Splitting Claims

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MYGOALS
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Joined: Thu Sep 29, 2016 12:22 pm

Splitting Claims

Post by MYGOALS » Thu Sep 29, 2016 12:35 pm

Hi all,
Was inquiring if there is a way to split claims to no more than 4 procedures per claim and store that as a permanent permission, or default. I need to find a way to do this because here in Florida with both PIP billing, as well as certain other managed plans, if more than 4 procedures show on a claim the overrun is
either disallowed/ignored, or counted as an additional visit that really wasn't.
We literally spend over 3 hours per week splitting claims before we can print, or send electronic because we have to run paper first!!! (Florida requires PIP claims go paper only with documentation attached.)
I figure that it shouldn't matter if all claims (paper and electronic) are split this way as the electronic should be able to "read" the date of service properly and apply the procedures (correctly) to a single date of service regardless.
This has really dragged the office and morale down big-time, so any direction on how to set this split as a default would be greatly appreciated!
Much thanks in advance,
Art

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Gavin Walker
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Re: Splitting Claims

Post by Gavin Walker » Thu Sep 29, 2016 4:25 pm

Try editing your insurance carrier and go the the EDI/Eligibility tab and enter 4 in EDI Max Transactions. This will only work if you are using Revenue Management to send ANSI 5010 claims. I never heard of an insurance requiring such a low number, so post back if you discover this works. Even the paper CMS-1500 supports 6 transactions.
Gavin Walker
Walker Tek Solutions, LLC
866-890-6777
417-890-6777

MYGOALS
Posts: 3
Joined: Thu Sep 29, 2016 12:22 pm

Re: Splitting Claims

Post by MYGOALS » Thu Sep 29, 2016 9:49 pm

Thanks Gavin, but will this work for paper claims? That is my major problem. If I can control the number of transactions by the payer (insurance), then I can just set this for all our PIP insurance companies and try to get my life back. I would think it should be do-able even for paper claims?
Thanks so much for your input!
Art

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Gavin Walker
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Re: Splitting Claims

Post by Gavin Walker » Sat Oct 01, 2016 2:51 am

One way to handle this with paper claims would be to create a custom CMS-1500 report template and adjust the height of the footer band so that only 4 lines will print before a page break.

MYGOALS
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Joined: Thu Sep 29, 2016 12:22 pm

Re: Splitting Claims

Post by MYGOALS » Mon Oct 03, 2016 4:41 pm

I'm not sure I understand how this would help to pre-program running a specific auto insurance to paper with the 4 lines.

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Gavin Walker
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Re: Splitting Claims

Post by Gavin Walker » Mon Oct 03, 2016 6:02 pm

The CMS-1500 forms are programmed to do a page break on 6 detail lines. It is possible to adjust the band heights on the report so that it breaks on 4 detail lines.

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