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Introduction Why is this needed? Federal Mandate Medicaid is payer of last resort

Introduction Why is this needed? Federal Mandate Medicaid is payer of last resort Michigan Document Was already needed in 4010. Want Medicare and insurance as non-covered NY Document 0-fill payer specific

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Introduction Why is this needed? Federal Mandate Medicaid is payer of last resort

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  1. Introduction • Why is this needed? • Federal Mandate • Medicaid is payer of last resort • Michigan Document • Was already needed in 4010. Want Medicare and insurance as non-covered • NY Document • 0-fill payer specific • The process previously known as “0FILL” is now indicated by usage of this AMT segment. As a result, this indicator is now payer specific.

  2. Entering the Insurance Data • Insurance Master • Put in address w/zip+4 • Insurance Info • Pat 5 • Medicare Info (Michigan) • Pat 10 • code 22 admin date or prior (date not MEDICARE level) (96) • A3 Benefits exhausted (119)

  3. Setting the Billing Parameters • 5010 ONLY!!!! • NY Basic 57 = D • Michigan (use non-covered days) Basic 57 = B • Basic 23 = X • Occur 22 = P and A3 = P • (uses history not “A”)

  4. Resident>System Parameters>Bill Print/Submit Parms>Field Group "B – Occurrence Codes">Click inside cell and make entry>Save.

  5. If A3 does not exist and needs to be added Resident>System Parameters>Bill Print/Submit Line Edit>Field Group "B – Occurrence Codes”

  6. Effect on the 5010 • Medicaid secondary • Insurance primary

  7. Note for 5010 CH changed to RP for Michigan BHT*0019*00*ABCDEF*20111122*114428*RP Medicaid secondary to Medicare HL*2*1*22*0 SBR*S*18*******MC NM1*IL*1*Aaaaaa*Dddddd*K***MI*0123456789 N3*431 PpppSppppp N4*CLIO*MI*484200000 DMG*D8*19520921*M NM1*PR*2*MEDICAID*****PI*00111 N3*201 TtttttttSssss N4*LANSING*MI*489130000 CLM*000802*7750***21:A:3**A*Y*Y DTP*434*RD8*20110801-20110831 DTP*435*DT*201006230000 CL1*1*4*30 REF*EA*011111 HI*BK:4019 HI*BJ:4019 HI*BF:3441*BF:V4976*BF:2729*BF:7291*BF:70723*BF:70705*BF:35571 HI*BH:A3:D8:20100615 HI*BE:81:::31*BE:D3:::863 NM1*71*1*WxxxxxN*Jxxxxx*H***XX*1111111111 SBR*P*18*******MA CAS*PR*119*7750 AMT*A8*7750 OI***Y***Y NM1*IL*1*Aaaaaa*Daaaaa*K***MI*322222222C1 NM1*PR*2*MEDICARE*****PI*00450 N3*7500 SECURITY BLVD N4*BALTIMORE*MD*212440000 DTP*573*D8*20111122 REF*F8*311125310215130000 LX*1 SV2*0120**7750*DA*31**0

  8. 270/271 to get information • PT270A • PT270S (code tables) • PT270R (code tables)

  9. 835 messages • In some cases no denial file (NY) • Shows primary payor • Needs to bill by adjustment after corrections (NY???)

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