Coding

Coding is the last step before insurance filing in AngelTrack. The Coding page, accessible from the Insurance Filing Queue, is built to make coding quick and easy.

You can take advantage of the coding features even if not using AngelTrack to file your insurance claims: once coded, dispatches can be exported in X12.837P format for upload or import elsewhere.

If you are not yet familiar with the numbers 837P, 999, 277CA, and 835, or if you do not yet know how your billing software, your clearinghouse, and the insurance carriers all work together, then read the EDI Primer first.

"Is this all there is?"

If you are migrating to AngelTrack from other billing software, you may find yourself wondering "Is this all there is?", as most billing software contains dozens and dozens of datafields that must be filled in, from scratch, for every call.

The answer is yes, this really is all there is to coding an EMS transport for filing. AngelTrack already has most of the information needed to bill the call, stored in the dispatch and PCR records. Because the data is vertically integrated, billers need not retype anything. Most of the 837P no longer requires manual intervention.

AngelTrack is not general-purpose medical coding software. It is not able to code for a doctor's office call, or for a CT scan, or for a dose of chemotherapy. It is only for EMS transports. Consequently it is vastly simpler to use, by design.


Patient Demographics

The demographic data on file for the patient is pre-loaded into the datafields, ready for final edits before claim filing. If some data is missing, you can switch to the "Librarian" tab to pull up a recent face sheet for the patient.

Remember that the "Patient weight" field is checkpointed, meaning that edits to the field do not necessarily propagate to the patient's other calls.

If your demographic data is regularly missing, then assign someone responsibility for the Missing Demographics Queue.


Mileage

Select the correct mileage to be submitted in the insurance claim. Make sure you understand the pros and cons of either choice; read the Mileage guide to learn more.

If neither mileage is acceptable, send the call back to QA.

If filing ☑ Normal mileage, the mileage value will be "frozen" when you file the primary claim. Any secondary claim will use the same mileage value, even though the statistically-derived normal mileage may have drifted since then.

Medically unnecessary mileage

If the patient demanded transport farther than to the closest appropriate medical facility, you will code the necessary mileage (to the closest appropriate facility) separately from the unnecessary additional mileage. There is an option to declare this mileage as ☑ A0888, under the "Additional service codes" section of the page. AngelTrack will then automatically subtract the unnecessary mileage from the total transport distance, to compute the claimed amount of necessary mileage.


Prior Authorization

The prior authorization number is uploaded in the X12.837P document. There may be a PAN document on file that applies to the current call, but AngelTrack usually cannot tell for sure what the actual authorization number is. The descriptions of all applicable PAN documents will appear in the dropdown list, or you can type something in yourself.

You may need to look at the actual PAN document in order to discover the authorization number. This is where the "Librarian" tab comes in handy. The tab shows all documents that apply to the current call, including PAN documents. You can use it to quickly view all applicable documents to find the correct PAN.

Patients with special PAN requirements

Remember that a patient record can be flagged as ☑ Always requires prior authorization or ☑ Never requires prior authorization.

If either flag is set, the Coding page will indicate it with a message adjacent to the "Preauth number" field, like this:

Prior auth flag advisory message


Claim Settings

The "Claim Settings" radio-buttons allow you to control certain fields in the 837P:

Original, Refile, or Replacement

☑ Original creates an ordinary claim: BHT02 will be set to "01" and CLM05-3 set to "1".

The claim control number will be generated using the underlying dispatch ID plus the number of times the call has already been filed. For example, the claim control number for the first time that dispatch ID 1234 is filed will be AD + 1234 + N1. The N1 means "number 1 claim", so you may sometimes see N2, N3, N4, and so forth. To learn more about AngelTrack's EDI control numbers, read the AngelTrack's EDI Control Numbers guide.

☑ Refile is the same as "Original", but each time the 837P is generated, regardless of whether for primary or for secondary, it will carry the same claim control number as before. This is done to avoid confusion with secondary documentation in the event that a claim is refiled; if the claim control number changed each time it was refiled, then additional documentation bearing the original claim control number would not match that of the refiled claim.

This setting will be automatically selected once a claim is filed, so that any re-filings or secondary filings will all carry the same control number. If your clearinghouse or if an insurer requires a claim to be refiled using a different claim control number, then select ☑ Original instead.

☑ Replacement creates a claim with BHT02 equal to "18" rather than "01", and CLM05-3 equal to "7" rather than "1", for the purpose of re-filing a claim already filed previously. The claim control number from the original filing will be reused.

