Sage Screening Program 2010

Billing and Remittance

1. The Sage Provider Agreement It is our basis for doing business It is the legal agreement between us It is signed by both parties

MDH and your organization It is cancelable by either party

With 30 day notice It references the Provider Manual

The Sage Provider Agreement Through it you agree to accept Sage

reimbursement as payment in full From all sources

Sage is payer of last resort Send EOB with claim

You agree covered services are free to the patient No carry-over to patient after insurance

2. The Sage Claims Process Your claim is received and entered

into Sage Database within 2 weeks Claim is “Validated” every 2 weeks At Validation, a remittance advice is

generated and mailed to you Sage sends payment information through

the state payment system Payment usually is sent by the State within

2 weeks Total time from receipt to payment should

be 4 weeks (can be as long as 6 weeks)

3. Sage-Covered Services Office visit Mammogram CAD Pap smear

Cytopathology Physician

interpretation Colposcopy

Pathology charges

Diagnostic mam Breast ultrasound HPV test* Breast bx FNA Endometrial bx* Case Management

* limited cases

3. Sage-Covered Services Current Procedural Terminology (CPT)

codes listed on the Sage Screening Program Reimbursement Rates sheet are covered

Any other CPT codes will be automatically denied

The Sage Reimbursement Rate Sheet details these codes with the current $ It can be found on the Web at MNSage.com

4. Submitting Claims Submit your claims on

one of three forms:

1. CMS 1500 (formerly HCFA 1500)

2. UB 92

3. The Sage Reimbursement and Billing Summary Sheet (to be discontinued)

Submitting Claims:Critical information on claims

Federal ID#, name, and address of organization to be paid

Date of Service (d.o.s.) Encounter # for patient’s d.o.s. Patient’s name CPT code (including modifier) Charge for the service provided Amount paid by insurance

Submitting Claims Bill patient’s insurance company first Sage will pay any balance up to the allowable

amount listed on the Sage Reimbursement Rate sheet

If the insurance has paid the allowable amount or more, it is not necessary to bill Sage

On your claim, show the amount of insurance paid per cpt code and attach the EOB

Claims must be received within 1 year from date of service

Submitting Claims: Special Case - Additional Mammographic Views

Encounter numbers for additional mammographic views should have an “A” added after the number that was used for the screening mammogram

This “A” must be included on claims for the additional mammographic view (Example: ABC 201A)

Submitting Claims: Special Case - Outpatient Breast Biopsies

Authorization needed — provider arranging the breast biopsy calls for authorization M#

Sage provides Outpatient Breast Diagnostic Procedure invoices- four copies of this invoice, complete with the patient’s name, encounter number and authorization number, can be sent to the person obtaining the authorization if desired

Submitting Claims: Special Case - Outpatient Breast Biopsies

Submitting Claims: Special Case - Outpatient Breast Biopsies All charges associated with the breast

biopsy—surgical consultation, biopsy, placement of wire, anesthesiology, and pathology are submitted “attached” to the OutpatientBreast Diagnostic Procedure invoice and, if applicable, the explanation of benefits.

If the Outpatient Breast Diagnostic Procedure form is not sent- Make sure the Sage Authorization or “M” number is on the claim

Submitting Claims: Special Case - Outpatient Breast Biopsies All Professional charges associated with the

breast biopsy should be submitted on the CMS1500, All Outpatient Hospital or Ambulatory Surgical Center charges should be submitted on a UB04.

If the Outpatient Breast Diagnostic Procedure form is not sent- Make sure the Sage Authorization or “M” number is on the claim

5. Getting Paid

The Sage Remittance Advice explains the payment for your claims (or non-payment)

To match checks or deposits to the appropriate remittance advice, use the Sage payment number reflected as year, month, day

(example: Sage Payment #20060511)

Remittance Advice information There are 4 categories of claims

outcome Paid Suspend- Pending Visit Suspend- Pending Test Results Dissallowed

If you have questions on any claim call

Breast Biopsy Payment Sage will reimbures professional fees

according to the CMS PFS Sage will reimburse lab tests

according to the CMS CLFS Sage will reimburse facility fees

according to CMS OPPS

Payment by Check

04-23-06 MEDICAL CLINIC- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

TRANS NUMBER AGENCY & PHONE NUMBER VENDOR INVOICE AMOUNT

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

H12 50000000000 HEALTH 651-215-0486 SAGE PMT 20060409 2,503.03

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - DATE NUMBER VENDOR NAME NET

04/23/06 41100000 MEDICAL CLINIC 2,503.03

Example of Check Stub From State of MN

Payment by Direct Deposit Direct Deposit Payments are transferred

electronically to the vendor's financial institution. The State website where you can find the payment information after a deposit is made is: http://www.mmb.state.mn.us/maps-eft?showall=1

Vendors of Sage can apply to become an EFT vendor by contacting MN Management & Budget at that same website

6. Contact for Billing/Remittance

651-201-5630 or

Joanne Noot (Sage forms & procedures) 651-201-5628Shannon McNamara (breast biopsy billing issues) 651-201-5904

Thank You!

The End