FSC (19)
DICTIONARY NARRATIVE
Please mark whether this is an addition, edit, or deactivation to the
FSC dictionary. If you are editing a FSC, only complete the fields
that you are editing and the FSC mnemonic. If you are adding a new
FSC, complete all required fields and any other field that might be
needed to do correct billing. If you are deactivating a FSC, only
complete the FSC mnemonic field.
If you need to delete the
information in the field, enter the word “delete” in the field.
1)
FSC Description: Enter the name of the financial class or insurance carrier. The name you
entered to the Add/Edit FSC prompt appears here as the default FSC description. This is a
required, free-text field and must be unique. (Example: Health Partners)
2)
FSC Number: This is a numeric code for the financial class. Whenever the system asks you
to specify a FSC, you can enter either the FSC name, (the description or short name), or the
unique FSC Number that you assign here. The FSC Number will be assigned by IS. This is
a required field.
3)
Send Statement? Enter one of the following: Y if you want invoices with balances in this
FSC to appear on statements. N or leave blank if you do not want charges to appear on
statements. For a charge to appear on a statement, you must enter Y here and the FSC must
be associated with the Statement Form in the Forms Dictionary (#106). The system
automatically makes this association when you add a new FSC, but not when you edit an
existing FSC. If you change the answer to this question from N to Y, you must run the
Statement Index Recreation Activity (F31/A6) to add accounts with balances in this FSC to
the Statement Index. If you change the answer to this question from Y to N, you must edit
the Statement Form in the Forms Dictionary (#106) and remove this FSC from the FSC list.
Then the balance in the next statement will not include any previous balances for this FSC.
You do not need to recreate the Statement Index. Statement Index Recreate is run monthly
on WUX.
4)
Claim Form Number: Enter a number that corresponds to a number in the Forms
Dictionary (#106). For example: 51 = CP-COMMERCIAL PAPER, 49 = HE-HMO
ELECTRONIC or 81= ME-MEDICARE. For a charge to appear on a claim form, the FSC
must also be associated with the claim form in the Forms Dictionary (#106). Changes to this
field are not recommended but can be done with proper planning.
5)
FSC mnemonic: Enter the short name for the FSC using up to three alpha characters of freetext. Whenever the system asks you to specify a FSC, you can either enter the FSC Short
Name, the FSC Description, or the FSC Number. This is a required field and the entry must
be unique.
6)
Certificate number required?: A N should be placed in this field when a certificate
number is not asked in the fsc/plan follow up questions. The edit will exclude any of
these fsc/plans from edits for the secondary and tertiary payers.
7)
Enter 1 if Reg FSC or 0 if not permitted as a Reg FSC : Enter a 1 if this FSC will be
entered to account Registrations. Example: 81-Medicare Enter a 0 if this is an invoice only
FSC. Example: 5-Do Not Bill.
10)
Force assignment when this FSC present? Use this feature with the Corresponding
Assigned FSC field described above. For example, you can choose to force assignment for
all of the patient’s FSCs if one of these FSCs is Welfare. Enter Y to convert any NonAssigned FSC for a patient to the Corresponding Assigned FSC when entering charges or
posting receipts, if the FSC is present in Registration. Enter N if you do not want to convert
the Non-Assigned FSCs.
11)
Corresponding registration FSC: Use this feature for printing insurance information on
claims. If a FSC does not have any follow-up questions, the system uses the information in a
Corresponding Registration FSC in the patient’s account when printing claims. For example,
Medicare would be a Corresponding Registration FSC for Medicare Appeal. Do not
change the entry in this field without consulting your system manager. Changing this
entry could affect data previously filed with the old value.
13)
Grouping Category: This feature prevents the entry of similar FSCs when registering
patients. For example, 21-Blue Shield and 22-Out-Of-State Blue Shield are in the same
Grouping Category, so a user cannot enter both of these FSCs in one patient’s account. This
feature also enables printing of insurance information on claims. If a FSC does not have any
follow-up questions and there is a no Corresponding Registration FSC (or the Corresponding
Registration FSC does not have any follow-up information), then the system uses the followup questions from a FSC in the same Grouping Category, when printing claims. For
example, the 21-Blue Shield, 23-Blue Shield Appeal, and 22-Out-Of-State Blue Shield FSCs
are in the same Grouping Category. So each of these FSC’s print claim form detail from the
Registration FSC, Corresponding Registration FSC or Grouping Category. If all three of
these fields are empty, no follow-up data for the FSC will print on claim forms and likely the
claim will go to the edit list for missing certificate number. Do not change the entry in this
field without consulting your system manager. Changing this entry could affect data
previously filed with the old value.
