MO HealthNet Internet Provider Training Program Presented by the Provider Education Unit MO HealthNet Division

1. MO HealthNet Internet Provider Training Program Presented by the Provider Education Unit MO HealthNet Division MO HealthNet Division

2. Proper Completion of the Online Medicare Part A Crossover Claim Presented by the Provider Education Unit MO HealthNet Division MO HealthNet Division

3. To file a claim go to the Internet Web site www.emomed.com and log on. This will bring up the eProvider Home Page. At the top of each page is a “Help” button in the form of a question mark. You can print out field-by-field instructions. MO HealthNet Division

4. CLAIM MANAGEMENT MO HealthNet Division

5. NEW XOVER CLAIM MO HealthNet Division

6. MEDICARE UB-04 PART A INSTITUTIONAL MO HealthNet Division

7. PARTICIPANT DCN PARTICIPANT LAST NAME PARTICIPANT FIRST NAME PATIENT ACCOUNT NUMBER PARTICIPANT MEDICARE ID (HIC) MO HealthNet Division

8. PARTICIPANT DCN PARTICIPANT LAST NAME PARTICIPANT FIRST NAME PATIENT ACCOUNT NUMBER PARTICIPANT MEDICARE ID (HIC) MO HealthNet Division

9. PARTICIPANT DCN PARTICIPANT LAST NAME PARTICIPANT FIRST NAME PATIENT ACCOUNT NUMBER PARTICIPANT MEDICARE ID (HIC) MO HealthNet Division

10. PARTICIPANT DCN PARTICIPANT LAST NAME PARTICIPANT FIRST NAME PATIENT ACCOUNT NUMBER PARTICIPANT MEDICARE ID (HIC) MO HealthNet Division

11. PARTICIPANT DCN PARTICIPANT LAST NAME PARTICIPANT FIRST NAME PATIENT ACCOUNT NUMBER PARTICIPANT MEDICARE ID (HIC) MO HealthNet Division

12. DATE OF SERVICE PARTICIPANT STATUS LIFETIME RESERVED DAYS ADMISSION DATE COVERED DAYS NON-COVERED DAYS CO-INSURANCE DAYS MO HealthNet Division

13. DATE OF SERVICE PARTICIPANT STATUS LIFETIME RESERVED DAYS ADMISSION DATE COVERED DAYS NON-COVERED DAYS CO-INSURANCE DAYS MO HealthNet Division

14. DATE OF SERVICE PARTICIPANT STATUS LIFETIME RESERVED DAYS ADMISSION DATE COVERED DAYS NON-COVERED DAYS CO-INSURANCE DAYS MO HealthNet Division

15. DATE OF SERVICE PARTICIPANT STATUS LIFETIME RESERVED DAYS ADMISSION DATE COVERED DAYS NON-COVERED DAYS CO-INSURANCE DAYS MO HealthNet Division

16. DATE OF SERVICE PARTICIPANT STATUS LIFETIME RESERVED DAYS ADMISSION DATE COVERED DAYS NON-COVERED DAYS CO-INSURANCE DAYS MO HealthNet Division

17. DATE OF SERVICE PARTICIPANT STATUS LIFETIME RESERVED DAYS ADMISSION DATE COVERED DAYS NON-COVERED DAYS CO-INSURANCE DAYS MO HealthNet Division

18. DATE OF SERVICE PARTICIPANT STATUS LIFETIME RESERVED DAYS ADMISSION DATE COVERED DAYS NON-COVERED DAYS CO-INSURANCE DAYS MO HealthNet Division

19. MEDICARE PROVIDER NPI ATTENDING PROVIDER NPI BILLED CHARGES DIAGNOSIS CODES SURGERY PROCEDURE CODES & DATE TYPE OF BILL MO HealthNet Division

20. MEDICARE PROVIDER NPI ATTENDING PROVIDER NPI BILLED CHARGES DIAGNOSIS CODES SURGERY PROCEDURE CODES & DATE TYPE OF BILL MO HealthNet Division

21. MEDICARE PROVIDER NPI ATTENDING PROVIDER NPI BILLED CHARGES DIAGNOSIS CODES SURGERY PROCEDURE CODES & DATE TYPE OF BILL MO HealthNet Division

22. MEDICARE PROVIDER NPI ATTENDING PROVIDER NPI BILLED CHARGES DIAGNOSIS CODES SURGERY PROCEDURE CODES & DATE TYPE OF BILL MO HealthNet Division

