correcting mco information this module is for discussing how to correct mco information on patient...
TRANSCRIPT
![Page 1: Correcting MCO Information This module is for discussing how to correct MCO information on Patient and Encounters](https://reader031.vdocuments.net/reader031/viewer/2022032523/56649d8d5503460f94a74c77/html5/thumbnails/1.jpg)
Correcting MCO Information
This module is for discussing how to correct MCO information on
Patient and Encounters
![Page 2: Correcting MCO Information This module is for discussing how to correct MCO information on Patient and Encounters](https://reader031.vdocuments.net/reader031/viewer/2022032523/56649d8d5503460f94a74c77/html5/thumbnails/2.jpg)
MCO # 3 – Passport/Amerihealth
6 – Coventry
7 – Kentucky Spirit
8 – Wellcare
9 - Humana
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Medicaid Payor Codes 2 – KY Medicaid
22 – HANDS
23 – Passport
24 – Amerihealth
26 – Coventry
27 – KY Spirit
28 – Wellcare
29 - Humana
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We will cover 3 different scenarios.
• Claim billed to KY Medicaid but should have billed to an MCO
• Claim billed to MCO but should have billed KY Medicaid
• Claim billed to MCO but denied• Claim billed to the wrong MCO
We will cover 4 Scenarios in this power point.
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The claim billed to KY Medicaid and should have billed to an MCO, take
the following steps to correct.
Scenario #1
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Now Report 578 looks like this
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EOB Codes 24 & N30
These codes mean that the claim should have been billed to a Managed Care Organization
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On Patient Registration, set the visit date to the date the patient
was originally seen.
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Set your Reason for Visit.
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Set the Medicaid MCO and the MCO Member #
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Ask for a PEF and Registration Label. DO NOT check ‘Additional Pef?’.
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DO NOT print the labels. You may hand write the corrections on the CH-5 with the effective date and
initial and date
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For GUI users, here is the path to get to the NERI screen.
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Call up the patient’s NERI screen
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Select the encounters and put the MCO# in the
Par# field and transmit.
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For GUI users, here is the path to get to the PERI screen.
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If you call up the PERI, it will now reflect that the
MCO has been added to the encounter.
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The CPOD will not be necessary for this
scenario.
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After the corrections have been made and the MCO # has been added via the NERI screen, the PEF will automatically bill off to
the correct MCO at the next billing.
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Check the appropriate invoice register report the following week
to verify services billed.
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Adjust off the A/R Invoice that was set up for KY Medicaid
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It is your agency’s decision on when to adjust off the invoice
that was set up for KY Medicaid. DPH recommends
adjusting after next invoice register is created.
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The claim billed to an MCO and should have billed to KY Medicaid.
Scenario #2
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Now your MCO report will look like this.
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Call up the patient’s NERI screen
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Select the encounters and remove the MCO# in
the Par# field and transmit.
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After the MCO # has been removed via the NERI screen, the
PEF will automatically bill off to KY Medicaid at the next billing.
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You will not need to CPOD this claim. It
should bill off automatically.
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Adjust off the Invoice that was set up for Managed Care at your
agency’s discretion.
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The claim billed to the correct MCO but denied.
Scenario #3
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Example of denied claim
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If denial was due to registration errors, make
the appropriate corrections on
registration screen.
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Pull up the encounter, make correction if needed, and re-transmit.
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On the encounter history screen, the PC field is the payor code. Since the payor code is 26, we
know that it billed or will bill to Coventry.
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For GUI users, here is the path to get to the PARI screen.
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PARI Inquiry – Payor codes & MCO #
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For GUI users, here is the path to get to the CPOD screen.
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When requesting the CPOD screen, make sure you enter the correct PEF# and the payor code you are wanting to rebill. In the example
below, we are rebilling PEF#19581689 and those services that went to payor code 26.
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The CPOD screen will only pull the services that went to payor code 26. Information on the screen
can be added, edited or removed.
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Make sure you enter the correct A/R invoice number. If the services are paid, this is the invoice
that the money will be posted.
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After you make changes and enter the A/R Invoice #, transmit. These services will bill on the
next billing cycle.
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If you still type commands in the old way, the CPOD will be executed as shown below. If no
services are pulled, verify your payor code on the PEF.
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For claims rebilling to Passport, they can’t be rebilled electronically.
You will need to change the Print HCFA? Flag to Y.
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The claim billed to the wrong MCO.
Scenario #4
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On Patient Registration, set the visit date to the date the patient
was originally seen.
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Set your Reason for Visit.
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Correct the MCO# and verify the MCO Member # is correct.
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Ask for a PEF and Registration Label. DO NOT check ‘Additional Pef?’.
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DO NOT print the labels. You may hand write the corrections on the CH-5 with the effective date and
initial and date
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Call up the patient’s NERI screen
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Put an X next to the claim to correct, enter the correct MCO# and transmit.
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To pull up the CPOD, click on Billing, Rebilling, Medicaid, and then PEF History.
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When requesting the CPOD screen, make sure you enter the correct PEF# and the payor code you are wanting to rebill. In the example
below, we are rebilling PEF#19581689 and those services that went to payor code 26.
![Page 54: Correcting MCO Information This module is for discussing how to correct MCO information on Patient and Encounters](https://reader031.vdocuments.net/reader031/viewer/2022032523/56649d8d5503460f94a74c77/html5/thumbnails/54.jpg)
The CPOD screen will only pull the services that went to payor code 26. Information on the screen
can be added, edited or removed.
![Page 55: Correcting MCO Information This module is for discussing how to correct MCO information on Patient and Encounters](https://reader031.vdocuments.net/reader031/viewer/2022032523/56649d8d5503460f94a74c77/html5/thumbnails/55.jpg)
Make sure you enter the correct A/R invoice number. If the services are paid, this is the invoice
that the money will be posted.
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After you make changes and enter the A/R Invoice #, transmit. These services will bill on the
next billing cycle.
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If you still type commands in the old way, the CPOD will be executed as shown below.
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For claims rebilling to Passport, they can’t be rebilled electronically.
You will need to change the Print HCFA? Flag to Y.
![Page 59: Correcting MCO Information This module is for discussing how to correct MCO information on Patient and Encounters](https://reader031.vdocuments.net/reader031/viewer/2022032523/56649d8d5503460f94a74c77/html5/thumbnails/59.jpg)
Any Questions????