MO HealthNet Internet Provider Training Program Presented by the Provider Education Unit MO HealthNet Division 1

Proper Completion of the Online Medicare Part B Crossover Claim Presented by the Provider Education Unit MO HealthNet Division 2

To file a claim go to the Internet Web site and log on under the appropriate NPI and Taxonomy code, if applicable for the claim to be submitted. Enter your user ID and Password. This will bring up the eProvider Home Page. At the top of each page is a “Help” button in the form of a question mark. You can print out field-by-field instructions. MO HealthNet Division3

4 CLAIM MANAGEMENT

MO HealthNet Division5 NEW XOVER CLAIM

MO HealthNet Division6 MEDICARE CMS-1500 PART B PROFESSIONAL

Participant DCNParticipant Last NameParticipant First Name Patient Account NumberParticipant Medicare ID (HIC) 7MO HealthNet Division

Participant DCNParticipant Last NameParticipant First Name Patient Account NumberParticipant Medicare ID (HIC) 8MO HealthNet Division

Participant DCNParticipant Last NameParticipant First Name Patient Account NumberParticipant Medicare ID (HIC) 9MO HealthNet Division

Participant DCNParticipant Last NameParticipant First Name Patient Account NumberParticipant Medicare ID (HIC) 10MO HealthNet Division

Participant DCNParticipant Last NameParticipant First Name Patient Account NumberParticipant Medicare ID (HIC) 11MO HealthNet Division

12 Medicare Provider NPIHospitalization Dates Save Claim HeaderDiagnosis Codes

MO HealthNet Division13 Medicare Provider NPIHospitalization Dates Save Claim HeaderDiagnosis Codes

MO HealthNet Division14 Medicare Provider NPIHospitalization Dates Save Claim HeaderDiagnosis Codes

MO HealthNet Division15 Medicare Provider NPIHospitalization Dates Save Claim HeaderDiagnosis Codes

MO HealthNet Division16 Dates of ServicePlace of Service Procedure CodeModifiers

MO HealthNet Division17 Dates of ServicePlace of Service Procedure CodeModifiers

MO HealthNet Division18 Dates of ServicePlace of Service Procedure CodeModifiers

MO HealthNet Division19 Dates of ServicePlace of Service Procedure CodeModifiers

MO HealthNet Division20 National Drug CodeDecimal Quantity Diagnosis Code Billed Charges Days/Units Billed

MO HealthNet Division21 National Drug CodeDecimal Quantity Diagnosis Code Billed Charges Days/Units Billed

MO HealthNet Division22 National Drug CodeDecimal Quantity Diagnosis Code Billed Charges Days/Units Billed

MO HealthNet Division23 National Drug CodeDecimal Quantity Diagnosis Code Billed Charges Days/Units Billed

MO HealthNet Division24 National Drug CodeDecimal Quantity Diagnosis Code Billed Charges Days/Units Billed

MO HealthNet Division25 Paid Amount Performing Provider NPI Save Detail Line to Claim

MO HealthNet Division26 Paid Amount Performing Provider NPI Save Detail Line to Claim

MO HealthNet Division27 Paid Amount Performing Provider NPI Save Detail Line to Claim

MO HealthNet Division28 Dates of Service Place of Service Procedure CodeModifiers

MO HealthNet Division29 Dates of Service Place of Service Procedure CodeModifiers

MO HealthNet Division30 Dates of Service Place of Service Procedure CodeModifiers

MO HealthNet Division31 Dates of Service Place of Service Procedure CodeModifiers

MO HealthNet Division32 Diagnosis CodeBilled ChargesDays/Units Billed Paid AmountPerforming Provider NPI Save Detail Line to Claim

MO HealthNet Division33 Diagnosis CodeBilled ChargesDays/Units Billed Paid AmountPerforming Provider NPI Save Detail Line to Claim

MO HealthNet Division34 Diagnosis CodeBilled ChargesDays/Units Billed Paid AmountPerforming Provider NPI Save Detail Line to Claim

MO HealthNet Division35 Diagnosis CodeBilled ChargesDays/Units Billed Paid AmountPerforming Provider NPI Save Detail Line to Claim

MO HealthNet Division36 Diagnosis CodeBilled ChargesDays/Units Billed Paid AmountPerforming Provider NPI Save Detail Line to Claim

MO HealthNet Division37 Diagnosis CodeBilled ChargesDays/Units Billed Paid AmountPerforming Provider NPI Save Detail Line to Claim

