MO HealthNet Internet Provider

1

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

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Proper Completion of the Online Medicare Part A
Crossover Claim

• Presented by the Provider Education Unit
• MO HealthNet Division

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• To file a claim go to the Internet Web site
• www.emomed.com and log on. This will
• bring up the Home Page. At the bottom
• of each claim screen is a Help button.
• You can print out field-by-field
• instructions.

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Medicare UB-04 Part A Institutional Crossover
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Provider Identifier
Taxonomy Code
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Provider Identifier
Taxonomy Code
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Claim Frequency Code
Medicare Provider Identifier
Patient MO HealthNet ID
Patient Name
Patient Medicare ID
Patient Account No.
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Claim Frequency Code
Medicare Provider Identifier
Patient MO HealthNet ID
Patient Name
Patient Medicare ID
Patient Account No.
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Claim Frequency Code
Medicare Provider Identifier
Patient MO HealthNet ID
Patient Name
Patient Medicare ID
Patient Account No.
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Claim Frequency Code
Medicare Provider Identifier
Patient MO HealthNet ID
Patient Name
Patient Medicare ID
Patient Account No.
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Claim Frequency Code
Medicare Provider Identifier
Patient MO HealthNet ID
Patient Name
Patient Medicare ID
Patient Account No.
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Claim Frequency Code
Medicare Provider Identifier
Patient MO HealthNet ID
Patient Name
Patient Medicare ID
Patient Account No.
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Patient Status
Type of Bill
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Patient Status
Type of Bill
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Dates of Service (Monty/Day/Year)
Admission Date (Month/Day/Year)
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Dates of Service (Monty/Day/Year)
Admission Date (Month/Day/Year)
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Covered Days
Resubmission Ref. No.
Billed Charges
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Covered Days
Resubmission Ref. No.
Billed Charges
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Covered Days
Resubmission Ref. No.
Billed Charges
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Diagnosis Codes
Attending Physician Provider Identifier
Taxonomy Code
Surgery Procedure Codes
Date (Month/Day/Year)
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Diagnosis Codes
Attending Physician Provider Identifier
Taxonomy Code
Surgery Procedure Codes
Date (Month/Day/Year)
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Diagnosis Codes
Attending Physician Provider Identifier
Taxonomy Code
Surgery Procedure Codes
Date (Month/Day/Year)
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Diagnosis Codes
Attending Physician Provider Identifier
Taxonomy Code
Surgery Procedure Codes
Date (Month/Day/Year)
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Diagnosis Codes
Attending Physician Provider Identifier
Taxonomy Code
Surgery Procedure Codes
Date (Month/Day/Year)
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Revenue Code
Days/Units Billed
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Revenue Code
Days/Units Billed
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Add Header Other Payers
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(No Transcript)
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Other Payer ID
Filing Indicator
Other Payer Name
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Other Payer ID
Filing Indicator
Other Payer Name
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Other Payer ID
Filing Indicator
Other Payer Name
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Paid Amount
Paid Date (Month/Day/Year)
Header Allowed Amount
Total Denied Amount
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Paid Amount
Paid Date (Month/Day/Year)
Header Allowed Amount
Total Denied Amount
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Paid Amount
Paid Date (Month/Day/Year)
Header Allowed Amount
Total Denied Amount
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Paid Amount
Paid Date (Month/Day/Year)
Header Allowed Amount
Total Denied Amount
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Group Code
Reason Code
Adjust Amount
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Group Code
Reason Code
Adjust Amount
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Group Code
Reason Code
Adjust Amount
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Group Code
Reason Code
Adjust Amount
Add Payer
Remark Code
Done
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Group Code
Reason Code
Adjust Amount
Add Payer
Remark Code
Done
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Group Code
Reason Code
Adjust Amount
Add Payer
Remark Code
Done
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Group Code
Reason Code
Adjust Amount
Add Payer
Remark Code
Done
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Group Code
Reason Code
Adjust Amount
Add Payer
Remark Code
Done
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Group Code
Reason Code
Adjust Amount
Add Payer
Remark Code
Done
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(No Transcript)
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Other Payer ID
Filing Indicator
Other Payer Name
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Other Payer ID
Filing Indicator
Other Payer Name
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Other Payer ID
Filing Indicator
Other Payer Name
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Paid Date (Month/Day/Year)
Paid Amount
Header Allowed Amount
Total Denied Amount
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Paid Date (Month/Day/Year)
Paid Amount
Header Allowed Amount
Total Denied Amount
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Paid Date (Month/Day/Year)
Paid Amount
Header Allowed Amount
Total Denied Amount
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Paid Date (Month/Day/Year)
Paid Amount
Header Allowed Amount
Total Denied Amount
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Group Code
Reason Code
Adjust Amount
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Group Code
Reason Code
Adjust Amount
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Group Code
Reason Code
Adjust Amount
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Group Code
Reason Code
Adjust Amount
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Group Code
Reason Code
Adjust Amount
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Group Code
Reason Code
Adjust Amount
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Group Code
Reason Code
Adjust Amount
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Group Code
Reason Code
Adjust Amount
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Group Code
Reason Code
Adjust Amount
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Group Code
Reason Code
Adjust Amount
Done
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Continue
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(No Transcript)
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View All Other Payers
Edit
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View All Other Payers
Edit
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Done
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Submit
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(No Transcript)
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View All Other Payers
Next
Print
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View All Other Payers
Next
Print
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Done
Print
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Done
Print
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View All Other Payers
Next
Print
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• Thank you again for participating in this
• training program. If you have questions
• regarding the information in this
• presentation, please contact the Provider
• Education Unit at 573-751-6683.