Check with your clearinghouse before attempting to file a replacement claim, as some carriers -- including all the MACs -- accept only original chargeable claims. If you are not sure whether a carrier accepts replacement claims, call their support line or perform an internet search for their "837 Companion Guide".


Chargeable or Report

☑ Chargeable creates a normal claim, setting BHT06 to "CH".

☑ Report only creates an "encounter" claim, setting BHT06 equal to "RP", for the purpose of reporting a service performed without also demanding payment. Check with your clearinghouse before using this setting.


Assignment of benefits

☑ Pay directly to EMS will set CLM08 to "Y", directing the insurer to pay benefits directly to EMS. The patient will receive an EOB and, if applicable, a notice of copay due.

☑ Pay to the patient will set CLM08 to "N", directing the insurer to pay benefits to the patient, rather than to EMS. EMS must then bill the patient for any balance owing.


Price schema

If you wish to claim a price other than retail, you may select one of the purple (patient) rates instead. The purple rates are configurable using the Pricing page under Billing Home.

Do not submit rates other than retail to any insurer without first understanding the compliance issues involved. Many insurers now have one or more government-funded plans, and charging such a plan a higher rate than that charged to other insurers creates a legal hazard... even if both insurers may ultimately adjudicate the same amount.


File against

☑ Secondary insurance will generate an 837P for the secondary insurer that automatically includes all the information returned in the 835 from the primary insurer. This includes all amounts claimed, all amounts paid, and all adjustment reasons and amounts. This information is communicated in the 2430 loop that accompanies each 2400 loop (i.e. that accompanies each service line).

In order for the aforementioned to work correctly, you must import the 835 from the primary insurer first. When that has been done correctly, the claim and benefit information will appear as a brief summary underneath the ☑ Primary insurance radiobutton.


If you are accustomed to CMS-1500 box numbers rather than 837P loop names, download yourself a "837P Crosswalk" document off the internet. A crosswalk shows how each CMS-1500 box number matches up to each 837P loop name.


Patient Insurance and Payor IDs

The Coding page gives you one last opportunity to revise the patient insurance fields, prior to filing the claim. Remember that any changes to the insurance fields are applied only to the relevant patient data checkpoint, but you can check the ☑ All checkpoints on or after box to apply the changes over a date range.

Remember, you can easily switch to the "Librarian" tab to pull up the patient's face sheet, or a scan of their insurance cards, if such documents are on file and if they apply to the current call.

In any event, you must select insurance payor IDs if that has not already been done. Click the red "Select Payor ID" link to open the payor ID selection popup window, as necessary. You can then search, sort, and filter the list until you find the one you need.

Once set, the payor ID will be carried forward through all of the patient's future calls... until somebody clicks the "Change" button to force the payor ID to be selected again.

Reviewing and updating the payor ID list

AngelTrack has a built-in list of payor IDs from your clearinghouse. When you first deployed AngelTrack, your AngelTrack integrator downloaded the latest list from your clearinghouse and then imported it into your AngelTrack cloud server.

Your clearinghouse updates its payor ID list from time to time, and (almost certainly) posts the latest version on its website. About once a year, you should download the latest list and import it into AngelTrack, so that you'll have access to the latest data. Simply visit the Insurance Payor ID List from Billing Home and click the + button. The Import Payor IDs List page will open, offering detailed instructions for uploading. The list from the clearinghouse will probably need just a bit of tweaking in Microsoft Excel, in order to name the columns so that the importer recognizes them.

You can also add payor IDs one at a time, by visiting the Insurance Payor ID List from Billing Home and clicking the + button.

Carrier mailing addresses

The 5010 specification ended the requirement for the carrier's mailing address to be included in the 837P. Consequently, most clearinghouses no longer include mailing addresses in their payor ID lists. However, AngelTrack has the capability of recording a mailing address for each payor ID, and will include that address where appropriate in any 837P or CMS-1500 that is bound for the carrier.

The payor ID list importer also supports mailing addresses, if your clearinghouse has included them in their published list.

Crews can clear the payor ID

When a crew runs a call and opens the PCR, they have the opportunity to review the patient's insurance information. If a payor ID has been set for the patient, then the controls for "Insurance Type" and "Insurance Provider Name" will be locked. If the crew -- looking at a face sheet -- decides that the locked fields are incorrect, they can click the "Change" button and make changes. When they do so, the old payor ID is discarded. The crews input the insurance type and the provider's name, but only a biller can re-select the payor ID.

Payor ID set

Therefore you must train your crews to use the "Change" button only if they are certain that their face sheet is up-to-date and only after double-checking that the current payor ID is wrong.

There is a built-in announcement explaining this to your crews. After reviewing and editing the announcement to fit your organization, you can activate it to disseminate this bit of training.

Setting the policy type

The policy type field governs the contents of loop 2000B segment SBR09. It is usually not necessary to specify the policy type, because AngelTrack infers the policy type from the carrier type:

Carrier type Policy type inferred 837P element SBR09 CMS-1500 box 1
None Self-pay 09 (no boxes checked)
Private Commercial insurance CI ☑ GROUP HEALTH PLAN
Medicare Medicare part B MB ☑ MEDICARE
Medicaid Medicaid MC ☑ MEDICAID
Other government Other federal program OF ☑ OTHER
Workers Comp Workers' Compensation WC ☑ OTHER

Of course you can override the inference by setting the appropriate policy type, according to the carrier's instructions or their 837P Companion Guide. You must set the policy type before locking the payor ID, as you will not be able to edit the policy type once it is locked.


Built-in Codes and Code Sets

AngelTrack has a built-in list of 950 ICD-10 codes that are relevant to ambulance transporation. You will probably find the code you are looking for within the picklists.

If the dispatch is a return trip, then the pick-lists will be preloaded with an abbreviated list of codes, containing only those considered relevant for a return trip (i.e. for a trip back home). You can switch to the full code list, or vice versa, by using the "Code set" radiobuttons.

If you don't find your code in the pick-lists, then you can type it in manually. If you are frequently required to type in certain codes because they are not in AngelTrack's list, then contact Technical Support and request a code addition to the built-in lists.

Novitas suggested codes

The MAC Novitas has published a list of 400 "suggested" diagnosis codes for ambulance transport (of which 98 are for return trips). AngelTrack has this list built right in, among its list of ambulance-relevant ICD-10 codes.

To use just the Novitas suggested list, tick the ☑ Hide codes not in the Novitas suggested list checkbox. The code-pickers will then show only the Novitas codes. AngelTrack will tick the checkbox for you automatically when the patient's primary insurance is Medicare. In that case, before unticking the checkbox, discuss the matter with your Director of Billing: even if your MAC is not Novitas, all MACs take their cues from them, and so it is usually safe to follow their recommendations.

Add-on codes

Once a code is selected or typed in, AngelTrack consults its internal lists to see whether the chosen code has any recommended add-on codes. If there are any, the add-on code dropdown box lights up, offering the choices.

Although the Coding page UI displays the add-on codes in a different column than the primary codes, they are all submitted together when the claim is filed (or when an 837P is exported).

Medicare only accepts four diagnosis codes

Although the coding UI allows up to eleven diagnosis codes, Medicare and many commercial carriers only accept four, a limit carried forward from the old CMS-1500 paper form's four boxes for diagnoses. Do not input more than four diagnosis codes unless you are sure that the carrier will accept them. The limit of four includes the constrained second diagnosis code, discussed below.

Reviewing the codes from previous dispatches

As a rule, each dispatch should be coded independently from all other dispatches... even from prior calls for the same patient to the same destination. The biller should choose codes organically, based on the narrative and other data in the run report.

That's the goal, anyway. Towards that end AngelTrack does not offer any UI buttons to automatically copy the codes from the patient's prior trip. You can switch to the "History" tab to review the codes on the patient's prior calls, but only for the purpose of familiarizing yourself with the code titles and categories applicable to the patient. Resist the temptation to cut and paste.

Coding in ICD-9

The code-pickers are ICD-10, but you can still code in ICD-9 if you wish... but the code-pickers will not be able to help you. You can ignore the code-pickers, and simply type or cut-and-paste ICD-9 codes into the code boxes.

When you do that, the resulting 837P document will preface your codes with BK/BF, rather than ABK/ABK as is used for ICD-10.

Input from crews and QA

The PCR collects high-level (mostly .XXX) codes from the attending, representing the attending's impression of the patient, and the patient's acute symptoms, and the causes of injury (if any). Although these are non-specific codes, they may serve as useful pointers when selecting the appropriately specific codes for the claim.

The PCR's code selections are displayed in the run report. To learn more about the PCR's code selections, read the ICD-10 Codes in the PCR guide.


The Significance of the First and Second Diagnosis Codes

Guidance from Novitas -- the premier MAC -- directs EMS billers to use the first diagnosis code to justify the transport, and the second diagnosis code to justify the stretcher. Additional codes can be added to further justify either the transport or the stretcher.

Although this is Novitas guidance, it is good advice for the other MACs and the private carriers too.

For the secondary diagnosis code (the stretcher justification), Novitas has provided a list of just five preferred codes to choose from. These five codes are built into AngelTrack and always appear in the dropdown list for the second diagnosis code:

You can override those five choices and type in whichever code you deem appropriate, but if you do so, make sure you understand the Novitas guidance and the implications of straying from it.

Automatic rearrangement of codes when necessary

If you specify an addon code for the primary code, then the addon will be placed after this special secondary code in any 837P or CMS-1500 that AngelTrack generates for you, in order to meet MAC expectations. For example, if you code your call like this:

  Diagnosis Code Add-on Code
Primary S02.01XA S06.890A
Secondary Z74.3 [Not applicable]
Tertiary S03.1XXA [None]

...then AngelTrack will emit a claim with the following diagnosis codes: S02.01XA, Z74.3, S06.890A, S03.1XXA, ensuring that the secondary code is always in the second slot where the MACs expect it to be.


Upcoding and Downcoding

AngelTrack will automatically select a procedure code based on dispatch, PCR, and QA records accumulated by the call. The selected procedure code, plus mileage and oxygen codes as appropriate, are displayed in a small grid.

You can override the selected procedure code by clicking "Set the procedure code manually". However, before you do so, have a talk with your QA reviewer first. A properly-functioning, properly-communicating organization will always produce agreement between the QA reviewers and the billers. If they disagree about a call, then they should meet and discuss until they resolve their differences. The resolution can then be expressed in a new policy document that is disseminated to both departments (perhaps using an AngelTrack announcement).

Nonstandard procedure codes for pickup and mileage

Some state Medicaid carriers use nonstandard procedure codes for pickup and/or for mileage. Once you click "Set the procedure code manually", you can enter a nonstandard procedure code for the pickup, and you can select one of the alternative mileage codes, according to the requirements of the carrier.

Standard codes for pickup and distance

If you choose a nonstandard procedure code for the mileage, then AngelTrack will match up the code with the appropriate price schedule in your retail price schema (or in the patient schema you selected).


☑ A0422 (Oxygen)

AngelTrack will enable the ☑ A0422 (Oxygen) checkbox when the crew says (via a PCR medication record) they gave oxygen to the patient. However, AngelTrack will not automatically tick the box to claim it; the biller must choose to do so.

When the A0422 box is checked, then a price must be input. If you have configured a price for A0422 line items using the Pricing page, it will be pre-loaded into the field.

The quantity for oxygen is always one unit; therefore you are not required to specify the quantity.

Medicare does not pay for A0422 service lines, but secondary insurers sometimes do, so AngelTrack will automatically add the GY modifier to any A0422 service line being filed against a Medicare primary insurer. The MAC will remove the modifier when forwarding the claim to the secondary. See this CMS bulletin and also this one for details.


☑ A0424 (Extra Crew Member)

AngelTrack will enable the ☑ A0424 (Extra crew member) checkbox when the dispatch records show that more than two crew members (or more than one for a wheelchair/car call) were involved in the transport. It will also underline the number of extra crew members shown in the dispatch records, so that you do not have to look it up.

Because AngelTrack does not know whether the extra crew members were medically necessary, it will not automatically tick the checkbox to claim them. The biller must choose to do so, after reviewing the narrative.

When the A0424 box is checked, then a price must be input. If you have configured a price for A0424 line items using the Pricing page, then that price will already be filled-in for you.

Medicare does not pay for A0424 service lines, but secondary insurers sometimes do, so AngelTrack will automatically add the GY modifier to any A0424 service line being filed against a Medicare primary insurer. The MAC will remove the modifier when forwarding the claim to the secondary. A fuller explanation is given in the linked CMS bulletins just above.


☑ A0420 (Waiting Time)

AngelTrack will enable the ☑ A0420 (Waiting time) checkbox when the dispatch records show that at least 30 minutes was spent waiting on-scene and/or at destination. It will also pre-select the appropriate number of 30-minute units, so that you do not have to look it up.

Because so few carriers cover this service, AngelTrack does not automatically tick the checkbox to claim it. The biller must do so, after verifying that the carrier will pay it.

When the A0420 box is checked, then a price must be input. If you have configured a price for A0420 line items using the Pricing page, then that price will already be filled-in for you.

Medicare does not pay for A0420 service lines, but a few secondary insurers sometimes do, so AngelTrack will automatically add the GY modifier to any A0420 service line being filed against a Medicare primary insurer. The MAC will remove the modifier when forwarding the claim to the secondary. A fuller explanation is given in the linked CMS bulletins just above.


☑ ECG (93041 or 93005)

AngelTrack will enable the ☑ ECG checkbox when the crew says (via the PCR data) they administered an ECG to the patient. However, AngelTrack will not automatically tick the box to claim it; the biller must choose to do so.