MO HealthNet Division38 Filing Indicator Other Payer IDOther Payer NamePaid Date

MO HealthNet Division39 Filing Indicator Other Payer IDOther Payer NamePaid Date

MO HealthNet Division40 Filing Indicator Other Payer IDOther Payer NamePaid Date

MO HealthNet Division41 Filing Indicator Other Payer IDOther Payer NamePaid Date

MO HealthNet Division42 Paid AmountTotal Denied AmountRemittance Advice Remark Codes Save Other Payer Data and Manage Codes

MO HealthNet Division43 Paid AmountTotal Denied AmountRemittance Advice Remark Codes Save Other Payer Data and Manage Codes

MO HealthNet Division44 Paid AmountTotal Denied AmountRemittance Advice Remark Codes Save Other Payer Data and Manage Codes

MO HealthNet Division45 Paid AmountTotal Denied AmountRemittance Advice Remark Codes Save Other Payer Data and Manage Codes

MO HealthNet Division46 Associated Line Items Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division47 Associated Line Items Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division48 Associated Line Items Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division49 Associated Line Items Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division50 Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division51 Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division52 Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division53 Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division54 Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division55 Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division56 Claim Group CodeClaim Adjustment Reason Code Adjustment AmountSave Codes to Other Payer

MO HealthNet Division57 Associated Line Items Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division58 Associated Line Items Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division59 Associated Line Items Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division60 Associated Line Items Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division61 Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division62 Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division63 Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division64 Claim Group CodeClaim Adjustment Reason Code Adjustment AmountSave Codes to Other Payer

MO HealthNet Division65 Save Other Payer to Claim

MO HealthNet Division66 Submit Claim

MO HealthNet Division67 Filing Indicator Other Payer IDOther Payer NamePaid Date

MO HealthNet Division68 Filing Indicator Other Payer IDOther Payer NamePaid Date

MO HealthNet Division69 Filing Indicator Other Payer IDOther Payer NamePaid Date

MO HealthNet Division70 Filing Indicator Other Payer IDOther Payer NamePaid Date

MO HealthNet Division71 Paid AmountTotal Denied Amount Save Other Payer Data and Manage Codes

MO HealthNet Division72 Paid AmountTotal Denied Amount Save Other Payer Data and Manage Codes

MO HealthNet Division73 Paid AmountTotal Denied Amount Save Other Payer Data and Manage Codes

MO HealthNet Division74 Associated Line Items Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division75 Associated Line Items Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division76 Associated Line Items Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division77 Associated Line Items Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division78 Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division79 Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division80 Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division81 Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division82 Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division83 Claim Group CodeClaim Adjustment Reason Code Adjustment Amount

MO HealthNet Division84 Claim Group CodeClaim Adjustment Reason Code Adjustment Amount Save Codes to Other Payer

MO HealthNet Division85 Associates Line Items Claim Group Code Claim Adjustment Reason Code Adjustment Amount

MO HealthNet Division86 Associates Line Items Claim Group Code Claim Adjustment Reason Code Adjustment Amount

MO HealthNet Division87 Associates Line Items Claim Group Code Claim Adjustment Reason Code Adjustment Amount

MO HealthNet Division88 Associates Line Items Claim Group Code Claim Adjustment Reason Code Adjustment Amount

MO HealthNet Division89 Claim Group Code Claim Adjustment Reason Code Adjustment Amount

MO HealthNet Division90 Claim Group Code Claim Adjustment Reason Code Adjustment Amount

MO HealthNet Division91 Claim Group Code Claim Adjustment Reason Code Adjustment Amount

MO HealthNet Division92 Claim Group Code Claim Adjustment Reason Code Adjustment Amount

MO HealthNet Division93 Claim Group Code Claim Adjustment Reason Code Adjustment Amount

MO HealthNet Division94 Claim Group Code Claim Adjustment Reason Code Adjustment Amount

MO HealthNet Division95 Claim Group Code Claim Adjustment Reason Code Adjustment AmountSave Codes to Other Payer

MO HealthNet Division96 Save Other Payer to Claim

MO HealthNet Division97 Submit Claim

MO HealthNet Division98 Claim ReceivedCopy ClaimPayment DetailsPrinter Friendly

MO HealthNet Division99 Claim ReceivedCopy ClaimPayment DetailsPrinter Friendly

MO HealthNet Division100 Claim ReceivedCopy ClaimPayment DetailsPrinter Friendly

MO HealthNet Division101 Claim ReceivedCopy ClaimPayment DetailsPrinter Friendly

MO HealthNet Division102 Claim Status New ClaimFinish

MO HealthNet Division103 Claim Status New ClaimFinish

Thank you again for participating in this training program. If you have questions regarding the information in this presentation, please contact the Provider Education Unit at MO HealthNet Division104