Medicare Patient History (NHSI) Mainframe 011-21100735

Description

This returns Medicare patient claim history screen for the patient.

Note: patient reference is a unique identifier of the patient for the Medicare card. It can be:

• reference number
• initial
• name

If the system cannot determine the patient uniquely, a list shows on screen. Use [PF5] to select the patient.

For a list of control line modifiers see Indicators, codes, modifiers and control lines for claims processing in Medicare.

Description

Place cursor on the field to expand and press [PF1].

Headings PI, RSN, TX, PRC DT and OPER change to CLM ID, OPER, INDX and MD.

Exits from NHSI to a blank screen.

Headings PI, RSN, TX, PRC DT and OPER change to FEE, DOL, SORC and N.

Select a member on a Medicare Card to view history.

[PF5] is only available when the system cannot uniquely identify the patient.

Headings PI, RSN, TX, PRC DT and OPER change to HOSP, GAP$ SUB$ and UNSUB$.

Scroll backwards 9 lines of patient claim history.

If the cursor is under a service line, the system scrolls from this point.

Scroll forward 9 lines of patient claim history.

If the cursor is under a service line, the system scrolls from this point.

Headings PI, RSN, TX, PRC DT and OPER change to PIN, PRC DT and TIME.

Headings PI, RSN, TX, PRC DT and OPER change to CHQ/EFT, ISS DT, STAT and S.

Headings FST DT, LSDT and NO change to QUALFR and FST DT.

Exits from NHSI to a blank screen.

Headings PI, RSN, TX, PRC DT and OPER change to CLM ID, DOL, POSN and CT.

Headings PI, RSN, TX, PRC DT and OPER change to MO, DIMS, VU, MMRI, ME and AST.

Headings PI, RSN, TX, PRC DT and OPER change to HOSP, GAP$ SUB$ and UNSUB$.

This information relates to the MSN.

Headings FST DT, LSDT and NO change to LSPN and FST DT.

Description

PF1

The patient’s abbreviate first name shows in this column.

• Patient’s name as shown on the Medicare card
• Gender
• Date of birth
• PIN
• Card Issue
• CSN and FTB eligibility

The item number or service code shows in this column.

Item description as written in QITI at the DOS claimed.

Explanation of Alpha value.

Example: AH or SR.

The date of service (DOS) or referral/request date is shown.

If item is CLID the Minor Customer ID name shows.

The date a referral expires shown as MMYY.

Note: indefinite referrals show as 1259.

The number in this column indicates:

• the number of patients seen for bulk consultation items
• the number of lines below relating to a PAYP line
• the number of lines above that a referral or request relates to
• the number of additional fields for a radiation oncology service

The provider number of the servicing, referring, requesting or PAYP appear in this column.

ACRF details also appear in this column.

• Paygroup ID and start date
• Mainframe search reference
• Provider Name
• Practice address
• Speciality codes

The payee code shows in this column.

Information of payee code used.

The amount charged or assigned for bulk bill shows in this column.

Note: notional charges show as a blank value and the total shows on the first item in the service group.

For patient claims, the claimant’s details show.

The system calculated benefit shows in this column.
Note: notional charges show as a blank value and the total shows on the first item in the service group.

For patient claim EMSN eligibility and benefit show.

Any processing indicators (PI) used show in this column.

Note: the system only shows one PI regardless if multiple are used on a claim.

Information of PI used.

Any reason (RSN) code used shows in this column.

Note: the system only shows one RSN regardless if multiple are used on a claim.

Information of the RSN used.

Any claim or service text shows in this column.

T: Shows claims text.

X: Shows Adjustment details.

The date of processing (DOP) for the service line.

The P number of the Service Officer who processed the service line.

Note: Mainframe shows an Service Officer’s P number Universal Logins are not used in mainframe.

The claim ID for bulk bill or simplified billing/ECLIPSE claims appear in this column.

The position number of a bulk bill claim, or patient claims relative position shows in this column.

Any fee modifiers used show in this column.

Information of the modifier used.

The schedule fee used by the system in determining the benefit for a service.

The date of lodgement (DOL) for the service line.

The position number of a bulk bill claim, or patient claims relative position show in this column.

The claim type shows in this column.

Information on the claim type.

The source office code of the Service Officer who processed the service line shows in this column.

Information on the Source office code.

This column indicates grouping of items processed as a notional charge.

This column shows what multiple operation rule applies to a service line.

Information on the Multiple Operation Rule applied to the item.

This column shows what diagnostic imaging multiple service rule applies to a service line.

Information on the Diagnostic Imaging Multiple Service Rule applied to the item.

This column shows what multiple vascular ultrasound service site rule to a service line.

Information on the Multiple Vascular Ultrasound Services Site Rule applied to the item.

This column shows what multiple musculoskeletal MRI service rule applies to a service line.

Information on the Multiple Musculoskeletal MRI Services Rule applied to the item.

This column shows what multiple echocardiogram service rule applies to a service line.

Information on the Multiple Echocardiogram Services Rule applied to the item.

This column indicates who an assistant surgeon item has been paid to.

Information on assistant payment method.

The gap amount for an in hospital service shows in this column.

The amount substantiated for a service line shows in this column.

Note: [PF6] shows EMSN amounts and [PF18] shows MSN amounts.

The amount unsubstantiated for a service line shows in this column.

The patient’s PIN shows in this column.

The time of processing the service line shows in this column. The time is Canberra time.

The Reserve Bank cheque number, or patient’s EFT details show in this column.

Information on bank account and claimant’s details for an EFT payment.

The issue date of a cheque or EFT payment shows in this column.

The status of a cheque or EFT payment shows in this column.

Information on the cheque’s status.

The state code of a system generated cheque shows in this column.

Information on the state code for a cheque.

Any item qualifiers (IE Equipment number) show in this column.

This column shows the LSPN for a diagnostic imaging item in this column.

Description

Allied Health referral line. This line details the referral information for allied health services. The associated services shows above this line. The value in the NO field indicates the number of lines above this referral relates to.

Diagnostic Imaging request line. This line details the request information for diagnostic imaging services. The associated services shows above this line. The value in the NO field indicates the number of lines above this request relates to.

Pathology request line. The line details the request information for pathology services. The associated services show above this line. The value in the NO field indicates the number of lines above this request relates to.

Specialist Referral line. The line details the referral information for referred specialist and consultant physician services. The associated services shows above this line. The value in the NO field indicates the number of lines above this referral relates to.

Account Reference line. This line shows the account reference number associated with a PDVC claim where the provider has requested an account reference.

Claim ID line. This line details information for claims electronically transmitted to Services Australia.

Pay Provider line. This line shows when a provider other than the servicing provider is to be paid for services rendered.

Over Payment line. This line indicates the total value of an adjustment that has been over paid.

Under Payment line. This line indicates the total value of an adjustment that has been under paid.