Octagon Systems                            

28 Charles Street

Williston Park, New York 11596

516-747-2362

 

 

 

 

 

 

 

 

 

 

 

 

 

Claim Master System

Physician User Guide

 

 

 

 

Document ID: claim master user r2a

 

 

Version Date: June 1, 2005

 

 

 

 


 

Table of Contents

 

 

 

 

 

 

 

Daily Use: 1

Extra Features: 7

Add a Practice: 8

Setup Lytec to use ClaimMaster for a new  practice. 10

LYTEC INFO USED BY CLAIMMASTER: 16

File extensions used: 18

TROUBLESHOOTING GUIDE. 18

Cannot file Lytec billing file. 18

 

 

 

 

 

 

 

 

 


 

Daily Use:

 

Overview:

 

ClaimMaster sends claims that are printed in Lytec to your insurance company. ClaimMaster will send claims to Empire Medicare, GHI Medicare, Medicaid and Blue Shield. It will also process the remittances that each of these return.

 

Sending your claims is easy. First, you print the claims for one insurance company in Lytec. Then, you process the Lytec billing file in ClaimMaster to create a HIPAA compliant transmission file.  That transmission file travels to the insurance company in the way that the insurance company determines, using the options that are lit for that insurance company.

 

Detailed step-by-step instructions follow.

 

1. Enter your claims in Lytec as you would normally. There are special instructions for secondary claims:

 

For secondary claims, you may have to enter the payment information. It is different depending on how you set up your system:

 

SETUP

What you must enter for secondary claims

If you use ClaimMaster’s payment table

 If the normal amount is paid, you don’t have to enter anything. If a different amount is paid, (usually due to a deductible), enter the claim detail allowed and paid custom fields.

If you charge the allowed amount  (and set your primary insurance’s custom field 4 to Y) and do NOT use ClaimMaster’s payment table

 For enter both the bill detail custom field payment and allowed amounts when the primary paid less than 80% of the amount charged. Medicaid tells some practices to insert “U2” as the first claim modifier also for a deductible.  

If you do not charge the allowed amount and do NOT use ClaimMaster’s payment table

You will always need to enter the paid amount for secondary claims. For a line with a deductible, you will always need to enter the amount paid. If the normal amount (either 80% or 50% depending on the practice) was paid, you only need to enter the payment amount and ClaimMaster will calculate the allowed amount.

If you want to summarize all detail lines into one for Medicaid secondary for physical therapists (and your insurance custom field 2 is set to “PTCD”)

Note: Medicaid does not seem to be paying any more right now for multiple units, so this feature may not be worth using anymore.

Enter the total units in  custom billing field 6 (billing / custom fields), and you do not have to enter the payment amount. If there was a deductible, just enter the allowed amount for the total of all lines on the first line.

 

 

If you needed to enter the allowed or paid amount for a line: hit the <detail> button and then the <custom fields> option and fill in the allowed amount in custom field one and the paid amount in custom field two.

 

Sometimes Medicaid wants practices to send a modifier of U2 to indicate a deductible. If your practice is supposed to (and most are), please also change the modifier of the line to U2.

 

 

2. Print your claims in Lytec.

 

a.       Select the Billing Menu, and choose print insurance claims.

b.      Choose the edi form that matches your insurance company's name. For secondary claims, be sure to choose the form that is named with “sec”. The same form name works for all different practices.

c.       Enter your insurance company code to restrict claims to only one insurance company.

d.      For clinic secondary claims only, be sure to check the include payments box. (If you use the PTCD feature, you must also check the include payments box.)

e.       Lytec will create a new claim file for each insurance company. You can append secondary and primary claims together, as long as they are the same insurance company.

f.        For Lytec 2005 only, you must process an insurance company for one practice before moving to the next. Lytec 2005 places all insurance claims files into the same directory, but the earlier versions separate by practice so there is no overlap.

 

3. Process your claims in Claim Master.

 

a)      Open Claim Master. Enter the password. When your system is delivered, the password is set to new. You must change that using “Change Password” on the File menu.

