California Medi-Cal. Eligibility/Benefits and Supplemental Transactions. Guide to PC-Based Transactions

Transcription

1 California Medi-Cal Eligibility/Benefits and Supplemental Transactions Guide to PC-Based Transactions Eligibility v2.3 Spenddown v2.2 Spenddown Reversal v2.2 Medical Services Reservation v2.1 Medical Services Reservation Reversal v

2 This publication is the proprietary property of Emdeon and is furnished solely for use pursuant to a license agreement giving the user the right to use the Emdeon product(s) referenced in this document. All uses of this document are subject to the terms of such license agreement. This document may not be used except as permitted by such license agreement or changed, copied, photocopied, reproduced, translated, or reduced to any electronic medium or machine readable form without the prior consent of Emdeon. Copyright is held by Emdeon Business Services, LLC. Emdeon is not liable for any losses or damages that result from the use of this material, including loss of profit or indirect, special, or consequential damages.

3 Table of Contents Table of Contents Overview About the Transaction Types of Medi-Cal Transactions Customer Support Requests Search Types Medi-Cal Eligibility Spendown Spendown Reversal Medical Services Reservation Medical Services Reservation Reversal Cascade Sequence Input Prompts Responses About Your Responses Status Indicators Input and Response Information Transaction Information Information Source Information Source Contact Information Receiver Subscriber Patient Eligibility/Benefit Error Messages Values Eligibility/Benefit Types Service Types Insurance Types Index Emdeon Business Services LLC. All rights reserved. Page i

4 Overview Overview About the Transaction Types of Medi-Cal Transactions The Emdeon TM PC-based products offer the following five California Medicaid transactions: a Medi-Cal eligibility inquiry, a Spenddown, a Spenddown Reversal, a Medical Services Reservation, and a Medical Services Reservation Reversal. Medi-Cal Eligibility Inquiries When a patient presents a Medi-Cal Benefits Identification Card, you must verify the patient's eligibility status before you submit a claim. (Benefits Identification Cards are not a guarantee of Medi-Cal eligibility because they are a permanent form of identification and patients retain the card even if they are not eligible for Medi-Cal during the current month.) A Medi-Cal inquiry transaction allows you to obtain the patient s eligibility status for Medi-Cal coverage. When you submit an eligibility transaction, Emdeon accesses the Medi-Cal Eligibility Data System (MEDS) to determine patient eligibility information. Once you have correctly verified patient eligibility and used the same provider number, subscriber ID, and date of service for the claim as used for the eligibility inquiry, the claim will not suspend or be denied for eligibility. Medical Services Reservation A Medical Services Reservation transaction allows you to reserve a Medi-Service. Note: Only certain providers can reserve and bill Medi-Service. Medi-Service reservations apply only to acupuncture, chiropractic, occupational therapy, psychology, speech pathology, audiology, and some podiatry services. See your Medi-Cal Provider Manual for details. Medical Services Reservation Reversal A Medical Services Reservation Reversal transaction allows you to void a Medical Services Reservation you have previously submitted. Make sure that the information you enter for a reversal duplicates the information you entered for the Medical Services Reservation. Note: Only certain providers can perform Medical Services Reservations and reversals. Medical Services Reservation and reversals apply only to acupuncture, chiropractic, occupational therapy, psychology, speech pathology, audiology, and some podiatry services. Spenddown A Spenddown transaction allows you to apply a dollar amount toward the clearance of a patient s Share of Cost liability (spenddown), which is a dollar amount that certain Medi-Cal patients must pay toward medical services prior to receiving Medi-Cal benefits. A Spenddown transaction deducts the applied amount from the patient s Share of Cost balance. A patient s Share of Cost liability is cleared once the patient s Share of Cost balance reaches zero. The patient then becomes Medi-Cal eligible. Spenddown Reversal A Spenddown Reversal transaction allows you to void a Spenddown transaction you have previously submitted Emdeon Business Services LLC. All rights reserved. Page 1

