Here are the toggles for:
AUTOMATED BILLING:
Hardcopy forms and Telecommunications:
These are set under the entry of PRTALL. These affect various programs as noted:
· hardcopy billing: regular
· hardcopy billing: sorted
· hardcopy billing: batch
· hardcopy billing: queues
· all hcfa 1500 forms (except worker’s comp) regardless of where they are run from. (Could be run from any of the above programs or line item posting).
· all ub forms – these can only be run from “hardcopy billing: regular”.
· Michigan hardcopy status forms
· Worker’s comp forms
· Medicaid 1649 forms
· Michigan tc billing
(Yes, all the billing programs should all be ‘in sync’, but they’re not).
ADDR=LT ADDR=MI ADDR=xx
Action: This will change where the carrier’s mailing address is printed at the top of the hcfa 1500 form. ADDR=LT will cause it to print on the left side, ADDR=MI will cause it to print in the middle, ADDR=xx will cause it to print at whatever column number you put in place of the ‘xx’.
Otherwise: It prints the address on the right side.
Affects: All HCFA1500 forms regardless of where they are run from.
AUTO141=xx
Action: If printing lab procedures only on a type 131 UB92 bill for a particular insurance type, it will automatically change to a type 141 bill. (You put the two byte insurance type in place of the ‘xx’.)
Otherwise: Type 131 bills print as normal.
Affects: All UB92 forms.
BAL0DOE=NO
^ That’s a zero
Action: Billing programs won’t bring up a zero balance claim when running by date of entry. This toggle should usually be set.
Otherwise: Zero balance claims will come up – but they won’t bill out unless forced to.
Affects: hardcopy billing (regular, sorted, and batch) and Michigan tc billing.
BALFORWARD=Y
Action: Skips pulling up claims where the first procedure code is “BF” (balance forward).
Otherwise: It doesn’t skip them.
Affects: Hardcopy billing (queues)
BILLEXP0=YES
^ That’s a zero
Action: Causes the claim forms to print claims when the expected amount is zero.
Otherwise: It skips those claims.
Affects: All UB92 forms and all HCFA1500 regardless of where they are run from.
BILLPDPRI=NO
Action: When billing by DOE for PRIMARY claims only, if will skip claims assigned to a primary carrier that have an insurance payment (function 4 only) posted to it.
Otherwise: It doesn’t do this.
Affects: Hardcopy billing (regular, sorted, and batch).
BOX33=NODR
Action: This will cause the hcfa 1500 forms to omit the doctor’s name in box 33. It will still print the other information.
Otherwise: It reports the doctor’s name, clinic name, address, city, state, zip, and phone as usual.
Affects: All HCFA1500 forms regardless of where they are run from.
BSBOX25=Y
Action: For Blue Shield claims (carriers with carrier type of BS but NOT a format of BN), this allows box 25 to be filled in.
Otherwise: Box 25 is blank for Blue Shield claims.
Affects: All HCFA1500 forms regardless of where they are run from.
BSFIX=N NEW!
Action: For Blue Shield claims (carriers with carrier type of BS but NOT a format of BN), this allows box 5 to be filled in.
Otherwise: Box 5 is normally blank for Blue Shield claims.
Affects: All HCFA1500 forms regardless of where they are run from.
CARRIERID=NAME CARRIERID=Y
Action: Prints carrier at the bottom left side of a HCFA 1500 form. CARRIERIED=NAME toggle will print the carrier name, CARRIERID=Y toggle will print the carrier code.
Otherwise: Nothing prints at the bottom of the form.
Affects: All HCFA1500 forms regardless of where they are run from.
CONV22=Y NEW!
Action: Will swap in pos “22” for pos “11” for MR claims with a dos before 9/30/1999
Otherwise: It doesn’t do this.
Affects: Hardcopy billing (regular, sorted, and batch) and Michigan tc billing
COREFID=LIC
Action: For referrals, the commercial claims will use the license number instead of the UPIN.
Otherwise: The UPIN is used.
Affects: All HCFA1500 forms regardless of where they are run from.
Note: This can be accomplished for individual carriers by putting “RF_LIC_NO” in the carrier dictionary field labeled “BOX_17A”.
CT_DLB=N NEW!
