Intellect™
CHARGES MENU OPTIONS
DME Encounter
This menu option is used to post additional claim information needed to process a patient’s claim for Durable Medical Equipment. Proper submission of data from this screen for electronic billing requires a procedure Utility --►Procedure <Status> = 'O' or 'D' to be posted with the encounter number attached.
DME is covered under Part B as a medical or other health service (§1861(s)(6) of the Social Security Act [the Act]) and is equipment that:
a. Can withstand repeated use,
b. Is primarily and customarily used to serve a medical purpose,
c. Generally is not useful to a person in the absence of an illness or injury; and
d. Is appropriate for use in the home.
All requirements of the definition must be met before an item can be considered to be durable medical equipment.
See instructions to add encounter information to a patient’s account.
Updates:
Effective version 16.05.20
In prior versions, for the Internal Control Number (ICN) to be included in the Electronic Claims, the ICN had to be entered in the <Internal Control> field. Effective this version, Intellect now pulls the ICN number from the charge. This is handled by Intellect when auto-posting is used to post payments from the payers. This modification is NOT retroactive. Additionally, this ICN now also prints on the printer EOB from Intellect.
Effective version 14.07.01
When Intellect looks for a Referring Provider (a.k.a. ordering physician), Intellect first looks at the encounter screen for either <Ordering Provider> or <Supervising Provider> and, when either is blank, Intellect looks at the Utility --►Set Up --►Parameter <Referring> setting and pulls the referring provider based on the setting.
Effective Version 9.12.27
For clients who complete most of the Encounter screen fields with the same values for each patient, version 9.12.27 allows a 'default' record to be set up with the value to be carried over to all new Encounters.
To set up a default screen, go to Charges --►Encounter. Select the type of Encounter screen the office uses (the sample below is for Generic Encounter), then select Modify. At the <Patient Account No> field, enter 0 (zero). At the <Encounter #> field, enter 0 (zero).
Complete any field to default to all new Encounters entered.
Setting up the default encounter screen does NOT affect any encounters already entered.
1. To add encounter information to a patient’s account in Intellect, go to Charges --► Encounter --►DME --►Add
The Add DME screen displays:
2. Patient’s Account No 
2.1 When not already displayed, type the patient’s account number.
2.2 Enter the account number, OR type up to 6 characters of the last name and press the [F2] key. To select the code from the list, either highlight the record and press the [Enter] key, OR double-click on the record.
3. Patients Name 
3.1 The patient’s name is displayed. This is a read-only field and may not be accessed.
3.2 The display is formatted Last, First.
4. Encounter # 
4.1 This number is assigned automatically when adding a new record.
4.2 This number is used to individually display and identify this encounter.
5. Encounter Description 
5.1 Type a meaningful description for this encounter.
6. Origin Address 
6.1 Not used for DME Encounter. Leave blank
7. Origin Zip 
7.1 Not used for DME Encounter. Leave blank.
8. City 
8.1 Not used for DME Encounter. Leave blank.
9. State 
9.1 Not used for DME Encounter. Leave blank.
10.1 Type the authorization number given by insurer for this treatment.
10.2 Intellect completes Box 23 on the CMS 1500 form with this number.
Or, when used for electronic claims submission, Loop 2300 REF*G*1.
11. Authorized Visits Left 
11.1 Enter the <Total Authorized Visits> minus the number of visits that have taken place.
11.2 This value is displayed in the Charges --►Charge <Visit No> field.
12. Total Authorized Visits 
12.1 This is informational only. Enter the total visits as authorized by the insurer.
13. Related: Accident (A/O/N) 
13.1 Indicate whether or not this treatment is related to an accident.
13.2 Select the default 'N' if it is not related to an accident.
13.3 Select 'A' for an automobile accident. Selecting 'A' places an 'X' in Box 10b Yes on the CMS 1500 form, and also places the resident state code in <Place> (see screen save below)
13.4 Select 'O' for another type of accident. Selecting 'O' places an 'X' in Box 10c Yes on the CMS 1500 form:
Electronic claims submission Loop 2300 CLM11 - 1 through CLM11 - 3:
AA Auto Accident
AB Abuse
AP Another Party Responsible
EM Employment
OA Other Accident
Note: When rebilling claims to indicate corrected claims or replacement claims with internal control numbers, this field may not be left blank -- a selection must be made. In addition, make sure to enter the proper <Internal Control> number on this screen.
14.1 Electronic claim submission first condition indicator. Code(s) used to identify condition(s) relating to this bill or relating to the patient. Loop 2400 CRC03 'Conditions Indicator.'
14.2 To view the list of codes with descriptions press the [F2] key. To view the list of only the codes either click on the arrow, OR press the → (right arrow) on the keyboard. To select, double-click on the correct code, OR use the ↑ (up) and ↓ (down) arrows to highlight the correct code, and then press the [Enter] key to select.
