Riverbend

Direct Data Entry (DDE) FAQ

What number should we dial in order to connect to the FISS system through Riverbend?

Provider should dial 423-648-1874. (7/6/2007)

Our facility filed a claim and I cannot locate the claim in FISS.

If the claim did not pass edits in FISS the claim will Return to Provider (RTP). The status/hold location for claims that are RTP'd is T B9997. When a claim is in this location it will not continue to process until the provider either corrects the claim via Direct Data Entry (DDE) or hardcopy. If the claim is not corrected within 60 days, it will "fall off" the system. It will appear that the claim was never filed. It will be necessary to resubmit the claim in order to receive payment for the services rendered. It is important to review your claims daily and correct them in order to avoid payment delays or claims falling off the system. (7/5/2007)

Where do I find claims that are pending or processed for a particular Beneficiary?

This information is located in the inquiry portion of the system. From the main menu, chose option 01, then option 12. Enter the HIC#, to receive all the data residing on the system, both pending and paid, OR enter the HIC# and then a particular FROM DATE and TO DATE to retrieve data on a specific date of service. When the desired information is retrieved, using your tab key, place your cursor beside the HIC#, type an S to select it and press the Enter key to view the claim detail. (7/5/2007)

How do I find the narrative for the reason codes listed on my claims in claims correction?

After you have selected your desired claim the reason codes are displayed at the bottom left hand corner of your screen. Press the F1 key to obtain the reason code narrative, Press F3 to return to the claim. (7/5/2007)

When adjusting a claim, where do I locate the adjustments reason codes?

When you are within the claim to be adjusted, using your tab key, place your cursor in the "SC" field, located in the upper let side of your screen. Key a 16, and press the Enter key. This takes you to the Adjustment Reason Code screen, which will be blank. Press the enter key again and the list will display in alphabetical order. Choose the reason code that most appropriately describes your adjustment reason, (don't key anything on this screen, only view and make your selection) F3 to go back to your claim. Enter the selected reason code on page 03 of your claim in the Adjustment Reason Code field. (7/5/2007)

Where can I locate information pertaining to the checks issued to my facility?

From the main menu, key in a 01 for Inquiry, then choose Check History by selecting the FI option, depress the enter key. When the screen changes, depress the enter key again. The system will display information pertaining to the last three checks issued to you facility. (7/5/2007)

When I am in the claims correction screen, is there an easy way to access locations such as the revenue code and diagnosis code files?

Yes. If you are in claims corrections, place your cursor in the field labeled "SC" in the top left-hand corner. This is the scroll or "short cut" option. Type the option number listed on the "Inquiry Menu", i.e., 13, 14, 15, and depress the enter key. Key in the appropriate information, i.e., revenue code, diagnosis code, and depress the enter key. View the data to determine the corrections to be made to your claim. F3 back to your claim, and make appropriate corrections, F9 to update your claim. (7/5/2007)

If I am using the Direct Data Entry System to enter claims, when I F9 to update the claim and receive an error, how do I know what the error means?

Depress your F1 key to obtain the reason code narrative, just like in claims correction. After reading the error message, F3 back to the claim and make the appropriate corrections and F9 the claim again. Do this each time until all corrections are made, and the system accepts the claim. (7/5/2007)

If I need to correct the HIC number on a claim, how do I get the system to accept my changes?

Place a "Y" in the field labeled "Process New HIC" on page 1 of the claim. Your cursor will then jump to an unlabeled location to the right of the "Y" where you can enter the new HIC number. Press the F9 key to update. (7/5/2007)

What purpose does the field labeled "SV" in the upper right hand corner of my screen serve?

This field is used only in rare situations. Example, you have a claim pending on the system that you do not intend to ever be processed by Riverbend Medicare. You can place a "Y" in that location, and F9 to update. This will suppress the view of the claim. Once the view of a claim is supressed, it cannot be restored to view. (7/5/2007)

How can I access information on my claims pending for additional development requests (ADR's)?

