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© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 1 Claims Submission, Adjustments.

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Presentation on theme: "© Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 1 Claims Submission, Adjustments."— Presentation transcript:

1 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 1 Claims Submission, Adjustments and Voids 2014 HP – Fiscal Agent for the Arkansas Division of Medical Services

2 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 2 Agenda Ways to Submit Claims How to Adjust/Void a Claim Timely Filing How to Check Claim Status

3 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 3 Paper Direct Data Entry (DDE) Provider Electronic Solutions (PES) Vendor Software Ways to Submit Claims

4 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Types of Paper Claims

5 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 5 CMS-1500

6 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 6 UB-04

7 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 7 Dental

8 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 8 Mail Paper Claims to: HP Enterprise Services Attn: Claims PO Box 8034 Little Rock, AR 72203

9 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Medicare/Advantage Plans and Medicaid (Crossover Claim Submission)

10 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 10 QUIZ!!!!!! Name one way to submit a claim.

11 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 11 Crossover Forms Inpatient Crossover – HP-MC-001 Long Term Care Crossover – HP-MC-002 Outpatient Crossover – HP-MC-003 Professional Crossover – HP-MC-004

12 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 12 Crossover Claims If the beneficiary has Medicare and Medicaid, and Medicare pays or applies money toward the deductible/co-insurance, then the claim can be billed as a crossover on PES, DDE, vendor software or the appropriate red and white crossover claim form. HP Enterprise Services Attn: Claims PO Box 8034 Little Rock, AR 72203

13 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 13 Crossover Claims If the beneficiary has Medicare and Medicaid, and Medicare denies the claim, then the claim must be billed on a red and white claim form (CMS-1500 or UB-04) with the Medicare denial attached. Attach a cover letter of explanation. Do NOT mix in with other claims you are sending in for regular processing. HP Enterprise Services Attn: Research Analyst PO Box 8036 Little Rock, AR 72203

14 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 14 Crossover Claims If the beneficiary has Medicare, TPL and Medicaid, and Medicare denies the claim and TPL paid, then the claim must be billed on a red and white claim form (CMS-1500 or UB- 04) with the Medicare and TPL EOB attached. Attach a note stating this is for Medicare override. Do NOT mix in with other claims you are sending in for regular processing. HP Enterprise Services Attn: Research PO Box 8036 Little Rock, AR 72203

15 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 15 Crossover Claims If the beneficiary has Medicare, TPL and Medicaid, and Medicare pays but the TPL denies the claim, then the claim can be billed as a crossover claim through PES software or be billed on the appropriate red and white crossover claim form with the TPL and Medicare EOB attached. HP Enterprise Services Attn: Claims PO Box 8034 Little Rock, AR 72203

16 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 16 Crossover Claims If the beneficiary has Medicare, TPL and Medicaid, and both Medicare and the TPL deny the claim, then the claim must be billed on a red and white claim form (CMS-1500 or UB- 04) with the Medicare and TPL denial EOBs attached. Attach a note stating this is for Medicare override. Do NOT mix in with other claims you are sending in for regular processing. HP Enterprise Services Attn: Research PO Box 8036 Little Rock, AR 72203

17 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Paper Adjustments

18 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 18 A legible signature must be on the adjustment form. This form can be found in Section V of your provider manual. Paper Adjustments

19 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. How to Order Forms from HP/Arkansas Medicaid

20 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 20 Claim Order Form

21 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 21 Claim Order Form Please indicate on the claim order form how many forms you are ordering. Mail request to: HP Enterprise Services Forms Request PO Box 8033 Little Rock, AR Fax:

22 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Return to Provider

23 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 23 Return to Provider Paper claims with errors are returned to provides on three forms according to the type of claim submitted: CMS 1500 UB 04 Crossover The PO Box to return a corrected claim is given at the bottom of each form. On the RTP forms, the reason(s) the claim is being returned will be indicated. Please make needed corrections and resubmit claim.

24 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Direct Data Entry (DDE)

25 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 25 Once you are logged on, your provider name will appear under “Welcome back.” To start a new claim, click on “Professional claim.” To void or adjust a previous claim, click on “Professional claim reversal.” Direct Data Entry (DDE)

26 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 26 Direct Data Entry (DDE)

27 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 27 Direct Data Entry (DDE).