5 Overview You cannot reverse a Spenddown transaction if it cleared the patient s Share of Cost liability (that is, it caused the patient s Share of Cost balance to reach zero). Note: If you submitted separate Spenddown Reversal transactions for multiple case numbers under the same subscriber ID, you must reverse each transaction individually. Date of Service Restrictions Up to one year in the past. Future dates not allowed. National Provider Identifiers In order for you to use a National Provider Identifier (NPI) as the provider ID, the following conditions must exist: The payer must be ready to accept NPI. Consult our payer lists at for this payer s NPI-readiness status. The inquiring provider must have fulfilled all of the payer s NPI registration requirements. Special Considerations The case number is optional for Spenddown and Spenddown Reversal transactions unless the patient has more than one case on file, then a case number is required. Customer Support Emdeon Customer Support customer.service@emdeon.com 2011 Emdeon Business Services LLC. All rights reserved. Page 2

6 Requests Requests Search Types Medi-Cal Eligibility ID Card The provider ID of the inquiring provider. The ID card number (read from the card swipe). The card issue date (read from the card swipe). The patient's date of birth. The date of service. ID The provider ID of the inquiring provider. The subscriber ID number. The date of issue of the patient's card. The patient's date of birth. The date of service. Spendown ID/Date of Birth The provider ID of the inquiring provider. The subscriber ID number. The date of issue of the patient's card. The case number (optional). The patient's date of birth. The spenddown. The billed amount. The date of service. Spendown Reversal ID/Date of Birth The provider ID of the inquiring provider. The subscriber ID number. The date of issue of the patient's card. The case number (optional). The patient's date of birth. The spenddown Emdeon Business Services LLC. All rights reserved. Page 3

7 Requests The billed amount. The date of service. Medical Services Reservation ID/Date of Birth The provider ID of the inquiring provider. The subscriber ID number. The date of issue of the patient's card. The patient's date of birth. The product ID number. The code source. The date of service. Medical Services Reservation Reversal ID/Date of Birth The provider ID of the inquiring provider. The subscriber ID number. The date of issue of the patient's card. The patient's date of birth. The product ID number. The code source. The date of service. Cascade Sequence Eligibility 1. Hard card 2. Subscriber ID What is Cascading? Cascading refers to the capability of the software to execute multiple searches automatically when a single search does not find the patient s record, or receives an error with a Retry status. To enable cascading in a transaction, you must enter data for more than one search type. In this case, the software will continue to cascade until one of the following occurs: The patient s record is found, or a valid non-error response is received (Closed status) All available search types have been exhausted An error is received with an Error status 2011 Emdeon Business Services LLC. All rights reserved. Page 4

8 Requests Input Prompts Prompts are listed in alphabetical order. Account # Requirement: Optional; not sent to the payer. The account number you have assigned to this account, for your internal use only. Amount Requirement: Optional; not sent to the payer. The amount applicable to this inquiry, for your internal use only. Billed Amt Requirement: Required for spenddown and spenddown reversal searches. The total amount billed on the period bill. Case # Requirement: Optional for Spenddown and Spenddown Reversal transactions unless the patient has more than one case on file, then a case number is required. The case number to which the amount is to be applied. Note: You will have to enter a case number only if the patient is affected by the Sneede v. Kizer lawsuit and presents a Share of Cost Summary letter listing all of the patient's case numbers. If the patient has multiple case numbers, you must submit a Spenddown Reversal transaction for each case number the patient wants to clear. See your Medi-Cal Provider Manual for details. Code Sce Requirement: Required for medical services reservation and medical services reservation reversal transactions. The code source of the product ID number that you entered. Date of Birth Requirement: Required for all transactions. The patient s date of birth, in MMDDCCYY format. Date of Issue Requirement: Required for all transactions. The card issue date, in MMDDYY or MMDDCCYY format. This date is read automatically when you swipe the patient's card or you can enter the date manually. Note: If you do not know the correct issue date, enter today s date instead. Date of Service Requirement: Required for all transactions. The date of service, in MMDDYY or MMDDCCYY format. Note: The date of service must be within the past year and cannot be in the future Emdeon Business Services LLC. All rights reserved. Page 5

