kyhealth choices cms 1500 medicare crossover workshop

KyHealth Choices

CMS 1500 Medicare Crossover Workshop

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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

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Representative List

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Representative List

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Reference List

Helpful Phone Numbers

EDI Helpdesk 800-205-4696ky_edi_helpdesk@eds.com

Provider Billing Inquiry800-807-1232

ky_provider_inquiry@eds.com

Web Addresses

EDS Website www.kymmis.com

KyHealthnethttp://home.kymmis.com

KyHealth Choiceswww.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.

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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

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Medicare EOB

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Required Information

• Medicare EOB Date

• Medicare Paid Amount

• Medicare Allowed Amount

• Medicare Coinsurance Amount

• Medicare Deductible Amount

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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.

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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