KyHealth Choices CMS 1500 Medicare Crossover Workshop.
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Transcript of KyHealth Choices CMS 1500 Medicare Crossover Workshop.
KyHealth Choices
CMS 1500 Medicare Crossover Workshop
Cabinet for Health and Family Services2
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
Cabinet for Health and Family Services3
Representative List
Cabinet for Health and Family Services4
Representative List
Cabinet for Health and Family Services5
Reference List
Helpful Phone Numbers
EDI Helpdesk [email protected]
Provider Billing Inquiry800-807-1232
Web Addresses
EDS Website www.kymmis.com
KyHealthnethttp://home.kymmis.com
KyHealth Choiceswww.chfs.ky.gov/dms
Cabinet for Health and Family Services6
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.
Cabinet for Health and Family Services7
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.
Cabinet for Health and Family Services8
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
Cabinet for Health and Family Services9
Medicare EOB
Cabinet for Health and Family Services10
Required Information
• Medicare EOB Date
• Medicare Paid Amount
• Medicare Allowed Amount
• Medicare Coinsurance Amount
• Medicare Deductible Amount
Cabinet for Health and Family Services11
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.
Cabinet for Health and Family Services12
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.
Cabinet for Health and Family Services13
Medicare EOB
Cabinet for Health and Family Services14
Coding Sheet
Cabinet for Health and Family Services15
CMS 1500 KyHealthnet Header
Cabinet for Health and Family Services16
CMS 1500 KyHealthnet Detail
Cabinet for Health and Family Services17
Medicare EOB
Cabinet for Health and Family Services18
Coding Sheet
Cabinet for Health and Family Services19
Coding Sheet
Cabinet for Health and Family Services20
Coding Sheet
Cabinet for Health and Family Services21
Medicare EOB
Cabinet for Health and Family Services22
Coding Sheet