Medicare Patient History (NHSI) Mainframe 011-21100735

Medicare patient claim history shows the services that have been processed for an individual patient. The information:

• shows in a line-by-line format
• is limited to nine lines per screen

The details of the group contact shows above the service details.

The service details show as:

Columns

• Patient name
• Item
• Date of service, referral or request
• Referral end date
• Provider number
• Payee code
• Charge
• Benefit
• Processing indicator used (if any)
• Reason code applied (if any)
• Processing date
• Operator’s P# of the person, or state system that processed the service.

Rows

Each row relates to one service request, referral or information line.

The Resources page contains detailed explanation of each field.

Medicare patient claim history can be shown using either the Medicare card number or individual’s PIN.

Medicare card

Use the Medicare card number to show services processed under that card for the customer. This includes payment details. Use Medicare cards to locate customers when enquiring about payment details.

Medicare Pin

Use the Medicare PIN to show services for the customer across any Medicare card enrolment. It will not show the payment details for the customer. Use the Medicare PIN when enquiring into patient item eligibility.

Access Medicare patient claim history in Medicare mainframe using the NHOI or NHSI control line.

• NHOI shows basic level Medicare patient claim history in mainframe
• Shows 6 months of Medicare patient claim history

• NHSI shows supervisor level Medicare patient claim history in mainframe
• Shows Medicare patient claim history up to the cull period
• Shows adjustment transactions
• Allows additional search modifiers

NHSI and NHOI are view only screens. No updates to a patient’s record can be made from these screens.

Use NHSI for enquires about Medicare patient claim history. It shows a more complete and detailed view.

The Resources page contains:

• details about viewing and understanding Medicare patient claim history, and
• explanations of fields and headings