These claims can be accessed by going into Inquiry, and selecting Option 12, "Claims". After the screen appears, tab to the "S/LOC" field and key in "SB6001". This is the location that houses all claims in an ADR status. You can select any claim you choose go to page 07 and a copy of the letter previously sent to your facility will appear on that page. This letter can only be viewed when your claim is in the "SB6001" location. If your claim does not appear in that location, your claim is no longer in the ADR status. Go to "Inquiry" and then the "Claims" options (12) to locate claims outside the "SB6001" location. (7/5/2007)

How can I check the status of a claim once Riverbend has received it?

The status can be obtained by again selecting the Inquiry option of the main menu, and then the claims option of 12. At this point, you can either key in the HIC of a particular patient along with the specific dates of service, or just depress the enter key once the HIC number is entered. That will bring up all claims pertaining to that particular HIC number. You can then select the claim and depress F1 to see the narrative of the reason code currently assigned to that claim. This status will indicate if action is necessary by you in order to get your claim processed. If the claim requires action on the part of the facility, it should be located in "TB9997" which is "claims correction". You can then go to the claims correction option, and select your claim to be corrected/processed. (7/5/2007)

When I receive a reject or denial code on a particular claim where can I locate the reject/denial code meaning to see what action I should take against the claim now?

Denial/Reject codes information is accessible through the claims inquiry screen, or the reason code database. To obtain information on these claims, go into the inquiry option of the main menu, and key in the HIC number, and the dates of service. When the claim appears on the listing, select that claim and depress the enter key. When the claim appears, there will be a code in the bottom left hand side of the screen. Depress the F1 key to obtain an explanation of the code. The narrative will also indicate any action to be taken by the provider to help get their claim reprocessed. (7/5/2007)

If I have online access to the FSS System can I find claims requiring Additional Development Requests (ADRs)?

Yes, providers can go online to make claim corrections Status Location (TB9997) and respond to medical information requests Status Location (SB6001). (7/5/2007)

How can DDE increase my cash flow?

DDE increases the cash flow to a facility by giving daily information on RTP'd (returned) claims, and access to information regarding ADR'd claims. This allows the provider to have quick access to claims situations, which warrant action by them to get their claims processed. Providers no longer have to wait for the weekly hardcopy "201" reports, as DDE shows daily claims flow, allowing providers to promptly remedy claims payment situations. (7/5/2007)

Can DDE inform me of payment information as well as claims processing information?

Yes. DDE affords you the option of viewing Check History using the FI option on the Inquiry screen, which indicates the last three checks issued to your facility. This will inform your facility of payment information, before the actual check is mailed to you. Do you want to put in here that payment data is available on page 6 of the paid claim? (7/5/2007)

What about cancels and adjustments? Can I make corrections to paid claims using DDE?

Yes. Adjustments and cancels to paid claims can be worked through the DDE system. This allows you to receive your corrected payments, or remove amounts incorrectly paid to your facility quickly. Using the DDE system to process you adjusted claims will also eliminate the need to show credit balance situation on the 835, "Credit Balance Report" as long as the adjustment or cancel is processed to finality before the credit balance report is due to Riverbend. (7/6/2007)

How can I determine why the claim was rejected?

When submitting a claim for payment, there are edits that the claim must pass in order to continue to process. When a claim encounters an edit it may be rejected. If the claim has been rejected, you may identify the reason for rejection in two ways. If your facility has access to Direct Data Entry (DDE,) you may access the reason code table or review the claim and reason code for rejection online. Sign onto DDE and select: 01 - Inquiries and then: 12 - Claims. The Claim Summary Inquiry Screen will be displayed; key in the beneficiary's HIC number and press enter. Scroll through the payment history to locate the claim, or you can narrow the scope of your search by entering the dates of service (DOS), when you enter the HIC number. Once the claim is displayed, tab down to the SEL column and key in "s" for select and press enter. The complete UB92 selected will be displayed. The reason code for rejection will be in the bottom left hand corner of the screen. Press F1 to review the narrative for the reason code.