 

 

 

b)      If the practice and insurance company you want do not display in the blue bar, open your practice by choosing Settings and then “Open Practice.” Double click on your company (so that you see it in the "look in" box), and then press "select".  (Do not double click on “config” or the insurance name.)  If you do not see your company, exit ClaimMaster and start again.

 

 

 

c)      You are now back at the ClaimMaster menu. In the blue title bar, you will see the name of the last insurance company you used for this practice.

  

d)      If you want to process claims for a different insurance company, choose Settings and then “Select Insurance.” Double click on the correct insurance company. When you are done, you should see the insurance company in the blue title bar above the menu.

 

 

e)      Select the Lytec billing file by choosing File and then “Select Lytec Billing File.” Then, double click on the correct insurance company’s “.inp” file. (If you choose a file for the wrong insurance company, it will give you a warning and not allow you to process.) If it does not show your Lytec billing file, see the troubleshooting section below for “Cannot find Lytec billing file.”

 

 

f)        Process your claims by choosing the  run  menu option and then “process”.  ClaimMaster will prompt you with a message to be sure you are matching insurance companies. Press enter.  If it asks you to over-write, you can press enter again.

 

 

 

g)      ClaimMaster will prompt you with a message listing the number of valid and invalid claims. Note whether you have invalid claims.

 

 

h)      If you had invalid claims, choose view  and then “invalid claims.” It will display all report names, with the current report already selected. Just press <ENTER>. Your invalid claims report will display.

 

i)        If you had valid claims, you can view or print them by choosing view and then “valid claims.” It will display all valid report names, with the current report already selected. Just press <ENTER>.

 

4.  You are are now ready to transmit. The options you need for the insurance company are turned on in the transmission menu. Choose the steps based on the insurance company below:

 

For GHI Medicare: transmit the claims from Claim Master, and download from Claim Master using the following steps:

 

a)      Choose the Send/Receive Menu option and the Connect now option. (If the connect now button does not do anything, please exit and re-enter Claim Master.)

 

b)      Press "enter" to accept the modem settings. (If you have more than one modem, select the correct one.)  You will then see the following transmission screen:

 

 

c)      Press "connect". It will dial.

d)      Enter your  logon and password.

e)      If you want to upload claims to GHI Medicare:

                                                               i.            Choose "F" and press "enter" for file upload.

                                                             ii.            Enter claims."your submitter code" for the first batch of the day. (For subsequent batches that day, append a unique number to the name.)

                                                            iii.            Choose "Z" & "enter" for zmodem

                                                           iv.            Choose the "upload now" button.

                                                             v.            Press enter to choose the claim you just processed. (You could also choose older claims that have not been sent.)

 

f)        If you want to download from GHI Medicare:

                                                               i.            Note that the statistics report using "S" does not work for hipaa claims.

                                                             ii.            You will need to redial from 16464586787. Just change the last "6" to a "7" before dialing.

                                                            iii.            Connect and enter your login and password.

                                                           iv.            Choose ”R" & "enter" for remote system download.

                                                             v.            Choose "F" & "enter" for file listing

                                                           vi.            Type the letter next to the file you want. The ".clm" report tells you whether the claims were accepted, but not whether they were paid. The ".zip" contains a remit file that can't be read. 

                                                          vii.            Press "ctrl" and "d" at the same time

                                                        viii.            Choose "Z" & "enter" for zmodem

                                                           ix.            Press the "download" button.

 

g)      When you are done, hit the "disconnect" button.

h)      Hit the "X" button to close the transmission window.

i)        If you did not upload all files for this insurance, it will ask whether you want to delete them. If you do not want to ever send a particular claim file, highlight it and press delete. 

 

For Medicaid, Empire Medicare and Blue Shield: Package the claim to be sent, and then send the claims by connecting to the insurance claim web site, and then tell ClaimMaster the file was sent:

 

a)      Choose the Send/Receive menu option and then “package to send.”

b)      If the last sent of claims have not already  been marked as sent, it will ask you if the last file was sent.  If you press yes, it will mark them as sent. If you press no, it will just add the new claims to the file waiting to be sent.

c)      Press <ENTER> to package the claim you just processed.

d)      Minimize Claim Master.

e)      For Blue Shield and Empire Medicare: send your claims through Ivans  by doing:

§         Connect to AT&T.

