FISS/DDE Provider Online Guide: Chapter VII


Credit Balance Report - CMS 838 (R3)

FISS main menu

Task

To access online reports, follow these steps:

Step Action
1 Key ‘04’ at the ENTER MENU SELECTION: prompt
2 Press <Enter>

Online Reports Menu

Task

To access the CREDIT BALANCE REPORT–CMS 838 option from the FISS DDE ONLINE REPORTS VIEW submenu, follow these steps:

Step Action
1 Key ‘R3’ at the ENTER MENU SELECTION: prompt
2 Press <Enter>

Initial ONLINE REPORTS SELECTION screen upon selecting the CREDIT BALANCE REPORT CMS 838 INQUIRY option.

To enter a credit balance in MAP1B21, enter ‘Y’ in the 838 entry field. The system will return the credit balance entry screen.

Credit Balance Report - Form 838 Inquiry Screen, Y entered in 838 entry field

The following chart describes the various fields/report headings contained within MAP12B1 Credit Balance Report–FORM 838 Inquiry

Field/Report Heading Description
PROVIDER Provider– Displays the identification number of the institution who rendered services to a particular beneficiary/patient. This number is designated by CMS as the identification number of the provider. (13-position alphanumeric field)
STARTING HIC Starting HIC– Identifies the HICN assigned to the beneficiary by the CMS, to be used on all correspondence and to facilitate the payment of claims. (12-position alphanumeric field)
838 ENTRY 838 Entry– Identifies the 838 Entry field (one- position alphanumeric field)

Valid values

Y = Yes
N = No

Note: When this field is populated with a 'Y', the credit balance entry screen is displayed and allows the provider to enter a new record.
HIC NUMBER Health Insurance Claim number– Identifies the HICN assigned to the beneficiary by the CMS, to be used on all correspondence and to facilitate the payment of claims (12-position alphanumeric field)
BENEFICIARY NAME LAST FI Beneficiary name/last, first initial– Identifies the beneficiary's last name and the first initial
TOB Type of bill– Identifies the type of facility, bill classification, and frequency of the claim in a particular period of care (three-position alphanumeric field)
FROM DATE Statement from date– Identifies the beginning date of service for the period included on the claim (six-digit field in MMDDYY format)
THRU DATE Statement through date– Identifies the ending date of service for the period included on the claim (six-digit field in MMDDYY format)
QUARTER ENDING Quarter ending– Identifies the quarter ending date (six-digit field in CCYYMM format.

MAP1B22– Credit Balance Report Entry

Credit Balance Report - Form 838 Inquiry Screen, results

The following chart describes the various fields/report headings contained within the CREDIT BALANCE REPORT– FORM 838 ENTRY MAP1B22 

Field/Report Heading Description
PROVIDER Provider– Displays the identification number of the institution who rendered services to a particular beneficiary/patient. This number is designated by CMS as the identification number of the provider. (13-position alphanumeric field)
HIC NUMBER Health Insurance Claim number– Identifies the HICN assigned to the beneficiary by the CMS, to be used on all correspondence and to facilitate the payment of claims (12-position alphanumeric field)
ICN/DCN ICN/DCN– Identifies the inhouse claim number/document control number (23-position alphanumeric field)
TOB Type of bill– Identifies the type of facility, bill classification, and frequency of the claim in a particular period of care (three-position alphanumeric field)
FROM/THRU DATE Statement from date– Identifies the beginning date of service for the period included on the claim (six-digit field in MMDDYY format)
Statement through date– Identifies the ending date of service for the period included on the claim (six-digit field in MMDDYY format)
PAID DATE Paid date– Identifies the scheduled payment date of the claim or the date the provider is actually reimbursed (six-digit field in MMDDYY format)
CONTACT PERSON Contact person– Identifies the name of the contact person, at the provider's location (30-position alphanumeric field)
PHONE NUMBER Phone number– Identifies the contact person's phone number (10-position alphanumeric field)
BENEFICIARY NAME: LAST Beneficiary name: last– Identifies the beneficiary's last name (20-position alphanumeric field)
FIRST INITIAL First initial– Identifies the beneficiary's first initial one-position alphanumeric field)
QUARTER ENDING Quarter ending– Identifies the quarter ending date (six-digit field in CCYYMM format)
CREDIT BALANCE AMOUNT Credit balance amount– Identifies the credit balance amount (11-digit field in 999999999.99 format)
CREDIT BALANCE REASON Credit balance reason– Identifies the credit balance reason (one-position alphanumeric field)