23. MEDICARE PROVIDER NPI ATTENDING PROVIDER NPI BILLED CHARGES DIAGNOSIS CODES SURGERY PROCEDURE CODES & DATE TYPE OF BILL MO HealthNet Division

24. MEDICARE PROVIDER NPI ATTENDING PROVIDER NPI BILLED CHARGES DIAGNOSIS CODES SURGERY PROCEDURE CODES & DATE TYPE OF BILL MO HealthNet Division

25. SAVE CLAIM HEADER MO HealthNet Division

26. REVENUE CODE DAYS/UNITS BILLED SAVE DETAIL LINE TO CLAIM MO HealthNet Division

27. REVENUE CODE DAYS/UNITS BILLED SAVE DETAIL LINE TO CLAIM MO HealthNet Division

28. REVENUE CODE DAYS/UNITS BILLED SAVE DETAIL LINE TO CLAIM MO HealthNet Division

29. REVENUE CODE DAYS/UNITS BILLED SAVE DETAIL LINE TO CLAIM MO HealthNet Division

30. REVENUE CODE DAYS/UNITS BILLED SAVE DETAIL LINE TO CLAIM MO HealthNet Division

31. REVENUE CODE DAYS/UNITS BILLED SAVE DETAIL LINE TO CLAIM MO HealthNet Division

32. MO HealthNet Division

33. FILING INDICATOR OTHER PAYER ID OTHER PAYER NAME PAID DATE MO HealthNet Division

34. FILING INDICATOR OTHER PAYER ID OTHER PAYER NAME PAID DATE MO HealthNet Division

35. FILING INDICATOR OTHER PAYER ID OTHER PAYER NAME PAID DATE MO HealthNet Division

36. FILING INDICATOR OTHER PAYER ID OTHER PAYER NAME PAID DATE MO HealthNet Division

37. PAID AMOUNT TOTAL DENIED AMOUNT RA REMARK CODES PAYER AT HEADER LEVEL SAVE OTHER PAYER DATA & MANAGE CODES MO HealthNet Division

38. PAID AMOUNT TOTAL DENIED AMOUNT RA REMARK CODES PAYER AT HEADER LEVEL SAVE OTHER PAYER DATA & MANAGE CODES MO HealthNet Division

39. PAID AMOUNT TOTAL DENIED AMOUNT RA REMARK CODES PAYER AT HEADER LEVEL SAVE OTHER PAYER DATA & MANAGE CODES MO HealthNet Division

40. PAID AMOUNT TOTAL DENIED AMOUNT RA REMARK CODES PAYER AT HEADER LEVEL SAVE OTHER PAYER DATA & MANAGE CODES MO HealthNet Division

41. PAID AMOUNT TOTAL DENIED AMOUNT RA REMARK CODES PAYER AT HEADER LEVEL SAVE OTHER PAYER DATA & MANAGE CODES MO HealthNet Division

42. CLAIM GROUP CODE CLAIM ADJUSTMENT REASON CODE ADJUSTMENT AMOUNT MO HealthNet Division

43. CLAIM GROUP CODE CLAIM ADJUSTMENT REASON CODE ADJUSTMENT AMOUNT MO HealthNet Division

44. CLAIM GROUP CODE CLAIM ADJUSTMENT REASON CODE ADJUSTMENT AMOUNT MO HealthNet Division

45. CLAIM GROUP CODE CLAIM ADJUSTMENT REASON CODE ADJUSTMENT AMOUNT SAVE CODES TO OTHER PAYER MO HealthNet Division

46. CLAIM GROUP CODE CLAIM ADJUSTMENT REASON CODE ADJUSTMENT AMOUNT SAVE CODES TO OTHER PAYER MO HealthNet Division

47. CLAIM GROUP CODE CLAIM ADJUSTMENT REASON CODE ADJUSTMENT AMOUNT SAVE CODES TO OTHER PAYER MO HealthNet Division

48. CLAIM GROUP CODE CLAIM ADJUSTMENT REASON CODE ADJUSTMENT AMOUNT SAVE CODES TO OTHER PAYER MO HealthNet Division

49. SAVE OTHER PAYER TO CLAIM MO HealthNet Division

50. SUBMIT CLAIM MO HealthNet Division