XEROX 06D-Reference 2wind-A



6.2 Reference Subsystem Online Functionality

The online functional groups of the Reference Subsystem are:

Claim Exception Code Functional Group

Diagnosis Code Functional Group

DRG Functional Group

PA Exception Code Functional Group

Parameter Reporting Functional Group

Procedure Code Functional Group

Revenue Code Functional Group

ICD Surgical Procedure Functional Group

o Pharmacy Functional Group

o Drug Code Functional Group

o Drug Labeler Functional Group

o Rates Functional Group

o Rate ASC Grouper/ASC Region Functional Group

o Rate Procedure Code/Special Procedure Pricing Group

o Rate Revenue Code/Provider Number Functional Group

o Rate Institutional Provider Number/Major Program Functional Group

o Rate Revenue Code/Major Program Functional Group

o Rate Revenue Code/Provider Type Functional Group

o Rate Tax Functional Group

o Rate Procedure Code Pricing Matrix Functional Group

o Procedure Modifier Functional Group

o National Correct Coding Initiative (NCCI) Edits Functional Group

o Text Functional Group

o Text Location Code Functional Group

o Text PA Reason Code Functional Group

o Text EOMB Functional Group

o Text RA EOB Code Functional Group

o Text RA Newsletter Provider Type Functional Group

o Utilization Review Functional Group

o UR Medical Criteria Procedure Code Functional Group

o UR Medical Limit Parameter Number Functional Group

o UR Medical Contra Parameter Number Functional Group

o UR Diagnosis List Number Functional Group

o UR Procedure List Number Functional Group

o UR Benefit Limit Code Functional Group

o UR Cap Limit Code Functional Group

Each functional group is discussed separately, beginning on the following page.

6.2.1 Claim Exception Code Functional Group

This functional group captures and displays information for Reference Claim Exception Code.

The following table presents the GOTO navigation capabilities for the functional group. For each GOTO option in the functional group, the following information is identified: the subsystem and functional group navigated to when the GOTO option is selected, the window field used as the key field for the GOTO functional group, and the window name where the key field resides (if appropriate).

|GOTO Subsystem |GOTO Functional Group |Window Field |Window |

|None |None |None |None |

The following windows are used by the Claim Exception Code functional group:

o Claim Exception Code Selection

o Main Tab Page

o Disposition Tab Page

o Resolution Tab Page

The following data is displayed in the title bar of all windows (except search/selection windows) in this functional group:

o Claim Exception Code: [Exception Code]

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WINDOW SPECIFICATION

CLAIM EXCEPTION CODE FUNCTIONAL GROUP

CLAIM EXCEPTION CODE SELECTION WINDOW

|Window Name: W_REF_CLM_EXC_SEARCH |

|Description: |

|The Claim Exception Code Selection Window is the primary window to add or select Claim Exceptional Code data maintained in the Reference Subsystem. The claims exception code is the key field |

|within the Claim Exception Code database. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|Exception Code |

|Remarks: |

|N/A |

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CLAIM EXCEPTION CODE FUNCTIONAL GROUP

CLAIM EXCEPTION CODE SELECTION WINDOW

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CLAIM EXCEPTION CODE FUNCTIONAL GROUP

CLAIM EXCEPTION CODE SELECTION WINDOW

| |

|Field Name |

|Description: |

|The Main Tab Page includes the exception code descriptions, begin and end dates, adjudicated EOB codes, suspense EOB codes, Claim Routing Locations, and Suspense Routing Location. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|N/A |

|Remarks: |

|N/A |

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CLAIM EXCEPTION CODE FUNCTIONAL GROUP

MAIN TAB PAGE

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CLAIM EXCEPTION CODE FUNCTIONAL GROUP

MAIN TAB PAGE

| |

|Field Name |

|Description: |

|The Disposition Tab Page is used to specify the exception code status by media type, document type, and major program. All valid combinations from the disposition driver table will appear on |

|this window, with the user making a selection to view and update the associated disposition settings. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|Major Program, Document Type, Media Type |

|Remarks: |

|N/A |

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CLAIM EXCEPTION CODE FUNCTIONAL GROUP