9 Requests ID Card # Requirement: Required for ID card searches. The identification number from the patient's California Medi-Cal card. This information is read automatically when you swipe the patient's card. Product ID Requirement: Required for medical services reservation and medical services reservation reversal transactions. The identifier of the product relating to your request. Choose a value from the drop-down list or enter one from Service Types on page 13. Provider ID Requirement: Required for all transactions. The provider ID of the inquiring provider. In order for you to use the National Provider Identifier (NPI), the payer must be ready to accept NPI. Additionally, the payer s NPI registration requirements must be fulfilled. Spend Down Requirement: Required for spenddown and spenddown reversal searches. The patient s spenddown amount. Enter the amount in whole dollars. Subscriber ID Requirement: Required for all transactions except ID card searches. The patient s California Medi-Cal subscriber ID. Note: If the transaction is for a newborn who is being billed under the mother's number, make sure you enter the mother's subscriber ID Emdeon Business Services LLC. All rights reserved. Page 6

10 Responses Responses About Your Responses All of the items described in the following response explanation may not appear in every response. Payers typically return only the information that is applicable to your query. If the payer does not return a particular piece or section of information in a specific response, the headings for that information will not print. Items will shift position to fill the vacancy. Your username appears in the upper left corner of the response. See your product User s Guide for information about creating usernames. Additional Reference Documents More information about your response can be found in the following documents: PC-Standard-Eligibility-Response-Dictionary.pdf - gives a more detailed description of data fields returned in the standard Emdeon response. Dictionary-of-Transaction-Error-Messages.pdf a complete dictionary of error messages. Common Response Abbreviations.pdf common abbreviations used in the standard Emdeon response, along with their full description. These documents are available on your installation CD, and on the Web at: Note: The above documents are in Portable Document Format (.pdf). You must have the Adobe Acrobat Reader to view this document. If you do not have the Reader, you can download it for free at Status Closed The patient is eligible or is on file. Read the response for clarification. Retry The patient is ineligible or is not on file, or you entered invalid information, or Emdeon did not receive a valid standard response. Read the message in the response for clarification. Error A communications-related error or error of greater severity occurred. Read the message in the response for clarification. Indicators This information appears on the top of the report. The indicators show the following: Benefit Indicates the presence or type of benefit information in the response. Y = Benefit information exists N = No benefit information exists P = Pending Q = QMB S = Spenddown 2011 Emdeon Business Services LLC. All rights reserved. Page 7

11 Responses Other Payer Indicates the patient s Other Payer coverage. Y = Patient has Other Payer coverage. NA = Unable to determine if Other/Additional Payer information is present in the response from the payer. Medicare Indicates the patient s Medicare coverage. A = Patient has Medicare Part A coverage. B = Patient has Medicare Part B coverage. A&B = Patient has Medicare Parts A and B coverage. NA = Unable to determine if Medicare information is present in the response from the payer. Y = Medicare information is present in the response from the payer. Input and Response Information The input area shows the data you sent in the request. For some of the input fields, the response area displays what the payer actually has on file. This arrangement enables you to verify what you entered against what is on file. Depending on your software product and report settings, response information fields can appear in one of two locations: They can appear in a column to the right of the input fields. They can appear beneath the input fields, with the heading (On File). An asterisk to the left of an input field indicates that the mirrored response data did not match your input data. The following response fields are displayed: - The patient s California Medi-Cal subscriber ID. - The patient s date of birth. - The patient s last name. - The patient s first name. Transaction Information The Transaction Information section returns reference information for this particular transaction, such as: - The Submit ID used for tracking. - The date and time when the transaction was created. - Benefit Indicator: Y = Benefit information exists. N = No benefit information exists. P = Pending. Q = QMB. S = Spenddown. - Medicare Indicator: A = Patient has Medicare Part A coverage. B = Patient has Medicare Part B coverage. A&B = Patient has Medicare Parts A and B coverage. NA = Unable to determine Medicare coverage. Y = Medicare information is present Emdeon Business Services LLC. All rights reserved. Page 8