22)
Group Restriction: Enter a group number or a sequence of group numbers separated by
commas. Example: 3,4 . This feature lets you limit access and display of a FSC to one or
more groups than Groups 4 and 7 have access to add or edit the new FSC. If you want to
make a FSC accessible to all Groups, leave blank. If you want to deny access to all groups,
enter a number that does not correspond to any group on your system (99). If you enter a
group restriction for an existing FSC, the restriction becomes effective from that point. The
new entry does not affect existing charges.
23)
Keep cert index for this FSC? Enter Y to create an index of patient certificate numbers.
Enter N if you do not want to create an index of patient certificate numbers. Keeping a
certificate number index for a FSC is another way to identify a patient. When the system
prompts you for a patient name, you can enter W followed by a certificate number. This
causes the system to display all patients who have that certificate number.
The system keeps this index only from the date on which you answer Y to this question.
That is, the system does not implement a retroactive index. If you did not choose this option
when you first added this FSC to the FSC Dictionary (#19) and you want a retroactive index,
you must contact I.S. to have the IMS Recreate Certificate Number Index Activity run.
26-1) Reporting Category #1 (#2 and #3):
27-2) Enter the name of the Reporting Category to which you want this FSC to belong. Your
answer must be a valid entry in the Reporting Categories Dictionary (#77).
28-3) For example: SELF PAY.
You can create categories (MANAGED CARE-FEE SCHEDULE, APPEAL, PPO, etc.) of FSCs in
order to consolidate data on the following reports:
 Aged Trial Balance Summary (ATBS)
 Collection Analysis
 Ratio Analysis Aging
 Month-To-Date Transaction Summary
The Month-To-Date Transaction Summary can not be consolidated by FSC. The prompt
repeats three times to allow you to define three different ways to accommodate information.
This change affects the next printing of the compiled monthly reports and is immediately
available for DBMS queries.
Reporting Category #1: used by Finance. The finance office uses the MGMA definitions.
Reporting Category #2: the Operational areas reporting of different Management areas, HMO,
PPO,Medicare, etc.
Reporting Category #3: the payor type used for the Payor Mix report.
29)
Sort value for this FSC if relationship is self: Enter a number between 1 and 100,000.
The sort value you specify here determines this FSC’s position in the FSC hierarchy for a
patient. The first sort value you can assign is 1, the last sort value is 100,000. The FSC
priority number that appears in the FSC Table, during registration and other activities, is
based upon the FSC’s sort value. In registration, users can change priority numbers only for
FSC’s that have equal sort values.
You can assign two sort values to a FSC. A value that is active when the patient is the
subscriber, and a second value that is active when the patient is not the subscriber. If you
change the sort value for an existing FSC, it does not affect any previously registered
patients. However, the next time you file the insurance’s for these accounts, the system
resorts the FSCs, based on the changed value.
30)
Sort value for this FSC if relationship is not self: Enter a number between 1 and 100,000.
See the Sort value for this FSC if relationship is self prompt, described previously, for more
information.
31)
Enter 1 to use effective dates for this FSC: Enter 1 or leave blank. If you enter 1 here, the
system compares a patient’s effective and expiration dates to the service dates for this FSC
when you enter charges or post receipts. This feature provides a safeguard against entering
charges for expired FSCs. When you activate this feature for an existing FSC, it affects only
new transactions. To use this feature you must ask the effective and termination dates as
follow-up questions for this FSC. If you enter an effective date during registration that
expires existing charges, you must manually edit the affected invoices.
If you enable effective date checking for a FSC, you must also set up that FSC’s follow-up
questions to prompt for effective and termination dates
36)
Fee schedule hierarchy (numbers separated by commas): Enter numbers separated by
commas. Specify the fee schedule hierarchy for this FSC. The fee schedule hierarchy is a
list of fee schedule numbers that tells the system which fee schedules to search for pricing
information, and in what order to search them. If the system encounters an invoice with this
FSC and it does not find a fee schedule hierarchy in the Group Profile Dictionary (#200), it
will search the fee schedules specified here, in this specified order, until it finds pricing
information for the procedures in the invoice.
