Relay Health Medicare Secondary

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PPS3510
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Joined: Fri Sep 23, 2016 10:01 am

Relay Health Medicare Secondary

Post by PPS3510 » Wed Feb 22, 2017 10:54 am

I need HELP!!! I have a continuous problem with filing Medicare as a secondary (Aetna-primary; Medicare-secondary). I can file it and send it but Medicare claims they NEVER receive the claim and/or never get the primary insurance processing information. I have contacted Sunrize (who we use for MediSoft support) and feel like I'm getting no where. I know I can not submit paper claims to Medicare with the primary EOB...so does anyone have any guidance on this topic?

TIA

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Gavin Walker
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Re: Relay Health Medicare Secondary

Post by Gavin Walker » Wed Feb 22, 2017 12:19 pm

Are you using Revenue Management to submit you claims in ANSI 5010 format?
Gavin Walker
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PPS3510
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Joined: Fri Sep 23, 2016 10:01 am

Re: Relay Health Medicare Secondary

Post by PPS3510 » Wed Feb 22, 2017 12:58 pm

yes we are

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Gavin Walker
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Re: Relay Health Medicare Secondary

Post by Gavin Walker » Wed Feb 22, 2017 2:44 pm

On the Process Claims window in Revenue Management go to Select -> Pri. & Sec. -> Ready to Send to select both primary and secondary claims to submit on your next batch.

PPS3510
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Re: Relay Health Medicare Secondary

Post by PPS3510 » Tue Jan 22, 2019 11:36 am

I am having the same issue. Medicare continues to not get the information for processing from primary EOB. Is there a place I need to add a claim number or something? We cant issue a paper claim w/primary EOB and unable to attach eobs via RM.

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Gavin Walker
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Re: Relay Health Medicare Secondary

Post by Gavin Walker » Wed Jan 23, 2019 4:12 pm

On the Case -> Medicaid and Tricare tab there is an Original Reference field. Enter the clam number there. In some cases they also need a Re submission Number. Enter that in the field just below.

mbpros
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Re: Relay Health Medicare Secondary

Post by mbpros » Tue Mar 19, 2019 1:10 am

First, are you posting your primary claim payments via ERAs? If not, you must (if the payer offers it). If you post ERAs from the primary payer and then send to the secondary, 99.5% of the time the claims will process correctly by Medicare. Secondly, make sure on the Policy 2 tab under Medicare Secondary Reason code you have the correct Medicare reason selected for the patient. If you have the incorrect reason selected, Medicare will deny the claims even if all of the EOB info is accurate. If you are unsure about the Secondary Reason code for a patient, you can call Medicare.
Steven Zats
Medical Billing Professionals

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