Valid values

1 = Duplicate payment
2 = Other insurance primary
3 = Other reason for credit balance        
AMOUNT REPAID Amount repaid– Identifies the repaid amount (11-digit field in 999999999.99 format)
VALUE CODE Value code– Identifies the value code (two-position alphanumeric field)

Valid values

12 = Working-aged with EGHP
13 = ESRD beneficiary in first-year coordination period
14 = Automobile, no-fault liability insurance
15 = Workers’ compensation
16 = VA, PHS, or other federal agency
41 = Black Lung
42 = VA
43 = Disabled beneficiary under 65
44 = Obligated to accept
47 = Any liability insurance

Note: Values equate to a MSP value code.
MEDICARE AMT OUTSTANDING Medicare amount outstanding– Identifies the outstanding Medicare amount (11-digit field in 999999999.99 format)
MEDICARE PART Medicare Part– Identifies whether the claim is Part A or Part B (one-position alphanumeric field)

Valid values
A = Medicare Part A
B = Medicare Part B
METHOD OF PAYMENT Method of payment– Identifies the method of payment (one-position alphanumeric field)

Valid values

A = Adjustment submitted hardcopy
C = Check submitted
X = Adjustment submitted hardcopy or electronically
Z = Combination of check and adjustment submitted
COST REPORT STATUS Cost report status– Identifies the cost report status (one-position alphanumeric field)

Valid values

O = Open
C = Closed
PRIMARY PAYER NAME Primary payer name– Identifies the name of the primary payer (25-position alphanumeric field)
PRIMARY PAYER ADDRESS: STREET Primary payer address street– Identifies the street address of the primary payer (30-position alphanumeric field)
CITY Primary payer address city– Identifies the city of the primary payer (15-postiton alphanumeric field)
STATE Primary payer address state– Identifies the state of the primary payer (two-position alphanumeric field)
ZIP CODE Primary payer address ZIP Code– Identifies the ZIP Code of the primary payer (nine-position alphanumeric field)
REMARKS Remarks– Identifies remarks lines (67-position alphanumeric field)
MSG Message– Identifies message lines to display error messages (73-position alphanumeric fields)

Example of Credit Balance Successfully Added

Once it is stored (<F9/PF9>), you should receive this message and can begin to enter the next credit balance.

Credit Balance Report - Form 838 Inquiry Screen, successful additional message

MAP1B21 Credit Balance Report– Form 838 Inquiry

The DDE inquiry screen displays the credit balance information that has already been entered. Select ‘R3’ from the online reports menu.

Credit Balance Report - Form 838 Inquiry

Press <Enter> key.

The INQUIRY screen will be populated with the HICNs that have been entered during the current quarter.

Credit Balance Report - Form 838 Inquiry Screen

Sample of Submitted Credit Balance Reports

From the list of credit balances HICNs already entered the following functions can be performed.

S = Select option will display the credit balance information that was entered for that HICN by the provider
D = Delete option will remove the HICN and the previously-entered credit balance information
U = Update option will display the credit balance information and allow the provider to update the information previously stored

Please note: 30 days after the quarter-end date all available information will be removed.

MAP1B21 Credit Balance Report– Update

Screen sample for updates to the credit balance report.

This is a screen sample of how to update a credit balance, after selecting ‘R3’ you will be on the inquiry screen, enter a ‘U next to the HICN you want to update and press <Enter>.

Credit Balance Report - Form 838 Inquiry Screen, First HIC selected for update with U in SEL field

MAP1B22 Credit Balance Report– Update

Screen sample for updates to the credit balance report.

When ‘U’ for update is accessed and changes are performed, the <F9/PF9> key will be displayed as an option at the bottom of the screen. The <F9/PF9> key is used to store the updated record.

Credit Balance Report - Form 838 Inquiry Screen, results

MAP1B21 Credit Balance Report– Delete

Screen sample for deleting the credit balance report.

This is a screen sample of how to delete a credit balance, after selecting ‘R3’ you will be on the inquiry screen, enter a ‘D’ next to the HICN you want to delete and press the <Enter> key.

Credit Balance Report - Form 838 Inquiry Screen, D entered next to HIC to be deleted

MAP1B22– Credit Balance Report– Delete

When ‘D’ for delete is selected, this option will remove the HICN and the previously entered credit balance information.

If the HICN/credit balance was entered in error, press the <F9/PF9> key to delete.

The <F9/PF9> key is listed on the bottom screen.

Credit Balance Report - Form 838 Inquiry Screen, results

Credit Balance Error Messages

When an error has been encountered, a message at the bottom of the screen will be displayed.