Action: If you are billing unbilled claims only it will skip the claims that show as billed in ‘claims tracking’ or have a ‘date last billed’ on the claim. (CLM.DLB[1] or CLM.DLB[2]).
Otherwise: If you are billing unbilled claims only it will skip the claims that show as billed in ‘claims tracking’ only.
Affects: Hardcopy billing (regular, sorted, and batch) and Michigan tc billing.
CUTSPOOL=YES
Action: Causes the spooled device to print each claim as you bill it.
Otherwise: If you are printing to a spooled device, normally the program must finish running (and go to the menu) before anything prints.
Affects: hardcopy billing (regular, sorted, batch, and queues) and Michigan hardcopy status forms.
Note: Printing to a ‘view’ file with this toggle set will result in a blank ‘view’ file.
CYCLE=YES
Action: Activates cycle billing for UB92 forms. (In other words, it would add together all charges for one patient for one cycle (usually one month) and print them together on one claim form).
Otherwise: UB92 billing works as usual.
Affects: All UB92 forms.
DEDUCT=PAN
Action: This is set if you are using rural health posting. (It tells the program how to get the deductible).
Otherwise: It may not print the correct deductible.
Affects: All HCFA1500 forms regardless of where they are run from.
DME=Y
Action: Activates the DME billing prompt. (Therefore allowing you to do DME billing). This is the prompt that, when billing Medicare, will ask “medical” or “d.m.e.”.
Otherwise: There is no prompt.
Affects: Medicare Hardcopy forms run from hardcopy billing (regular, sorted, and batch) only.
DXDESC=YES
Action: Prints abbreviated description of diagnosis next to code in box 21 of HCFA 1500 form.
Otherwise: No description prints. No carrier requires this.
Affects: All HCFA1500 forms, except worker’s comp, regardless of where they are run from.
DXDESC=WK NEW!
Action: Prints abbreviated description of diagnosis next to code in box 21 of HCFA 1500 form.
Otherwise: No description prints.
Affects: All worker’s comp forms, regardless of where they are run from.:
ENDLF=x ENDLF=FF NEW!
Action: Needed on some NT systems to line up forms ENDLF=x sets how many line feeds are done at the end of the hcfa form. (put the number of lines in place of the ‘x’). ENDLF=FF will do a form feed then open & close the printer channel.
Otherwise: It does the standard number of line feeds (three on windows systems or with laser printers, otherwise one).
Affects: All hcfa 1500 forms, including worker’s comp, regardless of where they are run from.
Note: ENDLF=FF will cause ascii devices/view files to be blank.
Codes used to line up forms on NT printers: ENDLF= EXTRALF= EXTRATOPLF=
ERM=x
Action: This is used for Michigan Medicaid claims only. This sets the default code for the “Emergency” box to whatever you put in place of the ‘x’.
Otherwise: The default is 2.
Affects: All Michigan Medicaid claims, hardcopy and tc, regardless of where they are run from.
ERM=1 ERM=3 NEW!
Action: Changes the code that prints in the ‘emergency condition code’ box on the Medicaid 1649 form. Only 1 and 3 can be used.
Otherwise: Box defaults to 2.
EXCLUDE_PHP=Y NEW!
Action: Doesn’t apply the 2COBG or 2MRBG or 2BSBG logic to any carrier with the letters PHP in the first line of the carrier name. In other words, it will use the ‘billed’ amounts not the ‘expected’ amounts when billing PHP as a secondary carrier.
Otherwise: The 2COBG, 2MRBG, and 2BSBG toggles works as normal.
Affects: hardcopy billing (regular, sorted, and batch)
EXCOV=NO
Action: Will prevent the program from asking ‘include/exclude which coverage code(s)’.
Otherwise: It will ask this question when processing CO or WK claims only.
Affects: hardcopy billing (regular, sorted, and batch) only. The prompt only appears when billing just commercial claims or just worker’s comp claims.
EXTRALF=x NEW!
Action: Needed on some NT systems to line up forms. Sets the number of line feeds to print in the middle of the hcfa 1500 form, after box 23 but before box 24 (put the number of lines in place of the ‘x’).
Otherwise: No linefeeds occur here.
