THIRD PARTY BILLING CDP USER MEETING FEBRUARY 5, 2013 1.
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THIRD PARTY BILLING CDP USER MEETING FEBRUARY 5, 2013 1
Transcript of THIRD PARTY BILLING CDP USER MEETING FEBRUARY 5, 2013 1.
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THIRD PARTY BILLINGCDP USER MEETINGFEBRUARY 5, 2013
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THIRD PARTY BILLING CONTACT502-564-6663, OPTION 1
• SHARON TRIVETTE• BARREN RIVER -303• BUFFALO TRACE – 321• LAKE CUMBERLAND – 309• LITTLE SANDY – 311• NORTH CENTRAL - 305• THREE RIVERS - 317• WEDCO - 315• Allen - 002 • Bell - 007• Bourbon - 009 • Bracken - 012 • Breckinridge - 014 • Calloway - 018• Clark - 025 • Fayette - 034 • Floyd - 036 • Garrard - 040 • Greenup - 045 • Jefferson - 056 • Johnson - 058 • Laurel – 063 • Lewis - 068 • Madison - 076 • Marshall - 079 • Mercer - 084 • Montgomery - 087 • Oldham - 093 • Powell - 099 • Whitley - 118
• NELLIE RAMSEY• CUMBERLAND VALLEY - 313 • GATEWAY - 316• GREEN RIVER - 314• KENTUCKY RIVER - 312 • LINCOLN TRAIL - 302 • NORTHERN KENTUCKY - 310• PENNYRILE - 318• PURCHASE - 304• Anderson – 003 • Boyd - 010 • Boyle - 011 • Breathitt - 013 • Bullitt - 015 • Christian - 024 • Estill - 033 • Fleming - 035 • Franklin - 037 • Graves - 042 • Hopkins - 054 • Jessamine - 057 • Knox - 061 • Lawrence - 064 • Lincoln - 069 • Magoffin - 077 • Martin - 080 • Monroe - 086 • Muhlenberg - 089 • Pike - 098 • Todd - 110 • Woodford - 120
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MEDICARE
• REMINDER: You must use the new “Q” codes instead of the 90658 for (injectable with preservative) flu shots. Billing files are being rejected at Medicare because of this coding error. Please make sure your providers are aware of this requirement.
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MEDICARE
• New Preventive Services are now covered.– Many are co-pay waived (like flu)– Must have qualified provider
• You must consult the updated Medicare Preventive Services Guide on CMS website to obtain correct coding and billing procedures.– KNOW THE RULES!– http://www.cms.gov/MLNProducts/35_PreventiveS
ervices.asp
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Place of Service 71
• For Medicare we have changed the default place of service to 71 Public Health.
• If you have denials for January due to place of service 71, please resubmit these to Medicare. They have fixed the edit on the G0101 to accept POS 71.
• We are testing the 71 with other payers as well.
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MEDICARE BILLING REQUIREMENTS IN BRIDGE
• All qualified providers performing services billed to Medicare must have Medicare PTAN provider numbers registered in Bridge. (PSI7 screen)
• A qualified provider is defined as Physician, APRN or Registered Dietician as it relates to Local Health Departments.
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PSI7 30 (YOUR HID/LOC)
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PSIE 30 HID EMPLOYEE # EX: PSIE 30 500 A1111
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MANAGED CARE
• BILLING REPORTSa) New numbering scheme based on which MCO is
being billed. Passport-3, Coventry-6, Ky Spirit-7, Well Care-8, Humana/Care Source-9.
b) Example: Invoice Register would be numbered 3083-Passport, 3086-Coventry, 3087-Ky Spirit, 3088-Well Care, 3089-Humana/CS.
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MANAGED CARE
• When entering managed care information on the registration screen, make sure the name and address on the card matches what is in the system. The MCOs validate billing against the member number, member name, DOB and address. So, they need to match.
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Insurance Billing Updates
• Pilot of the “Twice-a-Month” billing option.• All claims rebilled using CPOD function will bill off
the 2nd and 4th weeks automatically. No longer have to wait the whole month. This live now for entire state.
• Pilot of ICD-9 position indicator for insurance billing on PEF entry. This allows the user to dictate the appropriate ICD-9 code to use in primary position on claim.
• Pilot of CPT modifiers required for certain payers.
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M5990658
PILOT OF THE MODIFIER OVERRIDE-PRECEDE EACH TWO DIGIT MODIFIER WITH THE LETTER “M”. The example shown is for billing the 59 modifier to Passport for private stock vaccine during the VFC shortage. Per Passport Memo dated February 4, 2013.
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Medicaid Resubmission Code
• Field #22 on CMS1500 (HCFA)• When resubmitting a claim, enter the
appropriate bill frequency code in this field.– #7 Replacement of prior claim– #8 Void/cancel of prior claim
• This has been added to the CPOD for paper claims only at this time. (next slide) Electronic claims are under development.
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7= Replacement of prior claim8= Void/cancel of prior claim
ICN OF CLAIM ADJUSTING
7
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CDP BILLING REJECTION REPORTS• Three levels of rejection reports being developed by
CDP to detect unbillable or rejected claims.• Claims that cannot be billed by CDP due to LHD
error. IE: special characters in address field• Claims that rejected at the clearinghouse level.– Claim never makes it to the payer. Claim information
returned to CDP. • Claims that reject at the payer level.– Payer will not accept claim for payment or denial-
returned to CDP.
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QUESTIONS?
• LHO Webpage & Help Desk Email:http://chfs.ky.gov/dph/info/lhd/lhob.htm
Local Health Operations Branch502-564-6663, Option 1
