Fiscal Pend Page

You use the Fiscal Pend page to add or edit fiscal pend criteria.

The Fiscal Pend page contains the following panels:

Fiscal Pend Header Fields

Field	Description
ID	Unique ID assigned to the fiscal pend criteria by ND MMIS.
Description	Information about the fiscal pend criteria entered by the user when establishing the criteria.
LOB	The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid.
Fund Code	The budget and funding sources applicable to a claim.
Paid Date Begin Date	The first date that the fiscal pend criteria applies. Format: MM/DD/YYYY
Paid Date End Date	The last date that the fiscal pend criteria applies. Format: MM/DD/YYYY
Include Financial Payout Transaction	Indicates whether to apply the fiscal pend criteria against clams with a claim type of Financial Transaction.
Rank	Defines the order of precedence ND MMIS is to use for evaluating the criteria. The lower the numerical value assigned to the rank, the higher its precedence. Default: 999
Void	When editing, indicates that the entire record and all associated detail records are not valid and should not be used in processing claims. If the record has been voided, none of the information can be changed. Only records with beginning dates in the past can be voided.

Field

Description

Unique ID assigned to the fiscal pend criteria by ND MMIS.

Description

Information about the fiscal pend criteria entered by the user when establishing the criteria.

LOB

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

Fund Code

The budget and funding sources applicable to a claim.

Paid Date Begin Date

The first date that the fiscal pend criteria applies.

Format: MM/DD/YYYY

Paid Date End Date

The last date that the fiscal pend criteria applies.

Format: MM/DD/YYYY

Include Financial Payout Transaction

Indicates whether to apply the fiscal pend criteria against clams with a claim type of Financial Transaction.

Rank

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

Default: 999

Void

When editing, indicates that the entire record and all associated detail records are not valid and should not be used in processing claims. If the record has been voided, none of the information can be changed. Only records with beginning dates in the past can be voided.

Fiscal Pend Details Fields

Field	Description
To add fiscal pend details, click Add Fiscal Pend Details. To edit, in the Fiscal Pend Details table, click the appropriate row.
Show Voids	Indicator to display voided (inactive) records. Select to display both active and inactive records. Leave blank to display only active records.
Void Date or Void	In the table, the date the record was voided. If the record has been voided, none of the information can be changed. When editing, indicates whether the record is active (No) or inactive (Yes). If inactive the record 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.
Billing Provider ID Type	Unique code that indicates the type of provider ID entered. Examples: DEA, NPI, SSN/EIN
Billing Provider ID	Unique identifier used for a provider of healthcare services. Format: Up to 15 alphanumeric characters
Billing Provider Type	The provider classification. Based on the Level I Provider Type of the Taxonomy Code Set. Examples: Dental, Pharmacy, Hospital, Vision, Physician
Billing Taxonomy	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).
Claim Type	The type of claim. Examples: Inpatient, Outpatient, Financial Transaction
Benefit Plan	Unique identifier for the benefit plan.
COS	Category of Service. The services for which enrolled providers are authorized to bill.
Proc or Procedure Code	Indicates the procedure or service provided. Healthcare Common Procedure Coding System (HCPCS) or Current Dental Terminology (CDT) codes are typically used.
Mods or Modifiers	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.
MapSet ID	The ID of the map definition that defines the fiscal pend criteria. The map is established on the Map Definition page in Rules Management. Note: If a map definition ID is entered, the rest of the Fiscal Pend Detail fields cannot be entered.
Print RA	Indicates whether to report fiscally pended claims on the remittance.
Days to Pend	Indicates the maximum number of days a claim can be fiscally pended. If a claim matching the criteria is fiscally pended and the number of days it has been pended is greater than or equal to the Days to Pend, the claim is released for payment.
Cap Amt	The fiscal pend capitation amount. Indicates the maximum amount that is to be paid for claims matching the specified criteria. After the capitation amount is exceeded, claims matching the criteria are fiscally pended.
Rank	Defines the order of precedence ND MMIS is to use for evaluating the criteria. The lower the numerical value assigned to the rank, the higher its precedence. Default: 999

Field

Description

To add fiscal pend details, click Add Fiscal Pend Details. To edit, in the Fiscal Pend Details table, click the appropriate row.

Show Voids

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

Void Date or Void

In the table, the date the record was voided. If the record has been voided, none of the information can be changed.

When editing, indicates whether the record is active (No) or inactive (Yes). If inactive the record 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.

Billing Provider ID Type

Unique code that indicates the type of provider ID entered.

Examples: DEA, NPI, SSN/EIN

Billing Provider ID

Unique identifier used for a provider of healthcare services.

Format: Up to 15 alphanumeric characters

Billing Provider Type

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

Examples: Dental, Pharmacy, Hospital, Vision, Physician

Billing Taxonomy

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).

Claim Type

The type of claim.

Examples: Inpatient, Outpatient, Financial Transaction

Benefit Plan

Unique identifier for the benefit plan.

COS

Category of Service.

The services for which enrolled providers are authorized to bill.

Proc or Procedure Code

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

Mods or Modifiers

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.

MapSet ID

The ID of the map definition that defines the fiscal pend criteria. The map is established on the Map Definition page in Rules Management.

Note: If a map definition ID is entered, the rest of the Fiscal Pend Detail fields cannot be entered.

Print RA

Indicates whether to report fiscally pended claims on the remittance.

Days to Pend

Indicates the maximum number of days a claim can be fiscally pended. If a claim matching the criteria is fiscally pended and the number of days it has been pended is greater than or equal to the Days to Pend, the claim is released for payment.

Cap Amt

The fiscal pend capitation amount. Indicates the maximum amount that is to be paid for claims matching the specified criteria. After the capitation amount is exceeded, claims matching the criteria are fiscally pended.

Rank

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

Default: 999

Version as of 5/16/14.