KyHealth Choices. UB04 Medicaid Crossover Workshop

Transcription

1 KyHealth Choices UB04 Medicaid Crossover Workshop

2 Agenda Representative List Reference List 837 Requirements Medicare EOB examples Helpful Hints How to Bill Medicare Primary Claims to KyHealth Choices Evaluation 2

3 Representative List 3

4 Representative List 4

5 Reference List Helpful Phone Numbers Web Addresses EDI Helpdesk Provider Billing Inquiry EDS Website KyHealthnet KyHealth Choices 5

6 Billing Crossovers to KyHealth Choices Beginning September 29, 2008, KyHealth Choices will require their providers to prepare their own Medicare/Medicaid related claims. If you bill these by paper, your claim form must include the Medicare information necessary for processing. You will no longer send Medicare EOB s with your claim unless Medicare denies the service. You may bill Crossover claims by electronic means. 6

7 837I Claims Submission The 837I Companion Guide Version 3.0 will be available on the EDS website Contact your Software Vendor to check the capability and readiness for these changes. 7

8 837 Requirements Loop 2320 CAS02 - Adjustment reason code '1' deductible or '2' Co-insurance Loop 2320 AMT02 - Payor Paid Amount = Medicare paid amount Loop 2320 AMT01 Amount Qualifier Code = 'B6' Payor Allowed amount Loop 2320 AMT02 - Payor Paid Amount = Medicare Allowed amount Loop 2330B DTP01 Date/Time Qualifier = '573' Medicare EOB pay date For questions please contact EDI at

9 Required Information Medicare EOB Date Form Locator 37 (new change) Medicare Paid Amount Form Locator 54 (new change) Medicare Allowed Amount Form Locator 55 (new change) Medicare Coinsurance Amount Form Locator 39 Medicare Deductible Amount Form Locator 39 9

10 Helpful Hints A submission on paper or by electronic means must not be sent until you are sure the Medicare electronic Crossover was unsuccessful or denied by KyHealth Choices to avoid duplicate billing. If Medicare denied your charges, the claim must still be submitted to KyHealth Choices by paper with the Medicare EOB attached. 10

11 UB 04 Top Half 11

12 UB 04 Bottom Half 12

13 Medicare EOB 13

14 UB04 Top Half (Blank) 14

15 UB04 Bottom Half (Blank) 15

16 Medicare EOB 16

17 UB04 Top Half (Blank) 17

18 UB04 Bottom Half (Blank) 18

19 Medicare EOB 19

20 UB04 Header with Medicare #1 20

21 UB04 Header with Medicare #2 21

22 UB04 Deductible for Medicare 22

23 Co-Insurance for Medicare 23

24 Summary with Medicare (Top) 24

25 Summary with Medicare (Bottom) 25

26 KY MMIS Project Provider Evaluation Provider Workshop Date: Thank you for attending this session. We d appreciate your feedback, as well as suggestions on how we can improve future sessions. Please answer the following questions, rating them on a scale of 1-5, with 1 being strongly disagree and 5 being strongly agree. Strongly Disagree Somewhat Agree Strongly Agree Question Material was appropriate for the audience. Comments: 2. Presentation was well-organized and easy to follow. Comments: 3. Session leader was easy to hear/understand. Comments: 4. The Session leader was well-versed in their subject area and presented information in a clear, understandable manner. Comments: 5. I was given appropriate material/handouts. Comments: 6. Questions were answered to my satisfaction. Comments: 7. I was able to see/hear the audiovisual portion with no trouble. Comments: If you would like to receive information via , please provide address below. Comments: Optional: if you would like a member of the KY MMIS team to contact you, please provide your contact information below. Name: Department/Branch: Phone Number: