Note: Users need the authority, "Claims Process Medicare Query File," (Diamond Administration group) in order to access and run this function.
Once you have created the Medicare Query File (Diamond Administration: Create Medicare Query File), retrieved the file and converted it to an ANSI X12 207/271 format, the next step is uploading it to the CMS (Center for Medicare and Medicaid Services) Web Site for processing. Once they have completed processing the file, they will supply you with a query response file.
This file needs to be converted back to a text file (use the HEW Software), and then processed in Diamond using this function.
Access Administration / Claims / Process Medicare Query Response File.
This returns the Medicare Query Response File screen.
To locate the response file, click Browse.
Once you have located it, highlight it and select OK. This places the file's name in the field provided on the screen.
Select Process Query Response file.
During this process:
Diamond reads the response file and updates the Medicare HICN number.
It sets the Medicare recipient field for the claimant. (Please Note: This is done by tax number so if you have the same claimant on multiple claims all claimants will be updated.)
When finished, it displays a confirmation screen. Answer OK to the validation: "The Medicare Query Response file has successfully been processed."