15. Condition Indicator2 
15.1 Enter an electronic claim submission second indicator if necessary: Loop 2400 CRC04 'Conditions Indicator'.
15.2 To view the list of codes with descriptions press the [F2] key. To view the list of only the codes either click on the arrow, OR press the → (right arrow) on the keyboard. To select, double-click on the correct code, OR use the ↑ (up) and ↓ (down) arrows to highlight the correct code, and then press the [Enter] key to select.
15.3 See <Condition Indicator 1> above for a list of valid choices.
16. Condition Indicator3 
16.1 Enter an electronic claim submission third indicator if necessary: Loop 2400 CRC05 'Conditions Indicator.'
16.2 To view the list of codes with descriptions press the [F2] key. To view the list of only the codes either click on the arrow, OR press the → (right arrow) on the keyboard. To select, double-click on the correct code, OR use the ↑ (up) and ↓ (down) arrows to highlight the correct code, and then press the [Enter] key to select.
16.3 See <Condition Indicator 1> above for a list of valid choices.
17. Condition Indicator4 
17.1 Enter an electronic claim submission fourth indicator if necessary: Loop 2400 CRC06 'Conditions Indicator'.
17.2 To view the list of codes with descriptions press the [F2] key. To view the list of only the codes either click on the arrow, OR press the → (right arrow) on the keyboard. To select, double-click on the correct code, OR use the ↑ (up) and ↓ (down) arrows to highlight the correct code, and then press the [Enter] key to select.
17.3 See <Condition Indicator 1> above for a list of valid choices.
18. Condition Indicator5 
18.1 Enter an electronic claim submission fifth indicator if necessary: Loop 2400 CRC07 'Conditions Indicator'.
18.2 To view the list of codes with descriptions press the [F2] key. To view the list of only the codes either click on the arrow, OR press the → (right arrow) on the keyboard. To select, double-click on the correct code, OR use the ↑ (up) and ↓ (down) arrows to highlight the correct code, and then press the [Enter] key to select.
18.3 See <Condition Indicator 1> above for a list of valid choices.
19.1 This indicates whether or not the preceding condition indicators apply to this encounter.
19.2 For electronic claims submission, it uses Loop 2400 CR02. Certification Condition Code applies indicator. A 'Y' value indicates the condition codes in CRC03 through CRC07 apply; an 'N' value indicates the condition codes in CRC03 through CRC07 do not apply.
20.1 This specifies the situation or category to which the code applies. This is Loop 2400 CRC01 which qualifies CRC03 through CRC07 (<Condition Indicators>).
20.2 To view the list of codes with descriptions press the [F2] key. To view the list of only the codes either click on the arrow, OR press the → (right arrow) on the keyboard. To select, double-click on the correct code, OR use the ↑ (up) and ↓ (down) arrows to highlight the correct code, and then press the [Enter] key to select.
21.1 This is required if it is necessary to include supporting documentation in an electronic form for Medicare DMERC claims for which the provider is required to obtain a certificate of medical necessity ( CMN ) from the physician. Loop 2400 CR501.
21.2 To view the list of codes with descriptions press the [F2] key. To view the list of only the codes either click on the arrow, OR press the → (right arrow) on the keyboard. To select, double-click on the correct code, OR use the ↑ (up) and ↓ (down) arrows to highlight the correct code, and then press the [Enter] key to select.
22.1 Enter the length of time DME equipment is needed. It fills Loop 2400 CR303.
22.2 The field accepts numeric value only for the number of months. Use '99' to indicate lifetime.
23. Certification Revision Date 
23.1 This is required if <Certification Type Code>= 'R' or 'S'.
23.2 It fills electronic claims submission Loop: 2400 DTP03.
24. Attachment Transmission Code 
24.1 This is used to designate the status of the Certification. Attachment Transmission Code, Loop 2400 PWK .
24.2 To view the list of codes with descriptions press the [F2] key. To view the list of only the codes either click on the arrow, OR press the → (right arrow) on the keyboard. To select, double-click on the correct code, OR use the ↑ (up) and ↓ (down) arrows to highlight the correct code, and then press the [Enter] key to select.
25.1 This is required if the provider is required to routinely include supporting documentation (a standardized paper form) in electronic format. An example is for Medicare DMERC claims for which the provider is required to obtain a certificate of medical necessity (CMN) from the physician. Medicare or other payers may require other supporting documentation for other types of claims (e.g., home health). The selected form code goes to Loop: 2440 LQ01 UT Health Care Financing Administration (HCFA) Durable Medical Equipment Regional Carrier (DMERC) Certificate of Medical Necessity (CMN) Forms.
25.2 To view the list of codes with descriptions press the [F2] key. To view the list of only the codes either click on the arrow, OR press the → (right arrow) on the keyboard. To select, double-click on the correct code, OR use the ↑ (up) and ↓ (down) arrows to highlight the correct code, and then press the [Enter] key to select.
