OUTPATIENT - CUB1, CUB2, CUB3, CUB6
The MMIS screens in the OUTPATIENT claim queue are CUB1, CUB2, CUB3 and CUB6.
There are more than two line items on this claim. In the example below the CUB6 panel is shown twice so additional lines on this claim can be viewed.
In this table MMIS fields are populated with sample data to show how MMIS fields appear with valid values entered. For this course field entries containing Protected Health Information (PHI) appear as zeros in this example.
Table of OUTPATIENT claim CUB1, CUB2, CUB3, CUB6 panels
NEXT: CUB2 OUTPATIENT - CUB1
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: 60 MSG:
PATIENT CNTL NBR: 00000000 TYPE OF BILL: 323
COVERED FROM/TO DT: MMDDYY MMDDYY COVERED/NON COVERED DAYS:
LAST FIRST MI
RECIPIENT ID: 00000000 NAME: LAST FIRST I
DOB: MMDDYYYY SEX: F AGE: 000 MAJOR PROG: MA LA: 00
ADMISSION DT/HOUR/TYPE/SOURCE: 1 1 DISCH HR: PATIENT STAT: 01
MEDICAL RECORD NBR: CONDITION CODES:
CALCULATED TOTAL CHARGE: 000.00
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: 000.00
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: CUB3 OUTPATIENT - CUB2
TCN: 0 00000 00 000 0000 00
ACCOUNTING CD: 0 NORM-PAY CLAIM STATUS: N PAID
MHCP PROV NBR: 0000000 00 TYPE/COS: 60 MN SERVICE GROUP:
RECIPIENT ID: 00000000 NAME: LAST FIRST I
DOB: MMDDYYYY SEX: F AGE: 000 MAJOR PROG: MA LA: 00
OCCURRENCE CD/DT:
OCCURRENCE SPAN CD: FROM/THROUGH DTS:
VALUE CD/AMT:
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: CUB6 OUTPATIENT - CUB3
TCN: 0 00000 00 000 0000 00
ACCOUNTING CD: 0 NORM-PAY CLAIM STATUS: N PAID
MHCP PROV NBR: 0000000 00 TYPE/COS: 60 MN SERVICE GROUP:
RECIPIENT ID: 00000000 NAME: LAST FIRST I
PAY DOB: MMDDYYYY SEX: F AGE: 000 MAJOR PROG: MA LA: 00
CD PROVIDER NBR PRIOR PYMT -----ID NUMBER----- TRT AUTH CD NPI
D 000000000 00000000 00000000000 0000000000
ADM DIAG: ADM AUTH: TAXONOMY CD: 251E00000X
PAT RSN DX: ECI/POA:
DIAGNOSES/POA: 000.00
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: MMDDYY
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: CUB1 OUTPATIENT - CUB6
TCN: 0 00000 00 000 0000 00
ACCOUNTING CD: 0 NORM-PAY CLAIM STATUS: N PAID
MHCP PROV NBR: 0000000 00 TYPE/COS: 60 MN SERVICE GROUP:
RECIPIENT ID: 00000000 NAME: LAST FIRST I
DOB: MMDDYYYY SEX: F AGE: 000 MAJOR PROG: MA LA: 00
START LINE NBR: 001 MAX LINES: 5 CALCULATED TOTAL CHARGE: 000.00
REVENUE -MODIFIER-- DATE SUB TOTAL NONCOVERED TO DT +
LI CODE PROC 1 2 3 4 OF SVC UNIT CHARGES CHARGES SVC
001 0551 T1030 MMDDYY 0 00.00 MMDDYY
NDC: QTY: OVR EOB/EXC: RATE:
BASE RATE/SRC: 00.00 PP ALLOW UNITS: 0 PSI: GSI:
BASE RATE CHNG AMT/RSN: COS: 020 MSG: 541
CALC ALLOW CHRG: 00.00 REIMB AMT/STAT: 00.00 B FUNDING CD: 000
002 0551 T1030 031709 0 00.00 MMDDYY
NDC: QTY: OVR EOB/EXC: RATE:
BASE RATE/SRC: 00.00 PP ALLOW UNITS: 0 PSI: GSI:
BASE RATE CHNG AMT/RSN: COS: 020 MSG: 541
CALC ALLOW CHRG: 00.00 REIMB AMT/STAT: 00.00 B FUNDING CD: 000
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: CUB1 OUTPATIENT - CUB6
TCN: 0 00000 00 000 0000 00
ACCOUNTING CD: 0 NORM-PAY CLAIM STATUS: N PAID
MHCP PROV NBR: 0000000 00 TYPE/COS: 60 MN SERVICE GROUP:
