EMC Professional Table Maintenance

Use EMC Professional 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.

• Although there are two routines (the EMC Professional Table Maintenance and the Classic EMC Table Maintenance) available for maintaining EMC Tables, use the Classic EMC Table Maintenance to maintain EMC Tables for institutional billing.

Directions:

To see directions for...

• Opening EMC Professional Table Maintenance, click More.

   

  1.  Click Billing Functions from the Menu Bar.

  2.  Click Communications.

  3.  Click File Maintenance.

  4.  Click EMC Professional Table Maintenance.
   

  Advanced Methods:
  Click the following sequence:
  Billing Functions from the Menu Bar; Menu Panel; File Maintenance on the Menu Bar; and EMC Professional Table Maintenance.

   

  EMC Professional Table Maintenance Window Example:

  

   

   

• Creating a New Professional EMC Table, click More.

   

  EMC Professional 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 Tables, 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, although it can be edited. Valid Active Codes: 0 - No 1 - Test phase 2 - Live
  Status	Status describes the current electronic billing process and is maintained by INSight, although it can be edited.   Valid Statuses: 0 - Not setup 1 - Setup complete 2 - Transfer has been completed and ready to send
  Last Date Setup	The Last Date Setup displays for your reference and is maintained by INSight.
  Identification Code (1000A NM109)	Enter the Submitter Identification as specified by 1000A NM109. (up to 12 characters)
  Submitter ID (ISA06) GS02)	Enter the Submitter ID that is assigned by the insurance carrier and specified by ISA06 or GS02. (up to 15 characters)
  Set Transmit Number (ST01)	Enter the Set Transmit Number as specified by ST01. (up to 12 characters)
  Group Control # (GS02) (GE02)	Enter the Group Control Number as specified by GS02 or GE02. (up to 15 characters)
  Interchange Receiver ID (ISA08)	Enter the Interchange Receiver ID which is information the carrier wants to include 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.
  Appl. Receivers Code (GS03)	Enter the Application Receivers Code as specified by GS03. (up to 15 characters)
  Identification Code (1000B NM109)	Enter the Identification Code as specified by 1000B NM109. (up to 12 characters)
  Organization Name (1000B NM103)	Enter the Organization Name as specified by 1000B NM103. (up to 15 characters)
  Contact Account Number (1000A PER)	Enter the Patient Account Number that contains the contact information for the person in charge of electronic billing as specified by 1000A PER. (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.
  Interchange ID (ISA07)	Enter the Interchange ID as specified by ISA07. (up to 12 characters)
  Reference ID (Specialty) (2000A PRV03)	Enter the Reference ID or specialty for the provider as specified by 2000A PRV03. (up to 15 characters)
  Pay By Flag (2010AB REF)	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.  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.
  Form Type 1 - 5	To retrieve an additional Billing Number from the Provider Set, click S in the drop-down list. Or, to specify if another provider number is required for another Form Type, enter the Form Type, if applicable. (S, 1-9) Note:  For 90 % of insurance carriers, the Form Type fields are blank.
  Patient Certificate Length	To determine the minimum length for the Patient Certificate field in the transmission file, click a choice in the drop-down list. Note:  The default value for the field is 2.  You can maintain 0-9 as the minimum length.  For example, if the minimum length is set to 9, then INSight checks to see if that field has 9 or more characters.
  Patient Last Name Length	To determine the minimum length for the Patient Last Name field in the transmission file, click a choice in the drop-down list. Note:  The default value for the field is 2.  You can maintain 0-9 as the minimum length.  For example, if the minimum length is set to 9, then INSight checks to see if the field has 9 or more characters.
  Patient First Name Length	To determine the minimum length for the Patient First Name field in the transmission file, click a choice in the drop-down list. Note:  The default value for the field is 2.  You can maintain 0-9 as the minimum length.  For example, if the minimum length is set to 9, then INSight checks to see if the field has 9 or more characters.
  Patient Address Length	To determine the minimum length for the Patient Address field in the transmission file, click a choice in the drop-down list. Note:  The default value for the field is 2.  You can maintain 0-9 as the minimum length.  For example, if the minimum length is set to 9, then INSight checks to see if the field has 9 or more characters.
  Patient City Length	To determine the minimum length for the Patient City field in the transmission file, click a choice in the drop-down list. Note:  The default value for the field is 2.  You can maintain 0-9 as the minimum length.  For example, if the minimum length is set to 9, then INSight checks to see if the field has 9 or more characters.
  Patient State Length	To determine the minimum length for the Patient State field in the transmission file, click a choice in the drop-down list. Note:  The default value for the field is 2.  You can maintain 0-9 as the minimum length.  For example, if the minimum length is set to 9, then INSight checks to see if the field has 9 or more characters.