37)
Account Status: Enter a valid entry from the Account Statuses Dictionary (#196). The
system will look at this field to determine whether the account status should be assigned to
the patient account based upon the presence of this FSC in registration. WUX uses this for
employer cases.
43)
Employer FSC Only? Enter “Y” if this is an Occupational Medicine FSC. Leave blank if
this is not Occ Med.
49)
CARRIER ADDRESS: Enter the address line one for use in printing addresses on the top of
claim forms. All claims in this FSC will be sent to this address if field completed. If not all
invoices/claims in the FSC go to this address, leave field blank. When the field is blank the
claim form will look for alternate addresses for claim, including entries from the Commercial
Insurance (120) Dictionary.
50)
CARRIER CITY,STATE: Enter the City, State (City,ST) for use in printing addresses on
the top of claim forms. All claims in this FSC will be sent to this address if field completed.
If not all invoices/claims in the FSC go to this address, leave field blank. When the field is
blank the claim form will look for alternate addresses for claim, including entries from the
Commercial Insurance (120) Dictionary.
51)
CARRIER ZIPCODE: Enter the carrier zip code for use in printing addresses on the top of
claim forms. All claims in this FSC will be sent to this address if field completed. If not all
invoices/claims in the FSC go to this address, leave field blank. When the field is blank the
claim form will look for alternate addresses for claim, including entries from the Commercial
Insurance (120) Dictionary.
52)
FSC ASSIGNMENT INDICATOR: Enter a “Y” to check Yes Accepts Assignment,
Box # 27 on the 1500 claim form. Enter a “N” to check the No box.
53)
CARRIER ADDRESS LINE 2: Enter the address line two, if there is one or leave blank for
use in printing addresses on the top of claim forms. All claims in this FSC will be sent to
this address if field completed.
54)
REMITTANCE ADDRESS LINE 1: Enter the Address to print in Box #33 on the
1500 claim form. This is generally the address of the Banks Lock Box.
55)
REMITTANCE ADDRESS LINE 2: Enter the Address line two to print in Box #33 on
the 1500 claim form. This is generally the address of the Banks Lock Box.
56)
REMITTANCE CITY,STATE: Enter the City, State (City,ST) to print in Box #33 on
the 1500 claim form. This is generally the City, State of the Banks Lock Box.
57)
REMITTANCE ZIP CODE: Enter the Zip code to print in Box #33 on the 1500 claim
form. This is generally the zip code of the Banks Lock Box.
58)
CARRIER PHONE: Enter the phone number that can be used to contact the FSC’s
claims representatives. If there is more than one number or multiple Commercial
Insurance (120) dictionary entries associated with this FSC leave the field blank. This
should only be complete when there is one number to contact for the entire FSC.
61)
FAX NUMBER: Enter the fax phone number that can be used to contact the FSC’s
claims representatives. If there is more than one number or multiple Commercial
Insurance (120) dictionary entries associated with this FSC leave the field blank. This
should only be complete when there is one number to contact for the entire FSC.
62)
CASE FSC: Enter a Y if this is a FSC used for Occupational Medicine or Case Management
Billing. This field is for informational purposes.
63)
Destination Code: Enter the Electronic billing code assigned to this FSC by our electronic
billing carrier. (Healtheon) This number must match with the electronic claim vendors
system in order to submit claim forms electronically.
65)
Referral Not Required: Enter a ‘Y’ for this FSC to bypass the Referral/Authorization edits on
the claim form. By answering “Y” you are telling the claim form this FSC never requires the
Auth number field on the invoice to be completed.
66)
Referral Needed if Secondary: Enter a ‘Y’ if this requires a referral for secondary claims. This
is an informational field. No claim logic is tied to this field.
67)
MH CARRIER NAME: This field is for informational purposes. Enter the name of the
Mental Health Carve-out carrier.
68)
MH CARRIER ADDRESS LINE 1: This field is for informational purposes. Enter the
address of the Mental Health Carve-out carrier.
