Electronic Work Comp Claims

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ProCareSabrina
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Electronic Work Comp Claims

Post by ProCareSabrina » Thu Dec 03, 2015 7:44 pm

I am using Medisoft V19, this is my first time submitting work comp claims electronically thru our clearinghouse. We use Capario/Emdeon. All of my w/c claims are getting rejected in the clearinghouse portal due to: "PATIENT NAME INFORMATION IS MISSING OR INVALID (error Code 2010CA)" FRom the info the clearinghouse support can give me, it's because "The trading partner has requested that effective March 7, 2014 Capario should reject eBills that do not contain patient information in loop 2010CA." Then lists Segments NM1, N3, N4 and DMG as being necessary. From what i can tell, everything is fine in my Medisoft. Patient is the same as the insured, Guarantor is the same as patient, that is noted in the Case and Policy 1 tab.

What else am I missing? Need any more info from me? HELP!

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Gavin Walker
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Re: Electronic Work Comp Claims

Post by Gavin Walker » Fri Dec 04, 2015 9:24 pm

Check the relationship code on the Policy tab is set to Self.
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ProCareSabrina
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Re: Electronic Work Comp Claims

Post by ProCareSabrina » Sat Dec 05, 2015 8:36 pm

It is. In Medisoft. In the clearinghouse "claim data" area, Self is not an option - don't know if that matters. But, when I researched 2010CA, it said that that segment, etc would ONLY create if the Relationship was other than the insured. As is true with almost every single one of our work comp patients, the insured will always be the patient! I've also made sure the Guarantor and Insured all have the same Patient info showing.

ProCareSabrina
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Re: Electronic Work Comp Claims

Post by ProCareSabrina » Tue Dec 08, 2015 5:21 pm

*UPDATE* Apparently (per the lcearinghouse) when it is a work comp claim, the insured is the Employer, thus patient relationship status must be Employee.

However, I cannot figure out how to make the Insured/Policyholder info reflect the Employer.

I was able to correct and resubmit it through the portal, but I cannot figure out how t fix it in Medisoft.

If I say Employee Relationship, with patient in policyholder, Revenue Mgmt says "Invalid" If I delete the policy holder info, it says insured is missing name and demographics.

Any ideas?

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Gavin Walker
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Re: Electronic Work Comp Claims

Post by Gavin Walker » Tue Dec 08, 2015 8:01 pm

In Medisoft that is Patient's Relationship to Insured, so the correct selection would be Employee. Setup the Employer as the Guarantor and see if that works.

ProCareSabrina
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Re: Electronic Work Comp Claims

Post by ProCareSabrina » Tue Dec 08, 2015 8:56 pm

Ok, good news! That seemed to work. However, I entered the Employer as a non-entity as the Guarantor, but it still made me enter a first name, address and dob or it would get rejected within Revenue Management's reports. I put NA as first name and 5/5/1955 as dob.

So far it was sent successfully from Medisoft and the Emdeon portal says it was accepted. I will keep an eye on it to see if it asks for anything else.

Is there any other way to treat this Guarantor or Insured as a place, not a person?

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Gavin Walker
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Re: Electronic Work Comp Claims

Post by Gavin Walker » Wed Dec 09, 2015 4:49 pm

That would be an enhancement to Medisoft. I'll put in the request to McKesson. They are currently rounding up ideas for v21.

mbpros
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Re: Electronic Work Comp Claims

Post by mbpros » Tue Jan 05, 2016 6:55 pm

By the way, unless you are in a state that mandates sending work comp claims electronically, it is usually faster to fax the claim and the notes directly to the adjuster; you get paid much faster that way compared to sending the claim electronically and sending the notes (either faxing the notes or sending the notes electronically).
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ProCareSabrina
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Re: Electronic Work Comp Claims

Post by ProCareSabrina » Mon Jan 18, 2016 11:22 am

mbpros wrote:By the way, unless you are in a state that mandates sending work comp claims electronically, it is usually faster to fax the claim and the notes directly to the adjuster; you get paid much faster that way compared to sending the claim electronically and sending the notes (either faxing the notes or sending the notes electronically).
Thank you. However, most carriers I've touched base with state they prefer mail. (I'm in Texas btw). We had batches upon batches "lost" in the mail due to our mail carrier, so we opted for electronic OR a mail out system through our clearinghouse to show proof of service. Many adjustors do NOT let you fax to them directly.

However, I will admit, this new "electronic" claims - whether to the carrier or to the clearinghouse to be mailed has caused a GIANT hiatus in our getting paid - all due to notes not being received! I will check into my state's mandates to see what further we can do.

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