MICROMD PM SETUP SPECIFICATIONS FOR TN DOH PATIENT EXPORT

Transcription

1 MICROMD PM SETUP SPECIFICATIONS FOR TN DOH PATIENT EXPORT This document contains information regarding data format and setup specifics for the above interface. If you need any in-depth information about any of the fields within MicroMD PM, please refer to the most recent version of the MicroMD PM User s Reference Manual. If you need instructions on installation, refer to the most recent version of your MicroMD PM Software Installation Manual. INSTALLATION This interface requires a key code, but there is no installation outside of activating the export on the Additional Modules tab. VERSION AND BUILD The client must have at least the following version and build/release date of MicroMD PM for the interface to work properly. MicroMD PM Version: 6.0 CONFIGURATION Build Date: 11/1/ 2008 This section details the specifics used for configuring MicroMD PM for this particular interface. All instructions for this are in the most current version of your MicroMD PM Software Installation Manual. SPECIFICS FOR THE ADDITIONAL MODULES TAB IN MICROMD PM On the Additional Modules tab in MicroMD PM, you need to choose the following: From the Add-ons drop-down, select TN DOH Patient - Export. Leave the Export path field blank. Documents automatically export to the database path. Verify there is no check mark in the Auto checkbox. CONFIGURING THE INTERFACE OUTSIDE OF MICROMD PM No information required for setup outside of MicroMD PM. DATA CONTENTS This interface generates an export report of two ASCII-formatted TXT files of fixed-length records. The files are named for the type of claim (UB04 and CMS1500) and the quarter of the report. For example: ub042nd20082.txt and cms15002nd20082.txt. FIELDS EXPORTED FOR CMS 1500 FORMAT 1 Facility Type 2 Data Year 3 Vendor Identification No. 4 Bill Number 5 Record Sequence Number MicroMD PM Setup Specifications for TN DOH Patient Export 1

2 6 Facility Identification Number 7 Filler 8 Form Type 9 Type of Insurance 10 Insured s ID Number 11 Patient s Birth Date (DOB) 12 Patient s Sex 13 Patient s Address (City) 14 Patient s Address (State) 15 Patient s Address (Zip Code) 16 Patient s Relationship to Insured 17 Insured s Address (City) 18 Insured s Address (State) 19 Insured s Address (Zip-Code) 20 Patient s Status (Marital) 21 Patient s Status (Employment) 22 Other Insured s Policy/Group Number 23 Insurance Plan Name or Program Name (Other) 24 Filler 25 Outside Lab? 26 Outside Lab Charges 27 Patient s Condition Related to Employment 28 Patient s Condition Related to Auto Accident 29 Patient s Condition Related to Other Accident 30 Patient s Condition Related to Place (State) 31 Insured s Policy, Group, or FECA Number 32 Insured s Employer/School Name 33 Insurance Plan Name or Program Name (Primary) 34 Another Health Benefit Plan 35 Date of Current Illness, Injury, Pregnancy 36 First Date Patient Has Had Same or Similar Illness 37 Dates Patient Unable to Work (From Date) 38 Dates Patient Unable to Work (Through Date) 39 ID Number of Referring Physician 40 National Provider Identification (NPI) Number of Referring Physician 41 Hospitalization Related Current SVCS (From Date) 42 Hospitalization Related Current SVCS (Through Date) Diagnosis or Nature of Illness or Injury Code Dates of Service (From Date) Dates of Service (Through Date) Place of Service Emergency (EMG) Procedures, Services & Supplies MicroMD PM Setup Specifications for TN DOH Patient Export 2

3 77-82 Diagnosis Pointer Charges Days or Units Early & Periodic Screening, Diagnosis and Treatment (EPSDT) Family Plan ID Qualifier Rendering Provider ID. No Rendering Provider NPI. No. 119 Federal Tax ID Number 120 Federal Tax ID Number (SSN) 121 Federal Tax ID Number (EIN) 122 Patient s Account Number 123 Total $Charges 124 Billing Provider NPI Number 125 Billing Provider Other ID Number 126 Patient s Social Security Number 127 Patient s Race/Ethnicity 128 Insurance Plan or Program Payer Classification Code 129 Insurance Plan or Program Payer Classification Code (Other) 130 Encryption Key 131 Patient Initials First Name 132 Patient Initials Last Name 133 Primary Insured s Initials First Name 134 Primary Insured s Initials Last Name 135 Secondary Insured Initials First Name 136 Secondary Insured Initials Last Name Vendor and State Generated Fields 139 Patient s Address (Street 1) 140 Patient s Address (Street 2) 141 Patient s First Name 142 Patient s Last Name 143 Primary Insured s First Name 144 Primary Insured s Last Name 145 Secondary Insured s First Name 146 Secondary Insured s Last Name FIELDS EXPORTED FOR UB-04 FORMAT 1 Facility Type 2 Data Year 3 Vendor ID Number 4 Bill Number 5 Record Sequence Number MicroMD PM Setup Specifications for TN DOH Patient Export 3