§         Sign onto Ivan's.

§         Choose send files

§         Click the send and production boxes, and enter " C:\ASEND_MCARE” for Medicare and C:\ASEND_BLUE for Blue Shield. (For a test submission, check the test box instead of production, and use the TEST_ONLY configuration.)

§         Hit the “send” button to submit the claims.

§         You will be able to press “get files” to see whether the claims were submitted about 2 hours later. Within 3 days, you will be able to download a report indicating whether the claims were accepted. When you get files from Ivan’s you can download them to the download directory for the practice’s insurance. That directory is set by the insurance options in ClaimMaster. If you don’t specify a folder, it assumes c:\claimmaster\<practice name>\EMPCARE\download, or c:\claimmaster\<practice name>\BLUE\download. Anything in ClaimMaster’s download directory will be easily seen with ClaimMaster’s view / download option.

f)        For Medicaid send your claims directly through the internet  by doing:

§         Connect to web option.

§         Sign onto emedny.

§         Choose send files.

§         Change the type to professional claims (except for clinic, which is institutional).

§         Choose the Medicaid upload file, (usually C:\ASEND_MCAID). 

§         Hit the “send” button to submit the claims.

§         You will be able to look at your inbox to see whether the claims were submitted soon after. Within a few days, you will be able to download a report indicating whether the claims were accepted. You can download reports to the download directory for the practice’s insurance. That directory is set by the insurance options in ClaimMaster. Anything in ClaimMaster’s download directory will be easily seen with ClaimMaster’s view / download option.

g)      Maximize ClaimMaster.

h)      Choose the Send/Receive menu option and then “Mark as sent” and press <Enter>.

 

 

Exit claim Master by choosing the File menu and then selecting “Exit.”

 

Extra Features:

 

1.      If you want to see what dates you sent each transmission:

o       Choose view / sent claims.

o       You will see a list of claims you sent with the date the file was sent. You cannot see the contents of that transmission from this screen.

2.      If you want to view downloaded files:

o       Choose view/ download files.

o       Double click on the file you want to see.

If you want to view reports from prior runs:

o       Choose view / invalid or valid reports

o       Choose the older report by double clicking on it's transmission number. (It may help to press the upper right button to display file details, which will give you the date of the transmission.) 

If you want to rerun a Lytec claims file, but you have already replaced it:

o       Choose select billing file

o       Change files of type to (*.cpy) using the down arrow.

o       Navigate to the insurance output directory by pressing the down arrow under "look in".

o       Double click on the .cpy file for that transmission. (It may help to press the upper right button to display file details, which will give you the date of the transmission.) 

o       Choose run/ process.

If you want to never send a claims file:  

o       Choose File / Delete ClaimMaster Claim file.

o       Double click on the file that you want to never send.

If you want to change your password:  

o       Choose File / Change password.

o       Enter your new password twice.

If you want to reset the last transmission number:  

o       Choose settings / Reset Last Tran ID

o       Enter the new Transaction ID – It will effect the next transmission, but not any that have been previously selected.

If you want to prepare GHI Medicare or Medicaid remittance files:  

o       Choose Remit / Process Remittance

o       Select the file you want to process from the download directory.

 

 


 

Add a New Practice:

 

  1. Create your practice in ClaimMaster.

a.       Open ClaimMaster from the start /program menu.

b.      Choose the Settings menu and select “Open Practice.”

You should see all the other practices ClaimMaster handles for you. (If it does not, exit ClaimMaster and start over.) 

c.       Double click on  ( the new folder icon) to create your practice. (If you hover your cursor over the icon, it will say “new folder”. )

 

 

d.      Type your practice name as one word. (It does not have to match anything.)   Press <ENTER>. (This names the folder that will contain your practice.)

e.       Double click on the practice you just created. It will appear in “Look In”.

f.        Double click the Select Button.  

 

2.      Add the Insurance Configuration to ClaimMaster.  

 

a.       Choose the File menu option and select “Copy insurance or table file” to copy the configuration of another of your practices.

