introduction why is this needed? federal mandate medicaid is payer of last resort
DESCRIPTION
Introduction Why is this needed? Federal Mandate Medicaid is payer of last resort Michigan Document Was already needed in 4010. Want Medicare and insurance as non-covered NY Document 0-fill payer specific - PowerPoint PPT PresentationTRANSCRIPT
Introduction Why is this needed?
• Federal Mandate• Medicaid is payer of last resort
• Michigan Document• Was already needed in 4010. Want Medicare and
insurance as non-covered• NY Document
• 0-fill payer specific
The process previously known as “0FILL” is now indicated by usage of this AMT segment. As a result, this indicator is now payer specific.
Entering the Insurance Data • Insurance Master• Put in address w/zip+4
• Insurance Info• Pat 5
• Medicare Info (Michigan)• Pat 10
• code 22 admin date or prior (date not MEDICARE level) (96) • A3 Benefits exhausted (119)
Setting the Billing Parameters • 5010 ONLY!!!!
• NY Basic 57 = D
• Michigan (use non-covered days) Basic 57 = B Basic 23 = X Occur 22 = P and A3 = P
(uses history not “A”)
Resident>System Parameters>Bill Print/Submit Parms>Field Group "B – Occurrence Codes">Click inside cell and make entry>Save.
If A3 does not exist and needs to be added
Resident>System Parameters>Bill Print/Submit Line Edit>Field Group "B – Occurrence Codes”
Effect on the 5010 • Medicaid secondary
• Insurance primary
Note for 5010 CH changed to RP for Michigan
BHT*0019*00*ABCDEF*20111122*114428*RP
Medicaid secondary to Medicare
HL*2*1*22*0SBR*S*18*******MCNM1*IL*1*Aaaaaa*Dddddd*K***MI*0123456789N3*431 Pppp Sppppp N4*CLIO*MI*484200000DMG*D8*19520921*MNM1*PR*2*MEDICAID*****PI*00111N3*201 Tttttttt SssssN4*LANSING*MI*489130000CLM*000802*7750***21:A:3**A*Y*YDTP*434*RD8*20110801-20110831DTP*435*DT*201006230000CL1*1*4*30REF*EA*011111HI*BK:4019HI*BJ:4019HI*BF:3441*BF:V4976*BF:2729*BF:7291*BF:70723*BF:70705*BF:35571HI*BH:A3:D8:20100615HI*BE:81:::31*BE:D3:::863NM1*71*1*WxxxxxN*Jxxxxx*H***XX*1111111111SBR*P*18*******MACAS*PR*119*7750AMT*A8*7750OI***Y***YNM1*IL*1*Aaaaaa*Daaaaa*K***MI*322222222C1NM1*PR*2*MEDICARE*****PI*00450N3*7500 SECURITY BLVDN4*BALTIMORE*MD*212440000DTP*573*D8*20111122REF*F8*311125310215130000LX*1SV2*0120**7750*DA*31**0
270/271 to get information • PT270A
• PT270S (code tables)
• PT270R (code tables)
835 messages
• In some cases no denial file (NY)
• Shows primary payor
• Needs to bill by adjustment after corrections (NY???)