When the ECG box is checked, then the type of ECG must be selected: if it has twelve or more leads, the procedure code is 93005; otherwise the procedure code is 93041. A price must also be input. If you have configured a price for 93041 and 93005 line items using the Pricing page, then the prices will already be filled-in for you.

Medicare does not pay for ECG service lines, but secondary insurers sometimes do, so AngelTrack will automatically add the GY modifier to any ECG service line being filed against a Medicare primary insurer. The MAC will remove the modifier when forwarding the claim to the secondary. A fuller explanation is given in the linked CMS bulletins just above.


☑ DMS (A0382 or A0398)

A few insurance carriers will pay for Disposable Medical Supplies [DMS] claims that accompany an ambulance transport claim.

AngelTrack will enable the ☑ A0382 checkbox whenever a BLS or higher transport has occurred; likewise it will enable the ☑ A0398 checkbox whenever an ALS or MICU transport has occurred. However, AngelTrack will not automatically tick the checkboxes to claim them; the biller must choose to do so.

If claimed, then a price must also be input. If you have configured a price for A0382 and A0398 line items using the Pricing page, then the prices will already be filled-in for you.

Medicare does not pay for ambulance supplies service lines, but secondary insurers sometimes do, so AngelTrack will automatically add the GY modifier to any ambulance supplies service line being filed against a Medicare primary insurer. The MAC will remove the modifier when forwarding the claim to the secondary. A fuller explanation is given in the linked CMS bulletins just above.


☑ A0394 (IV Supplies)

AngelTrack will enable the ☑ A0394 checkbox when the crew says (via the PCR data) they installed, maintained, or removed an IV. However, AngelTrack will not automatically tick the box to claim it; the biller must choose to do so.

When the IV supplies box is checked, then a price must also be input. If you have configured a price for A0394 line items using the Pricing page, then the price will already be filled-in for you.

Medicare does not pay for IV supplies service lines, but secondary insurers sometimes do, so AngelTrack will automatically add the GY modifier to any IV supplies service line being filed against a Medicare primary insurer. The MAC will remove the modifier when forwarding the claim to the secondary. A fuller explanation is given in the linked CMS bulletins just above.


Non-Standard Service Lines

A few commercial carriers will pay for unusual procedure codes when submitted as additional service lines in the claim. For example, an EMS company may be permitted to claim (via an additional service line) a small charge for each medication that was administered.

Such claims are made using whichever codes the carrier dictates, in its policy documentation or in its 837P companion guide. To add one of these non-standard procedure codes to your claim in AngelTrack, click "Add non-standard service codes":

Add nonstandard codes for additional services

AngelTrack will then display a grid of the non-standard service codes already present in the claim. The grid will be empty at first; click the Add icon to add one, fill out the popover form, and then click "Save".

You must specify all modifiers for each service code, with the exception of the ET modifier (which always comes first when present) and the location modifier (which always comes next). Both are handled automatically by AngelTrack.

No guarantees and no technical support is offered for non-standard service lines

It is your responsibility to understand the carrier's offer to pay on non-standard codes, and to correctly input the codes and modifiers and notes. You must also consider the effects on the secondary carrier (if any). AngelTrack does not attempt to satisfy every carrier's idiosyncrasies, and so if AngelTrack is unable to produce an electronic claim with the desired non-standard elements, then you must resort to paper claims instead and modify them yourself.

Do not call AngelTrack Support for help with non-standard codes and carrier requirements.


Location Modifier

In a claim for EMS services, the first modifier after the service code is called the "ambulance modifier" or "location modifier". Here is a service line from an EMS claim showing the location modifier in its proper position at the head of the list of modifiers:

LX*1
SV1*HC:A0428:RJ:GY*1500*UN*1***1:2
DTP*472*D8*20150601
REF*6R*AS3N1

A location modifier is made from two individual HCPCS location codes, one for the origin and one for the destination. To learn more about location modifiers and how AngelTrack automates them, read the Location Modifiers Guide.


☑ GM Modifier

The GM modifier is used to inform the carrier that the ambulance was simultaneously transporting more than one patient. The carrier will then pay a moderately reduced rate for each transport.

AngeTrack will automatically tick the checkbox if the dispatch records show that this call's transport time overlapped another call's transport time in the same vehicle.

Consequently, AngelTrack may erroneously tick the checkbox if your dispatch records are incorrect. Remember, the crew -- or, failing that, the dispatcher -- is responsible for marking the time transport began and the time arrived at destination. If either mark was missed or incorrect, the attending or the dispatcher must edit the followup information to set it right. If they fail to do so, then the transport timeframe might overlap the timeframe of the vehicle's previous or next transport.

