EyeBase E-Claims Setup with VisionWeb Enhanced

These forms all need to be setup prior to submitting electronic claims. This information will help you to understand and setup EyeBase for claims submission through VisionWeb Enhanced. You must first register with VisionWeb Enhanced by calling 800-590-0873 to setup an account. All of the windows shown here can be opened from the Setup Menu of EyeBase. All of this information must be entered to properly submit electronic claims. For a short tutorial on how to submit claims, click Electronic Claims Setup or Creating/Submitting Electronic Claims.

Hover mouse over each field then click for more information.

Name: Third-party provider Name
Meaning: Name of payor
Required: Y
Where to get data: Payor
Example: Aetna, Blue Cross/Shield, Medicare
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Name: Provider Number
Meaning: Number that identifies you to your clearinghouse or payor
Required: Y
Where to get data: Payor
Example:
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Name: Physical or Mailing address of Payor
Meaning: Address of Payor
Required: Y
Where to get data: Payor
Example:
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Name: Physical or Mailing address of Payor
Meaning: Address of Payor
Required: Y
Where to get data: Payor
Example:
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Name: Physical or Mailing address of Payor
Meaning: Address of Payor
Required: Y
Where to get data: Payor
Example:
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Name: Physical or Mailing address of Payor
Meaning: Address of Payor
Required: Y
Where to get data: Payor
Example:
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Name: Reference ID Qualifier
Meaning: Provider secondary identification used to identify type of claim
Required: Y
Where to get data: HIPAA requirement
Example: Use "G5" for most payors
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Name: Interchange ID Qualifier
Meaning: Qualifier to designate the system/method of code structure used to designate the sender or receiver ID element being qualified
Required: Y
Where to get data: HIPAA requirement
Example: Use "ZZ" for most payors
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Name: Interchange Receiver ID
Meaning: Identification code published by the receiver of the data
Required: Y
Where to get data: VisionWeb
Example: 9-Digit number
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Name: Group ID Qualifier
Meaning: Identifies the type of payor
Required: Y
Where to get data: HIPAA requirement
Example: Use 1C for Medicare, 1B for BCBS, G2 for most commercial payors
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Name: Group ID
Meaning: ID number for your group
Required: N
Where to get data: Payor
Example:
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Name: NAIC Code
Meaning: National Association of Insurance Commissionersr
Required: N
Where to get data: Payor
Example: 54771V
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Name: GS08 Code
Meaning: Version Identifier
Required: N
Where to get data: Payor
Example: 60061 for Medicare
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Name: Payor ID Number
Meaning: ID number for each payor
Required: Y
Where to get data: VisionWeb
Example:
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Name: Transaction Type ID
Meaning: Claim or encounter number
Required: N
Where to get data: Automatically supplied in claim file
Example:
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Name: Doctor's Name
Meaning: Doctor's name
Required: Y
Where to get data:
Example:
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Name: UPIN number
Meaning: This Doctor's UPIN number
Required: Y
Where to get data: Federal ID number
Example:
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Name: EIN
Meaning: Employer Identification Number
Required: Y
Where to get data: State government
Example:
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Name: SSN
Meaning: This Doctor's social security number
Required: Y
Where to get data: Federal government
Example:
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Name: Federal Tax ID
Meaning: May be the same as EIN
Required: Y
Where to get data: Federal government
Example:
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Name: License Number
Meaning: State or Federal License number for this doctor
Required: Y
Where to get data: State Board of Optometry
Example:
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Name: DEA Number
Meaning: DEA Number
Required: N
Where to get data: Drug Enforcement Administration
Example:
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Name: Select Payor
Meaning: Select the third party payor then enter the individual ID number in the box below and click SAVE.
Required: Y
Where to get data: Payor
Example:
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Name: Individual Provider Number
Meaning: The provider number for this doctor and the Payor in the selection box above.
Required: Y
Where to get data: Payor
Example:
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Name: Claims File Location
Meaning: Folder location on your hard drive to store the file to be sent to VisionWeb.
Required: Y
Where to get data: Users Computer
Example: C:\Program Files\Mountain Computer Systems\EyeBase\Claims
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Name: Backup File Location
Meaning: Folder location on your hard drive to store a backup of the file to be sent to VisionWeb.
Required: Y
Where to get data: Users Computer
Example: C:\Program Files\Mountain Computer Systems\EyeBase\Claims\Backup
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Name: Test Production Indicator
Meaning: Set to TEST when sending test file then PRODuction when you have been approved..
Required: Y
Where to get data: User
Example: TEST or PROD
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Name: Interchange Sender ID
Meaning: ID number of sender of the data.
Required: Y
Where to get data: VisionWeb Enhanced
Example: 9-Digit Number
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Name: Submission Type
Meaning: Used for modem transmissions.
Required: N
Where to get data:
Example: AS4096
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Name: Submission Number
Meaning: Non-editable by user.
Required:
Where to get data:
Example:
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Name: Submission Sequence Number
Meaning: Non-editable by user.
Required:
Where to get data:
Example:
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Name: Last Submission Date
Meaning: Non-editable by user.
Required:
Where to get data:
Example:
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Name: Contact First Name
Meaning: First name of the contact person in your office.
Required: Y
Where to get data: User
Example:
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Name: Contact Last Name
Meaning: Last name of the contact person in your office.
Required: Y
Where to get data: User
Example:
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Name: Communication Number
Meaning: The number that corresponds to the Communication Qualifier below, usually a telephone number.
Required: Y
Where to get data: User
Example:
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Name: Communication Number Qualifier
Meaning: This defines the number above.
Required: Y
Where to get data: User
Example: TE (telephone)
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