Field: INSURED
NAME
Description/Notes : Enter the patient’s name as shown on the Medicare card
Field: CERT/SSN/HIC
Description/Notes : Enter the Medicare Health Insurance Claim Number as it appears on
the Medicare card if it does not automatically populate.
Field: TREAT. AUTH. CODE
Field: TREAT. AUTH. CODE
Description/Notes : Treatment Authorization Code – Enter the OASIS matching key output
by the Grouper software. This is the same code as was entered on the
RAP for the same episode.
Claim Variations
• Transfers
• Discharges and Readmissions
• LUPA
• No-RAP LUPA
Partial Episode Payment
• Proportional payment based on number of days of service provided
– Total number of days counted from first billable service to last billable service
• Applied when patient is transferred to another HHA within 60-day episode
• Applied when patient is discharged and readmitted to same HHA within same 60-day episode
Claim Variations
• Transfers
• Discharges and Readmissions
• LUPA
• No-RAP LUPA
Partial Episode Payment
• Proportional payment based on number of days of service provided
– Total number of days counted from first billable service to last billable service
• Applied when patient is transferred to another HHA within 60-day episode
• Applied when patient is discharged and readmitted to same HHA within same 60-day episode
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