MO HealthNet Internet Provider Training Program Presented by the Provider Education Unit MO HealthNet Division

1. MO HealthNet Internet Provider Training Program Presented by the Provider Education Unit MO HealthNet Division MO HealthNet Division

2. Proper Completion of the Online Medicare Part B Crossover Claim Presented by the Provider Education Unit MO HealthNet Division MO HealthNet Division

3. To file a claim go to the Internet Web site www.emomed.com and log on under the appropriate NPI and Taxonomy code, if applicable for the claim to be submitted. Enter your user ID and Password. This will bring up the eProvider Home Page. At the top of each page is a “Help” button in the form of a question mark. You can print out field-by-field instructions. MO HealthNet Division

4. CLAIM MANAGEMENT MO HealthNet Division

5. NEW XOVER CLAIM MO HealthNet Division

6. MEDICARE CMS-1500 PART B PROFESSIONAL MO HealthNet Division

7. Participant DCN Participant Last Name Participant First Name Patient Account Number Participant Medicare ID (HIC) MO HealthNet Division

8. Participant DCN Participant Last Name Participant First Name Patient Account Number Participant Medicare ID (HIC) MO HealthNet Division

9. Participant DCN Participant Last Name Participant First Name Patient Account Number Participant Medicare ID (HIC) MO HealthNet Division

10. Participant DCN Participant Last Name Participant First Name Patient Account Number Participant Medicare ID (HIC) MO HealthNet Division

11. Participant DCN Participant Last Name Participant First Name Patient Account Number Participant Medicare ID (HIC) MO HealthNet Division

12. Medicare Provider NPI Hospitalization Dates Save Claim Header Diagnosis Codes MO HealthNet Division

13. Medicare Provider NPI Hospitalization Dates Save Claim Header Diagnosis Codes MO HealthNet Division

14. Medicare Provider NPI Hospitalization Dates Save Claim Header Diagnosis Codes MO HealthNet Division

15. Medicare Provider NPI Hospitalization Dates Save Claim Header Diagnosis Codes MO HealthNet Division

16. Dates of Service Place of Service Procedure Code Modifiers MO HealthNet Division

17. Dates of Service Place of Service Procedure Code Modifiers MO HealthNet Division

18. Dates of Service Place of Service Procedure Code Modifiers MO HealthNet Division

19. Dates of Service Place of Service Procedure Code Modifiers MO HealthNet Division

20. National Drug Code Decimal Quantity Days/Units Billed Billed Charges Diagnosis Code MO HealthNet Division

21. National Drug Code Decimal Quantity Days/Units Billed Billed Charges Diagnosis Code MO HealthNet Division

22. National Drug Code Decimal Quantity Days/Units Billed Billed Charges Diagnosis Code MO HealthNet Division

23. National Drug Code Decimal Quantity Days/Units Billed Billed Charges Diagnosis Code MO HealthNet Division

24. National Drug Code Decimal Quantity Days/Units Billed Billed Charges Diagnosis Code MO HealthNet Division

25. Performing Provider NPI Paid Amount Save Detail Line to Claim MO HealthNet Division

26. Performing Provider NPI Paid Amount Save Detail Line to Claim MO HealthNet Division

27. Performing Provider NPI Paid Amount Save Detail Line to Claim MO HealthNet Division

28. Dates of Service Place of Service Procedure Code Modifiers MO HealthNet Division

29. Dates of Service Place of Service Procedure Code Modifiers MO HealthNet Division

30. Dates of Service Place of Service Procedure Code Modifiers MO HealthNet Division

31. Dates of Service Place of Service Procedure Code Modifiers MO HealthNet Division

32. Diagnosis Code Billed Charges Days/Units Billed Paid Amount Performing Provider NPI Save Detail Line to Claim MO HealthNet Division

33. Diagnosis Code Billed Charges Days/Units Billed Paid Amount Performing Provider NPI Save Detail Line to Claim MO HealthNet Division

34. Diagnosis Code Billed Charges Days/Units Billed Paid Amount Performing Provider NPI Save Detail Line to Claim MO HealthNet Division

35. Diagnosis Code Billed Charges Days/Units Billed Paid Amount Performing Provider NPI Save Detail Line to Claim MO HealthNet Division

36. Diagnosis Code Billed Charges Days/Units Billed Paid Amount Performing Provider NPI Save Detail Line to Claim MO HealthNet Division

37. Diagnosis Code Billed Charges Days/Units Billed Paid Amount Performing Provider NPI Save Detail Line to Claim MO HealthNet Division

38. Filing Indicator Other Payer ID Other Payer Name Paid Date MO HealthNet Division

39. Filing Indicator Other Payer ID Other Payer Name Paid Date MO HealthNet Division

40. Filing Indicator Other Payer ID Other Payer Name Paid Date MO HealthNet Division

41. Filing Indicator Other Payer ID Other Payer Name Paid Date MO HealthNet Division

42. Paid Amount Total Denied Amount Remittance Advice Remark Codes Save Other Payer Data and Manage Codes MO HealthNet Division

43. Paid Amount Total Denied Amount Remittance Advice Remark Codes Save Other Payer Data and Manage Codes MO HealthNet Division

44. Paid Amount Total Denied Amount Remittance Advice Remark Codes Save Other Payer Data and Manage Codes MO HealthNet Division

45. Paid Amount Total Denied Amount Remittance Advice Remark Codes Save Other Payer Data and Manage Codes MO HealthNet Division

46. Associated Line Items Claim Group Code Claim Adjustment Reason Code Adjustment Amount MO HealthNet Division

47. Associated Line Items Claim Group Code Claim Adjustment Reason Code Adjustment Amount MO HealthNet Division

48. Associated Line Items Claim Group Code Claim Adjustment Reason Code Adjustment Amount MO HealthNet Division

49. Associated Line Items Claim Group Code Claim Adjustment Reason Code Adjustment Amount MO HealthNet Division

50. Claim Group Code Claim Adjustment Reason Code Adjustment Amount MO HealthNet Division