TPL status codes

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Robin
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TPL status codes

Post by Robin » Thu Mar 13, 2014 2:27 pm

I bill Illinois Medicaid as a secondary payer, and when I used Availity as my clearinghouse I didn't have any problems and didn't need to do anything to my claims. I am now using Office Ally and my claims are getting denied as "invalid TPL status code." I called Medicaid and they told me what codes need to be sent and I should talk to my clearinghouse. I asked them and they said that there is nothing they can do on their end, that this is something that I need to add to my claims. Does anyone know where I would put the status codes in Medisoft V17? And will it be the same for V19?
Thanks!

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Gavin Walker
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Re: TPL status codes

Post by Gavin Walker » Thu Mar 13, 2014 10:11 pm

What loop, segment, and field is this? Are you submitting claims with Revenue Management?
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Robin
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Re: TPL status codes

Post by Robin » Fri Mar 14, 2014 9:34 am

I was told it needs to be in loop 2330b segment REF*2U

Robin
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Re: TPL status codes

Post by Robin » Fri Mar 14, 2014 9:34 am

And yes, I use Revenue Management

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Gavin Walker
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Re: TPL status codes

Post by Gavin Walker » Fri Mar 14, 2014 9:54 am

Did you switch over to an ANSI 5010 IGuide? It looks like that field is the Authorization field from the Case account tab and is sent with a qualifier of 9F. Does that sound right?

Robin
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Re: TPL status codes

Post by Robin » Fri Mar 14, 2014 10:12 am

Yes, I switched to 5010 a long time ago. When I talked with someone at HFS they faxed me something showing me what should be different. This is the fields they said were wrong.
NM1*PR*UNITED HEALTHCARE*****PI*87726
SVD*87726*94.5*HC:97001**1

According to her the "87726" should be 18901. The 87726 is the code for United Healthcare (which is the primary insurance carrier) and the 18901 are the TPL status codes. This doesn't make sense to me tho because I thought this field was for the primary insurance information.

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Gavin Walker
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Re: TPL status codes

Post by Gavin Walker » Fri Mar 14, 2014 3:25 pm

That typically comes from the insurance carrier EDI Payor Number field. There is a place for both a primary and secondary number in case the number changes when the insurance is secondary. Fill out both fields with the correct number for that insurance carrier.

Burhan
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Re: TPL status codes

Post by Burhan » Mon Apr 23, 2018 1:16 pm

Loop 2430 Segment SVD: Line Adjudication Info

Procedure Identifier
If Insurance Carrier, EDI/Eligibility, Extra 1/Medigap is not blank, then use Insurance Carrier, EDI Extra 1/Medigap

Otherwise, send Insurance Carrier, Claims Payer Number.

Claims Manager: If EDI Extra 1/Medigap is blank, send Insurance Carrier, Associated Payer, Claims Payer ID.


This is not working. Do you have any idea why?
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Gavin Walker
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Re: TPL status codes

Post by Gavin Walker » Mon Apr 23, 2018 7:45 pm

What exactly isn't working? Are you doing eligibility or claims?

Burhan
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Re: TPL status codes

Post by Burhan » Wed Sep 12, 2018 5:02 pm

SUBMITTING SECONDARY CLAIMS.

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Gavin Walker
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Re: TPL status codes

Post by Gavin Walker » Fri Sep 14, 2018 11:36 am

What error you are getting back from the clearinghouse?

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