DISPOSITION TAB PAGE

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CLAIM EXCEPTION CODE FUNCTIONAL GROUP

DISPOSITION TAB PAGE

| |

|Field Name |

|Description: |

|The Resolution Tab Page is used to specify the Claim Exception Resolution Text. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|N/A |

|Remarks: |

|N/A |

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CLAIM EXCEPTION CODE FUNCTIONAL GROUP

RESOLUTION TAB PAGE

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CLAIM EXCEPTION CODE FUNCTIONAL GROUP

RESOLUTION TAB PAGE

| |Table | | |

|Field Name |Column Name |Table Name |Format |

|None |None |None |None |

The following windows are used by the Diagnosis Code functional group:

o Diagnosis Code Selection

o Diagnosis Code Page

The following data is displayed in the title bar of all windows (except search/selection windows) in this functional group:

o Diagnosis Code: [Diagnosis Code]

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WINDOW SPECIFICATION

DIAGNOSIS CODE FUNCTIONAL GROUP

DIAGNOSIS CODE SELECTION WINDOW

|Window Name: R_REF_DIAG_SEARCH |

|Description: |

|The Diagnosis Code Selection Window is the primary window used to add or select diagnosis code data maintained in the Reference Subsystem. The diagnosis code is the key fields within the |

|diagnosis database. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|Diagnosis Code |

|Remarks: |

|N/A |

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DIAGNOSIS CODE FUNCTIONAL GROUP

DIAGNOSIS CODE SELECTION WINDOW

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DIAGNOSIS CODE FUNCTIONAL GROUP

DIAGNOSIS CODE SELECTION WINDOW

| |

|Field Name |

|Description: |

|The Diagnosis Code Page Window displays the information maintained within the Reference Subsystem for diagnosis codes. This window contains the indicators required by Claims Processing to |

|limit services by diagnosis code. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|N/A |

|Remarks: |

|N/A |

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DIAGNOSIS CODE FUNCTIONAL GROUP

DIAGNOSIS CODE PAGE WINDOW

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DIAGNOSIS CODE FUNCTIONAL GROUP

DIAGNOSIS CODE PAGE WINDOW

| |

|Field Name |

|ICD-9-CM Code Format |ICD-10-CM Code Format |

|[pic] |[pic] |

|Comparing ICD-9-CM and ICD-10-CM |

|ICD-10-CM differs from ICD-9-CM in its organization and structure, code composition, and level of detail. |

|ICD-9-CM diagnosis code |ICD-10-CM diagnosis code |

|Consists of three to five characters |Consists of three to seven characters |

|First digit is numeric or alpha (E or V) |First digit is alpha |

|Second, third, fourth, and fifth digits are numeric |All letters used except U |

|Always at least three digits |Second digit is numeric |

|Decimal placed after the first three characters |Third, fourth, fifth, sixth, and seventh digits can be alpha or |

| |numeric |

| |Decimal placed after the first three characters |

6. The Pregnancy Indicator cannot be checked if the Sex field is “Male”.

7. ICD-9 can only be selected if the Effective End Date is less than the ICD-10 Effective Date on System Parameter 5050. ICD-10 can only be selected if the Effective Start Date is on or after the ICD-10 Effective Date on System Parameter 5050.

8. If the version code entered is ‘09’ and the end-date in the span is > the ICD-10 effective date maintained on System Parameter 5050, an error message is displayed and the entry is not saved. If the version code entered is ‘10’ and the end-date in the span is < the ICD-10 effective date maintained on System Parameter 5050, an error message is displayed and the entry is not saved.

__________________________________________________________________________________________________________________________________

LEGEND: For Prot and Req: A = Always For Std Edits: D = Date Edit V = Valid Value Edit

C = Conditionally N = Numeric Edits S = System Generated

N = Never

6.2.3 DRG Functional Group

This functional group captures and displays information for Reference Diagnosis Related Groups (DRG).

