Exploring the Direct Data Entry (DDE) Inquiries Menu - December 2023 - Education Disclaimer

Aug 30, 2026

Upload by Oliver

This educational slide deck introduces the Medicare Direct Data Entry (DDE) Inquiries Menu and explains how key inquiry options display beneficiary eligibility, DRG pricing and grouper details, claim history and claim-line information, revenue code constraints, HCPCS rate data, adjustment and reason codes, and remittance advice-related ANSI reason codes. It clarifies that Medicare coverage outcomes depend on applicable CMS rules and that responses rely on provided facts, not on fixed slide assertions. The material also notes compliance limits on recording for profit-making use.

LanguageEnglish

CategoryPresentations

FormatPPTX

Pages31

Reading Time11 min

AccessFree to download

DDE Main Menu

Inquiries (01)

Beneficiary/CWF (10)

DRG (Pricer/Grouper) (11)

Claim Summary (12)

Revenue Codes (13)

HCPC Codes (14)

Adjustment Reason Codes (16)

Reason Codes (17)

Claim Count Summary (56)

ANSI Reason Codes (68)

FI - Check History

Resources

Locating the DDE Manual

DDE Overview

Questions

Exploring the Direct Data Entry (DDE) Inquiries Menu December 2023 Disclaimer We prepared this education as a tool to assist the provider community. Medicare rules change often. They are in the relevant laws, regulations and rulings on the Centers for Medicare & Medicaid Services (CMS) website. We will provide responses to questions based on the facts given, but the Medicare rules will determine final coverage. CMS prohibits recording of the presentation for profit-making purposes. Acronyms ADR – Additional Development Request ANSI – American National Standards Institute CMS – Centers for Medicare & Medicaid Services DDE – Direct Data Entry DRG – Diagnosis Related Group EFT – Electronic Funds Transfer FISS – Fiscal Intermediary Standard System HCPCS - Healthcare Common Procedure Coding System More Acronyms MBI – Medicare Beneficiary Identifier MSI – Multiple Services Indicator POA – Present on Admission PPS – Prospective Payment System RA – Remittance Advice RTP – Return(ed) to Provider SC – Screen Control or Short Cut TOB – Type of Bill DDE Main Menu 01 - Inquiries 10 – Beneficiary/CWF Displays current Medicare Part A and Part B entitlement Additional eligibility information Benefit period Current and prior Deductible Hospice Home Health Preventive services Medicare Advantage 11 – DRG (Pricer/Grouper) Displays detailed payment information Calculated by the Pricer and Grouper software programs Provides specific Diagnostic Related Group (DRG) assignment Prospective Payment System (PPS) payment calculations Specific information required for accurate calculation Data Required for DRG Inquiry Diagnosis and procedure codes Including Present on Admission (POA) indicators Discharge status code Discharge date Covered days Total charges Patient’s date of birth (or age) Gender 12 – Claim Summary Displays history information for claims Pending Processed Customize search by: Medicare Beneficiary Identifier (MBI) Type of Bill (TOB) Status Location Claim From/To date Claim Summary List Claim Detail Select claim to view in entirety F8 to move page by page No updates Inquiry only F1 to view narrative of Reason Codes Or 17 in Screen Control (SC) field Reason Code sub-menu Claim Page 1 Reason Code Narrative Claim Page 2 Line-Item Detail Claim Page 3 Claim Page 4 Claim Page 5 Claim Page 6 13 – Revenue Codes Revenue codes allowable on certain types of bills View other revenue code requirements: HCPCS Units Rate Effective date Termination date (if applicable) Enter four digits in REV CD field Zero in first position 14 – HCPC Codes View allowable revenue codes Display rate data for HCPCS pricing If multiple procedure payment reduction applies Multiple Services Indicator (MSI) = 5 Required in addition to HCPCS: Locality Code, or Carrier and Locality Codes, or Provider Number 16 – Adjustment Reason Codes Two-digit code and narrative Identifies reason for adjustment Supplements Claim Change Reason Code More detailed information Example: D1 – changes to charges SA – increase in covered charges SB – decrease in covered charges 17 – Reason Codes Narrative defines and gives instruction Processing and adjudication information Edit at claim or line level Identifies status/location 56 – Claim Count Summary Total claim count and dollar amount by status/location 68 – ANSI Reason Codes View codes on Remittance Advice (RA) American National Standards Institute (ANSI) Research narrative and associated information FI – Check History View three most current payments Check or electronic funds transfer (EFT) CHECK # field Leading zeros indicate payment by check Leading “eft” indicates electronic payment Dates payments issued Dollar amounts of payments Locating the DDE Manual Resources Direct Data Entry (DDE) Manual Direct Data Entry (DDE) Overview Questions Thank you

FAQs

What information does the DDE Beneficiary/CWF (10) screen display?

It shows current Medicare Part A and Part B entitlement, additional eligibility details, benefit period coverage, current and prior status, deductibles, hospice, home health, preventive services, and Medicare Advantage information.

How does the DDE DRG (Pricer/Grouper) (11) inquiry determine payment information?

It presents detailed payment information calculated by Pricer and Grouper software, including PPS payment calculations. Accurate results require specific data such as diagnosis and procedure codes, POA indicators, discharge status, discharge date, covered days, total charges, patient birth date (or age), and gender.

What can users view in the DDE Claim Summary (12) section?

It displays claim history including pending and processed items. Users can customize searches by MBI, TOB, status, location, and claim date range, then open claim detail pages to review narrative reason codes and line-item detail where available.

Aug 30, 2026

Upload by Oliver