So, if AngelTrack is incorrectly ticking the checkbox, send the call back to QA with a billing note. Or you can open the run ticket, visit the followup page, and correct the times yourself. To identify the overlapping call, use the "Vehicle's prior call" and "Vehicle's next call" links that appear next to the odometer readings, near the top of the Dispatch Followup page.


☑ GY Modifier

You are probably already familiar with the GY modifier, which is used to signal the carrier that you understand this claim will be denied. When the ☑ GY checkbox is ticked, AngelTrack will add the "GY" modifier to the claim. Do not include GY or any other special modifiers in the "Location Modifier" textbox.

The ☑ GY checkbox will be ticked for you if the patient signed a "Non-Covered Destination" document for the dispatch in question... but of course you can untick it as you see fit.

Automatic GY modifiers for Medicare claims

Medicare does not pay for oxygen (A0422), or for extra attendants (A0424), or for any of the DMS codes, but secondary insurers often do. Medicare MACs support the use of the GY modifier only on those uncovered service lines; the MACs will then forward the claims to the secondary carrier with the GY modifier removed. See this CMS bulletin and also this one for details.

In anticipation of this, AngelTrack will automatically add the GY modifier to all secondary service lines (i.e. everything other than the pickup code and the mileage code) when the claim is bound for Medicare as the primary insurer. Do not tick the ☑ GY checkbox unless you want the modifier applied to the entire claim.


☑ QL Modifier

This modifier is used to signify that the patient died after the ambulance was called but before the ambulance arrived. EMS arrives on-scene and simply confirms the patient's death.

EMS is entitled to reimbursement for the pickup, but obviously not for mileage. See section 10.2.6 "Effect of Beneficiary Death on Medicare Payment for Ground" of the Medicare Benefit Policy Manual chapter 10.

If the QL modifier is selected, then AngelTrack automatically applies it to all service lines in the claim.

The carrier may not want a location modifier in this situation. To accomodate this, AngelTrack allows the location modifier to be blank when ☑ QL is ticked.


☑ QJ Modifier

This modifier is used to signify that the patient is incarcerated yet is responsible for paying their own medical bills. In other words, the patient is incarcerated yet the state or local government does not pay for their healthcare.

If a prisoner's health care is paid for by the state or local government, then Medicare will not pay for the service simply because the patient is not responsible for payment. In that event you must bill the respective state or local government instead.

If the QJ modifier is selected, then AngelTrack automatically applies it to all service lines in the claim.


☑ CR Modifier

This modifier is used to signify that the services provided were related to a catastrophe. AngelTrack will automatically pre-select this modifier if the crew specifies any catastrophe-related injury causes in the PCR Injury form.

If the CR modifier is selected, then AngelTrack automatically applies it to all service lines in the claim.


Nonstandard Modifiers

State Medicaid carriers are the great villains of EMS billing: they often require nonstandard procedure codes, non-standard modifiers, and nonstandard modifier order, all of which raise the cost of EMS billing software and EMS billing personnel.

AngelTrack supports most of these nonstandard practices. However, you should not use any of these modifiers unless you are certain that the carrier requires it!

☑ ET Modifier

The ET modifier is an obsolete method of flagging the transport as emergent. If you check the box, then the ET modifier will appear first in the list of modifiers for the call.

Only a few insurers still accept/require the ET modifier. Do not check the box unless you know that the carrier specifically requires it.

The ☑ ET checkbox will be disabled (greyed out) if the underlying dispatch was not actually emergent. If you believe it should've been marked emergent, send it back to QA for re-review.

☑ QN Modifier

This modifier is normally used only by a hospital that operates is own ambulance service. That ambulance division will specify QN to explain why it did not file for prior authorization.

Normally this situation would never come up for a standalone EMS operation, but certain state Medicaid carriers require this modifier and interpret it incorrectly. They use it in place of QM, which means that ambulance transport was arranged by the facility, rather than furnished by the facility. For this situation, AngelTrack makes the QN modifier available for use.

☑ UB Modifier

Some state Medicaid carriers accept the UB modifier, which is used to indicate that transport mileage was not emergent. The carrier's 837P Companion Guide will say whether they accept this modifier.

☑ UJ Modifier

Some state Medicaid carriers accept the UJ modifier, which is used to charge a little extra for ambulance service that was provided between 19:00 at night and 07:00 the next morning. The carrier's 837P Companion Guide will say whether they accept this modifier.

The ☑ UJ checkbox will be disabled unless the transport time at least partially overlaps the time period of 19:00 to 07:00.