 (If you prefer, you can choose “Create new insurance or table from template” instead.)

b.      Double Click on the practice you want to copy.

c.       Double Click ONLY on the “config” folder, NOT an insurance name.

d.      Double Click on the insurance name you are creating.

(Never copy from a different insurance.)

e.       ClaimMaster will ask you for a new name:

 

f.        Type the practice and insurance name so you will recognize it,  and click ok. 

g.       ClaimMaster will show you the following Insurance Practice Values Screen (which you could also see by choosing File / Change Insurance Practice Values.)

 

 

h.       Set the following values and then press “save” and then “ok”.

 

§         Configuration: enter your practice name followed by "mcaid" or “mcare” or “blue”. If necessary shorten the practice name.

§         Report Name: enter your practice and insurance name.

§         Lytec data dir:  hit the <browse> button to find the folder that will hold your Lytec insurance form. For Lytec 2005, this is the Lytec directory in the Program Files folder on your C drive. For all other versions of Lytec, this is the Lytec data directory on your server.

§         Submitter Name: Enter the submitter name exactly as it appears on your license.

§         Electronic Submitter ID: Enter the submitter ID your insurance company assigned to you. (This is called an ETIN for Medicaid.)

§         Contact Name: Enter your name in contact name.

§         Phone: Enter your phone number in phone, without any dashes.

§         Lytec Practice Name: Enter the Lytec Practice Name that you find in Lytec’s Settings / Practice. You only need to enter a portion of the Lytec Practice Name. This will be used to match the practice in the claim file to be sure you are not processing the wrong company.

§         For Empire Medicare, Blue Cross and Medicaid:

o       Output Claims Filename: Change this filename to indicate your practice.

1.      Download Directory: .

§         If you send secondary claims for this insurance:

o       Pay Rate: This indicates the percentage of allowed amount at which the majority of your claims are paid. If the normal rate is 80%, enter “.8”. If the insurance usually only pays 50%, enter “.5”  

o       Use Prim Payor ID: If your claims are ever secondary to anything other than Empire Medicare, uncheck the “Use Prim Payor ID” box. You will then need to ensure you have the correct payor ID in Lytec’s insurance payor id fields.

o       Primary Payor ID: If your claims are always secondary to one insurance company, enter the primary payor id here. 00803 is Empire Medicare and Blue Cross; 31146 is GHI Medicare; 141797357 is Medicaid.

§         For Medicaid Only:

o       Locator POS Table: If your practice has only one locator code for each Lytec Facility code, leave this blank. Otherwise, you will need to first create a Locator POS table for this practice and then come back (using File / Change Insurance / Change Insurance Practice) to select that table using the browse button.

o       LOC Default: Enter the  locator code that you want ClaimMaster to use when it cannot find any other locator code to use. (For example, if you are putting the locator on the facility code, and you didn’t put a facility on the bill. If you put nothing here, ClaimMaster will give you an error when it cannot find a match. If you intend to always enter a facility code, leave this blank.) 

§         Hit <Save>

§         Hit <OK>

 

 

  1. Select this new insurance company.

§         Choose the Settings menu option and then “Select Insurance”.

§          Double Click on your new insurance company. You should see the practice and insurance company in the title bar.

 

 

  1. If you are need to create any table for the practice, create it now.

 

You will need  to create a physical therapy table if you are submitting physical therapy codes to Medicaid. You will need to create a locator table for Medicaid if you have more than one locator code per facility. You will need to create a pay table if you submit secondary claims for this insurance and have a pay table license.  For detailed instructions on what belongs in each of these tables, see the “ClaimMaster Tables” section of this manual.)

 

    1. Choose the File menu option and select “Copy insurance or table file” to copy the configuration of another of your practices.

      (If you prefer, you can choose “Create new insurance or table from template” instead.)

    1. Double Click on the practice you want to copy.
    2. Double Click ONLY on the “config” folder, NOT an insurance name.
    3. Hit the down arrow next to “Files of Type” and choose table file.
    4. Double Click on the table you are creating.
    5. ClaimMaster will ask you for a new name. Enter that name and choose ok.
    6. The table will display to you. You can make any changes you want.