  Insurance Address Length	To determine the minimum length for the Insurance Address field in the transmission file, click a choice in the drop-down list. Note:  The default value for the field is 2.  You can maintain 0-9 as the minimum length.  For example, if the minimum length is set to 9, then INSight checks to see if the field has 9 or more characters.
  Insurance City Length	To determine the minimum length for the Insurance City field in the transmission file, click a choice in the drop-down list. Note:  The default value for the field is 2.  You can maintain 0-9 as the minimum length.  For example, if the minimum length is set to 9, then INSight checks to see if the field has 9 or more characters.
  Insurance EMC Length	To determine the minimum length for the Insurance EMC field in the transmission file, click a choice in the drop-down list. Note:  The default value for the field is 2.  You can maintain 0-9 as the minimum length.  For example, if the minimum length is set to 9, then INSight checks to see if the field has 9 or more characters.
  Check Authorization	To check for claim referral authorizations for the charges, click Yes in the drop-down list. Or, to omit checking for claim referral authorizations for the charges, click No in the drop-down list.
  Bill By	To specify whether to Bill By provider or group, click a choice in the drop-down list. Bill By Options: Y - Default P - Provider G - Group
  Certificate Filter	To allow all characters in the Patient Certificate Number to be included in the transmission file, click Yes in the drop-down list. To exclude certain characters in the Patient Certificate Number from the transmission file, click the appropriate choice in the drop-down list. Notes: The Certificate filter eliminates certain characters in the patient certificate number from the transmission file, if applicable. Entry Options include Y=None, No, or 0-6 to indicate the level of characters to be excluded from the certificate number.
  Suppress Not Used	To suppress the not used fields, click Yes in the drop-down list. To omit suppressing the not used fields, click No in the drop-down list.
  Single Transaction Set	To have a single transaction set of claims in the transmission file, click Yes in the drop-down list. To have claims grouped into multiple transaction sets within the transmission file, click No in the drop-down list. Note:  The default value for this field is Yes, but if you are having trouble you can change the setting to No.
  Narrative Filter	To allow all special characters in the procedure narrative description to be included in the transmission file, click Yes in the drop-down list. To exclude certain characters in the procedure narrative from the transmission file, click the appropriate choice in the drop-down list. Notes: The Narrative filter eliminates certain characters in the procedure narrative description from the transmission file, if applicable. Entry Options include Y=None, No, or 0-6 to indicate the level of characters to be excluded from the narrative.
  Bundle Location	To bundle Charges by Location, click Yes in the drop-down list. To submit Charges by Location unbundled, click No in the drop-down list. Tip:  The default is Yes to bundle all claims for a location.
  Bundle Department	To bundle charges by departments, click Yes in the drop-down list. To submit charges by department unbundled, click No in the drop-down list. Tip:  The default is Yes to bundle all claims by department.
  Group Filter	To allow all special characters in the Patient's Policy Holder Group Number to be included in the transmission file, click Yes in the drop-down list. To omit certain special characters in the Patient Group Number from the transmission file, click the appropriate choice in the drop-down list. Notes:   The Drop-down list choices include, Y=None, No, and 0-6 to indicate the level of characters to be excluded from the group number. The Group filter eliminates certain characters in the procedure narrative description from the transmission file, if applicable. Narrative
  Bundle Bill Location	To bundle Billing Locations, click Yes in the drop-down list. To unbundle Billing Locations, click No in the drop-down list. Note:  Enter Y to bundle, N to send individually.
  Bundle Bill Department	To bundle Billing Departments, click Yes in the drop-down list. To send individually, click No in the drop-down list. Note:  Enter Y to bundle, No to send individually.
  Allow Edits	To report errors on Scrubber Report at the end, click Yes in the drop-down list. To report errors during the Setup, click No in the drop-down list. Note:   Generally, this field is set to No to report errors during setup.
  Bundle Primary Diag	To bundle charges by primary diagnosis code, click Yes in the drop-down list. To send charges individually, click No in the drop-down list. Note:  Set this field to No, if you do not want to bundle diagnosis codes.
  Bundle Supervising	To bundle charges by Supervising Physician, click Yes in the drop-down list. To send charges not grouped by Supervising Physicians, click No in the drop-down list. Note:  The Supervising Physician Code is maintained on the charge.
  Set Max Diag Codes	To specify the number of diagnosis codes allowed, click a choice in the drop-down list. (1-8) Note:  Anthem must be set to 4 as it can not handle 5-8.

   

• Editing an Existing Professional 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 Professional 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.