The following table presents the GOTO navigation capabilities for the functional group. For each GOTO option in the functional group, the following information is identified: the subsystem and functional group navigated to when the GOTO option is selected, the window field used as the key field for the GOTO functional group, and the window name where the key field resides (if appropriate).

|GOTO Subsystem |GOTO Functional Group |Window Field |Window |

|None |None |None |None |

The following windows are used by the DRG functional group:

o DRG Code Selection

o DRG Code Page

The following data is displayed in the title bar of all windows (except search/selection windows) in this functional group:

o DRG Code: [DRG Number]

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WINDOW SPECIFICATION

DRG FUNCTIONAL GROUP

DRG CODE SELECTION WINDOW

|Window Name: W_REF_DRG_SEARCH |

|Description: |

|The DRG Code Selection Window is the primary window to add or select Diagnosis Related Groups (DRG) data maintained in the Reference Subsystem. The DRG Number is the key field within the DRG |

|database. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|DRG Number |

|Remarks: |

|N/A |

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DRG FUNCTIONAL GROUP

DRG CODE SELECTION WINDOW

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DRG FUNCTIONAL GROUP

DRG CODE SELECTION WINDOW

| |

|Field Name |

|Description: |

|The DRG Code Page Window contains the pricing information for DRG codes that are utilized by Claims Processing to edit and price claims that require DRG pricing. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|Begin Date, End Date |

|Remarks: |

|N/A |

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DRG FUNCTIONAL GROUP

DRG CODE PAGE WINDOW

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DRG FUNCTIONAL GROUP

DRG CODE PAGE WINDOW

| |Table | | |

|Field Name |Column Name |Table Name |Format |

|None |None |None |None |

The following windows are used by the PA Exception Code functional group:

o PA Exception Code Selection

o Main Tab Page

o Disposition/Resolution Text Tab Page

The following data is displayed in the title bar of all windows (except search/selection windows) in this functional group:

o PA Exception Code: [Exception Code]

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WINDOW SPECIFICATION

PA EXCEPTION CODE FUNCTIONAL GROUP

PA EXCEPTION CODE SELECTION WINDOW

|Window Name: W_REF_AUTH_EXC_SEARCH |

|Description: |

|The PA Exception Code Selection Window is the primary window to add or select PA Exceptional Control data maintained in the Reference Subsystem. The PA exception code is the key field within |

|the PA Exception Control database. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|Exception Code |

|Remarks: |

|N/A |

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PA EXCEPTION CODE FUNCTIONAL GROUP

PA EXCEPTION CODE SELECTION WINDOW

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PA EXCEPTION CODE FUNCTIONAL GROUP

PA EXCEPTION CODE SELECTION WINDOW

| |

|Field Name |

|Description: |

|The Main Tab Page includes the exception code descriptions, begin and end dates. Disposition and Resolution Text data can be updated using window tabs. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|N/A |

|Remarks: |

|N/A |

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PA EXCEPTION CODE FUNCTIONAL GROUP

MAIN TAB PAGE

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PA EXCEPTION CODE FUNCTIONAL GROUP

MAIN TAB PAGE

| |

|Field Name |

|Description: |

|The Disposition/Resolution Tab Page is used to specify the exception code status by PA type. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|Authorization Type |

|Remarks: |

|N/A |

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PA EXCEPTION CODE FUNCTIONAL GROUP

DISPOSITION/RESOLUTION TAB PAGE

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PA EXCEPTION CODE FUNCTIONAL GROUP

DISPOSITION/RESOLUTION TAB PAGE

| |Table | | |

|Field Name |Column Name |Table Name |Format |

|None |None |None |None |

The following windows are used by the Parameter Reporting functional group:

o Parameter Reporting Selection

o Parameter Reporting User ID Request Number Page – based on the user’s selection from the Report Selection Tree, the following list of reports determines what information appears on the window:

o Procedure Code Report

o Selective Drug Code Report

o Rates Report

o Diagnosis Code Report

The following data is displayed in the title bar of all windows (except search/selection windows) in this functional group:

