1. Billing Medicare Part A Benefit Exhaust Claims
Presented by
EDS Provider Field Consultants

2. Agenda Objectives What is a Medicare Benefit Exhaust Claim
Billing Part B Charges
Billing Electronically
Paper Billing Locators 50 through 54
Paper Billing Locator 39
Supporting Documentation
Common Denials
Helpful Tools
Questions

3. Objectives At the end of this session, providers will understand:
What constitutes a Medicare Benefit Exhaust claim
How to bill the Part B charges
How to bill a Benefit Exhaust claim electronically
How to bill a Benefit Exhaust claim on the UB-04 claim form
How to identify and notate the supporting documentation
What denials are commonly associated with billing issues associated with a Medicare Benefit Exhaust claim

4. What Constitutes a Medicare Exhaust Claim
Dually eligible member (Medicare and Medicaid coverage)
IHCP member has exhausted his or her Medicare Part A benefits
Benefits exhaust prior to the admission for an inpatient stay
Medicare Remittance Notification (MRN) or online (Florida Shared System) FSS printout indicating exhaust status must accompany the claim to Medicaid
DO NOT BILL THE IHCP FOR PARTIAL INPATIENT STAYS

5. Part B Charges
Part B charges must be billed to Medicare before billing the exhaust inpatient claim to IHCP
Include Part B charges on the Part A Medicare claim
Medicare Part B claims automatically crossover
Must void the Medicare B crossover claim
Inpatient claim will deny as a duplicate claim if Part B claim is not voided
Must enter the Part B Medicare payment as a third-party liability (TPL) payment

6. Billing Electronically
Medicare Benefit Exhaust claims may be submitted electronically via Web interChange using the Attachment feature
“Benefits Exhausted” must be typed in the Notes field of the claim submission screen
The supporting documentation required for the electronic claim is the same as for the paper claim

7. Billing Information

8. Claim Note Information

9. Attachment Information

10. Benefits Exhausted

11. Claims Attachment Cover Sheet

12. Coordination of Benefits

13. Electronic Billing Demonstration
Demonstrate the fields of input for an Exhaust claim
Demonstrate the attachment control number (ACN) process
Demonstrate the Notes process

14. Paper Billing Locators 50 through 55
Providers must verify member eligibility to determine if the patient is enrolled in Traditional Medicaid including Care Select
These claims are billed on the UB-04 claim form
Part B payments are indicated by entering the word, “Exhaust” in locator 50 on lines a or b
Do not enter the word “Medicare” on the claim
The payment is entered in field 54
Commercial payments are entered in the same manner
Use line c in fields 50 through 55 for the Medicaid billing

15. Paper Billing Locator 39 Using value code 80, enter the covered days
Do not enter value codes for deductible and coinsurance or blood deductible
A1, A2, or 06
These claims are TPL claims
All other UB-04 billing policies apply

16. Paper Billing
DRAFT

17. Benefits Exhausted

18. Benefits Exhausted

19. Support Documentation
In the top or bottom margin of the UB-04 claim form boldly write the words:
“Benefits Exhausted”
On the top of the MRN or FSS screen print boldly print:
IHCP Member ID number
The information on the supporting documentation must match the information presented for Medicaid claim
Claims are Medicaid primary; all filing limit and prior authorization rules apply to these claims

20. Common Denials 0558 - Coinsurance and deductible amount missing
Cause – The word “Medicare” has been entered in field 50 on lines a, b, or c
Resolution – Remove the word “Medicare” from field 50

21. Common Denials
2501 – This recipient is covered by Medicare Part A; therefore, you must first file claims with Medicare
Cause – Claim has not been submitted indicating “Benefits Exhausted”
Resolution – Write the words “Benefits Exhausted” in the top or bottom margin of the UB-04 claim form. Type the words “Benefits Exhausted” in the “Notes” section of the electronic bill.

22. Helpful Tools Avenues of Resolution
IHCP Web site at
IHCP Provider Manual (Web, CD-ROM, or paper)
Customer Assistance
Local (317)
All others
Written Correspondence
EDS Provider Written Correspondence
P. O. Box 7263
Indianapolis, IN
Provider field consultant

23. Questions

24. Office of Medicaid Policy and Planning (OMPP)
402 W. Washington St, Room W374
Indianapolis, IN 46204
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