LOCATION
DICTIONARY NARRATIVE
Please mark whether this is an addition, edit, or deactativation to the location dictionary. If you are editing a location, only complete the fields that you are editing and the location number. If you are adding a new location, complete all required fields and any other field that might be needed to do correct billing. If you are deactativing a location, only complete the location number field. If you need to delete the information in the field, enter the word “delete” in the field.
Locations may be shared between departments. For example, the Barnes IP location is used by all departments but is only entered into the Location Dictionary once. Please check the dictionary for an existing location before sending a new location form to WUSBCS.
There is now a question on the add/edit form for FSC default table. If this location needs to be added to the FSC default table please check Yes and incate what the FSC default is based on and what the default FSC should be.
1) NAME. This field is required. Enter a description of the location. The description should contain the building identification and the type of location (inpatient, outpatient, office, etc.).
1A) BUILDING NAME: Enter the building name in which the treatment area is located if the building name is not included in the name.
1B) FLOOR, SUITE, OR ROOM NUMBER: Enter more information to identify the location.
1C) BUILDING ADDRESS: Enter the building’s address if the building is not located on the Medical School’s campus.
1D) LOCATION SHARED? Enter the departments this location is shared with.
1E) OTHER INFORMATION? Enter any other information about the location that might be helpful in identifying the type of location.
1F) ILLINOIS LOCATION? Tell I.S. to add a location to the FSC default table for Illinois Medicare if this is an Illinois location.
2) MNEMONIC. This field is required for all additions. Enter up to a four digit, free text abbreviation for the location.
3) NUMBER. This field is required for all edits and deactivations. The five digit number will be assigned by Information Systems for all additions.
The first two characters of the location number is the building number as assigned by the University Accounting Services. If the building does not have an assigned number, it is assigned number 92 if it is not located within a hospital. If it is located within a hospital, it is assigned number 44.
The third and fourth characters of the location number is the number of the location within that building. For example, Wohl Hospital is building number 22. The fifth floor could be location 2201. The third floor could be location 2202.
The fifth number of the location number identifies whether it is an inpatient, outpatient, office, etc. The codes are:
1 Inpatient
2 Outpatient
3 Emergency
4 Office
5 Office-Clinic
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6 Inpatient-Clinic
7 Outpatient-Clinic
8 Independent Laboratory
9 Miscellaneous-Nursing Home, Home, School, Etc.
4) CORRESPONDING LOCATION ON BLUE SHIELD FORM. This is a required field. Enter a two digit place of service code that is used on all Blue Shield claims for this location.
5) CORRESPONDING LOCATION ON MEDICARE FORM. This is a required field. Enter a two digit place of service code that is used on Medicare claims except for Medicare DME for this location.
6) CORRESPONDING LOCATION ON WELFARE FORM. This is a required field. Enter a two digit place of service code that is used on Welfare claims for this location.
7)CORRESPONDING LOCATION FOR HIC. This is a required field. Enter a two digit place of service code that is used on Commercial and Managed Care claims for this location.
8)TYPE OF LOCATION. This is a required field. Enter the one digit type of location in this field.
a) Enter a “D” if this is a Doctor’s Office location.
b) Enter an “I” if this is an Inpatient location. Based on this information, the name and address of the hospital will print on the claim form.
c) Enter an “O” if this is an Outpatient location. Based on this information, the name and address of the hospital or office will print on the claim form.
d) Enter a “C” if this is a Laboratory location. Based on this information, the name and address of the laboratory will print on the claim form. This will also be used to identify other unique requirements for lab billing.
12)WELFARE BILLING NUMBER. Enter a Welfare billing number only if this number applies to this location only. For example, if Missouri Medicaid assigned a group number to a laboratory location, you would enter the number here. The department’s Missouri Medicaid group number would be stored in the division dictionary. Special coding for this exception is required to print this number on the claim form.
13) MEDICARE BILLING NUMBER. Enter a Medicare billing number only if this number applies to this location only. For example, if Medicare assigned a group number to a laboratory location, you would enter the number here. The department’s Medicare group number would be stored in the division dictionary. Special coding for this exception is required to print this number on the claim form.