• Parameter Reporting: [User ID] [Request Number]

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PARAMETER REPORTING FUNCTIONAL GROUP

PARAMETER REPORTING SELECTION WINDOW

|Window Name: W_REF_PARAM_RPT_SEARCH |

|Description: |

|The Parameter Reporting Selection Window is the primary window to add or select report request data maintained in the Reference Subsystem. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|User ID |

|Remarks: |

|N/A |

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PARAMETER REPORTING FUNCTIONAL GROUP

PARAMETER REPORTING SELECTION WINDOW

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PARAMETER REPORTING FUNCTIONAL GROUP

PARAMETER REPORTING SELECTION WINDOW

| |

|Field Name |

|Description: |

|The Parameter Reporting User ID Request Number Page Window is a detail window used to select Reference Subsystem parameter reports. Any report title listed in the tree view with a blue report|

|icon may be further customized with additional parameter selections made to the right section of the window. Reports with red report icons do not have additional parameters for the user to |

|select from. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|N/A |

|Remarks: |

|N/A |

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REPORT SELECTION TREE LAYOUT

PARAMETER REPORTING FUNCTIONAL GROUP

PARAMETER REPORTING USER ID REQUEST NUMBER PAGE WINDOW

-Procedure Group

-Procedure Code Group

HCPCS RR219 – Procedure Code Report *

ICD Surgical RR230 – ICD Surgical Code Report *

-Revenue Group

Inpatient RR229 – Revenue Code Report *

Outpatient RR229 – Revenue Code Report *

Long Term Care RR229 – Revenue Code Report *

-Current Fee Schedule Group

HCPCS RR028 – Current Fee Schedule *

-Revenue Group

Inpatient RR028 – Current Fee Schedule *

Outpatient RR028 – Current Fee Schedule *

Long Term Care RR028 – Current Fee Schedule *

-Selective Procedure Code Group

HCPCS RR044 – Selective Procedure Code Report *

-Revenue Group

Inpatient RR044 – Selective Procedure Code Report *

Outpatient RR044 – Selective Procedure Code Report *

Long Term Care RR044 – Selective Procedure Code Report *

-Exception Control Group

Claim File List RR165 – Claim Exception Control File List

Claim Summary List RR033 – Claim Exception Control File Listing

Prior Auth File List RR051 – PAR Exception Control File Listing

Prior Auth Summary List RR035 – PAR Exception Control Summary Listing

Claim Code List RR240 – Claim Exception Code List

-Drug Group

Selective Drug Code RR030 – Selective Drug Code Report *

-DRG Group

DRG Code RR047 – DRG Code Report

Pricing History RR042 – DRG Pricing History Report

Current Pricing Segment RR043 – DRG Current Pricing Segment Report

-Text Group

Claim Exception Resolution RR026 – Text File Report

Claim Remit Advice EOB RR026 – Text File Report

PA Exception Resolution RR026 – Text File Report

Location RR026 – Text File Report

RA Newsletter RR026 – Text File Report

Explanation of Med Benefits RR026 – Text File Report

PA Reason Code RR026 – Text File Report

-Rates Group

Rates RR025 – Rates Report *

Provider Current Rate File RR049 – Provider Current Rates File List

-Other Group

Diagnosis Code RR220 Diagnosis Code Report *

Prepay UR Criteria RR028 Prepay U/R Criteria File Report

* = Additional Parameters Available for Report.

