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We are using a clearinghouse via the internet to file all of our electronic claims. We create a file after sending them through claims managerand then upload the file to their system. That has been going prefectly smooth with no problems. NOW THE ISSUE...

Medicare REQUIRES secondary claims to be billed electronically as well. I have created a seperate Medicare secondary payer, all is set up correctly. But when I go to file and select our EDI receiver, it keeps \"No transcations found, no file was created.\" I have lost sleep over this know it is something so incredibly simple, but I cannot figure out what the problem is. PLEASE HELP MEEE!

MANDY
GRIFFIN, GA

Hi Mandy, there are several ways to resolve this issue. First, you need to contact your clearinghouse to find out how they handle secondary claims. Many cannot even do secondary claims by using the CMS to file mapping that you are using with your clearinghouse. Here are a few ways to handle this using Medisoft:

1. Buy a direct module for Medicare. The direct module will handle secondary claims. You should also consider coupling this with ERA Autopay which will automatically plug in all your coordination of benefits information (COB) when the primary payor has an electronic remmittance that you auto post.

2. Switch to MedAdvant clearinghouse which uses the Phoenix module. The Phoenix module works like the direct modules above except with virtually any payer. If you also sign up for ERA Autopay, then COB is automatically generated for the secondary claim.

3. Switch to Availity clearinghouse using the AVAP module. Same idea as #2 above.

4. Switch to GatewayEDI clearinghouse. You most sign up for their Swift package which includes electronic remmitance. We have a special claim report that we wrote specifically for GatewayEDI that includes secondary payer information so GatewayEDI can create a secondary claim. When the primary payer pays with an electronic remmitance, then GatewayEDI automatically attaches that information to send a secondary claim. This is the method we use and it works very well for us.

Our clearinghouse does handle secondary claims. we are very happy with them so far. All of our claims go to them using CMS files and have not had a problem, until we try to bill Medicare secondary.

We did have a direct module we purchased through Medisoft and they had issues with billing Medicare secondary as well. I spoke with Victor there in Tech Support, he had me fax over to him the stream information from where we tried to file some so he could look through it to see if there was an error. After being given a reference number, I had to call back many times to check status. It has been since early February, and I have not heard one word back from them about this. Needless to say, this issue has me extremely frustrated.

You will have to get instructions from your clearinghouse on how to send secondary claims to them. What probably needs to happen is you need to switch the media type to paper on your secondary claims and submit your claims using the Export to File option on one of your secondary claim reports.