69)
MH ADDRESS LINE 2: This field is for informational purposes. Enter the second line
address of the Mental Health Carve-out carrier.
70)
MH CARRIER CITY,STATE: This field is for informational purposes. Enter the city
and state of the Mental Health Carve-out carrier.
71)
MH CARRIER ZIP CODE: This field is for informational purposes. Enter the zip code
of the Mental Health Carve-out carrier.
72)
DESTINATION CODE SUB-ID (ELECTRONIC) Code: Enter the Electronic billing
code sub ID assigned to this FSC by our electronic billing carrier. (Healtheon) This number
must be match with the electronic claim vendors system in order to submit claim forms
electronically.
73)
TES Category I: This field corresponds with the entry in this dictionary’s field #27Reporting Category #2. The exception to this is any Blue Shield FSC’s, they are designated
as Blue Shield in this field rather than PPO. This response is determined by the TES user
group. Direct questions to the FPP I.S. TES analyst.
74)
TES Category II: This field is not being used at this time.
77)
Medicode Payor Type: Enter “P” for Private/Commercial or “M” for Medicare. All
Medicare, Medicaid and HMO FSC’s are designated as “M”; all other FSC’s are designated
as “P”. This response is determined by the Medicode users group. Direct questions to PBS
Medicode Project Analyst.
78)
Medicode Proc Field: Enter the number of the procedure code dictionary field to be sent to
Medicode. This response is determined by the Medicode users group. Direct questions to
PBS Medicode Project Analyst.
10 = Blue Shield Procedure Code (used on all non-Medicare and non-Medicaid FSC’s)
14 = Medicare Code
19 = Medicaid Code
79)
Medicode Global Period Type: Always enter an “M” for Medicare. This response is
determined by the Medicode users group. Direct questions to PBS Medicode Project
Analyst.
80)
Medicode Global Period Default: Always enter a “U” for None. This response is
determined by the Medicode users group. Direct questions to FPP Medicode Project
Analyst.
81)
UHC FSC: Enter a ‘Y’ if this FSC is United Health Care. Extensive claim logic required for
UHC processing is added to claim form based on the ‘Y’ in this field.
82)
Capitation Referral Exception: Enter a ‘Y’ if this FSC has an Internal Medicine PCP capitation
agreement. The combination of this field and the Provider field Provider Capitation Referral
Exception will make invoices exempt from referral requirement
83)
Claims Status Available? Enter option below if HII claim status checking option is available.
N - if status available through NEIC
U - if status available through UHC
84)
Enter C if Capitation Enter a “C” if this FSC should be reported to the Finance office as
capitation revenue verses Fee for Service.
85)
Print Zero Claims? Enter a “Y” if this FSC should print claims for invoice balances of zero.
This is primary used for the printing of capitation encounters.
86)
HMO Use Anes Modifier Enter a “Y” if this HMO FSC should print the Anes Modifiers (QZ,
QK, etc. ) on the claim form in box 24D.
87)
HMO use Anes Mod when 2nd to Mcare Enter a “Y” if this HMO FSC should print the Anes
Modifiers (QZ, QK, etc. ) on the claim form in box 24D when this FSC is Secondary to Medicare.
88)
EKG Roll - Up Enter the appropriate roll up option from below. Leave blank for no roll up.
This will bundle EKG services and add modifiers according to the plans requirements.
MM - Mo Medicaid (101) - requires rollup up to 3 units on first line, additional units on the second line,
no modifiers
IM - IDPA (105) - requires 1 unit on first line, dummy procedure code (93799) on the second line, no
modifiers
T - requires all EKG charges rolled up to one line with the number of total units in the units field.
1 - 1 (one) requires the first charge for the day be billed on the first transaction line with a unit of one and
all additional services for the day be billed on a second transaction line with the total units, less the first
transaction line.
89)
OPENREF - OPEN HMO Number for tracking Open Referrals: If this FSC should allow
Open Referral Module tracking ability, enter "99". If not Open Referrals FSC, leave blank.
94)
(When transferring to this FSC, Request a Claim)? Y Enter a “Y” if during a FSC transfer
(paycode 70) the default to the “Request a Claim” prompt to be Y for Yes.
