Fund Code Page

You use the Fund Code page to add or edit fund code assignment criteria.

The Fund Code page contains the following panels:

You can open or close certain panels. Click

(the plus sign) beside a panel to open the panel. Click

(the minus sign) to close the panel.

Fund Code Header Fields

Field	Description
LOB	The unique code that identifies the line of business, a high-level payer, or funding source such as Medicaid.
Division	Department of Human Services agency responsible for the expenditure.
Fund Code	The budget and funding sources applicable to a claim.
Fund Code Type	The type of fund code. Examples: Title V, Title XIX
Begin Date	The first effective date for the fund code. Date ranges cannot overlap for the same LOB, division, and fund code. Format: MM/DD/YYYY
End Date	The last effective date for the fund code. Format: MM/DD/YYYY
Rank	Defines the order of precedence ND MMIS is to use for evaluating a Fund Code assignment. 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

LOB

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

Division

Department of Human Services agency responsible for the expenditure.

Fund Code

The budget and funding sources applicable to a claim.

Fund Code Type

The type of fund code.

Examples: Title V, Title XIX

Begin Date

The first effective date for the fund code. Date ranges cannot overlap for the same LOB, division, and fund code.

Format: MM/DD/YYYY

End Date

The last effective date for the fund code.

Format: MM/DD/YYYY

Rank

Defines the order of precedence ND MMIS is to use for evaluating a Fund Code assignment. 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.

Fund Code Assignment Criteria Fields

Field	Description
These fields indicate the criteria for claims to which the Fund Code applies. To add additional criteria for assigning a fund code, click Add Additional Criteria. To edit, in the Fund Code Assignment Criteria 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.
COS or Category of Service	The services for which enrolled providers are authorized to bill.
Benefit Plan ID	Unique identifier for the benefit plan.
Billing Provider ID Type	The type of provider ID. Examples: Medicaid, National Provider ID (NPI)
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
Level of Care	Indicates the level of care a patient receives in a long term care (LTC) facility.
Member Age	Member age range in years and months to which the fund code criteria applies. Displayed in the table.
Member Age Min. Year/Month	When adding or editing, the minimum age in years and months of the member to which the fund code criteria applies.
Member Age Max. Year/Month	When adding or editing, the maximum age in years and months of the member to which the fund code criteria applies.
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
COE	Category of Eligibility. Indicates the basis for the member's eligibility for Medicaid. To be eligible for Medicaid benefits, a member must meet the eligibility requirements for one or more specifically defined coverage groups.
Family Planning	Used to assign a fund code to claims with family planning services.
Service Begin Date	The first date of service to which the fund code criteria applies. Tip: Use if the fund code should be assigned based on the date of service on the claims versus the adjudication date.
Service End Date	The last date of service to which the fund code criteria applies. Tip: Use if the fund code should be assigned based on the date of service on the claims versus the adjudication date.
Default	Indicates the fund code criteria are the default for the LOB.
Procedure Code	Indicates the procedure or service provided. Healthcare Common Procedure Coding System (HCPCS) or Current Dental Terminology (CDT) codes are typically used. Options are: Range - to enter a range of values for the criteria Value - to enter a single value for the criteria, with up to four modifiers N/A - to enter the map definition ID
MapSet ID	The ID of the map definition that defines the fund code assignment criteria. The map is established on the Map Definition page in Rules Management. Note: If a map definition ID is entered, you cannot enter the other fund code assignment fields.
History Fields This panel displays when you edit fund code assignment criteria. To view details of a particular fund code assignment criterion, in the Fund Code Assignment History table, click the appropriate row. The fields are the same as when editing.

Field

Description

These fields indicate the criteria for claims to which the Fund Code applies. To add additional criteria for assigning a fund code, click Add Additional Criteria. To edit, in the Fund Code Assignment Criteria 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.

COS or Category of Service

The services for which enrolled providers are authorized to bill.

Benefit Plan ID

Unique identifier for the benefit plan.

Billing Provider ID Type

The type of provider ID.

Examples: Medicaid, National Provider ID (NPI)

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

Level of Care

Indicates the level of care a patient receives in a long term care (LTC) facility.

Member Age

Member age range in years and months to which the fund code criteria applies. Displayed in the table.

Member Age Min. Year/Month

When adding or editing, the minimum age in years and months of the member to which the fund code criteria applies.

Member Age Max. Year/Month

When adding or editing, the maximum age in years and months of the member to which the fund code criteria applies.

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

COE

Category of Eligibility.

Indicates the basis for the member's eligibility for Medicaid. To be eligible for Medicaid benefits, a member must meet the eligibility requirements for one or more specifically defined coverage groups.

Family Planning

Used to assign a fund code to claims with family planning services.

Service Begin Date

The first date of service to which the fund code criteria applies.

Tip: Use if the fund code should be assigned based on the date of service on the claims versus the adjudication date.

Service End Date

The last date of service to which the fund code criteria applies.

Tip: Use if the fund code should be assigned based on the date of service on the claims versus the adjudication date.

Default

Indicates the fund code criteria are the default for the LOB.

Procedure Code

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

Options are:

Range - to enter a range of values for the criteria

Value - to enter a single value for the criteria, with up to four modifiers

N/A - to enter the map definition ID

MapSet ID

The ID of the map definition that defines the fund code assignment criteria. The map is established on the Map Definition page in Rules Management.

Note: If a map definition ID is entered, you cannot enter the other fund code assignment fields.

History Fields

This panel displays when you edit fund code assignment criteria. To view details of a particular fund code assignment criterion, in the Fund Code Assignment History table, click the appropriate row. The fields are the same as when editing.

Version as of 5/16/14.