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We are billing DMerc and most of our claims for a podiatrist are going through. BUT a number of claims are rejecting, saying Missing/Invalid Ordering Provider.

We do have the ordering/referring provider listed in the Referring Provider field in the case...and I see it in the claim. But the payer claims they are receiving the practice's Group NPI, not the ordering provider's name and NPI.

Is there something I'm doing wrong? I'm using the standard IGuide for V22. Should I be using a different IGuide for DMerc? I can provide a sample claim if needed.

Thanks,
Steve

It should simply be the referring provider from the case. The entity type on this provider must be person and the NPI must be setup in the referring provider ids grid.

But, you also should be using the DME iGuide along with the appropriate DME Smart Screen.

We don't need CMNs for the services being provider (such as orthotics for a podiatrist). Again, strange thing is 90% of the claims go through without a problem; only 10% are rejected for this.

So we should be using the DME with CMNs IGuide, even though we don't need CMNS?

And I have never really looked at the smart screens. Do we have to add additional info to the smart screens in RM? And what's the cost?

Steve

What kind of DME claims are you billing? There are differences in the iGuides between standard and the one for DME claims.

For orthotics and walkers for a podiatrist (mainly codes L3000 and L4360). Seems like most claims are getting paid fine with the referring provider list, but at times some claims reject saying missing/invalid ordering provider. That's what makes no sense. We send the same way all the time and 9 claims out of 10 are paid fine...and the 10th claim is rejected for the above reason even though we have a referring provider and we have valid info including NPI...BUT DMerc claims they are not receiving the referring provider's info but rather my client's Group Practice info in that field (I know they're wrong when I view the paper claim).

Try just adding the CMN Supporting Data Smart Screen and switch to the CMN iGuide. See if that makes a difference. Also, double check your referring provider's setup. I am not sure if Supporting Data will work by itself or if you must combine it with one of the other smart screens. It looks like eMDs redid the CMN Smart Screens since the last time I looked at them.

Don't you have to purchase a smart screen? I don't have any Smart Screen under Smart Screens in Revenue Management.

You have to browse and find them. They are all under C:\medisoft\bin\rcm.

Dumb me...only problem was I didn't have the box checked for the payer (DMerc) to Send Order Provider in Loop 2420E. Checking that box solved the problem.

Steve

In Medisoft version 24, you would go to insurance companies and bring up the name of the your DME, such as DMERC. Go to EDI/eligibility tab, and check box SEND ORDERING PROVIDER in LOOP 2420E. NO NEED TO USE SMART SCREEN or IGuides.

This should then send the claim to CGS Medicare DME with ordering provider name properly recognized.

Richard 9-10-2020