4 6 Facility ID Number 7 Filler 8 Form Type 9 Patient Control Number 10 Medical/Health Record Number 11 Type of Bill 12 Federal Tax Sub ID Number 13 Federal Tax Number Statement Covers Period From and Through 16 Patient s Address City 17 Patient s Address State 18 Patient s Address Zip Code 19 Patient s Address Country Code 20 Patient s Date of Birth 21 Patient s Sex 22 Admission Date 23 Admission Hour 24 Type of Admission/Visit 25 Source of Admission 27 Do Not Resuscitate Flag 28 Accident State 29 Accident Code 30 Accident Date Revenue Codes HCPCS/Rates/HIPPS Rates Service Date(s) 100 Creation Date Unit(s) of Service Total Charges (by Revenue Code Category) 147 Total of Total Charges Non-Covered Charges (by Revenue Code Category) 171 Total of Non-Covered Charges 172 Payer Classification Code -Primary 173 Payer Classification Code -Secondary 174 Payer Classification Code -Tertiary 175 Health Plan ID Primary (formerly Provider Number) 176 Health Plan ID Secondary (formerly Provider Number) 177 Health Plan ID Tertiary (formerly Provider Number) 178 National Provider ID (NPI) 179 Patient s Relationship to Insured-Primary 180 Patient s Relationship to Insured Secondary 181 Patient s Relationship to Insured Tertiary 182 Insured s Unique ID Number Primary MicroMD PM Setup Specifications for TN DOH Patient Export 4

5 183 Insured s Unique ID Number Secondary 184 Insured s Unique ID Number Tertiary 185 Insurance Group Number Primary 186 Insurance Group Number Secondary 187 Insurance Group Number Tertiary 188 Name of Primary Insured s Employer 189 DX and PX Version Qualifier 190 Principal Diagnosis Code Other Diagnosis Codes 208 Admitting Diagnosis Code Patient s Reason for Visit Code 212 Prospective Payment System Code (PPS) External Cause Of Injury Code (E Code)1, 2 & Principal Procedure Code 217 Principle Procedure Code Date 218 Other Procedure Code1 219 Other Procedure Code Date1 220 Other Procedure Code2 221 Other Procedure Code Date2 222 Other Procedure Code3 223 Other Procedure Code Date3 224 Other Procedure Code4 225 Other Procedure Date Code4 226 Other Procedure Code5 227 Other Procedure Code Date Attending Physician ID Number Operating Physician ID Other Provider ID1 Number Other Provider ID2 Number 240 Filler 241 Patient s Social Security Number 242 Patient s Race/Ethnicity Fields for Vendor and State use only Patient s Initials First and Last Name Primary Insured Initials First and Last Name Secondary Insured Initials First and Last Name Tertiary Insured Initials First and Last Name 256 Patient s Address Street 257 Patient s Name First 258 Patient s Name Last Primary Insured s Name First and Last Secondary Insured s Name First and Last Tertiary Insured s Name First and Last MicroMD PM Setup Specifications for TN DOH Patient Export 5

6 265 Payer Name Primary 266 Payer Name Secondary 267 Payer Name Tertiary Condition Codes 279 Occurrence Code (1) 280 Occurrence Date (1) 281 Occurrence Code (2) 282 Occurrence Date (2) 283 Occurrence Code (3) 284 Occurrence Date (3) 285 Occurrence Code (4) 286 Occurrence Date (4) 287 Occurrence Code (5) 288 Occurrence Date (5) 289 Occurrence Code (6) 290 Occurrence Date (6) 291 Occurrence Code (7) 292 Occurrence Date (7) 293 Occurrence Code (8) 294 Occurrence Date (8) GENERATING THE EXPORT FILE To generate the export file, select Aux > TN DOH Patient Export from the main menu in MicroMD PM. The report defaults to the dates of the previous quarter, but you can change these if necessary. Once you generate the report, click the Generate File icon on the Task Pane. The system exports the files to the same location as the database. ADDITIONAL NOTES None. MicroMD PM Setup Specifications for TN DOH Patient Export 6