410 likes | 535 Views
Current TPOCS Helpdesk Issues. Billing Data Issues Revenue Codes Incorrect Billing Data - Pharmacy Codes and Rates Missing or Incorrect NPI. Current TPOCS Helpdesk Issues. Database Issues TPOCS Interface OHI Updates Provider Updates ICD-9-CM Diagnosis Codes.
E N D
Current TPOCS Helpdesk Issues • Billing Data Issues • Revenue Codes • Incorrect Billing Data - Pharmacy • Codes and Rates • Missing or Incorrect NPI UBO/UBU Conference - TPOCS - 22-25 March 2010
Current TPOCS Helpdesk Issues • Database Issues • TPOCS Interface • OHI Updates • Provider Updates • ICD-9-CM Diagnosis Codes UBO/UBU Conference - TPOCS - 22-25 March 2010
Current TPOCS Helpdesk Issues • Accounting Issues • Account is not in GL • Account Closed is in GL and Open in Patient Summary • TPOCS Report Issue • General Ledger reports do not balance in TPOCS UBO/UBU Conference - TPOCS - 22-25 March 2010
Billing Data Issues UBO/UBU Conference - TPOCS - 22-25 March 2010
Billing Data Issues • Revenue Codes • Incorrect or Missing Revenue Code • RC-250 for J-Codes UBO/UBU Conference - TPOCS - 22-25 March 2010
Billing Data Issues • Incorrect Billing Data • Incorrect Units of Service • Incorrect Dispense Quantities • Incorrect Rate Assigned UBO/UBU Conference - TPOCS - 22-25 March 2010
Billing Data Issues • Incorrect Billing Units or Quantities • Dispensing Unit Different from Billing Unit • Mismatch Units in CHCS/PDTS and TPOCS • TPOCS Calculations for Pharmacy Billing UBO/UBU Conference - TPOCS - 22-25 March 2010
Billing Data Issues Incorrect Billing Units or Quantities Pharmacy Fill Order from CHCS for Prescription # BX5174819 UBO/UBU Conference - TPOCS - 22-25 March 2010
Billing Data Issues Incorrect Billing Units or Quantities • Encounter Data • NDC No. - 00025141160 (Arthrotec 50 Table EC) • Qty - 180 • Days Sup - 90 • TPOCS Est. Charges • TPOCS Cost per unit - $1.81 • Total Line Item Charges - $ 325.80 UBO/UBU Conference - TPOCS - 22-25 March 2010
Billing Data Issues Incorrect Billing Units or Quantities Data from CHCS to TPOCS - PHARM Datfile Encounter Data string: (30)^0067^P^N^(152107)^52^A31^117^^^^09063004230^063020090824^124862^0306^FCCA^(BX5174819)^1^(1080000)^(90)^(00025141160)^N^A^188^06302009^^^0069^0069^2125804^1801958806^2 • File Rec No.- 30 • Patient IEN- 152107 • RX No. - BX5174819 • Qty - 108000 • Days Sup- 90 • NDC No.- 00025141160 UBO/UBU Conference - TPOCS - 22-25 March 2010
Billing Data Issues Incorrect Billing Units or Quantities • NDC No. - 00025141160 (Arthrotec 50 Table EC) • Qty - 108000 • Days Sup - 90 • TPOCS Cost per unit - $1.81 • Total Line Item Charges - ? UBO/UBU Conference - TPOCS - 22-25 March 2010
Billing Data Issues • Codes and Rates • Incorrect or No Rate for CPT-4 Code • NDC not in TPOCS UBO/UBU Conference - TPOCS - 22-25 March 2010
Billing Data Issues • Issues: Incorrect or No CPT-4 Code and/or Rate in TPOCS • Missing or Expired CPT-4 Code • CPT-4 Code Has No Rate in TPOCS • Incorrect Rate Populated on TPOCS Bill • Cannot Change Rate on TPOCS Bill UBO/UBU Conference - TPOCS - 22-25 March 2010
Billing Data Issues • Issues: NDC not in TPOCS • Missing, obsolete or inactive NDC numbers in TPOCS • NDC in CHCS and not in TPOCS • No rate for NDC in TPOCS UBO/UBU Conference - TPOCS - 22-25 March 2010
Billing Data Issues • National Provider ID - NPI • Missing or Incorrect NPI Data • Database • TPOCS Interface • Provider Data • DoD Extender Codes UBO/UBU Conference - TPOCS - 22-25 March 2010
Billing Data Issues • Issues: Missing or Incorrect NPI Data • NPI Type 1 - Provider NPI • Physician/Provider Does Not have a NPI in TPOCS • NPI Type 2 - Facility NPI • Treating Facilities without NPI’s in TPOCS • Incorrect Facility NPI Type 2 • DMIS ID with No Associated Facility NPI UBO/UBU Conference - TPOCS - 22-25 March 2010
