In addition to the above options, the Claims Tracking Menu (Insurance menu Reviews)… contains the Health Care Services Review (HCSR) 278 Response option. You can use this option to view an X12N Health Care Services Request for Review and Response (278) response from – the UMO. You can enter a name and the system will display a list of events. You can then select patient’s the event response you wish to view. When an X12N Health Care Services Request for Review and Response (278) response with a – final status is received by VistA, the entry on the HCSR Worklist is removed. To view patient’s the response or to take further action such as submitting an Appeal, you may use the Health Care Services Review (HCSR) 278 Response option or the HCSR Response WL action from within the HCSR Worklist. The following are final statuses: A1 Certified in total – A3 Not Certified – A6 Modified – C Cancelled – CT Contact payer – NA No Action Required – Sample 278 Response Screens HCSR Response View Nov 13, 2014@10:09:54 Page: 1 of 7 IB,PATIENT 343 XX-XX-XXXX DOB: XXX X,XXXX AGE: XX Insurance Company Information Name: CIGNA Reimburse?: WILL REIMBURSE Phone: 800/525-5803 Billing Phone: 800/525-5803 Precert Phone: 800/877-1209 Address: PO BOX 9358, SHERMAN, TX 75091 Group/Plan Information Type Of Plan: COMPREHENSIVE MAJOR MEDICAL Require UR: YES Group?: YES Require Amb Cert: Group Name: CIGNA Require Pre-Cert: YES Group Number: WXXXXX Exclude Pre-Cond: BIN: Benefits Assignable: YES PCN: Plan Comments: + Enter ?? for more actions SR (Send 278 Request) RP Remove 'In Progress' SP Set 'In Progress' VR View Sent Request EX Exit Select Action: Next Screen// HCSR Response View Nov 13, 2014@10:10:43 Page: 2 of 7 IB,PATIENT 343 XX-XX-XXXX DOB: XXX X,XXXX AGE: XX + Policy/Subscriber Information Insured's Name: IB,PATIENT 343 Effective: 1/1/2014
In addition to the above options, the Claims Tracking Menu (Insurance Reviews)… menu contains the Health Care Services Review (HCSR) 278 Response option. You can use this option to view an X12N Health Care Services – Request for Review and Response (278) response from the UMO. You can enter a patient’s name and the system will display a list of events. You can then select the event response you wish to view. When an X12N Health Care Services – Request for Review and Response (278) response with a final status is received by VistA, the patient’s entry on the HCSR Worklist is removed. To view the response or to take further action such as submitting an Appeal, you may use the Health Care Services Review (HCSR) 278 Response option or the HCSR Response WL action from within the HCSR Worklist. The following are final statuses: A1 – Certified in total A3 – Not Certified A6 – Modified C – Cancelled CT – Contact payer NA – No Action Required Sample 278 Response Screens HCSR Response View Nov 13, 2014@10:09:54 Page: 1 of 7 IB,PATIENT 343 XX-XX-XXXX DOB: XXX X,XXXX AGE: XX Insurance Company Information Name: CIGNA Reimburse?: WILL REIMBURSE Phone: 800/525-5803 Billing Phone: 800/525-5803 Precert Phone: 800/877-1209 Address: PO BOX 9358, SHERMAN, TX 75091 Group/Plan Information Type Of Plan: COMPREHENSIVE MAJOR MEDICAL Require UR: YES Group?: YES Require Amb Cert: Group Name: CIGNA Require Pre-Cert: YES Group Number: WXXXXX Exclude Pre-Cond: BIN: Benefits Assignable: YES PCN: Plan Comments: + Enter ?? for more actions SR (Send 278 Request) RP Remove 'In Progress' SP Set 'In Progress' VR View Sent Request EX Exit Select Action: Next Screen// HCSR Response View Nov 13, 2014@10:10:43 Page: 2 of 7 IB,PATIENT 343 XX-XX-XXXX DOB: XXX X,XXXX AGE: XX + Policy/Subscriber Information Insured's Name: IB,PATIENT 343 Effective: 1/1/2014
ib_2_0_p568_ct_ug.docx