RECIPIENT ID: 00000000 NAME: LAST FIRST I
DOB: MMDDYYYY SEX: F AGE: 000 MAJOR PROG: MA LA: 00
START LINE NBR: 003 MAX LINES: 5 CALCULATED TOTAL CHARGE: 000.00
REVENUE -MODIFIER-- DATE SUB TOTAL NONCOVERED TO DT +/-
LI CODE PROC 1 2 3 4 OF SVC UNIT CHARGES CHARGES SVC
003 0551 T1030 MMDDYY 0 00.00 MMDDYY
NDC: QTY: OVR EOB/EXC: RATE:
BASE RATE/SRC: 00.00 PP ALLOW UNITS: 0 PSI: GSI:
BASE RATE CHNG AMT/RSN: COS: 020 MSG: 541
CALC ALLOW CHRG: 00.00 REIMB AMT/STAT: 00.00 B FUNDING CD: 000
004 0551 T1030 MMDDYY 1 00.00 033109
NDC: QTY: OVR EOB/EXC: RATE:
BASE RATE/SRC: 00.00 PP ALLOW UNITS: 0 PSI: GSI:
BASE RATE CHNG AMT/RSN: COS: 020 MSG: 541
CALC ALLOW CHRG: 00.00 REIMB AMT/STAT: 00.00 B FUNDING CD: 000
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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Navigation within a claim
Remember we accessed this claim directly using the TCN number on the CINQ panel. Now all the navigation tools listed below are available.
- Function key F1 display or hide PF key display on panels.
- Function key F5 to lookup provider or recipient.
- Function key F4 to look up additional information.
- Place cursor on provider NPI number or MHCP provider number and press F4 to navigate to the PROVIDER APPLICATION FILE and look up information about that provider.
- Place cursor on PMI number and press F4 to navigate to the RECIPIENT FILE APPLICATION summary panel RSUM.
- Place cursor on the TRT AUTH CD (Treating Authorization Code) and press F4 to navigate to the service agreement.
- On the CUB3 panel place cursor on the diagnosis code and press F4 to navigate to the REFERENCE FILE and look information about the diagnosis code.
- On the CUB6 panel place cursor on the revenue or procedure code and press F4 to navigate to the REFERENCE FILE and look up information about that revenue or procedure code.
- Worker message INVALID NAVIGATION REQUESTED posts when function key F4 is not available on the field selected.
- Function key F6 returns to the claim after F4 or F5 navigation to look up information.
- On the CUB6 panel to view additional lines when there is a + or +/- on the screen use down arrow to place cursor anywhere on a line and press F8 to advance to additional lines on the claim.
- The MAX LINES field on the CUB6 panel indicates the number of lines on a claim.
- In this example there are five lines. Only four of the lines are shown.
- Function key F7 returns to previous lines when cursor is within a line item.
- On the CUB6 panel to view a specific line TAB to the START LINE NBR field and enter a line number. Then press F8 to go directly to that line.
- If there are edits posted on the claim place cursor on an edit number and press function key F4 to view the long description of the edit. Press function key F6 to return to claim.
- Enter acronym of claim panel in the NEXT field to navigate directly to that panel.
- TRANSMIT to advance through the panels in the claim queue.
- F6 to return to the CINQ panel.
There are other claim types not reviewed in this course. Navigation for all claim types is the same.
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