Paper Forms:
CMS-846 04.04B Pneumatic Compression Device
CMS-847 04.04C Osteogensis Stimulators
CMS849 07.03A Seat Lift Mechanism
CMS-10125 09.03 External Infusion Pump
CMS-10126 10.03 Enteral and Parenteral Nutrition
25.4 After selecting the appropriate <Form Code>, Intellect displays a popup dialog box to complete the necessary information:
25.4.1 C: Command Column: Accepts 'A' add, 'M' modify, or 'D' delete.
25.4.2 Line#: The line number of the question in the CMN.
25.4.3 Answer: Used to report responses to any CMN question, requiring a Yes/No response.
25.4.4 Description: Used to provide responses to any CMN question, requiring a text or uncodified response.
25.4.5 Date: Used to provide responses to any CMN requiring a date. Enter CCYYMMDD format.
25.4.6 Percent: The percentage in response to a question on the CMN.
USE the [ESC] key to save and return to the encounter screen.
26. Ordering Provider 
26.1 Type the code for the Ordering Provider, if required, for a service or supply ordered by a provider that is different from the rendering provider for this claim.
26.2 This code pulls information from Utility --►Referring <Referring Code>.
26.3 Effective version 13.10.29: For the CMS 1500 form, Intellect completes the Ordering Provider’s name in Box 17 with qualifier DK (for Ordering Provider) and the provider’s NPI in Box 17b.
Or, when used for electronic claim submission, Loop 2310E NM1*DK.
27.1 Enter the unique identification number assigned by the pharmacy or supplier to the prescription. It uses Loop 2410 REF02 with the Qualifier XZ.
27.2 A written prescription is required for all DME rental and purchases.
28.1 EDS assigns each claim an Internal Control Number (ICN) systematically when it is received electronically or by mail. Processing or returning the claim constitutes EDS’ final action on that claim. A resubmission of the same service is considered a new claim. Each claim sent to EDS is assigned an ICN automatically, which is used to track the claim. The ICN is made up of 13 digits in a specific format. The format of the ICN enables the determination of when the EDS actually received the claim.
28.2 This is used when rebilling a corrected claim to provide the insurance the original claim control number on a denied claim.
28.3 This number is included in the electronic transmission for all claims. It is a number assigned by the payer to identify a claim. The number is usually referred to as an Internal Control Number (ICN), Claim Control Number (CCN), or a Document Control Number (DCN). CLM, 2300 REF02 is the Loop and segment:
CLM*1.608.1.491.G*250***11:B:7*Y*A*Y*Y*P
REF*F8*20024E011000 ß
28.4 When making an appeal for a Worker's Comp claim, in addition to this field, the <Claim Frequency Code>, <Appeal Type>, and <Appeal Documentation File> fields MUST be filled.
29.1 This field is used to identify the level of the appeal, if needed.
29.2 Use the drop-down list and select the appropriate option:
29.3 When making an appeal for a Worker's Comp claim, in addition to this field, the <Claim Frequency Code>, <Internal Control>, and <Appeal Documentation File> fields MUST be filled.
30.1 If there is documentation that needs to be sent to the insurance company, enter the file name of the documentation.
30.2 Files with valid file names are sent directly to the insurance company.
30.3 Effective version 14.07.01:
Clients with Intellect only:
30.3.1 Create and save Appeal Document(s) files in the /home/staff/EB_ATTACHMENT folder. SBRs may also be saved as a .pdf to the /home/staff/EB_ATTACHMENT folder and attached as appeal documents.
30.3.2 Type the exact file name in this field. Note: This field is case-sensitive.
Clients with both Intellect and Patient Chart Manager (PCM) only:
30.3.3 With the focus in this field, press the [F2] key twice to display a list of document files pulled from the Progress Notes in PCM (the list does NOT include files generated in Intellect or manually saved to the /home/staff/EB_ATTACHMENT folder).
30.3.4 To display only a certain type of file, enter the beginning letters of the file and then press [F2].
30.3.5 Click on the appropriate file to select it. Multiple files may be selected by holding down the [Ctrl] and [Shift] keys while clicking on the desired files. The file's Document Id displays.
30.4 When making an appeal for a Worker's Comp claim, in addition to this field, the <Claim Frequency Code>, <Internal Control>, and <Appeal Type> fields MUST be filled.
31. When the information is completely entered, select one of these options:
31.1 Click [Add] to clear the screen and return the focus to the <Patient Account No> field, saving the new encounter.
31.2 Click [Clear] to display this message:
31.2.1 Click [Yes] to clear the screen and return the focus to the <Patient Account No> field, saving the new encounter.
31.2.2 Click [No] to clear the screen and return the focus to the <Patient Account No> field without saving.
31.3 Click [Exit] to display this message:
31.3.1 Click [Yes] to clear the screen and return the focus to the main Intellect screen, saving the new encounter.
31.3.2 Click [No] to clear the screen and return the focus to the main Intellect screen without saving.