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PARAMETER REPORTING FUNCTIONAL GROUP

PARAMETER REPORTING USER ID REQUEST NUMBER PAGE WINDOW

PROCEDURE CODE REPORT

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PARAMETER REPORTING FUNCTIONAL GROUP

PARAMETER REPORTING USER ID REQUEST NUMBER PAGE WINDOW

PROCEDURE CODE REPORT

| |Table | | |

|Field Name |Column Name |Table Name |Format |

|Reference |Rate Procedure Special Pricing |Procedure Code |Special Procedure Pricing |

The following windows and tab pages are used by the Procedure Selection functional group:

o Procedure Code Selection

o Main Tab Page

o Dtl - Data List Tab Page

o Dtl -Incl/Excl Tab Page

o Provider Data Tab Page

o Pricing Tab Page

o HCPCS Text Tab Page

o EPSDT Tab Page

Update and inquiry access is determined for each session by the presence or absence of a check mark in the Inquiry Only check box on the MMIS Control Panel window. When in inquiry mode, all window fields, arrow buttons, and Add/Update/Delete push buttons are protected from use.

The following data is displayed in the title bar of all windows (except selection windows) in this functional group:

• Procedure Code: [Procedure Code]

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WINDOW SPECIFICATION

PROCEDURE CODE FUNCTIONAL GROUP

PROCEDURE CODE SELECTION WINDOW

|Window Name: W_REF_PROC_SEARCH |

|Description: |

|The Procedure Code Selection Window is the primary window to add or select procedure code data maintained in the Reference Subsystem. Procedure code is the key field within the procedure |

|database. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|Procedure Code |

|Remarks: |

|N/A |

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PROCEDURE CODE FUNCTIONAL GROUP

PROCEDURE CODE SELECTION WINDOW

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PROCEDURE CODE FUNCTIONAL GROUP

PROCEDURE CODE SELECTION WINDOW

| |

|Field Name |

|Description: |

|The Main Tab Page is the first tab page displayed within the procedure code series of tab pages. Other procedure code tab pages are accessed through the tab function. This tab page displays |

|primary switches and indicators used by the MMIS to determine if a service is covered and under what circumstances. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|N/A |

|Remarks: |

|N/A |

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PROCEDURE CODE FUNCTIONAL GROUP

MAIN TAB PAGE

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PROCEDURE CODE FUNCTIONAL GROUP

MAIN TAB PAGE

| |

|Field Name |

|Description: |

|DTL – Data List Tab Page contains additional fields relevant to procedure codes. The Lab Classification, Medicare Coverage, Second Surgical Opinion, and ASC Grouper data is maintained using |

|this window. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s) for Lab Classification: |

|Descending by Begin Date |

|Presentation Sequence(s) for CLIA Type: |

|Descending by Begin Date |

|Presentation Sequence(s) for Medicare Coverage: |

|Descending by Begin Date |

|Presentation Sequence(s) for ASC Grouper: |

|Descending by Begin Date |

|Presentation Sequence(s) for Second Surgical Opinion: |

|Descending by Begin Date |

|Remarks: |

|N/A |

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PROCEDURE CODE FUNCTIONAL GROUP

DTL - DATA LIST TAB PAGE

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PROCEDURE CODE FUNCTIONAL GROUP

DTL - DATA LIST TAB PAGE

| |

|Field Name |

|Description: |

|The Incl/Excl Tab Page displays former procedure code data that is updated during the annual HCPCS procedure code batch update process. Procedure Modifier, Claim Type and Tooth Number or |

|Oral Cavity data is maintained using this window. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s) for Procedure Modifier: |

|Procedure Modifier |

|Presentation Sequence(s) for Claim Type: |

|Claim Type |

|Presentation Sequence(s) for Tooth Number: |

|Tooth Number |

|Presentation Sequence(s) for Oral Cavity: |

|Oral Cavity |

|Remarks: |

|N/A |

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PROCEDURE CODE FUNCTIONAL GROUP

DTL – INCL/EXCL TAB PAGE

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PROCEDURE CODE FUNCTIONAL GROUP

