The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid.

Unique identifier for the benefit plan.

The claim type of the claim that ND MMIS is processing.

Examples: Inpatient, Outpatient, Financial Transaction

Indicator to display voided (inactive) records. Select to display both active and inactive records. Leave blank to display only active records.

Indicates whether or not the record has been voided. Depending on which page you are viewing, a check mark or a void date indicates the record is void.

When editing, indicates whether the record is active (No) or inactive (Yes). If inactive, the record is void, and it is ignored when processing.

Only records with beginning dates in the past can be voided. Records with beginning dates in the future can be deleted.

The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid.

First date the duplicate check criteria is in effect.

Format: MM/DD/YYYY

Last date the duplicate check criteria is in effect.

Format: MM/DD/YYYY

Defines the order of precedence the ND MMIS is to use for evaluating the duplicate check criteria - the lower the numerical value assigned to the rank, the higher its precedence.

Default: 999

Indicates what level of the claims the duplicate check criteria are comparing. The claim level for the in-process claim is listed first.

Examples: Header to Header, Line to Header

Indicates how to compare the dates of service on the claims being evaluated by the duplicate check criteria.

Examples: Same, Overlapping, Same or Overlapping

Indicates the provider role to compare on the claims being evaluated by the duplicate check criteria.

Examples: Billing, Rendering

Indicates the benefit plan to compare on the claims being evaluated by the duplicate check criteria.

In Process Fields

These fields indicate the value(s) that must be on the in-process claim for it to be evaluated by the duplicate check criteria.

The claim type of the in-process claim.

Examples: Inpatient, Outpatient, Financial Transaction

Compare To Fields

These fields indicate the value(s) that must be on the compare-to claim - the claim to which the in-process claim is being compared - for it to be evaluated by the duplicate check criteria.

The claim type of the compare-to claim.

Examples: Inpatient, Outpatient, Financial Transaction

The name of modifier system list of the compare-to claim.

Used to limit the criteria to specific procedure code modifiers.

The name of procedure system list of the compare-to claim.

Used to limit the criteria to specific procedure codes.

The name of the revenue system list of the compare-to claim.

Used to limit the criteria to specific revenue codes.

Data Comparisons Fields

These fields indicate information to compare between the in-process claim and the compare-to claim.

• If the value is Ignore, the information is not considered.
• If the value is Same, and the values on the in-process claim and the compare to claim are the same, the criteria is met.
• If the value is Different, and the values on the in-process claim and the compare-to claim are different, the criteria is met.

All data comparisons criteria must be met for the exception to be applied to the in-process claim.

Unique identifier used for a provider of healthcare services.

Format: Up to 15 alphanumeric characters

The provider classification. Based on the Level I Provider Type of the Taxonomy Code Set.

Examples: Dental, Pharmacy, Hospital, Vision, Physician

The provider's certified medical specialty. The provider specialty is based on the Level Ill Area of Specialization of the Taxonomy Code Set.

Examples: Allergy, Blood Banking, Dentistry, Dermatology, Podiatry

CMS defines the Taxonomy Codes as an administrative code set for identifying the provider type and the area of specialization for all health care providers. The code set is used in X12-278 Referral Certification and Authorization and the X12 837 Claim transactions. It is maintained by the National Uniform Claim Committee (NUCC).

Indicates the procedure or service provided. Healthcare Common Procedure Coding System (HCPCS) or Current Dental Terminology (CDT) codes are typically used.

A two-digit code attached to the procedure code to modify or clarify the description of the procedure. Up to four modifiers may be submitted on a claim for each procedure code, if applicable.

Identifies specific accommodation or ancillary charges.

A standard code used to describe the nature of a patient's illness or injury.

The service area.

Examples: Radiology, Transportation

Unique identifier for the benefit plan.

Data Inclusion Fields

These fields indicate the values that must be present on both the in-process claim and the compare-to claim in order for the claims to be evaluated by the duplicate check process.

• To move an item from the Available list to the Selected list, select the item, and then click (the right arrow).
• To move an item from the Selected list to the Available list, select the item, and then click (the left arrow).
• To select or clear multiple items, press CTRL and click the items.

The provider classification. Based on the Level I Provider Type of the Taxonomy Code Set.

Examples: Dental, Pharmacy, Hospital, Vision, Physician

The provider's certified medical specialty. The provider specialty is based on the Level Ill Area of Specialization of the Taxonomy Code Set.

Examples: Allergy, Blood Banking, Dentistry, Dermatology, Podiatry

CMS defines the Taxonomy Codes as an administrative code set for identifying the provider type and the area of specialization for all health care providers. The code set is used in X12-278 Referral Certification and Authorization and the X12 837 Claim transactions. It is maintained by the National Uniform Claim Committee (NUCC).