In this example, the HICN and DCN are required

The following error messages will be displayed on the entry screen when an error is encountered:

  1. If a HIC and DCN is not entered, return the following error message: “HIC and DCN numbers required.”
  2. If a HIC/DCN combination does not match a HIC/DCN present in the FISS DDE, return the following error message: “No match for the HIC and DCN numbers entered.”
  3. If a duplicate HIC/DCN combination record is entered during the same report quarter, return the following error message: “Duplicate HIC and DCN entered for same quarter.”
  4. If the TOB present is equal to ‘xx0’ (i.e., third digit = zero), return the following error message: “Type of bill for HIC/DCN entered = xx0—no credit balance required.” FS5106—Add Credit Balance Process to System July 2008 Fiscal Intermediary Standard Systems 101”
  5. If the contact name and phone number information is not entered, return the following error message: “Contact name and phone number required.”
  6. If the phone number is entered with nonnumeric data, return the following error message: “Phone number must be numeric.”
  7. If the beneficiary name—last and first initial—is not entered, return the following error message: “Beneficiary last name and first initial required.”
  8. If the quarter ending date is entered with nonnumeric data, return the following error message: “Quarter end must be numeric.”
  9. If the quarter-ending date month do not equal to 03, 06, 09, or 12, return the following error message: “Quarter-end month must equal 03, 06, 09, or 12.”
  10. If the quarter-ending date year is greater than the current year, return the following error message: “Quarter-end year must be less than or equal to current year.”
  11. If the quarter-ending date entered is within the current quarter, return the following error message: “Credit balance report not allowed until quarter ends.”
  12. If the credit balance reason is equal to ‘1’ or ‘3,’ a Medicare amount outstanding can not be present; or if the credit balance reason is equal to ‘2’ and the paid date is not greater than 60 days prior and a Medicare amount outstanding is present, return the following error message: “MED AMT outstanding invalid with bal reason 1, 3, or 2 & PDDT > 60 days prior.”
  13. If a credit balance amount is not entered, return the following error message: “Credit balance amount required.”
  14. If the credit balance amount is entered with nonnumeric data, return the following error message: “Credit balance amount must be numeric.”
  15. If the credit balance reason is equal to ‘1’ and the credit balance amount and amount repaid is not equal, return the following error message: “credit balance reason equals 1: credit balance amount and amount repaid must equal.”
  16. If the credit balance reason is equal to ‘1’ and an amount outstanding is present, return the following error message: “Credit balance reason equals 1: amount outstanding must equal zero.”
  17. If the credit balance reason is equal to ‘2’ and the value code, payer name, or address is blank, return the following error message: “Credit balance reason equals 2: value code, payer name and address required.”
  18. If the credit balance reason is equal to ‘3’ and the remarks are blank, return the following error message: “Credit balance reason equals 3: remarks required.”
  19. If the quarter-ending date entered is prior to the current quarter, return the following error message: “Quarter-ending date entered is prior to current quarter.”
  20. If the credit balance amount minus the amount paid is not equal to the amount outstanding, return the following error message: “Credit balance amount minus amount paid must equal amount outstanding.”
  21. If the amount repaid is nonnumeric, return the following error message: “Amount repaid must be numeric.”
  22. If the cost-report status field is not equal ‘O’ or ‘C,’ return the following error message: “Cost-report status invalid: valid values ‘O’ or ‘C’.”
  23. If the method of payment field is not equal to ‘A,’ ‘C,’’X’, or ‘Z,’ return the following error message: “Method of payment invalid: valid values ‘A,’ ‘C,’ ‘X,’ or ‘Z’.”
  24. If the method of payment is equal to ‘X’ and the credit balance amount and amount repaid values are not equal, return the following error message: “Method of payment = X: credit balance amount and amount repaid must equal.”
  25. If the Medicare amount outstanding field value is nonnumeric, return the following error message: “Medicare amount outstanding must be numeric.”
  26. If the credit balance reason is not equal to ‘1,’ ‘2’, or ‘3,’ return the following error message: “Reason for credit balance invalid: valid values ‘1,’ ‘2’, or ‘3’.”
  27. If the value code present is not equal to 12–16, 41, 42, 43, 44, or 47, return the following error message: “Value code, if present, must equal 12–16, 41, 42, 43, 44, or 47.”
  28. If the payer name and address is present and the credit balance reason is not equal to ‘2,’ return the following error message: “Payer name and address present: credit balance reason must equal ‘2’.”
  29. If the provider number entered is not valid, return the following error message: “Invalid provider number entered. Please reenter provider number.”

Examples of Credit Balance Error Messages

Credit Balance Report - Form 838 Inquiry Screen

Credit Balance Report - Form 838 Inquiry Screen

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Last Modified: 1/13/14