- Introduction
- Chapter I - Online System Terminology
- Chapter II - Online Menu Functions Overview
- Chapter III - Navigating the Online System
-
Chapter IV - Inquiries Submenu (01)
- Accessing the Inquiries Submenu
- Beneficiary/CWF (10)
- DRG (Pricer/Grouper) (11)
- Claim Summary (12)
- Revenue Codes (13)
- HCPCS Codes (14)
- DX/Proc Codes ICD-9 (15)
- Adjustment Reason Codes (16)
- Reason Codes (17)
- ZIP Code File (19)
- OSC Repository Inquiry (1A)
- Claim Count Summary (56)
- Home Health Payment Totals (67)
- ANSI Reason Codes (68)
- Invoice Number/DCN Translator (88)
- DX Proc Codes ICD-10 (1B)
- Community Mental Health Centers Services Payment Totals (1C)
- Check History (FI)
- Provider Practice Address Query (1D)
- New HCPCS Screen (1E)
- Opioid Use Disorder (OUD) Demo 99 (1F)
- Chapter V - Claims and Attachments Submenu (02)
- Chapter VI - Claims Correction Submenu (03)
- Chapter VII - Online Reports View Submenu (04)
-
Resources
- Part A Electronic Medicare Secondary and Tertiary Payer Specifications for ANSI Inbound Claim
- Electronic Medicare Secondary Payer Specifications for Inbound Claims
- FISS UB-04 Data Entry Payer Codes
- Common Claim Status/Locations
- FISS Reason Code Overview
- FISS Reason Code/Claim Driver Overview
- Program Function/Escape Key Crosswalk
- How to Adjust a Claim
- FISS Claim Change/Condition Reason Codes
- How to Cancel a Claim
- How to Correct a Return to Provider Claim
- Online System Menu Quick-Reference
Chapter I: Online System Terminology
Document Control Number
Purpose
The FISS DDE Provider Online System refers to the claim control number as a DCN. The DCN provides a reference number for the control and monitoring of each claim. To differentiate between claims for the beneficiary, the system creates a unique control number. The DCN may also be referred to as the ICN.
The DCN is a 23-position number assigned by the system. It is the identifying code for each claim and serves the following functions:
- Completes the ‘key’ to automate the finding of claims on the claim file (with beneficiary identification number)
- Contains a Year (position 2‑3) and Julian date (position 4‑6) which provides the system with the claim's entry date
- Contains an Origin code (position 14) which identifies the claim's mode of submission
Points to Remember
- You are not able to search for claims in the online system using the DCN
- When an adjustment or cancel is submitted online, the system automatically plugs in the appropriate DCN of the original claim
- The DCN is referenced on the following documents:
- Remittance advice (shows as ICN due to standardization of the remittance advice)
- ADR
- The DCN is not referenced on the 201 Pend Report (claim status)
Every DCN tells a story; the following is an example DCN and an explanation of each position.
DCN = 21800700814502ILA
Position | 1 | 2–3 | 4–6 | 7–10 | 11–12 | 13 | 14 | 15–17 | 18-23 |
---|---|---|---|---|---|---|---|---|---|
DCN | 2 | 18 | 007 | 0081 | 45 | 0 | 2 | ILA | N/A |
The following chart defines the various DCN field positions.
DCN Field Position(s) | Definition | Significance |
---|---|---|
1 | Century code | This code is used to indicate the century in which the DCN is established: 1 is used to indicate years 1900–1999 2 is used to indicate years 2000 and after Valid values are 0 through 9 |
2–3 | Year | The last two digits of the year during which the claim is received |
4–6 | Julian date | Reports the Julian date which corresponds to the calendar date that the claim is received In the example above, the Julian date 007 equals January 7 |
7–10 | Batch sequence | Primary sequencing field, beginning with 0000 and ending with 9999 FISS can accept up to 10,000 batches of claims per day |
11–12 | Claim sequence | Secondary sequencing field, beginning with 00 and ending with 99 A batch may contain as few claims as one or as many as 100 |
13 | Choices/Split Indicator | Site-specific field used on split bills. Valid values are: C – Choices V – Veteran’s Administration 0 (zero) – default when not used at a site |
14 | Origin | Designates method of claim entry into the system. Valid values for the origin are: 0 – Unknown 1 – EMC batch format (electronic) 2 – EMC/UB04/Other 3 – EMC/Other 4 – FISS online data entered claim 5 – FISS non-DDE claim 6 – Other EMC/UB04 7 – Other EMCnon-UB04 8 – UB-04 hard copy 9 – Other hard copy |
15–17 | Business Segment Identifier (BSI) | Three-position alphanumeric field. First two characters (15-16) are jurisdiction (state) code Next character (17) identifies the type of Medicare contract. Valid values include: A – Part A MAC/Fiscal Intermediary B – Part B MAC/Carrier D – Durable Medical Equipment Regional Carrier R – Regional Home Health Intermediary |
18–21 | Home Health Split/Mass Adjustment Indicator/Future Area | (Field used as needed) Home Health Split Valid values include: B – Adjustment claim for services after the date of death C – Incarcerated beneficiary CWF error code U538H D – DCN altered due to file fix to make DCN unique E – XXG adjustment claim generated upon receipt of IUR with error code U538Q, beneficiary unlawfully present H – System generated adjustment for prior processed claim (inpt only) or blood data M – Duplicate mass adjustment N – Incorrect patient status on IPPS with payments rejected O – Benefits exhausted P – System generated Post Pay activity R – System generated adjustment for interrupted stay S – For HIS/Tribal Hospitals with payments rejected T – Unsolicited adjustments U – Unsolicited V – Unsolicted adjustment for assiciated service (prior auth.) Z – Adjustment for incorrect patient status on IPPS claim Mass Adjusment Indicator: User defined Future Area: positions reserved for future use |
22–23 | Site Location | (Field used as needed) Code used to identify site location controlling the workload where more than one location processes claims for a MAC |
Revised 4/15/2018