#ZOLLSummit

Billing Electronic Secondary Claims

Presented By: Stacey Bickford, Product Manager

To Receive CEU Certifications

http://www.surveymonkey.com/s/NAAC_Certs

Billing Secondary Claims

        MSP/Secondary Claims Overview EOB Comparison Is a separate payor/schedule necessary?

Customer and Trip Settings Generating the electronic batch What do I do with my rejections?

Tips to remember Questions?

Electronic Secondary Payors

 Medicare Secondary (MSP)  Medicaid  Major Commercial Payors (Ex: BCBS/UHC)  Clearinghouses • Email [email protected]

for a list of ZOLL Partnered Clearinghouses

Why electronic secondary?

 No more paper claims  No matching up EOB and claim  No need for postage  Reimbursed in 15-30 days (most payors)

Explanation of Benefits

Secondary Payor/Schedule

 Separate payor not required  Separate ECM not required  Separate schedule suggested but not required  Schedule used for tracking purpose  Workflow and most billing reports can restrict by schedule

Workflow / Reporting

Opening the trip

 Open trip in RescueNet Billing > Call Taking (ctrl + T)  Select trip by run number, Customer Name or SSN, then tab

Primary Payor Payments

    Primary payments must be posted by line item Primary payor selected on credit (

even if patient check

) Coinsurance/Deductible

REFUNDS:

Must use “Refund” type credit and post as a negative amount (Coins/Deduct as negative also)

Add Credit

Primary Payment Amount

    Select a “Payment Type Credit” Select the primary payor for credit Post the amount for that applicable charge line Repeat for each charge line (including ancillary)

Edit Amounts

    “Amount” reflects the payment amount for this line “Expected” does not output electronically Co-Insurance/Deductible for this line item If separated on EOB, apply both in each fields

Line Item Posting

 Don’t forget to tie the payment to a charge

Posting Denials

    Use HIPAA Adjustment Reason Codes RescueNet Reporting>Administration>Denial Codes Don’t forget the $0.00 payments ( by line item )!

No need to post PR1 or PR2 Ded/Coins Codes

Adding a Denial

$0.00 Credits with Denial

   Must add a $0.00 credit for each line item Apply the

total charge

to “Coinsurance”

or

“Deduct” Denial “HIPAA Reason Code” overrides Coins/Deduct

DON’T FORGET!!!

Importing remittances in Batch Credits/Batch Posting will do this automatically!!!

Batch Credits - Remittance

Batch Credit - Remittance

Batch Posting- Remittance

Batch Posting- Remittance

Payor Order – Modify Customer Payors must follow COB order

Tab 3 Settings

Magic COB Formula

 Secondary payors perform balance checks  All line items must equal claim total  Line items must follow

Magic COB Formula

 Payments + Contractual Adjustments + Patient Responsibility =

Gross Charge Amount

Magic COB Formula = Gross Charge Amount Payments + Contractual Adjustments + Patient Responsibility

Generating the Batch

   Same ECM as Primary Medicare/Payor Do not need to run two batches Go to Billing>Electronic Submissions

Generating the Batch

 Utilize restrictors if desired

File Submission

 Transmit .dat file for the batch  File located in Central Share>BillSave>batch#.dat

 Process no different than Primary Claims

Rejections

 Review 997/999 or .rsp/277CA file  Contact payor EDI for detailed information  Obtain Loop/Segment for rejection  Contact Billing Support (800) 663-3911 opt. 3

Tips to Remember

Secondary Claims Tips

 Payor order in Modify Customer  Primary payor on Tab 3  Old Denials for payors above Secondary  Supplemental Values  Line item posting (Payments)  Lumping/Combining combines credits  Magic COB Formula