 

  1. You might want to change the insurance options as well. You want to do this if you have a physical therapy practice, or if you use a pay table, or if you want to name the download directory.
    1. Choose the File menu.
    2. Choose Change Insurance or Table.
    3. Choose Change Insurance Options.
    4. Click on the <Open> button.
    5. See the following screen:

 

 

 

§         Modem Info: If your modem requires dialing 9 first, insert "9," before the modem phone number.

§         Claim Submission Web Address: This is the internet address used by the Transmit / Connect to Web option.

§         For Physical Therapy: Procedure Table File: This table file will replace one procedure code with another if it sees a match. For physical therapy, Medicaid wants a different code than Medicare, so you will need to enter a procedure table here. You can browse to find the correct directory.

§         Secondary Payment and Allowed Table: This table file holds all the standard payment and allowed amounts so that you do not have to enter normal payments. You will still have to enter deductible amounts. This option does require a license.

§         90 Day Ind: This is the value that will be sent when the 90 day indicator needs renewal.

§         CLM01: If you are autoposting, choose PATCODE. For Medicaid manual billing, choose BILLPATFIRST so the remittance will show the patient’s first name.

§         REFEA: If you are autoposting for Medicaid, you must use MCAIDREFEA. For any other insurance company, you may want BILLPATFIRST so that you can see the patient’s first name.

§         REF6R: It is always best to use REF6RNORMAL (which is the bill number – line number).

 

6.      If you are using a new Submitter ID, you will need to send one test batch first. To do that, you will need to turn the test mode on. When the test mode is on, your claims will not ever be paid. Be sure that you turn the test mode off when the test is complete. To turn on test mode:

 

a.       Choose the File menu.

b.      Choose Change Insurance or Table.

c.       Choose Change Insurance Test Status

d.      Click on the <Open> button.

e.       Click the test button until it is checked.

f.        Hit <YES> if asked.

g.       Hit <SAVE>.

h.       Hit <OK>.

i.         Submit your test using the normal claims submission instructions, (but you may need to check a “test” box on the web site screen).

j.        Immediately repeat a-h above to reset your test flag back.

 

7. Follow the instructions in the section to “Setup Lytec to Use ClaimMaster for a new practice.”

 

Setup Lytec to use ClaimMaster for a new  practice

 

The following setup must be done in Lytec:

 

1.      Create the following custom fields.   

(Note that you will not have to create many of these fields, but read though each item to see whether it applies to your practice.)

o       In Lytec, choose settings and then custom fields.

o       If you are using Lytec 2001, it is very important to create this field:

§         Click on the insurance tab and fill in the following field according to the table below:

 

14

Lytec version

text

4

2001,

2005

If Lytec2001, enter 2001.  Otherwise blank.

 

§         Click on the bill detail tab and fill in the following field according to the table below:

 

4

Original Claim

text

22

 

For Adjustment Only, enter original claim #

 

o       If ClaimMaster will process GHI Medicare or Blue Shield:

§         Click on the insurance tab and fill in the following field according to the table below:

 

10

Special Type

text

1

Y,N,B

Enter Y for GHI Medicare; B for Blue Cross; C for commercial

 

o       If ClaimMaster will process any secondary claims in this practice:

§         Click on the bill detail tab and fill in the following 2 fields according to the table below:

 

Field#

Name & Prompt

Type

Ln

Values

Description

1

Primary Allowed

Currency

 

 

Primary Allowed 

2

Primary Paid 

Currency

 

 

Primary Paid   

 

o            If ClaimMaster will process any secondary claims in this practice, AND you charge the primary the allowed amount:

§         Click on the insurance tab and fill in the following field  according to the table below:

 

4

Charge Allowed Amt?

Text

1

Y = Yes; N = No 

Enter  Y if you charge same as allowed. 

 

 

o            If ClaimMaster will process any secondary claims in this practice, AND those claims may have different primary payors, AND you cannot enter the payor ID  that your insurance is expecting into the Lytec payor Id field:

§         Click on the insurance tab and fill in the following 2 fields according to the table below:

 

2

special processing

Text

4

 

PAYR = payor found in field 15

15

Payor ID

Text

15

 

Primary Payor id only for secondary claims.