18) IS THIS LOCATION INPATIENT? Enter a “Y” if this location is an inpatient. This field is used by MCA. Locations marked with a "Y" will appear on several of the Utilization Review Reports.
23) REPORTING CATEGORY # 1. This is a required field. This is a dictionary pull from Dictionary 77, Reporting Categories. Enter the building number or name as it appears in the Reporting Categories dictionary. (If the building is not in dictionary 77, please submit a Reporting Category request form with the location request form.)
24) REPORTING CATEGORY # 2. This is a required field. This is a dictionary pull from Dictionary 77, Reporting Categories. Enter the type of location number or name as it appears in the Reporting Categories dictionary.
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25) REPORTING CATEGORY # 3. This is a dictionary pull from Dictionary 77, Reporting Categories. This field may be used by the department to group different locations together. If the department elects to use this field, they may not share locations with other departments. Please submit a Reporting Category request form with the location request form to establish these groupings.
49) CORRESPONDING LOCATION ON IDPA FORM. This is a required field. Enter a one digit place of service code that is used on IDPA claims for this location.
50) CORRESPONDING HOSPITAL. This is a required field for all inpatient and outpatient locations. This field is a dictionary pull from dictionary 101, Hospitals. (If the hospital is not currently in the dictionary, please submit a Hospital request form with the location form.)
51) CLIA NUMBER. Enter the CLIA number for a laboratory location if it is an independent laboratory. This number is used for Medicare billing. NOTE: If CLIA number required for billing, Field 76, CLIA Number Required must br completed with a “Y”. (There are old CLIA numbers no longer billed but required for A/R followup on old billing. The CLIA Number Required field was created to differentiate old CLIA numbers from CLIA numbers currently being billed on claims.
54) MEDICARE CPIN NUMBER. Enter a Medicare C-Pin number only if all services for this location are billed by one physician and the location has a separate Medicare group number from the department’s Medicare group number. Special coding for this exception is required to print this number on the claim form.
55) MISSOURI MEDICARE FEE LOCATION REGION. Enter a 99 in this field if the location is in Medicare region 2 or 3. (The St. Louis area is region 1.) If the location has a 99 in this field, the Provider’s Medicare Part B Region 99 CPIN and Group number will print on the Medicare claim form.
56) CORRESPONDING COMMERCIAL LABORATORY. This is a required field for all laboratory locations. This field is a dictionary pull from dictionary 103, Commercial Laboratories. (If the laboratory is not currently in the dictionary, please submit a Commercial Laboratory request form with the location form.)
57) DME MEDICARE PLACE OF SERVICE. This is a required field for any location that will bill DME supplies to the FSC, Medicare DME. This place of service code will print on the Medicare form when the FSC is Medicare DME. The place of service is location where the supply or drug will be used, such as home.
58)HMO Referral Not Needed enter a “Y” to bypass HMO referral requirements for this FSC. If this is a shared location, the referral exception must apply for every department using this location.
59)IDPA OUTPATIENT EM PLACE OF SERVICE. This is a required field for outpatient locations where the E/M CPT-4 codes will be used. This place of service will print on the IDPA form.
60) PARTNERS LAB CAP LOC? Enter a “Y” if this location is Capitated for the Partners HMO Laboratory Capitation contract. This field is used by MCA. This field is used for the Partners HMO Benefit Plan in the Coverage Category of Laboratory. If services performed in this location match the other benefit plan criteria they will be written off via BAR Adjudication.
61) OB ULTRASOUND LOCATION. Enter a “Y” if the claim form address in box 32 should be overwritten with the address information in Location fields 62, 63, 64, 65 and the name from field 66. The Department of OB/GYN uses this field for their Gencare HMO/ Utilimed contract billing.
62) OB ULTRASOUND LOCATION ADDR1. Enter the first line of address if the claim form address line 1 in box 32 should be overwritten. The Department of OB/GYN uses this field for their Gencare HMO/ Utilimed contract billing.