Affects: All hcfa 1500 forms, including worker’s comp, regardless of where they are run from.
Codes used to line up forms on NT printers: ENDLF= EXTRALF= EXTRATOPLF=
EXTRATOPLF=x NEW!
Action: Needed on some NT systems to line up forms. Sets how many line feeds to do before printing anything on the hcfa 1500 form (put the number of line feeds in place of the ‘x’)
Otherwise: No line feeds are used.
Affects: All hcfa 1500 forms, including worker’s comp, regardless of where they are run from.
Codes used to line up forms on NT printers: ENDLF= EXTRALF= EXTRATOPLF=
FACTOR=
Action: Forces a primary diagnosis code for claims bill on a hcfa 1500. Example:
FACTOR=77000TO77999=V580 If the first procedure on the claim has an external procedure code from 77000 to 77999 inclusive, the primary diagnosis code will be forced to be V580. (Note: the word “TO” and the second “=” are just placeholders. Any characters can be in this position, they will be ignored).
Otherwise: There is no forced diagnosis code.
Affects: All HCFA 1500 billing, status forms, and Michigan tc billing.
FIXNAME=N
Action: It will print the name exactly as it appears on the demographics screen.
Otherwise: It will attempt to “fix” the name by removing special characters and extra spaces and inserting a comma or period as necessary.
Affects: Hardcopy billing (regular, sorted, and batch).
GETPAN=N NEW!
Action: Prevents the automatic lookup of the prior authorization number
Otherwise: It will be automatically looked up for procedures with an ‘A’ procedure flag.
Affects: Hardcopy billing (regular, sorted, and batch).
GRP_TO=YES NEW!
Action: If running ‘sorted billing’ for a specific carrier, it will skip all claims where that specific code isn’t within the GRP_TO field.
Otherwise: If running ‘sorted billing’ for a specific carrier, it looks for a match on that specific carrier as usual.
Affects: Sorted hardcopy billing.
HC=SAME
Action: When you do “H” for Hardcopy it will keep the same claim on the screen.
Otherwise: It will page to the next claim.
Affects: hardcopy billing (regular, sorted, and batch).
HOLDCLAIM=YES
Action: Forces certain claims to be on hold pending completion. These claims will pull up in hardcopy forms, but will not bill out - there will be no *’s in the ‘O’ column and the words ‘hold claim’ will show on the screen. What kind of claims? UB92 hardcopy claims with at least one UB revenue code of 361 but no ICD9 procedure codes entered on the claim. (You enter ICD9 procedure codes for a UB claim with U at the action line).
Otherwise: There are no “hold” claims.
Affects: hardcopy billing (regular, sorted, and batch) & Michigan tc billing.
ID=N
Action: Suppresses ‘user id’ prompt that normally appears at start of billing.
Otherwise: The prompt is there.
Affects: hardcopy billing (regular and queues).
ITEM9A=A ITEM9A=C
Action: This toggle changes what will print in box 9a on the HCFA 1500 form for commercial claims. If this toggle is set to “C”, the contract number, if any, will print there. If the toggle is set to “A”, the group number will print – but if there is no group number the contract number will print instead.
Otherwise: The group number, if any, will print in box 9a.
Affects: All HCFA1500 forms, except worker’s comp, regardless of where they are run from.
Action: On the HCFA 1500 form, the “lab” box (box 20) will default to “NO”.
Otherwise: It defaults to blank.
Affects: All HCFA1500 forms, except worker’s comp, regardless of where they are run from.
LCHAR=xx NEW!
Action: Left margin. The left margin of the hcfa 1500 will be moved to this position. Moves all printing on the form to the right.
Otherwise: The left margin is at zero. Normally you line up the forms by moving the printer tractor feed.
Affects: All HCFA1500 forms, except worker’s comp, regardless of where they are run from.
NODR0=Y
Action: Disallows changing the doctor on the claim to doctor 000.
Otherwise: It’s allowed.
Affects: Hardcopy billing (regular, sorted, and batch).
NOEDIT=Y NEW!
Action: Prevents you from editing any of the columns on the screen except diagnosis, price modifiers, and output.
Otherwise: You can edit all the columns (except PROC).
Affects: All hardcopy and tc billing (except Michigan status forms)
NOMDFORM NEW!
