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KyHealth Choices UB04 Medicaid Crossover Workshop.

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Presentation on theme: "KyHealth Choices UB04 Medicaid Crossover Workshop."— Presentation transcript:

1 KyHealth Choices UB04 Medicaid Crossover Workshop

2 Cabinet for Health and Family Services 2 Agenda Representative List Reference List 837 Requirements Medicare EOB examples Helpful Hints How to Bill Medicare Primary Claims to KyHealth Choices Evaluation

3 Cabinet for Health and Family Services 3 Representative List

4 Cabinet for Health and Family Services 4 Representative List

5 Cabinet for Health and Family Services 5 Reference List Helpful Phone Numbers EDI Helpdesk Provider Billing Inquiry Web Addresses EDS Website KyHealthnet KyHealth Choices

6 Cabinet for Health and Family Services 6 Billing Crossovers to KyHealth Choices Beginning September 29, 2008, KyHealth Choices will require their providers to prepare their own Medicare/Medicaid related claims. If you bill these by paper, your claim form must include the Medicare information necessary for processing. You will no longer send Medicare EOBs with your claim unless Medicare denies the service. You may bill Crossover claims by electronic means.

7 Cabinet for Health and Family Services 7 837I Claims Submission The 837I Companion Guide Version 3.0 will be available on the EDS website Contact your Software Vendor to check the capability and readiness for these changes.

8 Cabinet for Health and Family Services Requirements Loop 2320 CAS02 - Adjustment reason code '1' deductible or '2' Co-insurance Loop 2320 AMT02 - Payor Paid Amount = Medicare paid amount Loop 2320 AMT01 Amount Qualifier Code = 'B6' Payor Allowed amount Loop 2320 AMT02 - Payor Paid Amount = Medicare Allowed amount Loop 2330B DTP01 Date/Time Qualifier = '573' Medicare EOB pay date For questions please contact EDI at

9 Cabinet for Health and Family Services 9 Required Information Medicare EOB Date Form Locator 37 (new change) Medicare Paid Amount Form Locator 54 (new change) Medicare Allowed Amount Form Locator 55 (new change) Medicare Coinsurance Amount Form Locator 39 Medicare Deductible Amount Form Locator 39

10 Cabinet for Health and Family Services 10 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 with the Medicare EOB attached.

11 Cabinet for Health and Family Services 11 UB 04 Top Half

12 Cabinet for Health and Family Services 12 UB 04 Bottom Half

13 Cabinet for Health and Family Services 13 Medicare EOB

14 Cabinet for Health and Family Services 14 UB04 Top Half (Blank)

15 Cabinet for Health and Family Services 15 UB04 Bottom Half (Blank)

16 Cabinet for Health and Family Services 16 Medicare EOB

17 Cabinet for Health and Family Services 17 UB04 Top Half (Blank)

18 Cabinet for Health and Family Services 18 UB04 Bottom Half (Blank)

19 Cabinet for Health and Family Services 19 Medicare EOB

20 Cabinet for Health and Family Services 20 UB04 Header with Medicare #1

21 Cabinet for Health and Family Services 21 UB04 Header with Medicare #2

22 Cabinet for Health and Family Services 22 UB04 Deductible for Medicare

23 Cabinet for Health and Family Services 23 Co-Insurance for Medicare

24 Cabinet for Health and Family Services 24 Summary with Medicare (Top)

25 Cabinet for Health and Family Services 25 Summary with Medicare (Bottom)

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