• Document: Direct Data Entry Quick Reference
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Direct Data Entry Quick Reference Wisconsin Physicians Service Insurance Corporation http://www.wpsmedicare.com QUICK REFERENCES AND OVERVIEWS Outpatient – 'Claim Page 02’ .............................................. 12 Common Claim Status/Locations Quick-Reference Guide Outpatient – 'Claim Page 03’ .............................................. 12 ........................................................................................... 2 Outpatient – 'Claim Page 04’ .............................................. 12 Reason Code Overview ........................................................ 2 Outpatient – 'Claim Page 05’ .............................................. 13 Status Code Overview........................................................... 3 Inpatient SNF – ‘Claim Page 01’......................................... 13 Location Overview ................................................................. 4 Inpatient SNF – ‘Claim Page 02’......................................... 14 Reason Code/Claim Driver Overview.................................... 5 Inpatient SNF – ‘Claim Page 03’......................................... 14 DDE System Menu Quick Reference Guide ......................... 6 Inpatient SNF – ‘Claim Page 04’......................................... 15 Program Function (PF) Key/Escape (ESC) Key Cross- Inpatient SNF – ‘Claim Page 05’......................................... 15 Walk Quick-Reference Guide............................................. 7 DDE SYSTEM CODES AND CORRECTIONS DDE SYSTEM – DATA ENTRY <TAB> DEFAULTS UB-04 Data Entry Payer Codes .......................................... 16 Inpatient Hospital – ‘Claim Page 01’ ..................................... 8 DDE System – How to Correct an RTP’d claim.................. 16 Inpatient Hospital – ‘Claim Page 02’ ..................................... 9 DDE System - How to "Adjust" a Claim .............................. 16 Inpatient Hospital – ‘Claim Page 03’ ..................................... 9 DDE System – How to "Cancel" a Claim ............................ 17 Inpatient Hospital – ‘Claim Page 04’ ..................................... 9 Claim Change Reason Codes ............................................ 18 Inpatient Hospital – ‘Claim Page 05’ ................................... 10 Outpatient – 'Claim Page 01’............................................... 10 August 2011 DDE Quick Reference August 2011 Quick References and Overviews COMMON CLAIM STATUS/LOCATIONS QUICK-REFERENCE GUIDE Status/Locations Claim Disposition P B9996 Claim waiting / payment floor hold P B9997 Paid claim – finalized location P O9998 Paid claim (off-line) - finalized location R B9997 Rejected claim - finalized location D B9997 Denied claim - finalized location T B9900 Daily RTP location – claims cannot be worked when in this location T B9997 Finalized RTP location – claims can be worked when in this location S B0100 Claims at the beginning of the system – all claims start here and cannot be worked S B9000 Claim has been updated by the provider “on-line”- awaiting duplicate check S B9000 ESRD claim waiting to go to CWF – has cleared all FISS edits S B6000 Claim waiting for Additional Development Request (ADR) to be created S B6001 Claim waiting for ADR response to be returned by the provider S B9000 Non-ESRD claim waiting to go to CWF – has cleared all FISS edits S B9099 Claim awaiting response from CWF REASON CODE OVERVIEW Reason Codes are six-digit codes that direct the outcome of a claim edit or process. The following chart outlines the various positions of the on-line reason code: If – Position 1 is: THEN – The Type of edit is: AND-Positions 2-5 Can be: 1 Consistency Edit 0125-9999 3 FISS DDE Edit 0000-9799 4 File Maintenance Alpha 001- Alpha 899 5 Medical Review 0001-9999 7 Site Specific 0001-9999 A-Z CWF (Except W) Current CWF 4-Digit Er

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