Billing Data Issues • Issue: Provider NPI Type 1 not in TPOCS • Only Physicians with a Provider Class of 01 will be assigned an NPI • Individuals with a Provider Class of 04 will not have a NPI in TPOCS • Provider NPI’s can be manually entered in TPOCS when processing encounters. UBO/UBU Conference - TPOCS - 22-25 March 2010
Billing Data Issues • Facility NPIs are related to site DMIS ID’s • Three (3) Types of Facility or NPI Type 2: • Treating Facility NPI- site associated with care or treatment • Billing Facility NPI- site submitting the claim • Pharmacy NPI- site Pharmacy/Dispensing facility • NOTE:Pharmacies do not have DMIS ID’s UBO/UBU Conference - TPOCS - 22-25 March 2010
Billing Data Issues • Issue: Missing or incorrect Facility NPI • Satellite site(s) attached to a host facility may not have a NPI Type 2(Facility) assigned. • Cannot generate claims without site NPI. • Cannot enter missing NPI into claim or TPOCS database. • Pharmacies do not have DMIS ID’s UBO/UBU Conference - TPOCS - 22-25 March 2010
Database Issues UBO/UBU Conference - TPOCS - 30 March - 2 April 2009
Database Issues • TPOCS Interface • Daily CHCS files are not loading in TPOCS • OHI Data not populating or updating in TPOCS • Provider Data • Provider Not in TPOCS • Invalid Provider Taxonomy Code • DoD Extender Codes • DoD Extender Codes for ICD-9-CM Codes UBO/UBU Conference - TPOCS - 30 March - 2 April 2009
Database Issue - TPOCS Interface • Issue: Daily CHCS files are not loading in TPOCS • Signs and Symptoms: • No encounters loaded for that day in TPOCS • Did not see all of the expected encounters in TPOCS • Did not get any Clinic or Lab/Rad or Pharmacy encounters in TPOCS UBO/UBU Conference - TPOCS - 30 March - 2 April 2009
Database Issue - TPOCS Interface • Issue: Daily CHCS files are not loading in TPOCS • Most Common Reasons: • TPOCS Interface Loader in not Turned-on • CHCS provided the incorrect file extension for the data file • CHCS did not send over the required (six) 6 daily files (5 out of 6) • Trailer record in missing from any one of the data files UBO/UBU Conference - TPOCS - 30 March - 2 April 2009
Database Issue - TPOCS Interface Three (3) Types of Other Health Insurance (OHI) Files: • DOHI - Daily OHI • SOHI - Supplemental OHI • IOHI - Initialization OHI UBO/UBU Conference - TPOCS - 30 March - 2 April 2009
Database Issue - TPOCS Interface • There are two (2) types of OHIrecords in OHI ASCII files. • The OHI Record Type is determined by the type of data which was added or modified during the 24-hour collection period. • The two (2) Record Types are “O” records and “D” records. • Record Type - O (Other Health Insurance) • Record Type - D (Patient Demographics) UBO/UBU Conference - TPOCS - 30 March - 2 April 2009
Database Issue - TPOCS Interface • Issue: OHI Data not populating or updating in TPOCS Most Common Reasons: • Patient has multiples of the same policy in TPOCS • Patient and/or Policy Link has been broken in CHCS • Patient Policy is inactive in TPOCS UBO/UBU Conference - TPOCS - 30 March - 2 April 2009
Database Issue - TPOCS Interface Update OHI in the TPOCS database There are two (2) additional CHCS files that can be provided that will update the TPOCS OHI database: • Supplemental OHI ASCII File (SOHI) • Initialization OHI ASCII File (IOHI) UBO/UBU Conference - TPOCS - 30 March - 2 April 2009