12 - Other Payer Indicator: Y = Patient has other payer coverage. NA = Unable to determine other payer coverage. California Medi-Cal Eligibility/Benefits and Supplemental Transactions Responses Information Source Information about the payer, such as primary ID and name. Information Source Contact Payer contact information. Information Receiver Information about the requesting provider, such as primary ID and name. Subscriber Information about the subscriber, or the patient, when the patient is the subscriber. Includes: - The transaction audit (trace) numbers and origins. - The subscriber s primary ID. - Demographic information, such as: Last, first, middle name Prefix and suffix Date of birth Gender Address Student status Handicap indicator Birth sequence - Whether any identifying elements for the subscriber have changed from those submitted in the request (Change). - Additional identification numbers other than the primary ID. - Eligibility or benefit dates. Dates can also appear in the Eligibility/Benefit section. Patient Information about the patient, when the patient is a dependent. Includes: - The transaction audit (trace) numbers and origins. - The dependent s primary ID. - Demographic information, such as: Last, first, middle name Prefix and suffix Date of birth Gender Address Student status Handicap indicator Birth sequence Relationship to subscriber - Whether any identifying elements for the subscriber have changed from those submitted in the request (Change) Emdeon Business Services LLC. All rights reserved. Page 9

13 - Additional identification numbers other than the primary ID. California Medi-Cal Eligibility/Benefits and Supplemental Transactions Responses - Eligibility or benefit dates. Dates can also appear in the Eligibility/Benefit section. Eligibility/Benefit Each Eligibility/Benefit section gives details about the patient s eligibility status and other types of benefits. There can be several Eligibility/Benefit sections. Information includes: - Eligibility Type: Identifies the type of information to which this section applies (see Eligibility/Benefit Types on page 11). - Coverage type. - Service types (see Service Types on page 13). - Applicable dollar amount or percentage. - Insurance type (see Insurance Types on page 18). - Plan coverage information. - Benefit period. - Benefit quantity. - Authorization or certification required. - In-network indicator. - Product or service ID. - Procedure Modifiers. - Health care service delivery details. - Additional identifiers. - Benefit-specific eligibility dates. - Limitations. - Information used to determine eligibility. - Benefit-related entity and entity contact information. For a complete description of the abbreviations appearing in this section, see Common Response Abbreviations.pdf on your installation CD and on the Web at Error Messages Transaction-related error messages begin with CL, HT, RH, or another alphabetic prefix, followed by a number and a line or so of text. For a comprehensive description of all error messages, see the document Dictionary of Transaction Error Messages. This document is available on your installation CD, and on the Web at: Emdeon Business Services LLC. All rights reserved. Page 10

14 Values Values Eligibility/Benefit Types The payer can return any of the values listed below. Value in Response Actv Cvg Actv Full Risk Capitation Actv Srvcs Capitated Actv Srvcs Capitated to PCP Actv Pend Investigation Inactv Inactv Pend Elig Updte Inactv Pend Investigation Co-Ins Co-Pay Deductible Cvg Basis Bene Descrip Exclusions Limitations Out of Pckt (Stop Loss) Unlim Non-Cvd Cost Containment Rsv PCP Pre-existing Cond MC Coord Svces Restricted to Following Not Deemed a Med Necessity Bene Disclmr 2nd Surg Opinion Reqd Other/Addl Payer Prior Year(s) History Card(s) Rptd Lost/Stolen Contact Following for Elig/Bene Cannot Process Other Sce of Data Description Active Coverage Active - Full Risk Capitation Active - Services Capitated Active - Services Capitated to Primary Care Physician Active - Pending Investigation Inactive Inactive - Pending Eligibility Update Inactive - Pending Investigation Co-Insurance Co-Payment Deductible Coverage Basis Benefit Description Exclusions Limitations Out of Pocket (Stop Loss) Unlimited Non-Covered Cost Containment Reserve Primary Care Provider Pre-existing Condition Managed Care Coordinator Services Restricted to Following Provider Not Deemed a Medical Necessity Benefit Disclaimer Second Surgical Opinion Required Other or Additional Payer Prior Year(s) History Card(s) Reported Lost/Stolen Contact Following Entity for Eligibility or Benefit Information Cannot Process Other Source of Data 2011 Emdeon Business Services LLC. All rights reserved. Page 11

