Online Claim Entry UB-04
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Online Claim Entry UB-04 Presented by: Xerox State Healthcare, LLC Provider Relations
description
Online Claim Entry UB-04 . Presented by: Xerox State Healthcare, LLC Provider Relations. Resources . When online use: Ask Service Representative [email protected] [email protected] Call Center 505-246-0710 or 800-299-7304 New Mexico Web Portal - PowerPoint PPT Presentation
Transcript of Online Claim Entry UB-04
Online Claim EntryUB-04
Presented by:Xerox State Healthcare, LLCProvider Relations
When online use: Ask Service Representative
Call Center 505-246-0710 or 800-299-7304
New Mexico Web Portal • Provider Information section • Links and FAQ section • Provider Login section
Resources
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Purpose of the WorkshopProvide complete explanation of how to fill out the UB-04 paper claim form for:
• Claim Form Instructions• Timely Filing• NCCI – National Corrective Coding Initiative• New Hospital Outpatient Payment Method• Add/Manage Templates• Medicaid Primary Claims• Medicaid secondary to a Third Party Liability (TPL)• HMO co-payments• Medicare Replacement Plans• Medicare Primary Claims
Important State Websites
STATE WEBSITES:
PROGRAM POLICY MANUAL• http://www.hsd.state.nm.us/mad/policymanual.html
BILLING INSTRUCTIONS• http://www.hsd.state.nm.us/mad/billinginstructions.html
REGISTERS AND SUPPLEMENTS:• http://www.hsd.state.nm.us/mad/registers/2012.html
Important Update
On October 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets.
The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). Please note, the change to ICD-10 does not affect CPT coding for outpatient procedures and physician services.
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Claim Form Instructions
Where to get a copy of claim form instructions
Click Forms , Publications, and Instructions under Provider Information
Where to get a copy of claim form instructions
Open file
Scroll down
Timely Filing
The first digit indicates what the claim “media” is:
2 = electronic crossover
3 = other electronic claim
4 = system generated claim or adjustment
8 = paper claim
9 = Web portal claim entry
The last two digits of the year the claim was received
The numeric day of the year.
This is the Julian Date - this represents the date the claim was received by Xerox: this claim was received the 87th day of 2013, or March 28, 2013
Batch number
The claim number within the batch.
91308700085000001
What is a Transaction Control Number (TCN)?
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The twelfth digit in an adjustment/ void TCN will either be:
1= Debit2= Credit
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MEDICAID 1234567891 1 082807
CONNIE CLIENT
8,100 000001
Timely Filing Denials
Re-filing Claims and Submitting AdjustmentsUB-04 form: Put the TCN in block 64 on the paper form.
NCCI National Corrective Coding
Initiative
NCCI (National Corrective Coding Initiative) Is a CMS program that consists of coding policies and edits. Medicaid NCCI Edits consist of two types:
(1) NCCI procedure-to-procedure edits that define pairs of Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes that should not be reported together for a variety of reasons; and
(2) Medically Unlikely Edits (MUE), units-of-service edits, that define for each HCPCS/CPT code the number of units of service beyond which the reported number of units of service is unlikely to be correct (e.g., claims for excision of more than one gallbladder or more than one pancreas).
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NCCI (National Corrective Coding Initiative)
RA EOB Codes:6501 or 6502 - Per the National Correct Coding Initiative, payment is denied because the service is not payable with another service on the same date of service. 6503 through 6505 - Per the National Correct Coding Initiative, payment is denied because provider billed units of service exceeding limit. Please visit the link below for any additional information:http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/National-Correct-Coding-Initiative.html
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New Hospital Outpatient Payment Method
New Hospital Outpatient Payment Method for New Mexico Medicaid
• All General Acute Hospitals and Rehabilitation Hospitals must include a procedure code on every line item to receive payment.
• It is recommended that you bill all outpatient services for the same date of service on the same claim form all inclusive.
New Hospital Outpatient Payment Method for New Mexico Medicaid
The following resources are available on the HSD/MAD website located at:
http://www.hsd.state.nm.us/mad/PFeeSchedules.html• Hospital Outpatient Payment Method FAQ• Hospital Outpatient Payment Method Revenue Codes• Hospital Outpatient Payment Method Procedure Codes• Notice of Hospital Outpatient Prospective payment System
Rates• Explanation of Simulation Spreadsheet for Outpatient services
Add/Manage Templates
UB-04 - Add Claim Template
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Please note template are limited to 25 per user. HINT: think about use procedure code, or dates (billing range dates)
The best time to directly enter your claim is Sunday through Friday between the hours of 6 a.m. - 6 p.m. (MST). Claims entered by Friday 6 pm could be adjudicated and reflect as early as Monday on your Remittance Advice.
UB-04 - Add Claim Template
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Fill out any information you would like included in your template
UB-04 - Add Claim Template
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Fill out any information you would like included in your template
UB-04 - Add Claim Template
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Fill out any information you would like included in your template
UB-04 - Add Claim Template
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Fill out any information you would like included in your template.
Sections can be expanded by checking all sections with Red Text.View next slide for additional fields.
UB-04 - Add Claim Template
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Fill out any information you would like included in your template.
Sections can be expanded by checking all sections with Red Text.
UB-04 - Add Claim Template
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Fill out any information you would like included in your template.
Sections can be expanded by checking all sections with Red Text.