If you have the reason code for rejection, you may review the narrative by selecting 01 - Inquiries and then 17 Reason code. Key in the reason code and press enter. The narrative assigned to the reason code will be displayed.

If your facility does not have access to Direct Data Entry (DDE) you may identify the reason code for rejection from your remittance advice (RA) in the reason code field. The description for the reason codes can be found on our website in the Tools section or accessed directly (8/15/2007)

How do I verify Hospital and/or Skilled Nursing Facility days available for the patient?

A facility can verify the days available for a beneficiary by accessing the Common Working File (CWF). You may access the CWF by entering HIQA on DDE, instead of FSS0. A screen will display prompting you to enter patient specific information into the appropriate fields. Once the fields are populated press enter. The CWF will display the beneficiary information. If the billing period has been over 60 days, benefit period days have renewed. When a claim is submitted to the Common Working File the benefit period will be updated. (7/6/2007)

How can I avoid submitting duplicate claims?

A facility can avoid submitting duplicate claims by accessing the beneficiary's claim history on Direct Data Entry. Sign onto DDE and select: 01 - Inquiries and then 12- Claims. The Claim Summary Inquiry Screen will be displayed; key in the beneficiary's HIC number and press enter. Scroll through the claim history to locate the claim. You can narrow the scope of your search by entering dates of service (DOS). If the claim has been paid the status/location will be PB 9997 and it will not be necessary to resubmit the claim.

If a facility does not have access to DDE, the facility should maintain its Remittance Advices to confirm claim payment. (7/6/2007)

Our claim has been returned to our facility for correction with reason code 19201. What does this reason code mean and how do we correct the problem?

FISS returned the claim due to an error in the physician Unique Provider Identification Number (UPIN). You should verify the correct UPIN for the attending physician. The attending physician ID and name must be present on the claim. Note: The attending physician UPIN will no longer be required for claims received on or after the NPI implementation date. However, if an attending physician UPIN is present, the UPIN will be accepted and edited accordingly under the same editing criteria that currently apply to the attending physician UPIN. (7/6/2007)

We have received reason code 32402 on several claims that have been returned to our facility for correction. How do we correct these claims?

Reason code 32402 states the claim contains an invalid revenue code. You will need to verify the correct revenue codes for the type of bill submitted by your facility. If your facility has access to Direct Data Entry (DDE) you can access a table to verify if the revenue code is acceptable under your type of bill. If you are using DDE you will choose 01-Inquiries; 13-Revenue codes and key in the revenue code you are researching. After pressing the enter key the table will be displayed. Scroll through the table to identify if the revenue code is applicable to your type of bill. (7/6/2007)

Our facility has had claims returned for reason code 19202. What do we need to do to fix this problem?

The claim has received 19202 because there is an error with the physician's UPIN or name. The physician's UPIN is alpha numeric and either one or both are not correct. If your facility is using a surrogate UPIN, you will need to ensure you are using a valid code. The following are the valid codes: INT, RES, VAD, PHS, OTH, SLF and RET. The code NPP is not a valid UPIN. (7/6/2007)

How do we correct our claims that are in the Returned To Provider (RTP) location through Direct Data Entry (DDE)?

There has been a modification within the FISS system that changes the way providers can update revenue code line data via Direct Data Entry (DDE) in order to correct claims that have been RTP'd. Providers can no longer simply revise data on a revenue code line (i.e. units, HCPCS, charges) and resubmit. Effective immediately, providers wishing to modify a revenue code line via DDE on a claim that has been RTP'd must follow the following procedure. 1. List item 1 Place a D, in the first position of the revenue code line that is to be changed. 2.Press Home 3.Press Enter 4.Go below the 0001 Revenue Code and key the total revenue code line with the changes. 5.Once the claim is ready for submission, press F9. The purpose of this change is to ensure that all revenue code line changes are made subject to the full series of edits, such as the Outpatient Code Editor. (7/6/2007)