Contents of Page

• Services
  • Electronic Claims Submission
    • Media and Formats
    • Accepted alternate Submission Media
    • Supported Data Formats
  • OBWC Claim Billing Software
  • Claim Lookup Software
• Company Profile
  • Officers
    • President
    • Director of Operations
  • Computer System

Claims to the Ohio Bureau of Workers' Compensation are normally submitted to North Shore Billing Services, Inc. from an MS-DOS compatible system using dial-up phone lines. Standard baud rates from 1200 to 57600 baud are supported as well as error correcting and data compression protocols. Submissions are controlled by BAT files and KERMIT script files (TAK files). NSBS, Inc. provides these BAT and TAK files at no charge to the customer. Currently, all of our customers are using MS-DOS compatible systems. Other machines and operating systems which have a version of KERMIT which supports both windowed packets (preferred) and a script language (required) may be used. However, versions for these other systems have not yet been developed and tested.

Accepted alternate Submission Media (at slightly higher fee) are:

• 1600 and 6250 bpi, 9-track, industry standard magtape, in ANSI or FOREIGN formats (either ASCII or EBCDIC).
• MS-DOS 3.5" or 5.25" floppy diskettes in all sizes except 2.0M.
• Macintosh OS 3.5" floppy diskettes in all sizes except 2.0M.
• Electronic submission using X-, Y-, or Z-Modem.

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• a one-time setup fee of $100 per site. This includes software installation and two-hours of training. Additional training is available at $50.00 per hour.
• a license fee of $30 per month. This license fee will be billed with your other monthly services.

• an IBM compatible 386, 486, or Pentium PC with at least 2 megabytes of memory and MS-DOS 3.3 or higher. (A 4 megabyte 486 PC is recommended.)
• at least 10 megabytes of hard disk space
• an internal or external modem (and phone line) capable of communicating at any standard baud rate between 1200 and 56K.

• minimum number of key strokes to enter data
• user maintainable diagnosis code, service code, and service charge tables
• rejected claims may be edited and re-submitted rather than re-entered
• patient/claim lookup by patient's last name, Soundex of patient's last name, claim number, social security number, or patient account number

• extensive checking of validity of date of service
• default of dates to date last entered
• enhanced reporting of accepted claims

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E-Z-Lookup™ system allows you to determine which MCO (managed care organization) is servicing an employer in the HPP (state funded) system and the employer in the QHP (self-insured) system. You can determine the employer's risk (policy) number and where to send FROI (first report of injury) reports and medical bills. You may also determine claim status and allowed conditions by claim number or claimant last name with optional specification of first name or date of injury for state funded and self-insured claims.

To access this service, software must be installed on your IBM-PC compatible computer running MS-DOS or Windows-95 with a high speed modem. This software allows your PC to emulate a terminal and access North Shore's computer and the data on the 57 MCOs, the more than 282,000 state-funded employers, the more than 3300 self-insured employers, and the more than 2.9 million active claims.

For this service, there is a set up charge and a monthly fee.

The set up charge is $50.00 and includes installation, a user manual, and 1 hour of on-site training.

The monthly fee is volume dependent. There is a $5.00 per month minimum charge. In large volume, employers/MCO data is $0.50 per lookup. In large volume, claim/employer/MCO data is $1.50 per lookup. A complete fee schedule is available upon request.

The technical requirements for your PC are:

• a PC running MS-DOS or Windows-95
• a high speed, non plug-and-play modem (at least 14,400 baud) and dial out phone line
• a 3.5" diskette drive (1.4 Mb drive)
• at least 150 kilobytes of spare disk space

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David A. Falk

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Joe H. Gallagher is a medical physicist with special expertise in computing, image processing, and medical data base design. Dr. Gallagher holds a Bachelor of Science in Mathematics and Physics from the University of North Texas and a Doctor of Philosophy in Physics from the University of Colorado. In addition to post-doctoral fellowships in Japan and Canada, Dr. Gallagher has been Assistant Profession of Diagnostic Radiology at the University of Kansas Medical Center, the Directory of Medical and Research Computing at the Cleveland Clinic Foundation, and Nuclear Medicine Physicist and Radiation Safety Officer at Research Medical Center in Kansas City, Missouri. Dr. Gallagher has worked in medical computer for over 20 years; he is the former Chairman and Newsletter Editor of the DATATRIEVE/Fourth Generation Language Special Interest Group of the Digital Equipment Computer Users Society. He is the author of many refereed papers and technical articles. Dr. Gallagher may be contacted at (440) 885-9560 or you may send E-mail.

Joe H. Gallagher

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• a Digital Equipment Corporation microVAX-3100 model 90 running the VMS operating system
• 80 megabytes of memory
• 3.0 gigabytes of disk
• 6250/1600 bpi magtape
• TSZ07 4mm DAT tape (4 gigabyte capacity)
• a DECserver 700 terminal/modem server
• 4 dialup phone lines with AT&T Paradyne DataPort Modems
• an Exide Electronics POWERWARE uninterruptable power supply
• a selection of DEC and Apple laser printers
• and other servers and communications resources not currently used by NSBS

Joe H. Gallagher, Ph. D. gallagher@eisner.decus.org dtrwiz@ix.netcom.com

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