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THIRD PARTY BILLING CDP USER MEETING FEBRUARY 5, 2013 1.

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Presentation on theme: "THIRD PARTY BILLING CDP USER MEETING FEBRUARY 5, 2013 1."— Presentation transcript:

1 THIRD PARTY BILLING CDP USER MEETING FEBRUARY 5,

2 THIRD PARTY BILLING CONTACT , OPTION 1 SHARON TRIVETTE BARREN RIVER -303 BUFFALO TRACE – 321 LAKE CUMBERLAND – 309 LITTLE SANDY – 311 NORTH CENTRAL THREE RIVERS WEDCO Allen Bell Bourbon Bracken Breckinridge Calloway Clark Fayette Floyd Garrard Greenup Jefferson Johnson Laurel – 063 Lewis Madison Marshall Mercer Montgomery Oldham Powell Whitley NELLIE RAMSEY CUMBERLAND VALLEY GATEWAY GREEN RIVER KENTUCKY RIVER LINCOLN TRAIL NORTHERN KENTUCKY PENNYRILE PURCHASE Anderson – 003 Boyd Boyle Breathitt Bullitt Christian Estill Fleming Franklin Graves Hopkins Jessamine Knox Lawrence Lincoln Magoffin Martin Monroe Muhlenberg Pike Todd Woodford

3 MEDICARE REMINDER: You must use the new “Q” codes instead of the 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. 3

4 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.Medicare Preventive Services Guide – KNOW THE RULES! – Services.asp Services.asp 4

5 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. 5

6 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. 6

7 PSI7 30 (YOUR HID/LOC) 7

8 PSIE 30 HID EMPLOYEE # EX: PSIE A1111 8

9 MANAGED CARE BILLING REPORTS a)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. 9

10 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. 10

11 Insurance Billing Updates Pilot of the “Twice-a-Month” billing option. All claims rebilled using CPOD function will bill off the 2 nd and 4 th 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. 11

12 M 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,

13 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. 13

14 7= Replacement of prior claim 8= Void/cancel of prior claim ICN OF CLAIM ADJUSTING 7 14

15 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. 15

16 QUESTIONS? LHO Webpage & Help Desk Local Health Operations Branch , Option 1 16


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