107)
OPENREF - Enter 1 to do Referral Limit Checking for each procedure: Enter a "1" if this
FSC should compare referral limits set up in Open Referrals. If answered with a "1" this FSC
will track referral limits. Leave blank if not Open Referrals FSC or you do not wish to have
referral limits tracked.
109)
OPENREF - Corresponding HMO Registration FSC: Enter a Registration FSC number if this
is an Invoice Only FSC that should allow Open Referrals. This field is used to correspond an
invoice only FSC with a single Registration FSC for the purposes of tracking Open Referrals. One
FSC may be entered.
124) (GHP FSC): Enter a “Y” if this FSC is of the GHP family. This field is used for claim form
logic to include changes made for all the GHP FSC’s.
125)
Ph No Referral This field is used by PRS to default the phone number for obtaining a
Referral from the carrier into FSC follow up questions.
126)
Ph No Precert/Auth This field is used by PRS to default the phone number for obtaining a
Precert or authorization from the carrier into FSC follow up questions.
127)
Ph No Eligibility This field is used by PRS to default the phone number for insurance
eligibility information from the carrier into FSC follow up questions.
128)
Ph No Benefits This field is used by PRS to default the phone number for obtaining Benefits
information from the carrier into FSC follow up questions.
129)
Ph No Mental Health This field is used by PRS to default the phone number for obtaining
Mental Health information from the carrier into FSC follow up questions.
130)
Valid Security Category: This field enables screen level security for FSC transfers into and out
of this FSC if completed. To allow transfers into and out of this FSC for all users, leave blank.
To enable security, enter the Security Plus category of the users that should have access to transfer
into and out of this FSC.
131)
OR Exempt from Psych TES Edit: Enter a"Y" into this field if this is an Open Referrals FSC
that only Psychiatry is using to track Open Referrals. This field will be used to direct other
departments TES and BAR Claim Form edits to use the Auth # field in charge entry/ TES instead
of the Open Referral fields.
169) Payer's website URL: Enter the full URL for the payer web site, entry must contain full
address. Example: for Aetna HTTPS://WWW.AETNA.COM/PROVWEB/
182) ETM ROLE: Enter the FSC’s role, selecting from the list below:
Payer:Commercial
Payer:Generic
Payer:HMO
Payer:Hosp Special Contracts
Payer:Interface
Payer:Medicaid
Payer:Medicare
Payer:Other
Payer:PPO
Payer:Self Pay
Payer:Special Billing
Payer:Work Comp
Comm
Generic
HMO
HospC
Interface
Medicaid
Medicare
Other
PPO
Self
SpecialB
Work
190) ETM InsFup # days unpaid Elect Claims: Enter a number between zero and 60.
191) ETM InsFup # days unpaid Paper Claims: Enter a number between zero and 60.
192) ETM InsFup # days for Invoice Follow-up: Enter a number between zero and 60.
193) ETM Stage (Custom Location 4118): Select the appropriate Stage from the list below:
Appeals
Billing
Central Processing
Charge Correction
Hold
Patient Followup
Special Billing
3
2
11
13
5
4
194) OS ETM VIEW GROUP BY: Custom field used by Orthopedic Surgery Department to
organize tasks in ETM View. Select the appropriate 48002 entry from the list below:
OS-BCBS
OS-BCBS-APPEALS
OS-CHARGE CORRECTION
OS-CIGNA
OS-COM
OS-COM-APPEALS
3001
3002
3003
3004
3005
3006
OS-CORE SERVICES
OS-GHP/CMR
OS-GOVERNMENT
OS-GOVERNMENT-APPEALS
OS-HEALTHLINK
OS-HMO
OS-HMO-APPEALS
OS-LOW
OS-MEDICAID
OS-MEDICAID OTHER
OS-MEDICAID OTHER-APPEALS
OS-MEDICAID-MO
OS-MEDICAID-MO APPEALS
OS-MEDICARE
OS-MEDICARE MO-APPEALS
OS-MEDICARE-OTHER
OS-MEDICARE-OTHER APPEALS
OS-MISC
OS-MISC-APPEALS
OS-NOT ORTHO
OS-PPO
OS-PPO APPEALS
OS-SPECIAL BILLING
OS-UHC
OS-WORK COMP
OS-WORK COMP-APPEALS
3007
3008
3009
3010
3011
3012
3013
3014
3015
3019
3016
3017
3018
3020
3021
3022
3023
3024
3025
3026
3027
3028
3029
3030
3031
3032
199) ETM Appeal Pending: Field used by ETM to roll together Appeals Pending FSC’s.
