errors during setup. 13th position - Bundle by primary diagnosis code | 1 char, Y/N Note:  Set to N if you do not want to bundle diagnosis codes. 14th position - Bundle by Supervising Physician | 1 char, Y/N Note:  The Supervising Physician Code is maintained on the charge. 15th position - Number of diagnosis codes allowed (1-8) | 1 char, 1-8 Note:  Anthem must be set to 4 as it can not handle 5-8.
  Line 3, Column 1	Enter the Set Transmit Number as specified by ST01. (up to 12 characters)
  Line 3, Column 2	Enter the Group Control Number as specified by GS02 or GE02. (up to 15 characters)
  Line 4, Column 1	Enter the Interchange Receiver ID that is information the carrier wants to show in the header record of the electronic billing file as specified by ISA08. (up to 12 characters) Note:  The carrier will provide the required information.
  Line 4, Column 2	Enter the Application Receivers Code as specified by GS03. (up to 15 characters)
  Line 5, Column 1	Enter the Identification Code as specified by 1000B or NM109. (up to 12 characters)
  Line 5, Column 2	Enter the Organization Name as specified by 1000B or NM103. (up to 15 characters)
  Line 6, Column 1	Note:  Please leave this field blank.  This field is no longer required because the provider NPI number has been implemented.
  Line 6, Column 2	Enter the Patient Account Number that contains the contact information for the person in charge of electronic billing. (up to 6 characters) Note:  The contact person Patient Account only contains the demographic contact information including the contact person's name, phone number, extension and location.
  Line 7, Column 1	Enter the Interchange ID as specified ISA07. (up to 12 characters)
  Line 7, Column 2	Enter the Reference Identification or provider specialty as specified by 2000A PRV03. (up to 15 characters)
  Line 8, Column 1	To identify items that are discontinued and to be able to shut off certain ref segments in all loops at once, maintain the following flags: Entry options: 1st position Ref_1G = UPIN | Max 1, Y/N 2nd position Ref_ei = Tax ID | Max 1, Y/N 3rd position Ref_sy = Social Security Number | Max 1, Y/N Note:  Generally, this is set to NYN for a group or NNY for a single provider.
  Line 8, Column 2	To specify who to pay the check to, enter a provider code, group code or a location code. (up to 12 characters) Tip:  The Pay By can be different than the Bill By field.  For example, you can bill the claims by group or location and have the check payment made to a provider.  In addition, the provider, group or location code provides the address and phone number for the entity receiving the check.
  Line 9, Column 1	Note:  This field is reserved for future use.  Please leave blank.
  Line 9, Column 2	Enter the version of electronic billing software used.  For example, 004010X098A1 is the electronic billing version that runs the 837 format.

   

• Editing an Existing Classic EMC Table, click More.

   

  CAUTION:  To avoid losing data, you must save new or changed records.

  1.  To display the record to be changed, enter the Table ID and click Retrieve , or press [ENTER].
  Keyboard shortcut:  [ALT + t]

  2.  To position the pointer to the information that you want to change, press [TAB] or click the field using the mouse.

  3.  Enter the data changes.

  4.  To complete the edit process, click Save , or press [ENTER].
  Keyboard shortcut:  [ALT + s]

   

• Deleting an Existing Classic EMC Table, click More.

   

  1.  To display the record to be deleted, enter the Table ID and click Retrieve , or press [ENTER].
  Keyboard shortcut:  [ALT + t]

  2.  Click File from the Menu Bar, and next click Delete.
  Keyboard shortcut:  [ALT] [f] [d]

  3.  At the Delete Records prompt, click Proceed to delete the record, or click Cancel to escape from the delete routine.

  Example:

  

   

  Note:  After you click Proceed, you will see the following message on the Status Bar.