Skip to Main Content
 
 
 
Web Content Viewer

Manuals

Web Content Viewer

FISS/DDE Provider Online Guide: Chapter I


Processing Drivers and System Claim Paths

Purpose

Claims that are filed through the FISS DDE Provider Online System follow a prescribed route referred to as a system claim path. Claim paths are constructed of processing drivers, and all claims submitted through the system will encounter these drivers. The claim path notifies the system which processing functions should be executed for each type of bill submitted. 

The processing drivers are the buckets that the claim falls into as it progresses through the system. Each bucket houses all the edits for that particular driver. For example, all of the medical review edits are contained within the medical policy driver (50). 

The following chart outlines all drivers housed within FISS.

Driver Driver Definition
01 Status/location/adjustment driver
02 Control driver
04 UB04 claim data element edit driver
05 Consistency edit driver (I)
06 Consistency edit driver (II)
15 Administrative edit driver
25 Duplicate edit driver
30 Entitlement edit driver
35 Lab HCPCS edit driver
40 ESRD edit driver
50 Medical policy driver
55 Benefits utilization edit driver
60 Additional development request driver
63 HHPPS pricer
65 PPS pricer driver
70 Payment driver
80 MSP primary driver
85 MSP secondary driver
89 Clean up driver
90 CWF driver
99 Session termination driver

As a claim clears the edits contained within each driver, the bucket is then emptied into the next appropriate one for the particular type of bill. This process continues until the claim makes it all the way through the system (i.e., through every driver). If a claim is suspended due to an error, once the error has been resolved the claim begins processing through the claim path back at the beginning. The claim then reprocesses through each of the drivers again, with the exception of the medical policy driver. 

While claim paths are very similar for all claims, they do differ slightly depending on the type of bill submitted.

Type of Bill Driver Claim Path
11X 01, 02, 04, 05, 06, 15, 25, 30, 35, 50, 55, 65, 70, 80, 85, 89, 90, 99
12X 01, 02, 04, 05, 06, 15, 25, 30, 35, 50, 55, 70, 80, 85, 89, 90, 99
13X 01, 02, 04, 05, 06, 15, 25, 30, 35, 50, 55, 70, 80, 85, 89, 90, 99
14X
01, 02, 04, 05, 06, 15, 25, 30, 35, 50, 55, 70, 80, 85, 89, 90, 99
18X 01, 02, 04, 05, 06, 15, 25, 30, 50, 55, 70, 80, 85, 89, 90, 99
21X 01, 02, 04, 05, 06, 15, 25, 30, 50, 55, 65, 70, 80, 85, 89, 90, 99
22X 01, 02, 04, 05, 06, 15, 25, 30, 35, 50, 55, 70, 80, 85, 89, 90, 99
23X 01, 02, 04, 05, 06, 15, 25, 30, 35, 50, 55, 70, 80, 85, 89, 90, 99
32X 01, 02, 04, 05, 06, 15, 25, 30, 35, 50, 55, 63, 70, 80, 85, 89, 90, 99
33X 01, 02, 04, 05, 06, 15, 25, 30, 35, 50, 55, 63, 70, 80, 85, 89, 90, 99
34X 01, 02, 03, 04, 05, 06, 15, 25, 30, 35, 50, 55, 70, 80, 85, 89, 90, 99
71X 01, 02, 04, 05, 06, 15, 25, 30, 35, 50, 55, 70, 80, 85, 89, 90, 99
72X 01, 02, 04, 05, 06, 15, 25, 30, 40, 50, 55, 70, 80, 85, 89, 90, 99
74X 01, 02, 04, 05, 06, 15, 25, 30, 35, 50, 55, 70, 80, 85, 89, 90, 99
75X 01, 02, 04, 05, 06, 15, 25, 30, 35, 50, 55, 70, 80, 85, 89, 90, 99
76X 01, 02, 04, 05, 06, 15, 25, 30, 35, 50, 55, 70, 80, 85, 89, 90, 99
77X 01, 02, 04, 05, 06, 15, 25, 30, 35, 50, 55, 70, 80, 85, 89, 90, 99
81A 01, 02, 04, 05, 25, 89, 90, 99
81X 01, 02, 04, 05, 06, 15, 25, 30, 35, 50, 55, 70, 80, 85, 89, 90, 99
82X 01, 02, 04, 05, 06, 15, 25, 30, 35, 50, 55, 70, 80, 85, 89, 90, 99
83X 01, 02, 04, 05, 06, 15, 25, 30, 35, 50, 55, 70, 80, 85, 89, 90, 99
85X 01, 02, 04, 05, 06, 15, 25, 30, 35, 50, 55, 70, 80, 85, 89, 90, 99
FISS/DDE Provider Online Guide: Chapter I - Processing Drivers and System Claim Paths
Web Content Viewer
Web Content Viewer
Complementary Content