28 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Provider Electronic Solutions (PES) Software

29 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 29 Provider Electronic Solutions (PES) Software Provider Electronic Solutions software is HP’s free eligibility and claims submission software. It is available for download from the Arkansas Medicaid website.

30 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 30 Creating Your Submitter ID for New PES Users Submitter ID Click Provider HIPAA New Submitters Registration. Click the New Submitter Registration Form link. Complete the New Submitter Registration Information Form and click NEXT. Select a question and complete the answer for Security Questions until you complete five questions and answers. Click NEXT. Enter your billing provider 9 digit Medicaid ID number. Click ADD. Click NEXT. Enter the number of submitter IDs you want, click FINISH and PRINT THIS PAGE showing your MC number.

31 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 31 Provider Electronic Solutions (PES) Software

32 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 32 Provider Electronic Solutions (PES) Software

33 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 33 Provider Electronic Solutions (PES) Software When submitting claims in PES, be sure to retrieve your response report to see rejections and claims accepted.

34 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 34 QUIZ TIME! How much does it cost to download the PES software?

35 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Timely Filing Medicare/Medicaid Crossover Claims and Claims with Retroactive Eligibility (Pseudo Claims)

36 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 36 Timely Filing Federal regulations dictate that providers must file the Medicaid portion of claims for dually-eligible beneficiaries within 12 months of the beginning date of service. The Medicare claim will establish timely filing for Medicaid. If the provider files with Medicare during the 12-month Medicaid filing deadline, Medicaid may then consider payment of a Medicare deductible and/or coinsurance, even if more than a year has passed since the date of service. Federal regulations permit Medicaid to pay its portion of the claim within six (6) months from the Medicare paid/denied date. Providers may not electronically transmit any claims for dates of service over 12 months.

37 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 37 Timely Filing Medicaid requires providers to submit all claims no later than 12 months from the date of service. The 12-month filing deadline applies to all claims, including: Adjustment requests and resubmissions of claims previously considered Claims for services provided to individuals who acquire Medicaid eligibility retroactively

38 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 38 Claims with Retroactive Eligibility (Pseudo Claims) Timely Filing Retroactive eligibility does not constitute an exception to the filing deadline policy. If an appeal or other administrative action delays an eligibility determination, the provider must submit the claim within the 12-month filing deadline. If the claim is denied for recipient ineligibility, the provider may resubmit the claim when the patient becomes eligible for the retroactive date(s) of service. Medicaid may then consider the claim for payment because the provider submitted the initial claim within the 12-month filing deadline and the denial was not the result of an error by the provider. To resolve this dilemma, Arkansas Medicaid considers the pseudo recipient identification number to represent an “...error originating within (the) State’s claims system.” Therefore, a claim containing that number is a clean claim if it contains all other information necessary for correct processing.

39 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 39 Claims with Retroactive Eligibility (Pseudo Claims) Timely Filing Providers have 12 months from the approval date of the patient’s Medicaid eligibility to resubmit a clean claim after filing a pseudo claim. After the 12-month filing deadline (12 months from the Medicaid approval date), claims will be denied for timely filing and will not be paid. It is the responsibility of the provider to verify the eligibility approval date. Once a beneficiary receives retro eligibility, the provider must submit a paper claim, proof of the pseudo claim and a cover letter to Research for special processing. HP Enterprise Services Attn: Research Analyst PO BOX 8036 Little Rock, AR 72203

40 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 40 Quiz Time How many days do you have to submit a clean claim to Arkansas Medicaid before it is considered timely?

41 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Claim Status

42 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 42 Check your remittance and status report (WebRA) each week for: Paid Claims Denied Claims Adjusted Claims Pending Claims Recoupments Claims Payment Summary HEOB Codes/Messages Remittance and Status Report

43 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 43 Claim Status Electronic claims are typically adjudicated on the next remittance advice. Paper claims that could have been sent electronically typically adjudicate days after submission. Claims that must be sent on paper typically adjudicate 2-3 weeks after submission.

44 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 44 Five Ways to Check Claim Status Claim Status Verify claims on the remittance advice PES software Medicaid website VRS Provider Assistance Center (800) or (501)

45 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Questions?

46 © Copyright 2014 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 46 Thank you


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