Other nonstandard requirements

For nonstandard requirements beyond these, you must emit your claims as CMS-1500 forms and then perform the necessary touch-ups in your browser or .PDF editor.

The CMS-1500 emitted by AngelTrack has freely editable fields. Of course AngelTrack will fill in as many as it can, and then you can add or change values to suit your Medicaid carrier.


Reason for Transport / Reason for Stretcher

The "Reason for transport" and "Reason for stretcher" fields are initially populated by an algorithm in AngelTrack's database. The algorithm attempts to summarize the fields and data input by the crews (in the Followup) and then checked and revised during QA review. If the fields do not contain good starting data, then consider pushing the call back to QA for revisions.

Once the fields contain enough information, you must condense them to fit within the 80 characters allowed by the X12.837-P specification. The Coding page will indicate how many characters you've got in each field.

Incidentally, when filing CMS-1500 paper claims, the "Reason for transport" is omitted because there is no available box on the form. The "Reason for stretcher" is placed in box 19 ("ADDITIONAL CLAIM INFORMATION").


Ambulance Certifications

Ambulance certification codes are the reasons why the patient required the care of EMS, as opposed to traveling by private car. The codes are submitted in loop 2300 CRC03, CRC04, CRC05, and so on.

The first time you code a claim, AngelTrack calculates which certification codes are justified by the data in the dispatch record and PCR records. It then ticks the appropriate checkboxes for you. Once you click "Save", your selected checkboxes are preserved, and will not be automatically re-ticked or un-ticked on subsequent visits to the Coding page.

If AngelTrack does not tick the checkboxes you expect, then there is probably something missing from the dispatch's documentation. Although you are free to tick additional boxes, you should probably send the dispatch back to QA instead, with instructions in the "Billing notes" field. That way your documentation will be safely compleat in the event of an audit.

Most carriers want two or three certifications to be checked; one is too few and four is usually too many.

If filing CMS-1500 paper claims, there is no box for ambulance certifications, so they will be omitted.


"Related Cause" / Accident Information

AngelTrack will automatically include accident information (loop 2300 CLM11) if the crew's run report indicates that an accident was the cause of injury.

There are four categories of related cause in an X12.837P claim. AngelTrack infers the correct category using the information provided by the crew in the PCR Injury form:

PCR Injury Inferred Cause X12.837P CLM11 CMS-1500 Box 10
Automotive accident AA + two-letter state code
of the dispatch's origin address
☑ AUTO ACCIDENT?
plus two-letter state code
Employment EM ☑ EMPLOYMENT?
Other accident OA ☑ OTHER ACCIDENT?
Another person AP [Not applicable]

Specifically, AngelTrack looks at the ICD-10 code selected by the crew in the first (#1) "Causes" field, plus the crew's answer to the ☑ The primary cause of injury is related to the patient's employment checkbox.

When a related cause is given in an insurance claim, then a date of occurrence must also be given (does not apply to CMS-1500). AngelTrack will calculate this date using the information provided by the crew in the PCR Assessment tab's "Primary complaint duration" field. The date will be emitted in the X12.837P document in a DTP*439 segment, as described in the next section.


Event Dates

There are many event date fields in an X12.837P for an EMS claim, which AngelTrack automatically populates like this:

Segment Loop Meaning in X12 Specification Source of Data in AngelTrack When Included in X12.837P by AngelTrack
DMG*D8 2010BA Subscriber's date of birth Patient Billing: Policyholder Date of Birth, or Patient Demographics: Date of Birth When the policyholder's DOB is on file
DMG*D8 2010CA Patient's date of birth Patient Demographics: Date of Birth When the patient's DOB is on file and the patient is not the policyholder.
DTP*431 2300 When did symptoms onset? PCR Assessment: Primary Complaint Duration subtracted from the Date/Time Assessed When an assessment has been performed that specifies a Primary Complaint Duration, if such date is different than the date of service (DTP*454)
DTP*439 2300 When did the accident occur? PCR Assessment: Primary Complaint Duration subtracted from the Date/Time Assessed When the PCR Injury: Primary Cause of Injury specifies an ICD-10 that is accidental
DTP*454 2300 When did provider treat patient? Followup: Date/Time Transport Began if available, else Dispatch: Date/Time Activated Always
DTP*472 2400 When was service rendered? Followup: Date/Time Transport Began if available, else Dispatch: Date/Time Activated Always
DTP*573 2430 When was the primary claim adjudicated? Date/Time of primary insurer adjudication, as reported in an X12.835 document When claiming against a secondary after the primary has returned an adjudication

You can review all these segments by loading the dispatch into the X12.837P Workbench.

