1. Manage Facilities (Block 24B and Block 32 and Statement 'Remit Payment To' Address)
Tools -> Manage Facilities
Setup Facility Details
Steps 1-5 identifies the Place of Service-Block 32
1. The commonly known Facility Name.
2. Legal Name of the facility. (block 32)
3. Physical address of the facility. (block 32)
4. City, State and Zip of the facility. You must include 9 digit Zip Code (Block 32)
5. Clinic Phone number.
6. NPI number assigned to the facility. (Block 32a)
7. Place of Service this selection specifies the code that is placed on claims (Block 24B) identifying the type of facility.
8. Phone number for Billing Inquiries. This number will appear on Patient Statements, Receipts, etc. for billing questions
9. Clinic CLIA number
10. State License Number
11. Press Update to save
When filing electronic claims for home visits, the 5010 format requires the patient's address as the Place of service. Gateway EDI will plug the patient's address into the file when they see that Place of Service code 12. Certain fields in the Facility Manager will have to be completed in order for claims with home visits to pass the scrubbing process in the Claims Manager, even though that information will not be included in the Electronic file. Simply typing 'Home' in the required fields will allow claims to pass the scrubber.
1. Type Home or any name for the Facility. (This name will be listed in the drop down options for facility selection).
2. Add Full Legal Name-Home
3. Add Street-Home
4. Enter City-Home
5. State-2 digit State abbreviation
6. Zip-5-9 digit zip code
7. Add Place of Service Home-12. This place of service will prompt Gateway EDI to add the patient's address as the Place of Service to the claim file.
Remaining fields can be left blank.
Add Return Address for Patient Statements/Remit Payment To Address
Remit Payment To drop down list in the Statement Processing/Reports-Statements feature is built by adding facilities/places of service to Manage Facilities. A separate facility can be added if patient payments are to be sent to a post office or lock box, instead of the facility street address. The next step shows an example of a printed statement when selecting the facility in this step to remit payment to.
Note: If uploading electronic statement files to TriZetto, do not add a second address line in the setup. The second line will not be pulled onto the statement in the print process, resulting in mail returns if the second line is a necessary part of the mailing address.
Facility Scheduler Tab
This is the location for the functional details of facilities in the Scheduler. Three main sections here: Provider/Resource Management, Business Hours Management, and Facility Closings.
In this area, should be a list of licensed providers for the site. If a provider is not already in this list, the provider likely does not have a license to the Scheduler. This area is the location to actually activate the providers/resources that will be using the Facility.
Business Hours Management
This section allows the working hours for the Provider/Resource to be set for the facility. If the user has multiple facilities, among which a Providers/Resource travel, set the days and hours that each will be working at each facility each week. These times that are set up will then be available for scheduling for each Provider/Resource.
Block off the days the clinic will not be open to see patients, or is closed entirely for holidays, etc. Notice this section applies to the overall facility regardless of the provider. To set up a new closing, Click the Add Closing button (with the green plus sign).
Facility Additional IDs Tab
Add ID numbers for Service Facility if Insurance company requires these in addition to Facility NPI.
Note: Leave blank unless specific payers require this information.
1. Click on Additional IDs tab.
2. Click Add icon (green plus) and select the insurance company from the list (Tools->Insurance Companies)
3. Enter additional ID numbers.
4. Click Okay.
Repeat for additional Payers only if required.
5. Click to edit information.