UB-04 - Add Claim Template
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Fill out any information you would like included in your template.
Sections can be expanded by checking all sections with Red Text.
UB-04 - Add Claim Template
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Fill out any information you would like included in your template.
Sections can be expanded by checking all sections with Red Text.
UB-04 - Manage Claim Template
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Edit or Delete created
templates
Medicaid Primary Claim Forms
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Online Claims Entry
To begin the claim submission, all field with a RED asterisk (*) must be completed
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Online Claims Entry Primary Claim (Cont.)Click on the Red Text for the UB-04
Claim form instructions
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Additional Information Option
Sections can be expanded by selecting all sections with Red Text
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Online Claims Entry Primary Claim (Cont.)
Sections can be expanded by selecting all sections with Red Text
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Online Claims Entry Primary Claim (Cont.)
Sections can be expanded by selecting all sections with Red Text
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Online Claims Entry Primary Claim (Cont.)
Click upload
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Review the Uploading Attachments Restrictions.
You can attach files up to 10 MB
Online Claims Entry Primary Claim (Cont.)
Do not upload ZIP Files, Excel Spreadsheets or Password Protected Files.
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Online Claims Entry Primary Claim (Cont.)
All field with a Red Asterisk (*) are REQUIRED fields
Diagnosis codes do not require a period(.)Only enter the numeric value
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Online Claims Entry Primary Claim (Cont.)
Indicate the Total charge
x
Verify Total charge is correct If total change is missing or does not match up with the line item provided on the claim, the claim will deny or post additional edits.
Medicaid Third Party Liability (TPL) Claim
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Third Party Liability (TPL) Tips
• TPL is commercial insurance• TPL must be billed primary to Medicaid• Medicaid does not consider Medicare TPL
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Third Party Liability (TPL) Tips• Always enter the amount paid in the “Paid Amount” field
provided in the “Other Insurance Info” section of claim.
• If Medicaid requires a PA for the service, then a PA issued by Medicaid Utilization Review is always required when TPL is involved, no matter if TPL paid or denied the service.
• Attach the TPL EOB showing the payment/denial with the claim.
• Always include the explanation page of the EOB along with the page of the EOB that shows payment/denial.
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Medicaid TPL Claim Example
Indicate Paid Amount
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Medicaid TPL Claim Example
TPL PaymentCo-pay/Co-insurance/
Deductiblex
Verify Total charge is correct If total change is missing or does not match up with the line item provided on the claim, the claim will deny or post additional edits.
Indicate the Total charge
Medicaid Co-payment Claim Forms
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PPO/HMO Co-Pay Tips
• Indicate PPO/HMO under “Other Insurance Info” section of the claim.
• Indicate Co-pay amount in the Co-pay field provided in the “Other Insurance Info” section of claim.
• Attach the EOB.
• In the “Prior Payment Amount” enter the difference between the billed amount and the co-payment\Amount Due.
• Enter the co-payment amount in the “Amount Due” field.
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HMO Co-pay Claim Example
Indicate Copay amount
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HMO Co-pay Claim Example
Difference Co-pay/Co-insurance/
Deductiblex
Indicate the Total charge
Verify Total charge is correct If total change is missing or does not match up with the line item provided on the claim, the claim will deny or post additional edits.
Medicare Replacement Plan Claim Forms
Medicare Replacement Plan
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Indicate “Medicare Advantage” for Medicare Replacement Plan
Medicare Replacement Plan
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Attach Copy of
EOB
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Difference between total charge and the co-payment amount
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Medicare Replacement Plan
Co-Payment Amount
Total Charge
Medicare Primary Claim Forms
Medicare Primary Claims
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Indicate “Medicare” for Medicare Crossover submissions
Medicare Primary Claims
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Attach Copy of
EOB
Medicare Primary Claims
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X
Only Indicate Total charge on Medicare CrossoversLeave the Prior Payment Amount and Amount Due Blank
Inpatient claims for Medicare Part B-only
clients
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• Certain Medicaid/Medicare clients only have Medicare Part B coverage.
• Medicare may cross over the Part B claim with type of bill 121. This claim does not have an accommodation revenue code on it.
• The claim will deny and the provider will need to resubmit and include the following four things on the claim:
Inpatient Claims for Medicare Part B-only clients
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• Use type of bill “121”.
• Attach a copy of the EOMB indicate Medicare paid amount in previous payment box (form locator 54).
Inpatient claims for Medicare Part B-only clients
Inpatient Claims for Medicare Part B-only clients
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Indicate “Medicare” for Inpatient Claims for Medicare Part B-Only Recipients
Inpatient Claims for Medicare Part B-only clients
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Attach Copy of
EOB
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TPL Payment Amount
X
Inpatient Claims for Medicare Part B-only clients
Difference between Total Charge and Prior Payment Amount
Total Charge
UB-04 Tips
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UB-04 Tips
Ensure the line item charges are correct and match the total charge.
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UB-04 Tips
• Include all appropriate EOB’s for TPL, HMO, etc.
• If you are a for profit organization, make sure gross receipts tax is included in the line items, if required.
• Rev codes, diagnosis codes, etc., are entered correctly.
When online use: Ask Service Representative
Call Center 505-246-0710 or 800-299-7304
New Mexico Web Portal • Provider Information section • Links and FAQ section • Provider Login section
Resources