15 Values Value in Response Health Care Facility Spend Down Description Health Care Facility Spend Down 2011 Emdeon Business Services LLC. All rights reserved. Page 12

16 Values Service Types The payer can return any of the service types listed below. Abbreviation Description Code Abortion Abortion 84 Acupuncture Acupuncture 64 Adjunctive Dntl Svcs Adjunctive Dental Services 28 AIDS AIDS 85 Air Transportation Air Transportation 57 Alcoholism Alcoholism AJ Allergy Testing Allergy Testing 79 Alternate Method Dial Alternate Method Dialysis 15 Anesth Anesthesia 7 Anesthesiologist Anesthesiologist 97 ASC Facility Ambulatory Service Center Facility 13 Audiology Exam Audiology Exam 71 Blood Charges Blood Charges 10 Brand Name Rx Drg Brand Name Prescription Drug 91 Cabulance Cabulance 58 Cancer Cancer 87 Cardiac Cardiac BL Cardiac Rehab Cardiac Rehabilitation BG CH Chemotherapy 78 Chiropractic Chiropractic 33 Chiropractic Office Visits Chiropractic Office Visits 34 Cognitive Thrpy Cognitive Therapy BD Consultation Consultation 3 CRD Equipment Chronic Renal Disease (CRD) Equipment 16 Day Care (PC) Day Care (Psychiatric) BC Dial Dialysis 76 DME Purchase Durable Medical Equipment Purchase 12 DME Rent Durable Medical Equipment Rental 18 Dntl Accident Dental Accident 37 Dntl Care Dental Care 35 Dntl Crowns Dental Crowns 36 Donor Procedures Donor Procedures 63 Drg Addiction Drug Addiction AK Dx Dntl Diagnostic Dental Emdeon Business Services LLC. All rights reserved. Page 13

17 Values Abbreviation Description Code Dx Lab Diagnostic Lab 5 Dx Medical Diagnostic Medical 73 Dx X-Ray Diagnostic X-Ray 4 Emergency Svcs Emergency Services 86 Endocrine Endocrine BP Endodontics Endodontics 26 Experimental Drg Thrpy Experimental Drug Therapy Eye Eye BR FP Family Planning 82 Frames Frames AM Free Standing Rx Drg Free Standing Prescription Drug 89 General Benefits General Benefits 60 Generic Rx Drg Generic Prescription Drug 92 GI Gastrointestinal BN Health Bene Plan Cvg Health Benefit Plan Coverage 30 HH Rxs Home Health Prescriptions 43 HH Visits Home Health Visits 44 HHC Home Health Care 42 Hosp Hospital 47 Hosp Ambulatory Surg Hosp Emergency Accident Hosp Emergency Medical AR Hospital Ambulatory Surgical 53 Hospital Emergency Accident 51 Hospital Emergency Medical 52 Hosp IP Hospital Inpatient 48 Hosp OP Hospital Outpatient 50 Hosp Room/Board Hospital Room and Board 49 Hspc Hospice 45 Immunizations Immunizations 80 Independent Medical Eval Independent Medical Evaluation Infertility Infertility 83 Inhalation Thrpy Inhalation Therapy 72 Invasive Procs Invasive Procedures BS IVF In vitro Fertilization 61 Lenses Lenses AO Licensed Ambulance Licensed Ambulance 59 LTC Long Term Care 54 Lymphatic Lymphatic BM BA 2011 Emdeon Business Services LLC. All rights reserved. Page 14

