KyHealth Choices CMS 1500Medicare Crossover Workshop
Agenda • Representative List • Reference List • 837 Requirements • Medicare EOB examples • How to Code your Medicare Primary Claims • Helpful Hints • How to Bill Medicare Primary Claims to KyHealth Choices • Evaluation
Helpful Phone Numbers EDI Helpdesk 800-205-4696 email@example.com Provider Billing Inquiry800-807-1232 firstname.lastname@example.org Web Addresses EDS Website www.kymmis.com KyHealthnet http://home.kymmis.com KyHealth Choices www.chfs.ky.gov/dms Reference List
Billing Crossovers to KyHealth Choices • Beginning September 29, 2008, KyHealth Choices will require providers to prepare their own Medicare/Medicaid related claims. • If you bill these by paper, a coding sheet will be required with your claim form. Use black ink only. • You will no longer send Medicare EOB’s with your claims unless Medicare denied a service. • You may bill Medicare Primary claims by electronic means.
837P Claims Submission • The 837P Companion Guide Version 3.0 will be available on the EDS website www.kymmis.com • Contact your Software Vendor to check the capability and readiness for these changes.
837 Requirements • Loop 2320 AMT02 - Payor Paid amount = Medicare paid amount • Loop 2320 AMT02 - Payor Paid Amount = Medicare Allowed amount • Loop 2330B DTP01 - Date Claim Paid = Medicare EOB date qualifier • Loop 2330B DTP03 - DTP03 - Date Time Period (CCYYMMDD) • Loop 2430 CAS01 - Claim Adjustment 'PR' Patient Responsibility • Loop 2430 CAS02 - Claim Adjustment Reason Code '1' Deductible or '2' Co-insurance • Loop 2430 CAS03 - Monetary Amount • Loop 2430 CAS04 - Quantity Adjusted units For questions please contact EDI at 1-800-205-4696
Required Information • Medicare EOB Date • Medicare Paid Amount • Medicare Allowed Amount • Medicare Coinsurance Amount • Medicare Deductible Amount
Helpful Hints • First arrow shows Medicare paid the allowed amount in full. You will not bill this line to Medicaid as no coinsurance or deductible is due. • Second arrow shows Medicare paid zero but left deductible due. In the Medicare paid amount field, enter zero as the amount paid.
Helpful Hints • A submission on paper or by electronic means must not be sent until you are sure the Medicare electronic Crossover was unsuccessful or denied by KyHealth Choices to avoid duplicate billing. • If Medicare denied your charges, the claim must still be submitted to KyHealth Choices by paper claim with the Medicare EOB attached.