63) OB ULTRASOUND LOCATION ADDR2. Enter the second line of the address or address overflow if the claim form address line 2 in box 32 should be overwritten. The Department of OB/GYN uses this field for their Gencare HMO/ Utilimed contract billing.
64) OB ULTRASOUND LOCATION CITY,ST. Enter the City and State if the claim form City and State in box 32 should be overwritten. The Department of OB/GYN uses this field for their Gencare HMO/ Utilimed contract billing.
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65) OB ULTRASOUND LOCATION ZIP. Enter the Zip Code if the claim form Zip Code in box 32 should be overwritten. The Department of OB/GYN uses this field for their Gencare HMO/ Utilimed contract billing.
66) OB ULTRASOUND LOCATION NAME. Enter the Location Name if the claim form Location name in box 32 should be overwritten. The Department of OB/GYN uses this field for their Gencare HMO/ Utilimed contract billing.
67) TES PRUDENTIAL MC+ REFERRAL NOT NEEDED. Enter a “Y” if the location does not require a referral for Prudential MC+. This field is used to create TES edits.
68) TES HMO RAD ONC REFERRAL NEEDED. Enter a “Y” if the location does require a referral for Radiation Oncology for the different HMO’s. This field is used to create TES Edits.
69) CHAMPUS POS. This is a required field. Enter the POS code for Champus for this location.
70) IL Office Name. This is a required field if the office is located in Illinois. Enter the office name for IL Medicare claims. This information will print on the claim form in box 31.
75) RR Medicare Number. Enter a Medicare Railroad number only if this number applies to this location only. For example, if Travelers assigned a group number to a laboratory location, you would enter the number here. The department’s Medicare Railroad group number would be stored in the division dictionary. Special coding for this exception is required to print this number on the claim form.
76 CLIA NUMBER REQUIRED?
77 ILLINOIS LOCATION
78 OB CLIA #
79 CARE PARTNERS CAP LOCATION
80 MEDICARE SUBMITTER ID
81 DESCRIPTION FOR NEW STATEMENT: This field is used for the patient statement to indicate the name of the location where services were rendered. It should be understandable to the patient and indicate exact physical location
For example, Antigen Lab will show as Clinical Research Bldg, BJC hosp. Please comply with the previouis named
Locations for consistency sake.
86 Box 32 Address line 1: Required field. This field is used to print in box 32 of the claim form for inpatient, outpatient, doctors office and nursing home visits. For the location type of H for home, the patients address info is pulled.
87 Box 32 City,State: Required field. This field is used to print in box 32 of the claim form for inpatient, outpatient, doctors office and nursing home visits. For the location type of H for home, the patients address info is pulled.
88 Box 32 Address Zip code + 4: Required field. Zip code plus 4 must be completed. This field is used to print in box 32 of the claim form for inpatient, outpatient, doctors office and nursing home visits. For the location type of H for home, the patients address info is pulled.
89 Tricare suffix: Thie fields is used to print in box 25 on the Tricare/Champus form. The suffix should pull from the WU office location address and suffix spreadsheet sent out by Jamie Hager on 1/18/02. A claim form edit will appear if blank for location type D.
100 Place of Service - new field called HIPAA Place of Service Code . Payer specific place of service codes are replaced with HIPAA compliant values. Generally these match the Medicare PLC codes.
118 Off campus for overhead? Field used by Dr. Crane, JOSP, Kelley Mullen, Jeanette St. Aubin, etc... Location is run by Helen Jansen in the Finance Office and it is primarily used to mirror what the Finance Office considers Off-Campus and On-Campus locations for the purpose of Deans Tax. This is used to determine where the service is provided.
125 ETM ROLE : Select entry from ETM Role Dictionary 35102, Loc:Hospital or Loc:Office. (for IM use only with Claim Edit Views)
126 ETM IM Office Registration Route to Center: Select entry from ETM IM Routing DICTIONARY 48000 (for IM use only with Claim Edit views)