Free Medisoft Tech Help- Medisoft V26, Medisoft Clinical EHR & More- Courtesy Support Resource

I have to send a legacy Medicaid provider number in both the bill-to and provider loops. I have it set with a 1D qualifier (Medicaid ID) but it is coming through with a G2 qualifier for commercial provider number.

NM1*PR*2*MEDICAID*****PI*86916
N3*P.O. BOX 200555
N4*AUSTIN*TX*78720
REF*G2*331063301
CLM*678*175***11:B:1*Y*A*Y*Y
HI*ABK:Z630
NM1*82*1*DARBY*DONNA****XX*1063942449
REF*G2*377047101

Please advise.

Thanks,
Steve

Do you have more than one provider id in the grid that matches?

No...in the grid I have a payer specific listing for Medicaid. The Medicaid legacy number is appearing both in the billing loop (331063301) and provider loop (377047101) but it is showing with a G2 qualifier rather than a 1D qualifier which should be used since I selected Medicaid provider number (1D) rather than Commercial which is G2.

Steve

Is the insurance type Medicaid?

Yes, I do have the type as Medicaid. Could the IGuide be wrong?

Steve

Hey Steve, you are right. The iGuide is hard coded to do a G2 qualifier for anything other than a predetermined list of qualifiers. Is this Texas Medicaid? Not sure why it isn't programmed to just send the qualifier that is selected.

Rendering provider (2310B):

Select Case rovider_ProviderID_LegacyQualifier1.toupper
Case "0B"
Result = rovider_ProviderID_LegacyQualifier1
Case "1G"
Result = rovider_ProviderID_LegacyQualifier1
Case "LU"
Result = rovider_ProviderID_LegacyQualifier1
Case Else
Result = "G2"
End Select

Payer (2010BB):
If rovider_ProviderID_ProviderClaimType = 2 Then
Select Case :Group_GroupID_LegacyQualifier1
Case = "LU"
Result = "LU"
Case Else
Result = "G2"
End Select
Else
If not string.isnullorempty( rovider_ProviderID_LegacyQualifier1 ) Then
Select Case rovider_ProviderID_LegacyQualifier1
Case "LU"
Result = "LU"
Case Else
Result = "G2"
End Select
End If
End IF

OK Steve, Medicaid should not be requiring that you send the legacy ID on the claim.

You can:
1. Setup the receiver to Suppress Sending Legacy IDs.
2. Delete the Medicaid Legacy ID for the provider out of Medisoft.

That should fix your claim.

No, Texas Medicaid does require a TPI on claims (both billing loop and individual loop). I could not really get an answer from them about the qualifier but I'm sure the claims rejected because, even though the TPI is on the claims, the qualifier is G2.

OK...ignore everything (basically). Found out finally with someone with a brain in the EDI Department of TX Medicaid that the legacy number (the TPI) is only required on paper claims. I was originally told NOT to send taxonomy codes, but the person in the EDI Department told me for electronic claims the billing and rendering provider taxonomy codes must go on the claims, not the TPI.

So the issue still exists with the guide being incorrect, but.....

Thanks,
Steve

You can simply reduce the logic down to
Result = rovider_ProviderID_LegacyQualifier1.ToUpper

The paper claim form would be configured to something similar.

OK...If I ever need it done, I'll let you guys do it so I don't screw anything up (lol).

Thanks,
Steve