DTL – INCL/EXCL TAB PAGE

| |

|Field Name |

|Description: |

|The Procedure Code Provider Tab Page displays former provider data that is updated during the annual HCPCS procedure code batch update process. Provider Type, Provider Specialty and Place of |

|Service data is maintained using this window. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s) for Provider Type: |

|Provider Type |

|Presentation Sequence(s) for Provider Specialty: |

|Provider Specialty |

|Presentation Sequence(s) for Place of Service: |

|Place of Service |

|Remarks: |

|N/A |

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PROCEDURE CODE FUNCTIONAL GROUP

PROVIDER DATA TAB PAGE

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PROCEDURE CODE FUNCTIONAL GROUP

PROVIDER DATA TAB PAGE

| |

|Field Name |

|Description: |

|The Pricing Tab Page is used to display up to sixty date-sensitive pricing segments for each procedure and revenue code. These segments include the factor code, maximum units, and pricing |

|source fields. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|Descending by Begin Date |

|Remarks: |

|N/A |

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PROCEDURE CODE FUNCTIONAL GROUP

PRICING TAB PAGE

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PROCEDURE CODE FUNCTIONAL GROUP

PRICING TAB PAGE

| |

|Field Name |

|Description: |

|The HCPCS Text Tab Page displays the HCPCS text from the annual HCPCS procedure code update tape for all HCPCS procedure code records. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|N/A |

|Remarks: |

|N/A |

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PROCEDURE CODE FUNCTIONAL GROUP

HCPCS TEXT TAB PAGE

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PROCEDURE CODE FUNCTIONAL GROUP

HCPCS TEXT TAB PAGE

| |

|Field Name |

|Description: |

|The EPSDT Tab Page contains Early Periodic Screening, Diagnosis, and Treatment related data. The checkbox is set if the procedure is EPSDT. Immunization and screening data is optional. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|Min Age (Months), Max Age (Months) |

|Remarks: |

|N/A |

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PROCEDURE CODE FUNCTIONAL GROUP

EPSDT TAB PAGE

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PROCEDURE CODE FUNCTIONAL GROUP

EPSDT TAB PAGE

| |Table | | |

|Field Name |Column Name |Table Name |Format |

|Reference |Rate Revenue Code/ Provider Number |Revenue Code |Rate Revenue Code/ Provider |

| | |Revenue Type |Nbr |

The following windows are used by the Revenue Code functional group:

o Revenue Code Selection

o Main Tab Page

o Include/Exclude Tab Page

The following data is displayed in the title bar of all windows (except search/selection windows) in this functional group:

1. Revenue Code: [Revenue Code]

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WINDOW SPECIFICATION

REVENUE CODE FUNCTIONAL GROUP

REVENUE CODE SELECTION WINDOW

|Window Name: W_REF_REV_SEARCH |

|Description: |

|The Revenue Code Selection Window is the primary window to add or select revenue code data maintained in the Reference Subsystem. The Revenue code and Revenue Type are the key fields within |

|the Revenue database. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|N/A |

|Remarks: |

|N/A |

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REVENUE CODE FUNCTIONAL GROUP

REVENUE CODE SELECTION WINDOW

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REVENUE CODE FUNCTIONAL GROUP

REVENUE CODE SELECTION WINDOW

| |

|Field Name |

|Description: |

|The Main Tab Page is the first tab displayed within the revenue code series of windows. Other revenue code windows are accessed through the tab function. This window displays primary |

|switches and indicators that are used by the MMIS to determine if a service is covered and under what circumstances. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|N/A |

|Remarks: |

|N/A |

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REVENUE CODE FUNCTIONAL GROUP

MAIN TAB PAGE

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REVENUE CODE FUNCTIONAL GROUP

MAIN TAB PAGE

| |

|Field Name |

|Description: |

|The Include/Exclude Tab Page displays the restrictions for Provider Type, Provider Specialty and Type of Bill. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s) for Provider Type: |

|Provider Type |

|Presentation Sequence(s) for Provider Specialty: |

|Provider Specialty |

| Presentation Sequence(s) for Type of Bill: |

|Type of Bill |

|Remarks: |

|N/A |

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REVENUE CODE FUNCTIONAL GROUP

