kyhealth choices cms 1500 medicare crossover workshop

KyHealth Choices

CMS 1500 Medicare Crossover Workshop

Cabinet for Health and Family Services2

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


Representative List


Reference List

Helpful Phone Numbers

EDI Helpdesk [email protected]

Provider Billing Inquiry800-807-1232

[email protected]

Web Addresses

EDS Website www.kymmis.com

KyHealthnethttp://home.kymmis.com

KyHealth Choiceswww.chfs.ky.gov/dms


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.


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.


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


Medicare EOB


Required Information

• Medicare EOB Date

• Medicare Paid Amount

• Medicare Allowed Amount

• Medicare Coinsurance Amount

• Medicare Deductible Amount


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.


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.


Medicare EOB


Coding Sheet


CMS 1500 KyHealthnet Header


CMS 1500 KyHealthnet Detail


Medicare EOB


Coding Sheet


Medicare EOB


Coding Sheet

kyhealth choices cms 1500 medicare crossover workshop

Documents