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DDE User’s Manual
Table of Contents
TABLE OF CONTENTS
SECTION 1 – INTRODUCTION
1
Provider Contact Center Numbers.......................................................................................................... 1
Keyboard ................................................................................................................................................ 1
Keyboard Function Keys ........................................................................................................................ 2
Status/Location Codes ............................................................................................................................ 2
Document Control Number (DCN) ........................................................................................................ 3
SECTION 2 – CONNECTION INSTRUCTIONS
5
Connection Procedures ........................................................................................................................... 5
Final Connectivity Instructions .............................................................................................................. 6
Sign-Off Procedures ............................................................................................................................... 7
Changing Passwords............................................................................................................................... 7
SECTION 3 – MAIN MENU
9
SECTION 4 – CLAIM INQUIRY
10
Beneficiary/CWF.................................................................................................................................. 10
Beneficiary/CWF Screens .................................................................................................................... 11
DRG (Pricer/Grouper) .......................................................................................................................... 28
DRG/PPS Inquiry Screen ..................................................................................................................... 28
Claims Summary Inquiry ..................................................................................................................... 41
Performing Claims Inquiries .......................................................................................................... 42
Viewing an Additional Development Request (ADR) Letter ........................................................ 42
Revenue Codes ..................................................................................................................................... 45
HCPC Inquiry ....................................................................................................................................... 46
Diagnosis & Procedure Code Inquiry – ICD-9 .................................................................................... 49
Adjustment Reason Code Inquiry ........................................................................................................ 50
Reason Codes Inquiry .......................................................................................................................... 52
OSC Repository Inquiry ....................................................................................................................... 56
Claims Count Summary ....................................................................................................................... 57
Home Health Payment Totals............................................................................................................... 58
ANSI Reason Code Inquiry .................................................................................................................. 59
ANSI Reason Code Narrative ........................................................................................................ 60
Check History Inquiry .......................................................................................................................... 62
Diagnosis & Procedure Code Inquiry – ICD10 .................................................................................... 63
SECTION 5 – CLAIM ENTRY
65
General Information ............................................................................................................................. 65
Transmitting Data .......................................................................................................................... 65
Electronic UB-04 Claim Entry ............................................................................................................. 66
UB-04 Claim Entry – Page 1 ................................................................................................................ 66
UB-04 Claim Entry – Page 2 ......................................................................................................... 70
UB-04 Claim Entry – Page 2: Additional NPI Lines ..................................................................... 72
UB-04 Claim Entry – Page 2: Line Level Reimbursement............................................................ 74
UB-04 Claim Entry – Page 2: Additional Detail ........................................................................... 80
UB-04 Claim Entry – Page 3 ......................................................................................................... 88
UB-04 Claim Entry – Page 4 ......................................................................................................... 92
UB-04 Claim Entry – Page 5 ......................................................................................................... 94
UB-04 Claim Entry – Page 6 ......................................................................................................... 96
Roster Bill Entry................................................................................................................................... 98
ESRD CMS-382 Form ....................................................................................................................... 100
Palmetto GBA
September 2015
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