INCLUDE/EXCLUDE TAB PAGE

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REVENUE CODE FUNCTIONAL GROUP

INCLUDE/EXCLUDE TAB PAGE

| |Table | | |

|Field Name |Column Name |Table Name |Format |

|None |None |None |None |

The following windows are used by the ICD Surgical Procedure functional group:

o ICD- Surgical Procedure Selection

o ICD- Surgical Procedure Page

The following data is displayed in the title bar of all windows (except search/selection windows) in this functional group:

o ICD- Code: [ICD Code]

NEW MEXICO OMNICAID MMIS REFERENCE SUBSYSTEM

WINDOW SPECIFICATION

ICD SURGICAL PROCEDURE FUNCTIONAL GROUP

ICD SURGICAL PROCEDURE SELECTION WINDOW

|Window Name: W_REF_ICD9_SEARCH |

|Description: |

|The ICD Sugical Procedure Selection Window is the primary window to add or select ICD surgical procedure data maintained in the Reference Subsystem. ICD Surgical Procedure Code is the key |

|field within the ICD database. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|ICD Code |

|Remarks: |

|N/A |

NEW MEXICO OMNICAID MMIS REFERENCE SUBSYSTEM

WINDOW LAYOUT

ICD SURGICAL PROCEDURE FUNCTIONAL GROUP

ICD SURGICAL PROCEDURE SELECTION WINDOW

[pic]

NEW MEXICO OMNICAID MMIS REFERENCE SUBSYSTEM

WINDOW EXHIBIT

ICD SURGICAL PROCEDURE FUNCTIONAL GROUP

ICD SURGICAL PROCEDURE SELECTION WINDOW

| |

|Field Name |

|Description: |

|The ICD Surgical Procedure Page Window displays primary switches and indicators that are used by the MMIS to determine if a service is covered and under what circumstances. |

|Special Security Requirements: |

|N/A |

|Presentation Sequence(s): |

|Begin Date, End Date, ICD Code, Grouper Number |

|Remarks: |

|N/A |

NEW MEXICO OMNICAID MMIS REFERENCE SUBSYSTEM

WINDOW LAYOUT

ICD SURGICAL PROCEDURE FUNCTIONAL GROUP

ICD SURGICAL PROCEDURE PAGE WINDOW

[pic]

NEW MEXICO OMNICAID MMIS REFERENCE SUBSYSTEM

WINDOW EXHIBIT

ICD SURGICAL PROCEDURE FUNCTIONAL GROUP

ICD SURGICAL PROCEDURE PAGE WINDOW

| |

|Field Name |

|ICD-10-PCS Code Format |

|[pic] |

|ICD-9-CM procedure code |ICD-10-PCS procedure code |

|Consists of three to four numeric characters |Consists of seven alphanumeric characters |

|Decimal placed after the first three characters |All numbers 0-9 and letters A-Z used, except O and I to avoid |

| |confusion with 0 and 1 |

| |Letter Z is used as a placeholder when a particular position is not|

| |applicable. |

| |Decimal is no longer used |

1. ICD-9 can only be selected if the Effective End Date is less than the ICD-10 Effective Date on System Parameter 5050. ICD-10 can only be selected if the Effective Start Date is on or after the ICD-10 Effective Date on System Parameter 5050. If the version code entered is ‘09’ and the end-date in the span is > the ICD-10 effective date maintained on System Parameter 5050, an error message is displayed and the entry is not saved. If the version code entered is ‘10’ and the end-date in the span is < the ICD-10 effective date maintained on System Parameter 5050, an error message is displayed and the entry is

2. Maximum age must be greater than minimum age.

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LEGEND: For Prot and Req: A = Always For Std Edits: D = Date Edit V = Valid Value Edit

C = Conditionally N = Numeric Edits S = System Generated

N = Never

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