Transcript Slide 1
#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