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KyHealth Choices. UB04 Medicaid Crossover Workshop. Agenda. Representative List Reference List 837 Requirements Medicare EOB examples Helpful Hints How to Bill Medicare Primary Claims to KyHealth Choices Evaluation. Representative List. Representative List. Helpful Phone Numbers
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KyHealth Choices UB04 Medicaid Crossover Workshop
Agenda • Representative List • Reference List • 837 Requirements • Medicare EOB examples • Helpful Hints • How to Bill Medicare Primary Claims to KyHealth Choices • Evaluation
Helpful Phone Numbers EDI Helpdesk 800-205-4696 Ky_edi_helpdesk@eds.com Provider Billing Inquiry 800-807-1232 Ky_Provider_Inquiry@eds.com Web Addresses EDS Website www.kymmis.com KyHealthnet http://home.kymmis.com KyHealth Choices www.chfs.ky.gov/dms Reference List
Billing Crossovers to KyHealth Choices • Beginning September 29, 2008, KyHealth Choices will require their providers to prepare their own Medicare/Medicaid related claims. • If you bill these by paper, your claim form must include the Medicare information necessary for processing. • You will no longer send Medicare EOB’s with your claim unless Medicare denies the service. • You may bill Crossover claims by electronic means.
837I Claims Submission • The 837I 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 CAS02 - Adjustment reason code '1' deductible or '2' Co-insurance • Loop 2320 AMT02 - Payor Paid Amount = Medicare paid amount • Loop 2320 AMT01 Amount Qualifier Code = 'B6' Payor Allowed amount • Loop 2320 AMT02 - Payor Paid Amount = Medicare Allowed amount • Loop 2330B DTP01 Date/Time Qualifier = '573' Medicare EOB pay date For questions please contact EDI at 1-800-205-4696
Required Information • Medicare EOB Date Form Locator 37 (new change) • Medicare Paid Amount Form Locator 54 (new change) • Medicare Allowed Amount Form Locator 55 (new change) • Medicare Coinsurance Amount Form Locator 39 • Medicare Deductible Amount Form Locator 39
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 with the Medicare EOB attached.