Action: Will cause Medicaid claims to be printed on a HCFA 1500 form.
Otherwise: They are printed on a Michigan Medicaid form.
Affects: Hardcopy billing (regular, sorted, and batch).
OPTJOBS=jjjjJJJJjjjj NEW!
(put job codes in place of the j’s/J’s – must be 4 characters each)
Action: Identifies optical jobs. It will print the vision prescription at the top of the hcfa form instead of the carrier address. This is for carriers with type CO.
Otherwise: No jobs will do this.
Affects: Hardcopy billing (regular, sorted, and batch).
PAYORID=YES
Action: For possible future Medicare requirements of reporting a carrier id number instead of a carrier name & address. This has been delayed by Medicare and is it not known when or if it will be implemented. It pulls from the second carrier name field (INS_NAME2).
Otherwise: The carrier name prints.
Affects: Michigan tc billing.
PHARM=Y NEW!
Action: Enables printing of Medicaid pharmacy forms. If billing Medicaid only, a box will pop up asking ‘regular forms’ or ‘pharmacy forms’. If you choose ‘pharmacy’, it will pull claims for Medicaid pharmacy and print them on that form.
Otherwise: You can’t do Medicaid pharmacy forms.
Affects: Hardcopy billing (regular).
PICKJOB=N
Action: Suppresses the job prompt on a multi-job system (there is no job prompt on a single job system). The bills will be generated only for your current job.
Otherwise: The job can be chosen as usual.
Affects: hardcopy billing (regular, sorted, and batch) and Michigan tc billing.
PSYCH=ALL PSYCH=FLAG
Action: Both of these will active psychiatric billing for Blue Shield. The PSYCH=ALL toggle will activate it for all procedure codes, the PSYCH=FLAG toggle will activate it just for procedure codes with an “O” in the “flags” field of the procedure code dictionary. So then it will pull the opc level from the provider’s 4th id number (DR_4TH_NO) and report it in box 24d next to the cpt.
Otherwise: It doesn’t do any of that.
Affects: hardcopy billing (regular, sorted, and batch) and Michigan tc billing.
PRINTLINK=YES
Action: Causes both the original and linked carrier information to print on a UB92 form.
Otherwise: Just the linked carrier information will print.
Affects: UB92 billing.
PT=PAY
Action: Adds the patient payment to the “amount paid” in box 29 for non-par claims.
Otherwise: The “amount paid” is just the insurance payments.
Affects: All HCFA1500 forms, except worker’s comp, regardless of where they are run from.
SAVEDR=NO
Action: Allows you to change the doctor on a claim and bill the claim without saving the change back to the claim.
Otherwise: The changed doctor number is saved to the claim.
Affects: hardcopy billing (regular, sorted, and batch) and Michigan tc billing.
SEC=BAL
Action: When doing “A” for Auto in regular hardcopy billing, it won’t pull up a secondary claim unless there’s a balance and it’s never been billed.
Otherwise: It pulls them up whether or not there’s a balance due. (unless BAL0DOE=NO toggle is set).
Affects: hardcopy billing (regular).
SIGN=N NEW!
Action: Don’t print dr’s name in box 31
Otherwise: It will print it.
Note: If the ‘F’ flag is in the HCFA_FLAGS field, it will print ‘signature on file’ whether or not this toggle is set.
Affects: All hcfa 1500 billing, excepts worker’s comp.
SORT_GRP_TO=Y NEW!
Action: Causes ‘sorted billing’ to sort carriers by the ‘grp_to’ field instead of the carrier code – if the grp_to field contains more than one character.
Otherwise: It sorts by the carrier code.
Affects: Hardcopy billing (sorted).
SPLIT=jjjj
(Put the job code in place of the ‘jjjj’)
Action: Activates Medicaid split billing for this job. (Medicaid will only be billed half of the charge amount).
Otherwise: It doesn’t do that.
Affects: Michigan tc billing.
TC=N NEW!
Action: In ‘sorted billing’, don’t bill the carriers with BS CO MR or MD in the TELCOM field if you’re not billing for a specific carrier type or group.
Otherwise: It bills them.
Affects: Hardcopy billing (sorted).