18 Values Abbreviation Description Code Mail Order Rx Drg Mail Order Prescription Drug 90 Major Medical Major Medical 55 Massage Thrpy Massage Therapy BE Maternity Maternity 69 Med Care Medical Care 1 Medically Related Transportation Medically Related Transportation 56 MFP Maxillofacial Prosthetics 27 MRI/CAT Scan MRI/CAT Scan 62 Neuro Neurology BQ Newborn Care Newborn Care 65 Nonmedically Necessary Physical Nonmedically Necessary Physical Nursery Nursery BI Oral Surg Oral Surgery 40 Orthodontics Orthodontics 38 Orthopedic Orthopedic BK OT Occupational Therapy AD Other Medcl Other Medical 9 Otological Exam Otological Exam 77 Pa Pathology 66 PC Psychiatric A4 PC IP Psychiatric Inpatient A7 PC OP Psychiatric Outpatient A8 PC Room/Board Psychiatric Room and Board A5 Peds Pediatric BH Periodontics Periodontics 24 Pharm Pharmacy 88 Physical Medicine Physical Medicine AE Plan Waiting Period Plan Waiting Period 32 Pneumonia Vaccine Pneumonia Vaccine 19 Podiatry Podiatry 93 Podiatry Nursing Home Visits Podiatry Office Visits AQ Podiatry Nursing Home Visits 95 Podiatry Office Visits 94 Pre-Admin Testing Pre Admission Testing 17 Private Duty Nursing Private Duty Nursing 74 Professional (PHY) Professional (Physician) 96 Professional (PHY) Visit Home Professional (Physician) Visit Home A Emdeon Business Services LLC. All rights reserved. Page 15

19 Values Abbreviation Description Code Professional (PHY) Visit IP Professional (PHY) Visit Nursing Home Professional (PHY) Visit Office Professional (PHY) Visit OP Professional (PHY) Visit SNF Professional (Physician) Visit Inpatient 99 Professional (Physician) Visit Nursing Home A1 Professional (Physician) Visit Office 98 Professional (Physician) Visit Outpatient Professional (Physician) Visit Skilled Nursing Facility Prosthetic Device Prosthetic Device 75 Prosthodontics Prosthodontics 39 Prtl Hospitalization (PC) Partial Hospitalization (Psychiatric) Psychotherapy Psychotherapy A6 Pulmonary Rehab Pulmonary Rehabilitation BF Radiation Thrpy Radiation Therapy 6 Rehab Rehabilitation A9 Rehab IP Rehabilitation Inpatient AB Rehab OP Rehabilitation Outpatient AC Rehab Room/Board Rehabilitation Room and Board AA Renal Supplies in the Home A0 A2 BB Renal Supplies in the Home 14 Respite Care Respite Care 46 Restorative Restorative 25 Routine (Preventive) Dntl Routine (Preventive) Dental 41 Routine Exam Routine Exam AN Routine Physical Routine Physical 81 SA Substance Abuse AI Second Surg Opinion Second Surgical Opinion 20 Skilled Nursing Care Skilled Nursing Care AG Skilled Nursing Care Room and Board Skilled Nursing Care Room and Board Skin Skin BJ Smoking Cessation Smoking Cessation 67 Social Work Social Work 22 Spch Thrpy Speech Therapy AF Surg Surgical 2 Surg Asstnce Surgical Assistance 8 Third Surg Opinion Third Surgical Opinion 21 Transplants Transplants 70 AH 2011 Emdeon Business Services LLC. All rights reserved. Page 16

20 Values Abbreviation Description Code Used DME Used Durable Medical Equipment 11 Vision (Optometry) Vision (Optometry) AL Well Baby Care Well Baby Care Emdeon Business Services LLC. All rights reserved. Page 17