Database Issues • Issue: Referring Provider data not in TPOCS • (Required for CMS-1500 e-billing) • Mainly electronic billing requirement (837p) • Referring Provider data comes from CHCS and does not appear in the TPOCS billing screen (SCR submitted) • Referring Provider data cannot be entered in TPOCS UBO/UBU Conference - TPOCS - 22-25 March 2010
Database Issue - Provider Data • Issue: Provider Not in TPOCS • Missing or Invalid data in the Provider file (DPROV) from CHCS UBO/UBU Conference - TPOCS - 30 March - 2 April 2009
Database Issue - Provider Data • Daily Provider ASCII File (DPROV) • TPOCS provider data is updated from CHCS. The DPROV • file contains all of the provider data information from CHCS. • The Daily Provider File - DPROV updates based on: • When a new record is added • When existing record is edited • When the Provider file is ‘initialized’ through a user menu option, for OIB UBO/UBU Conference - TPOCS - 30 March - 2 April 2009
Database Issue - Provider Data • CHCS Provider Criteria: • Providers must be DBA Active (field 13) • If the Primary Provider Taxonomy is recorded, then include it in the Provider ASCII file. UBO/UBU Conference - TPOCS - 30 March - 2 April 2009
Database Issue - Provider Data • Issue: Invalid Provider Taxonomy Code • Provider Taxonomy Codes currently not in TPOCS: • 1710I1002X - Corpsman, Independent Duty • 1710I1003X - Technical, Independent Duty Medical • 390200000X - Resident/Intern w/o License • http://www.wpc-edi.com/codes/taxonomy UBO/UBU Conference - TPOCS - 30 March - 2 April 2009
Database Issue - Provider Data • Issue: Invalid Provider Taxonomy Code Database Problems: • Provider(s) do not load in the TPOCS database • Provider(s) can be identified on the TPOCS File Upload Report • Data associated with the provider(s) do not populate into TPOCS • Encounters that list the provider as the primary HCP must be identified and manually entered in TPOCS to create claims. UBO/UBU Conference - TPOCS - 30 March - 2 April 2009
Database Issue - Provider Data • Issue: Provider Not in TPOCS • Due To: Missing or Invalid data in the Provider file (DPROV) from CHCS: • Which Could Be: • Provider is Not DBA Active in CHCS • Provider Taxonomy Code - (Missing/Invalid) • Provider Specialty Code - (Missing/Invalid) • EDI_PN as a placeholder - (Missing/Invalid) Identified: TPOCS File Upload Report Corrected:CHCS UBO/UBU Conference - TPOCS - 30 March - 2 April 2009
Database Issue - DoD Extender Codes • Issue: DoD Extender Codes for ICD-9-CM codes • TPOCS rejects ICD-9-CM Codes with more than six (6) characters for the Diagnosis Field. (123.56 01) • CHCS currently sending more than six (6) characters for this data field. • Encounters associated with those rejected ICD-9-CM as the primary diagnosis will not load in TPOCS. • Cannot use on claims (paper/electronic) UBO/UBU Conference - TPOCS - 30 March - 2 April 2009
Accounting Issues UBO/UBU Conference - TPOCS - 30 March - 2 April 2009
Accounting Issues • Issue: General Ledger reports do not balance in TPOCS • TPOCS General Ledger Reports are not designed to balance TPOCS. • Not all reports in TPOCS balance the other • There are reports in TPOCS that assist with balancing UBO/UBU Conference - TPOCS - 22-25 March 2010
Accounting Issues • Issue: GL Reports Do Not Balance DD2570 • The DD2570 does not balance with the other reports in TPOCS such as the; Activity Reports, Accounts Receivable Reports, and Break Out Reportsin TPOCS that provide the same or similar financial data. Reports use different criteria is: • DD2570 - Date of Encounter or DOS • TPOCS Reports - Date of Last Transaction(s) UBO/UBU Conference - TPOCS - 22-25 March 2010
??? Questions ??? UBO/UBU Conference - TPOCS - 30 March - 2 April 2009