Medical Billing - GE0 Record Fields 1 Through 8
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In our previous installment on medical billing, we covered the basics of enteral nutrition and billing and how it got to be such big business. In this installment we're going to review the GE0 record, fields 1 through 8, which is the CMN that has to be sent to the carrier with each enteral bill that is submitted for payment via electronic means using NSF 3.01 specifications.
GE0 field 1, positions 1 - 3, is the record type. This field needs to be filled in with GE0. If it is not, the claim will be denied by the carrier. Also, this record must come after the F record in the claim file that is specifically for the enteral product being billed.
GE0 field 2, positions 4 - 5, is the sequence number. Because there can be up to 99 CMN records in a claim file, the sequence number, or CMN number must be transmitted, such as GE0-01, GE0-02, etc. If these are out of sequence, the claim will be denied.
GE0 field 3, positions 6 - 22, is the patient ID number. This is the same number that is transmitted in the CA0 record and all subsequent records. If this field is not filled in, the claim will be denied.
GE0 field 4, position 23, is the certification type. This field is transmitted as either I, for initial or R for recertification. The carrier needs to know this because billing for each cert type is different.
GE0 field 5, positions 24 - 31, is the date therapy began field. This is the date that enteral nutrition therapy for the patient began. The format for this date is either yyyymmdd or mmddyyyy, depending on the requirements of the payor.
GE0 field 6, positions 32 - 33, is the therapy duration. This is the number of months that the patient is expected to be on enteral nutrition. Unlike other procedures that are done and completed, enteral nutrition is not so easy to pinpoint down to a time since it is impossible to say how long it will be until the patient is able to go without it. That's why this is an estimate. If the physician believes this will be for the life of the patient then they fill this field with the number 99.
GE0 field 7, positions 34 - 41, is the last date of certification. This is the last date that this particular treatment was certified and must be filled in if required by the payer. The format is either yyyymmdd or mmddyyyy, depending on the payer requirements.
GE0 field 8, positions 42 - 43, is the number of months of this certification. Most CMNs are good for a year. However, some initials are good for only 3 months. This is going to vary from payer to payer and from item to item.
In our next installment of medical billing via electronic media, using NSF 3.01 specifications, we're going to continue with our review of the GE0 record, picking up with field number 9.
Related: Medical Billing - GE0 Record Fields 1 Through 8
Additional information:
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