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2010 install guide

User manual physician

Article 28 Remittances handling exact payment with no CAS

Handle error on first claims causing no GS and BHT

NJ Medicaid payor ID change; Removal of underlying Net Framework requirement

Default new insurance templates to not use a specific primary insurance

Handle Medicaid HMOs by accepting insurance type 16

EPSDT will use ST if mod 1 of first procedure is EP. Will mark EPSDT yes if EPSDT referral field is AV, S2 or ST. Will mark EPSDT no if NU or nothing is in EPSDT referral.

Handle EPSDT. Put AV, NU, S2 or ST in EPSDT referral field to trigger EPSDT claim. It will not send EPSDT if Handicapped program also checked.

Handle referring physician with only NPI and no UPIN and System option of "A".

Accept new Medicare Submitter ID; Error on future date (more than 1 day ahead)

Correctly calculate remittance check totals for remittances with multiple bpr in one file - For Medicare.

Handle zip+4. It will include zip+4 for 2006 and later. It will give no error if zip+4 is not used.

Handle Remit split properly for clinic Medicaid. Report Contract Obligation for Medicare Secondary as difference between Charge and Allowed. Handle Podiatry when class findings filled using Date PCP last seen to fill DTE*374; Error on blank subscriber address; 90 day indicator error on date range

Medicare Secondary (Setup: Uses claim detail custom 1 as allowed and custom 2 as paid; can use ins custom 6 as reason secondary or can use claim master ins option)
Referring provider can use NPI or Pre-NPI ID (upin, license or medicaid id)

NPI version with maintenance screen; if using PTAX, must use ins cust 9 instead of 1;

NOTE: Must set your VersionSetting to your Lytec Version Equivalent.

NPI Compliant
Accept Assignment Option to use Lytec values.

Clinic claim remittance processing;
Mammography authorization handling;

Major change: one ST/SE, so Medicare report will be easier to read. 997 will no longer indicate true bill number. Can call insurance to ask for claim number in error based on line number. PA Medicare added.

Improved Remittance Report; Medicaid Remittance primary / secondary reset assuming clm01 is wrong; Add clm01 and 0FILL to valid report.

Medicaid Remittances default to secondary if SECOND is in remit.835.ctl; parse clp01 to determine secondary and original proc code. (inactive - 0FILL table control for medicaid & locator code entirely from tables); removes leading zero from batch number for Medicaid;
a: medicaid remittance - only swap PT codes for sec.

Old remittances construct account # from last name & ptcd uses entered claim only

Remittance splitting for Empire Medicare
Updated help text

Initial Release