Shut off automatic secondary status update

[hrw911]

When posting ERAs in RM, is there way to prevent it from automatically updating the secondary status of the claim to "Sent" when the claim is crossed over by Medicare to another carrier? I have many patients who have Medicaid replacement plans as secondary to Medicare. Medicare ERAs show that the claim crosses over to regular FFS Medicaid, but I actually have to bill the secondary Medicaid replacement plan myself. When I post ERAs for these patients, I have to manually go in and change the secondary status for each affected claim back to "Ready to Send", which is creating extra work. I'm using Advanced version 19 sp1.

[Gavin Walker]

You need to un-check Crossover Claim on the Policy 2 tab of the Case and then click Update All in Transaction Entry if you have already entered the transactions.

[hrw911]

Yes. I have already done that, but then when RM auto posts the primary payment, RM is changing the secondary status to sent as part of the primary posting process.

[Gavin Walker]

Make sure you clicked Update All and un-check Complementary Crossover on the insurance.

[hrw911]

I had already done that before posting the ERAs. Not only does RM update the secondary claim status to "Sent", it also updates the secondary sent date to the date that I post the ERA.

[hrw911]

Any word on if there's a way to change this? Right now, I am having to manually go back to every claim that didn't "actually" crossover, and change the secondary sent status to "Ready to Send"?

[Gavin Walker]

If it doesn't automatically cross over every time, then I would un-check all the crossover options and just send the secondary claim every time just to make sure the secondary insurance gets it. The worst that will happen is you get a few duplicate claims.

[hrw911]

Maybe I'm not expressing the issue well.When posting payments, RM is only looking at the ERA info (and ignoring all other settings and indicators that set up in Medisoft) when deciding whether or not the claim has crossed over. When a patient has regular Medicare primary and a Medicaid replacement plan (like Meridian) as secondary, here's what happens:

When I set up the case, I leave "Crossover Claim" unchecked and make sure that Meridian has "Complementary Crossover" also unchecked. So when I send the claim to the primary payer, the secondary payer status stays as "Ready to Send" which is correct.

Medicare processes the claim and then issues an ERA that says the claim crossed over to regular Medicaid. They do this for Medicare/Medicaid patients even if the patient is enrolled in Meridian Medicaid. When I auto post this remit in RM, it automatically updates the secondary status to sent (this is the problem).

Then I have to manually go through each Medicare/Medicaid claim on the remit to see which ones are actually Meridian secondary claims. I then have to manually change the secondary status back to "Ready to Send" in order to send the secondary claims.

[Gavin Walker]

So you are saying Medicare indicates that the claim crossed over when it really didn't?

[hrw911]

It did crossover to regular Medicaid, but it needs to actually be billed secondary to the Medicaid replacement plan (like Meridian).

[Gavin Walker]

Does Meridian have a MediGap #? I am thinking you need to include that so Medicare knows who to cross the claim over to.

[hrw911]

Including the Medigap # doesn't matter. Medicare will crossover to regular Medicaid no matter what. Those claims have to be manually billed to the correct secondary Medicaid replacement plan.