FBCS Patch 35 Overview

1. FBCS Patch 35 Overview

2. Patch 35 Overview • Primary Purpose • Enhancement Changes to Modules • Defect Changes • Questions and Answers

3. Patch 35 Primary Purpose Allow user to accept and process more than 6 lines on a paper HCFA claim form by: • identifying at time of scanning multipage HCFA claims • Merging multipage HCFAs • Entering more than six lines on a claim when manually creating a claim

4. Changes to FBCS Modules/Processes • Changes to the user process & interface: • Mail Sorting • Claim Scanning • FBCS Scan • FBCS Verify • FBCS Distribution & Processing

5. Changes to Mailing Sorting/Scanning Process • Users will now separate out multipage HCFA claims in the same manner that they separate out multipage UB claims. • Users will scan multipage HCFAs (all pages) into an exclusive batch by themselves in the same manner they scan multipage UB claims.

6. Changes to FBCS Scan • The message asking if there are any multipage claims in the batch will now include the form type to help users track the type of claim they are scanning when scanning claims into non exclusive batches (i.e. the Exclusive Batch box is NOT checked)

7. Changes to FBCS Verify • When verifying an exclusive batch, the Merge Multi-Page command button will display for both UB and HCFA claims. • Users will be able to manually add more than 6 lines to a HCFA claim. • Users will be able to merge HCFA claims into one claim when scanned into an exclusive batch. • Modified acceptable values for admission source to include any single character 1-9 or A-Z.

8. Changes to FBCS Verify • Users will now see the Merge Multi-Page command button when verifying an Exclusive HCFA batch.

9. Changes to FBCS Verify • User is able to manually add more than six lines to an existing claim or a manually created claim

10. Multipage HCFA Verification Process • Compare data points on each page of claim • Patient’s Birth Date (field 3) • Insured’s I.D. Number (field 1a) • Patient’s Name (field 2) • Diagnosis codes (field 21.1-21.4) • Line Item dates of service (field 24A). The dates of service should be the same or sequential from page to page • Tax ID (field 25) • Date Signed & Rendering Provider/Signature (field 31) • Service Facility Location Information (field 32) • Billing Provider Info & Ph # (field 33) • Service Facility NPI (field 32a) • Billing Provider NIP (field 33a) • Other notations indicating it is a multipage HCFA

11. Multipage HCFA Verification Process • Totaling Dollar Values • Add up “Total Charges” (field 28) • Add up “Amount Paid” (field 29) • Add up “Balance Due” (field) • Date Rules apply to all lines on claim • DOB must be before line item DOS • Signed date must be after line item DOS and before today’s date

12. Match Data Elements BEFORE Merging

13. Multipage HCFA Totals • Add up “Total Charges” (field 28) from each page • Add up “Amount Paid” (field 29) from each page • Add up “Balance Due” (field) from each page

14. Things To Remember • Claims that automatically require alignment can only be accessed by clicking on the alignment check box when working Non-Exclusive bathes • Batches cannot be checked out when the first available claim in that batch is: • In the Non-Exclusive alignment queue waiting to be OCR’d • Being Re-OCR’d • Is on “24 hour hold”

15. UB Admission Source • Now accepts any single character 1-9 or A-Z.

16. Changes to Distribution & Processing • Updated HCPCS/CPT Fly Over Descriptions for CY 2012 3rd Quarter. • Updated OIG Exclusionary List (up to and including May 2012 changes)

17. Defect Changes • Correct logic that was causing the “scrubber” alert to trigger a false positive.

18. Change in Sorting/Scanning

19. Questions and Answers