Billing Masshealth Secondary Claims Electronically

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bccmass
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Billing Masshealth Secondary Claims Electronically

Post by bccmass » Mon Jun 25, 2012 5:11 pm

I've been trying to send secondary electronic claims to Masshealth since they no longer accept paper claims however I'm not sure where to enter the required carrier codes for the primary insurance. There is a block titled "Alternate Carrier ID" under the Insurance Carrier EDI/Eligibility tab which I'm thinking might be it, but I'm not sure.

All I know is that I billed secondary claims to Masshealth but they denied saying they were missing Coordination of Benefits info/the carrier code.

Does anyone have experience billing Masshealth secondary or know what I'm talking about? Any guidance is appreciated!

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Gavin Walker
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Re: Billing Masshealth Secondary Claims Electronically

Post by Gavin Walker » Tue Jun 26, 2012 8:14 am

On Medisoft v17, you need to fill in EDI Receiver and Claims Payer ID in the Secondary Receiver frame and from that point on, the secondary receiver will default onto new claims that are generated. You can manually change the secondary receiver on the claim after it is created. Then you can send the secondary claims with Revenue Management either in a separate batch or together with your primary claims.
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bccmass
Posts: 11
Joined: Thu Nov 17, 2011 11:56 am

Re: Billing Masshealth Secondary Claims Electronically

Post by bccmass » Tue Jun 26, 2012 8:56 am

I have no problem sending my claims, it's just that Masshealth requires a "carrier code" for the primary insurance and I'm not sure where to enter it into Medisoft.

For example, I have a patient with Cigna primary and Masshealth secondary. Before I can send the claim to Masshealth I need to attach Cigna's carrier code to the claim. According to Masshealth's billing guide this 7 digit code should be in Loop 2330B segment NM1 09. I don't know where to enter the code in Medisoft to accomplish this.

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Gavin Walker
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Re: Billing Masshealth Secondary Claims Electronically

Post by Gavin Walker » Tue Jun 26, 2012 11:53 am

This should simply by the Claims Payer ID in the Primary Receiver frame. This should have been present when you submitted your primary claim as Revenue Management won't generate a claim without it. Have you switched over to use one of the ANSI 5010 IGuides?

bccmass
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Re: Billing Masshealth Secondary Claims Electronically

Post by bccmass » Tue Jun 26, 2012 12:54 pm

I'm sorry, I must not be explaining it right. There's no problem with the actual billing of the claim. I have the payer ID for Masshealth and can submit electronic claims to them fine, whether they are primary or secondary.

The problem lies in a piece of information that must be present in the electronic claim I submit to them. Masshealth has their own list of "carrier codes" which can be seen here: http://www.mass.gov/eohhs/docs/massheal ... -c-all.pdf

Masshealth needs this carrier code listed in Loop 2330B segment NM1 09, as stated by them in their billing guide (and a representative when I called). I looked this segment up in the Medisoft help guide and it looks like I should enter this carrier code into the "EDI Extra 1/Medigap" line, but I'm not sure. It looks like that might interfere with the Claims Payer ID.

...when I used to send secondary claims to Masshealth on paper, I would simply send an EOB with a claim form and I could write the carrier code right on the claim form, it would go in box 11c. They wouldn't pay secondary claims without it. Same situation here, except I can no longer send a paper claim so I must figure out how to attach this carrier code.

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Gavin Walker
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Re: Billing Masshealth Secondary Claims Electronically

Post by Gavin Walker » Tue Jun 26, 2012 4:53 pm

That stinks. You will have to switch the payer id when you send secondary claims. If you send claims through a clearinghouse then the clearinghouse has to deal with these types of headaches.

bccmass
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Re: Billing Masshealth Secondary Claims Electronically

Post by bccmass » Wed Jun 27, 2012 7:32 am

Oh well, that's what I was afraid of. I was hoping someone had figured out a better way! Thanks for your replies :)

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