 

o       If ClaimMaster will process any secondary claims in this practice, AND you created a different insurance code just for your secondary claims:

§         Click on the insurance tab and fill in the following field according to the table below:

 

5

Second Ins Indicator

Text

1

S,P

Enter S if only used as Secondary; otherwise blank

 

o        If ClaimMaster will process any MEDICAID claims in this practice:

§         Click on the bill header tab and fill in the following fields:

 

 

3

Sa exception

Text

1

1,2,3,4,5,6,7

Enter if medicaid and no auth: 1-7; 7 = none needed

4

Void indicator

Text

1

 

V = Void.

5

90 day ind

Text

1

1,2,3,4,5,7,8,9,10,11

Enter only if medicaid and want special 90 day reason

 

 

o       If you want Medicaid Physical Therapy claims to only send one line with all units :

§         Click on the bill header tab and fill in the following fields:  

 

6

Send only 1 line?

Text

5

 

If only 1 line should be sent: enter units.

 

o       If you are submitting Medicaid and your locator is not going to be placed in the facility’s insurance code 2 :

§         Click on the insurance tab and fill in the following fields:  

 

7

Facility Method

Text

1

Y,N,T,P,B,S,C

Medicaid only: P=Prov;T=fac;

N=CM cfg;Y or blank= fac ins id2, B = prov + facility, S=pat type; C=pat code

 

 

o       If you are submitting Medicaid and you want to charge one rate for all primary insurance claims for this insurance (ignoring the actual charged amount):

§         Click on the insurance tab and fill in the following fields:  

 

2

special processing

Text

4

 

OVRR = override rate found in field 16

16 

Override Rate  

Text

10

 

Charge for all primary claims for this insurance. (ex:123.33)

 

o       Make sure you are not using the following fields unless they are used for ClaimMaster

                                                               i.      On the bill detail tab – do not use field 4 (unless it is for original claim number)

                                                             ii.      On the bill header tab – do not use field 3-5

                                                            iii.      On the insurance tab – do not use the following field values:

2-Don't use a value of "ZERO", "RTH" or "PAYR" or "DEF" or "REF" or "SA7" or “PTCD” or “OVRR”

3-Do not use as “C”

4-Do not use as “Y”

5-Do not use as “S”

7-Do not use as P, N or T

10-Do not use as “Y”

12-Do not use as N, O or I

13-Do not use as N or O

14 -Do not use as 2001

 

2.      Update your insurance companies that ClaimMaster will submit, and all insurance companies to which Medicaid is secondary (i.e. Medicare) with the following information:

 

·        On the name and address tab of insurance, be sure the type is "medicaid physician" for Medicaid and “medicare” for Medicare.

·         The address must be filled.

·        On the identification tab for medicare and medicaid, be sure the provider id # is filled in.

·        If you are submitting secondary Medicaid that is primary to more than one insurance, ensure the correct payor id is in the payor id field for XE and 2004, and “commercial id” for 2001. The proper payor ID for Empire Medicare and Blue is 00803, and the proper payor ID for ghi medicare is  31146. If this conflicts with the system you use to submit other claims, set the ins custom field 2 to PAYR and place the payor id in custom field 15.  

·        If you want the check to go for all claims to go to a provider group’s address, enter their medicaid provider id in insurance / claims / group pratice. Otherwise, the checks will go to the address of the individual doctors. Medicaid must know the practice is a group in order for this to work. The Medicare and Blue Shield Group ID must be 10 digits: The first initial of the first word and the first initial of the second word in the practice name, followed by 0, and then the 6 character medicare id and then 0.  Call Medicare or Blue Shield to validate your ID.  (WARNING: Empire Medicare and Blue Shield will not give you an invalid group warning, but will instead just send the check to the physicians instead of the group. )

·        If you have Lytec 2001, set insurance custom field 14 to 2001.

·        If you charge allowed amount, set ins custom field 4 to Y for the primary insurance. (For Medicare with secondary Medicaid, this means Medicare will be set to Y, not Medicaid.)

·        If you use an insurance code just for secondary Medicaid, set ins custom field 5 to S.

·        If you always want to use ClaimMaster’s default locator code for the practice, set ins code 7 to N.

