# ZOLLSummit

1. #ZOLLSummit

2. Billing Electronic Secondary Claims Presented By: Stacey Bickford, Product Manager

3. To Receive CEU Certifications http://www.surveymonkey.com/s/NAAC_Certs

4. Billing Secondary Claims • MSP/Secondary Claims Overview • EOB Comparison • Is a separate payor/schedule necessary? • Customer and Trip Settings • Generating the electronic batch • What do I do with my rejections? • Tips to remember • Questions?

5. Electronic Secondary Payors • Medicare Secondary (MSP) • Medicaid • Major Commercial Payors (Ex: BCBS/UHC) • Clearinghouses • Email Col-ProviderRelations@zoll.com for a list of ZOLL Partnered Clearinghouses

6. No more paper claims No matching up EOB and claim No need for postage Reimbursed in 15-30 days (most payors) Why electronic secondary?

7. Explanation of Benefits

8. Separate payornot required Separate ECM not required Separate schedule suggested but not required Schedule used for tracking purpose Workflow and most billing reports can restrict by schedule Secondary Payor/Schedule

9. Workflow / Reporting

10. Open trip in RescueNet Billing > Call Taking (ctrl + T) Opening the trip • Select trip by run number, Customer Name or SSN, then tab

11. Primary payments mustbe posted by line item Primary payor selected on credit (even if patient check) Coinsurance/Deductible REFUNDS: Must use “Refund” type credit and post as a negative amount (Coins/Deduct as negative also) Primary Payor Payments

12. Add Credit

13. Primary Payment Amount • Select a “Payment Type Credit” • Select the primary payor for credit • Post the amount for that applicable chargeline • Repeat for each charge line (including ancillary)

14. Edit Amounts • “Amount” reflects the payment amount for this line • “Expected” does not output electronically • Co-Insurance/Deductible for this lineitem • If separated on EOB, apply both in each fields

15. Don’t forget to tie the payment to a charge Line Item Posting

16. Use HIPAA Adjustment Reason Codes RescueNet Reporting>Administration>Denial Codes Don’t forget the $0.00 payments (by line item)! No need to post PR1 or PR2 Ded/Coins Codes Posting Denials

17. Adding a Denial

18. Must add a $0.00 credit for eachline item Apply the totalchargeto “Coinsurance” or “Deduct” Denial “HIPAA Reason Code” overrides Coins/Deduct $0.00 Credits with Denial

19. DON’T FORGET!!! Importing remittances in Batch Credits/Batch Posting will do this automatically!!!

20. Batch Credits - Remittance

21. Batch Credit - Remittance

22. Batch Posting- Remittance

23. Batch Posting- Remittance

24. Payor Order – Modify Customer Payors must follow COB order

25. Tab 3 Settings

26. Secondary payors perform balance checks All line items must equal claim total Line items must follow Magic COB Formula Payments + Contractual Adjustments + Patient Responsibility = Gross Charge Amount Magic COB Formula

27. Magic COB Formula Gross Charge Amount = Patient Responsibility + Payments + ContractualAdjustments

28. Same ECM as Primary Medicare/Payor Do not need to run two batches Go to Billing>Electronic Submissions Generating the Batch

29. Utilize restrictors if desired Generating the Batch

30. Transmit .dat file for the batch File located in Central Share>BillSave>batch#.dat Process no different than Primary Claims File Submission

31. Review 997/999 or .rsp/277CA file Contact payor EDI for detailed information Obtain Loop/Segment for rejection Contact Billing Support (800) 663-3911 opt. 3 Rejections

32. Tips to Remember

33. Payor order in Modify Customer Primary payor on Tab 3 Old Denials for payors above Secondary Supplemental Values Line item posting (Payments) Lumping/Combining combines credits Magic COB Formula Secondary Claims Tips