TCBYJOB=YES
Action: Causes each job to have a separate telecommunications file.
Otherwise: Each billing location has a separate telecommunications file.
Affects: Michigan tc billing.
TCCO=Y NEW!
Action: This should be set if you telecommunicate commercial claims (other than USHDI). It will then ask which commercial claims to exclude from printing.
Otherwise: It doesn’t ask unless the USHDI billing is set up.
Affects: hardcopy billing (regular, sorted, batch, and queues).
TMARGIN=xx NEW!
Action: Set the top margin of the billing forms (put the number of inches (or parts of inches) in place of the ‘xx’).
Otherwise: There is no top margin unless the EXTRATOPLF= toggle is set.
Affects: hardcopy billing (regular, sorted, and batch) only. Not worker’s comp.
Note: Will not work on systems running bbx4.
TOB=xxx
Action: Sets the ‘type of bill’ for UB92 billing. (Put the type of bill in place of the ‘xxx’).
Otherwise: See explanation box at the end of this section: ‘How type of bill on the ub form is determined’.
Affects: UB92 billing only.
UB=BOTH
Action: This actives the UB prompt in hardcopy forms. This is the prompt that says ‘1500 forms or UB92 forms’.
Otherwise: It will only do hcfa 1500 billing - unless the UB=ONLY prompt is set.
Affects: Hardcopy billing (regular, sorted, and batch).
Note: You must have either UB=BOTH or UB=ONLY toggle on in order to do UB92 billing.
UB=jjjj
(Put the job code in place of the ‘jjjj’)
Action: Activates hardcopy UB billing for this one job only. This toggle
only works if this job ONLY does UB (no hcfa forms) and no other ‘UB=’ toggles
are set.
Otherwise: UB billing is determined by the other ‘UB=’ toggles, if any.
Affects: hardcopy billing (regular, sorted, and batch).
UB=ONLY
Action: Sets regular hardcopy forms to UB92 forms only. No hcfa 1500 forms will be generated.
Otherwise: It will only do hcfa 1500 billing - unless the UB=BOTH prompt is set.
Affects: hardcopy billing (regular, sorted, and batch).
Note: You must have either UB=BOTH or UB=ONLY toggle on in order to do UB92 billing.
UBORDER=PTINFO
Action: Forces the order of the insurance carriers on the UB92 form to be in the same order that they are in patient information.
Otherwise: The carrier that made a payment is listed as the primary. If there’s no payment, the carrier being billed is listed as the primary.
Affects: UB92 billing.
UBTC=Y NEW!
Action: Set if using print images as UB92 TC. Causes extra prompt to appear when doing UB92 hardcopy forms allowing you to choose PCACE or HC. If you choose PCACE, this will print to an ascii device in append mode.
Otherwise: This prompt doesn’t appear.
Affects: UB92 billing.
Note: device PZ must be set up on your system.
USE=EXT NEW!
Action: For self-referrals, use the external provider name (from carrier-specific provider screens).
Otherwise: Uses internal provider name for self-referrals (from page 1 of provider screen).
Affects: Hardcopy billing (regular, sorted, and batch) and Michigan tc billing.
USEGRP=YES
Action: If there’s a G in the HCFA_FLAGS field of the carrier being billed, it will look up the provider’s id number based on the carrier group-to, not the carrier code.
Otherwise: Provider id is determined by an exact match on the carrier code, or, lacking that, a match on the carrier type. (If no match there, it uses the ‘CO’ information).
Affects: Hardcopy billing (regular, sorted, and batch).
VALIDDOS=Y
Action: Warning will appear if the account & date of service selected doesn’t match a valid claim.
Otherwise: There is no warning, it just pulls up the next claim in the file (will probably be for another patient).
Affects: Hardcopy billing (regular, sorted, and batch) and Michigan tc billing.
VISION=Y
Action: When doing Blue Shield billing only, it will give the option of printing on vision/hearing claim forms. (If that option is chosen, it will only bill procedures with a “V” flag).
Otherwise: It doesn’t do vision/hearing claim forms.
Affects: Hardcopy billing (regular, sorted, and batch).
2BSBG
Action: Causes regular hardcopy billing to use the ‘expected’ amount as the billed amount on the claim form when billing a carrier secondary to Blue Shield.
