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ePACES Institutional Claim REFERENCE GUIDE

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Revised 8/9/2022 Version 1/Revision 27 Page 1 of 44 ePACES Institutional Claim REFERENCE GUIDE TABLE OF CONTENTS INITIAL 2 GENERAL Claim INFORMATION ........................................ ........................................ .............................. 5 Institutional Claim INFORMATION ........................................ ........................................ .................... 8 PROVIDER INFORMATION 13 DIAGNOSIS / PROCEDURE 16 OTHER PAYERS TAB ........................................ ........................................ ........................................ ....... 19 OTHER PAYER DETAILS.

Note: The Payer Claim Control Number field will only appear if you select Replace, Void, Interim or Final from the drop down. This number was reported on the provider’s remittance as the Transaction Control Number (TCN). This is not a required field for the Interim and Final options and should only be completed when adjusting a paid CHHA EPS claim.

  Guide, Reference, Peace, Claim, Institutional, Epaces institutional claim reference guide

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