Overriding the event dates

The event dates for the onset of symptoms (DTP*431) and for the occurrence of the accident (DTP*439) can be overridden from the values automatically populated by the PCR data.

If the PCR has no data for onset of symptoms or occurrence of accident, the respective fields will be empty on the Coding page. You can manually input these dates if you wish; however it is better to send the report back to the crew, and ask them to provide the necessary date information.


Round Trips are Filed as Separate Claims

AngelTrack always files round trips as two separate claims, in order to avoid the hazards of round-trip claims:

  1. The returned EOB will be marked "Approval" even if the return-trip leg is denied. It is therefore easy to mis-read the EOB, incorrectly concluding that both trips were approved.
  2. If one trip is approved but the other denied, it is a hassle to untangle and appeal or refile just the one trip.
  3. Commingled benefit lines on EOBs makes it difficult for AngelTrack to achieve one of its design goals: simplified, accessible billing usable even by novices.
  4. The usual reason for combining trips in a round-trip claim is to minimize the amount of keyboarding and data entry, which is necessary when using traditional billing software that knows nothing of EMS and does not have access to your dispatch records. This reason no longer applies, since AngelTrack pre-fills 90% of the claim with dispatch and PCR data.

Dealing With Non-Compliant Carriers

Normally it is the job of your clearinghouse to scrub your claims to please each carrier's odd requirements. However, the clearinghouse's claim scrubber is limited: it cannot add new datafields where none existed before. For carriers imposing such requirements, AngelTrack can customize its X12.837P documents as needed.

Alternate provider ID required in loop 2310B REF02

A few insurance carriers require an alternate ID to be sent in loop 2310B element REF02, sometimes referred to as CMS-1500 box 24j. AngelTrack supports this request.

To learn how to do it, read the Alternate Provider IDs in REF02 Guide.

Alternate provider ID required in loops 2010AA REF02 or 2010BB REF02

A few villainous Medicaid carriers issue alternate IDs and then require them to be submitted in a nonstandard loop in the X12.837P document. AngelTrack supports this request.

Open the Insurance Payor ID List and find the carrier's record. Open the record for editing and tick the appropriate checkbox:

To take advantage of this workaround, you must configure the alternate ID (issued by the carrier) as instructed just above, and your biller must select that alternate ID while coding the claim.

No decimal mileage

If the carrier fails to support decimal mileage, demanding only whole numbers of miles transported, AngelTrack can handle it automatically.

Open the Insurance Payor ID List and find the carrier's record. Open the record for editing and tick the ☑ Fails to support decimal mileage checkbox. AngelTrack will thereafter automatically round all mileage quantities to the nearest whole number; any mileage quantity less than zero will be rounded up to one.

Demand for a Rendering Provider NPI when same as Billing Provider NPI

If your clearinghouse says your claims are missing their rendering provider NPI, or says your claims are giving the wrong taxonomy qualifier, then you are probably a single organizational NPI provider but your clearinghouse isn't compliant with the X12.5010 standard's rules for such providers.

For an explanation of this problem, read the Single NPI Billing Guide.

Demand for no NPI in 2010AA/2310B

Some state Medicaid carriers are so presumptious as to demand the 837P competely omits the provider NPI(s), effectively making it an invalid 837P. If you face this demand, and if your clearinghouse is willing to accept an 837P that is missing its provider NPI(s), AngelTrack can satisfy the demand.

Simply visit the Insurance Payor ID List, find the carrier in question, and tick the ☑ Requires a blank NPI element in loop 2010AA/2310B checkbox under "Compliance".

Other carrier shenanigans

Some carriers do not fully comply with the 5010 specification, requiring an unusual element in the 837P, or rejecting one of the standard elements. Normally your clearinghouse is aware of each carrier's quirks, and will scrub your 837P in order to satisfy the carrier.

If your clearinghouse fails to do so, or is itself non-compliant, contact AngelTrack support. We can help carriers and clearinghouses understand their obligations under HIPAA and 5010. We can also help you quickly and smoothly migrate to a better clearinghouse.


Next Steps

Once the coding is finished, click "Save" and return to the Insurance Filing Queue. If not using AngelTrack to transmit the call to a clearinghouse, you can then export your work as a completed X12.837P document, suitable for upload to a clearinghouse of your choice (or directly to your MAC).

To learn more about transmitting your claims to your clearinghouse, read the Filing a Coded Claim guide. To learn more about managing your 837P batches of claims, read the Batch Management guide.



Help Index - AngelTrack EMS Billing Software