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FISS/DDE Provider Online Guide: Chapter V


Roster Bill Entry (87)

Purpose

Roster billing is a streamlined process for submitting Medicare claims for a large group of beneficiaries for influenza virus or pneumococcal vaccinations. Up to ten beneficiaries can be reported on a single roster bill.

The ROSTER BILL ENTRY option will allow the provider to enter data for roster bills for the influenza and pneumococcal pneumonia vaccines.

To access the Claim and Attachments Entry Menu screen in FISS, press 02 from the FISS main menu

To initiate a roster bill for either the influenza or pneumococcal pneumonia vaccine, type ‘87’ at the Enter Menu Selection: prompt, then press <Enter>.

Upon Selecting the ROSTER BILL ENTRY option, the initial VACCINE ROSTER FOR MASS IMMUNIZERS screen is available:

VACCINE ROSTER FOR MASS IMMUNIZERS screen in FISS. To initiate a roster bill for either the influenza or pneumococcal pneumonia vaccine, type ‘87’ at the Enter Menu Selection: prompt, then press <Enter>.

The RECEIPT DATE: field is automatically populated with the current date in the MMDDYY format.

The provider number is also auto-populated in the OSCAR: field. To enter a roster bill for another provider for which you have access, overwrite the OSCAR: field.

To data enter a roster bill for either the influenza or pneumococcal pneumonia vaccines, enter the details outlining the vaccination and administration using the following fields on the top of the VACCINE ROSTER FOR MASS IMMUNIZERS screen. Then press <Enter>.

Field Description
DATE OF SERVICE Type the service date of the mass immunization in MMDDYY format
TYPE-OF-BILL Type the first two digits type of bill

Valid Values:
12 - Hospital inpatient (Part B)
13 - Hospital outpatient
22 - SNF inpatient Part B
23 - SNF outpatient
34 - HH Part B
72 - Independent/hospital-based RDF
75 - CORF
85 - CAH
NPI Type the NPI associated with the OSCAR listed (NPI may be auto-populated)
TAXO. CODE Type the facility’s taxonomy code (taxonomy code may be auto-populated)
FAC. ZIP Type the facility’s ZIP Code (ZIP Code may be auto-populated)
REVENUE CODE Type the appropriate revenue codes for the vaccine (0636) and its administration (0771) (use the <Tab> key to report vaccine and administration codes on separate lines)
HCPC Type the HCPCS/CPT code indicating the vaccine and its administration (use the <Tab> key to report vaccine and administration codes on separate lines)
CHARGES PER BENEFICIARY Indicate the charges per beneficiary for the vaccine and its administration (use the <Tab> key to report vaccine and administration charges on separate lines)
Note:
Do not enter the total charges for all beneficiaries. This will result in overpayments.

Once you press <Enter> after entering the vaccination details, enter the beneficiaries’ information in the PATIENT INFORMATION section of the VACCINE ROSTER FOR MASS IMMUNIZERS screen.

Note: Four beneficiaries can be entered on the VACCINE ROSTER FOR MASS IMMUNIZERS screen. Use the <F6/PF6> key to advance to a new screen to include up to ten beneficiaries. Use the <F6/PF6> key to advance to a new screen to include up to ten beneficiaries.

Field Description
MID NUMBER Identifies the Medicare ID number (twelve-position alphanumeric field)
LAST NAME Identifies the patient’s last name at the time services were rendered. (20-position alphabetic field. Spaces and special characters are prohibited for this field)
FIRST NAME Identifies the patient’s first name (15-position alphabetic field)
INIT Identifies the patient’s middle initial (one-position alphabetic field. Spaces are allowed in this field)
BIRTH DATE Identifies the patients date of birth (eight-position numeric field in MMDDYYYY format)
SEX Identifies the patients sex as recorded at the time services were rendered (one-position alphabetic field).

Valid Values:
M
- Male
F - Female

Roster claims may be submitted for inpatient hospital or SNF beneficiaries. TOB 12 must be reported for inpatient hospital roster bills. TOB 22 must be reported for SNF roster bills.

The additional fields below are active once TOB 11 or 22 is entered:

Field Description
ADMIT DATE Identifies the date of the patient’s admission (six-position numeric field MMDDYY format)

This field applies to inpatient 12X and 22X TOB only

ADMIT TYPE Identifies the code indicating the priority of admission (one-position numeric field)

This field applies to inpatient 12X and 22X TOB only

Valid Values:
1
- Emergency
2 - Urgent
3 - Elective
4 - Newborn
5 - Trauma Center
ADMIT DIAG Identifies the diagnosis code describing the inpatient condition at the time of the admission (seven-position alphanumeric field)

This field applies to inpatient 12X and 22X TOB only
PAT STATUS Identifies the patient’s status code as of the ending service date in the period (two-position alphanumeric field)

This field applies to inpatient 12X and 22X TOB only
ADMIT SRC Identifies the admission source (the way a patient was referred to the hospital for admission) (one-position alphanumeric field)

This field applies to inpatient 12X and 22X TOB only

Valid Values:
1
- Physician referral
2 - Clinical referral
3 - HMO referral
4 - Transfer from a hospital
5 - Transfer from a SNF
6 - Transfer from another health care facility
7 - Emergency room
8 - Court/law enforcement
9 - Information not available
A - Transfer from a CAH       
B - Transfer from another home health agency
C - Readmission to the same home health agency
D - Transfer from hospital inpatient in the same facility resulting in a separate claim to the payer - The patient was admitted to this facility as a transfer from hospital inpatient within this facility resulting in a separate claim to the payer.
E - Transfer from ambulatory surgical center
F - Transfer from hospice and is under a hospice plan of care or enrolled in hospice program

Use the <P9/PF9> key to submit the roster bill.

[Return to FISS/DDE Provider Online Guide Index]

FISS/DDE Provider Online Guide: Chapter V - Roster Bill Entry (87)
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