KyHealth Choices

CMS 1500 Medicare Crossover Workshop

Agenda

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

Representative List

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Representative List

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Reference List

Helpful Phone Numbers EDI Helpdesk 800-205-4696 [email protected]

Provider Billing Inquiry 800-807-1232 [email protected]

Web Addresses EDS Website www.kymmis.com

KyHealthnet http://home.kymmis.com

KyHealth Choices www.chfs.ky.gov/dms

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Billing Crossovers to KyHealth Choices • Beginning September 29, 2008, KyHealth Choices will require providers to prepare their own Medicare/Medicaid related claims.

• If you bill these by paper, a coding sheet will be required with your claim form.

Use black ink

only.

• You will no longer send Medicare EOB’s with your claims unless Medicare denied a service.

• You may bill Medicare Primary claims by electronic means. Cabinet for Health and Family Services 6

837P Claims Submission

• The 837P Companion Guide Version 3.0 will be available on the EDS website www.kymmis.com

• Contact your Software Vendor to check the capability and readiness for these changes.

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837 Requirements

• Loop 2320 AMT02 - Payor Paid amount = Medicare paid amount • Loop 2320 AMT02 - Payor Paid Amount = Medicare Allowed amount • Loop 2330B DTP01 - Date Claim Paid = Medicare EOB date qualifier • Loop 2330B DTP03 - DTP03 - Date Time Period (CCYYMMDD) • Loop 2430 CAS01 - Claim Adjustment 'PR' Patient Responsibility • Loop 2430 CAS02 - Claim Adjustment Reason Code '1' Deductible or '2' Co-insurance • Loop 2430 CAS03 - Monetary Amount • Loop 2430 CAS04 - Quantity Adjusted units For questions please contact EDI at 1-800-205-4696 Cabinet for Health and Family Services 8

Medicare EOB

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Required Information

• Medicare EOB Date • Medicare Paid Amount • Medicare Allowed Amount • Medicare Coinsurance Amount • Medicare Deductible Amount Cabinet for Health and Family Services 10

Helpful Hints

• First arrow shows Medicare paid the allowed amount in full. You will not bill this line to Medicaid as no coinsurance or deductible is due.

• Second arrow shows Medicare paid zero but left deductible due. In the Medicare paid amount field, enter zero as the amount paid. Cabinet for Health and Family Services 11

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 claim with the Medicare EOB attached.

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Medicare EOB

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Coding Sheet

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CMS 1500 KyHealthnet Header

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CMS 1500 KyHealthnet Detail

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Medicare EOB

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Coding Sheet

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Coding Sheet

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Coding Sheet

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Medicare EOB

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Coding Sheet

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