Otherwise: It uses the ‘billed’ amount.
Affects: Hardcopy billing (regular, sorted, and batch).
2COBG
Action: Causes regular hardcopy billing to use the ‘expected’ amount as the billed amount on the claim form when billing a carrier secondary to a commercial carrier.
Otherwise: It uses the ‘billed’ amount.
Affects: Hardcopy billing (regular, sorted, and batch).
2MRBG
Action: Causes regular hardcopy billing to use the ‘expected’ amount as the billed amount on the claim form when billing a carrier secondary to Medicare.
Otherwise: It uses the ‘billed’ amount.
Affects: Hardcopy billing (regular, sorted, batch, and queues).
6DIGITPC
Action: Forces program to use 6 character external billing codes.
Otherwise: It uses 6 character billing codes for UB92 Medicaid only; 5 character external billing codes for all other billing.
Affects: hardcopy billing (regular, sorted, and batch) and status forms.
These toggles are set under “TELALL”:
ALL=CO NEW!
Action: This toggle is only valid if USHDI billing is activated is set. Unless you’ve selected a specific carrier to bill, it will skip all CO claims.
Otherwise: It doesn’t.
Affects: Tc billing.
ALLOWAMT=Y NEW! NT Only
Action: Allows you to change paid and expected amount fields in telecommunications billing. The changes will NOT be saved on the claim, but they will be put in the telecommunications file if you add that claim to the file.
Otherwise: You can’t do that.
Affects: Michigan tc billing.
CHANGEDR=Y NEW! NT Only
Action: You can change the provider on the claim.
Otherwise: You can’t
Unix version always lets you change the dr.
Affects: Michigan tc billing.
COMPDOE=N NEW!
Action: In tc billing, will skip bs (and fep) comp claims when billing by doe.
Otherwise: It doesn’t skip them.
Affects: Michigan tc billing.
TCDOE=LASTWEEK TCDOE=LASTDAY NEW! NT Only
Action: Sets default starting doe date. LASTWEEK sets starting date of 7 days prior to system date. LASTDAY sets it to 1 business day prior to system date.
Otherwise: It defaults to 1 day prior to system date.
Ending date always defaults to 1 day prior to system date.
Affects: Michigan tc billing.
These toggles are sent under ‘PRTUB’: They affect only the UB forms.
ADDPM1=YES NEW!
Action: If the billing format is MR, it will add the first price modifier from the dictionary to the code it prints in the ‘HCPCS’ column. (column 44).
Otherwise: There are no price modifiers.
MULTIRC=Y NEW!
Action: Allows different revenue codes based on format. If an alternate revenue code is present for this format, it will use that one instead of the normal one.
Otherwise: It always uses the revenue code from field 54 of procedure dictionary.
REF=ATT NEW!
Action: Uses the referring doctor as the attending doctor.
Otherwise: That doesn’t happen.
TOBjjjj=xxx NEW!
Action: Sets the ‘type of bill’ for UB92 billing for a specific job. (Put the type of bill in place of the ‘xxx’ and put the job code in place of the ‘jjjj’)
Otherwise: See explanation box at the end of this list: ‘How type of bill on the ub form is determined’
TOBMR=xxx TOBBS=xxx TOBWK=xxx TOBMD=xxx NEW!
Action: Sets the ‘type of bill’ for UB92 billing for a specific billing format only. (Put the type of bill in place of the ‘xxx’).
Otherwise: See explanation box at the end of this list: ‘How type of bill on the ub form is determined’
How the ‘type of bill’ on the UB form is determined:
1. If you use the ‘T’ for ‘type of bill’ command (Or enter a type of bill at the ‘type of bill’ prompt for cycle billing), it will use that.
2. If not, then it will look for the format-specific type of bill set by the toggle under PRTUB: TOBMR=xxx TOBBS=xxx, etc.
3. If that doesn’t exist, then it looks for the TOBjjjj= toggle under PRTUB.
4. If that doesn’t exist, it looks for the TOB= toggle under PRTALL.
5. If that doesn’t exist, it defaults to 131.
6. In all cases, if the type of bill ends up as 13x and the AUTO141= toggle is set under PRTALL, it will change it to 14x if appropriate.