·        If you are submitting to Medicaid, and you want the locator code to be entered in the facility’s insurance code 2, you do not need to do anything. Otherwise, set custom field 7 as follows:

o       If you want a different locator for each provider, enter P

o       If you want a different locator for each provider + facility combination, enter B

o       If you want a different locator for each patient type, enter S

o       If you want a different locator for each patient code, enter C

o       If you want a different locator for each facility, but do not want to use the facility’s Lytec field, enter T

o       If you always want to use the claimmaster default locator, enter N

You will need to create a table to map the facilities if you fill in custom field 7 to match your choice here.

·        If the insurance company is GHI Medicare, set ins custom field 10 to Y. If you are sending Blue Cross / Blue Shield claims, set custom field 10 to B.

·        If you don’t want to use the referring provider’s ins code 1 as the UPIN (for medicare) and ins code 2  for license number, set ins custom field 12 to “N”, and add the ClaimMaster provider table.

 

3. On the provider table:

 

4. On the address table for facilities:

 

5. On the address table for referring doctors:

 

6. On the practice settings:

 

7. On the Bill Detail:

 


 

REFERENCE - LYTEC INFO USED BY CLAIMMASTER  

 

Practice information:

 

Insurance information:

 

For every facility you use, change lists/addresses to have the following information filled:

 

For every patient, you must fill out the following information:

 

For every referring doctor, change lists/addresses to have the following information filled:

 

For every charge, the following information will be used from the header:

// 1 immediate/urgent care

// 2 services rendered in retro-active period

// 3 emergency care

// 4 client has temporary medicaid

// 5 request from county for second opinion to dermine if recipient can work

// 6 request for override clming

// 7 special handling (now must be used if no UT is needed)

 

For every charge, the following information will be used from the individual lines:

 

The following information must be filled on every provider:

 

Transaction code

File extensions used:

 

File

Extension

configuration file

.cfg

table file (provider and facility)

.tbl

control files

.ctl

input filesx

.inp

pending transmit files

.clm

sent transmit files

.sent

error report files

…err.html

valid claim report files

…rpt.html

claim index file

.cli

input file copy

.cpy

 

REFERENCE: Listing of the custom Insurance Fields:

 

 

#

ClaimMaster values:

2

Don't use a value of "ZERO", "RTH" or "PAYR" or "DEF" or "REF" or "SA7" or “PTCD” or “OVRR”

3

Do not use as “C”

4

Do not use as “Y”

5

Do not use as “S”

7

Do not use as P, N or T

10

Do not use as “Y”

12

Do not use as N, O or I

13

Do not use as N or O

14

Do not use as 2001

 

For a default setup, no custom insurance fields are required. Look at the “Why used” column in the table below to see whether you need to set up any of the insurance company custom fields:

 

Why used?

Field#

Name 

Typ

Ln

Values

Prompt

* see below

2

special processing

Text

4

 

See below

If you charge the allowed amount

4

Charge Allowed Amt?

Text

1

Y = Yes; N = No 

Enter  Y if you charge same as allowed. 

 

If mcaid secondary is a different code then mcaid primary

5

Second Ins Indicator

Text

1

S,P

Enter S if only used as Secondary; otherwise blank

If you don’t want to use the facility ins id 2 for the locator code.

7

Use facility?

Text

1

Y,N,T,P,B,S,C

Medicaid only: P=Prov;T=fac

N=CM cfg;Y or blank= fac ins id2, B = prov + facility, S=pat type; C=pat code

 

If you purchased the GHI Medicare or Blue Cross ClaimMaster option.

10

Special Type

text

1

Y,N,B

Enter Y for GHI Medicare; B for Blue Cross; C for commercial

If you have Lytec 2001

14

Lytec version

text

4

2001,2005

If Lytec2001, enter 2001. If Lytec2005 and you have Automatic Remittance, enter 2005. Otherwise blank.

If you are using the special processing “PAYR”  option.

15

Payor ID

Text

15

 

Primary Payor id only for secondary claims.

If you are using the special processing “OVRR”  option.