APPEALS
APPEALS
APPEALS
APPEALS
APPEALS
APPEALS
APPEALS
APPEALS
APPEALS
APPEALS
APPEALS
PEND,
PEND,
PEND,
PEND,
PEND,
PEND,
PEND,
PEND,
PEND,
PEND,
PEND,
BS
COMM
GHP/ADVANTRA
HMO
MC+ CAID
MEDICAID
MEDICARE
PPO
SPECIAL
TRICARE
WC
200) ETM FUP Pending Alternate field used by ETM to roll together Appeals Pending FSC’s,
includes Low Pay Appeals.
APPEALS
APPEALS
APPEALS
APPEALS
APPEALS
APPEALS
APPEALS
APPEALS
APPEALS
APPEALS
APPEALS
LOW PAY
PEND, BS
PEND, COMM
PEND, GHP/ADVANTRA
PEND, HMO
PEND, MC+ CAID
PEND, MEDICAID
PEND, MEDICARE
PEND, PPO
PEND, SPECIAL
PEND, TRICARE
PEND, WC
APPEALS
203) AN ETM View Group By: Custom field used by Anesthesiology Department to organize tasks
in ETM View. Select the appropriate 48002 entry from the list below:
AN
AN
AN
AN
AN
-
HMO-UHC-GHP
MEDICAID
MEDICARE
PPO-BS-HEALTHLINK
W/C-COMM
4000
4003
4002
4001
4004
205) ETM InsFup days unpaid elect claims:NOT USED, created by 4.0 upgrade as Standard Field
207) ETM InsFup days unpaid paper claims:NOT USED, created by 4.0 upgrade, Standard Field
208) ETM InsFup days for invoice inactivity: NOT USED, created by 4.0 upgrade as Standard Field
223) ETM Special Billing Group By: Custom field used by PBS Core Special Billing to organize
tasks in ETM View. No SCC approval needed for field update, PBS Special Billing Manager must
approve change. Select the appropriate 48002 entry from this list:
SB - 1
SB - 2
SB - 3
SB - 4
SB - 5
SB – 6
224) PA, NP billable? Enter a Y in this field if the payer will pay for services rendered by a PA or NP.
If the fsc has a dictionary 120 pull, then the field for PA, NP billable is in dictionary 120 too and
It should be answered with a Y. Please ask Trish Giaminetti to update the 120 entry.
227) SU ETM VIEW GROUP BY: Custom field used by Surgery Department to organize tasks in
ETM View. No SCC approval needed for field update, Surgery approved contact must request
change. Select the appropriate 48002 entry.
(AVM) Special Billing Specific Information
a) Name of Special Billing Type: What would you like the special billing type to be called? What
wll most people know it as?
b) should the patient’s registration insurance also be pulled into the visit? Do you want to use
the patient’s regular registration level insurance in addition to the special billing plan that will also be
on the visit?
c) If Y, should it be before or after the special billing plan? Only answer this question if the
answer to 231 above is Yes. Should the patient’s regular insurance be billed before or after the
special billing plan?
d) Last plan to use in visit list (optional): Is there a particular plan you would like the invoice to
default to after all insurances have paid? For example: P12 – Self Pay After Insurance, P907 – F/UP,
Pending, Special Billing.
233) SUBSCRIBER RELATIONSHIP IS ALWAYS SELF: This field should be completed with
a “Y” for any payor whose patient relationship to subscriber is always self. Examples: Medicare,
Medicare HMO products, Medicaid, and Medicaid MC+ HMO products.
239) OB ETM VIEW GROUP BY: Custom field used by O/B Departments to organize tasks in
ETM View. No SCC approval needed for field update, OB approved contact must request change.
Select the appropriate 48002 entry
240) OB ETM VIEW GROUP BY: Custom field used by O/B Departments to organize tasks in
ETM View. No SCC approval needed for field update, OB approved contact must request change.
Select the appropriate 48002 entry
Revised 07/22/09