21 Values Insurance Types The payer can return any of the values listed below. Value in Response Mcare 2ndary Working Aged Beneficiary or Spouse with EGHP Mcare 2ndary ESRD Beneficiary in the 12 mo coordination period with an EGHP Mare 2ndary, No-fault Ins including Auto is Primary Mcare 2ndary Work Comp Mcare 2ndary PHS or Other Federal Agency Mcare 2ndary Black Lung Mcare 2ndary Vets Admin Mcare 2ndary Disabled Beneficiary Under Age 65 with LGHP Mcare 2ndary, Other Liability Ins is Primary Auto Ins Pol Comm COBRA Mcare Conditionally Primary Disability Disability Benes Exclusive Provider Organization Fam or Friends Grp Pol HMO HMO Mcare Risk Spcl Low Income Medicare Beneficiary Indemnity Indiv Pol LTC Long Term Pol Life Ins Litigation Mcare A Mcare B Mcaid Description Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan Medicare Secondary End-Stage Renal Disease Beneficiary in the 12 month coordination period with an employer group health plan Medicare Secondary, No-fault Insurance including Auto is Primary Medicare Secondary Workers Compensation Medicare Secondary Public Health Service (PHS) or Other Federal Agency Medicare Secondary Black Lung Medicare Secondary Veterans Administration Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP) Medicare Secondary, Other Liability Insurance is Primary Auto Insurance Policy Commercial Consolidated Omnibus Budget Reconciliation Act (COBRA) Medicare Conditionally Primary Disability Disability Benefits Exclusive Provider Organization Family or Friends Group Policy Health Maintenance Organization (HMO) Health Maintenance Organization (HMO) Medicare Risk Special Low Income Medicare Beneficiary Indemnity Individual Policy Long Term Care Long Term Policy Life Insurance Litigation Medicare Part A Medicare Part B Medicaid 2011 Emdeon Business Services LLC. All rights reserved. Page 18

22 Values Value in Response Mgap A Mgap B Mcare Primary Other Property Ins Personal Personal Personal Payment (Cash - No Ins) PPO POS QMB Property Ins Real Supplemental Pol TEFRA Work Comp Wrap Up Pol Description Medigap Part A Medigap Part B Medicare Primary Other Property Insurance Personal Personal Personal Payment (Cash - No Insurance) Preferred Provider Organization (PPO) Point of Service (POS) Qualified Medicare Beneficiary Property Insurance Real Supplemental Policy Tax Equity Fiscal Responsibility Act (TEFRA) Workers Compensation Wrap Up Policy 2011 Emdeon Business Services LLC. All rights reserved. Page 19

23 Index Index A About the Transaction, 1 About Your Responses, 7 Account #, 5 Amount, 5 B Benefit, 7 Billed Amt, 5 C Cascade Sequence, 4 Case #, 5 Closed, 7 Code Sce, 5 Customer Support, 2 D Date of Birth, 5 Date of Issue, 5 Date of Service, 5 Date of Service Restrictions, 2 E Eligibility/Benefit, 10 Eligibility/Benefit Types, 11 Emdeon Customer Support, 2 Error, 7 Error Messages, 10 I ID, 3 ID Card, 3 ID Card #, 6 ID/Date of Birth, 3, 4 Indicators, 7 Information Receiver, 9 Information Source, 9 Information Source Contact, 9 Input and Response Information, 8 Input Prompts, 5 Insurance Types, 18 O Other Payer, 8 P Patient, 9 Product ID, 6 Provider ID, 6 R Retry, 7 S Search Types, 3 Service Types, 13 Special Considerations, 2 Spend Down, 6 Spenddown, 1 Spenddown Reversal, 1 Spendown, 3 Spendown Reversal, 3 Status, 7 Subscriber, 9 Subscriber ID, 6 T Transaction Information, 8 Types of Medi-Cal Transactions, 1 W What is Cascading?, 4 M Medi-Cal Eligibility, 3 Medi-Cal Eligibility Inquiries, 1 Medical Services Reservation, 1, 4 Medical Services Reservation Reversal, 1, 4 Medicare, 8 N National Provider Identifiers, Emdeon Business Services LLC. All rights reserved. Page 20

24 Emdeon is a leading provider of revenue and payment cycle solutions that connect payers, providers, and patients to improve the healthcare business processes. To learn more about our company, our services, and our commitment to improving healthcare, visit our website at Emdeon Business Services LLC. All rights reserved Lebanon Pike, Suite 1000 Nashville, TN EMDEON.6 ( )