Note: Users must have the authority, "Claims Create Medicare Claim File," (Diamond Administration group) to access and run this function.
On a quarterly basis, each client will be required to submit a claim file to CMS (Center for Medicare and Medicaid Services). This process is used to generate that file.
Access Processes / Claims / Create Medicare Claim File.
This returns the Medicare Query Response screen:
Enter a file submission date (this date is used as the file submission date in the claim file); format mm/DD/YYYY.
Select Create Claim File.
As the process begins, it creates two (2) files:
The first file is a TIN (Tax ID Number) Reference file that must be submitted anytime there is a change in the reporting TIN which includes the initial submission. Diamond generates this file whether or not a TIN is changed. The client does not need to submit the TIN Reference File unless changes were made. Please note that if you do not submit the file and there were changes to the TIN numbers then the claim records with the undefined TIN will be rejected.
The second file that is created is the claim file. This file includes records that have been added, updated and / or deleted required for the CMS reporting. Only records with valid data are reported. If basic claimant information has not been completed, the records are not reported. It is the responsibility of the client to complete the needed CMS information prior to creating the claim file.
When finished, click OK.