16 

Override Rate  

Text

10

 

Charge for all primary claims for this insurance. (ex:123.33)

 

* For field 2, special processing, you can use any of the following options:

 

 

 

TROUBLESHOOTING GUIDE

 

Cannot file Lytec billing file

 

Symptom: When you select Lytec billing file, it does not show you the Lytec billing file.

 

Solutions: The Select Lytec billing file option shows all the files in the Lytec Billing Directory for the insurance company chosen. Answer the questions below:

 

Did you ever print a ClaimMaster claim for that company using a form that begins with “edi”? If not, print the claim before looking for the claim in ClaimMaster.

 

Is the name of the company and insurance company at the top of the screen in the blue bar? If not, the practice and insurance were not properly set. Close ClaimMaster and restart it. Then, follow the instructions  for starting ClaimMaster in the beginning of this manual. After you select the insurance company, you should see the name on the top of the screen.

 

If the company and insurance company were at the top of the screen, then the Lytec Billing Directory is probably pointing to the wrong directory. To see the Lytec Billing Directory, Choose File / “Change insurance or table file” and then double click on the insurance company. See the “Lytec Data Dir.”  That must be set to your practice’s Lytec data directory. For Lytec/XE you can find your Lytec data directory, by going to the Lytec file menu and choose open. Lytec/XE will show you the path right on your screen.  If you see it is incorrect, change Lytec Data Dir and press Save and OK and then try again to Select Lytec Billing File.

 

If that still does not work, right click on your start menu and choose explorer. Navigate to your Lytec data directory and then to your practice. (If you are using ClaimMaster over a network, you can choose “my network places” to navigate.) On the top, you should see the full path of the Lytec billing directory.  (If you do not, choose tools / folder options / view, and check “Display the full path in the address bar”.) Highlight that directory path in the address bar and press edit / copy. Then, paste that into the Lytec Data Dir by highlighting the current path and pressing <CTRL> and “v” at the same time. Press Save and OK.

 

 

ClaimMaster Tables

 

Locator Table:

 

This table works in conjunction with the insurance custom field 7. The possible types of tables are:

 

Code

Table Lookup

P

Provider

B

Provider + facility (with no space inbetween)

S

Patient Type

C

Patient Code

T

Facility

 

Create the table from a template or a copy of an existing system. Then, change the first value in each line to match the value you entered in insurance custom field 7.  The locator code follows the key, and the Medicaid clinic POS follows that, and finally, the name of the location follows. * can be used in the key as a catch all.

 

For Example, a type B (provider + facility) would look like:

 

JAEG001,03,,Dr. Jaeg’s 001 facility

 

After creating this table, place its name into the insurance configuration’s locator table using the ClaimMaster Option “Change Insurance Practice Values”.

 

Pay Table:

 

This table requires a pay table license. You can create the table first from a template or a copy of an existing system.  This is a list of allowed and payment amounts for each procedure in each year, and can be specific for each primary insurance company. You set up the table for the secondary insurance, listing the normal payment rates for all the possible primary insurances.

 

You only need to include the insurance company when you have more than one primary insurance for a secondary. (For example, if Medicaid is secondary to GHI Medicare and Empire Medicare.) Your table should all use the insurance company or none should.

 (GHI Medicare's payor ID is 14330. Empire Medicare's payor ID is 00803.)

 

Each line starts with the procedure plus a “-“ plus the year, and optionally plus another “-“ and the insurance company.  It is followed by the allowed amount and the amount usually paid.

Be careful to have only 2 commas and no spaces. The Code may contain special characters '?' and/or '*'.   '?' means single character substitution while matching Procedure code. '*' means wildcard substitution while matching Procedure code.

 Limitations:  Only the first '*' character in the Procedure code string is used for wildcard substitution. 

  If the procedure code contains more than one '*', then the others will be used for literally matching.

   ex: 9*9-2005, 122.00, 22.00 OR ex: 95?5*, 23355

 

Example without insurance company:

 

76536-2005,106.7,85.36           

76700-2005,150.16,120.12    

 

Example with insurance company:

 

76536-2005-14330,106.7,85.36           

76700-2005-14330,150.16,120.12  

 

After creating this table, place its name into the insurance configuration’s locator table using the ClaimMaster Option “Change Insurance Options”.