Medicare Crossover claims

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ehc2010
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Joined: Tue Aug 26, 2014 8:26 am

Medicare Crossover claims

Post by ehc2010 » Thu Oct 27, 2016 3:25 pm

Hi,

This is Jason M and we use Medisoft Version 19. Off late we are getting denials from Sooner care (Medicaid) on radiology services on crossover claims from Medicare. The Evaluation and managements services billed on same claims gets paid though. We found that Loop 2420E NM1 has incomplete/invalid information (ordering physician/ referring physician information). Please suggest where are we supposed to enter the information on Medisoft to reflect this on above said loop.


Thank you,

Jason M

ehc2010
Posts: 27
Joined: Tue Aug 26, 2014 8:26 am

Re: Medicare Crossover claims

Post by ehc2010 » Thu Oct 27, 2016 3:41 pm

Please let me know if we need to check the option "send ordering provider in loop 2420E" on both the Insurances or just doing it on one of them would do. If so please let me know which one should be opted either medicare or medicaid?


Thanks in advance,

Jason M

lovehearing
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Joined: Thu Oct 27, 2016 4:15 pm

medicare claim

Post by lovehearing » Thu Oct 27, 2016 4:23 pm

Hi
how do I do claim with Medicare primary, Anthem secondary? How do I print both primary & secondary on 1 claim cms 1500? How do I check box 11d (is there another health plan).

Thanks in advance.

Emily

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Gavin Walker
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Re: Medicare Crossover claims

Post by Gavin Walker » Fri Oct 28, 2016 11:51 am

Hi Jason, if you check the box on the Insurance "Send Ordering Provider in Loop 2420E", Then the loop gets created and is filled in with the Referring Provider information that was on the case when the claim was created.

Emily, you fill out the Policy 2 tab on the case and click Update All in Transaction Entry if you filled that out after the charges were entered.

:D
Gavin Walker
Walker Tek Solutions, LLC
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417-890-6777

ehc2010
Posts: 27
Joined: Tue Aug 26, 2014 8:26 am

Re: Medicare Crossover claims

Post by ehc2010 » Fri Oct 28, 2016 12:30 pm

Hey Gavin,
Please let me know if we need to check the option "send ordering provider in loop 2420E" on both the Insurances or just doing it on one of them would do. If so please let me know which one should be opted either medicare or medicaid?

Thanks in advance,

Jason M

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Gavin Walker
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Location: Springfield, MO
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Re: Medicare Crossover claims

Post by Gavin Walker » Sat Oct 29, 2016 10:12 am

You would select that on Medicare since these are primary claims that Medicare is crossing over. If you need to resubmit the claim to Medicaid, then check the option on Medicaid too. So the short answer would be to check it on both in case you need to send the claim either way.

lovehearing
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Joined: Thu Oct 27, 2016 4:15 pm

Re: Medicare Crossover claims

Post by lovehearing » Mon Oct 31, 2016 11:21 am

Hi Gavin,

I filled out the insurance tab, both primary(Medicare) and secondary(Anthem) before I entered charges were entered, but secondary doesn't print on cms 1500 box 9a & 9d, and no Yes is not checked for line 11d. Please advise. Thank you very much.

Emily

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Gavin Walker
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Re: Medicare Crossover claims

Post by Gavin Walker » Mon Oct 31, 2016 12:52 pm

Hi Emily, it sounds like you are printing paper claims, and my instructions above are for ANSI 5010 electronic claims. I think you'll just need to work directly with your Medisoft value added re-seller on this one.

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