NURSING FC - CRS1, CRS2, CRS3, CRS4
The screens in the Nursing Facility claim queue are CRS1, CRS2, CRS3 and CRS4. Nursing facility claims are institutional claims and use claim form UB-04.
The fields in MMIS on the nursing facility claim are different from the CMS-1500 we viewed previously.
In this table MMIS fields are populated with sample data to show how MMIS fields appear with valid values entered. Field entries containing Protected Health Information (PHI) appear as zeros in this example.
Table of NURSING FACILITY - CRS1, CRS2, CRS3, CRS4 claim panels
NEXT: CRS2 NURSING FC - CRS1
TCN: 0 00000 00 000 0000 00
ACCOUNTING CD: 0 NORM-PAY CLAIM STATUS: N PAID
LAST CYCLE DT: MMDDYY
NPI: 0000000000 MHCP PROV NBR: 0000000 00 TYPE/COS: 05 MSG:
PATIENT CNTL NBR: 0000000000 TYPE OF BILL: 653
COVERED FROM/TO DT: MMDDYY MMDDYY COVERED/NON COVERED DAYS: 030
COINS DAYS: LAST FIRST MI
RECIPIENT ID: 000000000 NAME: LAST FIRST I
DOB: MMDDYYYY0 SEX: M AGE: 000 MAJOR PROG: MA LA: 00
ADMISSION DT/HOUR/TYPE/SOURCE: MMDDYY 12 1 1 DISCH HR: PATIENT STAT: 30
CONDITION CODES:
OVR LOC: OVR EOB/EXC: ATTACH FOUND: TPL BLNG IND:
WARRANT DATE: MMDDYY REPLACEMENT RSN: TCN REPLCD:
OBLIG ID: REPLCD BY TCN:
WARRANT NBR: 000000000 RA NBR: 000000000 TOT REIMB AMT: 0000.00
LI ERR ST USER ID LI ERR ST USER ID LI ERR ST USER ID LI ERR ST USER ID
ENTER---PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12
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NEXT: CRS3 NURSING FC - CRS2
TCN: 0 00000 00 000 0000 00
ACCOUNTING CD: 0 NORM-PAY CLAIM STATUS: N PAID
MHCP PROV NBR: 0000000 00 TYPE/COS: 05 MN SERVICE GROUP:
RECIPIENT ID: 00000000 NAME: LAST FIRST I
DOB: MMDDYYYY SEX: M AGE: 000 MAJOR PROG: MA LA: 00
OCCURRENCE CD/DT:
OCCURRENCE SPAN CD: FROM/THROUGH DTS:
VALUE CD/AMT: 24 0.00
LI ERR ST USER ID LI ERR ST USER ID LI ERR ST USER ID LI ERR ST USER ID
ENTER---PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12
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NEXT: CRS4 NURSING FC - CRS3
TCN: 0 00000 00 000 0000 00
ACCOUNTING CD: 0 NORM-PAY CLAIM STATUS: N PAID
MHCP PROV NBR: 0000000 00 TYPE/COS: 05 MN SERVICE GROUP:
RECIPIENT ID: 00000000 NAME: LAST FIRST I
PAY DOB: MMDDYYYY SEX: M AGE: 000 MAJOR PROG: MA LA: 00
CD PROVIDER NBR PRIOR PYMT -----ID NUMBER----- TRT AUTH CD NPI
D 000000000 00000000 0000000000
ADM DIAG: ADM AUTH: TAXONOMY CD:
PAT RSN DX: ECI:
DIAGNOSIS: 000.0
PROC/DT:
ATND PRV: OPER PRV OTHR PRV:
CARRIER ID: GROUP NAME ID: INS GRP NBR IND: EMPLR NAME IND:
REMARKS: SIGNATURE: Y DATE BILLED: 100208
LI ERR ST USER ID LI ERR ST USER ID LI ERR ST USER ID LI ERR ST USER ID
ENTER---PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12
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NEXT: CRS1 NURSING FC - CRS4
TCN: 0 00000 00 000 0000 00
ACCOUNTING CD: 0 NORM-PAY CLAIM STATUS: N PAID
MHCP PROV NBR: 0000000 00 TYPE/COS: 05 MN SERVICE GROUP:
RECIPIENT ID: 00000000 NAME: LAST FIRST I
START LINE NBR: 001 MAX LINES: 001
REVENUE RATE/ DATE OF SERVICE SUB TOTAL NON-COVERED
LI CODE HCPCS FROM THRU UNITS CHARGES CHARGES
001 0101 000.00 MMDDYY MMDDYY 000 0000.00
BASE RATE/SRC: 0000.00 RR ALLOW UNITS: RUG RATE: MR
BASE RATE CHNG AMT/RSN: 000.00 01
CALC ALLOW CHRG: 0000.00 REIMB AMT/STAT: 0000.00 A
COS: 013 MSG: 526 FUNDING CD: 000
002
BASE RATE/SRC: ALLOW UNITS: RUG RATE:
BASE RATE CHNG AMT/RSN:
CALC ALLOW CHRG: REIMB AMT/STAT:
COS: MSG: FUNDING CD:
LI ERR ST USER ID LI ERR ST USER ID LI ERR ST USER ID LI ERR ST USER ID
ENTER---PF1---PF2---PF3---PF4---PF5---PF6---PF7---PF8---PF9---PF10---PF11--PF12
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Fields on the nursing facility claim
On the CRS1 panel
CLAIM STATUS field indicates the status of the claim. In this example claim status is N PAID.
RECIPEINT ID and NAME fields identify the PMI number and name of the recipient on this claim.
TOT REIMB AMT field displays the total amount paid on this claim.
On the CRS3 panel
PROVIDER NUMBER and NPI number identify the provider.
On the CRS4 panel
LI, REVENUE CODE, RATE/HCPCS, DATE OF SERVICE FROM THRU, SUB UNTIS, TOTAL CHANGES fields are for each line of the claim. This is an institutional claim. In this example the claim is for one month of a nursing facility stay.
More claims navigation information
- The process we followed to access this claim was to enter search criteria on the CINQ panel and then select the claim from the list of claims on the CRPC panel. Function key F4 was used to navigate to the claim and view it. However further F4 navigation is not available.
- To navigate within a claim the search criteria entered on the CINQ panel must be claim specific.
On the next page we will learn how to access a claim directly.
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