*Loops will vary by Payer*

Electronic Location:
Loop 2400
"Service Line Number"

Segments

"Send HC If Procedure Code, ID Qualifier is not blank, then send the ID Qualifier. In the ANSI 5010, HC - Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes, ER - Jurisdiction Specific Procedure and Supply Codes IV - Home Infusion EDI Coalition (HIEC) Product/Service Code WK - Advanced Billing Concepts (ABC) Codes. "

"Claim, Transaction Procedure Code (based on Insurance Carrier, Procedure Code Set) If EDI Payor Number is 00039 and Procedure, National Drug Code is not blank, send 99199."

"Claim, Transaction Modifier 1"

"Claim, Transaction Modifier 2"

"Claim, Transaction Modifier 3"

Medisoft Location for Paper Claims

Box 24d

procedure codes and modifiers. This information comes from the Transaction Entry window, Procedure and M1, M2, M3, and M4 fields. Shaded area: see detail for Box 24A.

Electronic Location: Loop 2400 "Service Line Number"

Segments

Medisoft Location for Paper Claims

Electronic Location:
Loop 2400
"Service Line Number"